What are the priority areas of concern for the individual in an advanced nursing role to consider in reviewing the expected diagnostic test results for an individual suffering from DKA, which may include changes to acid-balance, bicarbonate level, and electrolyte balances?

Advanced nursing practitioners review the test results for DKA patients and prioritize them. There are three main areas that should be considered: changes in acid-base, bicarbonate, and electrolyte imbalances. In DKA, the body’s insulin deficiency leads to a shift towards ketone body metabolism, which results in an increase in the production of ketoacids. A decrease in blood pH can lead to metabolic acidosis. As a result, the priority areas of concern in the diagnostic test results include monitoring the patient’s pH, bicarbonate level, and electrolyte levels.

DKA patients usually have three options: fluid resuscitation and insulin administration. Insulin administration is essential to shift the body’s metabolism back to glucose metabolism, leading to a decrease in ketoacid production. To replenish fluids that have been lost due to excessive urination or to increase blood pressure, fluid resuscitation must be done. To address electrolyte deficiencies resulting from insulin or fluid loss, electrolyte replacement must be done. Hypokalemia, hyponatremia and hypophosphatemia are the main electrolyte deficiencies in DKA.

Recommendation: When reviewing diagnostic results for DKA patients, it is important to prioritize the concern areas in the acid-base, bicarbonate, and electrolyte levels. DKA sufferers have several treatment options. These include fluid resuscitation, insulin administration and electrolyte substitute.

His priority needs are glucose control and electrolyte substitution for the 45-year old, married African American, male with DKA. His care plan should include the administration insulin to regulate his blood sugar level and fluids to keep his electrolyte and fluid balance. Electrolyte replacement may also be required as necessary. If he has hypotension, he may need to be closely monitored for his cardiovascular condition. His care requirements may be greater for an 85-year old widowed African American man because of his advanced age. His care may include more insulin and fluid replacement to avoid hypoglycemia. Due to his advanced age and stress from hospitalization, it is possible that he will need monitoring for cognitive impairment. With the right treatment, both patients should see a slight improvement in their acid/base balance and electrolyte levels over the next 48-hours. To ensure they receive the right care, it is important to review and adjust their treatment plan as needed.

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