NURS 4406 EXAM 4 REVIEW
NURS 4406 EXAM 4 REVIEW
• Acid-Base Imbalances (3-5)
o ABG Analysis for Endocrine, Burns, & End of Life Conditions (3-5)
▪ Endocrine
• Metabolic Acidosis • Metabolic Alkalosis
o Diabetic ketoacidosis o Potassium depletion
o Pancreatitis ▪ Thiazide diuretics
o Excess elimination of ▪ Cushing’s syndrome
bicarbonate through diarrhea ▪ Hyperaldosteronism
▪ Burns
• Metabolic acidosis
▪ End of life disorders
• Respiratory acidosis
• Metabolism – Diabetes (12-17)
o Diabetic Ketoacidosis (DKA) (7-9)
▪ Clinical manifestations
• Polyuria, polydipsia, polyphagia
• Weight loss
• Nausea, vomiting, abdominal pain
• Orthostatic hypotension
• Blurred vision, headache, weakness
• Fruity breath
• Kussmaul respirations – deep rapid respirations
• Metabolic acidosis with respiratory compensation
• Altered LOC
• Extreme dehydration
▪ Nursing Interventions
• ABCs
• IV fluids
o 1 L wide open isotonic 0.9% NS
o Follow with controlled hypotonic fluids 0.45% NS
o When glucose levels reach 250 add glucose and switch to D5W
▪ Decrease risk of cerebral edema due to drastic osmolarity level changes
o KCl to increase or maintain K+ level
• Assess for fluid volume excess
• Check K+ before giving insulin
o Give insulin bolus and then continuous infusion
o Insulin will lower K+ level, monitor for hypokalemia
o Goal glucose level is < 200 after admin of insulin
• Give sodium bicarbonate if pH < 7
• Continuous cardiac monitoring
▪ Diagnostics
• Glucose > 300
• Sodium increased
• Potassium initially increased, drops in later stages
• BUN > 30
• Creatinine > 1.5
• Ketones in urine
,NURS 4406 EXAM 4 REVIEW
• Serum osmolarity > 300
•
, NURS 4406 EXAM 4 REVIEW
▪ Complications
• Hypokalemia
• Hypoglycemia/hyperglycemia
• Fluid overload
o Hyperosmolar Hyperglycemic Syndrome (HHS) (4-6)
▪ Clinical manifestation
• Polyuria, polydipsia, polyphagia
• Weight loss
• Nausea, vomiting, abdominal pain
• Orthostatic hypotension
• Blurred vision, headache, weakness
• Altered LOC
• Seizures, myoclonic jerking due to elevated osmolarity
• Reversible paralysis – due to elevated osmolarity
• Profound dehydration
• Sunken eyes
• Hypovolemia – decreased BP increased HR
▪ Risk factors
• Undiagnosed diabetes or Type 2 DM
• Inadequate fluid intake or poor kidney function
• MI, CVA, sepsis
• Infection or stress
▪ Diagnostics
• Glucose > 600
• Na+ & K+ normal to high
• BUN & creatinine increased
• Absent ketones in urine
• Glucose in urine
• Serum osmolarity > 320
• pH > 7.4
▪ Medications
• Insulin bolus & drip
▪ Nursing interventions
• ABCs – Intubate
• IVF fast! – NS
• Assess glucose & K+
• Admin inulin bolus then drip
• Assess neurological status for changes
▪ Patient teaching
• Wear medical alert bracelet
• Consume 2 – 3L of fluids daily
• If blood sugar is low consume fluids with sugar added
• Check glucose every 4 hrs
o If glucose is > 240 check urine for ketones
• Consume liquids with carbs and electrolytes when unable to eat solid food
• Notify provider if
o Illness lasts longer than 24 hrs
o Glucose is > 250
o Ketones in urine for more than 24 hrs
o Temp of 101.5 for 24 hrs
NURS 4406 EXAM 4 REVIEW
• Acid-Base Imbalances (3-5)
o ABG Analysis for Endocrine, Burns, & End of Life Conditions (3-5)
▪ Endocrine
• Metabolic Acidosis • Metabolic Alkalosis
o Diabetic ketoacidosis o Potassium depletion
o Pancreatitis ▪ Thiazide diuretics
o Excess elimination of ▪ Cushing’s syndrome
bicarbonate through diarrhea ▪ Hyperaldosteronism
▪ Burns
• Metabolic acidosis
▪ End of life disorders
• Respiratory acidosis
• Metabolism – Diabetes (12-17)
o Diabetic Ketoacidosis (DKA) (7-9)
▪ Clinical manifestations
• Polyuria, polydipsia, polyphagia
• Weight loss
• Nausea, vomiting, abdominal pain
• Orthostatic hypotension
• Blurred vision, headache, weakness
• Fruity breath
• Kussmaul respirations – deep rapid respirations
• Metabolic acidosis with respiratory compensation
• Altered LOC
• Extreme dehydration
▪ Nursing Interventions
• ABCs
• IV fluids
o 1 L wide open isotonic 0.9% NS
o Follow with controlled hypotonic fluids 0.45% NS
o When glucose levels reach 250 add glucose and switch to D5W
▪ Decrease risk of cerebral edema due to drastic osmolarity level changes
o KCl to increase or maintain K+ level
• Assess for fluid volume excess
• Check K+ before giving insulin
o Give insulin bolus and then continuous infusion
o Insulin will lower K+ level, monitor for hypokalemia
o Goal glucose level is < 200 after admin of insulin
• Give sodium bicarbonate if pH < 7
• Continuous cardiac monitoring
▪ Diagnostics
• Glucose > 300
• Sodium increased
• Potassium initially increased, drops in later stages
• BUN > 30
• Creatinine > 1.5
• Ketones in urine
,NURS 4406 EXAM 4 REVIEW
• Serum osmolarity > 300
•
, NURS 4406 EXAM 4 REVIEW
▪ Complications
• Hypokalemia
• Hypoglycemia/hyperglycemia
• Fluid overload
o Hyperosmolar Hyperglycemic Syndrome (HHS) (4-6)
▪ Clinical manifestation
• Polyuria, polydipsia, polyphagia
• Weight loss
• Nausea, vomiting, abdominal pain
• Orthostatic hypotension
• Blurred vision, headache, weakness
• Altered LOC
• Seizures, myoclonic jerking due to elevated osmolarity
• Reversible paralysis – due to elevated osmolarity
• Profound dehydration
• Sunken eyes
• Hypovolemia – decreased BP increased HR
▪ Risk factors
• Undiagnosed diabetes or Type 2 DM
• Inadequate fluid intake or poor kidney function
• MI, CVA, sepsis
• Infection or stress
▪ Diagnostics
• Glucose > 600
• Na+ & K+ normal to high
• BUN & creatinine increased
• Absent ketones in urine
• Glucose in urine
• Serum osmolarity > 320
• pH > 7.4
▪ Medications
• Insulin bolus & drip
▪ Nursing interventions
• ABCs – Intubate
• IVF fast! – NS
• Assess glucose & K+
• Admin inulin bolus then drip
• Assess neurological status for changes
▪ Patient teaching
• Wear medical alert bracelet
• Consume 2 – 3L of fluids daily
• If blood sugar is low consume fluids with sugar added
• Check glucose every 4 hrs
o If glucose is > 240 check urine for ketones
• Consume liquids with carbs and electrolytes when unable to eat solid food
• Notify provider if
o Illness lasts longer than 24 hrs
o Glucose is > 250
o Ketones in urine for more than 24 hrs
o Temp of 101.5 for 24 hrs
