LABS
What does your K+ need to be BEFORE you start your insulin gtt?
K+ > 3.3
What is your top priority intervention?
Fluid Resuscitation
A pt in DKA will present with "3 P's". What are those 3 P's?
Polyuria, polydipsia, polyphagia
Clinical manifestations of DKA are: _____(hyper/hypo)glycemia, ____(hyper/hypo)osmolarity, and anion gap _____(acidosis/alkolosis)
hyperglycemia, hyperosmolarity, and anion gap acidosis
*hyperglycemia=High BG
*Hyperosmolarity=a condition where the blood or other bodily fluids have an abnormally high concentration of salt, glucose, and other substances. (Think dehydration)
*Anion gap acidosis=a type of metabolic acidosis where the blood becomes too acidic due to a build-up of unmeasured anions, resulting in a larger than normal "anion gap" which is calculated by subtracting the measured negative ions (chloride and bicarbonate) from the measured positive ions (sodium) in the blood; essentially indicating an imbalance between positively and negatively charged electrolytes in the bloodstream.
What is the BG goal range for the targeted insulin infusion?
120-160
What do you do if your K+ drops below 3.3?
Stop insulin infusion until K+ is corrected
How often should you check BG while on an insulin gtt?
Q1h
What are potential neurological symptoms experienced for a pt in DKA?
headache, confusion, and decreased DTRs
If your BG increases twice consecutively, what should you do?
Notify the provider
How do you know what to titrate your insulin gtt to?
Glycemicare will do the calculation.
In the event there is downtime, you will need to use the proper algorithm to calculate the insulin gtt rates.
What is the "targeted" BG range glycemicare will titrate insulin gtt to accomodate for a pt with DKA?
150-200
What do you do if your BG drops below 70?
Follow hypoglycemia protocol (on the yellow sheet)
What are potential cardiovascular symptoms for a pt in DKA?
tachycardia, decreased CVP, decreased BP
If your BG drops by > 50 when < 250, what should you do?
Notify the provider
What is the difference between algorithm 1 & 2 for targeted insulin infusion?
algorithm 1 = most patients
algorithm 2 = CABG
**make sure you are selecting the correct algorithm
There is a standing order to notify the provider when the anion gap closes. Anion gap must be below ____ before you notify the provider?
12
How should you prime your tubing when starting insulin?
Waste 20mL
What are potential pulmonary symptoms of a pt in DKA?
kussmaul respirations, fruity breath (acetone production)
How does DKA develop?
DKA develops when the body does not have enough insulin to allow blood sugar/glucose into cells to use as energy. This then causes the body to break down fat for fuel, releasing ketones into the bloodstream. Excessive ketone production in the blood, leads to metabolic acidosis and DKA.
True or False: If your patient is on an IV insulin infusion they must have an IV dextrose solution OR enteral nutrition / TPN running.
TRUE: following targeted insulin infusion orders
How does insulin lower K+?
Insulin helps facilitate the transfer of glucose and K+ from the extracellular fluid back into the intracellular fluid, therefore resulting in a lower serum potassium level.
When should you start dextrose containing IV fluids?
When BG < 250
What are potential gastrointestinal symptoms for a pt in DKA?
nausea, vomiting, abd pain, wt loss
Glucose sucks water into blood stream and out into urine with it. This process is called ___ ____, leading to severe dehydration and fluid loss in DKA.
Osmotic diuresis
True or False: You are allowed to give scheduled insulin along with meals while on an insulin drip.
This is true in mom/baby areas.