Hey there, friend! In this video lecture, we are talking about the pathophysiology and
nursing interventions for diabetic keotacidosis. I'm going to break down the pathophysiology
into super simple steps for you to follow. These steps are SUPER helpful for students,
so stick around because you will finally understand it after this video. And write "LOVE" in the
comments below if you want more full video lectures just like this one to help you out
with nursing school. I want to know what you think! Now, let's do it!
So DKA, in a nutshell, happens when there is not enough insulin in the body. Insulin
is required to help move glucose into the cells. Glucose is the cells best energy source,
so without insulin, the cells can't get any glucose. So because the cells don't have insulin,
the cells start converting fat into energy instead. And this fat breakdown leads to ketones
building up in the blood, which are acids. So that's just a brief overview of what's
going on here.
Now DKA happens mostly in patients with type 1 diabetes, but it can also happen with type
2, although that's pretty rare. So let's think about this: DKA happens when there is not
enough insulin in the body. And during type 1 diabetes, the pancreas isn't making any
insulin. So that's why it mostly happens in type 1 diabetes.
During type 2 diabetes, the cells become resistant to insulin. So in type 2 diabetes, it's really
not a problem of a lack of insulin in the body, but rather, a lack of insulin's ability
to move glucose into the cell because the cells are resistant to that insulin. This
is pretty rare, though. DKA mostly happens in type 1 diabetes. But in either case, insulin
can't get glucose into the cell. So let's walk through what happens step by step. Now,
you won't see these steps anywhere else, they're not official or anything. I just made them
up to make learning all of this easier. So you won't find them in your textbook or anything.
Step 1 of the pathophysiology of diabetic ketoacidosis is there is not enough insulin.
So normally in your body, your pancreas produces insulin, and insulin's job is to grab onto
glucose and move it into the cells so that the cells can use them for energy. But in
the case of diabetic ketoacidosis, there isn't enough insulin.
And this leads to hyperglycemia, which is of the pathophysiology of DKA. This causes
hyperglycemia, because there isn't any insulin around to move glucose into the cells, so
all of that glucose just builds up and builds up in the blood. It can't get into the cell,
it's stuck outside!
So the cells are there really wanting their glucose, because they need energy. But thankfully,
they have some stored up fat to use for energy, and this is of DKA, the cells use fat as energy.
And here's a KEY POINT you need to know about diabetic ketoacidosis: when fat is converted
into energy, ketones are produced, and ketones are acids.
This is step 4, ketones are produced as a biproduct of fat metabolism. This is a key
point to remember for DKA: the cells use FAT for energy instead of glucose. And when fat
is broken down, ketones are released, and ketones are ACIDS.
And because there's all that acid release, it leads to step number 5, which is acidosis.
The more the ketone levels rise in the body, the more the acid level rises in the body,
because ketones are acids. And so the more ketones there are, the more serious the acidosis
becomes.
And this is considered metabolic acidosis. If you want a deep dive on metabolic acidosis,
don't worry, we've got you covered! I've got a whole video on metabolic acidosis that you
can check out, I'll put the link in the description below. In that video, I walk you through what
it is, and what causes it, so you will definitely want to check it out!
So now that we know the pathophysiology of diabetic keotacidosis, let's talk about the
nursing interventions for DKA. So what are the things you'll do as a nurse to help fix
it.
There are several nursing interventions you might do for a patient with DKA. These might
be things like: giving fluids, giving insulin, and continuing to assess them.
If you're in the NursingSOS Membership Community, you know that I'm ALWAYS talking about how
important the nursing assessment is. And, actually, that reminds me, I have a free nursing
assessment cheat sheet for you. But it's even better than a cheat sheet, it's a full assessment
TRANSCRIPT. So it literally walks you through the nursing assessment word-for-word, so you
can use it as a guide when you practice assessing a patient. It's AMAZING. You're going to LOVE
it! I'll put a link to it in the description below this video for you to check it out.
So, let's talk about fluid treatment for DKA. Giving fluids is one of the 2 main treatments
you'll do for a patient with DKA. The goal here is to reduce the blood glucose level
and keep the patient's organs perfused.
Of course, fluid treatment will depend on what the doctor has ordered, but typically
you'll give normal saline, lactated ringers, half normal saline or five to ten percent
dextrose in half normal saline.
There are different reasons for giving these different fluids, so let's walk through them.
Normal saline or lactated ringers is usually given first because these solutions are isotonic,
meaning they are not going to force fluid any which way. Those solutions are going to
stay inside the blood vessels, which is where we want them.
Half normal saline may be used after normal saline or lactated ringers in order to hydrate
the cells, because half normal saline solution will push some fluid inside the cells to help
rehydrate them.
You may also give five to ten percent dextrose in half normal saline as the blood glucose
level drops to around 250 to 300 miligrams per decileter. Now, this can be confusing,
why would we give glucose when we're trying to DROP the patient's blood glucose level?
Well, this is super important because we don't want it to drop too MUCH. We are basically
controlling the blood glucose level by giving some more glucose, and controlling the rate
that the blood glucose level decreases.
Let's think about it, if we just give normal fluids without glucose, PLUS insulin, that
insulin could drop the blood glucose level way to fast, so when the blood glucose level
reaches between 250 to 300 miligrams per decileter, you might give glucose along with fluids,
depending on the doctors orders. So that is the rationale for each of those IV fluids.
If you want a deeper dive into IV fluids, we have a whole video on that for you to check
out. It's super good and will give you a quick and easy breakdown of isotonic, hypertonic
and hypotonic solutions. I'll put the link to that video in the description too.
Now let's talk about insulin treatment. So we know that the core problem, and the pathophysiology
of DKA is a lack of insulin. So obviously, we'll need to give insulin to help the cells
take up that glucose for energy, so they can stop using fat for energy and stop producing
those acidic ketones.
Depending on the doctors orders, you might give regular insulin through the IV to help
move that glucose into the body cells. If you do this, you will need to constantly assess
their blood glucose level during treatment, because you don't want to drop their blood
sugar too fast and here's why: the body is always wanting to be in balance, so if you
drop the blood glucose level too fast, the water in the body will try to re-balance itself
and move from the intracellular fluid (called the ICF), to the extracellular fluid (called
the ECF). And if this happens too fast, fluid will move into the cerebrospinal fluid to
try to maintain that balance. And this can lead to swelling in the brain, and can cause
increased intracranial pressure. This is super dangerous and causes even more of a medical
emergency. So it's really important that you always assess your patient and be very careful
when giving insulin and fluid treatment.
And of course, like I said, I'm a stickler for the nursing assessment, so let's walk
through some things you'll need to assess. You'll assess their intake and output, their
weight, and continually monitor their respirations. You'll assess their IV, assess their fluids
and fluid status, make sure the correct fluids are infusing like they should be, check their
blood glucose levels, their ABG values, and their potassium and sodium levels. Diabetic
ketoacidosis can seriously mess up the fluid and electrolyte balance in the body, so it's
important to keep an eye on it!
You will also constantly assess their mental status, to clue you in on any increased intracranial
pressure. Like we said before, if the fluid shifts into the cerebrospinal fluid, it can
cause swelling on the brain and increased intracranial pressure. So you need to always
be assessing for that!
Friend, you are a ROCK STAR nursing student! I know all of this is a lot to learn, but
just because you're here with me right now watching this video tells me that you're doing
better than you think you are. You are obviously SUPER dedicated to becoming the BEST nurse
you can be. So keep going, and don't give up! I know you can do it!
If this video helped you out, write "LOVE" in the comments below to let me know you want
more full video lectures just like this one to help you out with nursing school. I want
to know what you think! And of course, make sure to subscribe and click the bell for more
videos to help you raise your grades and have more free time in nursing school.
And in the next video, we'll walk through the DKA lab values you need to know about.
Now go become the nurse that God created only YOU to be. I'll see you in the next video.