week 4 Flashcards
what does PTH do
increases blood calcium
where is calcitonin released from and what does it do
the thyroid gland when calcium is high it moves it into bone.
what are t3 and t4
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.
levothyroxine admin
give 2 hours before breakfast
what follows a total thyroidectomy secondary to cancer
radioactive iodine therapy followed by a nuclear scan
what is a nuclear scan
scans the body for cancer cells
what are the two parts of the adrenal gland and what do they do
Cortex(outer): glucocorticoids, mineralocorticoids, androgens
Medulla: Catecholamines
why do steroids cause circulatory collapse if they arent tapered off
someone on steroids longterm has a hypernating adrenal gland. Therefore they wont have any catecholamines/aldosterone being produced
what are the endocrine and exocrine functions of the pancreas
Exocrine(90%)-digestive enzymes
Endocrine(10%)-insulin and glucagon
what is thyroglobulin
a cancer marker should be non detectable (zero)
what does NPH stand for
Neutral Protamine Hagedorn
-Protamine is a protein that delays the absorption of insulin
what is the acronym for before meal and before bed
AC
HC
how often should you change insulin sites
5-7 days for better absorption
what are the s/s of hypoglycemia
- cold clammy
- dizziness
- shakiness
- changed LOC
what is your action if a hypoglycemic patient cannot intake PO
D50W
if machine says B.S high what is your action.
check serum glucose and give highest sliding scale
what are the normal A1Cs
normal below 6%
prediabetic: 6-6.5
diabetic above 7
what is normal fasting B.S
under 126
metabolic syndrome
- waist >40 or >35(w)
- triglycrides >150
- HDL <40 or 35(w)
- BP higher then 130/85
- fasting B.S >100
what causes the chain reaction that leads to DKA
zero insulin which then leads to
- increased B.S and Fat metabolism
- B.S leads to polyuria which leads to decreased fluid volume which eventually leads to shock.
- The fat metabolsim also creates lactic acid and leads to metabolic acidosis
what pH is incompatible with life
below 6.8 or above 7.8
Priorities in DKA
- Airway
- fluids challenge (3-4L bolus)
- Bicarb IV
- Mix bicarb into IV fluids
- regular insulin IV and accu check every hour
- after B.S drops below 250 start D5W and stop insulin IV and start insulin SubQ. Accu checks every 2 hours
how do you know someone is out of DKA
the anion gap which indicates normal metabolism is below 14
what is a primary concern for DKA patients
hypokalemia from all the IV insulin
HHS
The main problem here is caused by low levels of insulin which lead to
1.high B.S -> polyuria ->high serum osmolality
who has higher B.S DKA or HHS and why
HHS because theyre breaking down glycogen therefore they go into shock faster
priority management in HHS
- fluid challenge
2. Insulin IV
Diabetes Insipidus
no B.S issues common in head trauma 3 types 1.Central 2.Nephrogenic 3.Psychogenic
what is central DI and how do you treat
central can be subcategorized as primary and secondary. Treat with desmopressin (DAVP)
what is the difference between vasopressin and desmopressin
Vasopressin is long acting taking 24 hours to take effect
Demsmopressin is short acting taking 8 hours to work
what is nephrogenic DI caused by and how do you treat it
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
what is the water deprivation test
no fluids for an hour if urine specific gravity remains low then we confirm that there is a problem
SIADH risk factors
- Thiazide diuretics
- SSRI
- Head injury
- Cancer
- High PEEP
what B.S level is considered hypoglycemia and what should you do
under 70
give 15-20 grams of carbs recheck in 15 mins
how much does 10 grams of carbs raise B.S
40 over 30 mins
metformin actions
- reduces production of glucose by the liver and
- increases insulin sensitivity and
- slows carbohydrate absorption
metformin SEs
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)
metformin interventions
- take with food to decrease GI effects
- instruct client to take B12 and folic acid supplements
- lactic acidosis (myalgia(muscle pain), sluggishness, somnolence, hyperventilation)
what type of shoes should diabetics wear
- avoid open toe, open heel shoes
- leather shoes are preferred
- wear slippers with soles
- never go barefoot
why do we add D5W after glucose levels drop below 250 in DKA
to minimize the risk of cerebral edema associated with drastic changes in serum osmolarity and prevent hypglycemia
what can cause nephrogenic DI
hypokalemia and hypocalcemia
requirements for water deprivation test
- normal sodium levels
- urine osmolality less then 300 mOsm/kg (285-295)
- increases with dehydration
what happens to the urine osmolality during water deprivation test is patients have nephrogenic vs central DI
- it goes down because the kidneys are not able to concentrate the urine
- it goes up because atleast 9%
normal range for ADH
1 to 5 pg/mL
what electrolytes indicate SIADH
- low sodium
2. decreased osmolality and increased urine osmolality
expected range for urine specific gravity
1.010 - 1.025
