Endocrine
What's the difference between SIADH vs DI?
Syndrome of Inappropriate ADH - Too much ADH (Soaked Inside). Kidneys: low urine output and concentrated
Diabetes Insipidus- Not enough ADH (Dry inside). Kidneys: high urine output, diluted
What is the medication prescribed for hypothyroidism?
Levothyroxine
What are clinical manifestations of a Urinary tract infection?
•Dysuria (burning/pain with urination)
•Urinary frequency
•Urinary urgency
•Suprapubic pain/discomfort/pressure
•Hematuria
•Sediment in the urine giving it a cloudy appearance
What medications are prescribed for renal calculi?
•Opioids for renal colic pain.
•NSAIDs (usually ketorolac) can be considered if there’s no history of renal impairment.
•Alpha adrenergic blockers such as tamsulosin or terazosin may be used to relax the smooth muscles in the ureter to allow the stone to pass. Remember these medications lower blood pressure, so checking BP before and after administration is important!
•Antibiotics if there is a concurrent urinary tract infection.
How do you communicate with hearing impaired clients?
•Verbal Aids
•Speak in a normal or lower tone of voice and slowly.
•Do not shout.
•Do not exaggerate facial expressions.
•Do not speak in a high-pitched tone.
•Do not over-enunciate.
•Use simple sentences.
•Write names or difficult words.
•Speak in a normal voice directly into the better ear.
What are manifestations of Addison's disease?
-Weakness, fatigue, anorexia, and weight loss due to low cortisol levels.
-Altered hair distribution due to lack of androgens.
-Hyperpigmentation of the skin which appears bronze-colored.
-Hypotension and fluid volume deficit due to the lack of aldosterone (lack of fluid/sodium retention).
•Hyponatremia due to the lack of aldosterone (lack of sodium retention).
•Hypoglycemia due to the lack of cortisol.
•Hyperkalemia due to the lack of aldosterone (no aldosterone à no potassium excretion à potassium remains in the body).
What are medications that are prescribed for hyperthyroidism?
Antithyroid: Propylthiouracil (PTU), Betablockers: Atenolol, Iodine
What are clinical manifestations of renal calculi?
Manifestations depend on the location of the stone, presence of obstruction, infection and edema. Symptoms range from mild to excruciating pain and discomfort.
•Renal colic – severe flank pain radiating to the groin that results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone.
•Difficulty sitting still; clients may be restless and change positions frequently.
•Nausea and vomiting from the severe pain.
•Hematuria
What medications are ordered for a UTI?
Antibiotics: trimethoprim/sulfamethoxazole, nitrofurantoin, cephalexin, and fosfomycin
Fluoroquinolones (e.g., levofloxacin, ciprofloxacin) should be used to treat only complicated UTIs. In clients with UTIs from fungi, fluconazole (Diflucan) is the preferred therapy.
•Phenazopyridine – urinary analgesic that exerts a topical analgesic effect on the urinary tract mucosa which can relive the discomfort caused by dysuria.
What medication will the provider prescribe for Meniere's disease?
Meclizine
What are manifestations of Cushing's syndrome?
•Moon face, buffalo hump, and truncal obesity related to abnormal fat metabolism caused by excess cortisol.
•Muscle weakness and risk for falls due to increased catabolism or hypokalemia.
•Peptic ulcers due to increased acid production and decreased gastric mucous.
•Hypertension due to increased aldosterone which causes sodium and water retention.
•Edema and weight gain due to increased aldosterone which causes sodium and water retention.
•Hypernatremia due to increased aldosterone which causes sodium retention.
•Hyperglycemia due to increased cortisol which causes elevated glucose.
•Hypokalemia due to increased aldosterone which causes potassium excretion.
•Collagen loss which makes skin thinner, weaker, and easily bruised. Purple striae appear on the abdomen, breasts, or buttocks.
•Androgen excess may cause severe acne, menstrual irregularities, and male characteristics (hirsutism) in women and female characteristics (gynecomastia), testicular atrophy, and erectile dysfunction in men.
What's the order of mixing insulin?
Clear before cloudy
Air into NPH (Cloudy), Air into rapid/short acting (Clear), Draw up rapid/short acting (Clear), Draw up NPH (Cloudy)
5 stages. Stage 5 when GFR is less than 15mL/min
What are the causes of AKI?
Prerenal- perfusion
Intrarenal- direct damage to the kidneys themselves
Postrenal- obstruction
What's the difference between Otitis Externa and Otitis Media?
Otitis Externa
•Outer ear infection
•Common causes include swimming in contaminated water (swimmer’s ear) and trauma to either the auricle or ear canal.
•Manifestations – ear pain (otalgia) particularly when chewing, moving the auricle, or pressing the tragus.
Otitis Media
•Middle ear infection
•Commonly caused by swelling of the eustachian tube from colds or allergies that results in bacteria being trapped in the middle ear.
•Manifestations – ear pain (otalgia), fever, drainage, and reduced hearing. The jaw, teeth, gums, and throat may be painful as well.
What's the difference between hyperthyroidism vs hypothyroidism?
Hyperthyroidism: T3 + T4 = high and low TSH (Body processes are fast, weight loss, insomnia, heat intolerance, tachycardia, anxiety, nervousness, restlessness, tremors, irritability, rapid speech, exophthalmos and goiter)
Hypothyroidism: T3 + T4 = low and high TSH (Body processes are slow, weight gain, fatigue, depression, slow slurred speech, lethargy, forgetfulness, cold intolerance, goiter
What are the peaks or rapid-acting, short-acting, intermediate-acting and long-acting insulin?
Rapid: 0.5-3 hours
Short: 2-5 hours
Intermediate: 4-12
Long acting: No peak
What's the difference between oliguric and diuretic phase of AKI?
In the oliguric phase, manifestations are going to reflect kidneys that aren’t functioning. Oliguria, fluid volume excess, metabolic acidosis, sodium imbalances, hyperkalemia
In the diuretic phase, daily urine output may reach 5 liters or more.The nephrons are still not fully functional. This high urine output is caused by osmotic diuresis from the high urea concentration in the glomerular filtrate and the inability of the tubules to concentrate the urine. The kidneys have recovered their ability to excrete wastes, but not to concentrate the urine. Fluid volume deficit and hypotension can occur from massive fluid losses. Electrolyte losses (hypokalemia, hyponatremia) may occur from the increased urine output. Treat fluid volume deficit and electrolyte imbalances.
What is one of the most concerning electrolyte for CKD and what medications do we give?
Hyperkalemia
•Sodium polystyrene sulfonate – pulls potassium out of the body through the GI tract. Tell the client to expect diarrhea. Never give to a client with a hypoactive bowel (paralytic ileus).
•Insulin (with dextrose) to push potassium from the bloodstream into the cells.
•Calcium gluconate to stabilize myocardial cells and prevent dysrhythmias.
What's the difference between cataracts and glaucoma?
Cataracts- A cataract is the clouding or opacity of the normally clear lens of the eye. With age, the lens loses water and increases in density, which results in the production of new lens fibers and crystals. As density increases, transparency of the lens is lost, and vision is reduced.
Glaucoma-Glaucoma is a group of disorders characterized by increased intraocular pressure (IOP). This high pressure causes optic nerve atrophy, loss of peripheral vision, and eventually, permanent blindness. There are two common types of glaucoma: primary open-angle glaucoma and primary closed-angle glaucoma.
What's the difference between DKA and HHS?
DKA- dehydration, lethargy, Kussmaul respirations, ketones in the urine, fruity/acetone odor of the breath, hyperkalemia, blood sugar higher than 250 mg/dL
HHS- high blood sugar levels greater than 600 m/dL and increased in serum osmolality and more severe neurologic manifestations: somnolence, coma, seizures, hemiparesis, and aphasia
What medications would you give a client with diabetic ketoacidosis?
Fluids and regular insulin drip
What is needed in order to receive hemodialysis and what's the appropriate assessment?
A subcutaneous arteriovenous fistula (AVF) is usually created in the forearm or upper arm with an anastomosis between an artery and a vein (usually cephalic or basilic).
Palpate for the thrill and Auscultate for a bruit
What solution do we use for dialysis to help remove waste products in kidney failure?
Clinically, dialysis is a technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate). It corrects fluid and electrolyte imbalances and removes waste products in kidney failure. It also can be used to treat drug overdoses.
What are medications used for glaucoma?
Timolol and betaxolol are non-selective beta-blockers that are administered via eye drops.
•Side effects include blurred vision and photophobia.
•Systemic effects may include bradycardia, decreased blood pressure, and bronchospasm. Minimize systemic absorption by occluding the lacrimal duct.
•Contraindicated in clients with bradycardia, heart block, heart failure, asthma, and COPD. Use cautiously in clients already taking an oral beta-blocker.
Pilocarpine is a cholinergic medication that is administered via eye drops and causes miosis (pupillary constriction). It causes the iris sphincter to contract, which opens the trabecular meshwork, allowing outflow of aqueous humor (reducing IOP).
•Expected side effects include blurred vision, decreased visual acuity, decreased adaptation to dark environments, increased sweating, urination, and salivation.
•Systemic effects may include hypotension, vomiting, diarrhea, and dysrhythmias.