Lab Values
Your patient's initial labs show
Serum Osmo 320
AG 11
K+ 3.9
BHB 0.3
Patient's lab showing possible HHS
Patient complains of severe thirst, frequent urination, and weight loss with more food being consumed.
Possibly DKA
Why do we replace K+ aggressively in DKA patients?
Fluid and IV insulin therapies reset sodium-potassium pump and restore fluid balance.
Insulin; possibly long acting and rapid acting
Patient checks in through triage complaining of nausea/vomiting for the past 3 days with fruity breathe and hasn't been taking their Rx. diabetes medications for over a year. What intervention should you do in that moment for quick result?
Check the patient's blood sugar
Patient on 3200 has been on an insulin drip for about 9 hours. Their next set of labs have been drawn and you are awaiting their results. The previous labs showed:
BG 212
K+ 4.1
C02 22
AG 8
BHB 0.3
What would you as the nurse be anticipating the next BHB to be?
Bed-bound, dementia patient with incontinence issues who is always wearing a diaper is sent by their SNF d/t recurrent fever.
S/S of possible HHS
Why is Dextrose 10% given when a patient is on IV insulin?
Prevent hypoglycemia and sustain safe amount of cellular permeability to prevent cerebral edema.
Patient hasn't had x2 negative BHB's however their AG is <12 and patient is feeling better. The provider orders to discontinues the drip, what should you do?
Clarify the order. If the provider is adamant despite the order set request long acting to be given prior to stopping.
Patient's K+ level goes from 4.6 on initial labs down to 2.9 after 3L of fluids. Why?
Your remains on the insulin drip with an elevated AG and BHB. Most recent labs show patient's K+ 3.1.
What three things should you do based off of the K+?
What three common s/s of HHS?
1.) BG >600 mg/dL
2.) ALOC
3.) Serum Osmo >320 mOsm/L
Patient on IV insulin drip most recent BG level via accuchek is 116mg/dL, what two things should you do as the nurse?
1.) Give Dextrose 50% (D50W) IV push now
2.) Verify Dextrose 10% is infusing at 100ml/hr and discuss with the provider to possible decrease insulin by 50%
What is the rationale for a serum C-peptide to be ordered on a newly diagnosed DM who has been treated for DKA?
Diagnosis T1DM vs T2DM
Why is insulin so important?
Insulin is one of the most important hormones in the body because it helps facilitate homeostasis with electrolytes, metabolism, LOC, and many other things.
Your patient's s/p right hip fracture repair after they fell attempting to climb out of bed at their SNF. Their labs after surgery show Serum Osmo is trending up from 292 mOsm/kg to currently 340 mOsm/kg. Patient not screaming inappropriate comments as she was when she returned from surgery. What should your initial assessment be?
Assess your patient's mentation given there is a significant change and their Serum Osmolarity has drastically increased.
Hypoglycemia
2 hours
Do we as nurses adjust our plan of care?
YES, sometimes multiple times in a shift
What is insulin compatible with when transfusing through a Y line?
Patient comes through the ED with complaints of possible food poisonings. You over hear the provider doing their assessment of the patient and the patient states they don't go to the doctor or have any medical conditions. Provider asks you to check their BG level; it is 240mg/dL. What two things do will the provider will initially order to manage this patient?
1. Labs
2. IV fluids
The patient appears in DKA (unknown severity) which would make them severely dehydrated.
Tele tech informs you patient's HR in 3232 is 120-140's with more frequency in PVC's. What lab would you want checked?
Potassium
Why is the IV insulin Algorithm order set not appropriate for DKA patients?
The Algorithm titrates IV insulin dose based off of the BG levels with NO consideration of lab results.
ABSOLUTELY!!
If they can't afford it, they aren't going to fill it
In the end who is responsible for managing their diabetes?
The patient