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MedSurg > Lecture 6.2 - Endocrine Disorders > Flashcards

Lecture 6.2 - Endocrine Disorders Flashcards

1
Q

What are the goals of treatment for type 1 and 2 DM?

A

Type 1: Integrate insulin with eating and exercise

Type 2: heart-healthy diet and moderate weight loss of 10% to 20%
-> Spaced meals can help

All should have 150 mins/week of moderate intensity aerobic physical activity + resistance training 3 days/week.

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2
Q

What is Kussmaul breathing?

A

Rapid deep breathing indicative of DKA

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3
Q

A diagnosis for DM involves which lab results?

A

A1C - >6.5
FPG - >7.0
OGTT - >11.1

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4
Q

What would a prediabetic fasting glucose test be? What about a 2-hour glucose tolerance test? A1C?

A

Fasting - 6.1-6.9 mmol/L
OGTT - 7.1-11 mmol/L

A1C of 6-6.4%

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5
Q

When a patient isn’t alert enough to swallow, how can we correct low blood sugar?

A

1 mg of glucagon IM/SC

In acute care, 20-59 mL of 50% dextrose can be given as an IV push

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6
Q

When is the peak BGL after a meal?

A

Two hours - so continue to monitor

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7
Q

What is the 15-15-15 rule?

A

If pt has low BGL, give 15-20 grams of simple carbohydrate (orange juice)

Wait 15 minutes, take BGL - if still low do another dose of sugar

Repeat until sugar is in normal range

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8
Q

Normal BGL range?

A

4-7 mmol/L

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9
Q

Irritability, diaphoresis, tremens, confusion, weakness, and hunger are associated with what?

A

Hypoglycemia

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10
Q

What kind of drug is glyburide?

A

Sulfonurea
–> Increases insulin production from pancreas

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11
Q

What kid of medication is metformin?

A

Biguanide
–> Reduce glucose production in liver + reduces insulin resistance

Side effects include bloating, nausea, cramping, and diarrhea

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12
Q

What is the onset of of glargine (Lantus)? Duration?

A

Onset 1-5 h, duration 24.

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13
Q

What is the onset of Determir (Lantus)? Duration?

A

Onset 3-4 hrs; duration 24 hrs

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14
Q

Before we treat DKA, what do we need to do?

A

Administer 2L of fluid and recheck blood sugar for accurate values.
–> Ringer’s preferred d/t Bicarb content

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15
Q

DKA is characterized by…

A

Hyperglycemia, ketosis, acidosis, and dehydration

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16
Q

A patient presents for vomiting, abdominal pain, a dry mouth and flushed face, dehydration, and increased pulse.
They have rapid, deep breathing.

What might be wrong?

A

DKA

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17
Q

What are the emergency management goals for DKA?

A

Airway –> O2

Correct fluid imbalance –> .45/.9 NaCl and slowly bring sugar down

Focus on potassium and bicarb replacement and anticipate that it will be low

18
Q

Who is at risk for Hyperosmolar Hyperglycemic Syndrome?

A

Life-Threatening syndrome that often occurs in patients older than 60 with DM2.

19
Q

What is exothalmus?

A

Bulging eyes associated with hyperthyroidism

20
Q

A pt presents with weight loss, diarrhea, tachycardia and bruit over their throat. What else would you expect from this pt?

A

Hyperthyroidism
–> Enlarged thyroid, elevated t3 and t4 with low TSH

21
Q

What treatment is recommended for hyperthyroidism?

A

Diet: High protein and calorie, low caffeine and fiber

Drugs:
–> Propylthiouracil to block T3/4 synthesis
–> Iodine to destroy thyroid cells

Potential surgery

22
Q

What should you be aware of on a patient with thyroidectomy?

A

Check behind neck for drainage, position pt in high fowlers, and keep calcium gluconate at bedside

23
Q

A patient presents with fatigue, brady, weight gain, constipation and periorbital edema and an intolerance to cold. What would you expect from this patient?

A

Hypothyroidism
–> Low T3/4 with rising TSH

24
Q

What should you monitor when a patient is taking levothyroxine?

A

Hold if HR >100 BPM

25
Q

What foods contain high iodine?

A

Fresh fish

26
Q

What should you monitor for a patient with hypothyroidism?

A

Avoid food containing iodine, take medication in am and at same time.

Monitor for risk of constipation and monitor closely during pregnancy.

27
Q

What is Addison’s Disease?

A

Adrenal Insufficiency - Caused by sudden withdrawal from corticosteroids, hypofunction of adrenal cortex, or lack of pituitary ACTH

28
Q

Why should person with hypoglycemia avoid foods high in fat?

A

Because fat decreases absorption of sugar

29
Q

What arterial blood gas changes might be apparent in a person with DM1?

A

pH less than 7.30 and HCO <15mmol/L might be seen

30
Q

Use caution when administering insulin with which other medications?

A

Steroids, beta-blockers, and some antibiotics

30
Q

What lab values will be found in someone with HHS?

A

BGL >34mmol/L

No ketone bodies present

30
Q

What is hyperosmolar hyperglycemic syndrome?

A

When elevated blood sugar results is dramatic osmotic diuresis and dehydration – more common in DM2

31
Q

A patient prevents with hypovolemia, hypoglycemia, hyponatremia, hyperkalemia, postural hypotension, hyperpigmentation and loss of body hair. What might be the issue?

A

Addison’s disease

32
Q

What electrolyte imbalance is common in people with Addison’s disease?

A

Hyponatremia + Hyperkalemia

33
Q

What diet is recommended for Addison’s disease?

A

High sodium, low potassium and high carbohydrates.

At least 3L of fluid per day

34
Q

What patient teaching is necessary for Addison’s disease?

A

Carry emergency kit with 100 mg of IM corticosteroids

35
Q

What is Cushing syndrome?

A

Excess adrenal corticoid activity, caused by adrenal/pituitary/hypothalamus symptoms

symptoms of Cushing syndrome are also seen in people taking supplemental corticosteroids

36
Q

What lab results are seen in Cushing syndrome?

A

Hyperglycemia and increases plasma cortisol levels.

Hypernatremia + hypokalemia

37
Q

A patient presents with a round face, edema of the lower limbs, emotional disturbances, fat deposits in the lower back.

They have muscle atrophy and weakness, osteoporosis, and thin, dry, pale skin. What might be the problem?

A

Cushing Syndrome/Excess Cortisol

38
Q

What is diabetes indipidus?

A

Decreased ADH or response to - results in electrolyte imbalance (hypernatremia)

MedSurg (11 decks)

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