Endocrine: Diabetes/Thyroid
The nurse identifies the client problem "risk for imbalanced body temperature" for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? 1. Discourage the use of an electric blanket. 2. Assess the client's temperature every two (2) hours. 3. Keep the room temperature cool. 4. Space activities to promote rest.
1
Fasting blood glucose prediabetic
100-126 mg/dl
Expected responses to insufficient insulin: 1. Decreased glycogenesis (glucose converted to glycogen stores bc body thinks it needs more glucose) 2. Increased glycogenolysis (to be converted into glucose) 3. Increased gluconeogenesis (increase glucose levels from non carb sources) 4. Decreased lipolysis (not in type 1) 5. Increased ketogenesis (ketones are acidotic)
1235
dangerously high glycosylated
13%
How many minutes of exercise a week?
150 min
Which insulin should always be refrigerated?
Lantus
Diabetes feet
Neuropathy (glove and stocking distribution = numbing; use tuning fork to see if they can feel vibration) Dermatomes
Diagnostic with s/s and 2 hour post prandial
200 mg/dl
Lower limit for DKA
200mg/dl
Mild consumption for a man alcohol female?
2x a day 1x a day
The client diagnosed with type 2 diabetes is admitted to the intensive care unit with hyperosmolar hyperglycemic nonketonic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor.
3
The client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030 the unlicensed assistive personnel (UAP) tells the nurse the client has a headache and is really acting "funny." Which intervention should the nurse implement first? 1. Instruct the UAP to obtain the blood glucose level. 2. Have the client drink eight (8) ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one (1) ampule 50% dextrose intravenously.
3
Hyperthyroidism tx
PTU, tapazole, beta blockers, MONITOR WBC due to leukocytosis
Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1,000 mL/day. 4. Provide six (6) small, well-balanced meals a day.
4
Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism? 1. "I just don't seem to have any appetite anymore." 2. "I have a bowel movement about every 3 to 4 days." 3. "My skin is really becoming dry and coarse." 4. "I have noticed all my collars are getting tighter."
4
normal glycosylated hemoglobin
4-6%
How long do you count to on an insulin pen?
5 seconds
How many calories to lose 1-2lbs week?
500-1000 calorie decrease
Hypoglycemia level threshold
70mg
The nurse administers 10 units of regular insulin at 7am. What time is the patient most susceptible to hypoglycemia? The nurse administers 12 units of NPH insulin at 7am. What time is the patient most susceptible to hypoglycemia?
9-10am or 1pm
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) glucose level
>600mg/dl
Myxedema
swelling of the skin pretibial associated with higher levels of protein
Diabetes neuropathy tx
Anti-epileptics Gabapentin, Neurontin, Lyrica
Macrovascular diabetes complications
Atherosclerosis = stroke, arterial disease, CAD Diabetic foot (gangrene/amputation)
Thyroid storm
Decreased cardiac s/s Decreased filling time
Thyroid storm tx
Beta blockers PTU and steroids
What electrolyte should be monitored closely following thyroidectomy?
Calcium due to parathyroidism
Diabetes autonomic complications
Gastroparesis = slowing of GI tract Ortho hypo Erectile dysfunction
Main antagonist of insulin
Glucagon
Triggers of DKA
Illness (flu), stressor (surgery), no diet or exercise, lack of insulin
DKA Clinical Manifestations
Polyuria HIGH URINE OUTPUT (hyperglycemia) Dehydration LOC Dry mucous Poor skin turgor Tachycardia and weak pulse, low BP YOU NEED INSULIN Ketones in urine form fat breakdown No ketosis in type 2 Metabolic acidosis = ph less than 7.35, blood glucose > 300 Kussmauls breathing = breathing rapidly to blow off CO2 Fruity odor BUN and Cr is high
Urinalysis how long?
Q6mos
Diabetes microvascular complications
Retinopathy (cotton wool spot) Nephropathy (Ketonuria) (Proteinuria = ACEI = hyperkalemia, cough, angioedema, ortho hypo) HTN (ACEI delays renal involvement)
Next thing to give a pt after OJ
a small snack like a sandwich
Hyperthyroidism cardiac effects
afib = clots; HTN and tachy
The client is admitted to the ICU diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.
all
HHNS sudden or gradual? deadly or nah?
gradual. deadly.
Metabolic Syndrome
high BP, high glucose, high cholesterol, high waist circumf