DKA / HHS

Question 1

Fast Facts on DKA:

1. ____ insulin present –> gluconeogisis and lipolysis –> _______ —> and ________
2. More common in Type ___ DM
3. Onset is ____ ( _____
4. Mortality rate

Answer 1

1. NO insulin present –> gluconeogisis and lipolysis –> ketone production –> ketoacidosis and hyperglycemia!
2. More Common in Type 1 DM
3. Onset is 13.9
4. Mortality rate

Question 2

What can cause DKA / HHS to develop? (7)

Answer 2

1. infection
2. MI
3. Tx errors with insulin
4. Dirarrhea / vomiting
5. Stroke
6. Trauma
7. Pancreatitis

Question 3

The stresses that lead to DKA / HHS developing causes what 3 things to be released?

Answer 3

1. glucagon
2. cortisol
3. catecholamines

Question 4

What are the S/S of DKA?

Answer 4

polyuria, polydipsia, polyphagia, blurred vision, weakness, headache, orthostatic hypotension, anorexia, n/v, abdmn pain, acetone (fruity) breath, hyperventiliation, altered LOC

Question 5

Why would a pt. with DKA be hyperventilating?

Answer 5

In an attempt to breath off the acidosis

Question 6

Dx for DKA:

1. Elevated (5)
2. Low (1)
3. Accumulation of what? (1)
4. Changes in what electrolytes? (4)

Answer 6

1. Elevated: BG, Creatinine, BUN, Hgb, Hct
2. Low bicarb
3. Accumulation of ketones in blood and urine
4. Na+, K+, PO4, Cl-

Question 7

Treatment involves what 3 key concepts for DKA

Answer 7

1. Rehydration
2. Restoring electrolytes
3. Reversing acidosis

Question 8

Nursing care Includes the nurse:

1. Admin IV fluids (NS or .45% NS, 6-10 L at 200-300 ml/hr for 2-3 hours)
2. Admin IV insulin
3. Admin K+
4. Assessing I/O (renal function)
5. ECG
6. VS
7. ABGs
8. BG
9. Monitor electrolytes
10. Admin medications for what may have been the stressor to cause DKA
11. Chest X ray, blood samples, urinlaysis (attempting to find infection)

Answer 8

boom

Question 9

Why might K+ levels decrease once the pt. is receiving insulin? (3)

Answer 9

1. Rehydration dilutes the concentration of K+
2. Renal excretion of K+
3. Insulin then causes K+ to move back into the cells, which can then lead to low levels of it in the bood stream

Question 10

HHS:

1. Insulin ____ –> gluconeogesis & lipolysis mainly ______ –> ketones mild/ ____ –>pH normal/mild
2. Mostly type __ DM
3. Onset _____
4. BG > ____
5. Mortality rate _____

Answer 10

1. Insulin present –> gluconeogesis & lipolysis mainly inhibitied –> ketones mild / absent –> pH normal / mild
2. Mostly Type 2 DM
3. Onset days –> weeks (develops more slowly)
4. BG >33.3
5. Mortality rate 10-40%

Question 11

S/S of HHS include (4)

Answer 11

1. hypotension
2. profound dehydration (dry mucous membranes, poor skin turogour)
3. tachycardia
4. varying neurological signs

Question 12

Treatment of HHS is similar to DKA. What are the considerations that are different?

Answer 12

Consider the neuro symptoms may take 3-5 days to clear

Consider this is often in older adults so consider age/factors /education