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ENRP - Exam 2 > Adult Endocrine Cases > Flashcards

Adult Endocrine Cases Flashcards

1
Q

There are multiple names for ____ glucose monitoring

A

Capillary glucose monitoring

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2
Q

FSG

A

Fingerstick Glucose

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3
Q

BSG

A

Bedside Glucose

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4
Q

HGM

A

Home Glucose Monitoring

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5
Q

GSM

A

Glucose Self Monitoring

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6
Q

SBGM

A

Self Blood Glucose Monitoring

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7
Q

What is the difference between Basal and Bolus Insulin?

A 
Basal = long acting for steady state
Bolus = adjustable for meals
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8
Q

What are some signs/symptoms of Diabetes?

A 
Polyuria and Nocturia
Polydipsia
Unintentional weight loss
Blurred vision
Frequent recurrent infections
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9
Q

What FPG can diagnose Diabetes?

A

> 126

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10
Q

What 2 hour plasma glucose after a 75 gm OGTT can diagnose Diabetes?

A

> 200

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11
Q

What HbA1C can diagnose Diabetes?

A

> 6.5%

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12
Q

What is the best way for long term monitoring of Diabetes? How often is it checked?

A

Hemoglobin A1C = average 3 month glucose

– Checked every 3-4 months

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13
Q

What are 4 etiologies for DKA?

A

Inadequate Insulin
Precursor infections or infarctions
Cocaine

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14
Q

What symptoms set DKA apart from other glycemic conditions?

A

Abdominal pain
N/V
Kussmaul respirations

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15
Q

What are some symptoms of DKA?

A

Polyuria, polydipsia
Abdominal pain and N/V
Kussmaul respirations
Tachycardia, hypotension, fever

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16
Q

How much fluid is usually lost with DKA?

A

3-5 L

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17
Q

Describe how to replace fluid with DKA?

A

123

  • 2-3 L over 1-3 hours with normal saline
  • Then 1/2 strength saline at 150 ml/hour
  • When glucose reaches 250, switch to 5% dextrose and 1/2 strength saline
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18
Q

Describe how to replace fluid with DKA?

A

123

  • 2-3 L of normal saline over 1-3 hours
  • Then 1/2 strength saline at 150ml/hour
  • When glucose reaches 250 switch to 5% dextrose and 1/2 strength saline
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19
Q

Describe how the Insulin should be administered with DKA

A

10-20 Units IV

– Then 5-10 units/hour

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20
Q

When should you consider K+ replacement with DKA or NKHS?

A

K+ < 5.5

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21
Q

With DKA/NKHS, how often is the BSG, electrolytes and clinical status checked?

A

BSG = hourly
Clinical status = hourly
Electrolytes = 2-4 hours

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22
Q

What is the glucose goal for DKA?

A

150-250

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23
Q

When should you start long acting or intermediate insulin with DKA/NKHS?

A

When they are eating and stable

- No N/V, abdominal pain or anion gap

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24
Q

NKHS

A

Non-ketotic Hyperosmolar State

25
What are 3 etiologies for NKHS?
Insulin deficiency Inadequate fluid Osmotic diuresis from elevated glucose
26
What are the symptoms with NKHS?
Polyuria Thirst Altered mental status
27
What symptoms will NOT be present with NKHS that are present with DKA?
N/V Abdominal pain Kussmual respirations
28
How much fluid is lost with NKHS?
8-10 L
29
Fluid replacement for NKHS?
Same as DKA just takes longer
30
With NKHS, describe how the insulin should be administered
5-10 units IV bolus | - 3-7 units continuous
31
With NKHS, describe how the insulin should be administered
- 5-10 units IV bolus | - - 3-7 units continuous
32
What is a long term Diabetes complication that is a majority of the mortality with Type 2 DM?
Cardiovascular disease | CAD
33
What is the most additive risk for Diabetics with Cardiovascular disease?
Smoking
34
In general, what is Diabetic Gastropathy a form of?
Autonomic Neuropathy
35
Describe what happens with Diabetic Gastropathy
- Area of stomach that controls peristalsis --> neuropathy - Variable gastric emptying - Variable nutrient/glucose absorption - Variable and unpredictable insulin requirements
36
If a Diabetic has unpredictable and variable insulin requirements, what is likely occurring and how?
Diabetic Gastropathy - Variable gastric emptying - -> Variable nutrient/glucose absorption - -> Unpredictable and variable insulin requirements
37
In general, what is happening with Diabetic Nephropathy?
Decreased kidney function = Decreased Insulin excretion | => Increased levels of insulin
38
What is trending with Diabetic Nephropathy?
Decreased insulin requirements because the sugars are getting too low since the kidney is not excreting the insulin as fast as normal
39
Decreasing insulin requirements with Diabetics is likely what long term complication?
Nephropathy
40
With a Diabetic, what urine screen should you get to look for Nephropathy?
Microalbumin:Creatinine Ratio
41
What can show the first sign of proteinuria and effects of DM on the glomerulus?
Microalbumin:Creatinine Ratio
42
To avoid complications with Diabetes, what should be done QUARTERLY? (3)
- Foot inspection - Hemoglobin A1C - Review SGM log
43
To avoid complications with Diabetes, what 3 things should be done QUARTERLY?
- Foot inspection - Hemoglobin A1C - Review SGM log
44
What are 3 ANNUAL things to do for a Diabetic patient?
- Dilated eye exam - Monofilament testing - Urine screen microalbumin:creatinine ratio
45
What are 3 ANNUAL things to do for a Diabetic patient?
- Dilated eye exam - Monofilament testing - Urine screen microalbumin:creatinine ratio
46
What should you have the Diabetic patient do for their footcare?
Daily inspection Never barefoot - prescription shoes/podiatry Moisturize but NOT between or under the toes
47
Low TSH | Elevated FT4
Primary Hyperthyroidism
48
Elevated TSH | Low FT4
Primary Hypothyroidism
49
What will the levels of TSH/FT4 be with a Central/Tertiary Hypothyroidism?
LOW | -- hypothalamic issue
50
What lab results arise with Euthyroid Sick?
Do NOT fit a pattern
51
How will the patient present and lab results present with Euthyroid Sick?
ILL patient | Lab results do NOT follow a pattern
52
What 2 things are you concerned about damaging with Thyroid nodule surgery?
Recurrent Laryngeal Nerve | Parathyroid glands
53
If the calcium level is moving the opposite direction of the PO4 level, where is the problem?
PTH issue
54
If the calcium level is moving in the same direction as the PO4, where is the problem?
Vitamin D issue
55
What is the first step in treating Malignancy related Hypercalcemia?
Volume expansion with isotonic saline
56
High bone turnover can cause Hypercalcemia, what scan should you get?
DEXA for bone mineral density
57
What will be seen on the ECG with Hypercalceima?
Shortened QT interval
58
In an elderly patient, or post-menopausal women, what may be causing their Hypercalcemia?
Osteoporosis | -- high bone turnover

ENRP - Exam 2 (21 decks)

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