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Level 3 > Complex Exam 4 - metabolism: diabetes > Flashcards

Complex Exam 4 - metabolism: diabetes Flashcards

1
Q

What type of diabetes does DKA occur with?

A

Type 1

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2
Q

What is the blood glucose level with DKA?

A

> 300 mg/dL

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3
Q

What can metabolic acidosis lead to with DKA?

A

coma

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4
Q

What is present in the blood and urine with DKA?

A

ketones

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5
Q

What is the onset of DKA?

A
  • rapid
  • 48-72 hours
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6
Q

Do the 3 P’s occur with DKA?

A

yes

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7
Q

What type of respirations occur with DKA?

A

kussmaul

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8
Q

When is fruity breath present?

A

DKA

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9
Q

What neurological changes can occur with DKA?

A
  • blurred vision
  • HA
  • weakness
  • ortho hypo
  • mental status changes
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10
Q

What GI manifestations occur with DKA?

A
  • weight LOSS
  • N/V
  • GI pain
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11
Q

Why would cerebral edema occur with DKA or HHS?

A

if fluids are given too quickly

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12
Q

What F&E imbalances can occur with DKA and HHS?

A
  • hypokalemia
  • hypoglycemia
  • hypovolemia (dehydration)
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13
Q

How is insulin given for DKA?

A

via drip

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14
Q

When is 1/2 D5 added to NS with DKA and HHS?

A

when blood glucose reaches 250

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15
Q

When is potassium added to the drip with DKA?

A

if hypokalemia occurs

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16
Q

How should glucose levels be brought down with DKA?

A

slowly

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17
Q

How often should blood glucose levels be checked with DKA?

A

hourly

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18
Q

How should insulin be given once a DKA patient is stable?

A

sliding scale SQ

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19
Q

What happens to potassium levels with DKA?

A
  • initially elevated
  • decreased with treatment
20
Q

Why are BUN and creatinine increased with DKA?

A

dehydration

21
Q

What type of diabetes does HHS occur with?

A

Type 2

22
Q

What is the blood glucose level with HHS?

A

> 600 mg/dL

23
Q

Are ketones present with HHS?

A

no

24
Q

Who is at the highest risk for HHS?

A

older adults aged 50-70 with a mortality rate of 40-70%

25
Q

What medications can cause HHS?

A
  • glucocorticoids
  • thiazide diuretics
  • phenytoin
  • beta blockers
  • calcium channel blockers
26
Q

What can lack in the body that can cause HHS?

A
  • insulin
  • fluids
  • kidney function
27
Q

What can be present in the body that can cause HHS?

A
  • MI
  • cerebral vascular injury
  • sepsis
  • infection
  • stress
28
Q

Can HHS cause the 3 p’s?

A

yes

29
Q

What can dehydration cause with HHS?

A
  • blurred vision
  • HA
  • weakness
30
Q

What can an increased osmolarity (>350) cause with HHS?

A
  • seizures
  • myoclonic jerking
31
Q

What can occur with HHS but is reversible?

A
  • paralysis
  • coma
32
Q

At what osmolarity do neurological deficits occur?

A

> 315

33
Q

What follows rapid isotonic fluid replacement with HHS?

A

hypotonic fluids (0.45% NS)

34
Q

How is insulin given with HHS?

A
  • start with 0.1-0.15 unit/kg IV bolus
  • follow with 0.1 unit/kg/hr continuous infusion
35
Q

If an HHS patient experiences acidosis, what should be given?

A

sodium bicarbonate with potassium by slow IV infusion

36
Q

How can the risk of dehydration be reduced with HHS?

A
  • fluid intake of 2-3 L/day
  • consume sugar for low BG
37
Q

How often should blood glucose be monitored with HHS?

A

q 4 h

38
Q

What should be given to a patient with HHS if they cannot tolerate solid food?

A

liquids with carbs and electrolytes (sports drink)

39
Q

When should the provider be notified with HHS?

A
  • ill longer than 24 hours
  • BG > 250
  • inability to tolerate foods/liquids
  • ketones in the urine for more than 24 hours
  • temp of 101.5 for 24 hours
40
Q

What are the characteristics of the skin with hypoglycemia?

A
  • cool
  • clammy
  • sweaty
41
Q

What are other signs/symptoms of hypoglycemia?

A
  • shakiness
  • confusion
  • palpitations
  • HA
  • lack of coordination
  • blurred vision
  • seizures, coma
42
Q

What blood glucose occurs with hypoglycemia?

A

< 70

43
Q

What should be given to a conscious hypoglycemic patient?

A

15-20 g carbs

44
Q

What should be done 15 minutes after giving carbs to a conscious hypoglycemic patient?

A
  • recheck blood glucose
  • give a carb and a protein
45
Q

What are examples of things you can give to a conscious hypoglycemic patient?

A
  • 4-6 oz fruit juice or soft drink
  • glucose tablets or gel
  • 6-10 hard candies
  • 1 tbsp honey
46
Q

What should be given to a hypoglycemic patient who is unconscious or unable to swallow?

A

glucagon SQ or IM or 50 % dextrose if available

Level 3 (29 decks)

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