Diabetic Ketoacidosis
A 19-year-old client with type 1 diabetes reports two days of vomiting after running out of insulin. The client appears drowsy and has fruity-smelling breath.
Recognize cues
Vital signs: BP 96/58, HR 124, RR 30 and deep, SpO2 98%, temperature 37.2 C. Glucose 548 mg/dL, pH 7.18, bicarbonate 12 mEq/L, potassium 5.4 mEq/L, large serum ketones. Mucous membranes are dry.
Which finding requires the most immediate follow-up?
Take action
The provider orders 0.9% sodium chloride IV bolus, a regular insulin IV infusion, hourly glucose checks, and continuous cardiac monitoring.
Which two actions should the nurse take first?
Evaluate outcomes
Six hours later: glucose 214 mg/dL, pH 7.33, bicarbonate 20 mEq/L, potassium 3.6 mEq/L with potassium replacement infusing. The client is alert and respirations are 18 and unlabored.
Which finding best indicates the treatment is working?
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