PCCN Endocrine

Question 1

s/s of hyperglycemia

Answer 1

• polyuria (frequent urination)
• polydypsia (great thirst)
• hunger (body not using the glucose, not in the cells)
• weakness (no energy b/c glucose not in cells)
• fatigue
• flushed, dry skin (hot,dry–> sugar high)
• dehydration
• N/V
• postural hypotension
• weak pulse
• abdominal cramps
• acetone breath&raquo_space; kussmauls respirations
• rapid breathing
• stupor, coma

Question 2

Mgmt of DKA

diabetic ketoacidosis (***assoc w/ type 1 DM)

Answer 2

DKA cause: Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated, BG > 300

Mgmt:
Reverse dehydration> 1-1.5L NS to start, then based on Na+ level give ns if low or .45%NaCl normal or high; add 5% dextrose when BG 250 RN: I&O, wt, assess fluid overload

Replace Insulin (IV drip): goal is to decrease glucose 50-75 mg/dl q1h; monitor neuro for cerebral edema assoc. w/ rapid reduction in BG

> > give insulin SQ when BG, dehydration and hypotension and acid-base are normalized

Reverse ketoacidosis: fluid an insulin, bicarb only if pH<7.0

Replenish electrolytes: low K and phosphate once rehydrated, insulin drive K into cell resulting in hypokalemia

RESOLVED: BG<200, HCO3>18, pH>7.30

Question 3

HHNK (***assoc w/ type 2 DM)

Hyperglycemic, hyperosmolar nonketotic coma

Answer 3

cellular dehydration» hyperosmalality from hyperglycemia and hypernatremia» fluid shift from inside cell to outside to offset osmolality (osmotic diuresis) => lead to coma

***give enough insulin to inhibit lypolysis or ketogenesis in liver, not to prevent hyperglycemia

Question 4

INSULIN USE:
Basal
Nutritional
Correctional

Answer 4

BASAL: used over 24 hour, needed regardless of BG level (ie Lantus/glargine)

NUTRITIONAL: used if pt receiving nutrition (PO, TPN, TF)

CORRECTIONAL: given if BG out of range

Question 5

s/s of hypoglycemia

Answer 5

restlessness
apprehension
irritability
trembling
diaphoresis (cold, clammy--> give candy)
pallor
paresthesias
headache
hunger
loss of coordination
visual disturbances
difficulty talking
tachycardia, arrhythmias
shallow respirations
hypertension
seizures, coma

Question 6

how does hyperkalemia present on ECG

Answer 6

depressed ST segments

tall, tented T waves