NUR 504 Exam 5

Nursing interventions for HHS:

-safety -monitor VS -EKG/ telemetry --> essential d/t K+ -monitor fluid and electrolyte imbalance -monitor BG levels --> initially hourly then will decrease to 4-6 hrs as the condition improves -monitor for hypokalemia -monitor I & O -start subcut insulin once the patient can take PO fluids and the anion gap has resolved

Interventions for hypoglycemia:

-safety -question insulin orders -monitor BG levels -monitor cognition -identify cause of hypoglycemia -prevent future hypoglycemia

Labs for HHS:

-serum glucose > 600 -negative/ scant urine ketones -increased serum pH > 7.30 -elevated BUN & creatinine -elevated serum osmolality --> glucose is so high it makes the blood very concentrated

Risk factors for DKA:

*type 1 DM --> particularly new-onset (biggest risk factor) -usually they dont know they have diabetes and they may feel like they have the flu Type II DM --> less common Precipitating events: -acute illness -poor insulin compliance -use of medications that affect glucose use

Adrenal insufficiency (AI):

-*decreased levels of adrenocorticotropic hormone (ACTH)* --> symptoms may gradually occur quickly with stress

Labs for Cushing's Syndrome:

-Cortisol level --> tested through serum (in blood), urine, or saliva -Dexamethasone suppression test w/ 24 hr urine collection -Cholesterol --> assess for increases triglycerides -CBC w/ diff --> assess for decreased lymphocytes -CMP --> assess for hypernatremia, hypokalemia, hypocalcemia, and hyperglycemia

Nursing interventions for HIV:

-EDUCATION! -early intervention after detection of HIV --> can promote health and limit/delay progression of the disease -assessment is primary importance because the course of HIV is variable -Interventions are based on the patients condition upon assessment -assessment of these patients should focus on early detection of HIV, opportunistic diseases, and psychological problems

Potential Complications of adrenal disorders/ Cushing's Syndrome:

-FVO -Pulmonary edema -Infection -Fractures -GI bleed -Skin breakdown

Risk factors for Systemic Lupus Erythematosus (SLE):

-Female -Ages 15-44 --> commonly discovered when trying to get pregnant which will present as infertility -Dark skin --> African American, Hispanics/ Latinos, Asian Americans, Native Hawaiians, and Pacific Islanders (typically SLE develops at an earlier age and they have more severe cases) -Family hx -Hx of another autoimmune disorder

Potential complications of SIADH:

-HF -pulmonary edema -death

Treatment for hyperglycemia:

-Insulin as ordered -prevention of glucose consumption -hypdration

Dx testing for adrenal insufficiency (AI):

-MRI -CT -adrenal gland, pituitary, hypothalamus

Dx testing for Cushing's Syndrome:

-MRI -CT -of the adrenal gland, pituitary, lung, GI, and pancreas -Chest X-ray

Nursing Interventions for DI:

-treat underlying cause -symptom management -I & O -daily wt -oral and IV hydration -primary DI requires life long therapy -risk for fluid volume overload -medical alert bracelet

Identify the primary causes of adrenal insufficiency. select all a. hemorrhage b. tuberculosis c. pituitary tumors d. postpartum pituitary necrosis e. acquired immunodeficiency syndrome (AIDS)

a. hemorrhage b. tuberculosis e. acquired immunodeficiency syndrome (AIDS)

A client with DKA who is receiving IV fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. the nurse identifies a U wave on the cardiac monitor. which electrolyte imbalance is causing these clinical findings? a. hypokalemia b. hyponatremia c. hyperglycemia d. hypercalcemia

a. hypokalemia

a nurse is caring for a client who had an andrenalectomy. which clinical response would the nurse monitor while steroid therapy is being regulated? a. hypotension b. hyperglycemia d. sodium retention d. potassium excretion

a. hypotension

Key points for DKA:

-do not admin insulin until potassium has been started -correcting BG is not the main concern -goal of treatment: stop production of ketones -dropping BG more than 75-100/hr can cause cerebral edema and seizures -closing the anion gap is the main endpoint in treatment; NOT normalization of BG -continue insulin therapy along with dextrose infusion until anion gap is normalized

Risk factors for acute hyperglycemia:

-exacerbation of existing DM -new onset of DM -meds that elevated BG (corticosteroids, dobutamine) -trauma -physiological stress -infection or sepsis -sick day, common cold

Labs for SIADH:

-low serum sodium < 135 -high urine sodium > 20 -high urine osmolality -low serum osmolality < 275 -high specific gravity > 1.005 - WNL adrenal threshold -serum potassium low < 3.5

a client with a pituitary tumor develops a urine output of 300 mL/hr, dry skin, and dry mucous membranes. Which intervention would the nurse perform for the client? a. evaluate urine specific gravity b. implement fluid restrictions c. provide emollients to the skin to prevent breakdown d. slow the IV fluids and notify the primary HCP

a. evaluate urine specific gravity

the nurse reviews the serum lab values of a client. the nurse suspects hypofunctioning of the adrenal gland based on which results? select all a. increased calcium b. decreased cortisol c. decreased sodium d. decreased potassium e. increased glucose

a. increased calcium b. decreased cortisol c. decreased sodium

Which precaution is a priority to prevent harm for the nurse to teach a client with systemic lupus erythematosus (SLE) who is newly prescribed to take hydroxychloroquine for disease management? a. see your opthalmologist for visual field testing every 6 months b. report a reduction of joint swelling to you rheumatology HCP immediately c. see your othalmologist for intraocular pressure measurement every 6 months

a. see your opthalmologist for visual field testing every 6 months

What precaution is most important for the nurse to teach the client with systemic lupus erythematosus (SLE) prescribed to take 45 mg of corticosteroid daily for 2 wks to manage an SLE flare? a. check all of your stools for the presence of blood or a black, tarry appearance b. do not suddenly stop taking the drug when your flare is over c. be sure to take this drug with food d. take 30 mg in the morning and 15 mg at night

b. do not suddenly stop taking the drug when your flare is over

Which medication below used to treat Systemic Lupus Erythematosus decreases inflammation quickly, is not for long-term usage and can lead to wt gain, susceptibility to infection, diabetes, and osteoporosis? a. hydroxychloroquine b. prednisone c. azithioprine d. belimumab

b. prednisone

What is a normal CD4 count? a. 200-500 cells/mm3 b. 1500-2500 cells/ mm3 c. 500-1500 cells/ mm3 d. < 200 cells mm3

c. 500-1500 cells/ mm3

Which statement by a client who has systemic lupus erythematosus (SLE) indicates to the nurse that more education about the disorder and its management is needed? a. "My friend and I are going to start walking 2 miles daily" b. "taking my temperature everyday can help me recognize when a flair is starting" c. "if i still have a lot of pain after taking an NSAID, I can also take acetaminophen" d. "at the first sign of a flare I will begin taking my medication again"

d. "at the first sign of a flare I will begin taking my medication again" rationale: daily drug therapy is essential to slow the progression of the disease and organ damage

Cushing's Syndrome:

-An over secretion of glucocorticoids and androgen -*increased levels of ACTH* -this is a gradual onset

Interventions for hyperglycemia:

-monitor VS -monitor BG -monitor for s/s dehydration -monitor for DKA and hypoglycemia -identify the cause

Non-surgical treatment for SIADH:

-correct underlying causes -maintain safety Hypertonic sodium replacement with *3% NaCl* --> run at no more than 50 mL/hr -if Na levels rise to fast or are corrected to quickly it can lead to osmotic demylination syndrome (ODS) --> a destruction of myelin sheath covering cells in the brainstem -S/S of ODS are not immediate they can take up to 4 days --> acute paralysis, dysphagia, dysarthria -fluid restriction 5000-100 mL/day -diuretics --> monitor potassium -vasopressin receptor *antagonists* --> samsca (PO); vasopril (IV)

Hypopituitarism 911:

-disorder of the anterior pituitary -panhypopituitarism 911 --> life threatening -decreased secretion of ALL anterior pituitary hormones -effects ALL body systems -presents with adrenal crisis treatment: -ABC's -safety -fluid volume replacement -replacement of all anterior pituitary hormones (they will need life long repletion of hormones)

S/S of stage 3 HIV: AIDS

-encephalitis -meningitis -retinitis -pneumocytisis pneumonia -TB -tumors (including on the skin) --> kaposi sarcoma, purplish-brown raised lesions -esophagitis -chronic diarrhea -malnutrition and wasting syndrome -lymphadenopathy -skin lesions -night sweats -cough, SOB -N/V/D, wt loss -confusion/ dementia -visual changes -seizures -*CD4 count <200* --> very low and the immune system will not be able to fight off infection opportunistic infections: -toxoplasmosis (found in cat litter), cryptosporidiosis Fungal infections: -candidiasis (will dry out mucous membranes to the point where they bleed and crack), pneumocystis pneumonia Bacterial: -TB, myobacterium Viral: -cytomegalovirus, HSV, varicella Malignancies: -kaposis sarcoma (leopard like spots that are cancerous), lymphoma

Early S/S of HIV:

-fever and chills -sore throat, swollen lymph nodes, and mouth ulcers -muscle fatigue and aches -N/V, loss of appetite -joint pain -headaches and mood swings -pneumonia, cough w/ phlegm, SOB, chest pain -tachycardia and hypotension -clammy skin, rashes, and blueness of the skin -in women --> changes in menstruation, lower belly pain, and vaginal yeast infections (later stages of infection)

Labs for DKA:

-glucose >300 -positive urine ketones (educate patients to complete urine tests at home) -elevated serum ketones -decreased pH <35 --> d/t acidosis -elevated BUN & creatinine --> because they will be dehydrated -initially hyperkalmia -rapid shift to hypokalemia once insulin is administered --> because the potassium shifts into the cells -elevated lactate >2 -high anion gap (results from low bicarbonate) --> we want to look at the anion gap to determine effectiveness of treatment for DKA

Type II DM:

-has a gradual onset -NOT autoimmune -*insulin resistance* and beta cell dysfunction occurs preventing cellular uptake of glucose (it takes more insulin to reach the tissues d/t the resistance barrier) -most prominent in adults > 30, but can develop at any age -can be prevented through lifestyle modifications -may require insulin but oral glycemics are usually tried first

risk factors for DI:

-head trauma -post op --> hypophysectomy -tumors of pituitary/ surrounding tissue -CNS infection -infarct -increased ICP -hypoxia -toxicity --> lithium, demeclocycline, ectasy

S/S Addisonian Crisis (AC) *911*

-headache/ dizziness -difficulty speaking/ slurred speech -neuro deficits -severe vomiting/ diarrhea -lethargy/ listlessness -lower back pain -abdominal/ leg pain -pale skin/ shivering -loss of appetite -hypoglycemia -confusion -low/ high BP -seizures -cardiovascular collapse (may present with shock like symptoms)

S/S of panhyopituitarism:

-hypotension -tachycardia -cardiogenic shock -abdominal pain, N/V -hyperthermia --> they will be hot -hyponetremia -AMS/ decreased LOC -cerebral edema -increased ICP -*seizures*

Hypothalamus:

-located in the brain below the thalamus and above the pituitary -is the message coordinator --> the command center of the endocrine system -coordinates messages between the nervous system and endocrine system -controls the release of pituitary hormones -*produces ADH & oxytocin*

Risk factors for SIADH:

-malignancies -cancer treatments -trauma -CNS infections -tumor near hypothalamus/ pituitary -infarct -SLE lupus -pulmonary infections -toxicity --> SSRI's, opioids, anesthesia, fluroquinolones

Potential complications of HIV:

-malignancy -diarrhea -decreased cognitive function and neuropathy -vitamin D deficiency -thyroid dz -diabetes -hypogonadism -hyperlip -lactic acidosis -pulmonary HTN -pulmonary fibrosis -HTN -atherosclerosis -vascular dz -renal insufficiency -osteoporosis/ penia -fractures -myopathy -sarcopenia

Blood glucose monitoring and insulin injections:

-only fast acting insulin is used in insulin pumps -work with the client to develop compliance -we need to know their level of activity -PATIENT PREFERENCE

Types of endocrine disorders:

-primary --> dysfunction of the actual gland -secondary --> dysfunction of the anterior pituitary -tertiary --> dysfunction of the hypothalamus -quaternary --> inability of the target tissue to respond to the hormone

Nursing interventions for DKA:

-safety! -monitor VS -EKG/ telemetry --> essential d/t K + -monitor fluid and electrolyte balance -monitor BG levels --> initially hourly then will decreased to 4-6 hrs as the condition improves -monitor for hypokalemia --> will occur after insulin is given -monitor I & O -NG tube if the patient has gastroparesis with cyclic N/V -start subcut insulin once patient can take PO fluids and the anion gap is within normal limits

A 30 yr old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? select all a. 15 Ib wt gain b. decreased libido c. four sinus infections d. frequent constipation e. increased foot callus formation f. occasional dripping of clear fluid from both breasts g. severely sprained ankle from a volleyball injury

a. 15 Ib wt gain b. decreased libido f. occasional dripping of clear fluid from both breasts

Which health promotion activities should will the nurse recommend to prevent harm in a client with type II DM? select all a. avoid all dietary carbohydrate and fat b. have your eyes and vision assessed by an opthalmologist every year c. reduce your intake of animal fat and increased your intake of plant sterols d. be sure to take your antidiabetes drug right before you engage in any type of exercise e. keep your feet warm in cold weather by using either a hot water bottle or a heating pad f. avoid foot damage form shoe-rubbing by going barefoot or wearing flip-flops when you are at home

b. have your eyes and vision assessed by an opthalmologist every year c. reduce your intake of animal fat and increased your intake of plant sterols

patient is diagnosed with systemic lupus erythematosus (SLE). You not the patient has a res rash that starts on the nose and expands onto the cheeks of the face. This is know as what type of rash? a. discoid b. malar c. miliaria d. eczema

b. malar

Which electrolyte lab values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocortisone that the client is responding positively to this drug therapy? a. serum sodium 147; serum potassium 7.1 b. serum sodium 137; serum potassium 4.9 c. serum sodium 127; serum potassium 2.8 d. serum sodium 119; serum potassium 6.2

b. serum sodium 137; serum potassium 4.9

The primary HCP prescribes fludocortisone for a client with adrenal gland hypofunction. Which medication teaching about side effects and adverse effects should the nurse provide to the client? a. diarrhea is a common side effect of this medication b. the medication can cause hypertension; regularly monitor BP c. fever is an associated adverse effect; monitor temperature every 4 hrs d. changes in facial features are common with this medication

b. the medication can cause hypertension; regularly monitor BP

How will the nurse modify insulin injection technique for a client who is 5'10" and weights 106 Ib (48.1 kg)? a. use a 6 mm needle and inject at a 90 degree angel b. use a 6 mm needle and inject at a 45 degree angle c. use a 12 mm needle and inject at a 90 degree angle d. use a 12 mm needle and inject at a 45 degree angle

b. use a 6 mm needle and inject at a 45 degree angle

Which statement made by the client with stage HIV -III diseases (AIDS) who's CD4 has increases from 125 to 400 indicates to the nurse that more teaching is needed? a. "now my viral load is also probably lower" b. "i am so relieved by drug therapy is working" c. "although i am still HIV positive, at least i no longer have AIDS" d. "this change means i am less likely to develop an opportunistic infection

c. "although i am still HIV positive, at least i no longer have AIDS"

Which statement by the nurse during an admission assessment for a client who is HIV positive demonstrates a nonjudgemental approach in discussing sexual practices and behaviors? a. "you must tell me all of your partners' names, so i can let them know about you possible being infected" b." I hope you use condoms to protect your partners" c. "have you had sex with men or women or both?" d. "you don't participate in anal intercourse, do you?"

c. "have you had sex with men or women or both?"

The nurse is reviewing the EMR of a client admitted with syndrome of inappropriate antidiuretic hormone (SIADH). which medication order would the nurse question? a. furosemide (lasix) b. tolvaptan (aquaretic) c. IV 0.9% sodium chloride d. demeclocycline (declomycin)

c. IV 0.9% sodium chloride

Which client with persistent joint and muscle pain will the nurse consider as most likely to have a systemic lupus erythematosus (SLE) diagnosis? a. a 33 yr old African American man whos father dies from an MI b. a 33 yr old white women whose sister has graves disease c. a 33 yr old African American women whos mothers has psoriasis d. a 33 yr old man whose identical twin brother has acute myelogenous leukemia

c. a 33 yr old African American women whos mothers has psoriasis

Which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? a. providing oxygen b. encouraging carbohydrates c. administering fluid replacement d. teaching facts about dietary principles

c. administering fluid replacement

Which outcome would be expect after a client received treatment for Cushing disease? a. increased cortisol levels b. increased sodium levels c. decreased BG levels d. decreased serum calcium levels

c. decreased BG levels

Which new-onset condition or symptom in a client who has systemic lupus erythematosus (SLE) now taking hydroxychloroquine does the nurse deem to have the highest priority for immediate reporting to prevent harm? a. increasing bruising b. increased daily output of slightly foamy urine c. failure to see letters in the middle of a word d. sensation of nausea within an hour of taking the drug

c. failure to see letters in the middle of a word a side effect of hydroxychloroquine is retinal toxicity

Which manifestations are exhibited with syndrome of inappropriate secretions of antidiuretic hormone (SIADH)? a. increased BUN and hypotension b. hyperkalemia and poor skin turgor c. hyponatremia and decreased urine output d. polyuria and increased specific gravity of urine

c. hyponatremia and decreased urine output

Which outcome is the main focus of treatment for a client with Addison disease? a. decrease in eosinophils b. increase in lymphoid tissue c. restoration of electrolyte balance d. improvement of carbohydrate metabolism

c. restoration of electrolyte balance

What is the first action a nurse should take after sustaining a needle stick injury after injecting a client who is known to be HIV positive? a. send the syringe and needle to the lab for analysis of viral load b. inform the charge nurse c. thoroughly scrub and flush the puncture site d. go to the employee clinic for postexposure prophylaxis

c. thoroughly scrub and flush the puncture site

A nurse caring for a client with Cushing's syndrome who must remain on continues glucocorticoid therapy for another health problem will use which of the following actions to prevent harm? a. urging the client to salt his/her food b. testing voided urine for the presence of glucose c. using nonadhesive methods to secure an IV access d. ensuring the prescribed glucocorticoid drug is given on an empty stomach

c. using nonadhesive methods to secure an IV access rationale: the skin of a patient with Cushing's is fragile and thin

A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland asks the nurse whether the physical changes from the excessive cortisol will fo away as a result of the surgery so she can look like herself again. What is the nurse's best response? a. "the surgery is to remove the tumor not reconstructive surgery" b. "you will notice a great difference in your appearance starting within a week after surgery" c. "all the changes will resolve but may take a year or longer to completely disappear" d. "the fatty changes and acne will resolve with time but the stretch marks only fade"

d. "the fatty changes and acne will resolve with time but the stretch marks only fade"

Which lab results support the nurse's suspicion that a client diagnosed with type I DM is experiencing ketoacidosis? a. BG of 40, blood pH of 7.37 b. BG of 130, blood pH of 7.35 c. BG of 650, blood pH of 7.42 d. BG of 300, blood pH of 7.20

d. BG of 300, blood pH of 7.20

Bolus insulin:

*Carb coverage* -patients do not need this coverage if they don't eat -extra amounts of insulin in the pancreas would naturally make in response to glucose consumption through meals -the amount of bolus insulin given depends on the size of the meal -Humalog -Novolog -Regular

Potential complications of DI:

- fluid volume overload --> d/t too much replacement of ADH hormones -dehydration --> if we don't give enough EDH -hypovolemic shock/ death

S/S DKA:

-*acute onset <24 hrs* -*Kussmal's respirations* -*acetone/ fruity breath* --> because the body is trying to compensate -*abdominal pain* -*flu-like symptoms* -*appears "I'll"* -3 P's: polydipsia, polyuria, polyphagia -lethargy, coma -signs of dehydration -vomiting -gastroparesis --> cyclic vomiting -weakness -altered mental status -slurred speech -unsteady gait

Risk factors for Cushing's Syndrome:

-*bilateral adrenal hyperplasia* -*pituitary adenoma (benign tumor)* -malignancies -adrenal adenoma or carcinoma -*use of glucocorticoids*

Potential complications of hyperglycemia:

-DKA and HHS -death

Nursing interventions for SIADH:

-I & O -daily wt -oral hygeine -seizure precautions

Nursing Interventions for Addisonian Crisis (AC) *911*:

-I & O -prevent hypoglycemia -telemetry/ EKG monitoring --> d/t hyperkalemia -safety (they are at risk for postural hypotension --> teach to dangle at bedside before getting up -daily wt -education --> these patients will require lifelong hormone replacement therapy

Potential Complications of Addisonian Crisis (AC) *911*:

-seizures -coma -profound dehydration -shock -death

Essential endocrine functions:

1. regulate metabolic processes 2. regulate rate of chemical reactions 3. transport of substance through membrane 4. regulate fluid and electrolyte balance 5. vital role in reproduction, growth and development -glands secrete hormones in *response* to external and internal stimuli -hormones are chemical *messengers* -hormone messages are *transported* via blood -blood delivers hormones to organs and tissues with targeted *receptor* cells -receptor allows the message to be *delivered* to the cell

Systemic Lupus Erythematosus (SLE):

An autoimmune disorder causing *systemic inflammation* and impaired tissue integrity -environmental or genetic factors trigger onset of the disease -anti-self antibodies attack cells resulting in a hypersensitivity reaction -*a progressive chronic disease *; does not ever go away --> patients can have remissions and flare ups -the goal for these patients is to prevent flare ups and complications

Dx testing for Systemic Lupus Erythematosus (SLE):

Assessment is based on organ involvement -chest x-ray --> cam impact the lungs -echocardiogram -renal biopsy

S/S hypoglycemia:

Can result from too much insulin or not enough carb intake -BG <70 -cool, clammy skin -diaphoretic -shakiness/ mild tremors, dizziness -anxious/ confusion -seizures -weakness -double vision -blurred vision -hunger -tachycardia -palpations -*negative for urine ketones*

Tertiary etiology for the hypothalamus:

Causes: -TBI -Stroke -tuberculous meninigitis -benign tumors that arise in the hypothalamus such as carniopharyngiomas -malignant tumors that metastasize to the hypothalamus such and lung/breast cancer

Secondary etiology for the hypothalamus:

Causes: -infections -infarction -pituitary adenomas -pituitary surgery -radiation therapy of pituitary adenoma

Non-surgical treatment for DI:

Central/ neurogenic: -d/t primary cause (problem in the actual gland/ posterior pituitary) Vasopressin: -DDAVP desmopressin acetate (Sc, intranasal, PO) -pitressin Fluid volume replacement Hemodynamic support

S/S DI:

DI = " dry inside" -polydipsia, polyuria, nocturia (because they are waking up to pee a lot) -large volumes of dilute urine > 200 mL/hr (2-3 L/day w/ mild dz; up to 10-30 L/day w/ severe dz) -EXTREME thirst (may be desperate to drink from the tap or toilet) -profound dehydration/ hypovolemia -tachycardia -hypotension

Treatment for HHS:

Goal of treatment: BG reduction -oxygen -IV fluid replacement (up to 10 L) -IV potassium STAT --> only if urine output is >30 mL/hr -IV insulin bolus -SLOW reduction --> as BG decreased so will the serum osmolarity -when BG <300 IV fluid should be changed to a dextrose containing solution -continue insulin therapy along with a dextrose infusion until BG is normalized

HIV:

HIV = human immunodeficiency virus -a virus that causes HIV infection; HIV attacks and destroys the infection fighting cells (CD4 lymphocytes) of the immune system -loss of CD4 cells makes it difficult for the body to fight off infections and certain cancers

Risk factors for HIV:

Initial infection from contact with bodily fluids: -blood -semen -pre-seminal fluid -vaginal fluid -rectal fluids -breast milk Modes of transmission: -vaginal/ anal sex -sharing IV needles -needle stick -perinatal

Basal Insulin:

Insulin given at any time regardless of meals or not -given for the insulin that is normally supplied by the pancreas and is present 24 hrs/day whether or not the patient eats Lantus or Levemir: doesn't have a set peak -within 24 hrs the way its secreted 1 unit will be secreted each hr for 24 hrs -1 unit/hr x 24 hrs Humalog or Novolog via insulin pump

Rapid acting insulin:

Lispro (Humalog) & Aspart (Novolog):: -Route: subcut -Onset: within 15 min -Peak: 1-2 hrs -Duration: 3-4 hrs -highest risk for hypoglycemia: 1-2 hrs

Adrenal cortex:

Located on top of the kidneys -cortex secretes cortisol -the medulla secretes catecholamines: epinephrine and norepinephrine Adrenal Gland: -S --> sugar (glucocorticoids) -S --> salt (mineralcorticoids) -S --> sex (androgen)

DX testing for diabetes:

Ongoing monitoring for complications of the disease Eye exam: -they are at risk for diabetic retinopathy (sugar damages the vasculature in the eye and is irreversible) Cardiovascular health: -CAD is the biggest risk for diabetic patients which can lead to MU -we use an EKG to monitor baseline cardiac function Foot care: -they will have neuropathy

PrEP vs. PEP

PrEP: -pre exposure prophylaxis -good candidates for PrEP are those who have an HIV positive partner -can reduce the risk of getting HIV -taken every day, before possible exposure PEP: -post- exposure prophylaxis -taken 72 hrs after possible exposure -for people who don't have HIV but may have been exposed

Risk factors for adrenal insufficiency (AI):

Primary: happening at the site (AKA adrenal gland) -autoimmune -TB -metastatic cancers -HIV/ AIDs -hemorrhage -sepsis -adrenalectomy --> removal of the adrenal gland -abdominal radiation -toxicity --> mitotane Secondary: -pituitary tumor -postpartum pituitary necrosis -hypophysectomy -radiation to the brain/ pituitary -cessation of corticosteroid therapy

Mineralcorticoids:

Secretion of aldosterone is stimulates by angiotensin II, hyponatremia, and ACTH levels -regulates Na, K, and fluid balance

Labs for DI:

Serum sodium and urine electrolytes -serum sodium > 135 -serum osmolality > 145 Serum and urine osmolality -serum osmolality > 290 -urine osmolality < 300 Urine specific gravity -< 1.005 Water deprivation test -measure wt, plasma and urine osmolality Hematocrit 24hr urine collection

Diabetes:

a metabolic disorder affecting insulin production and insulin resistance

Which arterial blood gas results are associated with DKA? a. pH: 7.28, PCO2: 28, HCO3: 18 b. pH: 7.30, PCO2: 54, HCO3: 28 c. pH: 7.50, PCO2: 49, HCO3: 32 d. pH: 7.52, PCO2: 26, HCO3: 20

a. pH: 7.28, PCO2: 28, HCO3: 18 diabetic ketoacidosis is associated with *metabolic acidosis*

While making rounds the nurse finds a client with type I DM pale, sweaty, and slightly confused; the client can swallow. the clients BG is 48 mg/dL. What is the nurse's best first action to prevent harm? a. call the pharmacy and order a STAT does of glucagon b. Immediately give the client 30g of glucose orally c. start an IV and administer a small amount of concentrated dextrose solution d. Recheck the BG level and call the Rapid Response Team

b. Immediately give the client 30g of glucose orally

A patient with Systemic Lupus Erythematosus (SLE) is prescribed Hydroxychloroquine. Select all education points you will include in the patients education about this medication: a. Hydroxychloroquine is considered a Biological medication b. It is used long-term to prevent flares c. this medication doesnt produce results immediately. Therefore the patient may not see results for a couple of months d. this medication binds with a protein that supports the activity of B-cells, which decreases the activity of B-cells e. the patient must have their eyes checked regularly to monitor the retina while taking this medication

b. It is used long-term to prevent flares c. this medication doesnt produce results immediately. Therefore the patient may not see results for a couple of months e. the patient must have their eyes checked regularly to monitor the retina while taking this medication

A client who has hypofunction of the adrenal gland is prescribed oral hydrocortisone. which clinical finding indicates the needs for dosage adjustment in the client? select all a. fever b. fluid retention c. severe diarrhea d. rapid wt gain e. increase in BP

b. fluid retention d. rapid wt gain characteristics of Cushing's syndrome

Which is the reason the nurse would monitor a client with a diagnosis of cushings syndrome for symptoms of diabetes mellitus? a. cortical hormones stimulate rapid weight loss b. tissue catabolism results in negative nitrogen balance c. glucocorticoids accelerate the process of glucogenesis d. excessive adrenocortocoptropic hormone (ACTH) secretion damages pancreatic tissue

c. glucocorticoids accelerate the process of glucogenesis

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels? a. diabetes insipidus b. adrenal cushing syndrome c. pituitary cushing syndrome d. syndrome of inappropriate antidiuretic hormone (SIADH)

c. pituitary cushing syndrome

A primary HCP prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation would the nurse provide to the client about the need to follow this diet? a. the use of salt probably contributed to the disease b. excess weight will be gained if sodium is not limited c. the loss of excess sodium and potassium in the urine requires less renal stimulation d. excessive aldosterone and cortisol cause retention of sodium and loss of potassium

d. excessive aldosterone and cortisol cause retention of sodium and loss of potassium

which factor may have precipitated ketoacidosis in a client with type 1 DM who has been adhering to a prescribed insulin regimen? a. increased exercise b. decreased food intake c. working the night shift d. upper respiratory infection

d. upper respiratory infection

Anion gap:

measures Na + CL + HCO3 and determines the balance -if bicarb (HCO3) is low there will be a bigger anion gap -*normal level: 4-12* --> once its 12 or less we know that we have stopped ketoacidosis

Normal acid base balance:

pH: 7.35 -7.45 CO2: 35-45 HCO3: 22-26

Dx testing for HIV:

related to symptoms and opportunistic infections -biopsy -chest x-ray -stool culture -pulmonary function test

Glucocorticoids:

the hypothalamus secretes CRH which stimulates secretions of ACTH, and stimulates the adrenal cortex to secrete glucocorticoids -increased levels of adrenal hormones inhibits production of CRH and ACTH

Labs for Systemic Lupus Erythematosus (SLE):

there is no designated lab that identifies a person has lupus CBC: -low H&H -low WBC -low platelets Sed rate: -increased w/ inflammation Antinuclear antibodies (ANA): -if this is positive it indicates a stimulated immune system BUN/creatinine: -to assess renal function Urinalysis: -to assess renal function

DKA:

A *hyperglycemic state* (not everyone who has hyperglycemia has DKA) characterized by an insulin deficiency thats caused by the breakdown of adipose tissue -if the body doesn't have enough glucose it starts to burn fat and produces ketones --> ketoacidosis -this disrupts the acid base balance leading to the production of ketones and causes --> metabolic acidosis -the goal is to treat the underlying cause acidosis/ ketogenesis

Pheochromocytoma:

A benign tumor of the adrenal medulla -The medulla produces catecholamines --> adrenaline and noradrenaline (aka epinephrine and norepinephrine) S/S: - Significant HTN (not controlled with any medication) -Tachycardia -Headache -Diaphoresis -Constant fight or flight Dx: 24 hr urine test Treatment: -Beta blockers or adrenalectomy -Post op monitor BP -(Usually is a unilateral removal if its caused by a tumor)

Labs for HIV:

CBC w/ diff -lymphocytes will be elevated (a normal level is 30-40%) -a patient with AIDS will typically have leukopenia and lymphopenia (decreased) Antibody antigen: -positive --> 3 wks - 3 months post infection -this lab value identifies the presence of the HIV infection Viral load: -measures the amount of viral particles, used to measure the effectiveness of therapy -if medication regimen is working the viral load will be lower but not absent; if they start to increase in amount the medication may not be working -we want the viral load to be low Other: CMP, urinalysis, LFT's, toxoplasmosis, hepatitis titer, TB, lipids - R/T symptoms of opportunistic infections -high cholesterol is common related to HIV CD4 count: -we want it to be high --> this means that they have a good immune system

Potential complications for DKA and HHS:

Hypokalemia --> most common cause of death in DKA *S/S:* know these -fatigue -malaise -confusion -muscle weakness -shallow respirations -abdominal distention -paralytic ileus -hypotension -weak peripheral pulses Cerebral edema --> if we decrease the BG too FAST ODS (demyelination syndrome) occurs *S/S:* know these -changes in mental status --> 1st early sign of increased ICP -headache -sudden bradycardia -seizure -coma -irregular respirations -HTN -sudden bradycardia -hypoglycemia -pulmonary edema -renal failure -coma and death

Non-surgical and surgical treatment for Cushing's Syndrome:

If r/t prolonged steroid use: -Gradually discontinue steroid use -Reduction of dose -Change to alternate day schedule If r/t pituitary tumor: transphenoidal hypophysectomy --> removal of the pituitary tumor through the sphenoid sinus -removal requires replacement of hormones -these patients need to avoid bending over --> we should teach them to flex at the knees and bend at the ankles to prevent increased ICP If pituitary surgery fails to correct the over secretion of cortisol we can consider a bilateral adrenalectomy -bilateral: requires lifelong cortisol replacement -Unilateral: patients may require initial replacement until the other adrenal gland can compensate If syndrome is r/t adrenal disease or cancer: -Bilateral adrenalectomy --> surgical removal of the adrenal gland will (will require lifelong cortisol replacement)

Acute exacerbation of adrenal insufficiency (AI) = *Addisonian Crisis (AC)* = *911*

Precipitating events for adrenal crisis: -infection or sepsis -steroid withdrawal -physiological stress --> post surgery, MI, fluid volume loss -trauma to adrenal or pituitary glandss

Treatment for hypoglycemia:

Safety! Give 15-30 grams of carbs PO to the patient who is conscious, alert, and able to swallow --> should contain both rapid absorbing sugars and complex carb snack (4oz OJ) IM glucagon --> if the patient is unconscious or unable to ingest PO -adult dose 1 mg -can give glucagon IV if patient has an established IV D50 IV --> if the patient is unconscious or unable to ingest PO and has established IV access -typical dose = 1 amp Repeat cap glucose levels until stable, continue to monitor

Which activities can the nurse postpone or eliminate for the client with HIV who has extreme fatigue today? select all a. administering prescribed drug therapy b. ambulating in the hall c. culturing suspected infectious drainage d. preforming pulmonary hygiene e. preforming oral car e f. providing complete bedrest g. teaching about nutrition therapy

b. ambulating in the hall f. providing complete bedrest g. teaching about nutrition therapy

Which part of the HIV infection process is disrupted by the antiretroviral drug class of entry inhibitors? a. activating the viral enzyme "integrase" within the infected host's cells b. binding of the virus to the CD4 + receptors and either of the two co-receptors c. clipping the newly generates viral proteins into smaller functional pieces d. fusing of the newly created viral particle with the infected cell's membrane

b. binding of the virus to the CD4 + receptors and either of the two co-receptors

S/S of diabetes:

*new onset of diabetes will always present with symptoms consistent with high blood sugar or hyperglycemia* -polyphagia, polyuria, polydipsia -always hungry -always tired -dizziness -frequent urination (good red flag is children who have been potty trained wetting the bed or adults waking up in the middle of the night with urgency) -sexual problems -blurry vision -tingling in hands or feet -always thirsty -unexplained weight gain in type II --> type I there will be weight loss m -wounds that wont heal

risk factors for type I DM:

-family hx -autoimmune dz

which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus? a. pH of urine: 9 b. specific gravity of urine: 0.4 c. RBCs in urine: 6 hpf d. WBC in urine: 8 hpf

b. specific gravity of urine: 0.4

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? a. urine output volume increased; urine specific gravity increased b. urine output volume increased; urine specific gravity decreased c. urine output volume decreased; urine specific gravity increased d. urine output volume decreased; urine specific gravity decreased

c. urine output volume decreased; urine specific gravity increased

S/S Systemic Lupus Erythematosus (SLE):

-*pain* --> severe abd pain -*fatigue* -*intermittent fever* -*butterfly (malar) rash*/ macular rash on the face -*discoid rash* -> coin looking rash -*photosensitivity* --> prone to suburns -mouth, throat, and nose ulcers -can develop infection in the lungs --> pleuritis, pulmonary hemorrhage -cardiac --> endocarditis, atherosclerosis -kidneys --> hematuria (they will end up with lupus nephritis and kidney failure) -blood --> high BP, anemia -hair loss (alopecia) --> anywhere on the body -myalgias and swollen joints

Non-surgical treatment for Addisonian Crisis *911*:

-*treat circulatory shock 1st* --> they will need airway support and cardiovascular/ perfusion support -IV fluids -IV corticosteroids -trendelenburg positioning -monitor hemodynamics -vasopressors -supplemental oxygen -antipyretics -manage hyperkalemia -manage hypoglycemia -*administer IV insulin to reduce hyperkalemia* --> will shift potassium into the cells -if the patient is hypoglycemic d/t low cortisol give IV glucose and IM glucagon together --> *monitor BS hourly*

Non-surgical treatment for HIV:

Antiretroviral therapy (ART) --> a combination of HIV medications every day (called an IV regimen treatment) -*Truvada, Zidovudine* -recommended for everyone who has HIV -with ART there is a decreases risk for HIV transmission -the foal is to reduce the viral load to an undetectable level -an undetectable level --> the level of HIV in the blood is too low to be detected by a viral load test; patients with an undetectable viral load have effectively no risk of transmitting HIV through sex but still need to use protection

risk factors for type II DM:

-family hx -obesity -more prevalent in African American, Hispanic, and Native Americans -sedentary lifestyle -Hx of gestational DM

Short term side effects of HIV medications: Truvada and Zidovudine

-fatigue -N/V -fever -muscle pain -diarrhea -occasional dizziness -headache -insomnia

Potential complications of adrenal insufficiency (AI):

-fatigue -mood changes -mild dehydration -aches and pains -exacerbation to Adisson crisis

Potential Complications of Systemic Lupus Erythematosus (SLE):

-skin scarring -joint deformities --> once the joints are deformed they cannot go back to normal -kidney failure -stroke -heart attack, pericarditis -pregnancy complications --> miscarriages are common -hip destruction (avascular necrosis) -cataracts -bone fractures --> d/t steroid use, arthritis, and impaired mobility -Raynaud's phenomenon -risk for infection -biggest causes of death are: cardiovascular dz, infection, renal failure

Labs for adrenal insufficiency (AI):

ACTH Stimulation Test: -a normal response after ACTH injection is a rise in blood cortisol levels -patients who has Addison's or secondary adrenal insufficiency have little to no increase in cortisol levels --> meaning the body isn't responding and not making more cortisol Insulin Tolerance Test: -*hypoglycemia* causes physical stress; a normal functioning patient who is hypoglycemic should trigger the pituitary to make more ACTH -usually with corticosteroids patients will be hyperglycemic

Labs for diabetes:

Fasting Blood Sugar (FBS) --> representative of the bodies baseline rate -w/ out diabetes --> 70-90 -w/ diabetes --> 80-130 Random Blood Sugar: -gives a view of how the body is responding to food HBA1C: measures BG over the past 3 months (the lifecycle of RBCs) -normal non diabetic: <6 -prediabetes: 5.7-6.4 -diabetes: >7 (we don't want them to be super low because that means they are frequently hypoglycemic) Oral Glucose Tolerance Test (GTT): -blood is checked at 1,2, & 3 hours to see how insulin production is responding to carbohydrate and glucose intake

Intermediate Insulin:

NPH (Humulin N): -Route: subcut -Onset: 2-4 hrs -Peak: 4-10 hrs -Duration: 10-16 hrs -High risk for hypoglycemia: 4-10 hrs

S/S of adrenal insufficiency (AI):

Severity of symptoms is r/t the degree of hormone deficiency -muscle weakness -fatigue -joint/ muscle pain -anorexia -wt loss -N/V/D or constipation -abdominal pain -salt craving --> because aldosterone will be low and they are hyponatremic -vitilago or hyperpigmentation (bronze skin) -hair loss --> female axillary and pubic -anemia -hypotension --> d/t low aldosterone -hyperkalemia --> d/t sodium potassium pump; if Na is low K will be high -hyponatermia -hypercalcemia

The client who wants to use Truvada for pre-exposure prophylaxis (PrEP) asks the nurse why testing is needed for HIV status before starting this drug. How does the nurse respond? a. "although this drug can help prevent HIV infection, it is not enough by itself to control the disease if you are HIV positive" b. "the side effects of this drug are worse if you have a detectable HIV viral load" c. "if you take this drug ad are HIV positive, your risk for co-infection with the hepatitis B virus is increased" d. "some people have a genetic mutation that increases the risk for life-threatening reactions, while taking this drug if they are HIV positive"

a. "although this drug can help prevent HIV infection, it is not enough by itself to control the disease if you are HIV positive"

Which of the following are priority precautions the nurse will teach the client who remains at continuing risk for adrenal hypofunction and is taking hormone replacement therapy to prevent harm related to this disorder? select all a. "avoid crowds and people who are ill" b. "check you HR for irregular or skipped beats twice daily" c. "do not choose low-sodium versions of prepared foods" d. "get up slowly from sitting or lying positions" e. "keep a source of glucose, such as candy, with you at all times" f. "never skip your hormone replacement drugs"e replacement drugs"

a. "avoid crowds and people who are ill" b. "check you HR for irregular or skipped beats twice daily" c. "do not choose low-sodium versions of prepared foods" d. "get up slowly from sitting or lying positions" e. "keep a source of glucose, such as candy, with you at all times" f. "never skip your hormone replacement drugs"e replacement drugs"

The client on combination ART calls the nurse to report that he is on vacation and the bag with his drugs was accidentally left on the airplane, so he missed all of yesterday's dosage. what action does the nurse recommend? a. "take today's dosages as normally prescribed and continue to follow you therapy program" b. "don't worry unless you miss your drugs for 4 days consecutively, there is not a problem" c. "take double doses of the drugs for the next 2 days and do not have sex for at least 4 days" d." go to the nearest ED and have an immediate blood test for assessment of viral load"

a. "take today's dosages as normally prescribed and continue to follow you therapy program"

Which nursing intervention is appropriate to include in the plan of care for a client with diabetic ketoacidosis (DKA)? a. IV administration of regular insulin b. administer insulin glargine subcutaneously at hour of sleep c. maintain nothing prescribed orally (NPO) status d. intravenous administration of 10% dextrose

a. IV administration of regular insulin

S/S hyperglycemia:

-3 P's: polyuria, polyphagia, polydipsia -fatigue -weakness -altered mental status -abdominal pain -N/V -recurrent infections -slow healing wounds -wt loss -HGA1C >5.5 -FBS > 100 mg/dL -postprandial -2hr >140 mg/dL -*ketones in urine* -warm, moist skin -double or blurred vision -acetone smelling breath -can be alert or all the way to stupor/ coma -s/s dehydration -elevated BUN and creatinine

S/S HHS:

-3 Ps: polyphagia, polydipsia, polyuria -dehydration -wt loss -tachycardia --> d/t dehydration and hypermetabolic state -hypotension -*NO kussmal's respirations or acetonic/ fruit breath --> because there is NO ketosis* (big distinct difference between DKA and HHS) -delirium -seizures -coma -lethargy -*mental status changes d/t severe dehydration*

S/S SIADH:

-FVO - 3rd spacing/ edema -hyponatremia -anorexia, N/V -wt gain -oliguira -decreased LOC -cerebral edema -increased ICP -seizures -*bounding pulses* -JVD -crackles/ rales -vitals are typically stable --> HR WNL, BP WNL, moist mucus membranes, not dehydrated)

Nursing interventions for adrenal disorders/ Cushing's Syndrome:

-Monitor FVO -Skin care --> consider pressure reducing mattress -Reposition q 2 hrs -Steroidogenesis inhibitors -Daily wts -I & O -Fluid restriction -Low sodium or restricted salt diet

Treatment for adrenal insufficiency (AI):

-PO hydration -corticosteroid replacement -minceralcorticoid replacment -educate patient on s/s of Addison's crisis

Hyperosmolar state (HHS)

-SEVERE hyperglycemic state -characterixed by profound hyperosmolarity and dehydration -develops gradually over days to weeks -volume depletion occurs as the result of osmotic diuresis caused by prolonged hyperglycemia -can result in hypovolemic shock caused by poor perfusion/ severe dehydration

Treatment for adrenal disorders/ Cushing's Syndrome:

-Safety --> we want to prevent injury, infection, and wounds -Monitor VS -Monitor fluid and electrolyte balance -Monitor weights/ I&O -Monitor BG -Nutrition --> these patients should be on a no salt diet/ fluid restriction --> with high aldosterone we don't want them going into FVO

Nursing Interventions for Systemic Lupus Erythematosus (SLE):

-pain management -fatigue management -psychosocial support --> body image disturbances d/t skin rashes on their face -skin care -avoid perfumes, harsh cleaners, and powders -caution use of irritating ingredients in makeup and lotions -educate to limit UV light and sun exposure -educate on flare up risks --> increased risk for flare ups with physiological stress

HIV life cycle stage 2: Chronic

-patients are usually asymptomatic -HIV is active in the body and continues to reproduce -w/ treatment --> this stage of HIV may never move into stage 3 (AIDS) -w/out treatment --> this chronic stage may last 10+ years (can progress faster in children lasting 1-3 yrs) -at the end of the chronic stage the viral load increases and the patient moves into stage 3 (AIDS) -*CD4 count of 200-499*

Diabetes insipidus (DI):

-posterior pituitary problem (issue in the warehouse) -dehydration (dry you need ADH) = ADH is releaased DI there is too little ADH being excreted -deficiency or resistance of ADH hormone (vasopressin) -decreased ADH = *large volume* of dilute urine output -increases serum osmolarity and serum sodium -thirst stimulation increases, there will be increased water intake but also increased output -creates a state of dehydration -pt will have significant polydipsia and polyuria

Which lab results does the nurse expect to decrease in a client who has untreated HIV-III (AIDS)? select all a. total WBC b. viral load c. CD8 + T-cell d. HIV antibodies e. CD4 + T-cell count f. lymphocytes

a. total WBC e. CD4 + T-cell count f. lymphocytes

Which conditions/ factors will the nurse teach at a community seminar as probable transmission routes for HIV? select all a. using injection drugs b. sitting on public toilets c. changing a diaper on an HIV positive child d. having unprotected intercourse with multiple partners e. breast-feeding f. being bitten by mosquitos

a. using injection drugs d. having unprotected intercourse with multiple partners e. breast-feeding

Which lab test does the nurse analyze to determine the effectiveness of combination antiretroviral drug therapy in an HIV-positive client? a. viral load testing b. enzyme-linked immunosorbent assay c. fourth generation testing d. western blot analysis

a. viral load testing

S/S of Cushing's Syndrome:

Increased cortisol leads to: -Hyperglycemia --> insulin resistance and gluconeogenesis -Wt gain --> truncal obesity, buffalo hump (fat deposit on upper back and neck), moon face (round and plump face) -Muscle waisting and weakness --> thin extremities and osteoporosis -Inflammatory/ immune response --> lymphocytes, prostaglandins, and luekotrienes -Alterations in mood and sleep disturbances -Increased risk for infection -Poor wound healing -Dependent edema -Thin fragile skin, bruising, petechiae, striae Increased Adrogens leads to: -Female --> hirtuism, menstrual irregularities, oligomenorrhea, acne, clitoral hypertrophy -Male --> gynocomastia and erectile dysfunction

Which statements about the transmission of HIV are true? select all a. clients with HIV-III (AIDS) and no drug therapy are very infectious b. even with appropriate drug therapy, most clients infected with HIV live only about 5 yrs after diagnosis c. HIV may be transmitted only during the end stages of the disease d. the most common transmission route is casual contact e. newly infected clients with a high viral load are very infectious f. HIV positive clients who have an undetectable viral load appear to not transmit the disease

a. clients with HIV-III (AIDS) and no drug therapy are very infectious e. newly infected clients with a high viral load are very infectious f. HIV positive clients who have an undetectable viral load appear to not transmit the disease

A client with severe diabetes insipidus is receiving desmopressin acetate, intranasally, in a metered spray. During a follow-up visit to the HCP, the client reports frequent chest tightness. which medication prescriptions may be beneficial in minimizing or preventing the side effect? select all a. desmopressin acetate, orally b. lithium carbonate, intranasally c. antidiuretic hormone, IV d. antidiuretic hormone, intramuscularly e. desmopressin acetate, subcutaneously

a. desmopressin acetate, orally e. desmopressin acetate, subcutaneously

Short acting/ regular insulin:

regular (Humulin R or Novolin R): -Route: subcut -Onset: 30-60 min -Peak: 2-4 hrs -Duration 5-7 hrs -High risk for hypoglycemia: 2-4 hrs -Route: IV -Onset: 10-30 min -Peak: 15-30 min -Duration: 30-60 -High risk for hypoglycemia: ALL THE TIME

Insulin Delivery:

target BG is individualized and typically between 100-130 Sliding Scale: -*reactive* approach -we intervene once BG is already elevated --> does not prevent it from getting high -roller coaster effect --> letting the BG go high and then rapidly down many times -given B4 meals based upon ac BG Fixed method: -patients are given the same insulin dosage everyday -doesnt account for variations in meal carbs or time of eating Basal Bolus Correction: -*proactive* approach -Requires insulin and good carb coverage -mimics natural insulin delivery -can be given via insulin syringe/ insulin pump -insulin carb ratio --> I:C (helps does how much rapid acting insulin they'll need to "cover" the carbohydrate they'll at with a meal or snack) -correction factor/ sensitivity factor: used to calculate the amount of insulin you need to bring your BG into target range -requires complex carb counting and frequent BG monitoring to determine dosage of insulin

*Corticosteroid Therapy Key Points*:

-Widely used for anti-inflammatory effects and immune response -Patients should be educated to take these in the morning to minimize cushingoid effects and take with food -Do not give live virus vaccines --> because they are immunocompromised -S/S of infection may be masked

Negative feedback mechanism:

1. stimulus signals the *release* of a hormone 2. hormones reach *desired level* 3. hormones send signal to *stop release* of the hormone further

Long Acting Insulin:

Glargine (lantus): -Route: subcut -Onset: 3-4 hrs -Peak: No peak -Duration: 24 hrs -High risk for hypoglycemia: 3-24 hrs Detemir (levemir): -Route: subcut -Onset: 3-4 hrs n -Peak: 3-4 hrs -Duration: up to 24 hrs -High risk for hypoglycemia: 3-14 hrs

Non-surgical treatment for DKA:

Goal of treatment: ketone elimination, NOT glucose reduction -oxygen --> to support airway -fluids --> for dehydration -potassium --> *treat with this first B4 the insulin* for the shift into the cells -follower by insulin --> its titrated, *we want a slow reduction of BG* (always regular insulin IV 0.5-1 u/kg/unit)

Which assessment has the highest priority for the nurse to preform for a client with SIADH receiving tolvaptan therapy for 24 hrs? a. evaluating serum sodium levels b. evaluating serum potassium levels c. examining the skin and sclera for jaundice d. examining the IV site for indications of phlebitis

a. evaluating serum sodium levels

Which action is characteristic of the hormone vasopressin? a. helps produce concentrated urine b. causes tubular secretion of sodium c. promotes potassium secretion in the collecting duct d. enhances sodium reabsorption in the distal convoluted tubule

a. helps produce concentrated urine

a client with type I DM has dry, hot, flushed skin; a fruity odor to the breath; and is having kussmaul respirations. which complication does the nurse suspect that the client is experiencing? a. ketoacidosis b. somogyi phenomenon c. hypoglycemia reaction d. hyperosmolar nonketotic coma

a. ketoacidosis

A patient with systemic lupus erythematosus (SLE) is experiencing a complication called Lupus Nephritis. What are some s/s that correlate with this complication of SLE? select all a. decreased creatinine b. increased BUN c. 48 hr urinary output of 720 mL d. proteinuria e. wt loss f. edema in upper and lower extremities

b. increased BUN c. 48 hr urinary output of 720 mL d. proteinuria f. edema in upper and lower extremities

The nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan? a. increase potassium intake to replace renal losses b. increase protein intake to heal the adrenal tissue and this cure the disease c. take supplemental vitamins to supply energy and assist in regaining the wt that was lost d. consume extra salt to replace the amount being lost d/t a lack of sufficient aldosterone needed to conserve sodium

d. consume extra salt to replace the amount being lost d/t a lack of sufficient aldosterone needed to conserve sodium

Which clinical findings correspond with the secretion of antidiuretic hormone (ADH)? select all a. edema b. polyuria c. bradycardia d. muscle cramps e. hyponatremia

d. muscle cramps e. hyponatremia

The nurse is reviewing a preadmission testing lab values for a 62 yr old client scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding? a. the clients A1C is completely normal b. the client has type 1 diabetes c. the client has type 2 diabetes d. the client has prediabetes

d. the client has prediabetes

SIADH:

too much ADH; " in the potty not the body" -increased ADH = the collecting duct is highly permeable to water -water is retained, urine is decreased, hyponatremia occur -increases urine sodium loss which exacerbates hyponatremia

Non-surgical treatment for Systemic Lupus Erythematosus (SLE):

-ice, cold therapy for muscle joints -lifestyle changes to manage fatigue -NSAIDs -corticosteroids --> to decreased systemic inflammation (long term low dose; monitor for Cushing's Syndrome) Antimalarial drugs --> Hydroxychloroquine--> PO med take daily for life -treats: musculoskeletal, skin, fatigue, and prevents flairs -SE: upset stomach, *retinal toxicity* --> patients on this med will need annual eye exams Immune modulators--> such as methotrexate -methotrexate is considered a chemotherapy drug so chemo precautions need to be in place -protection is needed if you are pregnant or trying to get pregnant because its also used to terminate ectopic pregnancies IV monoclonal antibodies: these block cytokines/ inflammatory response

Dx findings of Addisonian Crisis (AC) *911*:

-hyperkalemia -*hyponetremia* -*hypercalcemia* -hypoglycemia -increases serum BUN -increased serum creatinine -decreased sodium cortisol

Pituitary gland:

-located below the hypothalamus and behind the bridge of the nose -"master gland" that controls all other glands -receives orders from the hypothalamus to make more or less -anterior pituitary -posterior pituitary --> storage facility for ADH and oxytocin that are made in the hypothalamus

Which interventions would the nurse implement in caring for a client with diabetes insipidus (DI) after a head injury? select all a. provide adequate fluids within easy reach b.report an increasing urine specific gravity c. administer prescribed erythromycin d. assess for and report changes in neurological status e. monitor for constipation, wt loss, hypotension, and tachycardia

a. provide adequate fluids within easy reach d. assess for and report changes in neurological status e. monitor for constipation, wt loss, hypotension, and tachycardia

Which interventions would the nurse implement when caring for a client with SIADH? select all a. provide frequent oral care b. institute fall precautions c. restrict fluids to 2 L per day d. place the client in high-fowler position e. monitor for and report neurological changes

a. provide frequent oral care b. institute fall precautions e. monitor for and report neurological changes

Which is a secondary cause of adrenal insufficiency? a. hemorrhage b. tuberculosis c. pituitary tumors d. metastatic cancer

c. pituitary tumors

A patient with chronic stage HIV , has a CD4 count ordered. What does this measure? a. RBCs b. B cells c. Cytotoxic T cells d. Helper T cells

d. Helper T cells

Which food, drink, or herbal supplement does the nurse teach the client take tipranavir (truvada) to avoid? a. caffeinated beverages b. grapefruit juice c. dairy products d. St. John's wort

d. St. John's wort

Lupus Nephritis:

-a symptom of lupus -treated as if the patient is in chronic renal failure (they may or may not need dialysis\) S/S: -*facial edema* -*urine appears foamy a sign of proteinuria* -BP increases -loss of appetite

Type I DM:

-an autoimmune disease with an acute onset -most prominent in children, teens, and adults <30 -*beta cells in the pancreas are destroyed*, causing an inability to produce a sufficient amount of insulin or none at all -cannot be prevented or cured -requires insulin injections for life

criteria for dx of System Lupus Erythematosus (SLE):

-arthritis in 2 or more joints -photosensitivity -serositis --> fluid accumulation and inflammation in either the lung or the heart -renal disorder --> hematuria -seizures or psychosis -anemia, luekopenia -postive antinuclear antibody -oral ulcers -macular rash/ discoid rash

Adrogens:

-contribute to the growth and development of males and females -minor contributor compared to those secreted by the testes and ovaries -patient may have complications in the breast, prostate, or ovarian cancers

HIV life cycle stage 3: AIDS

-the most severe stage of HIV which is now progressed to AIDS -there is a high viral load and may be easily transmmited to others -the patients immune system is damage --> they have almost no CD4 cells left -patients is at an increased risk for opportunistic infections and other serious illnesses d/t decreased CD4 count -without treatment for HIV, people with AIDS typically survive for about 3 yrs -*CD4 count <200*

Risk factors for HHS:

-type II DM --> because they are insulin resistant -age >50 precipitating events: -acute illness -poor insulin compliance or use of medication that affects glucose use

HIV life cycle stage 1: Acute

-usually develops within 2-4 wks after the infection -patient will present with flu like symptoms -the infection multiplies rapidly, and the virus attacks and destroys CD4 cells -the level of HIV in the blood is very high which greatly increases the risk of transmission -the patient in this stage doesn't know they've been infected with HIV -*CD4 count of >500* S/S: -fever -sore throat -swollen lymph nodes -rash -muscle aches -night sweats -mouth ulcers -chills -fatigue -females may have vaginal yeast infections

the nurse is assessing a client with DKA. which clinical manifestations would the nurse expect? select all a. dry skin b. abdominal pain c. kussmal respirations d. absence of ketones in the urine e. BG level of less than 72

a. dry skin b. abdominal pain c. kussmal respirations

Which nursing intervention would be provided to a client who has undergone unilateral adrenalectomy? a. offer a high-sodium diet b. encourage the client to sue saliva-inducing agents c. instruct the client to wear a medical alert bracelet d. administer temporary glococorticoid replacement therapy

d. administer temporary glococorticoid replacement therapy

the nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. which hormone can be impaired in its production because of this disease? a. estrogen b. androgens c. cortisol d. aldosterone

d. aldosterone

When preparing to administer a prescribed subcut does of NPH insulin from an open vial taken from a medication drawer to a client with DM, the nurse notes the solution is cloudy. What action will the nurse preform to ensure client safety? a. warm the vial in a bowl of warm water until it reached normal body temp b. return the vial to the pharmacy and open a fresh vial of NPH insulin c. roll the vial between the hands until the insulin is clear d. check the expiration date and draw up the insulin dose

d. check the expiration date and draw up the insulin dose