thyroid
List 3 manifestations of hypothyroidism
bradycardia, lethargy/weakness, dry skin, brittle nails, constipation, depression
addison disease nursing interventions
monitor F&E, weight, vitals, IV fluids, IV hydrocortisone, mineralocorticoid replacement, treat hyperkalemia, monitor for hypoglycemia
treatment for DI and expected outcomes
fluids, Desmopression (DDAVP) positive outcomes, drecreased urine output, increases urine specific gravity, increased bp)
priority interventions for DKA
IV fluids ( 0.9% NS initially, then dextrose with BS around 250), then IV insulin.
Monitor electrolytes, Q1H bs, ketones, K replacement as needed ABGs ( if intubated)
diabetes sick day rules
don't stop taking insulin, check glucose and ketones every 3-4 hrs ( type 1). eat frequent small meals, increase fluid intake, contact HCP if bs > 250 experiencing n/v, or ketones are positive.
identify the disease:
elevated T4
decreased TSH
primary hyperthyroidism
cushing presentation & testing
buffalo hump, moon face, hyperglycemia, change in personality, increased risk for infection, GI issues, osteoporosis, fluid retention, strech marks
cortisol level-serum or 24 hr urine collection or
dexamethasone suppression test
causes of SIADH
brain injury or lung carcinoma/pneumo
manifestations of DM
polyuria, polydipsia, polyphagia ( fatigue, weakness, slow healing wounds, paresthesia, dry skin, recurrent infections)
new diagnosis of diabetes
3 P's, Hypotension ( dehydration) increased Na, increased BUN & Create, increased hemoglobin.
hyperthyroidism testing and medication management
thyroid serum levels
possible bruit over carotids
positive radioactive iodine uptake test
PTU and methimazole
Cushing disease medication management
tapper of steroids, ketaconazole and mitotane
DI presentation
dry inside, dehydrated/ hypotensive, urinating large amounts of diluted urine, high serum electrolytes, low urine specific gravity ( 1.001-1.005)
hypoglycemia manifestations and interventions
shakiness/tremors, confusion, sweating, hunger, tachycardia/ palpitations.
15 mg simple carbs snack, IM glucagon, D50 iv push
DKA vs HHS
DKA- ketones in urine, metabolic acidosis ( GI symptoms), bs lower than HHS ( 300-800 average), high K, dehydration
HHs- no ketones, no acidosis, BS can be 1000+, K may be normal, dehydration
hyperthyroidism nursing management
IV fluids with dextrose, calm quiet envireonment, cooling blankets, meds
pheochromocytoma manifestations
Triad: headache, sweating, tachycardia
HTN, hypermetabolism, hyperglycemia
diagnostic testing for DI & SIADH
DI- fluid deprivation test
SIADH- unexplained hyponatremia
BOTH- specific gravity of urine ( opposites) and serum electrolytes ( opposites)
new diabetic diagnosis teaching
lifestyle modifications ( dietician referral), medication/ insulin administration, monitoring of glucose, monitoring of A1C, exercise, diet ( increasing fiber, omega 3), checking peripheral sensation, poor wound healing/ foot care education
causes of DKA/HHS
any type of stressor to the body
hypothyroidism/ Myxedema coma interverntions
Myxedema- ICU setting, IV fluids, IV levothyroxine, warming blankets/ bear hugger, watch airway, aspiration precautions
Addison manifestations
hypotension, hypoglycemia, GI symptoms (n/v/d abd pain, anorexia, weight loss) fluid volume deficit, hyponatremia, hyperkalemia
SIADH meds & nursing interventions
meds- diuretics, 3% saline, tetracycline, tolvaptan.
restrict fluids, monitor I&Os, dailiy weights, monitor for seizures and fluid overload.
insulin onset: Rapid acting, short acting, intermediate, long acting
Rapid- 15-30 min prior to meals- mostly used prior to meals & SS
short acting- 30-60 min- mostly used prior to meals, sliding scale or IV drip in DKA and HHS
intermediate NPH- 1-1.5 hr ( can mix with regular)
long acting- once a day no peak
complications of diabetes
non-healing wounds, retinopathy, nephropathy, infections ( yest, UTIs...), peripheral neuropathy, erectile dysfunction