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Chapter 84
Unit 12: Nursing care of clients with endocrine disorders
| Term | Definition |
|---|---|
| Complications of DM (Pg. 927) 1. DKA.. what is it? onset? | Diabetic ketoacidosis: acute, life threatening hyperglycemia -Rapid onset |
| DKA hyperglycemia > ___ & resulting in .. | >300 Breakdown of body fat for energy; accumulation of ketones in the blood & urine |
| 2. HHS | Hyperglycemic-hyperosmolar state; acute, life-threatening profound hyperglycemia -Generally occurs gradually over several days |
| HHS hyperglycemia > ___ | >600 Hyperosmolarity that leads to dehydration, & an absence of ketones -can lead to coma & death -alteration in the sense of awareness; caused by insulin resistance = loss of fluids & lytes |
| DKA risk factors; type __ DM insulin needs carbs | Type 1 DM Missed or reduced dose of insulin Any condition that increases carb metabolism; physical/emotional stress, illness/infection (#1 cause), surgery/trauma |
| Why does infection/stress/trauma etc. create a decreased effect of insulin? | BC increased hormone production occurs; (cortisol, epi/norepi, glucagon) & stimulates liver to produce glucose |
| HHS risk factors; | -Residual insulin secretion; enough to prevent production of ketones but not keep glucose down -Type 2 dm -poor kidney function; can't excrete glucose into urine -Infection/stress |
| HHS; older adults w/ poor fluid intake become ___ & experience ____ d/t high BG | Dehydrated osmotic diuresis |
| Which meds could lead to HHS? | Glucocorticoids, diuretics, phenytoin (Dilantin), Propranolol (Inderal), & CCB |
| S/S (listed and say whether its DKA, HHS, or both) Pg. 928 1. Polyuria | DKA & HHS (osmotic diuresis causing excess fluid loss) |
| 2. Polydipsia | DKA & HHS (osmotic diuresis causing excess fluid loss causing increased thirst) |
| 3. Polyphagia | DKA |
| 4. Wt Loss | DKA |
| 5. GI effects (Nausea, vomit, abdominal pain) | DKA (increased ketones & acidosis lead to this) |
| 6. Blurred vision, headache, weakness | DKA & HHS (fluid volume depletion caused by osmotic diuresis = dehydration) |
| 7. Orthostatic hypotension | DKA & HHS (dehydration) |
| 8. Fruity odor of breath | DKA (elevated ketone bodies (small fatty acids) used for energy that collect in the blood, which leads to metabolic acidosis) |
| 9. Kussmaul respirations | DKA (deep rapid respirations in attempt to excrete CO2 when in metabolic acidosis) |
| 10. Metabolic acidosis | DKA (caused by breakdown of stored glucose, protein, & fat to produce ketone bodies) |
| 11. Mental status changes | DKA & HHS (alert, sleepy or comatose) |
| 12. Seizures, myoclonic jerking | HHS (related to serum osmolarity > 350) |
| 13. Reversible paralysis | HHS (r/t to high serum osmolarity) |
| Lab tests (Pg. 929) DKA & HHS 1. Serum glucose | DKA: >300 HHS: >600 |
| 2. Serum lytes -sodium & potassium | DKA: Na+ ^ d/t water loss, K+ initial decrease d/t diuresis, may ^ d/t acidosis HHS: Na+ ^ d/t water loss, K+ initial decrease d/t diuresis |
| 3. Serum renal studies BUN & creatinine | DKA & HHS; ^ d/t dehydration BUN; >30 Creat; >1.5 |
| Normal BUN & creatinine | BUN: 10-20 Creatinine: .5-1.1 |
| 4. Ketones -serum & urine | DKA: present in both HHS: absent in both |
| 5. Serum osmolarity | DKA: high HHS: >320 |
| 6. Serum pH (ABG) | DKA: <7.3 d.t metabolic acidosis (respiratory compensation/kussmaul) HHS; normal PH >7.4 |
| Nursing care: Fluids start & follow w/ | Rapid isotonic (0.9% NS) replacement (monitor for FVE) Follow with: hypotonic fluid (0.45% NS) |
| Nursing care con't: When serum glucose levels get down to 250... | Add glucose to IV fluids; -Minimizes risk of cerebral edema d/t drastic changes in serum osmolarity & prevent hypoglycemia |
| Nursing care con't again: Insulin | Administer regular insulin (Humulin R) 0.1 unit/kg as an IV bolus dose & then follow w a con't IV infusion of regular insulin at 0.1 unit/kg/hr |
| Why is IV regular insulin administered? | 4 minute half life -avoiding delay of onset |
| What is the goal of BG & how often should it be monitored? | <200 & monitor hourly |
| Nursing care: Potassium | Initially increased w insulin then will decrease into the cells; monitor for hypokalemia -k+ replacement therapy in IV fluids -make sure urinary output is ok before giving k+ |
| Nursing care for severe acidosis: | Administer sodium bicarbonate by slow IV infusion for slow acidosis (pH <7.0) |
| Client education; | Medical alert bracelets encouraged Hydrate; at least 3L water/day -glucose q4h when ill -carbs/lyte sport drinks when unable to eat food |
Created by:
mary.scott260!
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