ADN235 Final Exam Study Guide ( Summary)

DIABETES: DKA - interventions from priority (best to least) - what would you expect to be ordered ● Hyperglycemia ( 300 mg/dL) ● Metabolic acidosis ● Increased production of ketones ● Results: ○ combination of insulin deficiency ○ liver and kidney glucose production and decreased use of glucose in the peripheral tissues ○ Occurs most in DM I, but seen in DM 2 - severe stress, surgery, trauma and most common cause INFECTION ○ Hyperglycemia leads to osmotic diuresis with dehydration and electrolyte loss. ● Manifestations: ○ 3 P’s, vomiting, abdominal pain, dehydration, weakness, confusion, shock, coma ○ Mental Status can vary - alert to profound coma ○ as ketones rise - pH of blood decreases - acidosis occurs ○ Kussmaul respirations (very deep and rapid respirations) cause respiratory alkalosis to correct metabolic acidosis by exhaling carbon dioxide. ○ Na - low or normal - depending on severity ○ K - depend on how long DKA existed before treatment. After therapy, K levels drop off quickly. Interventions: ● Assess: Airway, LOC, hydration status, electrolytes, and blood glucose ● Fluid/Electrolyte mgt: assess fluid status; risk for dehydration/shock; fluid overload ● 1st: Provide rapid isotonic fluid (0.9% sodium chloride) replacement to maintain perfusion to vital organs. ● Initial Infusion of 0.9% sodium chloride are 15-20 mL/kg/hr during 1st hr ● 2nd outcome achieved more slowly. fluid replacement depends on BP, electrolytes, urine output. In general 0.45% sodium chloride , infused at 4-14 mL/kg/hr ● when Glucose levels reach 250 mg/dL infuse 5% dextrose in 0.45% sodium chloride to prevent hypoglycemia and cerebral edema. ● Insulin therapy used to lower serum glucose by about 50 to 75 mg/dL/hr by continuous IV infusion ● DKA is considered resolved when BG 200 mg/dL; pH 7.3 ● mild-moderate hyperkalemia is common initially. ● Insulin therapy, correction of acidosis, and volume expansion = decreased serum K. To prevent hypokalemia: K replacement is initiated after serum levels fall below upper limits of normal. ** Before giving IV POTASSIUM solutions, make sure the urine output is at least 30 mL/hr Teaching: Teach measures to prevent dehydration: ● unless contraindicated: consume 2-3 L/day of water ● if BG levels are low, consume liquids with sugar ● monitor BG every 4 hr when ill, and continue to take insulin! ● teach clients to check urine for ketones if BG is 240 mg/dL ● consume liquids with carbohydrates and electrolytes when unable to eat solid foods KNOW your insulins: rapid acting, short acting. Intermediate acting & long acting Know onset, peak, & durations