Transcript Altered mental status Diabetic emergency

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)”lightheadedness, 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.
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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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