Chapter 20 Diabetic Emergency Flashcards Preview

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Flashcards in Chapter 20 Diabetic Emergency Deck (66)
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1
Q

ia condition in which there is a disturbance in the metabolism of carbs, fats, and protein

A

Diabetes Mellitus (DM)

2
Q

What are the 3 major food sources for the body’s cells?

A

carbohydrates, fats, and protein

3
Q

What is the primary energy source for the cell?

A
Carbohydrates (complex)
3 major sources
1. sucrose (table sugar)
2. lactose (milk & Dairy products)
3. starches (potatoes & Bread)
4
Q

Complex carbohydrates are broken down in the body into simple sugar known as?

A

glucose

5
Q

What percentage of glucose is used by the body?

A

95%

6
Q

What is the major source of fuel for the cell

A

glucose

7
Q

which cells in the body can only use glucose?

A

brain cells

8
Q

What is the most common sign of brain cell dysfunction?

A

Altered mental status

9
Q

What is osmotic pressure?

A

the glucose molecule attracts water as it moves

10
Q

Why is it dangerous to give glucose to a patient with a brain injury or stroke?

A

when giving glucose, the brain allows more glucose to cross into the cell bringing water with it. This leads to more edema (swelling) in the brain which will worsen brain & stroke.

11
Q

Why do diabetic patients become dehydrated?

A

glucose spills over into urine and water follows leading to dehydration

12
Q

What are the two hormones that are responsible for controlling glucose?

A

Insulin & glucagon

13
Q

What is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body.

A

Insulin

14
Q

What are the 3 functions of insulin?

A
  1. glucose out of blood into the cell
  2. cause liver to take glucose out of blood and convert it to glycogen
  3. decreases blood glucose by action of 1&2
15
Q

Does insulin facilitate the movement of glucose into the cell?

A

Yes, it attaches to a cell at a certain point and opens the door which allows a protein to carry glucose in.

16
Q

Do insulin and glucagon have the opposite effect on blood glucose levels

A

Yes
INSULIN ISECREATED WHEN GLUCOSE IS HIGH AND WORKS TO DECREASE BLOOD SUGAR LEVEL BY HELPING TO MOVE GLUCOSE OUT OF THE BLOOD INTO THE CELL

GLUCAGON IS SECRETED WHEN GLUCOSE IS LOW AND WILL WORK TO INCREASE GLUCOSE LEVELS

17
Q

what is glucagon’s main purpose

A

is to raise and maintain blood glucose levels

If glucose decrease below 70mg/dL glucagon is secreted.

18
Q

what is consider a normal glucose range

A

80-120mg/dL

19
Q

What is the range 1 hour after a person eats?

A

120-140mg/dL

20
Q

what is BGL?

A

Blood Glucose level

21
Q

How long can glycogen be stored in the liver?

A

24-48 hours

22
Q

What is a glucometer?

A

a portable device that determines blood glucose levels of a patient

23
Q

what is (mg/dL)

A

milligrams per deciliter

24
Q

what condition is defined as a BGL of 60mg/dL or less with signs/symptoms of hypoglycemia

or

50mg/dL without signs/symptoms of hypoglycemia

A

Hypoglycemia

25
Q

what is the primary sign of Hypoglycemia

A

Altered mental status

26
Q

A condition defined as a BGL of greater than 120mg/dL?

A

Hyperglycemia

27
Q

what supplies will you need to test with a glucose meter?

A

Glucose meter
test strips
lancet
alcohol swab

28
Q

what is the primary problem of diabetes mellitus

A

1) a lack of insulin being secreted by the pancreas

2) the inability of the cell receptors to recognize the insulin and allow the glucose to enter at a normal rate.

29
Q

what is polydipsia

A

frequent thirst

30
Q

What is polyuria

A

frequent urination

31
Q

what is polyphagia

A

hunger

32
Q

what are the three Ps that alert doctors to Diabetes Mellitus

A

polydipsia
polyuria
polyphagia

33
Q

what is type 1 diabetes?

A

insulin-dependent diabetes Mellitus

Type 1 diabetes occurs when the body’s own immune system destroys the insulin-producing cells of the pancreas (called beta cells).

34
Q

what is type 2 diabetes?

A

non-insulin-dependent diabetes Mellitus

35
Q

In type 1 does the pancreas secret insulin

A

not typically

36
Q

what is the peak age for the onset of type 1

A

10-14 years

37
Q

what is the condition that type 1 diabetics are prone?

A
diabetic ketoacidosis (DKA)
is a life-threatening hyperglycemic condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy, such as when you have diabetes and do not take enough insulin.
38
Q

what happens when there is no insulin

A

the body cannot use sugar for energy.
When the cells do not receive sugar, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis.

39
Q

If a patient presents with signs of dehydration what should you check? Why

A

blood glucose level

water follows glucose

40
Q

increase glucose also increase the demand for what?

A

oxygen

41
Q

What age group is most affected by Type 2 diabetes

A

middle age

42
Q

Do type 2 patients present the three P;s

A

Yes, especially if the condition is untreated

43
Q

what condition are type 2 diabetics prone

A

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

44
Q

what is hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

A

is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection.

45
Q

Diabetes is more common in what race of people

A

Caucasians

46
Q

Hypoglycemia facts:

A
  1. more common in type 1 patients
  2. most dangerous complication in diabetes mellitus
  3. most common cause of coma in diabetic patients
47
Q

why is hypoglycemia referred to as “insulin shock”

A

because of the shock like signs and symptoms seen with the condition which is caused by the release of epinephrine

48
Q

how fast can is the onset of hypoglycemia

A

a few to 20 minutes

49
Q

why does hypoglycemia come on so rapid

A

it is due to the rapid decline in brain function and secretion of epinephrine associated with a lack of glucose

50
Q

what are the signs/symptoms caused by epinephrine release

A
diaphoresis (sweating)
tremors
weakness
hunger
tachycardia
dizziness
pale, cool, clammy skin
warm sensation
51
Q

what are the signs/symptoms caused by brain cell dysfunction

A
confusion
drowsiness
disorientation
unresponsiveness
seizures
strokelike symptoms
52
Q

why must a patient that appears to be have an altered mental status, bizarre behavior, violence, or appears intoxicated be assessed for hypoglycemia?

A

because alcohol inhibits the body’s ability to convert other noncarbohydrate substances into glucose during hypogycemeia

53
Q

What is the emergency care for hypoglycemia?

A

unresponsive , unable to swallow, or unable to follow commands

  1. establish open airway
  2. SpO2 is<94 or signs of respiratory distress, hypoxia, hypoxemia, poor perfusion administer oxygen via nasal cannula
  3. if signs of serve hypoxia use nonrebreather mask at 15 lpm
  4. inadequate breathing=provide positive pressure ventilation.
  5. contact ALS
  6. Access BGL

if altered mental status, able to swallow/follow commands

  1. ensure patent airway
  2. assess BGL
  3. administer 1 tube glucose
54
Q

What is oral glucose

A

gel is an over-the-counter medication, consisting primarily of dextrose and water, along with small amounts of other compounds

55
Q

What are the criteria for administering oral glucose?

A
  1. altered mental status
  2. history of diabetes or BGL less than 50mg/dL
  3. has the ability to swallow
56
Q

Hyperglycemic patients have to much _____in the blood and not enough________?

A

glucose and insulin

57
Q

What is the mg/dL in diabetic ketoacidosis (DKA)

A

greater than 350mg/dL

58
Q

What are 2 problems of DKA

A

dehydration

acidosis

59
Q

describe the process of DKA

A

not enough insulin signals body that glucose is need so liver secrets glycogen but the cells still cant get the glucose so the liver metabolize fat which releases ketones (high acid) which get into the urine. The glucose and ketone attract water that goes into the urine and causes dehydrstion

60
Q

what other symptoms can occur from DKS?

A

electrolyte imbalances that lead to cardiac disturbances

61
Q

is there an early onset with DKA

A

No it takes several days to occur

62
Q

factors that cause hyperglycemia is a DKA patient

A
  1. suffering from infection that upset inulin/glucose balance.
  2. inadequate dose of insulin
  3. taking medication such as Dilantin or steroids
  4. surgery, trauma, pregnancy ot heart attack
  5. increased carb or sugar intake
63
Q

What are the signs and symptoms of

A
Polyuria
polyphagia
polydipsia
nausea/vomiting
poor skin turgor
tachycardia
rapid deep respirations 
fruity breath
BGL greater than 350
Muscle cramps
abdominal pain ( common in children)
warm dry skin
altered mental status
coma (late stage)
64
Q

is poor turgor useful to determine DKA in elderly patients? Why

A

NO because poor skin turgor in elderly is caused by the normal loss of skin elasticity

65
Q

In DKA patient is their alerted mental status caused by the lack of glucose reaching the brain?

A

No its caused by dehydration, fluid shift, and acidosis

66
Q

What is Kussmaul respiration

A

deep, rapid breathing usually as compensation for a metabolic acidosis, especially that seen with Diabetic Ketoacidosis - as a result of too much sugar in the blood
Note that at onset, it is shallow and as metabolic acidosis develops, it becomes deep and rapid. This is commonly seen in patient facing imminent death due to multiple organ failure particularly the kidneys secondary to hyperglycemia.