Assessment
This disorder results from a deficiency of vasopressin (ADH) from the posterior pituitary gland in which the patient will have large volumes of dilute urine.
What is Diabetes Insipidus?
This is the most common cause of hyperthyroidism.
What is Graves' Disease?
A characteristic manifestation with Graves' Disease is also exopthalmos - "bulging eyes"
Cells have a reduced ability to respond to insulin.
What is Type 2 Diabetes?
What is the defining characteristic differentiating DKA from HHS?
What is the presence of metabolic acidosis?
With HHS - they make just enough insulin to prevent the breakdown of fatty acids into ketone bodies
Ketones = acids
Diagnostic test used to trend glycemic control over the last 3 months
What is Hemaglobin A1C
•Normal: 4-6%
•Prediabetes: 5.7-6.4%
•Diabetes: > 6.5%
•Poor controlled DM: >8%
Long term corticosteroid therapy may result in a patient developing fat redistribution to their trunk and face consistent with
What is Cushing's syndrome
The definitive treatment for thyroid cancer
what is a thyroidectomy?
This may be partial or total depending on the type and location.
Autoimmune process is causing beta cell destruction.
What is Type 1 Diabetes?
Nurses should perform frequent neuro assessments of a patient in DKA or HHS to ensure management of this.
What is airway
DKA and HHS can cause profound neurological decline progressing from lethargy to coma; this can lead to loss of airway
Acronym used to educate patients with diabetes about proper management of their disease during times of illness
what is "SICK"
S= blood sugar - should be checking more frequently
I = Insulin - should still be taking their prescribed insulin (many will have a prescribed "sick day dose")
C = Carbs - attempt to eat while sick, smaller meals, easier to digest, if unable to tolerate solids focusing on liquids. Liquids if blood sugar levels are low should have a sugar in them, like gatorade.
K = Ketones, assessing their urine for ketones, they should have home test strips in which to do so
A patient with adrenal insufficieny AKA Addison's Disease will present with an elevation of which electrolyte?
What is potassium?
*remember adrenal deficiency – hypoadrenalism – less reabsorption of sodium and therefore greater retention of potassium
A severe state of hypothyroidism characterized by profound bradycardia, hypothermia and lethargy
What is Myxedema Coma?
These patients will be treated with IV levothyroxine (Synthroid) to replace thyroid hormone to correct the underlying issue. Severe hyopthyroidism - severe lack of circulating thyroid hormone
True or False? Patients with type 2 diabetes cannot be managed with oral hypoglycemic agents ("antidiabetic") alone and will always require insulin.
False
Type 1 - is insulin dependent, Type 2 may very well be able to manage their diabetes without pharmacologic intervention. However, during periods of increased stress, like with illness or injury they may require additional support in the form of subQ insulin therapy
The initiation of Insulin therapy IV for the treatment of DKA will lead to potentially dangerous drops in what electrolyte?
What is potassium?
Insulin facilitates the movement of potassium back into the cells thereby reducing serum potassium levels
Chvostek's is an assessment finding indicative of which electrolyte imbalance
what is calcium? specifically hypocalcemia
Hypertrophy of this endocrine gland may cause symptoms such as headache, blurry vision or blindness
what is the pituitary gland?
Hypertrophy = enlargement
an enlarged pituitary gland is going to put pressure on the sella turcica and pressure on the optic nerve causing the associated headaches and vision disturbances
Condition of severe hyperthyroidism characterized by hyperthermia, hypertension and altered mental status
what is thyroid storm
Microvascular and macrovascular complications, such as retinopathy, are a result of prolonged/chronic?
What is hyperglycemia
What is the underlying mechanism provoking Kussmauls respiration in a patient with DKA?
What is metabolic acidosis?
The deep, rapid hyperventilation (Kussmauls) is a compensatory mechanism to blow off greater amounts of CO2 in an attempt to correct the metabolic acidosis
Overproduction of this hormone often results in bone demineralization.
What is overproduction of PTH?
PTH is going to promote the reabsorption of calcium from the bone leading to osteoporosis
Calcitonin is the counter balance to PTH that in the presence of high serum calcium levels prevents further reabsorption of calcium from bone
Prolonged corticosteroid therapy will have this effect on the adrenal glands
what is atrophy?
Steroid hormones normally produced by the adrenal gland are being received in an exogenous form.
Common complication of thyroid surgery manifested by tetany and paresthesias
what is hypocalcemia?
Caused by parathyroid gland injury/removal
A patient who is hypoglycemic, unconscious without functioning IV access would receive what?
What is glucagon?
Onset is 30 minutes when given IM. Patients who are hypoglycemic in the acute setting with functioning IVs and decreased consciousness will respond more quickly to IV Dextrose 50%
What is the priority treatment in a patient with HHS?
What is fluid replacement?
The profound dehydration caused by HHS, if not corrected, will lead to eventual shock. Insulin therapy will be initiated to treat Hyperglycemia but is not the primary treatment.