Endocrine

Question 1

patho of SIADH

Answer 1

There is a hypersecretion of ADH from posterior pituitary gland. This goes to kidneys and promotes excessive water reabsorbtion.
This leads to dilutional hyponatremia.
Think H2O intoxication

Question 2

causes of SIADH

Answer 2

oat cell carcinoma AKA bronchogenic tumor
viral pneumonia
neurologic disorder
analgesics, anesthetics, & stress

Question 3

serum osmolality normal level

Answer 3

275-295

Question 4

how to quickly calculate serum osmolality

Answer 4

2x sodium level

Question 5

fluid status in low serum osmolality?

Answer 5

fluid volume overolad

Question 6

fluid status in high serum osmolality

Answer 6

concentrated/dehydration

Question 7

urine specific gravity normal levels

Answer 7

1.005-1.030

Question 8

assessment of SIADH patient

Answer 8

decreased LOC/lethargy
confusion/personality changes
Headache
NVD
anorexia
hyponatremia (cerebral edema)
seizures/coma

Question 9

medical management of SIADH

Answer 9

treat underlying cause - surgery/radiation/chemo
fluid restriction
Na replacement w/ 3%NS
Lasix if overloaded after 3%

Question 10

medications for SIADH

Answer 10

ADH inhibitor (vaprisol)
demeclocycline (abx) - abx that interferes with ADH effects in tubules
phenytoin/fludrocortisone - blocks effects of ADH in tubules

Question 11

nursing management for SIADH

Answer 11

fluid volume status
neuro
seizure precautions
oral care

Question 12

patho/causes of DI

Answer 12

improper posterior pitutitary development
neuro trauma
pituitary tumor
kidney disease - nephrogenic DI from failure to respond to ADH
dilantin - blocks effect of ADH on tubules

Question 13

what is the one thing you think of when you hear DI?

Answer 13

water wasting

Question 14

assessment of patient with DI

Answer 14

polyuria
polydipsia
dehydration
hypotension
tachycardia
decreased LOC
seizures

Question 15

what labs would you see with DI?

Answer 15

low urine osmolality/specific gravity/sodium

high serum osmolality/specific gravity/sodium

Question 16

what labs would you see with SIADH

Answer 16

high urine osmolality/specific gravity/sodium

low serum osmolality/specific gravity/sodium

Question 17

medical management of DI

Answer 17

fluid replacement w/ hypotonic crystalloids

exogenous ADH - DDAVP/pitressin/vasopressin

Question 18

nursing management of DI

Answer 18

fluid/electrolyte monitoring
seizure precautions
neuro

Question 19

what form of DM is DKA most prominent in?

Answer 19

DM1

Question 20

normal hyperglycemia range for DKA?

Answer 20

300-600

Question 21

risk factors for DKA?

Answer 21

decrease insulin intake, increase dietary intake, growth spurts, surgery, infection, trauma, emotional stress

Question 22

3 components of DKA?

Answer 22

hyperglycemia
ketosis
acidemia

Question 23

patho for DKA

Answer 23

not enough insulin leads to increased glucagon release because cells are not receiving glucose d/t lack on insulin.
Leads to hyperglycemia and increased serum osmolality which causes cellular dehydration and fluid excretion
Ketoacidosis occurs when fatty acid metabolizes in cells

Question 24

assessment for DKA

Answer 24

polyuria
polyphagia
glucosuria
polydipsia
NV
weight loss/dehydration
fruity breath
decreased LOC
dry skin/mucous membranes
tachycard/hypotensio
kussmaul respirs

Question 25

DKA is common in which type of DM1 patients?

Answer 25

newly diagnosed patients

Question 26

What is important with DKA patients when it comes to curing them?

Answer 26

Treat DKA, but also treat the underlying cause of DKA (infection)

Question 27

DKA/HHNK protocol?

Answer 27

NS 0.5-1L/hr x 2 hr bolus then 1/2NS @ 250-500mL/hr until BS <250 When BS reaches <250 then D5,1/2NS until DKA resolves ``` stat EKG to r/o hyperK if K >5.5, treat if symptomatic 4-5.5 give 20meq to each L of fluid 3-4 give 40meq to each L of fluid <3 give PO/IV 10meq K q1h or PRN ``` insulin 0.1units/kg initial bolus IV then continuous 0.1units/kg/hr with BSBG q1h until resolution

Question 28

Nursing management of DKA/HHNK

Answer 28

``` fluid management BSBG q1h neuro q4h UOP q1h Lab analysis cardiac monitor pt education ```

Question 29

HHNK Hallmark sign

Answer 29

grossly elevated BG w/o ketosis

Question 30

patho of HHNK

Answer 30

same as DKA, but insulin is produced but not effective in pushing glucose fast enough into cells

Question 31

Which DM is HHNK most associated with?

Answer 31

DM2

Question 32

How high can BG get in HHNK?

Answer 32

2000