Advanced Med
Surg Exam 2 Study
Guide: Complex
Metabolism &
Emergencies
Updated 2026
, lOMoAR cPSD| 64664050
ADVANCED MED SURG STUDY GUIDE EXAM 2
Unit 5 & 6: Complex Metabolism
Hyperglycemic- Hyperosmolar State (HHS)
Pathophysiology A hyperosmolar state caused by hyperglycemia. Sustained osmotic
diuresis leads to extremely high blood glucose levels and severe
dehydration.
Clinical Severe dehydration, CNS changes- confusion to coma, seizures,
Manifestations paralysis.
Etiology/ Risk DM II
factors Other causes: infection, other stressors, poor fluid intake, MI, sepsis,
pancreatitis, stroke, some drug therapy (glucocorticoids, diuretics,
phenytoin, betas, CCBs).
Tests/ Serum glucose > 600, blood osmolarity >320 (285-295), pH > 7.4,
Diagnostics elevated BUN
Therapeutic IV regular insulin, hypotonic fluids first 0.45%, then isotonic 0.9%
Management NS fluids
Nursing/ PRIORITY: Restore blood volume with IV fluids, correct
Assessment hyperglycemia, monitor potassium level with IV insulin.
Assess hourly for signs of cerebral edema (changes in mental
status, abnormal neuro signs, coma). Monitor neuro status and
changes in LOC and pupils.
Diabetic Ketoacidosis (DKA)
Pathophysiology Complication of diabetes characterized by uncontrolled
hyperglycemia, metabolic acidosis, and increased production of
ketones. Insulin deficiency and an increase in hormone release
leads to increased liver and kidney glucose production.
, lOMoAR cPSD| 64664050
Clinical Polyuria, polydipsia, polyphagia, fruity breath, vomiting, abd pain,
Manifestations kussmaul respirations, dehydration, weakness, confusion, shock, coma.
Etiology/ Risk DM I
factors Other causes: Infection, other stressors, inadequate insulin dose.
Tests/ Serum glucose >300, ketones in urine, hyperkalemia > 5 (causes ST
Diagnostics elevation on EKG), low pH < 7.35, low HCO3 < 22
Low lab values: calcium < 9, sodium < 135, mag < 1.5, phos < 2,
pH < 7.35, HCO3 < 22,
Therapeutic IV regular insulin, isotonic IV fluid NS 0.9%
Management
Nursing/ PRIORITY: Restore blood volume with fluids, correct
Assessment hyperglycemia, monitor K level with IV insulin- risk for
hypokalemia!! Sxs fatigue, malaise, confusions, muscle weakness,
shallow respirations, abdominal distention, paralytic ileus,
hypotension, weak pulse. EKG will show ST depression or U wave.
Hypokalemia is a common cause of death in the treatment of DKA.
Assess airway, level on consciousness, hydration status, electrolytes,
and BG. Dehydration: decreased skin turgor, low CVP, cool, clammy
skin, weak/ rapid pulse, hypotension.
Ensure UOP > 30 mL/hr before giving IV K. Assess cardiac, kidney,
and mental status to avoid FVO. Monitor for sxs of HF and pulmonary
edema, BP, strict I&Os, daily weights.
Teach pts and family to check blood sugar levels Q4H- Q6H when >
250 and check for ketones > 300.
Sick day rules: Call HCP when ill, monitor blood sugar Q4H, check
urine for ketones, continue to take insulin, drink 8-12 oz QH when
awake, continue scheduled meals, rest. Contact HCP if persistent n/v,
fever of 101.5 F longer than 24 hr, elevated blood sugar after 2
doses of insulin, and ketones in urine.
Downloaded by Weykey Pinn ()
Surg Exam 2 Study
Guide: Complex
Metabolism &
Emergencies
Updated 2026
, lOMoAR cPSD| 64664050
ADVANCED MED SURG STUDY GUIDE EXAM 2
Unit 5 & 6: Complex Metabolism
Hyperglycemic- Hyperosmolar State (HHS)
Pathophysiology A hyperosmolar state caused by hyperglycemia. Sustained osmotic
diuresis leads to extremely high blood glucose levels and severe
dehydration.
Clinical Severe dehydration, CNS changes- confusion to coma, seizures,
Manifestations paralysis.
Etiology/ Risk DM II
factors Other causes: infection, other stressors, poor fluid intake, MI, sepsis,
pancreatitis, stroke, some drug therapy (glucocorticoids, diuretics,
phenytoin, betas, CCBs).
Tests/ Serum glucose > 600, blood osmolarity >320 (285-295), pH > 7.4,
Diagnostics elevated BUN
Therapeutic IV regular insulin, hypotonic fluids first 0.45%, then isotonic 0.9%
Management NS fluids
Nursing/ PRIORITY: Restore blood volume with IV fluids, correct
Assessment hyperglycemia, monitor potassium level with IV insulin.
Assess hourly for signs of cerebral edema (changes in mental
status, abnormal neuro signs, coma). Monitor neuro status and
changes in LOC and pupils.
Diabetic Ketoacidosis (DKA)
Pathophysiology Complication of diabetes characterized by uncontrolled
hyperglycemia, metabolic acidosis, and increased production of
ketones. Insulin deficiency and an increase in hormone release
leads to increased liver and kidney glucose production.
, lOMoAR cPSD| 64664050
Clinical Polyuria, polydipsia, polyphagia, fruity breath, vomiting, abd pain,
Manifestations kussmaul respirations, dehydration, weakness, confusion, shock, coma.
Etiology/ Risk DM I
factors Other causes: Infection, other stressors, inadequate insulin dose.
Tests/ Serum glucose >300, ketones in urine, hyperkalemia > 5 (causes ST
Diagnostics elevation on EKG), low pH < 7.35, low HCO3 < 22
Low lab values: calcium < 9, sodium < 135, mag < 1.5, phos < 2,
pH < 7.35, HCO3 < 22,
Therapeutic IV regular insulin, isotonic IV fluid NS 0.9%
Management
Nursing/ PRIORITY: Restore blood volume with fluids, correct
Assessment hyperglycemia, monitor K level with IV insulin- risk for
hypokalemia!! Sxs fatigue, malaise, confusions, muscle weakness,
shallow respirations, abdominal distention, paralytic ileus,
hypotension, weak pulse. EKG will show ST depression or U wave.
Hypokalemia is a common cause of death in the treatment of DKA.
Assess airway, level on consciousness, hydration status, electrolytes,
and BG. Dehydration: decreased skin turgor, low CVP, cool, clammy
skin, weak/ rapid pulse, hypotension.
Ensure UOP > 30 mL/hr before giving IV K. Assess cardiac, kidney,
and mental status to avoid FVO. Monitor for sxs of HF and pulmonary
edema, BP, strict I&Os, daily weights.
Teach pts and family to check blood sugar levels Q4H- Q6H when >
250 and check for ketones > 300.
Sick day rules: Call HCP when ill, monitor blood sugar Q4H, check
urine for ketones, continue to take insulin, drink 8-12 oz QH when
awake, continue scheduled meals, rest. Contact HCP if persistent n/v,
fever of 101.5 F longer than 24 hr, elevated blood sugar after 2
doses of insulin, and ketones in urine.
Downloaded by Weykey Pinn ()
