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NSG 430 - Critical Care > T2: DKA, HHS, SIADH, DI > Flashcards

T2: DKA, HHS, SIADH, DI Flashcards

1
Q

What is DKA caused by

A

profound deficiency of insulin

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2
Q

what is DKA characterized by

A

Hyperglycemia
Ketosis
Acidosis
Dehydration

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3
Q

DKA is more likely to develop in why type of diabetic

A

type 1

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4
Q

pH normal range

A

7.35-7.45

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5
Q

PaCO2 normal range

A

35-45 mm Hg

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6
Q

HCO3 normal range

A

22-26

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7
Q

blood glucose in DKA

A

≥ 250 mg/dL

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8
Q

main s/s of hyperglycemia

A

polyuria
polydipsia
polyphagia
“hot and dry, sugar high”

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9
Q

precipitating factors of DKA

A

-Illness
-Infection
-Inadequate insulin dosage
-Undiagnosed type 1 diabetes
-Poor self-management
-Neglect

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10
Q

clinical manifestations of DKA

A

-Dehydration (poor skin turgor, dry mucus membranes, tachycardia, orthostatic hypotension)
-Lethargy and weakness early
-skin is dry and loose, eyes become soft and sunken
-Abdominal pain/ anorexia, nausea, vomiting
-Kussmaul Respirations
-Acetone breath

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11
Q

blood pH in DKA

A

lower than 7.30

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12
Q

serum bicarb in DKA

A

< 16 mEq/L

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13
Q

UA in DKA

A

Moderate to high ketone levels in urine or serum

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14
Q

fluids for DKA

A

start on 0.9% NS
when BG reaches 250mg/dL, add 5-10% dextrose to 1/2 NS

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15
Q

when the BG reaches 250 mg/dL

A

add 5-10% dextrose to 1/2 NS, turn off insulin drip, then begin sub-q insulin, and take off NPO

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16
Q

HINT HINT: what is the rate for continuous regular insulin

A

0.1 U/kg/hr

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17
Q

what are the IV/Lines needed in a patient in DKA?

A

A line: to get ABGs
2 IV access: one for fluids and one for insulin

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18
Q

what is the rate we want to restore the UO to in DKA

A

30-60 mL/hr

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19
Q

measuring potassium in patient with DKA:

A

If the patient is hypokalemic, insulin administration will further decrease the potassium levels since insulin drives potassium into the cells, may need to give potassium replacement

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20
Q

what do we do if the patient becomes hypoglycemic

A

push D50

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21
Q

Hyperosmolar hyperglycemic syndrome (HHS)

A

a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion

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22
Q

what type of diabetes does HHS occur more in

A

type 2

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23
Q

precipitating factors of HHS

A

*UTIs, pneumonia, sepsis
*Acute illness
*Newly diagnosed type 2 diabetes
*Impaired thirst sensation and/or inability to replace fluids

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24
Q

glucose levels in HHS

A

> 600 mg/dL

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25
Q

UA in HHS

A

Ketone bodies are absent or minimal in both blood and urine

26
Q

management for HHS

A

includes immediate IV administration insulin and either 0.9% or 0.45% NaCl,
When blood glucose levels fall to approximately 250 mg/dL, IV fluids containing dextrose are administered to prevent hypoglycemia.

27
Q

what is a useful aid in detecting hyperkalemia and hypokalemia

A

cardiac monitoring

28
Q

rapid insulin onset
rapid insulin peak
Rapid insulin duration

A

10-30min
30min-3hr
3-5 hrs

29
Q

Short acting insulin onset
short acting insulin peak
short acting insulin duration

A

30min-1hr
2-5 hr
5-8 hours

30
Q

intermediate acting insulin onset
intermediate acting insulin peak
intermediate acting insulin duration

A

1.5-4 hours
4-12 hours
12-18 hours

31
Q

long acting insulin onset
long acting insulin peak
long acting insulin duration

A

0.8-4 hours
none
24 hours

32
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by

A

*fluid retention,
*dilutional hyponatremia
*Concentrated urine

33
Q

clinical manifestations of SIADH

A

-Low urine output
Increased weight
-Initially, thirst
-Dyspnea on exertion
-Fatigue

34
Q

diagnosis of SIADH

A

get blood and urine samples at SAME TIME

35
Q

serum sodium in SIADH

A

<135 (dilutional hyponatremia from excess fluid)

36
Q

urine specific gravity in SIADH

A

> 1.025 (amber urine)

37
Q

Pathophysiology Map of SIADH

A

-Increased Antidiuretic Hormone
-Increased water reabsorption in renal tubules
-Increased intravascular fluid volume
-Dilutional hyponatremia and decreased serum osmolality

38
Q

Causes of SIADH

A

-Malignant Tumors; cancers
-CNS Disorders; head injuries, stroke, infection, Guillain-Barre, SLE (SWELLING IN BRAIN PUSHING ON PITUITARY)
-Drug Therapy; Tegretol, general anesthesia, opiods, thiazides, SSRI, Chemotherapy
-Miscellaneous; hypothyroid, COPD, HIV, and Adrenal insufficiency

39
Q

management for SIADH

A

-loop diuretics
-Monitor urine output and urine specific gravity
-Daily weights, I&O, vital signs, monitor Lab values
-Monitor for seizures, headache, vomiting, and decreased neurological function
-fluid restrictions: Provide frequent oral care

40
Q

In extreme dilutional hyponatremia give

A

3% fluid

41
Q

Medications to treat SIADH

A

-Demeclocycline
-Vassopressor receptor antagonists
-loop diuretics
-sodium and potassium replacement

42
Q

Demeclocycline action

A

blocks the effect of antidiuretic hormone on renal tubules resulting in more dilute urine.

43
Q

Vasopressor Receptor Antagonists action

A

block the activity of antidiuretic hormone to treat hyponatremia

44
Q

loop diruetic action

A

promotes diuresis

45
Q

diabetes insipidus (DI)

A

antidiuretic hormone (ADH) is not secreted, or there is a resistance of the kidney to ADH
“PEE THEIR BRAINS OUT”

46
Q

Central DI causes

A

Head injury, surgery, CNS infections

47
Q

clinical manifestations of DI

A

polyuria, polydipsia (2 to 20 L/day)

48
Q

urine specific gravity in DI

A

< 1.005 (dilute urine)

49
Q

serum sodium in DI

A

> 145mg/dl

50
Q

HINT HINT: DDAVP (desmopressin) is used for

A

diagnosis of DI

51
Q

Water deprivation test

A

for diagnosis of DI
no water intake 2-3 hours followed by hourly measurements of urine vol/oslmolarity and plasma Na+ conc. and osmolarity

52
Q

important things to know about a hypophysectomy

A

biopsy of pituitary
-check “mustache dressing” for CSF making sure it is not saturated with fluid
-keep HOB up

53
Q

what can be given if a lot of CSF is present after a hypophysectomy

A

caffiene or vasoconstrictors

54
Q

management for DI

A

-Maintain adequate hydration, IV or PO
-Maintain electrolyte balance
-Monitor BP, HR, LOC, I&O
-Monitor specific gravity-urine or serum

55
Q

Hypokalemia EKG changes

A

ST depression
T inversion
U wave

56
Q

Hyperkalemia EKG changes

A

Tall T wave
Flat P wave
Wide QRS
Prolonged PR

57
Q

DDAVP for central DI is a

A

hormone replacement

58
Q

what is important when a client is on DDAVP

A

monitor pulse

59
Q

diet considerations for DI

A

LOW sodium diet

60
Q

HINT HINT: indocine (NSAID) and DI

A

helps increase renal responsiveness to ADH (watch for bleeding in the gut)

NSG 430 - Critical Care (42 decks)

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