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Altered mental status Diabetic emergency

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					ALTERED MENTAL STATUS
 DIABETIC EMERGENCY

    Dr. Abdul-Monim Batiha
      Assistant Professor
     Critical Care Nursing
     Philadelphia university
          ALTERED MENTAL STATUS
            DIABETIC EMERGENCY
 DIABETES MELLITUS Diabetes mellitus is a
  metabolic disorder characterized by
  hyperglycemia and results from defective
  insulin production, secretion, or utilization.
CLINICAL MANIFESTATIONS

 Onset is abrupt with type 1 and insidious with
  type 2.
 1.Weight loss, fatigue

 2.Polyuria, polydipsia, polyphagia
CLINICAL MANIFESTATIONS EARLY

 1.Polydipsia, polyuria
 2.Fatigue, malaise, drowsiness

 3.Anorexia, nausea, vomiting

 4.Abdominal pains, muscle cramps
 1.Kussmaul respiration (deep respirations)
 2.Fruity, sweet breath

 3.Hypotension, weak pulse

 4.Stupor and coma
COMPLICATIONS

 Acute
 • Hypoglycemia occurs as a result of an
  imbalance in food, activity, and insulin/oral
  antidiabetic agent.
 • Diabetic ketoacidosis (DKA) occurs primarily
  in type 1 diabetes during times of severe
  insulin deficiency or illness, producing severe
  hyperglycemia, ketonuria, dehydration, and
  acidosis.
     PREVENTING INJURY SECONDARY TO
             HYPOGLYCEMIA

 • Closely monitor blood glucose levels to
  detect hypoglycemia.
 • Instruct patient in the importance of
  accuracy in insulin preparation and meal timing
  to avoid hypoglycemia.
 • Assess patient for the signs and symptoms
  of hypoglycemia.
 o Adrenergic (early symptoms)”sweating,
  tremor, pallor, tachycardia, palpitations,
  nervousness from the release of adrenalin
  when blood glucose falls rapidly
 o Neurologic (later symptoms)”light-
  headedness, headache, confusion, irritability,
  slurred speech, lack of coordination.
 • Treat hypoglycemia promptly with 15 to 20 g
  of fast-acting carbohydrates.
 o Half cup (4 oz) juice, 1 cup skim milk, three
  glucose tablets, four sugar cubes, five to six
  pieces of hard candy may be taken orally.
   o Nutrition bar specially designed for
    diabetics supplies glucose from sucrose,
    starch, and protein sources with some fat to
    delay gastric emptying and prolong effect; may
    prevent relapse. Used after hypoglycemia
    treated with fact-acting carbohydrate
   o Glucagon 1 mg (subcutaneously or I.M.) is
    given if the patient cannot ingest a sugar
    treatment. Family member or staff must
    administer injection.
   o I.V. bolus of 50 mL of 50% dextrose solution
    can be given if the patient fails to respond to
    glucagon within 15 minutes.
 • Encourage patient to carry a portable
  treatment for hypoglycemia at all times.
 • Assess patient for cognitive or physical
  impairments that may interfere with ability to
  accurately administer insulin.
 • Between-meal snacks as well as extra food
  taken before exercise should be encouraged to
  prevent hypoglycemia.
 • Encourage patients to wear an identification
  bracelet or card that may assist in prompt
  treatment in a hypoglycemic emergency.
SEIZURE DISORDERS

   Seizures (also known as epileptic seizures and,
    if recurrent, epilepsy) are defined as a sudden
    alteration in normal brain activity that causes
    distinct changes in behavior and body function.
    Seizures are thought to result from
    disturbances in the cells of the brain that
    cause cells to give off abnormal, recurrent,
    uncontrolled electrical discharges.
CLINICAL MANIFESTATIONS

   Manifestations are related to the area of the
    brain involved in the seizure activity and may
    range from single abnormal sensations,
    aberrant motor activity, altered consciousness
    or personality to loss of consciousness and
    convulsive movements.
 • Impaired consciousness
 • Disturbed muscle tone or movement

 • Disturbances of behavior, mood, sensation,
  or perception
 • Disturbances of autonomic functions
            NURSING INTERVENTIONS
    MAINTAINING CEREBRAL TISSUE PERFUSION

 • Maintain a patent airway until patient is fully
  awake after a seizure.
 • Provide oxygen during the seizure if color
  change occurs.
 • Stress the importance of taking medications
  regularly.
 • Monitor serum levels for therapeutic range
  of medications.
 • Monitor patient for toxic adverse effects of
  medications.
 • Monitor platelet and liver functions for
  toxicity due to medications.
STATUS EPILEPTICUS

   (acute, prolonged, repetitive seizure activity) is
    a series of generalized seizures without return
    to consciousness between attacks. The term
    has been broadened to include continuous
    clinical and/or electrical seizures lasting at
    least 5 minutes, even without impairment of
    consciousness.
   Status epilepticus is considered a serious
    neurologic emergency. It has high mortality and
    morbidity (permanent brain damage, severe
    neurologic deficits). Factors that precipitate
    status epilepticus in patients with preexisting
    seizure disorder include medication withdrawal,
    fever, metabolic or environmental stresses,
    alcohol or drug withdrawal, and sleep
    deprivation.
 Preventing Injury
 • Provide a safe environment by padding side
  rails and removing clutter.
 • Place the bed in a low position.

 • Do not restrain the patient during a seizure.

 • Do not put anything in the patient's mouth
  during a seizure.
 • Place the patient on side during a seizure to
  prevent aspiration.
 • Protect the patient's head during a seizure.
  If seizure occurs while ambulating or from
  chair, cradle head or provide cushion/support
  for protection against head injury.
 • Stay with the patient who is ambulating or
  who is in a confused state during seizure.
 • Provide a helmet to the patient who falls
  during seizure.
 • Manage the patient in status epilepticus.

				
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