Diabetic emergencies and altered mental status Flashcards
Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the
reticular activating system (RAS)
A lack of what can lead to rapid and serious alterations of function and result in altered mental status
Oxygen is needed to perfuse brain tissue, glucose is needed to nourish brain tissue, and water is needed to keep brain tissue hydrated
Patients with diabetes
(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
occurs when pancreatic cells fail to function properly and insulin is not secreted normally
Type 1 Diabetes
occurs when the body’s cells fail to use insulin properly
Type 2 Diabetes
The sympathetic nervous system signals the liver to release glycogen (a form of stored sugar) in an attempt to
raise blood glucose levels
Blood vessels constrict, the heart pumps faster and harder, and breathing accelerates because the cells are starving for sugar
Inside the body of a hypoglycemic patient
Signs and symptoms of a hypoglycemic patient are
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
Hyperglycemia is usually caused by
A lack of sufficient insulin, which leaves sugar in the bloodstream rather than helping it to enter the cells
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
Hyperglycemia
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
diabetic ketoacidosis (DKA)
Indications that a patient have diabetes include
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®)
children are more at risk for hypoglycemia or hyperglycemia
hypoglycemia
patients who are hyperglycemic
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
Hyperglycemic emergencies usually have a _________ onset
slower
hypoglycemia tends to ____________
come on suddenly
Hyperglycemic patients often have ______ skin. Hypoglycemic patients have __________ skin.
warm, red, dry /
cold, pale, moist, or “clammy”
hyperglycemic patient often has ________ breath
acetone
“sugar (glucose) for everyone” is the rule of thumb for
Diabetic emergencies
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 _____________
seizure
Partial seizures affect
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
Generalized seizures affect
the entire brain, and as a result affect the consciousness of the patient
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
Tonic-clonic seizure
Tonic clonic seizure have ______ phases
3
Tonic phase.
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.
Clonic phase.
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.
Postictal phase.
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.
An aura is
a sensation the patient has when a seizure is about to happen
The most common cause of seizures in adults is
failure to take prescribed antiseizure medications.
The most common cause of seizures in infants and children 6 months to 3 years of age is
high fever (febrile seizures)
Idiopathic seizures occur ______
spontaneously with an unknown cause. This is often the case with seizures that start in childhood
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
status epilepticus
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
just one
An absence seizure
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.
____________ is the most common cause of seizures in infants and children
High fevers or sudden rise in temperature
________ refers to the death or injury of brain tissue that is deprived of oxygen
stroke
ischemic stroke
A stroke caused by a blockage, can occur when a clot or embolism occludes an artery
hemorrhagic stroke
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.
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
expressive aphasia
transient ischemic attack (TIA)
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)
What conditions mimic the signs of stroke
Hypoglycemia, infections, and sepsis
