NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

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NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

NR 507 Week 5 Discussion Part One What is the etiology of Diabetic Ketoacidosis

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Week 5: Discussion Part One

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Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

Sodium (Na+)	156 mEq/L
Potassium (K+)	4.0 mEq/L
Chloride (Cl–)	115 mEq/L
Arterial blood gases (ABGs)	pH- 7.30; Pco2-40; Po2-70; HCO3-20
Normal values
Sodium (Na+)	136-146 mEq/L
Potassium (K+)	3.5-5.1 mEq/L
Chloride (Cl–)	98-106 mEq/L
Arterial blood gases (ABGs)	pH- 7.35-7.45 Pco2- 35-45 mmHg Po2-80-100 mmHg HCO3–22-28 mEq/L

 

1. What is the etiology of Diabetic Ketoacidosis?
2. Describe the pathophysiological process of Diabetic Ketoacidosis.
3. Identify the hallmark symptoms of Diabetic Ketoacidosis.
4. Identify any abnormal lab results provided in the case and explain why these would be abnormal given the patient’s condition.
5. What teaching would you provide this patient to avoid Diabetic Ketoacidosis symptoms?

In addition to the textbook, utilize at least one peer-reviewed, evidence based resource to develop your post.

A Sample Answer For the Assignment: NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

Title: NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

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Aug 5, 2018Aug 5 at 3:28pm

Manage Discussion Entry

Dr. Arredondo and class,

Diabetic ketoacidosis is a severe complication of diabetes that occurs when your body produces high levels of blood acids called ketones. “Diabetic ketoacidosis (DKA) develops when there is an absolute or relative deficiency of insulin and an increase in the levels of counterregulatory insulin hormones” (McCance, 2013). This disease commonly found in patients with type 1 diabetes. However, it can also occur in type 2 diabetes. The most common triggering aspect for DKA is other illness, such as infection, trauma, surgery, or myocardial infarction. Interruption of insulin administration also may result in DKA. (McCance, 2013).

The condition develops when your body can’t produce enough insulin. Insulin usually plays a crucial role in helping sugar (glucose) — a significant source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. (Mayo clinic staff, 2018).

2. Describe the pathophysiological process of Diabetic Ketoacidosis.

 

Diabetic ketoacidosis characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases arising in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. (Westerberg, 2013). According to, McCance, 2013. In a state of relative insulin deficiency, there is an increase in the concentrations of insulin counterregulatory hormones including catecholamines, cortisol, glucagon, and GH. “These counterregulatory hormones antagonize insulin by increasing glucose production and decreasing tissue use of glucose. Profound insulin deficiency results in decreased glucose uptake increased fat mobilization with the release of fatty acids and accelerated gluconeogenesis and ketogenesis. “(McCance, 2013).

3. Identify the hallmark symptoms of Diabetic Ketoacidosis.

 

Hallmark symptoms include polyuria with polydipsia (98 percent), dehydration, weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Other symptoms of diabetic ketoacidosis include Kussmaul respirations (hyperventilation to compensate for the acidosis), postural dizziness, central nervous system depression, ketonuria, anorexia, nausea.

 

 

4. Identify any abnormal lab results provided in the case and explain why these would be abnormal given the patient’s condition.

 

Sodium (Na+) 156 mEq/L elevated normal range 136-146 mEq/L. The American Diabetes Association criteria for the diagnosis of DKA are: (1) a serum glucose level >250 mg/dl, (2) a serum bicarbonate level <18 mg/dl, (3) a serum pH <7.30, (4) the presence of an anion gap, and (5) the presence of urine and serum ketones. Arterial blood gases (ABGs) Pco2-40; Po2-70; HCO3-20. Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. (Soeimanpour et al., 2013). These labs are abnormal because the body is compensating for the high level of glucose in the renal system and the loss of glucose in the urine. Ms. Blake has not been eating and probably has been taken her insulin as she was before she got sick. When you have diabetes and don’t get enough insulin and get dehydrated, your body burns fat instead of carbs as fuel, and that makes Ketones. Lots of ketones in your blood turn it acidic. People who drink much alcohol for a long time and don’t eat also enough build up ketones. It can happen when you aren’t eating at all, too. This condition can all lead to or be a predictor of existing Ketoacidosis.

5. What teaching would you provide this patient to avoid Diabetic Ketoacidosis symptoms?

 

First, I would emphasize the importance of managing her insulin regimen, instruct her that DKA is a life-threatening condition. I would teach Ms. Blake to Monitor her blood sugar levels closely, especially if you have an infection, are stressed, or experience trauma. Check your blood sugar levels often. You may need to check at least three times each day. If your blood sugar level is too high, give yourself insulin as directed by your healthcare provider. Manage your sick days. When you are sick, you may not eat as much as you usually would. You may need to change the amount of insulin you give yourself. You may need to check your blood sugar level more frequently than typical. Strategize with your healthcare provider about how to manage your diabetes when you are sick.

Ingrid

References NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

Mayo clinic staff (2018). Diabetic ketoacidosis/ Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.

Soleimanpour,H., Taghizadieh, A., Niafar, M., Rahmani, F., Golzari, S.E.J., Estanjani, R.M. (2013). Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876300/

Westerberg, D.P. (2018). Diabetic Ketoacidosis: Evaluation and Treatment. Retrieved fromhttps://www.aafp.org/afp/2013/0301/p337.html

Manage Discussion Entry

Ingrid,

Great post this week about the etiology and pathophysiology of diabetic ketoacidosis. You provided a great explanation about the pathophysiology of the disease. I found it interesting that you mentioned that about one third of all cases of DKA occur in people who do not have a history of diabetes mellitus. I knew that DKA occurs in children and it is often the onset of the disease of diabetes, however it was surprising that this situation comprises one third of all cases. I also liked how you included the percentages for signs and symptoms of the condition. It is a great teaching lesson to instruct patients to check their blood glucose levels more often when they are sick. Since DKA commonly occurs with infections, this can alert them to increasing blood glucose levels that they may need to consult medical attention for. Symptom recognition for DKA is also an important aspect of patient teaching (Smith & Schub, 2018). Thank you for sharing, and great job this week.

Reference: NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

Smith, N. C., & Schub, T. B. (2018). Diabetic Ketoacidosis in Adults. CINAHL Nursing Guide,

 

Aug 11, 2018Aug 11 at 2:43pm

Manage Discussion Entry

Hello, Ingrid

I enjoyed reading your post and agree with the fact that would point out the importance of managing the patient’s insulin regimen and telling her that diabetic ketoacidosis (DKA) is a life threatening emergency. I would like to add that poor insulin regimen adherence is the main cause of (DKA) in most individual. Many lifestyle behaviors, social economic, psychosocial and educational determinants impact to low adherence (Halepian, Saleh, Hallit & Khabbaz, 2018).  According to a study based on the Kaiser Permanente hospital population, the study found that a high percentage of patients who did not start their insulin regimen felt that their medical providers ineffectively disclosed the risks and advantages of insulin (Halepian et al., 2018). More counseling by medical providers is required to educate the patient about the probable aftereffects that may result with insulin regimen and most imperatively about the potency of insulin (Halepian et al., 2018). Emphasizing the benefits of insulin regimen at the time of prescribing, as well as clarifying the possibility of an adverse aftereffects occurring and its significance can enhance how patients comprehend information from different sources (Halepian et al., 2018). Second level of schooling was negatively linked with less trust in physician scores (Halepian et al.,

2018). This may clarify why the patients with higher education accomplishment are more involved in the health decision making process and confirm reliability of information offered by their providers (Halepian et al., 2018).  As advanced practice nurses it is important to recognize these factors and institute culturally competent intervention and patient education may reduce the reoccurrence of DKA.

Mwiche-

References NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis?

Halepian, L., Saleh, M.B., Hallit, S., & Khabbaz, L. R. (2018). Adherence to insulin, emotional distress and trust in physician among patients with diabetes. Diabetes Therapy, 9(2), 713-726. doi: 10.1007/s1333000-018-0389-1

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NR 507 Week 5: Discussion Part One What is the etiology of Diabetic Ketoacidosis? Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread)	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements per discussion thread	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement per discussion thread	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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