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Med surg > week 4 > Flashcards

week 4 Flashcards

1
Q

what does PTH do

A

increases blood calcium

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2
Q

where is calcitonin released from and what does it do

A

the thyroid gland when calcium is high it moves it into bone.

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3
Q

what are t3 and t4

A

t3 is the active form of thyroid hormone. T4 is the storage form it is what is usally given as thyroid replacement. T3 lasts 24 hours once it is activated. T4 lasts up to a week.

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4
Q

levothyroxine admin

A

give 2 hours before breakfast

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5
Q

what follows a total thyroidectomy secondary to cancer

A

radioactive iodine therapy followed by a nuclear scan

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6
Q

what is a nuclear scan

A

scans the body for cancer cells

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7
Q

what are the two parts of the adrenal gland and what do they do

A

Cortex(outer): glucocorticoids, mineralocorticoids, androgens
Medulla: Catecholamines

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8
Q

why do steroids cause circulatory collapse if they arent tapered off

A

someone on steroids longterm has a hypernating adrenal gland. Therefore they wont have any catecholamines/aldosterone being produced

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9
Q

what are the endocrine and exocrine functions of the pancreas

A

Exocrine(90%)-digestive enzymes

Endocrine(10%)-insulin and glucagon

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10
Q

what is thyroglobulin

A

a cancer marker should be non detectable (zero)

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11
Q

what does NPH stand for

A

Neutral Protamine Hagedorn

-Protamine is a protein that delays the absorption of insulin

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12
Q

what is the acronym for before meal and before bed

A

AC

HC

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13
Q

how often should you change insulin sites

A

5-7 days for better absorption

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14
Q

what are the s/s of hypoglycemia

A
  1. cold clammy
  2. dizziness
  3. shakiness
  4. changed LOC
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15
Q

what is your action if a hypoglycemic patient cannot intake PO

A

D50W

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16
Q

if machine says B.S high what is your action.

A

check serum glucose and give highest sliding scale

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17
Q

what are the normal A1Cs

A

normal below 6%
prediabetic: 6-6.5
diabetic above 7

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18
Q

what is normal fasting B.S

A

under 126

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19
Q

metabolic syndrome

A
  1. waist >40 or >35(w)
  2. triglycrides >150
  3. HDL <40 or 35(w)
  4. BP higher then 130/85
  5. fasting B.S >100
20
Q

what causes the chain reaction that leads to DKA

A

zero insulin which then leads to

  1. increased B.S and Fat metabolism
  2. B.S leads to polyuria which leads to decreased fluid volume which eventually leads to shock.
  3. The fat metabolsim also creates lactic acid and leads to metabolic acidosis
21
Q

what pH is incompatible with life

A

below 6.8 or above 7.8

22
Q

Priorities in DKA

A
  1. Airway
  2. fluids challenge (3-4L bolus)
  3. Bicarb IV
  4. Mix bicarb into IV fluids
  5. regular insulin IV and accu check every hour
  6. after B.S drops below 250 start D5W and stop insulin IV and start insulin SubQ. Accu checks every 2 hours
23
Q

how do you know someone is out of DKA

A

the anion gap which indicates normal metabolism is below 14

24
Q

what is a primary concern for DKA patients

A

hypokalemia from all the IV insulin

25
Q

HHS

A

The main problem here is caused by low levels of insulin which lead to
1.high B.S -> polyuria ->high serum osmolality

26
Q

who has higher B.S DKA or HHS and why

A

HHS because theyre breaking down glycogen therefore they go into shock faster

27
Q

priority management in HHS

A
  1. fluid challenge

2. Insulin IV

28
Q

Diabetes Insipidus

A 
no B.S issues 
common in head trauma 
3 types
1.Central
2.Nephrogenic
3.Psychogenic
29
Q

what is central DI and how do you treat

A

central can be subcategorized as primary and secondary. Treat with desmopressin (DAVP)

30
Q

what is the difference between vasopressin and desmopressin

A

Vasopressin is long acting taking 24 hours to take effect

Demsmopressin is short acting taking 8 hours to work

31
Q

what is nephrogenic DI caused by and how do you treat it

A

caused by decreased sensitivity of the kidneys to ADH therefore giving more ADH wont help. We give them thiazide diuretics which improves the sensitivity of the kidneys to ADH

32
Q

what is the water deprivation test

A

no fluids for an hour if urine specific gravity remains low then we confirm that there is a problem

33
Q

SIADH risk factors

A
  1. Thiazide diuretics
  2. SSRI
  3. Head injury
  4. Cancer
  5. High PEEP
34
Q

what B.S level is considered hypoglycemia and what should you do

A

under 70

give 15-20 grams of carbs recheck in 15 mins

35
Q

how much does 10 grams of carbs raise B.S

A

40 over 30 mins

36
Q

metformin actions

A
  1. reduces production of glucose by the liver and
  2. increases insulin sensitivity and
  3. slows carbohydrate absorption
37
Q

metformin SEs

A

1.GI
flatulence, anorexia, n/v
2.lactic acidosis
especially clients with kidney or liver dysorders
3.stop 48 hours before any test that requires iodine contrast (increase risk of lactic acidosis)

38
Q

metformin interventions

A
  1. take with food to decrease GI effects
  2. instruct client to take B12 and folic acid supplements
  3. lactic acidosis (myalgia(muscle pain), sluggishness, somnolence, hyperventilation)
39
Q

what type of shoes should diabetics wear

A
  1. avoid open toe, open heel shoes
  2. leather shoes are preferred
  3. wear slippers with soles
  4. never go barefoot
40
Q

why do we add D5W after glucose levels drop below 250 in DKA

A

to minimize the risk of cerebral edema associated with drastic changes in serum osmolarity and prevent hypglycemia

41
Q

what can cause nephrogenic DI

A

hypokalemia and hypocalcemia

42
Q

requirements for water deprivation test

A
  1. normal sodium levels
  2. urine osmolality less then 300 mOsm/kg (285-295)
    - increases with dehydration
43
Q

what happens to the urine osmolality during water deprivation test is patients have nephrogenic vs central DI

A
  1. it goes down because the kidneys are not able to concentrate the urine
  2. it goes up because atleast 9%
44
Q

normal range for ADH

A

1 to 5 pg/mL

45
Q

what electrolytes indicate SIADH

A
  1. low sodium

2. decreased osmolality and increased urine osmolality

46
Q

expected range for urine specific gravity

A

1.010 - 1.025

Med surg (35 decks)

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