NRNP 6566 WEEK 11 KNOWLEDGE CHECK
• Question 1
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.
• Question 2
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
• Question 3
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
• Question 1
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.
• Question 2
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
• Question 3
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
