The control of fluid balance is managed by what 4 things?
1. The thirst mechanism
2. ADH, causes reabsorption of water from the kidneys
3. Aldosterone and atrial natriuretic peptide, (ANP), regulaters the reabsorption of water and sodium ions from the kidney tubules
4. Baroreceptors in the carotid sinus and aortic arch, which detect pressure changes.
The Intracellular fluid is high in what?
Potassium K+
The Extracellular Fluid is high in what?
Sodium Na+
This is fluid within the blood vessels. Consist of plasma, contain large amounts of protein and electrolytes
Intravascular Fluid
Fluid in the spaces surrounding the cells. High in Na+. Example Lymph.
Intersitial Fluid
Fluid in the aqueous humor, saliva, and CSF.
Transcellular Fluid
How much water is in Fat Cells?
None
When substances move from a higer concentration to lower concentration until they are evenly distributed. This is possible due to kenetic motion. Glucose, carbon dioxide, water, and other small ions and molecules move by this.
Diffusion
The movement of pure solvent (liquid) across the membrane. Goes from area of low concentration to high concentration.
Osmosis
Equal solute concentration
Isotonic
Greater solute concentration
Hypertonic
Lesser solute concentration
Hypotonic
Active transport requires what
ATP/ Energy
Pt ubalble to take in sufficient quanities of fluid because of impaired swallowing, extreme weakness, disorientation or coma, or the unavailability of water are at risk for
Deficient Fluid Volume
Pt who lose excessive amounts of fluids through prolonged vomiting, diarrhea, hemorrhage, diaphoresis (sweating), excessive wound drainage, or diuretic therapy are at risk for
Deficiet Fluild Volume
Pt. is presented with signs of THIRST, poor skin turgor, weight loss, weakness, postural hypotension, decreased urine production, dark concentrated urine, dry mucous membranes, rapid weak thready pulse, you would expect the Dr. to Dx this pt. with
Dehydration
Pt present with weight gain, slow bounding pulse, elevated BP, crackles in lungs, decreased serum sodium, firm SubQ tissue, you would expect the Dr. to Dx this pt with
Overhydration
What is the most accurate measure of fluid gain or loss for any age group
Weight
The pt is Dx with fluid volume deficit what would you want to push to restore the fluid deficit
Water and Electrolytes
Prolonged vomiting can lead to what deficits
Na+
K+
Metabolic Acidosis
What is the biggest loss of K+
Diarrhea
What does excessive fluid volume due to BP
Jacks it up
Discuss the tx for Excessive Fluid Volume
Bedrest
HOB up
O2 and Pulse Ox
Daily Wt
I & O
Fluid Restriction
Na+ restriction in diet
What is the danger of Lasix?
6hr Non-K+ sparing Diuretic
The normal range for this is 135-145 mEq/L
This is a major ation of the Extracellular Fluid
Na+
The normal range for this is 3.5-5.0 mEq/L
Major intracellular cation
K+
Alot of fluid intake will do what to Na+ levels
Decrease
No fluid intake will do what to Na+ levels in the body?
Increase
Normal range is 21.5-4.5 mEq/L
Necessary for the formation of ATP
Phosphate PO4-
The normal range is 8.4 - 10.6 mg/dL
Necessary for Nerve transmission
Ca+
The normal range is 96-106 mEq/L
Help maintain acid-base balance.
Chloride Cl-
Normal Range is 1.3-2.5 mEq/L
Magnesium
The pH of body fluids is slightly
Alkaline 7.35-7.45
Name the 3 mechanisms that contal or try to rebalance pH
1. Buffer pairs
2. The respiratory system
3. The kidneys
What does hyperventilation result in?
Respiratory Alkalosis
What follows loss of hydrochloric acid from the stomach?
Metabolic Acidosis
A 28 yr old pt weighs 160 lbs. The pt body fluids account for about?
D. 80 lbs
In terms of planning for a pt body fluid needs the LPN should understand that throughout the life span, there is:
A gradual decline in body water
The componet of body fluid that provieds transportation of nutrients and waste products is:
A. Water
To plan care for a pt who has edema the LPN must know that the most important electrolyte in the retention of water in the body tissues is:
D. Na+
A pt is to be given aniemetic. The major side effects of antiemetics include:
A. oversedation and hypotension
What of the measures should be included in the care of a pt with severe vomiting and diarrhea?
D. Correcting potassium deficit
A pt is on a low Na+ diet. Which of the following foods are allowed on a low-sodium diet.
D. Frest Fruit
The pt has a blood pH of 7.45, which is considered
slightly alkaline
A pt lungs must be well ventilated because hypoventiliation of the lungs results in:
C. acidosis due to decreased elimination of CO2.
When a pt has vomiting, diuresis with K+ loss, or interinal fistulae, this can lead to :
D. alkalosis from excessive loss of acids
A pt is to have an infustion of an isotonic solution, which is one that has:
B. the same osmotic pressure as that of body fluids.
When a pt recieves a hypotonic solution IV. The LPN should expect the pt to receive:
D. The cells begin to swell as water enters the intracellular compartment
A pt. has a nursing diagnosis of Deficient fluid volume R/T vomiting and diarrhea. Which of the following measures is most likely to be implemented to correct this stituation:
B. IV therapy
A pt is instructed to eat foods high in K+, which include:
B. bananas
A 54 year old pt has been admitted to the unit with a K+ level of 2.6 mEq/L. The nurse would anticipate Mr. Hernandez to exhibit:
A. Muscle faccidity
A pt with Cushing disease will most likely exhibit signs and symptoms of
A. hypernatremia, pt retains sodium and water
Which of the following pt is most at risk for fluid volume overload?
A. a 35 year old with renal disease
A pt with a diagnosis of DM in metabolic acidosis has a blood glucose level of 250 mg/dl and has been admitted to your unit. Which symptom is most likely to accompany ketoacidosis:
A. Polydipsia
List 3 tx or nursing measures that can lead to water intoxication:
1. IV fluids too quickly
2. Given water tap enemas
3. Drink too much water and can't eliminate properly
What hormones are secreted by the Thyroid Gland?
T3
T4
Calcitonin
Intake of what is needed for the thyroid to secrete its hormones
Iodine and Protein
What is the most important day to day regulator of the metabolic rate?
Thyroid
What is the function of hte Parathyroid gland?
Secretes parathormone
A low calcium level will stimulate the secretion of ?, which increases the plasma level of calcium
parathormone
What is the most important regulator of blood calcium levels?
Parathormone
What 2 hormones are secreted by the adrenal medulla?
Epinephrine and Norepinephrine
Name the 3 hormones secreted by the adrenal cortex.
1. Mineralcorticoids
2. Glucocorticoids
3. Gonadocorticoids
The mineralcorticoids affect what 3 things
1. Sodium
2. Potassium
3. Chloride
The cheif mineralocorticoid is
Aldosterone
This hormone promotes conservation of water by acting on the kidneys to retain sodium in exchange for potassium
Aldosterone
The glucocorticoids are essential for proper utilization of what 3 things
Carbs
Protein
Fats
The primary glucocorticoid is what
Cortisol
What does cortisol do to glucose levels in the blood
Increases
Both aldosterone and cortisol are controlled by
ATCH
The pancreas secretes what
Insulin
What cells secrete insulin
Beta
What cells secrete glucagon
Alpha
This is needed for the cells of the body to be able to utilize glucose as fuel
Insulin
What are 5 affects of aging on the Endocrine System?
1. Pit is smaller
2. Thyroid becomes lumpy, metabolism declines
3. Blood glucose levels rise
4. Older adults experience hypoglycemia more quickly
5. Immune system
What 4 things may effect the result of a Serum T3, Serum T4 and TSH Test?
1. Asprin
2. Iodine containing meds
3. Contrast Media
4. Other meds
What pt teaching should you given when you are doing a Radioactive Iodine Uptake or Thyroid Scan test?
1. Must not be pregnant or lactating
2. Radiacitve iodine is small
3. 24hr specimen if required
If a RAIU detects a Hot spot you could expect to tell the pt that they have a:
Non Malignant Nodule
If a RAIU detects a "Cold Spot" then you could expect to tell the pt:
That they found a Malignant Nodule
What test determines the degree of Diabetic control of blood sugar over the preceding 6-8 wks
Glycosylated Hemoglobin or HbA1C
What hormones are secreted by the Anterior Pituitary?
GH
TSH
ACTH
FSH
LH
Prolactin
The adenohypophysis is also known as
Anterior Pit
The target tissue is most tissues in the body
The principal action is it stimulates growth by promoting protein synthesis
WHAT IS THE HORMONE
Growth Hormone
The target tissue is Thyroid Gland
The principal action is to increase secretion of thyroid hormone and increases the size of the thyroid gland
WHAT IS THIS HORMONE
TSH
The target tissue is Adrenal Cortex
The principal action is to increase the secretion of the adrenocortical hormones
WHAT IS THE HORMONE
ATCH
The target tissue is Ovarian Follicles in female, and Seminiferous tubules in Males
The principal action is follicle maturation (ova) and estrogen in the female, and sprematogenesis in the male
WHAT IS THE HORMONE
FSH
The target tissue is Ovary in the females, and Testes in the Male
The principal action is Ovulation, progesterone production in females, and Testosterone production in Males
WHAT IS THE HORMONE
LH
The target tissue is mammary gland
The principal action is to stimmulates milk production
WHAT IS THE HORMONE
Prolactin
What are the 2 hormones stored in the Posterior Pituitary Gland, and synthesized in the Hypothalamus?
ADH
Oxytocin
What is the neruohypophysis also known as
Posteior Pituitary
The target tissue is Kidneys
The principal action is to increase water reabsorption (decreases water loss in urine)
Osmoreceptors detect increase in Na+ which send for signal to secrete....
WHAT IS THE HORMONE
ADH
The target tissue is Uterus; mammary gland
The principal action is to increase uterine contractions; stimulates ejection of milk from mammary gland
Let Down Reflex
WHAT IS THE HORMONE
Oxytocin
What 3 hormones does the thyroid secrete
T3
T4
Calcitonin
The target tissue is most body cells
The principal action is to increase meatbolic rate
WHAT ARE THE 2 HORMONES
T3
T4
The target tissue is Primarly Bone
The principal action is to decrease bone calcium by inhibiting bone breakdown and release of calcium
WHAT IS THE HORMONE
Calcitonin
What hormone does the parathyroid secrete
parathormone
The target tissue is bone, kidney, digestive tract
The principal action is to increase blood calcium by stimulation bone breakdown and release of calcium; increases calcium absorption in the digestive tract
WHAT IS THE HORMONE
Parathormone
What hormones does the adrenal cortex secrete
Mineralocorticoids
Glucocorticoids
Gonadocorticoids
The target tissue is Kidney
The principal action is to increase Na+ reaborption and K+ excretion in kidney tubules, Increase water retension
WHAT IS THE HORMONE
Aldosterone
The target tissue is most body tissues, and the Liver
The principal action is to increase blood glucose levels; inhibits inflammation and immune responses
WHAT IS THE HORMONE
Cortisol
The target tissue is Heart, Blood vessels, liver and adipose
The principal function is to help cope with stress, increases ht rt. and BP
WHAT ARE THE 2 HORMONES
Epi and Norepi
The target tissue is liver
The principal action is to increase breakdown of glycogen ot increase blood glucose levles
WHAT IS THE HORMONE
Glucagon
The target tissue is general, but especially liver, skeletal muscles, adipose
The principal action is to decrease blood glucose level by facilitating uptake and utilization of glucose by cells
WHAT IS THE HORMONE
Insulin
The Pineal gland secretes what
Melatonin
The target tissue is Hypothalamus
The principal action it to inhibit gonadotropins-releasing hormone, regulates daily rhythms
WHAT IS THE HORMONE
Melatonin
What does the thymus secreted
Thymosin
The target tissue is tissues involved in the immune response
The principal action is to delvelop the immune system
WHAT IS THE HORMONE
Thymosin
What is the tempurature regulator
Hypothalamus
A pt is admitted to the hospital with a suspected diagnosis of hyperthyroidism. She asks you about the throid scan for which she is scheduled this morning. You should tell her that the test is done to:
B. detect abnormal areas of growth or tissue in the thyroid
Three of the following are signs or symptoms of hyperthyroidism. Which one is not?
C. mental sluggishness
Immediately after a pt has a thyroidectomy, the pt should be placed in which of the following positions?
A. Fowler's
During the immediate postoperative period, a pt who has had a thyroidectomy should be watched for:
C. edema, hoarness, and increase in VS
Muscular twitching and cramps in the muscles following thyroidectomy may indicate:
B. damage to the parathyroid glands during surgery
In the postoperative period, you should observe a pt who has had a thyroidectomy for evidence of thyroid crisis. Two common signs of thyroid crisis are:
B. extreme temperature elevation and rapid pulse rate
The LPN can expect thyroid crisis to be tx by:
A. reducing the body temperature and lowering the pulse rate
When you evaluate the tx of a hyperthyroid pt who has received oral radioactive iodine, the pt describes bieng very tired and lethargic. You should know that this indicates that:
D. the treatment is working
A 42 year old pt complains that she has been losing a lot of her hair, is fatigued, and is cold all the time. You should recognize that these symptoms are indicative of:
A. Hypothyroidism
A pt is dx as having Addison's Disease. This condition is the result of :
B. insufficiencies of the mineralocorticoids and glucocorticoids
In addition to generalized malaise and muslce weakness, three of the following symptoms are also common when a pt has Addison's disease. Which one in not a symptom:
B. Headache
When caring for a pt with Addison's disease, you should observe for and report which of the following findings?
D. a sudden drop in BP
Three of the following are symptoms of Cushings syndrome. Which one is not?
B. Hypotension
When doing a discharge teaching for a pt with Addison's disease, you should explain to the pt that getting an infection may:
B. precipitate crisis
A pt has DI. You should anticipate giving which of the follwoing drugs:
B. Pitressin
A pt who has hyperthyroidism has a nursing diagnosis of "anxiety R/t nervousness and agitation. Because of this nursing diagnosis, which of the following interventions should be included in the pt's care?
B. keeping the environmental stimuli to a minimum
If a pt has hypoparathyroidism, the pt's chief symptoms is likely to be:
A. tetany
Aldosterone's major function is to:
D. conserve water and sodium in the body
A pt is at risk for developing osteoporosis if she is producing abnormal:
B. calcitonin
A pt is admitted with a suspected endocrine disorder. His symptoms include changes in blood glucose levles, weakness, and irritability. Diagnostic procedures to determine etiology of the problem would include:
B. lab studies
A pt with deficiency of which of the following hormones will exhibit symptoms of DI?
a. insulin
b. glucagon
c. estrogen
d. ADH
D. ADH
When a pt has alterations in serum Ca+ and PO4-, which of the following is dysfunctional?
C. parathyroid
The nurse would monitor a pt for signs and symptoms of glucose intolerance when a pt is dx with which of the following disorders? (select all that apply)
a. acromegaly
b. cushings syndrome
c. pheochromocytoma
d. graves disease
b. cushings
c. pheochromocytoma
A pt is scheduled for thyroid function tests in the morning. Pt preparation for the diagnostic procedure includes: (select all that apply)
a. keeping the pt NPO after Midnight
b. asking the pt if she has recently eaten shrimp or clams
c. explaining to the pt that the dose of radioactivity she will be exposed to during the test is very small
d. ascertaining if the pt is claustrophobic
e. instructing her to discard her first mornings urine
b and C
A pt is dx with a thyroid disorder. You should anticipate that the pt is mostly likely to have problems with:
C. metabolic rate
The dr orders a dexamethasone suppression test to assist in the dx of cushings syndrome. An appropriate nursing action would be to:
B. check orders for drugs to withheld
Which of the following is at greatest risk for injury related to bone fracture:
D. pt with a parathyroid disorder
This tumor secretes GH leading to continued growth of bones and soft tissue
Tumor of the pituitary usually a genign pituitary adenoma.
Excessive secretion of GH caused what in children
Gigantism
Excessive secretion of GH in adults
Acromegaly
What is tx for a pituitary tumor
Hormone Therapy
Removal of the pituitary gland
Hypophysectomy
A post op hypophysectomy pt is kept in what position
Semi Fowlers
A rare disorder characterized by a decrease in the level of one or more pituitary hormones
hypofunction of the pit gland
What is the most common cause of pituitary hypofunction
Tumor
What is used to replace GH
Somatropin via SubQ Injection
Decreased muscle mass, pathologic fractures is shown in what diminished hormone secretion
GH
Menstrual irregularities, diminished libido, decreased breast size, testicular atrophy, impotence, decreased facial hair is shown when what hormone diminishes
FSH
LH
Weakness, fatigue, headache, postural hypotension, decreased tolerance for stress, susceptibility to infection is shown when which hormones are diminished
ACTH
Cortisol
Cold intolerance, constipation, fatigue, lethargy, weigh gain is shown when which hormone is diminished
Thryoid
Your pt is experiencing profound diuresis, thirst, weakness, fatigue from nocturia, wt loss, and poor skin turgor. What do you expect the dr to dx this pt with
DI
List the 3 primary mechanisms of DI:
1. Central DI
2. Nephrogenic DI
3. Dispogenic DI
This mechanism of DI is associated with brain tumors, and head injury
Central
This mechanism of DI is caused by drug therpay or kidney disease
Nephrogenic DI
This mechanism of DI is caused by excessive water intake and is sometimes associated with schizophrenia
Dispogenic DI
Explain the Tx for DI
Replacement of fluid and electrolytes, along with hormone therapy.
This is oppisite of DI. Excessive amounts of ADH are produced, resulting in fluid retention
Syndrome of Inappropriate ADH or SIADH
You pt is experiencing symptoms of confusion, loss of consciousness, wt gain, and edema. Her urine output is diminished. She is experiening muscle cramps and weakness.When you listen to her lungs you notice crackling. You would expect the dr to dx this pt with
SIADH
Explain the tx for SIADH
Restricting fluid to 500-1000 ml per day. Admin sodium chloride, diuretics, and demeclycyline to increase free water clearance.
Your pt has an enlargement on the front of her neck. She is complaining that she is having difficulty swallowing. What would you expect the dr to dx this pt with.
Goiter
Explain the tx for a goiter
Iodine
What nursing considerations should you be aware of when tx a person with a goiter.
Iodine preparations should be well diluted and given through a straw because they can cause staining to the teeth.
What is another name for Graves Disease
Hyperthyroidism.
Your pt is a 45 yr old woman. She is present with symptoms of wt loss, nervousness, weakness, insomina, tremulousness, agitation, tachycardia, palpitations, ankle edema, difficulty concentrating, diarrhea, increased thirst, decreased libido. Upon assessment you notice exophthalmos. What would you expect the dr to dx this pt with.
Graves Disease
Hyperthyroidism
Explain the tx for Graves Disease
Radio active iodine
Antiythyroid drugs
When a pt in not responding to iodine tx or antithyroid meds they may have to undergo a
Thyroidectomy
Your pt who is post op from recieving a thyroidectomy is presenting with symptoms of increased pulse, increased respiration rate, tetany, and rise in body temp. What should you do STAT
Report to charge nurse or dr
What is a complication in thyroidectomy that is caused by a sudden increase in the output of thyroxine caused by the manipulation of the thyroid as it is being removed
Thyroid Storm
Your post op pt from a thyroidectomy is present with 106 degree fever, 200 bpm, rapid respirations, apprehension and restlelessness, what do you anticipate
Thyroid storm which must be tx quickly
Myxedema is also known as
Hypothyroidism
Your pt is a 8 wk old infant. The infant is presenting with signs of delayed physical growth, mental growth, sluggish. What do expect the dr. to dx this infant with
Cretinism
Your pt is a 32 year old presenting with a decreased appetite, wt gain, bagginess under the eyes, swelling of the face, lethargic, slurred speach, abdominal distention, depression, husky voice, dry scaly skin, brittle nails, easy brusing, and nonpitting edema. What do you expect the dr. to dx this pt. with
Myxedema
What is the tx for myxedema
Replacement of thyroid hormones
What should you keep in mind when dealing with pt that have been dx with myxedema
1. Cold intolerence
2. Dont rush pt
A pt who presents with painless enlargement of the thyroid gland, and dysphagia is most likely to be suffering from what
Thyroiditis or Hasimotos
Explain the tx for hosimoto's disease
Given thyroid hormone to prevent hypothyroidism and suppress TSH secretion.
What is the most common form of thyroid cancer
Papillar carcinoma.
Your pt presents with muscle tetany, positive chvosteks and trousseaus sign, mild tingling, muscle cramps, and irritability. What do you expect the dr. to dx this pt with
Hypoparathyroidism
Explain the tx for hypoparathyroidism
Raise the calcium levels to a normal range. Milk, yogurt, and chese are high in phosphorus and therefore not advised.
Your pt is a 62 year old postmenopausal woman. She is presenting with adenoma, dehydration, confusion, lethargy, N & V, wt. loss, thirst, hypertension. Upon assessment you notice that she has a right fractured femur. What do you expect the dr to dx this pt with
Hyperparathyriodism
Explain the tx for hyperparathyroidism
Infusion of isotonic sodium chloride
admin of diuretic
Phosphate Therapy
Your pt is presenting with intermittent unstable hypertension, diaphoresis, anxiety, severe headache, and palpations. What do you expect the dr to dx this pt with
Pheochromocytoma
This is a rare tumor of the adrenal medulla that secretes catchcholamines (epi and norepi).
phecochromocytoma
Explain the tx for pheochromocytoma
adrenalectomy
Your pt is presenting with signs of generalized malaise, muscle weakness, muscle pain, othrostatic hypotension, cardiac dysrythmia, anorexia, flatulence, and diarrhea. You would expect the dr to dx with pt with
Adrenocortical Insufficiency
Addisons Disease
What is also known as Adernocortical Insufficiency
Addisons Disease
Explain the tx for Addisons disease
Life long therapy replacement
hydrocortisone
fludrocortisone
Physical stress form the flu or other infection can tip the scales for a pt with Addison's disease and send them into
crisis
Excess Adrenocortical Hormone is also known as
Cushings Syndrome
A pt presents with painful fatting swellings in the intrascapular space (buffalo hump) and facial area (moon face), enlarged abdomen with thin extremities, easily brusing, impotence, amenorrhea, hypertension, hirsutism, streaked purple markings in the abdominal area. You would expect the dr to dx this pt with
Cushings Syndrome
Explain tx of cushings syndrome
microsurgy on the pituitary gland
radiation
keocanazole
The most common cause of cushings is
prolonged use of corticoids for chronic inflammatory disorders such as COPD, RA, Crohns Disease
What is oversecreting in cushings sydrome
Cortisol
A pt has been admitted for management of hypoparathyroidism. The nurse should anticipate an order for:
A. calcium
A pt with addisons disease will most likely exhibit which of the follwoing symptoms:
C. bronae skin pigment
A pt with Cushings disease should be instructed to :
B. litmit dietary sodium
A pt with a pituitary tumor will most likely exhibit symptoms of:
A. alteration in visual activity
Which electrolyte is directly affected by the hormone secreted by the parathyroid:
D. calcium
A pt with acromegaly will most likely exhibit which of the following symptoms:
C. bone pain
You are caring for a pt with Graves Disease.Which of the following findings would indicate a complication of this pts disease process:
A. SOB
You are caring for a pt after a thyroidectomy. Your priority should be to:
B. maintain the pt in a semi-fowlers position
What type of Diabetes does the body's immune system destroy the beta cells
Type 1 IDDM
Which type of DM requires injections of Insulin to maintain life because they produe little or no insulin on their own
Type 1
People that have type 1 DM are more prone to what
Ketoacidosis
What type of DM is related to insulin resistence
Type 2
A pt is presented to you with symptoms of polyuria, polydipsia, polyphagia, rapid wt loss, irritability, weakness, fatigue and N & V. What do you expect the dr to dx this pt with
Type 1 DM
A pt is presented to you with wt gain, poor healing of wounds, blurred vision, increased fatigue, numbness in the feet. Upon getting a hx, he tells you that his mother and grandfather have DM. What do you expect the dr to dx this pt with
Type 2 Dm
What 4 factors influence the pt development of DM
1. Genetics
2. Metabolic
3. Microbiologic
4. Immunologic
Explain the wt loss in a pt with Type 1 DM
1. the loss of body fluid
2. in the absence of sufficient insulin the body begins to metabolize its own protein and fat.
What is the cure for DM
No Cure
What is the goal for DM pt
maintain blood glucose levels
What is the number 1 tx for DM
Insulin Therapy
What is Type 2 Dm tx
Diet
Exercise
OHA's
Insulin
Oral Hypoglycemic agents
OHA's
explain the precautions you take with NPH
Cloudy
Roll in hands
Which routes can insulin be taken by
Injection
Inhaled
Why can insulin not be taken by PO
Gastric juices destroy it
Are OHA's a form of insulin
NO
If your pt is taking an OHA should you advise them to stop their diet and exercise program
NO
Explain the cautions used with Lantix and Levomere
Cant be mixed with anything
Name 3 problems with Insulin Therapy
Allergic reaction
Lipodystrophy
Somogy Effect and Dawn phenomenon
What should you do when taking Metgormin and need a contrast dye
Hold metformin 48-72 hrs
You have a pt that is presenting with symptoms of 3 P's, Flu like symptoms, Kussmauls Respirations, Fruity acetone breath, and dehydration. What do you expect the dr to dx this pt with
Diabetic Ketoacidosis
This is a serious condition caused by incomplete metabolism of fats due to the absence or insufficienty supply of insulin. The body breaks down protein and fat for energy. This produces an abundance of ketones
Diabetic Ketoacidosis
A pt presents with the following symptoms polyuria, lethargy, BS of 1,00-1,500 and no N & V. What would you expect the dr. to dx this pt with
HNKS
Hyperglycemic Hyperosmolar Nonketotic syndrome
This occurs in type 2 DM who experience high blood glucose levels because of illness or added stress, such as infection.
Hyperglycemic hyperosmolar nonketotic syndrome
This is encountered with type 1 diabetes. This follows a period of hypoglycemia.
Rebound Hyperglycemia
this is characterized by elevated blood glucose in the morning, but is not related to hypoglycemia. This is caused by a release of GH, glucagons and epinephrine during the night. These are all counterregulatory hormones which act to raise the bodys blood sugar. This is why most DM can't tolerate carbs in the morning
Dawn Phenomenon
When does the Somogi Effect need to have BS checked
Midnight
Your pt presents with symptoms of tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, weakness, confusion. You would expect the dr to dx this pt with
Hypoglycemia
This is a syndrome whereby a pt has insulin resistance, hypertension, increased LDLs and decreased HDLs.
Insulin Resistence Syndrome
Disease of the kidney occurs directly from changes in the renal blood circulation.
nephropathy
Very poor circulation in feet and lower extremities.
peripheral vascular disease
Visual impairment and blindness due to Dm
Retinopathy
The three most common visual disturbances
Diabetic Retinopathy
Cataracts
Glaucoma
Pathologic changes in the NS causes deterioration of nerves
neuropathy
Your pt is presented with rapid heart beat, weakness, anxiety, nervousness, and hunger. What can you expect the dr to dx this pt with
Hyperglycemia
A pt recently diagnosed as having hypoglycemia says, "Hypoglycemia! I can't live with that. My neighbor had that and acted crazy!" Which of the following responses should you give him:
C. Hypoglycemia has been succussfully tx by diet modifications
DM is best defined as a (n):
A. disturbance in utilization of glucose
Three of the following are early signs of hypoglycemia. Which one is not:
A. polyuria
When teaching a pt with type 1 diabetes about home care, you assure her that she can recognize the early signs of Diabetic Ketoacidosis, which are:
A. thirst dry mucous membranes and dry skin
When drawing up a long-acting insulin and regular insuling in one syringe, which of these actions should you take:
C. draw up the reglular insulin first
Which of the following is most likely to occur if hypoglycemia is not tx properly?
B. Loss of consciousness
A pt may be at risk for developing hyperglycemic hyperosmolar nonketotic syndrome if three of these conditions are present. Which condition is not considered a factor?
A. drinking too much water
A pt with Dm has been maintained on Meformin (glucophage) for reglulation of her blood glucose levels. Which of the following issues should be included in this pt's teaching?
B. report changes in voiding pattern
A pt with DM is taking Lantus insulin. The nurse is aware that this insulin will most likely be admin:
D. at night
A pt presents in the ER with Polyuria, polydipsia, and polyphagia related to diabetes. You should expect these symptoms are related to :
B. hyperglycemia
A pt newly dx with DM is learning to admin his injections of NPH and regular insulin. Which statment indicates that the pt understands your teaching regarding proper insulin admin?
C. I will draw up the regular before the NPH
CLEAR B4 CLOUDY
THE FOLLOWING ARE ALL EXAMPLES OF
Inhalation powder=Exubera
Aspart Injection=NovoLog
Lispro injection=Humalog
Glulisine injection=Apidra
Rapid Acting Insulin
THE FOLLOWING ARE ALL EXAMPLES OF
Regular human insulin injection=Humulin R
Buffered regular human insulin injection= Velosulin BR
Short acting Insulins
THE FOLLOWING ARE ALL
NPH
Intermediate
What does metformin have an effect on and what should you keep in mind
Liver and No contrast dyes
What are acarbose (precose)
Startch blockers, Intestine
pioglitazone (Actos) does what
Decreases liver production of glucose, making muscle more sensitive to insulin
What does Starlix and Prandin do
stimulates insulin secretion Pancreas
Januvia does what
enhances natural body systems, regulates glucose Pancreas`
