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Define Ketoacidosis Quizlet

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 >>

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 >>

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 >>

Diabetes

Diabetes

Sort 1. A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C."With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas." B."With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus. 2. The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level D. Glycosylated hemoglobin level Rationale. A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is pr Continue reading >>

Multiple Choice Quiz

Multiple Choice Quiz

(See related pages) Please answer all questions 1 Cerebrospinal fluid, fluid within the eyes, joints, and body cavities, and fluid secretions of exocrine glands are all classified specifically as ______________ fluid. 2 What are the two major factors that regulate the movement of water and electrolytes from one fluid compartment to the next? B) osmoreceptors in the hypothalamus detect the increase in osmotic pressure of body fluids and signal the posterior pituitary to release ADH C) chemoreceptors in the renal tubule sense the increased viscosity of renal filtrate and signal the hypothalamus which, in turn, signals the posterior pituitary D) the juxtaglomerular apparatus senses the greater osmotic pressure in the blood and triggers the release of ADH 4 How does alcohol function as a diuretic? B) Alcohol receptors in the liver sense its presence and trigger a biochemical pathway that increases urine output to rid the body of alcohol. D) Alcohol prevents the distal convoluted tubule from reabsorbing water from the filtrate. 5 A so-called "salt craving" is primarily the result of _________________. 6 _______________ ions account for nearly 90% of the positively charged ions found in extracellular fluid. 7 The hormone aldosterone regulates the concentrations of _____________ and ______________ in the body. 8 Edema can be caused by all of these factors except ________________. 9 The imbalance known as ____________ can be caused by certain diuretic medications. 10 Which of the following does not occur as a result of a shift in the acid- base balance of the body? 12 The three most important buffer systems in body fluids include the bicarbonate buffer system, the ______________ buffer system, and the protein buffer system. 13 How is it possible for the rate and depth of breath 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 >>

Basic Emt Fall Session Chapter 17

Basic Emt Fall Session Chapter 17

Sort When obtaining a SAMPLE history from a patient with diabetes, it would be MOST important to determine: Choose one answer. A. if he or she has had any recent illnesses or excessive stress. Correct B. if there is a family history of diabetes or related conditions. Incorrect C. the name of the physician who prescribed his or her insulin. Incorrect D. approximately how much water the patient drank that day. Incorrect A. if he or she has had any recent illnesses or excessive stress. Diabetic coma is a life-threatening condition that results from: Choose one answer. A. hyperglycemia, excess insulin, and ketoacidosis. Incorrect B. hypoglycemia, excess insulin, and dehydration. Incorrect C. hypoglycemia, dehydration, and ketoacidosis. Incorrect D. hyperglycemia, ketoacidosis, and dehydration. Correct D. hyperglycemia, ketoacidosis, and dehydration. Diabetic ketoacidosis occurs when: Choose one answer. A. insulin is not available in the body. Correct B. the cells rapidly metabolize glucose. Incorrect C. the pancreas produces excess insulin. Incorrect D. blood glucose levels rapidly fall. Incorrect A. insulin is not available in the body. Assessment of a patient with hypoglycemia will MOST likely reveal: Choose one answer. A. warm, dry skin. Incorrect B. combativeness. Correct C. sunken eyes. Incorrect D. hyperactivity. Incorrect B. combativeness. A 29-year-old female presents with confusion and disorientation. Her respirations are rapid and shallow and her pulse is 120 beats/min and thready. She is markedly diaphoretic and has an oxygen saturation of 89%. You should: Choose one answer. A. provide ventilatory support. Correct B. administer oral glucose. Incorrect C. treat her for hyperglycemia. Incorrect D. transport immediately. Incorrect A. provide ventilatory support. A 4 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 >>

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 >>

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 Mellitus

Diabetes Mellitus

Sort List the 6 classes of oral hypoglycaemic mediations 1. sulfonylureas (gliclazide) primary involvement with stimulating the pancreas to secrete insulin 2. biguanides (metformin) enhancing the glucose lower and combined with other oral hypoglycaemic 3. sulfanylureas & biguanide combination (mixed) 4. thiazolidinediones (pioglitazone) enhance insulin action at receptor cite by increasing insulin secretion from beta cells - targets beta cells 5. alpha-glycosidase inhibitors (acarbose) 6. glitinide (novanorm) lowering glucose level agent What is the action of insulin? insulin allows glucose to move into cells to make energy. It does this by: * glycogenisis - promotes production & storage of glycogen * glycogenolysis - inhibits glycogen breakdown into glucose * increases protein and lipid synthesis * inhibits tissue breakdown by inhibiting liver glycogenolysis (ketogenesis - converts fats to acids) and gluconeogenisis (conversion of proteins to glucose) * in muscle, promotes protein and glycogen synthesis * in fat cells, promotes triglyceride storage List the physical signs of DKA * altered mental status without evidence of head trauma * tachycardia * tachypnea or hyperventilation (kussmaul respirations) * normal/low BP Increased capillary refill time - poor perfusion * lethargy and weakness * fever * acetone door of the breath reflecting metabolic acidosis Describe the treatment management of DKA * initial stabilisation: ABCD, 1/2 hourly BP HR urine output, hourly capillary BGL, 2 hourly electrolytes especially potassium * fluids & electrolytes: most pt's have a deficit of several litres (40-80 ml/kg), rapid fluid reuses for hypovolaemia (first 24hrs give 1/3 fluid in the first 5-6 hours of N/saline), potassium replacement (if not above 6mmol/L give 1/2-2g, 6-26mmol/hr 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 >>

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

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 >>

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