Diabetic Ketoacidosis (DKA) Nursing Diagnosis & Care Plan – devshopsimplenursing

Diabetic Ketoacidosis (DKA) Nursing Diagnosis & Care Plan

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By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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Diabetic Ketoacidosis (DKA) requires fast and focused care. 

For nurses, understanding the key DKA nursing interventions is essential to:

  • Stabilize patients.
  • Correct imbalances.
  • Prevent further complications.

From insulin therapy to fluid resuscitation, nurses play a central role in managing DKA and supporting recovery.

What is Diabetic Ketoacidosis (DKA)? 

Before forming a clear nursing diagnosis of diabetic ketoacidosis, it’s important to understand what’s happening inside the body. 

DKA is a serious metabolic crisis that throws off fluid balance, electrolytes, and acid-base status.

Definition and pathophysiology 

DKA is a life-threatening diabetes complication characterized by hyperglycemia, ketosis, and metabolic acidosis. It occurs due to a severe deficiency of insulin, leading the body to break down fat for energy, producing ketones as a byproduct. 

The build-up of ketones in the blood leads to acidosis, while hyperglycemia causes osmotic diuresis and dehydration. 

DKA vs. Hyperglycemic Hyperosmolar Syndrome (HHS) 

DKA HHS
Occurs in: Type 1 DM Mostly Type 2 DM
Blood glucose: > 250 mg/dL > 600 mg/dL
Ketones: Present Absent or minimal
Acidosis (pH): < 7.3 > 7.3
Serum osmolality: Moderately increased Severely increased
Onset: Rapid (hours to days) Slow (days to weeks)

How DKA impacts fluid and electrolyte balance 

  • Fluid loss: Excess glucose in the blood pulls water into the urine (osmotic diuresis), leading to dehydration. 
  • Electrolyte imbalances: Acidosis initially raises potassium levels, but insulin therapy causes them to drop. Sodium and bicarbonate depletion also occur. 
  • Metabolic acidosis: The accumulation of ketones leads to an anion gap metabolic acidosis, causing compensatory respiratory alkalosis (Kussmaul respirations). 

Causes of Diabetic Ketoacidosis (Related To) 

  • Insulin deficiency or non-compliance: The patient missed insulin doses or didn’t receive adequate insulin therapy.
  • Infection or illness: Infections such as pneumonia or urinary tract infections trigger increased stress hormone release, leading to insulin resistance. 
  • Stress or trauma: Physical stress (e.g., surgery, myocardial infarction) or emotional stress can precipitate DKA. 
  • Undiagnosed diabetes: Some patients present with DKA as the first indication of Type 1 diabetes. 

Signs and Symptoms of Diabetic Ketoacidosis (As Evidenced By) 

  • Hyperglycemia and ketonuria: Elevated blood glucose (> 250 mg/dL) with ketones in urine and blood 
  • Kussmaul respirations and fruity breath: Deep, rapid breathing to compensate for metabolic acidosis; fruity odor due to acetone 
  • Dehydration signs: Dry mucous membranes, poor skin turgor, tachycardia, hypotension
  • Abdominal pain, nausea, and vomiting: Due to ketosis and metabolic acidosis 

Risk Factors for Diabetic Ketoacidosis 

Knowing what puts a patient at risk for DKA is the first step toward preventing it — and choosing the right diabetic ketoacidosis nursing interventions when it does happen. 

Whether it’s missed insulin doses, an underlying infection, or uncontrolled stress, recognizing these triggers early can help nurses jump into action before things get critical.

  • Medication non-adherence: The patient missed insulin doses or discontinued diabetes medications.
  • Stress, infection, and chronic conditions: Illness, surgery, or conditions like pancreatitis increase risk. 

Nursing Assessment for Diabetic Ketoacidosis 

Getting a full picture of what the patient says they feel and what their vitals or labs show is key to making an accurate DKA nursing diagnosis. 

From what they’re saying to what the vitals and labs are showing, every detail matters. Start with the basics — subjective and objective data — to guide the plan of care.

Subjective data

Subjective data gives valuable insight into how the patient feels and what might have triggered the episode. 

It helps nurses connect symptoms to possible causes and decide what to prioritize in the care plan. Listening carefully during this stage sets the tone for accurate diagnosis and timely intervention.

  • Complaints of excessive thirst, frequent urination, nausea, or confusion
  • History of diabetes, insulin use, medication adherence, recent infections 

Objective data

Objective data provides measurable signs supporting the clinical picture of DKA. 

Vital signs often reflect the body’s attempt to compensate for metabolic changes, making them essential for monitoring severity and guiding urgent interventions. Watching for key patterns helps shape immediate priorities in care.

Vital signs

  • Tachycardia
  • Hypotension
  • Tachypnea (Kussmaul respirations) 

Lab values

  • Blood glucose: > 250 mg/dL 
  • Serum ketones: Positive 
  • pH: < 7.3 (acidosis) 
  • Anion gap: Elevated (> 12) 
  • Serum potassium: Initially high but drops with insulin therapy 

Nursing Diagnosis for Diabetic Ketoacidosis 

Nurses identify the appropriate nursing diagnosis for diabetic ketoacidosis based on the patient’s assessment data. 

DKA involves serious fluid loss, electrolyte shifts, and respiratory changes, so nursing priorities should reflect those challenges. From fluid imbalances to gaps in diabetes knowledge, these are the key diagnoses to guide care.

Expected Outcomes & Nursing Goals 

When managing DKA, having clear nursing goals keeps the care plan focused and effective. 

The main priorities? 

Stabilize blood sugar, correct fluid and electrolyte imbalances, and prevent future episodes. Setting these outcomes early helps guide interventions and track progress throughout treatment.

  • Stabilize blood glucose levels to prevent further ketoacidosis.
  • Correct acidosis and electrolyte imbalances to restore homeostasis.
  • Restore fluid balance and prevent dehydration-related complications.
  • Educate patients on DKA prevention, insulin therapy, and sick-day management.

Nursing Interventions for Diabetic Ketoacidosis 

After diagnosis, nurses initiate interventions for DKA, starting with managing hyperglycemia. 

Insulin therapy plays a critical role, but it requires close monitoring and careful adjustments to bring glucose levels down safely and avoid complications.

Managing Hyperglycemia 

  • Administer IV insulin therapy per hospital protocol (continuous infusion). 
  • Monitor blood glucose and ketone levels every one to two hours. 
  • Adjust insulin infusion based on blood glucose trends to avoid rapid drops. 

Restoring Fluid and Electrolyte Balance 

DKA affects more than just blood sugar — it leads to serious fluid loss and electrolyte imbalances. 

That’s why restoring fluid and electrolyte balance is a top priority alongside insulin therapy. IV fluids help correct dehydration, while ongoing monitoring ensures potassium and other key levels stay within a safe range.

  • Initiate IV fluids.
    • Start with 0.9% normal saline for volume replacement. 
    • Switch to D5 ½ NS when blood glucose drops to ~200 mg/dL to prevent hypoglycemia. 
  • Monitor for potassium shifts.
    • Insulin therapy drives potassium into cells, leading to hypokalemia. 
    • Replace potassium as needed (K+ < 3.5 mEq/L). 
  • Correct severe acidosis with sodium bicarbonate if pH < 6.9. 

Preventing Complications and Monitoring Patient Status 

  • Assess for cerebral edema: Monitor for headache, confusion, or changes in level of consciousness. 
  • Continuous cardiac monitoring for arrhythmias due to potassium shifts
  • Monitor urine output and hydration status to ensure renal function

Diabetic Ketoacidosis (DKA) Nursing Care Plan Examples 

The following examples show how to apply DKA nursing diagnoses, expected outcomes, assessments, and interventions in different patient scenarios.

Care Plan #1: DKA in Newly Diagnosed Diabetes 

  • Nursing diagnosis: Deficient Knowledge related to new diabetes diagnosis 
  • Expected outcomes: Patient will verbalize understanding of insulin therapy.
  • Assessment: Evaluate patient’s current knowledge and readiness to learn. 
  • Interventions: Provide education on insulin use, diet, and self-monitoring. 

Care Plan #2: Severe DKA with Electrolyte Imbalance 

  • Nursing diagnosis: Risk for electrolyte imbalance related to acidosis and potassium shifts 
  • Expected outcomes: Maintain normal electrolyte levels without complications.
  • Assessment: Monitor lab values for potassium, bicarbonate, and sodium.
  • Interventions: Administer electrolyte replacements as needed, as well as cardiac monitoring.

Care Plan #3: Recurrent DKA in a Non-Compliant Patient 

  • Nursing diagnosis: Ineffective health management related to non-adherence 
  • Expected outcomes: Improve adherence to the diabetes management plan. 
  • Assessment: Identify barriers to adherence (cost, education, access to care).
  • Interventions: Provide personalized education and support resources.

Prevention of Diabetic Ketoacidosis & Long-Term Management 

Preventing DKA requires consistent daily habits and a strong understanding of managing diabetes under different conditions. 

Helping patients feel confident in their routine care and prepared for unexpected changes can make a big difference in reducing the risk of future episodes.

Here are key strategies nurses can use to empower patients and support long-term diabetes management:

  • Strategies for insulin compliance and glucose monitoring
  • Early identification of warning signs to prevent severe DKA
  • Managing diabetes during illness or stress using sick-day guidelines

Patient Education & Discharge Planning 

Before heading home, patients need clear, simple instructions on how to manage their diabetes safely, especially during times of illness or stress. 

Education now can prevent another DKA admission later.

  • Sick-day guidelines: Adjusting insulin, hydration, and monitoring glucose/ketones 
  • When to seek medical attention: Persistent vomiting, blood glucose > 300 mg/dL, ketonuria
  • Follow-up care: Regular endocrinology visits and diabetes education

Recommended Resources for Diabetic Ketoacidosis 

Nurses rely on trusted resources to stay current, deliver safe care, and provide accurate education to patients. 

From clinical guidelines to practical teaching tools, these references help reinforce best practices for managing and preventing DKA.

Nursing Care Plan Resources

Simple Steps, Life-Safing Care

Nurses play an essential role in preventing DKA from progressing by responding quickly with appropriate interventions and a focused care plan. 

Supporting hydration, stabilizing blood glucose, and educating patients gives them the tools to control their condition. With timely and consistent care, nurses help patients recover safely.

References and Sources

1. American Diabetes Association (ADA). Standards of Medical Care in Diabetes (20224) 

2. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 1335-1343. DOI: 10.2337/dc09-9032 

3. National Institute for Health and Care Excellence (NICE). (2023). Diabetic ketoacidosis: Recognition, management, and prevention. 

4. McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.