Endocrine
Insulin is secreted by the _________ and is increased following the ingestion of a meal, specifically with ________ being the main trigger of insulin secretion.
pancreas, carbohydrates
(carbohydrates are a trigger because the body breaks down carbs into glucose)
The nurse recommends a high calorie and high protein diet to a patient with a TSH of 0.2. What is the rationale for this?
Hyperthyroidism leads to increased cellular regulation and metabolism.
The thyroid gland is overactive (T3 and T4 regulate metabolism, so when there is too much of them, the body's metabolic rate increases, leading to faster energy expenditure. Even though their appetite increases, they lose weight due to the higher metabolic demands of their body.)
List target blood sugar goals for a patient with diabetes
80-130 mg/dL pre-prandial
<180 mg/dL post-prandial (2 hours post meal)
What is the priority nursing intervention for a patient experiencing transfusion reaction
STOP infusion. Disconnect tubing and start a new infusion with 0.9% NS
pH 7.21
PCO2 61 mmHg
HC03 22 m3q/L
Respiratory acidosis
pH 7.21 indicates acidosis
pCO2 61mmHG is significantly elevated, points to resp acidosis
HCO3 22 is normal but towards the lower end of the normal range, suggesting that there hasn't been enough time or compensatory response by the kidneys to buffer the acidosis.
This condition is caused by excessive growth hormones related to pituitary tumors
Acromegaly
Elevated TSH with decreased T3 and T4 is diagnosed as
Hypothyroidism
TSH: The pituitary gland releases more TSH when it detects low levels of thyroid hormones in the bloodstream, attempting to stimulate the thyroid to produce more T3 and T4)
Decreased T3 and T4: When the thyroid is unable to produce enough thyroid hormones, both T3 and T4 levels drop.
What is the treatment for hypoglycemia in an awake and alert patient?
Consume 15g of fast acting carbohydrate
Examples: juice 4-6 ounces, soda 4 ounces, hard candy 5-6 pieces like life savers, glucose tabs 3-4
What type of IV solution would be administered to replace blood loss and increase blood pressure?
Isotonic
Lactated Ringers, 0.9% NS
pH 7.24
Co2 28 mmHg
HCO3 18 MEq/L
Metabolic acidosis with respiratory compensation
pH 7.24 is acidotic
CO2 28 (normal range 35-45mmHG)
HC03 (normal range 22-28mEq/L)
Name an intervention for a patient with SIADH
Fluid restriction, measure I&O, Loop diuretics, seizure and fall precautions, HOB flat, frequent neuro checks, if severe administration of hypertonic solution
What position should a patient post thyroidectomy be placed in?
Semi-fowlers (30 to 45 degrees)
Immediately post op this positioning helps reduce neck strain and promotes better respiratory function.
Avoid full neck flexion. Keep head and neck neutral.
Diagnostic criteria for diabetes
A1C >6.5
Fasting plasma glucose >126 mg/dL
2 hour OGTT >200 mg/dL
Symptomatic random glucose >200 (polyuria, polydipsia, unexplained weight loss)
This electrolyte will be decreased in patients with SIADH
Serum sodium
Clinical manifestations of hyperkalemia
Arrhythmia (peaked T wave, prolonged PR interval, wide QRS, v fib, cardiac arrest)
Fatigue, paresthesia, nausea/vomiting, abdominal cramping
Elevated 24 hour urine cortisol, buffalo hump, thinning hair, purple streaks on the abdomen, and moon face are indicative of?
Cushing's Syndrome
Patient complains of fatigue with difficulty walking to the mailbox, constipation, and cold intolerance. You suspect what diagnosis?
Hypothyroidism
Hypothyroidism causes a slowdown of body functions because it involves a deficiency of thyroid hormones (mainly T3 and T4), which are critical for regulating the body's metabolism. Slower metabolism contributes to weight gain, low energy, and fatigue.
Three assessment findings of complications related to diabetes
vascular disease- ulcers, decreased pedal pulses, necrotic areas on the toes and feet, thickened or crumbling toenails, changes to vision
neuropathy- decreased sensation to the extremities, numbness, and tingling, impotence, n/v/d
kidney disease- decreased urine output
A patient with DKA is prescribed regular insulin and IV fluid. What fluid do you anticipate to be ordered initially?
0.9% Normal Saline
NS is preferred initially, isotonic, does not contain glucose. After initial rehydration, may switch to 0.45% as it is hypotonic and helps maintain fluid balance without causing excess sodium retention.
pH 7.32
C02 47 mmHg
HCO3 27 mEq/L
Respiratory acidosis with partial metabolic compensation
7.32- Acidic
pCO2- 47 is elevated (suggests resp acidosis)
HC03- 27 (normal indicating partial compensation)
Bronze skin pigmentation, fatigue, weight loss, and postural hypotension are indicative of?
Addison's disease
Patient 48 hours post thyroidectomy presents with a temp 104.8, tremors, HR 152, and agitation. What do you suspect is going on?
Acute thyrotoxicosis/thyroid storm
Life threatening condition. Body experiences a severe and sudden exacerbation of thyroid hormone excess. Massive release of T3 and T4.
Treatment: PTU, beta blockers, cooling measures, IV fluids, etc
Patient with T2 DM and Influenza is experiencing n/v/d, abdominal pain, fatigue, dry mucous membranes, increased dark urination with ketones in urine. Blood sugar 321, BP 80/64, 14 RR, 101.3F, 95%. What is the priority diagnosis?
DKA
Key factors in administering IV potassium
10 mEq/hr is the usual recommended rate, may need to slow rate if causing burning/irritation to vein, should have a 18-20 g IV, continuous cardiac monitoring during infusion, monitor the potassium level
pH 7.48
C02 36
Hc03 29
Metabolic alkalosis
Give examples of patient education related to radioactive iodine treatment
keep a safe distance (approx 6 feet) from pregnant women, kids, and young children. Flush the toilet twice after each use, avoid pregnancy and breastfeeding. Common side effects include nausea, dry mouth, sore throat. Discuss lifelong thyroid hormone replacement. Encourage healthy diet, exercise, hydration.
A patient post thyroidectomy presents with contraction and a twitch of the facial muscles elicited by tapping the facial nerve just in front of the ear. What is the cause of these findings?
Hypocalcemia related to parathyroidectomy
positive Chvostek's sign is seen with tremor, treat with Ca Gluconate
(In hypocalcemia, there is increased excitability of nerve and muscle cells due to low calcium levels in the blood.)
Name 3 sick day protocol interventions for diabetic patients
Check blood sugars more frequently, Call the doctor for blood sugars >300, inability to keep fluids down due to v/d, or ketones are seen in urine. Continue to eat small soft foods at least 6-8 times a day if you cannot eat full meals. Continue to take insulin and all other medications.
A patient exhibits difficulty concentrating, headache, nausea and vomiting. You suspect this electrolyte to be decreased.
Sodium
pH 7.38
C02 38
HC03 24
Normal ABG