Care of Pats with DM

Question 1

Lot care directly related to mitigating comps - helping to limit amount comps pats with diabetes have
All considered emergencies; most often admitted to hospital
Diabetic Ketoacidosis (DKA)
Hyperglycemic-hyperosmolar state (HHS)
Hypoglycemia
***All considered medical emergencies

Answer 1

Acute comps of DM

Question 2

Insulin deficiency and acidosis

Answer 2

Diabetic Ketoacidosis (DKA)

Question 3

Insulin deficiency and severe dehydration

Answer 3

Hyperglycemic-hyperosmolar state (HHS)

Question 4

Too much insulin or too little glucose/intake to compensate for that

Answer 4

Hypoglycemia

Question 5

Caused by changes in blood vessels in tissue and organs - integrity of blood vessels impaired with diabetes and because of that not getting all O2 and blood supply to certain areas (kidney, retina) and causes cell damage, ischemia and eventually death
Vascular changes result from:
Changes in blood vessels lead to poor tissue perfusion and cell damage and death
Two types vascular areas affected:
Macrovascular
Microvascular

Answer 5

Chromic comps of DM

Question 6

Hyperglycemia thickens basement membranes and causes organ damage
Hyperglycemia affects cell integrity

Answer 6

Vascular changes result from:

Question 7

Macrovascular
Microvascular

Answer 7

Two types vascular areas affected:

Question 8

Cardiovascular disease
Cerebrovascular disease
Peripheral vascular disease
Risk factors of hypertension, obesity, dyslipidemia and sedentary lifestyle increase risk of these complications - expenetialy increase risk of macrovascular changes
Big Focus for Nursing should be on decreasing modifiable risk factors - high cholesterol, HTN, obesity, increase exercise

Answer 8

Macrovascular

Question 9

Increased issues with this
Pats die from this
Increased risk for this Myocardial Infarction; Increased risk for this Heart Failure
Increased risk for any embolic event
Higher risk dysrhythmias if survived MI; heart muscle effected so see HF

Answer 9

Cardiovascular disease

Question 10

Increased issues with this
Pats die from this
2-4 times higher risk for stroke

Answer 10

Cerebrovascular disease

Question 11

Increased issues with this
Peripheral artery disease (vascular changes, increased risk for developing wounds); Leg uclers - esp in LE; Do develop get extensions that develop rapidly because not having blood supply so harder to heal

Answer 11

Peripheral vascular disease

Question 12

Retinopathy
Neuropathy
Nephropathy

Answer 12

Microvascular

Question 13

Vessels in retina damaged and so leak resulting in retinal hemorrhage and not allow blood supply to get there and lead to blindness; because leaking beading increase risk for rupture; sometimes eye make new tiny vessels to compensate for that but high risk for rupturing but damage to tiny vessel in back of eye
Without retina cannot see - lot pats have issue
Also form plaque; increased risk for macular degeneration
Caused by damage to the retinal vessels causing leaking and retinal hypoxia

Answer 13

Retinopathy

Question 14

Progressive deterioration of nerves
Either have Loss in sensation (numbness/tingling) or muscle weakness - innervation not there to innervate muscles
Caused by blood vessel changes that cause nerve hypoxia
Can affect all areas of the body (extremities, organ sys: GI (delayed gastric emptying and reflux), cardiac, urinary)
Any area of body

Answer 14

Neuropathy

Question 15

Kidney issues
Changes in kidney - high BG - causes damages to blood vessels in kidney which then causes hypoxia to kidneys and not getting blood supply need and start damaged
Change in kidney that decreases function and causes kidney failure
Chronic high blood glucose causes damage to blood vessels in kidneys causing leaking and hypoxia
Kidneys allow filtration of larger particles that should not go through through which damage the kidneys further
Cause scarring; narrowing blood vessels and other comps causing kidneys be further hypoxic and lead to kidney failure
HTN - higher risk for kidney issues

Answer 15

Nephropathy

Question 16

Values use diagnose diabetes and see how well diabetics doing in regards to controlling disease
Fasting BG test
Glucose tolerance test
Glucosylated Hgb (Hgb A1C)

Answer 16

BG values

Question 17

Depending on pat fasting
Normal range: 70-100; less than 100; older adults: levels rise 1 mg/dL per decade of age
Sig of abnorm results: levels greater than 100 but <126 = impaired fasting glucose (not fast well); >126 on at least 2 diff occasions diagnostic of diabetes (dependent on eating)

Answer 17

Fasting BG test

Question 18

Do check for gestational diabetes; dependent on pat - specific on how prep
Normal range: <140
Sig of abnorm results: 140-200 impaired glucose tolerance (not diagnostic); >200 indicate provisional diagnosis (concern)

Answer 18

Glucose tolerance test

Question 19

More and more used in acute care and community
Indication of how pats BG over period time; glucose attaches to Hgb gives avg BG over 120 days - lifespan RBC; good clue on how pats with diabetes doing
Higher level higher BG been
Correlate with what avg BG been
Normal range: 4-6%; levels greater than 6.5% diagnostic for DM
Sig of abnorm results: >8% poor diabetic control - commonly used and imp blood work for DM pat; not matter if eat before lab draw because do when come in

Answer 19

Glucosylated Hgb (Hgb A1C)

Question 20

Related to initial hyperglycemia/comps secondary to hyperglycemia
Risk for injury related to hyperglycemia - hypoglycemia, neuropathy, nephropathy, retinopathy, pain related to diabetic neuropathy (main things look at for diabetic pats)
Potential for impaired wound healing related to endocrine and vascular effects of diabetes
Risk for injury related to diabetic neuropathy
Acute pain and chronic pain related to diabetic neuropathy
Risk for injury related to diabetic retinopathy-induced reduced vision
Potential for kidney disease related to impaired kidney circulation
Potential for hypoglycemia
Potential for diabetic ketoacidosis
Potential for hyperglycemic-hyperosmolar state and coma

Answer 20

Planning and priorities

Question 21

What want at end of care for DM pats
Main priority: Maintaining blood glucose in expected range decided by provider and preventing acute and chronic complications of DM are the primary outcomes - help pat self manage DM so have as min comps related to it as possible; prevent comps and maintain BG within range supposed to be and if do that should help with comps
Performs treatment regimen as prescribed
Follows recommended diet
Monitors blood glucose/suger using correct testing procedures
Seeks health care if blood glucose levels fluctuate outside of recommended parameters
Meets recommended activity levels - exercise always big
Uses drugs as prescribed
Maintains optimum weight
Problem-solves about barriers to self-management

Answer 21

Expected outcomes

Question 22

Nutrition
Exercise
Blood glucose monitoring
Medications

Answer 22

Interventions

Question 23

Worried about BG and concerned about what eating so nutrition huge
Dietician should be involved and collab with them; if not have them refer them to someone outpat so can absorb info and not in stressful situation; make sure getting resources outpat setting
Should be individualized
45-65% carbohydrates - “carb counting” (more pop esp if BG harder control, dose insulin based on carbs eating for each meal) - oftentimes with insulin give basal dose then give based on high BG or meals eating; very specific; pop in all settings
15-20% protein (if normal kidney function); make sure only if no nephropathy; if probs with kidneys cut back
Limit saturated fats and cholesterol - high cholesterol increases risk for macrovascular changes - keep cholesterol as low and same with triglycerides
Watch alcohol intake (can lead to hypoglycemia) - way works on liver - suppresses release of glucose; oftentimes BG go down with alcohol; if do drink eat in moderation so not have issues with alcohol
Need to take patient preferences and culture into consideration

Answer 23

Nutrition

Question 24

Help regulate blood glucose and increases insulin sensitivity; more receptive to insulin - huge for T2DM
Important in weight loss for DM 2
Should monitor blood glucose and watch for injury - increase BG if already stressed and also drop it so monitor closely; careful with injury because harder to heal
More cognisent

Answer 24

Exercise

Question 25

Very important in self care - Very imp to monitor BG - indication how doing with care; teach how check BG and make sure have equiment Target goals are individualized - BG to be; provider and goals Frequency depends on drug regimen - frequency of treatments Accuracy is essential - make sure BG accurate Ensure proper technique - where on finger checking it Continuous glucose monitoring (inserted in sub-q tissue) - insulin pumps

Answer 25

Blood glucose monitoring

Question 26

adequate sample; using correct and all supplies needed; calibrate machine; BG monitoring - need teach pats how use monitor because one first things need know how do if new diabetics; go over machines: ensure able do it and see; use good infection control, cleaning it and not sharing equipment

Answer 26

Accuracy is essential - make sure BG accurate

Question 27

All patients with type 1 DM will require insulin Patients with type 2 DM may require medication (antidiabetic drugs or insulin) if they do not achieve blood glucose control with diet and exercise - some may need oral insulin; vary with pat and how able control BG

Answer 27

Medications

Question 28

Shorter-acting drugs (ex. glipizide (Glucotrol)) Longer-acting drugs (ex. glyburide (Diabeta); glimepiride (Amaryl)) Metformin (Glucophage) Other common medications

Answer 28

Drug therapy for DM

Question 29

Increases insulin secretion - T2DM (producing some but not very much) Better for patients with irregular eating - not eating reg time Preferable in older patients or decreased/diminished kidney, liver or cardiac function Take around meal time and need know BG before taking them

Answer 29

Shorter-acting drugs (ex. glipizide (Glucotrol))

Question 30

Increases insulin secretion - T2DM (producing some but not very much) Daily dosing is better for adherence: once a day

Answer 30

Longer-acting drugs (ex. glyburide (Diabeta); glimepiride (Amaryl))

Question 31

Very common for diabetic pats Reduced hepatic glucose production and increases tissue sensitivity to insulin - more able pull glucose into cells Should not be used with anyone with kidney disease can cause lactic acidosis in patients with renal insufficiency - be aware of s/s of that: malaise, fatigue, muscle pain, changes in LST, abd discomfort Upset stomach - take with food Needs to be held for 48 hours after administering any contrast media or surgery - make sure kidney func back up to where needs to be and contrast dyes toxic on kidneys and want make sure good before start med again

Answer 31

Metformin (Glucophage)

Question 32

Exenatide (Byetta, Bydureon) – SQ (sim to insulin) - frequent; given before meals bid; respond well to it Acarbose (Precose) – PO; commonly seen Pioglitazone (Actos) - PO Sitagliptin (Januvia) - PO; commonly seen Either increase sensitivity to insulin or increase secretion of insuli

Answer 32

Other common medications

Question 33

Given in subcutaneous tissue Do not mix long acting insulin or premixed insulin - some do mix Regimens are used to duplicate the basal and prandial release pattern of the pancreas - Insulin doing in T1DM is body has certain basal insulin and releases more insulin based on when eat - prandial release pattern - with insulin given to pats give base dose (long acting) and give bolus doses around meal time; BG high and when eating body needs insulin so can handle glucose Can be given by a continuous subcutaneous infusion of insulin

Answer 33

Insulin admin

Question 34

Give it: Abdomen (best place and absorbs quickest), back of arm, buttocks, thigh - fat tissue; want rotate spots within area (such as within abd)

Answer 34

Given in subcutaneous tissue

Question 35

Externally worn pump - monitor and insulin pump Need lots of education - pats have that know LOT - need tons edu; well-versed on it; know what doing with it because high risk

Answer 35

Can be given by a continuous subcutaneous infusion of insulin

Question 36

Need know type insulin giving, when works, peaks, duration - because if pats goes hypoglycemic tells how long going to last and how going to treat it Rapid Acting Insulin (ex. aspart (Novolog); lispro (Humalog)) Short Acting Insulin (ex. regular U100; regular U500) Intermediate Acting Insulin (ex. NPH; 70/30; 50;50) Long Acting Insulin (ex. glargine (Lantus); detemir (Levemir))

Answer 36

Types insulin (Chart 64-8)

Question 37

Work fastest; peak fastest; last shortest amount of time

Answer 37

Rapid Acting Insulin (ex. aspart (Novolog); lispro (Humalog))

Question 38

Second fastest

Answer 38

Short Acting Insulin (ex. regular U100; regular U500)

Question 39

Basal dose then do rapid or short acting in between/for meals during day

Answer 39

Long Acting Insulin (ex. glargine (Lantus); detemir (Levemir))

Question 40

Injection site Absorption rate Injection depth Timing of injection Mixing insulin

Answer 40

Factors affecting insulin absorption

Question 41

Absorption fastest in the abdomen Where inject affects how absorbed Teach to rotate around a site but not to another site

Answer 41

Injection site

Question 42

In any particular affected by type of insulin, amount (larger amount takes longer to absorb), local heat, massage, exercise, or scarring (cannot feel it so less painful but not absorb as well)

Answer 42

Absorption rate

Question 43

Affect it 90 degree angle usually always given (thinner patients may need to inject at a 45-degree angle to avoid IM injection and absorb much faster vs subQ)

Answer 43

Injection depth

Question 44

How close given to meal

Answer 44

Timing of injection

Question 45

Sometimes 2 insulins mixed together not absorb as if were give 2 sep shots at same rate; got onset of short-acting and duration of longer-acting so harder to judge with mix; make sure before inject that swirling it to make sure fully mixed Response to mixed insulin may differ from the response to the same insulins given separately

Answer 45

Mixing insulin

Question 46

A sig amount to edu Refrigerate insulin not in use - can refrigerate insulin before opened and once opened keep out fridge for 28 days and then throw away after 28 days Insulin in use may be kept at room temperature for up to 28 days Discard unused insulin after 28 days Prefilled syringes are stable up to 30 days when refrigerated Have a spare bottle of each type of insulin used on hand and extra needles; not reusing needles - imp: painful and injection not effective Inspect the insulin before each use Use disposable needles one time Follow infection control measures: swabbing top of vial Drawing up own insulin: can do it themself: can see it: magnifiers and help them with; ones can dial in dose - easier if issues with fine motor; whatever utilizing make sure can effectively use it/someone designated to be caregiver can

Answer 46

Patient edu-insulin

Question 47

Lantus should always be stored in a refrigerator

Answer 47

Insulin in use may be kept at room temperature for up to 28 days

Question 48

Store upright

Answer 48

Prefilled syringes are stable up to 30 days when refrigerated

Question 49

Transplantation of the pancreas (cadaver donor) Islet cell transplantation

Answer 49

Surgical interventions

Question 50

Not lot whole lot Almost all pancreas transplants are done to treat Type 1 diabetes Requires lifelong drug (immunosuppressive) therapy to prevent rejection - issues with infection later on Seen often with kidney transplants Considered in patients with diabetes and end-stage kidney disease who have had or plan to have a kidney transplant Complications are common (ex. infection, rejection, cancer)

Answer 50

Transplantation of the pancreas (cadaver donor)

Question 51

Transplant some beta cells - not common Considered experimental

Answer 51

Islet cell transplantation

Question 52

High risk for injury: peripheral neuropathy: issues with foot care because of that are; foot issues/wounds common reasons why diabetics come into hospital; really bad wound Foot injury is the most common complication of diabetes leading to hospitalization There is an increased risk for wound progression that could eventually lead to amputation - very serious Most lower extremity amputations are preceded by foot ulcers Make sure shoes fit; check for sensation and mobility Assess the patient for risk for diabetic foot problems Assess the foot Cleanse and inspect feet daily Wear properly fitting shoes Avoid walking in bare feet Wear clean, dry socks daily - not wear socks with seams that could put pressure that might not notice Trim toenails properly - big; done specific way Report non-healing breaks in the skin of the feet to the health care provider - taken care of right away

Answer 52

Reducing risk for injury-peripheral neuropathy/foot care

Question 53

for status of circulation for evidence of deformity for loss of strength for loss of protective sensation

Answer 53

Assess the foot

Question 54

Neuropathic pain big issue for diabetic pats; not typ pain; results from damage anywhere along the nerve Manifestations for diabetic pats - cannot describe it well or describe it as pain Pharmacologic agents to manage neuropathic pain:

Answer 54

Managing pain - diabetic neuropathy

Question 55

Tingling, numbness, loss of proprioception in lower extremities Burning Muscle cramps Piercing or stabbing pain Metatarsalgia (walking on marbles) Allodynia (pain from normal nonpainful stimuli) - pain feels more than should be because all nerve damage Hyperalgesia (exaggerated pain response)

Answer 55

Manifestations for diabetic pats - cannot describe it well or describe it as pain

Question 56

Gabapentin (Neurontin) - anticonvulsant meds; for seizures; more for neuropathic pain now Pregabalin (Lyrica) - anticonvulsant meds; for seizures; more for neuropathic pain now Duloxetine (Cymbalta) - antidepressant; effective

Answer 56

Pharmacologic agents to manage neuropathic pain:

Question 57

Ensure have these taken care of Reducing risk for injury by reducing BG as much as can Regular eye exams - yearly Appropriate eyewear if needed Reading aids Adaptive devices for administering insulin - impaired vision and check BG, admin insulin, draw it up in tiny syringes, are magnifiers or switch to pen or get prefilled syringes; also have talking meters so easier time checking BG Specialized adaptive equipment for blood glucose monitoring

Answer 57

Reducing risk for injury-sig impaired vision

Question 58

Kidney damage big issue for diabetic pats Control hypertension - damage to kidney occurs is big issue - keep under control Correct hyperlipidemia - keep down Kidney function evaluation: If microalbuminuria develops: Smoking cessation Drug therapy for nephropathy - having albumin in urine

Answer 58

Reducing risk for injury - diabetic nephropathy (big comps want prevent)

Question 59

Monitor all of these: Annual serum creatinine level/BUN; GFR Annual test for microalbuminuria in specific patients - urine tested for albumin; check beginning kidney damage so do other interventions so limit amount of damage to kidney

Answer 59

Kidney function evaluation:

Question 60

Control BP and blood glucose Restrict dietary protein Avoid nephrotoxic agents including contrast dyes Promptly treat UTI’s Prevent dehydration; make sure staying hydrated Monitor on all of this and take care of it before proceeds further

Answer 60

If microalbuminuria develops:

Question 61

Helps with lot comps; constricts vessels in kidneys when smoke

Answer 61

Smoking cessation

Question 62

Angiotensin-converting enzyme (ACE) inhibitors (ACEIs) Angiotensin receptor blockers (ARBs)

Answer 62

Drug therapy for nephropathy - having albumin in urine

Question 63

Reduce level of albuminuria and progression of kidney damage

Answer 63

Angiotensin-converting enzyme (ACE) inhibitors (ACEIs)

Question 64

Block action of angiotension, blood vessels enlarge and BP decreased to block kidney damage

Answer 64

Angiotensin receptor blockers (ARBs)

Question 65

Treatments do higher risk for this Skin Dehydration Respirations Mental status Symptoms Glucose Ketones

Answer 65

Hypoglycemia

Question 66

Cool, clammy, sticky

Answer 66

Skin

Question 67

Absent

Answer 67

Dehydration

Question 68

No particular/consistent change

Answer 68

Respirations

Question 69

Anxious, nervous, irritable, mental confusion, seizures, coma: issues with this

Answer 69

Mental status

Question 70

Weakness, double vision, blurred vision, hunger, tachycardia, palpitations

Answer 70

Symptoms

Question 71

Less than 70

Answer 71

Glucose

Question 72

Negative

Answer 72

Ketones

Question 73

Issue with this if DM Skin Dehydration Respirations Mental status Symptoms Glucose Ketones

Answer 73

Hyperglycemia

Question 74

Warm, moist

Answer 74

Skin

Question 75

Present

Answer 75

Dehydration

Question 76

Rapid, deep Kussmal type/respirations: rapid and deep Acetone odor (fruity odor) to breath

Answer 76

Respirations

Question 77

Varies from alert to stuporous, obtunded, or frank coma: issues with this quickly; irritable at first, not quite right progress if not treated to coma

Answer 77

Mental status

Question 78

Issues with blurred vision, tachycardia None specific for DKA Acidosis; hypercapnia; abdominal cramps, N/V Dehydration: decreased neck vein filling, orthostatic hypotension, tachycardia, poor skin turgor

Answer 78

Symptoms

Question 79

>250

Answer 79

Glucose

Question 80

Positive - body trying break down other things to get glucose and produces the ketones in body

Answer 80

Ketones

Question 81

Not want pat be here Prevention is the best treatment! - check BG, not giving too much insulin, making sure eating Avoid: Treatments:

Answer 81

Hypoglycemia treatment

Question 82

Excess insulin Deficient intake or absorption of food Exercise Alcohol intake - give hypoglycemia because impact on liver because stops releasing glucose

Answer 82

Avoid:

Question 83

For patients who can tolerate oral intake: - awake and alert For patients who can not tolerate oral intake: - not want cause aspiration Frequent checks of PBG following treatment Follow protocols of health system/hospital

Answer 83

Treatments:

Question 84

Take 15-20 grams of oral glucose if PBG<70 - tab, gel, orange juice, candy, marshmallows Take 30 grams of oral glucose if PBG <50 Repeat in 15 minutes after initial treatment if glucose remains low

Answer 84

For patients who can tolerate oral intake: - awake and alert

Question 85

Give to self at home and convert glycogen in liver to glucose and increase BG Glucagon subcutaneous or intramuscular - short acting - follow up if good response with food to keep BG up; continually monitor because can go back down because can go back down to make sure not go back down 50% Dextrose intravenous - short acting - follow up if good response with food to keep BG up; continually monitor because can go back down because can go back down to make sure not go back down

Answer 85

For patients who can not tolerate oral intake: - not want cause aspiration

Question 86

T1DM come in with Uncontrolled hyperglycemia - key, metabolic acidosis - key, increased production of ketones Aciditic because body breaking down other things than glucose for energy and increased production of ketone bodies and causes lot CM Sudden onset Precipitating factor: infection, stress, inadequate insulin intake (not doing insulin regiment appropriate); have infection or stress increases insulin needs so pushes into DKA Manifestations: Emergency and typ straight to ICU Monitor: Treatment:

Answer 86

Diabetic ketoacidosis

Question 87

Ketosis (increased production of ketone bodies causes this which is an acidosis: have: Kussmaul respirations (RR trying blow off CO2 - get rid acid so better balance with pH); ketones produce fruity breath; nausea; abdominal pain) Dehydration and electrolyte loss/imbalance

Answer 87

Manifestations:

Question 88

Airway - acidosis LOC/mental status Hydration (VS; I&O) - rehydrate Electrolytes (assess for S/S of hypokalemia-fatigue, malaise, confusion, muscle weakness, shallow respirations, abdominal distention or paralytic ileus, hypotension, and weak pulse)

Answer 88

Monitor:

Question 89

Priority is give IV fluids to get BG back under control then give IV fluids so adequately hydrated then look at electrolytes if needed Regular insulin by continuous IV infusion Replace potassium (ensure urine output is at least 30 mL/hr) - common electrolyte imbalance (it being low) for these pats IV Sodium Bicarbonate (used only for severe acidosis) - body’s working recover from acidosis may need to give something alkalotic to get acidosis under control

Answer 89

Treatment:

Question 90

Hyperglucemic episode - T2DM Hyperosmolar (increased blood osmolarity) state caused by hyperglycemia Gradual onset Precipitating factor: dehydration; infection; poor fluid intake Higher BG with this than DKA Big emergency situation Manifestations: Monitor: Treatment:

Answer 90

Hyperglycemic-hyperosmolar state (HHS)

Question 91

Lot Neurological symptoms-seizures, myoclonic jerking, reversible paralysis Severe dehydration and electrolyte loss - more profound dehydration No ketone bodies

Answer 91

Manifestations:

Question 92

Airway LOC/mental status Hydration (VS; I&O) Electrolytes (assess for S/S of hypokalemia-fatigue, malaise, confusion, muscle weakness, shallow respirations, abdominal distention or paralytic ileus, hypotension, and weak pulse)

Answer 92

Monitor:

Question 93

IV fluids of NS if shock or severe hypotension, otherwise IV fluids of ½ NS - hydration most imp because can go into shock from dehydration and HTN Assess/watch for signs of cerebral edema (abrupt changes in mental status, abnormal neurological signs, coma) - all fluid replacement IV insulin is administered only after fluids have been replaced

Answer 93

Treatment:

Question 94

Serum glucose Osmolarity Serum ketones Serum pH Serum HCO3 Serum Na+ BUN Creatinine Urine ketones

Answer 94

DKA

Question 95

High >300

Answer 95

Serum glucose - DKA

Question 96

Variable

Answer 96

Osmolarity - DKA

Question 97

Positive at 1:2 dilutions

Answer 97

Serum ketones - DKA

Question 98

Because has ketones will have lower pH Less than 7.35

Answer 98

Serum pH - DKA

Question 99

Because severe acidosis Less than 15

Answer 99

Serum HCO3 - DKA

Question 100

Low, normal, or high

Answer 100

Serum Na+ - DKA

Question 101

Both dehydrated Greater than 30; elevated because of dehydration

Answer 101

BUN - DKA

Question 102

Both dehydrated Greater than 1.5; elevated because of dehydration

Answer 102

Creatinine - DKA

Question 103

Positive

Answer 103

Urine ketones - DKA

Question 104

Serum glucose Osmolarity Serum ketones Serum pH Serum HCO3 Serum Na+ BUN Creatinine Urine ketones

Answer 104

HHS

Question 105

Significantly high >600

Answer 105

Serum glucose - HHS

Question 106

High - causing severe dehydration - diuresising from high osmolarity >320

Answer 106

Osmolarity - HHS

Question 107

Not in serum or urine Negative

Answer 107

Serum ketones - HHS

Question 108

Greater than 7.4

Answer 108

Serum pH - HHS

Question 109

Greater than 20

Answer 109

Serum HCO3 - HHS

Question 110

Normal or low

Answer 110

Serum Na+ - HHS

Question 111

Both dehydrated Elevated

Answer 111

BUN - HHS

Question 112

Both dehydrated Elevated

Answer 112

Creatinine - HHS

Question 113

Negative

Answer 113

Urine ketones - HHS