Medical Surgical DKA vs HHS #4

Question

A client with diabetes type 1 is admitted to the emergency room with COVID-19-like symptoms. Which symptoms should the nurse report immediately? Select all that apply.

Answers

  1. Blood glucose of 475 mg/dL
    • Rationale:

      This answer is correct because a blood glucose of 475 mg/dL is extremely elevated. DKA can occur due to illness, infection, or insufficient insulin. The client with DKA has symptoms including extreme thirst, nausea, abdominal cramping, fruity (acetone) breath, deep rapid breaths (Kussmaul breathing), frequent urination, and confusion. The blood glucose is extremely elevated and ketones are found in the blood and urine. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis associated with DKA.

  2. Coughing and temperature of 99.8 F
    • Rationale:

      This answer is not correct because coughing and low-grade temperature is not something to report immediately. These are the symptoms why the client is seeking help but DKA can occur quickly with sickness and should be reported immediately.

  3. Deep rapid breathing
    • Rationale:

      This answer is correct because DKA can occur due to illness, infection, or insufficient insulin. The client with DKA has symptoms including extreme thirst, nausea, abdominal cramping, fruity (acetone) breath, deep rapid breaths (Kussmaul breathing), frequent urination, and confusion. The blood glucose is extremely elevated and ketones are found in the blood and urine. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis associated with DKA.

  4. Abdominal cramping
    • Rationale:

      This answer is correct because abdominal cramping is associated with DKA symptoms, especially with a recent illness, extremely elevated blood glucose, and Kussmaul breathing. DKA can occur due to illness, infection, or insufficient insulin. The client with DKA has symptoms including extreme thirst, nausea, abdominal cramping, fruity (acetone) breath, deep rapid breaths (Kussmaul breathing), frequent urination, and confusion. The blood glucose is extremely elevated and ketones are found in the blood and urine. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis associated with DKA.

  5. ABGs with pH of 7.46
    • Rationale:

      This answer is not correct because a pH of 7.46 is within normal range, but should be monitored carefully for acidosis, especially with the other symptoms pointing to DKA. The client with DKA has symptoms including extreme thirst, nausea, abdominal cramping, fruity (acetone) breath, deep rapid breaths (Kussmaul breathing), frequent urination, and confusion. The blood glucose is extremely elevated and ketones are found in the blood and urine. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis associated with DKA.

Overview

Diabetic ketoacidosis (DKA) can occur quickly for a type 1 diabetic during illness. The nurse should be on alert for symptoms of DKA including elevated blood glucose, deep rapid breathing (Kussmaul breathing), and abdominal cramping pain.

Explanation

Learning Outcomes

Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus. It occurs when ketones or blood acids increase in the bloodstream in response to elevated blood glucose levels and inadequate insulin. DKA can occur due to illness, infection, or insufficient insulin. The client with DKA has symptoms including extreme thirst, nausea, abdominal cramping, fruity (acetone) breath, deep rapid breaths (Kussmaul breathing), frequent urination, and confusion. The blood glucose is extremely elevated and ketones are found in the blood and urine. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis associated with DKA. Priority treatments are fluid replacement, insulin therapy, and electrolyte correction.

Test Taking Tip

DKA- think of the “K” being for ketones and Kussmaul breathing.

Video Rationale