TAEM10: Endocrine Emergency - Nurse

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Text of TAEM10: Endocrine Emergency - Nurse

  • 1. [email_address]

2.

  • ( Hypoglycemia )
  • ( Hyperglycemic Crisis )
    • ( Diabetic Ketoacidosis, DKA )
    • (Hyperosmolar Hyperglycemic Syndrome, HHS or Non-ketotic Hyperglycemia)

3. ( Hypoglycemia )

Triage Ongoing Assessment & Monitoring Discharge planning 4. Triage Nurse

  • Rapid Assessment + DTX

5. 80 1

  • 3 days PTA6 / NO N/V2 days PTA 1 days PTA
  • GA:
  • BP 150/80PR 84RR 18T 35CR > 2 sec
  • DTX 21 mg%

6. 84 3 .

  • U/D DM HT Dementia1 day PTA 3 hrs. PTA ( Gliben x 1, Metformin 1 x1)
  • GA:
  • BP 142/72PR 107RR 22T 36.7
  • DTX41 mg%

7. 47 10

  • U/D DM3 1 hrs. PTA
  • GA:
  • BP 140/80PR 92RR 22T 36.7
  • O2 sat 98% pupil RTL BE 3 mm
  • DTX31 mg%

8.

  • Subjective Data
    • CC / PI
      • Rapid onset
      • No recent food intake
      • Alcohol ingestion in the last 36 hrs.
      • Weakness , dizziness
      • Lethargy , alter mental status
      • Nausea
      • Anxiety

Emergency Nursing, 2007 9. Early physical Signs (Autonomic nervous System dysfunction) Neurological disturbances (Neuroglycopenic symptoms ) Gastro-intestinal disturbances pallor, Cool, diaphoretic skin Sweating and clamminess Tachycardia anxiety orRestlessness Irritability Palpitation Tremors Confusion Agitation or aggression Loss of co-ordination coma orSeizures Headache Slurred speech Diplopia orBlured vision Nausea and vomiting Abdominal pain 10.

  • Subjective Data
    • PI
      • ( infection )
      • (increased amounts of exercise or physical activity)
      • (Alteration in lifestyle circumstances )

11.

  • Subjective Data
    • PI
      • (irregular eating habits)
      • ( Alteration to insulin or oral hypoglycemia )

12.

  • Subjective Data
    • PH
      • DM Alcoholism

13.

  • Objective Data
    • GA
      • LOC, Behavior, affect
      • RR
      • Temp

Emergency Nursing, 2007 14.

  • oxygen
  • Lab [ CBC BS BUN Cr ELyte] glucose
  • NS VS

15.

  • DTX
    • BS90 140 mg/dL

16.

  • Disturbed thought processr/t insufficient blood glucose to brain
  • Imbalanced Nutrition: less than body requirements r/t imbalance of glucose and insulin level

17.

  • Ineffective health maintenance r/t deficient knowledge regarding disease process, self-care

18. ER

  • ( Hypoglycemic Unawareness )
  • ( Diabetes Self-management )

19.

  • ( Compliance )

20. 58 1

  • U/D DM 2 1
  • 10 Days PTA 4 .
  • BP 128/76 mmHg PR 130/min RR 24/min T 36 C

21. 58 1

  • DTX 560 mg%
  • GA:
    • dry lips
    • sunken eye balls
    • warm & dry skin
    • kussmaul breathing

22. ( Hyperglycemic Crisis )

  • Dehydrate
  • Elyte imbalance

Metabolic Acidosis

  • ( cerebral edema )

DKA HHS 23. DKA

  • /
  • 24 - 48 .
  • ( Stress )

24. DKA

  • /( )

25. HHS

  • /
  • DKA
  • ( Stress )

26. DKA

  • /
  • UTI/ Stress

27. HHS

  • /
  • DMT2
  • StrokeMyocardial infarction

28. HHS

  • /( )
  • Beta-Blockers, Histamine 2 Blockers (H2RA)
  • Stress

29.

  • GA:( Level of Consciousness), (Behavior), ( Affect) :
  • Vital Signs: Tachycardia, Orthostatic Hypotension,Kussmauls Respiration( pH7.2 )
  • ( flushed )poor skin turgor

30.

  • ABCs
  • 2 Crystalloid FluidsIV drip in 1-2 . 0.45% NSS IV drip
  • monitor EKGSat O 2

31.

  • NG tube
  • Urine Output
  • insulin , NaHCO3, Potassium

( ) 32.

  • Monitor NSCerebral Edema
  • Monitor Hemodynamic Status15 60

33.

  • 1 .Elyte2 .
  • -
  • Sat O 2 Capillary RefillRespiratory distress Syndrome

( ) 34.

  • DKA
    • Hypokalemia
    • Hypoglycemia
    • Hyperglycemia
    • Cerebral Edema
    • ARDSSevere DKA
    • Hyperchloremia metabolic acidosis

( ) 35.

    • pH
    • Blood Glucose 100 200 mg/dL
    • Serum K+4 5 mEq/L
    • Serum Osmolality 285 300 mOsm/kg

( ) 36.

  • Deficient Fluid Volume r/t excess excretion of urine, nausea, vomiting, increased respiration

: DKA 37.

  • Impaired memory r/t fluid and electrolyte imbalance

: DKA 38.

  • Ineffective therapeutic regimenmanagement r/t denial of illness, lack ofunderstanding of preventive measures, and adequate blood sugar control

: DKA 39.

  • Noncompliance: diabetic regimen r/t ineffective coping with chronic disease

: DKA 40.

  • Risk for unstable blood glucose level

: DKA 41.

  • Deficient Fluid Volume r/t Hyperglycemia resulting in polyuria

: HHS 42.

  • ,Disturbed thought process r/t hyperglycemia, presence of excessive metabolic acids

: HHS 43.

  • Ineffective management of therapeutic regimen r/t lack of understanding of preventive measure adequate blood sugar control

: HHS 44.

  • ( :,)Risk for infection: risk factors: hyperglycemia, changes in vascular system
  • Risk for unstable blood glucose level

: HHS 45.

Rapid Assessment & Triage Ongoing Assessment & Monitoring Discharge planning Care Delivery