88. A client with diabetic ketoacidosis (DKA) has been receiving IV insulin for 6 hours. Laboratory findings are: Na+ 131, K+ 3.7, Cl– 102, HCO3 22, and glucose 170. Which action should a nurse take?
88. A client with diabetic ketoacidosis (DKA) has been receiving IV insulin for 6 hours. Laboratory findings are: Na+ 131, K+ 3.7, Cl– 102, HCO3 22, and glucose 170. Which action should a nurse take?
. Administer 3% sodium chloride at 200 mL/hr.
. Expect the insulin drip to be discontinued.
. Give potassium IV.
. Administer D5 ¼ NS with the insulin drip.
Test-Taking Tip
First ask: Are the values within normal limits? Then, look at the impact of each option on the laboratory values. Select the option that is different from the three others ("discontinue" versus three "gives").
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 the sodium will rise another 1 or 2 points as the blood sugar returns to normal. This will not require aggressive treatment; 3% NaC1 at 200 mL/hr would raise sodium levels very rapidly, and could cause seizures. Answer 2 is correct because the anion gap is closed and the glucose is close to normal. The client can be switched to subcutaneous insulin and the insulin drip discontinued. An anion gap occurs in metabolic acidosis when there is an excessive accumulation of fixed acid. Anion gap is determined by the balance between the anions (Na+ and K+) and the cations (Cl– and HCO3–). Answer 3 is incorrect because the potassium level might be treated if the client were to remain on an insulin drip. The blood sugar of 170 without an elevated anion gap indicates that the insulin drip can be discontinued. Answer 4 is incorrect because, when the dextrose is metabolized, 5% dextrose in one-quarter normal saline (D5 ¼NS) becomes just ¼NS. This hypotonic solution will further dilute the sodium.