Which of the following is an often fatal complication of diabetes and also the first indication of diabetes in many young patients?
Answer(s): D
Often the first signs and symptoms of diabetes onset is diabetic ketoacidosis (DKA). When there is no fuel, i.e. glucose, for the cells to burn, they will burn fat and protein which does not burn clean. The incomplete combustion produces acids which are not cleared and build up which can be fatal if not treated aggressively. Hypertension and cardiovascular disease are long term complications of diabetes.
Diabetic ketoacidosis (DKA) has the following signs and symptoms: ● acetone on breath, ● dry skin, ● poor skin turgor, ● altered mental status, ● confusion, ● thirst and frequent urination.What other symptoms are associated with DKA?
Answer(s): B
Due to the hyperglycemic state, the kidneys try to diereses the glucose out of the blood stream causing the patient to become more dehydrated. As the blood becomes thicker and thicker, the cardiac output lowers and the heart has to work harder. With the excess glucose and incomplete combustion from other fuel sources, the brain is impaired as if the patient is intoxicated.
There are two types of cerebral vascular accidents (CVA; i.e. strokes). The most common is an ischemic stroke. What is the other type?
The second type of cerebral vascular accidents (CVA) is a hemorrhagic stroke, also known as a bleed. Thrombotic and embolic strokes are types of ischemic strokes where the blood flow is stopped by a clot. A transient ischemic attack is most often referred as a mini stroke, a prelude to a full-on CVA.
The symptoms of a transient ischemic attack (TIA), often referred to as a mini stroke, resolve within 24 hours ______________.
Most TIAs will resolve within 15 minutes, however for it to be diagnosed as a TIA all signs and effects must be resolved within 24 hours after onset. TI's are often the precursor to a major stroke.
To assess a patient with a stroke, there are two major assessment tools: the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen. Which one of these two tools uses arm drift as a diagnostic tool?
The Cincinnati stroke scale uses arm drift as a diagnostic tool. Ask the patient to lift both arms up in front of them, close their eyes and watch for an arm to drift downward. If there is a drift downward on one arm then assess for a CVA on that side.
Stroke symptoms are often the same as other medical problems. To prevent improper treatment for the signs and symptoms, working through the differentials is a must. One of the most common medical problems which is often mistaken for a CVA is hypoglycemia. How can a clinician rule in or out this differential?
One of the easiest and most often overlooked diagnosis tools is the glucometer check the blood sugar. The other screening info in this question do not rule in or out hypoglycemia.
The clinician’s best role in the assessment and treatment of a stroke patient is rapid recognition and transport to a stroke center. What is the window of opportunity from the onset of symptoms until treatment?
Anytime there is a blockage not allowing blood flow, the quicker blood flow is returned, the better the results. It is well established if tPa is infused within three hours of the onset of symptoms, there is a greater chance that all deficits will resolve without lasting effects.
Statements from patients are used as assessment tools. Which of the following statements about stroke symptoms should cause the clinician to use a higher index of suspicion?
Answer(s): A
“This is the worst headache I have ever had.” This statement should not be ignored or considered to be dramatic, it should cause the clinician to modify their assessment to include a hemorrhagic stroke in their differential. All of the other statements do classify the intensity of their headache and it may not rule out a stroke, however, the statement of the worst headache should alert you to the possibility of a more acute findings.
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