NURS 640 QUESTIONS AND ANSWERS SURE A+
✔✔HHS PE - ✔✔lethargy/confusion w severe
NO KUSSMAUL resp or acetone breath
dehydration
✔✔HHS diagnosis - ✔✔•BG very high 800 - 2400 mg/dL
•High serum osmolality
•Absent (or mild) ketosis / acidosis
•pH > 7.3, serum bicarb > 20
Mild
-Hyponatremia
Advanced
-Hypernatremia
-Serum osmolality 330 - 440 mOsm / kg
-BUN > 100 mg / dL
HHS symptoms / history
-Neurologic abnormalities common
✔✔HHS acute testing - ✔✔Fingerstick
BG
Lytes
BUN creat
osmolality
ketones
✔✔HHS management - ✔✔•Aggressive rehydration
•Insulin administration, reduce glucose
-Less insulin needed compared to DKA
•Monitor for hypokalemia
-Initiate earlier then in DKA
, •Hourly BG monitoring
BG < 250: convert to SC insulin
✔✔hypoglycemia risk factors w DM - ✔✔Insulin therapy
-Inappropriate dosing
-Unplanned reduced oral caloric intake (nausea, procedure)
Oral anti-hyperglycemics
-Insulin secretion stimulators
•Sulfonylureas (glyburide, glipizide, glimipride)
•Meglitinide analogs (repaglinide, nateglinide)
•Combo drugs with above agents included
-Insulin sensitizers should not cause hypo
•Ex: biguanides (metformin), thiazolidinediones (pioglitazone) and other classes
✔✔hypoglycemia risk factors w/o DM - ✔✔•Less common than iatrogenic / DM side
effect
•Critical illness - sepsis, hepatic, renal, cardiac failure
•Adrenal insufficiency
•Insulinoma / tumors
•Alcohol ingestion
•Medications (ex: quinolones, beta-blockers, ACE-inhibitors)
Past history of hypoglycemic events
✔✔Hypoglycemia sx - ✔✔neurogenic
- tremors
- palpitations
- anxiety
- sweating
- hunger
- paresthesias
neuroglycopenic
- confusion, sensation of warmth, weakness, fatigue
Severe
- cognitive failure, seizure, come
✔✔hypoglycemia by BG - ✔✔BG <70
mild sx or none
- admin 15 g fast acting cab
- T1 continue insulin infusion
- recheck BG in 15 mins, repeat if not goal
-provide snack/meal w complex carbs
✔✔HHS PE - ✔✔lethargy/confusion w severe
NO KUSSMAUL resp or acetone breath
dehydration
✔✔HHS diagnosis - ✔✔•BG very high 800 - 2400 mg/dL
•High serum osmolality
•Absent (or mild) ketosis / acidosis
•pH > 7.3, serum bicarb > 20
Mild
-Hyponatremia
Advanced
-Hypernatremia
-Serum osmolality 330 - 440 mOsm / kg
-BUN > 100 mg / dL
HHS symptoms / history
-Neurologic abnormalities common
✔✔HHS acute testing - ✔✔Fingerstick
BG
Lytes
BUN creat
osmolality
ketones
✔✔HHS management - ✔✔•Aggressive rehydration
•Insulin administration, reduce glucose
-Less insulin needed compared to DKA
•Monitor for hypokalemia
-Initiate earlier then in DKA
, •Hourly BG monitoring
BG < 250: convert to SC insulin
✔✔hypoglycemia risk factors w DM - ✔✔Insulin therapy
-Inappropriate dosing
-Unplanned reduced oral caloric intake (nausea, procedure)
Oral anti-hyperglycemics
-Insulin secretion stimulators
•Sulfonylureas (glyburide, glipizide, glimipride)
•Meglitinide analogs (repaglinide, nateglinide)
•Combo drugs with above agents included
-Insulin sensitizers should not cause hypo
•Ex: biguanides (metformin), thiazolidinediones (pioglitazone) and other classes
✔✔hypoglycemia risk factors w/o DM - ✔✔•Less common than iatrogenic / DM side
effect
•Critical illness - sepsis, hepatic, renal, cardiac failure
•Adrenal insufficiency
•Insulinoma / tumors
•Alcohol ingestion
•Medications (ex: quinolones, beta-blockers, ACE-inhibitors)
Past history of hypoglycemic events
✔✔Hypoglycemia sx - ✔✔neurogenic
- tremors
- palpitations
- anxiety
- sweating
- hunger
- paresthesias
neuroglycopenic
- confusion, sensation of warmth, weakness, fatigue
Severe
- cognitive failure, seizure, come
✔✔hypoglycemia by BG - ✔✔BG <70
mild sx or none
- admin 15 g fast acting cab
- T1 continue insulin infusion
- recheck BG in 15 mins, repeat if not goal
-provide snack/meal w complex carbs
