DIABETIC KETOACIDOSIS

PRESENTED BY:SIMI M PAUL

PEDIA WARD

DEMOGRAFIC DATA Name : case no: 4MR no : 157203Diagnosis : DKA (Diabetic ketoacidosis)Age : 13 yearsGender : FemaleDate 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 lethargicc) Head and neck : No deformities foundd) Thorax: Normally symmetrical in sizee) Cardiovascular : No Deformities foundf) Genitourinary: Polyuria,g) Gastrointestinal: vomiting, nausea ,abdominal painh) Musculoskeletal: No deformities foundi) Neurologically: No deformities found

PATIENT HISTORYPASTMEDICAL 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

HereditaryGeneticsObesity

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 PATIEND MANIFESTED

Polyuria

    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

BOOK BASED PATIONT TREATMENT

INSULIN THERAPY INSULIN THERAPY

Eg: Human insilin RHuman misted

Eg:Injection human insulin R IV infusion

SUPPORTIVE MEASENCE :

IV therapy, electrolyte replacement

TREATMENT

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 DIAGNOSI

S PLANNING IMPLEMENTTATI

ON RATIONALEEVALUATI

ON

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 intervention the goal was partially met

ASSESSMENTNURSING

DIAGNOSIS PLANNING IMPLEMENTTATIO

N RATIONALEEVALUATIO

N

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

a) To determine the correct amount of insulin injection

b) Helps to decrease blood glucose level

c) Provide relaxation

After 24 hrs patient blood glucose level decreased.

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!!!!!!!