SIADH and urine and serum specific gravity
decrease serum specific gravity (due to retention of water)
* Increase urine specific gravity (due to decrease urine volume)
S/Sx of DM
o Polyuria—pee a lot
o Polydipsia—thirsty
o Polyphagia—(eat/swallow a lot)
Treatment for DM Type I
- They will “DIE”
- Diet (calories from carbs, least important)
- Insulin (most important)
- Exercise
Treatment for Type II DM
- They are “DOA”
- Diet (most important)
- Oral hypoglycemic
- Activity
Diet for DM2
- Primary treatment modality is Calorie restriction
- 1200 Cal, 1400 Cal, 1600 Cal
- These pts need to eat 6 small feeding per day—smaller more frequent meals—keeps blood
sugar more stable
What is the best dietary action a DM2 should take?
a. Restrict calories
b. Divide meal into 6 feedings a day
(a) because pt can eat 6 meals but does not limit the Cal with each meal
R-Regular insulin
clear solution, Can be given IV drip (HESI-intermediate, Rapid, Run IV)
* Onset: 1 hour
* Peak: 2 hours
* Duration: 4 hours … (Audio says 3 hours, but it is 4 hours)
* Pattern: 1-2-4 (Pay attention to peak)
N-NPH
Intermediate insulin—it is cloudy, N = Not So Clear, Fast (Cloudy =
Suspension—it precipitates—can’t give IV drip), N = not so fast, not in the bag
* Onset: 6 hours
* Peak: 8 to 10 hours
* Duration: 12 hours
* Pattern: 6-8-10-12 (Hear the even #s and pay attention to peak)
How would the board ask question about peak of insulin? pt was given NPH at 7 a.m.,
Check for hypoglycemia between 3 and 5 p.m.
Lispro: (Humalog)
Don’t give it AC (before meal) … Give it with the meal
* Onset: 15 min
* Peak: 30 min
* Duration: 3 hrs
* Pattern: 15-30-3
Glargine (Lantus)
- Long-acting insulin
- No Peak
- Duration 12 to 24 hrs
- Little to no risk for hypoglycemia (only one you can safely give at bedtime)
What action invalidates the manufactures date
- Opening the package
- Once the package is open, the new expiration date is 30 days after that
- Open package without an opening or expiration date should be thrown out
- Label the package either with
o “OPEN” and date package is open
or
o “EXP” and expiration date - Once the package is open, refrigeration is optional
o However, unopened bottle must be kept refrigerated
o Although it is good practice to teach pt to refrigerate insulin at home
Exercise potentiates insulin action
- Exercise is like another shot of insulin
- Therefore, if a student is schedule to play soccer (exercise) this afternoon … It is necessary
to decrease the dosage of insulin - In addition, the school nurse must give the student rapidly metabolized carbohydrates—
snacks or juice
Sick Days … Pt has a fever or the flu, and so on
- Serum glucose levels go up
- Need their insulin even though pt is not eating
- Take sips of water because they get dehydrated
- Any sick diabetic pt has 2 problems
o Hyperglycemia and Dehydration
Acute Complications of Diabetes
- Low blood glucose—a.k.a. Hypoglycemia or Hypoglycemic shock or Insulin shock/reaction
- Why are some of the causes
o Not enough food
o Too much insulin (#1 cause, can lead to permanent brain damage)
o Too much exercise
What does hypoglycemia look like?
- Think of Drunk pt in Shock
- Drunk
o Staggering gait
o Slurred speech
o Cerebral impairment (labile)
o Slow reaction time
o Decrease social inhibition - Shock—Vasomotor collapse
o Tachycardia, tachypnea, Low BP
o Cold/clammy, mottled skin
Treatment of hypoglycemia
- Give pt sugars or Rapidly metabolizable carbohydrates such as
o Juice (any), candy, regular soda, milk (lactose), honey, icing, jelly, jam - Boards want sugar + starch or protein
o For example, apple juice + turkey, Milk is sugar/protein—1/2 cup Skim milk - Bad answer
o Candy + Soda—1 sugar is good, 2 sugars are bad (give starch or protein, crakers) - Unconscious pts—pay attention to location
- Glucagon IM if the mother is on the phone
- Dextrose IV (D10, D50) if in the ER
DKA causes
- Too much food
- Not enough insulin
- Not enough exercise
- # 1 cause acute viral Upper Respiratory Infection within last 2 weeks
S/Sx of DKA is “DKA”
- Dehydration (dry, poor skin elasticity and turgor, warm) … Water is a coolant (you overheat)
- Ketones in serum, Kussmauls, High K+
- Acidosis, Acetone breath, Anorexia due to nausea
Treatment of DKA
- Insulin IV (Regular!)
- IV fluid! 200 mL/hr (some of the fastest rate)
HHNK or HHS or HHNS
- High blood sugar in a Type 2
- These pts don’t burn ketones, no acid
- Whenever you see HHNK, think dehydration
- Severe Dehydration!
o Skin is dry, flushed, decreased turgor, increased HR
o #1 Nursing diagnosis: fluid volume deficit (same as dehydration)
o #1 Nursing intervention: Rehydration!
o Outcomes in successful treatment: Increase urine output, Moist mucous membrane, etc.
Long-term complications of HHNK or HHS or HHNS
Poor perfusion, Peripheral neuropathy
Long-term complications of diabetes
- Related to
o Poor tissue perfusion
or
o Peripheral neuropathy - Examples of long-term complications: Renal failure, Gangrene, Heart failure, Urinary
incontinence, Pt can’t feel a burn on the foot - For instance
o Renal failure is a cause of poor perfusion
o Urinary incontinence is a cause of peripheral neuropathy
Differences between DKA and HHNK (* Which one is more dependent on insulin?)
o DKA pt is more dependent on insulin
o HHNK pt needs to be rehydrated
