Acid Base Balance, Glucose Regulation, Hormonal Regulation NUR 305 Exam 3 ~ Burcham Fall 2022

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what question do we need to ask DI patients?

are they a diabetic?

ABB risk factors (brain drain)

asthma COPD congition renal function BABIES/INFANTS -lungs and kidneys arent fully developed OLDER ADULTS -health complications -kidney shrinks -renal reserves -DKA -drug OD -alcohol abuse -anorexia -vomiting and diarrhea -hyperventilation -lots of diuretics - massive blood transfusion

hormonal regulation risk factors (concept map)

autoimmune disorders cancer chronic diseases age chromosomal disorders receiving hormonal therapy sedentary/obesity high stress levels/trauma

•To determine the presence of respiratory alkalosis in the laboring client, what should the nurse evaluate her for? a.A change in the respiratory rate b.A tingling sensation in the hands c.Periodic changes in the fetal heart rate d.A pulse oximetry reading of less than 98%

b.A tingling sensation in the hands

•A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure? a.Remain in the house. b.Avoid holding an infant. c.Save urine in a lead-lined container. Refrain from using a bathroom used by others.

b.Avoid holding an infant.

•An adolescent with type 1 diabetes is brought to the emergency department in ketoacidosis. The adolescent admits to not adhering to the diabetic regimen. What can the nurse do to help the adolescent become more accepting of the diabetic regimen? a.Determine what the adolescent has been taught about diabetes. b.Encourage the adolescent to express feelings about having diabetes. c.Explain to the parents that it is their responsibility to demonstrate their acceptance. d.Provide the family with printed materials about the consequences of ineffectively controlled diabetes.

b.Encourage the adolescent to express feelings about having diabetes.

•An adolescent with type 1 diabetes is brought to the emergency department unconscious. The blood glucose level is found to be 742 mg/dL. What clinical manifestation does the nurse expect the adolescent to exhibit during the initial assessment? a.Pyrexia b.Hyperpnea c.Bradycardia d.Hypertension

b.Hyperpnea

•A woman who has gestational diabetes gives birth at term to a large-for-gestational age (LGA) infant weighing 9 lb 6 oz (4250 g). For what complication should the newborn be monitored? a.Anemia b.Hypoglycemia c.Increased calcium d.Meconium aspiration

b.Hypoglycemia

•A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? a.Arterial blood pH b.Intake and output c.Fasting serum glucose Pulse and respiratory rates

b.Intake and output

•A client's parathyroid glands are removed with total thyroidectomy surgery. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery? a.Constipation b.Muscle spasms c.Hypoactive reflexes Increased specific gravity

b.Muscle spasms

when to check blood sugar?

before meals before bed when they are not feeling well

the nurse would instruct a patient newly diagnosed with diabetes to self-check the blood glucose level at which time?

before meals frequently if you are ill if you are thirsty and urinate frequently

what does the bicarb (HCO3) represent?

bicarb represents the metabolic system

in cushings patients what are we checking cortisol for?

blood, urine, saliva

which assessment finding would require priority nursing interventions in a patient with metabolic or respiratory acidosis?

bradycardia with widened QRS complex

signs and symptoms of DKA?

breath smells like juicy fruit gum (acetone breath) -kussmaul respirations -thirsty, dehydration -tachycardia -hypotension -acidosis -high blood sugar (>300 mg/dL) -hyperkalemia -polyuria -breaks down fats -taking thiazides and loop diuretics -seen in kids -no insulin -mainly seen in type 1 diabetics

ABB collaborative interventions (brain drain)

breathing (vent) treatment (oxygen) find the cause and treat the cause fluid and electrolytes (NEEDS FLUIDS) or may need hemodialysis give sodium bicarb to balance acidosis

how to treat someone with respiratory acidosis?

bronchodilators, anti-inflammatories, and mucolytics for improving ventilation; ventilatory support if O2 less than 90 or have respiratory muscle fatigue; oxygen therapy

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a. Potassium is returned to extracellular fluid when metabolic acidosis is corrected. b. Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells. c. Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells. d. In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.

c. Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells.

A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to a. Withhold the regular dose of insulin. b. Drink cool fluids with high glucose content. c. Check the blood glucose level every 2 to 4 hours. d. Use a less strenuous form of exercise than usual until the illness resolves.

c. Check the blood glucose level every 2 to 4 hours.

c. Check the blood glucose level every 2 to 4 hours...

The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goal is most appropriate? a. Make all patients responsible for the management of their disease. b. Involve the family and significant others in the care of these patients. c. Enable the patients to become active participants in the management of their disease. d. Provide the patients with as much information as soon as possible to prevent complications.

c. Enable the patients to become active participants in the management of their disease.

•Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? a.Providing oxygen b.Encouraging carbohydrates c.Administering fluid replacement d.Teaching facts about dietary principles

c.Administering fluid replacement

A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis? a.An elevated pH, elevated PCO2 b.A decreased pH, elevated PCO2 c.An elevated pH, decreased PCO2 d.A decreased pH, decreased PCO2

c.An elevated pH, decreased PCO2

•What is a nursing priority to prevent complications in clients with respiratory acidosis? a.Assessing the nail beds b.Listening to breath sounds c.Monitoring breathing status d.Checking muscle contractions

c.Monitoring breathing status

•A nurse is caring for an 11-year-old child with type 1 diabetes. Two hours after breakfast the child becomes pale, diaphoretic, and shaky. What action should the nurse take? a.Notifying the practitioner b.Administering supplemental insulin c.Obtaining a current blood glucose level d.Giving orange juice with a slice of bread

c.Obtaining a current blood glucose level

•A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? a.Skeletal and nervous b.Circulatory and urinary c.Respiratory and urinary d.Muscular and endocrine

c.Respiratory and urinary

a patient with emphysema is in acute respiratory distress and is becoming more confused. respirations remain rapid but are shallower. the most recent blood gas results are pH 7.29, PaO2 62 mmHg, PaCO2 56 mmHg, bicarb (HCO3-) 25 mEq/L. which intervention would the nurse take?

call the rapid response team

what does high potassium put patients at risk for?

cardiac dysrhythmias (HR, BP, and cardiac rhythms)

what does cortisol cause glucose to do?

causes glucose levels to RISE

what will we do for an assessment for acid-base imbalance?

check LOC check respiratory status check for skin and dehydration check ABGs and electrolytes check their vital signs

treatment options for the somogyi affect?

check blood sugar in the middle of the night if needed give a cracker, or juice

what is a hormone?

chemical substance that stimulates cellular action in targeted tissue

which serum electrolyte result would be of concern to the nurse? chloride 88 sodium 143 potassium 4.8 magnesium 2.0

chloride 88

what assessment will we do with DM patients?

complete medical history review of systems

how do you prevent complications in patients with impaired glucose for their complications?

complications -foot care and eye care -diabetic retinopathy—get regular eye exams -diabetic or peripheral neuropathy can lead to foot ulcers and necrosis

is acid-base balance a disease or concept? (brain drain)

concept

what does the adrenal cortex release?

corticosteroids, aldosterone, and sex hormones

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "The laboratory test result is positive for type 2 diabetes." b. "You will develop type 2 diabetes within 5 years." c. "The test is normal, and diabetes is not a problem." d. "You are at increased risk for developing diabetes."

d. "You are at increased risk for developing diabetes."

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "The laboratory test result is positive for type 2 diabetes." b. "You will develop type 2 diabetes within 5 years." c. "The test result is normal, and diabetes is not a problem." d. "You are at increased risk for developing diabetes."

d. "You are at increased risk for developing diabetes."

•When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a client who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful? •a. Increased insulin levels •b. Decreased diarrhea •c. Improved nasal patency d. Decreased thirst

d. Decreased thirst

The nurse is caring for a female patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. d. The patient makes harsh, vibratory sounds when breathing.

d. The patient makes harsh, vibratory sounds when breathing.

e nurse is caring for a female patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. d. The patient makes harsh, vibratory sounds when breathing.

d. The patient makes harsh, vibratory sounds when breathing.

A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? a.7.20 and 60 mg/dL b.7.50 and 60 mg/dL c.7.50 and 460 mg/dL d.7.20 and 460 mg/dL

d.7.20 and 460 mg/dL

•A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? a.7.20 and 60 mg/dL b.7.50 and 60 mg/dL c.7.50 and 460 mg/dL d.7.20 and 460 mg/dL

d.7.20 and 460 mg/dL

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? a.A patient with a traumatic brain injury b.A patient with type 1 diabetes mellitus c.A patient with acute respiratory failure d.A patient with nasogastric tube suction

d.A patient with nasogastric tube suction

•A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? a.Fluid loss b.Glycosuria c.Increased blood glucose level d.Kussmaul respirations

d.Kussmaul respirations

•One week after beginning anti-thyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis (thyroid storm). The nurse determines that the most important intervention for this client is: a.Limiting fluid intake b.Observing for an exaggerated response to sedatives c.Treating the associated hyperglycemia and ketoacidosis d.Reducing body temperature and heart rate

d.Reducing body temperature and heart rate

peripheral neuropathy

damage to nerves in lower legs and hands as result of diabetes mellitus; symptoms include either extreme sensitivity or numbness and tingling · Tingling, pins, and needles feeling in their toes

when do you give intermediate acting insulin?

dawn phenomenon PREVENTING HIGH GLUCOSE IN THE MORNING

ABB assessment data (brain drain)

decreased LOC check ABG and electrolytes -head -respiratory -cardiac ~check skin! ~vital signs (O2 and pain) ~fatigue and muscle weakness

RESPIRATORY ACIDOSIS POSSIBLE CAUSES (burcham handout)

decreased respiratory due to drug overdose or anesthesia acute or chronic respiratory conditions: COPD, pneumonia, asthma, bronchitis, emphysema, sleep apnea, atelectasis, airway obstruction, pulmonary brain injury airway obstruction, pulmonary edema WILL SEE HYPOVENTILATION AND CNS DEPRESSION

what are some other causes of respiratory acidosis (burcham notes)

decreased respiratory stimuli (anesthesia, drug overdose) COPD pneumonia atelectasis

retinopathy

degenerative disease of the retina · Will have had diabetes for a while · If diagnosed in 40s could get this by the 60s

what is the synthetic form of ADH?

desmopressin

what do hydrogen ions (H+) do for the body?

determine the pH of the body

what are two other things for type 2 diabetics to do while taking oral insulin?

diet and exercise

which method must a patient with diabetes implement regarding insulin safety?

discard any unused insulin after 28 days

do the feedback mechanisms function properly in SIADH?

do not function properly

for the patient newly diagnosed with type 1 diabetes mellitus, which statement indicates understanding of teachings received about prevention of eye changed?

double vision could mean that my blood glucose is too low blurred vision could men that my blood glucose is too high in 5 years, i will need to have an eye examination every year

which feature of the glycosylated hemoglobin A1C test is important?

eating habits, within 24 hours before the test, do not alter the results

a postoperative patient has the following arterial blood gas (ABG) results: pH 7.30, PaCO2 60 mmHg; PaO2 80 mmHg; bicarb (HCO3-) 24 mEq/L; and oxygen saturation is 96%. which action would the nurse take?

encourage the patient to do deep breathing, and assist with repositioning

what are crackles a telltale sign of?

excess fluid in the body

what would we expect with the a diabetes diagnosis of a postprandial (after eating) blood glucose test?

expect to go up to 140 within 2 hours of eating

why do we need to monitor feet and eye with glucose regulation?

feet- peripheral neuropathy; looking for any wounds or sores, could have numbness and tingling in their feet eyes- could develop retinopathy

which manifestations would the nurse anticipated finding when assessing a patient with metabolic and respiratory acidosis? select all that apply one, some or all responses may be correct?

flaccid paralysis kussmaul respiration delayed electrical conduction

what are we monitoring in DI patients?

fluid retention LISTEN TO THEIR LUNGS FOR CRACKLES

S/S of DKA

fruity smelling breath (acetone) ketones in the urine warm, dry skin nausea

glucose regulation assessment/diagnostic tests (concept map)

full H&P workup vital signs- weight and height, mental status, skin , respiratory and cardiovascular blood glucose testing- antibody test (confirming type 1 diabetes), glutamic acid decarboxylase -GAD, lipid analysis - total cholesterol, HDLs, LDLs, triglycerides, renal function tests CRP

glucose regulation risk factors (concept map)

genetic markers HLA genes insulin resistance people with history of type 2 diabetes obesity factors associated with metabolic syndrome poor diet with high intake of saturated trans fatty acids and a low fiber intake medication cause affect inhibitors: corticosteroids, estrogen, diuretics, racial/ethnic groups

what are oral insulin stimulators?

glipizide glyburide

is HHNS a gradual or rapid onset?

gradual onset, will be dehydrated

does HHNS have insulin in the body?

has some insulin NOT ENOUGH BLOOD SUGAR IS OFTEN GREATER THAN >600

what to look for in METABOLIC acidosis (CNS depression)

headache decreased BP hyperkalemia muscle twitching warm, flushed skin (vasodilation) nausea, vomiting, diarrhea changes in LOC - (confusion, increased drowsiness) KUSSMAUL RESPIRATIONS -(compensatory respirations)

signs and symptoms of METABOLIC ACIDOSIS

headache decreased blood pressure hyperkalemia muscle twitching warm, flush skin (vasodilation) nausea, vomiting, diarrhea changes in LOC (confusion and increased confusion) kussmaul respirations (compensatory hyperventilation)

what vital signs do we monitor closely with acid base balance?

heart rate and rhythm

what are some primary buffers?

hemoglobin plasma protein carbonic and bicarbonate systems

how do we get a confirmation of diabetes?

hemoglobin A1C will be above 6.5 fasting blood glucose will be above 126

why is hyperglycemia?

high blood sugar

a patient is admitted for IV fluids to treat dehydration caused by several days of vomiting and diarrhea. the patient's admission blood work reveals a pH of 7.27 and bicarbonate of 26 mEq/L; potassium and chloride levels are within normal ranges. the health care provider has prescribed adding bicarbonate to the IV fluids. which action by the nurse is correct?

hold the bicarbonate, and report the laboratory values to the healthcare provider

hormonal regulation scope (concept map)

hormonal regulation ranges from the circulating hormone to abnormal secretion, in either excess or deficient amounts

what do hormones cause in pregnancy?

hormones can cause insulin resistance

what does someone need if they are in DKA?

hydration insulin electrolyte replacement

how to treat someone with metabolic acidosis?

hydration and drugs; insulin for DKA; rehydration and antidiarrheals for prolonged diarrhea; continuously monitor for cardiovascular and skeletal muscle system changes

glucose regulation consequences (concept map)

hyperglycemia and insulin resistance- known to be toxic and proinflammatory states, causing cellular changes, cell death and contributing to various long term health problems hypoglycemia- impaired function of the neurological system and cause grave danger to the patient angiopathy, peripheral neuropathy, fluid and electrolyte and acid base imbalance

what if the blood sugar is greater than 100 or 140?

hyperglycemic

what is HHNS?

hyperglycemic hyperosmolar nonketotic syndrome -occurs more frequently in Type 2 due to illness or infection, some insulin is present -no ketones present, occurs more often in elderly, gradual onset - >600 BG -polyuria, polydipsia -watch for seizures, coma, paralysis, confusion, cognitive changes

acidosis (common electrolyte imbalance)

hyperkalemia

what are some other causes of respiratory alkalosis (burcham notes)

hyperventilation anxiety fear mechanical ventilation pulmonary embolism (PE)

RESPIRATORY ALKALOSIS POSSIBLE CAUSES (burcham handout)

hyperventilation (anxiety, fear, PE) mechanical ventilation pain high altitudes hypoxia WILL CNS STIMULATION/EXCITATION

what if the blood sugar is below 60 or 70?

hypoglycemia

a patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with IV fluids and insulin. which electrolyte imbalance would the nurse monitor for as the acid-base imbalance resolves?

hypokalemia

alkalosis (common electrolyte imbalance)

hypokalemia and hypocalcemia

what to look for with respiratory acidosis (CNS depression)

hypoventilation --> hypoxia -rapid shallow respirations -decreased BP with vasodilation -dyspnea -headache -hyperkalemia -dysrhythmias (increased potassium) -lethargy -drowsiness, dizziness, disorientations -muscle weakness, hyperreflexia

signs and symptoms of RESPIRATORY ACIDOSIS

hypoventilation --> hypoxia rapid, shallow respirations (kussmaul respirations) DECREASED BP with vasodilation (dilation of the blood vessels) dyspnea headache hyperkalemia dysrhythmias (increased K) drowsiness, dizziness, disorientation muscle weakness, hyperreflexia

how to treat someone with metabolic alkalosis?

if caused by diuretic therapy receives fluid and electrolyte replacement, and diuretic is adjusted or stopped; Antiemetic drugs are prescribed for vomiting; Monitor the patient's progress and adjust fluid and electrolyte therapy; Monitor electrolytes daily until they return to near normal.

what does it mean if the PaCO2 is above 45?

if it is above 45 it is an ACID (ACIDOTIC)

what does it mean if the PaCO2 is below 35?

if it is less than 35 it is a BASE (ALKALOTIC)

when testing blood sugar why do we need to know if they have eaten or not?

if testing for a FBS the patient CANNOT EAT BEFORE THEIR LAB DRAW

when does insulin production reduce?

in older adults

the nurse reviews the medical record of an older adult patient and notes assessment findings of frequent urination, white, foul-smelling discharge from the vagina, poor wound healing, and above normal body weight. which finding would the nurse anticipate?

increased fasting blood glucose

what is cushing's

increased secretion of cortisol cushings=cortisol

which mechanism in the body compensated for a low pH?

increases respiratory rate

when a patient with diabetes returns to the medical unit after CT with contrast dye, which prescribed intervention would the nurse implement first?

infuse 0.45% normal saline at 125 mL/hr

what meds are used to treat hyperglycemia for type 1 diabetics?

insulin

which causes is associated with acidosis?

kidney failure

what is the history of DKA?

lack of insulin GI upset febrile illness

•A nurse is caring for an older client who had non-insulin dependent diabetes for 15 years that progressed to insulin dependent diabetes 2 years ago. What common complications of diabetes should the nurse assess for when examining this client? Select all that apply. a.Leg ulcers b.Loss of visual acuity c.Increased creatinine clearance d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

leg ulcers loss of visual acuity prolonged capillary refill in the toes decreased sensation in the lower extremities

respiratory alkalosis (KNOW THE SIGNS)

lethargy Lightheadedness Confusion Tachycardia dysrhythmias related to hypokalemia (RISK FOR SEIZURES) nausea, vomiting epigastric pain numbness and tingling of the extremities Hyperventilation (tachypnea)

is HHNS life-threatening?

life threatening complication of diabetes

what is hypoglycemia?

low blood sugar

which action does insulin provide?

lowers blood glucose levels

which goal must the patient with diabetes mellitus strive for to decrease the risk for acid-base imbalance?

maintaining blood glucose level within normal limits

ABB pt education (brain drain)

manage chronic illness recognize signs of when to call doctor or go to the ER

deep and rapid breaths consistent with kussmaul respiration are found in patients with which type of acid-base imbalance?

metabolic acidosis

example of acid-base scenario pH 7.31 paCO2 26 mm Hg HCO3- 17 mEq/L what is the imbalance and is there compensation?

metabolic acidosis partial compensation

what is fever an example of in acid base imbalance?

metabolic acidosis (101* degress F)

what is diabetic ketoacidosis an example of in acid base imbalance?

metabolic acidosis (DKA)

what is diarrhea an example of in acid base imbalance?

metabolic acidosis (i have diarrhea from my acidosis)

what is renal failure an example of in acid base imbalance?

metabolic acidosis (kidneys)

•A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis

metabolic acidosis (uncompensated)

•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results?

metabolic acidosis (uncompensated)

when would you give bicarb to a patient and why would you give it?

metabolic acidosis—Bicarbonate is given only if serum bicarbonate levels are low, and the pH is less than 7.2.

what is excessive ingestion of antacids or baking soda an example of in acid base imbalance?

metabolic alkalosis (antacids)

what is excessive vomiting an example of in acid base imbalance?

metabolic alkalosis (emesis)

what happens to older adults metabolsim?

metabolism slows way down when theres no way to metabolize and no way to use blood glucose

which type 2 diabetic medication cannot have CT with contrast?

metformin

whic nursing is the greatest priority in the plan of care for a patient recovering from an acute episode of chronic obstructive pulmonary disease? (COPD)

monitor the respiratory rate and effort hourly.

•What is a nursing priority to prevent complications in clients with respiratory acidosis?

monitoring breath status

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have

muscle cramping (metabolic alkalosis uncompensated)

in acid base imbalance what do we need to find and treat?

need to find the UNDERLYING CAUSE and treat it

hormonal regulation collaborative interventions (concept map)

nutritional therapy fluid and electrolyte balance surgery to remove gland radiation education psychosocial pharmacotherapy

glucose regulation interrelated information

o Adherence o Family culture o Behavior o Nutrition o Mobility o Patient education o Hormones § Insulin § Cortisol § Pregnancy hormones

what is addisons disease?

o Adrenal insufficiency decreased secretion aldosterone and cortisol

what are the functions fo ACTH?

o Adrenocorticotropic hormone § Releases from the pituitary gland · Causes the adrenal cortex to release cortisol

LONG TERM DIABETIC COMPLICATIONS

o Atherosclerosis o Renal damage o Neuropathy § MUST CHECK THEIR FEET § Wounds will not heal as quickly as someone who does not have diabetes o Vision and hearing damage § Retinopathy § Routine checks o UTIs - most common infection

S/S of addisons disease

o Autoimmune disease o Decreased aldosterone levels and decreased cortisol

addisons disease interventions

o Blood work § Cortisol · Low § Glucose · Low § Sodium · Low § BUN · Will be high

why can;t we give mifepristone to pregnant women?

o CANNOT BE GIVEN TO A WOMAN WHO IS PREGNANT, TRYING TO GET PREGNANT, OR THINKING OF GETTING PREGNANT § Need to understand that this medication will cause loss of baby · Medications interfere with ACTH

what does metformin cause?

o Cause lactic acidosis (causes slow heart rate) in pt. with kidney disease § If have kidney disease CANNOT TAKE THIS MEDICATION

signs and symptoms of hypoglycemia

o Change in mental status o Skin will be cold and clammy o Heart rate will go up (palpitations) o Anxious and irritable

what are some causes of DKA?

o Could not even know they were diabetic o Illness or stress § Needs to check every 2-4 hours § Sickness causes blood sugars to go whack o Skipping a meal o Medications § Thiazide diuretics · Lasix and bymex § Not taking insulin appropriately

what will if the body is deficient in aldosterone?

o Decreased cortisol level cause decreased blood sugar levels

important patient education information

o Diabetic patients need at least 130 g of carbohydrates daily o Patients should not exercise when they have ketones in their urine o Patients should be active participants in the management of their disease o Fasting blood glucose 120 mg/dL is at an increased risk for developing diabetes o Insulin Is a small protein that is destroyed by stomach enzymes o Insulin needs will increase in the second trimester

What is the dawn phenomenon?

o Elevate blood glucose levels early in the morning 0600

diabetic labs

o Fasting blood glucose test o Hemoglobin A1C § Blood sugar over the span of 3 months § Must be over 6.5 to give a diagnosis of diabetes

how do we respond to SIADH

o Fluid restriction o Drug therapy (diuretic, hypertonic saline, demeclocycline) o Tolvaptan- used for low sodium level (vasopressin antagonist) - helps get rid of all the fluid without sodium loss- GIVEN IN THE ICU; could cause sodium level to rise quickly o Monitor for fluid overload

treatment of DKA

o Hydrate § IV fluids § Normal saline · Then hand REGULAR INSULIN o Regular insulin is the only insulin you can hang through an IV line § Will then goes to half normal saline § Then half 5% dextrose § Will start IV bolus · Managing blood glucose levels o Will be titrating those levels

complications of diabetes

o Hyperglycemia o Hypoglycemia (seen primarily in type 1 diabetes) o Atherosclerosis

addisons disease treatment?

o IV cortisol § As fast as you can get it o Solucortef § IV push - over 30 seconds at least o D5 Normal saline § At high risk for infection

when do we give dextrose 50% to patients with hypoglycemia?

o If their blood sugar is lower than 20-30S o Given in the hospital if the patient o GIVEN NEARLY COMATOSE § Given IV push SLOWLY § Push over 1-5 minutes

why do we watch the sodium level?

o If they become hyponatremic; THIS CAUSES SEIZURES (puts them at risk for seizure precautions) § Add seizure precautions if sodium drops too low

causes of HHNS

o If they don't know they have type 2 diabetes o It happens most often in older adults o Illness and infection (number 1 reason)

what is metformin?

o Inhibits glucose production in the liver

what is the process of glucose regulation?

o Insulin is released to facilitate the movement of glucose into the cells § Move glucose into the cells to be utilizes; § Glucagon which a counter-regulatory hormone · Suppresses insulin · Stimulates hepatic glucose production when there is a deficiency in the body o Body will release glucagon when you haven't eaten in a long time o Can start to stimulate glycogen to break down so the body can use the glucose

what do we monitor BUN and creatine?

o LOW BLOOD SUGAR IS A SAFETY CONCERN o If BS is too high, they can go into diabetic coma § Times of stress § May have to go on insulin in the hospital

What is the Somogyi effect?

o Middle of the night blood sugar drops. And when you wake up blood sugar will become hyperglycemic

what are we monitoring in patient with DKA?

o Monitoring heart rhythms o Monitoring kidney function o Monitoring IV site

more S/S of addisons disease

o Muscle weakness o Weight loss o Anorexia o Nausea and vomiting o Anemia o Abdominal pain o Fatigue o Constipated or diarrhea o Hyper pigmentation o Vitiligo § Patchy areas § Hypopigmentation

when do DI patients need to call doctor

o Need to call the doctor if they gain 2.2 pounds overnight - THEY ARE RETAINING FLUID, AND THEY COULD BE EXPERIECNING POLURIA, AND POLYDIPSIA

examples of cushing's disease

o People with asthma or COPD who takes lots of steroids run a high risk for developing Cushing's disease or syndrome o A tumor on the pituitary gland increases the risk for developing cushing's disease or syndrome § More common in women

signs and symptoms of DKA

o Polyuria, polydipsia o Dehydration o Nausea and vomiting o Fruity smelling breathing o Kussmual respirations § Body is trying to compensate for the metabolic acidosis o Tachycardia

S/S of HHNS

o Polyuria, polydipsia o Severe dehydration o Fever o Fatigued o Changed in level of consciousness § If left untreated · Coma · Seizures

warning signs of HHNS

o Polyuria, polydipsia o Very high glucose

addisons disease medications

o Prednisone o Cortisone o Hydrocortisone § Steroids will end in ONE

sign and symptoms of hyperglycemia

o Rapid thready pulse o Hot and dry o Dehydration o Blurred vision o Frequent urination o Excessive thirst § Can lead to diabetic ketoacidosis

what do the oral insulin stimulators do?

o Release insulin from beta cells and helps lower blood glucose § Lower blood sugar even if patient is not hypoglycemic § Still need to monitor blood sugar levels

what are the functions of aldosterone?

o Retains salt, which helps retain water o Secretes potassium o Regulate the blood pressure

addisons STEROID

o S - low blood sugar, low sodium o T - tired, weak o E - electrolyte imbalance § Increased potassium § Increased calcium o R - reproductive changes o O - lOw BP shock o I - increased pigmentation skin o D - diarrhea, Nausea and vomiting, depression

type 1 hypoglycemic event signs and symptoms

o Seen most in type 1 diabetics o Too much glucose in the cells leaving insufficient amount in the blood stream § Need supply to the brain, brain is first affected during hypoglycemia · Nervousness · Shakiness · Confusion o Seizures or diabetic coma

what will do for our assessment for DI patients?

o Symptoms of dehydration o Increased in frequency of urination and excessive thirst o Dehydration and hypertonic saline tests used for diagnosis o Urine diluted with low specific gravity (<1.005)

what are we teaching diabetic patients?

o Teach them how to take their insulin o Teach them how to monitor their blood glucose levels o Teach them not to skip meals § Teach them when they are sick to check frequently § Teach them to monitor for ketones in the urine § Teach them to watch for signs of hyper and hypoglycemia o Know when they are going into DKA and call MD if they are starting to feel that way

in SIADH what does vasopressin secrete?

o Vasopressin secretes even when plasma osmolarity is low or normal

in SIADH pts are we watching potassium levels/

o Watching their potassium level because Lasix drowns potassium

what happens in SIADH?

o Water is retainined, results in hyponatremia (DECREASED SERUM SODIUM LEVEL)

addisions disease interventions

o Wear medical bracelet for Addisonian crisis o Monitor strict I's and O's o Daily weights o Monitor glucose levels o Watch cardiac monitoring due to elevated potassium level § Put them on tele o Monitor vitals o Maintain fluid and electrolyte balance o Watch for postural hypotension § Orthostatic hypotension o Monitors Labs o Teach patients of signs and symptoms of steroid use

24-hour urine test important information?

o Will put out 4 liters or more to be diagnosed with diabetes insipidus (can put out 4-30 liters of urine)

what is the glucose tolerance test?

o is testing gestational diabetes § Will drink sugary drink and will test 2 hours after drinking § The test will be greater than 200 · Will be asked about previous pregnancy o Watching for if previous baby was over 9 lb.

which clinical manifestation would the nurse identify in a patient with type 2 diabetes mellitus?

obesity

what is rapid acting insulin used in?

often used in insulin pumps, subq injection typically within 10 minutes of meal -If BG is normal, can give during the meal, or if BG is lower, give after the meal

what is the onset of DKA?

onset of 4-10 hours

how does desmopressin come?

oral tablet nasal spray

what are the pH and bicard (HCO3-) in METABOLIC ALKALOSIS?

pH is ABOVE NORMAL LEVEL bicarb (HCO3-) is ABOVE NORMAL LEVEL

what are the pH and CO2 doing in RESPIRATORY ALKALOSIS?

pH is ABOVE NORMAL LEVEL paCO2 is BELOW NORMAL LEVEL example: pH: 7.50 paCO2: 30

what are the S/S of hypoglycemia?

- "cold and clammy, get the candy" -anxious, nervous, irritable -palpitations, tachycardia -hunger -blurry vision, double vision -weakness, shaky, tremors -mental confusion -seizures, coma

how are electrolytes related to glucose regulation?

-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. -hyperglycemia causes hyperkalemia

what symptoms might you see with metabolic acidosis?

-CNS depression -headache -decreased BP -hyperkalemia -muscle twitching -warm, flushed skin (vasodilation) -nausea, vomiting, diarrhea -changes in level of consciousness (confusion, drowsiness) -Kussmaul respirations (compensatory hyperventilation)

what symptoms might you see with respiratory alkalosis?

-CNS stimulation/excitation -dizziness -lethargy and confusion -agitation -hyperreflexia -hyperventilation -tachycardia -decreased or normal BP -hypokalemia -numbness and tingling of extremities -lightheadedness -nausea, vomiting

what would cause a person to have metabolic acidosis?

-DKA -severe diarrhea—due to loss of bicarb in stool -renal failure -sepsis -shock -shock, carb free diet plan (ketosis diet) -overdose of ASA (salicylate) (aspirin)

how do you prevent complications in patients with impaired glucose for their diet?

-Diet: -counting carbs—get 130 g per day -avoid simple carbs like white bread and rice -healthy unsaturated fats—25-35% -keep cholesterol low -protein, unless kidney issues -Fiber at least 25 g per day

what meds are used to treat hyperglycemia for type 2 diabetics?

-Insulin stimulators (2nd generation sulfonylureas): Glipizide and Glyburide -Stimulate insulin release -lower BG even if patient not hyperglycemic -need to monitor for s/s of hypoglycemia -Biguanides: Metformin -no IV contrast!! Causes lactic acidosis -hold before and 48 hours after -GI symptoms -NOT given to patient's w/ kidney disease -wait until kidney function is back after surgery to give again

. What are the nursing interventions for hypoglycemia?

-Mild hypoglycemia, but fully conscious (BG<60) -give 15 g of carb: ½ cup of juice (4oz), 8 oz skim milk, 6-10 hard candies, 4 sugar cubes, 4 teaspoons of sugar, 6 saltines -wait 15 minutes, recheck glucose, if still low repeat treatment -if meal is not for another hour, add more carb and protein to the treatment (for more sustainability) - <40 BG: pulse increases, shallow respirations, mood change, drowsy, cold, and clammy -give 15-30 g of carb: 8 oz of juice -wait 15 minutes, recheck, if still low, repeat treatment - <20 BG and unconscious: give IM or IV treatment -give IM glucagon (also subq) to suppress insulin -IV dextrose: hard to push due to thickness, harsh on veins -better route, less invasive -follow up with doctor for changes in condition

what are the treatments for HHNS?

-Treatments: -(NS—1/2NS—D5W) -insulin drip -don't want to drop BG too fast -may need IVPB potassium like with DKA, monitor for hypokalemia

when is insulin utilized?

-Type 1 diabetics must take insulin and type 2 diabetics may need to take it if diet, lifestyle changes, and oral anti-diabetic drugs aren't enough. -Illness, infection, and stress increase the blood glucose level and the need for insulin; insulin should not be withheld during times of illness, infection, or stress because hyperglycemia and DKA can result.

what are the nursing interventions for hyperglycemia?

-administer insulin or oral anti-diabetic meds depending on the patient -use sliding scale and carb coverage if prescribed

common information about type 2 diabetes (compare and contrast paper)

-blood sugar levels are too high -manage with oral meds, diet, exercise -diagnosed between 40-50s -sedentary lifestyle -history of high blood pressure -insulin levels are too HIGH -obese -reccurent infections/wounds won't heal -FBS- >126 mg/dL -complications *retinopathy *neuropathy *cardiovascular disease *HHNS -gradual onset -preventable

common information about type 1 diabetes (compare and contrast paper)

-born with -will develop in childhood most likely before or at age 15 -pancreas does not produce insulin -needs insulin injections -polyuria, polydipsia, and polyphagia -weight loss -rapid onset -maintain normal metabolism and nutrition -autoimmune response -will be checking Blood Sugar multiple times a day -hypoglycemia -treatment ~insulin injections -pumps ~dexcom

what do DKA (diabetic ketoacidosis) and HHNS (hyperglycemic hyperosmolar nonketotic syndrome) have in common?

-both are life-threatening if not treated -illness and infection -will get the same treatment (saline-insulin drip and potassium) -polyuria and polydipsia -can lead to coma or death

similarities between type 1 and 2 diabetes

-both can experience hyper and hypoglycemia -can be genetic -no cure, chronic condition -polyuria, polydipsia -diabetic ketoacidosis -fatigue -infections -peripheral neuropathy (pins and needles) -cardiovascular issues -family history

what would cause a person to have respiratory acidosis?

-decreased respiratory function due to drug overdose or anesthesia -acute or chronic respiratory conditions: -COPD, pneumonia, asthma, bronchitis, emphysema, sleep apnea, atelectasis, airway obstruction, pulmonary edema -brain injury -chest trauma -hypoventilation

alkalosis possible signs and symptoms

-disorientation/altered LOC -irritable/restlessness -dizziness/lightheaded -VS may vary depending on situation -hypokalemia & hypocalcemia (increased calcium binding with albumin) -cardiac dysrhythmias -hyperactive reflexes -tetany -convulsions -tingling of fingers and toes -positive Chvostek & Trousseaus

how do you prevent complications in patients with impaired glucose for their exercise?

-exercise -make sure they are cleared by doctor -helps utilize glucose and increase insulin sensitivity

when to give regular insulin?

-give 20-30 before a meal, may give earlier if BG is, if BG is low, give after meal -the only insulin type that can be given IV!!

when do you give intermediate insulin?

-give between meals, "basal or bolus" insulin

what could cause a person to have respiratory alkalosis?

-hyperventilation due to anxiety, fear, or pulmonary embolism -mechanical ventilation -pain -high altitudes -hypoxia -fever -initial stages of pulmonary emboli -pregnancy

what symptoms might you see with respiratory acidosis?

-hypoventilation and CNS depression -hypoxia -rapid, shallow respirations -decreased BP with vasodilation -dyspnea -headache -hyperkalemia w/ potential cardiac dysrhythmias -drowsiness, dizziness, disorientation -muscle weakness, hyperreflexia

what is DKA?

-life-threatening complication of type 1 diabetes mellitus that develops when a severe insulin deficiency occurs. -hyperglycemia (>300), dehydration, ketosis, and acidosis, polyuria, polydipsia, polyphagia, rapid, weak pulse, abdominal pain, fruity breath, Kussmaul respirations, N/V

signs and symptoms of HHNS (hyperglycemic hyperosmolar nonketotic syndrome)?

-mainly in type 2 diabetics -little insulin -gradual onset -mainly seen in older adults -BLOOD SUGAR WILL BE GREATER THAN >600 -no ketosis and acidosis -NO breakdown of fats

glucose regulation treatment

-monitoring A1C -fingerstick throughout the day *educate on self management *help them cope through this chronic condition -education on medication (hyper or hypoglycemia)

what is the onset, duration, and peak of long acting insulin?

-onset 1-2 hour, lasts 14-24 hours, no peak

what is the onset, duration, and peak of intermediate insulin?

-onset 1-2 hour, peak 4-5 hour

what is the onset, peak, and duration of regular or short acting insulin?

-onset 30-60, peak 2-3 hour, duration 3-6 hour

what is the onset, peak, and duration of rapid acting insulin?

-onset 5-15, peak 1-2 hour, duration 2-4 hour

what are some causes of METABOLIC ALKALOSIS?

-overuse of antacids -loss of gastric juices -potassium wasting diuretics (increased loss of hydrogen)

what are the S/S of hyperglycemia?

-polyuria, polydipsia, polyphagia -sweaty -dehydration -blurred vision -rapid, thready pulse, diabetic coma

if the hemoglobin A1C test is above 6.5% what will we do?

-pt will be put on regiment to get numbers down -numbers should be below 6.5% § Diet, exercise, medications

what would cause a person to have metabolic alkalosis?

-severe vomiting -excessive GI suctioning—loss of gastric juices -loop diuretics & thiazides (loss of potassium = loss of hydrogen ions, hypokalemia) -excessive NaOH3 use (sodium bicarbonate) -massive whole blood transfusion

how do you prevent complications in patients with impaired glucose for their sick days?

-sick days -check blood glucose frequently, every 2-4 hours

acidosis possible signs and symptoms

-warm, flushed skin (metabolic) -pale to cyanotic skin (respiratory) -kussmaul respirations (compensatory) -depressed respirations (respiratory) -disorientation/altered LOC/headache -VS may vary depending on situation (often hypotensive) -hyperkalemia -cardiac dysrhythmias -hyporeflexia -weakness -muscle paralysis

normal creatinine level

0.6-1.3

dawn phenomenon important patient education

1. Hyperglycemia upon morning awakening that results from excessive early morning release of GH and cortisol. 2. Treatment requires an increase in the client's insulin dose or a change in the time of insulin administration.

exercise important patient education for diabetics

1. Monitor BG level before, during, and after exercising 2. If the client requires extra food during exercise to prevent hypoglycemia, it need not be deducted from the regular meal plan. 3. If the blood glucose level is higher than 250 mg/dL (13.9 mmol/L) and urinary ketones (type 1 DM) are present, the client is instructed not to exercise until the blood glucose level is closer to normal and urinary ketones are absent. 4. The client should try to exercise at the same time each day and should exercise when glucose from the meal is peaking, not when insulin or glucose-lowering medications are peaking. 5. Insulin should not be injected into an area of the body that will be exercised following injection, as exercise speeds absorption. 6. Exercise lowers the blood glucose level, encourages weight loss, reduces cardiovascular risks, improves circulation and muscle tone, decreases total cholesterol and triglyceride levels, and decreases insulin resistance and glucose intolerance.

somogyi phenomenon important patient education for diabetics

1. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 a.m., which causes an increase in the production of counterregulatory hormones. 2. By about 7 a.m., in response to the counterregulatory hormones, the blood glucose rebounds significantly to the hyperglycemic range. 3. Treatment includes a decrease in the client's insulin dose or increase in the bedtime snack, or both. 4. Clients experiencing the Somogyi phenomenon may complain of early morning headaches, night sweats, or nightmares caused by the early morning hypoglycemia.

Sick day important patient education for diabetics

1. Take insulin or oral antidiabetic medications as prescribed. 2. Determine the blood glucose level and test the urine for ketones every 3 to 4 hours. 3. If the usual meal plan cannot be followed, substitute soft foods 6 to 8 times a day. 4. If vomiting, diarrhea, or fever occurs, consume liquids every 30 to 60 minutes to prevent dehydration and to provide calories. 5. Notify the primary health care provider if vomiting, diarrhea, or fever persists; if blood glucose levels are higher than 250 to 300 mg/dL (13.9 to 16.7 mmol/L); when ketonuria is present for more than 24 hours; when unable to take food or fluids for a period of 4 hours; or when illness persists for more than 2 days.

how to mix insulin: NPH and regulation?

1. Withdraw enough air equal to the total amount of insulin 2. Inject air into NPH w/o touching insulin 3. Inject air into Regular, then withdraw dosage 4. Withdraw NPH dosage

sodium level

135-145

how many bicarbonates ions are 1 carbonic acid?

20 bicarbonates are 1 carbonic acid

when do you give short acting insulin?

20-30 minutes before the meal

what is the normal level for bicarb (HCO3)?

22-26 mEq/L

when do they test for gestational diabetes?

24-28 weeks

when are we testing for gestational diabetes?

24-30 weeks TESTED IN THE SECOND TRIMESTER

what is the normal serum osmolality?

275-295 mOsm/kg

potassium level

3.5-5.0

what is the normal level for PaCO2?

35-45 mmHg

cortisol level

5-25 mcg/dL

after a patient receives discharge instructions about managing hypoglycemia at home, which patient food selection to treat mild hypoglycemia demonstrates effective teaching?

6 saltine crackers 3 graham crackers 4 teaspoons of sugar

a client is in a state of uncompensated acidosis. what approximate arterial blood pH does the nurse expect the client to have?

7.20

what is the normal level for pH?

7.35-7.45

what is the range of postprandial (after eating) blood glucose?

70-140

what is the range of a fast blood glucose?

70-99

What are normal blood glucose values?

70-99 FBG 100-140 post-prandial A1C normal <5.7% A1C prediabetic 5.7-6.4% A1C diabetic >6.5% -want to see # lower than 6.5 to see if meds are working

how much will the babies weigh if mom has gestational diabetes?

9 lbs

after administering insulin aspart at 7 am, the nurse would assess the patient for signs of hypoglycemia at which time?

9:00 am

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication? A. Alcohol B. Organ meats C. Whole-grain cereals D. Carbonated beverages

A. Alcohol When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication.

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. A.Nausea B.Confusion C.Bradypnea D.Tachycardia E.Hyperkalemia (is acidosis) F.Lightheadedness

A. nausea B. confusion D. tachycardia F. lightheadness

•The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? A."I will need to increase my insulin dosage during the first 3 months of pregnancy." B."My insulin dose will likely need to be increased during the second and third trimesters." C."Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." D."My insulin needs should return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding."

A."I will need to increase my insulin dosage during the first 3 months of pregnancy."

Which patient with Cushing's disease is at greatest risk for developing heart failure? A.42-year-old with a serum creatinine level of 3.7 mg/dL B.59-year-old with a history of hypertension C.32-year-old with a history of hepatitis B infection D.60-year-old with pneumonia

A.42-year-old with a serum creatinine level of 3.7 mg/dL

A postoperative plan of care for a patient after a total thyroidectomy should include which intervention? A.Avoiding extending the patient's neck B.Administering oxygen via nasal cannula as needed C.Assessing the patient's voice once per shift D.Encouraging the patient to be out of bed in a chair

A.Avoiding extending the patient's neck

Which symptom requires immediate intervention during a hypoglycemic episode? A.Confusion B.Hunger C.Headache D.Tachycardia

A.Confusion

•A client with adrenal insufficiency is to be discharged and will take prednisone 10 mg orally each day. Which instruction would the nurse be sure to teach the client? A.Excessive weight gain or swelling should be reported to the health care provider. B.Changing positions rapidly may cause hypotension and dizziness. C.A diet with foods low in sodium may be beneficial to prevent side effects. D.Signs of hypoglycemia may occur while taking this drug.

A.Excessive weight gain or swelling should be reported to the health care provider.

Which of the following is a priority nursing intervention for a patient with primary adrenal cortex dysfunction? A.Monitor vital signs and the patient's physiologic response to stress. B.Closely measure fluid intake and output. C.Provide emotional support during stressful situations. D.Weigh the patient daily.

A.Monitor vital signs and the patient's physiologic response to stress.

A patient is diagnosed with small cell lung cancer. Which endocrine condition is consistent with this diagnosis? A.Syndrome of inappropriate antidiuretic hormone (SIADH) B.Diabetes insipidus (DI) C.Cushing's syndrome D.Adrenal crisis

A.Syndrome of inappropriate antidiuretic hormone (SIADH)

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? A.pH 7.25, Paco2 50 mm Hg B.pH 7.35, Paco2 40 mm Hg C.pH 7.50, Paco2 52 mm Hg D.pH 7.52, Paco2 28 mm Hg

A.pH 7.25, Paco2 50 mm Hg

ABB diagnostics (brain drain)

ABG'S electrolytes

what do we need to do if something is going wrong with the buffers?

ACT FAST

what is a rule of thumb for drawing up insulin?

ALWAYS DRAW UP CLEAR BEFORE CLOUDY

what do diabetics always need to have scheduled?

AN ANNUAL VISIT

what do DI patients need to avoid?

AVOID CAFFEINE -dehydrates the body

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. A.Respirations that are shallow B.Respirations that are increased in rate C.Respirations that are abnormally slow D.Respirations that are abnormally deep E.Respirations that cease for several seconds

B. respirations that are increased in rate D. respirations that are abnormally deep

B. tingling sensation in the hands

Which assessment finding should trigger a more detailed assessment of the patient's endocrine system? A.Weight gain B.Changes in hair texture and distribution C.Fatigue D.Poor peripheral pulses

B.Changes in hair texture and distribution

Besides low serum osmolality, SIADH is characterized by: A.Hypernatremia B.Hyponatremia C.Polyuria Polydipsia

B.Hyponatremia

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? A.Sodium level of 145 mEq/L (145 mmol/L) B.Potassium level of 3.0 mEq/L (3.0 mmol/L) C.Magnesium level of 1.8 (0.74 mmol/L) D.Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

B.Potassium level of 3.0 mEq/L (3.0 mmol/L)

The nurse is caring for a client who has a fever and is diaphoretic. The nurse monitors the client's intake and output and expects which finding? A.The client's urine is diluted. B.The client's output is decreased. C.The client's urine production is increased. D.The majority of the client's fluid is excreted through the skin.

B.The client's output is decreased.

hormonal regulation age related differences (concept map)

BABIES- not all glands are active yet ~ will do a heelstick b/c looking for hypothyroidism (growth and development) adolescents- glands become active older adults - glands become smaller, metabolism slows down, cold intolerance, testosterone decreases and menopause occurs in women

what is considered overweight?

BMI 25-29.9

what is considered obese?

BMI > 30

how is DKA brought on?

BY NOT CONTROLLING DIABETES

The client newly diagnosed with diabetes asks why he is always so thirsty. What is the nurse's best response? A. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." B. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." D. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost

C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

•The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. A. Administer regular insulin. B. Encourage the child to ambulate. C. Give the child a teaspoon of honey. D. Provide electrolyte replacement therapy intravenously. E. Wait 30 minutes and confirm the blood glucose reading. F. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

C. Give the child a teaspoon of honey. F. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

• nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? a.pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg b.pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg d.pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg

C. pH of 7.40, PO2 of 85 mmHg, PaCO2 40 mmHg

Which is a possible outcome for the patient experiencing an age-related decrease in antidiuretic hormone? A.Constipation, lethargy, and dry skin B.Greater-than-ideal body weight C.Diluted urine and dehydration D.Yeast infection and polydipsia

C.Diluted urine and dehydration

What parameter should be critically evaluated when providing care to a patient with Graves' disease? A.Irregular heart rate and rhythm B.Elevated blood pressure C.Elevated temperature D.Change in respiratory rate

C.Elevated temperature

When should a patient with type 1 diabetes avoid exercise? A.When serum glucose is less than 150 B.During colder months C.When ketones are present in the urine D.When emotional stressors are high for the patient

C.When ketones are present in the urine

can we mix anything with glargine (lantus)?

CANNOT MIX THIS INSULIN WITH ANYTHING

what symptoms might you see with metabolic alkalosis?

CNS stimulation/excitation -Restlessness followed by lethargy -dysrhythmias and tachycardia -compensatory hypoventilation -confusion (decreased level of consciousness) -dizzy, irritable -nausea, vomiting, diarrhea -tremors, muscle cramps, tingling of fingers and toes -hypokalemia

what is a way of remembering hypoglycemia?

COLD AND CLAMMY GET THE CANDY telltale sign: cold and diaphoretic

what is compensation?

Compensation—the body adapts to attempt to correct changes in blood pH and maintain acid-base balance

what are counter regulatory hormones?

Counterregulatory hormones increase blood glucose by actions opposite those of insulin when more energy is needed.

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? . A decreased pH and an increased Paco2 B. An increased pH and a decreased Paco2 C.A decreased pH and a decreased HCO3- D.An increased pH and an increased HCO3-

D. increased pH and increased HCO3- -because the client has been vomiting for 3 DAYS, loss of gastric acid

D. kussmaul respirations

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm (72 mmol/L), and HCO3− = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make? A.The client has acidotic blood. B.The client is probably overreacting. C.The client is fluid volume overloaded. The client is probably hyperventilating

D. the client is probably hyperventilating

•Assessment findings for a client with Cushing disease include all of the following. For which finding would the nurse notify the health care provider (HCP) immediately? A.Purple striae present on the abdomen and thighs B.Weight gain of 1 lb (0.5 kg) since the previous day C.Dependent edema rated as +1 in the ankles and calves D.Crackles bilaterally in the lower lobes of the lungs

D.Crackles bilaterally in the lower lobes of the lungs

D.Reducing body temperature and heart rate

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mmol/L), and HCO3- is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? A.Metabolic acidosis with compensation B.Respiratory acidosis with compensation C.Metabolic acidosis without compensation D.Respiratory acidosis without compensation

D.Respiratory acidosis without compensation

what is decreased in patients with DI?

DECREASED AMOUNT OF URINE

what are some causes of metabolic acidosis?

DIABETIC KETOACIDOSIS -salicylate OD -shock -severe diarrhea (i have diarrhea from my ACIDOSIS) -renal failure

what are some other causes of METABOLIC acidosis (burcham notes)

DKA severe diarrhea renal failure shock

METABOLIC ACIDOSIS POSSIBLE CAUSES (burcham handout)

DKA severe diarrhea renal failure shock, carb free diet plan overdose of ASA, salicylate WILL SEE CNS DEPRESSION

diabetes insipidus means they are...

DRY INSIDE

what routine visit is it important to keep up with?

EYE EXAMS!! to check for retinopathy

what education do you give for DKA?

Education: -teach insulin -no skip meals -if sick, check BG frequently -call doctor -teach signs of hyperglycemia -monitor for ketones in the urine

how do we track management of glucose regulation?

FBG and A1C

what is the number one thing in SIADH patients?

FLUID RESTRICTION

what are some causes for an Acid-base imbalance?

GI and GU disturbance kidney failure nausea vomiting respiratory disturbance (hyper or hypoventilating)

what is the first thing we give diabetics who are experiencing a hypoglycemic event and we do not have IV access?

GIVE JUICE

what is long acting insulin?

Glargine (Lantus)

what is an example of long acting insulin?

Glargine and Detemir

what are types of counterregulatory hormones?

Glucagon is the main balancing hormone. Other hormones that increase blood glucose levels are epinephrine, norepinephrine, growth hormone, and cortisol. The combined actions of insulin and balancing hormones participate in glucose regulation and keep blood glucose levels in the range of 60 to 100 mg/dL (3.3 to 5.6 mmol/L) to support brain function.

does diabetes insipidus have anything to do with diabetes mellitus?

HAS NOTHING TO DO WITH DIABETES MELLITUS

what is a way of remember hyperglycemia?

HOT AND DRY THEIR SUGARS HIGH telltale sign: their face is flushed

what are some causes of RESPIRATORY ALKALOSIS?

HYPERVENTILATION: -initial stages of pulmonary emboli -hypoxia -fever -pregnancy -high altitudes -anxiety

what are infants of mothers who had gestational diabetes at risk for?

HYPOGLYCEMIA AFTER BIRTH o Their body is already compensating for the mom

what are some causes of respiratory acidosis?

HYPOVENTILATION -drug overdose -pulmonary edema -chest trauma -neuromuscular disease -airway obstruction (COPD)

what does insulin do?

Insulin lowers blood glucose levels by moving glucose into the cell

what is the adrenal cortex?

Is located above the kidney in the adrenal glands

What are Kussmaul Respirations? Why would a patient in DKA have Kussmaul respirations?

Kussmaul respirations are deep and rapid respirations usually present in metabolic acidosis as the body's compensatory mechanism to blow off CO2 and rebalance the pH.

what is one of the BIGGEST medications that cause diabetes insipidus?

LITHIUM (A BIPOLAR MEDICATION)

what is rapid acting insulin?

Lispro (Humalog)

what are some types of rapid acting insulin?

Lispro, Aspart, Glulisine

in respiratory (acidosis or alkalosis) what would you do first for this patient if they were struggling to breathe?

MAINTAIN THEIR AIRWAY

what acid base imbalance are clients at risk for they have the following conditions? -severe diarrhea -kidney injury and disease

METABOLIC ACIDOSIS - CNS DEPRESSION -DKA -severe diarrhea -renal failure -shock -OD of aspirin -CARB FREE DIET

what acid base imbalance are clients at risk for if they have the following conditions? -GI suctioning -severe vomiting -ingestion of antacids -thiazides diuretics -massive blood transfusion

METABOLIC ALKALOSIS -CNS EXCITATION -hypokalemia (causes increased risk for seizures)

What is Hyperglycemic Hyperosmolar State (HHS)?

Marked hyperglycemia (600-2000) without ketoacidosis, but with hyperosmolality and dehydration

what does metabolic acidosis look like in an ABG?

Metabolic Acidosis- pH low, PaCO2 low or normal, HCO3 low

what does metabolic alkalosis look like in an ABG?

Metabolic Alkalosis- pH high, PaCO2 high or normal, HCO3 high

what is an example of biguanide?

Metformin (Glucophage)

can patients getting a CT with contrast take metformin?

do you ever give insulin before taking a blood sugar?

NO NEVER!!

what is an example of intermediate acting insulin?

NPH (cloudy insulin, must roll to mix it)

What is the intermediate acting insulin?

NPH, 70/30

hormonal regulation health promotion (concept map)

PRIMARY -education -avoiding injury -NO environmental hazards SECONDARY -check thyroid (infants, and pancreas levels

what is a type of regular or short acting insulin?

REGULAR!!

if a patient having an acid base imbalance and they were choking what acid base would it be?

RESPIRATORY

what acid base imbalance are clients at risk for if they have the following conditions? -brain injury -atelectasis: chest isn't expanding?

RESPIRATORY ACIDOSIS- CNS DEPRESSION

what acid base imbalance are clients at risk for if they have the following conditions? -hyperventilation -pain

RESPIRATORY ALKALOSIS- CNS EXCITATION -dizzy -confusion -decreased LOC -agitated -hyperreflexia -hyperkalemia

what is short acting insulin?

Regular insulin (Humulin R)

what does respiratory acidosis look like in an ABG?

Respiratory Acidosis- pH low, PaCO2 high, HCO3 high or normal

what respiratory alkalosis look like in an ABG?

Respiratory Alkalosis- pH high, PaCO2 low, HCO3 low or normal

what precautions are we putting SIADH patients on and why?

SAFETY PRECAUTIONS -for confusion -hypertension -tachycardia

what does cortisol suppress?

SUPPRESSES the action of insulin

what is an example of cushing's syndrome?

TAKING TOO MUCH PREDNISONE

what are the functions of cortisol?

THE STRESS HORMONE § Raises the blood glucose levels · Must check their blood sugar § Breaks down fats, proteins, and carbs § Regulates electrolytes

are there ketones and acidosis in HHNS?

THERE ARE NO KETONES AND NO ACIDOSIS

if DI patients gain 2.2 lbs overnight what could be happening?

THEY ARE RETAINING FLUID, AND THEY COULD BE EXPERIECNING POLURIA, AND POLYDIPSIA

what systems are involved in compensation?

The respiratory system is much more sensitive to acid-base changes and can begin compensation efforts within seconds to minutes after a change in pH. However, these efforts are limited and can be overwhelmed easily. The kidney compensatory actions are much more powerful and result in rapid changes in ECF composition. However, these more powerful actions are not fully triggered unless the acid-base imbalance continues for several hours to several days.

how do you treat DKA?

Treatments: -assess respiratory status and LOC -administer IVF!!! -IV insulin (regular) -monitor potassium, may need IV potassium -watch cardiac rhythm, kidney failure, and for phlebitis -monitor BG often -(NS—1/2NS—D5W)

what is the antidiuretic hormone (ADH) also known as?

VASOPRESSIN

after treatment has started for the DI patients what do we need to ask them?

WHAT DO THEY LIKE TO DRINK!!!! (exam question)

if they have METABOLIC acidosis what are some possible causes they might have?

WILL HAVE CNS DEPRESSION DIABETIC KETOACIDOSIS -salicylate OD -severe diarrhea -renal failure -shock -sepsis

if they have respiratory acidosis what are some possible causes they might have?

WILL HAVE CNS DEPRESSION HYPOVENTILATION drug overdose pulmonary edema chest trauma neuromuscular disease airway obstruction COPD

if they have RESPIRATORY alkalosis what are some possible causes they might have?

WILL HAVE CNS EXCITATION -initial stages of pulmonary emboli -hypoxia -fever -pregnancy -high altitudes -anxiety

if they have METABOLIC alkalosis what are some possible causes they might have?

WILL HAVE CNS EXCITATION -overuse of antacids -potassium wasting diuretics (increased loss of hydrogen) -loss of gastric juices

should a diabetic call the DR if they become sick?

YES DEFINITELY!! needs lots of rest and fluids

is diabetes a chronic condition?

YES! both type 1 and 2 are chronic conditions

will the gestational diabetes leave mom after birth?

YES! gestational diabetes will leave mom after birth

can diabetes affect every system and organ in the body?

YES! it can affect every system and organ in the body

can we give hypoglycemic diabetic patients glucose tabs?

YES!!

will a patient with DI have increased urination?

YES!!!

which patient is most likely to develop premature atherosclerosis from microvascular damage?

a 50 year old patient with diabetes mellitus

what is cortisol?

a stress hormone -RELEASED WHEN BODY IS STRESSED

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have • a. Muscle cramping b. Warm, flushed skin C, Respiratory rate of 36 d. Blood pressure of 94/52

a. Muscle cramping

The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? a. Hypokalemia b. Fluid overload c. Hypoglycemia d. Hyperphosphatemia

a. hypokalemia

•A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? a.7.20 b.7.35 c.7.45 d.7.48

a.7.20

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis?

a.A patient with nasogastric tube suction

•The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a.Acid-base balance b.Fluid balance c.Oxygen depletion d.Metabolic acidosis

a.Acid-base balance

•A nurse is caring for a client with Addison disease. What should the nurse teach the client to do regarding an appropriate diet? a.Add extra salt to food b.Limit intake to 1200 calories c.Omit protein foods at each meal d.Restrict the daily intake of fluids to 1 L

a.Add extra salt to food

•A nurse is caring for a client with Adrenal Insufficiency. What should the nurse teach the client to do regarding an appropriate diet? a.Add extra salt to food b.Limit intake to 1200 calories c.Omit protein foods at each meal d.Restrict the daily intake of fluids to 1 L

a.Add extra salt to food

•The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? a.Insulin needs will increase during the second trimester. b.Insulin needs will decrease during the second trimester. c.Insulin needs will not change during the second trimester. d.Insulin will be switched to an oral antidiabetic medication during the second trimester.

a.Insulin needs will increase during the second trimester.

a.Leg ulcers b.Loss of visual acuity d.Prolonged capillary refill in the toes e.Decreased sensation in the lower extremities

•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis

a.Metabolic acidosis

•After receiving levothyroxine for 3 months for congenital hypothyroidism an infant is brought to the pediatric clinic for a checkup. What does the mother tell the nurse about her baby that indicates that the drug is effective? a.The infant's stools are soft. b.The skin is cool to the touch. c.The baby's fine tremor has ceased. The baby's activity level has decreased.

a.The infant's stools are soft.

an active 14 year old male patient has recently been diagnosed with type 1 diabetes. which insulin pump infusion site would the nurse recommend?

abdomen

glucose regulation (concept map)

achieved through a delicate balance between nutrient intake, hormonal signaling and glucose uptake by the cell

the nurse is caring for a client with the following arterial blood gas value ofL PO2 89 mmHg, PaCO2 35 mmHg, and pH of 7.37. these findings indicate that the client is experiencing which condition?

acid base balance

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because

acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells.

what can acids do?

acids can either donate or release the hydrogen ions

a patient who received insulin GLARGINE sub-q 30 minutes ago is now cool, clammy, and anxious with a current blood glucose level of 54 mg/dL. the patient states "something is wrong with me" which intervention would the nurse implement?

administer a carbohydrate replacement

what kidney functions are we monitoring?

albumin BUN and creatine

what do we monitor albumin in glucose regulation?

albumin is in the urine -means kidneys are not functioning well

what is peripheral vascular disease?

all the vessels will start to ger smaller

if women already have diabetes what will we be doing?

already will be monitoring them

a client develops respiratory alkalosis. when the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis?

an elevated pH, and decreased PaCO2

where is ACTH released from?

anterior pituitary gland

which blood gas result would the nurse anticipate early in the course of pulmonary embolism? (PE)

pH7.46 PaCO2 30 mmHg HCO3- 26 mEq/L PaO2 68 mmHg (respiratory alkalosis)

what are the normal ranges for (pH, PaCO2, HCO3)?

pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-26 Acidosis = CNS depression Alkalosis = CNS excitation

glucose regulation collaborative interventions (concept map)

patient education for self-management monitoring and managing blood glucose self monitoring of blood glucose monitoring glycosylated hemoglobin (A1C) correcting hypoglycemia nutrition therapy pharmacologic agents oral hypoglycemic agents insulin statin agents glucose control

ABB nursing interventions (brain drain)

patient safety and comfort semi-fowlers position mouth care if on a vent on-going assessment

after receiving a change of shift report about four patients, which patient would the nurse attend to first?

patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL

what are examples of macrovascular complications?

peripheral vascular disease cerebral vascular disease decreased immunity GI and GU issues

hormonal regulation consequences (concept map)

physiologic changes hormone imbalance infertility diabetes insipidus cognition problems metabolism problems DKA growth deficiences

signs and symptoms of type 1 diabetes

polyuria (increased urination) polydipsia (increased thirst) polyphagia (increased hunger) -weight loss -fatigue -increased of infections -rapid onset -insulin dependent -familial tendency -peak incidence from 10-15 years

how do lifestyle and diet impact glucose regulation?

poor diet and sedentary lifestyle increase blood sugar -exercise lowers blood sugar

glucose age related differences

pregnant women- hormonal changes produce a state of insulin resistance and associated risk for hyperglycemia infants - large gestational age infant is at high risk for hypoglycemia after birth older adults - impaired glucose metabolism and hyperglycemia because of increase visceral fat, and reduction in lean muscle mass

glucose regulation health promotion (concept map)

primary prevention -maintaining optimal body weight -exercise, diet secondary prevention (screening) early detection of disease glucose screening among adults at risk including pregnant women A1C twice per year annual renal function lipid tests annual dental, food and dilated eye examines thyroid function annually

what is mifepristone?

progesterone blocker

which action would the nurse implement when drawing up a single dose of insulin?

pull back the plunger to draw air into the syringe equal to the insulin dose

What is glycosylated hemoglobin (A1C)?

reflects glucose levels over past 2-3 months less than 5.7 (no diabetes detected) 5.7-6.4 (prediabetic) above 6.5 (hyperglycemic or diabetic)

what is the ONLY insulin to be given IV?

regular (only IV)

What is the only insulin that can be given IV?

regular insulin

what do we need to do to the system if the pH is off balance?

regulate the system to get the pH in balance

which factor contributes to the development of metabolic acidosis? select all that apply; one, some or all responses may be correct

reported heavy alcohol consumption chronic cirrhosis of the liver with liver failure seizure in the ambulance on the way to the hospital

scope of glucose regulation (concept map)

represented by the categories of normal/optimal regulation and impaired regulation throughout the lifespan

what does the PaCO2 represent?

represents the respiratory system

a patient having continous nasogastric suction after abdominal surgery has become irritable and anxious with hyperreflexia, tachycardia, and tachypnea. which action by the nurse is correct?

request an order ot evaluate serum electrolytes and turning off the NG suction

why are small infants at risk for hypoglycemia?

require increased energy needs

what is chronic obstructive pulmonary disease an example of in acid base imbalance?

respiratory acidosis (COPD)

what is asthma an example of in acid base imbalance?

respiratory acidosis (hypoventilation)

a laboratory report for a patient shows the following results: pH 7.32, bicarb (HCO3-) 24 mEq/L; PaO2 77 mmHg; PaCO2 48 mmHg. these findings are consistent with which acid base imbalance?

respiratory acidosis uncompensated

what is gram negative sepsis, causing overstimulation of the respiratory center?

respiratory alkalosis

example of acid-base scenario pH 7.49 paCO2 27 mmHg HCO3- 24 mEq/L what is the imbalance and is there compensation?

respiratory alkalosis no compensation

what is hyperventilation an example of in acid base imbalance?

respiratory alkalosis (deep, rapid breathing)

ABB patho review (brain drain)

respiratory and metabolic

respiratory and urinary

signs and symptoms of METABOLIC ALKALOSIS

restlessness followed by lethargy dysrhythmias (tachycardia) compensatory hypoventilation confusion (decreased LOC, dizzy, irritable) nausea, vomiting, diarrhea tremors, muscle cramps, tingling of fingers and toes hypokalemia

what to look for in METABOLIC alkalosis (CNS excitation)

restlessness followed by lethargy dysrhythmias (tachycardia) compensatory hypoventilation confusion - (decreased LOC, dizzy, irritable) nausea, vomiting, diarrhea tremors, muscle cramps, tingling of fingers and toes hypokalemia

what are examples fo microvascular complications?

retionpathy peripheral neuropathy

what is the administration education of insulin?

rotate and clean injection sites, assess the skin for rashes, lumps, bumps (avoid these areas), Subq = back of the arm, abdomen

special considerations for glargine (lantus)

rotate sites for injection

what environment and assessment will we make sure to include?

safe environment neurologic assessment

causes of type 2 diabetes

sedentary lifestyle -familial tendency -average age of 50 years -history of high blood pressure (hypertension) -fatigue and decreased energy -obese -recurrent infection -polyuria -polydipsia -Fasting blood sugar >126 mg/dL

signs and symptoms of RESPIRATORY ALKALOSIS

seizures deep rapid breathing hyperventilation tachycardia low or normal BP hypokalemia numbness and tingling of extremities lethargy and confusion lightheadedness nausea and vomiting

what to look for in RESPIRATORY alkalosis (CNS excitation)

seizures deep,rapid breathing hyperventilation tachycardia decreased or normal BP hypokalemia (reason for seizure precaution) numbness and tingling of extremities lethargy and confusion lightheadness N/V

what are some other causes for METABOLIC alkalosis (burcham notes)

severe vomiting excessive GI suctioning diuretics excessive NaHCO3 (sodium bicarbonate)

METABOLIC ALKALOSIS POSSIBLE CAUSES

severe vomiting excessive GI suctioning loop diuretics and thiazides (loss of K, hypokalemia) massive whole blood transfusion WILL SEE CNS STIMULATION/EXCITATION

which clinical manifestation would the nurse associate with a patients autonomic neuropathy of the feet secondary to diabetes mellitus?

skin cracks and fissures

which assessment finding may indicate the presence of diabetes mellitus?

slow wound healing

which condition does the nurse suspect in a patient who reports several days of abdominal pain and has abdominal distention with visible peristaltic waves in the abdomen, nausea and vomiting, inability to pass stool, fluid and electrolyte imbalances, and metabolic alkalosis?

small bowel obstruction

How to prevent Somogyi phenomenon

snack before bed don't exercise before bed

what will SIADH sodium level be like?

sodium level will be low

treatment of HHNS IV fluids

start with normal saline -then half normal then half D5

how to treat someone with respiratory alkalosis?

supplemental oxygen and reducing the risk of hyperventilation

while the nurse is assessing a patient with metabolic acidosis, which finding supports that the patient has lactic acidosis

symptoms of hypoxia

What is SIADH?

syndrome of inappropriate antidiuretic hormone

what is desmopressin?

synthetic ADH

what is happening to the blood during HHNS?

the blood is severely concentrated

hormonal regulation (concept map)

the general regulation process including hormona, production, secretion, and action

acid-base balance (brain drain)

the maintenance of arterial blood pH between 7.35 and 7.45 through regulation of hydrogen ion (H+) production and elimination -not a disease -has a pH balance in the blood and body system

what does is mean if the pH is below 7.35?

the pH is ACIDIC

what does it mean if the pH is above 7.45?

the pH is ALKALOTIC

what are the pH and Bicarb doing in metabolic acidosis?

the pH is BELOW NORMAL LEVEL the bicarb is BELOW NORMAL LEVEL example: pH: 7.3 HCO3-: 17

what are the pH and paCO2 doing in respiratory acidosis?

the pH is BELOW NORMAL LEVEL the paCO2 is ABOVE NORMAL LEVEL example: -pH: 7.25 -paCO2: 55

what will happen to the patient's body during diabetes insipidus?

the patient gets rid of TOO much water causing DEHYDRATION

what is glucose regulation?

the process of maintaining optimal blood glucose levels

what will the serum sodium look like in diabetes insipidus?

the serum sodium will be EXTREMELY high

when providing education to young teenage (specifically girls) what could cause them to have an acid base imbalance?

the starvation diet

what is glycogen?

the storage form of glucose

what do diabetics need to watch when they exercise?

their blood sugar level could drop when they begin to exercise

what do we need to do if they hydrogen ions get thrown off balance?

they need to reabsorb and release other hydrogen ions that are causing ions

hormonal regulation assessment/diagnostic tests (concept map)

thorough H&P lab work ultrasound/MRI/biopsy

which rationale supports the nurse's instruction for the patient to discontinue metformin for 24 hours before the scheduled kidney test using contrast medium?

to prevent lactic acidosis

which finding is a feature of metabolic syndrome?

triglycerides 220 mg/dL

when a patient recently diagnosed with type 2 diabetes mellitus states, "i dont understand how i got DM. i dont eat sugary foods which response would the nurse use.?

type 2 DM includes a resistance to insulin combined with an inability to secrete sufficient insulin

which diabetic patient sees HHNS the most?

type 2 diabetes

infants whose mothers had gestational diabetes will be?

typically will be 9 lbs or heavier

tolvaptan

used for low sodium level (vasopressin antagonist) - helps get rid of all the fluid without sodium loss- GIVEN IN THE ICU; could cause sodium level to rise quickly

which intervention may be considered to promote gas exchange and prevent respiratory acidosis in a patient with a constructing chest injury?

ventilatory assistance

what lab level do we need to watch when treating DI patients who are receiving desmopressin?

watching for sodium levels (will begin to elevate)

S/S of SIADH

water retention, hyponatremia, & seurm hypo-osmlality; blood volume expands, but plasma diluted brain cells swell causing headache ;change in mental status or personality lethragy and irritability weight gain occurs without edema

what weeks do the hormones ramp up during pregnancy?

week 24-28

what do we teach these patients?

weight themselves daily to identify weight gain

when is ABGs is it considered ALKALOSIS?

when the pH is ABOVE 7.4 or (7.45)

when in ABGs is it considered ACIDOSIS?

when the pH is LESS THAN 7.4 OR (7.35)

when should diabetics check their blood sugar every 2-4 hours?

when they are sick, they are hard to control

when will we do a 24 hour urine test for DI patients?

when they deny being a diabetic

what to do if o Patients if they are come into the ER with hypoglycemic signs and symptoms?

will do a workup for diabetes

how do we get an accurate blood sugar level with patients with suspected HHNS?

will need to do a blood draw

•A 50-year-old female, was shot in the right side of her chest. She is currently in the progressive care unit. Her arterial blood gases are as follows: •pH 7.30 •Pao2 88 mmHg •Paco2 50 mmHg •Bicarbonate 26 mEq/L •Lactate 5 mg/dL •Does Ms. Kuohui have an acid-base imbalance? If so, what type of imbalance?

yes she has respiratory acidosis

will patients who have DKA have ketones in their urine?

yes!! they will also experience polyuria

which nursing instruction is most beneficial to the patient with a fasting blood glucose level of 140 mg/dL?

you should report to the primary health care provider

what will we give SIADH patients in their IV?

§ 3% sodium chloride for their IV fluids · Need the hypertonic IV solution: NEED SALT

what is ACTH?

§ ACTH is the hormone that is released from the pituitary gland that replaces the adrenal cortex

lab work for diabetes mellitus

§ Actual or potential problems § Finger sticks § Hemoglobin A1C § Hyperlipidemia · Shows poor diet § Looking at renal function · High blood sugars will affect vessels § C-reactive protein

who is at high risk for diabetes mellitus?

§ American Indians § Alaskan Americans § Hispanic/Latinos § African Americans § Asian Americans § Genetic § Sedentary lifestyle § Poor diet · Not eating healthy · A lot of carbs

glucose regulation prevention and education

§ Balanced diet § Regular physical activity § Early detection § Early prevention § Regular screenings

hypoglycemia consequences

§ Body is unable to use the glucose § The one way the brain can function is by having that supply of glucose · Confused · Out of it (SAFETY ISSUE)

what imagining are we looking at for cushing's patients?

§ CT § MRI · Looking for tumor on the pituitary gland, or adrenal cortex o Will do surgery to take out

hypogylcemia common signs and symptoms

§ Cold and clammy skin § Altered level of consciousness § Sweating § Shakiness § Irritability

labs for cushing's patients?

§ Decreased potassium § Increased blood glucose § Decreased WBC § Increased sodium § Decreased calcium level

what is primary DI?

§ Detected in the hypothalamus or pituitary gland itself

type 1 hyperglycemia event signs and symptoms

§ Excessive hunger § Thirst § Frequent urination § Weight loss § Fatigue § Weakness § Irritability § Blurry vision · If not treated can become severely ill o Atherosclerosis (thickening or hardening of the arteries) o Blindness

are cushings disease patients at high risk for infection?

§ High risk for infection · Handwashing is important o No sick visitors

type 2 diabetes tidbits

§ Inactive sedentary lifestyle higher risk § African American, pacific islanders · Hypertension and high cholesterol are at an increased risk for type 2

what is nephrogenic DI?

§ Kidneys are not responding the way they are supposed to, tubules excrete urine are not working, kidney injury

what are we monitoring for fluid overload in SIADH patients?

§ Listen for crackles to disappear or develop § Get excess water out § May be short of breath § Could have bounding pulse § Neck veins could be distended § Increased peripheral edema · May develop into pulmonary edema could cause death § Urine specific gravity will be elevated § Blood will be thick · Too much water inside

what are some causes of SIADH?

§ Lung cancer § Certain drugs § CNS disorders

imagining for addisons disease

§ MRI · Look for tumor · Biopsy

DKA lab work

§ Monitor potassium level (3.5-5) · Moves out of the blood and into the cell causing HYPOKALEMIA · Potassium Must be 3.3 or higher to hang piggyback potassium

how does the fasting blood glucose test work?

§ Must fast for 8 hours § if their FBS is above 126 -They will be deemed diabetic

hyperglycemia common signs and symptoms

§ Polyuria, polydipsia, polyphagia § Fatigue § Dehydration § Weight loss § Blurred vision § Slow wound healing

diabetic diet instructions

§ Proper amount of carbs · When carbs enter the body, it turns into glucose § Weight management and exercise · Mainly for type 2 diabetics § Stay hydrated § Foot care (checking feet throughout the day)

SIADH findings

§ Recent head trauma § Stroke § Tuberculosis or other pulmonary disease § Cancer (LUNG) § All past and current drug use § Decrease in serum sodium levels § Decreased appetite § Nausea and vomiting § Dependent edema § Change in their level of consciousness § Dark urine § Will have low sodium level § Lethargic § Confused/disoriented · Fluid restriction · Hypertonic

consequences of impaired elevated glucose

§ Reduce elasticity of blood vessels § Damaging basement membrane § Reduces blood vessels · Neuropathy · Problems of healing wounds · Poor blood flow · At risk for F/E and Acid-base balance · Diabatic ketoacidosis · Hypermolar hyperglycemic state o Severe hyperglycemia >600 § Severe mental status state § Damage can be done · Weight · Diet · Smokers? o All of these can put diabetic patients at an even higher risk

what do we teach our patients about insulin?

§ Rotate the sites · DRAW UP CLEAR BEFORE CLOUDY § Teach about hyper and hypoglycemia § When to give insulin

what are the 5 S's of addisonsi disease?

§ S - sudden pain in abdomen, back, legs § S - syncope, will go unconscious, loosing volume § S - super low blood pressure § S - severe vomiting, diarrhea, and headache § S - shock

what is addisonian crisis?

§ Same symptoms as the disease § THIS IS LIFE-THREATENING · MORE SEVERE · WILL GO INTO SHOCK AND DIE!! o Need to wear a medical alert bracelet § If they go into a crisis, they

what is cushings disease?

§ Something is going on the inside · If pituitary gland is releasing to much ACTH, the adrenal gland is releasing too much cortisol

what to do in addisonian crisis?

§ Start fluids § D 5 normal saline § Sulocortef - steroids § Frequent vital signs § Will go to the ICU § Will give K-exlate -given because of high potassium § Need to be on tele monitor § Will have hypoglycemia (glucagon, IV glucose) and blood sugar checks in crisis

what does the antidiuretic hormone do?

§ Supposed to hold onto water in the body § Secreted by the posterior pituitary gland

what is cushings syndrome?

§ The cause is coming from the outside · Too much cortisol due to taking too much prednisone

how to treat the dawn phenomenon?

§ Treat by giving intermediate acting dose at 2200 instead of with evening meal

what is secondary DI?

§ Tumors near the hypothalamus and pituitary gland; decreased ADH, head trauma, increased intracranial pressure, infection (SEPSIS), brain surgery

what are we monitoring in cushing's patients?

§ Vital signs § Blood sugar levels § Checking their skin · Looking for bruising, striae, pressure ulcers o Turn these patients every 2 hours § Asses their mobility § Listen to lungs for crackles § Check their pulses · May have bounding pulse § Look for Peripheral edema § Assessing their psychosocial · Mood

cushing's disease interventions

§ Watch and maintain fluid and electrolyte balance § Daily weights § Strict I's and O's § Turn them every two hours § Monitoring for edema and fluid overload · Low sodium diet · Fluid restriction

what is diabetes insipidus?

§ Water metabolism problem caused by and ADH hormone deficiency (either decrease in ADH synthesis or inability of kidneys to response to ADH)

S/S of cushings disease

§ Weight gain § Moon face § Buffalo hump § Elevated blood sugar § Elevated sodium level § Decreased potassium level § Truncal obesity · Listen to their lungs for crackles § Acne § Thinner skin § Decreased muscle mass and decreased strength § Osteoarthritis § Dependent edema § Hypertension (elevated blood pressure) § High risk for infection · WBC will drop § Change of pigmentation · Typically, on the abdomen · Striae - purple marks (looks like stretch marks) § Mood swings § Irritability § Depression

will SIADH be on a loop diuretic?

§ Will be on a loop diuretic (Lasix) and see if the fluid is leaving the body

diabetes insipidus S/S

§ Will cause polyuria, and polydipsia § Poor skin turgor § Confusion § Cracked lips § Dry mucous membranes § Low blood pressure § Tachycardia § Weak peripheral pulse § Urine will be very light · Dilute · Very pale

what is the ACTH stimulation test?

§ Will run through IV § Check cortisol levels between 30 minutes to an hour · WE WANT LEVEL TO GO UP § Check ACTH before giving medication, can go up at 30 minutes, then check at hour · If at the hour check and it goes back down o ADDISONS DISEASE DIAGNOSIS

what will happen to the body if it is deficient in aldosterone and fluid and electrolyte imbalance?

§ hyponatremia (low sodium) § Hypovolemia (low volume) § Hyperkalemia (high potassium

what is drug related DI?

§ lithium (bipolar disorder) § diclomyicin (tetracycline) (antibiotic used to treat bacteria)

type 1 diabetes treatment

· Check before and after meals · Give insulin 15 minutes before they eat · If given too early they can develop hypoglycemia · Recheck blood sugar If tray did not hit the floor, give them juice if low · Can be on the fence at anytime

type 2 diabetes information

· Control with oral medications, diet, exercise · Diagnosed between 40 to 50s o Brought on by being overweight § Both can be genetic · Blood sugar level is too high

what do we as the nurse do for DI patients?

· DAILY WEIGHTS - EXAM QUESTION · Watch their I's and O's · Maintain their safety · Watching their sodium level

what as the nurse we will do for SIADH patients?

· Fluid restriction · If they are getting tube feeding dilute them with saline · Give meds with saline, if giving through a tube o For the sodium level · Monitor their I's and O's · Monitor their weight

education for cushings patients?

· High protein · Low fat · Low sodium o PICK CHICKEN AND VEGETABLES ON TEST

why are we checking ACTH in cushings patients?

· If producing too much will get too much cortisol

glucocorticosteroids (addison's disease)

· If they are on this medication, stops abruptly, could cause a crisis o Stress o Large surgery o Major trauma to the body o Sepsis

why are older adults at an increased risk for diabetes

· Increase in visceral fat and decrease in lean muscle mass · Which causes the metabolism to slow way down o No way to metabolize and use the blood glucose o Insulin production reduces

treatment of HHNS insulin drip

· Must be 3.3 or higher (potassium) · Will be on regular insulin o Monitoring potassium level § If drops will have to give IVPB of potassium

patients who take metformin instructions when getting a CT scan with contrast

· Must hold it a few hours before and a few hours after · Cannot give metformin to ta patient going into surgery, must wait for kidneys to wake up after surgery to be able to give metformin o Causes GI upset

DKA process

· NO INSULIN IN THE BODY o Breaks down the fats o Then ketones are release § Will be hyperglycemic (will be greater than 300) o Ketosis and acidosis (metabolic) § Cannot get the glucose to the cells so will stay in the blood stream which is the reasoning for the hyperglycemia o Liver will kick in and think the body is in hypoglycemia § Releases glucagon § Which turns into glycogen which is a stored form of glucose · This will raise the blood sugar ever more o Ketones will break down § Then become acidotic o Kidneys kick in and all the glucose starts leaking into the urine and they will have ketones in the urine. Th o They will experience polyuria o Electrolytes will go down (potassium, sodium, chloride) § MOSTLY SEEN IN TYPE 1 § Brought on by not controlling diabetes

type 1 diabetes information

· Need insulin injections · Pancreas does not produce insulin · Born with · By the age of 15 or younger o Pancreas does not produce insulin o To maintain proper sugar levels

what are some GI and GU issues of diabetes?

· Neurogenic bladder · Delayed emptying of the stomach and acids

cortisol common information?

· Regulates blood sugar o Will be low § Will see hypoglycemia o Hypovolemia § Low volume § Hypotension § Elevate legs, get IV wide open bag to get BP up o Hyperkalemia o Hypercalcemia § Calcium will be elevated o Hyponatremia § Crave salt

aldosterone common information

· Regulating blood pressure · Helps retain water · Regulates sodium o Water falling sodium · Secretes potassium o Low sodium o Low blood pressure § Hypovolemic - because low water volume o Increased hydrogen ions § Leads to acidosis

when do you give rapid acting insulin?

· Right before meals · 10-15 minutes before they eat o If sugar is higher before meal this is what you want to give · FASTEST ACTING

STRESSED mnemonic

· S- Skin is fragile · T - truncal obesity · R - round moon face · E - ecchymosis, elevated blood pressure o Bruising · S - striae o Purple stretch marks on the abdomen · S - sugar o Elevated blood glucose levels · E - excessive body hair o More common in women o Face, back, chin · D - dorsocervical fat pad (buffalo hump) o Depressed

what medications put people at high risk for diabetes?

· Steroids (common) · ACE inhibitors · Estrogen · Beta blockers · Potassium sparing diuretics · Bronchodilators · Antibiotics · Orla hypoglycemic · Antipsychotics

what is the dexamethasone suppression screening test?

· Take the pill before bed · Have blood work drawn in the AM o If the cortisol is still high in the morning than she has a diagnosis of Cushing's disease

what would we do for surgical cushing's disease patients?

· To get the tumor removed o If they have adrenal gland removed, will be on lifelong medication to make up to produce hormone

what will SIADH urine be like?n

· Urine will become thick, dark, concentrated

what is cerebral vascular disease?

· Vessels in the brain will become smaller o At risk for stroke

at home proper insulin injection instructions

· Watch them draw up the medication and watch them give themselves the injection · Make sure they have a glucometer to take home

when there isnt enough ACTH what happens to the body?

· When this is insufficient the body does not have enough aldosterone

what happens if medication is stopped abruptly in addison's disease?

· Will cause Addisonian crisis · Life-threatening · Will need immediate treatment o Aldosterone and cortisol

what will SIADH blood osmolarity be like?

· Will have hyposmolarity in their blood o Blood will be very thin

•Which precaution is most important for the nurse to teach a client who is prescribed oral corticosteroids for hormone replacement therapy after a unilateral adrenalectomy? •A. "Do not stop taking this drug without consulting your prescriber." •B. "Avoid crowds and people who are ill." •C. "Be sure to take this drug with food." •D. "Reduce your salt intake."

•A. "Do not stop taking this drug without consulting your prescriber."

Why is controlling blood glucose levels important? •A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure. •B. High blood glucose levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures. •C. Low blood glucose levels increase the risk for peripheral neuropathy, Alzheimer's disease, and premature aging. •D. Low blood glucose levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.

•A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure.

Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? •A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." •B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." •C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." •D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

•B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level."

•Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? •A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." •B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." •C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." •D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

•B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level."

•Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? •A. A history of taking oral contraceptives for more than 2 years •B. A weight loss of 15 lbs in the past 6 weeks without dieting •C. The client's father's diagnosis of prostate cancer •D. A recent need for corrective lenses

•B. A weight loss of 15 lbs in the past 6 weeks without dieting

•The serum electrolyte values for a client with syndrome of inappropriate antidiuretic hormone being treated with tolvaptan indicate the following changes within the past 12 hours. Which change does the nurse report immediately to the health care provider? •A. Serum potassium decrease from 4.2 mEq/L to 3.8 mEq/L •B. Serum sodium increase from 122 mEq/L to 140 mEq/L •C. Serum calcium increase from 9.5 mg/dL to 10.2 mg/dL •D. Serum chloride decrease from 109 mEq/L to 99 mEq/L

•B. Serum sodium increase from 122 mEq/L to 140 mEq/L

•Which response in a client with diabetes insipidus indicates to the nurse that another dose of desmopressin acetate (DDAVP) is needed? •A. Urine output and specific gravity are increased. •B. Urine output is increased and urine specific gravity is decreased. •C. Urine output and specific gravity are decreased. •D. Urine output is decreased and urine specific gravity is increased.

•B. Urine output is increased and urine specific gravity is decreased.

•The client newly diagnosed with type 1 diabetes asks why insulin is given only by injection and not as an oral drug. What is the nurse's best response? •A. "Injected insulin works faster than oral drugs to lower blood glucose levels." •B. "Oral insulin is so weak that it would require very high dosages to be effective." •C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes." •D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."

•C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes."

•A client with type 2 diabetes who also has heart failure is prescribed metformin extended-release (Glucophage XR) once daily. On assessment, the nurse finds that the client now has muscle aches, drowsiness, low blood pressure, and a slow, irregular heartbeat. What is the nurse's best action? •A. Assess the client's blood glucose level and prepare to administer IV glucose. •B. Reassure the client that these symptoms are normal effects of this drug. •C. Hold the dose and notify the prescriber immediately. •D. Administer the drug at bedtime to prevent falls.

•C. Hold the dose and notify the prescriber immediately.

•When reviewing the laboratory values of a client who has chronic obstructive pulmonary disease and pneumonia, the nurse observes these findings. Which one does the nurse report to the provider immediately? •A. International normalized ratio (INR) 2.1 •B. Serum chloride 96 mEq/L (mmol/L) •C. Serum sodium 117 mEq/L (mmol/L) •D. pH 7.28

•C. Serum sodium 117 mEq/L (mmol/L)

•D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."

The client newly diagnosed with type 2 diabetes asks how diabetes type 1 and diabetes type 2 are different. What is the nurse's best response? •A. "Diabetes type 1 develops in people younger than 40 years and diabetes type 2 develops only in older people." •B. "Diabetes type 2 develops in people younger than 40 years and diabetes type 1 develops only in older people." •C. "Patients with type 1 diabetes are at higher risk for obesity and heart disease, whereas patients with type 2 diabetes are at higher risk for strokes." •D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

•D. "Patients with type 1 diabetes produce no insulin and patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it."

•In the preoperative holding area, the client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by IV infusion. What is the nurse's best action? •A. Request a "time-out" to determine whether this is a valid prescription. •B. Ask the client whether he or she usually takes prednisone. •C. Hold the dose because the client has a high cortisol level. •D. Administer the drug as prescribed.

•D. Administer the drug as prescribed.

what is a diabetic systemic disease that causes leg tingling?

•Diabetic neuropathy is the result of nerve damage that is caused by chronically high blood sugar levels and can have other symptoms such as a burning sensation, feeling of numbness, and pain in the affected limbs."

•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. -increased pH -hyperventilation -increased CO2 elimination -decreased blood H+ ions

•Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions •Increased pH

•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. •Increased pH •Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions

•Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions •Increased pH

what is SIADH?

•SIADH involves ongoing reabsorption of water by the kidneys, and elimination of small amounts of urine. The concentration of urine eliminated will be affected. Specific gravity (SG) is a measure of concentration. It would be appropriate to check the SG of Mary's urine.

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