Endocrine Flashcards
patho of SIADH
There is a hypersecretion of ADH from posterior pituitary gland. This goes to kidneys and promotes excessive water reabsorbtion.
This leads to dilutional hyponatremia.
Think H2O intoxication
causes of SIADH
oat cell carcinoma AKA bronchogenic tumor
viral pneumonia
neurologic disorder
analgesics, anesthetics, & stress
serum osmolality normal level
275-295
how to quickly calculate serum osmolality
2x sodium level
fluid status in low serum osmolality?
fluid volume overolad
fluid status in high serum osmolality
concentrated/dehydration
urine specific gravity normal levels
1.005-1.030
assessment of SIADH patient
decreased LOC/lethargy confusion/personality changes Headache NVD anorexia hyponatremia (cerebral edema) seizures/coma
medical management of SIADH
treat underlying cause - surgery/radiation/chemo
fluid restriction
Na replacement w/ 3%NS
Lasix if overloaded after 3%
medications for SIADH
ADH inhibitor (vaprisol) demeclocycline (abx) - abx that interferes with ADH effects in tubules phenytoin/fludrocortisone - blocks effects of ADH in tubules
nursing management for SIADH
fluid volume status
neuro
seizure precautions
oral care
patho/causes of DI
improper posterior pitutitary development
neuro trauma
pituitary tumor
kidney disease - nephrogenic DI from failure to respond to ADH
dilantin - blocks effect of ADH on tubules
what is the one thing you think of when you hear DI?
water wasting
assessment of patient with DI
polyuria polydipsia dehydration hypotension tachycardia decreased LOC seizures
what labs would you see with DI?
low urine osmolality/specific gravity/sodium
high serum osmolality/specific gravity/sodium
what labs would you see with SIADH
high urine osmolality/specific gravity/sodium
low serum osmolality/specific gravity/sodium
medical management of DI
fluid replacement w/ hypotonic crystalloids
exogenous ADH - DDAVP/pitressin/vasopressin
nursing management of DI
fluid/electrolyte monitoring
seizure precautions
neuro
what form of DM is DKA most prominent in?
DM1
normal hyperglycemia range for DKA?
300-600
risk factors for DKA?
decrease insulin intake, increase dietary intake, growth spurts, surgery, infection, trauma, emotional stress
3 components of DKA?
hyperglycemia
ketosis
acidemia
patho for DKA
not enough insulin leads to increased glucagon release because cells are not receiving glucose d/t lack on insulin.
Leads to hyperglycemia and increased serum osmolality which causes cellular dehydration and fluid excretion
Ketoacidosis occurs when fatty acid metabolizes in cells
assessment for DKA
polyuria polyphagia glucosuria polydipsia NV weight loss/dehydration fruity breath decreased LOC dry skin/mucous membranes tachycard/hypotensio kussmaul respirs
DKA is common in which type of DM1 patients?
newly diagnosed patients
What is important with DKA patients when it comes to curing them?
Treat DKA, but also treat the underlying cause of DKA (infection)
DKA/HHNK protocol?
NS 0.5-1L/hr x 2 hr bolus
then
1/2NS @ 250-500mL/hr until BS <250
When BS reaches <250 then D5,1/2NS until DKA resolves
stat EKG to r/o hyperK if K >5.5, treat if symptomatic 4-5.5 give 20meq to each L of fluid 3-4 give 40meq to each L of fluid <3 give PO/IV 10meq K q1h or PRN
insulin
0.1units/kg initial bolus IV
then continuous 0.1units/kg/hr with BSBG q1h until resolution
Nursing management of DKA/HHNK
fluid management BSBG q1h neuro q4h UOP q1h Lab analysis cardiac monitor pt education
HHNK Hallmark sign
grossly elevated BG w/o ketosis
patho of HHNK
same as DKA, but insulin is produced but not effective in pushing glucose fast enough into cells
Which DM is HHNK most associated with?
DM2
How high can BG get in HHNK?
2000
