Wk 3 Flashcards
what is up regulation
When there are low hormone levels, there is an increase in number of receptors
what is the pituitary gland
Regulates the operation of all the other glands
Regulates growth and development through secretion of somatotropin
Secretes vasopressin, which regulates re-absorption of fluid in the kidneys
posterior: oxytocin, antidiuretic
anterior: thyroid stimulating hormone, growth hormone, adrenocorticotropic, follicle stimulating hormone
describe the insulin glucose metabolism
- Cell membranes impermeable to glucose
o Insulin binds to insulin receptor on cell surface
o Generation on intracellular signal
o Glucose transporter moves from inactive site to cell wall
o Glucose transported across cell wall
what is diabetes
- Inability of the body to produce or to use insulin, resulting in a lack of ability to use of metabolize glucose
- Type 1 v type 2
o Nearly 90% of people with DM have type 2 - Cause is unknown; some factors include
o Genetic disposition
o Smoking
o Obesity
o Lack of activity
o High levels of stress/anxiety
describe type 1 diabetes
- Absolute insulin deficiency
o The body cannot produce insulin - Destruction of the Islet Beta cells
o Genetic predisposition and autoimmune response
o Body forms autoantibodies that destroy the insulin- producing beta cells - Dependent on exogenous insulin to prevent ketosis and for survival
describe type 2 diabetes
- Relative lack of insulin- hyperglycaemia despite presence of insulin
- Positive family history increases chances two to four times of acquiring type 2 DM
- Obesity and physical inactivity
- Resistance to insulin
- Causes a rise in the level of glucose in the blood Hyperglycaemia
- Beta cells increase production of insulin to try to maintain a normal blood glucose level
- Beta cells fail, lose ability to secrete insulin
gestational diabetes
- Glucose intolerance detected during pregnancy
- Risk factors
o Family history of diabetes
o History of stillbirth, foetal abnormalities, large baby - Management
o Risk assessment during pregnancy
o Insulin therapy if necessary
o Mother may develop diabetes later in life
S&S of type 1 diabetes
- Frequent Urination (“diabetes” means “frequent urination”)
- Extreme hunger and thirst
- Fatigue
- Hyperglycaemia
- Glycosuria
- Blurred vision
- Dry, itchy skin
- Poor wound healing
- Impotency in men due to vascular problems
- Numbness and tingling in upper and lower extremities
S&S type 2 diabetes
- Obesity and lack of physical activity
- Family history
- Over 55
- Polycystic ovary disease
- Gestational diabetes
- Borderline glucose tolerance test results
- Heart attack, heart disease, high BP
- Polydipsia
- Polyphagia
- Smell of acetone
- Kussmaul breathing (hyperventilation
treatment for type 1 and type 2 diabetes
t1: Insulin Pancreas/kidney and islet cell transplant • Nutrition • Exercise • Oral medication • Insulin therapy • Monitoring • Education • Optimal medical management
t2: Lifestyle Modification
Oral Hypoglycaemics
Insulin
- Nutrition
- Exercise
- Oral medication
- Insulin therapy
- Monitoring
- Education
- Optimal medical management
what is diabetic ketoacidosis
Due to an absolute insulin deficiency
usually in Type I but possible in Type 2
Hyperglycaemia develops due to reduced peripheral utilisation of glucose (as no insulin available)
• also gluconeogenesis (glycogen from fatty acids)
• increased glycogenolysis (glycogen to glucose in the liver)
Acidosis develops due to fat breakdown (fatty acids)
Cause: Infection 50%, Non-compliance 25%, newly diagnosed 10-30%, stress, alterations in insulin regime and drug
S&S of DKA
- polyuria
- polydipsia
- weight loss
- nausea
- vomiting
- shortness of breath
- abdo pains (kids)
- increased resp rate/ Kussmaul’s breathing
- ketotic breath (acetone; fruity smell)
- postural hypotension
- hypothermia
- hypovolaemia
- acidosis
- shock
nursing considerations and complications of DKA
- Fluid replacement: lots!
- Insulin therapy: sliding scale
- Potassium replacement
- Treatment of precipitant
Consideration for Intensive Care Unit
• haemodynamic instability, severe acidosis, impaired conscious level, precipitating illness
what is hyperosmolar hyperglycemic state (HHS)
Relative insulin deficiency seen in type 2 DM
• sufficient insulin to prevent gluconeogenesis and therefore ketoacidosis
• but not enough to prevent hyperglycaemia
• dehydration arising from osmotic diuresis from hyperglycaemia
S&S of HHS
- Insidious onset
- Confusion
- Profound dehydration (up to 9- 10L deficit)
- Coma
- Fitting: especially with very high osmolality
- Deep Vein Thromboses and CerebroVascular Accidents (Stroke) may occur
Nursing considerations and complications of HHS
hourly BSLs, ABG for electrolytes or UEC
Continue iv fluids and insulin for 24 hrs after stabilisation
Convert to oral hypoglycaemic agents or subcutaneous insulin
– PATIENT EDUCATION IS THE KEY TO PREVENTING FURTHER EPISODES!
Tx of HHS
Fluid replacement
Insulin therapy
Potassium replacement
Treatment of precipitant
what is hypoglycaemia
Low level of blood glucose
• Mild - recognised & treated by the person
• Severe - requires assistance from another person to treat
Plasma glucose concentration below 2.2 or 2.7 mmol/L
Treat patients with glucose less than 4 mmol/L
main causes of hypoglycaemia
Causes: Insufficient carbohydrate (CHO) intake
• Missed/delayed meal or snack
Exercise/Physical activity
Alcohol
Vomiting and Diarrhoea
Delayed digestion - stress and gastroparesis
Medications
• Excess insulin/oral hypoglycaemic agents
S&S hypoglycaemia
palllor • Sweating • Shakiness • Weakness • Tachycardic • Palpitations • Hunger • Tingling lips • Anxiety • Restlessness • Changes in concentration • Confusion • Headache • Blurred vision • Slurred Speech • Anger/Aggression • Decreasing consciousness • Seizures • Coma
Tx hypoglycaemia
Mild Hypoglycaemia • Glucose or fasting acting sugar (15gm) • 3 tsp sugar • 1/2 can of soft drink • 5 to 7 jelly beans • 2 to 3 glucose tablets • Follow with longer acting CHO or have that meal/snack due within 30 minutes
Moderate to Severe
• IV dextrose (25mls of 50% dextrose) if IVC present
• SC or IM glucagon for decreasing consciousness/coma
• Check blood sugar level as soon as possible
• Regular checks of BSL every 5-10 mins until sugar normal
what is hyperthyroidism
• Overproduction of thyroxine, causing metabolism to speed up. – Graves Disease: autoimmune – Thyroiditis: Subacute, Postpartum – Thyroid Nodule – Increased iodine – Thyroid Medication
S&S of hyperthyroidism
- Person usually develops goiter–swelling of thyroid in the neck.
- Person is agitated, restless, may lose weight, have trouble sleeping.
- May develop exophthalmos–bulging of the eyeballs.
Tx of hyperthyroidism
Treatment is removal of thyroid or destruction of thyroid by drinking radioactive iodine.
what is hypothyroidism
Under-secretion of thyroxine, causing lowering of the body’s metabolism
causes of hypothyroidism
autoimmune: Hashimoto’s thyroiditis – May develop as a result of destruction of thyroid as treatment for hyperthyroidism – Medication: lithium – Pituitary Problem – Iodine Deficiency
S&S of hypothyroidism
Lethargy, weakness, tiredness, weight gain, bradycardia, brittleness of hair and skin, deepening of voice
Increased likelihood of development of cardiovascular disease
Tx of hypothyroidism
Thyroxine replacement (medications)
what is thyroid deficiency: cretinism
Cretinism: Prenatal condition caused by deficiency of thyroid hormones in mother. Results in: • Dwarfed stature • Mental retardation • Dystrophy of the bones • Low metabolism
what is cushings syndrome
Caused by overproduction of steroids by adrenal cortex, or by overuse/abuse of steroidal drugs
• More common in women than in men
• Bones mass may lessen, diabetes may develop
S&S of cushings syndrome
- Person will gain weight in face, stomach and buttocks but will have wasted limbs
- Disease is extremely debilitating with reduced capacities for physical activities
- Fat pads around neck
- Striae
- Thin skin
- Poor wound healing
- Red cheeks
Tx of cushings syndrome
- Surgical or radiological removal of the adrenal cortex
* Necessary to take steroidal medications
what is Addison disease
Underproduction of steroids by adrenal cortex
S&S of addisons disease
- Person is easily fatigued, loses weight, may have problems with dehydration
- Low blood pressure and low blood sugar
- Susceptible to infection due to decreased activity of immune system
- Hypoglycaemia
- Postural hypotension
- Bronze pigmentation of skin
Tx of addison disease
• Replacement and regulation of steroids, which has to be closely monitored and is difficult.
what is diabetes insipidus
- A pituitary disorder- not sugar diabetes
- Insufficiency of ADH leading to polyuria and polydipsia
- caused by lack of vasopressin, causing kidney to fail in reabsorption of fluid
name some pituitary disorders
Gigantism: oversecretion of somatotrophin (Growth Hormone), causes overgrowth of skeleton and soft tissues.
Acromegaly-Complication of gigantism involving enlargement of the head, hands and feet
Dwarfism: caused by undersecretion of somatotrophin, causes stunting of growth
