Management of Patients with Diabetes Mellitus

Question 1

What are the Signs & Symptoms of Diabetic Ketoacidosis

Answer 1

Commonly seen in T1 DM
3 P’s: Polydipsia, Polyphagia, Polyuria

Acidosis: PH is less than 7.35
Rapid, deep breathing: Kussmaul’s Breathing resembling sweet, rotting fruit

Abdominal pain Nausea & Vomiting
Alertness to confusion
Hyperkalemia: mild to moderate
Clinical Tip: Be careful when giving 1L fluid per hour, the patient is at risk for fluid up in the lungs can cause fluid overload.

Question 2

What are the priority interventions for DKA ?

Answer 2

Priority Intervention: Correct Imbalances first
Safety Alert: Too rapid administration of IV fluids & rapid lowering of serum.
Drug Therapy Insulin Rx
Need to hold

Question 3

What is Diabetic Ketoacidosis?

Answer 3

Most common in T1 DM (mainly seen)

An acute life-threatening complication with T1 Patients
Profound deficiency of Insulin
Uncontrolled Hypoglycemia
Metabolic Acidosis
Increased production of ketones
Severe hydration - Fluid Loss
Electrolyte Imbalance
Ketones in the urine & blood
Fatigue, unexplained weight loss

Question 4

What are other lab findings for DKA?

Answer 4

Potassium Level: dependding on the amount of water loss
Acidemia: hyperkalemia ( mild-moderate)
ABG: Acidosis
Na: low, normal or high Sodium level
BUN
Creatnine:
Osmolarity/Osmolaity: Elevated
Urinalysis: Ketouria - ketones in the urine

Question 5

What are the clinical manifestations of DKA?

Answer 5

Dehydration & Electrolyte losses
Polydipsia, polyuria - Shock
Poor Skin turgor
Skin dry and loose
Eyes appear soft & sunken
Weight loss
lethargic and weakness: often early signs

Question 6

Hyperosmolar Hyperglycemic State
HyperosmolarHyperglycemic NonKetosis

Question 7

What are the clinical manifestations of HHS?

Question 8

What are the laboratory diagnostics for HHS?

Answer 8

Serum glucose
Serum osmolarity
Serum Ketones
PH: 7.4: HCO3 20 mEq/L
Serum NA: Normal or low
BUN: Elevated, Serum creatinine: Elevated

Question 9

Anion Gap

Answer 9

High Anion gap metabolic acidosis
Seen with Lactic Acidosis, DKA, Hyperchloremia

Formula: Na - Cl + HCO3

Normal Value: 7-9 mEq/L

Question 10

Oral Antidiabetics for Type 2

Answer 10

Sulfonylureas
Biguanides - Metformin
Alpha-glucosidase
Dipeptidyl - Peptides 4

Question 11

Slow Acting Insulin

Question 12

Rapid Acting Insulin

Question 13

Intermediate Acting Insulin

Question 14

Long-Acting Insulin

Question 15

A nurse is assessing a patient who came into the ER with a hypoglycemic episode. What will be the nurse’s findings on this patient?

Question 16

A nurse is treating a client diagnosed with hypoglycemia. What are simple carbohydrates that can be given to a client who is Hypoglycemic?

Answer 16

6 -10 lifesavers
4 tsp of sugar
4 sugar cubes
1 tbsp of honey
1/2 of a fruit cup
8 oz of lowfat milk
6 saltine crackers
3 graham crackers

Question 17

Knowing that glucoenesis helps to maintain blood glucose levels, a nurse should …

Question 18

A nurse is taking care of patient came in the clinic with chronic complications of diabetic neuropathy? What will be her findings?

Answer 18

automatic neuropathy
can affect nearly all body systems
Gastroparesis: delayed gastric emptying
Cardiovascular abnormalities: postural hypotension, resting tachycardia, painless myocardial infarction
Sexual function: erectile dysfunction, decrased libidio/impotece
Women -vaginal infections
meds: bethanechol
neurological bladder- urinary retention, empty frequently, use of crede maneuver

Question 19

What are Kussmaul’s Respirations, who are they commonly seen in what patients?

Question 20

A nurse is caring for a client admitted to the ER with DKA. in the acute phase the priority nursing action is to prepare to:

Question 21

How do we test glycated Hemogloblin?

Question 22

How do we diagnose a client with Type 2 Diabetes?

Question 23

Glycosylated hemoglobin test measures the average blood glucose control of an individual over 3 months. which lab value is considered a diagnosis of prediabetes?

Question 24

A client recently diagnosed with type 1 diabetes has a glycosylated hemoglobin of 8.1% which interpretation should the nurse make based on this result?

Question 25

Examples of HHS: Precipating Factors

Answer 25

Sepsis
UTI, DNA, Acute Illness
Newly Dx T2 DM
MI
Pancreatitis
Stroke
Some Meds: Diuretics, Glucoricoids, Phenytonn, calcium. channel blockers