Thyroid Storm
A patient presents with hyperthroidism/thyroid storm. Sudden fever, tachycardia, and confusion. What lab pattern will we typically see with hyperthyroidism?
What is low TSH and high T3/T4?
Labs reveal blood glucose >250 mg/dL, low bicarbonate, and ketones in urine. What is the underlying metabolic problem?
metabolic acidosis
pH < 7.3; HCO3 ≤ 15 mEq/L
Blood glucose in HHS can be severely elevated above this level.
600 mg/dL
Urine output in SIADH is usually this.
low
A patient with DI experiencing excessive fluid loss develops a serum sodium level greater than 145 mEq/L. What electrolyte imbalance is occurring?
hypernatremia (Sodium >145)
A nurse is caring for a patient with hyperthyroidism. Which intervention helps prevent hyperthermia during a thyroid crisis?
Using cooling blankets or active temperature management
Which breath and respiratory pattern is characteristic of DKA?
fruity-smelling breath and Kussmaul respirations
A key feature of HHS is extremely high serum osmolality, usually above this value.
320 mOsm/kg
This serum electrolyte is typically low in SIADH due to water retention.
sodium (hyponatremia)
A patient reports extreme thirst and produces very large amounts of dilute urine throughout the day. This finding suggests a disorder involving deficiency of a hormone that regulates water balance.
ADH (Antidiuretic Hormone)
A patient requires lifelong thyroid hormone replacement. When should the nurse instruct the patient to take the medication?
On an empty stomach, 1 hour before breakfast or 3 hours after a meal
What is the first nursing priority when a patient is diagnosed with DKA?
initiating aggressive IV fluid resuscitation
What is the immediate priority intervention for a patient with HHS?
restoring intravascular volume with IV fluids
Which lab value is most indicative of SIADH and which solution may be prescribed?
Serum sodium <135 mEq/L, hypertonic saline
How is DI different from SIADH
DI is caused by too little ADH, leading to high urine output, hypernatremia (>145), and dilute urine (specific gravity <1.005), and is treated with Desmopressin.
SIADH is caused by too much ADH, leading to low urine output, hyponatremia, and concentrated urine (specific gravity >1.030), and is treated with fluid restriction, loop diuretics, and possibly hypertonic saline.
Lifelong replacement therapy for hypothyroidism is this medication, and when should you take it?
Levothyroxine, before breakfast or after a meal
During DKA management, the nurse monitors electrolytes closely. Which electrolyte is most critical due to insulin therapy shifts?
Potassium?
Why is close glucose monitoring necessary during HHS treatment?
To prevent rapid hypoglycemia after fluid and insulin therapy.
Excess ADH leads to water retention and these changes in urine.
Low urine output and high urine specific gravity (>1.030)
Urine specific gravity in DI is typically this.
low (<1.005)
This hormone helps regulate blood calcium levels and supports bone health.
Calcitonin
This lab finding is present in DKA but not in HHS, caused by fat breakdown.
ketones in blood and urine?
ketones in blood and urine
A patient with HHS shows a serum osmolality above 320 mOsm/kg. What clinical risk does this increase?
Risk of severe dehydration and altered mental status
This is the primary nursing intervention to manage SIADH.
Water restriction
Which medication is administered to decrease excessive urine output by replacing the action of antidiuretic hormone?
Desmopressin
Desmopressin