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)