Chapter 19: Diabetic Emergencies and Altered Mental Status Flashcards
Reticular activating system (RAS)
series of neurological circuits in the brain that control the functions of staying awake, paying attention, and sleeping
How to determine baseline mental status?
hello and AVPU
What secretes insulin within the pancreas?
the islets of the Langerhans
Diabetes mellitus
condition brought about by decreased insulin production or the inability of the body cells to use insulin properly
Type I diabetes
- 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
Type II diabetes
- 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
Hypoglycemia causes
- 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
Hyperglycemia causes
- 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
Diabetic ketoacidosis (DKA)
- 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)
Onset in hyper and hypoglycemia
- hyper: slower onset; sugar still reaches the brain
- hypo: tends to come on suddenly; possibly no sugar reaches the brain
Skin in hyper and hypoglycemia
- hyper: warm, red, dry skin
- hypo: cold, pale, moist, or clammy
Breath in hyper and hypoglycemia
- hyper: often has acetone breath (some, not all)
- hypo: no breath smell
Sepsis
- infection, especially a severe, systemwide response to infection
- disruptive shock and hypovolemic shock can result
Findings as evidence of severe sepsis
- altered mental status
- increased HR
- increased respiratory rate
- low BP
- high blood glucose levels
- decreased cap refill time
Seizure
a sudden change in sensation, behavior, or movement
The most sever form of seizure produces violent muscle contractions called convulsions
Partial seizure
a seizure that affects only one part or one side of the brain
Generalized seizure
a seizure that affects both sides of the brain
Tonic-clonic seizure
a generalized seizure in which the pt loses consciousness and has jerking movements of paired muscle groups
Tonic phase
- 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
Clonic Phase
- 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
Postictal phase
- 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
Aura
a sensation experienced by a seizure pt right before the seizure, which might be a smell, sound, or general feeling
Epilepsy
a medical condition that causes seizures
Status epilepticus
a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness
Stroke
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
