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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
Q

What are some other treatments for DKA?

A

Rehydration with IV fluids, continuous infusion of regular insulin, reverse acidosis and restore electrolyte balance

26
Q

What does the rehydration with IV fluids do while treating DKA?

A

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
Q

What are some important assessments done for patients with DKA?

A

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
Q

What age ranges are usually affected by HHNS and DKA?

A

HHNS is usually >40 yrs old and DKA is usually <40 yrs old

29
Q

Both HHNS and DKA can present with drowsiness, stupor, and coma, but how do symptoms differ in regards to polyuria?

A

HHNS = polyuria for 2 days to 2 weeks before clinical presentation. DKA = polyuria for 1-3 days prior to clinical presentation

30
Q

How do HHNS and DKA differ in breathing symptoms?

A

HHNS = no hyperventilation or Kussmaul’s respirations and no fruity breath

31
Q

How do the symptoms differ in HHNS and DKA in the GI system?

A

HHNS = occasional GI symptoms. DKA = abdominal pain, N/V/D

32
Q

Which one, HHNS or DKA, presents with stronger hyponatremia?

A

DKA has mild hyponatremia, while HHNS has hypernatremia

33
Q

Which one, HHNS or DKA, has a higher serum osmolality?

A

Both have high serum osmolality but HHNS has it with minimal CNS symptoms (disorientation, focal seizures)

34
Q

Which one, HHNS or DKA, presents with hypokalemia?

A

DKA presents with extreme hypokalemia. HHNS usually has normal serum K+

35
Q

Which one, HHNS or DKA, presents with ketones?

A

DKA

36
Q

How does DKA & HHNS affect HCO3 and CO2 levels?

A

HCO3 and CO2 are less than 10 mEq/L. In HHNS CO2 is normal and HCO3 is above 16.

37
Q

One has a high recovery rate and the other has a high mortality rate. Which is HHNS and which is DKA?

A

HHNS = high mortality. DKA = high recovery

38
Q

Does acidosis accompany HHNS?

A

No

39
Q

Are the symptoms of DKA the same for every patient?

A

Symptoms vary from patient to patient. Symptoms also vary related to the rapid decrease in blood glucose range

40
Q

What causes DKA?

A

An absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat

41
Q

What key factor differentiates DKA from HHNS?

A

Acidosis

42
Q

How is an IV infusion of regular insulin given to a patient with DKA?

A

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
Q

What causes HHNS?

A

Hyperosmolarity and hyperglycemia occur due to lack of effective insulin. Ketosis is minimal or absent

44
Q

What does the hyperglycemia cause in HHNS?

A

Osmotic diuresis with loss of water and electrolytes, hypernatremia, and increased osmolarity occur

45
Q

What are the s/s of HHNS?

A

Hypotension, profound dehydration, tachycardia, and variable neurologic signs due to cerebral dehydration

46
Q

What are some long-term complications of diabetes?

A

Macrovascular, Microvascular, and Neuropathic complications/changes

47
Q

What are some macrovascular complications associated with diabetes?

A

Accelerated atherosclerotic changes (plaque builds up quicker) which increases the risk for CVA, MI, and peripheral vascular disease

48
Q

What are some microvascular complications associated with diabetes?

A

Diabetic retinopathy, nephropathy

49
Q

What are some neuropathic changes associated with diabetes?

A

Peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction

50
Q

Why is the IV tubing flushed with insulin before beginning the infusion?

A

The IV tubing will absorb the insulin. By flushing the tubing with insulin first, it keeps the insulin going directly to the patient

51
Q

What is the treatment of choice for thyroid CA?

A

Total or subtotal thyroidectomy

52
Q

What might thyroid CA surgery include?

A

Modified or radical neck dissection, and may include treatment with radioactive iodine to minimize metastasis

53
Q

When is a subtotal thyroidectomy performed?

A

For the treatment of hyperthyroidism when medication therapy fails or radiation therapy is contraindicated

54
Q

Does the remaining thyroid tissue after a subtotal thyroidectomy supply enough thyroid hormone for normal function?

A

Yes, usually

55
Q

What is required after a total thyroidectomy?

A

Lifelong thyroid replacement therapy

56
Q

What pre-op meds are given prior to a thyroidectomy?

A

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
Q

What needs to be done while assisting a patient to deep breathe and cough post-thyroidectomy?

A

Support the patient’s neck

58
Q

Why does a post-thyroidectomy patient need to be in the high-Fowler’s position?

A

To promote venous return from the head and neck and to decrease oozing into the incision and to prevent aspiration

59
Q

How do you check for laryngeal nerve damage in a post-thyroidectomy patient?

A

By asking the client to speak as soon as they awaken from anesthesia and then every 2 hrs

60
Q

What needs to be done while changing the patient’s position post-thyroidectomy?

A

Support the back of their neck with pillows or sandbags

61
Q

What needs to be inspected on the surgical dressing following a thyroidectomy?

A

Bleeding, especially at the back of the neck, and change the dressing as directed

62
Q

How is the Jackson-Pratt drain monitored?

A

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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