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

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.