#1
Diagnostic findings indicating a client is in DKA.
What is
Blood glucose levels greater than 250 mg/dL
Arterial pH levels less than or equal to 7.3
Serum bicarbonate levels less than 18 mEq/L
Urine or serum ketones
Effective serum osmolality greater than 300 mOsm/kg
Anion gap +
Table 44.7
Complications associated with Cushing’s disease.
What is hypertension, cardiovascular disease, osteoporosis, depression, diabetes, muscle weakness, weight gain, bruising, and infections.
Medical management of hypercortisolism focuses on preventing complications associated with fluid overload, changes in immune status, changes in skin integrity, and changes in body structure.
Complications of hyperglycemia if left untreated.
What is hypotension, tachycardia, Kussmaul respirations, fruity, acetone smell to the breath, nausea, vomiting, lethargy, and coma.
Medical management for a client having a thyroid storm.
What is airway management and fluid resuscitation, antithyroid medications (methimazole), iodine preparations, beta-adrenergic blockers, glucocorticoids, and cooling blankets
Complications associated with 3% normal saline.
Fluid overload, increasing peripheral edema, and hypertension.
Most important lab result to monitor for a client in DKA. This lab must also be obtained prior to administering insulin to a client in DKA.
What is potassium.
Adverse effect of pasireotide.
What is adrenal insufficiency, the nurse must monitor for signs of adrenal suppression including hypoglycemia and hyponatremia.
Diagnostic findings indicating a client is experiencing HHS.
Blood glucose levels Greater than 600 mg/dL
Arterial pH levels greater than 7.4
Serum bicarbonate levels greater than 15 mEq/L
Urine or serum ketones - negative
Effective serum osmolality Greater than 320 mOsm/kg
Anion gap negative
Table 44.7
Comparison of TSH levels in Graves disease verses secondary or tertiary hyperthyroidism.
What is decreased TSH levels in Graves disease compared to increased TSH levels in secondary or tertiary hyperthyroidism.
Risk factors for the development of SIADH.
CNS disorders such as tumors in the brain or neck, side effects of medications such as NSAIDs, psychotropic medications, and bronchogenic carcinoma can cause SIADH.
Medical management for diabetes insipidus (DI).
What is maintaining adequate fluid volume status, monitored for hyperglycemia, volume overload, and correction of hypernatremia, Desmopressin (DDAVP), vasopressin (Pitressin), and frequent monitoring of fluid status, serum electrolytes, and urine output.
Teaching for clients diagnosed with adrenal insufficiency.
What is take oral hormone replacement daily, wear medical alert bracelet at all times, clinical manifestations of adrenal insufficiency, and signs of corticosteroid excess.
Topics to include when educating a client on diabetes insipidus (DI).
What is the importance of taking medications (ADH replacement such as desmopressin administered intranasally or subcutaneously) as ordered, Weigh daily at same time and on same scale (report a weight gain of 2lbs. in a day), pathophysiology of DI, and clinical manifestations of fluid overload.
Clinical manifestations associated with hypothyroidism.
What is decreased energy, increased sleep, fatigue, weight gain, decreased appetite, and susceptibility to cold temperatures, myxedema, osmotic edema and a fluid collection that is associated with a generalized nonpitting edema.
Diagnostic findings associated with SIADH.
What is urine-specific gravity, serum and urine osmolality, and electrolytes.
Goal of treatment related to DKA.
What is
Fluid replacement with isotonic normal saline
• Correction of electrolyte imbalances, focusing on monitoring and correction of decreased potassium level if necessary, prior to insulin administration
• Insulin administration, usually by intravenous delivery to obtain a drop of 10% in glucose level within the first hour of insulin administration
Clinical manifestations of adrenal insufficiency.
What is darkened, bronzed hyperpigmentation, weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, and emotional lability, irritability, depression, and inability to concentrate, decreased pubic and axillary hair, as the loss of sodium and water continues, the patient may develop dehydration and hypotension.
Diagnostic evaluation for diabetes insipidus include.
What is serum and urine electrolytes, serum and urine osmolality, urine-specific gravity, and CT or MRI of the head.
What are some complications associated with myxedema coma? Include nursing management of complications.
Daily Double!!!
What is hypoxia and carbon dioxide retention (secondary to hypoventilation), fluid and electrolyte imbalances, and hypothermia.
Nursing management include :
Administer thyroid replacement therapy
Administer narcotics and sedatives with caution
Provide warming blankets as needed
Turn patient and reposition to promote skin integrity
Expected outcomes of a patient treated for Cushing's disease.
What is stable vital signs and fluid volume status, serum electrolytes within normal limits, weight loss, and intact skin.
Education to include when teaching clients how to avoid DKA.
What is signs of hypoglycemia and hyperglycemia, insulin administration, drink plenty of fluids, continue monitor blood glucose when ill and replace electrolytes if unable to eat food, check urine for ketones if hyperglycemic, healthy lifestyle that includes diet and exercise.
Risk factors associated with adrenal insufficiency.
What is destruction of the adrenal glands, decreased secretion of adrenocorticotropic hormone (ACTH), dysfunction of the hypothalamus, Nonspecific autoimmune destruction of the adrenal gland, infectious, cancerous, and traumatic processes that lead to direct insults to the adrenal cortex, Patients who are prescribed exogenous corticosteroids for longer than 2 weeks are at risk for acute adrenal insufficiency (acute adrenal crisis) if the medications are abruptly discontinued, and stress.
Medical management for clients experiencing hyperglycemic hyperosmolar state (HHS).
What is standard care for dehydration with IV fluid and treatment for altered mental status, including airway management as appropriate. Patients may respond to fluids alone, but IV insulin may be necessary to correct hyperglycemia.
Measures that can be taken to address moral distress.
Nurses cope with moral distress by talking with other nurses about the situation and sharing their feelings and values with their peers. They also share with and receive support from nurse managers and chaplains. They share decisions with colleagues, sometimes acceding to the majority opinion. Such discussions enable the nurse to consider alternatives in the situation. Providing education in ethical decision making and instituting ethics rounds can help manage moral distress. Nurses who have developed expertise, experience, problem-solving skills, and an ability to take risks tend to take action in an ethical manner when confronted with moral dilemmas. These nurses may act as role models and are a valuable resource for new nurses.
Hospice Care compared to Palliative care.
What is:
Palliative care (PC) is a specialized form of care that focuses on relief of pain and other symptoms and stress associated with a severe illness.
Hospice care, which focuses on the care of a patient with a terminal illness who has less than 6 months to live.