Chapter 20 Diabetic Emergency Flashcards Preview

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Flashcards in Chapter 20 Diabetic Emergency Deck (66)
1

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

Diabetes Mellitus (DM)

2

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

carbohydrates, fats, and protein

3

What is the primary energy source for the cell?

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

4

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

glucose

5

What percentage of glucose is used by the body?

95%

6

What is the major source of fuel for the cell

glucose

7

which cells in the body can only use glucose?

brain cells

8

What is the most common sign of brain cell dysfunction?

Altered mental status

9

What is osmotic pressure?

the glucose molecule attracts water as it moves

10

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

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

Why do diabetic patients become dehydrated?

glucose spills over into urine and water follows leading to dehydration

12

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

Insulin & glucagon

13

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

Insulin

14

What are the 3 functions of insulin?

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

Does insulin facilitate the movement of glucose into the cell?

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

16

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

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

what is glucagon's main purpose

is to raise and maintain blood glucose levels

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

18

what is consider a normal glucose range

80-120mg/dL

19

What is the range 1 hour after a person eats?

120-140mg/dL

20

what is BGL?

Blood Glucose level

21

How long can glycogen be stored in the liver?

24-48 hours

22

What is a glucometer?

a portable device that determines blood glucose levels of a patient

23

what is (mg/dL)

milligrams per deciliter

24

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

Hypoglycemia

25

what is the primary sign of Hypoglycemia

Altered mental status

26

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

Hyperglycemia

27

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

Glucose meter
test strips
lancet
alcohol swab

28

what is the primary problem of diabetes mellitus

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

what is polydipsia

frequent thirst

30

What is polyuria

frequent urination

31

what is polyphagia

hunger

32

what are the three Ps that alert doctors to Diabetes Mellitus

polydipsia
polyuria
polyphagia

33

what is type 1 diabetes?

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

what is type 2 diabetes?

non-insulin-dependent diabetes Mellitus

35

In type 1 does the pancreas secret insulin

not typically

36

what is the peak age for the onset of type 1

10-14 years

37

what is the condition that type 1 diabetics are prone?

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

what happens when there is no insulin

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

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

blood glucose level

water follows glucose

40

increase glucose also increase the demand for what?

oxygen

41

What age group is most affected by Type 2 diabetes

middle age

42

Do type 2 patients present the three P;s

Yes, especially if the condition is untreated

43

what condition are type 2 diabetics prone

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

44

what is hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

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

Diabetes is more common in what race of people

Caucasians

46

Hypoglycemia facts:

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

47

why is hypoglycemia referred to as "insulin shock"

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

48

how fast can is the onset of hypoglycemia

a few to 20 minutes

49

why does hypoglycemia come on so rapid

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

50

what are the signs/symptoms caused by epinephrine release

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

51

what are the signs/symptoms caused by brain cell dysfunction

confusion
drowsiness
disorientation
unresponsiveness
seizures
strokelike symptoms

52

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

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

53

What is the emergency care for hypoglycemia?

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

What is oral glucose

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

55

What are the criteria for administering oral glucose?

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

56

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

glucose and insulin

57

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

greater than 350mg/dL

58

What are 2 problems of DKA

dehydration
acidosis

59

describe the process of DKA

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

what other symptoms can occur from DKS?

electrolyte imbalances that lead to cardiac disturbances

61

is there an early onset with DKA

No it takes several days to occur

62

factors that cause hyperglycemia is a DKA patient

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

What are the signs and symptoms of

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

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

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

65

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

No its caused by dehydration, fluid shift, and acidosis

66

What is Kussmaul respiration

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.