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BSNC 5000 > Module 5 - Viral AGE, DKA, Acid-base > Flashcards

Module 5 - Viral AGE, DKA, Acid-base Flashcards

1
Q

Gastroenteritis

A

inflammation of stomach/small/large intestine s/t infection

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2
Q

Common viruses causing AGE

A

rotavirus
norovirus
adenovirus

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3
Q

Rotavirus pathophysiology

A

virus binds to enterocytes
virus produces enterotoxin NSP4
alters villi function (blocks transport of glucose/Na+ & flattens cell –> lack of ATP/changed shape = decreased absorption)
decreased absorption = osmotic diarrhea

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4
Q

S/S of AGE

A

fever
nausea
vomiting
abdominal cramping/pain
++ diarrhea
dehydration s/t to fluid losses
anorexia –> hypoglycemia

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5
Q

S/S of mild dehydration

A

dry mucous membranes
increased thirst
asymptomatic

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6
Q

S/S of moderate dehydration

A

dry mucous membraness
sunken eyes
sunken fontanels
delayed cap refill
abnormal skin turgor
tachypnea
decreased urine output

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7
Q

S/S of severe dehydration

A

tachycardia
cold extremities
decreased LOC/impaired cognition
increased RR
hypotension (LATE sign)
oliguria

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8
Q

Dehydration treatment

A

oral rehydration therapy (pedialyte)
breastfeed as normal
encourage food
rest
IV therapy (severe)
treat underlying cause (fever, vomiting, etc)

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9
Q

Pediatric bolus

A

10-20 mg/kg
infused over 30 minutes

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10
Q

Diabetic ketoacidosis

A

more common in T1DM
ketosis
metabolic acidosis
hyperglycemia >11.1 pediatrics (13.8 adults)

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11
Q

DKA symptoms

A

dehydration
weight loss
hypokalemia
polyphagia
polyuria
polydipsia
weakness
nausesa/vomiting
hypotension + tachycardia
*kussmaul breathing
*acetone breath

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12
Q

Pseudohyponatremia

A

false normal serum levels of Na+ caused by intracellular shift of H2O to ECF

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13
Q

What does insulin do to K+?

A

causes K+ to shift from ECF into ICF –> hypokalemia

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14
Q

What should K+ be before beginning insulin?

A

> 3.3 mmol

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15
Q

DKA treatment

A

IV fluids (crystalloid –> dextrose when glucose drops)
IV insulin
potassium supplements
foley –> monitor urine output
cardiac monitor

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16
Q

What fluid is used for bolus?

A

normal saline
balanced crystalloids –> RL, plasmalyte

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17
Q

When is insulin initiated in pediatrics with DKA?

A

1 hour after fluid therapy
when potassium is >/= 3.3 mmol/L

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18
Q

RF for cerebral edema

A

bicarbonate

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19
Q

DKA tests

A

plasma glucose
electrolytes (calcium, magnesium, phosphate)
anion gap
urea/creatinine
blood gas
serum osmolality
serum/urine ketones
beta hydroxyburate

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20
Q

Acid-base

A

balance of pH, bicarbonate, paCO2

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21
Q

Types of acidosis

A

respiratory acidosis (paCO2)
metabolic acidosis (HCO3-)

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22
Q

Diabetic tests

A

oral glucose tolerance test
fasting blood glucose
hemoglobin A1C

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23
Q

Lipolysis

A

glycerol –> gluconeogenesis
free fatty acids –> converted into ketones in liver

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24
Q

DKA Patho

A

insulin deficiency –> hyperglycemia -> diuresis –> fluid/electrolyte imbalance –> dehydration –> reduced intravascular volume –> impaired perfusion
inability to use glucose –> lipid/protein catabolism
protein + glycerol –> gluconeogenesis –> worsens hyperglycemia
free fatty acids –> ketones –> ketosis/acetone breath

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25
S/S hyperglycemia
nausea/vomiting headache polydipsia polyuria polyphagia (T1DM) paresthesia recurrent infection/UTi fatigue (d/t reduced intravascular volume) blurry vision weight loss (T1DM)
26
Causes of hyperglycemia
missed insulin corticosteroids growth stress
27
Causes of hyperglycemia
missed insulin corticosteroids growth stress
28
Types of dehydration
hypotonic isotonic hypertonic
29
Kidneys & HCO3-
kidneys reabsorb & produce HCO3- decreased renal perfusion = less reabsorption in acidosis kidneys exchange ammonia for bicarbonate --> less bicarbonate retained
30
3 processes r/t acid-base balance
acid production (cellular metabolism) acid buffering acid excretion
31
How is CO2 transported in blood?
dissolved in plasma bicarbonate attached to hemoglobin
32
Carbonic anhydrase equation
CO2 enters RBC CO2 binds with water --> carbonic acid carbonic acid --> hydrogen + bicarbonate bicarbonate exchanged for Cl- in plasma
33
Buffer systems
bicarbonate (can only buffer metabolic acids) transcellular hydrogen-potassium exchange body proteins bone
34
IV fluids used to manage DKA
initial fluid bolus (NS or isotonic fluids) IV insulin 20-40 mEq/L K after glucose levels --> dextrose fluids
35
What BG would you begin dextrose fluids in the setting of DKA?
14-17 mmol/L
36
How quickly should you drop BG in the setting of DKA?
2.8-5 mmol/L an hour
37
Fasting blood glucose
4-7 mmol/L
38
2 hour postprandial blood glucose
5-10 or 5-8 mmol/L
39
Random BG indicating hyperglycemia
>11.1 mmol/L
40
How to calculate daily fluid requirements
100, 50, 20 <10kg: 100 mL/kg 10-20 kg: 1000 mL + (50 mL per kg over 10 kg) >20kg: 1500 mL + (20 mL per kg over 20 kg)
41
How to calculate hourly fluid requirements
<10 kg: 4 mL/kg 10-20 kg: 40 + (2 mL/kg for each kg >10) >20 kg: 60 + (1 mL/kg for each kg >20)
42
How to calculate hourly output
1-3 mg/kg/hr
43
Mild dehydration ORT recommendations
50 mL/kg over 4 hours
44
Moderate dehydration ORT recommendations
100 mL/kg over 4 hours
45
Which cells require insulin to intake glucose?
skeletal muscle fat cells (GLUT4 transporter located inside cells. insulin promotes insertion of GLUT4 into cell membrane allowing glucose to enter cells)
46
Volume for fluid bolus
10-15 mL/kg
47
Anion gap acidosis
caused by retention/increased production of acids causes an INCREASE in anion gap (cations - anions) increases b/c available serum bicarbonate (anion) is decreased in acidotic state
48
Hyperchloremic acidosis
caused by a LOSS of bicarbonate --> decreased buffering capacity GI, renal, exogenous causes
49
What is the only insulin that can be given IV?
regular human insulin
50
When should K+ supplements be given?
when K+ is
51
What is NSP4
only toxin known to be produced by a virus non-structural protein 4
52
What does NSP4 do
blocks transport of glucose and sodium into enterocytes flattens villi --> decreased absorption paracrine effect increases release of calcium from endoplasmic reticulum --> increased GI motility/secretion calcium stimulates vagal nerve --> vomiting
53
how long does acute gastroenteritis typically last
4-7 days usually self-resolving
54
S/S of rotavirus
fever watery diarrhea (non-bloody, explosive) vomiting
55
Causes of metabolic acidosis
increased lactic acid increased ketones decreased serum bicarbonate increased serum hydrogen
56
Types of dehydration
hypotonic <135 isotonic 135-145 hypertonic >145
57
Types of ketones
acetone beta hydroxyburate ACAC
58
Mild dehydration weight loss
3+-5%
59
Moderate dehydration weight loss
6-10%
60
Severe dehydration weight loss
>10%
61
Mild dehydration treatment
oral rehydration continue breastfeeding avoid fluids high in sugar (worsen diarrhea) age-appropriate foods in small amounts rest
62
Moderate dehydration treatment
50-100 mL/kg oral rehydration solution every 2-4 hours additional rehydration to compensate for ongoing losses
63
Severe dehydration treatment
rapid rehydration --> fluid bolus isotonic fluids glucose, electrolyte, urinalysis tests
64
Methods of fluid replacement
IV NG subc
65
Function of insulin
protein & fat anabolism glucose entry into skeletal/fat cells inhibits glycogenolysis promotes glycogenesis inhibits glucagon
66
Nursing interventions DKA
start IV access monitor weight (sign of hydration status) foley catheter --> monitor output cardiac monitor (arrhythmia s/t hypokalemia) administer fluids per doctor's order frequent assessments (blood glucose, VS, PAT)
67
IV potassium administration
confirm lab values for potassium assess kidney function --> need working kidneys to prevent hyperkalemia NEVER bolus potassium
68
Most common causes of DKA
missed insulin illness, infection, stress (increase insulin requirement)
69
Complications of T1DM
hypoglycemia (more common d/t use of insulin) DKA
70
Hyperglycemia and cerebral edema
hyperglycemia --> acidosis d/t dehydration acidosis --> vasodilation of cerebral arteries --> cerebral edema cognitive fx do not occur until this occurs
71
S/S of DKA
ketonuria hyperglycemia >13.8 acetone breath kussmaul resps (when pH <7.3) abdominal pain nausea/vomiting (d/t inflammatory mediators)
72
S/S of DKA
ketonuria hyperglycemia >13.8 acetone breath kussmaul resps (when pH <7.3) abdominal pain nausea/vomiting (d/t inflammatory mediators)
73
Cushing reflex
d/t increased ICP bradycardia widened pulse pressure irregular respiration

BSNC 5000 (11 decks)

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