ATI Endocrine Flashcards
Alcohol with Type 1 DM
ingest alcohol with meals to reduce alcohol induced hypoglycemia. alcohol prevents liver production of glucose, consume carbs during to prevent hypoglycemia.
One alcoholic beverage = 2 fat exchanges.
insulin may need to be decreased.
Pt taking insulin glargine (Lantus) and Regular insulin (Humulin R)
Draw them up in separate syringes. insulin glargine cannot be mixed with any other insulin in the same syringe.
Hypoglycemia
cool clammy skin, anxious
Hyperglycemia
rapid, deep respirations. dehydration- orthostatic hypotension.
DKA- abdominal cramping.
Insulin has been effective
fasting blood glucose 106.
Postprandial glucose
after meal- needs to be <180
Bedtime glucose
100-140
Preprandial glucose
90-130
Propylthiouracil (PTU)
Treatment goals have been met when client reports increase in weight. PTU is given to suppress thyroid hormone and allow for weight gain. Causes reduction in appetite, bowel movements, and sweating.
DKA
ph low, carbon dioxide normal, bicarbonate low. metabolic acidosis.
SIADH
pt retains fluids, causes dilutional hyponatremia- sodium 110 needs to be reported.
DM, peripheral neuropathy. protect feet:
check bath water temp with thermometer. Examine feet daily. Shop for shoes later in the day when feet are slightly swollen. Change body position regularly, not just when uncomfortable.
DI
increased hematocrit, dehydration, low urine SG- increased urine output.
Tachycardia. Increased BUN r/t dehydration.
Pheochromocytoma, priority intervention
avoid palpating the abdomen- palpation could cause sudden release of catecholamines from the adrenal gland precipitating a hypertensive crisis.
Not priority- ensure adequate hydration to maintain blood volume, manage headaches with analgesics, private darkened room to promote rest.
24 hours after total thyroidectomy. report to pcp-
laryngeal stridor- harsh high pitch sound on inspiration, indicates respiratory obstruction.
expected findings- productive cough, pain on hyperextension of neck, hoarse weak voice
Thyroid replacement meds
take on empty stomach to absorb best. 30 min before breakfast. Will prob experience increased appetite.
Pt being screened for pheochromocytoma, scheduled for vanillymandelic acid test.
Restrict caffeine 2-3 days prior to the test. Discard first morning void, begin collecting urine after that.
Avoid aspirin and antihypertensives during collection.
DKA
blood glucose over 300, deep kussumal respirations, weight loss, increased urine output
Screening for Cushings, labs
blood glucose elevated.
lymphocytes, potassium, calcium decreased.
Foot care
apply lotion to dry areas of feet, avoid application between toes- avoid bacterial growth.
Dont let feet air dry after shower- dry between toes.
wear closed toe shoes.
dont use orc meds- can impair skin integrity.
Thyroid storm
Propanolol (inderal)- reduces the effects of thyroid hormone on the heart. decreases rapid heart rate caused by excess thyroid stimulation.
desmopressin acetate (DDAVP) for pt with DI, metered dose spray
blow nose prior to using nasal spray for better absorption.
Dont need to breathe deeply- spray needs to be absorbed in the nose not the lungs.
Sit upright without tilting the head to administer the spray.
Acute adrenal insufficiency
administer hydrocortisone succinate (Solucortef)- needed to replace the cortisol deficiency that occurs with adrenal insufficiency.
also want to decrease potassium- encourage fluids.
HG A1C
indicates glucose levels over a 3 month period.
Hyperthyroidism
tremors, heat intolerance, restlessness, irritability, wide eyed, startled
Cushings Disease
increased hair growth, hirsutism, increased BO, weight gain, thinning of the skin
Hypothyroidism
hypotension, wt gain, constipation, bradyc
Long term effects of corticosteroid therapy
osteoporosis b/c depletes calcium in bones, development of moon shaped face (fat face, upper back, trunk), increased risk of infection (decreased lymphocytes), muscle wasting of extremities (due to depletion of nitrogen which causes decreased muscle mass), weight gain secondary to deposition of fat in certain areas of the body and fluid retention
Test for Addisons Disease
ACTH Stimulation test
Hyperglycemic hyperosmolar nonketoic syndrome (HHS) labs
Glucose 846, serum pH 7.40. With hhs the pt produces enough insulin to prevent ketosis but not enough to prevent hyperglycemia. ph is expected range, glucose is above 600
after thyroidectomy–> hypocalcemia
tingling and numbness of hands and feet- paresthesias, hyperactive DTR, increased GI motility, weak thready pulse.
Adrenal insufficiency
elevated serum calcium level, low sodium, weight loss
DM teaching
call dr if BS is over 250. take insulin even when sick. check urine for ketones when BS is above 240. check blood sugar q4 when sick.
DI receiving intranasal aqueous vasopressin (Pitressin), teaching:
increased urination and thirst indicate the need for another dose of vasopressin therapy.
