4 Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans

January 4, 2017

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) and nursing diagnosis for patients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome:

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

Unfamiliarity with the risk factors, treatment, and prevention of the disease.
Lack of exposure or recall, information misinterpretation.

Possibly evidenced by

Inaccurate follow-through of instructions, development of preventable complications.
Questions or request for information.

Desired Outcomes

Client will verbalize understanding of the disease condition and potential complication.
Client will correctly perform necessary procedures and explain rationale on each action.
Client will demonstrate lifestyle changes and participate in treatment regimen.

Nursing Interventions	Rationale
Establish rapport and trust.	Create an environment where trust and good rapport facilitates good relationship in the learning process.
Explain the signs and symptoms of diabetic ketoacidosis.	Symptoms of hyperglycemia include polyuria, polydipsia, polyphagia, flushed skin, and body malaise.
Discuss the following with the client: Normal blood glucose level. Risk factors. Client’s type of diabetes. The relationship between elevated glucose level and insulin deficiency.	Baseline knowledge enables the client to make informed lifestyle choices.
Demonstrate proper blood glucose testing using the glucometer. Instruct client to check the urine for ketones once blood glucose reaches 250 mg/dL or higher.	Monitoring blood glucose 3-4 times a day is an essential part of managing diabetes to avoid further complications. Blood glucose >250mg/dl and high urine ketones should be reported to the physician immediately.
Teach signs of hypoglycemia: Dizziness. Sweating. Hunger. Pallor. Diaphoresis. Nervousness. Tremors.	These are signs of excessive insulin dosage, resulting in hypoglycemia. Early recognition of these symptoms promotes immediate intervention.
Teach client that polyuria, polydipsia, and polyphagia are signs of hyperglycemia which requires increased dosage of insulin.	These are signs of insufficient insulin dosage and hyperglycemia which may lead to coma and death if untreated.
Explain the importance of having a dietary plan: Limit intake of simple sugar, fat, salt and alcohol. Increase intake of whole grains, fruits, and vegetables.	Medical nutrition therapy is important in managing diabetes and preventing the rate of development of diabetes complications. A high-fiber diet can slow the absorption of glucose, decreased excess insulin levels and lowered lipid concentrations in clients with type 2 diabetes.
Teach client to monitor blood glucose during periods of exercise and adjust insulin dose.	The insulin dose should be adjusted after increased or decreased food intake and before any exercise. Exercise may increase usage of glucose.
Advise the client the importance of daily examination of the feet and foot care.	Decreased peripheral circulation place the client at risk for an undetected foot injury.
Advise the client the importance of routine eye examination.	Clients with a poorly controlled diabetes may experience changes in vision that may lead to blindness.
Review of medication regimen, including, onset, peak, and duration of prescribed insulin, as applicable with the client.	A good way to properly use insulin is to learn these aspects of drug usage. This will help in the adjustment of the doses or the food intake to stop unwanted ups and downs in the glucose level.
Review self-administration of insulin and care of equipment. Have client demonstrate procedure (e.g., drawing up and injecting insulin, insulin pen technique, or pump therapy).	Evaluate understanding of the procedure. Recognizes potential problems such as short-term memory so that alternative solutions can be made for the administration of the insulin.
Discuss timing of insulin injection and mealtime.	Regular insulin works best if administering it 30 minutes before eating. While a product called insulin lispro (Humalog) works best when taking within 15 minutes of eating. With the onset twice as fast as regular insulin and a duration nearly half as long. Hypoglycemia may result more rapidly. If a blood glucose reading is >80 mg/dL, the insulin should be injected after eating rather than before the meal.
Discuss the use of a medical alert bracelet.	This enables the client to have a quick entry into the health system, and appropriate care will be given immediately.
Stress the importance of strict follow-up care.	To prevent or delay the development of complications from diabetes.