Question

what orders would be appropriate for a patient with diabetic ketoacidosis?

a. 1000 ml Lactated Ringer's (LR) IV stat b. 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now C. CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and ces. stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone osmolality; ABGs on room air d. 1800 calorie, carbohydrate controlled diet e. Bed rest f. Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN g. Furosemide (Lasix) 60 mg IV push now h. Urinary output every hour i. VS every shift Pg. 873 in textbook

Answer 1

Diabetic ketoacidosis is life threatening complication of diabetes mellitus. Itvis characterised by abdominal pain, gasping breathing, vomiting, confusion, increased urine output and occasionally loss of consciousness.

relevant orders will be

• 36 units nph and 20 units regular insulin to control blood sugar
• serum ketones to check the level of ketones
• urine osmolality as it will increase in DKA
• ABG on room air to check metabolic acidosis and respiratory compensation.
• 2800 calories and carbohydrates controlled diet to control hyperglycemia yet providing necessary nutrition.
• bed rest as patient may fall because of confusion and loss of consciousness
• urinary output to maintain intake output record and there is increased frequency in dka so as guide intravenous fluid replacement
• vital signs to assess hypotension out of dehydration, increased respiratory rate, heart rate changes as a result of electrolytes imbalance.