Providing nursing care to a patient with DKA presents a multisystem challenge. To prevent serious complications, think critically and act quickly.During fluid replacement, assess your patient’s fluid balance to ensure adequate hydration without the complications of fluid overload. Evaluate her vital signs, level of consciousness, body weight, intake and output, urine specific gravity, and blood osmolality. And assess her skin turgor and mucous membranes for signs of improved hydration.
Frequently check the I.V. site for signs of infiltration or infection. If your patient has a central line, check all connections. During rapid fluid replacement, monitor your patient for signs and symptoms of fluid overload especially if she’s elderly, a child, or at risk for heart failure. Signs and symptoms of heart failure include pulmonary crackles, labored respirations, hypotension, tachycardia, and heart sounds.
Monitor your patient’s blood sodium, potassium, bicarbonate, magnesium, and phosphate levels closely. And evaluate her electrocardiogram (ECG) tracings to detect arrhythmias or characteristic changes from abnormally high or low potassium levels.
Before starting the insulin infusion, flush the tubing with 50 ml of insulin solution to saturate the tubing with insulin. Remember, insulin adheres to I.V. tubing, so if you don’t saturate it with insulin, your patient won’t receive the full insulin dose. Use an infusion pump to ensure insulin delivery at the prescribed rate.
Monitor the blood glucose level hourly. As the level falls, monitor your patient closely for signs and symptoms of hypoglycemia.
Your patient also requires basic nursing interventions for comfort and hygiene. Although she’s dehydrated and thirsty, she may not be able to eat or drink anything until she’s no longer feeling nauseated, vomiting, or complaining of abdominal pain. Providing frequent oral care helps moisten dry lips and mucous membranes, increasing her comfort and giving you an opportunity to assess her hydration.
Skin care is especially important because dehydration and poor tissue perfusion from DKA increase the risk of skin breakdown. Turn and reposition your patient every 2 hours. Use an emollient to keep her skin from becoming scaly, flaky, and vulnerable to breakdown. As you provide skin care, check your patient’s skin turgor, color, temperature, and perfusion.