A nurse is teaching a newly licensed nurse about reportable communicable diseases. Which of the following diseases should the nurse include in the teaching?

A. Initiate cardiac monitoring: Cardiac monitoring is important because the client has hyperkalemia (potassium 5.5 mEq/L) and is at risk for arrhythmias. Monitoring allows early detection of changes in cardiac rhythm, which can occur rapidly in electrolyte imbalances associated with hyperglycemic crises.

B. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L: Potassium replacement is not indicated at this time because the client’s serum potassium is elevated at 5.5 mEq/L. Administering potassium now could worsen hyperkalemia and increase the risk of life-threatening cardiac dysrhythmias.

C. Regular insulin 20 units subcutaneously: Subcutaneous insulin is not appropriate for severe hyperglycemia with ketoacidosis risk, as it has a slower onset and may not provide adequate glycemic control. Intravenous insulin infusion is preferred in this setting to allow rapid titration and prompt reduction of blood glucose and ketone levels.

D. 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr: Aggressive IV fluid resuscitation with isotonic saline is indicated for dehydration from hyperglycemia and osmotic diuresis. Calculated fluid replacement helps restore intravascular volume, improve perfusion, and support renal function.

E. Dextrose 5% in water (D5W) intravenous at 5 ml/kg/hr for 4 hr: Dextrose is not indicated initially because the client’s blood glucose is extremely elevated at 468 mg/dL. Dextrose would worsen hyperglycemia at this stage. Dextrose is added later during insulin therapy when glucose levels fall to prevent hypoglycemia while continuing ketone clearance.

F. Insert indwelling urinary catheter: Routine catheterization is not indicated for this client, as there is no urinary retention or obstruction reported. Inserting a catheter unnecessarily increases the risk of infection without improving outcomes in hyperglycemia management.

G. Blood glucose checks every 4 hr: For a client with severe hyperglycemia and suspected DKA or hyperosmolar state, glucose monitoring every 4 hours is insufficient. Hourly monitoring is needed to safely titrate IV insulin and fluids, allowing rapid response to changing glucose and electrolyte levels.

H. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L: Continuous IV insulin infusion is the treatment of choice for severe hyperglycemia with ketones and acidosis. It allows precise titration based on glucose levels while ensuring potassium levels are safe.

Rationale for Correct Choices

• Client urinating 100 mL/hour: Adequate urine output indicates improved renal perfusion and effective fluid resuscitation. In DKA, polyuria can lead to dehydration, so normalization of urine output reflects stabilization of fluid balance.

• Bilateral pedal pulses 2+: Stronger peripheral pulses suggest improved circulatory volume and perfusion after initial IV fluid resuscitation, indicating that hypovolemia is resolving.

• Pulse rate 84/min: The decrease from 110/min to 84/min reflects improved hemodynamic status as intravascular volume is restored and dehydration resolves, reducing compensatory tachycardia.

• Blood pressure 106/76 mm Hg: An increase from 96/65 mm Hg indicates improved intravascular volume and perfusion, reflecting a positive response to fluid therapy.

• Blood glucose 310 mg/Dl: Decrease from 468 mg/dL indicates partial correction of hyperglycemia, showing that insulin therapy and fluid replacement are effectively improving glycemic control.

Rationale for Incorrect Findings

• Temperature 36.8° C (98.2° F): Temperature remained stable and within normal range; while not worsening, it does not specifically reflect improvement in DKA status.

• Bowel sounds hyperactive in all 4 quadrants: Hyperactive bowel sounds were present initially and remain unchanged; this is not a direct indicator of DKA improvement.