DKA and HHNS – NCLEX Review (Nursing)

00:00 Now, DKA. Why are we talking about this in pharmacology? Because we use insulin to treat DKA. Diabetic ketoacidosis.

00:10 Now, write in the word metabolic acidosis because this patient will be in metabolic acidosis.

00:18 Now, what it looks like is you have a really, really high blood sugar.

00:21 They're gonna have ketoacids present in their blood and in their urine.

00:25 They're gonna be extremely dehydrated.

00:29 We already talked about them being in acidosis and because it's metabolic acidosis, Kussmaul's respirations are -- remember when they're fast and deep because their body's trying to compensate by blowing off CO2 to bring that pH back within normal.

00:45 And lastly, coma is a definite unwanted yet possible characteristic of diabetic ketoacidosis.

00:54 Alright, those are the signs and symptoms so how do we treat it? Well, we're gonna replace insulin to try to get that blood sugar under control.

01:01 Patients are often on a drip which requires very close blood sugar monitoring.

01:06 We might give them bicarbonate to try to address the pH imbalance of acidosis.

01:11 We're gonna have to do water and sodium replacement carefully and slowly.

01:16 So you notice that physicians will order alternating IV fluids.

01:20 You're gonna watch that potassium closely. Can you remember why? Right, because we're giving insulin that will cause potassium to go into the cell which means you'll see their serum potassium drop.

01:33 So if I'm looking at taking care of a diabetic ketoacidosis patient, I have to recognize the characteristics of hyperglycemia, ketoacids, hemoconcentration, acidosis, and coma would be kind of an obvious one.

01:47 But how can we take this information? We know the treatment plan is obviously you wanna restore balance.

01:53 We wanna get blood sugar back within normal.

01:56 What are the ways they could ask us this question? Well, they won't ask you likely what are the signs that dehydration has resolved but they might give you lab work and say which of the following is an indication of an effective treatment plan for diabetic ketoacidosis.

02:13 It won't be something as simple as a normal blood sugar.

02:16 They may see if you know the other ways that we could evaluate the resolution of the severe dehydration that comes along with diabetic ketoacidosis.

02:26 So we're looking for like, normal H and H because we know in dehydration, the H and H will be elevated because that's based on a percentage.

02:34 When you're dehydrated, that percentage is thrown off so it looks inaccurately elevated.

02:42 As you replace those fluids, it will also look like that H and H drops.

02:46 They haven't bled out. It's just re-establishing order.

02:50 So takeaway point from this, the questions are always gonna be application and analysis level on passing level questions.

02:58 So they're not gonna ask you straightforward, recall, recognition.

03:02 Memorizing list won't help you unless you understand how you apply that information to keep your patients safe.

03:10 Now, when we talked about diabetic ketoacidosis, that's what happens in type 1 diabetics.

03:15 Type 2 diabetics have hyperglycemic hyperosmolar nonketotic syndrome.

03:21 Now, this is also severe hyperglycemia. It's brought on by insulin deficiency.

03:26 Happens more often in the type 2s like we just talked about but this happens over a slower period of time.

03:32 Maybe even 1-2 months it's happening. So it's hyperosmolar.

03:37 That means a large amount of glucose is excreted in the urine and also water.

03:42 So this patient is also severely dehydrated.

03:46 Type 1 and type 2, you see the differences there between DKA and HHNS.

03:52 We just shortened it so it all fit in the box. Both cause severe hyperglycemia.

03:57 DKA develops quickly. HHNS develops slowly. You have ketoacidosis in DKA.

04:04 No ketoacidosis in HHNS. Great summary slide.

04:09 You're welcome. But keep that in mind.

04:12 That will help you with the patho and with the pharmacology in addressing those.