Running head: DIABETIC KETOACIDOSIS PROTOCOL

Diabetic Ketoacidosis Protocol

Andrea R VanPortfliet
Ferris State University

DIABETIC KETOACIDOSIS PROTOCOL

This article discusses the difference between the different ways to treat a patient who
comes into the hospital with diabetic ketoacidosis. It focuses on the difference of care with using
an evidence based practice protocol and using the usual standard of care. Since most patients
who come in with DKA are seen in the ER first, it is important for the nurses to know the
protocol to treat this patient. Many hospitals do not have a standardized protocol set up for this
type of situation so it can cause confusion among the nurses involved in treatment. This study
was meant to prove that hospitals that adhere to the evidenced-based guidelines, provide better
care and outcomes for their patients.
During this study, data was collected in a retrospective review of charts and
documentation of patients. Data was collected on the standard care, and then the hospital set in
place and trained the nurses on a set protocol. Data was also collected after the protocol was set
in place. The protocol being used was the ADAs most recent EBP recommendations on treating
DKA. Patients selected for this study were non-pregnant, 18 or older, and with diabetes mellitus
1 or diabetes mellitus 2. Patient characteristics including, race, gender, age, diabetes type, and
others were reviewed to ensure both groups were at a similar baseline. Data collected for
comparison was severity of acidosis, electrolyte levels, average time to dextrose replacement,
average time to insulin administrations, and much more.
The results of this study show that a hospital using the evidenced based practice protocol
will decrease treatment times, therefore improve the care for a patient with diabetic ketoacidosis.
Decreasing the treatment time means we are decreasing the risk for complications and declining
health. This is done through timely intravenous fluid replacement for dehydrations, AG closure,
and dextrose and potassium replacement. The patients who were treated with usual standard of
care, had an AG closure time on average 4 hrs longer. Overall, patients who were treated with
protocol received better care and improved faster.

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Limitations are variables that can somehow change the outcome of the study, but are out
of the researchers control. One of these is that nurses and doctors are always learning new
protocols and practices, so they were learning many other things along with this DKA protocol.
This could be why some patients were only partially treated following the protocol, which is
another limitation. Every nurse will treat a patient differently and follow protocol differently.
This can affect how the patient is treated and the outcome. With more time and education on this
protocol, care would become more consistent for each patient.
This study included all ages and genders, but the outcome could have been different if
they had focused on one age group or gender. Younger adults may respond differently to the
same treatment as an older patient, and same with males and females. Each patient needs to be
treated differently depending on their size, weight, and condition.
A plan on care should be set up to make it easier for the nurses. It needs to be taken into
account that each patient will needed to be treated differently depending on their state of health,
age, and if they have any other diseases to worry about. A few nursing diagnoses and
interventions would be fluid volume deficit related to dehydration from hyperglycemia.
Interventions would be monitor intake and output, give oral and IV fluids, and watch vitals.
Imbalanced Nutrition related to insufficient of insulin is another nursing diagnosis for DKA.
Interventions would include patient education about diet and insulin, listen to bowel sounds to
assess digestive function, and working with team members to design proper diet for the patient.
The last nursing diagnosis for this issue could be knowledge deficit of the disease and treatment.
Some interventions would be education about diabetes and how to manage using the teach-back
method and providing written instructions on types of insulin and when to use.
I think that this study holds a lot of relevance to the nursing world. Nurses always want to
treat their patients in the most effective and efficient ways. If developing a protocol to treat
diabetic ketoacidosis patients decreases the time needed to treat and reducing complications with

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DKA, than it should be used. I think it is important for nurses to stay up to date on current
evidenced based practice studies because it can help improve care for our patients.

References

Evans, Kathryn, Julie Thompson, Susan E. Spratt, Lillian F. Lien, and Allison Vorderstrasse.
"The Implementation and Evaluation of an Evidence-Based Protocol to Treat Diabetic

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Ketoacidosis A Quality Improvement Study." Advanced Emergency Nursing
Journal 36.2: 189-98. Web. 8 July 2015.