NSG 430 exam 1 (topic 2) Questions with Correct Answers 100% Verified| Guaranteed Success
Acute complications of insulin metabolism: hyperglycemia - diabetic ketoacidosis (DKA)
- hyperosmolar hyperglycemic syndrome (HHS)
Acute complications of insulin metabolism: hypoglycemia act immediately
Diabetic ketoacidosis (DKA) - caused by profound deficiency of insulin
- type 1 (no insulin) most common
Diabetic ketoacidosis (DKA): characteristics 1. hyperglycemia
2. ketosis
3. acidosis
4. dehydration (the real emergency)
Diabetic ketoacidosis (DKA): precipitating factors - illness
- infection
- inadequate insulin dosage
- undiagnosed type 1 diabetes
- poor self management
- neglect
Diabetic ketoacidosis (DKA): clinical manifestations - ketonuria = ketones in the urine
(causes acidosis to develop)
- dehydration (poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension)
- lethargy and weakness early
- skin dry and loose; eyes soft and sunken
,Diabetic ketoacidosis (DKA): clinical manifestations cont. - abdominal pain, anorexia, N/V
- Kussmaul respirations (deep rapid breathing), sweet, fruity breath odor
- blood glucose level over or equal to 250 mg/dL
- blood pH lower than 7.3
- serum bicarb level less than 16 mEq/L
- moderate to high ketone levels in urine or serum
- if there are NO ketones its NOT DKA
Diabetic ketoacidosis (DKA): treatment - less severe form may be treated on outpatient
basis
- hospitalize for severe fluid and electrolyte imbalance, fever, N/V/D, AMS (considered
unstable, often treated in ICU to initially stabilize)
- patients with DKA who have an illness such as pneumonia or a UTI are usually admitted to the
hospital
Diabetic ketoacidosis (DKA): treatment cont. - establish IV access FIRST and begin fluids at
0.45% or 0.9% NS
- when blood glucose levels approach 250 mg/dL, add 5% to 10% dextrose to the fluid regiment
to prevent hypoglycemia
- administer O2 and ensure patent airway via a nasal cannula or a non rebreather mask
- continuous regular insulin drip 0.1 U/kg/hr started immediately
- a blood glucose reduction of 36-54 mg/dL per hour will avoid complications
- potassium replacement as needed (insulin allows water and potassium to enter the cell along
with glucose and can lead to a depletion of vascular volume and hypokalemia)
Diabetic ketoacidosis (DKA): electrolyte imbalances - potassium imbalance
- many complications including the heart
- keep balanced with IV and oral supplements
- continuous ECG monitoring
, Hyperosmolar hyperglycemic syndrome (HHS) - life threatening syndrome
- occurs with type 2 diabetes
- caused by profound dehydration
- osmolality: relationship of H2O+ solute
- decreased H20, increased solute = concentrated (hyperosmolar)
- a life threatening syndrome that can occur in the patient with diabetes who is able to produce
enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic
diuresis, and extracellular fluid depletion
- less common than DKA, often occurs in patients older than 60 years with type 2 diabetes
Hyperosmolar hyperglycemic syndrome (HHS): precipitating factors - UTIs, pneumonia,
sepsis
- acute illness
- newly diagnosed type 2 diabetes
- impaired thirst sensation and/or inability to replace fluids
Hyperosmolar hyperglycemic syndrome (HHS): about - enough circulating insulin to prevent
ketoacidosis
- fewer symptoms lead to higher glucose levels (over 600 mg/dL)
- more severe neurologic manifestations because of increased serum osmolality such as
somnolence, coma, seizures, hemiparesis, and aphasia
- because these manifestations resemble a stroke, immediate determination of the glucose
level is critical for correct diagnosis and treatment
- ketones absent or minimal in blood and urine
Hyperosmolar hyperglycemic syndrome (HHS): treatment - HHS constitutes a medical
emergency and has a high mortality rate
- the management of DKA and that of HHS are similar and includes immediate IV administration
insulin and either 0.9% or 0.45% NaCl
Acute complications of insulin metabolism: hyperglycemia - diabetic ketoacidosis (DKA)
- hyperosmolar hyperglycemic syndrome (HHS)
Acute complications of insulin metabolism: hypoglycemia act immediately
Diabetic ketoacidosis (DKA) - caused by profound deficiency of insulin
- type 1 (no insulin) most common
Diabetic ketoacidosis (DKA): characteristics 1. hyperglycemia
2. ketosis
3. acidosis
4. dehydration (the real emergency)
Diabetic ketoacidosis (DKA): precipitating factors - illness
- infection
- inadequate insulin dosage
- undiagnosed type 1 diabetes
- poor self management
- neglect
Diabetic ketoacidosis (DKA): clinical manifestations - ketonuria = ketones in the urine
(causes acidosis to develop)
- dehydration (poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension)
- lethargy and weakness early
- skin dry and loose; eyes soft and sunken
,Diabetic ketoacidosis (DKA): clinical manifestations cont. - abdominal pain, anorexia, N/V
- Kussmaul respirations (deep rapid breathing), sweet, fruity breath odor
- blood glucose level over or equal to 250 mg/dL
- blood pH lower than 7.3
- serum bicarb level less than 16 mEq/L
- moderate to high ketone levels in urine or serum
- if there are NO ketones its NOT DKA
Diabetic ketoacidosis (DKA): treatment - less severe form may be treated on outpatient
basis
- hospitalize for severe fluid and electrolyte imbalance, fever, N/V/D, AMS (considered
unstable, often treated in ICU to initially stabilize)
- patients with DKA who have an illness such as pneumonia or a UTI are usually admitted to the
hospital
Diabetic ketoacidosis (DKA): treatment cont. - establish IV access FIRST and begin fluids at
0.45% or 0.9% NS
- when blood glucose levels approach 250 mg/dL, add 5% to 10% dextrose to the fluid regiment
to prevent hypoglycemia
- administer O2 and ensure patent airway via a nasal cannula or a non rebreather mask
- continuous regular insulin drip 0.1 U/kg/hr started immediately
- a blood glucose reduction of 36-54 mg/dL per hour will avoid complications
- potassium replacement as needed (insulin allows water and potassium to enter the cell along
with glucose and can lead to a depletion of vascular volume and hypokalemia)
Diabetic ketoacidosis (DKA): electrolyte imbalances - potassium imbalance
- many complications including the heart
- keep balanced with IV and oral supplements
- continuous ECG monitoring
, Hyperosmolar hyperglycemic syndrome (HHS) - life threatening syndrome
- occurs with type 2 diabetes
- caused by profound dehydration
- osmolality: relationship of H2O+ solute
- decreased H20, increased solute = concentrated (hyperosmolar)
- a life threatening syndrome that can occur in the patient with diabetes who is able to produce
enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic
diuresis, and extracellular fluid depletion
- less common than DKA, often occurs in patients older than 60 years with type 2 diabetes
Hyperosmolar hyperglycemic syndrome (HHS): precipitating factors - UTIs, pneumonia,
sepsis
- acute illness
- newly diagnosed type 2 diabetes
- impaired thirst sensation and/or inability to replace fluids
Hyperosmolar hyperglycemic syndrome (HHS): about - enough circulating insulin to prevent
ketoacidosis
- fewer symptoms lead to higher glucose levels (over 600 mg/dL)
- more severe neurologic manifestations because of increased serum osmolality such as
somnolence, coma, seizures, hemiparesis, and aphasia
- because these manifestations resemble a stroke, immediate determination of the glucose
level is critical for correct diagnosis and treatment
- ketones absent or minimal in blood and urine
Hyperosmolar hyperglycemic syndrome (HHS): treatment - HHS constitutes a medical
emergency and has a high mortality rate
- the management of DKA and that of HHS are similar and includes immediate IV administration
insulin and either 0.9% or 0.45% NaCl
