endocrine

what are the 3 risks of getting hashimoto's disease

1. vitiligo (skin discoloration patches) 2. rheumatoid arthritis 3. addison's disease

management of type 1 dm

- carbohydrate counting - safe exercise - recognize/treat signs of hyperglycemia and hypoglycemia - demonstration of self administering insulin - learn to differentiate levels of normal blood glucose, fasting, and A1C levels, and lipids

The practitioner prescribes levothyroxine 1.7 mcg/kg per day. What would R.M.'s daily dose of levothyroxine be based on her current weight of 130 pounds in milligrams?

0.1 mg

risk factors of t2dm r/t ethnicity, diagnosis, pregnancies

3. First-degree relative with T2DM Ethnicity (Black, Hispanic, Native American, Asian American, Pacific Islander)*** 5. PCOS (hormone of women of childbearing age) 6. History of gestational diabetes or delivering a baby >9 lbs

if the hypoglycemia pt has a stabilized RR of 16, pulse of 112/regular, what would ur next step be if u had all possible resources?

1) Administer glucagon (1-2 mg IM or subcutaneous) or 2) Start an IV infusion of NS and administer 50g of D50. If working in an outpatient area, you would begin an infusion of D5 or D10 until help arrives.

when admitting a hypoglycemia pt, what nursing assessment questions should the nurse ask to find out what precipitated the event?

1) How much and what type of insulin did he take, and when did he take it? 2_ Has TR had anyting to eat or drink today? 3) Has this ever happened to T.R. before? 4) What was T.R.'s morning glucose?

K.B. (he/him) is a 65-year-old admitted to the hospital after a 5-day episode of "the flu" with symptoms of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed with Graves' disease 6 months ago and placed on methimazole (Tapazole) 15 mg/day. His other past medical history includes heart failure and hypertension requiring antihypertensive medications; however, he says that he has not been taking these medications on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2° F (37.9° C). Admission assessment findings are: height 5 ft, 8 in (173 cm); weight 132 lb (60 kg); appears anxious and restless; loud heart sounds; 1+ pitting edema noted in bilateral lower extremities; diminished breath sounds with fine crackles in the posterior bases. K.B. begins to cry when he tells you he recently lost his wife; you notice someone has punched several more holes in his belt so he could tighten it. hyperthyroid pt presents w/ elevated T3 and T4, BUN of 33 (6-24 mg/dL), ESR of 44 (0-15 mm/hr in men), Hgb of 11.8 g/dL (13-16) and Hct 36% (38-48)

1) T3 and T4 are elevated (indicating a hyperthyroid state). 2) BUN is elevated and is most likely caused by dehydration from the hypermetabolic state. 3) His ESR is elevated, which is associated with infection, inflammation, and tissue necrosis or infarction. 4) His low Hgb and Hct levels could be caused by his hypermetabolic state as well as reflecting anemia caused by chronic disease.

4 treatments of hyperthyroidism pts

1. methimazole - not baby safe 2. PTU (puts thyroid underground) 3. SSKI (potassium iodine) 4. beta blockers (lol) l - lowers HR o l - lowers BP

if pt has Graves Disease and history of hyperthyroidism, what questions should u include in ur assessment (H&P)

1. Do u have trouble with insomina and fatigue often? 2. Do you have any chest pain, dyspnea, and palpitations? 2. Have you experienced any difficulty concentrating, irritability? 3. Do you experience any photophobia, exophalamus, or any other eye changes? 4. Heat intolerance or wt loss? 5. Changes in bowels? Diarrhea?

risk factors of t2dm r/t labs and statistics

1. Elevated BMI 2. Sedentary lifestyle 4. HTN (>140/90) 7. HDL-C <35 mg/dL 8. Triglycerides >250 mg/dL 9. Impaired fasting glucose or impaired glucose tolerance

what are the 3 main causes of hyperthyroidism?

1. GRAVE'S DISEASE 2. iodine excess 3. levothyoxine excess - thyroid storm risk

4 diagnostic testing methods to indicate whether or not pt has DM

1. HgA1c = 6.5% or higher 2. Fasting plasma/serum glucose higher than 126 mg/dL 3. 2-hour plasma glucose higher than 200 mg/dL during an oral glucose tolerance test (think when u consume glucose, u consume more so thats why the number is 200) 4. Random plasma/serum glucose higher than 200 mg/dL + symptoms of DM (polydipsia, polyphagia, polyuria, unexplained weight loss

what types of lifestyle changes can a hypothyroid pt make aka what are some other general teaching issues u can address?

1. Maintain a well-balanced diet; follow prescribed caloric intake to promote weight loss, avoid salty foods 2. Encourage moderate exercise but avoid overexertion 3. Plan frequent rest periods until the dosage is established 4. Get 7-8 hours of sleep nightly 5. Prevent skin breakdown 6. Prevent heat loss by layering clothing 7. Prevent or treat constipation

what should you teach hypothyroidism pt about preventing myxedema coma? how can u prepare for a myxedema event?

1. Take prescribed meds exactly as directed at the same time daily , don't ABRUPTLY STOP LEVO 2. Avoid stressful events (infection, trauma, exposure to cold) 3. Wear an ID bracelet indicating she has hypothyroidism

In type 1 DM, there is an _____(1)_________ deficiency of insulin. In type 2, there is a deficiency of insulin and the pancreas usually continues to produce ____(2)_______ insulin. However, the insulin that is produced is either ____(3)_________ for the body's needs and/or is poorly used by the tissues, which are classified as _______(4)________________

1. absolute 2. some 3. insufficient 4. insulin-resistant

list s/s of hypothyroidism (think low and slow)

1. decreased energy - fatigue, weakness, muscle pains/aches 2. decreased metabolism - wt gain 3. decreased digestion - constipation 4. decreased amts of hair - alopecia 5. decreased MS 6. libido 7. irregular/missed periods: amenorrhea 8. heavy periods: hypermenorrhea 9. SLOW DRY skin decreased turgor !

what types of food would u avoid with hyperthyroidism pt

1. high fiber - risk for diarrhea 2. caffeine - worsen HTN, afib, tachycardia 3. spicy foods - diarrhea? link to heat intolerance?

what type of dietary foods should a pt with hyperthyroidism follow?

1. high in calories (4000-5000/day) 2. high in protein/carbs 3. frequent meals and snacks (6-8x a day)

because YL has symptoms of neuropathy that place them at risk for developing foot complications, you should include what information regarding foot care in their education?

1. inspect all surfaces of the feet daily for cuts, blisters, swelling, and red, tender areas 2. wash feet daily and dry feet thoroughly. Avoid hot water/temperature extremes 3. wear properly fitted shoes and inspect the shoes daily for cracks, pebbles, nails, and loos lining. Avoid wearing shoes with pointed toes. Avoid walking barefoot. Always wear clean, absorbent socks. 4. avoid heating pads or hot water bottles on the feet 5. moisturize skin daily. Do not use lotion between the toes. Avoid lotions with alcohol. 6. cut toenails straight across and file sharp edges. May require referral to a podiatrist.

A1C should be measured every____ months (typical goal <7.5%) for pediatric clients

3

3-5 years post diagnosis: complete and comprehensive ______ exam with an annual exam after, and why for pediatric clients

eye exam bc a complication of diabetes can be retinopathy (blindness) - want to do freq eye exams

Before the pt leaves the clinic, she asks how she will know if the medication is working. How long does it take to see the effects of levothyroxine therapy?

4-6 weeks to reach therapeutic levels

Blood glucose should be measured ____- ____ times daily or continuously for pediatric clients

6-10

t/f: alopecia is a s/s of Cushing's syndrome

f; alopecia is a s/s of hypothyroidism (decreased amounts of hair)

t/f: An A1c is to measure a person's hemoglobin level over a 6-10 week period

f; its to measure a blood sugar level over 6-10 weeks (3m) period

what must the nurse include in the teaching plan of a pt recovering from their RAI surgery postop on the floor?

AVOID EVERYONE! - no pregnant ppl - no crowds - no same bathroom (flush 3x) - no same utensils - no small laundry - no physical contact

Fasting glucose: 184 mg/d/L (10.2 mmol/L) Hemoglobin A1C: 8.8% Total cholesterol: 256 mg/dL (6.6 mmol/L) Triglycerides: 346 mg/dL (3.91 mmol/L) Low-density lipoprotein (LDL): 155 mg/dL (4.01 mmol/L) High-density lipoprotein (HDL): 32 mg/dL (0.83 mmol/L) Urinalysis (UA): glucose, - ketones What can we interpret w/ these lab findings?

Elevated fasting glucose levels and A1C = DM Elevated total cholesterol, LDL, and low HDL, and increased triglycerides can be seen in T2DM pts Glucose should not be present in the urine; also suggests DM. No ketones is consistent with T2DM. because of insulin resistance and indicate a potential but elevated risk for atherosclerosis.

describe characteristics of Kussmaul respirations, why would u not treat this with breathing into a paper bag t/f: Kussmaul respirations for shallow, rapid respiration that have a fruity smell

FALSE! KR are deep, rapid respirations that have fruity smell as the CO2 is let out by exhaling you wouldn't want your DKA pt to use a paperbag bc you are in metabolic acidosis where u are letting out too much CO2 a paperbag wont help cuz this is mainly use for respiratory alkalosis where CO2 is too. little with *shallow fast respirations

which symptoms can a type2 dm patient report today that can lead you to believe they have some form of neuropathy?

Foot pain, "burn or feel like there are pins in them"

what other findings in t2dm pt's history can increase their risk for developing neuropathy?

HTN, elevated cholesterol levels, and high triglycerides, high blood sugar levels

TR tells you he took 35 units of glargine insulin and 12 units of regular insulin at 0745. He says he was late to class so he ate an apple on his walk to the shuttle. Based on this information, why did T.R. experience the episode of hypoglycemia? Based on your knowledge of the types of insulin T.R. is receiving, when would you expect T.R. to experience a hypoglycemic reaction? *think of the diff types of insulin affecting onset, peak, and duration

He did not eat enough food to cover the 12 units of regular insulin. Regular insulin peaks around 2 to 3 hours after administration, and T.R. could expect to experience a hypoglycemic reaction around lunchtime. Lantus has an onset of 1.5 hours and a duration of up to 24 hours but has no identified peak so would not contribute to a hypoglycemic reaction.

At 10:45, you recheck pt's blood glucose and the reading is 64 mg/dL. His vital signs are 120/72, 18, and 92. Has his status improved or not? Defend your answer.

He is still hypoglycemic and requires active treatment. Give another 15g of simple carbohydrates. Follow with a protein and carb snack. If in 15 minutes blood glucose is still less than 70 mg/dL, treat a third time.

What should you teach T.R. about alcohol consumption and managing his diabetes?

He should check his glucose levels before, while, and after drinking. If it is low, he should eat something to raise it and should not drink on an empty stomach or drink in substitution of a meal (ex: a liquid lunch, drinking for breakfast to prevent a hangover).

Weight gain, decrease in appetite, paresthesias of the extremities, chest pain, shortness of breath, edema, vocal changes, effusions, hair loss, nail brittleness are all s/s of what condition?

Hypothyroidism

if the hypoglycemia pt can not safely drink simple carbs, what should the nurse do as the second step?

I would prepare to give IV or subcutaneous glucagon and activate the emergency medical system.

the hypoglycemia pt is showing s/s (pale, sweating, tachycardia) , what would your next action(s) be if you had no emergency supplies or resources?

If no emergency supplies are available, support respirations and institute seizure precautions while wating on emergency personnel.

A few minutes after administering 2m of subcutaneious glucagon, pt begins to awaken. He becomes alert and asks where he is and what happened. You orient him and explain what has occurred. What further action should you take at this time?

Recheck his glucose level and vital signs.

What role does methimazole have in treating Graves disease?

Methimazole decreases the formation of T3 and T4 by interfering with the incorporation of iodine (essential for the activity of thyroid hormones) into the thyroid hormone molecule. It is used as monotherapy for Graves' disease or to lower thyroid activity before surgery or radioiodine treatment.

pt diagnosed w hypothyroidism takes levothyroxine daily, but forget to take her medication, what should u as the nurse advise?

NO doubling on the dose take levo as soon as u remember

what should the diet order of a hyperthyroidism pt be before and after RAI surgery?

NPO 2-4 hrs after midnight 1-2 hours after

what is the diff between prandial insulin and basal insulin given to pediatric clients for the management of diabetes

Prandial insulins include rapid-acting insulin analogues (lispro, aspart, glulisine, and fast-acting aspart) or short-acting (regular human) insulin and are given before each meal, and at each time a correction of a high blood glucose value is required There are three types of basal insulin currently available: Glargine, and detemir. Some people use long-acting insulin in combination with shorter-acting insulins for the most effective glycemic control.

pt is taking levothyroxine for hypothyroidism, what s/s should u report to the HCP

Report heat intolerance, nervousness, excitability, profound weight loss, chest pain, tachycardia, diarrhea, irritability

A 7 year old pediatric client comes into the clinic. What types of intensive insulin regimens would we recommend using multiple injections? Name 3

The majority of children with T1DM should be treated with intensive insulin regimens using multiple injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion

T.R. says he had a few similar episodes recently. He treated them by eating a candy bar. He says he is on a 2000-calorie, carbohydrate-controlled diet but has been checking his blood glucose levels every "couple of days" only. What common mistake in previously treated episodes of hypoglycemia did T.R. make?

Treating hypoglycemia with sweet foods that contain fat (candy, cookies, and ice cream) will slow down the absorption of the sugar and delay the response to treatment. He also needs to be monitoring his glucose levels more closely.

He goes on to say he has had "a little bit much to drink at a few of the parties he has been to" on the weekends. What effect does alcohol have on blood glucose?

While the liver is metabolizing alcohol, the inability to release needed and stored glucose into the bloodstream can lead to hypoglycemia shortly after drinking and for up to 24 hours after the last drink.

Which of the following would be included in YL's plan of care for neuropathy? Select all that apply. a. Slowing progression of the neuropathy b. Lowering elevated A1C levels c. Administration of ordered gabapentin d. Administration of ordered duloxetine e. Administration of ordered lorazepam

a Slowing progression of the neuropathy b. Lowering elevated A1C levels c. Administration of ordered gabapentin d. Administration of ordered duloxetine (Antidepressant and Nerve pain medication)

You tell T.R. to check his blood glucose at 12:30 and then eat lunch at the normal time. You determine that he understands your teaching regarding averting hypoglycemia if he states: a. "I need to eat within 30 minutes of taking the regular insulin." b. "If I am too sick to eat, I will not take any insulin until I feel better." c. "Only certain kinds of alcoholic drinks will affect my blood glucose levels." d. "I will exercise just before eating and taking insulin so I do not get cramps."

a. "I need to eat within 30 minutes of taking the regular insulin."

Which statements show R.M. understands your teaching about hypothyroidism and taking levothyroxine? Select all that apply. a. "It may take several weeks before I feel better." b. "The best time to take my medicine is half an hour before breakfast." c. "If my heart rate is over 100, I will hold my medication until is back below 100." d. "I will be able to discontinue my medication after the symptoms are under control." e. "I will come in when needed so my blood levels can be checked to make sure the medicine is working."

a. "It may take several weeks before I feel better." b. "The best time to take my medicine is half an hour before breakfast." e. "I will come in when needed so my blood levels can be checked to make sure the medicine is working."

the nurse questions what orders if a hyperthyroidism pt is undergoing RAI treatment

any order where antithyroid meds are still ordered u need to make sure they are held for 5-7 days before surgery

what are the nursing main priorities after thyroidectomy surgery? what s/s of breathing should the nurse monitor for?

assess airway since surgery is down near neck - noisy breathing - laryngeal stridor - hoarseness

how would we know how much glucose to give a hypoglycemic pt if there is no glucose meter avaliable?

assume that the pt is hypoglycemia and administer glucose! remember that pts can survive longer w/ elevated BG levels for longer periods of time. since the CNS is largely dependent on glucose in the blood, u need to give glucose as the pt is at risk of death if patients are HYPOglycemic!

what is one major complication of T1 diabetes? if blood glucose levels were not controlled, what is the pt at risk for?

at risk for untreated hyperglycemia or DKA (diabetes ketoacidosis) a condition where there isn't enough insulin in the body leads to ketones triggered by infection or other illnesses

Which assessment findings would support the theory that T.R. is experiencing a hypoglycemic reaction? a. Extreme thirst and nausea b. Nervousness and tachycardia c. Hypertension with bounding pulses d. Fruity breath and deep, rapid respirations

b. Nervousness and tachycardia

You determine YL understands your teaching aout treating hypoglycemia if they state, "If my blood sugar is low, I should eat: a. an apple with milk." b. peanut butter sandwich." c. fruit juice or regular soda." d. crackers with cheese slices."

c. fruit juice or regular soda.

What is the most common cause of primary hypothyroidism? a. Thyroidectomy b. Acute thyrotoxicosis (thyroid storm) c. Hashimoto's thyroiditis d. Radioactive iodine exposure

c. hashimoto's thyroiditis - other causes: dietary low iodine, pituary tumor, thyroidectomy NOT B. thyroid storm (acute thyrotoxicosis) AND D. radioactive iodine exposure which are causes of HYPERthyroidism

if the hypoglycemia pt can not safely drink simple carbs like juice, what should the nurse do *priority?

check airway, breathing, circulation, and VS

why would exercise be beneficial to a pt with type 1 diabetes, what should the nurse educate a patient before, during, and after exercise

exercise is recommended bc it can improve glucose uptake and lower risk of heart disease (labs r/t total cholesterol, triglycerides LDL, and increasing HDL) frequently monitor blood glucose levels (70-115) before, during, and after exercise to prevent, detect, and treat hypoglycemia and hyperglycemia

who is prioritized first the client with diabetes whos BS is between 250-300 this past week, or the hyperthyroidism pt who had elevated fever

elevated fever bc this is a sign of thyroid storm in hyperthyroid pts

at 10:20, pt reports s/s of hypoglycemia, at 10:25 am, the pt's glucose reading is 50, what is the nurse's priority action

give 15g of simple carbs (4 oz of fruit juice/soda, 8 oz of milk, 7 lifesavers) follow up w/ complete carb and protein snacks ex: peanut butter and crackers its the next mealtime is more than an hr away

if hypoglycemia type i dm pt only responds to painful stimuli, and BG is 38 mg/dL what is the best priority response

give 50% dextrose in water IV push instead of giving 15 g of OJ

if a ED client is presenting with DKA, what should the nurse immediately do after obtaining their BG level?

give isotonic 0.9% NS IV bolus first*** and not regular insulin rationale: DKA is a lack of insulin, and high BG insulin will usually transport glucose into cells for energy lack of insulin means intracellular starvation bc theres just high amounts of glucose in the blood = hyperglycemia NOT in the cells where its suppose to be! IV isotonic fluids can help bc giving insulin right away to treat DKA can make all water, K+., and glucose into the cell too quickly worsening the pt's condition with dehydration and electrolyte imbalances, this will increase hypovolemic shock if fluids aren't given first

metformin will decrease ____________ and glipizide will increase __________

glucose in the liver insulin in the pancreas

what in the urine indicates whether or not a person might have hyperglycemia

glucose in urine aka increased urine osmolarity

Insulin reduces the body's blood sugar levels and provides cells with _________________ for energy by helping cells absorb it. When blood sugar levels are too low, the pancreas normally releases ________________. ____________________ instructs the _____________ to release stored glucose, which causes the body's blood sugar levels to rise.

glucose, glucagon x2, liver

why is an IV line recommended for dka patients

helps administer bolus of NS rationale: insulin can move water, potassium, and glucose into the cell causing vascular dehydration and hypokalemia (too little potassium in blood stream)

s/s of polyuria, and wt loss are usually associated with _____________________

hyperglycemia

thyroidectomy is done for _____________ pts

hyperthyroidism

s/s of pallor, diaphoresis, nervousness, tachycardia are all r/t to what diabetic condition?

hypoglycemia - bg less than 70

what are the diff between long acting vs rapid acting diabetes meds; - provide examples - times of onset, peak, and duration for one of the meds

in long acting meds, we want to draw up two sep vials - remember "old guys" phase w/ no peak and no mixing!!! 1) detemir 2) glargine (Lantus) duration is 24 hours and more onset is 1 1/2 - 2 hrs (not that important) in rapid acting medications, they have a very very fast onset of 15 mins peak of 30-90 mins duration is much shorter 3-5 hrs 1) lispro 2) asparat

why is D5W given to hypoglycemia patients and not to DKA

it can prevent hypoglycemia bc it is a form of glucose (sugar) can worsen DKA

what type of medicine should be prescribed for hypothyroidism? what pt education can be provided for hypothyroidism?

levothyroxine think levO = hypO *leaves T3 and T4 in the body! 1. lifelong therapy 2. early morning = empty stomach x1 daily NO NIGHTTIME MED ADMINISTERATION 3. v hyper (report agitation and confusion) = thyroid storm 4. oh the baby is fine! preg is safe but still discuss this with HCP

metformin decreases glucose production in the ____________; but increases ____________________ in cells glipizide (second gen sulfonylurea) releases ________________ from the ___________________ islets

liver; sensitivity of insulin receptors in the cells insulin pancreatic

if hyperthyroid pt is postop recovering for thyroidectomy, what must the nurse monitor for circulation of blood and positioning?

make sure head is in neutral position and in alignment of the neck not supine 30-45 deg no flexing or extending neck

nursing considerations with NPH what is important when NPH is administered? why is there a risk of hypoglycemia?

mix clear to cloudy (2x) day most dangerous in middle of peak, bring a plate of food why? greater risk of nocturnal hypoglycemia bc of how its duration is 12-18 hrs thru the night, peak is at midnight where insulin may be the lowest in the body w/o any food!

if the pt takes levothyroxine for hypothyroidism, but forgot to take it for the past week, what is the pt at risk for?

myxedema coma if the pt stops abruptly taking medications

The thyroid gland is unable to make T3 and T4. Because the thyroid functions on a ______________feedback system, the TSH will be ____________ proportional to the T3 and T4 levels. A decrease in thyroid hormones stimulates the release of TSH from the anterior pituitary. TSH then stimulates the thyroid gland to make and secrete T3 and T4, which is an indicator of thyroid function

negative INVERSELY *if TSH is high theres low T3 and T4 and vice versa

before giving radioactive iodine to a woman, what must u ensure as the nurse

negative pregnancy test remove neck jewelry and dentures before procedure

should pregnant women take methimazole for treating Graves disease?

no this is NOT baby safe! we prefer PTU (proplthiouracil) - puts the thyroid underground!, babysafe!

if the hyperthyroid pt is postop recovering for thyroidectomy surgery, what should the nurse advise with assessing the pt's breathing?

noisy breathing and laryngeal stridor

what is a norm range of 1) normal blood glucose, 2) fasting and 3) A1C

normal blood glucose: 70-115 if below 70: hypoglycemia if above 115: hyperglycemia fasting: 100 or lower A1C: 6.5% and lower

whats the difference between nph and regular insulin - which one can u give thru IV push or bag - which one is clear vs cloudy - provide examples - times of onset, peak, and duration for one of the meds

nph is intermediate insulin u never give in an IV, but regular insulin can be through an IV bag or IV push nph (humulin, novolin) onset: 2-4 hrs peak: 4-12 hrs duration: 12-18 hrs regular onset: 1 hr peak: 2-4 hrs duration: 4 hrs

what is the nurse's priority action when seeing a pt having a HYPOglycemic reaction?

obtain BG reading. do rapid assessment

onset, peak, and duration

onset : how quickly insulin lowers blood sugar peak: when is insulin is at MAX strength duration: how long the insulin can work to lower blood sugar

a type 1 dm pediatric client has a BP of 140/90 despite continuous exercise and exercise for 3-6 months, what should the nurse consider

pharmacological treatment

the pt is presenting with noisy breathing and laryngeal stridor after his thyroidectomy surgery, what must the nurse do beforehand?

place endotracheal tube (ET) or tracheostomy kit by the bedside - intubation supplies, tracheostomy set up

insulin can cause a shift of ________________ into cells from intravascular space, which can lead to __________________ and other life-threatening arrhythmias and what is an intravascular space?

potassium, hypokalemia hyperkalemia can happen when theres too much potassium in the bloodstream, not the cells hypokalemia can happen when theres too little potassium in the bloodstream intravascular is part of the extracellular space

pt education when administering lispro

remember that lispro is a rapid acting insulin injection the onset is 15 mins meaning that it works that quickly to lower the blood sugar - you should always tell ur patient to eat something or sit down to eat 10 mins before u give this med bc eating can increase ur body's blood sugar level - giving this insulin med will then lower ur body's blood sugar level if u don't eat anything and the nurse gives u lispro, u are at risk of HYPOglycemia!

if pt presents with exopthalamus conditions what can we predict as a nursing diagnosis? how can we assess this condition?

resolve with eye patch and tape eyelids down .. this is sign of hyperthyroidism

identity s/s of DKA

similar to hyperglycemia 1) polyuria - increased urine 2) polydipsia - increased thirst 3) fruity-scented breath *** acetone 4) n/v 5) abdominal pain 6) weakness 7) hyperkalemia 8) Kussmaul respirations

why would u question drugs like propranolol and verapamil with hyperthyroidism pts?

they should not be ordered for patients with a history of heart failure because their negative inotropic effects can diminish cardiac output and worsen heart failure. Carvedilol is a better option. The activity order should be questioned (increased activity would increase his myocardial oxygen consumption and demand and metabolic activity). Continuous fluid orders could worsen his possible heart failure due to volume overload. beta blockers can result in low BP and low HR !

s/s of hypermetabolism aka hyperthyroidism

think HIGH AND HOT - monitor for thyroid storm - assess for early s/s of agitation and confusion 1. grape eye = exopthalamus - "eyes exiting the body" 2. golf balls in the throat = goiter 3. high BP, HTN, fever 4. tachycardia, Afib risk 5. anxiety restlessness, insomina 6. wt loss (skinny) 7. diaphoresis - heat intolerance 8. diarrhea

raiu (radioactive iodine uptake) destroys ____________ in one dose

thyroid *monitor for hypothyroidism s/s

what are normal labs - total cholesterol - triglycerides - LDL - HDL

total cholesterol: 200 or less triglycerides: 150 or less LDL: 100 or less HDL: 40+

t/f: puffy face and hands and extremity edema are s/s of hypothyroidism

true

why are oral antidiabetic meds NOT considered for type 1 diabetes

type I dm does not produce any insulin in the body (pancreas can't function) therefore giving oral meds don't work bc these lower the amt of glucose secreted, and increase insulin sensitivity (need some stores of insulin already like type ii) *insulin sensitivity - sensitive the body's cells are in response to insulin

if the duration of glargine (lantus) is 24+, what does this mean for administration and risk of hypoglycemia?

u administer the med less frequently than rapid acting lispro; duration is how long the insulin med is in ur body! - risk of hypoglycemia is low bc the duration is longer and u only administer it once daily than frequently like lispro

what is correct carb counting? why would a pt with type 1 benefit from this?

u match the serving of carb ur eating and match this with ur dose of insulin insulin coverage is based on factors such as previous insulin requirements, body weight, and insulin sensitivity. This would be beneficial for K.W. because it would allow her more flexibility in meal planning

how can u treat "sick days" like DKA complication in a T1 diabetic (7 steps)

u still want to give insulin even if they don't eat! 1. check the blood glucose level 2. check urine for ketones 3. illness requires insulin 4. administer lispro dose 5. check glucose 2-3 hrs 6. drink small amounts of carbs 15 g at least hourly 7. take OTC for flu-like s/s

why would both metformin and glipizide be recommended for t2dm patients

we can give these 2 meds in combination bc of their different MOAs. - metformin decreases glucose production in the liver, BUT INCREASES the # of insulin receptors and sensitivity - it also decreases hepatic production of triglycerides and cholesterol. It can cause moderate weight loss, which makes it beneficial for patients who are overweight. - glipizide is a second-generation sulfonylurea and stimulates the release of insulin from the pancreatic islets (pancreas). - BAD FOR THE HEART, THINK IDE .. THE HEART MAY DIE (MI HISTORY)

hyperthyroidism pt is asking about what type of sedation is avaliable for RAI procedure, what should u as the nurse educate on ?

you are fully awake and in conscious sedation, there is no general anesthesia provided