Module 11 - Endocrine Flashcards
Hyperglycemia is stimulated by
Fight or flight -Sympathetic
Decreased Immune response
Cerebral ischemia
Poor wound healing
Increased risk for clots
DKA Causes
Mismanagement of sick days
Glucocorticoids
Missed insulin
Severe stress - trauma surgery AMI
Undiagnosed Type 1
DKA S/S
Glycosuria
Ketonuria
METABOLIC ACIDOSIS
Polyuria, polydipsia, polyphagia
Fruity breath
Kussmaul’s / Hyperventilation
Lethargy
Abdominal Pain N/V
Glucose > 250
Osmotic DIuresis - worsens dehydration
DKA electrolytes
Hypokalemia
Phosphate depletion
Hyponatremia
Elevated BUN / Cr
HHNS
Caused by inadequate insulin secretion
Type 2
Osmotic diuresis (hyperosmolarity) - dehydration
NO KETOACIDOSIS
Meds can cause : Thiazides, phenytoin, glucocorticoids, ccb
Enteral and Parenteral nutrition can cause
S/S HHNS
Gradual onset
Polyuria, Polydipsia, Polyphagia
Dry skin
Shallow breathing
DEHYDRATION S/S
Lethargy
Glucosuria
Glucose > 1000
NO KETONURIA OR KUSSMALS
DKA / HHNS Interventions
- Manage airway
- Fluids - (0.9% NS, then when glucose gets to 200 add dextrose, monitor for fluid overload)
Insulin Therapy when potassium >3.3 Basal/bolus prefered
Rapid decline of glucose can cause
Cerebral edema
DKA and HHNS subq insulin can occur when
Blood glucose less than 200 and
2 of the following are met
venous ph > 7.3
serum bicarb>15
ion gap less than 12
Electrolyte replacement for DKA HHNS begins after
1 L of IV fluid adminstered
K > 3.3
Pt producing urine
Hypoglycemia
Less than 70
activates sympathetic ns
first s/s is Change in mental status
S/s tachy, diaphoresis, pallor, dilated pupils
Hypoglycemia treatment
15 g carbohydrate, 50% dextrose, glucagon, oral glucose
assess response, short/rapid insulin withheld
Adrenal Crisis Causes
Primary-
Autoimmune- addison’s
Cancer, hemorrhagic, HIV/AIDS, meds
Secondary - Interfere with ACTH
Lack of cortisol
decreased..
glucose, metabolism, vascular tone, gi mobility, respond to stress, and effect of catecholamines (SHOCK)
Lack of aldosterone
Loss of sodium, water, circulating blood volume,
hyperkalemia
Adrenal Crisis S/S
Hypovolemia
CLOC
Fatigue
GI complaints
Decreased urine
Hyponatremia, hyperkalemia, hypercalcemia
METABOLIC ACIDOSIS
cortisol
ACTH
Adrenal Crisis Interventions
Correct fluid and electrolytes
Hormonal replacement - glucocorticoid, PPI
Pt or family education
Hyperthyroidism Thyroid Storm
Caused by graves , stress, untreated hyperthyroid
S/S - thermal energy, fever, hypermetabolic
Elevated T3, T4
Decreased TSH
S/S Thyroid Storm
Tachy
A fib
Fever
Increased RR
Fear, delirium, psychosis, tremors, coma
fatigue
N/V/D cramps
NI Thyroid Storm
Safe environment
Seizure precautions
asses chest pain
monitor VS (BP)
assess urinary output
02
Monitor temp - cooling blanket?
adm meds - propylthiouracil and methimazole
iodine
bbb
Myxedema Crisis
Hypothyroidism
Hypometabolism
Primary - Hashimotos, surgical treatment of graves.
Myxedema Crisis Assessment
Cognitive changes
Activity intolerance
Cardiovascular - brady, hypo, decreased, CO, edema, enlarged tongue,
Pulmonary - Hypoventilation, pleural effusion
Hypothermia
Myxedema Crisis
Treat w thyroid hormone (levothyroxine)
Fluid and electrolyte replacement
Cardio monitor
Hypothermia tx
Protect from injury
educate
Antidiuretic Hormone
DI
SIADH
CSW
DI
Dry inside - loss of ADH
Excessive water loss
caused - genetics, head trauma, ICP
S/S High urine output, thirst, polydipsia, tachy, neuro, low PA, hypernatremia, low osmolality, Increased BUN Cr, hypokalemia
Di Tx:
Volume replacement - D2.5W
Hormone replacement - vasopressin
sodium restriction thiazide diuretics
SIADH
Excessive ADH
S/S seizures, headache, increased RR, dyspnea, hypertension, edema, anorexia, nausea, muscle cramps, vomiting, decreased bowel sounds
hyponatremia, concentrated urine, decreased serum osmolality, decreased BUN cr
1.030
SIADH Tx
Fluid restriction
Hypertonic saline 3%
Loop diuretics
Mouth and skin care
Pt and family education
CSW
Defect in sodium transport
BRAIN INJURY
Similar to SIADH - hypervolemia, hyponatremia
S/S Tachy, weight loss, hypotension, dry mucous membranes, poor skin turgor, seizures, coma
Tx: Isotonic saline, restore sodium and fluid volume
