Week 5 Simulation: Nursing Management of DKA Flashcards Preview

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Flashcards in Week 5 Simulation: Nursing Management of DKA Deck (12)
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1
Q

Collaborative management of DKA includes what 5 things?

A

Fluid therapy, insulin therapy, correction of electrolytes, correction of acidosis, and treatment of the precipitating cause

2
Q

Fluid therapy replacement based on estimated losses

A

-100ml/kg of weight.
-During first 8 hours, pt. receives approx. one 1/2 of total fluid replacement.
-Usually use .9 normal saline
EX: pt weight 75kg=7,500 mL first 24 hours
-FIrst hour flow rates=1,000ml/hr
-Hours 2-8 (7 hours)=500ml/hr
-Hours 9-24 (16 hours)=200ml/hr=3,200mL

3
Q

inulin therapy for DKA

A
  • Standard bolus dose is 0.15 u/kg

- Insulin infusions are often started at 0.1u/kg/hr

4
Q

How to give a bolus?

A

-May be administered undiluted, up to 20 units over 1 minute

5
Q

How to start insulin IV infusion?

A
  • insulin IV infusion should be diluted in 0.45 or 0.9 NS
  • prior to initiating the IV infusion, waste 25-50mL through the new IV tubing because insulin adheres to the IV tubing
  • Measure BG hourly
  • When BG reaches 250-300 mg/dL, the rate of administration of insulin is either stopped or transitioned to SQ or decreased by half to 0.05u/kg/hr until signs of acidosis have resolved
6
Q

Serum potassium in DKA may be?

A

High, normal, or low

7
Q

Potassium no no’s

A
  • Never give IV push or in any concentrated form.
  • Never add potassium to an IV that is infusing. After adding potassium to an IV bag, invert it several times to ensure even distribution of potassium solution
8
Q

Potassium administration IV

A
  • If possible, infuse into a central vein to prevent pain at the IV site and phlebitis
  • Monitor ECG of pts exceeding 10meq/hr
  • Given IV 10meq/hr or a high dose of 20-40meq/hr and diluted to 10-20 meq per 100mL of solution.
9
Q

Bicarb therapy in DKA

A
  • reserved for those pts with severe acidosis with a pH of less than 7.0.
  • often mixed in an IV solution of water or .45NS. It is then administered slowly over 1 hour
10
Q

If sodium levels are low,then?

A

Seizure precautions are appropriate

11
Q

Most common cause of DKA?

A

Infection. Nurse should culture potential sites of infection and wait to administer antibiotics until after cultures have been obtained

12
Q

Atlanta Multiplier Method for insulin

A

atlanta multiplier method

starting rate units/hour = (BG - 60) x .02