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25 Cards in this Set
- Front
- Back
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What are consequences of deficient PMN's in DM pts?
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impaired adherance, phagocytosis, and bactericidal activity
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What is target blood glucose range for hospitalized DM pts?
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120-200
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Why are oral hyperglycemic agents ineffective during an acute illness?
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Because acute illness is assoc. with significant stress response, inadequate nutritional intake, and increased tissue requirement for energy all of which lead to increased secretion of catecholamines, cortisol, GH, and glucagon which in turn lead to insulin secretion and increased insulin resistance
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T or F? Hospitalized DM pts are best managed with IV insulin.
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True
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What is used to determine the initial dose of insulin for a hospitalized DM pt?
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body weight, severity of hyperglycemia, knowledge of previous Hx of diabetic Tx and its effectiveness
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What are general guidelines for starting insulin in a hospitalized DM pt?
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.5U/kg - 75% for meal mediated glycemia and 25% for overnight plasma glucose
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Can a sliding scale be used for effective mgmt. of a hospitalized DM pt?
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no
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What characterizes DKA?
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hyperglycemia, ketosis, and acidosis
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What characterizes HHNKS?
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plasma glucose>600, plasma osmolality>320, little or no ketones, arterial pH>7.3
typically DMII >50y.o. |
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Tx of DKA or HHNKS?
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*dx and tx rapidly
*restore blood volume/support BP to maintain organ perfusion *IV insulin *electrolyte replacement *minimize thrombolic events *look for and treat concurrent illness |
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How do you perform fluid replacement in DKA/HHNKS?
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*NS 1L/hr x 1-2hrs then 500mL/hr x 4hrs then 250mL/hr thereafter
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If a pt has a fluid deficit of 5-8L of body water, how much Na/K should be given?
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300-1000mEq of K
400-700mEq of Na |
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T or F? Rehydration itself lowers blood glucose via increased renal perfusion and glucose excretion and by decreasing plasma levels of circulating hormones.
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True
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If a pt has HHNKS, what should you consider switching to after the first hour of fluid replacement, esp. if hyponatremia is present?
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hypotonic solution
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What are starting doses of IV insulin infusion for DKA and HHNKS? How often should blood glucose be monitored?
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DKA: 5-10U/hr
HHNKS: 1-5U/hr monitor BG every hour |
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What are Tx goals for DKA/HHNKS?
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75-90mg/dL decrease/hr until 250 then maintained at 2-4U/hr and glucose infusion until ketosis and acidosis are resolved
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How does death typically occur in DKA?
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hypokalemia
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How do you maintain K replacement in DKA?
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20-30mEq/hr unless hypokalemia is present, then 40-80mEq/hr
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When do you use Bicarb in DKA patients?
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only if they are in imminent danger of cardiovascular collapse - otherwise of no benefit and may increase ketone production
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Define nociceptive pain.
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typically the result of musculoskeletal or visceral injury or disease. MS pain characterized by: aching, throbbing, stabbing, and/or sensation of pressure. Visceral pain characterized by: gnawing, cramping, aching, sharp, and/or stabbing sensations
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Define neuropathic pain.
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caused by lesions or physiologic changes in nervous system. Characterized by hypersensitivity to damaged and surrounding areas and often has qualities of burning, tingling, shooting (electrical shock), numbness.
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How do you treat dyspnea in a terminally ill pt?
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o2, low dose inhaled morphine, delottid, fentanyl, lasix
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How do you treat n/v in a terminally ill pt?
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try to det. cause. can treat with haldol. r/o constipation
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How do you treat depression in a terminally ill pt?
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psychostimulants (adderall)
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define infection
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microbial phenomenon char. by inflammatory response to presence of microorganisms or invasion of normally sterile host tissue by those organisms.
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