What is the mechanism that results in Kussmaul respirations? To achieve the goal of restoring Lara’s fluid volume, the nurse would expect to implement which intervention?

Meet the Patient: Lara Fielding
Lara Fielding, a 20-year-old college student, comes to the student health center with a 4-day history of flu-like symptoms. She reports feeling increasing fatigue, thirst, and nausea over the last 24 hours. Further assessment and lab work indicates that Lara is experiencing diabetic ketoacidosis (DKA). She is transferred to an acute care facility for treatment.

Assessment
The nurse notes that Lara’s breath has a fruity odor, and she is exhibiting Kussmaul respirations.

Question 1: What is the mechanism that results in Kussmaul respirations?

Lab work reveals that Lara’s blood glucose level is 370 mg/dl, plasma bicarbonate is 8 mEq/L, potassium is 5.2 mEq/L, and she has elevated ketones in her urine. The goals of treatment in DKA include correcting fluid imbalance and restoring normal pH, electrolytes, and glucose.

Question 2: To achieve the goal of restoring Lara’s fluid volume, the nurse would expect to implement which intervention?

Question 3: To restore Lara’s blood glucose to a normal level, what should the nurse prepare to administer?

Question 4: In addition to monitoring Lara’s blood glucose level, what additional lab values should the nurse monitor carefully? (Select all that apply)
1. Uric acid
2. Hemoglobin
3. Calcium
4. Potassium
5. Blood urea nitrogen (BUN)

Manifestations
Once the acute ketoacidosis is controlled, Lara is told that she has Type 1 diabetes mellitus. The nurse obtains Lara’s history. Lara states that prior to the flu, she had been healthy. However, she had noticed that she had been eating more than normal, but had not been gaining any weight. Lara also states that she had been drinking a lot of diet colas and that she got up at night frequently to go to the bathroom.

Question 5: List the classic symptoms of diabetes.