Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) Quiz
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Questions and Answers

What is hypoglycemia?

  • Low sugar in the blood (correct)
  • Fluctuating sugar in the blood
  • High sugar in the blood
  • Normal sugar in the blood

    • What can cause hypoglycemia?

  • Excessive physical activity and too little food
  • Too much food and no physical activity
  • Too little insulin or oral hypoglycemic agents
  • Skipping meals and excessive insulin (correct)

    • When may midmorning hypoglycemia occur?

  • When breakfast is being digested
  • When evening insulin is peaking
  • When there is too little insulin
  • When the morning insulin is peaking (correct)

    • What are the clinical manifestations of hypoglycemia?

    <p>Sweating and tachycardia</p> Signup and view all the answers

    What is the blood glucose level for hypoglycemia?

    <p>Less than 70 mg/dL</p> Signup and view all the answers

    What causes the sympathetic nervous system to be stimulated in hypoglycemia?

    <p>Low blood glucose level</p> Signup and view all the answers

    What are the symptoms of moderate hypoglycemia?

    <p>Inability to concentrate, confusion, slurred speech, and double vision</p> Signup and view all the answers

    What is the immediate treatment for hypoglycemia?

    <p>15 to 20g of fast-acting concentrated carbohydrates</p> Signup and view all the answers

    What causes Diabetic Ketoacidosis (DKA)?

    <p>An absence or inadequacy of insulin</p> Signup and view all the answers

    What leads to increased gluconeogenesis and hyperglycemia in the absence of insulin?

    <p>Reduced glucose entry into cells</p> Signup and view all the answers

    What is a cause of DKA during illness?

    <p>Missed insulin doses</p> Signup and view all the answers

    What are the 'sick day rules' for preventing DKA during illness?

    <p>Not eliminating insulin doses when nauseous or vomiting and consuming frequent small portions of carbohydrates</p> Signup and view all the answers

    What insulin administration changes are recommended for hospitalized patients with diabetes?

    <p>Eliminating rapid-acting insulin, reducing intermediate-acting insulin, and using frequent dosing of rapid-acting insulin</p> Signup and view all the answers

    What may be given to prevent hypoglycemia and provide calories for hospitalized patients with diabetes who are not eating?

    <p>IV dextrose</p> Signup and view all the answers

    What insulin regimens may be used for hospitalized patients NPO for an extended period?

    <p>NPH insulin every 12 hours, rapid-acting insulin every 4 to 6 hours, or an IV insulin drip</p> Signup and view all the answers

    Why should diagnostic tests, procedures, and surgeries for patients with diabetes be scheduled early in the morning?

    <p>To avoid the need to withhold food</p> Signup and view all the answers

    What do enteral tube feedings for patients with diabetes contain more of, affecting blood glucose levels?

    <p>Simple carbohydrates</p> Signup and view all the answers

    What are hospitalized patients with diabetes at increased risk for, requiring daily dental care and assistance in maintaining skin hygiene?

    <p>Periodontal disease and skin breakdown</p> Signup and view all the answers

    How can pressure on the heels be alleviated for a patient in the supine position?

    <p>Elevating the lower legs on a pillow with the heels hanging off the edge</p> Signup and view all the answers

    When seated in a chair, how should a patient's feet be positioned to prevent heel pressure?

    <p>So that pressure is not placed on the heels</p> Signup and view all the answers

    What should a nurse provide to a patient with an ulceration on one foot?

    <p>Preventive care to the unaffected foot and special care to the affected foot</p> Signup and view all the answers

    What should be included in diabetes self-management education?

    <p>Daily oral, skin, and foot care</p> Signup and view all the answers

    What additional instruction should female patients receive?

    <p>Measures for the avoidance of vaginal infections</p> Signup and view all the answers

    Why is it important for nurses to emphasize personal hygiene during hospitalization?

    <p>Patients often take cues from nurses and understand the importance of hygiene</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with Diabetic Ketoacidosis (DKA)?

    <p>Minimal or absent ketosis</p> Signup and view all the answers

    What triggers Hyperglycemic Hyperosmolar Syndrome (HHS) most commonly?

    <p>An illness, medication, or acute event</p> Signup and view all the answers

    What is a key difference in the presentation of DKA and HHS?

    <p>Lack of ketosis in HHS</p> Signup and view all the answers

    How long may it take for neurologic symptoms to clear after treatment for HHS?

    <p>3 to 5 days</p> Signup and view all the answers

    Which intervention is NOT part of the management for Hyperglycemic Hyperosmolar Syndrome (HHS)?

    <p>Administration of oral antidiabetic medications</p> Signup and view all the answers

    What adjustment is necessary for patients with diabetes who must be NPO (nothing by mouth)?

    <p>Adjustments in insulin dosage</p> Signup and view all the answers

    What is the blood glucose level indicating hypoglycemia?

    <p>Less than 70 mg/dL (3.9 mmol/L)</p> Signup and view all the answers

    What are the clinical manifestations of mild hypoglycemia?

    <p>Sweating, tremor, tachycardia, and hunger</p> Signup and view all the answers

    What is the immediate treatment for hypoglycemia?

    <p>Consuming 15-20 grams of glucose or simple carbohydrates</p> Signup and view all the answers

    What is the main cause of hypoglycemia?

    <p>Too much insulin or oral hypoglycemic agents</p> Signup and view all the answers

    When does midmorning hypoglycemia often occur?

    <p>When the morning insulin is peaking</p> Signup and view all the answers

    What are the symptoms associated with the sympathetic nervous system stimulation in hypoglycemia?

    <p>Sweating, tremor, tachycardia, and nervousness</p> Signup and view all the answers

    How can pressure on the heels be alleviated for a patient in the supine position?

    <p>Elevating the lower legs on a pillow with the heels positioned over the edge of the pillow</p> Signup and view all the answers

    What should be emphasized when educating female patients about diabetes self-management?

    <p>Measures for the avoidance of vaginal infections</p> Signup and view all the answers

    How should the feet be positioned when a patient is seated in a chair to prevent pressure on the heels?

    <p>Positioned so that pressure is not placed on the heels</p> Signup and view all the answers

    What should the nurse provide for a patient with an ulceration on one foot?

    <p>Preventive care to the unaffected foot and special care of the affected foot</p> Signup and view all the answers

    What should be emphasized during the hospitalization of patients with diabetes?

    <p>The importance of daily personal hygiene</p> Signup and view all the answers

    What is the recommended position for the lower legs when a patient is in the supine position to alleviate pressure on the heels?

    <p>Elevated on a pillow with the heels positioned over the edge of the pillow</p> Signup and view all the answers

    Which of the following is a characteristic of Hyperglycemic Hyperosmolar Syndrome (HHS)?

    <p>Presence of hyperosmolality and hyperglycemia</p> Signup and view all the answers

    What is a key difference between Diabetic Ketoacidosis (DKA) and HHS?

    <p>Presence of ketosis and acidosis</p> Signup and view all the answers

    What is a precipitating factor for Hyperglycemic Hyperosmolar Syndrome (HHS)?

    <p>Acute illnesses</p> Signup and view all the answers

    What is the immediate treatment for hypoglycemia?

    <p>15 to 20 g of fast-acting concentrated carbohydrate</p> Signup and view all the answers

    What is a clinical manifestation of Diabetic Ketoacidosis (DKA)?

    <p>Orthostatic hypotension</p> Signup and view all the answers

    What is a cause of Diabetic Ketoacidosis (DKA)?

    <p>Missed insulin doses</p> Signup and view all the answers

    What is the treatment approach for Hyperglycemic Hyperosmolar Syndrome (HHS)?

    <p>Fluid replacement, correction of electrolyte imbalances, and insulin administration</p> Signup and view all the answers

    What is the result of insulin deficiency in Diabetic Ketoacidosis (DKA)?

    <p>Increased gluconeogenesis and ketone body production</p> Signup and view all the answers

    What is important for preventing recurrence of Hyperglycemic Hyperosmolar Syndrome (HHS)?

    <p>Frequent self-blood glucose monitoring</p> Signup and view all the answers

    How can patients prevent dehydration during illness?

    <p>Consume frequent small portions of carbohydrates and fluids</p> Signup and view all the answers

    What should patients have during illness to manage diabetes?

    <p>A 'sick day' kit with urine and blood glucose test strips</p> Signup and view all the answers

    What should be assessed after the acute phase of Diabetic Ketoacidosis (DKA)?

    <p>Underlying causes</p> Signup and view all the answers

    What insulin regimens may be used for hospitalized patients NPO for an extended period?

    <p>NPH insulin every 12 hours, rapid-acting insulin only every 4 to 6 hours, or an IV insulin drip</p> Signup and view all the answers

    What should be provided to prevent hypoglycemia and provide calories for hospitalized patients with diabetes who are not eating?

    <p>IV dextrose</p> Signup and view all the answers

    What causes a rapid rise in blood glucose levels when eaten alone, requiring matching of peak times of insulin effect with peaks in the blood glucose concentration?

    <p>Simple carbohydrates</p> Signup and view all the answers

    What must be given at regular intervals when continuous tube feedings are provided to patients with diabetes?

    <p>Insulin doses</p> Signup and view all the answers

    What may result from inadvertent or purposeful discontinuation of continuous tube feedings in patients receiving insulin?

    <p>Hypoglycemia</p> Signup and view all the answers

    What should be monitored and given at regular intervals for patients receiving continuous parenteral nutrition?

    <p>Blood glucose level and insulin</p> Signup and view all the answers

    What type of insulin administration is crucial for type 1 diabetes patients who are NPO?

    <p>Basal insulin</p> Signup and view all the answers

    What may lead to diabetic ketoacidosis (DKA) in type 1 diabetes patients who are NPO?

    <p>Elimination of insulin doses</p> Signup and view all the answers

    What insulin dosing changes may be needed for hospitalized patients with diabetes?

    <p>Eliminating rapid-acting insulin and decreasing intermediate-acting insulin</p> Signup and view all the answers

    What should clear liquid diets for diabetic patients in hospitals include?

    <p>Simple carbohydrate foods like juice and gelatin desserts</p> Signup and view all the answers

    What may enteral tube feedings in diabetic patients lead to?

    <p>Increased glucose levels</p> Signup and view all the answers

    What is important for preventing periodontal disease and skin issues in hospitalized diabetic patients?

    <p>Focused attention on oral hygiene and skin care</p> Signup and view all the answers

    What is a crucial management strategy for type 1 diabetes patients who are nil per os (NPO)?

    <p>Regular glucose testing and insulin administration</p> Signup and view all the answers

    What is a potential consequence for type 1 diabetes patients if insulin doses are eliminated?

    <p>Diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    What insulin administration changes are necessary for hospitalized patients with diabetes NPO for an extended period?

    <p>IV insulin drip</p> Signup and view all the answers

    What is essential for diabetic patients receiving parenteral nutrition?

    <p>Regular glucose testing</p> Signup and view all the answers

    What is a potential consequence of discontinuation of enteral tube feedings for diabetic patients receiving insulin?

    <p>Hypoglycemia</p> Signup and view all the answers

    What should nurses assess for in diabetic patients to prevent skin breakdown?

    <p>Symptoms of neuropathy</p> Signup and view all the answers

    Study Notes

    Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS)

    • DKA's hyperglycemia leads to polyuria, polydipsia, fatigue, blurred vision, weakness, and headache, and can result in orthostatic hypotension, hypotension, acetone breath, and Kussmaul respirations.
    • Mental status in DKA varies, with patients being alert, lethargic, or comatose.
    • HHS, mainly in older adults with type 2 diabetes, is characterized by hyperosmolality and hyperglycemia with minimal or absent ketosis.
    • HHS is often triggered by an illness, medication, or acute event and presents with polyuria, polydipsia, hypotension, dehydration, and variable neurologic signs.
    • Distinguishing HHS from DKA, HHS does not involve ketosis and acidosis due to differences in insulin levels.
    • HHS management involves fluid replacement, correction of electrolyte imbalances, and insulin administration, with close monitoring of volume and electrolyte status.
    • Treatment of HHS may take 3 to 5 days for neurologic symptoms to clear and may continue well after metabolic abnormalities have resolved.
    • After recovery from HHS, many patients can control their diabetes with Medical Nutrition Therapy (MNT) or oral antidiabetic medications, with insulin not always being needed.
    • Insulin is given at a continuous low rate to treat hyperglycemia, and replacement IV fluids with dextrose are given after the glucose level decreases to a certain range.
    • Frequent self-blood glucose monitoring (SBGM) is important in preventing the recurrence of HHS.
    • Patients who must be NPO require adjustments in insulin dosage.
    • Dietary modifications during hospitalization for patients with diabetes require special consideration.

    Hypoglycemia and Diabetic Ketoacidosis: Symptoms, Management, and Prevention

    • Moderate hypoglycemia symptoms include impaired CNS function like headache, confusion, and slurred speech
    • Severe hypoglycemia symptoms may include disoriented behavior, seizures, and loss of consciousness
    • Immediate treatment for hypoglycemia involves 15 to 20 g of fast-acting concentrated carbohydrate
    • Diabetic Ketoacidosis (DKA) is caused by insulin deficit, leading to hyperglycemia, dehydration, and acidosis
    • Insulin deficiency results in increased gluconeogenesis and ketone body production, leading to metabolic acidosis
    • Causes of DKA include missed insulin doses, illness, infection, and undiagnosed diabetes
    • Patients may make errors in insulin dosage during illness, resulting in decreased insulin levels
    • Illness and infections contribute to insulin resistance, leading to hyperglycemia and potential progression to DKA
    • Prevention of DKA during illness involves managing diabetes with "sick day rules," including not eliminating insulin doses during nausea and vomiting
    • Patients are taught to consume frequent small portions of carbohydrates and fluids to prevent dehydration during illness
    • Patients should have a "sick day" kit with urine and blood glucose test strips and know how to contact their primary provider 24/7
    • After the acute phase of DKA, underlying causes should be assessed by the nurse

    Managing Diabetes in Hospitalized Patients

    • Management strategies for diabetic patients in hospitals include adjusting insulin doses, using IV dextrose to avoid hypoglycemia, and monitoring glucose levels closely.
    • Type 1 diabetes patients may develop diabetic ketoacidosis (DKA) if insulin doses are eliminated.
    • Basal insulin administration is crucial for type 1 diabetes patients who are nil per os (NPO).
    • Type 2 diabetes patients on insulin may not develop DKA when insulin doses are skipped due to endogenous insulin production, but close glucose monitoring is essential.
    • Regular glucose testing and insulin administration are necessary for patients NPO for extended periods, with insulin regimens including NPH insulin, rapid-acting insulin, or IV insulin drip.
    • Diagnostic tests, procedures, and surgeries for diabetic patients should be scheduled early in the morning to minimize the need for food withholding.
    • Clear liquid diets in hospitals for diabetic patients should include simple carbohydrates like juice and gelatin desserts to maintain nutritional status and promote healing.
    • Enteral tube feedings can cause increased glucose levels in diabetic patients, necessitating regular insulin dosing and careful monitoring to prevent hypoglycemia and hyperglycemia.
    • Hypoglycemia in patients receiving tube feedings and insulin may result from discontinuation of the feeding, requiring alterations in insulin doses or administration of IV dextrose.
    • Diabetic patients receiving parenteral nutrition may require IV and subcutaneous insulin, with regular blood glucose monitoring and insulin administration to coincide with parenteral nutrition infusion times.
    • Hospitalized diabetic patients require focused attention on oral hygiene, skin care, and prevention of skin breakdown, including daily dental care, skin assessments, and foot care to prevent neuropathy-related complications.
    • Nurses should assess for symptoms of neuropathy, such as tingling, pain, numbness, and reduced deep tendon reflexes, and provide appropriate care to prevent skin breakdown, especially at pressure points.

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    Description

    Test your knowledge of Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) with this quiz. Explore the differences in symptoms, management, and treatment approaches for these two serious diabetic complications.

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