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Ketoacidosis Can Result In Quizlet

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 >>

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 What are the two main reasons you must treat a DKA patient with adequate fluids? replenish volume so that the kidneys can keep working and so that insulin can reach its target tissues to finally stop hormone sensitive lipase from initiating lipolysis Also need to keep in mind that in their DKA they are in a state of volume depletion because of the glycosuria. this means the capillaries in the peripheral tissues vasoconstrict in order to maintain blood (and glucose) flow to the brain. if you don't achieve volume expansion at a safe rate, and you keep giving the patient increasing doses of insulin, all of the sudden when their capillaries become reperfused they get massive amounts of insulin, which causes the potassium channel to swing open with potassium influx, leading to hypokalemia, which can be deadly. This is why it's so important to address volume expansion first and foremost, more than tweaking glucose and potassium levels on your own. What are some conditions that place a patient at risk for hypoglycemic episodes while being treated in the hospital? sudden NPO status without adjustment of insulin accordingly unexpected transport after rapid-acting insulin is given enteral feeding, TPN or intravenous dextrose discontinued premeal rapid insulin given without actually having the meal reduction of corticosteroid use (steroids increase your sugars because they cause insulin resistance) Continue reading >>

Diabetes - Diabetic Ketoacidosis & Hyperosmolar Hyperglycemia Syndrome

Diabetes - Diabetic Ketoacidosis & Hyperosmolar Hyperglycemia Syndrome

Sort Hyperglycemia: Causes type of glucose level caused by 1) too much food, 2) too little diabetic medications, 3) inactivity, 4) emotional/physical stress, 5) poor absorption of insulin 6) illness 7) corticosteroids **counterregulatory hormones released when stress, illness persist Hyperglycemia: Manifestations manifests as 1) polyuria: osmotic diuresis (glucose in renal tubules cannot be reabsorbed; consequent hyperosmolarity and osmotic pressure results in more water in tubules) 2) polyphagia followed by lack of appetite, 3) polydipsia: hyperosmolarity of blood causes thirst as cells release more water into circulation 4) weakness/fatigue, 5) blurred vision, 6) glycosuria, 7) nausea/vomiting, 8) abdominal cramping 9) dry, warm, itchy skin Hyperglycemia: Treatment 1) exercise **do NOT exercise if BG 250 mg/dL (stress hormones released) and ketones (Type 1); do NOT exercise if >300 mg/dL (Type 2) 2) drink water 3) eat less CHO at meals **contact HCP if BG >250 mg/dL two-three times in one week During illness: 1) do NOT stop taking medication 2) check BG more frequently 3) clear liquids until no more nausea Hypoglycemia: Manifestations MILD: sweating, tremor, tachycardia, palpitation, nervousness, hunger MODERATE: poor concentration, numb lips/tongue, HA, light-headedness, slurred speech, irrational/combative behavior, visual disturbances SEVER: disorientation, loss of consciousness, difficult to arouse, seizures, coma **Can mimic alcohol intoxication. ***use of beta blockers interferes with recognizing the symptoms Hypoglycemia: Treatment RULE of 15: 1) check blood glucose for levels < 70 mg/dL 2) ingestion of 15-20g of a simple (fast-acting) carbohydrate: glucose tablets, 4 oz of juice, 1 T of honey, 4-6 oz soda ***NO CANDY BARS/COOKIES: treatment with fats s/b avoid Continue reading >>

Shared Flashcard Set

Shared Flashcard Set

Details Title Chapter 17 Questions Description Emergency Care and Transportation of the Sick and Injured Total Cards 86 Subject Health Care Level Undergraduate 1 Created 03/12/2014 Click here to study/print these flashcards. Create your own flash cards! Sign up here. Additional Health Care Flashcards Cards Term Common signs and symptoms of diabetic coma include all of the following EXCEPT: A. warm, dry skin B. rapid, thready pulse C. cool, clammy skin D. acetone breath odor Definition C. cool, clammy skin Term Diabetes is MOST accurately defined as a/an: A. abnormally high blood glucose level B. disorder of carbohydrates metabolism C. lack of insulin production in the pancreas D. mass excretion of glucose by the kidneys Definition B. disorder of carbohydrates metabolism Term A 28-year old female patient is found to be responsive to verbal stimuli only. her roomate 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: A.has a urinary tract infection B. has low blood glucose level C. has overdosed on her insulin D. is signically hyperglycemic Definition D. is signically hyperglycemic Term The signs and symptoms of insulin shock are the result of: A. prolonged and severe dehydration B. fat metabolism within cells C. increased blood glucose levels D. decreased blood glucose levels Definition D. decreased blood glucose levels Term Kussmaul respirations are an indication that the body is: A. trying to generate energy by breathing deeply B. attempting to eliminate acids from the blood C. compensating for Continue reading >>

Chapter 17: Endocrine Emergencies

Chapter 17: Endocrine Emergencies

Sort Hyperglycemia (Diabetic Coma) S/S -frequent urination -thirst -dehydration -dry, warm skin -rapid, weak pulse (hypotension) -non-healing wounds and infections -air hunger -sweet, fruity odor -slow progression to unresponsiveness -ketoacidosis (DKA) -excessive food intake -insufficient insulin dosage -infection -lack of appetite -weakness -N/V -rapid, deep (Kussmaul) respirations -restlessness -abnormal/slurred speech -unsteady gait -response to treatment=6-12 hours following medical treatment Hypoglycemia (insulin Shock) S/S -dizziness/headache -aggressive/confused -rapid progression of ALOC -hunger -fainting, seizure, or coma -deep, rapid breathing -pale, cool, moist skin -sweating -weak, rapid pulse -normal to low BP -insufficient food intake -excessive insulin dosage -rapid onset -absence of thirst and intense hunger -seizure -fainting -coma -unsteady gait -response to treatment=immediate Long Term Diabetes Complications -arteriosclerosis -heart disease -CVA -periphreal vascular disease -increases risk of infections -amputations -blindness -kidney disease Hyperglycemic Crisis -diabetic coma -state of unconsciousness resulting from DKA, hyperglycemia, or dehydration due to excessive urination -sometimes caused by excess blood glucose itself -can occur in diabetic patients who aren't under treatment, have taken insufficient insulin, have markedly overeaten, are under stress -can cause in death if untreated -treatment may take hours in a well-controlled hospital setting Hypoglycemic Crisis -insulin shock -result of insufficient levels of glucose in the blood -can occur when insulin-dependent patients take too much insulin, take a regular dose but have not eaten enough food, engage in vigorous activity and use up all available glucose, or vomit a meal after taking a Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Sort Symptoms of Ketoacidosis Shortness of breath Stomach pain Fatigue Polydipsia, polyphagia Confusion Breath that smells fruity N/V A very dry mouth Muscle stiffness Symptoms of hypoglycemia Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness Clumsy or jerky movements Difficulty paying attention Insulin Regimens: 3 types *Fixed (standard/conventional) constant basal insulin rapid acting * Flexible (intensive) multiple daily injections of bolus insulin before meals Basal insulin 1-2 x/day * CSII-continuous subcutaneous insulin infusion a form of intensive therapy constant basal insulin bolus before meals - Dose based on body wt., then adjusted individually Continue reading >>

Ketoacidosis/hypoglycemia

Ketoacidosis/hypoglycemia

Sort What is the basic cause of DKA? What can lead to this? A high blood glucose level (>/= 250, usually 600-900) and too little insulin Causes: 1. INFECTION (e.g., UTI, pneumonia) (most common; physiologic stress will raise glucose levels) 2. diet indiscretion (too much glucose, not giving adequate insulin) 3. not taking enough insulin 4. certain meds increase glucose levels (steroids, theophylline [asthma med]) 5. enterofeedings or TPN 6. condition causing physiologic stress e.g., MI What are the signs/symptoms of DKA? 1. polyuria followed by decreased urine production (<30 cc/hr) 2. dehydration causing: -skin tenting, decreased turgor, dry oral mucosa -increase in serum lactate -increase in BUN and creatinine from poor perfusion to kidneys -increase HR (tachycardia), decreased BP 3. metabolic acidosis: -N/V, anorexia -increased RR/Kussmaul resp [rapid and deep] (hyperventilation, blowing off CO2) 4. neurologic: sleepy, lethargic, confused --> stuporous, obtunded, comatose 5. abdominal distension 6. protein and fat breakdown -presence of serum ketones -ketonuria (ketones in urine) -acetone breath (fruity) What are some possible complications of DKA and how are they prevented? From dehydration and immobility 1. DVT --> PE (from dehydration, thickened blood): worried pt will be DVT that travels to heart -tx: compression stockings, SC meds (heparin) to prevent clots 2. atelectasis --> pneumonia (immobility): as person becomes more lucid, will have pt do incentive spiromtery/deep breathing exercises to open up alveoli to prevent atelectasis 3. infection from foley cath (UTI): remove ASAP What are the treatment goals of DKA? 1. correct dehydration (want to happen quickly): fluid resuscitation -NPO (if GI symptoms, might not absorb water) -N/S based on body weight (often 20 Continue reading >>

Like This Study Set?

Like This Study Set?

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings would the nurse expect to note as confirming this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level 6. Low plasma bicarbonate level 3,5,6 Rationale: In DKA, the arterial pH is lower than 7.35, plasma bicarbonate is lower than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria, and Kussmaul's respirations (deep and rapid breathing pattern) would be present. A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor 2,3,5 A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1. Ampule of 50% dextrose 2. NPH insulin subcutaneously 3. Intravenous fluids containing dextrose 4. Phenytoin (Dilantin) for the prevention of seizures 3 Rationale: During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution 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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Sort What are symptoms and signs of Diabetic Ketoacidosis? 1. fatigue 2. tachypnea (kussmaul's respirations) 3. tachycardia 4. Altered mental status 5. abdominal pain 6. vomiting 7. polyuria 8. polydipsia What are potential precipitating causes of DKA? 1. recent or current infection of any type 2. Injury or trauma 3. ACS or MI 4. TIA or CVA 5. Medications 6. acute or acute-on-chronic pancreatitis 7. ethanol or drug abuse 8. gastroenteritis or GI bleeding 9. psychosocial factors, such as depression or inability to afford medications, limiting compliance 10. Noncompliance with insulin regimen due to psychological or physiological reasons Symptoms and signs of DKA? 1. general fatigue and weakness 2. orthostasis 3. abdominal pain 4. Kussmaul's respirations (rapid dep respirations attempting to compensate for acidosis) 5. fruity or acetone-like odor 5. polyuria 6. poydipsia 7. polyphagia 8. N/V are found in up to 25% of pt's (emisis may have a coffee ground appearance due to hemorrhagic gastritis) 9. Mental status changes (mild confusion to coma) Key laboratory findings in DKA 1. serum glucose > or = 250 mg/dl 2. serum ketones or ketonuria 3. serum bicarbonate < or = 15 mEq/L 4. arterial pH < 7.3. Other important findings: 1. anion gap (nl values = 8-16)-- helps assess severity of acidosis and to follow progress of therapy 2. Serum osmolality-- values above 340mOsm/kg usually result in mental status changes. Below this value, other causes for lethargy or coma should be investigated. used to diagnose HHS and ingestions of ethanol, ethylene glycol, or other alcohols 3. serum ketones-- not always reliable. 4. BUN and CR-- may be elevated because of severe hydration, acute tubular necrosis, or renal failure. In these cases, establish urine output prior to initiating potassium re Continue reading >>

Type 1 Diabetes Vs. Type 2 Diabetes

Type 1 Diabetes Vs. Type 2 Diabetes

Diabetes affects over 29 million people in the United States, and 1 in 4 of those affected are unaware that they have diabetes.[1] Type 1 diabetes is usually diagnosed in younger people and occurs when the body cannot produce enough insulin. In type 2 diabetes, the body cannot use the insulin it produces. This disease, frequently related to obesity, a sedentary lifestyle, and genetics, is most often diagnosed in adults, but incidence rates are increasing among teens in America.[2][3] Comparison chart Type 1 Diabetes versus Type 2 Diabetes comparison chart Type 1 Diabetes Type 2 Diabetes Definition Beta cells in pancreas are being attacked by body's own cells and therefore can't produce insulin to take sugar out of the blood stream. Insulin is not produced. Diet related insulin release is so large and frequent that receptor cells have become less sensitive to the insulin. This insulin resistance results in less sugar being removed from the blood. Diagnosis Genetic, environmental and auto-immune factors, idiopathic Genetic, obesity (central adipose), physical inactivity, high/low birth weight, GDM, poor placental growth, metabolic syndrome Warning Signs Increased thirst & urination, constant hunger, weight loss, blurred vision and extreme tiredness, glycouria Feeling tired or ill, frequent urination (especially at night), unusual thirst, weight loss, blurred vision, frequent infections and slow wound healing, asymptomatic Commonly Afflicted Groups Children/teens Adults, elderly, certain ethnic groups Prone ethnic groups All more common in African American, Latino/Hispanic, Native American, Asian or Pacific Islander Bodily Effects Beleived to be triggered autoimmune destruction of the beta cells; autoimmune attack may occur following a viral infection such as mumps, rubell Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Background In 1940, Dillon and colleagues first described alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration. [1, 2] Although AKA most commonly occurs in adults with alcoholism, it has been reported in less-experienced drinkers of all ages. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting. [3, 4, 5] A concomitant metabolic alkalosis is common, secondary to vomiting and volume depletion (see Workup). [6] Treatment of AKA is directed toward reversing the 3 major pathophysiologic causes of the syndrome, which are: This goal can usually be achieved through the administration of dextrose and saline solutions (see Treatment). 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 >>

Diabetes/dka Part 3

Diabetes/dka Part 3

Use the directions found in a emergency manual such as Plunkett or Matthews to: (1) to provide adequate amounts of insulin (0.2U/kg regular insulin) to normalize intermediary metabolism: start regular insulin by IV CRI or IM q4‐6hr (not SQ) within a few hours of initiating treatment. Insulin is often not started immediately as potassium levels are already dangerously low and need to be bolstered with fluid therapy to prevent complications. It may be 2 to 6 hours before you can start insulin. Note that glargine may become an insulin used in DKA. (2) to restore water and electrolyte losses: fluid therapy using 0.9% saline or sometimes an alkalinizing solution. Add potassium (often based on measured values) and add phosphorus (based on measured values or empirically as half the volume of the potassium (1/2 as KCl and ½ as KPhos). (3) to correct the acidosis: usually just fluids but may need bicarb (4) to identify precipitating factors for the current illness: pancreatitis, infection (5) to provide a carbohydrate substrate when required by the insulin treatment. As BG is normalized (<250mg/dl), add dextrose to IV solutions to maintain BG and continue giving insulin so that cells can continue to metabolize/use the ketones. Continue reading >>

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