final part 4 Flashcards
Management of Hyperos hypergly
Similar to DKA, more fluid, might need a foley, breath sounds, IV- normal half normal, add dextrose at 250, insulin electrolytes, watch cardiac, renal, Mental status.
What is the number for hypoglycemia
less than 70
Types of DI and about them
Central- Interference with ADH production tumors, infections, brain surgery
Neph-kidneys wont respond- Lith, renal damage
primary- Thirst issues
Manifestations of di 5 causes with with r/t s/s
polydipsia, polyuria,- 2-20 l a day with low SG
Increased plasma osmolality
Sleepy from nocturia
dehydration-thirst, hypo, tachy, shock
Hyperna+ irritable, mental dullness, coma
DI and three things to watch for one thing to teach
Specific tx for neph and central-
Hyperna+-Watch s/s, hypotonic solutions, dextrose-watch glucose and its diuretic effect.
Increase fluids-DDAVP and aqueous vassopressin
FVD- Thirst- CLor and carban, I and O, Vitals-esspecially volume rt, Specific gravity, daily weights, flushed skin- sign of FVD
Long term mat
Nephro-Fluids and decrease Na+ no hormones, thiazides, indometh-NSAID and increases kid sensitivity.
Explain test for DI
Water deprivation test before test measure body weight, urine osmo, volume, and sg no water for 8-12 hr Give presser Central-increse urine osmo nephro- no increase in urine osmo
Myedexema coma
Long standing hypothyroidism from acculumulation of hydrophilic monopolysacerides, in dermis and tissue
Myedex coma s/s 5
caused by?
Puffy face and peri orbital,
coma-mentally slow, drowsy, lathargic
infection, drugs, cold, trauma, stopping tx
Manifestaions of My coma 4
Subnormal temp, hypotn, hypovolemia, cardiac collapse- hypovent, hypona hypogly lactic acidosis,
Care for myex coma
two drugs
Mechanical respiration, cardiac monitoring, temp, skin care, vitals weights i LOC
IV thyroid hormone vassopressors
Cushings cause
types
Common
Over exposure to corticosteroids, iatrogenic- prednisone, ACTH Secreting pituitary adneoma or adrenal tumor
Ectopic-Tumors somewhere else- lungs and pancreas
women 20-40
Manifestations that you don’t know of chushings
hyperglycemia, mm weak and atrophy, osteoporosis, weak skin, delayed wound healing, hypoK, hypertn, acne, buffalo hump edema, awkward gate, CNS changes, GI increased Acid, bruise and petechiae
What tests would you expect with cushings.
MRI or CT for tumor, Plasma ACH- low or high, blood penias-white, glucose in urine, hyperca, hypo k and alkolosis
TX for cushings
Radiation- for those who can’t have surg,
surgery
drugs-destroy adrenal-ketoconazole and mitotane
Mifepristone0 for hypergly
What to watch for with cushings
Thrombolytic event, medical alert bracelet, no extreme temps, may need more steroids for stress, watch for infection and OSHTN
Addisons causes
TB, amylodisis, fungal infection, AIDS, meta cancer. chemo, ketoconazole, bilat adrenoectomy, Anticoag therapy
pheochromcytoma
Tumor in the medulla affecting chromaffin cells aka catecolamines
pheochromcytoma s/s 7
Severe pounding HA, High BP, tachy, chest pain, diaphoresis ab pain
Causes of pheochromcytoma 10
direct trauma, stress, sex, alcohol, smoking, drugs antihypertensives, opioidsm contrast, tri antidepressants,
tx of pheochromcytoma
Alpha and beta blockers sin and lol surg decrease bp and dysr
watch orthp
ANION GAP
(na+-k+)- (Cl+HCO3)
normal 8-10
stoma colors rose to brick pink pale blanching, dark red to purple small blood
Rose- viable stoma mucosa
maybe anemia
inadequate blood supply
when touched is normal from high vascularity
bile billy and ammonia
Bile salts aid in digestion by making cholesterol, fats, and fat-soluble vitamins easier to absorb from the intestine. Bilirubin is the main pigment in bile. Bilirubin is a waste product that is formed from hemoglobin (the protein that carries oxygen in the blood) and is excreted in bile.
Ammonia is protein breakdown that turns into urea in the liver and leaves
Manifestations of acute pancreatitis
Sudden inflam, edema, necrosis, hemorrhage, fat necrosis, vascular perm, smooth mm contractions, shock, ab pain in LUQ, and mid epi that radiates to shoulder and worse with food, N/V that dosent help pain, low fever, Hypotension, Jaundice, gry turners sign, cullens sign (eccymosis), Hyposctive or no bowel sounds, crackles,
Complications of acute pancreatitis
plural effusion, atelectasis, pneumonia, ARDS,
Emboli, DIC
Hypotension
hypocalcemia-Tetany
Pseudo cyst- from all the gunk
Ab pain, palpable mass, anorexia, NV, Perf, peritonitis
Abscess- infection of pseudocyst
