418 Final

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

what is a normal urine specific gravity?

1.005-1.030

what is a normal specific gravity?

1.010-1.025

what is a normal anion gap?

12-14

how long do we have to transplant a liver after procurement?

12-15hrs

how long do kidney transplant patients typically spend in ICU? total in the hospital?

12-24hrs 4-5 days

how long does a RBC live?

120 days

HHNS is a complication of what type of diabetes?

2

how many physicians must declare a patient brain dead before their organs can be procured?

2

ODS symptoms typically appear how long after rapid elevation of sodium?

2-6 days later

what is the T4:T3 ratio?

20:1

what is a normal bicarbonate/CO2?

23-29

what is a normal total CO2

23-30

when can cadaveric tissue donation take place?

24-48hrs after death

there is a ______% chance that siblings will be exact HLA matches

25; if identical twins, they WILL be exact matches

what is a normal serum osmolarity?

275-295

what IV fluid is used for SIADH?

3% saline (hypertonic)

what is the goal urine output for DKA fluid resuscitation?

30-60mL/hr

what is a normal urine osmolality?

300-1400

how high can blood sugars get with DKA?

300-800

what GCS score triggers the need to call LOPA?

5 or less

HLA matches of _______ are least likely to be rejected

5-6

how do you treat hypoglycemia for the patient with altered LOC?

50 ml of 50% dextrose IVP - given IV push in big bristajet if D50 not available - give glucagon 1mg SQ, IM, or IV follow with infusion of D5W or D10W to achieve a blood glucose >100

how fast should blood glucose drop with DKA treatment?

50-70mg/dL/hr

fluid intake is restricted to how much with SIADH?

500mL less than average daily UO

how high can blood sugars get with HHNS?

600-2000 (commonly over 1000)

how many HLA's are important for transplant and what are they?

6; A, B, and DR (1 of each from both mom and dad)

your patient has DI and weighs 70kg. their serum sodium is 160. what is their water deficit?

6L

when can graft vs host disease occur?

7-30 days after transplant

what is urine specific gravity changed to with DI?

<1.005

what is urine osmolality changed to with DI?

<200

what is serum osmolality changed to with SIADH?

<270

what A1C level is recommended?

<6.5

what is urine specific gravity changed to with SIADH?

>1.030

what UO is characteristic of DI?

>200mL/hr (2-20L/day)

what is serum osmolality changed to with DI?

>295

what are the typical serum osmolarity levels with HHNS?

>310

the anterior pituitary releases what 7 hormones?

ACTH TSH LH FSH PRL GH MSH

what are two endogenous causes of cushing syndrome?

ACTH-secreting pituitary tumor adrenal tumors/ectopic ACTH secreting tumors outside HPA axis

what is another name for vasopressin?

ADH

what are three potential problems with fluid replacement for HHNS/DKA?

CV overload, pulmonary edema, and cerebral edema

describe the bicarbonate buffer system

Carbon dioxide, a by-product of cellular respiration, is dissolved in the blood, where it is taken up by red blood cells and converted to carbonic acid by carbonic anhydrase. Most of the carbonic acid then dissociates to bicarbonate and hydrogen ions

your patient comes into the ER with DKA. you receive the following orders: regular insulin 0.15U/kg bolus now, then 0.1U/kg/hr insulin drip; NS 1,000mL/hr, K+ checks q2h, and bicarbonate 200mL/hr. which order do you implement first?

IV fluids!! NS 1,000mL/hr

what two scores are used for liver transplant urgency determination?

MELD (model for end-stage liver disease) or PELD (pediatric end-stage liver disease)

what can CAV lead to?

MI

DI is diagnosed based on what four things?

UO, serum Na, serum osmolality, and urine osmolality

what does a higher anion gap indicate?

acidosis

how do polyclonal antibodies work?

acts as lymphocyte immune globulin

what type of rejection has the most optimistic prognosis?

acute

describe the treatment for thyroiditis (6)

acute and subacute may resolve in weeks or months without treatment bacterial - antibiotics or surgical drainage NSAIDs can help with symptoms corticosteroids for severe pain propanolol or atenolol (beta blockers) for cardiovascular symptoms related to hyperthyroidism (HTN, palpitations, tachycardia) thyroid hormone replacement therapy for hypothyroid - usually need chronic replacement

what are 6 s/s heart transplant rejection?

SOB fever weight gain from fluid retention less urine production fatigue cardiac allograft vasculopathy

what are four parts of manging goiters?

TSH, T3 and T4 levels to determine if goiter is associated with hyper or hypothyroidism. thyroid antibodies to assess for thyroiditis surgical removal of large goiters - cause compresion of trachea and breathing problems treatment with thyroid hormone may prevent further enlargement

what act regulates organ/tissue donation?

anatomical gift act

what measurement do physicians use to determine whether they are accurately correcting acidosis with DKA?

anion gap

how do monoclonal antibodies work?

anti-antigen receptor antibody that interferes with the function of the T lymphocyte, the pivotal cell in the response to graft rejection

what are three treatments for psychogenic DI?

anti-compulsive meds anxiolytics H2O restriction

how can bacterial thyroiditis be treated? (2)

antibiotics or surgical drainage

what is a hyperacute graft rejection?

antibody mediated recipient already has antibodies against the donor organ, resulting in life-threatening reaction

what are 8 sympathetic responses to hypoglycemia?

anxiety tremors/nervousness cold/clammy skin tachycardia/palpitations hyperventilation n/v hunger diaphoresis

describe the goal of a subtotal thyroidectomy

approximately 90% of the thyroid tissue is removed - leave some of it so it will continue to produce T3 and T4 to have normal levels... doesn't always work, often overdo it and they end up having hypothyroidism

what drug class is cyclosporine in?

calcineurin inhibitor

what drug class is tacrolimus in?

calcineurin inhibitor

sirolimus is typically used in combination with what two drugs?

calcineurin inhibitor (tacrolimus, cyclosporine) and corticosteroids

what does triple immunosuppressant therapy consist of?

calcineurin inhibitor, corticosteroid, and mycophenolate mofetil

what are the most effective immunosuppressants?

calcineurin inhibitors

what type of immunosuppressants serve as the foundation for most regimens?

calcineurin inhibitors

what hormones regulate blood levels of calcium?

calcitonin and parathyroid

what is the treatment for hypocalcemia?

calcium gluconate

what is important to monitor after a patient has a subtotal thyroidectomy?

calcium/parathyroid levels

does hasimoto's onset fast or slow?

can be either fast or slow

how can alcohol consumption increase risk for hypoglycemia?

can inhibit liver's ability to make glucose, so don't have gluconeogenesis; drinking heavily without eating can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia.

how can phenothiazine cause DI?

can lead to sensation of dry mouth

what can myxedema coma result in?

cardiovascular collapse from hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis.

what is trousseau sign?

carpopedal spasm -a spasmodic contraction of the muscles of the hands, feet, and especially the wrists and ankles (as that occurring in alkalosis and tetany) put blood pressure cuff around arm and leave it inflated for a few min, will see spasms of hands/fingers indicates hypocalcemia

what does the adrenal medulla secrete? (2)

catecholamines and peptides

the transplanted heart no longer responds to drugs like atropine and ephedrine. however, what drugs will the heart respond to?

catecholamines; extra sensitive to these

why can DKA cause electrolyte imbalances?

cations are lost with the anionic ketones to maintain electrical neutrality. ketones are negative ions, so positive cations are excreted with anions to maintain neutrality can have electrolyte problems from things like potassium following out into urine

long term survival of liver transplant depends on what?

cause of liver failure

what are three classifications of DI?

cental/neurogenic nephrogenic psychogenic

what are 18 s/s cushing syndrome?

central obesity buffalo hump on back of neck moon face acne poor wound healing purple striae hirsutism - hair where it shouldn't be hypertension weakness amenorrhea impotence headache polyuria & thirst labile moods frequent infections osteoporosis thin, fragile skin hyperglycemia

what can overzealous rehydration with DKA lead to?

cerebral edema

your patient has type 1 diabetes and comes to the ER complaining of a headache, slurred speech, anxiety, tremors, tachycardia, diaphoresis and nausea. what should you do first?

check their blood sugar

what is another name for hashimoto's?

chronic autoimmune thyroiditis

what is the treatment for hypothyroidism associated with thyroiditis?

chronic thyroid hormone replacement

what is hyperthyroidism?

clinical syndrome in which there is sustained release of thyroid hormones by the thyroid gland

what is tetany?

condition that is due usually to low blood calcium (hypocalcemia) and is characterized by severe spasms of the hands and feet, cramps, spasm of the voice box (larynx), and overactive neurological reflexes

how do you determine when DKA is resolved?

continue to check electrolytes, BUN, creatinine, and glucose q 2-4 hours until stable

what are the 6 treatment goals with DKA?

correct fluid/electrolyte balance monitor K+ and supplement dec serum glucose correct acidosis prevent further complications education

what is used for severe pain with thyroiditis?

corticosteroids

what hormones are deficient with secondary adrenocortical insufficiency?

corticosteroids and androgens are deficient but mineralocorticoids rarely are.

what is the most abundant glucocorticoid produced by the adrenal cortex?

cortisol

how can new onset T1DM precipitate DKA?

could be what brings them into ER or PCP initially

why should patients receiving steroids have frequent CBG checks?

could cause cushing syndrome which will increase blood sugar

what is hyperfunction of the adrenal cortex called?

cushing syndrome

why is most thyroid hormone unusable in the body?

it is bound to plasma proteins

how long does glucose remain attached to hemoglobin?

its entire lifespan (120 days)

ketone buildup with DKA results in what four s/s?

ketone breath (fruity) ketonuria (ketones in urine) kussmaul breathing (deep/labored; trying to compensate by blowing off CO2) nausea and vomiting

why does a higher anion gap indicate acidosis?

ketones are an anion and are not measured in electrolyte panel

what are 5 features of DKA?

ketosis acidosis hyperglycemia dehydration electrolyte imbalance

what are the 3 clinical features of DKA?

ketosis, acidosis, and hyperglycemia

what was the first organ to be successfully transplanted?

kidney

HLA matches are most important for what two transplants?

kidney and bone marrow

what 6 organs/tissues can be donated from a living donor?

kidney, bone marrow/stem cell, one or two lobes of liver, lung or part of a lung, part of a pancreas, part of the intestines

what are the three most commonly transplanted organs?

kidney, liver, and heart

what is hypothyroidism?

lack of circulating thyroid hormone

what should you expect regarding urine output after a kidney transplant and why?

large volumes of urine due to establishment of blood supply to new kidney

which kidney is preferred for transplant and why?

left; has longer renal vein

what will serum sodium be like with SIADH?

less than 134

which is more common, levothyroxine or liothyronine?

levo

what are two medications used to treat hypothyroidism?

levothyroxine and liothyronine

what organ is subject to a less aggressive immunologic attack after transplant?

liver

why is bleeding a complication of a liver transplant?

liver makes coagulation products

what four organs can be used in part for transplantation?

liver, lungs, pancreas, and intestines

what does chronic rejection usually result in?

lose the graft

how does chronic rejection manifest with liver transplants?

loss of bile ducts

why do we try to quickly get patients off of corticosteroids within a few years or avoid them entirely after organ transplant?

lots of side effects

how does TSH change with hyperthyroidism?

low

how is bicarbonate/CO2 affected by DKA?

low

how do calcium levels impact PTH secretion?

low calcium levels = inc secretion high = dec secretion

what triggers TSH release and what is it released by?

low circulating T3 and T4; pituitary gland

what causes electrolyte imbalance with DKA?

low pH --> potassium shifts from intra to extracellular in response to low pH... extra potassium is being excreted in urine (so may look normal), so once you finally treat acidosis, K+ will shift back into the cells, resulting in hypokalemia; sodium may look low as pull fluid from intracellular space and lose sodium in urine

what are the three treatments for nephrogenic DI?

low sodium diet <3g thiazide diuretic indomethacin

how are GI toxicities managed for patients taking mycophenolate mofetil?

lower dose or give smaller doses more frequently

with what organ is chronic rejection most common? where is is most rare?

lung liver

what method is used for the lung transplant waitlist?

lung allocation score

where are ectopic ACTH secreting tumors typically located? (2)

lung/pancreas

how does mycophenolate mofetil work?

lymphocyte specific inhibitor of purine synthesis suppressive effects on both T and B lymphocytes

how will WBC be affected by addison's disease?

lymphocytes increased (subtype of leukocytes)

why is it important to monitor calcium levels after thyroidectomy?

may accidentally remove or injure parathyroid gland, so can have crisis hypocalcemia!

patients severely affected with ODS may experience what?

may become "locked in"; they are awake but are unable to move or verbally communicate. they can usually move their eyes and blink

why is it important for the patient with exophthalmos to maintain eye moisture via saline drops, ointments, or even taping the eyes shut?

may not be able to close eyes which moistens the sclera, so will have dry sclera and risk for corneal abrasion

how can thyroid storm occur post-op?

may release some hormone with destruction of gland

why don't we measure bicarbonate regularly with labs?

measure serum total CO2 instead, which includes bicarb and other CO2 forms (dissolved and carbonic acid)

what is an acute rejection?

mediated by t-cytotoxic lymphocytes, activated against donor tissue

how do you treat cushing syndrome for patients that are not candidates for surgery?

medical adrenalectomy with drugs to suppress the synthesis and secretion of cortisol from the adrenal gland

what is gluconeogenesis?

metabolic pathway in the liver that results in the generation of glucose from non-carbohydrate carbon substrates such as lactate, glycerol, and glucogenic amino acids

T3 and T4 regulate what 6 things?

metabolic rate caloric requirements oxygen consumption carb/lipid metabolism growth/development brain function

what are four causes of psychogenic DI?

middle-aged women psychiatric illness phenothiazine structural lesion in thirst center

PRL has what 6 functions?

milk production immune system maintenance puberty ovulation libido fertility

what is the treatment for subclinical hyperthyroidism?

monitor and recheck

how long does it take for chronic rejection to occur?

months to years

describe the relationship between bicarb and CO2 lab values

most of the CO2 in serum is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level; if CO2 is low, their bicarb is prolly low!

what are 13 s/s hypocalcemia?

muscle aches/cramps tingling, burning, or numbness in fingertips, toes, and lips muscle spasms, esp around the mouth dysphagia voice changes wheezing/bronchospasm patchy hair loss dry skin brittle nails fatigue anxiety/depression trousseau sign chvostek's sign

why does hypocalcemia result in muscle aches and spasms?

need calcium for normal muscle contraction

describe the procedure for an open live donor kidney procurement

nephrectomy performed by a urologist or transplant surgeon begins an hour or two before the recipient's surgery is started rib may need to be removed for adequate view takes about 3 hours if open

what three things cause central/neurogenic DI?

neurosurgery, traumatic brain injury, tumors

your patient is recovering from a heart transplant and is on tacrolimus, mycophenolate mofetil, and a corticosteroid. they begin to complain of a HA, paresthesia, and tremors. what do you suspect?

neurotoxicity from tacrolimus, a calcineurin inhibitor

what is graft vs host disease?

newly transplanted donor's cells attack the recipient's body

what is the treatment for chronic rejection?

no definitive therapy; primarily supportive

what are 3 types of goiters?

nontoxic nodular toxic nodular

what two catecholamines are released by the adrenal medulla?

norepinephrine and epinephrine

how is sodium affected by DKA?

normal or low

how is K+ affected by DKA?

normal, low, or elevated

describe the pathophysiology of DI

normally, when serum osmolality rises above 290mOsm/kg H2O, the synthesis and release of ADH is triggered. In DI, no ADH is released and the kidney is incapable of concentrating urine and retaining water.

what is psychogenic DI?

not really ADH problem, but patient drinks too much; compulsive drinking >5L/day

what is cardiac allograft vasculopathy (CAV)?

o accelerated coronary artery disease-like process characterized by vascular injury induced by a variety of noxious stimuli, including the immune system response to the allograft, ischemia-reperfusion injury, viral infection, immunosuppressive drugs, and classic risk factors such as hyperlipidemia, insulin resistance, and hypertension

what are 3 risk factors for hypoglycemic unawareness?

older patient frequent episodes of hypoglycemia beta blockers

where is the adrenal gland located?

on top of the kidneys

even with the large number of people signed up as organ donors, why is there still a severe organ shortage?

only 3/1,000 people die in a way that allows for solid organ donation

describe chronic rejection

organ is infiltrated with t and b cells characteristic of chronic, low-grade immune-mediated injury; results in fibrosis and scarring

why is geographic location important to consider when matching an organ donor to a recipient?

organ must get to recipient in specific window of time

what does rapid sodium correction result in?

osmotic demyelination syndrome

your patient is receiving hypertonic saline for SIADH treatment. their sodium level pre-treatment was 128. 8 hours after starting treatment, their sodium levels increased to 140. after 24 hours, their serum sodium was 150. after 48 hours, the patient begins to exhibit dysarthria, dysphagia, confusion, lethargy, and difficulty moving. what do you suspect?

osmotic demyelination syndrome

why are people with cushing syndrome at risk for fractures?

osteoporosis

what is diabetes insipidus characterized by?

output of vast quantities of very dilute urine and increased serum osmolality due to dehydration (1-2L of urine/hr that's very clear)

what are four causes of goiters?

overactive thyroid lack of iodine in diet certain drugs certain foods

the posterior pituitary releases what two hormones?

oxytocin vasopressin (ADH)

describe bicarbonate dosing for DKA

pH < 6.9 - NAHCO3 (100 mmol in 400ml) and infuse at 200 ml / hr ) pH 6.9 - 7.0 - NAHCO3 (50 mmol in 200ml and infuse at 200 ml / hr ) pH of 7.0 - no NAHCO3

what are five s/s thyroiditis?

pain localized in thyroid or radiating to throat, ears, or jaw fever chills sweats fatigue

what releases parathyroid hormone?

parathyroid glands

what is the anatomical gift act?

passed in the US in 1968 and has since been revised in 1987 and in 2006; sets a regulatory framework for the donation of organs, tissues, and other human body parts in the US.; helps regulate body donations to science, medicine, and education; HCPs required to report all deaths to organ procurement agency

what is an autologous stem cell transplant?

patients receive their own stem cells back after myeloablative chemotherapy. use when there is no suitable allogenic donor or to avoid problems of rejection or graft vs host disease

a subtotal thyroidectomy is indicated in what three cases?

patients unresponsive to anti-thyroid therapy patients with large goiters thyroid cancer

what is Hgb A1C?

percentage of hemoglobin with glucose attached to it

which cells are more mature, bone marrow stem cells or peripheral stem cells?

peripheral

what is thyrotoxicosis?

physiologic effects of hyper metabolism from excesses of circulating T3 or T4

what does oxytocin do? (2)

plays a crucial role in the childbirth process and also helps with male reproduction

thyroid storm/thyrotoxicosis commonly occurs in what two cases?

post-op thyroidectomy or chronic hyperthyroidism

how do calcineurin inhibitors work?

prevent cell-mediated attack against transplanted organ

after organ transplant, what is the goal of immunosuppressants?

prevent rejection while maintaining sufficient immunity to prevent overwhelming infections

what is the difference between primary and secondary adrenocortical insufficiency?

primary is a problem with the adrenal gland itself; secondary is a lack of pituitary ACTH secretion

what is another name for psychogenic DI?

primary polydipsia

how will TSH, T3, and T4 be affected by primary hypothyroidism? secondary?

primary: high TSH, low T3 and T4 secondary: all low

where is ADH produced and stored?

produced in the hypothalamus and stored in the posterior pituitary

what does diabetic ketoacidosis result from?

profound deficiency in insulin

what is myxedema coma?

progression of the mental sluggishness, drowsiness, and lethargy of hypothyroidism to notable impairment of consciousness or coma.

what is PRL?

prolactin; hormone secreted by the pituitary gland that stimulates lactation (milk production)

what is the purpose of androgens? (3)

promote growth spurt in adolescence, secondary sex characteristics, and libido in both sexes

extrapontine involvement of ODS can have what five s/s?

psychiatric disturbances, catatonia, postural limb tremor, myoclonic jerks, and a parkinsonian picture with choreoathetosis or dystonia that responds to dopaminergic treatment

how often should sodium levels be assessed with SIADH treatment?

q4h

what is primary hypothyroidism? secondary?

r/t destruction of tissue, so problem in thyroid itself have high TSH pituitary disease with low TSH (usually)... tumors, disease processes, etc

what three things indicate an acute phase of addison's disease, AKA addisonian crisis?

rapid worsening of chronic symptoms fever LOC changes

should fluids be replaced rapidly or slowly for DI?

rapidly

what determines whether CNS or SNS symptoms predominate with hypoglycemia? (2)

rate of onset and patient's age

what is the treatment for thyroid storm?

reduce circulating thyroid hormone with PTU, methimazole; treat fever, replace fluids, beta blockers, etc

describe typical insulin dosing for DKA

regular insulin @0.15 units/kg bolus, then....0.1 unit/ kg /h by infusion - will have sliding scale to follow with q1h ABGs if serum glucose doesn't fall by 50 - 70 mg/dL in one hour double the infusion the insulin infusion rate should be doubled every hour until a steady decline in serum glucose of this magnitude is achieved. when serum glucose reaches 200- 250mg/dl add dextrose to saline solution

what does aldosterone do?

regulates sodium and potassium to maintain ECF volume

how does pH change with HHNS?

relatively normal unless in shock with lactic acidosis from dehydration

what is the only treatment for hyperacute rejection?

removal of the graft

sirolimus is typically given for what type of organ transplants?

renal

what three things cause nephrogenic DI?

renal disease, genetic predisposition, or lithium

what does aldosterone act on and how?

renal tubules of the kidney; tells it to reabsorb sodium and excrete potassium/hydrogen

what are the two means of treating addison's disease?

replace gluco/mineralocorticoids IV solu-cortef with D5

how is potassium corrected with addison's disease?

replace mineralocorticoids to manage fluid/electrolyte balance

what does the anatomical gift act require HCPs to do?

report all deaths (or predicted deaths) to organ procurement agency

what is the goal of hypothyroidism treatment?

restoration of a euthyroid state with hormone replacement therapy

what causes weight gain with SIADH?

retaining fluid

what causes HTN with cushing syndrome?

retaining of sodium

what food is a good source of iodine?

seafood

is TSH deficiency a primary or secondary cause of hypothyroidism?

secondary

how do primary and secondary adrenocortical insufficiency present differently?

secondary does not have hyperpigmentation

what is a nodular goiter?

secrete thyroid hormone independent of TSH (not stimulated by TSH, just release on their own) usually benign follicular adenomas

HHNS most often occurs in type 2 diabetics with what characteristics?

sick elderly with comorbidities

describe how HHNS is different from DKA

similar to DKA in that they have high blood sugar, osmotic diuresis, and dehydration... difference is no ketoacidosis/metabolic acidosis unless it's lactic acidosis from dehydration

what are three target organs of graft vs host disease?

skin, liver, GI tract

is symptom onset fast or slow with HHNS?

slow

what can we do to prevent ODS with SIADH treatment?

slow and steady sodium replacement

how does the heart's response to hemodynamic changes differ after transplant and why?

slower due to dennervation of sympathetic and parasympathetic nervous systems

do we want to decrease blood sugar quickly or slowly with HHNS?

slowly

should sodium be replaced quickly or slowly with SIADH?

slowly

when is ADH primarily released? (1) when is it secondarily released? (2)

small increases in serum osmolality hypovolemia and hypotension

how do we correct acidosis for DKA?

sodium bicarb IV

what medication is used via IV inpatient for addison's disease?

solu-cortef

what two peptides are released by the adrenal medulla?

somatostatin and substance P

the high blood sugar levels of HHNS can lead to what 5 neuro manifestations?

somnolence, coma, seizures, hemipariesis and aphasia

what is chvostek's sign?

spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland; seen in tetany with hypocalcemia

what is cushing syndrome?

spectrum of clinical abnormalities caused by excess corticosteroids, particularly the glucocorticoids

in patients with pontine involvement of ODS, what s/s occur early on?

speech abnormalities occur early and persist, and patients often become mute

what is DKA?

state of intracellular dehydration that results from elevated blood sugar and osmolality, causing diuresis and ketone production, resulting in acidosis

graft vs host disease is commonly associated with what type of transplant?

stem cell

what is an allogenic stem cell transplant?

stem cells are acquired from a donor who, through HLA tissue typing, has been determined to be HLS matched to the recipient

what is a peripheral stem cell transplant?

stem cells taken from the blood stream and reinfused into recipient; these stem cells are more mature

what is a bone marrow transplant?

stem cells taken from the bone marrow and injected into recipient bone marrow

how does indomethacin work for nephrogenic DI?

steroid that increases renal responsiveness to ADH

addisonian crisis is triggered by what four things?

stress sudden withdrawal of corticosteroid hormones adrenal surgery sudden pituitary gland destruction

what 6 things increase cortisol levels?

stress, burns, infection, fever, acute anxiety, and hypoglycemia

what are two types of thyroiditis?

subacute granulomatous thyroiditis acute thyroiditis

what are goitrogens?

substances (whether in drugs, chemicals, or foods) that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland

does DKA onset suddenly or gradually?

suddenly (within hours)

how can hypoglycemia lead to a coma?

sugar drops too low and brain needs glucose to function, so goes into coma

how is myxedema coma treated? (2)

support of vital functions IV thyroid hormone replacement

what is a xenograft?

surgical graft of tissue from one species to an unlike species (or genus or family). a graft from a baboon to a human is a xenograft

how do you treat cushing syndrome caused by an adrenal tumor?

surgical removal of adrenals; need long-term replacement of hormones

what is the etiology of hyperthyroidism?

sustained increase synthesis and release of thyroid hormone

what hypoglycemia symptom is typically not blocked by beta blockers?

sweating

how will rapid onset hypoglycemia present? slow onset?

sympathetic response like sweating and shaking will predominate CNS symptoms like neuro changes predominate

why do blood sugars get so high before symptoms are recognized with HHNS?

symptom onset is slow

what is treatment for hyperthyrodism based on?

symptoms

describe the pathophysiology of hypoglycemia

symptoms are related to insufficient levels of glucose for the brain (altered LOC) and catecholamine effects

what is SIADH?

syndrome of inappropriate antidiuretic hormone; over secretion of ADH

what is liothyronine?

synthetic T3

what is levothyroxine?

synthetic T4

what are two examples of calcineurin inhibitors?

tacrolimus and cyclosporine

what are 6 s/s thyroid storm?

temp up to 105.3, restlessness, agitation, seizures, delirium, coma

what makes a lung transplant successful?

the ability to wean the patient off the vent

what is myxedema and when does it occur?

the accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues may occur with severe longstanding hypothyroidism

describe the pathophysiology of DKA

the deficit of insulin causes the inability of glucose to move into the cell increasing serum glucose levels gluconeogenesis and glycogenolysis occur in the liver further increasing hyperglycemia (in response to cells starving for glucose) elevated serum glucose leads to increased intravascular osmotic pressure which draws fluid from intracellular space >>kidneys excrete glucose, ketones and water (osmotic diuresis)>>loss of electrolytes and dehydration to compensate: renin- angiotensin-aldosterone and ADH are active>>decrease in urine output and increased BP (become dehydrated) finally, compensatory mechanisms are exhausted leading to cardiovascular collapse from severe dehydration; can go into diabetic coma a breakdown of fatty acids leads to a buildup of ketones decreasing the pH (as low as 7.2)

cardiac allograft vasculopathy is induced by what 5 things?

the immune system response to the allograft, ischemia-reperfusion injury, viral infection, immunosuppressive drugs, and classic risk factors such as hyperlipidemia, insulin resistance, and hypertension

what is the bicaval approach to heart transplant?

the right atrium of the recipient's heart (with SA node and maintenance of atrial conduction) is preserved, and then donor heart is connected - results in 2 P waves

why don't atropine and ephedrine work for patients with heart transplants?

these drugs act on the vagolytic mechanism, which no longer directly innervates the heart

why is it important to monitor renal function with calcineurin inhibitors?

they are nephrotoxic

why are patients at high risk for infection following organ transplant?

they are on immunosuppresants to prevent rejection

what is TSH?

thyroid stimulating hormone; stimulates thyroid to release T3 and T4

what is another name for thyrotoxicosis?

thyroid storm

what is an allograft?

tissue graft from a donor of the same species as the recipient but not genetically identical

why do we give beta blockers for graves disease?

to relieve symptoms

how do you treat cushing syndrome caused by a pituitary tumor?

trans sphenoidal resection of tumor; go in through nose and suck it out

what are two other names for CAV?

transplant coronary artery disease or cardiac transplant vasculopathy

what is the target of treatment for cushing syndrome?

treat the cause

with stem cell transplants, many patients die from what two things?

treatment-related complications or from recurrence of the original disease

true or false? ODS is irreversible most of the time

true

true or false? acute rejection reactions are common with organ transplantation

true

true or false? for cadaver donors with a perfect recipient match, one kidney MUST be sent to that recipient regardless of where they are geographically or on waiting list

true

true or false? laparoscopic nephrectomies are the primary method of live donor kidney procurement

true

true or false? little can be done to modify the course of graft vs host disease

true

true or false? living organ donors are usually family members of the recipient

true

true or false? most thyroid nodules are benign

true

true or false? the liver can be transplanted from a live donor

true

true or false? thyroid storm is a life threatening emergency

true

true or false? graft vs host disease can occur with blood products

true, if product contains lymphocytes

true or false? if the patient is signed up as an organ donor, LOPA does not need consent from the family before procuring the organs

true, technically... but they usually approach the family anyway to explain everything

true or false? for a heart-lung transplant, there is a better chance that something will become available versus an individual heart or lung transplant

true; maintained on both waitlists, and if one becomes available, the other comes with it

true or false? there is no adequate treatment for graft vs host disease

true; steroids are used, but increase risk for infection

what is central obesity?

truncal obesity with skinny arms and legs

deficient growth hormone will have what 6 s/s?

truncal obesity, decreased muscle mass and strength, weakness, fatigue, depression, flat affect.

how do you treat cushing syndrome caused by an ectopic ACTH secreting tumor?

tumor resection

what are 7 causes of hypopituitarism?

tumors, lymphoma, metastases, infections (TB, syphilis), postsurgical resection, TBI, radiation of brain

besides bone marrow and the bloodstream, where can stem cells be acquired?

umbilical cord blood

what are 8 s/s of lung transplant rejection?

unable to extubate flu-like symptoms cough/chest pain fatigue fever shortness of breath decreased incentive spirometry decreased oxygen saturation

how is addisonian crisis treated?

unresponsive to usual treatment for circulatory collapse... fluids and vasopressors won't work! need corticosteroid replacement

how quickly should sodium levels increase with treatment for SIADH?

up to 12 in first 24hrs with total rise of 18 in 48hrs

with DKA, where can ketones be found?

urine and serum

what is the anion gap measurement?

usually for every cation, we have a balancing anion, so should be equal; don't measure all the anions in the serum, so we call that the anion gap and there's a certain amount that is normal; just know that physicians use this to determine if they're correcting the acidosis

where is the transplanted kidney placed and how is it connected?

usually placed extra-peritoneally in the iliac fossa and connected to internal iliac artery and vein

what do desmopressin, vasopressin, and lypressin do?

vasoconstrict

what does preparation for a stem cell transplant consist of?

very high doses of chemotherapy with or without radiation therapy to kill off existing bone marrow

wha causes subacute granulomatous thyroiditis?

viral infection

ADH is released in response to what three things?

volume depletion, increased serum osmolality (dehydration), and hypotension

what are three treatments for HHNS?

volume resuscitation, electrolyte correction, and insulin to get sugar down

what is the difference between cadaveric donation and brain death/cardiac death donation?

we are more limited with what we can obtain from cadavers... we can only get certain tissues and organs, not so much solid organs. with brain death or DCD, can get solid organs

deficient ACTH will have what 7 s/s?

weakness, fatigue, headache, dry and pale skin, diminished axillary and pubic hair, lowered resistance to infection, fasting hypoglycemia (cortisol deficiency)

how do you treat cushing syndrome caused by high doses of steroids?

wean them down or stop if possible

after how long can acute and subacute thyroiditis resolve on its own?

weeks or months

what are 5 s/s SIADH?

weight gain lethargy anorexia n/v severe neuro changes with sodium <120

what is hypoglycemic unawareness?

when a person does not experience the warning signs and symptoms of hypoglycemia until the glucose levels reach a critical point (like a coma)

what does parathyroid hormone do?

when calcium levels are low, this triggers pulling of calcium from bone stimulates transfer of calcium from bone to blood inhibits bone formation triggers calcium reabsorption and phosphate excretion in the kidney activates vitamin D

when do severe neuro changes occur with SIADH?

when sodium drops below 120

when are benign thyroid nodules dangerous?

when they cause tracheal compression

when is mycophenolate mofetil most effective?

when used in conjunction with tacrolimus or cyclosporine

what should you first determine when deciding how to treat hypoglycemia?

whether they are conscious or not

what is the difference between brain death donors and cardiac death donors?

with brain death, all support is left on the patient so organs can perfuse during the procedure and they are kept "alive" with DCD, support is withdrawn and expect pt to pass within an hour

with DKA, what do we do to correct hyperkalemia?

with insulin therapy, potassium will be driven back into cells

how quickly does an acute rejection occur?

within days to months

how quickly does hyperacute rejection occur?

within minutes to hours

deficiency of FSH and LH will have what 3 s/s in women? what 6 s/s in men?

women: menstrual irregularities, loss of libido, changes in secondary sex characteristics such as decreased breast size men: testicular atrophy, diminished spermatogenesis, loss of libido, impotence, decreased facial hair and muscle mass

describe how graft vs host disease affects the skin, liver, and GI tract

· Skin painful pruritic rash starting with hands and feet. Can become generalized. · Liver - mild jaundice with elevated liver enzymes to hepatic coma · GI - mild to severe diarrhea, severe abdominal pain, GI bleeding, and malabsorption

the parkinsonian symptoms that can occur with ODS can be treated with what?

dopaminergic treatment

what are 13 s/s DKA?

dry mouth polyuria polydipsia polyphagia n/v abd pain dehydration dry skin flushed hypotension tachycardia acetone breath mental confusion/LOC changes

what can exophthalmos result in?(5)

dry/irritated corneal surface ulcers loss of vision muscle weakness diplopia

describe the s/s myxedema (6)

dull, puffy skin coarse, sparse hair peri-orbital edema prominent tongue mask-like effect dec CO/contractility - HF

what are 11 s/s ODS?

dysarthria, dysphagia, paraparesis or quadriparesis, behavioral disturbances, movement disorders, seizures, lethargy, confusion, disorientation, obtundation, and coma

when should levothyroxine be scheduled and why?

early morning before breakfast; food will inhibit absorption, so take on empty stomach

decribe typical potassium dosing for DKA

if K+ < 3.3 mEq/L, hold insulin and give 40 mEq K+ per hour (insulin drives K+ into cells, so need to correct first so we don't drop it even more) if K+> 5.0 do not give K+ but check levels q 2 hours (as you correct the acidosis, will drop) if K+ is between these values, give 20 -30 mEq K+ in each liter of fluid.

what IV fluids should you use for DKA based on the client's BP?

if high or normal switch to 0.45% saline. If low, continue with 0.9% saline.

what makes thyroid hormone biologically active?

if it is free - not bound to plasma protein

when would a goiter need to be surgically removed?

if obstructing trachea and causing breathing problems

describe the process for DCD

if patient is expected to pass within an hour of withdrawing life support, will take them down to the OR, withdraw support, then wait to see if they die within a certain amount of time... if they do, then organs can be procured

how can insulin pumps lead to DKA?

if they malfunction, battery dies, needle disconnects, etc

what drug class is sirolimus in?

immunosuppresant

what is the treatment for acute rejection?

immunosuppressants

what causes exophthalmos with hyperthyroidism?

impaired venous return, causing edema and swelling and inc fat deposits in orbital tissue/ocular muscles

why do breathing patterns differ between DKA and HHNS?

in DKA< have kussmaul since trying to blow off CO2; in HHNS, have shallow breathing

how does growth hormone deficiency present differently in adults vs children?

in adults, findings are subtle and nonspecific, while in children we will see changes in growth and development

where is the thyroid gland located?

in the neck

what does LH do in women? men?

in women, LH helps regulate the menstrual cycle and egg production in men, LH stimulates the production of testosterone, which plays a role in sperm production.

what are 6 severe neuro changes that take place when serum sodium drops below 120 from SIADH?

inability to concentrate, confusion, seizures, decreased LOC, coma, death

what is central/neurogenic DI?

inability to secrete an adequate amount of ADH

describe the pathophysiology of SIADH

inc ADH release leads to inc water reabsorption, inc intravascular volume, and dilutional hyponatrema/dec serum osmolality

what can the dehydration of DKA lead to?

inc Bun/Creatinine (become prerenal and can have intrarenal AKI if not treated)

what causes the bruit with hyperthyroidism?

inc vascularity of thyroid

how will ESR be affected by addison's disease?

increased

how will WBC be affected by cushing syndrome?

increased

how will glucose be affected by cushing syndrome?

increased

how will potassium be affected by addison's disease?

increased

how will sodium be affected by cushing syndrome?

increased

what is urine osmolality changed to with SIADH?

increased

how is serum osmolality affected by DKA?

increased >290

what causes hyperpigmentation of the skin with addison's disease?

increased secretion of β-lipotropin (which contains melanocyte-stimulating hormone.); pituitary still works and is secreting ACTH which causes this

how does epinephrine affect glucose metabolism?

increases glucose production by stimulating both glycogenolysis and gluconeogenesis from amino acids, glycerol, and pyruvate. increases the delivery of these gluconeogenic substrates from the peripheral tissue, inhibits glucose utilization by several tissues, and, via the alpha-2-receptors, inhibits insulin secretion

what are polyclonal antibodies used for after organ transplant? (2)

induction therapy (to initially suppress them) or to treat acute rejection.

what is the biggest problem with graft vs host disease?

infection

myxedema coma is precipitated by what four things?

infection drugs exposure to cold trauma

what are two risks of stem cell transplants?

infection and bleeding dyscrasias

thyroid storm can be triggered by what three things?

infection, trauma (surgery), or stressors

what are 9 precipitating factors for HHNS?

infection/sepsis/illness diet controlled DM (not on insulin but need it) pancreatitis trauma severe diarrhea severe burns peritoneal dialysis MI hypertonic feedings

immunosuppressants put patients at risk for what two things?

infections and malignancies/cancers

what are four adverse reactions to calcineurin inhibitors?

infections, malignancy, nephrotoxicity, neurotoxicity

what is urine output changed to with DI?

1-1.5L/hr

true or false? patients with recurring infections like viral hepatitis are not candidates for liver transplant

false; still a candidate, but infection may recur

does thyroiditis onset fast or slow?

fast

deficiency of TSH will have what 5 s/s?

fatigue, cold intolerance, constipation, lethargy, weight gain (mild hypothyroidism)

what are the s/s hypothyroidism? (7)

fatigue/lethargy slowed memory low exercise tolerance constipation cold intolerance hair loss thin, coarse hair

describe what you must be prepared to do when calling LOPA about your patient

have chart nearby to provide info about patient and document referral number in chart and give to nursing supervisor

what is the most common cause of cushing syndrome?

iatrogenic administration of exogenous corticosteroids (prednisone, hydrocortisone, dexamethasone)

why does HHNS not have ketoacidosis like DKA even though they both occur as a result of high blood sugar?

HHNS occurs in type 2 diabetics, and type 2 usually make SOME insulin, enough to prevent fatty acid breakdown and production of ketones

is the mortality rate higher with DKA or HHNS? why?

HHNS; probably since it targets the sick elderly specifically while DKA targets young population as well

what thyroid hormone is produced the most?

T4

what is the difference between T3 and T4?

T4 has a longer half life, but T3 is 3-4x stronger

describe the volume replacement regimen for DI treatment (formula)

(0.6 [kg weight]) X (Serum Sodium-140) = 140

DKA usually occurs with what type of diabetes?

1

what is a normal urine output per day?

1-1.5L

how long do we have once the heart is procured to transplant it without extra preservation means?

4-6hrs

how much time do we have to transplant lungs after procurement without extra technology?

4-6hrs

what 5 aspects go into matching donors with recipients?

ABO group HLA geographic location body size severity of condition of recipient

what kind of IV fluid is solu-cortef mixed with?

D5 solution

what drug is used most often for central DI?

DDAVP/desmopressin

high anion gaps are caused by what 3 abnormal things? what are 3 normal causes?

DKA, lactic acidosis, and uremia diarrhea, hypokalemia, renal tubular acidosis

what is mycophenolate mofetil limited by?

GI toxicities (NVD)

what organization regulates tissue and organ transplants in louisiana?

LOPA

what five electrolytes are lost in the urine with HHNS?

Na, K, Mg, Ca, Ph

which is better for an acute hyperthyroidism crisis, PTU or methimazole? what about for chronic management?

PTU methimazole

what are four treatments for graves disease?

PTU methimazole iodine beta blockers

what 6 drugs are goitrogens?

PTU (propylthiouracil) tapazole sulfonamides salicylates lithium amiodarone

what two drugs inhibit the release of T3 and T4?

PTU and tapazole

what's the difference between PTU and methimazole?

PTU is more effective and works faster in a crisis, but TID dosing so less convenient; methimazole is once a day and better for chronic management

what 3 hormones are released by the thyroid?

T3, T4, and calcitonin

what is graves disease?

autoimmune disorder of unknown cause that causes development of antibodies to TSH receptors

what can cause hypoglycemic unawareness?

autonomic neuropathy

what are six contraindications to organ transplantation?

disseminated malignancies (cancer with metastasis), refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders

what is osmotic demyelination syndrome?

a degenerative process that erodes away the myelin sheath that normally protects nerve fibers. demyelination exposes these fibers and appears to cause problems in nerve impulse conduction that may affect many physical systems.

thyroiditis frequently causes what?

a goiter

where may pain be experienced with addisonian crisis? (3)

abdomen, lower back, or legs

what makes a kidney transplant successful?

ability of kidneys to concentrate urine

what makes a heart transplant successful?

ability to maintain hemodynamic stability without drugs like epinephrine

what is hypoglycemia?

abnormally low blood glucose level (<70mg/dl)

what serum sodium is characteristic of DI?

above 145

what serum osmolality is characteristic of DI?

above 295

how does chronic rejection manifest with heart transplants?

accelerated coronary artery disease

what is primary adrenocortical insufficiency called?

addison's disease

what is acute adrenocortical insufficiency called?

addisonian crisis

what is nephrogenic DI?

adequate ADH but the inability of the nephrons to respond to ADH.

what is hypofunction of the adrenal cortex called?

adrenocortical insufficiency

what is ACTH?

adrenocorticotropic hormone; stimulates adrenal gland

what is the most abundant mineralocorticoid released by the adrenal cortex?

aldosterone

what causes ketone production in DKA?

all cells except brain cells need insulin to use glucose, so if not brought in by insulin, begins to break down fat and results in byproduct ketones in blood, which are acids and cause metabolic acidosis

what are three types of stem cell transplants?

allogenic syngeneic autologous

what is a syngeneic stem cell transplant?

allogenic from one identical twin to the other

what antiarrhythmic can cause thyroid problems such as goiters?

amiodarone

where do muscle spasms especially occur with hypocalcemia?

around the mouth

why may patients with hashimoto's have a transient phase of hyperthyroidism before they become hypothyroid?

as antibodies destroy thyroid tissue, may leak thyroid hormone

why is it important to monitor K+ and supplement as needed for DKA treatment?

as we correct acidosis, potassium will shift back into cells and will drop, so need to monitor and adjust frequently

the risk for ________ increases as LOC changes with drops in sodium from SIADH

aspiration

swallowing dysfunction from ODS can lead to what?

aspiration pneumonia and respiratory failure

what IV fluids are used for DKA?

at first, NS for low BP or 0.45% saline for high/normal BP, then when glucose gets to 250 will switch to D5 1/2NS...

what is the usual cause of addison's disease?

autoimmune adrenalitis, destroying the adrenal cortex and causing a loss of hormones

what causes acute thyroiditis?

bacterial/fungal infection

what urine osmolality is characteristic of DI?

below 100, with SG <1.005

what is urine output changed to with SIADH?

below normal

what may high PRL (hyperprolactinemia) be caused by?

benign tumor in the pituitary gland called a prolactinoma

what medications will mask s/s hypoglycemia?

beta blockers like propanolol and atenolol

what is used for cardiovascular symptoms of thyroiditis related to hyperthyroidism?

beta blockers like propanolol or atenolol

what are two advantages of kidney transplants from live donors?

better graft survival rate elective surgery, so can find the best match and schedule it when they are in good health

what are the two approaches to heart transplants?

biatrial and bicaval

what comprises most of the body's CO2 content?

bicarb

what heart transplant approach results in 2 P waves and why?

bicaval; right atrium of the recipient's heart (with SA node and maintenance of atrial conduction) is preserved

what are 3 complications post-op liver transplant?

bleeding, infection, and rejection

how do PTU and methimazole work?

block the synthesis of thyroid hormones.

how do beta blockers increase risk for hypoglycemia?

blocks sympathetic response, which helps manage hypoglycemia... may not recognize symptoms of hypoglycemia

how is bicarb measured with ABGs?

blood gas machine measures pH and pCO2 and then calculates a bicarbonate value using the Henderson-Hasselbalch equation

how do you treat hypoglycemia for the conscious patient?

blood glucose < 70 15 -20 g simple sugar (orange juice, candy, honey, etc) blood glucose < 50 20-30 g simple sugar recheck blood glucose 15 -20 minutes and repeat sugar as needed keep precipitating factors in mind since insulin will keep working and could have another drop... may need to put on drip of D10W until insulin wears off and do frequent CBG checks 4oz sweetened CHO beverage, unsweetened fruit juice, 1 tbsp honey, pieces hard candy, etc.

do goiters occur with hyperthyroidism, hypothyroidism, or both?

both

what are the four types of organ donors?

brain death donation after cardiac death cadaver donor (after death) living donor

what are stem cells?

brand new cells that have not differentiated

what is a corticobulbar sign of ODS?

brisk jaw jerk

what are 9 foods that are goitrogens?

broccoli brussel sprouts cabbage cauliflower kale mustard peanuts strawberries turnips

how does chronic rejection manifest with lung transplants?

bronchiolitis obliterans

what is exophthalmos?

bulging of the eyes

true or false? after kidney transplant, patients put out a lot of urine since they've been retaining fluids before the transplant, so it is important to continue to restrict fluids in order to promote this diuresis process

false; need to replace fluids as they are lost or else they could become prerenal and have ATN

what is the biatrial heart transplant approach?

damaged heart removed at midatrial level and donor heart connected at the left atrium, pulmonary artery, aorta, & right atrium

what are 9 CNS s/s of hypoglycemia?

dec ability to reason/remember changing mental status emotional lability HA dizziness slurred speech loss of coordination/proprioception numbness coma

how do thiazide diuretics work for nephrogenic DI?

dec flow to ADH-sensitive distal nephrons, which encourages salt and water reuptake

how will glucose be affected by addison's disease?

decreased

how will potassim be affected by cushing syndrome?

decreased

how will sodium be affected by addison's disease?

decreased

how will plasma cortisol be affected by addison's disease?

decreased <5 at 0800

what is kussmaul breathing and why is it present with DKA?

deep/labored; trying to compensate for acidosis by blowing off CO2

what is glycogenolysis?

degradation of glycogen, which is the main storage form of glucose in the body

a sudden decrease in urine output after kidney transplant may indicate what four things?

dehydration rejection urine leak into peritoneal space obstruction from hyperplasia, kinking, etc

what causes the dry mucous membranes and loss of skin turgor with HHNS?

dehydration from polyuria

what two androgens are released by the adrenal cortex?

dehydroepiandrosterone (DHEA) and androstenedione

what causes abdominal pain, nausea and vomiting with HHNS?

delayed gastric emptying caused by hyperglycemia

why is presentation of hypopituitarism variable?

depends on which hormones are deficient

what three drugs may be used for central/neurogenic DI?

desmopressin (DDAVP) vasopressin lypressin

what can put residents of underdeveloped countries at higher risk for goiters?

developed countries obtain iodine via salt, but 3rd world countries don't have access to iodized salt; thyroid needs iodine to make thyroid hormone

patients with thyroiditis should report what three changes?

difficulty breathing/swallowing swelling of face/extremities rapid weight gain/loss

what is a nontoxic goiter?

diffuse enlargement of thyroid gland normal thyroid hormone levels (benign)

how does hypoglycemia present differently in the elderly?

elderly have more severe symptoms and they may be missed (attribute neuro changes to dementia or other problems)

what will urine sodium be like with SIADH?

elevated >30

how will plasma cortisol levels be affected by cushing syndrome?

elevated in the morning

how does T3 and T4 change with hyperthyroidism?

elevated or normal if subclinical

what is a goiter?

enlargement of the thyroid gland

how can infection/sepsis/illness lead to DKA?

epinephrine release triggers fight/flight and liver to make glucose, resulting in hyperglycemia

what is the goal of a stem cell transplant?

eradicate diseased tumor cells and/or clear the marrow of its components to make way for engraftment of the transplanted, healthy stem cells

how often should I&O checks be done for the patient with DKA?

every hour

why does cushing syndrome result in an increase in sodium and decrease in potassium?

excess aldosterone, which stimulates kidneys to retain sodium and water and excrete potassium

what are 7 precipitating factors of hypoglycemia?

excessive admin of insulin/oral antidiabetic agents consumption of too little food/NPO high activity levels beta blockers hormonal changes diarrhea/vomiting ETOH consumption

what is hirsutism?

excessive hair growth in unusual places

what does excess ADH cause?

excessive water resorbed>>dilutional hyponatremia

what is glycosuria?

excreting glucose into urine

what causes secondary adrenocortical insufficiency?

exogenous corticosteroids can suppress the hypothalamic-pituitary-axis and suppress ACTH secretion - if d/c them too quickly, then could have insufficiency

what are 11 s/s hyperthyroidism

exophthalmos bruit HTN dyshrythmia palpitations a-fib weight loss fine, silky hair diaphoresis fatigue insomnia

true or false? most kidney transplants from cadavers do not last very long

false; 90% 1-yr graft survival rate

true or false? if your patient is brain dead, it is the nurse's role to approach the family to discuss organ donation

false; LOPA rep will approach them

true or false? if you have reason to believe that a dying patient is not a candidate for organ donation, there is no need to call LOPA

false; call for all deaths and agency will determine if they're a candidate

true or false? a kidney taken from the left side of the body must also be transplanted into the left side

false; can go on either side

true or false? during kidney transplant, the diseased kidney is removed and the new kidney is put in its place

false; diseased kidney remains in place unless there's a malignancy or something

true or false? for brain death organ donors, all supplemental supports are withdrawn before the organs can be procured

false; left on support so organs can perfuse while the procedure is performed

true or false? more critically ill patients are considered last for organ transplant since they are higher risk

false; more critical = higher priority to receive organ

how does chronic rejection manifest with kidney transplants? (2)

fibrosis and glomerulopathy

what does cortisol do? (2)

fight or flight anti-inflammatory

where may patients experience tingling/burning/numbness with hypocalcemia?

fingertips, toes and lips

what medication can be used to replace mineralocorticoids with adrenal insufficiency?

fludrocortisone acetate

what is the priority of treatment for DKA?

fluid and electrolyte balance

what are five important aspects of nursing care for SIADH treatment?

fluid restriction mouth care daily weights constipation seizure precautions

what is the first priority after a kidney transplant?

fluid/electrolyte balance

why may psychosocial disorders be a contraindication to organ transplant?

follow-up after transplant is important and need to be compliant with meds and follow-up, have good support system and be stable

when will patients with an organ transplant be prescribed monoclonal antibodies?

for prevention and treatment of acute rejection episodes - added to regimen if experiencing acute rejection until under control

where are the parathyroid glands located?

four little glands on back of thyroid

how can fluid replacement for HHNS/DKA lead to cerebral edema?

give too much insulin too quickly and fluids shift from vascular to cellular space

the adrenal cortex secretes what three things?

glucocorticoids mineralocorticoids androgens

what can happen if hashimoto's progresses rapidly?

goiter can obstruct breathing

what is hashimoto's?

gradual destruction of thyroid tissue by antibodies

most cases of hyperthyroidism are caused by what?

graves disease

what is a cause of hyperthyroidism?

graves disease

what will urine specific gravity be like with SIADH?

greater than 1.030

what is diabetes insipidus?

group of conditions associated with a deficiency of production or secretion of ADH or a decreased renal response of ADH (have enough, but kidneys don't respond)

what is the most common cause of a hypothyroid goiter?

hashimoto's

your patient comes to the ER with complaints of SOB and voice changes. they have a history of hypothyroidism. what do you suspect?

hashimoto's

without preservation methods, describe the window of time we have for heart, lung, liver, pancreas, kidney, and intestinal transplants

heart - 4-6hr lungs - 4-6hr liver - 8-12hr pancreas - 12-18hr kidney - 24-36hr intestines - 8-16hr

s/s heart transplant rejection are similar to what?

heart failure

why is it important to consider body size for a heart transplant?

heart must fit in rib cage

calcineurin inhibitors are used most commonly for what three types of organ transplants?

heart, liver, and kidney

what is another name for a stem cell transplant?

hematopoietic stem cell transplantation (HSCT)

how should you monitor response to DI treatment?

hemodynamic measurements like HR, BP, CVP, and PA pressure

what is used to measure glycemic control and regimen compliance over the last 2-3 months?

hgb A1C

is serum sodium high or low with HHNS?

high

what is leukocytosis?

high WBC

describe the pathophysiology of HHNS

high cellular glucose levels produce an osmotic gradient>>osmotic diuresis severe dehydration urinary loss of NA, K, Mg, Ca, Ph - electrolyte imbalances hyperglycemia (600 - 2000) altered LOC, progressing to seizure, shock, coma, and death

is BUN/Cr high or low with HHNS? why?

high; dehydration leads to prerenal kidney injury, which can lead to acute intrarenal injury

what is oxytocin?

hormone produced by the hypothalamus and secreted by the pituitary gland for childbirth and other functions

what is a toxic nodular goiter?

hormone secreting nodules associated with hyperthyroidism

what is HLA?

human leukocyte antigen; gene complex encoding the major histocompatibility complex (MHC) proteins in humans. these cell-surface proteins are responsible for the regulation of the immune system in humans

what medication can be used to replace glucocorticoids with adrenal insufficiency?

hydrocortisone

are goiters more common with hyper or hypothyroidism?

hyper

what are the three types of graft rejection?

hyperacute, acute, and chronic

what are two other names for hyperglycemic hyperosmolar nonketotic syndrome?

hyperglycemic hyperosmolar state (HHS) and hyperglycemic hyperosmolar nonketotic (HHNK) syndrome

what causes the polyuria/osmotic diuresis of DKA?

hyperosmolarity, so body tries to equal out by shifting water from intracellular to intravascular space

what are 4 s/s addison's disease?

hyperpigmentation of buccal mucosa and skin creases diffuse tanning/freckles orthostatic hypotension scant hair in pubic/axillary areas

what are two corticospinal signs of ODS?

hyperreflexia and bilateral babinski sign

what will serum osmolarity be like with SIADH?

hypo-osmolar <280

hypoparathyroidism will result in s/s of what?

hypocalcemia

what causes orthostatic hypotension with addison's disease?

hyponatremia and hyperkalemia from deficit of aldosterone

what is a major complication of treatment for DI?

hypotension

what are 12 s/s addisonian crisis?

hypotension tachycardia dehydration hyponatremia hyperkalemia hypoglycemia fever weakness confusion vomiting diarrhea pain in abdomen/lower back/legs

what are 12 clinical manifestations of HHNS?

hypotension tachycardia warm/dry skin (unless in shock) dry mucous membranes polyuria loss of skin turgor weight loss sunken eyeballs abd pain n/v neuro changes (seizures, LOC) shallow breathing

describe how the adrenal cortex is stimulated to release hormones

hypothalmus secrets corticotropin-releasing hormone (CRH) and stimulates the secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary.

what tonicity IV fluids should be used for DI?

hypotonic

how does iodine work for graves disease?

inhibit synthesis of T3 and T4 and decreases the vascularity of the thyroid

what does calcitonin do?

inhibits the transfer of calcium from bone to blood, increases calcium storage in bone, increases renal excretions of calcium and phosphorus to balance them out; important for bone strength!

what does FSH do? (3)

initiates the formation of follicles in the ovary stimulates follicle cells to secrete estrogen stimulates sperm production in testes

how do you mix NPH and regular insulin? why do you do it this way?

inject air into NPH, air into regular, withdraw regular then withdraw NPH. prevents the contamination of regular with NPH. (RN- regular, then NPH)

what are three theoretical factors that might cause graves disease?

insufficient iodine supply, infection, stressful life

what are 6 precipitating factors of DKA?

insulin pumps infection/sepsis/illness pancreatitis trauma/surgery new onset type 1 noncompliance with insulin regimen

how does autonomic neuropathy affect response to hypoglycemia?

interferes with the counter regulatory mechanisms... don't respond to hypoglycemia with sympathethic symptoms like a normal person would

hypocalcemia that results in acute airway problems like laryngospasm may require what treatment?

intubation or tracheostomy


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