77. Ten hours after beginning an insulin drip on a client with diabetic ketoacidosis, the following laboratory results are returned: Na+ 130, K+ 4.4, Cl– 100, bicarb 15, BUN 60, creatinine 2.5, glucose 100. Which action should a nurse take?
77. Ten hours after beginning an insulin drip on a client with diabetic ketoacidosis, the following laboratory results are returned: Na+ 130, K+ 4.4, Cl– 100, bicarb 15, BUN 60, creatinine 2.5, glucose 100. Which action should a nurse take?
Test-Taking Tip
Know the effects of high blood sugar levels on fluid and electrolyte levels, as well as the shifts that occur with the administration of insulin.
Content Area: Adult Health, Endocrine; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
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Answer 1 is incorrect because clients on insulin drips often require supplemental potassium to replace that carried into the cells by insulin. A K+ of 4.4 is on the high end of the normal and would not need to be replaced. Answer 2 is correct because this client is still acidotic, which means the cells are burning fats and releasing ketones. (Anion gap is 130 – 100 – 15 = 15, which is high; bicarbonate is low at 15). Insulin is still required. With blood sugar at 100, you will also need to give sugar. Answer 3 is incorrect because sodium level needs to correct slowly as blood sugar is lowered from the high admission level. At 130, a correction has almost occurred. Giving sodium tablets to increase sodium too quickly will pull fluid out of the cells, further dehydrating the cells. Salt may be given to correct hypertension, but is not required in this client. Answer 4 is incorrect because clients with DKA need fluids, not fluid restriction. The high blood sugar creates an osmotic loss of intracellular fluids, and when sugar is spilled into the urine, there is osmotic fluid loss from the body.
