causes
causes of dka
- occurs most frequently in type 1, can occur in type 2 if under stress/ very ill
- new dx of diabetes
- omitting doses of insulin
- when increased insulin is needed (infection, surgery, trauma, pregnancy)
symptoms of diabetes insipidus
- polyuria, polydispia, dehydration
- shock
- hypernatremia (thirst, lethargy, weakness, seizures, coma)
define ketoacidosis
- respiratory compensation (kussmaul)
- kidney compensation: ketones take water with them (dehydration), hemoconcentration (decreased delivery of o2 levels leading to lactic acid production)
interventions of hypoglycemia
- mild <70: check blood glucose, 15 grams CHO, retest and retreat if necessary
- moderate <40: patient specific, 15g CHO/ 1mg glucagon IM or SQ, recheck and retreat
- severe <20: 50% dextrose, 25-50mL slow IV push, glucagon 1mg IM or IV
nursing diagnosis/ tx for diabetes insipidus
- fluid volume deficit
- give IV/ oral fluids
- monitor dehydration, I/Os, weights
- administer vasopressin/ desmopressin
risks of low blood sugar
- seizures
- loss of consciousness
- endocrine damage/ death
symptoms of HHS
- extreme hyperglycemia >600mg/dl
- profound dehydration
- none/ mild ketonuria
define gestational diabetes
- elevated glucose develops during mid pregnancy
- high risk for obese women, advanced maternal age, family hx of DM
- tested during 24-28 weeks
interventions/ treatment of HHS
- similar to DKA, IV saline, IV insulin
- frequent blood glucose checks
- cardiac monitoring
- ICU care
complications of dka
- hypokalemia
- cerebral/ pulmonary edema
- kidney failure
- cardiac arrest
- coma/ death
causes of HHS
- new diagnosis of diabetes
- stress, acute illness
- drugs (corticosteroids, beta blockers)
- elderly
symptoms of hypoglycemia
- mild: tremors, tachycardia, cool skin, diaphoresis
- moderate: headache, irritability, slurred speech, double vision
- severe: disorientated, seizures, unconscious
define diabetes insipidus
- absence of antidiuretic hormone (neurogenic)
- disruption of hypothalamus + pituitary
- idiopathic
- nephrogenic, drug related (lithium)
interventions/ treatment for dka
- IV fluid bolus with isotonic first
- then continuous fluids with hypotonic
- when glucose reaches 250, give D5 1/2 NS to prevent cerebral edema/ hypoglycemia
- IV insulin drip
education of gestational diabetes
- healthy diet
- exercise
- monitoring blood glucose/ insulin injections
risks/ causes of SIADH/ DI
- SIADH: idiopathic, CNS, pulmonary, cancer, drugs, post op
- DI: (idiopathic) brain tumors, infections, brain surgery, renal failure, sickle cell disease
symptoms/ affects on the body for dka
- glucose >300mg/dl, kussmaul, rotting. fruity breath, dry mouth, fever, thirst, N/V, ketonuria, confusion
define SIADH
- syndrome of inappropriate ADH
- too much antidiuretic hormone
treatment for SIADH
- fluid restriction, diuretics
- 3% NaCI IV (caution)
- monitor electrolytes + LOC
- monitor for overload (HF + pulmon. edema)
- I/Os, daily weights
education for dka
- sick day management: always take insulin/ hypoglycemic agent
- check blood glucose frequently (every 4 hours)
- continue to eat/ drink
- call MD early
what can gestational diabetes cause in mom and baby after/ during labor
- increase risk for DM2 in mom for up to 10 years
- babies can be big, birth trauma, pre-term, preeclampsia
- CPD (disproportioned head), c-sections, baby can be born with hypoglycemia (sugar water)
symptoms of SIADH
- hyponatremia (CONFUSION, FALLS, muscle cramps, N/V, weakness
- fluid retention, decreased urine output
- weight gain (edema), HTN
- water intoxication (brain cells swell) leading to headaches, changes in LOC, twitching/ seizures
define HHS
- no/ mild breakdown of fat, insulin still present, but cells are resistant to it
- dehydration due to high levels of glucose (hyperosmolar) and excessive urination
- slow onset taking days to weeks
- may not be recognized until additional event occurs
- NO ACIDOSIS, NO/ MILD KETONES, ONLY TYPE 2)
what to monitor for in DKA
- blood glucose
- vital signs, urine output
- LOC
- cardiac rhythm, potassium levels
- o2 saturation
education for hypoglycemia
- do not workout if blood glucose is <80
- keep something in pocket that has glucose
- check glucose before and after exercise