DKA Nursing Care Plan

What is a DKA Nursing Care Plan template?

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication primarily associated with diabetes mellitus, particularly type 1 diabetes. It occurs when there's a critical shortage of insulin in the body, leading to a spike in blood sugar levels. As a result, the body starts breaking down fat for energy, producing ketones as a byproduct. These ketones accumulate in the blood, making it acidic.

DKA manifests with symptoms such as excessive thirst, frequent urination, nausea, vomiting, abdominal pain, fruity-smelling breath, confusion, and, in severe cases, unconsciousness. If left untreated, it can lead to complications requiring immediate medical attention. These complications include electrolyte imbalances, particularly dangerously low potassium levels (hypokalemia) or high blood potassium levels (hyperkalemia), which can disrupt normal heart function.

Another critical complication of DKA is cerebral edema, a swelling in the brain. Although rare, it's a severe complication, especially in children with DKA. This condition requires prompt medical intervention as it can lead to increased intracranial pressure and neurological damage, further highlighting the importance of regular monitoring through a nursing care plan. 

DKA can cause dehydration due to excessive urination and vomiting, leading to a dangerous drop in blood pressure, which may result in shock. Additionally, it can trigger acute kidney injury due to reduced blood flow to the kidneys and the accumulation of toxic substances in the blood. 

These symptoms require careful monitoring and a well-utilized care plan for the nursing team and other health professionals to ensure effective care is given. Timely intervention and proper management are crucial to prevent severe consequences and ensure the patient's well-being.

How does it work?

Step One: Gather your resources

DKA nursing care plans are a valuable resource and essential to keep on hand. Make sure that you have a copy of the free printable PDF when the need arises by either clicking the “Download Template” or “Use Template” button or by searching “DKA nursing care plan” on Carepatron’s template library’s search bar on the website or app.

Step Two: Collate essential information

Once the patient has been diagnosed and assessed for abnormally high glucose levels, the DKA nursing care plan template is utilized to ensure all goals of care are met and are both seamless and easily accessible to relevant parties via Carepatron's centralized workspace.

Assessment, symptom management, and interventions can be collated within the single care plan and safely stored on a single database. The care plan allows for individualized treatment options. It acts as a scaffolding to ensure goals of care are met, and the next steps are recorded for future reference or for distribution to other healthcare specialists who are part of the patient's care team.

Step Three: Store the chart securely

After reviewing the DKA nursing care plan and creating a viable and individualized plan for the patient, you need to secure the plan so that access is only granted to relevant parties.

Ensure this through Carepatrons HIPAA-compliant free patient records software. Here, all relevant medical records can be safely stored and collated for ease and security.

When would you use this template?

A DKA nursing care plan is implemented when caring for individuals diagnosed with DKA, typically in hospital or acute care settings. The nursing care plan for DKA may be used in the following situations:

Emergency department admissions

Patients presenting with symptoms of DKA, such as high blood sugar, ketones in urine or blood, dehydration, altered mental status, and abdominal pain, often require immediate medical attention. Nursing care plans are crucial in managing these patients upon admission to the emergency department.

Inpatient hospital care

Individuals admitted to the hospital due to DKA or its complications need close monitoring and management. Nursing care plans help to guide ongoing care, including fluid and electrolyte management, insulin therapy, vital sign monitoring, and assessment for complications.

Patients with known diabetes

Patients with a history of diabetes, particularly type 1 diabetes, who might develop DKA due to illness, infection, inadequate insulin administration, or other triggers require vigilant monitoring. They may benefit from a proactive nursing care plan to prevent DKA episodes.

Pediatric cases

DKA can be particularly critical in pediatric patients. Nursing care plans are essential in managing children with DKA, as they might exhibit different symptoms and require specialized care to prevent complications like cerebral edema.

Home care and education

After acute treatment, individuals recovering from DKA may require ongoing monitoring and education to manage their condition at home. Nursing care plans include educating patients and their families on insulin administration, monitoring blood glucose levels, recognizing warning signs, and adhering to dietary recommendations.

Evaluating DKA

The nursing assessment for diabetic ketoacidosis (DKA) covers a comprehensive review of health history and physical examination to gather both subjective and objective data related to the condition.

Review of health history

The nurse explores the patient's symptoms, insulin use, history of infections, medication list, and potential barriers to insulin therapy adherence. This includes understanding general symptoms like unintended weight loss, altered consciousness, nausea, increased urination, dry skin, and muscle stiffness. Inquiring about insulin use, barriers, infections, and medications helps identify triggers or factors contributing to DKA.

Physical assessment

Monitoring vital signs for fever or hypothermia, tachycardia, rapid breathing (Kussmaul breathing), and performing a thorough physical examination aids in detecting signs of dehydration, cerebral edema, or infections. These signs encompass general appearance, neurological changes, skin condition, respiratory distress, cardiovascular and gastrointestinal symptoms, urinary output, and ketones or fruity breath odor.

Assessment for cerebral edema

Recognizing symptoms of cerebral edema, especially in children, is crucial. These signs include changes in consciousness, heart rate patterns, incontinence, abnormal responses to pain, posture changes, and lethargy.

By integrating both subjective and objective data, nurses can form a comprehensive understanding of the patient's condition, identifying potential causes or exacerbating factors, and enabling timely intervention and appropriate management of diabetic ketoacidosis.

DKA interventions

The nursing interventions for diabetic ketoacidosis (DKA) focus on immediate management, complication prevention, and patient education to facilitate recovery and prevent recurrence.

Reverse diabetic ketoacidosis

• Management of DKA: Initiate fluid resuscitation, insulin therapy, electrolyte restoration, and supportive care as cornerstones of DKA management.
• Hydration Promotion: Administer fluids to reverse hypovolemia and improve glycemic control, using 0.9% normal saline initially.
• Insulin Administration: Administer IV insulin until glucose levels drop below 200 mg/dL and certain biochemical markers normalize.
• Electrolyte Correction: Monitor and replenish electrolytes intravenously to maintain normal physiological function.
• Potassium Replenishment: Monitor and adjust potassium levels closely, preventing severe hypokalemia during insulin therapy.
• Lab Monitoring: Regularly assess glucose, electrolytes, blood urea nitrogen (BUN), and arterial blood gas (ABG) levels to guide treatment.

Treat or prevent complications

• Infection Management: Administer appropriate antibiotics based on culture results to treat concurrent infections.
• Cerebral Edema Prevention: Utilize mannitol as a treatment for cerebral edema, closely monitoring neurological status.
• Fluid Balance: Prevent overhydration, especially in patients with a history of renal or heart failure, and use diuretics if needed.
• Prevent Hypoglycemia: Monitor glucose levels carefully to avoid hypoglycemia during treatment.

Provide education to prevent recurrences

• Glucose Monitoring: Educate patients on using glucose monitoring devices and demonstrate proper usage.
• DKA Avoidance: Instruct patients on insulin regimen adjustments during illness and self-testing for ketones during high blood sugar.
• Maintain Glucose Levels: Educate patients on maintaining blood glucose within recommended ranges and adhering to their insulin regimen.
• DKA Signs: Educate patients and families on signs indicating potential DKA episodes.
• Collaboration with Educators: Engage diabetic educators to assist patients in managing diabetes effectively, this may be in the form of a community nurse or support group.

Research & evidence

Diabetic ketoacidosis predominantly occurs in individuals with type 1 diabetes but can also manifest in those with type 2 diabetes, posing a risk in both groups. Acute illness, including trauma, surgeries, or infections, serves as a triggering factor in both populations. Factors like non-compliance, newly developed diabetes, and other serious medical conditions are common precursors for DKA. 

Pneumonia and urinary tract infections represent typical infections associated with this condition. Additionally, alcohol abuse, trauma, pulmonary embolism, and heart attacks can suddenly cause DKA. Certain medications, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, affecting carbohydrate metabolism, may also prompt DKA. Both conventional and atypical antipsychotic drugs have the potential to induce hyperglycemia and, in rare cases, trigger DKA (Kitabchi et al., 2009).

Within the U.S. context, it is suspected that for the inner-city population, a significant contributor to repeated occurrences of DKA is the lack of adherence to insulin treatment (Lizzo et al., 2023). Socioeconomic and educational influences heavily impact medication adherence, notably with insulin. Recent findings indicate that cocaine abuse stands as an independent risk factor linked to the recurrence of DKA (Gosmanov & Kitabchi, 2000).

The incidence of diabetic ketoacidosis varies widely, ranging from 0 to 56 cases per 1000 person-years across studies conducted in diverse geographic regions. DKA shows a higher prevalence among women and non-caucasian individuals. Incidence rates are elevated in patients using injectable insulin in comparison to those using subcutaneous insulin infusion pumps (Farsani et al., 2017). 

In children, DKA rates exhibit considerable disparity from one country to another. The lowest incidence was observed in Nigeria at 2.9 cases per 100,000, while Sweden and Finland reported the highest rates at 41.0 and 37.4 per 100,000, respectively (Große et al., 2018). 

Prognosis notably worsens in extreme age groups, particularly in the presence of coma, hypotension, and severe underlying health conditions (Kitabchi et al., 2009). Poor compliance with insulin emerges as the primary precipitating factor for DKA among urban Black patients. 

Substance abuse significantly contributes to non-adherence to preventive and management therapies. Among Black individuals with DKA, obesity is prevalent, affecting more than half of those recently diagnosed with diabetes mellitus. Enhanced patient education and improved access to medical care play pivotal roles in mitigating the onset of these hyperglycemic emergencies further pushing the need for effective nursing care plans (Umpierrez et al., 1997).

References

Farsani, S. F., Brodovicz, K., Soleymanlou, N., Marquard, J., Wissinger, E., & Maiese, B. A. (2017). Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open, 7(7), e016587. https://doi.org/10.1136/bmjopen-2017-016587

Gosmanov, A. R., & Kitabchi, A. E. (2000). Diabetic Ketoacidosis (K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W. W. de Herder, K. Dhatariya, K. Dungan, J. M. Hershman, J. Hofland, S. Kalra, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrère, M. Levy, E. A. McGee, & R. McLachlan, Eds.). PubMed; MDText.com, Inc. https://pubmed.ncbi.nlm.nih.gov/25905369/

Große, J., Hornstein, H., Manuwald, U., Kugler, J., Glauche, I., & Rothe, U. (2018). Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index (HDI): An Updated Systematic Review, Meta-Analysis, and Meta-Regression. Hormone and Metabolic Research, 50(03), 209–222. https://doi.org/10.1055/s-0044-102090

Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 32(7), 1335–1343. https://doi.org/10.2337/dc09-9032

Lizzo, J. M., Goyal, A., & Gupta, V. (2023). Adult diabetic ketoacidosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560723/

Umpierrez, G. E., Kelly, J. P., Navarrete, J. E., Casals, M. M., & Kitabchi, A. E. (1997). Hyperglycemic crises in urban blacks. Archives of Internal Medicine, 157(6), 669–675. https://pubmed.ncbi.nlm.nih.gov/9080921/