NURS 405 Week 6 Wednesday Flashcards
1
Q
Ketoacidosis
A
A complication of DM that results in a combination of ketosis and acidosis
2
Q
Criteria for DKA
A
- Hyperglycemia BG > 200
- Metabolic acidosis <7.3 or plasma bicarbonate <15mEq
- Ketosis: determined by presence of ketones in blood or urine
- Standard qualitative measurements of ketones can underestimate severity of ketosis.
- Serum beta-hydroxybutyrate is a more accurate measure of ketosis and should be used whenever available.
Beta-hydroxybutyrate concentrations ≥3mmol/L (31 mg/dL) are consistent with DKA BOB
3
Q
Severity of DKA
A
Severity / pH / Serum Bicarbonate
Severe / <7.1 / <5 (ICU)
Moderate 7.1 to 7.2 / 5-9 (ICU)
Mild 7.2 to 7.3 / 10 to 15
4
Q
DKA Diagnosis
A
Hyperglycemia
High anion gap acidosis
Ketonuria
Ketonemia
5
Q
Precipitating Factors to DKA
A
Poor metabolic control or missed insulin Stress Vomiting and dehydration Medications Drugs and Alcohol
6
Q
DKA clinical features
A
- 3 Ps
- As insulin deficiency becomes worse, apppetite is suppressed
- Pts present with anorexia, vomiting, nausea, abd pain - Hyperventilation (Kussmaul breathing)
- Tachypnea / fruity breath - Dehydration
- May not exhibit classic signs such as decreased skin turgor, or decrease u/o
7
Q
DKA Management
A
NPO Fluids - 2 bag system Monitoring - Labs - Neuro status --> b/c of dehydration, can develop cerebral edema
8
Q
2 bag system
A
Bag A - NS
Bag B - D10NS
if K+ = 5.5, then KCl or Kphos is added
9
Q
Cerebral Edema Peds Risk Factors
A
Severe acidosis
Elevated BUN
Severe Hypocapnia
Young child <5 years or new onset of diabetes
10
Q
Cerebral Edema Treatment
A
Mannitol, 0.5 to 1 g/kg IV over 15 minutes, repeated in 30 minutes if there is no initial response
11
Q
Risk Factors for Obesity
A
Activity is less, more sedentary Increased urbanization Requirement for PE have decreased Cell Phones/texting/social networks Neighborhood Safety Regular intake of sugar - sweetened beverages Portion sizes Eating out Skipped meals Fewer family meals Eating past satiety Decreased Fruit/Vegetable intake
