Endocrine | Exam 3 Flashcards by Lindsay Schneider

Diabetic Ketoacidosis
Pathology

Very LOW INSULIN
TYPE I DIABETES

Body burns fat as fuel, creates ketones
Ketones = metabolic acidosis, excreted in urine

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
Symptoms

Dehydration
Lethargy, weakness
Abd pain, N/V
Kussmal resps
Acetone breath
BG > 250
pH < 7.3
Ketones in serum/urine

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
Emergency Management

Patent airway, give O2
NS Bolus 1L/hour x 1-2 hrs
Regular INSULIN IV 1:1
If serum K+ <5, keep between 4 - 5

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
Insulin Administration

Serum Glucose should not drop more than 65 to 125 mg/dL per HOUR

Serum draws q 2 hrs
Fingerstick q 1 hr

Admin REGULAR INSULIN IV 1:1

When serum glucose reaches 250 or below, switch to dextrose-containing IVF

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
Lab Results

HYPOnatremia
HYPOchloremia

HYPERkalemia initially… then progresses to HYPOkalemia due to treatment (IVF and IV Insulin)

LOW Bicarbonate < 16 mEq/L [22 - 26] (Metabolic Acidosis)

BG > 250 mg/dL

MOD - HIGH Ketones in serum + urine

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
Complications

Dehydration –>
Hypovolemia –>
Shock –>
Renal Failure –>
Death

How well did you know this?

Not at all

Perfectly

Diabetic Ketoacidosis
IVF Administration

Priority nursing action: REPLACE FLUIDS

Bolus NS 1L/hour x 1 - 2 hrs
Followed by 0.45% NS 200 - 1000 mL/hr

When serum glucose is 250 or under, switch to dextrose-containing IVF

Goal: Restore urine output to 30 - 60 mL/hr

How well did you know this?

Not at all

Perfectly

HHS
Pathology

HYPERosmolar
HYPERglycemic
LOW Insulin
More common in Type II Diabetes

How well did you know this?

Not at all

Perfectly

HHS
Symptoms

DEHYDRATION
HYPERglycemia
LOW/No Ketones
Serum glucose >1000 mg/dL
Profound LOC changes!
NO ACIDOSIS: pH > 7.3
Shallow Resps

How well did you know this?

Not at all

Perfectly

HHS
Emergency Management

Similar to DKA…

Patent airway, give O2
NS Bolus 1L/hour x 1-2 hrs
Regular INSULIN IV 1:1
If serum K+ <5, keep between 4 - 5

How well did you know this?

Not at all

Perfectly

HHS
Lab Results

HYPERnatremia
HYPERosmolarity
HIGH BUN/Creatinine
Serum Glucose 600+ mg/dL
No Acidosis –> pH > 7.3

How well did you know this?

Not at all

Perfectly

HHS
Nursing Management

Monitor
Blood Glucose
Urine Output + Ketones
IVF
Insulin therapy
Electrolytes (esp K+)

Assess
Renal status
Cardiopulmonary status
LOC!!!

How well did you know this?

Not at all

Perfectly

Hypoglycemia
Pathology

HIGH Insulin resulting in a Blood Glucose level < 70 mg/dL

Causes:
Too much insulin
Too little food
Too much exercise
Delaying time of eating

How well did you know this?

Not at all

Perfectly

Hypoglycemia
Symptoms

Shakiness
Palpitations
Nervousness
Diaphoresis
Anxiety
Hunger
Pallor
Altered LOC
“Mimics alcohol intoxication”

How well did you know this?

Not at all

Perfectly

Hypoglycemia
Complications

Priority over pt with high blood sugar!
Untreated can progress to:
Loss of conciousness –>
Seizure –>
Come –>
Death!

How well did you know this?

Not at all

Perfectly

Hypoglycemia
Treatment of Concious Patient

Priority over pt with high blood sugar!

Consume 15 g of a simple carb (4 - 6 oz juice/soda)
Recheck glucose level in 15 minutes
Repeat if still < 70 g/dL
If stable, give CARB + Protein

How well did you know this?

Not at all

Perfectly

Hypoglycemia
Treatment of
Unconcious Patient

Priority over pt with high blood sugar!

With IV Access:
* 50% dextrose 20 - 50 mL IV push

Without IV Access:
* Glucagon 1 mg IM or SC
* Watch for N/V –> Aspiration precautions

How well did you know this?

Not at all

Perfectly

Diabetes
Rapid-Acting Insulin

Rapid
Lispro/Humalog/Aspart
Onset: 15 mins
Peak: 1 hour

How well did you know this?

Not at all

Perfectly

Diabetes
Short-Acting (Regular) Insulin

Study These Flashcards

Short
Regular/Humulin R
Onset: 30 - 60 mins
Peak: 2 - 3 hours
CLEAR (1st)

Diabetes
Intermediate-Acting Insulin

Study These Flashcards

Intermediate
NPH/Humulin N
Onset: 2 - 4 hours
Peak: 4 - 12 hours
CLOUDY (2nd)

Diabetes
Long-Acting Insulin

Study These Flashcards

Long
Glargine/Lantus
Onset: 1 hour
Peak: No peak

Addison’s Disease
Pathology

Study These Flashcards

Adrenal Gland HYPOfunction

Aldosterone insufficiency

Causes:
* Autoimmune or Idiopathic
* Long-term steroid use
* Infection (TB, Histoplasmosis)
* Removal of adrenal glands

Addison’s Disease
Symptoms I

Study These Flashcards

Muscle weakness + fatigue
Anorexia + emaciation
N/V, weight loss, ABD pain, constipation or diarrhea
HYPERpigmentation (bronzing)
Decreased body hair
Menstrual changes + Impotence
Increased urine output

Addison’s Disease
Symptoms II

Study These Flashcards

HYPOtension
HYPOglycemia
HYPOnatremia
HYPOvolemia
Anemia, Low H/H
Headache, Lethargy, Depression, Confusion, Emotional Lability

**Addison's Disease** Symptoms III

HYPERkalemia HYPERcalcemia Increased HR Tachy dysrhythmias

**Addison's Disease** Complications

Addisonian Crisis May be caused by stress r/t surgery, dehydration, acute infection, overexertion, exposure to cold Can lead to circulatory shock and death S/S: Severe N/V, Diarrhea, Dehydration, Sudden pain in lower back/ABD/legs, Hypotension, Tachycardia, Confusion, Restlessness, Fatigue, Headache

**Addison's Disease** Diagnosis + Labs

ACTH Stimulation Test (Most definitive) ACTH is given and plasma cortisol levels are checked Absent/Low: PAI Increased: SAI HYPOglycemia HYPOnatremia HYPERkalemia WBCs: Elevated

**Addison's Disease** Nursing Management

**Interventions** Treat HYPOvolemia Increase Na+ levels (IVFs + foods) Monitor K+ levels (HYPERkalemia) --> Dysrhythmias, Acidosis Monitor weight and I/Os Manage HYPOglycemia

**Addison's Disease** Nursing Management II

**Education** Medical alert/ID card Avoid strenuous activity in hot/humid weather Strategies to deal with stress Notify Drs about disease BEFORE Tx Increase fluid + salt intake when sweating High carb, high protein diet w/ adequate sodium

**Addison's Disease** Medical Management

**Hydrocortisone (Solu-Cortef):** Corrects glucocorticoid deficiency Oral is Prednisone --> Divided Doses 2/3 in AM + 1/3 in PM **Mineralocorticoid Hormone (Fludrocortisone)** Maintains or restores F/E balance Dosage adjustment in hot weather

**Addison's Disease** Emergency Kit

* Corticosteroid prefilled syringes: 100 mg vials of hydrocortisone or 4 mg of dexamethasone + NS to reconstitute * Verbal/written instruction on how and when to use injection for pt, family, or caregivers * ENTIRE dose of 100 mg of hydrocortisone or 4 mg of dexamethasone should be given and medical attention * Should be seen IMMEDIATELY after administration

**Cushing's Disease** Pathology

A cluster of clinical abnormalities caused by **excessive** levels of adrenocortical hormones (particularly cortisol) CUSHING'S = CORTISOL More common in women than in men Primarily between ages 25 - 40

**Cushing's Disease** Causes

* Hyperplasia of the adrenal cortex * TUMOR: Cortisol-secreting + usually benign * Long-term steroid therapy r/t asthma or RA * Small cell lung cancer

**Cushing's Disease** Symptoms

**Classic Presentation:** * Buffalo hump: Fat pads over the upper back * Moon face: Excess fat on the face * Truncal obesity: Fat pads throughout the trunk with thin limbs

**Cushing's Disease** Symptoms II

Atrophy of lumphoid tissue = Compromised immune system Skin: Thin, fragile, easily bruised Peptic ulcer r/t inadequate prostaglandins Muscle weakness, wasting, lack of energy Osteoporosis = Pathological FRACTURES Distrubed sleep, irritability **Hypertension** + Heart failure Weight gain

**Cushing's Disease** Symptoms III

HYPERtension Tachycardia Bounding Pulse Dependent Edema Risk for thrombus

**Cushing's Disease** Lab Results

HYPERnatremia HYPOkalemia Glucose HIGH

**Cushing's Disease** Diagnosis

Serum Cortisol: * Usually higher in the morning and lower in the evening * Loss of variation = positive Urinary Cortisol: * Requires 24-hour urine collection * 3x upper limit of normal = positive Low-dose Dexamethasone Suppression Test * Dexamethasone given orally late in evening/bedtime + plasma cortisol obtained next morning * Suppression of cortisol to < 5 mg/dL = negative * Lack of suppression = positive result * Stress, obesity, depression, anticonvulsants can falsely elevate cortisol

**Cushing's Disease** Nursing Assessment

* Health history: Level of activity and ability to perform ADLs * Physical exam: Skin assessed for trauma, infection, breakdown, bruising, and edema * Mental function: Mood, responses to questions, awareness of environment, and level of depression

**Cushing's Disease** Nursing Interventions

* Fluid + electrolyte balance, daily weights IOs * Diet: Increase protein, calcium, and vitamin D to minimize muscle wasting and osteoporosis * Low carb, Low sodium * Fall risk: Susceptible to bruising, skin trauma, fractures * Reduce risk of infection: Compromised immune system * Promote periods of rest * Promote skin integrity * Psychosocial: Body image + weight gain

**Cushing's Disease** Nursing Education

F/U appointments Medication compliance

**Cushing's Disease** Treatment: Drugs

Adrenal enzyme inhibitors may be used to reduce hyperadrenalism if the syndrome is caused by ectopic ACTH secretion by a tumor that cannot be eradicated * Metyrapone * Aminoglutethimide * Mitotane * Ketoconazole Cortisol therapy: Essential during and after surgery, to help the patient tolerate the physiologic stress imposed by the removal of the pituitary or adrenals

**Diabetes Insipidus** Pathology

ADH LOW Urine Output - (up to 12 L/day) UNKOWN HEAD TRAUMA CNS INFECTION KIDNEY ISSUES (2nd) MEDS - LITHIUM

**Diabetes Insipidus** Symptoms

* Primary Symptom = Excretion of large quantities of urine (250 mL/hour) * Extreme thirst, craving cold water (2 - 20 L) * Severe dehydration can occur if fluid intake cannot keep up * The patient will experience hypotension, tachycardia, hypovolemic shock

**Diabetes Insipidus** Labs

LOW specific gravity < 1.005 [1.005 - 1.030] LOW URINE osmolality < 100mOsm/kg [500 - 800] HIGH SERUM osmolality Hypernatremia caused by pure water loss of the kidneys

**Diabetes Insipidus** Labs

LOW specific gravity < 1.005 [1.005 - 1.030] LOW URINE osmolality < 100mOsm/kg [500 - 800] HIGH SERUM osmolality Hypernatremia caused by pure water loss of the kidneys

Endocrine | Exam 3 Flashcards

(46 cards)