MS4 EXAM 3 ACTUAL QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
Care of DKA patient
#1 intervention is fluid replacement
- restore volume and maintain perfusion to the brain, heart, and kidneys
- NS at 15-20 mg/kg/hr
#2 outcome is to replace lost fluid
Secondary fluid for DKA (w/ perameters)
5% Dextrose in 1/2 NS
- can be started if BGL less than 250
What is DKA?
diabetic ketoacidosis
- characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased
production of ketones
Who gets DKA?
Type 1 diabetics (d/t lack of insulin reserve)
- may occur in Type 2 resulting from trauma, surgery or infection
INFECTION is most common factor
DKA symptoms
3 P's (Polyuria, Polydipsia, Polyphagia)
Nausea/ Vomiting
,Abdominal pain
Weakness
Confusion
Shock
Coma
Kussmaul Respirations
- leads to respiratory alkalosis in attempt to correct metabolic acidosis
DKA pertinent lab values
BGL > 300
Positive serum and urine ketones
Low bicarb/ Low pH REMEMBER METABOLIC ACIDOSIS
CBC (signs of dehydration)
BUN > 30
BMP (elevated K in mild, decreased in severe) (decreased Na)
Anion Gap > 10- 12
Anion Gap
difference between primary measured cations (Na and K) and the primary measured
anions (Cl and HCO3) in blood
Normal: 7-9
Elevated: > 10-12 Metabolic acidosis
Considerations for K administration in DKA pts
Make sure urine output is at least 30 ml/hr or 0.5 ml/kg/hr
Only insulin for IV administration
, Regular Human insulin
Goal of insulin therapy in DKA
Decrease BGL by 50-75 mg/dl/hr
- initial bolus dose of 0.1 unit/kg followed by 0.1 unit/kg/hr
- can begin SQ when pt is able to take PO fluids and ketosis stops
When is DKA considered resolved?
BGL < 200
Bicarb > 18
pH > 7.3
Anion gap < 12
negative ketones
DKA prevention and family teaching
Check BGL Q4-6hrs when anorexia, N/V present with BGL 250
Check urine ketone levels when BGL > 300
Drink at least 2L of fluid daily (more if infection present)
If nauseous, take liquids with glucose and electrolytes
Ingest 150g of carbohydrates daily
When to seek medical attention DKA
BGL > 250
Ketonuria more than 24 hrs
Pt cannot take food or fluids
Illness more than 1-2 days
What is HHS?
COMPLETE SOLUTIONS VERIFIED GRADED A++
Care of DKA patient
#1 intervention is fluid replacement
- restore volume and maintain perfusion to the brain, heart, and kidneys
- NS at 15-20 mg/kg/hr
#2 outcome is to replace lost fluid
Secondary fluid for DKA (w/ perameters)
5% Dextrose in 1/2 NS
- can be started if BGL less than 250
What is DKA?
diabetic ketoacidosis
- characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased
production of ketones
Who gets DKA?
Type 1 diabetics (d/t lack of insulin reserve)
- may occur in Type 2 resulting from trauma, surgery or infection
INFECTION is most common factor
DKA symptoms
3 P's (Polyuria, Polydipsia, Polyphagia)
Nausea/ Vomiting
,Abdominal pain
Weakness
Confusion
Shock
Coma
Kussmaul Respirations
- leads to respiratory alkalosis in attempt to correct metabolic acidosis
DKA pertinent lab values
BGL > 300
Positive serum and urine ketones
Low bicarb/ Low pH REMEMBER METABOLIC ACIDOSIS
CBC (signs of dehydration)
BUN > 30
BMP (elevated K in mild, decreased in severe) (decreased Na)
Anion Gap > 10- 12
Anion Gap
difference between primary measured cations (Na and K) and the primary measured
anions (Cl and HCO3) in blood
Normal: 7-9
Elevated: > 10-12 Metabolic acidosis
Considerations for K administration in DKA pts
Make sure urine output is at least 30 ml/hr or 0.5 ml/kg/hr
Only insulin for IV administration
, Regular Human insulin
Goal of insulin therapy in DKA
Decrease BGL by 50-75 mg/dl/hr
- initial bolus dose of 0.1 unit/kg followed by 0.1 unit/kg/hr
- can begin SQ when pt is able to take PO fluids and ketosis stops
When is DKA considered resolved?
BGL < 200
Bicarb > 18
pH > 7.3
Anion gap < 12
negative ketones
DKA prevention and family teaching
Check BGL Q4-6hrs when anorexia, N/V present with BGL 250
Check urine ketone levels when BGL > 300
Drink at least 2L of fluid daily (more if infection present)
If nauseous, take liquids with glucose and electrolytes
Ingest 150g of carbohydrates daily
When to seek medical attention DKA
BGL > 250
Ketonuria more than 24 hrs
Pt cannot take food or fluids
Illness more than 1-2 days
What is HHS?
