endocrine Flashcards
Diabetes Mellitus
An error of glucose metabolism||* Don’t use or Metabolize Insulin (Insulin being the primary fuel source in the body)
Diabetes insipidus
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
SIADH is the opposite of what?
Diabetes insipidus |- Have a normal blood glucose|- retain water (decreased urine output)|- HIGH specific gravity (1.010-1.030)
Type I Diabetes Mellitus
Insulin dependent (not producing insulin) |Juvenile onset|Ketosis prone
Type II Diabetes Mellitus
NON insulin dependent|Adult Onset|NON ketosis prone
What are the S/S of Diabetes Mellitus?
Polyuria (↑urine output)|Polydipsia(↑ thirst)|Polyphagia (↑swallowing/Eating) ||* NOTE: only in DM will polyphagia mean increased eating
Treatment for Type 1 Diabetes?
- D- Diet (Calories from carbs) → Least important|- I- Insulin → Most Important|- E- Exercise ||* If you don’t Treat type I they will DIE
Treatment for Type II Diabetes?
-D - Diet → Most Important|- O- Oral Hypoglycemics |- A- Activity ||* Don’t treat type II they will be DOA
What is the Diet of Diabetes?
- 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
Insulin acts to _____________ blood sugar
Lower
How many types of insulin do you need to know?
4|1. R- Regular|2. N- NPH|3. Humalog|4. Lantus
When is hypoglycemia tested for?
At the peek of the drug given
Insulin type: R
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
Insulin type: N
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.
Insulin type: Humalog
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)
Remember peek, onset and duration of R and N by
1 2 4 / 6 8-10 12
Insulin type: Lantus
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.
With Insulin remember to:
- Check the expiration date (Best Answer)|- Refrigerate until opened|- Once opened label the new expiration date (30 days from date opened) & put date opened
Exercise is
Another shot of Insulin
Exercise _________________ Insulin: If the client exercises more they need ________________ insulin.
Potentiates, LESS
What 2 things ALWAYS happen to a sick diabetic?
- Hyperglycemia|2. Dehydration
What are the sick day rules for Insulin?
Take Insulin|Take sips of water (Dehydration)|Stay as active as possible (Exercise is another shot of insulin)
What causes Hypoglycemia (insulin shock) in diabetics?
- Not enough food|- Too much Insulin → is the primary cause|- Too much exercise
Why is insulin shock so dangerous?
Permanent Brain Damage
How should you remember the s/s of hypoglycemia?
Drunk in Shock
What are the s/s of hypoglycemia?
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
What is the treatment for hypoglycemia?
-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)
DKA is only in
Type I
DKA is caused by
- 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
With DKA the blood glucose is super __________________
HIGH
Signs and symptoms for DKA is?
DKA|D- Dehydration|K- ketones (Blood), Kussmaul, High K+|A- Acidosis, Acetone breath, Anorexia from nausa
Treatment for DKA is ?
Insulin IV R and IV fluids at a rate of 200
What is hyperosmolar hyperglycemic non ketotic coma (HHNK)?
Sever dehydration
What are the signs and symptoms of HHNK?
Same as dehydration||hot, flush, dry, tachycardia, ↓ skin turgor
What is the number 1 nursing dx of HHNK?
fluid volume deficit
What is the number 1 nursing intervention of HHNK?
IV fluids
What are the long term complications of diabetes related to?
poor tissue perfusion|peripheral neuropathy
Which lab test is the the best indicator of long term blood glucose control (compliance/effectiveness/adherence of treatment) ?
HemoGLOBIN A1C||6% and below: Good to go|7%: need a check up|8% and above : Oh no out of control
Cold and clammy
get some candy
hot and dry
sugars high (dehydration)
Normal blood sugar
70-110
Hyperthyroidism S/Sx
Hyper-metabolism:||Weight loss|Tachycardia|HTN|Palpitations|Agitation|Restlessness|Nervousness|Diarrhea|Increased energy|Bulging eyes|Warm|Heat intolerance***
Graves Disease||-What is it?|-Treatment?
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)
You are going to run yourself into the grave!!!
RUN = HYPER||Graves = Hyperthyroidism
Radioactive Iodine
Treatment for Hyperthyroidism||Precautions:|-careful with urine|-use private bathroom|-flush 2-3 times
PTU (Propylthiouracil)
Cancer drug used to treat hyperthyroidism||Monitor WBC!||Education - isolation, wear mask, no kids, immunosuppressed
When you see PTU, think…
Puts Thyroid Under –> treats hyperthyroidism
Total Thyroidectomy
-Need lifelong T3, T4 hormone replacement||-Risk for Hypocalcemia (bc at risk for loosing parathyroid gland)||Hypocalcemia S/Sx:|-tetany|-paresthesia (earliest sign)
Subtotal (partial) Thyroidectomy
(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*
Thyroid Storm aka
thyrotoxicosis
Thyroid Storm - treatment
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)
Thyroidectomy Post-op risks ||What is priority?
1st 12 hours…||1. Airway|2. Hemorrhage
Total Thyroidectomy post-op risk 12-48 hrs||What is priority?
Hypocalcemia –> Tetany
Subtotal Thyroidectomy post-op risk 12-48 hrs||What is priority?
Thyroid Storm |(high fever, high BP, tachycardia, psychotic delirium)
Hypothyroidism
Hypo-metabolism:||-Weight gain|-cold|-sluggish|-slow|-decreased BP|-bradycardia|-hair and nails brittle|-decreased energy|-cold intolerance***
Myxedema
Hypothyroidism!!!||Tx: Thyroid Hormone replacement (Levothyroxine, Synthroid)||Caution: do NOT sedate them
Do NOT sedate patients with _____________
Hypothyroidism/Myxedema
Never hold the hormone for what patient?
patient who is NPO with myxedema (hypothyroidism)
Adrenal Cortex diseases start with…
A or C||Addison’s Disease - undersecretion||Cushing Syndrome - oversecretion
Addison’s disease
Undersecretion of adrenal cortex||S/Sx:|-Hyperpigmentation|-Inability to adapt normally to stress –> stress turns to shock|-Weakness|-Hypoglycemia|-Postural hypotension|-Weight loss
Addison’s Disease Tx
Steroids ||(all steroids end in -sone)|(Prednisone, etc)
Mnemonic for Addison’s treatment
Addison’s you add a -SONE
Addisonian crisis
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
Cushing Syndrome
Oversecretion of the adrenal cortex
Cushing Syndrome S/Sx
-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
Cushing Syndrome - glucose levels
Hyperglycemia
***S/Sx of Cushing is the same as the side effects of….
Steroids
Cushing Syndrome - Tx
Adrenoectomy
Myxedema Coma S/Sx
Severe Hypothyroidism:||-Hypothermia|-Bradycardia|-Hypoventilation|-Hypotension||-Decreased LOC|-Psychosis|-Seizures, Coma|-Nonpitting edema of hands, face, tongue|-Hyponatremia|-Hypoglycemia|-Pericardial effusion|-
***diabetes insipidus (DI)
LOW ADH||-Polydipsia|-Polyuria|-Dehydration|-Weight loss|-Hypernatremia||-High serum osmolality|-Low specific gravity (urine is dilute and copious)
Post-op Thyroidectomy ||Nursing Actions:
-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
Pheochromocytoma
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
safety r/t all endocrine glands
- all VERY VASCULAR: worry about hemorrhaging during and after surgery
thyroid produces… (3)
- T3||- T4||- calcitonin
function of calcitonin
decreases serum Ca levels by taking Ca out of the blood and pushing it back into bone (opposite of PTH)
function of T3/T4
gives us energy
you need _____ to make hormones produced by the thyroid
Iodine (salt)
Hyperthyroidism:|- main problem||- other name
- too much energy||- Grave’s Disease
Hyperthyroidism:|- s/s (12)
- 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
3 of the earliest signs of hyperthyroidism
- HTN|- tachycardia|- arrythmias/palpitations (increasing workload on heart)
Hyperthyroidism: diagnosis (4)
- T4 increased|- TSH decreased|- thyroid scan|- ultrasound/MRI/CT
thyroid scan
given a dose of radioactive iodine to visualize thyroid
Pt teaching: thyroid scan (2)
- discontinue any iodine-containing medications 1 week prior to the thyroid scan||- wait 6 weeks to restart medications
1 drug that contains high levels of iodine that may affect thyroid function
amiodarone
4 different drugs for hyperthyroidism
- Anti-thyroids|2. Iodine compounds|3. B-blockers|4. Radioactive Iodine therapy
Antithyroids:|- 2 examples|- action|- use
- methimazole|2. prophylthiouracil||- stops thyroid from making hormones||- used Pre-op to stun the thyroid; make pt “euthyroid” = normal thyroid
Iodine compounds:|- 2 examples|- action|- pt teaching (2)
- 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
B-blockers:|- 2 examples|- action (3)|- use (2)|- considerations (2)
- 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
Radioactive Iodine therapy:|- # of doses|- route|- action|- considerations (3)
- 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
possible rebound effect of radioactive iodine tx
thyroid storm (thyrotoxicosis, thyrotoxic crisis)
considerations for possibility of thyroid storm during radioactive iodine tx (2)
(hyperthyroidism multiplied by 100)||- can lead to MI||- pt should be in ICU setting
hyperthyroidism: surgery|- name
thyroidectomy (partial/complete)
what is the priority post-thyroidectomy
HEMORRHAGING: thyroid is very vascular
thyroidectomy:|- report any feelings of _____|- check for bleeding where? (2)|- assess for laryngeal nerve damage how?|- have _____ at bedside table
- pressure||1. at incision site|2. back of neck (pooling)||- listening for hoarseness||- trach kit
Why are we listening for hoarseness?||Why is there a trach at the bedside table post-thyroidectomy?
- assess for vocal cord damage/paralysis||- paralysis of both cords leads to airway obstruction -> trach
post-thyroidectomy manifestations indicating need for trach (3)
- swelling||- hoarseness/vocal cord paralysis||- hypocalcemia (parathyroid accidentally removed)
s/s of hypocalcemia (5)
- rigid|- tight|- tetany|- seizures|- laryngospasm
5 other nursing interventions post-thyroidectomy:|- ____ care|- support ____|- personal items|- positioning|- nutrition
- eye care||- support neck||- put personal items close to them||- HOB elevated (decrease edema)||- increase calories pre and post-op
eye care post-thyroidectomy (3)
- hypoallergnic tape to close eyelids and protect eyes if pt can’t||2. dark glasses if photosensitive||3. artificial tears for dryness
does treating hyperthyroidism fix vision problems?
no
what kind of pt’s will often be diagnosed w/ hypothyroidism?
- depressed pts||- psych pts
S/S of hypothyroidism (8)
- 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
hypothyroidism:|- diagnosis (2)
- T4 decreased|- TSH increased
Hypothyroidism:|- tx (medications, 2)|- use|- take for how long
- levothyroxine|2. liothyronine||- increase energy levels||- for the rest of your life
levothyroxine/liothyronine:|- pt teaching (3)
- take on empty stomach||2. C/O chest pain or change in rhythm, call HCP
Why/what are we worried about when a pt is taking thyroid hormones? (2)
- MI||- people with hypothyroidism tend to have coronary artery dz
think ____ when you think about parathyroid problems
calcium
Parathyroid:|- secretes _____|- action
- PTH||- PTH pulls Ca from bones and puts it in blood, increasing serum Ca levels (opposite of calcitonin)
Hyperparathyroidism = ____________ = ______________
= hypercalcemia = hypophosphatemia
Hyperparathyroidism:|- S/S|- tx
- sedative effect (hypercalcemia)||- partial parathyroidectomy: PTH secretion decreases
2 priorities post-parathyroidectomy
- bleeding|2. hypocalcemia (rigid, tight muscles)
hypoparathyroidism = ____________ = ___________
hypocalcemia = hyperphosphatemia
Hypoparathyroidism:|- s/s |- tx (medications, 2)
- hyperactive effect: hypocalcemia, not sedated||1. IV Ca|2. Phosphorus-binders
you need your adrenal glands for what?
to handle stress
2 parts of adrenal gland
- medulla||2. cortex
medulla secretes what? (2)
- epi||- NorEpi||(adrenal Medusa: Medusa is scary, increase in epi)
problem w/ adrenal medulla
pheochromocytoma
pheochromocytoma:|- patho||- risk factor
- benign tumor that secretes epi and norepi in boluses||- family hx
pheochromocytoma:|- s/s (5)
- HTN|2. tachycardia|3. palpitations|4. flushing/diaphoresis|5. headache
pheochromocytoma:|- diagnosis (2)
- catecholamine levels||2. 24-hr urine sample
2 tests for catecholamine levels
- VMA (vanillymandelic acid)||2. MN (metanephrine)
foods that alter VMA/MN tests (5)
- anything w/ vanilla in it|- caffeine|- vitamin B|- fruit juices|- bananas
looking for (2) in 24-hr urine test for pheochromocytoma
- epi|2. norepi||(catecholamines)
pheochromocytoma: pt teaching (4)
- avoid any activities that can increase epi/norepi||1. no stress|2. remain calm|3. avoid exercise|4. no smoking
pheochromocytoma: tx (1)
- surgery to remove tumors
nursing considerations for pheochromocytoma
- avoid palpating the abd because it may cause sudden release of catecholamines and severe HTN
adrenal cortex produces (3)
Steroids!||1. glucocorticoids|2. mineralocorticoids|3. sex hormones
adverse effects of steroids are more pronounced when…
pt is receiving oral or IV steroids
4 major actions of glucocorticoids
- 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
3 major actions of mineralocorticoids (aldosterone)
- retain Na|2. retain H2O|3. lose K+
Sex hormones:|- 3 examples|- too many (3)|- too few (2)
- testosterone|- estrogen|- progesterone||Too many:|- hirsutism|- acne|- irregular periods||Too few:|- decreased axillary/pubic hair|- decreased libido
ACTH:|- made where|- action
- pituitary||- stimulates cortisol to be made
increased ACTH = ….
increased cortisol = increased steroids
Not enough steroids
Addison’s Disease
4 biggest problems w/ adrenal cortex problems (Addison’s Disease)
- not enough steroids|2. shock|3. hyperkalemia|4. hypoglycemia
S/S of Addison’s Disease (8)
- 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
Addison’s Disease: tx (4)
- combat shock (losing Na/H2O -> increase Na in diet)|2. I/Os|3. daily wt|4. medications
2 medications for Addison’s
- prednisolone (Prednisone)||2. Fludrocortisone
Prenisolone:|- dosing|- type of steroid
- 2x/day in split doses: 2/3 in morning, 1/3 at night||- glucocorticoid
Fludrocortisone:|- type of steroid
mineralocorticoid (aldosterone)
Pt teaching: steroid tx (3)
- daily weights|- routine BP monitoring|- must taper off; cannot withdraw abruptly
Pt teaching: daily wt (medications where wt needs to be monitored daily, in general)
- keep weight between 2-3 lbs or 1-2 kgs (+/-) of their normal wt||- report a gain of > 5 lbs
Addisonian Crisis:|- r/f (4)||- biggest worry
- infections|2. emotional stress|3. physical exertion|4. stopping steroids abruptly||- = severe hypoTN and vascular collapse|- blood sugar bottoms out
Cushing’s Disease (3)
- too many glucocorticoids, sex hormones, and mineralocorticoids
Cushing’s: s/s|- too many glucocorticoids (8)
- 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
Cushing’s: S/S|- too many sex hormones (3)
- oily skin/acne|- women w/ male traits|- poor libido (sex drive)
Cushing’s: S/S|- too many mineralocorticoids (4)
- HTN|- CHF|- Wt gain|- fluid volume excess
Cushing’s: labs|- K+|- Cortisol (urine)
- low K+: too much aldosterone||- high cortisol levels
Cushing’s: tx (4)
- adrenalectomy (unilateral or bilateral)|2. quiet/non-stressful environment|3. dieting|4. avoid infection
if both adrenal glands are removed, pt needs what?
lifetime replacement of steroids
why quiet environment?
cannot handle any stress
Diet pre-Cushing’s tx (4)|- K+|- Na|- protein|- Ca
- increase K+||- decrease Na||- increase protein||- increase Ca
Why do we want pt to increase Ca if they are on steroids or have Cushing’s?
- steroids decrease serum Ca by excreting it thru GI tract||- brittle bones!
2 alterations in urine sample you may see if a pt is on long-term steroids
- glucose||2. ketones
normal blood glucose levels
70-110
normal Hgb A1C levels:|- non-diabetic|- good diabetic control|- fair diabetic control|- poor diabetic control
- Non: 2.2-4.8%||- Good: 2.5-5.9%||- Fair: 6.0-8.0%||- Poor: > 8.0%
Diabetes: type 1|- problem|- usually diagnosed when?
- little or no insulin||- in childhood
DT1:|- how does it appear?|- common first sign?|- 3 hallmark S/S
- abruptly||- DKA||1. Polyuria|2. Polydipsia|3. Polyphagia
DT1/DKA patho
- 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
hyperglycemia: think ___
3 P’s
Polyuria: think what first? then what?
- SHOCK first||- then, renal failure: polyuria -> oliguria -> anuria -> renal failure
DT1: tx
- MUST have insulin: oral hypogylcemic agents will not work
DT2:|- problem|- common weight
- not enough insulin, or their insulin is no good||- usually obese
How is DT2 usually found?
- on accident: wound that won’t heal, repeated vaginal infections
DT2:|- evaluate these pt’s for…
metabolic syndrome
Features of Metabolic Syndrome (5)
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
DT2: tx
- start w/ diet and exercise||- may need oral hypoglycemic agents or insulin
Gestational Diabetes:|- resembles what?|- pregnant mothers need for insulin|- risk factors (3)
- DT2||- need 2-3x more insulin than normal||1. obese|2. family hx|3. previous hx
When to screen for GDiabetes?
- at 1st prenatal visit if they have risk factors||- screen all moms at 24-48 weeks
GDiabetes:|- complications to baby (2)
- increased birth weight||- hypoglycemia
General diabetes (T1/T2) diet breakdown (4)
- Majority of calories should come from complex carbs (45%)||2. Then, fats (30-40%)||3. Lastly, proteins (15-20%)||4. high fiber diet
why high fiber for diabetes?
slows down glucose absorption in intestines, eliminating sharp rise/fall in blood sugar
diabetes: exercise pt teaching (4)
- 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
how do all oral anti-diabetics/non-insulin injectables work? (3)
- decrease amount of circulating glucose||improving:|2. how body produces insulin|3. how body uses insulin and glucose
Extreme blood sugar levels = …..
vascular/brain damage
Most common oral antidiabetic
metformin
Metformin:|- action (3)
- reduces glucose production|- enhances how glucose enters cell|- does not stimulate release of more insulin (NO HYPOGLYCEMIA)
Pt teaching: metformin
- 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
How is insulin dose determined?||Usual dose?
- by body weight||- 0.4-1.0 unit/kg/day
Types of insulin:|- rapid (2)|- short-acting (1)|- intermediate (1)|- Long-acting (2)
Rapid:|- aspart|- novolog||Short:|- regular||Intermediate:|- NPH||Long:|- Glargine|- Lantus
Appearance:|- regular|- NPH
- regular: clear||- NPH: cloudy
Order to draw up:|- regular|- NPH
RN||- regular before NPH||- Clear before Cloudy
What can you mix long-acting insulins with?
nothing (they are also clear, but cannot be drawn up w/ anything)
What insulin can be given IV?
regular
goal of insulin tx
keep before meal glucose near normal at 70-130
Most common method of daily dosing insulin
- 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
Snacks required w/ basal/bolus?
NO: but pts must eat when dosing w/ rapid-acting
pts should eat when insulin levels are….
at its peak (BS at its lowest)
Glycosated hemoglobin (HbA1c)
average of what your BS has been over the past 6 months
HbA1c:|- diagnostic for diabetes|- goal for pts w/ diabetes
- > 6.5%||- < 7.0%
What happens to BS when you are sick or stressed?
increases (illness = DKA)
Pt teaching: insulin admin (2)
- rotate sites (rotate within an area first)||- do not aspirate
What kind of insulin can be used w/ an insulin infusion pump?
ONLY rapid-acting
9 s/s of hypoglycemia
- fatigue|- clammy|- shaky|- confused|- HA|- nervous|- nauseous|- tachycardia|- hunger
if hypoglycemic, what should you do?
- eat something: simple carbs (juice, candy, soda
snacks should be _____ g of carbs if hypoglycemic
15 g
rule for eating carbs if hypoglycemic
15-15-15 rule:|- eat a little, recheck in 15, eat 15 more, recheck, eat 15 more
glucose absorption is delayed in foods high in ____
fat
once blood sugar is up, what should the pt do?
- eat a complex carb + protein: crackers and peanut butter
2 other interventions for hypoglycemia/unconscious
- D50W: large bore IV|2. injectable glucagon IM if no IV access
4 measures to prevent hypoglycemia
- eat!|2. take insulin regularly|3. know s/s of hypoglycemia|4. check BS regularly
DKA: tx (6)
- find the cause|2. hourly labs and UO|3. IV insulin|4. ECG|5. ABGs|6. IVFs
2 labs you will want to draw hourly w/ DKA
- blood glucose||- potassium
IVFs for DKA
- 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
hyperosmolar hyperglycemic nonketosis (HHNK)/hyperglycemic hyperosmolar state (HHS):|- which diabetes|- patho
- type 2||- looks like DKA, but no acidosis; BS > 600||- making just enough insulin so that they are not breaking down body fat
Kussmaul’s in HHS?
no
3 other complications of diabetes
- vascular problems|2. neuropathy|3. increased risk for infection
Vascular problems:|- patho|- 2 examples
- poor circulation everywhere d/t vessel damage d/t hypergylcemia -> sugar decreases size of vessel -> decreased blood flow||1. diabetic retinopathy|2. nephropathy
Neuropathy:|- 4 problems
- sexual problems|2. foot/leg paresthesia/pain/numbness|3. neurogenic bladder|4. gastroparesis
sexual problems r/t neuropathy
permanent impotence/decreased sensation
diabetic foot care (7)
- 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
neurogenic bladder
- bladder does not empty properly||- bladder may empty spontaneously or may not empty at all
gastroparesis:|- patho|- risk for..
- stomach emptying is delayed||- increased risk of aspiration
