Management of Patients with Diabetes Mellitus Flashcards
What are the Signs & Symptoms of Diabetic Ketoacidosis
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.
What are the priority interventions for DKA ?
Priority Intervention: Correct Imbalances first
Safety Alert: Too rapid administration of IV fluids & rapid lowering of serum.
Drug Therapy Insulin Rx
Need to hold
What is Diabetic Ketoacidosis?
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
What are other lab findings for DKA?
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
What are the clinical manifestations of DKA?
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
Hyperosmolar Hyperglycemic State
HyperosmolarHyperglycemic NonKetosis
What are the clinical manifestations of HHS?
What are the laboratory diagnostics for HHS?
Serum glucose
Serum osmolarity
Serum Ketones
PH: 7.4: HCO3 20 mEq/L
Serum NA: Normal or low
BUN: Elevated, Serum creatinine: Elevated
Anion Gap
High Anion gap metabolic acidosis
Seen with Lactic Acidosis, DKA, Hyperchloremia
Formula: Na - Cl + HCO3
Normal Value: 7-9 mEq/L
Oral Antidiabetics for Type 2
Sulfonylureas
Biguanides - Metformin
Alpha-glucosidase
Dipeptidyl - Peptides 4
Slow Acting Insulin
Rapid Acting Insulin
Intermediate Acting Insulin
Long-Acting Insulin
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?
A nurse is treating a client diagnosed with hypoglycemia. What are simple carbohydrates that can be given to a client who is Hypoglycemic?
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
Knowing that glucoenesis helps to maintain blood glucose levels, a nurse should …
A nurse is taking care of patient came in the clinic with chronic complications of diabetic neuropathy? What will be her findings?
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
What are Kussmaul’s Respirations, who are they commonly seen in what patients?
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:
How do we test glycated Hemogloblin?
How do we diagnose a client with Type 2 Diabetes?
Glycosylated hemoglobin test measures the average blood glucose control of an individual over 3 months. which lab value is considered a diagnosis of prediabetes?
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?
Examples of HHS: Precipating Factors
Sepsis
UTI, DNA, Acute Illness
Newly Dx T2 DM
MI
Pancreatitis
Stroke
Some Meds: Diuretics, Glucoricoids, Phenytonn, calcium. channel blockers
