Endocrine: Diabetes Complications (DKA, HHNK or HHS, etc) Flashcards
What types of things can throw a client into DKA ?
Anything that increases blood sugar
(ex: illness, infection, skipping insulin)
What may be the first sign of Diabetes ?
DKA
How does DKA present ?
All the usual s/s of Type 1 diabetes (3 P’s)
Pathophysiology of DKA
____1.____ or ____2._____ insulin –> blood sugar goes ___3.___ ____4.___ –> causing ____5._____, ____6._____, ____7.______ –> ____8.__ breakdown (____9.____), –> which leads to ____10._______ _____11._____ (trying to blow off CO2 to compensate for the metabolic acidosis). Also, as the client becomes more acidotic, the LOC ___12.____ ____13.____.
- Absent
- inadequate
- sky
- high
- Polyuria
- Polydipsia
- Polyphagia
- Fat
- Acidosis
- Kussmaul
- Respirations
- goes
- down
What happens to a clients LOC as they become more Acidotic ?
There LOC goes down
In DKA what do you have ?
Which leads to what? and what ?
Very little or no insulin and severe hyperglycemia
Which leads to fat breakdown
and then metabolic acidosis
What are the Tx’s for DKA ?
- Find the cause
- Hourly blood sugars and K+ levels
- IV insulin
the insulin decreases the blood sugar and K+ by driving them out of the vascular space and into the cell - ECG (b/c of the K+)
- Hourly outputs (b/c the polyuria causes shock)
- ABG’s (metabolic acidosis)
- IV Fluids (b/c the polyuria causes shock) (need 2 large bore IV’s)
start with NS, then when the blood sugar gets down to 250 to 300mg/dL, switch to D5W to prevent Hypoglycemia - Anticipate that the PCP will want to add K+ to the IV solution at some point
(d/t lowering potassium)
What is another complication of Diabetes that looks like DKA but has no acidosis ?
Hyperosmolar Hyperglycemic Nonketosis (HHNK) or Hyperglycemic Hyperosmolar State (HHS)
Hyperosmolar Hyperglycemic Nonketosis (HHNK) or Hyperglycemic Hyperosmolar State (HHS) are commonly characterized by what types of blood sugars ?
Blood sugars > 600
With HHNK or HHS why is the body not breaking down fats ?
Because the body is making just enough insulin
With HHNK or HHS, no fat breakdown = ?
No ketones
With HHNK or HHS, no ketones = ?
No acids
Will clients with HHNK or HHS have Kussmaul respirations ?
No !
b/c they are not acidotic b/c they these clients are not breaking down fats
TESTING STRATEGY
In the NCLEX world…
Type 1 –> _______
Type 2 –> _______
Type 1 –> DKA
Type 2 –> HHNK (HHS)
DKA & HHNK (HHS) are both what ?
Hyperosmolar states (caused by hyperglycemia and dehydration
