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Diabetes Type 1, with Acute Illness/Sick Day Rules — Initial MD/CRNP/RN Rapid Assessment — Clinical Pathway: Emergency

Diabetes Type 1 with Acute Illness Clinical Pathway — Emergency Department

Initial MD/APP/RN Team Assessment

History

  • Home glucose levels
  • Home urine or blood ketones
  • Total daily insulin dose, recent doses
  • Insulin pump
  • Other symptoms

Physical Exam

  • Vital signs
  • Brief neurologic assessment
    • AVPU/GCS
    • Pupils
  • Respiratory distress
  • Perfusion
    • Capillary refill
    • Pulses

RN Bedside Procedure

General

  • Place patient on CR monitor
  • Begin documentation on DKA flowsheet
    • Blood glucose every 2 hours
    • POC glucose and BOHB every 2 hours, notify FLOC with results
    • I/O hourly
    • VS hourly (document in computer)
    • Insulin dose, time given

IV Placement

  • Discuss the need for IV placement with patient/family, obtain the following specimens:
    • Bedside glucose
    • Basic metabolic panel

 

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