Module 11 - Endocrine

Question 1

Hyperglycemia is stimulated by

Answer 1

Fight or flight -Sympathetic
Decreased Immune response
Cerebral ischemia
Poor wound healing
Increased risk for clots

Question 2

DKA Causes

Answer 2

Mismanagement of sick days
Glucocorticoids
Missed insulin
Severe stress - trauma surgery AMI
Undiagnosed Type 1

Question 3

DKA S/S

Answer 3

Glycosuria
Ketonuria
METABOLIC ACIDOSIS
Polyuria, polydipsia, polyphagia
Fruity breath
Kussmaul’s / Hyperventilation
Lethargy
Abdominal Pain N/V
Glucose > 250
Osmotic DIuresis - worsens dehydration

Question 4

DKA electrolytes

Answer 4

Hypokalemia
Phosphate depletion
Hyponatremia
Elevated BUN / Cr

Question 5

HHNS

Answer 5

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

Question 6

S/S HHNS

Answer 6

Gradual onset
Polyuria, Polydipsia, Polyphagia
Dry skin
Shallow breathing
DEHYDRATION S/S
Lethargy
Glucosuria
Glucose > 1000

NO KETONURIA OR KUSSMALS

Question 7

DKA / HHNS Interventions

Answer 7

1. Manage airway
2. 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

Question 8

Rapid decline of glucose can cause

Answer 8

Cerebral edema

Question 9

DKA and HHNS subq insulin can occur when

Answer 9

Blood glucose less than 200 and

2 of the following are met
venous ph > 7.3
serum bicarb>15
ion gap less than 12

Question 10

Electrolyte replacement for DKA HHNS begins after

Answer 10

1 L of IV fluid adminstered
K > 3.3
Pt producing urine

Question 11

Hypoglycemia

Answer 11

Less than 70
activates sympathetic ns
first s/s is Change in mental status
S/s tachy, diaphoresis, pallor, dilated pupils

Question 12

Hypoglycemia treatment

Answer 12

15 g carbohydrate, 50% dextrose, glucagon, oral glucose

assess response, short/rapid insulin withheld

Question 13

Adrenal Crisis Causes

Answer 13

Primary-
Autoimmune- addison’s
Cancer, hemorrhagic, HIV/AIDS, meds

Secondary - Interfere with ACTH

Question 14

Lack of cortisol

Answer 14

decreased..
glucose, metabolism, vascular tone, gi mobility, respond to stress, and effect of catecholamines (SHOCK)

Question 15

Lack of aldosterone

Answer 15

Loss of sodium, water, circulating blood volume,
hyperkalemia

Question 16

Adrenal Crisis S/S

Answer 16

Hypovolemia
CLOC
Fatigue
GI complaints
Decreased urine
Hyponatremia, hyperkalemia, hypercalcemia
METABOLIC ACIDOSIS
cortisol
ACTH

Question 17

Adrenal Crisis Interventions

Answer 17

Correct fluid and electrolytes
Hormonal replacement - glucocorticoid, PPI
Pt or family education

Question 18

Hyperthyroidism Thyroid Storm

Answer 18

Caused by graves , stress, untreated hyperthyroid
S/S - thermal energy, fever, hypermetabolic
Elevated T3, T4
Decreased TSH

Question 19

S/S Thyroid Storm

Answer 19

Tachy
A fib
Fever
Increased RR
Fear, delirium, psychosis, tremors, coma
fatigue
N/V/D cramps

Question 20

NI Thyroid Storm

Answer 20

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

Question 21

Myxedema Crisis

Answer 21

Hypothyroidism
Hypometabolism
Primary - Hashimotos, surgical treatment of graves.

Question 22

Myxedema Crisis Assessment

Answer 22

Cognitive changes
Activity intolerance
Cardiovascular - brady, hypo, decreased, CO, edema, enlarged tongue,
Pulmonary - Hypoventilation, pleural effusion
Hypothermia

Question 23

Myxedema Crisis

Answer 23

Treat w thyroid hormone (levothyroxine)
Fluid and electrolyte replacement
Cardio monitor
Hypothermia tx
Protect from injury
educate

Question 24

Antidiuretic Hormone

Answer 24

DI
SIADH
CSW

Question 25

DI

Answer 25

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

Question 26

Di Tx:

Answer 26

Volume replacement - D2.5W
Hormone replacement - vasopressin
sodium restriction thiazide diuretics

Question 27

SIADH

Answer 27

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

Question 28

SIADH Tx

Answer 28

Fluid restriction
Hypertonic saline 3%
Loop diuretics
Mouth and skin care
Pt and family education

Question 29

CSW

Answer 29

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