Adult Health I - Endocrine

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MeganM
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276457
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Adult Health I - Endocrine
Updated:
2014-06-12 20:18:16
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DM
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AH - DM
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  1. 3 p's for hyperglycemia
    • polyuria
    • polydipsia
    • polyphagia
  2. Precipitating factors for DKA
    • infection
    • inadequate or undermanagement of glucose
  3. 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
  4. Insulin that can be given IV.
    Regular insulin
  5. 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?
    expect hyperglycemia
  6. Difference b/w HHNS and DKA?
    tend to avoid the decrease in pH and ketosis
  7. Too rapid infusion of insulin to lower BGL can lead to ?
    cerebral edema
  8. If in doubt whether a client is hyperglycemic or hypoglycemic, treat for?
    hypoglycemic
  9. What is the earliest sign of diabetic nephropathy and indicates the need for follow-up evaluation?
    Microalbuminuria
  10. Continuous IV infusion of magnesium can cause?
    hypotension
  11. 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.
  12. Clients with primary aldosteronism exhibit a profound decline in serum levels of ________.
    potassium
  13. Where is aldosterone secreted from?
    adrenal cortex
  14. When should Levothyroxine be taken/administered?
    in the morning before breakfast to increase absorption
  15. 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
  16. How does hyperparathyroidism happen?
    • oversecretion due to parathyroid tumor or
    • response to hypocalcemia
  17. How should a diabetic pt prevent DKA during an acute infection?
    • stop taking insulin if vomiting
    • (illness and stress increase insulin requirements)
  18. What happens with treatment of hyperthyroidism?
    • (ablation, radiation, thyroidectomy, adenectomy)
    • *makes pt hypothyroid and they need DAILY hormone replacement
  19. Labs indicating hyperthyroidism.
    • T3 > 220
    • T4 > 12
    • decreased TSH = primary disease
    • increased TSH = anterior pituitary problem
  20. What is Thyroid Storm?
    sudden oversecretion of TSH due to Grave's
  21. Signs of thyroid storm?
    • fever
    • tachycardia
    • agitation
    • anxiety
    • HTN
  22. Recommended diet for hyperthyroidism.
    • high calorie, high protein
    • low caffeine
    • low fiber (if diarrhea)
  23. What is the possibility with a post-op thyroidectomy?
    laryngeal edema
  24. What should you keep at the bedside post-op thyroidectomy?
    • tracheostomy set
    • keep nearby = O2, suction, calcium gluconate
    • (possibility of laryngeal edema)
  25. What would hoarseness or inability to speak clearly after a thyroidectomy indicate?
    laryngeal damage
  26. What is the best indicator of parathyroid problems after thyroidectomy?
    decreased Ca++ levels compared to pre-op
  27. What is increased if two or more parathyroid glands are removed?
    increased chance of TETANY
  28. How do you assess for tetany after thyroidectomy?
    • monitor Ca++ levels
    • tingling in fingers, toes, mouth
    • chvostek sign
    • trousseau sign
  29. s/s of myxedema coma.
    • hypotension
    • hypothermia
    • hyponatremia
    • hypoglycemia
    • respiratory failure
  30. What type of diet is recommended for hypothyroidism?
    high fiber
  31. What brings on an Addison crisis?
    • sudden w/d of steroids
    • stressful event (trauma, severe infection)
    • exposure to cold
    • overexertion
    • decrease in Na+ intake
  32. What are important nursing interventions for Addison crisis pts?
    • monitor vitals q 15 min
    • administer IV glucose w/ hydrocortisone
  33. What happens if a pt w/ Addison disease is untreated?
    it is fatal!
  34. What test is done for Addison diagnosis?
    ACTH
  35. What causes secondary Addison disease?
    When ACTH production by anterior pituitary fails
  36. s/s of Addison disease (not labs).
    • fatigue, weakness
    • wt loss, anorexia, N/V
    • postural hypotension
    • body hair loss
    • hypovolemia 
    • hyperpigmentation of mucous membranes & skin (primary only)
  37. Labs indicative of Addison disease.
    • hypoglycemia
    • hyponatremia
    • hypERkalemia
  38. What encompasses hypovolemia (s/s of addison)?
    • hypotension
    • tachycardia
    • fever
  39. What is it important to protect AD pts from?
    • noise, light, extreme temp
    • (keep it low stress)
  40. What type of diet is important for AD pts?
    • high sodium & complex carbs
    • low potassium
    • increase fluids to 3 or more L per day
  41. Signs of Addison crisis.
    • signs of shock
    •     -hypovolemia/vascular collapse (decreased BP, increased HR,   fever)
    • loss of body hair
    • hypoglycemia
  42. Nursing interventions for Addison crisis.
    • vitals q 15 min
    • IV glucose w/ parenteral hydrocortisone
  43. What is administered for aldosterone replacement?
    • fludrocotisone acetate (Florinef) *PO ONLY* 
    • with simultaneous admin of NaCl (if deficit)
  44. What is usually the cause of Cushing syndrome?
    chronic steroid use
  45. Physical signs of Cushings.
    • moon face, buffalo hump, truncal obesity amenorrhea, hurstuism (females)
    • edema, poor wound healing
    • impotence
    • easily bruise
  46. S/S of Cushings (not physical).
    • HTN
    • osteoporosis
    • peptic ulcers
    • hyperglycemia
    • hypernatremia
    • hypokalemia
    • increased cortisol
    • decreased WBC (eosin & lymph)
  47. Big thing we need to protect Cushing pts from.
    • infection
    • (fever, candida in mouth, vag yeast, adv lung sounds)
  48. Diet for Cushing syndrome pt.
    • low Na+
    • increase vitamin D & Ca++ intake
  49. 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
  50. How is prediabetes diagnosed?
    • fasting BGL 100-125 or
    • HbA1c 5.7% - 6.4%
  51. Patients with DM type ____ can easily become hyperglycemic and ketosis-prone.
    type 1
  52. 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
  53. Treatment for DKA.
    isotonic IV fluids until BP is stable & UOP =    30-60 mL/hr
  54. Extreme hyperglycemia in type 2 DM pts can cause?
    HHNKS
  55. S/S HHNKS.
    • BGL >600
    • dehydration
    • change in mental status
    • no ketones
  56. Treatment for HHNKS.
    • isotonic IV fluids
    • monitor K+ & glucose closely
    • IV insulin until BGL is stable at 250
  57. What is hair loss on extremities (DM) indicative of?
    poor perfusion
  58. Treatment for hyperglycemia.
    • increase water intake
    • check BGL often
    • assess for ketoacidosis (ketones & glucose in urine)
    • administer insulin as directed
  59. Treatment for hypoglycemia.
    • *Can be life threatening quickly!!*
    • immediately give complex carbs
    • check BGL
  60. What may happen to a DM pt when BGL < 40?
    seizure
  61. What diagnostic test is used to determine thyroid activity?
    T3, T4
  62. What condition results from all treatments for hyperthyroidism?
    hypothyroidism (requires replacement therapy)
  63. Symptoms of hyperthyroidism.
    • wt loss
    • heat intolerance
    • diarrhea
  64. Symptoms of hypothyroidism.
    • fatigue
    • cold intolerance
    • wt gain
  65. 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
  66. Symptoms of hyperglycemia.
    • polydipsia
    • polyuria
    • polyphagia
    • weakness
    • wt loss
  67. Symptoms of hypoglycemia.
    • hunger
    • lethargy
    • confusion
    • tremors or shakes
    • sweating
  68. Peak axn time of rapid-acting regular insulin, intermediate, & long-acting insulin.
    • rapid = 2-4 hrs
    • immediate = 6-12 hrs
    • long = 14-20 hrs

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