DIABETIC KETOACIDOSIS

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DIABETIC KETOACIDOSIS
PRESENTED BY SIMI M PAUL PEDIA WARD
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• DEMOGRAFIC DATA
•  
• Name 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

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• 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

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• 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

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• 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 .

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ANATOMY AND PHYSIOLOGY PANCREAS
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• 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.

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• 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 .

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• FUNCTION
• The function of exocrine pancreas is to produce
  pancreatic juice containing enzymes that digest
  carbohydrates, proteins and fats

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• 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.

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• ETIOLOGY
• Hereditary
• Genetics
• Obesity

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• PATHOPHYSIOLOGY
•  
• Insulin deficiency
•  
• Free fatty acids
• Ketone bodies in the liver
• Causes metabolic acidosis
•  
• Increased secretion of glucagon,
  catecholamine's,
• Serum cortisol.
•  
• Hyperglycemia
•  
• DKA

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• SIGNS AND SYMPTOMS

BOOK BASED PATIEND MANIFESTED
Polyuria     Polyuria
   Polydipsia   Polydipsia
  Fatigue, malaise and drowsiness  drowsiness
Anorexia, nausea , vomiting vomiting
Abdominal pain abdominal pain
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• 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

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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
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• COMPLICATION
• Cerebral edema
• Extended Hyperglycemia
• Microvascular complication.
• Retinopathy
• Nephropathy

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• 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.

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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 Encourage oral intake of fluid. Administer IV fluid( 5 Dextrose in 1/2 ns 5ml KCL at 85ml /hour) provide calm and quiet environment. monitor intake and output chart 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 intervention the goal was partially met
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ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTTATION RATIONALE EVALUATION
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 Monitor blood glucose level every 1 hourly Administer proper medication's Provide calm and quiet environment Monitor urine ketone To determine the correct amount of insulin injection Helps to decrease blood glucose level Provide relaxation After 24 hrs patient blood glucose level decreased.
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• 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

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• 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

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• BIBLIOGRAPHY
• Lippincott manual of Nursing practice 9th
  edition .
• Ross and Wilson , anatomy and physiology in
  health and illness 9th edition .

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THANK YOU!!!!!!!