Endocrine Exam 3 Flashcards
(113 cards)
1
Q
diabetic ketoacidosis (DKA)
A
- uncontrolled hyperglycemia
- increased ketone production
- metabolic acidosis
2
Q
DKA patho
A
NO INSULIN, so no glucose is being absorbed
-often initial presentation of type 1 DM
-missed doses of insulin
3
Q
DKA causes
A
- infection!!! - pneumonia, UTI, abscess, sepsis
- trauma / surgery
- stress
- pregnancy
- growth spurts in children
4
Q
DKA s/s
A
- flushed , dry skin
- dry mucous membranes
- decreased skin turgor
- tachycardia
- hypotension
- abd pain
- altered LOC
- kussmal RR
- acetone breath!!! - fruity breath
- n/v
- increased thirst - polydipsia!!!
- increased UO - polyuria
5
Q
DKA labs
A
- CBC = WBC mildly elevated
- CMP =
-blood glucose = high
-serum bicarb = decreased
-potassium = elevated –CAREFUL (decreased)
-creatinine = elevated
-ANION GAP = elevated - ABGs = Metabolic acidosis
- UA = ketones and glucose
6
Q
in DKA anion gap will be….
A
elevated r/t metabolic acidosis
7
Q
DKA criteria
A
- blood glucose level > 250
- ketonuria
- pH < or = 7.3
- serum bicarb < 18
- positive anion gap
8
Q
DKA actual complications
A
-hyperglycemia
-metabolic acidosis
-electrolyte imbalance
-dehydration
9
Q
DKA potential complications
A
-respiratory compromise
-electrolyte imbalance
-fluid overload
-kidney injury
**cerebral edema
10
Q
what is the most dangerous potential complication of DKA
A
cerebral edema!!
11
Q
DKA respiratory support
A
may need ventilator support
prevent aspiration – NG tube for those vomiting and impaired mental status
12
Q
DKA fluid replacement
A
initial fluid = NS
-1L bolus –> infusion of 10-15 mL during first hr
-shock s/s 20 mL
**sodium elevated or normal use hypotonic saline (0.45%) at slower rate!!!!
13
Q
when is 5% dextrose added to fluids…
A
when serum glucose approaches 200 mg/dL
14
Q
goal of fluid replacement
A
normovolemia , prevent fluid overload
15
Q
fluid overload s/s
A
- tachypnea
- neck vein distention
- crackles
- increased pulmonary artery occlusion
- decreasing LOC –> CEREBRAL EDEMA
16
Q
DKA insulin therapy
A
check POTASSIUM FIRST , should be > 3.3 prior to insulin given
-initial bolus is 0.1 unit regular insulin
17
Q
transition of sub-q insulin….
A
when blood glucose is <200 …
1. venous pH > 7.3
2. serum bicarb is > 15
3. anion gap < or = 12
18
Q
DKA electrolyte management
A
potassium!! - drops quickly after insulin therapy
-usually added to maintenance fluids after insulin is started
19
Q
potassium management
A
maintain b/t 4-5 mEq / L
**UO must be 30 mL before administering IV potassium!!!
20
Q
DKA nursing interventions
A
hemodynamic monitor
HOURLY i/o
HOURLY glucose check
neuro exams
fluid overload monitor
21
Q
DKA education
A
maintain glucose level : diet, exercise, meds
monitor hemoglobin A1c
maintain regular schedule
insulin pump instructions
AVOID exercise / excessive activity when glucose > 240
22
Q
hyperglycemic hyperosmolar state (HHS)
A
- hyperglycemia
- hyperosmolality
- dehydration
ALL WITHOUT KETOACIDOSIS
23
Q
HHS patho
A
occurs when there is enough insulin to prevent rapid dat breakdown and ketone release but not enough to prevent hyperglycemia
24
Q
HHS risks
A
-type 2 DM
-older adults
-major illness and infection = stress response !!
-high cal tube feeds
-meds
25
HHS s/s
1. flushed dry skin
2. dry mucous membranes
3. decreased skin turgor
4. shallow RR
5. altered LOC -worse than in DKA
6. hypotension
7. tachycardia
26
HHS labs
1. CBC
2. CMP
-glucose increased
-sodium increased
3. increased serum osmolality
4. ABGs:
-pH > 7.3
-bicarb > 15
5. UA - no ketones
27
HHS dx criteria
1. blood glucose > or = 600 mg
2. serum osmolality of 320 mOsm or >
3. serum pH Greater than 7.3 = not acidic
4. profound dehydration
5. serum bicarb > 15
6. absent ketonuria
7. altered LOC
28
HHS management
same protocol as DKA
-initial fluid NS
-insulin therapy : check K+ first
29
Primary adrenal crisis
destruction of adrenal gland
-autoimmune
-cancer
-infection
-hemorrhage
-adrenalectomy
-genetics
30
secondary adrenal crisis
mechanisms decrease ACTH secretion
-abrupt withdrawal of corticosteroids!!!
-pituitary patho
-systemic inflammation - sepsis, sickle cell
-trauma
31
adrenal crisis risk
1. medication :
-steroids
-phenytoin
-barbituates
-rifampin
2. illness
-infection
-cancer
-autoimmune disorder
-disease tx w/ steroids
3. family hx :
-addison's disease
32
adrenal crisis patho
life threatening absence of cortisol and aldosterone
33
deficiency of cortisol
-decrease glucose production
-decrease metabolism of fat and protein
-decrease appetite
-decrease intestinal motility
-decrease vascular tone
-decrease effect of catecholamines
34
deficiency of aldosterone
-decrease retention of sodium and water
-decrease circulating volume
-increase potassium and hydrogen ion reabsorption
35
adrenal crisis s/s
1. hypotension
2. weak rapid pulse
3. cold, pale skin
4. dysrhythmias
5. HA
6. fatigue
7. weakness
8. confusion , lethargy
9. abdominal pain
10. anorexia
11. decreased UO
36
adrenal crisis labs
1. CBC - increase eosinophils
2. CMP -
-decrease glucose
-increase potassium
-decrease sodium
-increase BUN
3. ABGs : metabolic acidosis
4. Cortisol = DECREASED in crisis
5. cosyntropin stimulation test
37
cosyntropin stimulation test
1. obtain baseline cortisol level 30 min before test
2. administer cosyntropin over 2 min
3. check cortisol levels 60 min after administration
38
adrenal crisis actual complications
1. hypovolemia
2. decreased tissue perfusion
3. electrolyte imbalance
39
adrenal crisis potential complications
1. shock
2. dysrhythmias
40
adrenal crisis fluids
D5NS : tx hypoglycemia , may get up to 5L
41
adrenal crisis glucocorticoid....
most important initially!!!!
-if no previous dx give dexamethasone
-if hx give Solu-Cortef
42
SE of adrenal crisis meds
-hyperglycemia
-cushing's syndrome
-electrolyte disorder
-euphoria
-fluid retention
-masking infection
-HTN
-peptic ulcers!!!!
-n/v
43
adrenal crisis meds considerations
1. GI bleed prophylaxis med!!!
2. drug interactions
3. no abrupt discontinuation
4. monitor glucose / electrolytes
5. monitor for fluid overload
6. monitor for infection
7. maintain nutrition
8. mouth care
44
adrenal crisis nursing action
1. VS and i/o
2. s/s of GI bleed
3. HOB 45 degrees
4. education on pt s/s and prevention
45
corticosteroids can....
have big effects on GI tract, check for bleeding and tx prophylactically
46
myxedema coma
end stage of improperly tx, neglected, underdiagnosed HYPOthyroidism
47
myxedema coma patho
pt experiences increased hormone use but had DECREASED hormone production... does not have enough
48
myxedema coma risks
1. infection
2. trauma
3. meds
4. older women
5. winter time
6. hypothermia
49
myxedema coma s/s
1. decrease HR and BP
2. pericardial effusion - distant heart sounds
3. hypoventilation
4. CO2 retention
5. pleural effusion
6. delirium
7. seizures
8.coma
9. hypothermia
10. sluggish movements
11. edema
50
myxedema coma labs
1. CBC - decrease RBC and platelets
2. CMP -
-decrease sodium
-decrease glucose
-decrease potassium
3. thyroid hormone
-TSH increase if primary hypothyroidism
-TSH levels will be normal or low if secondary
-T3 and T4 decreased
51
myxedema coma imaging
1. CXR - pleural effusion
2. EKG - U waves w/ decreased potassium
52
myxedema coma thyroid meds
levothyroxine = PUSH OVER 5 min
liothyronine - avoid in older adults
53
myxedema coma and sedatives
need more observation b/c the absorption of medication is slower and resp compromise could occur
**narcotics and hypnotics
54
myxedema coma education
take meds!!!
-may be titrated depending on levels
55
myxedema coma potential complications
1. respiratory arrest
2. cardiac arrest
56
when intubating what is the order for medication....
sedative THEN paralytic
**keep in mind for myxedema coma oversedation is possible d/t slow metabolism
57
thyroid storm
occurs in untreated hyperthyroidism
-precipitated by stress r/t
-underlying illness
-general anesthesia
-surgery
-infection
-stroke
-DKA
-trauma
58
thyroid storm s/s
abrupt onset :
-severe fever : up to 106
-warm, moist skin
-tachycardia
-tremors
-HF
-systolic murmur!!!
-respiratory failure
-abd pain
-diarrhea
-weight loss
-shallow respirations
59
thyroid storm labs
1. CBC : WBC increase , RBC decrease
2. CMP :
-increase sodium
-increase glucose
-increase BUN
-increase calcium
Thyroid hormone :
-decrease TSH
-increase T3 and T4
3. ABG : normal
60
thyroid storm meds
1. Beta blocker - propranolol
2. Tapazole - lack immediate effect!
3. SSKI - given 1-2 hours after antithyroid (tapazole) medications
61
thyroid storm supportive care
1. fever control : acetaminophen
2. O2 administration
3. vitals and i/o
4. eye lubricant for exophthalmos
5. high calorie , high protein diet
62
thyroid storm supportive care
1. fever control : acetaminophen
2. O2 administration
3. vitals and i/o
4. eye lubricant for exophthalmos
5. high calorie , high protein dietthy
63
thyroid storm education
1. consume adequate calories
2. long term treatment : medications or surgery
64
definitive treatment thyroid storm
thyroidectomy :
-given potassium iodine before surgery
post op:
-VOICE CHANGE = laryngeal nerve damage
-bleeding
-hypocalcemia
65
what is needed at bedside after thyroidectomy....
airway / O2 supplies
suction
trach tray
66
diabetes insipidus
primary cause is traumatic injury to posterior pituitary or hypothalamus
67
neurogenic DI
ADH deficiency
-idiopathic
-intracranial surgery!!
-tumor
-infection : meningitis / encephalitis
-TB
-severe head trauma
68
nephrogenic DI
ADH insensitivity
-hereditary
-renal disease
-multisystem disorder affecting kidney
-medications
69
secondary DI
-idiopathic
-psychogenic polydipsia
-sarcoidosis
-excessive IV fluids
-medications
70
diabetes insipidus patho
impaired renal conservation of water = polyuria , > 3L / 24 hours
71
neurogenic DI s/s
occurs suddenly with abrupt onset of polyuria
72
nephrogenic DI s/s
will have gradual onset
73
DI s/s
-pale dilute urine
-polydipsia
-hypovolemia
-hypernatremia
74
hypovolemia s/s
1. hypotension
2. decreased skin turgor
3. tachycardia
4. dry mucous membranes
5. weight loss
6. low R atrial and pulmonary occlusion pressure
75
hypernatremia s/s
1. altered mental status
2. weakness
3. focal neurological deficit
4. ataxia
76
DI labs
-low urine osmolality!!!
-decreased urine specific gravity!!
-high serum osmolality
CBC : increase H and H
CMP :
-increase sodium
-increase calcium
-decrease potassium
-increase BUN
77
DI dx criteria
1. urine specific gravity : < 1.005
2. urine osmolality : < 200 mOsm
3. water deprivation test
-serum osmolality increases w/ no increase in urine osmolality
78
water deprivation test
all water is withheld and urine osmolality and pts weight's are measured hourly
**not appropriate for pts that are critical
79
DI complications
dehydration
hypovolemia
hypernatremia
80
DI potential complications
circulatory collapse
neuro complications : r/t hypernatremia
81
DI volume replacement
1. hypovolemia = D5W corrects hypernatremia and replaces lost water
2. PO when able
82
DI neurogenic hormone replacement
DESMOPRESSIN- ADH replacement
**inject over 1 min
83
desmopressin SE
HA
nausea
mild abd cramps
84
desmopressin monitor
dyspnea
HTN
weight gain
hyponatremia
HA
drowsiness
85
DI nursing interventions
-I/O monitor
-IV access
-meds
-oral fluids
86
DI education
-medications
-when to call dr
-daily weights
-drinking according to thirst and not over drinking
87
DI 7 D's
1. diuresis (high UO)
2. diluted urine (pale, low specific gravity)
3. dry inside (hyperosmolality, hypernatremia)
4. drinking a lot
5. dehydrated mucous membranes
6. decrease BP
7. desmopressin
88
SIADH
excess secretion of ADH
89
SIADH causes
-head injury
-hemorrhage
-stroke
-surgery
-tumor
-small cell cancer of ling
-pancreatic cancer
-pneumonia
-NSAIDs
-ACE inhibitors
90
SIADH s/s
-edema
-crackles!!!
-pink frothy sputum
-increase respirations
-confusion
-seizure
-HA
-n/v
-increased BP
91
SIADH labs
-CBC : h and h low
-CMP : decrease sodium
-Serum osmolality : decrease
-Urine osmolality : increase
-UA : urine specific gravity increase
92
SIADH dx
based on decrease UO
increase urine specific gravity
decrease sodium
decrease serum osmolality
93
SIADH complication
fluid volume overload
-edema and crackles
94
SIADH potential complication
s/s of hyponatremia
cerebral edema
95
SIADH tx goal
-tx underlying cause
-eliminate water excess
-increase serum osmolality
96
SIADH fluids
on fluid restriction
-less than 1,000mL / day
97
SIADH meds
1. 3% saline via central line
-use a PUMP!!!
-do NOT go over 50 mL/hr
-monitor sodium every 4 hrs
-wean solution
-mental status change
-lung sounds
-i/o hourly
2. diuretics
3. demeclocycline
98
when should 3% saline be held...
when sodium is > 155 mEq
99
SIADH nuring action
1. vitals
2. i/o
3. seizure precuation
4. fluid restriction
5. s/s of fluid overload
100
SIADH education
AVOID NSAIDs
fluid restriction
cerebral edema s/s
daily weight
101
SIADH 7 S's
1. stop urination (low UO)
2. sticky / thick urine (high specific gravity)
3. soaked inside (hypoosmolality, hyponatreamia)
4. sodium low
5. seizures
6. severe high BP
7. stop all fluids , give salt (3% IV) , diuretics
102
phenochromocytoma
excessive catecholamines may lead to life threatening HTN or cardiac dysrhythmias
103
phenochromocytoma s/s
1. severe HA
2. severe HTN : >250 / 140
3. tachycardia
4. palpitations
5. excessive sweating
6. hypermetabolism
7. hyperglycemia
104
what do you NOT do when assessing a pt with phenochromocytoma...
do NOT palpate the abdomen!!!
105
phenochromocytoma labs
-increase blood glucose
-increase metanephrines
-increase normetanephrines
106
plasma free metanephrines / normetanephrines test...
pts must lay down 30 min prior to blood collection!!!
107
urine matanephrines / normetanephrines test...
pts should avoid
-bananas
-chocolate
-vanilla
-tea
-coffee
108
phenochromocytoma dx
based on presentation, urine and plasma levels, imaging
109
phenochromocytoma imaging
abd CT
head CT
110
phenochromocytoma medication
1. BP mamagement
-nipride : IV admin
-alpha adrenergic blocker : Cardura
2. HR control
-beta blockers
111
phenochromocytoma surgery
Adrenalectomy is definitive tx
1. preop: alpha adrenergic blocker 7-10 days before surgery , GLUCOCORTICOID morning of surgery
2. postop- monitor BP, HR , glucose
**bilateral adrenalectomy = cortisol daily!!!
112
phenochromocytoma nursing action
1. elevate HOB
2. quiet non stimulating environment
3. cardiac monitor
113
phenochromocytoma education
s/s of adrenal insufficiency
post op care
