DKA: Cerebral Edema (Nursing)

00:02 So, we're going to take a moment to talk about what I call the Big Bad. These are things that you cannot miss. These are the things that can kill your patient. And in DKA, when we start insulin therapy, one of the things that can happen is cerebral edema so we're going to talk about that for a moment. There are some signs and symptoms that you want to be on the lookout as we're starting therapy for DKA once you start that insulin. If your patient starts complaining of a headache especially if it wasn't there before and any alterations in the neurological status, you're going to needed to pay very very close attention to. In fact, for most patients when they come in to the hospital and they're being treated for DKA, you're going to be checking that neuro status every hour at least for the first 12-24 hours because we do not want to miss cerebral edema. So if you see restlessness or irritability, if your patient is all of the sudden drowsy or confused, if they become incontinent when they weren't before or if you are tracking their Glasgow Coma Scale, their GCS, and you notice a lowering in that level. Any of those things, any changes in neurological status might be a sign and symptom of cerebral edema. So, additionally when you're looking for cerebral edema, you can be looking for any asymmetric facial features, they might complain of double vision, they might have some cranial nerve palsies, again any change in that neurologic check needs to be reported immediately.

01:50 The other thing that will happen as a late sign of cerebral edema, and again this is important to note, it is a late sign of cerebral edema, is Cushing's triad. So, if you notice that your patient's heart rate is slowing down, their blood pressure is going up, and they have a widening of that pulse pressure, your patient is in trouble. This means that their brain is swelling to the point where it is trying to push down and herniate and will result in the patient's death. So, hopefully we have caught the neurological signs and symptoms before we get to Cushing's triad, but if not, if we see this, this is a clinical emergency and must be dealt with immediately.