NUR 4227 Lecture Notes - Lecture 8: Orthostatic Hypotension, Diuresis, Infusion Set
Document Summary
Inadequate insulin dosage: undiagnosed type 1 diabetes, poor self-management, neglect, deliberate or accidental omission of insulin dose. Use . 45% saline: hour 4 - adjust rate to meet clinical needs, when glucose 250mg/dl change to d51/2ns until acidosis corrected and tolerating fluids/food, yes! Glucose drop of 36 to 54 mg/dl/hr is ideal: monitor glucose and adjust infusion q 1 hour, when tolerating fluids and glucose control improved, may discontinue iv insulin, first dose of subcutaneous insulin given prior to discontinuing drip. Insulin regimen should reflect what will be used at home: continue to monitor urine ketones for recurrence of acidosis, dose may require frequent adjustment, honeymoon effect may result in hypoglycemia. Important points on insulin: activity may vary by individual, patients with renal insufficiency or renal failure may have erratic glucose control, patients with diabetic neuropathy (gastroparesis) may have difficulty matching intake to insulin action. Introduce solids slowly - high risk for aspiration: aggressive fluid replacement may lead to chf.
