Diabetic Emergencies and Altered Mental Status Flashcards
Mental Status Regulation
• Regulated by neurologic circuits in brain
that comprise reticular activating system
(RAS)
• RAS responsible for functions of staying
awake, paying attention, and sleeping
• RAS keeps person alert and oriented
Requirements to Maintain Mental Status
- Oxygen to perfuse brain tissue
- Glucose to nourish brain tissue
- Water to keep brain tissue hydrated
Causes of Altered Mental Status
• Deficiences in oxygen, glucose, water to brain tissue • Trauma, infection, chemical toxins harming brain tissue • Primary brain problem (stroke) • Problem within another system (hypoxia due to asthma)
Often altered mental status is rapidly correctable by treating the underlying cause.
Safety
• Patient with altered mental status can be dangerous to responders • Always consider safety of yourself and your team before approaching a patient • Use law enforcement when necessary
Primary Assessment
• Identify and treat life-threatening problems
• Consider oxygen administration
• Be alert to the need for positioning and
suctioning if patient requires it or if mental
status worsens
Secondary Assessment
• Body systems exam and complete history
may reveal information about the
suspected cause of altered mental status
• Interview family members and bystanders
to obtain patient’s baseline mental status
• Family may provide information patient is
unable to give
difference between hypo and hyperglycemia
brain needs oxygen, glucose and water to brain tissue
diabetes mellitus
• Two types • Type 1 – Underproduction of insulin by pancreas • Type 2 – Inability of body’s cells to use insulin properly
Glucose
• Form of sugar
• Body’s basic source of energy
• Body cells require glucose to remain alive
and create energy
Glucose and the
Digestive System
- Glucose molecule is large
* Will not pass into cell without insulin
no insulin, no enzyme - no glucose gets in and the cell uses fat and protein to produce energy - this produces ketone acids
Lock and key mechanism
Insulin
• Produced by pancreas
• Binds to receptor sites on cells
• Allows large glucose molecule to pass into
cells
• Sugar intake–insulin production balance
allows body to use glucose effectively as
energy source
Type 1 Diabetes
• Pancreatic cells do not function properly
• Insulin not secreted normally
• Not enough insulin to transfer circulating
glucose into cells
• Synthetic insulin typically prescribed to
supplement inadequate natural insulin
Type 2 Diabetes
• Body’s cells fail to utilize insulin properly
• Pancreas is secreting enough insulin, but
body is unable to use it to move glucose
into cells
• Condition often controlled through diet
and/or oral antidiabetic medications
Diabetic Emergencies
- Hypoglycemia (low blood sugar)
* Hyperglycemia (high blood sugar)
Hypoglycemia: Causes
- Diabetic takes too much insulin
- Diabetic does not eat
- Diabetic overexercises or overexerts
- Diabetic vomits
- Very rapid onset
- May present with abnormal behavior mimicking drunken stupor
- Pale, sweaty skin
- Tachycardia
- Seizures
- altered mental status
- Starvation of brain cells
- Altered mental status
- Unconsciousness
- Permanent brain damage
normal blood sugar
80-120 mg/dl
hypoglycemia
insulin shock
take too much insulin too much sugar goes into the cells and there is not enough glucose for the brain which can absorb glucose without insulin
rapid onset
cool skin
hyperglycemia
diabetic coma - too much sugar slow onset altered mental status polyuria polydypsia ketones kussmal resp dehydration acetone breath - sweet smelling fruity breath blood pressure 90/60 because of hypovolemic
hyperglycemia causes
• Decrease in insulin – May be due to body’s inability to produce insulin – May exist because insulin injections not given in sufficient quantity • Infection • Stress • Increasing dietary intake
Hyperglycemia: Signs
- Develops over days or weeks
- Chronic thirst and hunger
- Increased urination
- Nausea
Hyperglycemia: Results
• Profound dehydration
• Excessive waste products released into
system
• Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis: Signs and Symptoms
- Profoundly altered mental status
- Shock (caused by dehydration)
- Rapid breathing
- Acetone odor on breath
insulin shock (hypoglycemic)
rapid onset mimic druken stupor pale sweaty tachycardia seizures
diabetic coma (hyperglycemia)
slow onset cells stare for glucose increased urination - polyuria drinks lots of fluid ketoacidosis nausea signs of shock
Blood Glucose normal range
80-120
hypoglycemia
< 60-80 mg/dL is a symptomatic diabetic
What happens when blood glucose is less than 50mg/dL
significant alternations in mental status
Blood glucose level 140mg/dL
hyperglycemia
if the patient hasn’t eaten enough calories, thrown up or taken insulin
insulin shock
if the patient is unresponsive…
you can’t give anything by mouth - can give them 02
glucometer
meter to
when you go to do this wipe with alcohol - wipe that off and then squeeze the blood
low 500
tube of glucose
25 gm
will work as long as the patient is not a brittle diabetic at the end of the road
works slowly
if it is not working get ALS there
seizure
a sudden change in sensation, behavior, or movement. The most severe form of seizure produces violent muscle contraction.
rapid firing of electrons in the brain
Causes of Seizure
Normal functions of the brain are upset by injury, infection or disease the brains electrical activity can become irregular.
Hypoxia Stoke Traumatic Brain Injury Toxins Hypoglycemia Brain Tumor Congenital Brain Defects Infection of the Brain Metabolic Idiopathic
Epilepsy
Eclampsia
Heat Strojke
can give O2
.
know the 3 stages of a seizure
tonic - rigid - stiffening for no more than 30 sec
clonic - jerk violently usually 1-2 min (up to 5)
postictal - convulsions stop - regain consciousness and may be drowsy
What seizure are not preceded by an aura
grand mal
Partial Seizures
affect only one side, or part, of the brain. May or may not be conscious.
Generalized Seizures
affect the entire brain and the consciousness of the patient
Greatest cause of seizures in adults
in adults greatest reason people have seizures is because the person don’t take the medicine
TIA
plaque in the arteries -similar to angina in the heart
75% of all strokes are caused by embolus
25% are caused by a bleed
.
brain aneurysm
bad headache
hemiparesis
weakness on one side of the body
most common cause of aneurysm occurring
high blood pressure
aphasia
difficulty in speaking or communicating
FAST
Face - ask to smile
Arms - hold up palm up do you see drift
Speech - silly sentence
Time - when
test only good for the initial test
if you fail one it is a stroke alert
time between onset and TPA can be no more than 3 hours
tonic-clonic seizure
a generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups
postictal phase
the period of time immediately following a tonic-clonic seizure in which the patient goes from full loss of consciousness to full mental status
aura
a sensation experiences by a seizure patient right before the seizure, which might be a smell sound or general feeling
insulin
a hormone produced by the pancreas or taken as a medication by any diabetics
status epilepticus
a prolonged seizure or situation when person suffers two or more convulsive seizures with our regaining full consciousness
syncope
fainting
altered mental status
common cause - hypoxia
oxygen to the patient during the primary assessment
Secondary assessment
altered mental status indicates a serious underlying issue.
do a good body systems exam and complete history
ask bystanders if this is the patients normal
