T2: DKA, HHS, SIADH, DI

Question 1

What is DKA caused by

Answer 1

profound deficiency of insulin

Question 2

what is DKA characterized by

Answer 2

Hyperglycemia
Ketosis
Acidosis
Dehydration

Question 3

DKA is more likely to develop in why type of diabetic

Answer 3

type 1

Question 4

pH normal range

Answer 4

7.35-7.45

Question 5

PaCO2 normal range

Answer 5

35-45 mm Hg

Question 6

HCO3 normal range

Answer 6

22-26

Question 7

blood glucose in DKA

Answer 7

≥ 250 mg/dL

Question 8

main s/s of hyperglycemia

Answer 8

polyuria
polydipsia
polyphagia
“hot and dry, sugar high”

Question 9

precipitating factors of DKA

Answer 9

-Illness
-Infection
-Inadequate insulin dosage
-Undiagnosed type 1 diabetes
-Poor self-management
-Neglect

Question 10

clinical manifestations of DKA

Answer 10

-Dehydration (poor skin turgor, dry mucus membranes, tachycardia, orthostatic hypotension)
-Lethargy and weakness early
-skin is dry and loose, eyes become soft and sunken
-Abdominal pain/ anorexia, nausea, vomiting
-Kussmaul Respirations
-Acetone breath

Question 11

blood pH in DKA

Answer 11

lower than 7.30

Question 12

serum bicarb in DKA

Answer 12

< 16 mEq/L

Question 13

UA in DKA

Answer 13

Moderate to high ketone levels in urine or serum

Question 14

fluids for DKA

Answer 14

start on 0.9% NS
when BG reaches 250mg/dL, add 5-10% dextrose to 1/2 NS

Question 15

when the BG reaches 250 mg/dL

Answer 15

add 5-10% dextrose to 1/2 NS, turn off insulin drip, then begin sub-q insulin, and take off NPO

Question 16

HINT HINT: what is the rate for continuous regular insulin

Answer 16

0.1 U/kg/hr

Question 17

what are the IV/Lines needed in a patient in DKA?

Answer 17

A line: to get ABGs
2 IV access: one for fluids and one for insulin

Question 18

what is the rate we want to restore the UO to in DKA

Answer 18

30-60 mL/hr

Question 19

measuring potassium in patient with DKA:

Answer 19

If the patient is hypokalemic, insulin administration will further decrease the potassium levels since insulin drives potassium into the cells, may need to give potassium replacement

Question 20

what do we do if the patient becomes hypoglycemic

Answer 20

push D50

Question 21

Hyperosmolar hyperglycemic syndrome (HHS)

Answer 21

a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion

Question 22

what type of diabetes does HHS occur more in

Answer 22

type 2

Question 23

precipitating factors of HHS

Answer 23

*UTIs, pneumonia, sepsis
*Acute illness
*Newly diagnosed type 2 diabetes
*Impaired thirst sensation and/or inability to replace fluids

Question 24

glucose levels in HHS

Answer 24

> 600 mg/dL

Question 25

UA in HHS

Answer 25

Ketone bodies are absent or minimal in both blood and urine

Question 26

management for HHS

Answer 26

includes immediate IV administration insulin and either 0.9% or 0.45% NaCl, When blood glucose levels fall to approximately 250 mg/dL, IV fluids containing dextrose are administered to prevent hypoglycemia.

Question 27

what is a useful aid in detecting hyperkalemia and hypokalemia

Answer 27

cardiac monitoring

Question 28

rapid insulin onset rapid insulin peak Rapid insulin duration

Answer 28

10-30min 30min-3hr 3-5 hrs

Question 29

Short acting insulin onset short acting insulin peak short acting insulin duration

Answer 29

30min-1hr 2-5 hr 5-8 hours

Question 30

intermediate acting insulin onset intermediate acting insulin peak intermediate acting insulin duration

Answer 30

1.5-4 hours 4-12 hours 12-18 hours

Question 31

long acting insulin onset long acting insulin peak long acting insulin duration

Answer 31

0.8-4 hours none 24 hours

Question 32

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by

Answer 32

*fluid retention, *dilutional hyponatremia *Concentrated urine

Question 33

clinical manifestations of SIADH

Answer 33

-Low urine output Increased weight -Initially, thirst -Dyspnea on exertion -Fatigue

Question 34

diagnosis of SIADH

Answer 34

get blood and urine samples at SAME TIME

Question 35

serum sodium in SIADH

Answer 35

<135 (dilutional hyponatremia from excess fluid)

Question 36

urine specific gravity in SIADH

Answer 36

>1.025 (amber urine)

Question 37

Pathophysiology Map of SIADH

Answer 37

-Increased Antidiuretic Hormone -Increased water reabsorption in renal tubules -Increased intravascular fluid volume -Dilutional hyponatremia and decreased serum osmolality

Question 38

Causes of SIADH

Answer 38

-Malignant Tumors; cancers -CNS Disorders; head injuries, stroke, infection, Guillain-Barre, SLE (SWELLING IN BRAIN PUSHING ON PITUITARY) -Drug Therapy; Tegretol, general anesthesia, opiods, thiazides, SSRI, Chemotherapy -Miscellaneous; hypothyroid, COPD, HIV, and Adrenal insufficiency

Question 39

management for SIADH

Answer 39

-loop diuretics -Monitor urine output and urine specific gravity -Daily weights, I&O, vital signs, monitor Lab values -Monitor for seizures, headache, vomiting, and decreased neurological function -fluid restrictions: Provide frequent oral care

Question 40

In extreme dilutional hyponatremia give

Answer 40

3% fluid

Question 41

Medications to treat SIADH

Answer 41

-Demeclocycline -Vassopressor receptor antagonists -loop diuretics -sodium and potassium replacement

Question 42

Demeclocycline action

Answer 42

blocks the effect of antidiuretic hormone on renal tubules resulting in more dilute urine.

Question 43

Vasopressor Receptor Antagonists action

Answer 43

block the activity of antidiuretic hormone to treat hyponatremia

Question 44

loop diruetic action

Answer 44

promotes diuresis

Question 45

diabetes insipidus (DI)

Answer 45

antidiuretic hormone (ADH) is not secreted, or there is a resistance of the kidney to ADH "PEE THEIR BRAINS OUT"

Question 46

Central DI causes

Answer 46

Head injury, surgery, CNS infections

Question 47

clinical manifestations of DI

Answer 47

polyuria, polydipsia (2 to 20 L/day)

Question 48

urine specific gravity in DI

Answer 48

< 1.005 (dilute urine)

Question 49

serum sodium in DI

Answer 49

>145mg/dl

Question 50

HINT HINT: DDAVP (desmopressin) is used for

Answer 50

diagnosis of DI

Question 51

Water deprivation test

Answer 51

for diagnosis of DI no water intake 2-3 hours followed by hourly measurements of urine vol/oslmolarity and plasma Na+ conc. and osmolarity

Question 52

important things to know about a hypophysectomy

Answer 52

biopsy of pituitary -check "mustache dressing" for CSF making sure it is not saturated with fluid -keep HOB up

Question 53

what can be given if a lot of CSF is present after a hypophysectomy

Answer 53

caffiene or vasoconstrictors

Question 54

management for DI

Answer 54

-Maintain adequate hydration, IV or PO -Maintain electrolyte balance -Monitor BP, HR, LOC, I&O -Monitor specific gravity-urine or serum

Question 55

Hypokalemia EKG changes

Answer 55

ST depression T inversion U wave

Question 56

Hyperkalemia EKG changes

Answer 56

Tall T wave Flat P wave Wide QRS Prolonged PR

Question 57

DDAVP for central DI is a

Answer 57

hormone replacement

Question 58

what is important when a client is on DDAVP

Answer 58

monitor pulse

Question 59

diet considerations for DI

Answer 59

LOW sodium diet

Question 60

HINT HINT: indocine (NSAID) and DI

Answer 60

helps increase renal responsiveness to ADH (watch for bleeding in the gut)