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Marissa Wiesen

Concept Map
4832 Nursing Care of Children and Families
October 29, 2020

Diabetic ketoacidosis

Glucose cannot be stored in the liver, so it stays in the blood.

In the absence of insulin, fat begins to breakdown for energy. This
causes increased ketones in the blood, which are very acidic.
Thus, causing DKA and metabolic acidosis.
Type 1 diabetes cannot be cured.
The goal of treatment is to prevent complications such as
retinopathy, neuropathy, nephropathy, and cardiac problems.
Lifestyles changes and compliance to the treatment plan is very
important in preventing complications.
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Key Problem: Key Problem:

Risk for infection Caregiver role strain

Supporting data: Supporting data:

1. Dry skin 1. Mom having 9 children at home.

2. Blood sugar level of 172, 357 & 2. Patient being hospitalized 2 times
234. within the last 2 months related to
3. A1C levels of 13.3. DKA
4. Increase WBCs level 3. Overnight hospital stays
5. Chronic disease of diabetes 4. Financial stress
mellitus. 5. Single mom

Key Problem:
Reason for Needing Health Care Knowledge deficit
Diabetic ketoacidosis Supporting data:
Key assessment: 1. Patient wanting the nurse to do blood
glucose checks and give insulin. Not
1. Urine for ketones participating in care.
2. Polyuria, polydipsia, polyphagia 2. Mom going to diabetes classes in
3. Blood glucose and A1C levels Cleveland.
4. Nausea, vomiting, diarrhea 3. Patient being noncompliant insulin
5. Sudden weight loss and abdominal pain therapy evidenced by A1C level of
6. Paresthesia in the hands/feet 13.3 and BS level of 172 & 357.
7. Compliance with insulin therapy, 4. Noncompliant with lifestyle changes
exercise, and diet as evidenced by diet, ordering to many
carbohydrates for meals.
5. Not participating in physical activity

Key Problem:
Key Problem:
Risk for fluid volume deficit
Imbalanced nutrition: less
than body requirements
Supporting data:
Supporting data:
1. H&H levels
2. Sodium level of 131 and potassium
1. Weakness
level of 6.2
2. Fatigue
3. Dry skin
3. Ketones in urine
4. Ketones 2+ in urine
4. Polyuria
5. Decrease kidney function
5. Insufficient insulin
6. Creatinine level of .47
7. Nausea and vomiting
8. Hyperglycemia induced osmotic
diuresis – polyuria
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Problem:
 Risk for infection

General Goal:
 Patient will have no infection related to DKA.

Predicted Behavioral Outcome Objective(s):

 The patient will have blood sugar level under 150 before dinner on the day of
care.

Nursing interventions:
1. Assess for signs of infection and inflammation such as fever, chill, dysuria, and
increased WBC count.
2. Teach about good skin care, hand hygiene, and monitoring for paresthesia and
poor wound healing.
3. Encourage adequate oral fluid intake of 2-3 liters a day.
4. Use aseptic technique when starting IV or obtaining blood.
5. Teach about the proper intake of protein-rich and calorie-rich foods.

Patient responses:
1. Patient should no signs of infections. Her temperature was 97.5, she did not have
chill or dysuria and her labs showed a normal WBCs value.
2. Patient states that she does not have any tingling or numbness of her hands or feet.
She states that she has good hand hygiene after going to the bathroom, before
meals and when necessary.
3. During the day of care, patient drank 750 ml of fluids.
4. When obtaining a blood sample on the patient, I used aseptic technique to prevent
infection. Patient responded well to the procedure.
5. Patient states that she tries to eat healthy but admits that she does not also eat
healthy.

Evaluation of outcomes objectives:

 Patient did not achieve goal because blood sugar level was 234 at 1730 prior to
dinner.
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Problem:
 Caregiver role strain

General Goal:
 Patient show understand of disease process and how to control blood sugar.

Predicted Behavioral Outcome Objective(s):

 The patient will state 3 ways to keep blood sugar under control to prevent another
hospitalization on day of care.

Nursing interventions:
1. Assess family dynamic, resources and support system.
2. Encourage patient involvement in care.
3. Encourage caregiver to know available family and friends who can help with care
when needed.
4. Teach patient how to take blood sugar and give insulin.
5. Encourage patient to go to diabetic classes with mom in Cleveland.

Patient responses:
1. The patient’s mother is a mother to 9 children at home. She does have a good
support system and resources.
2. Patient wants the nursing staff to do blood sugars and insulin in the hospital and
mom does it at home.
3. The patients mother states that she has her mom and sisters who can help her
when needed.
4. Patient is able to give herself insulin and take her blood sugar, but she prefers
someone else to do it for her.
5. The patient’s mother currently goes to diabetic classes in Cleveland to better
understand diabetes.

Evaluation of outcomes objectives:

 Patient did achieve goal because she stated that exercise, proper diet and insulin
therapy are important to prevent hospitalization for DKA.
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Problem:
 Knowledge deficit

General Goal:
 Patient will comply with treatment plan.

Predicted Behavioral Outcome Objective(s):

 The patient will list three foods that are appropriate to eat for someone with
diabetes mellitus.

Nursing interventions:
1. Explain the signs and symptoms of diabetic ketoacidosis. Such as polyuria,
polydipsia, polyphagia, flushed skin, and body malaise.
2. Teach about normal blood glucose level and demonstrate the proper use of
glucometer.
3. Educate patient to assess urine for ketones when blood sugar is 250 or higher
4. Teach the signs and symptoms of hypoglycemia. Which includes dizziness,
sweating, hunger, pallor, diaphoresis, nervousness, and tremors.
5. Educate the patient the importance of limiting simple sugars, fat, and salt. Also, to
increase the intake or whole grains, fruits, and vegetables.

Patient responses:
1. Patient was able to restate the signs and symptoms of hyperglycemia when asked
2. Patient was able to explain to me the proper use of a glucometer.
3. The patient had 2+ ketones in her urine.
4. Patient was able to state that dizziness and sweating are signs and symptoms of
hypoglycemia
5. Patient was able to list appropriate foods to eat with diabetes.

Evaluation of outcomes objectives:

 Patient did achieve goal because she stated that vegetables, Greek yogurt, and
nuts are appropriate foods to consume.
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Problem:
 Imbalanced nutrition: less than body requirement

General Goal:
 Patient will show understand of the importance of carbohydrate control and
proper nutrition.

Predicted Behavioral Outcome Objective(s):

 The patient will eat 100% of dinner that has less than 25 carbohydrates on the day
of care

Nursing interventions:
1. Auscultate bowel sounds and note abdominal pain/bloating, nausea or vomiting
2. Monitor laboratory values of glucose, pH, HCO3.
3. Assess glucose levels via fingerstick.
4. Monitor weight daily.
5. Educate patient to monitor for sudden weight loss, abdominal pain, nausea,
vomiting and urine for ketones, which is indicative of DKA.

Patient responses:
1. The patient had normoactive bowel sounds and no bloating. She states that she
sometimes get stomach aches. She has no nausea or vomiting.
2. The patient’s glucose was 172 & 357. Her HCO3 was 20.4
3. The patient’s glucose levels are not within normal range. She is hyperglycemic.
4. Patient weight has been consistent during this hospital stay. The most recent
weight was 71.8 kg.
5. The patient report no recent weight loss, but does have abdominal pain and
ketones in her urine.

Evaluation of outcomes objectives:

 Patient did achieve goal because she ate 100% of her meal and it had 20
carbohydrates.
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Problem:
 Risk for fluid volume deficit

General Goal:
 Patient will understand the importance of proper fluid intake for kidney function
and fluids that are not high is sugars.

Predicted Behavioral Outcome Objective(s):

 The patient will drink 500 ml of fluids (within 8 hours) on the day of care.

Nursing interventions:
1. Assess skin turgor, mucosal membranes, and thirst.
2. Monitor I&O
3. Monitor respiration for acetone breath, Kussmaul’s respirations
4. Assess lab values daily for potassium, sodium, BUN, and creatinine.
5. Encourage fluids and administer dextrose 5% NaCl 0.9% KCl 20 mEq/hr.

Patient responses:
1. The patient had good skin turgor with no tenting. Her mucosal membranes were
moist and pink. She is drinking appropriately
2. The patient had appropriated I&O. she drank 750 ml during day of care.
3. The patient had normal respirations of 18 breaths per minutes with no Kussmaul
respirations.
4. The patient’s potassium level was 6.2, sodium was 131, BUN was normal, and
creatinine was .47.
5. The patient drank 750 ml of liquid during the day. She was on dextrose 5% NaCl
0.9% KCl 20 mEq/hr at 100ml/hr.

Evaluation of outcomes objectives:

 Patient did achieve goal because she drank 750 ml of fluids during day of care.