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NUR 445 Simulation DKA
Simulation
Course
Medical Surgical (NUR425)
418 Documents
Students shared 418 documents in this course
University
Arizona College of Nursing
Academic year: 2023/2024
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358
8-4 Diabetic Ketoacidosis (DKA)
CRITICAL CARE STANDARD FORMS
These templates are included in the Appendix; copy before
each use.
LEARNING OUTCOMES
Cognitive
The participant will be able to:
1. Describe signs and symptoms of DKA.
2. Differentiate diabetes mellitus type 1 and type 2.
3. Correlate the signs and symptoms of DKA to the
pathophysiology.
4. Identify the signs and symptoms of hyperglycemia and
hypoglycemia.
5. Identify appropriate intervention for a patient with
DKA.
Psychomotor
The participant will be able:
1. Perform an assessment on a patient with DKA.
2. Initiate appropriate interventions, such as start and main-
tain IV, insert Foley catheter, place patient on monitor.
Affective
The participant will be able to:
1. Reflect upon performance in a simulated situation and
care of a patient with DKA.
2. Identify areas that worked well during the scenario.
3. Identify areas that need improvement.
4. Reflect on overall feeling about the scenario.
5. Discuss feelings related to working as a team member.
6. Develops confidence in caring for a patient with DKA.
7. Perform self-reflective evaluation.
Communication
The participant will be able to:
1. Communicate effectively with healthcare team members
in the care of a patient with DKA.
2. Communicate effectively with the patient and family
members.
3. Use SBAR format when communicating with healthcare
team members.
4. Work collaboratively as part of the healthcare team.
5. Accurately and succinctly document assessments,
interventions, and evaluations.
6. Practice Transparent Thinking (thinking out loud) to
facilitate group problem solving.
7. Use Directed Communication (directing a message to
specific individual) when delegating tasks.
8. Employ Closed-Loop Communication (acknowledgment
of receipt of the message and status) to acknowledge
communications from others.
Safety
The participant will be able to:
Administer and maintain specific protecting interventions
with attention to safety of the client and healthcare professional.
1. Demonstrate a safe environment with attention to hazards
to healthcare providers, visitors, and the client. Includes
body mechanics, tripping hazards, and equipment issues.
2. Demonstrate attention to national patient safety goals.
Includes patient identification standards, effective com-
munication among healthcare providers, and safe med-
ication administration.
3. Demonstrate attention to standard precautions. Includes
hand washing, infection control measures, and use of
personal protective equipment (PPE) as needed.
Leadership and Management/Delegation
The participant will be able to:
1. Identify and prioritize patient’s needs in care of a patient
with DKA.
2. Identify those interventions that can be delegated to
unlicensed assistive personnel (UAP) or licensed practical
nurse (LPN).
Diabetic Ketoacidosis (DKA) 359
OVERVIEW OF THE PROBLEM
Definition
Diabetic ketoacidosis (DKA) is a major metabolic complica-
tion occurring when there is insufficient insulin for metabo-
lism of carbohydrates, fats, and proteins. It is seen most often
in patients who are insulin dependent, and can be precipitated
by stressors such as infection, trauma, and major illness that
increase insulin needs.
Pathophysiology
In DKA, circulating glucose cannot be used due to a
lack of insulin, which “turns on” ketogenic pathways. The
supply of ketones exceeds peripheral demand, and keto-
sis results.
Risk Factors
■ Insufficient insulin or oral hypoglycemics
■ Noncompliance with dietary regimen
■ Major illness/infection
■ Steroid therapy
■ Trauma/surgery
■ Elevated blood sugar >200 mg/dL
Assessment
Assessment Subjective Objective
Behavior Irritable, confused
Visual Soft, sunken eyeballs
Skin Decreased turgor, flushed face, pruritus vulvae
Vital signs Tachycardia, thready pulse, Kussmaul’s respirations,
hypotension, hypovolemic shock
Gastrointestinal Increased thirst and Vomiting, diarrhea, dry mucous membranes,
hunger, abdominal pain, lips and tongue red and parched,
nausea fruity breath (acetone)
Neurological Headache, irritability,
confusion, lethargy
Muskuloskeletal Fatigue, malaise, weakness Decreased muscle tone and strength
Renal Polyuria
Blood sugar >300 mg/dL
Treatment
■ Regular insulin
■ Fluid replacement
■ Bicarbonate and electrolyte replacement
Nursing Management
Goal: Promote normal balance of intake and insulin.
■ Administer regular insulin as ordered and monitor
response
■ IV saline as ordered
■ Bicarbonate and electrolyte replacement
■ Potassium replacement once therapy begins and urine
output is adequate
Goal: Provide health teaching
■ Diet, desired and side effects of insulin or hypoglycemic
therapy, importance of recognizing signs of imbalance
Evaluation/Outcome Criteria
■ Follows prescribed diet
■ Takes medication as ordered
■ Avoids serious complication
Diabetic Ketoacidosis (DKA) 361
Admission Sheet
Name: Shannon O’Reilly
Age: 24
Gender: Female
Marital Status: Single
Educational Level: College
Religion: Catholic
Ethnicity: Irish
Nationality: American
Language: English
Occupation: Accountant
Hospital Patient’s Name: Shannon O’Reilly
Provider’s Orders Allergies: NKDA
Diagnosis: DKA
Date Time Order Signature
6/20/18 3:10 PM Vital signs: q 15 min
Diet: NPO
Activity: Bed rest
Diagnostic studies:
Serum electrolytes, glucose
BUN, creatinine, ABGs
Medications: IV regular insulin drip at
0 units/kg/hr
IV therapy: 1,000 mL NSS to maintain
systolic BP >
Treatments:
Accu-Checks q hr
Strict I and O
Oxygen via NR mask Dr. L. Fisher
6/20/18 3:15 PM K
+
rider 40 mEq in 100 mL over 4 hr
ABGs now and repeat in one hour Dr. L. Fisher
6/20/18 5 PM Change IV to 5% D/ 1 ⁄ 2 NSS
Admit to ICU
Maintain insulin drip
Accu-Checks q hr
Repeat BUN, creatinine, electrolytes, glucose, ABGs Dr. L. Fisher
362 Critical Care Nursing
Nursing Report
Mother states she went to work this morning and her daugh-
ter was asleep. When mother called home later in the morn-
ing daughter didn’t answer the phone and she rushed home
to check on her. She found her unconscious lying on the sofa.
She has had the flu for the past couple days with vomiting and
loss of appetite. She was diagnosed with diabetes mellitus
type 1 at 3 years of age. Her mother said since her daughter
wasn’t eating, she hasn’t taken her insulin.
Medications she was taking:
10 units Humulin Regular, 20 units of Humilin NPH
before breakfast.
10 units Humulin NPH at bed time.
IV line inserted in the field. NSS hanging wide open.
4. Initial Focused Assessment
After reviewing the client background and nursing report,
you are ready to assess your client’s current status. Under
each category, identify how you would target your assess-
ment and what you would expect to find for the patient with
DKA.
History
Are there any questions you need to ask the patient or family
to obtain additional relevant data?
Physical Exam
■ General appearance:
■ Integumentary:
■ HEENT:
■ Respiratory:
■ CV:
■ Breasts:
■ Abdominal/GI:
■ Neuro:
Simulation Prep Assignments
1. Identify items and their purpose in the care of a patient with DKA.
Item Purpose
IV with pump
O 2 nonrebreather mask, cannula
Accu-Check
Foley
Monitor
2. Identify team members and their specific roles in the care of the patient with DKA.
Team Member Role
Primary nurse
Secondary nurse
Physician
3. Relevant Data Assignment: Fill in columns below.
Relevant Data Relevant Data from Data Missing Sources for Data Requiring
from Report Other Sources Missing Data Follow-Up
364 Critical Care Nursing
7. Nursing Problems/Diagnoses
Identify three priority nursing problems/diagnoses.
Assessment Data Priority Intervention Expected Which Intervention
Problem Patient Could Be Delegated
Outcome to Unlicensed
Personnel?
1.
2.
3.
References
Deglin, J. H., & Vallerand, A. H. (2017). Davis’s drug guide for nurses
(15th ed.). Philadelphia: F. A. Davis.
Dillon, P. (2007). Nursing health assessment: A critical thinking and case studies
approach (2nd ed.). Philadelphia: F. A. Davis.
Erikson, E. (1950). Childhood and society. New York: Norton.
Hoffman, J., & Sullivan, N. (2017). Medical-surgical nursing: Making
connections to practice. Philadelphia: F. Davis.
Lagerquist, S. L.(2012). Davis’s NCLEX-RN for success (3rd ed.).
Philadelphia: F. A. Davis.
Treas, L. S., & Wilkinson, J. M. (2017). Basic nursing (2nd ed.). Philadelphia:
F. A. Davis.
Van Leeuwen, A. M., & Bladh, M. L. (2017). Davis’s comprehensive handbook
of laboratory and diagnostic tests with nursing implications. (7th ed.).
Philadelphia: F. A. Davis.
Was this document helpful?
NUR 445 Simulation DKA
Course: Medical Surgical (NUR425)
418 Documents
Students shared 418 documents in this course
University: Arizona College of Nursing
Was this document helpful?
358
8-4 Diabetic Ketoacidosis (DKA)
CRITICAL CARE STANDARD FORMS
These templates are included in the Appendix; copy before
each use.
LEARNING OUTCOMES
Cognitive
The participant will be able to:
1. Describe signs and symptoms of DKA.
2. Differentiate diabetes mellitus type 1 and type 2.
3. Correlate the signs and symptoms of DKA to the
pathophysiology.
4. Identify the signs and symptoms of hyperglycemia and
hypoglycemia.
5. Identify appropriate intervention for a patient with
DKA.
Psychomotor
The participant will be able:
1. Perform an assessment on a patient with DKA.
2. Initiate appropriate interventions, such as start and main-
tain IV, insert Foley catheter, place patient on monitor.
Affective
The participant will be able to:
1. Reflect upon performance in a simulated situation and
care of a patient with DKA.
2. Identify areas that worked well during the scenario.
3. Identify areas that need improvement.
4. Reflect on overall feeling about the scenario.
5. Discuss feelings related to working as a team member.
6. Develops confidence in caring for a patient with DKA.
7. Perform self-reflective evaluation.
Communication
The participant will be able to:
1. Communicate effectively with healthcare team members
in the care of a patient with DKA.
2. Communicate effectively with the patient and family
members.
3. Use SBAR format when communicating with healthcare
team members.
4. Work collaboratively as part of the healthcare team.
5. Accurately and succinctly document assessments,
interventions, and evaluations.
6. Practice Transparent Thinking (thinking out loud) to
facilitate group problem solving.
7. Use Directed Communication (directing a message to
specific individual) when delegating tasks.
8. Employ Closed-Loop Communication (acknowledgment
of receipt of the message and status) to acknowledge
communications from others.
Safety
The participant will be able to:
Administer and maintain specific protecting interventions
with attention to safety of the client and healthcare professional.
1. Demonstrate a safe environment with attention to hazards
to healthcare providers, visitors, and the client. Includes
body mechanics, tripping hazards, and equipment issues.
2. Demonstrate attention to national patient safety goals.
Includes patient identification standards, effective com-
munication among healthcare providers, and safe med-
ication administration.
3. Demonstrate attention to standard precautions. Includes
hand washing, infection control measures, and use of
personal protective equipment (PPE) as needed.
Leadership and Management/Delegation
The participant will be able to:
1. Identify and prioritize patient’s needs in care of a patient
with DKA.
2. Identify those interventions that can be delegated to
unlicensed assistive personnel (UAP) or licensed practical
nurse (LPN).
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