Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis. Which of the following is of primary importance when caring for the child?
A. Giving I.V. NPH insulin in high doses
B. Evaluating the child for cardiac abnormalities
C. Limiting fluids to prevent aggravating cerebral edema
D. Monitoring and recording the child’s vital signs for hypertension
Correct Answer: B. Evaluating the child for cardiac abnormalities.
As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.
Option A: Regular insulin is the only insulin that can be given I.V. NPH is an intermediate-acting insulin; continuous low-dose infusion of rapid-acting insulin is preferred. Short-acting or regular insulin should be administered as a continuous IV infusion to treat hyperglycemia and clear ketonemia. Bolus dosing of insulin has NO role in DKA treatment in children
Option C: I.V. fluids should be given to correct dehydration. IV fluids should also be given to treat shock, acidosis, and dehydration. Strict “ins and outs” fluid balance assessments should be kept.
Option D: Hypertension is more likely to happen secondary to dehydration. DKA patients will have an ileus and have vague, diffuse abdominal pain. Dehydration, thirst, and polyuria are common at the time of presentation due to glycosuria and osmotic diuresis.