How is insulin used to treat diabetic ketoacidosis?
Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? Glargine ONPH insulin Insulin aspart Al Insulin detemir
Can we manage diabetic ketoacidosis in adults in the emergency department?
Insulin is the mainstay of therapy for DKA. Administration of insulin allows cellular utilization of glucose, which decreases ketosis and blood glucose concentrations. However, because insulin also results in an intracellular shift of potassium, it is essential to obtain the patient's serum potassium concentration before administering insulin.
What is a ketoacidosis in nursing?
May 01, 2003 · Administering hypertonic dextrose (1 litre 10% dextrose + 40 units insulin at 250 ml/h) rather than isotonic dextrose (1 litre 5% dextrose + 10 units insulin at 250 ml/h) may accelerate the clearance of ketone bodies but also causes a rise in [glucose] without an additional improvement in blood pH or bicarbonate. 8.
When to stop insulin infusion after ketoacidosis?
Aug 11, 2021 · Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies, namely acetone, acetoacetate, and beta-hydroxybutyrate. During catabolic states, fatty acids are metabolized to ketone bodies, which can be readily utilized for fuel by individual cells in the body. Of the three major ketone bodies, acetoacetic acid is the …
Which insulin is used for ketoacidosis?
Which insulin is given in emergency?
What insulin type would you expect to be ordered for the immediate treatment of diabetic ketoacidosis?
What is the correct nursing treatment for diabetic ketoacidosis?
How do you give insulin to someone with ketoacidosis?
When is ketoacidosis an emergency?
Which type of insulin acts most quickly?
What is diabetic emergency?
What type of insulin is regular insulin?
What is diabetic ketoacidosis nursing?
Why is regular insulin used in DKA?
What type of insulin can be given IV?
How many hospitalizations for diabetic ketoacidosis in 2009?
In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars.
What is the protocol for the management of patients with DKA?
The protocol for the management of patients with DKA is presented in Figure 1. It must be emphasized that successful treatment requires frequent monitoring of clinical and metabolic parameters that support resolution of DKA (Table 1).
What is DKA in diabetes?
Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management.
What are the therapeutic goals of DKA?
The therapeutic goals of DKA management include optimization of 1) volume status; 2) hyperglycemia and ketoacidosis; 3) electrolyte abnormalities; and 4) potential precipitating factors. The majority of patients with DKA present to the emergency room. Therefore, emergency physicians should initiate the management of hyperglycemic crisis while a physical examination is performed, basic metabolic parameters are obtained, and final diagnosis is made. Several important steps should be followed in the early stages of DKA management: 1 collect blood for metabolic profile before initiation of intravenous fluids; 2 infuse 1 L of 0.9% sodium chloride over 1 hour after drawing initial blood samples; 3 ensure potassium level of >3.3 mEq/L before initiation of insulin therapy (supplement potassium intravenously if needed); 4 initiate insulin therapy only when steps 1–3 are executed.
How does volume resuscitation help with hyperglycemia?
Intravascular and extravascular volume resuscitation will decrease hyperglycemia by stimulating osmotic diuresis if renal function is not severely compromised and enhance peripheral action of insulin (insulin effects on glucose transport are decreased by hyperglycemia and hyperosmolarity). When glucose levels fall below 200–250 mg/dL, intravenous fluids should be switched to dextrose-containing 0.45% NaCl solution to prevent hypoglycemia, and/or insulin infusion rate should be decreased. Special considerations should be given to patients with congestive heart failure and chronic kidney disease. These patients tend to retain fluids; therefore, caution should be exercised during volume resuscitation in these patient groups. Urine output monitoring is an important step in patients with hyperglycemic crises.
Why is bicarbonate not indicated in mild and moderate forms of DKA?
Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy.3, 8The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies.
How much volume loss in DKA?
Fluid loss averages approximately 6–9 L in DKA. The goal is to replace the total volume loss within 24–36 hours with 50% of resuscitation fluid being administered during the first 8–12 hours. A crystalloid fluid is the initial fluid of choice.10Current recommendations are to initiate restoration of volume loss with boluses of isotonic saline (0.9% NaCl) intravenously based on the patient’s hemodynamic status.3Thereafter, intravenous infusion of 0.45% NaCl solution based on corrected serum sodium concentration will provide further reduction in plasma osmolality and help water to move into the intracellular compartment. Hyperosmolar hyponatremia due to hyperglycemia is a frequent laboratory finding in DKA and is usually associated with dehydration and elevated corrected sodium concentrations.
How much insulin should I infuse?
The 2009 ADA consensus statement recommends either beginning with an insulin bolus of 0.1 units/kg or beginning an infusion of insulin at a rate of 0.14 units/kg/hr, without a bolus in adults. Boluses are not recommended in pediatric patients ( Kitabchi et al., 2009 ). If a bolus is used for an adult patient, it should be followed by a continuous infusion of insulin at a rate of 0.1 units/kg/hr. If the patient's blood glucose concentration does not decline by at least 10% of the original value in the first hour, a bolus of 0.14 units/kg may be given ( Kitabchi et al., 2009 ). In pediatric patients, continuous infusion of insulin should begin 1–2 hours after initial fluid resuscitation ( Wolfsdorf et al., 2007 ). For patients with excessive insulin sensitivity, it may be necessary to start the infusion of insulin at a lower or higher rate than recommended. In particular, the initial infusion rate for pediatric patients may need to be decreased to 0.05 units/kg/hr. Frequent injections of subcutaneous insulin may be used in place of continuous infusions, especially in mild DKA. However, continuous infusions are preferred because of faster onset, ability to titrate, and shorter half-life ( Kitabchi et al., 2009; Kitabchi, Umpierrez, Fisher, Murphy, & Stentz, 2008 ). Blood glucose concentrations should decline by 50–75 mg/dl/hr in adults. If this does not occur, the infusion rate of insulin may be increased hourly to achieve a steady decline of blood glucose concentration. Once blood glucose concentrations fall below 200 mg/dl, it may also be appropriate to decrease the infusion of insulin to 0.02–0.05 units/kg/hr to prevent hypoglycemia.
What are the causes of DKA?
Regardless of the inciting factor, the pathophysiology of DKA consists of insulin deficiency , which leads to decreased cell utilization of glucose. Insulin deficiency may be a consequence of insulin insufficiency and/or insulin resistance. Another important component is increased production of counterregulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. This, in conjunction with insulin deficiency, results in ketosis and accelerated glycogenolysis and gluconeogenesis, leading to hyperglycemia ( Koul, 2009 ). Hyperglycemia causes an increase in serum osmolality, which, in combination with decreased insulin, results in osmotic diuresis. This diuresis leads to many of the electrolyte abnormalities observed in DKA, namely, sodium, potassium, calcium, magnesium, chloride, and phosphate abnormalities. Osmotic diuresis can cause hypovolemia, which can be profound and may lead to decreased perfusion of organs including the kidneys ( Defronzo, Cooke, Andres, Faloona, & Davis, 1975; Kitabchi et al., 2001 ). Finally, decreased insulin action along with hormone alterations leads to lipolysis and free fatty acids are released. In the liver, free fatty acids are metabolized to ketone bodies. The accumulation of ketone bodies results in an anion gap metabolic acidosis characteristic of DKA.
How much NaCl should I take for resuscitation?
Initial fluid repletion in adults includes 0.9% NaCl administered at 15–20 ml/kg/hr over the first hour, or a total of 1–1.5 L in the first hour, in the absence of cardiac dysfunction. Further choice of intravenous fluids should be based on serum sodium concentration; patients with a normal or elevated corrected serum sodium concentration may receive 0.45% NaCl, whereas patients with a lower than normal serum sodium concentration should continue to receive 0.9% NaCl. Estimated fluid deficits should be repleted over the initial 24 hours ( Kitabchi et al., 2009 ). In either patient population, appropriate volume resuscitation may be monitored using blood pressure, heart rate, and urine output.
What is the most severe diabetic condition?
Diabetes, a chronic medical condition, continues to increase in prevalence. One of the most severe complications of diabetes, diabetic ketoacidosis (DKA), results from insulin deficiency and is a medical emergency that is frequently encountered in the emergency department. Prompt diagnosis, assessment of key laboratory values, appropriate treatment, and close monitoring are important to the successful treatment of this complex metabolic disorder. Fluid repletion and insulin administration are mainstays of DKA treatment and serve to restore normal hemodynamic status while decreasing the metabolic acidosis. Careful monitoring of glucose concentrations, vital signs, and electrolytes is essential to prevent complications arising from the treatment of DKA. This article provides an overview of the pathophysiology, presentation, diagnosis, treatment, monitoring, and complications of DKA.
What are the factors that contribute to DKA?
The inciting factors for developing DKA include infection, noncompliance, previously undiagnosed diabetes, pancreatitis, myocardial infarction, stroke, and medications . Although previously undiagnosed diabetes accounts for approximately 20% of presentations, infection remains the most common precipitating event for adults ( Kitabchi et al., 2001; Thewjitcharoen & Sunthornyothin, 2011 ). In contrast, pediatric patients have a high incidence of insulin noncompliance (unintentional or purposeful) leading to DKA ( McFarlane, 2011 ).
What are the complications of DKA?
Some of the most common complications arising from the treatment of DKA include hypoglycemia and hypokalemia. As previously discussed, both of these complications may be prevented by careful monitoring and addition of dextrose and potassium to maintenance fluids when appropriate. Another potential complication arising from excessive fluid resuscitation is chloremic acidosis, which can aggravate concurrent ketoacidosis. Recent evidence suggests that fluid resuscitation with a balanced electrolyte solution may lead to decreased incidence of chloremic acidosis in adults with DKA ( Mahler, Conrad, Wang, & Arnold, 2011 ). However, until additional evidence is available, initial fluid resuscitation per the 2009 ADA consensus statement should be strongly considered. If a chloremic acidosis develops, switching maintenance fluids to a formulation with a lower chloride concentration, such as a balanced electrolyte solution or lactated Ringer's, would be appropriate.
How many people were diagnosed with diabetes in 2010?
Diabetes continues to increase in prevalence, with the most recent data indicating that 1.9 million people were newly diagnosed in 2010 ( Centers for Disease Control and Prevention, 2010 ). Two of the most serious and life-threatening complications of diabetes are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state.
What to do if you have diabetic ketoacidosis?
If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and order blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis.
What blood test is used to diagnose ketoacidosis?
Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level.
What tests are done to determine if you have ketoacidosis?
Tests might include: Blood electrolyte tests. Urinalysis. Chest X-ray.
What happens when you have excess ketones in your blood?
Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body.
What happens if your blood sugar is 200?
When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
Is ketoacidosis life threatening?
Diabetic ketoacidosis is life-threatening. If you develop mild signs and symptoms, contact your doctor immediately.
When to start potassium supplementation after insulin treatment?
Start potassium supplementation after insulin treatment once [K +] is below the upper limit of the reference range.
What is failure to respond to insulin?
Failure to achieve a reduction with this regimen for insulin should prompt a check of intravenous access, all connections, and the infusion device. If no mechanical cause is found a failure to respond may represent untreated infection or inadequate volume replacement. An additional bolus of insulin (equivalent to the previous hourly rate) should be given and the infusion rate doubled.
What is the pH of DKA?
Defining DKA as serum glucose >250 mg/dl (>14 mM), metabolic acidosis with corrected pH<7.30 or serum bicarbonate <15 mM and ketonaemia, the sensitivity of urine ketone dip test for ketonaemia in patients with DKA is 97% (95% CI 92% to 99%). 5 The absence of ketonuria makes the diagnosis of DKA unlikely. It is possible that clinical staff in the study were using negative urine dip stick test to rule out DKA; the study would therefore overestimate its sensitivity. Few laboratories offer an urgent ketone level; an estimate of the severity of ketonaemia can be made from the anion gap (available immediately on some “blood gas analysers”); an anion gap >20 mM is abnormal.
What are the main features of DKA?
The main features of DKA are hyperglycaemia, metabolic acidosis with a high anion gap and heavy ketonuria (box 1). This contrasts with the other hyperglycaemic diabetic emergency of hyperosmolar non-ketotic hyperglycaemia where there is no acidosis, absent or minimal ketonuria but often very high glucose levels (>33 mM) and very high serum sodium levels (>150 mM). 3
Why is continuous insulin infusion used?
Continuous subcutaneous insulin infusions are commonly used in continental Europe to treat type I diabetes mellitus and their use is increasing in the UK. They were initially associated with an increased risk of DKA because of equipment failure. 18,19 As the technology has improved this risk has fallen. Treatment of DKA in patients usually treated with continuous subcutaneous insulin infusions does not differ from the conventional approach.
Why do we use soluble insulin?
A soluble insulin is normally used with the aim of permitting more rapid titration of circulating insulin levels (though there are no trial data comparing soluble against other types of insulin). If an intravenous bolus is followed by an intravenous infusion steady state insulin levels are reached very quickly. The half life of circulating insulin is five minutes; use of an intravenous infusion has the advantage over intermittent boluses of permitting a more rapid reduction in insulin level.
How often should blood potassium be measured?
Blood potassium levels should be measured hourly (hyperkalaemic and hypokalaemic cardiac arrest are common causes of death in patients with DKA 2)
What is ketoacidosis in nursing?
Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies, namely acetone, acetoacetate, and beta-hydroxy butyrate. During catabolic states, fatty acids are metabolized to ketone bodies, which can be readily utilized for fuel by ...
Who is responsible for preventing ketoacidosis?
To prevent the complications of diabetes like ketoacidosis, the condition is best managed by an interprofessional team that includes the nurse practitioner, pharmacist, primary care provider, and an endocrinologist; all these clinicians should educate the patient on glucose control at every opportunity.
What are the ketone bodies in ketoacidosis?
Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies, namely acetone, acetoacetate, and beta-hydroxybutyrate. During catabolic states, fatty acids are metabolized to ketone bodies, which can be readily utilized for fuel by individual cells in the body. Of the three major ketone bodies, acetoacetic acid is the only true ketoacid chemically, while beta-hydroxybutyric acid is a hydroxy acid, and acetone is a true ketone. Figure 1 shows the schematic of ketogenesis where the fatty acids generated after lipolysis in the adipose tissues enter the hepatocytes via the bloodstream and undergo beta-oxidation to form the various ketone bodies. This biochemical cascade is stimulated by the combination of low insulin levels and high glucagon levels (i.e., a low insulin/glucagon ratio). Low insulin levels, most often secondary to absolute or relative hypoglycemia as with fasting, activate hormone-sensitive lipase, which is responsible for the breakdown of triglycerides to free fatty acid and glycerol.
What is a DKA?
DKA is a potentially life-threatening complication of uncontrolled diabetes mellitus if not recognized and treated early.
What is the name of the disease that occurs when the body is deprived of glucose?
Alcoholic ketoacidosis occurs in patients with chronic alcohol abuse, liver disease, and acute alcohol ingestion. Starvation ketoacidosis occurs after the body is deprived of glucose as the primary source of energy for a prolonged time, and fatty acids replace glucose as the major metabolic fuel. Nursing Diagnosis.
What are the symptoms of ketoacidosis?
They may have a rapid and deep respiratory effort as a compensatory mechanism, known as Kussmaul breathing. They may have a distinct fruity odor to their breath, mainly because of acetone production. There may be neurological deficits in DKA, but less often in AKA. AKA patients may have signs of withdrawal like hypertension and tachycardia. There are signs of muscle wasting in patients with starvation ketoacidosis like poor muscle mass, minimal body fat, obvious bony prominences, temporal wasting, tooth decay, sparse, thin, dry hair and low blood pressure, pulse, and temperature.
What is the treatment for AKA?
AKA typically responds to treatment with intravenous saline and intravenous glucose, with rapid clearance of the associated ketones due to a reduction in counter-regulatory hormones and the induction of endogenous insulin. Like in DKA, this is the first step in management because of the need for correction the hypovolemia/shock. Thiamine replacement is important in alcohol-related presentations, including intoxication, withdrawal, and ketoacidosis, and should be initially done parenterally and after that maintained orally. Electrolyte replacement is critical. Potassium losses that occur through gastrointestinal (GI) or renal losses should be monitored and replaced closely as glucose in the replacement fluid induces endogenous insulin, which in turn drives the extracellular potassium inside the cells. Also of paramount importance is monitoring and replacing the magnesium and phosphate levels, which are usually low in both chronic alcoholism and prolonged dietary deprivation as in starvation.
When to administer insulin before bedtime?
Administer the prescribed bedtime insulin immediately before going to bed.
What does a nurse do when a client is diagnosed with type 1 diabetes?
The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client states, "I will drink orange juice and eat a slice of bread when I feel: Nervous and weak.". Flushed and short of breath.".
What is a nurse caring for?
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? (Select all that apply.)
Why do people with type 1 diabetes come to the clinic?
A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia.
What is a Humalog nurse?
1. Insulin lispro (Humalog) A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia, and 15 g of a simple sugar is prescribed.
What is a diabetic client given?
A client with diabetes is given instructions about foot care. The nurse determines that the instructions are understood when the client states, "I will:
What is a client who has acromegaly and insulin-dependent diabetes undergoes?
A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will:
How to treat diabetic ketoacidosis?
The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution. This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level. 9 As a result, insulin sensitivity may be augmented.
What are the preventive measures for diabetic ketoacidosis?
Preventive measures include patient education and instructions for the patient to contact the physician early during an illness. Diabetic ketoacidosis is a triad of hyperglycemia, ketonemia and acidemia, each of which may be caused by other conditions ( Figure 1). 1 Although diabetic ketoacidosis most often occurs in patients with type 1 diabetes ...
What is the PH of a diabetic ketoacidosis patient?
Successful outpatient therapy requires the absence of severe intercurrent illness, an alert patient who is able to resume oral intake and the presence of mild diabetic ketoacidosis (pH of greater than 7.2 and a plasma bicarbonate concentration of greater than 10 mEq per L). 24
How long does subcutaneous insulin last?
When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started. The half-life of regular insulin is less than 10 minutes. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued. 1, 22 A protocol for the administration of subcutaneous insulin is included in Figure 2.
What are the main components of the pathogenesis of diabetic ketoacidosis?
Major components of the pathogenesis of diabetic ketoacidosis are reductions in effective concentrations of circulating insulin and concomitant elevations of counterregulatory hormones (catecholamines, glucagon, growth hormone and cortisol). 6 These hormonal alterations bring about three major metabolic events: (1) hyperglycemia resulting from accelerated gluconeogenesis and decreased glucose utilization, (2) increased proteolysis and decreased protein synthesis and (3) increased lipolysis and ketone production. 7
What does IV mean in ketoacidosis?
Protocol for the management of patients with diabetic ketoacidosis. ( IV = intravenous; SC = subcutaneous; IM = intramuscular)
Is insulin effective for diabetic ketoacidosis?
Modern management of diabetic ketoacidosis has emphasized the use of lower doses of insulin. This has been shown to be the most efficacious treatment in both children and adults with diabetic ketoacidosis. 11 – 14 The current recommendation is to give low-dose (short-acting regular) insulin after the diagnosis of diabetic ketoacidosis has been confirmed by laboratory tests and fluid replacement has been initiated.
Why do diabetics get ketoacidosis?
Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections (UTI, etc), prolonged vomiting, surgery or when they miss doses of insulin. Alcohol and drug abuse in a diabetic patient can also cause the body to produce ketones that poison the blood.
What is the cause of ketoacidosis?
Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body can’t produce enough insulin to use the glucose. When this happens, the body begins to break down fat as energy which produces a build-up of acid in the bloodstream called ketones.
What causes ketones to form in the blood?
Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educate patients on healthy diet and lifestyle to prevent DKA. Teach patients and caregivers of the warning signs / symptoms of DKA.
What is DKA in diabetes?
Alright, so let’s take a look at what DKA actually is. So, it’s very important to know that this is a very serious complication of diabetes mellitus that can occur when blood sugars are poorly controlled. So, what happens is you get really increased blood sugar levels and they rise to an extreme level. So, they’re very, very high, but the body doesn’t have the insulin that it needs to use the glucose. So, this glucose and blood sugar is not accessible to the body. When that happens, the body has to start using fat for energy. So we’re not using blood sugar, we’re using fat for energy. When the body uses fat as an energy source, a type of acid called ketones actually builds up in the bloodstream, so you can see where the name for diabetic ketoacidosis comes from, again, acidosis that’s caused by these ketones that are building up secondary to using fat for energy.
Why do you give a medication to lower your glucose level?
Medications may be given to lower the blood glucose level in order to prevent further production of ketones or to manage symptoms of vomiting and underlying infection.
What is the primary indicator of ketone production?
Consistently high blood glucose levels, over 400 mg/dL, are the primary indicator of ketone production. Monitor glucose and intervene with prescribed insulin as appropriate to reduce glucose levels and prevent further ketone production.
How to get rid of ketones in urine?
Avoid alcohol / illicit drug use. Choose foods that are high in fiber and low in fats, sugars and simple carbs. Eat regular meals and snacks, don’t miss meals. Check for urine ketones when you have symptoms. Do not exercise when urine shows positive for ketones.
What is a nurse after a thyroidectomy?
A nurse is caring for a client after a thyroidectomy. Because of concerns about potential nerve injury associated with this type of surgery, the nurse should assess for which functional ability?
What should a nurse discuss with an aging female patient?
The nurse should discuss with the patient which age-related changes that occur due to the decrease in estrogen levels experienced with menopause?