Included In This Lesson
Study Tools
Outline
Overview
Pathophysiology
Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body can’t produce enough insulin to use the glucose. When this happens, the body begins to break down fat as energy which produces a build-up of acid in the bloodstream called ketones. This is a serious life-threatening condition that occurs most often in Type I diabetics
Etiology
Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections (UTI, etc), prolonged vomiting, surgery or when they miss doses of insulin. Alcohol and drug abuse in a diabetic patient can also cause the body to produce ketones that poison the blood.
Desired Outcome
Maintain blood glucose level within the target range, maintain normal fluid balance
Diabetic Ketoacidosis (DKA) Nursing Care Plan
Subjective Data:
- Excessive thirst
- Nausea
- Abdominal pain
- Weakness / fatigue
- Shortness of breath
- Reports of:
- Blurry vision
- Excessive urination
Objective Data:
- Frequent urination
- Vomiting
- Fruity-scented breath
- Confusion
- Hyperglycemia, usually >400 mg/dL
- High urine ketone levels
- Kussmaul respirations
- Metabolic Acidosis with elevated Anion Gap
Nursing Interventions and Rationales
- Monitor blood glucose levels and administer insulin as appropriate
- Monitor fluid and electrolyte balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium
- Monitor for and treat signs / symptoms of infection
- Administer medications as appropriate
- Insulin as necessary
- Antibiotics
- IV fluids
- Electrolyte replacement
- Antiemetics
- Monitor vitals for signs / symptoms of hypovolemia
- Prevent injury and falls; assist with ambulation
- Nutrition and lifestyle education
- Avoid alcohol / illicit drug use
- Choose foods that are high in fiber and low in fats, sugars and simple carbs
- Eat regular meals and snacks, don’t miss meals
- Check for urine ketones when you have symptoms
- Do not exercise when urine shows positive for ketones
- Maintain compliance with medication and insulin therapy
Marie Clark, MSN, RN, CMSRN 
Paige Canarr, MSN, RN, MHA 
Kara Tarr, BSN, RN 
Miriam Wahrman, MSN/Ed, RNC-MNN 
Chance Reaves, MSN-Ed, RN 
Nichole Weaver, MSN/Ed, RN, CCRN 
Ashley Powell, MSN, RN, PCN 