Metabolism Flashcards
hyperglycemia
up BS polyuria increased appetite weak, fatigued blurred vision headache glycosuria DKA or HHS
Cause:
infection
corticosteroids
hypoglycemia
BS
ketoacidosis
“profound deficiency in insulin” body breaks down fat stores instead of glucose that can’t be used, makes ketones
dry mouth thirst abd pain N/V flushed, dry skin sunken eyes breath smells like ketones Kussmaul BS >250
intervene: patent airway O2 via NC or non-rebreather IV access 0.9%NS 1L/hr to stabilize BP & increase UO continuous insulin drip VS breath sounds BS and K+ sodium bicarb if too acidodic
metformin
Reduce glucose production by the liver
• Enhance insulin sensitivity at the tissues
• Improve glucose transport into cells
• Do not promote weight gain.
• Not safe for clients with kidney disease, liver disease, or heart failure
• Danger of lactic acidosis
• IV contrast media that contain iodine pose a risk of acute kidney injury
• Could exacerbate metform-induces lactic acidosis
• Discontinue metformin 1-2 days before a procedure with iodine
• Resume after 48 hours
• Not advised with clients who drink heavily
Know other meds DM patient is taking
- Beta blockers
- Mask symptoms of hypoglycemia
- Prolong hypoglycemia effects of insulin
- Thiazide/loop diuretics
- Can potentiate hyperglycemia by inducing potassium loss
sick day instructions
Increases blood glucose levels
• Continue regular meal plan if not nauseated and vomiting
• 8-12 ounces of sugar free fluids per hour.. If hypoglycemia may have sugared
• Continue taking oral agent and/or insulin
• Monitor Capillary Blood Glucose every 2-4 hours
• Test ketones every 3-4 hours if BS is 240mg/dL or above
• Notify physician if ketones are mod to large amount, and blood glucose is 300mg/dL
or above for two tests.
• Call health care provider for uncontrolled N/V
Addison’s (low corisol)
not enough ACTH to stimulate cortisol production
S/Sx: muscle weakness, fatigue, weight loss, hyperpigmentation, hypoTN, syncope, anemia, irritability
DOES NOT respond to normal resuscitation: give steroids, hydrocortisone, fluids and dextrose
Tx: I&O, prevent hypoglycemia, meds, better to give stress dose than not,
Meds: cortisone, hydrocortisone, prednisone, fludrocortisone
Cushing’s (high cortisol)
weight gain and fatty tissue deposit (truncal, upper back, face, buffalo hump)
striae (pink/purple stretch marks)
thin, fragile skin; slow healing; hirsutism
men: low libido, ED
osteoporosis, HTN, DM, low muscle mass
Tx: remove adrenal glands (can lead to addison’s), cytotoxic agents, fluid/Na restriction, I&O
glucocorticoids before/after surgery
prevent injury and infection
“moon face”
hyperthyroidism (Graves)
TSH is low, T3 & T4 high
GI: weight loss, up appetite, diarrhea
Muscles: weakness, wasting
Resp: SoB, up RR
Skin: warm & moist skin, fine/silky body hair
Heart: up HR & stroke volume
neuro: blurred vision, corneal ulcers, photophobia, globe eyes (exophthalmus), tremors, insomnia
low stimulation, drug therapy, comfort, monitor VS
Surgery: euthyroid state up protein/carbs if underweight cough/deep breathe s/sx of infection teaching Post OP: VS q15m semi-Fowler's and support head/neck w/pillows humidify air, suction mouth monitor for hemorrhage, resp distress, tetany, laryngeal nerve damage
hypothyroidism (Hashimoto’s)
myxedema/cretinism pale, puffy, expressionless face cold, dry skin brittle hair, hair loss low HR and temp lethargy, fatigue intolerance to cold constipation
Cause: iron deficiency or exposure to radioactive iodine
increased TSH, low T3/T4
if thyroiditis is cause, fix it and it’ll be fixed
hashimoto’s is autoimmune
methimazole
choice for hyperthyroidism
SE: rash, joint pain, liver pain, low WBCs
levothyroxine
T4
half life is 7 days
check apical pulse
take in the morning, 30-45m before breakfast
SE: tachycardia, angina, tremors, up effects warfarin
Complications of Graves
miscarriage, preeclampsia, maternal HF, fetal thyroid dys
heart disorders: CHF, rhythm
osteoporosis: increased T3/4 interferes with ability to incorporate Ca into bones
Thyroid storm
sudden and drastic flood of thyroid hormones
significant stress: surgery, illness, dental work
not triggered by increase in thyroid hormones (they’re already high)
Can’t be ID’d by lab tests
S/Sx: hyperthermia (>105*), severe tachycardia, restless, agitated, tremors, diaphoresis, vomiting, unconscious, coma, hypoTN, HF
Tx: sodium iodine solution, PTU, Beta blocker, sedation, cooling measures, glucocorticoids, IV fluids
Insulin
-log = rapid
-lin = short
NPH = intermediate
levemir = long
