What Causes It?
DKA (diabetic ketoacidosis) is seen in this type of diabetes
Type 1
A patient asks about the long-term, systemic effect of diabetes. What complications will you talk about with the patient?
Cardiovascular diseases, stroke, kidney disease (nephropathy), neuropathy, retinopathy, peripheral vascular disease.
The nurse knows the priority action for a patient presenting with headache, blurry vision, and mild confusion is ____________?
Testing Blood Glucose.
These are notable features of DKA.
“Think D K A A”
1. Dry and high sugar (250 - 500)
2. Ketones and Kussmal respirations (rapid, fruity breath)
3. Abdominal pain
4. Acidosis (metabolic) = pH 7.35 or less
5. Hyperkalemia
6. Polyuria
7. Tachycardia
A nurse knows a patient with SIADH will have chloride and sodium levels that are ___________?
LOW
Dry mucous membranes, poor skin turgor, tachycardia, and hypotension are signs of what condition?
Dehydration which occurs in DKA.
These are the causes of SIADH (think ”S”)
1. Small cell lung cancer
2. Severe brain trauma (trauma/surgery)
3. Sepsis infections of brain (meningitis)
What are three things the nurse anticipates a patient with HHNS will need?
H I E R
Hydration
Insulin
Electrolyte Replacement
The nurse knows the urine osmolality of a patient with diabetes insipidus will be ___________
Decreased
This is the range of blood sugar in DKA
250 - 500
These are the causes of diabetes insipidus
Damage to brain (tumors, trauma, surgery)
A Type I diabetic patient is NPO. What does the nurse anticipate this patient will need during this period of time?
Frequent, blood glucose monitoring (at least Q2H)
Insulin administration (basal dose)
What disorder is characterized by hyperglycemia, metabolic acidosis, and ketosis?
DKA
The expected urine specific gravity in a patient with diabetes insipidus is __________
Decreased
This is the range of blood sugar in HHNS
Over 600+
HHNS (hyperglycemic hyperosmolar non-ketotic syndrome) is seen in this type of diabetes
Type 2
A patient experiencing SIADH is at high risk of what?
Seizures
Medication used in treatment of diabetes insipidus
DDAVP- desmopressin which is an analog to the hormone vassopressin. (also called ADH)
The 7 S’s of SIADH
1. STOPS urination (low urine output)
2. STICKY and thick urine (high sp. gr >1030)
3. SOAKED inside (low and liquidy labs)
A. Hypo-osmolality
B. Hyponatremia (below 135)
4. SODIUM low (headache early sign)
5. SEIZURES - Key words - headache/confusion
6. SEVERE HIGH blood pressure
7. STOP ALL FLUIDS - give salt + diuetics - no IV or drinking - IV 3% saline + eat salt
The urine sodium level in a patient with SIADH will be __________________
Increased
What are the signs or symptoms of rapid glucose decline?
Sympathetic Nervous System Responses -
Tachycardia
Diaphoresis
Anxiety
(in response to release of epinephrine in setting of low glucose)
Risk factors for Type II Diabetes Mellitus?
BMI > 25 and at least 1 of the following:
sedentary lifestyle
45 years old or older
relative with DM
African, Hispanic, American Indian, Pacific Islander, Asian
Consistent hypertension
Low LDL, High Triglycerides
Vascular disease
Gestational Diabetes
Delivering baby > 9pounds
A patient with diabetes insipidus is at risk for what life-threatening disorder?
Hypovolemic shock
Nursing interventions for a patient with DKA
Administer IV Insulin
Initiate IV fluids
Monitor for hypokalemia
The 7 D’s of diabetes insipidus
1. DIURESE - high urine output
2. DILUTED urine - low sp. gr. (1.005)
3. DRY inside (high & dry labs)
A. Hyperosmolality
B. Hypernatremia (over 145)
4. DRINKING a lot - “thirsty”
5. DEHYDRATED - dry mucosa and skin
6. DECREASED blood pressure
7. DESMOPRESSIN (vasopressin) (ADH) to decrease urine output and to decrease sodium to less than 135
A patient with diabetes insipidus will have blood testing results that are generally ____________
Increased
Concentrated Blood increases:
Blood osmolarity (< 300mm/L)
Blood Sodium
Blood Potassium