Tuesday, September 10, 2013

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

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