DiabetesPt2

Question 1

What are examples of acute complications for diabetes?

Answer 1

Hypoglycemia, hyperglycemia, hyperglycemic hyperosmolar state/syndrome (HHS), diabetic ketoacidosis (DKA)

Question 2

General nursing concerns for diabetes?

Answer 2

Infection, injury (vision impairment, neuropathy), tissue perfusion

Question 3

An emergent condition in which there is too much insulin and not enough food. S/s?

Answer 3

Hypoglycemia. BG <70 (74).

Decreased glucose to CNS, LOC, pallor, diaphoresis, nervousness, irritability, H/A, weak, shaky, hunger, palpitations.

Question 4

Treatment for hypoglycemia?

Answer 4

Check BG frequently. Hypoglycemia protocol. Give 15-20g CHO. Recheck BG in 15 minutes, if still low then treat again. Give snack if meal is greater than 60 minutes away.
Glucagon SQ/IM, IV D50 if severe.

Question 5

Prevention of hypoglycemia?

Answer 5

Eat at regular intervals. Check BG ac, HS, PRN. Prepare for exercise. Call HCP if unable to eat. Instruct pt to carry their diabetic supplies on them when traveling.

Question 6

Causes of hyperglycemia?

Answer 6

BG 160-190 mg/dL. Decreased insulin production, decreased exercise. Increased food intake, infections and illness, stress. Drugs such as steroids.

Question 7

S/s of hyperglycemia?

Answer 7

Extreme thirst, polyuria, dry skin, hungry, blurry vision, drowsy, slow-healing wounds. Often starts slowly, may lead to a medical emergency if not treated. Call HCP if BG is higher than normal for 3 days without an obvious cause.

Question 8

Treatment of hyperglycemia?

Answer 8

Treat the underlying cause. Administer insulin as prescribed. Sliding scale with rapid-acting insulin. Increase in anti-diabetic meds (insulin, oral). Exercise. Check urine for blood ketones if BG >300.

Question 9

Morning hyperglycemia. Counter-regulatory response. Treatments?

Answer 9

Somogyi effect. Identified by 02:00-03:00 reading.

Moving supper NPH to HS. Give HS snack. Decrease PM NPH insulin.

Question 10

An acute complication in which there is a deficiency of insulin but it produces enough to prevent ketosis. Onset is gradual, over several days.

Answer 10

Hyperglycemia hyperosmolar state (HHS). More common in older type 2. Life-threatening, coma and death.
Profound hyperglycemia, >600 mg/dL. Increased serum osmolarity, >320 mmil/L. Dehydration. Absence of ketosis.

Question 11

Why is dehydration associated with HHS? Triggers and etiology?

Answer 11

Persistent hyperglycemia causes osmotic diuresis with loss of water and electrolytes.
Etiology includes underlying untreated infection. Undiagnosed type 2 diabetes. Drugs such as diuretics and steroids

Question 12

S/s of HHS?

Answer 12

Polyuria, polyphagia, polydipsia. Typical diabetic s/s. Hypotension, tachycardia. Profound dehydration. Neurological changes to coma.

Question 13

Fluid treatment of HHS?

Answer 13

Fluids first, cautiously. Restore BG within 48-72 hours. 0.9% NaCl. 1 L/hr, 100-200 mL/hr. Replace half of deficit in the first 12 hours, the rest over the next 24-48 hours. Treat underlying cause.

Question 14

Insulin treatment of HHS?

Answer 14

Bolus 0.15 units/kg IV then continuous 0.1 units/kg/hr. Lower BG by 50-70 mg/dL/hr.
D/C insulin drop when BG reaches 250 mg/dL. Then check BG q2hrs. Cover BG sliding scale with homolog (regular) insulin when no longer on the drip. SQ insulin started at this point.

Question 15

Nursing concerns for HHS?

Answer 15

Goals are slow, steady improvement in CNS function which reflects re-hydration. Assess for cerebral edema from too much or too fast fluid intake(sudden change in LOC, abnormal neurologic checks, coma). Fluid and electrolyte balance (I+O, labs q1-2hr, potassium). BG control, accuchecks q1-2hr. Pt education.

Question 16

Etiology of diabetic ketoacidosis?

Answer 16

No insulin production, acute, life-threatening. Uncontrolled hyperglycemia >300 mg/dL. Onset is rapid.
Metabolic acidosis. Body fat provides energy. Ketones in blood and urine.

Question 17

Causes of DKA?

Answer 17

Infection is the most common precipitating factor. Undiagnosed type 1. Inadequate treatment of type 1 (poor insulin/BG management, too many calories). Change in diet, insulin, or exercise.

Question 18

Assessment findings for DKA?

Answer 18

Kussmaul’s respirations, fruity breath. Gradually increasing restlessness, confusion, lethargy, coma. Polydipsia: dry mouth. Polyuria: dehydration. Polyphagia: weight loss.

Question 19

Lab findings for DKA?

Answer 19

Serum glucose is >300 mg/dL. Glycosuria and ketonuria. Increased serum osmolarity. Increased WBC with infectious process.

Question 20

Initial nursing interventions for DKA?

Answer 20

Ensure pt airway, administer oxygen. Assess LOC. Assess hydration status, IV access with large-bore catheter. Assess BG levels, electrolytes. q1hr vitals, strict I+O.

Question 21

Treatment of DKA?

Answer 21

Restore fluid volume to maintain perfusion of vital organs. Replace total body fluid losses at a lower infusion rate.
Always IV insulin, regular only. Bolus 0.1 units/kg then continuous 0.1 units/kg/hr. Lower BG by 50-75 mg/dL/hr.
K+ and acidosis. Ensure U/O before giving K+ replacement. Treat underlying cause.

Question 22

Nursing responsibilities with DKA?

Answer 22

BG checked q1hr with insulin drop. Q4hr BMP, serum acetone, and ABG draws. BG goal is 250 mg/dL, infuse D5.45% saline (prevents hypoglycemia and cerebral edema from rapid decrease in serum osmolarity.
May give sodium bicarbonate with severe acidosis of pH <7.0. K+ drops with insulin infusion.

Question 23

What should be done with DKA when serum glucose levels approach 250 mg/dL?

Answer 23

Add glucose to IV fluids to minimize the risk of cerebral edema associated with drastic changes in serum osmolality (D5.45 NS). Discontinue insulin drop per protocol or order usually changing to sliding scale insulin every 2-4 hours.

Question 24

Prevention of DKA?

Answer 24

Pt education. Most effective measure is to check BG. Monitor q4hr when ill; continue to take insulin as directed. Notify HCP if BG >250 mg/dL and ketonuria >24hrs. Consume liquids with carbs and electrolytes when bale to eat solid food. Notify if illness lasts more than none day. Monitor HbA1c.

Question 25

DKA overview?

Answer 25

Type 1. Insulin absent. Serum glucose >300 mg/dL. Urine ketones are positive. Acidosis, with pH <7.35. Younger patient population. Onset less than 24 hours. Plasma bicarb is less than 15 mEq/L.

Question 26

HHS overview?

Answer 26

Type 2. Insulin resistance. Serum glucose is >600 mg/dL. Urine ketones are negative. No acidosis, pH >7.40. Older patient population. Onset is several days. Plasma bicarb is normal. Mortality of 10-20%.

Question 27

DKA without hyperglycemia, <200 mg/dL. Associated with SGLT-2 inhibitors.

Answer 27

Euglycemic DKA. Occurs in type 1 and rarely in 2. Anion gap acidosis. Plasma ketones. IV hydration and electrolyte replacement.

Question 28

Latent immune diabetes of adulthood?

Answer 28

Late onset type 1. Slow progression. Not related to age, weight, or ethnicity. Islet failure in the pancreas. Treatment is life-long insulin.

Question 29

When should a sick diabetic call their doctor?

Answer 29

Persistent N/V. Moderate to large ketonuria. BG increased after 2 supplemental infusion doses. Fever greater than 101.5 for over 24 hours.