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Define Ketoacidosis Quizlet

Nurs 355 Chapter 33

Nurs 355 Chapter 33

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? Replacement therapy requires daily subcutaneous injections. Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? PPP may be viewed as a variation in sexual development PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH. The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? Encourage the child to wear medical identification DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limite Continue reading >>

Diabetic Ketoacidosis And Patho

Diabetic Ketoacidosis And Patho

pathophysiology ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing) acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients elevated anion gap Methanol intoxication Uremic acidosis Diabetic ketoacidosis Paraldehyde ingestions Intoxicants (salicyclate, ethylene glycol, nipride, epinephrine, norepinephrine) Lactic acidosis (drug induced; didanosine, iron, isoniazid, metformin, zidovudine) Ethanol ketoacidosis Severe renal failure starvation Blood glucose regulation (6) 1. When blood glucose levels rise above a set point, 2. the pancreas secretes insulin into the blood. 3. Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels. 4. When glucose levels drop below a set point, 5. the pancreas secretes glucagon into the blood. 6. Glucagon promotes the breakdown of glycogen and the release of glucose into the blood. (The pancreas signals distant cells to regulate levels in the blood = endocrine function.) Insulin and Glucagon (Regulation) (10) 1. High blood glucose 2. Beta cells 3. Insulin 4. Glucose enters cell 5. Blood glucose lowered 6. Low blood glucose 7. Alpha cells 8. Glucagon 9. Liver releases glucose from glycogen 10. Blood glucose raised What is the manifestations (symptoms) of Type 1? (10) 1. Extreme thirst 2. Frequent urination 3. Drowsiness, lethargy 4. Sugar in urine 5. Sudden vision change 6. Increased appetite 7. Sudden weight loss 8. Fruity, sweet, or wine like odor on breath 9. Heavy, laboured breathing 10. Stupor, unconscious Continue reading >>

What`s The Difference Between Diabetic And Insulin Comas?

What`s The Difference Between Diabetic And Insulin Comas?

Dear Dr. Johnson: What is the difference between a diabetic coma and an insulin coma? A diabetic coma is the result of hyperglycemia--too much blood sugar --and typically develops slowly over a matter of hours or days as blood sugar and other unwanted blood products build up in the body. Diabetic coma is treated with insulin administered intravenously. This lowers the blood sugar level. Insulin shock is caused by too much insulin, a state that leads to hypoglycemia--too little blood sugar. This condition can come on very rapidly in a person taking insulin for diabetes; therefore, diabetics are instructed to recognize hypoglycemia`s early warning symptoms (mental changes, sweating, etc.) and then to take action to raise their blood sugar levels. When a person with diabetes is found in an unconscious state, it is often difficult to know whether it is the result of a blood sugar level that is too high or too low. Therefore, the usual course of action is to raise the blood sugar level until testing confirms the nature of the problem. There will be little danger in giving added blood sugar to an individual with an already high level, and it might be lifesaving if the problem is low blood sugar. Dear Dr. Johnson: What is your opinion on the current debate on whether restaurants and fast-food joints should list the ingredients of the foods they prepare? I personally favor a simple form of ingredient listing that would give the percentages of fat, carbohydrates and protein as well as the calorie and salt content of foods. I don`t think all ingredients have to be listed, though I do believe the information should be made available if someone requests it. I think we all would be well served by having the major items of nutritional interest for public view. Continue reading >>

Chapter 16: The Endocrine System (study Modules 16.09-16.11)

Chapter 16: The Endocrine System (study Modules 16.09-16.11)

Sort Match the following hormone with its function: Insulin Increases Na+ reabsorption in the kidneys Facilitates glucose transport into cells Stimulates embryonic cells (stem cells) to undergo mitosis Causes kidneys to conserve water Increases cell reactions during sympathetic response Facilitates glucose transport into cells Match the following hormone with the appropriate category of hormones: Androgens Gonadocorticoids Mineralocorticoids Glucocorticoids Gonadotropins Gonadocorticoids Sympathetic nerve stimuli are responsible for the release of __________. estrogen insulin aldosterone epinephrine thyroid hormone epinephrine Match the following homeostatic imbalance with the hormone deficiency (or overproduction): Diabetes insipidus Hyposecretion of ADH Insulin deficiency Oversecretion of catecholamines Overproduction of GH Hypersecretion of thyroid hormone Hyposecretion of ADH Insulin enhances the membrane transport of glucose in all of the following tissues except __________. the brain the myocardium skeletal muscle adipose tissue the brain Match the following gland with the hormone it produces (or releases): Adrenal medulla Insulin Growth hormone Antidiuretic hormone Aldosterone Epinephrine Epinephrine Match the following hormone with the condition that would be balanced by that hormone: Insulin High levels of blood sugar Dehydration and low blood pressure Decrease in blood Ca2+ levels Decrease in body metabolism Loss of Na+ from extracellular fluids High levels of blood sugar Which of the following homeostatic imbalances usually results from deficits in both glucocorticoids and mineralocorticoids? Cretinism Graves' disease Cushing's syndrome Addison's disease Addison's disease Match the following hormone with the appropriate category of hormones: Cortisol Gonadotr Continue reading >>

Emt - Chapter 17

Emt - Chapter 17

Sort A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she: is significantly hyperglycemic. A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing: a heart attack. A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma and the patient's blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should: suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital. A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2 diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your primary assessment reveals that the patient is unresponsive and not breathing. You should check for a carotid pulse for no longer than 10 seconds. You are treating a 40-year-old male with a documented blood sugar reading of 300 mg/dL. The patient is semiconscious and breathing shallowly, and is receiving assisted ventilation from y Continue reading >>

Acute Complications Of Diabetes Mellitus

Acute Complications Of Diabetes Mellitus

Sort Diabetic Ketoacidosis: Collaborative Care • Continuous cardiac monitoring • Start a large bore intravenous line • Administer fluid replacement • Place an indwelling urinary catheter • Monitor serum electrolyte and glucose levels • Replace potassium before administering insulin • Administer Regular Insulin infusion starting at 0.1 units/kg/hour • Monitor blood glucose levels frequently (Q 1 hr) - Blood glucose should fall at a rate of 30 to 50 mg/dL per hour • Monitor fluid status Hyperosmolar Hyperglycemic Syndrome: treatments • Treatments - Fluid replacement • IV 0.9% Sodium Chloride followed by 0.45% Sodium Chloride • Dextrose may be added to IV fluids when blood glucose is 250 mg/dl to prevent hypoglycemia - IV Regular insulin via an infusion pump (in dosages similar to those used in DKA) - Monitor fluid and electrolyte status. • Hypokalemia not as significant as with DKA. Continue reading >>

Chapter 25

Chapter 25

Sort Characteristics of Cushing's syndrome include all of the following EXCEPT: The following are included - heavy body and round face - atrophied skeletal muscle in the limbs - atrophy of the lymph nodes STARING EYES WITH INFREQUENT BLINKING page 566 The anterior pituitary gland secretes all of the following hormones EXCEPT: The following is secreted by the anterior pituitary gland: - prolactain (PRL) - adrenocorticotropic hormone (ACTH) - growth hormone (GH) - antidiuretic hormone GLUCAGON Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State

Sort Describe treatment of volume status in DKA/HHS Administer NaCl (0.9% if low Na, 0.45% if normal or high) @ 15-20 mL/kg (1-1.5 L) for 1 hour Administer NaCl (0.9 or 0.45%) @ 250-500 mL/h for 24 hours Can switch to D5W+1/2NS to allow for continued insulin @ 250-500 mL/h Describe administration of potassium in DKA/HHS K < 3.3 Hold insulin (insulin causes K levels in decrease due to intracellular shift) K 20-40 mEq/h K: 3.4-5.2 Continue K 20-30 mEq/h (b/c as insulin is given K will go down) K > 5.2 Check q2h Describe treatment of blood glucose in DKA/HHS Goal: 150-200 mg/dL (DKA) or 250-300 mg/dL (HHS) Start insulin drip 0.14U/kg/h or 0.1U/kg bolus for 1 hour Increase insulin dose if BG does not decrease by 50-75 mg/dL or 10%; repeat every hour Once blood glucose is 200-300 mg/dL, decrease to 0.02-0.05U/kg/h Continue reading >>

Diabetes Mellitus 1

Diabetes Mellitus 1

Sort Which statement is true about insulin? a. It is secreted by alpha cells in the Islet of Langerhans b. It is a catabolic hormone that builds up glucagon reserves. c. It is necessary for glucose transport across cell membranes. d. It is stored in muscles and converted to fat for storage. c. It is necessary for glucose transport across cell membranes. Why is glucose vital to the body's cells? a. It is used to build cell membranes b. It is used by cells to produce energy c. It affects the process or protein metabolism d. It provides nutrients for genetic material b. It is used by cells to produce energy A patient with diabetes presents to the emergency department (ED) with a blood sugar of 640 mg/dL and reports being constantly thirsty and having to urinate "all the time." How does the nurse document this subjective finding? a. Polydipsia and polyphagia b. Polydipsia and polyuria c. Polycoria and polyuria d. Polyphagia and polyesthesia b. Polydipsia and polyuria Which cultures tend to have higher incidence of DM? (Select all that apply) a. Mexican American b. African American c. Caucasian d. American Indian e. Eastern European a. Mexican American b. African American d. American Indian According to the American Diabetes Association (ADA), which laboratory finding is most indicative of DM? a. Fasting blood glucose = 80 mg/dL b. 2-hour postprandial blood glucose = 110 c. 1- hour glucose tolerance blood glucose = 110 mg/dL d. 2- hour glucose tolerance blood glucose = 210 mg/dL d. 2- hour glucose tolerance blood glucose = 210 mg/dL In a patient with hyperglycemia, the respiratory is triggered in an attempt to excrete more carbon dioxide and acid, thus causing a rapid and deep respiratory pattern. What is the term for this respiratory pattern? a. Tachypnea b. Cheyne-strokes Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

List Clinicopathologic features that might be present with DKA? Elevation in liver enzymes (hepatic lipidosis, pancreatitis) Hyperlipidemia Hyperlipasemia Hyperamylasemia Metabolic Acidosis Serum Hyperosmolality Azotemia (usually pre-renal) Hemeturia, pyuria, bactiuria (always submit cysto for culture an dsensitivity) Ketonuria Continue reading >>

Diabetes 1

Diabetes 1

Sort A client with type one diabetes comes to the clinic because of concerns regarding uratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? Somogyi effect A nurses caring for a client newly diagnosed with type one diabetes. When the healthcare provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia and 15 G of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia? Increases blood glucose levels Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Sort pathophysiology ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing) acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients elevated anion gap Methanol intoxication Uremic acidosis Diabetic ketoacidosis Paraldehyde ingestions Intoxicants (salicyclate, ethylene glycol, nipride, epinephrine, norepinephrine) Lactic acidosis (drug induced; didanosine, iron, isoniazid, metformin, zidovudine) Ethanol ketoacidosis Severe renal failure starvation Continue reading >>

Diabetes

Diabetes

Sort What are common signs and symptoms of diabetes mellitus Polydypsia Polyphagia Polyuria Fatigue Weight loss Slowed healing Nausea Dizziness What s/s of ketoacidosis Fruity breath Dehydration Large amount of sugar/acetone in urine Hypoalkemia Flu like symptoms Polydypsia Polyphagia Polyuria Continue reading >>

Diabetes (hyperglycemia) & Hypoglycemia

Diabetes (hyperglycemia) & Hypoglycemia

Sort Role of Insulin and Plasma/Blood Glucose Produced by beta cells of pancreas Glucose is important fuel for cell - enters bloodstream first before being delivered to the tissues and cells of the body Ingestion increases plasma and blood sugar levels. Brain can ONLY use glucose Glucose cannot enter tissues and cells without insulin Body's need for insulin will fluctuate with body's need Normal Process 1. Eat 2. Glucose in plasma/blood 3. Insulin released 4. Glucose enters cells/tissue 5. Maintain glucose balance Diabetes 1. Eat 2. Glucose in plasma/blood 3. No insulin release 4. Glucose stays in bloodstream 5. Hyperglycemia Diabete Mellitus Higher risk: American Indian/Alaskan Native, Native Americans, Hispanic/Latino American 2x risk of periodontal disease 6th leading cause of death Chronic Complications Damage to larger vessels DM causes thickening and hardening - leads to arteriosclerosis Damage to smaller blood vessels causes blindness, kidney disease, amputations Amputations- damage to the nervous system. Person cannot feel peripheral tissues. Normal sweat recreation and oil production that lubricates the skin of the is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during the walking and can lead to breakdown of the skin of the foot. Sore may develop. Blood supply damage = tissue damage, immunity compromised Type 1 Diabetes Risk factors - autoimmune response, genetic, environmental factors i.e. virus Immune system destroys pancreatic beta cells - the only cells in the body that make insulin and lead to insulin deficiency children and young adults most affected, though it can occur at any age 10% of all diabetes More severe form of diabetes Type 2 Diabetes Previously call non-insulin dependent DM or adult Continue reading >>

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