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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
Q

What are 3 etiologies for NKHS?

A

Insulin deficiency
Inadequate fluid
Osmotic diuresis from elevated glucose

26
Q

What are the symptoms with NKHS?

A

Polyuria
Thirst
Altered mental status

27
Q

What symptoms will NOT be present with NKHS that are present with DKA?

A

N/V
Abdominal pain
Kussmual respirations

28
Q

How much fluid is lost with NKHS?

A

8-10 L

29
Q

Fluid replacement for NKHS?

A

Same as DKA just takes longer

30
Q

With NKHS, describe how the insulin should be administered

A

5-10 units IV bolus

- 3-7 units continuous

31
Q

With NKHS, describe how the insulin should be administered

A
  • 5-10 units IV bolus

- - 3-7 units continuous

32
Q

What is a long term Diabetes complication that is a majority of the mortality with Type 2 DM?

A

Cardiovascular disease

CAD

33
Q

What is the most additive risk for Diabetics with Cardiovascular disease?

A

Smoking

34
Q

In general, what is Diabetic Gastropathy a form of?

A

Autonomic Neuropathy

35
Q

Describe what happens with Diabetic Gastropathy

A
  • Area of stomach that controls peristalsis –> neuropathy
  • Variable gastric emptying
  • Variable nutrient/glucose absorption
  • Variable and unpredictable insulin requirements
36
Q

If a Diabetic has unpredictable and variable insulin requirements, what is likely occurring and how?

A

Diabetic Gastropathy

  • Variable gastric emptying
  • -> Variable nutrient/glucose absorption
  • -> Unpredictable and variable insulin requirements
37
Q

In general, what is happening with Diabetic Nephropathy?

A

Decreased kidney function = Decreased Insulin excretion

=> Increased levels of insulin

38
Q

What is trending with Diabetic Nephropathy?

A

Decreased insulin requirements because the sugars are getting too low since the kidney is not excreting the insulin as fast as normal

39
Q

Decreasing insulin requirements with Diabetics is likely what long term complication?

A

Nephropathy

40
Q

With a Diabetic, what urine screen should you get to look for Nephropathy?

A

Microalbumin:Creatinine Ratio

41
Q

What can show the first sign of proteinuria and effects of DM on the glomerulus?

A

Microalbumin:Creatinine Ratio

42
Q

To avoid complications with Diabetes, what should be done QUARTERLY? (3)

A
  • Foot inspection
  • Hemoglobin A1C
  • Review SGM log
43
Q

To avoid complications with Diabetes, what 3 things should be done QUARTERLY?

A
  • Foot inspection
  • Hemoglobin A1C
  • Review SGM log
44
Q

What are 3 ANNUAL things to do for a Diabetic patient?

A
  • Dilated eye exam
  • Monofilament testing
  • Urine screen microalbumin:creatinine ratio
45
Q

What are 3 ANNUAL things to do for a Diabetic patient?

A
  • Dilated eye exam
  • Monofilament testing
  • Urine screen microalbumin:creatinine ratio
46
Q

What should you have the Diabetic patient do for their footcare?

A

Daily inspection
Never barefoot - prescription shoes/podiatry
Moisturize but NOT between or under the toes

47
Q

Low TSH

Elevated FT4

A

Primary Hyperthyroidism

48
Q

Elevated TSH

Low FT4

A

Primary Hypothyroidism

49
Q

What will the levels of TSH/FT4 be with a Central/Tertiary Hypothyroidism?

A

LOW

– hypothalamic issue

50
Q

What lab results arise with Euthyroid Sick?

A

Do NOT fit a pattern

51
Q

How will the patient present and lab results present with Euthyroid Sick?

A

ILL patient

Lab results do NOT follow a pattern

52
Q

What 2 things are you concerned about damaging with Thyroid nodule surgery?

A

Recurrent Laryngeal Nerve

Parathyroid glands

53
Q

If the calcium level is moving the opposite direction of the PO4 level, where is the problem?

A

PTH issue

54
Q

If the calcium level is moving in the same direction as the PO4, where is the problem?

A

Vitamin D issue

55
Q

What is the first step in treating Malignancy related Hypercalcemia?

A

Volume expansion with isotonic saline

56
Q

High bone turnover can cause Hypercalcemia, what scan should you get?

A

DEXA for bone mineral density

57
Q

What will be seen on the ECG with Hypercalceima?

A

Shortened QT interval

58
Q

In an elderly patient, or post-menopausal women, what may be causing their Hypercalcemia?

A

Osteoporosis

– high bone turnover

ENRP - Exam 2 (21 decks)

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