Chapter 20 - Acute Diabetic Emergencies

Question 1

disease that frequently causes changes in the Pts mental status resulting from alterations in the BGL.

Answer 1

Diabetes mellitus (DM)

Question 2

carbs are a primary energy source for the cells. three major sources of carbohydrates:

Answer 2

sucrose (table sugar)
lactose (milk and dairy)
starches (potatoes and bread)

Question 3

simple sugars:

Answer 3

glucose
galactose
fructose

Question 4

the two hormones primarily responsible for controlling levels of blood glucose are ______ and ______, both of which are secreted by the pancreas.

Answer 4

insulin and glucagon

Question 5

____ is secreted when the BGL is elevated.

Answer 5

insulin

Question 6

insulin has three main functions:

Answer 6

increase movement of glucose out of the blood and into the cells

causes the liver to take up the glucose out of the blood and convert it into glycogen, the stored form of glucose

decreases the BGL by the actions listed in 1 and 2: facilitating the movement of glucose into the cells and the liver

Question 7

_____ is secreted by the pancreas when the blood glucose level is low and will work to increase the BGL.

Answer 7

glucagon

Question 8

three major functions of glucagon are:

Answer 8

converts glycogen stored in the liver back into glucose and releases it into the blood.

it converts other, noncarbohydrate substances into glucose in the liver

increases and maintains the BGL by the actions listed in 1 and 2: converting glycogen and other substances into glucose

Question 9

________ is released by the adrenal glands when the BGL decreases to a dangerously low level. stops the secretion of insulin and promotes the release of stored glucose from the liver as well as the conversion of other substances into glucose.

Answer 9

epinephrine

Question 10

normal BGL

Answer 10

80-120mg/dL

Question 11

glycogen stores in the liver can last for up to________.

after that fats and proteins will begin to be used by the body at a high rate for energy

Answer 11

24-48hrs

Question 12

the BGL of a nondiabetic pt following a meal will typically rise to ________

Answer 12

120-140mg/dL

Question 13

after a 8- to 12-hr fast, a nondiabetic pt’s BGL will typically read _______

Answer 13

80-90mg/dL

Question 14

typically defined as a BGL of 60mg/dL or less with signs or symptoms or a BGL of less than 50mg/dL with or without s/s

Answer 14

hypoglycemia

Question 15

the primary sign of hypoglycemia is an _______

Answer 15

altered mental status

Question 16

_______ can be defined as a persistent BGL greater than 120mg/dL

Answer 16

hyperglycemia

Question 17

diabetes mellitus (DM) is a condition in which there is disturbance in the metabolism of carbohydrates, fats, and proteins. the primary problem in this condition is either one of two things:

Answer 17

1 ) a lack of insulin being secreted by the pancreas

OR

2 ) the inability of the cell receptors to recognize the insulin and allow the glucose to enter at a normal rate

Question 18

the three P’s

Answer 18

polydipsia (frequent thirst)
polyuria (frequent urination)
polyphagia (hungry)

Question 19

type 1 diabetes

Answer 19

insulin-dependent diabetes mellitus (IDDM)\

pancreas does not secrete any insulin

typically younger

Question 20

type 2 diabetes

Answer 20

non-insulin-dependent diabetes mellitus (NIDDM)

regulate diet and exercise and take oral drugs to help the pancreas secrete more insulin or to make the insulin that is secreted more effective

usually middle aged or older

Question 21

hypoglycemia in type 1 (IDDM) pt who takes his insulin, but with excessive results (BGL decreases too much), for one of the following reasons:

Answer 21

pt takes insulin but does not eat

pt takes insulin, eats, but drastically increases activity

pt takes too much insulin - either takes too much or forgets and takes an extra dose

Question 22

signs and symptoms caused by epinephrine release

Answer 22

diaphoresis
tremors
weakness
hunger
tachycardia
dizziness
pale, cool, clammy skin
warm sensation

Question 23

signs and symptom caused by brain cell dysfunction

Answer 23

confusion 
drowsiness
disorientation
unresponsiveness 
seizures
strokelike symptoms including hemiparesis

Question 24

Oral glucose may only be administered if the patient meets all of the following three criteria:

Answer 24

1 ) has an altered mental status

2 ) has a history of diabetes controlled by medication or a blood glucose reading less than 60 mg/dL

3 ) has the ability to swallow

Question 25

A condition typically found in type 1 diabetics where the blood glucose level is excessively elevated and insulin level is extremely low to absent, which causes glucose to be excreted in the urine, dehydrating the patient, and causing the body to metabolize fat for energy, producing ketones and creating an acidic environment

Answer 25

Diabetic ketoacidosis (DKA)

Question 26

Factors causing hyperglycemia in the diabetic ketoacidosis patient

Answer 26

Infection that has upset insulin/glucose balance

Patient takes inadequate dose of insulin

Patient is taking medications such as thiazide, Dilantin, or steroids

Patient suffered some type of stress – surgery, trauma, pregnancy, or heart attack

Patient had over eaten or increased carb or sugar intake

Question 27

A pattern of deep and rapid breathing that is commonly seen in the patient with DKA. It is an attempt by the body to blow off carbon dioxide to reduce the acid load of the body. Produces a fruity odor.

Answer 27

Kussmaul respirations

Question 28

A condition typically found in type two diabetic’s where the blood glucose level rises excessively, causing loss of large amounts of fluid from glucose spilling into the urine, leading to severe dehydration

Answer 28

Hyperglycemic hyperosmolar nonketotic syndrome

Question 29

Glucose draws large amounts of water with it into the urine, which is called a _________ effect.

Answer 29

Hyperosmolar

Question 30

Emergency care for diabetic ketoacidosis:

Answer 30

Establish/maintain patent airway

SpO2 > 94% no O2
SpO2

Question 31

Emergency medical care for HHNS:

Answer 31

Est./maintain a patent airway

SpO2 > 94% no O2
SpO2

Question 32

Medications often taken by diabetics:

Answer 32

Insulin (humulin, novolin, iletin, semilente)
Actos
Diabinese, glucamide
Orinase
Micronase, DiaBeta
Tolinase
Glucotrol
Humalog
Glucophage
Glynase
Exenatide (byetta)
Lantus

Question 33

diabetic medications:

Answer 33

insulin (humulin, novolin, iletin, semilente
actos
diabinese, glucamide
orinase
micronase, diabeta
tolinase
glucotrol
humalog
glucophage
glynase
exenatide (byetta)
lantus

Question 34

diabetic/alt mental status SS:

Answer 34

rapid onset of alt mental after missing meal, unusual exercise or physical work

intoxicated appearance - staggering or slurred speech

tachycardia

cool, moist skin

hunger

seizure activity
uncharacteristic or bizarre behavior, combativeness

anxious or restless

bruising at insulin injection sites on the abdomen

BGL