DKA, HHS, SIADH, DI

• No insulin production causes breakdown of fat and increased ketones in the blood

  DKA
• What disorder has the following S/S?

  
  

  - Hyperglycemia (> 250)

  - pH < 7.3

  - Serum Bicarb < 16

  - Ketones present in urine and blood

  - Dehydration

  - 3 P's

  - Poor skin turgor

  - Dry mucous membranes

  - Orthostatic hypotension

  - Lethargy & weakness

  - Sunken / soft eyes

  - Kussmaul respirations

  - Fruity breath

  
  

  DKA
• - Illness

  - Infection

  - Inadequate insulin

  - Neglect

  - Undiagnosed DMT1

  What are some precipitating factors for DKA?
• Ketonuria

  Ketones in the urine
• Hypovolemic shock


  What is the worst case scenario for a Pt with DKA?
• Ketones

  Why does a Pt with DKA have fruity breath?
• Body is trying to remove acidic CO2 to compensate for acidic ketones in the blood


  Why does a Pt with DKA usually present with Kussmaul's respirations?
• Glucose and ketones in blood pull water from cells


  Why is a Pt with DKA dehydrated?
• Fluids


  What is the first nursing intervention for a Pt with DKA or HSS?
• - IV Fluids (0.45 or 0.9 NS)

  - Insulin drip (regular insulin)

  - When BG reaches 250, add 5-10% dextrose

  - Potassium supplement


  What are nursing interventions to treat DKA?
• Potassium supplement


  What is needed for a Pt with DKA when they begin receiving an insulin drip?
• Cerebral edema


  Shifting a clients BG too quickly can cause what?
• HHS (Hyperosmolar hyperglycemia syndrome)


  Life-threatening syndrome characterized by severely high blood glucose in a Pt with DMT2
• - Infection (UTI, sepsis, pneumonia)

  - Illness

  - New DMT2 diagnosis

  - Impaired fluid replacement


  What are precipitating factors for HHS?
• HHS


  What disorder has the following S/S?

  
  

  - Hyperglycemia (>600)

  - Neurological changes

  - Seizures / Coma
• HHS has no Kussmauls, no ketones, and no acidity, but has neurological changes


  What are main differences between HHS and DKA?
• - IV fluids (0.45-0.9% NS)

  - IV insulin drip

  - Potassium supplement

  - Once BG reaches 150 add 5-10% Dextrose

  - Monitor mental status and renal status

  - Correct underlying precipitating cause

  What are nursing interventions for a Pt with HHS?
• BUN

  What lab value is associated with increased serum osmolarity?
• Lispro


  Another name for rapid acting insulin
• Regular (humilin)


  What is the only insulin type that can be given IV?
• NPH


  Another name for intermediate acting insulin
• Glargine


  Another name for long acting insulin
• Hypoglycemia


  What disorder has the following S/S?

  
  

  - Confusion

  - Shaking

  - Sweating

  - Nervousness
• Check BG


  If a Pt has S/S of hyperglycemia, what is your first intervention?
• Rule of 15


  If a Pt has a BG of 65 and they are awake what is your intervention?
• IM glucagon (turn Pt to side - risk for aspiration)

  IV dextrose


  If a Pt has a BG of 65 and they aren't responsive what is your intervention?
• Fat


  A diet high in what will decrease glucose absorption?
• - Retinopathy

  - Nephropathy

  - Neuropathy


  What are common complications from uncontrolled diabetes?
• Nonproliferative


  Type of retinopathy caused by capillary fluid leaking out of walls
• Proliferative


  Type of retinopathy caused by occlusion of the retinal blood supply
• Albumin, ACE inhibitors


  A Pt with nephropathy would have what present in the urine? And what is the intervention?
• Sensory


  Type of neuropathy characterized by B/L loss of feeling in extremities
• Autonomic


  Type of neuropathy characterized by urinary retention, diarrhea, and hypoglycemic unawareness
• - Empty bladder every 3 hours

  - Crede maneuver (massage lower abdomen)

  - Sit down

  - Tighten abdominal muscles


  How can we prevent neurogenic bladder?
• SIADH


  Inappropriate release of ADH causing retention of fluid
• - Cancer (small lung cancer)

  - Brain injuries

  - SSRIs

  - Anesthesia

  - Opioids

  - COPD

  - HIV

  - Hypothyroid

  What are some causes of SIADH?
• SIADH


  What disorder has the following S/S?

  
  

  - Weight gain

  - Dilutional hyponatremia

  - Low urine output

  - Concentrated urine (increased urine specific gravity)

  - Dyspnea on exertion

  - Fatigue

  - Hypertension
• - Daily weights

  - Strict I/Os

  - Monitor VS

  - Seizure precautions


  What are nursing interventions associated with SIADH?
• Give small amounts of 3% NS


  What is your intervention if a Pt with SIADH severe edema and is on fluid restriction, but has a sodium level of 120?
• - Demeclocycline = Block ADH at renal tubules

  - Vasopressor receptor antagonists = Blocks ADH to treat hyponatremia

  - Loop diuretics = Promotes diuresis


  What are medications to treat SIADH?