Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sophomore 2 Test 6 > DKA/HHNK > Flashcards

DKA/HHNK Flashcards

1
Q

What is diabetes?

A
  • Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from deficits of insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does insulin do?

A

Insulin helps lower the blood sugar by moving glucose from the blood into the muscle, liver, and fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DKA Pathophysiology

A
  • Without insulin, the amount of glucose entering the cells decreases
  • The liver produces and releases more glucose which causes elevated blood glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do the kidneys react during DKA?

A

They attempt to rid the body of the excess glucose along with water and electrolytes, so they excrete more fluid

    • Results in:
      • Loss of electrolytes
      • Dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DKA - Acidosis

A
  • It is metabolic acidosis
  • The lungs try to compensate resulting in Kussmaul’s respirations (usually the first outward sign of DKA)
  • Acidosis occurs when there is an increase in H+ production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of DKA

A
  1. Missed insulin doses
  2. Markedly inadequate amount of insulin
  3. Illness or infection
  4. Undiagnosed or untreated diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who are increased risk for DKA?

A
  1. Chronic alcohol
  2. Drug abuse
  3. Mental illness
  4. African American
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sick Day Rules

A
  1. Never omit insulin (cut long acting in half)
  2. Prevent dehydration and hypoglycemia (fluids every hour)
  3. Monitor blood sugar and ketones every 4 hours
  4. Provide supplemental fast acting insulin
  5. Treat underlying triggers
  6. Maintain contact with medical team
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical Manifestations of DKA

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Fatigue
  5. N/V
  6. Kussmauls
  7. Acetone fruity breath
  8. HA
  9. Extreme drowsiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnostic Findings for DKA

A
  1. BG level 300-800 (but could be 250)
  2. Venous pH < 7.30 and bicarb of < 18 (tells how bad DKA is)
  3. Ketoacidosis is reflected in low serum bicarb and low pH
  4. Positive urine ketones
  5. Hyponatremia
  6. Hypokalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pH ABG for Moderate DKA

A

7.15 - 7.25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pH ABG for Severe DKA

A

Less than 7.15

** They need to be in the ICU!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nursing Assessment of DKA Patient

A
  1. Assess mucous membranes for dehydration
  2. Assess cardiac changes (ECG)
  3. Assess respiratory status (rapid, shallow breaths)
  4. Assess GI symptoms (N/V)
  5. Assess mental status (lethargy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DKA Treatment

A
  1. Correct dehydration
  2. Treat the hyperglycemia
  3. Correct the electrolyte loss
  4. Correct acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DKA Rehydration

A
  • Draw labs first!!!!
  • May need up to 6-10 L of fluid
  • Normal saline is infused rapidly
  • Frequent VS to be careful with BP
  • Can lose 6-9 L of fluid
    * Replace 50% of that in the first 24-36 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DKA Electrolyte Concerns

A
  • K is biggest concern
  • Major loss of K from body stores
  • K must be monitored frequently
  • Cautious K replacement is vital to avoid dysrrhythmias
    • CANNOT have insulin is K < 3.3 because insulin can cause a further drop in K (if it starts to drop, stop insulin!)
17
Q

DKA IV Insulin

A
  1. Initial bolus of 0.1 units/kg (ONE TIME)
  2. 0.1 units/kg/hr
  3. Once BG reaches 200-250, can decrease insulin by 50%
  4. SQ is effective but inferior to IV
  5. Insulin is given after fluids
  6. BG monitoring every hour to ensure it doesn’t drop too quickly
  7. Waste 20-50 mL so the insulin can have the initial adherence done
18
Q

When do we give bicarb to DKA patients?

A
  • For a pH less than 6.9
  • 100 mEq of sodium bicarb every 2 hours
  • Giving bicarb is controversial but ADA continues to recommend it
19
Q

DKA Complications

A
  1. Infection
  2. Shock
  3. Vascular thrombosis
  4. Pulmonary edema
  5. Cerebral edema
  6. Hypoglycemia
20
Q

DKA Complications: Infection

A
  • Precipitates DKA
  • Fever
  • Leukocytosis can be secondary to acidosis
21
Q

DKA Complications: Shock

A

If fluids does not improve it, then perform other tests to rule out an MI

22
Q

DKA Complications: Vascular Thrombosis

A
  • Severe dehydration
  • Cerebral vessels
  • Occurs hours to days after DKA
23
Q

DKA Complications: Pulmonary Edema

A

Result of aggressive fluid resuscitation

24
Q

DKA Complications: Cerebral Edema

A
  • First 24 hours
  • Mental status changes
  • Treat with Mannitol
  • May require intubation with hyperventilation
25
Q

How do you know when DKA is resolved?

A
  1. Glucose is between 200-250
  2. pH is > 7.3
  3. Bicarb is > 15
    * * Give intermediate insulin about 2 hours before terminating IV
26
Q

HHNK

A

Hyperglycemic Hyperosmolar Nonketotic Coma

  • Seen in Type 2 DM
  • No ketones
  • Usually evolves of several days to weeks
  • Common in elderly
27
Q

Why is HHNK common in the elderly?

A
  1. Decreased fluids
  2. Decreased kidney function
  3. Increased sugar
28
Q

Clinical Manifestations of HHNK

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Fatigue
  5. Blood sugar > 600
  6. Warm, dry skin
  7. Hallucinations
  8. Weakness on one side of body
  9. NO KUSSMAULS
  10. N/V less common
29
Q

Diagnostic Findings for HHNK

A
  1. Blood sugar > 600
  2. pH > 7.3
  3. Bicarb 20
  4. CNS changes (degree related to serum osmolarity)
  5. Dehydrated with high BUN and creatinine
30
Q

HHNK Treatment

A
  1. Fluids
  2. Insulin
  3. Monitor airway
  4. Large bore IV to run fluids quickly
  5. Brain can swell with rapid reduction
  6. 24-48 hours to get back to normal levels (don’t bring BG down too fast)
31
Q

HHNK Fluid Resuscitation if patient has a normal BP

A

Use 0.45% NS

32
Q

HHNK Fluid Resuscitation if patient is in shock or has severe hypotension

A

Use normal saline

33
Q

HHNK Fluid Resuscitation Rate of IV

A
  1. Initially 1 L/hr until BP and UOP are adequate
  2. Then decrease to 100-200 mL/hr
  3. Replace 1/2 fluid deficit in 12 hours
  4. If LOC is not improving then you aren’t giving them enough fluid!!
34
Q

HHNK Fluid Resuscitation for CHF patients

A

Watch for fluid overload

35
Q

HHNK Fluid Resuscitation for patients with kidney disease

A

Watch their respiratory status

36
Q

If your HHNK patient’s mental status declines what do you do?

A

Think cerebral edema!

Give Mannitol

37
Q

HHNK Complications

A
  1. Stroke (from dehydration)
  2. Cerebral edema (from BG being brought down too quickly)
  3. Sepsis
38
Q

HHNK Insulin Therapy

A
  1. Initial bolus of 0.15 units per kg IV
  2. Then, 0.1 units/kg/hr until BG is 250
    * * Fluids first though!!!!

Sophomore 2 Test 6 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions