1750: Metabolism 1 EXAM III

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1750: Metabolism 1 EXAM III
2015-05-18 00:45:14

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  1. Pituitary Gland aka: hypophysis.

    Anterior portion releases which hormones?

    Which disorders are present from having too much or too little thyroid hormone?
    FSH, LH, prolactin,*ACTH, *TSH, *GH

    Hyper: *Cushing, gigantism, acromegaly

    Hypo: dwarfism, panhypopituitarism
  2. Pituitary Gland aka: hypophysis.

    Posterior portion of Pituitary gland..

    Which hormones are released?
    *ADH/vasopression, Oxytocin

    Hyper: SIADH

    Hypo: DI (decreased ADH=large urine output)

    Tumors: 95% benign

    Surgery: hypophysectomy
  3. What is DI (diabetes insipidus)? what happens..

    what is the tx?
    Decreased ADH/vasopressin produced = LARGE volumes of dilute urine excreted (>250mL/h)

    Specific gravity of urine <1.005

    Tx: Desmopressin (DDAVP)
  4. What is SIADH (syndrome of inappropriate antidiuretic hormone)?

    What happens (s/sx) and what are some interventions?
    Excessive ADH secretion = holding onto fluids

    Restrict fluid intake

    Concentrated urine

    Monitor I/O
  5. What does "ADrenocortical Insufficiency" (decreased cortisol production from adrenal glands) cause (disorder)?

    What symptom presents w/ Addisonian crisis (electrolyte imbalances)?

    What is a Dx test used?
    ADdison's Disease: adrenal suppressed d/t exogenous steroid use.

    Addisonian crisis: dark pigmentation of skin & mucosa; decreased Na+, increased K+

    Dx test: ACTH levels.
  6. What are some nursing dx for Addison's Disease?
    • —Risk for FVD: monitor for s/sx of FVD;
    • encourage fluids and foods; select foods high in sodium; administer hormone
    • replacement as prescribed.

    • —Activity intolerance:
    • avoid stress and activity until stable, reduce anxiety
  7. What is the cause of Cushing Syndrome?

    What are the 2 major sx?

    Electrolyte imbalance?

    What is the Dx test?
    Excessive adrenocortical activity or corticosteroid medications

    Hyperglycemia w/ *"BUFFALO HUMP", heavy trunk & thin extremities, fragile, muscle wasting,*MOON FACE.

    Dx: —Dexamethasone suppression test
  8. Cushing Syndrome: assessment; what should you assess?
    • Activity level; self-care
    • Skin assessment
    • Changes in physical —appearance & patient responses to these changes
    • Mental function
    • Emotional status
    • Medications
  9. What should you teach the Pt with steroid use? 

    Corticosteroid Therapy
    —Patient education: refer to Table 52-5

    —Timing of doses

    • —Need to take as prescribed, TAPER OFF
    • required to d/c or reduce therapy

    —Potential SFX & measures to reduce SFX.
  10. Islets of Langerhans.

    (alpha cells/beta cells)

    What are the primary functions of alpha cells?
    • Alpha cells:
    • —Produce glucagon

    —Aids in breakdown of glycogen in liver, formation of CHO in liver, breakdown of lipids

    • —Primary function:
    • Decrease glucose, oxygenation and increase blood glucose level.
  11. Islets of Langerhans.

    (alpha cells/beta cells)

    What are the primary functions of beta cells?

    What is the function of Somatostatin?
    • —Produce insulin:
    • aids in movement of glucose across cell membranes; leads to decreased
    • serum blood glucose level

    —Insulin level increases when BG level increases

    • —Somatostatin (NT):
    • Inhibits production of glucagon and insulin
    • Blood glucose homeostasis
  12. Functions of Insulin
    —Transports and metabolizes glucose for energy

    —Stimulates storage of glucose in the liver and muscle as glycogen

    —Signals the liver to stop the release of glucose

    —Enhances storage of fat in adipose tissue

    —Accelerates transport of AA into cells

    —Inhibits the breakdown of stored glucose, protein, and fat
  13. What is Type I Diabetes?

    Does it require insulin?

    Onset (age)?
    —Insulin-producing beta cells in the pancreas are destroyed by an autoimmune process

    —Requires insulin because little or no insulin is produced

    —Onset is acute and usually before 30 years of age

    —5% - 10% of persons with diabetes
  14. What is Type II diabetes?

    Onset (age)?

    What is the initial tx (non-pharm)?
    insulin resistance & impaired beta cell function results in decreased insulin production

    —90% - 95% of person with diabetes, onset >30 yo, increasing in children, obesity

    —Slow, progressive glucose intolerance

    —Treated initially with diet/exercise (more so about the use of sugar)

    —Oral hypoglycemic agents initially may need to convert to insulin or use both (*only Type II)
  15. What are some risk factors for type I/II diabetes?
    • T1:
    • early onset
    • genetics
    • environment factors

    • TII:
    • obesity
    • age
    • previous identified impaired fasting glucose HTN: > or equal to 140/90 mm Hg
    • HDL < or = to 35 mg/dL 
    • Triglycerides > = to 250 mg/dL
    • Hx of gestational diabetes or babies >9 lbs.
  16. Clinical Manifestations of diabetes.

    What are the 3 sx (P's)?

    What are some s/sx?
    Polyuria, Polyphagia, Polydipsia

    • Sx:
    • fatigue, weakness, vision changes, tingling&numbness, wounds slow to heal, recurrent infections
  17. Clinical Manifestations of diabetes.

    What are some more severe sx?
    • Hyperglycemia
    • Ketosis (DKA)
    • Glucosuria
  18. Diagnostic Findings: (diabetes)

    What is the FBG value that will indicate diabetes?

    Hgb A1C: what does it reflect (glycosylated-hemoglobin; higher levels mean @ risk for diabetes P/C).
    >126 mg/dL

    Hgb A1C: reflects your avg BG level for the past 2-3 months. Specifically, the A1C test measures what % of your Hgb — a protein in RBCs that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.
  19. What is the Tx goal for maintaining BG levels (Hgb A1C: <7%)?
    • —Intensive control, defined as 3-4 insulin injections per day
    • Continuous subQ insulin infusion, insulin pump therapy + frequent blood glucose monitoring,
    • Weekly contacts with diabetic educators dramatically decreases development and progression of complications such as retinopathy, nephropathy, and neuropathy.
  20. What are some "meal planning" goals for Pts w/ diabetes?

    (amt % of carbs, fats, proteins, fiber)
    —Carbs: 50% - 60%; emphasize whole grains

    —Fat: 20% - 30%, with >10% from saturated fat and <300 mg cholesterol; protein: 10% to 20%

    —Fiber: 25 g/daily; refer to Table 51-2
  21. What is the purpose of the glycemic index?
    a diet to eat carb-containing foods that are less likely to cause large increases in BG levels.

    It is used to guide food choices.
  22. Insulin Therapy

    What are the categories of insulin therapy? (table 51-3, p. 1428)
    —Rapid acting-NovoLog (acts in 5 min/lasts 2-4h)

    —Short acting-Novolin (acts 1h/lasts 4-6h)

    —Intermediate acting-NPH (2-4h/16h)

    —Very long acting-Lantus (1 dose/24 hours)
  23. Which insulin has a "cloudy" appearance?

    What is the rule of thumb?

    Can you mix very long-acting insulin (Lantis) w/ others?
    NPH is cloudy.

    "air into cloudy, air into clear; draw up clear, draw up cloudy"

    Always, draw "clear before cloudy" insulin into the syringe.
  24. Educating Pts in insulin self-management.
    —Use and action of insulin

    —Sx of hypoglycemia & hyperglycemia

    —Required actions

    —Blood glucose monitoring

    —Self-injection of insulin

    —Insulin pump use
  25. What are some "complications" of diabetes?

    Dawn Effect, what is it (BG)?

    Which type does it occur?
    —Rise in BG between 4 am - 8 am

    —Not a response to hypoglycemia

    —Occurs with both TI & TII

    —Cause unknown

    —Growth hormone?
  26. What are some "complications" of diabetes?

    Somogyi Phenomenon, what is it?
    —Nighttime hypoglycemia with rebound morning hyperglycemia

    —Gluconeogenesis and glycogenolysis occurs and decreases peripheral glucose use

    —May lead to insulin resistance for 12-48 hours
  27. What are some "complications" of diabetes?


    Most common in which type I or II?
    —Common in type 1 DM

    —Insulin reaction

    —Intake of alcohol, drugs can cause


    —Compensatory ANS response

    —Hypoglycemic unawareness

    l-fill-alpha:100.0%'>Insulin pump use
  28. Treatment for Hypoglycemia.

    At what "BG reading" should someone be hospitalized for hypoglycemia?
    —15 g of rapid-acting sugar

    • —Hospitalized if: 
    • Blood glucose <50 mg/dL
    • —Coma, seizures
    • —Altered behaviors
    • —Caused by sulfonylurea drug
  29. Diabetes Mgmt monitoring.

    What range should "normal" FBG be?
    FBG: 70-110 mg/dL
  30. Emgergency measures.

    What should you administer under emergency conditions?

    What if the Pt had a BG of 50 mg/dL?
    When should IV or IM be used?
    subQ or IM glucagon (1mg); 25-50 mL 50% DW IV

    If 50 mg/dL, then give half cup of soda/juice. If unconscious, give glucagon or IV.
  31. What is diabetic ketoacidosis (DKA)?

    Is the person experiencing hyper or hypoglycemia?
    • —Absence or inadequate amount of insulin resulting in abnormal metabolism of
    • CHO, protein, and fat.

  32. What are some s/sx of DKA?
    • Acetone breath
    • dehydration
    • ketones in urine/blood
    • hyperglycemia
    • kussmaul respirations (rapid, deep breathing)
    • decreased HCO3-, PCO2, pH, met. acidosis
  33. What is the Tx for DKA?
    —Rehydration w/ IV fluid: 8-10 L of 0.9% or 0.45% saline

    —IV continuous infusion of regular insulin

    —Reverse acidosis and restore electrolyte balance