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16 Cards in this Set
- Front
- Back
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What type of diabetes do we most commonly see DKA?
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DMI
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What type of diabetes do we most commonly see HHNS?
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DMII
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What s/s are involved in DKA?
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-severe dehydration (poor turgor, dry mucous membranes, tachycardia, orthostatic hypotension)
-abdominal pain, anorexia, n/v -kussmaul respirations (attempt to increase pH by blowing off CO2) -fruity odor breath -profound hyperglycemia (glucose >250) -serum pH <7.3, HCO3 <15 -ketones in blood and urine -osmotic diuresis (polyuria, polydipsia, polyphagia) |
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What s/s are involved in HHNS?
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-hallmark: extremely high plasma glucose causing hyperosmolarity and osmotic diuresis
-ketosis is absent or mild -inability to replace fluids, lost in diuresis -profound dehydration (changes in LOC) -blood glucose >600 -arterial pH >7.3 -bicarb >15 -minimal ketonemia and ketonuria |
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What is the patho behind the s/s in DKA?
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-no insulin stimulates lipolysis which goes to fatty acids
-fatty acids convert to ketone bodies in liver by glucagons -ketosis -decrease pH (acidosis -blood is hyperosmolar from increase in glucose -glucose stays in blood instead of entering the cells |
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What is the patho behind the s/s in HHNS?
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-low insulin, glucose cannot go into cells
-severe blood hyperosmolar state -pt has enough insulin to prevent ketosis -usually caused from decrease in fluid intake r/t illness or debilitation -coma is more frequent that DKA.and mortality is 10x greater than DKA -typically caused from serious illness |
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How does DKA differ from HHNS?
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-primary difference: ketoacidosis does not usually occur in HHNS. because pt has enough insulin to prevent ketoacidosis.
-high glucose levels before s/s are seen. this increase serum osmolarity and produce more severe neuro s/s (coma, seizures) -HHS usually related to impaired thirst or inability to take PO fluids usually pt with DMI do not develop HHS |
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How is DKA treated?
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-reverse dehydration immediately: NS or 1/2NS (FIRST)
-replace insulin (Check K level first) -reverse ketoacidosis |
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What is included in a hydration assessment?
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-hourly I & O's
-BP changes: orthostatics, pulse (rate and rhythm) -skin turgor -skin moisture -body weight -CVP -pt c/o thirst |
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How is HHNS treated?
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-similar to DKA
-fluid replacement -insulin administration -electrolyte replacement -hypokalemia not as pronounced with HHNS -HHS requires greater fluid replacement |
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GA is diagnosed with HHNS. His pH will be _________ and his glucose will be __________?
A. high, high B. normal, normal C. normal, high D. low, high |
C. normal, high
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The RN is concerned about what specific thing in a patient with HHNS?
A. dehydration B. acidosis C. hypoglycemia D. fluid overload |
A. dehydration
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What are potential complications of DKA?
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-fluid volume excess
-hypoglycemia less than 70 (s/s: change in LOC, diaphoresis, tremors) -hyper or hypo K |
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EC is on an insulin drip in the ICU. Besides checking serum glucose levels, what else doe the nurse need to monitor?
A. sodium B. potassium C. calcium D. BUN |
B. potassium
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What causes the acidosis in DKA?
A. lactic acid buildup B. decreased respiratory drive C. dehydration D. ketone buildup |
D. ketone buildup
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What are the most common reason HHNS occurs?
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infection (pneumonia, UTI)
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