Med Surg Exam II Misc
A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?
"It binds with enzymes to help prevent digestion of fat."
labs that identify pheochromocytoma
-24 hr catecholamine urine -serum catecholamine -clonidine suppression
key components of DKA
-3ps -kussmaul breathing -anorexia -abd pain coma
somogyi effect tx
-DECREASE evening dose of intermediate acting insulin, or INCREASING bedtime snack
name pituitary disorders of posterior gland
-Diabetes Insipidus -SIADH
SE for GLP-1 (Liraglutide)
-N/V, constipation, cardiac issues, H/A
SE of selective serontergic agonist (Lorcaserin)
-constipation, fatigue, dizziness, dry mouth
causes of HHS
-dialysis -diuretics -illness
function of insulin
-does NOT breakdown stored glucose -inhibits glycogenolysis, gluconeogensis -does not break down protein and fat in adipose -transports Amino Acids into cells
if NPO and severely hypoglycemic what tx
-glucagon 1mg -dextrose 5% IV push
Tx with corticosteroids when
-hypercalcemia -Hashimotos -thyroid storm -post extraction of pheochromocytoma
key charactersitics in addisons
-hyperkalemia -hyponatremia -hypotension -thyroid insuff -DM
key characteristics in HHS
-hypotension -hemiparesis -BG 600-100 -altered LOC
key charactersitics in cushings
-increased Na -increased BG -decreased K+ -ecchymosis, osteoporosis, straiae, moon face, HTN
insulin waning
-progressive rise in BG from bedtime to morning
labs that identify cushings
-serum, urinary cortisol -dextromethadone suppression
interventions for hyperparathyroidism
-thiazide diuretics -acitivity; reduce osteoporosis -hydration: 2L
insulin waning tx
-treated by INCREASING evening doses of intermediate or long acting insulin to institute dose BEFORE evening meal
order of tx for DKA
1. rehydrate 2. once at BG of 300 add D5W and Insulin IV
chain events for DM
12 hours w/o food liver forms glucose from glycogen --> glucose cannot be stored in liver so circulates in blood --> pulse pressure >180 kidneys absorb glucose --> glycosuria--> osmotic diuresis
for SGMS, how many times a day do you administer insulin and what times of day
4-6x -morning, evening, before eating, aftereating, fasting
pH for DKA
6.8-7.3
all of these endocrine levels correspond where there is deficiency
ANTERIOR PITUITARY!!! PTH: Calcium, phosphorus TH: metabolism: HR, body temp, blood glucose, etc. ACTH Cortex: Cortisol Medulla: norepineprhine/epi
comorbidities that can lead to obesity
CAD, HTN, DM
contrandicated in gastroparesis,
GLP, GLP/GIP Agonist
enhances first and second phase of insulin, increase risk for thyroid cancer, pancreatitis, slows gastric emptying
GLP/GIP combo drug injection
causes of DKA
ILLNESS: MOST COMMON injury, trauma, wound healing
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?
Illness increases BG- need MORE insulin
prevent kidney reabsorp, release into urine, UTI, increase LDL
SGLT, dapalgiflozin, anagliflozin, empagliflozin
tx for pheochromocytoma
Salt with Iodine -calcium channel blocker
what medications cause Addisons Disease
TB Abx (Rifampin) -Anticonvulsants -Anticoagulants
ACTH and ______go hand in hand
TH
must be taken with first bite of food
alpha-glucosidase inhib (arcarbose)
sensitizes body to insulin
biguanides
monitor PTH levels how and why?
by blood work (serum, plasma) -bc patient can be asymptomatic
avoid what before removal of thyroid
caffiene, can exacerbate norepi, epi
tx of dawn phenomenon:
change TIME of injection of evening intermediate acting from DINNER to BEDTIME
main goal of pheochromocytoma
control BP
SE for symphatoimes (Phenteramines)
dry mouth, metallic taste, tachycardia, do not drink alcohol, dizziness, cardiac effects
adrenal medulla secretes
epinephrine and norepinephrine
in treating hypercalcemia watch out for _____ ______
fluid load, urine output
12 hours without food liver forms
glycogen --> glucose
no _______ for pts post bary instead LOVENOX
heparin
hypoparathyroidism can lead to
hypoglycemia (ESP after thyroidectomy)
cause of diabetes insipidus
idiopathic; lacking ADH
causes of HHS
illness, thiazide, diuretcics
second gen sulfas
in what oral antidiabetic med do you watch closely for renal function in geriatric pop and interacts with NSAIDs, coumadin, and sulfas, causes weight gain, risk of hypoglycemia 4-6 hrs postprandial
does NOT breakdown stored glucose in pancreas
insulin
what lab would be elevated in DKA
ketonuria
types of insulin that are cloudy
long and intermediate
A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering? Glyburide (Sulfa) Metformin (Biguanide) Glipizide (sulfa) Pioglitazone (thiagliazone)
metformin all others promote weight gain
short half life, interacts w antifungals, must eat directly after, weight gain
non sulfas (repaglinide, nateglinide)
dawn phenomenon:
normal BG until early morning when levels begin to rise
somogyi effect
normal or elevated blood glucsoe, early morning hypoglycemia caused by counter-regulatory hormones
what organ releases alpha and beta cells
pancreas
clonidine neg =
pheocytochroma
timing for rapid, regular, intermediate, and long-acting
rapid onset: 15 min peak: 30-60 min duration: 2-4hrs regular onset: 30-60min peak: 2-3 hours duration: 4-6 hours intermediate onset: 2-4 hours peak: 4-12 hours duration: 16-20 hrs long onset: 1-6 hrs peak: none duration: basal
what types of insulin are clear
rapid and short
second gen sulfas watch closley for impaired ________ function in geriatric population
renal
phenobarbs prevent ______ in hypoparathyroidism tx
seizures
cause jaundice, pancreatitis, gray-blue discoloration of periumbilical area, increase incretin
sitagliptin, saxagliptin, linagliptin, alogliptin
ACTH
stimulates the adrenal cortex
what stimulates the adrenal medulla
sympathetic nervous system
increases circulating volume, contra for CHF patients stimulate receptor sites
thiazolidinediones (pioglitazone, rosiglitzone)