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
