• NRNP 6566 week 11 knowledge check

• NRNP 6566 week 11 knowledge check How would you differentiate between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? Correct Answer: Both of these conditions will include high levels of blood glucose readings. DKA will exhibit acidosis and urinary ketones while HHS will not. Treatment for each condition is similar with fluid bolus and infusion as well as insulin bolus and infusion. Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What are the appropriate initial orders to treat this patient? Correct Answer: Admission to the ICU Normal saline IV bolus to counter the vascular dehydration that has occurred. Bolus insulin dose followed by an insulin drip Electrolyte and blood glucose monitoring frequently fluid resuscitation and insulin administration. Bicarbonate is typically not administered unless the pH is below 7 Assess the patient for presence of any infection that may have precipitated this event Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What is the “ corrected” sodium level for the hyperglycemia? What does this mean and how would it impact your treatment plan for this patient? Correct Answer: The equation for corrected sodium is: Corrected sodium (mEq/L) = measure sodium (mEq/L) + 0.016 {glucose (mg/dL)-100}. Juans corrected sodium is 136. 126+ 0.016 {722-100} = 135.95 The measured serum sodium concentration should be corrected for the hyperglycemia by adding 1.6 mEq per L to the measured sodium value. Corrected serum sodium concentrations of greater than 140 mE1 per L and calculated total osmolalities greater than 330 most per kg of water are