UALR 1410 Unit 2

Treatment of Diabetes Insipidus

*desmopressin (DDAVP) nasal spray *vasopressin injection (not for use for those with heart disease)

Treatment for hyperparathyroidism

*increased fluid intake *I/O *decreased calcium diet *cranberry juice to reduce calculus formation and acidic urine

Nursing interventions for SIADH

- Monitor Na+ levels and - Watch for S/S seizures - Monitor I&O's and restrict fluids - Administer hypertonic saline - administer furosemide (Lasix) - Daily weights

A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? ◦1) Dehydration ◦2) Polyphagia ◦3) Hyperglycemia ◦4) Bradycardia

1

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? ◦1) Hyperpigmentation ◦2) Intention tremors ◦3) Hirsutism ◦4) Purple striations

1

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect? 1) Tingling of the extremities 2) Hypoactive deep tendon reflexes 3) Shortened QT intervals 4) Constipation

1

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client? 1) Chvostek's sign 2) Babinski's sign 3) Brudzinski's sign 4) Kernig's sign

1

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.) ◦1) hirsutism ◦2) tremors ◦3) moon face ◦4)purple striations ◦5) buffalo hump

1, 3, 5

A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.) 1) assess blood glucose level 2) assess for neck vein distention ◦ 3) monitor for an irregular heart rate 4) monitor for postural hypotension 5) weigh the client daily

1, 5

specific gravity

1.010-1.030

A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? ◦1) Give the ordered KCL as prescribed. ◦2) Omit the KCL dose and document it was not given. ◦3) Call the HCP and inform them of the client's serum potassium level results. ◦4) Call the lab to verify the client's result.

2

A nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take? ◦1) Check the pedal pulses. ◦2) Verify the most recent calcium level. ◦3) Request prescription for a relaxant. ◦4) Administer an oral potassium supplement.

2

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH? ◦1) Osteoarthritis ◦2) Lung Cancer ◦3) Liver cirrhosis ◦4) Dyspepsia

2

A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client? 1) Radioactive iodine 2) Levothyroxine 3) Sumatriptan 4) Levofloxacin

2

A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client? 1) "Take this medication until your symptoms are gone and then discontinue." 2) "Tremors, nervousness, and insomnia may indicate your dose is too high." 3) "Symptoms improve immediately after starting the medication." 4) "The medication decreases the overproduction of the thyroid hormone thyroxine."

2

A nurse is preparing to administer potassium chloride 20 mEq suspension PO daily. The amount available is potassium chloride suspension 10 mEq/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies. Do not use a trailing zero.)

2 mL

A nurse is preparing to administer levothyroxine 0.275 mg PO daily to a client. The amount available is levothyroxine 137 mcg/tablet. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero)

2 tabs

Serum Osmolality

285-295

A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication? ◦1) Serum sodium 146 mEq/L ◦2) Blood glucose 80 mg/dL ◦3) Urine specific gravity 1.015 ◦4) Blood urea nitrogen (BUN) 15 mg/dL

3

A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings? 1) Exophthalmos 2) Palpitations 3) Weight gain 4) Diaphoresis

3

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take? ◦ 1) Provide a low-carb diet 2) weigh the client daily 3) administer oral corticosteroids 4) restrict fluid intake

3

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? ◦1) A decrease in blood sugar. ◦2) A decrease in blood pressure. ◦3) A decrease in urine output. ◦4) A decrease in specific gravity.

3

A nurse is caring for a client who is in a myxedema coma. Which of the following actions should the nurse take? 1) Turn the client every 4 hours. 2) Check the client's blood pressure every 2 hours. 3) Initiate measures to cool the client. 4) Place the client on aspiration precautions

3

A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving diuretic therapy. The nurse reviews the client's serum potassium level results and discovers the client's potassium level is 3.2 mEq/L. Which of the following actions should the nurse take? ◦1) Give the ordered KCL as prescribed. ◦2) Omit the KCL dose and document that it was not given. ◦3) Hold the prescribed dose and notify the provider or the serum potassium level. ◦4) Call the lab to verify the client's results.

3

A nurse is assessing a client who has an exacerbation of Graves' disease. Which of the following findings should the nurse expect? ◦1) Weight gain ◦2) Bradycardia ◦3) Lethargy ◦4) Heat intolerance

4

A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor? 1) Airway patency 2) Temperature 3) Urination 4) Pain control

4

A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism? 1) A client who has a vitamin D of 25 ng/mL 2) A client who has a magnesium of 1.8 mEq/L 3) A client who has a calcium of 9.8 mg/dL 4) A client who has a phosphate of 5.7 mg/dL

4

A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications? 1) Impaired skin integrity 2) Fluid retention 3) Pathologic fractures 4) Dysphagia

4

Thyroxine (T4) normal levels

4-12

A nurse is preparing to administer Ringer's lactate 500 mL IV bolus to infuse over 3 hr. The drop factor of the manual IV tubing is 20 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

56

Triiodothyronine (T3) normal levels

70-205

A diabetic client reports feeling shaky and has a headache. The client's blood glucose is 57 mg/dL. How will the nurse treat these symptoms? A. Have client eat 4 teaspoons sugar and reassess in 30 minutes B. Have client eat 1 tablespoon of honey and reassess in 15 minutes C. Administer 1mg glucagon IM and wait for symptoms to resolve D. No treatment is necessary; all assessments are within normal limits

B

Diabetes mellitus is characterized by which classic signs and symptoms? A. Excessive thirst, weight gain, and nausea B. Excessive thirst, urination, hunger C. Decreased thirst, weight gain, and nausea D. Decreased thirst, urination, hunger

B

Which statement is correct? A. Type 1 diabetes can be prevented through lifestyle modifications B. Type 1 diabetes requires insulin for life and there is no cure C. Type 1 diabetes can be managed with diet, exercise and oral medication D. Type 1 diabetes is treated with oral anti-hyperglycemic meds only

B

For screening purposes for diabetes mellitus, which value would be considered pre-diabetes? A. HbA1c 4.5% B. HbA1c 7.2% C. Fasting Plasma Glucose 210 mg/dL D. Fasting Plasma Glucose 112 mg/dL

B, C

A client is administering 2 units of regular insulin at 0800 in the presence of the nurse. The nurse will remind the client to expect the insulin to begin working at what time? A. 0800 B. 0815 C. 0830 D. 0900

C

The nurse is caring for a client diagnosed with HHS. What assessment finding does the nurse expect? A. Confusion B. Ketones C. Nausea D. Dyspnea

C

The nurse is caring for a client newly diagnosed with Type 1 DM. Which statement by the nurse best describes Type 1 DM? A. It is a respiratory disorder resulting in prolonged shortness of breath B. It is a metabolic disorder resulting in excess production of insulin C. It is a metabolic disorder resulting in an inadequate production of insulin D. It is a metabolic disorder resulting in excess production of red blood cells

C

The nurse is preparing to discharge an older adult with diabetes. What information will the nurse include regarding hypoglycemia? A. Hypoglycemia can be caused by not enough insulin B. Increased food intake can result in hypoglycemia C. Hypoglycemia can be caused by too much insulin D. Hydrocorticosteroid use can cause hypoglycemia

C

The nurse is reviewing nutrition goals with a diabetic client. The nurse determines the client understands the goals when the client states, A. "I can eat whatever foods I want as long as I am taking my medications correctly." B. "I should avoid sweet foods and sugary drinks until my diabetes is under control." C. "I should eat foods to maintain my blood sugar levels in the normal range." D. "I will adjust my insulin dose according to my food choices at the previous meal."

C

The nurse is providing education on mixing insulins to the caregiver of a diabetic client. The nurse will include which statement in the teaching? A. You can mix long acting insulin with a short-acting insulin. B. You can mix a long acting insulin with a rapid acting insulin. C. You will give two injections, insulins should never be mixed. D. You can mix some insulins but long-acting should not be mixed.

D

insulin how does it work A. Insulin works by decreasing the amount of cholesterol in the bloodstream B. Insulin works by increasing the amount of cholesterol in the bloodstream C. Insulin works by increasing the amount of glucose in the bloodstream D. Insulin works by decreasing the amount of glucose in the bloodstream

D

What happens with fluid/electrolyte imbalances?

DECREASED SERUM POTASSIUM AND CALCIUM • INCREASED CORTISOL- INC SERUM GLUCOSE • INCREASED CORTISOL-DEC LYMPHOCYTE PRODUCTION • INCREASED ANDROGEN PRODUCTION- MENSTRUAL IRREGULARITIES; HIRSUTISM; ACNE • INCREASED FLUID VOLUME- HYPERVOLEMIA

Teaching for diabetes Insipidus

DI REQUIRES LIFELONG DRUG THERAPY • CHECK CLIENT'S ABILITY TO ASSESS SX AND ADJUST DOSAGES AS PRESCRIBED • TEACH POLYURIA AND POLYDIPSIA ARE SIGNALS OF THE NEED FOR ANOTHER DOSE. • TEACH THE CLIENT TO WEIGH THEMSELVES DAILY • TEACH CLIENT S/S OF WATER TOXICITY. • INSTRUCT CLIENT TO WEAR MEDICAL ALERT BRACELET

Nursing intervention for Diabetes Insipidus

EARLY DETECTION OF DEHYDRATION MAINTAINING ADEQUATE HYDRATION STRICT I&O LABS: URINE SPECIFIC GRAVITY, SERUM SODIUM, SERUM POTASSIUM • DAILY WEIGHTS: SAME TIME, SAME SCALE, SAME CLOTHES

S/S of hypothyroidism

Fatigue, Mental sluggishness, Hypothermia, Dry flaky skin and thinning nails, cold intolerance, weight gain

What concepts are involved with DI and SIADH other than hormone regulatiom?

Fluid/Electrolyte balance Elimination Perfusion Anxiety Intracranial regulation

s/s of diabetes insipidus

HYPOTENSION TACHYCARDIA POOR TURGOR DRY MUCUS MEMBRANES KIDNEY/URINARY SX URINE OUTPUT 4-30 L/DAY DILUTE, LOW SPECIFIC GRAVITY (LESS THAN 1.005) COGNITION ATAXIA (IMPAIRED BALANCE OR COORDINATION) WEAK PERIPHERAL PULSES HEMOCONCENTRATION THIRST IRRITABILITY

S/S of Addison's Disease?

Hyperpigmentation Do not adapt to stress. Becomes dehydrated easily

Acute complications of DM

Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemic-hyperosmolar state (HHS)

Treatment for hypoparathyroidism

IV Calcium. Phosphorus binding drugs

s/s of hyperparathyroidism

Kidney stones- renal colic and dull back pain. Observe urine for signs of blood or stones. Bones become demineralized- causing skeletal pain, pain on wt bearing, and pathological Fx. Muscle weakness. Vomiting, wt loss. HTN and brady. Decreased LOC.

S/S of SIADH

LOSS OF APPETITE CARDIAC AND PULMONARY SX CRACKLES IN LUNGS PERIPHERAL EDEMA DYSPNEA VITAL SIGN FULL, BOUNDING PULSES HYPOTHERMIA RESPONSIVENESS, SEIZURES AND COMA DISORIENTATION INLOC DEEP TENDON REFLEX LETHARGY HA HOSTILITY

Treatment for hypothyroidism

Levothyroxine (Synthroid)

What is Hyperglycemic Hyperosmolar State (HHS)?

Life threatening BS > 600mg/dL No fat breakdown Dehydration

What is DKA

Life threatening Insulin deficiency Fat breakdown BG > 300 mg/dL

Causes of SIADH

MALIGNANCIES (MULTIPLE TYPES OF CANCERS) • PULMONARY DISORDERS (TB) • CNS DISORDERS (RECENT HEAD TRAUMA) • DRUGS (SSRI)

Chronic complications of DM

Nephropathy Neuropathy Retinopathy

S/S of hyperthyroidism

Nervousness, anxiety, increased sweating, emotional lability, fine tremors,hyperreflexia of DTRs, increased appetite, weight loss, fine/thin hair, heat intolerance, exophthalmos, goiter

What is diabetes insipidus?

Not enough ADH, pituitary gland

Treatment for hyperthyroidism

PTU, methimazole

S/s of Thyroid crisis

Pt will experience N/V, tachy, severe hypertension, poss. hyperthermia 106. extreme restlessness. cardiac dysrhythmias, delirium, and heart failure.

s/s of hypoparathyroidism

Tetany, Anxiety, Irritability, depression, HA, Nausea

S/S of Cushing's Syndrome?

Think of the Cush Man... Moon face, buffalo hump, thin legs and bones, striae (stretch marks), male breasts, hirstusism etc,

What is Addison's disease?

Under secretion of the adrenal cortex.

exophthalmos

abnormal protrusion of the eyeball

What is SIADH?

abnormal stimulation to the hypothalmic area of the brain, causing excessive secretion of antidiuretic hormone (Vasopressin)

What does serum osmolality measure?

concentration of dissolved particles in the blood

What does specific gravity measure?

concentration of urine

Causes of Addison's disease

destruction of adrenal gland, may be auto immune or complication of TB, def secretion of ACTH from pit

Hyperthyroidism

excessive activity of the thyroid gland

Myxedema

swelling of the skin caused by deposits under the skin

Hypothyroidism

underactivity of the thyroid gland