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3 p's for hyperglycemia
Precipitating factors for DKA
- inadequate or undermanagement of glucose
Clinical characteristics of DKA
- BGL >250
- ketonuria in lg amts
- pH < 7.3, HCO3 <15
- N,V, dehydration, abd pain, Kussmaul's respirations, acetone breath odor
Insulin that can be given IV.
A client with type II diabetes is being educated about what to do if he catches the flu or a cold. What is something he should be informed of?
Difference b/w HHNS and DKA?
tend to avoid the decrease in pH and ketosis
Too rapid infusion of insulin to lower BGL can lead to ?
If in doubt whether a client is hyperglycemic or hypoglycemic, treat for?
What is the earliest sign of diabetic nephropathy and indicates the need for follow-up evaluation?
Continuous IV infusion of magnesium can cause?
A female client with a history of alcoholism shows a prolonged QT interval, a heart rate of 160 beats/min, and BP 90/54. Based on these findings, which IV medication should the nurse administer?
- Magnesium sulfate.
- Because the client has chronic alcoholism, she is likely to have hypomagnesemia.
Clients with primary aldosteronism exhibit a profound decline in serum levels of ________.
Where is aldosterone secreted from?
When should Levothyroxine be taken/administered?
in the morning before breakfast to increase absorption
Why should you teach a client to force fluids who has hyperparathyroidism?
pts with hyperparathyroidism have increased serum Ca++ levels and increasing fluids prevents formation of renal calculi
How does hyperparathyroidism happen?
- oversecretion due to parathyroid tumor or
- response to hypocalcemia
How should a diabetic pt prevent DKA during an acute infection?
- stop taking insulin if vomiting
- (illness and stress increase insulin requirements)
What happens with treatment of hyperthyroidism?
- (ablation, radiation, thyroidectomy, adenectomy)
- *makes pt hypothyroid and they need DAILY hormone replacement
Labs indicating hyperthyroidism.
- T3 > 220
- T4 > 12
- decreased TSH = primary disease
- increased TSH = anterior pituitary problem
What is Thyroid Storm?
sudden oversecretion of TSH due to Grave's
Signs of thyroid storm?
Recommended diet for hyperthyroidism.
- high calorie, high protein
- low caffeine
- low fiber (if diarrhea)
What is the possibility with a post-op thyroidectomy?
What should you keep at the bedside post-op thyroidectomy?
- tracheostomy set
- keep nearby = O2, suction, calcium gluconate
- (possibility of laryngeal edema)
What would hoarseness or inability to speak clearly after a thyroidectomy indicate?
What is the best indicator of parathyroid problems after thyroidectomy?
decreased Ca++ levels compared to pre-op
What is increased if two or more parathyroid glands are removed?
increased chance of TETANY
How do you assess for tetany after thyroidectomy?
- monitor Ca++ levels
- tingling in fingers, toes, mouth
- chvostek sign
- trousseau sign
s/s of myxedema coma.
- respiratory failure
What type of diet is recommended for hypothyroidism?
What brings on an Addison crisis?
- sudden w/d of steroids
- stressful event (trauma, severe infection)
- exposure to cold
- decrease in Na+ intake
What are important nursing interventions for Addison crisis pts?
- monitor vitals q 15 min
- administer IV glucose w/ hydrocortisone
What happens if a pt w/ Addison disease is untreated?
it is fatal!
What test is done for Addison diagnosis?
What causes secondary Addison disease?
When ACTH production by anterior pituitary fails
s/s of Addison disease (not labs).
- fatigue, weakness
- wt loss, anorexia, N/V
- postural hypotension
- body hair loss
- hyperpigmentation of mucous membranes & skin (primary only)
Labs indicative of Addison disease.
What encompasses hypovolemia (s/s of addison)?
What is it important to protect AD pts from?
- noise, light, extreme temp
- (keep it low stress)
What type of diet is important for AD pts?
- high sodium & complex carbs
- low potassium
- increase fluids to 3 or more L per day
Signs of Addison crisis.
- signs of shock
- -hypovolemia/vascular collapse (decreased BP, increased HR, fever)
- loss of body hair
Nursing interventions for Addison crisis.
- vitals q 15 min
- IV glucose w/ parenteral hydrocortisone
What is administered for aldosterone replacement?
- fludrocotisone acetate (Florinef) *PO ONLY*
- with simultaneous admin of NaCl (if deficit)
What is usually the cause of Cushing syndrome?
chronic steroid use
Physical signs of Cushings.
- moon face, buffalo hump, truncal obesity amenorrhea, hurstuism (females)
- edema, poor wound healing
- easily bruise
S/S of Cushings (not physical).
- peptic ulcers
- increased cortisol
- decreased WBC (eosin & lymph)
Big thing we need to protect Cushing pts from.
- (fever, candida in mouth, vag yeast, adv lung sounds)
Diet for Cushing syndrome pt.
- low Na+
- increase vitamin D & Ca++ intake
What are the four ways to diagnose DM?
- fasting PGL > or = 126
- HbA1c > or = 6.5%
- random BGL > or = 200 w/ hyperglycemia symptoms
- oral glucose tolerance > 200
How is prediabetes diagnosed?
- fasting BGL 100-125 or
- HbA1c 5.7% - 6.4%
Patients with DM type ____ can easily become hyperglycemic and ketosis-prone.
S/S of DKA
- BGL > or = 250
- lg amts ketonuria
- arterial pH <7.3 & HC03 <15
- Kussmauls respirations
- acetone odor on breath
- N/V, dehydration, abdom pain
Treatment for DKA.
isotonic IV fluids until BP is stable & UOP = 30-60 mL/hr
Extreme hyperglycemia in type 2 DM pts can cause?
- BGL >600
- change in mental status
- no ketones
Treatment for HHNKS.
- isotonic IV fluids
- monitor K+ & glucose closely
- IV insulin until BGL is stable at 250
What is hair loss on extremities (DM) indicative of?
Treatment for hyperglycemia.
- increase water intake
- check BGL often
- assess for ketoacidosis (ketones & glucose in urine)
- administer insulin as directed
Treatment for hypoglycemia.
- *Can be life threatening quickly!!*
- immediately give complex carbs
- check BGL
What may happen to a DM pt when BGL < 40?
What diagnostic test is used to determine thyroid activity?
What condition results from all treatments for hyperthyroidism?
hypothyroidism (requires replacement therapy)
Symptoms of hyperthyroidism.
- wt loss
- heat intolerance
Symptoms of hypothyroidism.
- cold intolerance
- wt gain
Important teaching aspects for pts beginning corticosteroids.
- monitor serum K+, glucose, Na+ often
- weigh daily
- report wt gain > 5 lbs/wk
- monitor BP & HR closely
- teach symptoms of Cushing syndrome
Symptoms of hyperglycemia.
- wt loss
Symptoms of hypoglycemia.
- tremors or shakes
Peak axn time of rapid-acting regular insulin, intermediate, & long-acting insulin.
- rapid = 2-4 hrs
- immediate = 6-12 hrs
- long = 14-20 hrs