The main nursing measures for diabetic ketoacidosis

Diabetic ketoacidosis is an acute complication of diabetes that occurs regardless of how long the diabetes has been present. The most common cause of diabetic ketoacidosis is infection, such as cold, cough, and urinary tract infection. The second is the improper application of insulin in the process of diabetes**, such as inappropriate reduction or interruption**; Some other triggers include:

Overeating, alcoholism, surgery, anorexia, trauma, fractures, anesthesia, pregnancy, overwork, etc. The manifestations of diabetic ketoacidosis include extreme thirst, increased urination, significant weight loss, and general fatigue in the early stages. At this stage, if the patient is not vigilant and does not time**, the condition will continue to deteriorate, and within 2-4 days, there will be loss of appetite, nausea, vomiting, abdominal pain, the smell of rotten apples on exhalation, and psychoneurological symptoms such as headache, drowsiness, irritability, etc.

This is followed by severe dehydration, such as decreased urine output, dry mucous membranes, decreased blood pressure, and cold extremities. It can even threaten the patient's life. Once ketoacidosis is found, the patient should be treated as soon as possible, and the patient can be given more water on the way to the hospital, preferably light saline, pay attention to monitoring and recording the patient's blood sugar and urine output, if possible, keep part of the urine sample, and give the doctor a reference after admission.

**: First, the active hydration doctor will first supplement the patient with normal saline, and when the blood sugar drops, switch to 5% glucose and insulin hormone to continue the injection; Second, correct acidosis and water and electrolyte metabolism disorders, and replenish potassium and alkali. Third, monitor blood sugar every two hours, measure urine ketone bodies and urine glucose, pay attention to electrolyte and blood gas changes, and do liver and kidney function, electrocardiogram and other examinations, so as to adjust the ** plan in time.

Prevention: Insulin should be used rationally, and insulin should never be stopped or reduced. Stick to regular self-monitoring of your blood glucose.

Shanxi Diabetes Medical Network.

(1) Disease monitoring: For patients who may have or have developed ketoacidosis and hyperosmolar coma, the patient's vital signs and changes in condition should be closely observed, and the fluid intake and output should be recorded for 24 hours. In the process of infusion and insulin**, specimens should be taken every 1 2 hours and sent for urine glucose, urine ketones, blood glucose, blood ketones, blood potassium, blood sodium, carbon dioxide binding capacity, etc., and the monitoring results should be reported to the doctor in charge for processing in time.

2) Immediately open 2 intravenous access and accurately follow the doctor's instructions to ensure fluid and insulin infusion.

3) The patient should be on absolute bed rest, pay attention to keeping warm, and give low-flow continuous oxygen; Strengthen life care to prevent pressure ulcers and secondary infections; Comatose people are cared for according to coma.

Fluid rehydration is a critical part of rescuing ketoacidosis, so fluid infusion should be completed within the prescribed timeframe.

5 Pathophysiological studies of diabetes have proved that when fatigue, anxiety, disappointment or agitation, the body causes blood sugar to rise due to stress and the demand for insulin increases.

At the same time, the secretion of adrenaline and adrenocorticosteroid increases, the excitation of sympathetic nerves increases, and the decomposition of fat accelerates, producing a large number of ketone bodies, and ketosis occurs.

Actively communicate with patients in emergency care, and conduct individualized psychological counseling. Do a good job of explaining before and after each operation, eliminate the patient's fear, increase the sense of trust, and actively cooperate with the first and the nurse.

61. Help patients find out the triggers of mold sensitive ketoacidosis and prevent them to avoid the next diabetic ketoacidosis.

2. Explain the knowledge of diabetes to patients and their families.

3. Advise the patient to insist on taking the medicine according to the doctor's instructions, and not to increase, decrease or stop the medicine at will.

4. Strictly control the diet and carry out appropriate physical exercise.

5. Pay attention to prevent all kinds of infections and trauma and other stressful factors.

6. Learn how to self-monitor blood sugar and urine glucose. Frequent measurement of rapid weight loss, waist circumference, regular re-examination of liver function, renal function, glycosylated hemoglobin, fundus, etc.

7. Maintain a good attitude.

Answer]: Closely monitor the condition for changes and monitor blood gases, electrolytes, and changes in sugar clusters and ketones in blood and urine. Correct the disorder of water, electrolyte, acid-base balance, and ensure the balance of inflow and output.

Ketoacidosis occurs with a decrease in extracellular fluid volume and dehydration of 100 mL kg (10%), mostly isotonic dehydration. Rapid expansion of blood volume and improvement of microcirculation, and then the rate of replenishment of finger fluid can be slowed down, requiring at least half of the cumulative loss to be made up in the first 12 hours, and then within 24 hours, the physiological needs and continued fluid losses can be replenished as appropriate. Assist with insulin**

Conventional use of low-dose insulin intravenous infusion, first from the intravenous bolus of regular insulin, and then according to the calculation, the regular insulin 25U added to 250ml of isotonic saline (, with a micropump from the intravenous route of slow infusion, closely monitor blood sugar fluctuations, adjust the ** regimen at any time. Infection control: ketoacidosis is often complicated by infection, and effective antibiotics must be given at the same time as first aid**.

Answer]: A analysis: When rescuing diabetic ketoacidosis, rehydration is the key link.

Because patients often have severe dehydration, the biological effect of insulin can only be fully exerted after the effective tissue perfusion is improved and recovered. Low-dose insulin is a simple, safe, and effective method for diabetic ketoacidosis.

1. When the patient has an attack of diabetic ketoacidosis, the patient should be quickly placed in bed, and the patient in shock should be placed in a concave position, and attention should be paid to keeping warm. Continuous oxygen inhalation promotes acid metabolism.

2 Diabetic ketoacidosis patients should establish two intravenous lines immediately after admission, preferably in the same limb, or one in the upper limb and one in the lower limb, while the other arm is convenient for blood pressure measurement and serum specimen examination. Fluids are usually given with normal saline, and the amount of fluid should vary from person to person, depending on the degree of dehydration loss the patient.

3. Observe the changes in consciousness, pupil, body temperature, pulse, respiration, blood pressure, color, elasticity, blood vascularity and urine output of the patients with diabetic ketoacidosis, and give ECG monitoring. If any abnormality is found, report it to the doctor in time and give effective treatment according to the doctor's instructions.

4. Make the coma patients with diabetic ketoacidosis flatten and grind the lying head to one side, remove the respiratory secretions in time, keep the respiratory tract unobstructed, and give oxygen inhalation according to the breathing. Patients with severe nausea and vomiting should be placed in the lateral decubitus position to prevent suffocation caused by aspiration of vomit into the trachea.