EXAM 1 - DKA Flashcards
Info on DKA and diabetic conditions
Treatment for insulin reaction/hypoglycemia?
oral sugar if conscious, rule of 15s - if unconscious 50% dextrose IV push or glucagon as ordered.
What are some assessment findings of DKA?
Fruity breath, polydipsia, polyphagia, polyuria, warm/dry/flushed skin, Compensatory kussmauls respirations.
Assesment findings for insulin reaction?
hypoglycemic (60 or less), diaphoretic, confused, dizzy
In DKA, what happens to potassium and why?
Hyperglycemia causes Dehydration via osmotic diuresis /glucose in the urine which then causes Hyperkalemia.
Hypoglycemia occurs during night (2-4 am), body reacts and secretes glucagon which results in early morning hyperglycemia - what is this known as?
Somogyi
In DKA what causes increased ECF K+
Dehydration/cellular exit
Treatment for HHNS?
Insulin, rehydration, Elyte correction
what is the normal range for albumin?
3.5 to 5.5
What is responsible for conserving Na+ in DKA
Aldosterone
at what speed does DKA manifest?
Slow, may be hours or days.
Treatment for Type 1 DM
Insulin, Diet, exercise
at what speed does an insulin reaction occur?
Rapidly - minutes to hours
Normal Fasting plasma glucose?
70-99
What is a predictor of DM that may precede DM by 10 years?
Microalbuminuria - >20mg/L
what are the goals for treating DKA?
correct volume depletion, electrolyte imbalance, acidosis, ketosis and precipitating factors - infection, emotional stress, trauma
In DKA what decreases Na+
diuresis
Treatment for DKA?
Initially fluid (0.9 to 0.45), 5 to 10 unit bolus regular insulin then drip, once BS is down to 250 mg/dl switch to 5% dextrose and K+ added when urine output is adequate
how do you avoid lipodystrophy with insulin patients?
rotate injection sites.
Summarize the pathophis of type 1 diabetes DKA
Hyperglycemia due to lack of insulin to take gluc into cells–>Osmotic diuresis due to glucose in blood causes polyuria/glucosuria –>Cellular starvation of glucose causes polyphagia—>Ketones are produced when body turns to fat for energy (in absence of glucose)(fat acid oxidation)–>ketoacidosis
In DKA what decreases K+
osmotic diuresis
What are some labs you might see in DKA?
glucose above 250-positive ketones/glucose in urine- osmolarity>296- elevated BUN/HCT - MAD- Anion gap >12
What causes coma in DKA and why?
Ketones are a CNS depressant and decreased blood flow to brain lead to coma.
can happen to anyone with insulin resistance who is stressed, no ketones involved, especially in elderly.
HHNS
What should be around for low blood sugar?
rapid acting glucose, complex carbs - rule of 15s
occurs when the renal threshold for sugar exceeds 180 mg/dL
Glucosuria
Diabetes A1C?
6.5 or above
What is used to diagnose type 1 diabetes?
- A1C >6.5
- Random BGL >200
- Fasting BGL > 126
Elevated BS between 4 am to 8 am, early morning
Dawn Phenomenon
whats a major side effect of Insulin?
Hypoglycemia - tachy, tremor, cool, clammy
What is the average blood sugar for 7% A1C? How does that change with change in %?
150 mg/dl - for each 1% change add or subtract 30. E.g. 8% would be 180 mg/dl
You cant correct potassium unless this is in range.
Magnesium
Assessment findings of HHNS?
very elevated BS (>600), >320 serum hyperosmolality, osmotic diuresis, Elevated BUN and HCT secondary to dehydration, scant to little ketones.
Treatment for type 2 DM
Diet, exercise, oral hypoglycemics, sometimes insulin when severe insulin resistance.
When does gestational diabetes present itself and how is it treated?
24 to 28 weeks gestation - treated with diet exercise, sometimes insulin.
what complications come from DKA?
excess loss of F&E leads to hypovolemia, hypotension, renal failure, decreased blood flow to brain leads to coma & death.
What is the order in which you mix insulin?
Nancy reagan RN - air in NPH(cloudy), air in Regular(clear), Draw up Regular, Draw up NPH
