Chapter 19: Diabetic Emergencies and Altered Mental Status

Question 1

Reticular activating system (RAS)

Answer 1

series of neurological circuits in the brain that control the functions of staying awake, paying attention, and sleeping

Question 2

How to determine baseline mental status?

Answer 2

hello and AVPU

Question 3

What secretes insulin within the pancreas?

Answer 3

the islets of the Langerhans

Question 4

Diabetes mellitus

Answer 4

condition brought about by decreased insulin production or the inability of the body cells to use insulin properly

Question 5

Type I diabetes

Answer 5

• insulin dependent
• occurs when pancreatic cells fail to function properly and insulin is not secreted normally.
• typically does not have enough insulin in their body to transfer circulating glucose into the cells

Question 6

Type II diabetes

Answer 6

• non-insulin dependent
• body’s cells fail to use insulin properly
• pancreas may be secreting enough insulin, but the body is unable to use it to move glucose out of the body and into the cells.
• can mostly control with diet and/or medication

Question 7

Hypoglycemia causes

Answer 7

• takes too much insulin, which transfers glucose into the cells too quickly and causes a rapid depletion of available sugar
• reduces sugar intake by not eating
• overexercises or overexerts theirself, using sugar faster than normal
• vomits a meal
• increases the metabolic rate in conditions such as fever or shivering

Question 8

Hyperglycemia causes

Answer 8

• due to decrease in insulin
• body unable to produce insulin
• forgot to inject insulin or used too little
• pt w/ this breathes deeply and rapidly, dry mouth, intense thirst, frequent urination, abdominal pain, vomiting

Question 9

Diabetic ketoacidosis (DKA)

Answer 9

• a condition that occurs as the result of high blood sugar characterized by dehydration, altered mental status, and shock
• person will breathe rapidly, often emit a fruity, acetone odor on his breath as the body works to breathe off these by-products (ketones)

Question 10

Onset in hyper and hypoglycemia

Answer 10

• hyper: slower onset; sugar still reaches the brain

- hypo: tends to come on suddenly; possibly no sugar reaches the brain

Question 11

Skin in hyper and hypoglycemia

Answer 11

• hyper: warm, red, dry skin

- hypo: cold, pale, moist, or clammy

Question 12

Breath in hyper and hypoglycemia

Answer 12

• hyper: often has acetone breath (some, not all)

- hypo: no breath smell

Question 13

Sepsis

Answer 13

• infection, especially a severe, systemwide response to infection
• disruptive shock and hypovolemic shock can result

Question 14

Findings as evidence of severe sepsis

Answer 14

• altered mental status
• increased HR
• increased respiratory rate
• low BP
• high blood glucose levels
• decreased cap refill time

Question 15

Seizure

Answer 15

a sudden change in sensation, behavior, or movement

The most sever form of seizure produces violent muscle contractions called convulsions

Question 16

Partial seizure

Answer 16

a seizure that affects only one part or one side of the brain

Question 17

Generalized seizure

Answer 17

a seizure that affects both sides of the brain

Question 18

Tonic-clonic seizure

Answer 18

a generalized seizure in which the pt loses consciousness and has jerking movements of paired muscle groups

Question 19

Tonic phase

Answer 19

• the body becomes rigid, stiffening for no more than 30 seconds
• breathing may stop, the pt may bite his tongue (rare), and bowel and bladder control could be lost

Question 20

Clonic Phase

Answer 20

• the body jerks about violently, usually for no more than 1 or 2 minutes (sometimes 5)
• the pt may foam at the mouth and droll; face and lips may become cyanotic

Question 21

Postictal phase

Answer 21

• when convulsions stop
• the pt may regain consciousness immediately and enter a state of drowsiness and confusion, or he may remain unconscious for several hours; headache common

Question 22

Aura

Answer 22

a sensation experienced by a seizure pt right before the seizure, which might be a smell, sound, or general feeling

Question 23

Epilepsy

Answer 23

a medical condition that causes seizures

Question 24

Status epilepticus

Answer 24

a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness

Question 25

Stroke

Answer 25

a condition of altered function caused when an artery in the brain is blocked or ruptured, disrupting the supply of oxygenated blood or causing bleeding into the brain