DKA & HHNS-Vironee Flashcards
Review: DM is a _____disease
metabolic
the hormone insulin is produced by the
pancreas and controls the level of glucose in the blood
DKA & HHNS
DKA is diabetic ketoacidosis
HHNS is hyperglycemic-hyperosmolar non-ketotic syndrome
DKA can be caused by
anything that stress the body
3 main common clinical features in DKA
- hyperglycemia
- dehydratin and electrolyte loss
- acidosis
S & S of DKA
polyuria polydipsia blurred vision muscle weakness HA orthostatis hypotension weak rapid pulse kusmalls fruity breath Gi discomfort N/V mental changes
assessment findings for DKA
glucose between 300-800 low bicarb low ph low partial pressure of co2-blowing it off ketones in blood and urine Elevated serum K levels
Potassium in DKA
potassium is pushed out of cells and into the intravascular-so really we have atotal body depletion of K and NA potassium and ph have an inverse relationship ph decreases(acid)---> K goes up (acidic)
What are sick days
teaching patients how to prevent DKA by telling them not to elliminate insulin when nausea and vomiting occur
- -they should attempt to eat small carbs
- -drink fluids every hour
- -assess bg and ketone every 3-4 hours
- -notify md when levels go above 300
Medical Management of DKA
rehydrate 6-10 L
- -start w/ .9 % NS for 2-3 Hr
- —–then .45% NS-watch Na and BP
- ———–when glucose reaches 250-300 change to Dextrose 5%
Why would we want to give a DKA patient dextrose
to prevent a precipitate decline
Management of DKA and K
total K low- replace and monitor ECG q 2-4 hours
HOLD IF PATIENT IS NOT URINATING
REVERSING ACIDOSIS?
slow iv insulin at 5 units per hur or .1 units/kg/hr
continue until bicarb rises to 15-18
GOAL is to drop at 10% an hour do not go too fast
HHNS is characterized mainly by being
mainly elderly–type II–insulin resistance–no ketones–change in LOC
S &S of HHNS
Hypotension profound dehydration tachy neuro ph normal bicarb normal BLOOD GLUCOSE 600-1200
