Stage 4 — Generate solutions. Review the confirmed DKA findings in the EHR. Which interventions should the nurse implement now or anticipate during treatment? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Five appropriate interventions Correct care combines individualized isotonic fluid; potassium-safe IV insulin; serial potassium replacement planning; glucose and biochemical monitoring with dextrose below 250 mg/dL; and continued insulin plus precipitant management until ketonemia and acidosis resolve. Routine bicarbonate is not recommended at pH 7.18, and anion gap alone should not determine resolution.
Step 1 — Restore volume and give insulin safely Use isotonic saline or balanced crystalloid and individualize the rate. Because potassium is 5.8 mmol/L, prescribed IV insulin can begin; insulin would be delayed only if potassium were below 3.5 mmol/L.
Step 2 — Anticipate potassium movement Total-body potassium is depleted even when the serum value is initially high. Begin replacement after serum potassium falls below 5.0 mmol/L and adjust to maintain 4 to 5 mmol/L.
Step 3 — Continue insulin beyond glucose correction When glucose falls below 250 mg/dL, add 5 to 10 percent dextrose and reduce insulin as prescribed so ketonemia can clear without hypoglycemia. Follow beta-hydroxybutyrate and acid-base status rather than urine ketones or anion gap alone.
Step 4 — Avoid routine bicarbonate The consensus recommends considering bicarbonate only for severe acidosis around pH below 7.0. It is not routine treatment for this pH of 7.18.
Scenario (Stage 4 — Generate solutions)The DKA protocol has begun and the nurse anticipates treatment-driven changes in glucose and potassium.
Clinical judgment targetSelect the complete treatment and monitoring bundle and reject premature biochemical endpoints.
Dextrose during DKA treatment — Dextrose is added below 250 mg/dL so insulin can continue safely until ketonemia resolves.
Total-body potassium deficit — Body potassium is depleted through urinary and gastrointestinal losses even when acidosis initially raises the serum level.
Bicarbonate exception — Routine bicarbonate is not recommended; it may be considered when metabolic acidosis is severe, such as pH below 7.0.