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CH 1 > Diabetes/Endocrine (Module 3) > Flashcards

Diabetes/Endocrine (Module 3) Flashcards

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1
Q

Type 1 Diabetes

A

AUTOIMMUNE

pancreas doesn’t secrete insulin by beta cells
w/o insulin, DKA and severe metabolic disturbances can develop

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2
Q

Type 2 Diabetes

A

insulin resistance/secretory deficit with insulin deficiency

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3
Q

Polydipsia Symptoms

A

loss of skin turgor, skin warm and dry
dry mucous membranes
weakness/malaise
rapid weak pulse and hypotension

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4
Q

Polyphagia

A

excessive hunger and eating caused by inability of cells to receive glucose because of lack of insulin or cellular resistance to insulin and body use of protein and fat for energy (causes ketosis)

weight loss
ketones in blood due to breakdown of fatty acids when insulin isn’t available, metabolic acidosis

kussmauls respirations

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5
Q

Kussmauls Respirations

A

increased RR and depth in an attempt to excrete CO2 and acid due to metabolic acidosis (r/t ketones; see also protein in urine)

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6
Q

Diabetes Risk Factors

A

insulin resistance
metabolic syndrome (Syndrome X, Insulin-resistance syndrome) obesity, sedentary lifestyle, HTN, elevated cholesterol and triglycerides, cardiovascular disease

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7
Q

Fasting Blood Glucose Test

A

levels >100 mg/dL but less than <126 indicate impaired fasting glucose (IFG)

levels >126 mg/dL obtained in at least 2 occasions

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8
Q

Glucose Tolerance Test (2hr postload result)

A

levels >140 mg/dL (7.8 mmol/L) and <200 mg/dL indicate impaired glucose tolerance

levels >200 mg/dL (11.1 mmol/L) indicate diagnosis

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9
Q

Glycosylated Hemoglobin (A1C) Test

A

levels of 5.7-6.4% indicate prediabetes

levels >6.5% indicate diabetes
levels >8% indicate poor diabetes control and need for changes in therapy

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10
Q

Labs and Diagnostics

A

blood glucose
gylcosated hemoglobin A1C (HgbA1C)
urine ketones

duloxetine for peripheral neuropathy

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11
Q

Lispro, Aspart and Glulisine

A

RAPID INSULIN; SQ WITHIN 15 MIN OF MEALTIME

15 min onset
1-2 hr peak
half life 80 min.; duration 3-5 hrs

can give with NPH, draw lispro up first, give inmed

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12
Q

Isophane (NPH)

A

INTERMEDIATE; SQ MIX CLOUDY

1-2 hr onset
4-8 hr peak
10-18 hr duration (monitor for issues 9hr after admin)

can mix with aspart, lispro, reg.; DONT MIX WITH GLARGINE

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13
Q

Regular (Humulin R, Novolin R)

A

SHORT ACTING; SQ 30-60 MIN BEFORE MEAL; IV

30-60 min onset
2.5 hr peak
6-10 hr duration

CAN MIX WITH NPH, sterile water, NS; DO NOT MIX WITH GLARGINE

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14
Q

Detemir (Levemir)

A

LONG ACTING INSULIN; SQ (1/day or 2/day, same time each day)

gradual onset
6-8 hr pear
up to 24 hr duration

DONT MIX WITH ANY OTHER INSULIN

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15
Q

Glargine (Lantus)

A

LONG ACTING INSULIN; SQ, 1/day or 2/day, same time each day

1-2 hr onset
no peak
24 hr duration

DONT MIX WITH OTHER INSULIN

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16
Q

Lipoatrophy

A

loss of subQ fat around the site of repeated insulin injections, a rare complication of insulin therapy causing erratic insulin absorption

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17
Q

Insulin Patient Education

A

refrigerate insulin not in use; may be kept at room temp for up to 28 days to reduce injection site irritation from cold insulin; DONT FREEZE

store prefilled syringes in upright position, needle pointing upward

roll prefilled syringes between hands before using

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18
Q

Oral Hypoglycemics (Biguanides/Glucophage (metformin))

A

reduces insulin resistance, decreases sugar production in liver and should be taken with meals for best absorption and effect; decreasing intestinal absorption of glucose

DONT DRINK ALCOHOL TO REDUCE RISK FOR LACTIC ACIDOSIS
MUST BE DISCONTINUED 48 HRS BEFORE AND AFTER CONTRAST TESTING DUE TO INCREASED RISK OF KIDNEY DAMAGE AND LACTIC ACIDOSIS

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19
Q

DM Nursing Care

A

diet (AVOID ALCOHOL; CAN POTENTIATE HYPOGLYCEMIA)
WATER exercise
foot care
sick days

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20
Q

DM Complications

A

cardiovascular and cerebrovascular disease (HTN)
diabetic retinopathy (impaired vision and blindness)
diabetic neuropathy and nephropathy
sexual dysfunction
hyper/hypoglycemia
dawn phenomenon
somogyi phenomenon

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21
Q

Dawn Phenomenon

A

hyperglycemia in the AM (2-3 am)

caused by nighttime release of adrenal hormones because pt doesn’t have nighttime insulin prescribed or not enough

treated by adding intermediate insulin at 10pm or raise dose

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22
Q

Somogyi Phenomenon

A

nocturnal hypoglycemia followed by a marked increase in glucose and increase in ketones

hyperglycemia in the AM caused by rebound effect of nighttime hypoglycemia

treated by lower 10 pm dose or ensure adequate snack with 10 pm dose or evaluate exercise program

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23
Q

Hypopituitarism

A

deficiency of 1+ more anterior pituitary hormones resulting in metabolic problems, sexual dysfunction

selective hypopituitarism is most common where only one hormone is deficient, opposite of panhypopituitarism

deficiency of gonadotropins (sexual characteristics); GH stimulates liver to produce somatomedins that enhance growth activity

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24
Q

Life-Threatening Deficiencies

A

adrenicorticotropic hormone (ACTH) and TSH
because both deficiencies effect hormones vital for balanced metabolism

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25
Gonadotropin (LH and FSH)
loss of sexual characteristics (facial hair, decreased libido, impotence, amenorrhea, infertility, breast atrophy, painful intercourse, decrease of axillary/pubic hair) neurologic changes (loss of visual acuity esp. peripheral vision, temporal headaches, diplopia, ocular muscle paralysis, limiting eye movement)
26
Hypopituitarism Diagnostics Testing
blood levels of pituitary hormones hormone stimulation testing CT scan of head MRI of head angiography of brain lab assessment measures effects of hormones rather than actual hormone levels (ex. T3 and T4 for thyroid function)
27
Hypopituitarism Management
lifelong replacement of deficient hormones; human growth hormone injections SQ Gonadotropin: androgen therapy for virilization (**gynecomastia, acne, baldness, prostate enlargement SE**)..contraindicated w/prostrate cancer; HRT (**DVT and HTN SE**) TSH AND ACTH are replaced with thyroid hormone and cortisol
28
Hyperpituitarism
pituitary tumors or tissue hyperplasia; GH, prolactin, ACTH pituitary adenoma (prolactin secreting benign tumors) most common (**decreases in normal lvl of sex hormones, loss of libido, infertility and spontaneous milk flow, HA, visual changes, increased ICP**)
29
Gigantism
GH; BEFORE PUBERTY continues in adulthood resulting in abnormal height
30
Acromegaly
GH; AFTER PUBERTY changes are seen in face, hands, feet and ears
31
Hyperpituitarism Patient Assessment
age sex family history of endocrine issues change in appearance (lip/nose size, clothing size changes) fatigue and lethargy backache arthralgias HA and vision changes menstrual changes changes in sexual functioning
32
Hyperpituitarism Diagnostic Testing
hormone lvls in blood and urine CT or MRI suppression testing (high glucose lvls should normally suppress release of GH; give 100g of oral glucose or 0.5 g/kg followed by serial GH measurements..GH LVLS DONT FALL BELOW 5 ng/mL
33
Hyperpituitarism Non Surgical Management
encourage pt to express concerns and fears about altered appearance or sexual function help identify personal strengths and positive characteristics drug therapy may be used alone or in combo with surgery and radiation (*take long time to complete and many years may pass before an effect is seen, not recommended for acromegaly; SE: hypopituitarism, optic nerve damage, other vision problems*) gamma knife procedure
34
Hyperpituitarism Drug Management
dopamine agonists to stimulate dopamine receptors in brain and inhibit release of certain pituitary hormones (prolactin and GH) (*Bromocriptine (Parlodel) and Cabergoline (Dostinex)*) somatostatin analogs (*Ocreotide (Sandostatin) and lanreotide*) GH receptor blockers (*Pegvisomant*)
35
Hypophysectomy
most common treatment (removal of pituitary gland along with tumor; minimally invasive trans-nasal or trans-sphenoidal vs craniotomy) **decrease abnormal hormone lvls, relieve HAs, possible reversal of sexual dysfunction**
36
Hyperpituitarism Pre-Op Care
explain the procedure, that body changes, organ enlargement and visual changes are usually not reversible explain post-op wound management: nasal packing for 2-3 days after surgery, and mustache dressing placed under nose (breath through mouth) instruct not to brush teeth, blow nose, cough sneeze or bend forward after surgery (increased ICP and delays healing) decreases sense of smell may persist 3-4 mths after
37
Hyperpituitarism Post Op Care
monitor neurological symptoms hourly for 24 hrs then every 4 hrs and document any changes in vision, mental status, LOC, decreased strength in extremities observe for complications such as DI, CSF leakage, infection and increased ICP keep HOB elevated avoid coughing, perform deep breathing exercises hourly avoid bending forward perform oral rinses and apply moisturizer over lips assess for manifestations of meningitis teach pt self administration of prescribed hormones
38
CSF Leak (Hyperpituitarism Post Op Complication)
assess nasal drainage for presence of glucose halo signs report persistent, severe HAs most CSF leaks may heal themselves, repair surgery may be needed provider must be notified
39
Diabetes Insipidus
water metabolism problem caused by ADH deficiency or inability of kidneys to respond to ADH; excretion of large amount of dilute urine
40
Nephrogenic DI
renal tubules don’t respond to ADH (severe kidney injury)
41
Primary Neurogenic DI
problem in hypothalamus or pituitary gland; lack of ADH production/release
42
Secondary Neurogenic DI
tumors, head trauma, infections, surgeries
43
Drug-Related DI
lithium and demeclocycline interfere with kidney response to ADH
44
DI Assessment
large amount of very dilute urine (*causes dehydration and hypovolemia*) increased thirst but often not enough to compensate for volume less, can lead to hypovolemic shock causes may include brain tumors and head trauma 24 hr fluid I/O: consider if urine output is more than 4L dilute with low specific gravity and low osmolarity or osmolality
45
DI Cardiac Symptoms
hypotension tachycardia weak pulses hemoconcentration
46
DI Skin Symptoms
poor skin turgor dry mucous membranes
47
DI Neurologic Symptoms
decreased cognition ataxia increased thirst irritability
48
DI Drug Therapy
desmopressin (DDAVP; FIRST LINE AGENT), a synthetic form of vasopressin given intranasally in a metered spray or oral tab aqueous vasopressin (IV, IM, SQ) for short term therapy or when dosage must be changed often (*may be required in acute care for dosage titration*) chlorpropamide (oral) hydration with hypotonic IV fluids in acute care (lifelong vasopressin therapy with permanent condition, teach pt to weight themselves daily)
49
DI Nursing Interventions
replace fluids by encouraging pt to drink fluids equal to urinary output monitor I/O, daily weights, report weight changes in a timely manner (1kg=1L of fluid) monitor for s/s of dehydration monitor serum and urine lab results
50
Fluid Deprivation Test
best test to diagnose central DI; urine production, blood electrolyte lvls and weight are measured regularly for a period of 24 hrs during which the person isn’t allowed to drink
51
DI Patient Education
teaching pt that polyuria and thirst are signals for need for another dose use daily weights to estimate dehydration/overhydration SE of nasal sprays, including **ulceration of mucous membranes, allergy sensation of chest tightness, inhalation of spray into lungs which precipitates pulmonary issues** how to self inject drug always wear a self-ID bracelet
52
SIADH
failure of negative feedback system; ADH (Vasopressin) secretes even when plasma osmolarity is low/normal caused by shock, trauma, stress, malignancies water retention>fluid overload
53
SIADH Assessment
dilutional hyponatremia neurological symptoms r/t hyponatremia GI disturbances, n/v, loss of appetite weight gain bounding pulse, hypothermia decreased urine volume and increased urine osmolarity
54
SIADH Interventions
fluid restriction 500-1000 mL/24 hrs to monitor fluid overload drug therapy with vasopressin receptor antagonists (vaptans), diuretics treat/manage underlying cause hypertonic saline (3% NaCl) tube feedings and GI tube med admin (use saline instead of water)
55
SIADH Nursing Considerations
frequent neurologic checks patient safety needs (fall risks, seizure precautions) measure I and O treat hyponatremia assess for signs of volume overload (esp. cardiac and respiratory complications)
56
Adrenal Gland Hypofunction
adrenal cortex production of steroid hormone may decrease due to *inadequate secretion of ACTH, dysfunction of hypothalamic-pituitary control mechanism or direct problems of adrenal gland tissue* **acute adrenocorticol insufficiency (adrenal crisis) is life threatening** loss of aldosterone and cortisol action (*hypoglycemia, potassium excretion decreased BUT Na and H2O excretion increased*)
57
Primary Adrenal Gland Hypofunction
Addisons Disease (autoimmune, dx, metabolic dx, AIDS, adrenalectomy)
58
Secondary Adrenal Gland Hypofunction
pituitary tumors hypophysectomy sudden cessation of long term high dose glucocorticoid therapy
59
Adrenal Gland Hypofunction Assessment
ask about factors that may cause (radiation activity, drug use?) changes in activity level (lethargy, fatigue, muscle weakness) GI problems (anorexia, n/v, diarrhea, abdominal pain) assess for hypoglycemia (decreased cortisol) and fluid depletion (*sweating, HA, tachycardia, changes in neuro status, dehydration*) hyperkalemia (*risk for dysrhythmias*) hyponatremia (*decreased cognition*)
60
Adrenal Gland Hypofunction Interventions
promote fluid balance monitor for fluid deficit (*weight pt daily, strict I/Os, monitor lab values for hemp concentration and electrolyte disturbances*) prevent hypoglycemia (*steroids, -sone for fluid and electrolyte balance; glucose monitoring*) assess cardiac function (*monitoring and vitals every 1-4 hrs*)
61
Addisonian Crisis
life threatening event, need for cortisol and aldosterone is greater than available supply usually occurs in response to stressful event like surgery, trauma, severe infections loss of aldosterone leads to severe hypotension r/t blood volume depletion
62
Hypercorticolism (Cushing’s Syndrome/Disease)
syndrome (surplus of cortisol) disease (ACTH tumor) can be caused by drug therapy (steroids) most common non drug cause is ACTH-producing pituitary adenoma
63
Cushing’s Syndrome History Assessment
other health problems and glucocorticoid therapy weight gain, increased appetite sleep disturbances common emotional instability
64
Cushing’s Syndrome S/S
changes in fat distribution (trunkal obesity, moon face, buffalo hump) skin, cardiac, MSK, immune changes glucose metabolism (fasting glucose high) increased androgen production (acne, body hair, oligomenorrhea)
65
Hypercorticolism Lab Assessment
blood, salivary, urine cortisol lvls dexamethasone testing (*either 24 hr or 3 day period of time; set doses are given with a 24-hr urine collection after administering, urine corticosteroid excretion and cortisol lvls are suppressed in healthy pts with med*) CT MRI arteriography
66
Priority Problems for Hypercorticolism
fluid overload due to hormone induced water and sodium retention potential for injury due to skin thinning, poor wound healing, bone density loss potential for infection due to hormone-induced reduced immunity potential for acute adrenal insufficiency
67
Hypercorticolism Nursing Considerations
HTN due to increased aldosterone increased hepatic gluconeogenesis and insulin resistance can lead to cardiovascular disease and frequent/poor wound healing
68
Pheochromocytoma
nonmalignant catecholamine-producing tumors of adrenal medulla tumors produce, store and release epinephrine and norepinephrine (*overproduction, hypertensive crisis!!*)
69
Pheochromocytoma S/S
high BP HA sweating flushing anxiety/panic palpitations abdominal pain dizziness blurry vision diabetes symptoms tachycardia heart failure
70
Pheochromocytoma Nursing Management
assess for and manage symptoms of HTN or HTN crisis prevent additional injury and complications perioperative care includes pt education, informed consent, post op management **alpha-adrenergic blockers (doxazosin, tolazoline) or removal of tumor**
71
Hypoparathyroidism
decreased function of parathyroid gland; serum Ca lvls cannot be maintained occurs post surgically after thyroid/parathyroid removal or after surgery for head and neck cancer
72
Hyperparathyroidism
increase in parathyroid hormone; hypercalcemia and hypophosphatemia kidney stones, Ca deposits, bone lesions
73
Parathyroidism Diagnostics
Ca lvl parathyroid US scintigraphy (radioisotope use with imaging) CT/MRI
74
Hypoparathyroidism Treatment
correct hypocalcemia prevent kidney stones calcium gluconate IV, oral calcitrol, oral Ca carbonate oral vitamin D supplements
75
Hyperparathyroidism Treatment
drug therapy via cinacalcet, bisphosphonates parathyroidectomy
76
DM Foot Care
NO SOAKING FEET or heat pads moisturize (not between toes) wear socks don’t cross legs cut nails straight across
77
DM Sick Days
monitor BG Q4H drink 8-12 oz of water call doctor if n/v, large ketones, fever for more than 24 hrs or high BG after 2 doses of insulin

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