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Med Surg III Nrsg 116 > Unit 5: Endocrine > Flashcards

Unit 5: Endocrine Flashcards

1
Q

What does HHNS stand for?

A

Hyperglycemic Hyperosmolar Nonketotic Syndrome

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2
Q

What blood glucose level is considered gypoglycemic?

A

<70

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3
Q

What causes hypoglycemia?

A

Too much insulin/oral hypoglycemics, excessive exercise, too little food

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4
Q

What are the adrenergic symptoms of hypoglycemia?

A

Sweating, tremors, tachycardia, palpitations, nervousness, hunger

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5
Q

What are the CNS symptoms of hypoglycemia?

A

Inability to concentrate, HA, confusion, slurred speech, numbness of lips and tongue, irrational/combative behavior, double vision, drowsiness

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6
Q

What can severe hypoglycemia cause?

A

Disorientation, seizures, loss of consciousness

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7
Q

Is the onset of hypoglycemia slow?

A

No, it’s abrupt

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8
Q

What group of pts may have decreased symptoms with hypoglycemia?

A

People who have had diabetes for many years due to neuropathy

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9
Q

What is the first treatment for hypoglycemia?

A

If blood sugar is <70, give 15 gm of fast acting, concentrated carbs

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10
Q

What are some examples of 15 gm of carbs?

A

3-4 glucose tablets, 4-6 oz of juice, 6-10 hard candies, or 2-3 tsp of honey

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11
Q

What is done after carbs are given to a pt with hypoglycemia?

A

Retest blood sugar in 15 mins. Retreat if blood sugar is <70

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12
Q

If symptoms of hypoglycemia persist or testing is not possible, what do you do?

A

Give protein/carb snack, unless they plan to eat in <60 min

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13
Q

When do you give glucagon for hypoglycemia?

A

If the patient can’t swallow or is unconscious

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14
Q

How much glucagon is given to a pt with hypoglycemia?

A

1 mg SubQ or IM, or 25-50 mL of 50% dextrose solution IV

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15
Q

What are the 3 main clinical features of DKA?

A

Hyperglycemia, dehydration, and acidosis

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16
Q

What are some s/s of DKA?

A

Polyuria, polydipsia, blurred vision, weakness, HA, anorexia, abdominal pain, N/V, acetone breath, hyperventilation with Kussmaul respirations, mental changes

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17
Q

What are Kussmaul’s respirations?

A

Deep diaphragmatic breaths, sometimes followed by periods of apnea

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18
Q

What blood glucose levels indicate DKA?

A

300-800

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19
Q

What differentiates hypoglycemia from DKA?

A

Kussmaul respirations

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20
Q

Is severity of DKA related to blood sugar levels?

A

No

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21
Q

What do you look at to determine ketoacidosis?

A

Low levels of serum bicarbonate, low pH, and low PCO2. Ketones in blood and urine

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22
Q

What happens to electrolytes in DKA?

A

They vary by the level of water loss/hydration

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23
Q

How does a diabetic prevent DKA?

A

With sick day rules, which is basically what to do if they become sick

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24
Q

What do you do when glucose levels drop to below 250 again?

A

Add glucose to the treatment and check hourly

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25
What are some other treatments for DKA?
Rehydration with IV fluids, continuous infusion of regular insulin, reverse acidosis and restore electrolyte balance
26
What does the rehydration with IV fluids do while treating DKA?
Rehydration increases plasma volume and decreases serum K+. Insulin helps move K+ from extracellular fluid into the cells causing even less K+ (increases risk for dysrhythmias)
27
What are some important assessments done for patients with DKA?
Blood sugar, renal function/UO every hr; EKG, electrolyte levels (especially K+); Every 1-2 hrs do VS & lung assessment for s/s of fluid overload (coughs, crackles, dyspnea, edema)
28
What age ranges are usually affected by HHNS and DKA?
HHNS is usually >40 yrs old and DKA is usually <40 yrs old
29
Both HHNS and DKA can present with drowsiness, stupor, and coma, but how do symptoms differ in regards to polyuria?
HHNS = polyuria for 2 days to 2 weeks before clinical presentation. DKA = polyuria for 1-3 days prior to clinical presentation
30
How do HHNS and DKA differ in breathing symptoms?
HHNS = no hyperventilation or Kussmaul's respirations and no fruity breath
31
How do the symptoms differ in HHNS and DKA in the GI system?
HHNS = occasional GI symptoms. DKA = abdominal pain, N/V/D
32
Which one, HHNS or DKA, presents with stronger hyponatremia?
DKA has mild hyponatremia, while HHNS has hypernatremia
33
Which one, HHNS or DKA, has a higher serum osmolality?
Both have high serum osmolality but HHNS has it with minimal CNS symptoms (disorientation, focal seizures)
34
Which one, HHNS or DKA, presents with hypokalemia?
DKA presents with extreme hypokalemia. HHNS usually has normal serum K+
35
Which one, HHNS or DKA, presents with ketones?
DKA
36
How does DKA & HHNS affect HCO3 and CO2 levels?
HCO3 and CO2 are less than 10 mEq/L. In HHNS CO2 is normal and HCO3 is above 16.
37
One has a high recovery rate and the other has a high mortality rate. Which is HHNS and which is DKA?
HHNS = high mortality. DKA = high recovery
38
Does acidosis accompany HHNS?
No
39
Are the symptoms of DKA the same for every patient?
Symptoms vary from patient to patient. Symptoms also vary related to the rapid decrease in blood glucose range
40
What causes DKA?
An absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat
41
What key factor differentiates DKA from HHNS?
Acidosis
42
How is an IV infusion of regular insulin given to a patient with DKA?
First a bolus is given based on the patient's weight, then a continuous infusion is given which is also based on the patient's weight
43
What causes HHNS?
Hyperosmolarity and hyperglycemia occur due to lack of effective insulin. Ketosis is minimal or absent
44
What does the hyperglycemia cause in HHNS?
Osmotic diuresis with loss of water and electrolytes, hypernatremia, and increased osmolarity occur
45
What are the s/s of HHNS?
Hypotension, profound dehydration, tachycardia, and variable neurologic signs due to cerebral dehydration
46
What are some long-term complications of diabetes?
Macrovascular, Microvascular, and Neuropathic complications/changes
47
What are some macrovascular complications associated with diabetes?
Accelerated atherosclerotic changes (plaque builds up quicker) which increases the risk for CVA, MI, and peripheral vascular disease
48
What are some microvascular complications associated with diabetes?
Diabetic retinopathy, nephropathy
49
What are some neuropathic changes associated with diabetes?
Peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction
50
Why is the IV tubing flushed with insulin before beginning the infusion?
The IV tubing will absorb the insulin. By flushing the tubing with insulin first, it keeps the insulin going directly to the patient
51
What is the treatment of choice for thyroid CA?
Total or subtotal thyroidectomy
52
What might thyroid CA surgery include?
Modified or radical neck dissection, and may include treatment with radioactive iodine to minimize metastasis
53
When is a subtotal thyroidectomy performed?
For the treatment of hyperthyroidism when medication therapy fails or radiation therapy is contraindicated
54
Does the remaining thyroid tissue after a subtotal thyroidectomy supply enough thyroid hormone for normal function?
Yes, usually
55
What is required after a total thyroidectomy?
Lifelong thyroid replacement therapy
56
What pre-op meds are given prior to a thyroidectomy?
Propythlouracil or methimazole (4-6 wks before to decrease hormones), Iodine (10-14 days before to decrease the gland's size and prevent excess bleeding), and Propranolol (Inderal)(to block adrenergic/epinephrine effects)
57
What needs to be done while assisting a patient to deep breathe and cough post-thyroidectomy?
Support the patient's neck
58
Why does a post-thyroidectomy patient need to be in the high-Fowler's position?
To promote venous return from the head and neck and to decrease oozing into the incision and to prevent aspiration
59
How do you check for laryngeal nerve damage in a post-thyroidectomy patient?
By asking the client to speak as soon as they awaken from anesthesia and then every 2 hrs
60
What needs to be done while changing the patient's position post-thyroidectomy?
Support the back of their neck with pillows or sandbags
61
What needs to be inspected on the surgical dressing following a thyroidectomy?
Bleeding, especially at the back of the neck, and change the dressing as directed
62
How is the Jackson-Pratt drain monitored?
Expect approx 50 mL in the first 24 hrs; If no drainage, check for drain kinking or suction; Expect only scant drainage after 24 hrs

Med Surg III Nrsg 116 (3 decks)

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