Chapter 17 - Endocrine / Hematologic Emergencies

Question 1

Frequent and plentiful urination.

Answer 1

polyuria

Question 2

Frequent drinking of liquid to satisfy continuous thirst.

Answer 2

polydipsia

Question 3

Excessive eating as a result of cellular “hunger.”

Answer 3

polyphagia

Question 4

Formed when fat is used as an immediate energy source.

Answer 4

ketones and fatty acids
diabetic ketoacidosis (DKA)
Body needs increased fluids and carbohydrate energy to avoid ketoacidosis leading to unconsciousness, hyperglycemic crisis and eventually, death.
Recognize DKA by sweet smell of breath.

Question 5

Deep, rapid breathing.

Answer 5

Kussmaul respirations

Question 6

In Type 2 diabetes, absence of insulin results in:

Answer 6

hyperosmolar hyperglycemic nonketotic coma (HHNC)

Typically slower onset that DKA with no sweet smell on breath.

Question 7

A state of unconsciousness resulting from ketoacidosis, hyperglycemia and dehydration.

Answer 7

Hyperglycemic crisis (blood glucose > 800 mg/dL
Kusmaul respirations
dehydration (dry, warm, "tenting" skin and sunken eyes
sweet (acetone) odor on breath
rapid, weak (thready) pulse
normal to slightly low blood pressure
varying degrees of unresponsiveness
weakness, nausea, vomiting
polyuria, polydipsia, polyphagia

Question 8

Result of insulin increase in absence of glucose.

Answer 8

hypoglycemic crisis (blood glucose <40 mg/dL)
declining mental status; aggressive or unusual behavior
unconsciousness and brain damage may follow
Children at high risk due to high activity and lack of attention to diet.

Question 9

Signs of hypoglycemia

Answer 9

pale, moist (clammy) skin
diaphoresis (sweating)
dizziness, headache
rapid pulse
altered mental status
hunger
seizure, fainting, coma
normal to shallow, or rapid respirations

Question 10

Care of hyper/hypoglycemic patient.

Answer 10

Survey scene re: sharps
Clear airway, consider airway adjuvant if not conscious
High flow oxygen (15 L/min) via non-rebreathing mask
Check glucose level
Position patient on side if having seizures
Consider rapid transport if altered mental state and impaired ability to swallow

Question 11

Blood is made up of two main components.

Answer 11

plasma is straw colored fluid
erythrocytes (red blood cells) 47% (male) and 42% female by voume
also contains leukocytes (WBC) and platelets

Question 12

An inherited blood disorder affecting red blood cells.

Answer 12

Sickle cell disease
predominant in african americans
cells contain hemoglobin S (not normal Hb A)
cells are oblong or sickle shaped
cells lodge in smaller blood vessels or in spleen

Question 13

Pain, ischemia and organ damage caused by restricted blood flow.

Answer 13

Vaso-occlusive crisis
lasts 5 - 7 days
splenic

Question 14

Worsening of a patients baseline anemia.

Answer 14

Aplastic crisis (reduced level of RBCs)
tachycardia, pallor and fatigue
parvovirus B19 can stop production of new cells for 2 - 3 days

Question 15

Acute drop in patients hemoglobin levels.

Answer 15

Hemolytic crisis
caused by RBCs breaking down at a fast rate
common in patients with glucose-6-phosphate dehydrogenase deficiency (common in sickle cell disease)

Question 16

Painful, acute enlargement of the spleen.

Answer 16

Splenic sequestration crisis

causes the abdomen to become very hard and bloated

Question 17

Tendency to develop blood clots.

Answer 17

Thrombophilia
blood clots = thrombosis
affects 5% to 7% of Caucasians of European descent in US
Deep vein thromboses a leading cause of death in hospital
aspirin, heparin, coumadin decrease threat of thrombosis

Question 18

Genetic disorder of bleeding

Answer 18

Hemophilia
predominately in males
Hemophilia A due to low levels of factor VIII
Hemophilia B due to deficiency of factor IX
Both types have same S/S
Spontaneous intracranial bleeding major cause of death