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Medical: 5 Endocrinology: 4

          • (a)

            Lowers blood glucose levels

          • (b)

            Facilitates a stable, normal glucose range of approximately 70 to 120 mg/ dl

      • d.

        Ketone formation

        • (1)

          When insulin supply is insufficient, glucose cannot be used for cellular energy

        • (2)

          Response to cellular starvation

        • (3)

          Body releases and breaks down stored fats and protein to provide energy

        • (4)

          Free fatty acids from stored triglycerides are released and metabolized in the liver in such large quantities that ketones are formed

        • (5)

          Excess ketones upset the pH balance and acidosis develops

        • (6)

          Gluconeogenesis from protein is the last source used by the body as a compensatory response to provide cellular energy

          • (a)

            Results in an increase in glucose and nitrogen

          • (b)

            Due to prevailing insulin insufficiency, the glucose can not be used resulting in

            • i)

              Increased osmotic diuresis

            • ii)

              Dehydration and loss of electrolytes, particularly potassium

    • 4.

      Assessment findings

      • a.

        History

        • (1)

          Has insulin dosage changed recently?

        • (2)

          Has the patient had a recent infection?

        • (3)

          Has the patient suffered any psychologic stress?

      • b.

        Signs and symptoms

        • (1)

          Altered mental status

        • (2)

          Abnormal respiratory pattern (Kussmaul's breathing)

        • (3)

          Tachycardia

        • (4)

          Hypotension

        • (5)

          Breath has a distinct fruity odor

        • (6)

          Polydipsia

        • (7)

          Polyphagia

        • (8)

          Warm dry skin

        • (9)

          Weight loss

        • (10)

          Weakness

        • (11)

          Dehydration

    • 5.

      Management

      • a.

        Airway and ventilation

      • b.

        Circulation

      • c.

        Pharmacological interventions

      • d.

        Non-pharmacological interventions

      • e.

        Transport consideration

        • (1)

          Appropriate mode

        • (2)

          Appropriate facility

      • f.

        Psychological support/ communication strategies

  • B.

    Hypoglycemia

    • 1.

      Epidemiology

      • a.

        Incidence

      • b.

        Morbidity/ mortality

      • c.

        Risk factors

United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

7

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