Final study guide: DKA and HHS

Question 1

DKA: what are we doing for this pt(7)

Answer 1

– Intracranial pressure monitoring
– Mannitol
– Elevate the HOB
– Treat fever
– Treat HTN
– Minimize noxious stimuli
– Correct hypercapnia and
hypoxemia

Question 2

Hyperglycemic Hyperosmolar State HHS: what

Answer 2

absence of ketone formation

Question 3

HHS: def (6)

glucose, osmolarity, pH, HCO3, Ketosis, LOC

Answer 3

– Hyperglycemia— 600-2000 (average 1100)
– Hyperosmolality (>350) and osmotic diuresis
– Arterial pH > 7.3
– Serum bicarb > 15
– Ketosis is mild or absent
– Changes in LOC

Question 4

HHS: pt profile (age, preciperatory events (7))

Answer 4

*age: over 50
*Precipitated: – Infection, stroke, MI, trauma, burns, stress of a major illness and medications

Question 5

DKA specific s/s: (6)

Answer 5

*HA
*N
*extreme fatigue
*kussmaul breathing
*acetone breath
*ABD pain

Question 6

HHS specific s/s: (6)

Answer 6

*Convulsions
*coma
*PROFOUND dehydration: little salivation, tachy, increased resps, poor skin turgor, HoTN
*PROFOUND weight loss
*paresthesia (abnorm limb sensation), paresis (partial paralysis), plegia (severe paralysis), aphasia (not able to talk right)
*decreased DTR

Question 7

DKA gulcose

Answer 7

300 – 800 average 600
Glucometers can’t handle
>600

Question 8

HHS glucose

Answer 8

600 – 2000 average 1100

Question 9

DKA potassium (3pts)

Answer 9

• Total body depletion
• Normal or elevated
• Insulin therapy increases the transport of K resulting in lower serum K levels

Question 10

HHS potassium (2 pts)

Answer 10

• Total body depletion
• Low

Question 11

DKA HCO3 and pH

Answer 11

both low

Question 12

HHS HCO3 and pH

Answer 12

both normal

Question 13

DKA serum osmolality

Answer 13

variable

Question 14

HHS serum osmolality

Answer 14

elevated

Question 15

DKA urinalysis (UA)

Answer 15

*glucose: positive
*Ketones: elevated

Question 16

HHS UA

Answer 16

*Glucose: positive
*Ketones: negative

Question 17

DKA: rehydration (2)

Answer 17

5 – 10% of body weight
Up to 6L of fluid

Question 18

HHS: rehydration (2)

Answer 18

150 ml/kg of body weight
7 – 10 L of fluid

Question 19

DKA: isotonic solution (2)

Answer 19

*1-2L for 1st hour and cont till pt is hemodynamically stable
*1/2 NS and D5W: 50/50 mix when BS drops to 200

Question 20

HHS: isotonic solution (2)

Answer 20

*2 – 4 L over the 1st hour
*6 – 10 L over the 1st 10 hours is typical may change to D5W ½ NS when glucose gets to 300

Question 21

DKA and HHS: other potential fluids (2)

Answer 21

• ½ NS is used if Na is > 140
• Colloids (albumin) may be needed if the patient continues
  hypotensive

Question 22

DKA: Insulin (5)

Answer 22

*give IV regular insulin bolus
*IV insulin infusion (0.1 u/kg/hr)
*serum glucose should NOT drop more that 50-70mg/dl/hr to avoid low BS
*insulin usually decreased 3-5 u/hr
*when glucose is <250 d/c drip but only 1-2 hr after SQ insulin started

Question 23

HHS: insulin (6)

Answer 23

*smaller amounts of insulin needed
*give IV regular insulin bolus
*IV insulin infusion (0.1 u/kg/hr)
*serum glucose should NOT drop more that 50-70mg/dl/hr to avoid low BS
*insulin usually decreased 3-5 u/hr
*when glucose is <300 d/c drip but only 1-2 hr after SQ insulin started

Question 24

DKA: Bicarbonate RN management (3)

Answer 24

*only if pH <6.9
*DC when pH >7
*HCO3 crosses the BBB more slowly than CO2 -> alkalosis -> pushes K into cells -> low K levels

Question 25

HHS: Bicarbonate

Answer 25

pt not usually acaidotic

Question 26

DKA specific monitoring (4)

Answer 26

*measuring ketones w/ I&Os hourly
*Fruity acetone odored breath
*ABGs monitored per shift
*BG chems every hour

Question 27

HHS specific monitoring (4)

Answer 27

*just I&O Q1hr
*ABG Qdaily
*BG chems Q30min-1hr
*electrolytes Q1hr

Question 28

DKA & HHS: s/s of fluid vol overload (4)

Answer 28

Neck vein engorgement, dyspnea without exertion, elevated CVP, washing machine lung sounds

Question 29

DKA & HHS: fluid vol overload tx

Answer 29

• Lower IV rate and add O2 if not already on it

Question 30

s/s of hypoglycemia (3) and tx (2)

Answer 30

• Hypoglycemia—unexpected behavioral changes,
  diaphoresis, tremors
• Stop insulin and notify MD

Question 31

DKA: hyperglycemia s/s (3) and tx (1)

Answer 31

Hyperglycemia—Kussmaul resps, dry skin, fruity acetone breath-notify physician

Question 32

HHS: hyperglycemia s/s (1) and tx (1)

Answer 32

• Change in LOC
• Notify physician

Question 33

Seizures are a risk for HHS patients
related to

Answer 33

profound osmotic diuresis
and resulting dehydration