Week 3 - Endocrine and DM

The nurse is providing patient education to a high school athlete with diabetes who was seen in the emergency department after a syncopal episode during a basketball game. Which teaching interventions are appropriate for the nurse to provide?

- "Carry a source of quick-acting carbohydrate with you." Exercise lowers blood glucose levels so the nurse should instruct the patient to carry a source of quick-acting carbohydrate to prevent hypoglycemia. - "Obtain a capillary blood glucose level before you exercise." Exercise lowers blood glucose levels, so the nurse should instruct the patient to check his or her blood glucose level before exercise to obtain a baseline reading NOT - "Monitor blood glucose levels every hour when you are exercising." The patient should check the blood glucose level every 30 minutes, not every hour, during exercise.

DB Case study 1 Hanna Zuckerone What dada supports that she has diabetes?

- A1c - Insuling pump

What are the two top priorities for hannah the diabetic pt

- Alteration of electrolyte fluid balance related to fluctuation in glucose - Ineffective coping related to chronic dz - knowledge deficit related to health maintenance

What labs do we monitor for Diabetics?

- Blood sugar - Potassium - Lipid levels - BUN and Creatnine

A client is diagnosed with hyperthyroidism and is treated with I-131. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy induced hypothyroidism. Which would be included in the teaching? (select all that apply) - Fatigue - Dry skin - Insomnia - Weight gain

- Fatigue - Dry skin - Weight gain

What would you do to treat this pt?

- Give pt bolus of fluid to get BP up. Isotonic solution - Lower blood sugar slowly - Dextrose solution - Look out for fluid overload!!

What are nursing priorities for Mr. Pablo?

- Hyper/hypoglycemia - Neuropathy due to Diabetes and smoking - Kidney injury due to diabetes or decrease blood flow to kidneys - knowledge deficit - Alteration to perfusion related to smoking

A pt with HHS (Hyperglycemia Hyperosmolar State) looks like what?

- Hyperglycemia >600 mg/dl with dehydration - Very high serum osmolarity (>350 = coma) - No ketones?

How do you treat a pt with HHS. Hyper glycemia Hyperosmolar state

- IVF resuscitation d/t dehydration (0.9% NaCl to increase blood volume) - Monitor fluids status and Vital Signs - IV insulin D5 - Monitor potassium (cardiac dysrhythmias), assess hourly for s/s of cerebral edema.

A nurse is preparing a patient with suspected diabetes for a fasting blood glucose test. The nurse should ask the patient about which factors?

- Recent acute illness - History of alcohol use - History of recent exercise (can cause glucose lvls to increase) NOT - Recent antibiotic therapy (antibiotics do not affect glucose - Typical daily caloric intake

Sick day rules for diabetics

- Take insulin or oral anti-diabetics as usual. Never eliminate insulin doses - snack in between. - Test blood glucose and test urine ketones every 3 to 4 hours Report glucose levels >300 or urine ketones to provider Supplemental doses of insulin may be needed every 3 to 4 hours(if taken) - If you can't follow usual meal plan, sub soft foods (gelatin, 1 cup cream soup, ½ cup custard, 3 squares graham crackers) 6 to 8 times a day. If vomiting, diarrhea, or fever persists, take liquids (1/2 cup regular soda oj, or broth, 1 cup Gatorade) every ½ hour to 1 hour to prevent dehydration and to provide calories. Report extreme fluid loss to provider - may be dangerous

What stick's out abt Mr. Pablo's case being type 2 D

- cholesterol 200 mg/dL - A1C is 9%

The four methods used to test for diabetes include:

- hemoglobin A1c (HgbA1c) - fasting plasma glucose (FPG) - oral glucose tolerance test (OGTT) - random plasma glucose.

Symptoms of hyperglycemia include:

- polyuria, - polydipsia, - polyphagia - Confused - Dry skin Hot and dry sugar high

Assess the pt

- pt stopped taking insulin and is a state of hyperglycemia (confused) - pt is experiencing metabolic acidosis as evident by low PH and Low HCO2 (you can also see resp trying to compensate Low CO2 and deep breaths) - Hyponatremia due to polyuria. Kidneys are trying to flush out glucose (Ketones are large) - Pt is dehydrated due to polyuria and dry skin

The nurse administers a dose of NPH insulin to a patient at 8:00 am. At which time should the nurse provide a snack or meal?

12:00 pm The peak time for NPH insulin is 4 hours, so the nurse should make sure the patient eats at 12:00 pm

OGTT

A plasma glucose level ≥200 mg/dL or 11.1 mmol/L 2 hours after oral ingestion of a 75-g glucose load confirms a diagnosis of diabetes.

Random plasma glucose (RPG)

A random plasma glucose value ≥200 mg/dL or 11.1 mmol/L is highly indicative of diabetes in a patient with: - polyuria/polydipsia/polyphagia/unexplained weight loss - hyperglycemic crisis In a patient with no symptoms of diabetes and a random plasma glucose value ≥200 mg/dL, the test must be repeated and/or confirmed with one of the other diagnostic tests. If the patient has a random plasma glucose value ≥200 mg/dL and is having symptoms of diabetes, that one abnormal value is considered diagnostic of diabetes.

Diabetics receive insulin lispro frequently when hospitalized. It is known as

Short acting peaks at 2 hours, given more often than daily, mixed with other insulins

FPG

An FPG level ≥126 mg/dL (7.0 mmol/L) confirms a diagnosis of diabetes. Fasting is defined as no caloric intake for at least 8 hours.

What are we worried about with a pt with low potassium

Cardiac dysrhythmias

Hypothyroidism symptoms

Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.

What is the Hypoglycemia 15:15 rule?

Give 15 g of carbs (ex orange juice) if no improvement in 15 min give another 15 g

What is a priority for a pt with DKA Diabetic ketoacidosis

HYDRATE pt isotonic solution DKA is life threatening!!

Hgb A1c

HgbA1c measures what percentage of hemoglobin is coated with glucose (glycated). The higher the HgbA1c, the higher the patient's blood glucose levels have been over the past 90 days.

The nurse is awake that insulin in glargine has the following traits

Long acting, no peak, given once a day, cannot mix with other insulins

The nurse is caring for a patient with diabetes who is also receiving treatment for chronic obstructive pulmonary disease. The nurse should obtain capillary blood glucose levels based on documentation of which medication in the patient's chart?

Prednisone Prednisone is a corticosteroid that can increase blood glucose levels.

The core drug gabapentin is classified as a

anticonvulsant (treat seizures)

Normal A1c is

below 5.7

If BG <20 mg.dL give

glucagon 1 mg IM or SC repeat dose in 10 min if pt is still unconscious

Hyperthyroid symptoms

increased metabolic rate, diarrhea, flushing, increased appetite, muscle weakness, fatigue, palpitations, irritability, nervousness, sleep disorders, heat intolerance, altered menses

Check dr H NOTES

she mentions them a lot in lecture