Diabetic ketoacidosis (DKA) is a life-threatening emergency caused by a relative or absolute deficiency of insulin. This deficiency in available insulin results in disorders in the metabolism of carbohydrate, fat, and protein. Main clinical features of DKA are hyperglycemia, acidosis, dehydration, and electrolyte losses such as hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypophosphatemia.
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) is a condition characterized by the presence of hyperglycemia, hyperosmolarity, and dehydration. There is enough production of insulin to reduce ketosis but not to control hyperglycemia. Persistent hyperglycemia causes osmotic diuresis, which results in the fluid and electrolyte imbalances. The clients with HHNS may present with symptoms of hypotension, tachycardia, marked dehydration, and neurological manifestation such as seizures, hemiparesis, and alterations in the sensorium).
Nursing Care Plans
The nursing care plan for clients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome includes provision of information about disease process/prognosis, self-care, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system (CNS) function, avoiding dehydration, and correcting hyperglycemia and hyperglycemia complications.
Here are four (4) nursing care plans (NCP) for Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome:
- Risk For Fluid Volume Deficit
- Risk For Infection
- Deficient Knowledge
- Imbalanced Nutrition: Less Than Body Requirements
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
Risk Factors
- Preexisting respiratory infection, or UTI.
- High glucose levels.
- Decreased leukocyte function.
- Changes in circulation.
Possibly evidenced by
- [not applicable].
Desired Outcomes
- Client will identify interventions to prevent reduce risk of infection.
- Client will demonstrate techniques, lifestyle changes to prevent the development of infection.
| Nursing Interventions | Rationale |
|---|---|
| Assess for signs of infection and inflammation. | Infection is a common cause of DKA. Signs of infection includes fever, chills, dysuria, and increased WBC count. |
| Observe client’s feet for ulcers, infected toenails, or other medical problems. | Due to impaired circulation in diabetes, foot injuries are predisposed to poor wound healing. |
| Observe aseptic technique during IV insertion and medication administration. | Elevated blood sugar weakens the immune system thus clients are more prone to infection. |
| Provide skin care. | An intact skin protects against infection. |
| Encourage proper handwashing technique. | To avoid the risk of cross-contamination. |
| Encourage adequate oral fluid intake (2-3 liters a day unless contraindicated). | Reduces susceptibility to infection. |
| Encourage deep breathing exercise; Maintain client in semi-Fowler’s position. | Helps in mobilizing secretions. And expanding the lung. |
| Obtain sample for culture and sensitivity as indicated. | Identifies the bacteria/fungus that causes an infection and the appropriate drug for it. |
| Administer antibiotics as indicated. | Early initiation of antibiotic may help to prevent sepsis. |
See Also
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- Acid-Base Balance
- - Respiratory Acidosis Nursing Care Plan
- - Respiratory Alkalosis Nursing Care Plan
- - Metabolic Acidosis Nursing Care Plan
- - Metabolic Alkalosis Nursing Care Plan
- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans
Further Reading
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans
