A patient is brought to OPD with diabetic ketoacidosis. In the acute phase, the priority action is to?

SCTIMST Staff Nurse - 2015 (Set-B)

Medical & Surgical Nursing

Medium

Appeared in: SCTIMST Staff Nurse - 2015 (Set-B)

Explanation

The core problem in DKA is insulin deficiency, which leads to uncontrolled ketone production (ketoacidosis) and high blood sugar (hyperglycemia).
Administering insulin is the definitive treatment that directly reverses this pathophysiology.
Insulin stops the breakdown of fat into ketones, allows cells to use glucose for energy, and thereby corrects both the acidosis and the hyperglycemia.
While fluid resuscitation is the first step, it is not an option here. Therefore, among the choices given, insulin is the priority therapeutic action.

Option A: Sodium bicarbonate is not used routinely due to risks of hypokalemia, cerebral edema, and paradoxical CNS acidosis. It does not correct the underlying cause of the acidosis, which is ketone production.
Option B: Administering 50% glucose would dangerously worsen the patient's severe hyperglycemia, which is already a hallmark of DKA.
Option D: Monitoring the ECG is a crucial assessment and surveillance activity, not a therapeutic intervention to correct the DKA itself. While vital for safety, it does not treat the root cause.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Priority nursing action in the management of Diabetic Ketoacidosis (DKA) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's primary role in acute DKA is the prompt administration of IV fluids and insulin as prescribed, along with meticulous monitoring.
Hourly blood glucose monitoring, strict intake/output charting, and frequent electrolyte checks are critical to guide therapy and prevent complications.
Nurses must be vigilant for signs of hypokalemia (muscle weakness, arrhythmias) and cerebral edema (headache, confusion, change in consciousness), a rare but fatal complication of DKA treatment.

How to Approach the Question

First, identify the patient's condition: Diabetic Ketoacidosis (DKA), which is a medical emergency.
Recall the pathophysiology of DKA: a lack of insulin causes high blood sugar and the production of acidic ketones.
Analyze the question's focus: it asks for the 'priority action' in the 'acute phase'. This means you must choose the most critical therapeutic intervention.
Evaluate the options based on the treatment goals for DKA, which are to stop ketosis, lower blood glucose, and restore fluid/electrolyte balance.
Option A (Bicarb) is for extreme cases. Option B (Glucose) is for later. Option D (ECG) is monitoring, not treatment.
Conclude that administering insulin (Option C) directly addresses the root cause of DKA and is the priority therapeutic action among the choices.

Concept Tested & Keywords

Concept Tested: Priority nursing action in the management of Diabetic Ketoacidosis (DKA).
Stem keywords: diabetic ketoacidosis, acute phase, priority action
Lead-in keywords: priority action
Clinical cues: The diagnosis of DKA implies a life-threatening metabolic emergency requiring immediate intervention.

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