endocrine

Thyroid Storm Tx

PTU preferred 500-1,000 mg loading dose, then 250 mg PO Q4H --> ≥1 hr before iodide to block synthesis of thyroid hormone inorganic iodide therapy + BB (propranolol 40-80 mg PO Q6H + systemic Steroid (dexamethasone 2-4 mg PO Q6H + aggressive cooling w/ acetaminophen and cooling blankets and supportive treatments

pancreatitis s/s

Severe upper abdominal pain, radiating to the back, nausea and vomiting, worsened with eating, abd tenderness, elevated heart/resp. rates, fever, jaundice Cullen's sign (ecchymosis of the umbilicus), Grey Turner's sign (bruising of the flank).

SIADH tx

The first line of treatment is to limit fluid intake to avoid further buildup. Furosemide (Lasix) to reduce fluid retention Hypertonic Solutions: 3-5% normal saline

Addison's Clinical Manifestations

WEIGHT LOSS Low cortisol level and hypoglycemia Low aldosterone level- hyponatremia and hyperkalemia Low ACTH- decrease corticosteroids hypotension Severe abdominal pain and diarrhea Weight loss Craving salty foods DHN Lightheadedness/confusion weakness

HHS tx

• correct fluid and electrolyte balance via IV (0.9% NS, followed by 0.45% NS, AND K+) • IV insulin until BG level at 250 or lower

Myxedema coma tx

protect airway fluid replacement PRN levothyroxine IV support hypotension slow rewarming with blankets avoid circulatory collapse symptomatic care

After a craniotomy to remove a brain tumor, the client develops the syndrome of inappropriate antidiuretic hormone (SIADH). For which clinical indicators would the nurse monitor the client? Select all that apply. One, some, or all responses may be correct.

Increased weight Decreased serum sodium Decreased LOC

Which unique response is associated with diabetic ketoacidosis (DKA) that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Kussmaul Respirations

Cushing's Disease s./s

* Generalized muscle wasting & weakness. * Moon face, buffalo hump. * Truncal obesity with thin extremities, supraclavicular fat pads; * Weight gain * Hirsutism (masculine characteristics in female). * Hypertension * Fragile skin that easily bruises. * Reddish-purple striae on the abdomen & upper thighs. * Hyperglycemia, hypernatremia * Hypokalemia, hypocalcemia

DKA Tx (know this)

****First tx is 0.9NS for dehydration Next start IV regular insulin drip - infused continuously until SQ insulin can be given to prevent rebound effect Correct and monitor K levels: may be up due to dehydration/acidosis; with treatment and correction may drop to low and need to be replaced Cardiac monitoring due to K imbalance Monitor: BS q 1h, K levels, VS, urine output, s/s of fluid overload and mental status Monitor for s/s of increased ICP: If BS levels fall too far or too quickly before the brain has time to reach equilibrium, water is pulled from the blood to the CSF and the brain, causing cerebral edema and increased ICP

Thyroid storm

***increased temp, pulse and HTN Causes Lung infections DKA Thyroid surgery or trauma Abrupt withdrawal of antithyroid medications or overdose of med Severe emotional stress

Myxedema Coma s/s

*decreased LOC- 1st sign* respiratory depression bradycardia confusion shock s/s weakness decreased O2 constipation hypotension hypothermia

GI bleed s/s

-Hematemesis (vomiting of blood) • Bright red—esophageal bleed • Coffee ground—stomach bleed -Melena (black tarry stool—upper GI bleed) -Occult: small amounts of blood in vomit, secretions, or stool—must use guaiac test Shock, Oligura, Tachycaridia, SOB, Palor cramping.

Diabetes Insipidus s/s

-Polyuria -Polydipsia -Fatigue -Symptoms of dehydration/hypovolemia (dry mucous membranes, hypotension, dizziness, poor skin turgor) ADH is not secreted adequately, or the kidney is resistant to its effect low specific gravity Hypernatremia *low salt diet

Cushing's Disease Dx/Tx

24hr urine test- measure hormone levels and show whether your body is producing excessive cortisol Electrolyte and cortisol level Treatment: Monitor: VS, I &Os, wt, glucose, WBC, K+, Ca+ Ketoconazole - Blocks adrenal corticosteroid synthesis - decreases cortisol If the cause is d/t steroid use dose maybe lowered If cause is a tumor doctor may need complete surgical removal and chemo/radiation. After the operation, you'll need to take cortisol replacement medications to provide your body with the correct amount of cortisol Diet: decrease Na+ intake and fluid restriction (600-1000ml)

Addisonian crisis

N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP, tachycardia, LOC Hydrocortisone 0.9NS Dextrose

GIB Tx

ABC's IV 2 lines Transfuse if Hgb <8 Levage Antacids/PPI

Addisons Dx and Tx:

ACTH stimulation test: This tests the adrenal glands' response after you are given a shot of artificial ACTH. If the adrenal glands produce low levels of cortisol after the shot, they may not be functioning properly. Electrolyte panel & cortisol level CT Treatment: Hydrocortisone, prednisone or methylprednisolone to replace cortisol. These hormones are given daily Will need to increase steroids in time of stress Monitor VS, wt loss and I & O, neuro status Diet: Increase salt intake in diet

Pt admitted with HHS

Administer fluid replacements

Acute Pancreatitis Treatment (KNOW THIS)

NPO initially IV lipids - monitor triglycerides Enteral parenteral feeding Small, frequent feedings if allowed HIGH Carb LOW fat HIGH protein Abx

The nurse administers desmopressin acetate (DDAVP) to a client with diabetes insipidus. Which would the nurse monitor to evaluate the effectiveness of the medication?

I & O's

GIB dx

CMP, BUN, creat CBC, WBC, H&H, Plt PT/PTT(HIGHER in GIB) LFT Amylase Fecal occult blood Guaic Stool OB Endoscopy Colonoscopy Capsule Barium CT angio US

DKA s/s

D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea Hyperglycemia Ketosis Acidosis Dehydration DM1 typically

DI vs SIADH

DI: high urinary output, low levels of ADH, hypernatremia, dehydrated, lose too much fluid SIADH: low urinary output, high levels of ADH, Hyponatremia, over hydrated, retain too much fluid Both will present with excessive thirst

DKA clinical manifestations (know this)

Dehydration Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension Lethargy and weakness Kussmaul respirations Hyperkalemia Elevated Bun/Creat Blood glucose level of greater than or equal to 250 mg/dL Blood pH lower than 7.35 Serum & Urine positive for Ketones

HHS clinical manifestations

Enough circulating insulin to prevent ketoacidosis Blood glucose greater than 600 mg/dL Ketones absent or minimal PH > 7.4 Elevated BUN/Creat Serum & urine negative for Ketones Potassium can be normal or elevated More severe neurologic manifestations because of increased serum osmolality Somnolence, coma, seizures, hemiparesis, aphasia; similar to stroke

Nursing interventions for DKA

Fluids .9 regular insulin

pancreatic enzymes

only for chronic pancreatitis

Addison's Disease s/s

adrenal insufficiency muscle weakness, fatigue, nausea, vomiting, anorexia, weight loss, conspicuous bronze coloring of the skin, irregular pulse, fasting hypoglycemia, craving salty foods

SIADH s/s

decreased loc (cerebral edema/increased icp) seizures coma sodium less than 120 decreased urine output N/V specific gravity HIGH

Upper GI bleed

esophagus, stomach, duodenum

HHS

hyperosmolar hyperglycemic state DM2 Causes -UTI, neumonia, sepsis

hypo vs hyperthyroidism

hypo: - high TSH - low T3/T4 - dysfunction/removal of thyroid gland - decreased metabolism and VS - fatigue hyper: - low TSH - high T3/T4 - hypersecretion of thyroid gland - increased metabolism and VS - restlessness/anxiety

Pancreatitis

inflammation of the pancreas; acute or chronic excruciating pain Causes -etoh -gallstones -obesity -abd surgery

Lower GI bleed

jejunum, ileum, colon, rectum