Med-Surg: Endocrine/2 Flashcards
myxedema coma
rare, life threatening condition seen in untreated or uncontrolled hypothyroid
rare, life threatening condition seen in untreated or uncontrolled hypothyroid
myxedema coma
myxedema coma s/s
3
- hypothermic
- changes in mental functioning - depression to unconsciousness
- severely decreased metabolism leading to respiratory depression and cardiac collapse
hypothyroid med
1
levothyroxine
levothyroxine administration
in the morning on an empty stomach
thyroid storm s/s
4
- hyperpyrexia (fever over 106)
- tachycardia
- HTN
- exaggerated symptoms of hyperthyroid
hyperthyroid meds and reasons
4
- beta blocker - manage tachycardia, anxiety, tremors
- PTU - blocks thyroid hormone production
- methimazole - short term use to block production of thyroxine
- iodides - decrease vascularity and inhibit the release of THs
hyperthyroid surgery - med pre op
saturated solution of potassium iodide SSKI
thyroidectomy post op
4
- semi fowlers
- assess dressing
- monitor RR, keep trach tray, oxygen, and suction at bedside
- keep calcium gluconate at bedside
parathromone/PTH maintains
calcium and phosphate balance
hypoparathyroidism meds acute and chronic
acute - calcium gluconate
chronic - oral calcium salts, vitamin D
kidney stones is to
hyperparathyroidism
hyperparathyroidism NIs
6
- min. of 2L/day
- low calcium, low vitamin D diet
- prevent constipation
- strain all urine
- prevent fractures
- encourage cranberry juice
hyperparathyroid - hypercalcemia crisis
number and tx
4
occurs when calcium >15:
- IV rehydration
- phosphate therapy
- calcitonin
- dialysis
hyperparathyroidism meds
- calcimimetics such as cinacalcet mimi calcium in the blood
- citonin
- hydration and diuretics - lasix; avoid thiazide diuretics
- biphospates
metabolic syndrome
insulin reisstance leads to increased insulin production in an attempt to maintain glucose at a normal level
metabolic syndrome s/s
3
- HTN
- hyperchloesterolemia
- abd obesity
normal fasting glucose
70-105
normal postprandial blood glucose
<180
NIs for hypoglycemia
15 g
4 examples
- 3-4 glucose tabs
- 4 oz juice or soda
- 6-10 hard candies
- 2-3 tsp of sugar of honey
NIs for hypoglycemia - pt unconscious
glucagon IM or subq, repeat in 10 mins if client is still uncon.
NIs for hypoglycemia - 15 15 15 rule
4
- administer 15 g of fast acting carbs
- wait 15 mins and recheck
- administer 15 more Gs if <70
- give 7 g protein when WNLs (i.e. 2 tbs PB, 1 oz cheese, or 8 oz milk)
insulin pumps administers what
2
rapid acting
regular insulin
insulin pump - change how often
q3days
DM foot care
- clean feet daily in warm, soapy water, rinse and dry carefully
- trim nails straight across
- wear supportive protective shoes
- do not go barefoot
DM sick day care
3
- take usual dose
- check BG q3-4 h
- encourage to consume 4 oz of sugar free, non caff. fluids every 30 mins to prevent dehydration
DKA manif
10
- PPP
- anorexia, NV
- metabolic acidosis with ketonuria
- kussmaul’s
- acetone breath/fruity breath
- altered MS
- blurred vision
- headache
- weak, rapid pulse
- OH
DKA - administer what
3
IV fluids to promote perfusion
- NS to maintain perfusion
- follow with 45% saline infusion to replace total body fluid losses
- add fluids containing dextrose when BG is around 250
DKA - administer insulin
3
- infusion at 0.1 mg/kg/hr - regular insulin is the only insulin that can be given IV
- BG check hourly
- resume subq when possible
hyperglycemic hyperosmolar state HHS
an acute, life threatening complication of diabetes - more common in type 2
HHS is characterized by
3
- elevated BG levels >600
- hyperosmolar state
- fluid and electrolyte losses
HHS CFs
- acute illness
- meds that exacerbate hyperglycemia - like thiazides
- tx such as dialysis
HHS manifs.
3
- dehydration - hypotension, tachycardia
- elevated BUN
- altered MS
HHS NIs
- replace fluids
- administer insulin and electrolytes
- monitor BG, LOC, VSs, electrolytes, acid base
