NON-DKA, hypoglycemia Flashcards
metabolic complications
-DM is same thing as having HF same risks?? she said this
-Acute
-DKA
-HHNK
-Hypoglycemia
-Chronic
-Macrovascular- Cardiovascular disease; cerebrovascular disease
-Microvascular:
-Retinopathy
-Nephropathy
-Neuropathy
HHNK (hyperglycemia, hyperosmolar nonketotic syndrome)
-MC occurs in older adults with type 2 diabetes
-always look for precipitating factors
factors associated with HHNK
-Drugs
-Procedures
-Chronic illness
-Acute illness
-K is not as urgent bc insulin is present
-4 major clinical features
-Severe hyperglycemia
-No or slight ketosis
-Profound dehydration
-Hyperosmolality
-Complications: MI, Stroke, PE, Mesenteric vein thrombosis, DIC
-No acidosis
-The severe dehydration and low output state may predispose the patient to complications such as MI, stroke, PE, mesenteric vein thrombosis, and disseminated intravascular coagulation
treatment
-similar to DKA
-Volume replacement
-Insulin
-Find underlying cause
hypoglycemia
-AKA insulin reaction or hypoglycemia reaction
hypoglycemia risk factors
-Overdose of insulin/hypoglycemic medication
-Omitting a meal
-Overexertion
-Nausea and vomiting
-Alcohol intake
symptoms of hypoglycemia
-ADRENERGIC:
-Shakiness
-Irritability
-Nervousness
-Tachycardia
-Tremor
-Hunger
-Diaphoresis
-Pallor
-Paresthesias
-NEUROGLYCOPENIC:
-Headache
-Mental illness
-Inability to concentrate
-Slurred speech
-Blurred vision
-Confusion
-Irrational behavior
-Lethargy
-LOC, coma, seizure
-diff dx- hypothyroid, stroke
hypoglycemia interventions
-Mild- carbohydrate 10-15 gram*
-Moderate:
-20-30 gram of carbohydrates*
-Glucagon, 1 mg IM - if unconscious
-Severe:
-50% dextrose 25 g IV
-Glucagon 1 mg IM or IV
hypoglycemia other complications: somogyi phenomenon
-tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar
-hormones can change at night and affect sugar
-Somogyi effect, also known as the “rebound” effect
-adjust nighttime insulin
hypoglycemia other complications: dawn phenomenon
-Hormones (growth hormone, cortisol, and catecholamines) release large amounts of glucose: released in the early morning hours: may partially block the effect of insulin,—-hyperglycemia ensues
-adjust nighttime insulin
diabetic client and surgery
Preoperative care- stop PO and start injection insulin
Intraoperative care
Postoperative care
sick days and diabetes
-Individualized plan
-Monitoring:
-glucose levels
-ketones
-insulin
-nutrition
-fluids
-Know when to call the Clinician