Test 4 (Mod 4) Flashcards by Ryan Ernest

 One of the most common medical disorders in the United States

Hypothyroidism

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 Results from insufficient circulating thyroid hormone

Hypothyroidism

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 Related to destruction of thyroid tissue or defective hormone synthesis

Primary Hypothyroidism

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 Related to pituitary disease with ↓ TSH secretion or hypothalamic dysfunction

Secondary Hypothyroidism

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Iodine deficiency is the most common cause of this worldwide

Hypothyroidism

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 Amiodarone and lithium can produce

Hypothyroidism

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caused by thyroid hormone deficiencies during fetal or neonatal life

Cretinism

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	↓ cardiac output
	↓ cardiac contractility
	Anemia
	Cobalamin, iron, folate deficiencies
	↑ serum cholesterol and triglycerides

These are all cardiovascular system signs of _______

Hypothyroidism

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 Low exercise tolerance
 Shortness of breath on exertion
These are both respiratory system signs of ______

Hypothyroidism

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 Fatigued and lethargic
 Personality and mood changes
 Impaired memory, slowed speech, decreased initiative, and somnolence

These are all neurologic system signs of _________

Hypothyroidism

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 ↓ motility
 Achlorhydria
 Constipation
These are all gastrointestinal system signs of ________

Hypothyroidism

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	Cold intolerance
	Hair loss
	Dry/coarse skin
	Brittle nails
	Hoarseness
	Muscle weakness and swelling
	Weight gain
	Menorrhagia
These are all clinical manifestations of \_\_\_\_\_\_\_\_\_

Hypothyroidism

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 Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues
 Causes puffiness, periorbital edema, masklike effect

Myxedema (seen with severe long-standing hypothyroidism)

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Complications of this can lead to:
Mental sluggishness
 Drowsiness
 Lethargy progressing gradually or suddenly to impairment of consciousness or coma

Myxedema

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This medication must be taken regularly, and need to monitor for angina and cardiac dysrhythmias

Levothyroxine (Synthroid)

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Physical exam in someone with this may reveal:
	Bradycardia
	Distended abdomen
	Dry, thick, cold skin
	Thick, brittle nails
	Paresthesias
	Muscular aches and pains

Hypothyroidism

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excessive thyroid hormone secretion from the thyroid gland, where normal feedback control over thyroid hormone secretion fails

• Hyperthyroidism

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hypermetabolism and increased sympathetic nervous system activity are caused by

Excessive thyroid hormones

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The most common cause of hyperthyroidism

Graves’ disease (toxic diffuse goiter)

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usually have thyrotoxicosis, a goiter or enlargement of the thyroid gland, exophthalmos or abnormal protrusion of the eyes, and pretibial myxedema or dry, waxy swelling of the front surfaces of the lower legs.

Graves’ disease

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an autoimmune disorder in which antibodies are made and attach to the thyroid stimulating hormone receptor sites on the thyroid.

Graves’ disease

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• A hallmark of _________ is heat intolerance with diaphoresis even when environmental temperatures are comfortable for others.

hyperthyroidism

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• Cardiac problems of _________include increased systolic blood pressure, tachycardia, dysrhythmias, and atrial fibrillation, which may be apparent on electrocardiography.

hyperthyroidism

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evaluates the position, size, and functioning of the thyroid gland.

Thyroid scan

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can determine size and the composition of any masses or nodules

Ultrasonography

• Priorities for nursing care of _________ focus on monitoring for complications, reducing stimulation, promoting comfort, and teaching about therapeutic drugs and procedures.

Hyperthyoridism

• Drug therapy with antithyroid drugs is the initial treatment of

Hyperthyoridism

occurs when the disease is untreated or poorly controlled or is triggered by stressors such as trauma, infection, diabetic ketoacidosis, and pregnancy.

• Thyroid storm or thyroid crisis

• This is an extreme state of hyperthyroidism in which manifestations are more severe and life threatening and is most common in patients who have Graves’ disease.

Thyroid Storm

• The patient at risk for _______ should remain in a cool, dark, and quiet environment

thyroid storm

the result of decreased metabolism from low levels of thyroid hormones.

Hypothyroidism

• Decreased metabolism causes the heart muscle to become flabby and dilated, resulting in decreased cardiac output and perfusion to the brain and other vital organs, with __________

Myxedema

an inflammation of the thyroid gland

Thyroiditis

The most common type of thyroiditis

Chronic thyroiditis or Hashimoto's disease

an autoimmune disorder that is usually triggered by a bacterial or viral infection.

Hashimoto's disease

papillary, follicular, medullary, and anaplastic, are the four distinct types of

Thyroid Cancer

Initial manifestation is a single, painless lump or nodule

Thyroid Cancer

Treatment of choice for papillary, follicular, and medullary carcinomas

Surgery

is a life-threatening event in which the need for cortisol and aldosterone is greater than the available supply.

• Acute adrenal insufficiency, or Addisonian crisis

• Anorexia, nausea, vomiting, diarrhea, abdominal pain, and weight loss occur with ________

Adrenal insufficiency, Addison's disease

• Laboratory findings include low serum cortisol, low fasting blood glucose, low sodium, elevated potassium, and increased serum blood urea nitrogen levels.

Adrenal insufficiency, Addison's disease

• Instruct the patient with ________ to wear a medical alert bracelet and to carry simple carbohydrates with them at all times.

adrenal insufficiency

disease causes problems with exaggerated actions of glucocorticoids which affect metabolism and all body systems to some degree.

Cushing's disease

• The most common cause of _______ is a pituitary adenoma.

Cushing’s disease

physical changes in a pt with ______, include fat pads on the neck, back, and shoulders; enlarged trunk with thin arms and legs; and a round face.

Hypercortisolism

Can result in emotional lability and mood swings, and pt's often say that they don't feel like themselves anymore

Hypercortisolism

 Regulate metabolism and ↑ blood glucose |  Critical to physiologic stress response

Glucocorticoids

These regulate Sodium balance, and Potassium balance

Mineralocorticoids

contributes to  Growth and development in both genders  Sexual activity in adult women

Androgen

 Caused by excess of corticosteroids, particularly glucocorticoids

Cushing Syndrome

 Iatrogenic administration of exogenous corticosteroids is the most common cause of

Cushing Syndrome

 Cushing disease and primary adrenal tumors are more common in women aged

20 tp 40

 Weight gain most common feature of _______, to include:  Trunk (centripetal obesity)  Face (“moon face”)  Cervical area  Transient weight gain from sodium and water retention

Cushing Syndrome

 Catabolic effects of cortisol  Leads to weakness, especially in extremities  Protein loss in bones leads to osteoporosis, bone and back pain.

Protein wasting

Inflammatory reaction in the glomerulous

Glomerulonephritis

Strep is the main cause of this renal disease

Glomerulonephritis

BUN and Creatinine ____ with glomerulonephritis

Increase

Sediment, protein, and blood, will be found in urine with

Glomerulonephritis

BP is ______ with glomerulonephritis

Increased

Urine output ________ with glomerulonephritis

Decreases

Urine specific gravity ________ with glomerulonephritis

Increases

With glomerulonephritis, client will go into fluid volume _____

Excess

Tx for glomerulonephritis

``` Get rid of strep Balance activity with rest I+O and daily weights Monitor BP Fluid replacement Dialysis ```

How to determine fluid replacement

24 hour fluid loss + 500cc

Dietary needs for glomerulonephritis include a _____ in protein, a ________ in sodium, and a _______ in carbs

Decrease Decrease Increase

Diuresis for glomerulonephritis usually begins ___ to ____ weeks after onset

1 to 3

Malaise, H/A, anorexia, N/V, decreased output, weight gain

Signs and symptoms of RENAL FAILURE

an inflammatory response in the glomerulous, which result in big holes that allow protein to leak out into the urine

Nephrotic Syndrome

Protein in the urine

Proteinuria

Low albumin in the blood

Hypoalbuminemic

Low albumin leads to a loss of fluid in the _______ space, into the ________

Vascular | Tissue

Aldosterone causes retention of

Sodium and water

Total body edema

Anasarca

Can be caused by bacteria or viral infections, NSAIDs, Cancer and genetic predisposition, systemic disease like lupus or diabetes, or strep

Nephrotic Syndrome

Proteinuria, Hypoalbuminemia, Edema (anasarca), Hyperlipidemia

Signs and symptoms of Nephrotic Syndrome

Ace inhibitors are used in nephrotic syndrome to

block aldosterone secretion

Prednisone is used in nephrotic syndrome to

reduce inflammation. It shrinks holes so protein (albumin) cant get out.

Prednisone can lead to

Immunosuppression

Lipid lowering drugs are used in nephrotic syndrome to

lower lipid levels

We need to ______ Na to treat nephrotic syndrome

decrease

We need to ______ protein to treat nephrotic syndrome

INCREASE

Anticoagulation therapy may be used for up to six months to treat

nephrotic syndrome

Limit protein with all kidney problems except __________

Nephrotic Syndrome

This requires bilateral failure

Renal failure

Blood cant get to the kidneys

Pre-renal failure

Causes of pre-renal failure

Hypotension Decreased HR (arrhythmia) Hypovolemic Any form of shock

20 minutes of poor perfusion can lead to

kidney necrosis

Shock _____ kidneys

KILLS

Damage has occurred inside the kidney

Intra-renal failure

Causes of Intra-renal failure

Glomerulonephritis Nephrotic Syndrome Dyes used in tests such as cardiac cath or CT scan Drugs (Aminoglycosides, Mycins)- causes nephrotoxicity Malignant HTN (uncontrolled HTN) DM (causes severe vascular damage)

Urine cant get out of the kidneys

Post-renal failure

Causes of post-renal failure

``` Enlarged prostate Kidney stone Tumors Ureteral obstruction Edematous stoma (Ileal conduit) ```

Creatinine and BUN will be _______ with renal failure

Increased

Specific gravity will initially be _____ with renal failure

High

Because there is not enough erythropoietin, _______ will occur with renal failure

Anemia

Stimulates RBC production

Erythropoietin

Retention of fluid in renal failure will lead to S&S of _____ and _______

HTN and HF

Anorexia, N/V, occur in renal failure due to

retaining toxins

Potassium will be _____ in renal failure

High- will have hyperkalemia

Metabolic _______ will occur with renal failure

Acidosis

Phosphorous will be ________ with renal failure

High

High phosphorous in renal failure will lead to a ______ in serum calcium

Decrease

A decrease in serum calcium in renal failure will lead to

calcium being pulled from bones

First phase of acute kidney failure

Oliguric phase

Urine output _____ in oliguric phase of kidney failure

decreases

UO of 100 to 400 ml / 24 hours is typical in the _____ phase of acute kidney failure

Oliguric

Client will be in fluid volume _______ excess during the oliguric phase of kidney failure

Excess

Potassium will ______ during the oliguric phase of kidney failure

Increase

Second phase of Acute Kidney Failure

Diuretic phase

This phase of acute kidney failure will have a sudden onset

Diuretic phase

UO will_______ during the diuretic phase of kidney failure

Increase

Client will be in fluid volume ________ during the diuretic phase of kidney failure

Deficit (SHOCK)

During the diuretic phase of acute kidney failure, it is possible for the client to lose up to __________ liters of fluid per day

Potassium will _________ during the diuretic phase of acute kidney failure

Decrease

It may take up to ____ months to recover completely from acute kidney failure

In ________, the machine is the glomerulus (filter).

Hemodialysis

Is done 3-4 times per week; the client must watch what they eat and drink between treatments

Hemodialysis

To prevent blood clots, the client is given an _________ during dialysis

Anticoagulant

Heparin lasts _____ to _______ hours in the body

4 to 6

With hemodialysis, blood is being removed, cleansed, and then retuned at a rate of ______ to ________ mL/min.

300-800

In forearm with an anastomosis between an artery and a vein

AVF (arteriovenous fistula)

A synthetic graft to join the vessels in dialysis use

AVG (arteriovenous graft)

Assess hemodialysis access by

Palpating for a thrill, and auscultating for a bruit

Uses the peritoneal membrane as a filter

peritoneal dialysis

Dialysate is warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter

Peritoneal dialysis

How much dialysate is used in peritoneal dialysis

200-2500 mL

This is what the time that the dialysate remains in the peritoneal cavity is called

Dwell time

The bag is lowered and the fluid, along with the toxins, are drained. This is referred to as the _____ in peritoneal dialysis

Exchange

We warm the dialysate to promote

vasodilation, and more blood flow

What should peritoneal dialysis drainage look like?

Clear, straw-colored.

Cloudy peritoneal dialysis drainage means

Infection

If fluid doesn't come out during peritoneal dialysis, you should ________

turn the client side to side

This type of peritoneal dialysis is done 4 times a day, 7 days a week, and can cause pressure on the back, and is not recommended for someone with a colostomy due to a high risk of infection

CAPD (Continuous Ambulatory Peritoneal Dialysis)

This type of peritoneal dialysis is done at night, and the exchange is done automatically while the client sleeps. It is then disconnected in the AM. Allows for more freedom

CCPD (Continuous Cycle Peritoneal Dialysis)

Major complication of peritoneal dialysis

Peritonitis

``` Constant sweet taste May get a hernia Altered body image/sexuality Anorexia Low back pain ```

Other complications of peritoneal dialysis

Peritoneal dialysis clients need to increase their dietary ______ and _______

Fiber and protein

Typically done in an ICU setting, and is continuous so that the client doesn't have drastic fluid shifts

CRRT (Continuous Renal Replacement Therapy)

With this type of dialysis, there is typically never more than 80mL of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much

CRRT (Continuous Renal Replacement Therapy)

Pain, N/V, WBC in urine, Hematuria, are all signs of

Kidney stones

Get a _________ anytime you suspect a kidney stone, to have it checked for _________

Urine sample | RBCs

Ketorolac (Toradol), Ondansetron (Zofran), and Hydromorphone (Dilaudid), are typically used to treat

Kidney stones

ESWL

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy is used to

break up kidney stones into smaller pieces

Produces three hormones (T3, T4, Calcitonin)

Thyroid Gland

Calcitonin _________ serum Ca+ levels by taking the calcium out of the blood and pushing it back into the bone

Decreases

You need ______ to make hormones

Iodine

Eyes bulge

Exophthalmos

Attention span _____ with Graves Disease

Decreases

Will ______ weight with Graves Disease

lose

Will have a _______ appetite with Graves Disease

Increased

Will have a ______ GI with graves disease

Fast

Will have an ___________ BP with Graves disease

Increased

Thyroid gets __________ with Graves disease

Bigger (Hypertrophy)

Serum T4 (thyroxine) levels are ________ with Graves disease

Increased

Client must stop taking any iodine containing medication ______ prior to a thyroid scan

1 week

Propylthiouracil (PTU), and Methimazole (Tapazole), are both

Anti-thyroid medications

Anti-thyroid meds stop the thyroid from making _______

Thyroid hormone

Anti-thyroid meds are used _______ to stun the thyroid

Pre-op

Euthyroid means _______

Normal thyroid

Potassium Iodine (SSKI), Strong Iodine Solution (Lugol's solution), are both _________

Iodine Compounds

These meds decrease the size and vascularity of the thyroid gland

Iodine Compounds

It is important to give these meds in milk or juice, and to use a straw, because they will stain teeth

Iodine Compounds

Decrease myocardial contractility, could decrease cardiac output, decrease HR and BP, decrease anxiety

Beta Blockers, such as Propanolol (Inderal)

Do not give beta blockers to

asthmatics or diabetics

Given PO (liquid or tablet form) to treat hyperthyroid

Radioactive Iodine

Once given radioactive iodine, it is important for the client to stay away from babies for _______, and to not kiss anyone for _______.

24, 24

__________ can occur post-radioactive iodine due to a rebound effect

Thyroid storm

Surgical removal of the thyroid

Thyroidectomy (partial or complete)

________ the HOB post thyroidectomy to _______ edema

Elevate, decrease

Post thyroidectomy, check for bleeding ___________

Behind the neck

Pre and post op thyroidectomy, calorie intake needs to be ________

Increased

Listen for horseness and a weak voice post thyroidectomy to assess for __________

Recurrent laryngeal nerve damage

If vocal cord paralysis occurs, it could lead to an airway obstruction, and an immediate ________ will be needed

Trach

It is important to assess for __________ post thyroidectomy

Hypocalcemia

Assess for __________ removal post thyroidectomy

Parathyroid

Rigid, tight muscles, seizures, laryngospasm, are all signs of

Hypocalcemia

Form of hypothyroidism

Myxedema

When myxedema is present at birth, it is called ________

Cretinism

This is very dangerous, and can lead to slowed mental and physical development if undetected

Cretinism

GI will be ________ with Myxedema (hypothyroid)

slow

Weight will ______ with Myxedema (hypothyroid)

increase

Client will be _______ with Myxedema (hypothyroid)

cold

Speech will be _______ with Myxedema (hypothyroid)

slow and slurred

People with hypothyroidism tend to have ______

CAD

The parathyroids secrete __________

PTH

makes you pull calcium from the bone and place it in the blood

PTH

makes the serum calcium level go up

PTH

Too much PTH in your body will make the serum calcium level _______

High

Not enough PTH in your body will make the serum calcium level ________

low

Hypercalcemia and Hypophosphatemia equals

Hyperparathyroidism

Too much PTH is seen with

Hyperparathyroidism

Client may appear sedated with this problem

Hyperparathyroidism

when you take out two of your parathyroids, PTH secretion will ___________. This is known as a ___________.

Decrease | Partial parathyroidectomy

Monitor for __________ post op parathyroidectomy

Hypocalcemia

Hypocalcemia and Hyperphosphatemia equals

Hypoparathyroidism

Not enough PTH leads to

Hypoparathyroidism

Used to treat hypoparathyroidism

IV Calcium, and Phosphorous binding drugs (Renegel, Oscal)

These glands are needed to handle stress

Adrenal Glands

Responsible for the epi and norepi response

Adrenal Medulla

Benign tumors that secrete epi and norepi in boluses

Pheochromocytoma

Will see an increased BP, increased HR and pulse, and flushing and diaphoresis with this adrenal gland problem

Pheochromocytoma

A 24 hour urine specimen that looks for increased levels of epi and norepi (catecholamines).

VMA (vanillylmandelic acid) test

With a 24 hour urine test, you should throw away the ____ voiding, and keep _______ voiding.

First | The last

Glucocorticoids, mineralocorticoids, and sex hormones, are all _______

Adrenal Cortex Steroids

These steroids change your mood, alter defense mechanisms, break down fats and proteins, and inhibit insulin

Glucocorticoids (ex. Prednisone)

These steroids make you retain sodium and water, and make you lose potassium

Mineralocorticoids: Aldosterone

Fluid volume excess and a decrease in serum potassium can be the result of too much ___________

Aldosterone

Fluid volume deficit and an increase in serum potassium can be the result of not enough ___________

Aldosterone

made in the pituitary and stimulate cortisol to be made

Adrenocorticotropin hormones (ACTH)

A hormone of the adrenal cortex

Cortisol (steroid)

Too many steroids equals ________

Hypercortisolism

An increase in ACTH equals an increase in

Cortisol levels

This disease is a result of adrenocortical insufficiency- not enough steroids

Addison's Disease

With Addison's disease, we don't have enough Aldosterone, therefore we will lose _______ and _________ and retain _______

Sodium Water Potassium

With Addison's disease, serum potassium will be

High

S/S of this start with muscle twitching, then proceed to weakness, then flaccid paralysis

Hyperkalemia

Client may experience anorexia/nausea, hyperpigmentation-bronzing color of the skin and mucous membranes, GI upset, and hypotension, with this adrenal cortex problem

Addison's disease

Addison's disease will have ________ bowel sounds

decreased

Addison's disease will have a ________ sodium, _______ potassium, and _____________

Decreased Increased Hypoglycemia

Need to _______ sodium in the diet to treat addisons disease

Increase

Used to treat Addsion's disease. It is really Aldosterone

Fludrocortisone (Florinef)

When on a medicine where weight has to be monitored daily, keep the weight within __________ of their normal weight

2-3 pounds (+ or -)

Severe hypotension and vascular collapse can mean

Addisonian Crisis

Addison's means _______ steroids

Not enough

Cushing's means _________ steroids

Too many

Growth arrest, thin extremities, increased risk of infection, hyperglycemia, psychosis to depression, moon faced, truncal obesity, buffalo hump, are all signs of

Too many glucocorticoids (Cushing's)

Oily skin/acne, women with male traits, and poor sex drive (libido), are all signs of

Too many sex hormones (Cushing's)

High BP, CHF, weight gain, and fluid volume excess, are all signs of

Too many mineralocorticoids (Aldosterone) (Cushing's)

In Cushing's, the client will have too much mineralocorticoid (Aldosterone), and therefore, the serum potassium will be

LOW

A 24 hour urine on a client with Cushing's, would reveal ______ levels of Cortisol (steroids)

HIGH

Diet for pre-treatment of Cushing's disease

Increase potassium, decrease sodium, increase protein, increase calcium

Steroids ______ serum calcium

Decrease

Steroids decrease serum calcium by excreting it through the _________

GI tract

These clients have little or no insulin

Type I diabetic

This type of diabetes is usually diagnosed in childhood

Type I DM

Auto-immune response (Type 1 A) or Idiopathic (Type 1 B) are causes of this

Type I DM

First sign of Type I DM may be

DKA

This type of DM may appear abruptly

Type 1

You have to have _______ to carry glucose out of the vascular space into the cell.

Insulin

Since Type ____ diabetics have no insulin, the glucose just builds up in the _______ space.

I | vascular

Because glucose builds up in the vascular space in Type I DM, the blood becomes _________, and pulls fluid into the vascular space.

Hypertonic

The ______ filter excess glucose and fluids. This is called ______ and _________

Kidneys Polyuria Polydipsia

When cells starve, they start breaking down protein and fat for energy. This is called _______

Polyphagia

When you break down fat, you get _______

Ketones (acids)

Ketones lead to ______

Metabolic Acidosis

Metabolic Acidosis leads to ______ respirations, to ______ CO2, which is known as _________ respirations.

Increased Decrease Kussmauls

Excessive urination

Polyuria

Excessive thirst

Polydipsia

Excessive hunger

Polyphagia

Polyuria, polydipsia, and polyphagia together equals

Hyperglycemia

Oral hypoglycemia agents will _____ for Type I DM

Not work

In this type of DM, the client does not have enough insulin, or the insulin they have is no good

Type II

Client's with this type of DM are usually overweight

Type II

This type of diabetic can't make enough insulin to keep up with the _________ load the client is taking in

Glucose

This type of DM may be found by accident. The client may be coming in to MD for things like a wound that won't heal, repeated vaginal infections, etc.

Type II

Features of this include insulin resistance, abdominal obesity (waist circumference > 40 inches), increased triglycerides, decreased HDL, increased BP, and CAD

Metabolic Syndrome (Syndrome X)

Resembles Type II DM, but occurs during pregnancy

Gestational Diabetes

During pregnancy, mom needs 2-3 times more ______ than normal

Insulin

Screen all moms at ______ gestation for DM

24-28 weeks

Extreme blood sugar equals

vascular damageq

Majority of diabetic calories should come from _______, then _______, and lastly _________.

Complex carbs fats protein

Limit protein to _______ in clients with DM

10-20%

Diabetics tend to have ________ disease

Renal

Oral hypoglycemic agents work by

Stimulating the pancreas to make insulin (most times)

Despite whether or not oral hypoglycemic agents stimulate the pancreas or not, all oral hypoglycemics work to _________

Decrease the amount of circulating glucose

Oral hypoglycemic agents are only effective on type _____ diabetics

Glipizide (Glucotrol), Metformin (Glocophage), Pioglitazone (Actos), and Sitagliptin (Januvia) are all

Common Oral Anti-Diabetic Agents

Insulin dose is determined by

Body Weight

Average adult insulin dose range is

0.4-1.0 units/kg/day

Insulin dose is adjusted until the blood sugar is normal, and until there is no more ______ or ________ in urine

glucose, ketones

Regular insulin is ________, while NPH insulin is ________

Clear, cloudy

What is the only type of insulin that can be given IV?

Regular

What is the most common method of daily dosing insulin?

Basal-bolus

Basal-bolus dosing involves the total daily dose of insulin being a combination of a ______ insulin, and a _______ insulin.

Long-lasting, Rapid acting

Long lasting insulin is given______

Once a day

Clients should eat when insulin is at its _________

Peak

When insulin is at its peak, blood sugar is at its ______

Lowest

When drawing up both regular and NPH insulin together, always draw up ________ first

Regular (clear to cloudy)

blood test that gives an average of what your blood sugar has been over the past three months

Glycosylated Hemoglobin (HbA1c)

Ideal goal for HbA1c for a diabetic is

4 to 6% or less

The ADA defines a HbA1c of _____ as diagnostic for diabetes

6.5%

Only _______ insulin is used in infusion pumps

Rapid acting

If hypoglycemic, client should

Eat or drink simple sugars

Glucose absorption is delayed in foods with lots of _____

Fat

Once you get the blood sugar up, then the client should eat ___________

Complex carbs and protein

ADA defines hypoglycemia as a glucose level of

70mg/dL or less

Anything that increases blood sugar can throw a client into

DKA

Absent or inadequate insulin leads to sugar going sky high

DKA

Polyuria, polydipsia, and polyphagia lead to fat breakdown (acidosis), which leads to Kussmaul's respirations, and LOC decreases

DKA

Hourly blood sugar levels and potassium levels for

DKA

Insulin decreases _____ and _______ by driving them out of the vascular space into the cell

Blood sugar | Potassium

Hourly outputs needed for

DKA

For DKA, when giving IV fluids, start with NS, then when blood sugar gets down to about _______ switch to _____ to prevent throwing the client into _________

300 D5W Hypoglycemia

Anticipate giving IV _______ at some point to the client in DKA

Potassium

Type 1 leads to _______, whereas Type II leads to ______

DKA, HHNK(HHS)

HHNK or HHS look like DKA, but have no ________

Acidosis

Clients in HHNK or HHS are making just enough insulin so they don't break down _____. This means no ______, which means no ________.

Fat Ketones Acidosis

Will a client with HHNK or HHS have Kussmaulls respirations?

DKA and HHNK (HHS) are both hyperosmolar states caused by ________ and _______, but there is no ___________ with HHNK(HHS)

Hyperglycemia Dehydration Acidosis

Diabetic retinopathy leads to

Blindness

Nephropathy leads to

Kidney disease

Neuropathy leads to

Nerve damage

This is when the bladder does not empty properly, it may empty spontaneously, called __________, or it may not empty at all, and this is called __________

Neurogenic bladder, Incontinence, Retention

Stomach emptying is delayed so there is an increased risk for aspiration

Gastroparesis

Rapid acting insulin onset

5-15 minutes

Rapid acting insulin peak

1-3 hours

Rapid acting insulin duration

3-5 hours

Aspart (NovoLog), Lispro (Humalog), and Glulisine (Apidra) are all examples of

Rapid acting insulin

Short acting insulin onset

30 mins to 1 hour

Short acting insulin peak

2-4 hours

Short acting insulin duration

6-8 hours

Used for patients on a sliding scale

Short acting insulin

Humulin R, and Novolin R are examples of

Short acting insulin

Intermediate acting insulin onset

1-1.5 hours

Intermediate acting insulin peak

6-12 hours

Intermediate acting insulin duration

18-24 hours

Isophane suspension (NPH, Humulin N, Novolin N) are examples of

Intermediate Acting Insulin

Long acting insulin onset

2-4 hours

Long acting insulin peak

No peak

Long acting insulin duration

24 hours

Glargine (Lantus) is an example of

Long acting insulin

Intermediate acting insulin combined with either rapid acting or short acting (Regular) insulin

Combination Insulin (Pre-mixed)

Humulin 70/30, NovoLog Mix 70/30, Humalog Mix 75/25, and Humalog Mix 50/50 are all examples of

Combination Insulin

Post op care for cushings should include bed rest until

BP is stabilized after surgery

Normal inflammatory responses are __________ post op surgery for cushings.

Suppressed

Stimulate the release of insulin from the pancreas

Sulfonyureas

Decreases the rate of hepatic glucose production and lowers the glucose uptake by the tissues

Biguanides

Delays absorption of glucose from the GI tract

Alpha-Glucosidase Inhibitors

Glipizide (Glucotrol), Glyburide (Diabeta, Glynase), Glimepride (Amaryl) are all examples of

Sulfonyureas

Metformin (Glucophage, Glucophage XR) is an example of a

Biguanide

Acarbose (Precose), and Miglitol (Glyset) are examples of

Alpha-Glucosidase Inhibitors

Improves glucose uptake in the muscles, decreases endogenous glucose production. Should be avoided in pt's with symptomatic heart disease. May cause heart failure or MI.

Thiazolidineodiones "Glitazones"