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Mohammad Cassin V
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This 10 page Class Notes was uploaded by Mohammad Cassin V on Wednesday October 28, 2015. The Class Notes belongs to NUR3112 at Villanova University taught by IsabellaErickson in Fall. Since its upload, it has received 10 views. For similar materials see /class/230560/nur3112-villanova-university in Nursing and Health Sciences at Villanova University.
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Date Created: 10/28/15
Complications of DM Acute Chronic Acute Complications of DM lHyperglycemia lDiabetic Ketoacidosis lHyperosmolar H yperglycemic NonKetotic Coma HHNK aka H yperosmolar H yperglyeemic N onK etotic S yndromeHHNS I Hypoglycemia Newly DX ed diabetic needs to know Why reactions occur When reactions most likely to occur Early clinical manifestations S amp Sx Danger of severe or repeated reactions Importance of early treatment How to prevent these reactions Diabetic Ketoacidosis lCause of hyperglycemia Too little insulin or omitting doses increased need for insulin or insulin resistance lPrevention Triad of Treatment Sick Days DKA Pathophysiology lHyperglycemia Increased blood glucose lBut body increases glucose production Glycogenolysis amp Gluconeogeuesis lKetosis lMetabolic Acidosis Decreased blood pH lKetonuria Glucosuria Dehydrati0n Hyper0smolarity Hyp0tensi0n lKussmaul s Respirations Fruity Odor DKA Pathophysiology cont d lAcidosis causes depression of cerebral function ILactic Acidosis le blood volume gthemoconcentration gt JrJr blood circulation gt tissue anoxia amp TT production of lactic acid Assessment lSigns amp symptoms Early 3 polys Dehydration Ket0acidosis anorexia nausea vomiting ABD pain Electrolytes glucose Naetc Ketones on breath Depression of CNS lethargy amp fatigue stupor gt coma DKA Treatment IF luid replacement Reverse Shock type Normal Saline Physiologic Saline or 12 NS D5W IV once blood glucose down to 250300 lInsulin IV Push amp DripPump 5 10 uhr lMonitor glucose levels q3 0 min 16 amp pH levels As insulin lets glucose into the cell it decreases the serum Kr along with decreasing the serum glucose Sodium bicarb If really necessary phlt771 HHNK Hygerosmolarz Hygerglycemicz NonKetotic Coma AKA also known as HHNS Hygerosmolarz Hygerglycemicz NonKetotic Syndrome HHNK HHNS 10 40 mortality rate I Causes I Characteristics TT Blood sugar No Ketones pH okay Hypovolemia T Na T BUN T Hct Shock HHNK Signs and Symptoms lSevere Dehydration lNeurological changes HHNK Treatment Vig0r0us Fluid Replacement 1 Rx 12 Normal Saline lInsulin IV Push amp DripPump IE Iectrolytes I Treat underlying cause Hypoglycemia Insulin Reaction lBlood sugar 5 50 brain damage lUsually Type I lCauses Too much insulin Not enough food skipping a meal ETOH alcohol lowers blood sugar overexertion retinopathy so administering too much insulin nephropathy so oral meds not excreted Type 2 some meds amp diseases blood sugar some blood sugar Signs amp Symptoms some similar to us when we get hungry but more severe Sudden A drenergic stress response diaphoresis irritability tachycardia shakiness pallor blunted by beta blockers Later Neur0glypenic blood sugar to brain s0 neuro st confusion headache lack of muscle coordination slurred speech blurred vision irrational behavior consciousness coma death Treatment I Glucose fast acting Orange Juice follow with longer acting carb protein 802 milk glucagon only lasts 12 hr IV Dextrose 1025 9 over 13 min then D5W IV at 510 ghr Retest in 15 minutes Prevention Better than Treatment IT imes to watch for low blood glucose Insulin reaction times IT imes to snack I When insulin dose changed lwhen lifestyle changes Nursing Diagnosis Chronic Complications lRednce lifespan by 13 lComplication or part of disease Vascular Disease lMicroangiopathy microvascnlar Eye Kidney lMacroangiopathy macrovascnlar Complication Neuropathx lPeripheral Nerve Degeneration numbness tingling pain constant nagging pain painless neuropathy lack of awareness of trauma lAntonomic Nervous System Changes decreased peristalsis decreased sweating neurogenic bladder impotence Management lNarsing Diagnosis Kn0wledge de cit Disorders of the Eye lBlurring of Vision I Cataracts lRetinopath y Kidney Disease lInfection Pyelonephritis lSpeci c Nephropathy Intercapillary Glomerulosclerosis Symptoms Edema HTNProteinuria Azotemia IA cute Renal F ailuregt Chronic Renal Failure Infection lSoft Tissue I Osteomyelitis leelonephritis lCandida of skin amp Mucous Membranes lPoor Wound Healing
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