Diabetic emergencies and altered mental status

Question 1

Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the

Answer 1

reticular activating system (RAS)

Question 2

A lack of what can lead to rapid and serious alterations of function and result in altered mental status

Answer 2

Oxygen is needed to perfuse brain tissue, glucose is needed to nourish brain tissue, and water is needed to keep brain tissue hydrated

Question 3

Patients with diabetes

Answer 3

(1) don’t produce insulin, (2) don’t produce enough insulin, and/or (3) have a body that has become resistant to the insulin that is produced

Question 4

occurs when pancreatic cells fail to function properly and insulin is not secreted normally

Answer 4

Type 1 Diabetes

Question 5

occurs when the body’s cells fail to use insulin properly

Answer 5

Type 2 Diabetes

Question 6

The sympathetic nervous system signals the liver to release glycogen (a form of stored sugar) in an attempt to

Answer 6

raise blood glucose levels

Question 7

Blood vessels constrict, the heart pumps faster and harder, and breathing accelerates because the cells are starving for sugar

Answer 7

Inside the body of a hypoglycemic patient

Question 8

Signs and symptoms of a hypoglycemic patient are

Answer 8

Confusion, stupor, unconsciousness, and seizures are common. Constricted blood vessels give the patient pale and sweaty skin. The fight-or-flight response increases the pulse rate and the respiratory rate

Question 9

Hyperglycemia is usually caused by

Answer 9

A lack of sufficient insulin, which leaves sugar in the bloodstream rather than helping it to enter the cells

Question 10

As blood sugar increases, water is pulled away from cells, causing systemic dehydration and potentially hypovolemic shock. Brain cells are damaged by dehydration, leading to a profound change in mental status. The overall dehydration results in the signs and symptoms of shock, including tachycardia, rapid respirations, and dropping blood pressure

Answer 10

Hyperglycemia

Question 11

As a last resort, cells begin to break down fats and proteins, giving off ketones and other waste products. These waste products build up and combine with dehydration to cause a condition called

Answer 11

diabetic ketoacidosis (DKA)

Question 12

Indications that a patient have diabetes include

Answer 12

a medical identification bracelet, wallet card, or other item suggesting a diabetic condition, such as a home-use blood glucose meter. medications such as insulin, a medication with a trade name for insulin (e.g., Humulin®), or an oral medication used to treat diabetes (such as metformin, Glucotrol®, Glucophage®, or Micronase®)

Question 13

children are more at risk for hypoglycemia or hyperglycemia

Answer 13

hypoglycemia

Question 14

patients who are hyperglycemic

Answer 14

frequently breathe very deeply and rapidly, as though they have just run a race. Dry mouth, intense thirst, abdominal pain, and vomiting are all common signs and symptoms of this condition

Question 15

Hyperglycemic emergencies usually have a _________ onset

Answer 15

slower

Question 16

hypoglycemia tends to ____________

Answer 16

come on suddenly

Question 17

Hyperglycemic patients often have ______ skin. Hypoglycemic patients have __________ skin.

Answer 17

warm, red, dry /
cold, pale, moist, or “clammy”

Question 18

hyperglycemic patient often has ________ breath

Answer 18

acetone

Question 19

“sugar (glucose) for everyone” is the rule of thumb for

Answer 19

Diabetic emergencies

Question 20

If the normal functions of the brain are upset by injury, infection, or disease, the brain’s electrical activity can become irregular. This irregularity can bring about a sudden change in sensation, behavior, or movement, called a _____________

Answer 20

seizure

Question 21

Partial seizures affect

Answer 21

only one part or one side of the brain. Often these seizures affect only one area of the body, and the patient usually does not lose consciousness

Question 22

Generalized seizures affect

Answer 22

the entire brain, and as a result affect the consciousness of the patient

Question 23

The patient will thrash about wildly, and the entire body is involved. The convulsion usually lasts only a few minutes and has three distinct phases

Answer 23

Tonic-clonic seizure

Question 24

Tonic clonic seizure have ______ phases

Answer 24

3

Question 25

Tonic phase.

Answer 25

The body becomes rigid, stiffening for no more than 30 seconds. Breathing may stop, and the patient may bite the tongue (rare) and could lose bowel and bladder control.

Question 26

Clonic phase.

Answer 26

The body jerks about violently, usually for no more than 1 or 2 minutes. (Some can last 5 minutes.) The patient may foam at the mouth and drool. The face and lips often become cyanotic.

Question 27

Postictal phase.

Answer 27

The postictal phase begins when convulsions stop. The patient usually regains consciousness quickly and enters a state of drowsiness and confusion that gradually clears. Some postictal patients may remain unconscious for more prolonged periods. Headache is common. Some postictal patients may show temporary strokelike unilateral weakness.

Question 28

An aura is

Answer 28

a sensation the patient has when a seizure is about to happen

Question 29

The most common cause of seizures in adults is

Answer 29

failure to take prescribed antiseizure medications.

Question 30

The most common cause of seizures in infants and children 6 months to 3 years of age is

Answer 30

high fever (febrile seizures)

Question 31

Idiopathic seizures occur ______

Answer 31

spontaneously with an unknown cause. This is often the case with seizures that start in childhood

Question 32

When the patient has two or more convulsive seizures in a row without regaining full consciousness, or has a single seizure lasting more than 10 minutes, it is known as

Answer 32

status epilepticus

Question 33

In a simple partial seizure (also called a focal motor, focal sensory, or Jacksonian seizure), there is tingling, stiffening, or jerking in _______ part of the body

Answer 33

just one

Question 34

An absence seizure

Answer 34

is brief, usually less than 10 seconds. There is no dramatic motor activity, and the person usually does not slump or fall. there is a temporary loss of concentration or awareness.

Question 35

____________ is the most common cause of seizures in infants and children

Answer 35

High fevers or sudden rise in temperature

Question 36

________ refers to the death or injury of brain tissue that is deprived of oxygen

Answer 36

stroke

Question 37

ischemic stroke

Answer 37

A stroke caused by a blockage, can occur when a clot or embolism occludes an artery

Question 38

hemorrhagic stroke

Answer 38

A stroke caused by bleeding into the brain frequently is the result of long-standing high blood pressure (hypertension). It also can occur when a weak area of an artery (an aneurysm) bulges out and eventually ruptures, forcing the brain into a smaller-than-usual space within the skull.

Question 39

Sometimes patients will understand you and know what they want to say, but will say the wrong words. This difficulty in using words is known as

Answer 39

expressive aphasia

Question 40

transient ischemic attack (TIA)

Answer 40

When this condition occurs, a patient appears to be having a stroke because the typical signs and symptoms of the condition are present. However, unlike stroke, a patient with a TIA has complete resolution of these symptoms without treatment within 24 hours (usually much sooner)

Question 41

What conditions mimic the signs of stroke

Answer 41

Hypoglycemia, infections, and sepsis