PCCN Exam Complete Study Guide |
Questions and Answers Graded A+ |
Latest 2024
When is glucagon secreted? What is its main action?
- Correct Answer - When blood amino acid levels rise in the presence of a
decreased blood glucose.
Its main action is to antagonize insulin and thus increase blood glucose
Does DKA typically occur in patients with Type I or II diabetes?
- Correct Answer - Type I
Summarize the process of DKA
- Correct Answer - 1. lack of insulin
2. cells can't use circulating blood sugar without insulin release
3. due to lack of blood sugar for cell uptake, proteins are released into
blood
4. proteins eventually break down into ketones (acids) and are produced
faster than they can be excreted
====> DKA
Name some conditions that might produce DKA
- Correct Answer - 1. failure to take insulin
2. stress due to illness/infection/trauma/surgery/cardiac complications
,3. pregnancy
4. pancreatitis
5. undiagnosed type I diabetes mellitus
What respiratory pattern is typically observed in DKA
- Correct Answer - Kussmaul with an acetone smell
What are the three major clinical features seen in DKA
- Correct Answer - 1. hyperglycemia
2. kenonuria
3. metabolic acidosis (pH < 7.3 and HCO3 <15)
Describe the goals of rehydration in DKA
- Correct Answer - The patient is typically hyperosmolar, so hypotonic or
isotonic fluids are given. You want to correct it slowly to prevent cerebral
edema that can happen with a rapid osmolarity shift.
*when the glucose is 250 or less, fluids should be changed to 5% glucose
in 1/2 saline to avoid hypoglycemia.
How quickly do you want blood glucose to fall in DKA management?
- Correct Answer - approximately 100 mg/dL every 1 to 2 hrs.
Why would cerebral edema occur if DKA was corrected too quickly?
- Correct Answer - Because glucose is an osmotic particle, it pulls fluid to
the brain when the serum glucose is rapidly decreased.
,*The brain doesn't require insulin and the blood brain barrier prevents rapid
movement of glucose OUT of the CSF.
Why does hypokalemia typically occur during the management of DKA
- Correct Answer - Because circulating insulin forces K into the cells
What waveform is associated with hypokalemia?
- Correct Answer - U waves
What ECG change is often associated with hyperkalemia?
- Correct Answer - peaked, tented T waves. There may be tachycardia
which converts to bradycardia if the hyperkalmeia increases.
Around what blood glucose level should a patient recovering from DKA be
switched from IV to SQ insulin?
- Correct Answer - < 200 mg/dL, assuming the serum anion gap is
normal, serum bicarb is > 18 and venous pH is > 7.30
When do symptoms of cerebral edema typically begin to appear following
initiation of treatment for DKA?
- Correct Answer - 12-24 hours
When should bicarbonate be considered in the management of DKA? Why
is it not necessarily a good idea to use
- Correct Answer - If the serum pH is < 7and/or the patient shows signs of
cardiac dysfunction or signs of life-threatening hyperkalemia
, -***it is thought that bicarb can increase acidity in the CSF (as H+ moves
out of the the serum and crosses the blood brain barrier) potentially
prolonging a diabetic coma
What distinguishes DKA from HHS?
- Correct Answer - Hyperglycemic hyperosmolar state is a condition where
enough insulin is being released to prevent ketosis, but not hyperglycemia.
What is the major problem in HHS? What signs/symptoms would you
expect to observe?
- Correct Answer - Cellular dehydration (high blood sugar in the serum
depletes the cells of H2O)
s/s: dry mucous membranes, dry skin, tachycardia, hypotension,
glycosuria.
**blood sugars are frequently greater than 1000
What reported effects of hyperglycemia have prompted physicians to treat
high blood sugar in critical illness?
- Correct Answer - 1. impaired immune function
2. increased inflammation
3. impaired wound healing
What are some early signs of hypoglycemia?
- Correct Answer - restlessness
diaphoresis,
tachycardia
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