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Complex Care > Hyperglycemia > Flashcards

Hyperglycemia Flashcards

1
Q

Define Diabetes

A

A chronic multisystem disease related to
* Abnormal insulin production
* Impaired insulin utilization
* Or both

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2
Q

Diabetes is the leading cause of

A
  • End-stage renal disease
  • Adult blindness
  • Nontraumatic lower limb amputation
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3
Q

Diabetes is a major contributing factor to

A
  • Heart disease
  • Stroke
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4
Q

Indigenous communities have a rate ______ general population

A

3-5x higher rate

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5
Q

How can personal health practices and coping affect a diabetes diagnosis

A

If diagnosed, progression can be delayed with good habits

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6
Q

How does sex play a role in the incidence of diabetes?

A

CAD risk amongst type 2 diabetics impact female > male

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7
Q

Etiology of diabetes

A
  • Genetic
  • Autoimmune
  • Viral
  • Environmental
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8
Q

Types of Diabetes

A

Two most common types
* Type 1
* Type 2
Other types
* Gestational
* Prediabetes
* Secondary diabetes

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9
Q

What produces insulin

A
  • Produced by the  cells - Islets of Langerhans
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10
Q

Explain the release of insulin

A

Released continuously into bloodstream in small increments with larger amounts released after food

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11
Q

What range does insulin normally stabilize blood glucose to?

A

4 to 6 mmol/L

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12
Q

What does insulin promote?

A

glucose transport from bloodstream across cell membrane to cytoplasm of cell

Decreases glucose in the bloodstream

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13
Q

What A1C test is diagnostic of diabetes

A

> 6.5

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14
Q

Why can A1C test show glucose levels over the last 3 months?

A

Shows the amount of glucose attached to hemoglobin molecules over RBC life span which is
approximately 120 days

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15
Q

8 Clinical Manifestations of Diabetes

A
  1. polyuria
  2. polydipsia
  3. polyphagia
  4. elevated BG
  5. blurred vision
  6. weight loss
  7. weakness/fatigue
  8. abdominal cramping
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16
Q

Treatment of hyperglycemia (5)

A
  1. assessment and reassessment of if this is an existing or new diagnosis
  2. insulin reassessment of dose (SC/IV)
  3. fluids oral or IV
  4. BG monitoring
  5. monitor for acute complications
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17
Q

What causes DKA

A

profound insulin deficiency

18
Q

What type of diabetes usually sees DKA

A

Type 1

19
Q

What 4 things characterize DKA?

A
  1. hyperglycemia
  2. ketosis
  3. acidosis
  4. dehydration
20
Q

Why does hyperglycemia and ketosis characterize DKA

A

(r/t impaired secretion of insulin, glucose sits in vessels, body must break down fat leading to ketosis)

21
Q

Why does acidosis characterize DKA

A

high ketones which drive down patient’s pH, leading to metabolic acidosis

22
Q

Why does dehydration characterize DKA

A

Body attempting to correct a-b balance

23
Q

Precipitating Factors of DKA (7)

A
  • Illness
  • Infection
  • Inadequate insulin dosage; patients rationing doses
  • Undiagnosed type 1; come in with extreme sugars
  • Poor self-management/neglect
  • Change in diet, insulin or exercise regimen
  • Stress
24
Q

Early signs and symptoms of DKA are associated with

A

Lack of perfusion r/t lack of circulating volume (dehydration)

25
Q

Signs and Symptoms of DKA

A
  • lethargy/weakness
  • BG > 11.1
  • dehydration - poor skin turgor
  • dry mucous membranes
  • tachycardia
  • orthostatic hypotension
  • sunken eyes
26
Q

Lab pH expectation of DKA patient

A

< 7.35 (acidic)

27
Q

Urinalysis expectation DKA

A

Ketone spill

28
Q

Electrolyte expectation for DKA labs

A

Hyperkalemia early

Hypokalemia can occur with insulin therapy

Remainder of electrolytes can be depleted with dehydration

29
Q

What are kussmauls respirations and why are they seen in DKA

A
  • Rapid deep breathing – body is trying to get rid of acid by blowing off CO2 to increase pH
  • Attempt to reverse metabolic acidosis
  • Sweet fruity odour
30
Q

Why is abdominal pain seen in DKA

A

Gastroparesis associated with ischemia to mesentry

31
Q

ABC PRIORITY assessments for DKA

A
  1. airway and O2 admin r/t kussmauls
  2. LOC + VS
  3. hydration status + IV access
  4. electrolytes + BG monitoring
32
Q

Fluid resuscitation for DKA - solution and purpose

A

IV infusion 0.45% or 0.9% NaCl
* Restore urine output
* Raise blood pressure

33
Q

How does fluid therapy change when BG levels approach 13.8 in DKA patients?

A
  • 5% dextrose added to regimen
  • To prevent hypoglycemia- avoid rapid drop in blood sugar levels
34
Q

Why can IV potassium replacement be necessary in DKA patients?

A
  • Insulin drives potassium into the cells which can cause …
  • Potential hypokalemia – why don’t we like this?
  • Differentiation in potassium levels can cause arrhythmias
35
Q

When is IV insulin administration started?

A

only AFTER fluid resuscitation

36
Q

Describe IV insulin administration

A
  1. after fluid resuscitation
  2. slow careful continuous infusion
  3. hourly BG or more often
  4. SC insulin when patient is taking oral fluids and ketone spill in urine stops
37
Q

Nursing Management of DKA patient

A
  1. Monitoring during administration
  2. subjective assessment
  3. objective assessment
38
Q

What will be administered to DKA patient that nurse will have to monitor/manage?

A
  • IV fluids
  • Insulin therapy
  • Electrolytes
39
Q

What subjective information is key in management of DKA patient?

A
  • History or DM
  • Nutrition/pharma hx
40
Q

What objective information is key in management of DKA patient?

A
  • Renal status (output)
  • Full Cardio/Resp assessment
  • Breath sounds
  • Cardiac rhythm (monitor)
  • Level of consciousness (r/t glucose impairment)
  • Other systems?
  • N/V – abdominal
  • Hydration status
41
Q

4 Points of Evaluation for DKA patient

A
  • Pt will achieve glucose control
  • Avoid common complications from diabetes
  • Remain free from foot lesions, infections and deformities
  • Have decreased episodes of DKA

Complex Care (9 decks)

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