16- abd pain, vomit Flashcards Preview

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Flashcards in 16- abd pain, vomit Deck (20):
1

3 components of glasgow coma scale

eye opening response 1-4

verbal response 1-5

motor response 1-6

2

why do kids have higher risk of dehydration compared to adults?

Higher surface area:body mass->evaporation

Higher basal metabolic rates than adults, which generates heat and expends water,

Higher percentage of body weight that is water

3

Diabetic ketoacidosis presentation

vomiting
diffuse abdominal pain
preceding history of polydipsia and enuresis
significant dehydration
mental status altered
tachypnea- kussmaul

4

steps to do immediately if DKA suspected

isotonic saline (0.9%) IV bolus
STAT electrolytes
random glucose test
UA
blood gas
continuous cardiac monitoring

5

DM diagnosis

random blood glucose >200 + symptoms
oral glucose tolerance test >200 (2 hr post-prandial)
fasting blood glucose >126
Hg A1c >6.5

6

next steps to do in next hour with DKA

vitals
insulin drip (after 1 hr of fluids)
maintenance and replacement fluids
frequent glucose measurements
serum osmolality
CBC
monitor cerebral edema
endocrinologist consult
admit to hospital

7

DKA labs

pH low
sodium low- dictional- H2O follows glucose into ECM
postassem normal- varies- drops with insulin
bicarb low
Cr high- dehydration
glucose high
blood and urine ketones high

8

corrected sodium equation in DKA

Corrected sodium = [{(measured glucose - 100) / 100} x 1.6] + measured sodium

9

example of isotonic/isonatremic dehydration and how many hours to replace

gastroenteritis- diarrhea
most common in kids

12 hours to replace

10

example of hypotonic/hyponatremic dehydration and how many hours to replace

consume diluted fluids
adrenal insuff.

replace over 24 hours to not get locked in -central pontine myeilnosis

11

example of hypertonic/hypernatremic dehydration and how many hours to replace

breastfeeding failure
diabetes insipidus

replace over 48 hours to avoid cerebral edema

12

Holliday-Sugar method of calculating maintenance fluids

100 mL/kg/day for the first 10 kg of body weight
50 mL/kg/day for the second 10 kg of body weight
20 mL/kg/day for each additional 1 kg of body weight

13

percent saline in initial IV bolus compared to maintenance IV fluids

isotonic initialy 0.9%

then replace with 0.45%

14

signs of cerebral edema

A. Headache
B. Recurrence of vomiting
D. (bradycardia)
F. Rising blood pressures (hypertension)
G. Decreased oxygen saturation (hypoxia)
H. Restlessness, irritability
I. Increased drowsiness (lethargy)
J. Cranial nerve palsies: CN VI - Abducens nerve
K. Abnormal pupillary responses: unequal pupils, fixed dilated pupils, absent response unilaterally or bilaterally

15

admission orders

ADC VANDISMAL

A =Admit (floor, room, service, attending, resident)
D=Diagnoses (list in order of priority)
C=Condition (good, fair, guarded, critical)
V=Vitals (q 2 hrs, q shift, routine)
A=Activity (ad lib, bed rest, up to chair, walk 3x/d)
N=Nursing (ins and outs, drains, wound care, etc.)
D=Diet (regular, low sodium, diabetic, NPO, etc.)
I=IV fluids (type and rate)
S=Studies (imaging, ECG)
M=Medications (include both scheduled and prn)
A=Allergies (drug or food)
L=Labs (CBC, lytes, cultures, etc.)

16

when can DKA patient start eating by mouth

until her blood sugars, neurologic status, and vomiting resolve.

17

is oral hypoglycemic agent given to DKA patient?

no

18

what other tests do you give to DKA patient?

other autoimmune diseases: thyroid antibodies and celiac labs

Anti-pancreatic antibodies including insulin, GAD, and IA2

19

rare serious complication of DKA

cerebral edema- any point during DKA management (up to 24 hours of initiating treatment)

20

differential for vomiting and altered mental status

DKA
toxic ingestion
GI obstruction
Gastroenteritis
Appendicitis
increased ICP
Bacterial pneumonia
pyelonephritis