NRNP 6566 Week 11 Knowledge Check (100% Correct) Verified Answers

NRNP 6566 Week 11 Knowledge Check • Question 1 How would you differentiate between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? • Question 2 Juan is a 42 year old ...

NRNP 6566 Week 11 Knowledge Check • Question 1 How would you differentiate between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? • Question 2 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What are the appropriate initial orders to treat this patient? • Question 3 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What is the “ corrected” sodium level for the hyperglycemia? What does this mean and how would it impact your treatment plan for this patient? • Question 4 A 56 year old male with an acute COPD exacerbation is admitted to the ICU. He has type I diabetes and utilizes NPR and regular insulin twice a day to manage his diabetes. He is currently taking very little orally due to his shortness of breath. What would the best way to manage his diabetes and insulin needs in the ICU? • Question 5 A 56 year old male with an acute COPD exacerbation is admitted to the ICU. He has type I diabetes and utilizes NPR and regular insulin twice a day to manage his diabetes. He is currently taking very little orally due to his shortness of breath. What is the blood glucose goal for this patient in the ICU? • Question 6 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What patient education would be important to provided related to sick day management of his diabetes (include management of insulin) ? • Question 7 A 37 year old female with a 20 year history of DM is post cholecystectomy with complications. She has been on four time daily blood sugar testing with sliding scale insulin coverage. She is preparing for discharge and wanted to return to her previous blood sugar management. Her pre-hospitalization insulin regime included: NPH insulin 16 units in AM and 8 units in PM Regular insulin 8 units in am and 3 units in PM She resumed this regime 2 days ago. Upon rounding this am, the patient tells the NP that she has woken up feeling awful. She is sweaty and shaky during the night and lethargic in the morning. The NP reviews her blood sugar readings and discovers this: 0300 0700 1200 1700 2100 62 196 109 90 146 64 203 82 100 150 What is your working diagnosis for this patient? • Question 8 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What is the anion gap? What does this mean and how would it impact your treatment plan for this patient? • Question 9 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What is your working diagnosis for this patient? • Question 10 Juan is a 42 year old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS 94/64 P 112 RR 30 T 99.4 wt 195 pounds ht 5’11 » Lungs clear bilaterally, rapid respiration CV : RRR, no murmurs or gallops Abd: soft, non-tender, positive bowel sounds Labs: Hb 146 Hct 58% Cr 4.9 Bun 53 Cholesterol 238 Na 126 K 5.6 CL 95 Ca 8.8 Gluc 722 Phosphorus 5.8 Ketone Moderate AST 248 Alk Phos 132 ABG’s ph 7.01 Pco2 20 Po2 100 Sat 98% (on room air) HCO3 7.5 What is the most reliable method of assessing and monitoring the patients acidosis?