When developing a teaching plan for a client with newly diagnosed type 1 diabetes, the nurse should explain that an increased thirst is an early sign of diabetic ketoacidosis (DKA). Which action should the nurse instruct the client to implement if this sign of DKA occurs?

When a preoperative client expresses fear and uncertainty about undergoing surgery, the priority action for the practical nurse (PN) is to notify the charge nurse of the client's concerns. This is important because the charge nurse can coordinate appropriate interventions and support for the client, ensuring their emotional well-being and addressing their fears.

Let's evaluate the other options:

a) Encourage the client to continue with the scheduled surgery.
While it is important to provide support and reassurance to the client, simply encouraging them to continue with the scheduled surgery may not adequately address their specific concerns and fears. The charge nurse and the healthcare team should be involved to provide the necessary support and information to help alleviate the client's anxiety.

b) Document that the client has expressed concerns about the surgery.
Documenting the client's concerns is important for accurate record-keeping and continuity of care. However, it should not be the only action taken. Notifying the charge nurse is crucial to ensure appropriate follow-up and support for the client.

d) Remind the client that the consent has already been obtained.
Reminding the client that they have already signed the informed consent may not effectively address their fears and concerns. Reassurance and support should be provided, and involving the charge nurse and healthcare team is essential to address the client's emotional well-being.

In summary, when a preoperative client confides in the practical nurse (PN) about being frightened and unsure about undergoing surgery, the priority action is to notify the charge nurse of the client's concerns. This allows for appropriate interventions, support, and coordination of care to address the client's fears, ensure their emotional well-being, and provide necessary information about the surgical procedure.

Choice A rationale:

Hyperglycemia is a key symptom of DKA. It occurs when there is an insufficient amount of insulin in the body to allow glucose to enter cells for use as energy. As a result, the body begins to break down fat for fuel, leading to the production of ketones and causing blood glucose levels to rise1. Normal blood glucose levels are between 4.0 to 6.0 mmol/L when fasting and up to 7.8 mmol/L two hours after eating2.

Choice B rationale:

Ketonuria, or the presence of ketones in the urine, is another symptom of DKA. When the body breaks down fat for energy, ketones are produced. If too many ketones build up in the blood, they can spill over into the urine1.

Choice C rationale:

Metabolic acidosis occurs in DKA due to the accumulation of ketones in the blood. Ketones are acidic, and when they build up in the blood, they cause the blood to become more acidic, leading to metabolic acidosis1.

Choice D rationale:

Hypokalemia is not a symptom of DKA. In fact, patients with DKA often have high potassium levels in their blood at presentation because acidosis causes potassium to move from inside the cells into the bloodstream1. However, during treatment for DKA, when insulin is administered and acidosis is corrected, potassium moves back into the cells and can lead to low potassium levels or hypokalemia1.

Choice E rationale:

Dehydration is a common symptom of DKA. High blood glucose levels lead to increased urination as the body tries to get rid of the excess glucose. This can result in dehydration1.

Choice F rationale:

Kussmaul respirations are a type of hyperventilation that occurs in DKA as the body tries to get rid of excess acids (ketones) through the lungs by breathing rapidly and deeply1.