Transcription of Med Surg: Endocrine
1 DKA vs. HHNSMed Surg: EndocrineFRUITY BREATHABDOMINAL PAINNO FRUITY BREATHHEADACHE &CONFUSIONNO ABDOMINAL PAINDKAHHNST reatmentRe-AssessmentPotassium Pumps MusclesPatho & Causes:Patho & Causes:Signs & SymptomsTreatmentSigns & SymptomsTYPE 1 FASTER & YOUNGER D COMES 1ST IN ALPHABET S SEPSIS (INFECTION) S SICKNESS "STOMACH VIRUS & FLU" (MOST COMMOM)S STRESS (SURGERY)S SKIP INSULIN EASIER FIXD DRY & HIGH SUGAR K KETONES & KUSSMAUL RESP. (DEEP/RAPID/REGULAR RESPIRATIONS AND FRUITY BREATH) A ABDOMINAL PAIN A ACIDOSIS METABOLIC LESS THAN (NORMAL ) HYPERKALEMIA (ABNORMALLY HIGH K+)250-500+D Dehydration FIRST! ( normal saline)K Kill the sugar (SLOWLY) prevent low sugar *Hourly BS checks* land the plane slow & smooth Over 250: IV Regular insulin ONLY (bolus 1st) Below 200 (or ketones resolve): SQ insulin + 1/2 NS with D5W IV A Add Potassium K+ (Yes even if norm: - ) During IV Insulin IN-sulin = sugar & K+ IN the cellH Hydration NS 1st, then HYPO tonic S Stabilize Sugars (Insulin) CAUTION: Insulin IV = ONLY Regular Insulin IV bolus IV titration SQ injection & IV SQ onlyCommon NCLEX QuestionQ:Child is nauseous NOT eating maybe vomiting do you still give INSULIN?
2 A: Ye s, we give sick day insulin to prevent because glucose is HIGH during times of TIPOVER-600+H HIGHEST SUGARH HIGHER fluid loss & Extreme dehydrationH Head change LOC, Confusion, neurological ManifestationsN No ketones No Acid, (NO fruity breath/ ketones) S Slower Onset & Stable Potassium ( )NCLEX TIPNCLEX TIPNCLEX TIPNCLEX TIPNCLEX TIPNCLEX TIPST DepressionO2 NormalST elevationBlood Glucose Hourly Re-Hydration Signs: BP stable & Cap Refill (3 sec or less) Skin color & warm temp (NOT cool/pale) 30ml/hr + Urine Output Low spec gravity ( ) NOT Apical pulse NOT Lung sounds NOT PupilsPotassium IV (Normal - ) First Action = Heart monitor Never push = DEATH 10 20 mg MAX per hour IV!
3 ! (IV Pump) Site (central) and Slow infusionHigh Potassium ( +) Low Potassium (Below ) High Pump Low PumpPeaked T waves, ST elevation Flat T wave, ST depression, U waveDKA patients DIE from hypokalemia whereas HHNS patients die from hypovolemiaTYPE 2 SLOWER & OLDER H COMES 2ND IN ALPHABET ILLNESSINFECTIONSOLDER AGE HARDER TO FIXNCLEX TIP
