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Think Like A NurseAuthor: Brooke Wallace
Guided by 20-year experienced ICU nurse Brooke Wallace and powered by AI here's your study buddy from the classroom to the bedside. Think Like A Nurse is your go-to podcast for nursing students, NCLEX test-takers, and new graduate nurses who want to survive nursing school, thrive in clinicals, and step confidently into practice. Powered by AI and real-world nursing experience, each episode features conversational insights based on common questions and challenges faced by student and new graduate nurses. The discussions are designed to feel like listening in on a supportive study session connecting evidence-based strategies, encouragement, and clinical wisdom in a relatable way. Whether you're tackling pharmacology, preparing for clinicals, or learning to manage your first 12-hour shift, this podcast helps you grow in confidence, knowledge, and resilience from student nurse to strong nurse. Inspired by the most common FAQs from nursing students and new grads, this podcast answers the real questions future nurses are asking: How do I survive pharmacology? How do I talk to patients with confidence? What should I expect on my first 12-hour shift? Created by seasoned ICU nurse Brooke Wallace, RN, BSN, CCRN, CPTC, each episode delivers practical study tips, NCLEX prep strategies, and real-world clinical pearls alongside honest conversations about the challenges of nursing school and early practice. Language: en Genres: Courses, Education, How To Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Diabetic Emergencies: Mastering DKA and HHS Crisis Management
Episode 43
Saturday, 22 November, 2025
Check out ThinkLikeANurse.orgCOMPREHENSIVE NOTESCore Difference: DKA vs HHSDKA (Type 1 diabetic, absolute insulin deficiency)No insulin → body burns fat → ketones formed → metabolic acidosisDeep, rapid Kussmaul respirationsTotal body potassium depleted though serum may appear highState of starvation + dehydrationHHS (Type 2 diabetic, relative insulin deficiency)Some insulin remains → prevents ketones → no significant acidosisExtreme hyperglycemia (often 600–1200+)Severe dehydration + high serum osmolalitySlow onset, often in older adultsDiagnostic MarkersDKA Diagnostic TriadHyperglycemia > 250Metabolic acidosispH < 7.30Bicarb < 18Anion gap elevatedKetones moderate to large (blood or urine)HHS Diagnostic MarkersExtreme hyperglycemia > 600 (often > 1000)Serum osmolality > 320Minimal or no ketones, pH > 7.3DKA Treatment Priorities (FIK Sequence)This is a major NCLEX priority sequence.F – Fluids firstSevere dehydration: 4–6 liters lostStart aggressive normal salineAbout 1 liter in the first hourGoal: restore perfusion and blood pressure quicklyI – Insulin secondOnly after fluids have begunRegular insulin IV bolus → insulin infusionCritical NCLEX rule: Check potassium FIRSTK – Potassium lastInsulin drives potassium into cells → serum potassium drops fastIf potassium < 3.3 → HOLD insulin and replace potassium immediatelyBegin potassium replacement once potassium < 5.2 AND urine output is presentWhen glucose reaches 200–250Switch to D5 ½ NSPurpose: prevent hypoglycemia while continuing insulin to clear ketones and acidosisHHS Treatment PrioritiesFluids (most critical)Fluid loss often 9–12 litersMore aggressive initial resuscitation than DKAStart 0.9% normal saline, often 1–2 liters in the first hourSlow, careful insulinLower dose: ~0.05–0.1 units/kg/hrBegin only after fluid resuscitationTarget glucose drop: 50–70 per hourPurpose: prevent cerebral edema, caused by rapid osmotic shiftsPrevent thrombosis (HHS-specific)Hyperosmolar blood → massive thrombosis riskEarly low molecular weight heparin unless contraindicatedFluid transitionSwitch fluids when glucose reaches 250–300Use 0.45% sodium chlorideHigh-Yield ScenariosScenario 1: DKA with potassium 3.0Priority:Start normal salineHold insulinImmediate aggressive potassium replacementOnce potassium rises above 3.3 → start insulin infusionNCLEX trap: Giving insulin first.Scenario 2: HHS elderly patient, glucose 1250, osmolality 400Priority:Aggressive normal salineInsert Foley catheter for hourly urine outputStart LMWH for clot preventionDelay insulin until hydration improvesThen start low-dose insulin infusion slowlyPrevention and Patient EducationWho is high risk for DKA?Type 1 diabeticsYoung adultsThose experiencing diabetes burnoutPatients omitting insulin dosesAny illness that increases metabolic demandDischarge teaching essentialsSick-day rules: Never skip insulinCheck blood glucose 4–10 times/dayCheck ketones when glucose > 250Evolving Role of TechnologyContinuous glucose monitors (e.g., Eversense 365)Automated insulin delivery systemsOmnipod 5iLet / Twist systemThese systems significantly reduce DKA admissions (40–60%)Nurses increasingly become educators and system managers rather than crisis responders Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com
