Exam 2 -- 143

In addition to stimulating insulin production, glyburide has which of the following effects? A. Stimulate glyconeogenesis B. Promotes fat break down C. Increases tissue sensitivity to insulin D. Enhances appetite

C

Signs and symptoms of SIADH

* Fluid overload * Hypertension * Increased HR * Hyponatremia * Confusion * Seizures * Anorexia * Decreased urine output (increase in urine specific gravity)

At what point after the injection regular insulin, when does the peak action occur?

2-3 hours

An excess of which hormone is responsible for acromegaly? A. TSH B. Insulin C. Growth hormone (GH) D. Adrenocorticotropic hormone (ACTH)

C

Mrs. Smith is hospitalized following a motor vehicle accident where she suffered from a head injury. She is diagnosed with diabetes insidious (DI). What symptoms do DI and DM have in common?

Excretion of large amounts of dilute urine Polydipsia Weakness

Insulin Secretogoues

Helps the pancreas make and release insulin. Control/prevents hyperglycemia

Serum HCo3 * Normal Value

NV: 22-26 mEq/L

Mrs. Smith is hospitalized following a motor vehicle accident where she suffered from a head injury. She is diagnosed with diabetes insidious (DI). What fluid related concept would Mrs. Smith be MOST at risk for?

dehydration --> kidney's excrete too much urine

Sodium-Glucose Cotransport Inhibitors

Reabsorbs sugar back into the body from urine

Incretin Mimetics

Suppress appetite and inhibit glucagon secretion which lowers blood sugar

Long acting insulin * Types * Onset * Peak * Duration

Types * Levemir * Lantus Onset: 2 hours (45 minutes-4hours) Peak: Never peaks Duration: 24 hours * " The TWO LONG nursing shifts NEVER PEAK but lasted TWENTY-FOUR hours"

Mrs. Smith is hospitalized following a motor vehicle accident where she suffered from a head injury. She is diagnosed with diabetes insidious (DI). Would serum osmolarity be high or low?

high

Hyperglycemia or hypoglycemia symptoms Abdominal pain

hyper

Causes of SIADH

* Hypothalamus or posterior pituitary damage * Lung cell cancer * Infection * Medication - Chlorpropamide (DI med)

Priority labs for glucose regulation

- Serum Glucose - Serum Ketones - Serum pH - Serum HCO3 - Serum Na - BUN - Creatinine - Urine ketones

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1. "I should limit my fluids to 1 liter per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps to keep calcium from coming out of my bones."

1 In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to 2 liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps to protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Clients should follow a moderate-calcium, high-fiber diet. Even though serum calcium is already high, clients should follow a moderate-calcium diet because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the health care provider (HCP) because of these symptoms."

1 When a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. The client should consume additional fluids and should notify the HCP. The client should monitor the blood glucose level every 3 to 4 hours. The client should also monitor the urine for ketones during illness.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1 Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia. Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with diabetes mellitus. Test-Taking Strategy: Focus on the subject, chronic complications of diabete

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1, 2, 4, 5 Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

1, 3 In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure by holding salt and water and excreting potassium. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with addisonian crisis.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

1, 3 The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high Fowler's. 5. Administer a vasopressin antagonist as prescribed.

1, 3, 5 Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? 1. Lack of knowledge 2. Inadequate fluid volume 3. Compromised family coping 4. Inadequate consumption of nutrients

2 An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are not related specifically to the information in the question.

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. What is the appropriate intervention to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4. Make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

2 Anxiety is a subjective feeling of apprehension, uneasiness, or dread. The appropriate intervention is to address the client's feelings related to the anxiety. Administering a sedative is not the most appropriate intervention and does not address the source of the client's anxiety. The nurse should not ignore the client's anxious feelings. Anxiety needs to be managed before meaningful client education can occur.

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2 After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I should not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "NPH is a basal insulin, so I should exercise in the evening."

2 Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps to control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10- to 15-gram carbohydrate snack, and they should check their blood glucose level before exercising. Option 1 is incorrect because clients with diabetes should exercise, though they should check with their health care provider before starting a new exercise program. Option 3 in incorrect; clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Option 4 is incorrect; NPH insulin in an intermediate-acting insulin, not a basal insulin.

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. 1. Increase in pH 2. Comatose state icon 3. Deep, rapid breathing 4. Decreased urine output 5. Elevated blood glucose level

2, 3, 5 Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism, build up and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option 1 is incorrect because in acidosis the pH would be low. Option 4 is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2 Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptom or symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Lightheadedness 6. Fruity breath odor

2, 3, 5 Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1. Anxiety 2. Leukocytosis 3. Chvostek's sign 4. Urinary output of 800 mL/hour 5. Clear drainage on nasal dripper pad

2, 4, 5 Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

3 Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure for DKA.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101 °F (38.3 °C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3 In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

3 Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3, 4, 5, 6 Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated health care provider's prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

The nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention? 1. Correct the acidosis. 2. Administer 5% dextrose intravenously. 3. Apply a monitor for an electrocardiogram. 4. Administer short-duration insulin intravenously.

4 Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin administration (short- or rapid-acting), intravenous fluid administration (normal saline initially, not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? 1. It is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3. It is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream. 4. It administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.

4 An insulin pump provides a small continuous dose of short-duration (rapid- or short-acting) insulin subcutaneously throughout the day and night. The client can self-administer an additional bolus dose from the pump before each meal as needed. Short-duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1. "I will stop taking my insulin if I'm too sick to eat." 2. "I will decrease my insulin dose during times of illness." 3. "I will adjust my insulin dose according to the level of glucose in my urine." 4. "I will notify my health care provider (HCP) if my blood glucose level is higher than 250 mg/dL (14.2 mmol/L)."

4 During illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the HCP if the level is higher than 250 mg/dL (14.2 mmol/L). Insulin should never be stopped. In fact, insulin may need to be increased during times of illness. Doses should not be adjusted without the HCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

A patient with hypothyroidism is started on levothyroxine (Synthroid). You know she understands the side effects of the medication when she makes the following statement: A. "I know I should call my doctor if my heart races" B. "I understand that I may develop a moon-shaped face" C. "The sleepiness I experience when I start this medication will subside within 2 weeks" D. "I'll have to watch my diet to avoid further weight gain while on this medication"

A

Following surgery for thyroidectomy, the nurse watches carefully for which of the following signs and symptoms of tetany? A. Numb fingers, muscle cramps B. Weakness, muscle fatigue C. Hallucinations D. Dyspnea and tachycardia

A

A 26 year old female patient is hospitalized for radioactive iodine treatment for hyperthyroidism. Which of the following precautions by the nurse is appropriate? A. Talk with the patient only over the intercom system B. Wear gloves when emptying her bedside commode C. Maintain reverse isolation for 3 months D. No precautions are necessary because the dose is so small

B

A patient enters a clinic with a possibility of Cushing syndrome. Which of the following assessment findings supports this diagnosis? A. Weight loss, pale skin B. Buffalo hump, easy bruising C. Nausea, vomiting D. Polyuria, polydipsia

B

Before giving insulin, the nurse always checks which test results? A. Most recent potassium level B. Blood sugar level C. Urine ketones D. White blood cell count

B

The nurse needs to accomplish all the following interventions for a patient who is 24 hours post-thyroidectomy. Place the interventions in the correct order in which they should be completed. A. Check the surgical site dressing for signs of bleeding B. Verify the airway is patent C. Assess vital signs D. Administer morphine for pain E. Teach the patient about Synthroid in preparation for discharge F. Assist with range of motion of the neck

B A C D F E

How does SIADH affect ADH?

Causes an increase * S(I)ADH -- increase

Long-Acting Insulin Analogs

Humalog MIX

Creatinine * Normal Value * Clinical Significance * Nursing Assessment/Interventions

NV: 0.5-1.5 mg/dl * Elderly may be decrease CS: * Increase -- ARF, diabetic nephropathy Assess/Intervention: * May decrease with a small muscle mass * I/O * Compare BUN & creatinine. If both increase, most likely kidney disease.

BUN * Normal Value * Clinical Significance * Nursing Assessment/Interventions

NV: 10-20 mg/dl * Older adults slightly increase CS: * Increase -- hypo-function of adrenal gland, DM, renal insufficiency, high protein diet * Decrease -- Liver damage, over hydration, malnutrition Assess/Intervention: * If BUN and creatinine both increase, kidney disease should be suspected * I/O * Avoid fluid overload

Serum Na * Normal Value * Clinical Significance * Nursing Assessment/Interventions

NV: 135-145 CS: * Increase -- Dehydration, vomiting, diarrhea, CHF, Cushing * Decrease -- Severe vomiting, diarrhea, and SIADH Assess/Intervention: * Cortisone medications may cause an increase * May need a specific gravity test

Serum pH * Normal Value * Clinical Significance

NV: 7.35-7.45 CS: * Increase -- Alkalotic * Decrease -- Acidotic

Serum Glucose * Normal Value * Clinical Significance * Nursing Assessment/Interventions

NV: 70-110 CS: * Increases -- DM, DKA, adrenal gland hyper-function (cushings) * Decease -- Insulin excess, adrenal gland hypo-function, malnutrition Assess/Intervention: * Trauma may cause > BS * Cortisol (steroids, thiazide, loop diuretics) may elevate BS * Stressful situation may elevate BS

Urine Ketones * Normal Value * Clinical Significance * Nursing Assessment/Interventions

NV: Negative CS: * Positive -- diabetic acidosis, malnutrition, decrease cho, insulin medications Assess/Intervention: * Urine should be fresh * Assess for s/s of DKA

Serum Ketones

Normal Value: 0.5-4 mg/dl CS: * Increase -- DKA, starvation, vomiting, diarrhea, exercise

Mrs. Smith is hospitalized following a motor vehicle accident where she suffered from a head injury. She is diagnosed with diabetes insidious (DI). Why does a head injury place Mrs. Smith at risk for DI?

damaged pituitary gland or hypothalamus

Mr. Jones is diagnosed with SIADH related to lung cancer. He enters the hospital for treatment of symptoms. How will you monitor his fluid balance?

S/S of fluid overload changes in LOC urine output and concentration I/O F/E balance restrict fluids loop diuretics vasopressin antagonists (declomycin)

Intermediate-Acting Insulin * Types * Onset * Peak * Duration

Types: * Humulin * NPH Onset: 2 hours (1.5-4) Peak: 8 hours (4-12) Duration: 16 hours (up to 24 hours) * "Nurses play hero TO (TWO) EIGHT SIX-TEEN year olds"

Rapid-Acting Insulin * Types * Onset * Peak * Duration

Types: * Novolog * Humalog Onset: 15 min (10-30 minutes) Peak: 1 hour (30 min - 3 hours) Duration: 3hours ( 3-5 hour) * "15 MINUTES feels like an 1 HOUR during 3 RAPID responses"

Short-Acting Insulin * Types * Onset * Peak * Duration

Types: * Regular Onset: 30 minutes (30-60 minutes) Peak: 2 hours. (2-5 hours) Duration: 8 hours (up to 12 hours) * "SHORT staffed nurses went from THIRTY patients TO(TWO) EIGHT patients"

Sally is a 56 year-old overweight woman admitted to your rehab facility following LTHA. She has a long history of DM; her blood sugar level at this time is 436. Upon doing her home medication reconciliation, she tells you that you she takes insulin glargine (Lantus) 18 unity every night and insulin lispro (Humalog) 10 units with each meal. Sally is unsure if she has DM 1 or DM 2. When you enter Sally's room to check her 1600 vital signs, she complains of a headache. By the time you finish taking her blood pressure, she has developed a cold sweat. At 1700 you recheck her blood sugar. It is now 80 mg/dl. What should you do now?

give 15 g of a simple carb and check BS in 15 mins

Amylin Analog

hormone that is released into the bloodstream by the β cells of the pancreas along with insulin after a meal and inhibits glycogen secretion

Hyperglycemia or hypoglycemia symptoms Fruity breathe

hyper

Hyperglycemia or hypoglycemia symptoms Polydipsia

hyper

Hyperglycemia or hypoglycemia symptoms Polyuria

hyper

Hyperthyroidism or hypothyroidism Symptoms Restlessness

hyper

Hyperthyroidism or hypothyroidism Symptoms Frequent Stools

hyper

Hyperthyroidism or hypothyroidism Symptoms Insomnia

hyper

Mrs. Smith is hospitalized following a motor vehicle accident where she suffered from a head injury. She is diagnosed with diabetes insidious (DI). Will her urine specific gravity be low or high?

low (dilute)

A 44 year-old woman enters the outpatient clinic with symptoms of weight gain and fatigue. Labs have been completed, and she is diagnosed with hypothyroidism. What labs do you think they ran?

low T4 high TSH

ADH is secreted by the

posterior pituitary

Sally is a 56 year-old overweight woman admitted to your rehab facility following LTHA. She has a long history of DM; her blood sugar level at this time is 436. Upon doing her home medication reconciliation, she tells you that you she takes insulin glargine (Lantus) 18 unity every night and insulin lispro (Humalog) 10 units with each meal. Sally is unsure if she has DM 1 or DM 2. When you enter Sally's room to check her 1600 vital signs, she complains of a headache. By the time you finish taking her blood pressure, she has developed a cold sweat. What do you think caused her blood sugar to drop?

rapid acting insulin with her meal

A decease in ADH causes water to be

released or excreted

Mr. Jones is diagnosed with SIADH related to lung cancer. He enters the hospital for treatment of symptoms. How will you reduce his risk for injury from seizures?

restrict fluids loop diuretics hypertonic IV fluids

An increase in ADH causes water to be

retention

Mr. Jones is diagnosed with SIADH related to lung cancer. He enters the hospital for treatment of symptoms. Why is he at risk for seizures?

severe hyponatremia can cause seizures

You are explaining the importance to a diabetic of eating 3 meals a regular schedule. She asks why? How do you explain this to her?

to keep BS at a continuous level

Sally is a 56 year-old overweight woman admitted to your rehab facility following LTHA. She has a long history of DM; her blood sugar level at this time is 436. Upon doing her home medication reconciliation, she tells you that you she takes insulin glargine (Lantus) 18 unity every night and insulin lispro (Humalog) 10 units with each meal. Sally is unsure if she has DM 1 or DM 2. At this point, which type of DM do you think she has? Why.

type 1

Sally is discharged and follows her diet, exercise, and insulin regimen carefully. She even loses 50 lbs. One year later she ends up in the ED with a blood sugar of 32. Why do you think her blood sugar dropped?

weight loss decreases BS --> ketosis?

Hyperthyroidism or hypothyroidism Symptoms Tremors

hyper

Hyperthyroidism or hypothyroidism Symptoms Warm, diaphoretic skin

hyper

Hyperthyroidism or hypothyroidism Symptoms Weight loss

hyper

Diabetes type 1 and 2 both lead to

hyperglycemia

Hyperglycemia or hypoglycemia symptoms Sweating

hypo

Hyperglycemia or hypoglycemia symptoms Irritability

hypo

Hyperglycemia or hypoglycemia symptoms Lethargy

hypo

Hyperglycemia or hypoglycemia symptoms Tremor

hypo

Hyperthyroidism or hypothyroidism Symptoms Bradycardia

hypo

Hyperthyroidism or hypothyroidism Symptoms Lethargy

hypo

Hyperthyroidism or hypothyroidism Symptoms Decreased appetite

hypo

Hyperthyroidism or hypothyroidism Symptoms Dry hair

hypo

Hyperthyroidism or hypothyroidism Symptoms Hypercholesterolemia

hypo

Hyperthyroidism or hypothyroidism Symptoms Mental dullness/confusion

hypo

The nurse recognizes that teaching is effective if a patient with DM knowns to use subQ glucagon for an emergency episode of which of the following conditions? A. Hyperglycemia B. Ketonuria C. Diabetic ketoacidosis D. Hypoglycemia

hypoglycemia

Mr. Jones is diagnosed with SIADH related to lung cancer. He enters the hospital for treatment of symptoms. What fluid-related concept would be most appropriate for Mr. Jones?

hyponatremia and decreased plasma osmolality (fluid overload)

ADH or vasopressin is regulated by the ...

hypothalamus

Serum pH & Serum HCo3 are used

in conjunction

Sally's insulin has been discontinued and is started on Glipizide 5mg BID. How are two ways oral hypoglycemia medication work?

increased responsiveness to B-cells slow absorption of glucose after meal

DPP-4 inhibitors

inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.

Glucose cannot enter the cells without

insulin

Complications of diabetes

* Hyperglycemia * Hypoglycemia * Organ damage * DKA * HHNS

Signs and symptoms of Addison's disease

low STEROID hormone S * Sodium & sugar levels are low, Salt cravings T * Tired & weak muscles E * Electrolyte imbalances (K & Ca) R * Reproductive changes (menstrual irregularities, ED) O * lOw BP (vascular collapse) I * Increased pigmentation (brownish) D * Diarrhea, nausea, Depression

Treatment of Addisonian crisis

* IV cortisol STAT Solu-cortef * IV fluids D5NS to increase BP * Oral glucorticoids (prednisone) and mineralocorticoids (aldosterone) * With mineralocorticoids consume enough sodium * Educate - take routinely or stop abruptly * If there is an increase in stress notify the doctor * Monitor BS, K, and Na * Prevent infection

Interventions of HHNS

* IVF (.9% NS, .45% NS, 5% dextrose) * Monitor for cerebral edema * Insulin - REGULAR IN IV ONLY (K must be >3.3) (insulin absorbs into tubing, waste the first 50-100cc before administering) * Monitor BS frequently * IV K (monitor for phlebitis, EKG, renal function)

Causes of myxedema coma

* Illness (urinary, respiratory), surgery, chemotherapy * Elderly women with hypothyroidism * Discontinuation of thyroid replacement therapy * Use of sedatives or opioids * Antithyroid toxicity * Thyroidectomy Medication - lithium (inhibits TH release), sedatives, opioids

Hyperthyroidism causes

* Increased iodine * Graves disease (autoimmune - body produces TSI) * Toxic nodular goiter (produces its own hormones) * Thyroid replacement therapy

What hormone imbalances do you see in Addison's disease?

low levels of cortisol and aldosterone * cortisol (in cushings) and ADD Aldosterone * both are corticosteroids

Diet management for diabetics

* Individualized to each patient * Carb 45-60% * Fats 20% (limit saturated & trans fats, encourage mono & poly saturated fats) * Proteins 15-20% (no red meats)

What are the causes of DI?

* Kidney problems * Damage to hypothalamus or pituitary gland * Stroke * Tumor * Pregnancy * Medications - Declomycin (SIADH med)

Biguanides function

* Liver decrease it store of glucose * Held before surgery - causes diarrhea * Metformin

Medications for SIADH

* Loop diuretics (hypokalemia) * Hypertonic IV solution 3% NS (fluid overload, crackles) * Declomycin (Do not give with calcium foods)

Tylenol function

reduce fever * Avoid salicylates

Graves occurs as result of

severe hyperthyroidism

Addisonian crisis is when

there is no cortisol in the body * life threatening

Life threatening complication of hyperthyroidism

thyroid storm

HHNS is most commonly seen in

type 2 diabetes

Thyroid storm occurs in

uncontrolled hyperthyroidism

Myxedema coma occurs in

uncontrolled hypothyroidism

DKA occurs most commonly in

untreated type 1 diabetes * rarely in type 2

Interventions for thyroid storm

* Monitor HR, BP, RR (respiratory failure - mechanical vent) * Maintain airway * EKG (cardiac dysrhythmias) * Vitals Q30 min * Stressors * Monitor temperature * Keep environment cool and quiet * Do not give food with iodine (seafood, dairy, eggs) * Medication - decrease thyroid hormone level, decrease fever (antithyroid medications, iodide solution, Tylenol, beta blockers, glucocorticoids) * NS

Interventions for graves

* Monitor HR, BP, and weight * Keep environment cool and quiet * Educate about medication, treatment (radioactive and thyroidectomy), thyroid storm * Medications - Antithyroids - methimazole or PTU * Thyroidectomy

Thyroidectomy interventions

* Monitor for thyroid storm * Monitor calcium levels * Monitor for respiratory distress * Keep in semi-fowlers position * Keep tracheostomy kit & suction close to bedside * Splint neck

Sulfonylureas function

* Most Common * * Stimulate the release of insulin from beta cells * No alcohol, watch for hypoglycemia

Signs and symptoms of DI

* Polyuria * Polydipsia * Dehydration * Hypotension * Increase urine output (decrease urine specific gravity) * hypernatremia

Signs and symptoms of thyroid storm

* Severe hyperthyroid symptoms * * Violent, accelerated storm * * Increase metabolism * High fever * Hypertension * Tachycardia (CHF or MI) * Increase respirations * Respiratory failure * Confusion * If disease progresses - seizures, delirium, coma, diarrhea

Signs and symptoms of graves

* Severe hyperthyroidism * * Weight loss * Heat intolerance * Increased HR & BP * Diarrhea * Irritable * Smooth hair & skin * PROTRUDING EYES * GOITER * PRETIBAL MYXEDEMA

Gestational diabetes

* Similar to type 2 diabetes * Typically goes away after pregnancy

Meglitinides function

* Stimulate beta cells to release insulin * Take right before eating * Glinide

Interventions for DKA

* Teach patient how to prevent it * Monitor BS & ketones in the urine * Teach warning signs * Monitor BS Q4 hours when sick * When patient isn't able to eat or drink notify the DR * Call DR is BS is >300 or ketones in the urine * Monitor for polyuria, polydipsia, and fruity breath * Monitor K (>3.3)

Medications that cause hyperglycemia

* Thiazides * Glucocorticoids * Estrogen therapy

Treatment for hypothyroidism

* Thyroid hormone replacement (Synthroid) * Avoid sedative and narcotics - myxedema coma

Types of diabetes mellitus?

* Type 1 * Type 2 * Gestational

Medications for Diabetes Mellitus

* Type 1 - requires insulin * Type 2 - oral medications if diet and exercise doesn't work * Sulfonylureals * Meglitinides * Biguanides * Alpha-glucoside inhibitor * Thialzolidinedione

Causes of thyroid storm

* Uncontrolled hyperthyroidism * Illness, stress, trauma, thyroidectomy * Graves disease, if not treated * Vigorous palpation of goiter * Exposed to iodine (therapy) * Pregnancy * DKA * Not taking antithyroid properly * Medications that increase thyroid hormone (aspirin, salicylates) * Pregnancy * Radioactive iodine

Signs and symptoms of hypothyroidism

* Weight gain * Cold intolerance * Goiter (hashimotes) * Tired & fatigue * Decreased heart rate * Constipation * Memory loss * Myxedema (swelling of eye/face, waxy) * Dry skin * Depression * Menstrual problems

Signs and symptoms of hyperthyroidism

* Weight loss * Heat intolerance * Goiter (graves) * Increase HR * Restless * Irritable * Diarrhea * Unable to focus * Oily skin * Menstrual problems

Signs and symptoms of hypoglycemia

* cold sweats * weakness * trembling * nervousness * irritability * increased heart rate * confusion - altered LOC * irrational behavior * diaphoresis * hunger * headache * blurred vision

What are some interventions for Cushing's?

* hypophysectomy (pituitary gland removal) * Adrenalectomy (for tumors) * Educate patients about hormonal replacement therapy * Patients may see high BS due to higher cortisol levels * When cortisol levels increase potassium levels decrease - hypokalemia * Educate over signs of infection * Give emotional support

Cortisol function

* is a glucocorticoid * STRESS hormone * Increase or decrease BS * breaks down fats, proteins & carbohydrates * regulates electrolytes

Aldosterone function

* is a mineralocorticoid * Regulate blood pressure through the renin-angiotensin-aldosterone system * Retains sodium * Secretes potassium

Glucose is stored in the ____ in the form of _____.

* liver * Glucagon

Signs and symptoms of hyperglycemia

* polyuria * polydipsia * dehydration * fatigue * fruity odor to breath * kussmaul breathing * weight loss * hunger * poor wound healing

Interventions for Addisons disease

* Lower potassium levels (hyperkalemia is common) * Increase glucose levels (hypoglycemia is common) * Educate about hormone replacement therapy (prednisone, fludrocortisone & hydrocortisone) * Report stress, illnesses, or surgeries to prescriber for dosage adjustments * Take medication as prescribed, do not abruptly stop taking * Consume adequate levels of salt * Wear a medical alert bracelets * Consume a diet high in protein & carbs. * Avoid stress

Alpha-glucose inhibitors function

* Lowers BS by breaking down starchy foods * Take right before eating

Thiazolidinedione function

* Lowers glucose production in the liver * glitazone * Watch liver and heart function

Assessment for both type 1 and type 2 diabetes

"SUGAR" S * Slow wound healing U * blUrry vision G * Glycosuria A * Acetone breath R * Repeated yeast infections

Interventions for myxedema

* Maintain airway * Monitor HR, Bp, EKG, temperature, respirations * No sedatives * Monitor for changes in mental changes * aspration precautions * IV fluids normal or hypertonic for hyponatremia * Monitor for hyperthyroidism * IV Synthroid - can cause adrenal insufficiency, may put patient on glucocorticoids. * IV glucose

What are the causes of Cushing's?

* Medications - glucocorticoids * An over production of ACTH by the pituitary gland

Most common signs and symptoms of hyperglycemia

* 3 P'S * P * Polyuria P * Polydipsia P * Polyphagia * Im hot and dry must be a sugar high *

Exercise management for diabetics

* Aerobic exercises - cardio, walking, running & swimming * Check BS prior, if <100 eat a snack first * Carry simple carbs * Monitor for s/s of hypoglycemia * Extended exercise, required BS check prior, during & after * When glucose is >250 with ketones in the urine, avoid exercise

The adrenal cortex releases which corticosteroids?

* Aldosterone * Cortisol * Sex hormones

Treatment for Hyperthyroidism

* Antithyroid drugs (methimazole, propylthiouracil, lugol solution) * Beta blockers * Radioactive iodine therapy * Thyroidectomy * Avoid salicylates and foods with iodine

What are some causes of Addison's disease?

* Autoimmune * TB * Trauma or hemorrhage

Medications that cause hypoglycemia

* Beta blockers * Sulfonylureas * Alcohol & aspirin * MAO inhibitors * Bactrim

Causes of type 1 diabetes

* Beta cells in the pancreas are damaged * No insulin production * Genetic, autoimmune

Causes of type 2 diabetes

* Cells don't respond to insulin * Over secretion of insulin (hyperinsulinemia) - metabolic syndrome * Overweight/obesity * Sedentary life style * Poor eating habits

What are some medications for DI?

* Chlorporpamide (increases ADH) (hypoglycemia & photosensitivity) * Desmopresson or vasopressin (hyponatremia)

Insulin mixes ..

* Clear to cloudy * R to N * Sub@ normally, insulin R in IV ONLY * Don't massage injection sites, rotate sites

What are interventions of DI?

* Daily weights * I/O * Safety * Restrict foods that promote diuresis (caffeine, watermelon)

Interventions for SIADH

* Daily weights * I/O * Safety * Fluid restriction

Addisonian crisis causes

* Damage to the adrenal cortex * Not taking medications properly * Increase in stress * Not treated properly * Adrenalectomy * Pituitary gland damage - not producing enough ACTH

Causes for Hypothyroidism

* Decreased iodine * Hashimotes disease (autoimmune - body attacks the thyroid gland) * Anti-thyroid medications * Pituitary tumor

Home to manage type 2 diabetes?

* Diet * Exercise * Weight mangaement * If the patient cannot manage weight with diet and exercise then medications are used.

Education for patients with graves

* Don't stop taking abruptly - thyroid storm * Take at the same time everyday * Avoid iodine foods * Avoid salicylates * Watch for antithyroid toxicity (hypothyroidism)

Causes of DKA

* First sign of undetected diabetes * Body needs more insulin due to stress or illness * Medications (corticosteroids, thiazides) * Not eating or skipping meals - starvation * Not taking insulin as prescribed

Diabetes is diagnosed by

* Glucose levels * Hemoglobin A1C

Warning signs of HHNS

* HAPPENS GRADUALLY * * Extremely high BS * Polyuria * Polydipsia

Signs and symptoms of HHNS

* HAPPENS GRADUALLY * * BS >600 * Polyuria * Polydipsia * Majorly dehydrated * Fever * Fatigue * Changes in mental status * Coma & siezures

Signs and symptoms of DKA

* HAPPENS SUDDENLY * * Hyperglycemia * Ketones. in the urine * Metabolic acidosis I= * Polyuria * Polydipsia * Dehydration * N/V * Abdominal pain * Kussmal respirations * Acetone breath * BS >300 * pH <7.35 * HCO3 <15

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1, 3, 4 Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the manifestations of hypoglycemia. In hypoglycemia, usually the client feels hunger.

The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? 1. A urinary output of 50 mL/hour 2. A coagulation time of 5 minutes 3. A heart rate that is 90 beats/minute and irregular 4. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)

3 Pheochromocytoma is a catecholamine-producing tumor usually found in the adrenal medulla, but extraadrenal locations include the chest, bladder, abdomen, and brain; it is typically a benign tumor but can be malignant. Excessive amounts of epinephrine and norepinephrine are secreted. The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from shock, stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An irregular heart rate indicates the presence of a dysrhythmia. A coagulation time of 5 minutes is normal. A urinary output of 50 mL/hour is an adequate output. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L) is a normal finding.

Severe hypoglycemia is less than

50

Signs and symptoms of addisonian crisis

5s S * Sudden pain (stomach, back, legs) S * Syncope (unconscious) S * Shock S * Super low BP S * Severe vomiting, diarrhea, headache leads to 3Hs H * Hyponatremia <135 H * Hypoglycemia <70 H * Hyperkalemia >5.1

Hypoglycemia is anything less than

70

Fasting glucose normal range is

70-110

Fasting glucose range should be

<140 * >140 indicated hyperglycemia

Severe hyperglycemia considered

>180

Blood sugar greater than ___ is considered DKA?

>300

What BS greater that what is considered HHNS?

>600

Diabetic ketoacidosis is

A life threatening complication of DM. There is no insulin fats breaking down ketones.

Iodide Solution function

Also called lugols solution * Blocks the secretion of thyroid hormones

Causes of Graves

Autoimmune disorder causing the body to produce an antibody called TSI that produces same effects on the body as TSH.

A INCREASE in cortisol would cause the BS to increase or decrease?

BS would increase

Antithyroid medications

Block the synthesis of thyroid hormone * Lithium * methimazole (can't be taken during 1st trimester) * propylthiouracil (PTU) (can cause lever failure) * Monitor for signs of hypothyroidism

When BS decreases the pancreas will cause an increase or decrease in insulin?

Decrease

How does diabetes insidious affect ADH?

Decreases the amount of ADH

When is hypoglycemia likely to occur in a patient who has received insulin at the appropriate time prior to eating?

Depending on what type of insulin they took, hypoglycemia will occur during the peak time

Radioactive iodine function

Destroys the thyroid gland over time

How do you manage the somagel effect?

Eat a snack at bedtime to counteract or decrease the bedtime dose.

How do you manage dawn phenomenon

Extra NPA to lower glucose in the morning

Medications for DKA

Goals - hydrate, lower BS, monitor K levels, acid-base balance * IV fluids (.9% NS, .45% NS, 5% dextrose) * IV insulin drip- REGULAR ONLY (K must be >3.3) (insulin absorbs into tubing, waste the first 50-100cc before administering) * IV Potassium (watch for phlebitis, EKG, and renal function)

Cushing's causes a hyper or hypo secretion of cortisol?

Hyper secretion * Hypercortisolism * C in Cushing -- C in cushion -- Extra (hyper) padding

Management for type 1 diabetes includes

INSULIN

When is hypoglycemia likely to occur in the patient who has received regular insulin but then does not eat?

If they don't eat it'll occur when the insulin's onset time reaches

Causes HHNS

Illness and infection * Especially in older adults

When BS increase the pancreas will cause an increase or decrease in insulin?

Increase

Type 1 diabetes

Is caused by a lack on insulin in the body

What is HHSN?

Life threatening complication of DM. EXTREME hyperglycemia > * Heavy-duty Hyperglycemia * * No ketosis or acidosis

Beta blockers function

Lowers BP which can affect the way elevated thyroid levels effect the body * Inderal * Don't give to patients with asthma * Masks hypoglycemia

Life threatening complication for hypothyroidism

Myxedema coma

Treatment for hypoglycemia

Need a simple carb, hard candy, or juice. * Cold and clammy need some candy * * For unconcious patients use IVD50

Glucocorticoids function

Reduce the level of circulating thyroid hormones * Dexamethasone

Signs and symptoms of Cushing's?

STRESSED S * Skin fragile T * Truncal obesity (small arms & legs) R * Round face (moon face), reproduction issues (no menstration, ED) E * Ecchymosis (bruising), Encrease (incensed) BP S * Stride (purplish stretch marks) S * Sugar extremely high E * Excessive body hair (hirsutism) D * Depression, Dorsocevical fat pad (C-cushing, c-cushion - x-padding)

Signs and symptoms of myxedema coma

Severe hypothyroidism * SLOW * * Hypothermia * Thick tongue * Decreased BP and HR * myxedema (swelling of tissues, waxy appearance of hands & face) * Very drowsy * Respiratory failure - vent * Hyponatremia * Hypoglycemia * Coma * Death

What is the somagel effect?

Sleeping hours between 2a-3a there's a drop in BS causing the body to release cortisol, catecholamines, and GH to increase BS.

What happens in type 2 diabetes

The body has glucose but is resistant to insulin therefore, it can be brought into the cell * leads to hyperglycemia

What is diabetes mellitus?

The body is unable to access the glucose that you're eating caused by either * no insulin in the body * the body is resistant to insulin

How will a person with type 1 diabetes appear?

Thin, young, happens suddenly, and there will be ketones in the urine. `

What is dawn phenomenon?

Walking hours the body releases glucose in preparation for waking house (5-8am)

Addisons disease is also called

adrenal insufficiency

Medications taken for graves

antithyroid meds, beta blockers (inderal), radioactive iodine

Sally is a 56 year-old overweight woman admitted to your rehab facility following LTHA. She has a long history of DM; her blood sugar level at this time is 436. Upon doing her home medication reconciliation, she tells you that you she takes insulin glargine (Lantus) 18 unity every night and insulin lispro (Humalog) 10 units with each meal. Sally is unsure if she has DM 1 or DM 2. When you enter Sally's room to check her 1600 vital signs, she complains of a headache. By the time you finish taking her blood pressure, she has developed a cold sweat. What is happening? What should you do?

check blood sugar -- possible hypoglycemia

Mr. Jones is diagnosed with SIADH related to lung cancer. He enters the hospital for treatment of symptoms. How do you expect Mr. Jones' urine to look like?

concentrated

Type 1 diabetes causes the body to metabolize what?

fats for energy