Transcript DIABETIC KETOACIDOSIS - Dr. Ahmad Abanamy Hospital

PRESENTED BY:
SIMI M PAUL
PEDIA WARD
DEMOGRAFIC DATA
 Name
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
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
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
: case no: 4
MR no
: 157203
Diagnosis : DKA (Diabetic ketoacidosis)
Age
: 13 years
Gender
: Female
Date of admission: 09/10/2012
Date of discharge: 11/10/2012
Physical Assessment
General Assessment
a) Chief complaint: Vomiting, Drowsiness, Polyuria,
Lethargic
b) Skin : Dehydrated , look lethargic
c) Head and neck : No deformities found
d) Thorax: Normally symmetrical in size
e) Cardiovascular : No Deformities found
f) Genitourinary: Polyuria,
g) Gastrointestinal: vomiting, nausea ,abdominal pain
h) Musculoskeletal: No deformities found
i) Neurologically: No deformities found
PATIENT HISTORY
PASTMEDICAL HISTORY
Known case of DKA since 3 yrs.She is on insulin
treatment (insulin humolog 22 unit TID )
PRESENT MEDICAL HISTORY
Now the patient is admitted with the complaint of
polyuria, polydipsia, vomiting and drowsiness
TOPIC PRESENTATION
DEFINITION
It is a disorder of glucose intolerance caused by
deficiency in insulin production and action resulting
in hyperglycemia and abnormal carbohydrate , protein
and fat metabolism .
ANATOMY AND PHYSIOLOGY
PANCREAS
The pancreas is a pale gray gland weighing
about 60 grams. It is about 12 to 15 cm long
and is situated in the epigastric and left
hypochondriac region of the abdominal
cavity .it consist of a broad head and a body
and a narrow tail. The head lies in the curve
of the duodenum. The body behind the
stomach and the tail lies in front of the left
kidney and just reaches the spleen.
The pancreas both exocrine and endocrine gland
EXOCRINE GLAND
It consists of large number of lobules made up of small
alveoli the walls of which consist of secretary cells
.each lobules is drained by a tiny duct and these unite
eventually to form the pancreatic duct , which extends
the whole length of the gland opens in to the
duodenum .
FUNCTION
The function of exocrine pancreas is to
produce pancreatic juice containing
enzymes that digest carbohydrates, proteins
and fats
ENDOCRINE PANCREAS
 Distributed throughout the gland are groups of
specialized cells called the pancreatic islets .The islets
have no ducts so the hormones diffuse directly in to
the blood.
 The function of the endocrine pancreas is to secrete
the hormones insulin and glucagon , which are
principally concerned with control of blood glucose
levels.
ETIOLOGY
 Hereditary
 Genetics
 Obesity
PATHOPHYSIOLOGY
Insulin deficiency
Free fatty acids
Ketone bodies in the liver
Causes metabolic acidosis
Increased secretion of glucagon, catecholamine's,
Serum cortisol.
Hyperglycemia
DKA
SIGNS AND SYMPTOMS
BOOK BASED
Polyuria
PATIEND MANIFESTED
Polyuria
Polydipsia
Polydipsia
Fatigue, malaise and drowsiness
drowsiness
Anorexia, nausea , vomiting
vomiting
Abdominal pain
abdominal pain
INTERVENTION
 Restoring fluid and electrolyte balance.
 Promoting rest and conserving energy
 Promoting frequent monitoring of blood
glucose level
 Promoting family knowledge
 Monitoring and preventing complication
TREATMENT
BOOK BASED
PATIONT TREATMENT
INSULIN THERAPY
INSULIN THERAPY
Eg:
Human insilin R
Human misted
Eg:
Injection human insulin R IV
infusion
SUPPORTIVE MEASENCE :
IV therapy, electrolyte
replacement
COMPLICATION
Cerebral edema
Extended Hyperglycemia
Microvascular complication.
Retinopathy
Nephropathy
PRIORITIZATION OF NURSING PROBLEMS
 Altered fluid volume deficit related to severe
dehydration
 Activity intolerance related to poor glucose control.
 Altered electrolyte imbalance related to vomiting
 Risk for impaired skin integrity related to decreased
sensation and circulation to lower extremities
 Ineffective coping related to chronic disease and
complex self-care regimen.
ASSESSMENT
NURSING
DIAGNOSIS
PLANNING
IMPLEMENTTATION
RATIONALE
EVALUATION
Subjective :
Patient mother
complaints of
increase
number of
vomiting
Objective :
Vomiting more
than 5 times
per day
a) Dry skin
b) Cracked lips
Altered
fluid
volume
deficit
related to
active fluid
loss.
With in 12 hrs
of nursing
intervention
patient will.
•Hydrated
• No vomiting
a) Encourage
oral intake of
fluid.
b) Administer
IV fluid( 5 %
Dextrose in
1/2 ns + 5ml
KCL at 85ml
/hour)
c) provide calm
and quiet
environment.
d) monitor
intake and
output chart
e) provide DM
diet .
a ) Helps to
promote
hydration
b) Helps to
provide fluid ,
calories and
electrolytes.
C) To maintain
electrolyte
imbalance
d) will
determine if
out put
exceeds input
E) Helps to
decreed blood
glucose level
After 12
hrs of
nursing
interventio
n the goal
was
partially
met
ASSESSMENT
NURSING
DIAGNOSIS
PLANNING
IMPLEMENTTATION
RATIONALE
EVALUATION
a) To
determin
e the
correct
amount
of insulin
injection
b) Helps to
decrease
blood
glucose
level
c) Provide
relaxatio
n
After 24 hrs
patient blood
glucose level
decreased.
Subjective :
Mother
complaints
patients
experience
fatigue and
drowsiness
Objective :
Increase blood
glucose level
Activity
intolerance
related to
poor glucose
control
Within 24
hrs Patient
blood
glucose
level
gradually
decrease
and back to
normal
range
a)
Monitor blood
glucose level
every 1 hourly
b) Administer
proper
medication's
c) Provide calm
and quiet
environment
d) Monitor urine
ketone
NURING HEALTH TEACHING
 Encourage the mother to monitor blood sugar properly
 Demonstrate and teach the mother how to give insulin
properly
 Educate the mother regarding proper preparation of
diabetic diet
 Teach about the signs and symptoms of DKA
CONCLUSION
 Patient relieved from signs and symptoms of DKA
and maintains blood glucose level in normal range
 Discharge medications :- Insulin Humalog 22
units 3 times daily
BIBLIOGRAPHY
 Lippincott manual of Nursing practice 9th edition .
 Ross and Wilson , anatomy and physiology in health
and illness 9th edition .
THANK
YOU!!!!!!!