Endocrine (DKA) Flashcards
What are the three endocrine emergencies?
- DKA
- Thyroid storm
- Adrenal Crisis
Provide an overview of endocrine?
endocrine = hormones
- system is a collection of glands e.g. pancreas, thyroid, adrenal
- responsible for sending chemical signals which are hormones e.g. adrenaline
- hormones fall under 2 categories
1. proteins (AA)
2. Steroids
- aids with metabolism, growth, sleep, reproduction, mood
- affects every other organ and is supported by organs e.g. kidney secreting renin
- Most common endocrine disturbance is diabetes
why is endocrine important in nursing>
- when hormone levels are high or low impacts all body systems including body functions e.g. HR and BP
What is homeostasis & explain difference between positive and negative feedback loops
Homeostasis = the bodys ability to maintain an internal stability/ balancce
Positive = change that moves response in the same direction (amplifies the response) e.g. Breastfeeding
Negative = change that negates the response (moves in another direction) e.g. thermoregulation`
Outline the differences between type 1 diabetes and type 2?
Type 1:
= Autoimmune
- genetic link
- characterised by destruction of insulin producing beta cells in pancreas
- rapid onset
- not linked to modifiable lifestyle factors
- CANNOT be prevented
Type 2:
= progressive condition
- insulin resistance –> unable to transfer glucose to energy & therefore glucose stays in the blood
- risk factors: diet, lifestyle, family related
- CAN be prevented
What is DKA?
= Diabetic ketoacidosis
= life threatening metabolic state characterised by high BGLs, ketosis and acidosis
- if untreated results in severe dehyrdation, cerebral oedema, coma & death
- Who gets it: mostly T1
What are the Signs and symptoms of DKA?
- severe dehyrdration
- polydipsia & polyuria.
- weight loss
- hyperventilation (Kussmaul respiration)
- acetone smell breath
- flushed cheaks
- N & V
- Abdominal pain
- disorientation / coma
- shock
What is the pathophysiology of DKA?
- Insulin deficiency —> Hyperglycaemia for long period of time activates cascade of events
— Cellular starvation causing release of counter regulatory hormones e.g. epinephrine
— these hormones produce more glucose in an attempt to supply energy to cells
— hyperglycaemia due to body’s inability to use glucose
— BGLs exceed kidneys ability to reabsorb = polyuria
— high glucose spills into urine in process of osmotic diuretics = polyuria, polydispsia, hyperkalaemia
— Counter- regulatory hormones activate lipolysis to drastically increase energetic source = weight loss
— Ketone production (mainly acetone) —> large amt of ketone results in metabolic acidosis = ketone breath
Clinical management of DKA?
- ABCDEF
- Minimum 2 x large Bore IVC
- treat the cause
- investigations: bloods, CSR, UA, MSU, weight, ECG, BGL
What are the specific nursing responsibilities in a DKA endocrine emergency?
- assess, reassess and management with A-G
- symptomatic treatment
- IDC, strict FBC, fluid replacement
- insulin infusion
- check ketones (blood & Urine), check K+
What is a thyroid storm
= overproduction of thyroid hormones (hyperthroidism)
what are the signs and symptoms of thyroid storm?
- weight loss
- tachycardia, AF, HTN
- poor sleep
- goiter/ thyroid enlargement
- thermoregulatory dysfunction: fever
- neuro: altered LOC, Seizure, coma
- Tachypnoea
Management of thyroid storm?
- stopping thyroid hormone release through PTU given IV
- FLuids and electrolyte
What is an adrenal crisis?
= insufficient release of hormone cortisol -> increase BGL, suppress immune system (lack of cortisol)
Signs and symptoms of adrenal crisis
- hyponatreamia
- hyperkalaemia
- hypoglycaemia
- hypotension
- hypothyroid
- N & V, LOC, Confusion
- fever
