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DKA & HHS
Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State ( HHS)
| Question | Answer |
|---|---|
| DKA most serious diabetic emergency for? | both types 1 and 2 |
| Reasons for DKA admission?: | 1) infection; 2) D/C Meds or inadequate therapy 3) trauma; 4) med/surg illnesses |
| Classic symptoms of DKA? | -Polyuria -polydypsia -polyphagia with weight loss -Weakness -N/V -A-pain |
| “So what are you critically thinking about when you first lay eyes on the patient ? ” | -always think airway. -Breath smells fruity odor– so when your burning ketones, you know the pt is diabetic. |
| Are they awake when BG is 600? | NO, -no, room spining/confused. |
| DKA: what are some s/s of acidosis? | -CENTRAL -RESPIRATORY -MUSCLUAR -INTESTINAL -RESPIRATORY (SOB, coughing) -HEART (^HR, Arrythmias) -GAStric (NV) |
| Pathophysiology - DKA 1. Loss of insulin dependent glucose transport into? 2. Increased in liver? 3. Increased breakdown of? 4. Hyperglycemia- BG >? 5. _ketone___/____ 6. Acidosis pH <_____________? 7. HCO3 <_____________ | Pathophysiology - DKA 1. peripheral tissues 2. gluconeogenesis 3. fat, protein, and glycogen 4. 200mg/dL 5. Ketonemia/ketonuria 6. pH < 7.3 7. <15 |
| Hyperglycemia: 1. above renal threshhold: > ________ 2. > 180-200 BG is_______________ 3. Osmotic diuresis drags solutes (Na, K, Cl, PO4) with it leading to loss of ---------> | Hyperglycemia 1. > 180-200 2. glycosUria 3. Dehyration & Electrolyte loss |
| Dehydration: 1. aggrivates existing______________ 2. Lactic ________ | Dehydration: 1. ketoacidosis 2. lactic acidosis |
| HHS: 1. Altered sensorium without __________? 2. critical deficit of what but enought to prevent ketonemia? 2. there is profound what? 4. severe loss of ? 5. PLASMA GLUCOSE >______? 6. SERUM OSMOLARITY >_______? 7.SERUM CO2 is >___ | HHS: 1. true coma 2. Insulin 3. Dehydration 4. Electrolytes 5. > 600 6. > 320 7. >15 |
| (HHS) is a serious complication of ____ that involves a cycle of increasing ______levels and ____, without ____ | Diabetes blood sugar Dehydration ketones |
| HHS usually occurs with? | type 2 diabetes, but it can also occur with type 1 diabetes. |
| HHS IS often triggered by? serious ____ or another severe _____, or by medications that lower glucose tolerance or increase _____ (especially in people who are not drinking enough fluids). | -infection -illness -Medications -fluid loss |
| HHS symptoms -high blood ____ levels, -dry ___ -extreme ____ -dry ____, and -high _____. HHS can lead to: | HHS symptoms -high blood sugar -mouth, -extreme ____ -dry ____, and -high ___ LOC--seizures-coma, and death. |
| 1. HHS INITIAL TREATMENT is ______ 2. Type of solution? 3. replace urinary loses with? (faster way to hydrate) 4. what do you do until the fluid resuscitation has been accomplished and serum glucose is no longer decreasing from rehydration alone. | 1. FLUID RESUSCITATION 2.. Isotonic saline – 0.9 % saline- 3. with 0.45% saline 4. hold insulin |
| HHS: 1. Monitoring decision making is based on what? 2. what type of assessment done hourly? 3. what are monitored Q 2 hours until normal? and until HCO3 is greater than what ________? then Q 4hours | HHS: 1. Trends 2. Neuro assessments and Blood glucose 3. Electrolytes- >15 |
| HHS: high risk and ICU pts pediatrics: 1. pH< _________ 2. Glucose > _________ 3. Na calculated > __________ 4. K < ________ 6. Severe hyperosmolality > _______ 7. dysfunction of? | HHS: high risk and ICU pts pediatrics: 1) pH< 7.2 2) Glucose > 1000 3) Na calculated > 160 5) K < 3.5 6)>350mOsm 7)Organ systems |
| You must know ____when managing a patient with DKA and HHS: Labs will be drawn frequently and interventions based on _______ | LABS TRENDS (interventions based on trends) |
| HHS & DKA: requires constant monitoring of ? -monitoring___vital signs, -managing at least 2 ____ -hourly ____ -insulin drips, and patient care. | -v/s -IV lines -blood draws, |
| Dehydration: 1. Physical exam reveals______deficits. 2. Estimated _________ml/kg water deficit 3. Abnormal Labs : Triad of: | Dehydration: 1. Volume 2. 100 3. Hyperglycemia, hyperketonemia, and metabolic acidosis |
| DKA vs. HHS GLUCOSE PH OSMOLARITY | Glucose: DKA vs. HHS > 250 DKA > 600 HHS pH < 7 to 7.3 DKA >7.3 HHS osmolality______ Variable: DKA >320 HHS |
| Goals of treatment: (of HHS & DKA) 1. Prevent _____ collapse 2. Prevent overwhelming_____ 3. Reverse ____ 4. Protect against ____ ____ 5.Prevent Cardiovascular collapse by Expanding volume with _______ – saline | HHS & DKA treatment goals: 1. Cardiovascular 2. acidosis 3. hypokalemia 4.cerebral edema 5.isotonic fluids |
| -Prevent overwhelming acidosis by initiation of ___ to stop fatty acid oxidation and ____ production -Volume expansion and tissue reperfusion to correct lactic acidosis | -insulin, ketone |
| Reverse _____ by by adeqaute _____ replacement in rehydration fluids and monitoring with blood tests / ECG | -hypokalemia -potassium |
| 1. Rapid rates of rehydration may lead to ? 2. Danger hours after start of therapy are 3. Careful neuro assessment for early signs of ? | 1. -cerebral cellular swelling 2. 6-18 hours 3. ICP ( headache, slurred speech, lethargy) |
| DKA (CHART) 1. onset is_____& is____ hours 2. lack of ? 3. _____ illnesses? 4. Upset---? 5. Breath smells like? 6. type of Respirations? 7. hydration status is? 8. ph status? 10. high BG >__? 11. K level? 12. urine status? | DKA-CHART) 1. slow, 4-10 hours 2. insulin 3. Febrile 4. GI 5. Juicy fruity gum 6. Kussmaul 7. thirsty & dehyration 8. Acidosis 10. BG > 240 11. HyperKalemia 12. Poly urea |
| DKA NEEDS/ treatment? | "hi e" HYDRATION INSULIN ELECTROLYTE REPLACEMENT |
| DI 1. ___ and_____ 2. urine increase or decrease? 3. Na status? 4. Osmolarity >__? 5. Urine SG<______? 6.what happens to urine osmolality? 7. hydration status | DI: 1. High (urine output) and dry 2. Increased urination 3. Hypernatremia 4. >300 5. Urine SG<1.005 6. Decreases 7. Dehydration, thirst |
| SIADH 1. ______ and_______ 2 urination status? 3. sodium status? 4. osmolality <_______ 5. Urine SG>_________ 6. urine osmolality increase or decrease? 7. weight, BP, fluid status? | SIADH: 1. Low and wet (urine output) 2 Decreases 3. Hyponatremia 4. < 280 5. >1.030 6. Increased 7. Fluid retention, weight gain, and hypertension |
| SIADH: 1. ADH is released, water is retained, and the extracellular water is ? 2. Serum sodium is diluted which leads to? | SIADH: 1.inCREASED 2. hypoNateremia |
| causes of SIADH include? 1. 2. 3. 4. | causes of SIADH include? 1.Trauma (Head) 2.Tumors (Brain) 3.Meningitis 4.Chemotherapy |
| SIADH Treatment goal is to restore what? | fluid balance |
| DIABETES INSIPIDUS 1. is a disorder of the? 2. Deficiency is secretion of ? 3. without vasopressin kidney loses massive amounts of what ? 4. Excessive ___ &____? 5. is usually a ____ condition? | DIABETES INSIPIDUS: 1. Posterior pituitary 2. ADH ( vasopressin) 3. water and sodium in serum 4.thirst and urination 5. permanent |
| DIABETES INSIPIDUS (DI) REVIEW 1. I need more_____ to decrease the flow of urine? 2. causes of DI include what type of injury? 3. possible tumor where? 4._____ | DI-REVIEW: 1. ADH 2. Head 3. pituitary 4. CRANIOTOMY |
| what meds do you treat diabetes insipidus with? | * VASOPRESSIN * DDAVP |
| DIABETES INSIPIDUS S/S 1.HR? 2. bp 3. volume 4. osmolarity 5. SG 6 # URINE 7. thirst | DI SYMPTOMS 1. tachycardia 2. decreased 3. Hypo volumia 4. decreases 5. decreases 6. up to 20 L urine/ day 7. increased |
| DI: nursing care: 1. monitor? 2. Replace 3. ___ status? 4. _____ | DI: nursing care: 1. Fluids 2. Fluids 3. Neuro status 4. vital signs |
| Diabetes Insipidus Treatment 1. 1. Daily replacement of ? 2. ______aqueous Vasopressin – short acting 3. ________long-acting Vasopressin analog Intranasal, subcutaneous, oral Every 8 -12 hours Dose depends on age, urine output, urine SG | 1. ADH (vasopressin) 2. Pitressin 3. DDAVP |
| Diabetes Insipidus Symptoms Infections Early signs of ______? poly___/ poly____ Drinking__ When no access to water, __ Thirsty,___ Excretes > ____ Serum osmolarity > ___ Serum sodium ____ | ( leukemia ) dehydration Polyuria/ polydypsia Drinking lots of water When no access to water, weight loss Thirsty, irritable Excretes > 3 L/day SG 1.005 Serum osmolarity > 300 mOsm/L Serum sodium elevated |
| Vasopressin Teaching 1. Keep DDAVP in? 2. Goal of treatment is UO ? 3. Measure ? 4. Teach signs of water intoxication: ? | 1. in refrigerator at all times 2. 1-2 mL/kg and SG at least 1.010. 3. daily weight using same scale . 4. Drowsiness, listlessness, headache, no urine output, weight gain |
Created by:
sterfe