Endocrine/Diabetes Concepts

Question 1

76. SIADH treatment:

Answer 1

syndrome of inappropriate ADH (excess)
- Symptoms: dilutional hyponatremia, confusion, seizures
- Treatment: tolvaptan to increase the serum sodium, seizure precautions, sodium precautions,
no fluid restrictions, patient must be able to drink and report thirst

Question 2

77. Diabetes Insipidus treatment:

Answer 2

deficiency of ADH
- Symptoms: excessive fluid loss from polyuria (dilute urine & concentrated blood), extreme
thirst, hypernatremia, (Turn off toilet water because patients will be SO thirsty they will drink
out of the toilet)
- Treatment: vasopressin (injectable), desmopressin (intranasal)

Watch for signs of hypertension, such as headache with either medication rebound stuffiness with the nasal preparation

Question 3

78. Hypothyroidism signs & symptoms/treatment:

Answer 3

deficiency, think “low metabolism”

• Symptoms: lethargy, weight gain, bradycardia, cool dry skin, intolerance to cold, constipation,
  atherosclerosis, heart problems
• Thyroid replacement: levothyroxine (Synthroid), levothyroxine, liothyroine etc.
  DO NOT SWITCH BETWEEN GENERIC AND NAME BRAND
• TSH level (-) negative feedback loop for dosing

Signs of toxicity: will mimic signs and symptoms of hyperthyroidism

Question 4

79. Hyperthyroidism signs & symptoms/treatment:

Answer 4

excess, think “high metabolism”

• Symptoms: tremors, nervousness, weight loss, tachycardia, warm skin, intolerance to heat, GI
  distress, exophthalmos
• Treatment: anti thyroid drugs, mostly short term due to toxicity of drugs (used to stabilize
  patient for thyroidectomy Examples: propylthiouracil, radioactive iodine solution, etc.
• ADR: hypothyroidism symptoms

Beta Blockers: symptom management of hypertension and tachycardia

Question 5

80. Cushing Syndrome signs & symptoms/treatment:

Answer 5

Excess adrenal gland to much “sugar & salt”
- Symptoms: fluid retention due to hypernatremia, hypertension, hyperglycemia,
hypokalemia, thin extremities with muscle wasting, buffalo hump, moon face, gastric
hyperacidity
- Treatment: adjust steroid therapy if that’s the cause - DON’T STOP ABRUPTLY
- Adrenalectomy if primary tumor

Question 6

81. Addison’s Disease signs & symptoms/treatment:

Answer 6

Deficit adrenal gland not enough “sugar & salt”
- Symptoms: hypoglycemia, dehydration, hyponatremia, hyperkalemia, inability to respond
to stress
- Treatment: hormone replacement with cortisol like drugs and mineraloids
- Steroids: aldosterone (for sodium) & Glucocorticosteroids (drugs that mimic cortisol)
prednisolone, dexamethasone, methylprednisolone, etc.
*If treatment goes to far will have elevated glucose and sodium levels, Cushing’s symptoms

Question 7

82. What are signs and symptoms of hypoglycemia? Treatment options?

Answer 7

Dizziness, unceasing hunger, irritability, clammy skin, mood swings, difficulty thinking
- If patient is able to swallow: glucose tablet = 15 grams of glucose.
- Glucose gel, Glucagon (IM, IV, SQ), D50W (IV push)

Some common nursing interventions in place of the tablets: 4oz orange juice, 4oz regular
soda, 2Tbsp raisins, 3-4 glucose tablets, 8-10 lifesaver candies, 5-6 jellybeans

Question 8

83. What medications treat T2DM? List examples and mechanism of action.

Answer 8

Biguanide: metformin (Glucophage) first line drug and is most commonly ordered oral agent for DM2 works by decreasing glucose production by liver, also increases GI absorption and receptor sensitivity

Sulfonylureas: glyburide, glipizide, glimepiride (“ide’s” family)
- Works on beta cells of pancreas to increase secretion of insulin, can be used in combo with
metformin. Can cause hypoglycemia, especially when given with other sulfa drugs. Watch for
sulfa allergies.

Question 9

Rapid acting insulin (lispro, aspart, glulisine)

Onset of action
Peak action
Duration

Answer 9

Onset of action: within 15 mins.
Peak action: 1-2 hour
Duration: 3-4 hour

Question 9

Short acting/regular insulin
IV & SC

Onset of action
Peak action
Duration

Answer 9

Onset of action: IV 10-30 min | SC 30-60 min
Peak action: IV 15-30 min | SC 2-4 hour
Duration: IV 30-60 min | SC 5-7 hour

Question 9

Intermediate/NPH insulin
70/30 & NPH

Onset of action
Peak action
Duration

Answer 9

Onset of action: 70/30 30 min | NPH 2-4 hour
Peak action: 70/30 2-12 hour | NPH 4-10 hour
Duration: 70/30 24 hour | NPH 10-16 hour

Question 10

Long acting *Insulin glargine (Lantus)

Onset of action
Peak action
Duration

Answer 10

Onset of action: 3-4 hour
Peak action: none
Duration: 24 hour