EXAM 1 - DKA

Question 1

Treatment for insulin reaction/hypoglycemia?

Answer 1

oral sugar if conscious, rule of 15s - if unconscious 50% dextrose IV push or glucagon as ordered.

Question 2

What are some assessment findings of DKA?

Answer 2

Fruity breath, polydipsia, polyphagia, polyuria, warm/dry/flushed skin, Compensatory kussmauls respirations.

Question 3

Assesment findings for insulin reaction?

Answer 3

hypoglycemic (60 or less), diaphoretic, confused, dizzy

Question 4

In DKA, what happens to potassium and why?

Answer 4

Hyperglycemia causes Dehydration via osmotic diuresis /glucose in the urine which then causes Hyperkalemia.

Question 5

Hypoglycemia occurs during night (2-4 am), body reacts and secretes glucagon which results in early morning hyperglycemia - what is this known as?

Answer 5

Somogyi

Question 6

In DKA what causes increased ECF K+

Answer 6

Dehydration/cellular exit

Question 7

Treatment for HHNS?

Answer 7

Insulin, rehydration, Elyte correction

Question 8

what is the normal range for albumin?

Answer 8

3.5 to 5.5

Question 9

What is responsible for conserving Na+ in DKA

Answer 9

Aldosterone

Question 10

at what speed does DKA manifest?

Answer 10

Slow, may be hours or days.

Question 11

Treatment for Type 1 DM

Answer 11

Insulin, Diet, exercise

Question 12

at what speed does an insulin reaction occur?

Answer 12

Rapidly - minutes to hours

Question 13

Normal Fasting plasma glucose?

Answer 13

70-99

Question 14

What is a predictor of DM that may precede DM by 10 years?

Answer 14

Microalbuminuria - >20mg/L

Question 15

what are the goals for treating DKA?

Answer 15

correct volume depletion, electrolyte imbalance, acidosis, ketosis and precipitating factors - infection, emotional stress, trauma

Question 16

In DKA what decreases Na+

Answer 16

diuresis

Question 17

Treatment for DKA?

Answer 17

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

Question 18

how do you avoid lipodystrophy with insulin patients?

Answer 18

rotate injection sites.

Question 19

Summarize the pathophis of type 1 diabetes DKA

Answer 19

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

Question 20

In DKA what decreases K+

Answer 20

osmotic diuresis

Question 21

What are some labs you might see in DKA?

Answer 21

glucose above 250-positive ketones/glucose in urine- osmolarity>296- elevated BUN/HCT - MAD- Anion gap >12

Question 22

What causes coma in DKA and why?

Answer 22

Ketones are a CNS depressant and decreased blood flow to brain lead to coma.

Question 23

can happen to anyone with insulin resistance who is stressed, no ketones involved, especially in elderly.

Answer 23

HHNS

Question 24

What should be around for low blood sugar?

Answer 24

rapid acting glucose, complex carbs - rule of 15s

Question 25

occurs when the renal threshold for sugar exceeds 180 mg/dL

Answer 25

Glucosuria

Question 26

Diabetes A1C?

Answer 26

6.5 or above

Question 27

What is used to diagnose type 1 diabetes?

Answer 27

• A1C >6.5
• Random BGL >200
• Fasting BGL > 126

Question 28

Elevated BS between 4 am to 8 am, early morning

Answer 28

Dawn Phenomenon

Question 29

whats a major side effect of Insulin?

Answer 29

Hypoglycemia - tachy, tremor, cool, clammy

Question 30

What is the average blood sugar for 7% A1C? How does that change with change in %?

Answer 30

150 mg/dl - for each 1% change add or subtract 30. E.g. 8% would be 180 mg/dl

Question 31

You cant correct potassium unless this is in range.

Answer 31

Magnesium

Question 32

Assessment findings of HHNS?

Answer 32

very elevated BS (>600), >320 serum hyperosmolality, osmotic diuresis, Elevated BUN and HCT secondary to dehydration, scant to little ketones.

Question 33

Treatment for type 2 DM

Answer 33

Diet, exercise, oral hypoglycemics, sometimes insulin when severe insulin resistance.

Question 34

When does gestational diabetes present itself and how is it treated?

Answer 34

24 to 28 weeks gestation - treated with diet exercise, sometimes insulin.

Question 35

what complications come from DKA?

Answer 35

excess loss of F&E leads to hypovolemia, hypotension, renal failure, decreased blood flow to brain leads to coma & death.

Question 36

What is the order in which you mix insulin?

Answer 36

Nancy reagan RN - air in NPH(cloudy), air in Regular(clear), Draw up Regular, Draw up NPH