NUR 146 - Week 14 - Concept Review

Question 2

Compare Dawn Phenomenon and Somogyi Effect

Answer 2

Dawn:
- Early morning rise in blood sugar, NOT preceded by hypoglycemia
Treatment: change time of intermediate insulin from dinner to bedtime

Somogyi Effect:
- Pt experiences hypoglycemia overnight
- Body responds by attempting to raise blood glucose which = hyperglycemia
Treatment: Lower evening dose of insulin OR implement bedtime snack + complex carbs

Question 3

Oral Diabetes drugs:

Metformin

Answer 3

Only for T2DM

Effective as monotherapy
Side effects: GI upset, lactic acidosis

Question 4

Which oral diabetes drugs are most likely to cause hypoglycemia?

Answer 4

Sulfonylureas

• All anti-diabetic drugs can cause hypoglycemia

Question 5

Oral diabetes drugs:

Sulfonylureas

Question 6

Diabetes Insipidus:

Answer 6

“Dry inside; concentrated blood, dilute urine”

Polyuria
LOW levels of ADH
Hypernatremia (high sodium d/t low fluid)
Dehydrated

Treatment: ADH (if they’re lacking the hormone, give them the hormone)

s/s: hypotension, dry mucosa, tachycardia

Question 7

Syndrome of Inappropriate Anti Diuretic Hormone Secretion (SIADH)

Answer 7

Soaked inside; diluted blood, concentrated urine

Low urine / oliguria
High levels ADH
Hyponatremia
Fluid overload
Concentrated urine

s/s: JVD, pulmonary edema

Question 8

Gigantism

Answer 8

Excess growth hormone prior to epiphyseal plates close
- Extreme height
Cause: usually pituitary adenoma

Question 9

Acromegaly

Answer 9

Excess growth hormone AFTER epiphyseal closure
- Enlarged irregular shaped bones (face, sternum, jaw)
Cause: pituitary tumor

Can develop macrovascular diseases

Question 10

Hypophysectomy:

Post-op Care

Answer 10

• Avoid increasing intra-cranial pressure (coughing, straining, constipation)
• HOB > 30 degrees
• Assess for CSF leak (nasal drip gets tested for glucose)
• NO WOUND CARE until after packing is remove
• PT at risk for DI

Question 11

Hypothyroidism:

Answer 11

Too much TSH relative to low T3, T4

Everything slows down
- Constipation
- Fatigue
- Dry skin
- Weight gain
- Cold intolerance

Question 12

Hyperthyroidism

Answer 12

Low TSH relative to the high T3, T4

Everything speeds up
- Diarrhea
- Weight loss
- Anxiety, tremors
- Tachycardia
- Heat intolerance
- Exophthalmos (eyes jutting out)

Question 13

Hypothyroidism

Treatment

Answer 13

Supplements
Levothyroxine
Avoid use of sedatives

Question 14

Hyperthyroidism:

Treatment

Answer 14

Radioactive iodine
- Patient is radioactive, stay away from others
Thyroidectomy
- ABC’s, check their neck
Anti-thyroid drugs