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endocrine Flashcards

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1
Q

Diabetes Mellitus

A

An error of glucose metabolism||* Don’t use or Metabolize Insulin (Insulin being the primary fuel source in the body)

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2
Q

Diabetes insipidus

A

Dehydration, Polyurethane, Polydipsia||* Is the same as DM only with fluid. Will not have a glucose component. ||* Remember that Polyuria and polydipsia LEAD to dehydration due to LOW ADH

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3
Q

SIADH is the opposite of what?

A

Diabetes insipidus |- Have a normal blood glucose|- retain water (decreased urine output)|- HIGH specific gravity (1.010-1.030)

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4
Q

Type I Diabetes Mellitus

A

Insulin dependent (not producing insulin) |Juvenile onset|Ketosis prone

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5
Q

Type II Diabetes Mellitus

A

NON insulin dependent|Adult Onset|NON ketosis prone

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6
Q

What are the S/S of Diabetes Mellitus?

A

Polyuria (↑urine output)|Polydipsia(↑ thirst)|Polyphagia (↑swallowing/Eating) ||* NOTE: only in DM will polyphagia mean increased eating

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7
Q

Treatment for Type 1 Diabetes?

A
  • D- Diet (Calories from carbs) → Least important|- I- Insulin → Most Important|- E- Exercise ||* If you don’t Treat type I they will DIE
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8
Q

Treatment for Type II Diabetes?

A

-D - Diet → Most Important|- O- Oral Hypoglycemics |- A- Activity ||* Don’t treat type II they will be DOA

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9
Q

What is the Diet of Diabetes?

A
  • Remember when talking about Diet is normally Type II |- Decrease in Calories (Carbs)|- Need to 6x pre day- smaller more frequent meals cause a more normal BG level without spiking||In a best question → Pick a decrease in calories
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10
Q

Insulin acts to _____________ blood sugar

A

Lower

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11
Q

How many types of insulin do you need to know?

A

4|1. R- Regular|2. N- NPH|3. Humalog|4. Lantus

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12
Q

When is hypoglycemia tested for?

A

At the peek of the drug given

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13
Q

Insulin type: R

A

R= Regular, Rapid, Run (IV)|Onset: 1 hour|Peek: 2 hours|Duration: 4 hours||Regular Insulin is a CLEAR solution and is the ONLY one that can be run by IV

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14
Q

Insulin type: N

A

N= NPH, Not so fast, Not in the bag|Onset: 6 hours|Peek: 8-10 hours|Duration: 12 hours||NPH Insulin is a true Intermediate acting insulin, It is a CLOUDY suspension which means it can NOT be run IV drip.

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15
Q

Insulin type: Humalog

A

HumaLog = Lispro|Fastest acting insulin known to man|Onset: 15 minutes |Peek: 30 minutes |Duration: 3 hours||Lispro MUST be given WITH meals not before (AC) or after (PC)

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16
Q

Remember peek, onset and duration of R and N by

A

1 2 4 / 6 8-10 12

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17
Q

Insulin type: Lantus

A

Also know by glargine|Long acting with a slow absorption|Slow absorption = NO PEEK|Duration:12-24 hours (decreased risk of hypoglycemia)||ONLY insulin that can be given without regards to bedtime.

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18
Q

With Insulin remember to:

A
  • Check the expiration date (Best Answer)|- Refrigerate until opened|- Once opened label the new expiration date (30 days from date opened) & put date opened
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19
Q

Exercise is

A

Another shot of Insulin

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20
Q

Exercise _________________ Insulin: If the client exercises more they need ________________ insulin.

A

Potentiates, LESS

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21
Q

What 2 things ALWAYS happen to a sick diabetic?

A
  1. Hyperglycemia|2. Dehydration
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22
Q

What are the sick day rules for Insulin?

A

Take Insulin|Take sips of water (Dehydration)|Stay as active as possible (Exercise is another shot of insulin)

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23
Q

What causes Hypoglycemia (insulin shock) in diabetics?

A
  • Not enough food|- Too much Insulin → is the primary cause|- Too much exercise
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24
Q

Why is insulin shock so dangerous?

A

Permanent Brain Damage

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25
Q

How should you remember the s/s of hypoglycemia?

A

Drunk in Shock

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26
Q

What are the s/s of hypoglycemia?

A

cerebral impairment, vasomotor collapse, cold, clammy, slow reaction time (Drunk in shock)||Drunk → Staggering gait, slurred speech, ↓ reaction time, |Shock=cold, clammy, ↓BP, ↑ HR, ↑ RR, modeled skin

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27
Q

What is the treatment for hypoglycemia?

A

-Administer a rapidly metabolizable carbohydrate (sugar) → Juice, Candy, Milk, Honey|- Ideal combination is a sugar and a protein/starch||- If the pt is unconscious give IV D50 or D10(Hospital) or IM glucagon)

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28
Q

DKA is only in

A

Type I

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29
Q

DKA is caused by

A
  • Too much food|- Not enough insulin|- Not enough exercise||** the number ONE cause is acute vial upper respiratory infection with in the last 10 days
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30
Q

With DKA the blood glucose is super __________________

A

HIGH

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31
Q

Signs and symptoms for DKA is?

A

DKA|D- Dehydration|K- ketones (Blood), Kussmaul, High K+|A- Acidosis, Acetone breath, Anorexia from nausa

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32
Q

Treatment for DKA is ?

A

Insulin IV R and IV fluids at a rate of 200

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33
Q

What is hyperosmolar hyperglycemic non ketotic coma (HHNK)?

A

Sever dehydration

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34
Q

What are the signs and symptoms of HHNK?

A

Same as dehydration||hot, flush, dry, tachycardia, ↓ skin turgor

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35
Q

What is the number 1 nursing dx of HHNK?

A

fluid volume deficit

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36
Q

What is the number 1 nursing intervention of HHNK?

A

IV fluids

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37
Q

What are the long term complications of diabetes related to?

A

poor tissue perfusion|peripheral neuropathy

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38
Q

Which lab test is the the best indicator of long term blood glucose control (compliance/effectiveness/adherence of treatment) ?

A

HemoGLOBIN A1C||6% and below: Good to go|7%: need a check up|8% and above : Oh no out of control

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39
Q

Cold and clammy

A

get some candy

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40
Q

hot and dry

A

sugars high (dehydration)

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41
Q

Normal blood sugar

A

70-110

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42
Q

Hyperthyroidism S/Sx

A

Hyper-metabolism:||Weight loss|Tachycardia|HTN|Palpitations|Agitation|Restlessness|Nervousness|Diarrhea|Increased energy|Bulging eyes|Warm|Heat intolerance***

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43
Q

Graves Disease||-What is it?|-Treatment?

A

Hyperthyroidism!!!||Tx:|-Radioactive Iodine (careful with urine, flush 2-3 times, use private bathroom, no visitation in first 24 hrs)||-PTU (Propylthiouracil)||-Surgical removal of thyroid gland (thyroidectomy)

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44
Q

You are going to run yourself into the grave!!!

A

RUN = HYPER||Graves = Hyperthyroidism

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45
Q

Radioactive Iodine

A

Treatment for Hyperthyroidism||Precautions:|-careful with urine|-use private bathroom|-flush 2-3 times

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46
Q

PTU (Propylthiouracil)

A

Cancer drug used to treat hyperthyroidism||Monitor WBC!||Education - isolation, wear mask, no kids, immunosuppressed

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47
Q

When you see PTU, think…

A

Puts Thyroid Under –> treats hyperthyroidism

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48
Q

Total Thyroidectomy

A

-Need lifelong T3, T4 hormone replacement||-Risk for Hypocalcemia (bc at risk for loosing parathyroid gland)||Hypocalcemia S/Sx:|-tetany|-paresthesia (earliest sign)

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49
Q

Subtotal (partial) Thyroidectomy

A

(do NOT need lifelong hormone replacement)||At risk for THYROID STORM (thyrotoxicosis)||Thyroid Storm S/Sx:|-very high fever >104 |-very high BP|-severe tachycardia|-psychotic delirium**||Thyroid Storm Tx:|-Oxygen via mask 10 L/min|-Lower body temp (first = ice packs, best = cooling blanket)|save the brain*

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50
Q

Thyroid Storm aka

A

thyrotoxicosis

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51
Q

Thyroid Storm - treatment

A

Self-limiting complication, trying to save the brain until the patient comes out of it||-Oxygen via mask |-Lower body temp (ice packs, cooling blanket)

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52
Q

Thyroidectomy Post-op risks ||What is priority?

A

1st 12 hours…||1. Airway|2. Hemorrhage

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53
Q

Total Thyroidectomy post-op risk 12-48 hrs||What is priority?

A

Hypocalcemia –> Tetany

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54
Q

Subtotal Thyroidectomy post-op risk 12-48 hrs||What is priority?

A

Thyroid Storm |(high fever, high BP, tachycardia, psychotic delirium)

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55
Q

Hypothyroidism

A

Hypo-metabolism:||-Weight gain|-cold|-sluggish|-slow|-decreased BP|-bradycardia|-hair and nails brittle|-decreased energy|-cold intolerance***

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56
Q

Myxedema

A

Hypothyroidism!!!||Tx: Thyroid Hormone replacement (Levothyroxine, Synthroid)||Caution: do NOT sedate them

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57
Q

Do NOT sedate patients with _____________

A

Hypothyroidism/Myxedema

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58
Q

Never hold the hormone for what patient?

A

patient who is NPO with myxedema (hypothyroidism)

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59
Q

Adrenal Cortex diseases start with…

A

A or C||Addison’s Disease - undersecretion||Cushing Syndrome - oversecretion

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60
Q

Addison’s disease

A

Undersecretion of adrenal cortex||S/Sx:|-Hyperpigmentation|-Inability to adapt normally to stress –> stress turns to shock|-Weakness|-Hypoglycemia|-Postural hypotension|-Weight loss

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61
Q

Addison’s Disease Tx

A

Steroids ||(all steroids end in -sone)|(Prednisone, etc)

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62
Q

Mnemonic for Addison’s treatment

A

Addison’s you add a -SONE

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63
Q

Addisonian crisis

A

Life-threatening complication of Addison’s disease - can lead to shock, triggered by stress||S/Sx:|-hypotension|-tachycardia|-dehydration|-hyperkalemia|-hyponatremia|-hypoglycemia|-fever|-weakness/confusion

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64
Q

Cushing Syndrome

A

Oversecretion of the adrenal cortex

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65
Q

Cushing Syndrome S/Sx

A

-Buffalo hump|-Moon face|-Truncal obesity, thin extremities|-Gynecomastia |-Striae|-Thin, fragile skin|-Immunosuppressed|-Acne|-Decreased libido|-Decreased fertility|-Amenorrhea, Hirsutism|-Fatigue|-Muscle weakness|-Cognitive difficulties|-Irritability|-Osteoporosis|-Bruises + Petechiae||-Na+ and Fluid retention|-Hypokalemia|-Hyperglycemia

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66
Q

Cushing Syndrome - glucose levels

A

Hyperglycemia

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67
Q

***S/Sx of Cushing is the same as the side effects of….

A

Steroids

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68
Q

Cushing Syndrome - Tx

A

Adrenoectomy

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69
Q

Myxedema Coma S/Sx

A

Severe Hypothyroidism:||-Hypothermia|-Bradycardia|-Hypoventilation|-Hypotension||-Decreased LOC|-Psychosis|-Seizures, Coma|-Nonpitting edema of hands, face, tongue|-Hyponatremia|-Hypoglycemia|-Pericardial effusion|-

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70
Q

***diabetes insipidus (DI)

A

LOW ADH||-Polydipsia|-Polyuria|-Dehydration|-Weight loss|-Hypernatremia||-High serum osmolality|-Low specific gravity (urine is dilute and copious)

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71
Q

Post-op Thyroidectomy ||Nursing Actions:

A

-Assess for signs of hypocalcemia (paresthesias, stridor, Trousseau, Chvostek)||-Assess for Stridor or changes in voice strength and quality||-Keep emergency airway equipment at the bedside||-Semi-fowler position

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72
Q

Pheochromocytoma

A

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine||Resulting in –> Hypertensive crisis –> treat with vasodilator, avoid abdominal palpation, avoid activities that can precipitate a hypertensive crisis such as bending/lifting/valsalva

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73
Q

safety r/t all endocrine glands

A
  • all VERY VASCULAR: worry about hemorrhaging during and after surgery
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74
Q

thyroid produces… (3)

A
  • T3||- T4||- calcitonin
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75
Q

function of calcitonin

A

decreases serum Ca levels by taking Ca out of the blood and pushing it back into bone (opposite of PTH)

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76
Q

function of T3/T4

A

gives us energy

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77
Q

you need _____ to make hormones produced by the thyroid

A

Iodine (salt)

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78
Q

Hyperthyroidism:|- main problem||- other name

A
  • too much energy||- Grave’s Disease
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79
Q

Hyperthyroidism:|- s/s (12)

A
  • nervous|- irritable|- attention span decreased|- appetite increased|- wt decreased|- sweaty/hot (intolerance to heat)|- exophtalamus |- fast GI emptying|- HTN|- tachycardia|- arrythmias/palpitations|- increased thyroid size
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80
Q

3 of the earliest signs of hyperthyroidism

A
  • HTN|- tachycardia|- arrythmias/palpitations (increasing workload on heart)
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81
Q

Hyperthyroidism: diagnosis (4)

A
  • T4 increased|- TSH decreased|- thyroid scan|- ultrasound/MRI/CT
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82
Q

thyroid scan

A

given a dose of radioactive iodine to visualize thyroid

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83
Q

Pt teaching: thyroid scan (2)

A
  • discontinue any iodine-containing medications 1 week prior to the thyroid scan||- wait 6 weeks to restart medications
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84
Q

1 drug that contains high levels of iodine that may affect thyroid function

A

amiodarone

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85
Q

4 different drugs for hyperthyroidism

A
  1. Anti-thyroids|2. Iodine compounds|3. B-blockers|4. Radioactive Iodine therapy
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86
Q

Antithyroids:|- 2 examples|- action|- use

A
  1. methimazole|2. prophylthiouracil||- stops thyroid from making hormones||- used Pre-op to stun the thyroid; make pt “euthyroid” = normal thyroid
87
Q

Iodine compounds:|- 2 examples|- action|- pt teaching (2)

A
  1. potassium iodine|2. Lugol’s solution||- decrease size and vascularity of thyroid||1. give in milk or juice|2. use straw to prevent teeth staining
88
Q

B-blockers:|- 2 examples|- action (3)|- use (2)|- considerations (2)

A
  1. metoprolol|2. propanolol||1. decreases contractility|2. decrease HR|3. decrease CO||1. decrease workload on heart|2. decrease anxiety||do not give to asthmatics or diabetics
89
Q

Radioactive Iodine therapy:|- # of doses|- route|- action|- considerations (3)

A
  • one PO dose||- destroys thyroid cells -> hypothyroidism||1. rule out pregnancy|2. stay away from babies for 1 week|3. don’t kiss anyone for 1 week
90
Q

possible rebound effect of radioactive iodine tx

A

thyroid storm (thyrotoxicosis, thyrotoxic crisis)

91
Q

considerations for possibility of thyroid storm during radioactive iodine tx (2)

A

(hyperthyroidism multiplied by 100)||- can lead to MI||- pt should be in ICU setting

92
Q

hyperthyroidism: surgery|- name

A

thyroidectomy (partial/complete)

93
Q

what is the priority post-thyroidectomy

A

HEMORRHAGING: thyroid is very vascular

94
Q

thyroidectomy:|- report any feelings of _____|- check for bleeding where? (2)|- assess for laryngeal nerve damage how?|- have _____ at bedside table

A
  • pressure||1. at incision site|2. back of neck (pooling)||- listening for hoarseness||- trach kit
95
Q

Why are we listening for hoarseness?||Why is there a trach at the bedside table post-thyroidectomy?

A
  • assess for vocal cord damage/paralysis||- paralysis of both cords leads to airway obstruction -> trach
96
Q

post-thyroidectomy manifestations indicating need for trach (3)

A
  • swelling||- hoarseness/vocal cord paralysis||- hypocalcemia (parathyroid accidentally removed)
97
Q

s/s of hypocalcemia (5)

A
  • rigid|- tight|- tetany|- seizures|- laryngospasm
98
Q

5 other nursing interventions post-thyroidectomy:|- ____ care|- support ____|- personal items|- positioning|- nutrition

A
  • eye care||- support neck||- put personal items close to them||- HOB elevated (decrease edema)||- increase calories pre and post-op
99
Q

eye care post-thyroidectomy (3)

A
  1. hypoallergnic tape to close eyelids and protect eyes if pt can’t||2. dark glasses if photosensitive||3. artificial tears for dryness
100
Q

does treating hyperthyroidism fix vision problems?

A

no

101
Q

what kind of pt’s will often be diagnosed w/ hypothyroidism?

A
  • depressed pts||- psych pts
102
Q

S/S of hypothyroidism (8)

A
  • no energy/fatigue|- no expression|- slow, slurred speech|- increased weight|- slow GI emptying|- cold intolerance: do not give heating pad/electric blankets!|- amenorrhea|- pt may be totally immobile
103
Q

hypothyroidism:|- diagnosis (2)

A
  • T4 decreased|- TSH increased
104
Q

Hypothyroidism:|- tx (medications, 2)|- use|- take for how long

A
  1. levothyroxine|2. liothyronine||- increase energy levels||- for the rest of your life
105
Q

levothyroxine/liothyronine:|- pt teaching (3)

A
  1. take on empty stomach||2. C/O chest pain or change in rhythm, call HCP
106
Q

Why/what are we worried about when a pt is taking thyroid hormones? (2)

A
  • MI||- people with hypothyroidism tend to have coronary artery dz
107
Q

think ____ when you think about parathyroid problems

A

calcium

108
Q

Parathyroid:|- secretes _____|- action

A
  • PTH||- PTH pulls Ca from bones and puts it in blood, increasing serum Ca levels (opposite of calcitonin)
109
Q

Hyperparathyroidism = ____________ = ______________

A

= hypercalcemia = hypophosphatemia

110
Q

Hyperparathyroidism:|- S/S|- tx

A
  • sedative effect (hypercalcemia)||- partial parathyroidectomy: PTH secretion decreases
111
Q

2 priorities post-parathyroidectomy

A
  1. bleeding|2. hypocalcemia (rigid, tight muscles)
112
Q

hypoparathyroidism = ____________ = ___________

A

hypocalcemia = hyperphosphatemia

113
Q

Hypoparathyroidism:|- s/s |- tx (medications, 2)

A
  • hyperactive effect: hypocalcemia, not sedated||1. IV Ca|2. Phosphorus-binders
114
Q

you need your adrenal glands for what?

A

to handle stress

115
Q

2 parts of adrenal gland

A
  1. medulla||2. cortex
116
Q

medulla secretes what? (2)

A
  • epi||- NorEpi||(adrenal Medusa: Medusa is scary, increase in epi)
117
Q

problem w/ adrenal medulla

A

pheochromocytoma

118
Q

pheochromocytoma:|- patho||- risk factor

A
  • benign tumor that secretes epi and norepi in boluses||- family hx
119
Q

pheochromocytoma:|- s/s (5)

A
  1. HTN|2. tachycardia|3. palpitations|4. flushing/diaphoresis|5. headache
120
Q

pheochromocytoma:|- diagnosis (2)

A
  1. catecholamine levels||2. 24-hr urine sample
121
Q

2 tests for catecholamine levels

A
  1. VMA (vanillymandelic acid)||2. MN (metanephrine)
122
Q

foods that alter VMA/MN tests (5)

A
  • anything w/ vanilla in it|- caffeine|- vitamin B|- fruit juices|- bananas
123
Q

looking for (2) in 24-hr urine test for pheochromocytoma

A
  1. epi|2. norepi||(catecholamines)
124
Q

pheochromocytoma: pt teaching (4)

A
  • avoid any activities that can increase epi/norepi||1. no stress|2. remain calm|3. avoid exercise|4. no smoking
125
Q

pheochromocytoma: tx (1)

A
  • surgery to remove tumors
126
Q

nursing considerations for pheochromocytoma

A
  • avoid palpating the abd because it may cause sudden release of catecholamines and severe HTN
127
Q

adrenal cortex produces (3)

A

Steroids!||1. glucocorticoids|2. mineralocorticoids|3. sex hormones

128
Q

adverse effects of steroids are more pronounced when…

A

pt is receiving oral or IV steroids

129
Q

4 major actions of glucocorticoids

A
  1. change your mood|- depressed, psychotic, euphoric, insomnia||2. alter defense mechanisms|- immunosuppression|- high risk for infection||3. breakdown fats and proteins|- help regulate glucose metabolism|- Cushing’s: moonface, buffalo hump, skinny extremities||4. inhibit insulin|- hyperglycemia|- do blood glucose monitoring
130
Q

3 major actions of mineralocorticoids (aldosterone)

A
  1. retain Na|2. retain H2O|3. lose K+
131
Q

Sex hormones:|- 3 examples|- too many (3)|- too few (2)

A
  • testosterone|- estrogen|- progesterone||Too many:|- hirsutism|- acne|- irregular periods||Too few:|- decreased axillary/pubic hair|- decreased libido
132
Q

ACTH:|- made where|- action

A
  • pituitary||- stimulates cortisol to be made
133
Q

increased ACTH = ….

A

increased cortisol = increased steroids

134
Q

Not enough steroids

A

Addison’s Disease

135
Q

4 biggest problems w/ adrenal cortex problems (Addison’s Disease)

A
  1. not enough steroids|2. shock|3. hyperkalemia|4. hypoglycemia
136
Q

S/S of Addison’s Disease (8)

A
  1. extreme fatigue|2. N/V/D|3. anorexia/wt loss|4. hypoTN|5. confusion|6. hyponatremia/hyperkalemia/hypoglycemia|7. hyperpigmentation: bronzing of skin|8. vitiligo: depigmented areas of skin
137
Q

Addison’s Disease: tx (4)

A
  1. combat shock (losing Na/H2O -> increase Na in diet)|2. I/Os|3. daily wt|4. medications
138
Q

2 medications for Addison’s

A
  1. prednisolone (Prednisone)||2. Fludrocortisone
139
Q

Prenisolone:|- dosing|- type of steroid

A
  • 2x/day in split doses: 2/3 in morning, 1/3 at night||- glucocorticoid
140
Q

Fludrocortisone:|- type of steroid

A

mineralocorticoid (aldosterone)

141
Q

Pt teaching: steroid tx (3)

A
  • daily weights|- routine BP monitoring|- must taper off; cannot withdraw abruptly
142
Q

Pt teaching: daily wt (medications where wt needs to be monitored daily, in general)

A
  • keep weight between 2-3 lbs or 1-2 kgs (+/-) of their normal wt||- report a gain of > 5 lbs
143
Q

Addisonian Crisis:|- r/f (4)||- biggest worry

A
  1. infections|2. emotional stress|3. physical exertion|4. stopping steroids abruptly||- = severe hypoTN and vascular collapse|- blood sugar bottoms out
144
Q

Cushing’s Disease (3)

A
  • too many glucocorticoids, sex hormones, and mineralocorticoids
145
Q

Cushing’s: s/s|- too many glucocorticoids (8)

A
  1. growth arrest|2. thin extremities/skin (lipolysis)|3. increased risk of infection|4. hyperglycemia|5. psychoses -> depression|6. moon-faced (fat redistribution/fluid retention)|7. trunk-al obesity (fat redistribution; lipogenesis)|8. buffalo hump
146
Q

Cushing’s: S/S|- too many sex hormones (3)

A
  • oily skin/acne|- women w/ male traits|- poor libido (sex drive)
147
Q

Cushing’s: S/S|- too many mineralocorticoids (4)

A
  • HTN|- CHF|- Wt gain|- fluid volume excess
148
Q

Cushing’s: labs|- K+|- Cortisol (urine)

A
  • low K+: too much aldosterone||- high cortisol levels
149
Q

Cushing’s: tx (4)

A
  1. adrenalectomy (unilateral or bilateral)|2. quiet/non-stressful environment|3. dieting|4. avoid infection
150
Q

if both adrenal glands are removed, pt needs what?

A

lifetime replacement of steroids

151
Q

why quiet environment?

A

cannot handle any stress

152
Q

Diet pre-Cushing’s tx (4)|- K+|- Na|- protein|- Ca

A
  • increase K+||- decrease Na||- increase protein||- increase Ca
153
Q

Why do we want pt to increase Ca if they are on steroids or have Cushing’s?

A
  • steroids decrease serum Ca by excreting it thru GI tract||- brittle bones!
154
Q

2 alterations in urine sample you may see if a pt is on long-term steroids

A
  1. glucose||2. ketones
155
Q

normal blood glucose levels

A

70-110

156
Q

normal Hgb A1C levels:|- non-diabetic|- good diabetic control|- fair diabetic control|- poor diabetic control

A
  • Non: 2.2-4.8%||- Good: 2.5-5.9%||- Fair: 6.0-8.0%||- Poor: > 8.0%
157
Q

Diabetes: type 1|- problem|- usually diagnosed when?

A
  • little or no insulin||- in childhood
158
Q

DT1:|- how does it appear?|- common first sign?|- 3 hallmark S/S

A
  • abruptly||- DKA||1. Polyuria|2. Polydipsia|3. Polyphagia
159
Q

DT1/DKA patho

A
  • no insulin -> glucose builds up in blood||- blood becomes hypertonic -> pulls fluid into vascular space||- kidneys filter excess glucose/fluids (polyuria/polydipsia)||- cells starving -> breakdown fats and proteins (polyphagia)||- fat breakdown -> Ketone (acid) buildup||- metabolic acidosis -> Kussmaul’s Respirations
160
Q

hyperglycemia: think ___

A

3 P’s

161
Q

Polyuria: think what first? then what?

A
  • SHOCK first||- then, renal failure: polyuria -> oliguria -> anuria -> renal failure
162
Q

DT1: tx

A
  • MUST have insulin: oral hypogylcemic agents will not work
163
Q

DT2:|- problem|- common weight

A
  • not enough insulin, or their insulin is no good||- usually obese
164
Q

How is DT2 usually found?

A
  • on accident: wound that won’t heal, repeated vaginal infections
165
Q

DT2:|- evaluate these pt’s for…

A

metabolic syndrome

166
Q

Features of Metabolic Syndrome (5)

A

MUST HAVE 3 OR MORE OF THESE:||1. Waist circumference: |- M: > 40 in|- F: > 35 in||2. Triglycerides:|- > 150||3. HDL:|- M: < 40|- F: < 50||4. BP:|- > 130/85||5. FBS:|- > 100

167
Q

DT2: tx

A
  • start w/ diet and exercise||- may need oral hypoglycemic agents or insulin
168
Q

Gestational Diabetes:|- resembles what?|- pregnant mothers need for insulin|- risk factors (3)

A
  • DT2||- need 2-3x more insulin than normal||1. obese|2. family hx|3. previous hx
169
Q

When to screen for GDiabetes?

A
  • at 1st prenatal visit if they have risk factors||- screen all moms at 24-48 weeks
170
Q

GDiabetes:|- complications to baby (2)

A
  • increased birth weight||- hypoglycemia
171
Q

General diabetes (T1/T2) diet breakdown (4)

A
  1. Majority of calories should come from complex carbs (45%)||2. Then, fats (30-40%)||3. Lastly, proteins (15-20%)||4. high fiber diet
172
Q

why high fiber for diabetes?

A

slows down glucose absorption in intestines, eliminating sharp rise/fall in blood sugar

173
Q

diabetes: exercise pt teaching (4)

A
  1. wait until BS normalizes to begin exercise||2. eat something to prevent hypoglycemia pre-exercise||3. exercise when BS is at its highest||4. exercise same time and amount each day
174
Q

how do all oral anti-diabetics/non-insulin injectables work? (3)

A
  1. decrease amount of circulating glucose||improving:|2. how body produces insulin|3. how body uses insulin and glucose
175
Q

Extreme blood sugar levels = …..

A

vascular/brain damage

176
Q

Most common oral antidiabetic

A

metformin

177
Q

Metformin:|- action (3)

A
  • reduces glucose production|- enhances how glucose enters cell|- does not stimulate release of more insulin (NO HYPOGLYCEMIA)
178
Q

Pt teaching: metformin

A
  • temporarily discontinue if undergoing surgery/radiologic procedure that involves contrast dye||- can resume 48 hr after procedure if kidney function has returned and creatinine is normal
179
Q

How is insulin dose determined?||Usual dose?

A
  • by body weight||- 0.4-1.0 unit/kg/day
180
Q

Types of insulin:|- rapid (2)|- short-acting (1)|- intermediate (1)|- Long-acting (2)

A

Rapid:|- aspart|- novolog||Short:|- regular||Intermediate:|- NPH||Long:|- Glargine|- Lantus

181
Q

Appearance:|- regular|- NPH

A
  • regular: clear||- NPH: cloudy
182
Q

Order to draw up:|- regular|- NPH

A

RN||- regular before NPH||- Clear before Cloudy

183
Q

What can you mix long-acting insulins with?

A

nothing (they are also clear, but cannot be drawn up w/ anything)

184
Q

What insulin can be given IV?

A

regular

185
Q

goal of insulin tx

A

keep before meal glucose near normal at 70-130

186
Q

Most common method of daily dosing insulin

A
  • basal/bolus||- combination of long-acting and a rapid-acting||- long-acting: give once per day||- rapid-acting: given thruout the day before meals, in divided doses
187
Q

Snacks required w/ basal/bolus?

A

NO: but pts must eat when dosing w/ rapid-acting

188
Q

pts should eat when insulin levels are….

A

at its peak (BS at its lowest)

189
Q

Glycosated hemoglobin (HbA1c)

A

average of what your BS has been over the past 6 months

190
Q

HbA1c:|- diagnostic for diabetes|- goal for pts w/ diabetes

A
  • > 6.5%||- < 7.0%
191
Q

What happens to BS when you are sick or stressed?

A

increases (illness = DKA)

192
Q

Pt teaching: insulin admin (2)

A
  • rotate sites (rotate within an area first)||- do not aspirate
193
Q

What kind of insulin can be used w/ an insulin infusion pump?

A

ONLY rapid-acting

194
Q

9 s/s of hypoglycemia

A
  • fatigue|- clammy|- shaky|- confused|- HA|- nervous|- nauseous|- tachycardia|- hunger
195
Q

if hypoglycemic, what should you do?

A
  • eat something: simple carbs (juice, candy, soda
196
Q

snacks should be _____ g of carbs if hypoglycemic

A

15 g

197
Q

rule for eating carbs if hypoglycemic

A

15-15-15 rule:|- eat a little, recheck in 15, eat 15 more, recheck, eat 15 more

198
Q

glucose absorption is delayed in foods high in ____

A

fat

199
Q

once blood sugar is up, what should the pt do?

A
  • eat a complex carb + protein: crackers and peanut butter
200
Q

2 other interventions for hypoglycemia/unconscious

A
  1. D50W: large bore IV|2. injectable glucagon IM if no IV access
201
Q

4 measures to prevent hypoglycemia

A
  1. eat!|2. take insulin regularly|3. know s/s of hypoglycemia|4. check BS regularly
202
Q

DKA: tx (6)

A
  1. find the cause|2. hourly labs and UO|3. IV insulin|4. ECG|5. ABGs|6. IVFs
203
Q

2 labs you will want to draw hourly w/ DKA

A
  • blood glucose||- potassium
204
Q

IVFs for DKA

A
  • 2 large bore IVs||- start w/ NS, then when BS gets down to 250-300, switch to D5W to prevent hypoglycemia||- at some point, HCP will want to add K+ to IVFs
205
Q

hyperosmolar hyperglycemic nonketosis (HHNK)/hyperglycemic hyperosmolar state (HHS):|- which diabetes|- patho

A
  • type 2||- looks like DKA, but no acidosis; BS > 600||- making just enough insulin so that they are not breaking down body fat
206
Q

Kussmaul’s in HHS?

A

no

207
Q

3 other complications of diabetes

A
  1. vascular problems|2. neuropathy|3. increased risk for infection
208
Q

Vascular problems:|- patho|- 2 examples

A
  • poor circulation everywhere d/t vessel damage d/t hypergylcemia -> sugar decreases size of vessel -> decreased blood flow||1. diabetic retinopathy|2. nephropathy
209
Q

Neuropathy:|- 4 problems

A
  1. sexual problems|2. foot/leg paresthesia/pain/numbness|3. neurogenic bladder|4. gastroparesis
210
Q

sexual problems r/t neuropathy

A

permanent impotence/decreased sensation

211
Q

diabetic foot care (7)

A
  1. check your feet every day|2. don’t clip toenails too short|3. clip toenails straight across|4. don’t wear tight shoes|5. don’t go barefoot|6. dry in between toes after bathing|7. no harsh soaps
212
Q

neurogenic bladder

A
  • bladder does not empty properly||- bladder may empty spontaneously or may not empty at all
213
Q

gastroparesis:|- patho|- risk for..

A
  • stomach emptying is delayed||- increased risk of aspiration

NCLEX (4 decks)

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