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.
