Deficient Fluid Volume related to Diabetic Ketoacidosis

Nursing Care Plan for Diabetic Ketoacidosis - Nursing Diagnosis : Deficient Fluid Volume

Diabetic ketoacidosis is a state of emergency or acute Type I diabetes, is caused by the increased acidity of the body of ketone bodies due to deficiency or insulin deficiency, characterized by hyperglycemia, acidosis, and ketones due to a lack of insulin (Stillwell, 1992).

Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.

Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes.

Symptoms of diabetic ketoacidosis include:

• Deep, rapid breathing
• Dry skin and mouth
• Flushed face
• Fruity smelling breath
• Nausea and vomiting
• Stomach pain

Deficient Fluid Volume

Decreased intravascular, interstitial, and/or intracellular fluid (refers to dehydration, water loss alone without change in sodium level)

Defining Characteristics:

• Decreased urine output;
• increased urine concentration;
• weakness;
• sudden weight loss (except in third-spacing);
• decreased venous filling;
• increased body temperature;
• decreased pulse volume/pressure;
• change in mental state;
• elevated hematocrit;
• decreased skin/tongue turgor;
• dry skin/mucous membranes;
• thirst;
• increased pulse rate;
• decreased blood pressure

Nursing Diagnosis for Diabetic Ketoacidosis : Deficient Fluid Volume related to excessive secretion of fluid (osmotic diuresis) due to hyperglycemia

Outcomes:

• Vital signs within normal limits
• Peripheral pulse can be palpated
• Skin turgor and capillary refill good
• Balance urine output
• Normal electrolyte levels

Nursing Intervention:

• Observation of input and output of fluids every hour.
• Observation drip infusion.
• Monitor vital signs and level of consciousness every 15 minutes, if stable continue for every hour.
• Observation of skin turgor, mucous membranes, acral, capillary refill
• Monitor results of laboratory tests: hematocrit, BUN / creatinine, blood osmolarity, sodium, potassium.
• EKG monitor.
• CVP monitoring (when used).
• Collaboration with other health team:
• Parenteral fluid administration : Giving insulin therapy, Catheter urine, CVP installation if possible