While recovering from injuries obtained in a motor vehicle crash, a patient with type 1 diabetes mellitus begins to demonstrate signs of developing diabetic ketoacidosis (DKA)
What findings would suggest to the nurse that the patient was developing DKA? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Abdominal pain
2. Nausea and vomiting
3. Deep rapid respirations
4. Ketones in the urine
5. Capillary refill 5 seconds
1,2,3,4
Rationale 1: Abdominal pain is an indication of metabolic acidosis, which is seen in DKA.
Rationale 2: Nausea and vomiting are indications of metabolic acidosis, which is seen in DKA.
Rationale 3: Kussmaul's respirations are an indication of metabolic acidosis, which is seen in DKA.
Rationale 4: Ketones in the urine are seen in DKA.
Rationale 5: A change in capillary refill is not an indication of developing DKA.
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The NANDA taxonomy of nursing diagnoses was first published in 1990 and has been in use since that time
Indicate whether the statement is true or false
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