DI
which hormone deficiency causes a water loss or the bodies inability to respond to it?
ADH
What happens in SIADH
too much ADH. water retention
how do you get type 1
pancreas can't make insulin
how do you get type 2 dm
pancreas makes insulin but body is insulin resistant. not working at optimal level that the body needs.
Cause of Addison
damage to adrenal glands
autoimmune disease
TB
Causes...
Prednisone
Pituitary Adenoma
Adrenal Tumor
Cushing's
(Buffalo Hump, Fat Pad, Moon Face, Weight Gain, Slow Wound Healing)
short acting insulins
aspart
humalog
Labs specific to thyroid
T3 & T4 & TSH
who do you consult with diabetic concerns
renal
optic
derm
ID
wound care
social work
Card
nutrition
End result of DI
large volume of dilute urine : polyuria
distal kidney tubules and collecting ducts can't reabsorb water
dehydration
impaired F & E balance
causes of SIADH
cancer treatment
pulmonary infection
specific medications
treatment for type 1 dm
carb counting, fats and proteins
take insulin via injections
implanted pump
basal rate
treatment for dm type 2
SSI
scheduled insulin
diet/exercise
what would you anticipate their labs to look like
low blood sugar from decreased cortisol level
decreased GFR
Increased BUN
Hyperkalemia
Hyponatremia/Hypovolemia
common cause of hypercortisolism
glucocorticoid therapy (stress hormones)
describe intermediate acting insulin
NPH
cloudy
draw up second but inject with air first
works within 1-2 hours
peaks at 6-10 hours
duration can last for 24 hours
Electrolytes related to thyroid
Calcium
Phosphate
largest general survey difference between DKA and HONK
DKA is severely symptomatic
HONK is not symptomatic, or barely
Causes of DI
Neurogenic: primary or secondary
Primary: impaired hypothalamus or pituitary gland which end up in lack of ADH production or release
Secondary: result of tumor, head trauma, infectious process, brain surgery.
Nephrogenic: drug related
sodium
dilutional hyponatremia
what disease process can type 1 exacerbate into
DKA
what disease process can type 2 exacerbate into
HONK
major life threatening concern from Addison's
shock
low bp/elevated HR: from volume depletion with the loss of aldosterone
Low-Dose Dexamethasone suppression test
24 hr urine cortisol levels (80-120 mcg/24hrs)
Midnight or late night salivary cortisol levels
How to confirm increased plasma cortisol levels in Cushing's
only insulin to be given IV
regular
Signs/Symptoms of what disorder:
low metabolic rate
weight gain
constipation
scaly tongue
decrease heart contractility
fatigue/lethargy
Hypothyrodism
What are nursing interventions/considerations for thyroidectomy?
monitor for hypocalcemia, hemorrhage, laryngeal nerve damage, infection, patent airway.
Limited ROM
IV calcium available
Choking, frequent swallowing, saturated dressings, fullness feeling at site.
O2, suction, trach tray
signs and symptoms of DI in your pts
increase urination
excessive thiirst
signs of shock
poor skin turgor
dry/cracked mucous membranes
weight loss
s/s of SIADH
gi disturbances
loss of appetite
weight gain
confusion
headache
lethargy
disorientation
LOC
ketones in urine
3 P's
metabolic acidosis
nausea/diarrhea/vomiting
respiratory depression/coma
s/s of HONK
lethargy
3 P's
dry mouth
elevated HR
dry skin turgor
n/v/d
confusion, slurred speech
primary causes
secondary causes
primary: autoimmune disease, TB, cancer that has mets, hemorrhage, medications,ect
secondary: pituitary tumors, hypophysectomy, cessation of long term corticosteroid drug therapy
priority problems for pts with cushings disease
fluid overload d/t hormone induced water and sodium retention
potential for injury d/t skin thinning, poor wound healing, bone density loss
potential for infection due to hormone induced reduced immunity
long acting insulin
detemir
lantus
glargine
Signs/Symptoms of what disorder:
impaired LOC
hypotension
cv collapse
hypothermic temp
mask like face
medical emergency
myxedema ( prolonged hypothyroidism )
Etiology: infection, drugs, cold, trauma
Tx: IV thyroid hormone, low calorie diet
Nursing considerations for RAI therapy
private toilet
separate laundry
avoid being near pregnant women or kids for 1 wk
teach s/s of hypothyrodism
diagnostic tests for DI
low urine specific gravity: <1.005)
low osmolarity: 50 to 200 mOsm/kg
UOP: > 4 Liters / 24 hr period
(can be 4-30L/day)
lab levels
increase in urine osmolarity
increased plasma volume
decreased plasma osmolarity
elevated urine sodium levels
decreased serum sodium levels
blood sugar in DKA
250-1000
blood sugar in HHNK
>1000
s/s in addisons pt
lethargy, fatigue, muscle weakness, salt cravings, anorexia, n/v/d, abd pain, weight loss, menstral changes, impotence
skin pigmentation changes
s/s associated with glucose, electrolyte imbalances, heart palpitations, syncope, depression, confusion, disorientation
Treatment of Cushing's Disease
Surgical removal or irradiation
Adrenalectomy for adrenal tumors
Removal of ACTH secreting tumors
Steroid use; decreased dose, gradually dc therapy
what does insulin do in the body
lowers blood sugar by helping the body move the glucose out of bloodstream and into the cells to be used as energy
What is the medication of choice for hypothyroidism
synthroid ( levothyroxine )
Monitor for irregular HR or tachycardia, insomnia
Lifelong replacement...don't stop abruptly
Emergency IV Calcium given
Treatment: calcium, mag, vit d
What is the dx?
hypoparathyroidism
Monitor on tele for dysthymias, give iv calcium slowly, calcium level assessments
Treatment for DI
desmopressin: Synthetic version of vasopressin
May be IV or IM depending on severity
manage dehydration, electrolyte imbalance, check daily weight, strict I & O
Heart and lung assessments: medications induce water retention ( fluid overload )
Will require life-long therapy
nursing interventions for SIADH
fluid restriction (500-1000 ml/24)
replace sodium slowly
educating the family/pt
I & O
Daily weight
oral rinse
monitor ECG
F & E replacement as needed
seizure precautions
Assessment: neuro checks, heart, lungs, skin
treatment of DKA
IVF....SEVERAL LITERS
regular insulin
antiemetic
treatment of HONK
IV fluids....liters (monitor for heart/lung overload)
regular insulin IV
neuro assessment
safety interventions
what would you expect the labs to look like
low serum sodium
low salivary cortisol levels
low fasting blood glucose
elevated potassium
increased BUN
nursing interventions for cushings disease
monitor F & E
Monitor for heart/lung overload from increased fluid (pulmonary edema)
monitor for skin breakdown/turn q 2, pressure reducing items
monitor blood sugars
monitor for weight loss
monitor for ECG changes
potential fluid/salt restrictions
prep for surgical interventions
sick day rules for insulin
continue to take insulin
check blood sugar every 4 hours
Signs/Symptoms:
weight loss
feeling warm
goiter
exopthalmos
insomnia
brittle nair
thin hair
DYSPNEA ON EXERTION
hyperthyrodism
what can cause hypophosphatemia (<3), hypercalcemia (>10), elevated creatinine, bone density loss, elevated PTH, muscle weakness,
hyperparathyrodism
Tx: complete / partial parathyroid gland removal
annual bone density scans
labs to monitor: PTH, phosphorus, creatinine, calcium
Ambulation!
what is something a patient can wear to help HCP's
medical alert bracelet
* identify disorder
* identify drugs
medication to treat SIADH
Drug tx: vasopressin, diuretics, Hypertonic saline
how long does it take for DM type 1 to turn into DKA
only a few hours
how long does DM type 2 take to turn into HONK
days to weeks
Definitive test for addisons:
how do we treat this:
ACTH stimulation test: given IV, check plasma cortisol levels at 30 mins, then 1 hr.
If acute crisis, don't wait for results to come back to treat.
Tx: CT/MRI, HRT for cortisol and aldosterone deficiencies, oral cortisol replacement (prednisone). possible mineralocorticosteroid (fludrocortisone)
What is Cushing's Syndrome vs. Cushing's Disease?
Cushing's Disease: Pituitary is producing too much ACTH
Cushing's Syndrome: Outside cause... Too much cortisol/ too much prednisone
when to hold insulin
BS <100-110
symptomatic pt
NPO
per orders if adjusting medications
How do we treat an overactive thyroid?
Propylthiouracil & Methimazole(anti-thyroid meds)
Radioactive idodine therapy
Surgical intervention
tachycardiac
heart failure
shock
hyperthermia (106)
agitation
delirium
seizures
n/v/d
coma
Tx: double points if you can answer this
acute thyrotoxicosis ( thyroid storm )
Tx: cool room, heart monitor, F & E replacement, anti-thyroid medications, ICU, o2 if needed, anti-emetic,