Week 5 Metabolism & Fluid Regulation Flashcards
Hyperthyroidism
- Problem
- Result
- Labs
- Manifestations
- Nutritional needs
- Nursing interventions
- Complications
- Thyroid storm/crisis
+ Priority assessments
+ Nursing actions
Hyperthyroid med: Thionamides
Methimazole & Propylthiouracil (PTU)
- MOA
- Nursing interventions
- Pt education
Hyperthyroid med: Beta-adrenergic blockers
Metoprolol
- Uses
- Nursing interventions
- Side effects
- Pt education
Hyperthyroid med: Med & prep for Thyroidectomy
Iodine Solutions
- MOA
- Thyroidectomy
Hypothyroidism
- Problem
- Result
- Labs
- Manifestations
- Nutritional needs
- Nursing interventions
Hypothyroid med: Thyroid hormone replacement therapy
Levothyroxine
- MOA
- Nursing interventions
- Pt education
- Complication
Posterior pituitary gland
- Function
- Location
Antidiuretic (ADH) hormone function
- ↑Renal reabsorption of water => Water retention
- ↑Na+ excretion
How can a head injury lead to posterior pituitary issues?
Damage/pressure to hypothalamus => Affects posterior pituitary
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Problem
- Results
- Causes
- Pathophysiology
- Diagnostics and labs
- Priority assessments
+ Early v Late s/s - Priority nursing interventions
SIADH med: Hypertonic Na+ IV Infusion
3% NaCl
- MOA
- Nursing interventions
- Complications
SIADH med: Vasopressin antagonist
Tolvaptan & Conivaptan
- MOA
- Goal
- Nursing interventions
- Complications
Diabetes Insipidus (DI)
- Problem
- Results
- Causes
- Pathophysiology
- Diagnostics and labs
- Priority assessments
+ Early v Late s/s - Priority nursing interventions
DI meds: ADH Replacement Agents
Vasopressin & Desmopressin
- MOA
- Pt education
- Complications
Diabetes Mellitus (general)
- Leading cause of…
- Major contributing factors
- Insulin fxn
+ ↑Insulin
+ ↓Insulin - Normal glucose & insulin metabolism
- Counter-regulatory hormones
- Complications
+ Acute DM v Chronic DM - 3 P’s
- Diagnostic studies
+ HbA1C
+ Fasting plasma glucose level
+ 2-hr random plasma glucose level during OGTT - Interprofessional care
Pre-diabetes
- Manifestations
- Priority
- HbA1C
Type 1 Diabetes Mellitus
- Primary defect
- Pathophysiology
- Age of onset
- Type of onset
- Prevalence
- Environmental factors
- Islet cell antibodies
- Endogenous insulin
- Nutritional state
- Symptoms
- Ketosis
- Nutrition therapy
- Insulin
- Vascular & neurologic complications
- Treatment considerations
Type II Diabetes Mellitus
- Primary defect
- Pathophysiology
- Age of onset
- Type of onset
- Prevalence
- Environmental factors
- Islet cell antibodies
- Endogenous insulin
- Nutritional state
- Symptoms
- Ketosis
- Nutrition therapy
- Insulin
- Vascular & neurologic complications
Human insulin
- Genetically engineered in labs from E. coli or yeast cells
- Insulins differ by onset, peak action, & duration
- Categories
Rapid-acting insulin
Lispro (Humalog), aspart (Novolog, Fiasp), glulisine (Apidra)
- Onset
- Peak
- Duration
Short-acting insulin
Regular (Humulin R, Novocain R)
- Onset
- Peak
- Duration
Intermediate-acting insulin
NPH (Humulin N, Novocain N)
- Onset
- Peak
- Duration
Long-acting insulin
Glargine (Lantus, Toupee, Basaglar), detemir (Levemir), degludec (Tresiba)
- Onset
- Peak
- Duration
Inhaled insulin
Afrezza
- Onset
- Peak
- Duration
Insulin
- Injection sites
- Steps for insulin injection
- Monitor
Insulin plans: Basal-bolus regimen
- Intensive or physiologic insulin therapy → Most closely mimics endogenous insulin production
- Admin multiple daily injections (or insulin pump) w/ frequent self-monitoring of BG (or continuous glucose monitoring system)
- Bolus - Rapid- or short-acting insulin before meals
- Basal - Intermediate- or long-acting (background) insulin 1-2x/day
- Goal: Achieve glucose level as close to normal as possible as much of time as possible
Insulin plans: Mealtime insulin
Manage postprandial glucose levels
- Rapid-acting synthetic (bolus)
- Short-acting regular (bolus)
Insulin plans: Combination insulin therapy
- Can mix
in same syringe - Provides mealtime & basal coverage in 1
injection - Commercially premixed formula or pen; flexible
dosing limited - Many self-mix from 2 vials
- Consider visual, manual, or cognitive skills
Insulin plans: Long-acting (basal) insulin
Degludec (Tresiba), detemir (Levemir), and glargine (Lantus, Toujeo, Basaglar)
- Released steadily & continuously w/ no peak action for many people
- Onset varies
- Admin 1x or 2x/day
- Do NOT mix or dilute w/ any other insulin or
solution
Insulin plan: Intermediate-acting insulin (NPH)
- Duration
- Peak
- Can mix w/ short- & rapid-acting insulins
- Cloudy => Agitate to mix
+ Lispro protamine & aspart protamine are also cloudy
Diabetic Ketoacidosis (DKA)
- Pathophysiology/Cause
- Urine & blood ketones
- ABGs
- Characteristics
- Precipitating factors
- Clinical manifestations
- Diagnostics & labs
- Medications
- Treatments
Hyperosmolar Hyperglycemic Syndrome (HHS)
- Pathophysiology/Cause
- Urine & blood ketones
- ABGs
- Characteristics
- Precipitating factors
- Clinical manifestations
- Medications
- Treatments
Priority nursing interventions for DKA & HHS
- Dehydration
- Elevated glucose
- Ketones/Metabolic acidosis
- Hypokalemia
Shared assessments b/w DKA & HHS
- Elevated glucose
- Hyperosmolar blood
- Polyuria → Dehydration → Tachycardia & confusion
- Polydipsia & polyphagia
Nursing management for DKA & HHS
- Monitor
- Assess
Hypoglycemia
- Pathophysiology
- Clinical manifestations
+ Mild
+ Moderate to severe - Causes
- Nursing care
- Treatments
