Cardiac monitoring is initiated for a patient with diabetic ketoacidosis. The nurse determines that this measure is important to identify:
A.
Electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
B.
The presence of hypovolemic shock related to osmotic diuresis.
C.
Cardiovascular collapse resulting from the effects of hyperglycemia.
D.
Fluid overload resulting from aggressive fluid replacement.
The Correct Answer and Explanation is:
The correct answer is A. Electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia.
Explanation
Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes characterized by hyperglycemia, ketonemia, and metabolic acidosis. One of the critical management aspects in DKA involves careful monitoring of electrolyte levels, particularly potassium.
1. Importance of Potassium Monitoring in DKA
During DKA, patients often experience significant osmotic diuresis due to hyperglycemia, which results in the loss of electrolytes, including potassium. Despite the initial high serum potassium levels often seen in DKA, the potassium is predominantly in the extracellular space, and as insulin therapy is initiated, potassium shifts back into the cells, potentially leading to hypokalemia. This shift is compounded by the loss of potassium in the urine due to diuresis.
2. ECG Changes Due to Hypokalemia
Hypokalemia can have significant effects on cardiac function, and ECG monitoring is crucial to identify these changes early. Low potassium levels can lead to various ECG abnormalities, including:
- Flattened T waves
- Presence of U waves
- Prolonged QT interval
- ST-segment changes
These ECG changes are indicative of the heart’s altered electrical activity due to insufficient potassium levels, increasing the risk of dysrhythmias and potentially life-threatening arrhythmias such as ventricular tachycardia or fibrillation.
3. Clinical Implications
Monitoring the ECG in patients with DKA helps in the early detection of hypokalemia and its associated complications, allowing for prompt correction of potassium imbalances. Correcting potassium levels and addressing ECG abnormalities can significantly reduce the risk of serious cardiac events and improve overall patient outcomes.
4. Other Options
- B. Hypovolemic shock is a concern due to fluid loss but is not directly monitored through ECG changes.
- C. Cardiovascular collapse related to hyperglycemia is less specific and more generalized.
- D. Fluid overload is monitored through fluid balance and clinical signs rather than ECG.
In summary, ECG monitoring in DKA is crucial for detecting hypokalemia-related changes and dysrhythmias, which is why option A is the correct answer.