Medsurg I Exam 2

Diabetes Mellitus (Diabetes)

• A chronic condition that affects how the body processes blood sugar (glucose)

• Occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces

• Leads to elevated levels of glucose in the blood

Types of Diabetes

• Type 1 Diabetes: An autoimmune condition where the body attacks insulin-producing cells in the pancreas

• Type 2 Diabetes: A condition where the body becomes resistant to insulin or doesn’t produce enough insulin

• Gestational Diabetes: Diabetes that develops during pregnancy and usually disappears after birth

Hyperglycemia

• Elevated levels of glucose in the blood

• Often linked to diabetes and can result from various factors such as insufficient insulin production or action, excessive carbohydrate intake, or stress

• Management: monitoring blood sugar levels, adhering to a balanced diet, and taking prescribed medications

Hypoglycemia

• Low levels of glucose in the blood

• Triggered by factors such as excessive insulin, prolonged fasting, or intense physical activity

• Immediate treating involves eating fast-acting carbohydrates to quickly raise blood sugar

• Prevention: regular monitoring and a consistent eating schedule

Symptoms of Hyperglycemia

• Fatigue

• Vision changes

• Excessive thirst

• Fruity breath

• Increased hunger

• Nausea and vomiting

Symptoms of Hypoglycemia

• Headache

• Shaking

• Sweating

• Hunger

• Fast heartbeat

Macrovascular Complications of Diabetes

• Coronary Artery Disease (CAD)

• Cerebrovascular Disease

• Peripheral Artery Disease (PAD)

• Reduced immunity

Microvascular Complications of Diabetes

• Diabetic Retinopathy

• Diabetic Nephropathy

• Diabetic Neuropathy

Other Complications of Diabetes

• Erectile Dysfunction

• Muscle Weakness

• Infections

• Diabetic Gastroparesis

• Peripheral Neuropathy

• Cognitive Dysfunction

Acute Complications of Diabetes

• Diabetic Ketoacidosis (DKA)- caused by absence of insulin and generation of ketoacids

• Hyperglycemic-Hyperosmolar State (HHS)- caused by insulin deficiency and profound dehydration

• Hypoglycemia

• General Symptoms: fatigue, tachycardia, lack of concentration, sweating, irritability, hunger

Cardiovascular Risk Factors of Type 2 Diabetes

• Hyperlipidemia (HLD)

• Hypertension (HTN)

• Increased clot formation

Parts of the Endocrine System

• Hypothalamus

• Pituitary Gland

• Thyroid Gland

• Parathyroid Glands

• Adrenal Glands

• Pancreas

• Ovaries

• Testes

Hypothalamus

• Connects the nervous system to the endocrine system and controls the pituitary gland

• Known as the “control center” of the endocrine system

• Produces vasopressin (ADH), oxytocin, dopamine, somatostatin

• Produces thyrotropin-releasing hormone, gonadotropin-releasing hormone, corticotropin-releasing hormone, growth hormone-releasing hormone

Pituitary Gland

• Known as the “master gland”

• Regulates other endocrine glands and various bodily functions

• Produces adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH), prolactin

Thyroid Gland

• Produces hormones that regulate metabolism, energy, and growth

• Produces T₃ and T₄

Parathyroid Glands

• Regulate calcium levels in the blood

• Produces parathyroid hormone (PTH)

Adrenal Glands

• Produce hormones that regulate metabolism, immune system, blood pressure, and stress responses

• Produces steroids in the cortex → cortisol and aldosterone

• Produces catecholamines in the medulla → epinephrine and norepinephrine

Pancreas

Produces insulin and glucagon to regulate blood sugar levels

Ovaries

Produce estrogen and progesterone, which regulate menstrual cycles and pregnancy

Testes

Produce testosterone, which affects male characteristics and sperm production

Hypopituitarism

• A rare condition where the pituitary gland fails to produce one or more of its hormones or doesn’t produce enough of them

• Can affect various bodily functions such as growth, blood pressure and reproduction

• Symptoms depend on which hormones are deficient but can include fatigue, muscle weakness, and infertility

• Treatment: hormone replacement therapy and surgery and/or radiation therapy for pituitary adenomas

Causes of Hypopituitarism

• A tumor of the pituitary gland

• Stroke or hemorrhage

• Malnutrition or rapid fat loss

• Certain medications such as narcotics, steroids, and certain cancer meds

• Swelling of the pituitary gland (hypophysitis)

• Infections of the brain (meningitis, TB)

• Sheehan syndrome- significant blood loss during childbirth that damages the pituitary gland

• Genetics

• Shock or severe hypotension → pituitary ischemia

Symptoms of GH Deficiency (Hypopituitarism)

• Fatigue

• Muscle weakness

• Changes in body fat

Symptoms of LH and FSH Deficiency (Hypopituitarism)

• Hot flashes

• Irregular periods or no periods

• Loss of pubic hair

• Not being able to make milk for breastfeeding

• Erectile dysfunction

• Decreased facial or body hair

• Mood changes

• Fatigue

Symptoms of TSH Deficiency (Hypopituitarism)

• Tiredness

• Weight gain

• Dry skin

• Constipation

• Sensitivity to cold or trouble staying warm

Symptoms of ACTH Deficiency (Hypopituitarism)

• Severe tiredness

• Hypotension

• Frequent infections

• Nausea, vomiting, or abdominal pain

• Confusion

Symptoms of Prolactin Deficiency (Hypopituitarism)

Problems making milk for breastfeeding

Diabetes Insipidus (DI) “dry inside”

• A condition characterized by an imbalance of water in the body, leading to excessive thirst and frequent urination

• Occurs due to a deficiency of ADH or the kidneys’ inability to respond to ADH → results in the production of large amounts of dilute urine and can cause dehydration if not managed properly

• Interventions: desmopressin, preventing and managing dehydration, daily weights

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) “soaked inside”

• A condition where the body produces too much ADH, causing the body to retain water and have low sodium levels in the blood (hyponatremia)

• Can result in symptoms like nausea, headache, confusion, and in severe cases, seizures or coma

• Often associated with conditions like lung cancer, brain injuries, and certain meds

• Additional Symptoms: GI disturbances, weight gain, bounding pulses, hypothermia

• Interventions: fluid restriction, Is and Os, vasopressor receptor agonists, diuretics, hypertonic saline, neurologic checks

Addison’s Disease (think absence)

• When the body produces too little steroid hormones in the body such as cortisol and aldosterone (adrenal gland hypofunction)

• Present as thinner, frail, weaker and tanner

• The most common primary form of adrenal gland hypofunction (autoimmune)

• Treatment: hormone therapy

• Interventions: promote fluid balance, monitor for fluid deficit, prevent hypoglycemia

Symptoms of Addison’s Disease (Primary) and Secondary Adrenal Gland Hypofunction

• Hypotension

• Low weight due to water loss

• Low temp (cold intolerance)

• Alopecia

• Depression

• Irritability

• Fatigue

• Muscle weakness

• Hyponatremia

• Hypoglycemia

• Slow or absent periods (amenorrhea)

• Bronze pigment

• Hyperkalemia

Hyperpituitarism

• Hormone over secretion that occurs with anterior pituitary tumors or tissue hyperplasia

• May be caused by a benign tumor

• Overproduction of GH in adults results in acromegaly

• Hypophysectomy (surgical removal of pituitary gland) may be needed in severe cases

Cushing’s Disease (think cushion)

• When the body produces too much ACTH → to much cortisol

• Present as larger, round, and hairy

• Causes: glucocorticoid therapy, pituitary adenoma

• Lab assessment: blood, salivary, and urine cortisol levels, dexamethasone suppression testing

• Imaging assessment: CT, MRI, Arteriography

Secondary Adrenal Gland Hypofunction

Happens when the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol

Acute Adrenocortical Insufficiency

• Is life threatening → can lead to adrenal crisis → can then lead to adrenal shock

• Management of acute adrenal crisis includes rapid IV normal saline or D5NS, IV hydrocortisone

• For hyperkalemia → IV insulin + dextrose

• Loop or thiazide diuretics (NO potassium-sparing)

Symptoms of Cushing’s Disease

• Hypertension

• Osteoporosis

• Immune suppression

• Muscle weakness with thin extremities

• Stretch marks (striae)

• Moon face

• Buffalo hump

• Peptic ulcers

• Irritability

• Cardiac changes

• Hyperglycemia

If left untreated, it increases mortality from infection, cardiovascular disease, or metabolic complications

Innate Immune System

The body’s first line of defense and includes physical barriers (like skin and mucous membranes), chemical barriers (such as stomach acid), and various immune cells (like macrophages and neutrophils) that respond quickly to infections

Adaptive Immune System

This system is more specialized and involves lymphocytes (B cells and T cells) that recognize specific antigens. It has a memory component, which allows for a faster and stronger response upon subsequent exposures to the same pathogen

Two Main Components of the Immune System

1. Innate (or general) immune system

2. Adaptive Immune system

Cell Types Involved in Inflammation

• Neutrophils

• Macrophages

• Basophils

• Eosinophils

• Tissue mast cells

Five Cardinal Symptoms of Inflammation

1. Warmth

2. Redness

3. Swelling

4. Pain

5. Decreased function

Neutrophil

Nonspecific ingestion and phagocytosis of microorganisms and foreign proteins

Macrophage

• Nonspecific recognition of foreign proteins and microorganisms; ingestion and phagocytosis

• Assists with antibody-mediated immunity and cell-mediated immunity

Monocyte

Destruction of bacteria and cellular debris; matures into macrophage

Eosinophil

Releases vasoactive amines during allergic reactions and in response to parasite infestations

Basophil

Releases histamines, kinins, and heparin in areas of tissue damage

Stages of HIV

• Stage 1 → acute response (“flu-like” symptoms)

• Stage 2 → chronic (often has little to no symptoms due to active treatment)

• Stage 3 → AIDS (final, most serious)

When AIDS is typically diagnosed

When the CD4 count drops below 200 or when certain opportunistic infections or cancer develops

How HIV is transmitted

• Body fluids such as blood, semen, vaginal fluids, and breast milk

• Mother to child during pregnancy, childbirth, or breastfeeding

• Sexual contact

• Sharing or using contaminated needles

Symptoms of Prolactin Excess (Hyperpituitarism)

• Galactorrhea

• Amenorrhea

• Infertility

• Decreased libido

Symptoms of Growth Hormone Excess (Hyperpituitarism)

Note: excess GH causes acromegaly in adults

-Physical

• enlarged hands, feet, and facial bones

• thickened skin

• organ enlargement (heart, liver)

• deepened voice (vocal cord hypertrophy)

-Musculoskeletal

• bone overgrowth

• joint cartilage breakdown

• ligament hypertrophy

• nerve entrapment (ex. carpal tunnel)

skeletal changes are permanent, even after treatment

-Metabolic

• hyperglycemia

Causes of Acromegaly

• GH-secreting pituitary tumor

• MEN1 genetic mutation

• Excess hypothalamic GHRH stimulating a normal pituitary

Causes of Addison’s Disease (Primary)

• Autoimmune disease (most common)

• TB

• Metastatic Cancer

• HIV/AIDS

• Hemorrhage

• Sepsis

• Adrenalectomy

• Radiation

• Drugs/toxins

Causes of Secondary Adrenal Hypofunction

• Sudden stop of long-term glucocorticoids (most common)

• Pituitary tumors

• Postpartum pituitary necrosis (Sheehan syndrome)

• Hypophysectomy

• Brain radiation

Symptoms of HIV Stage 1

Note: symptoms are “flu-like” and can take up to 4 weeks to show

• Fever

• Sore Throat

• Rash

• Night Sweats

• Chills

• Headache

• Muscle aches

Symptoms of AIDS

• Swollen lymph nodes

• Weight loss

• Fever

• Diarrhea

• Cough

• Skin lesions

• SOB

• Unexplained bleeding or bruising

• Persistent fatigue

• Yeast infections

Antiretroviral Therapy (ART)

Reduces the viral load in the blood, preventing the progression to AIDS and reducing the risk of transmission

Preventive Measures for HIV

• Condoms

• Preexposure prophylaxis (PrEP)

• Postexposure prophylaxis (PEP)

• Avoiding sharing needles

• ART to prevent mother-child transmission

• Abstinence

Opportunistic Infections with AIDS

• TB

• Cryptococcal Meningitis

• Kaposi’s Sarcoma

• Pneumocystis Pneumonia (PCP)

• Candidiasis

• Toxoplasmosis

• Herpes Simplex Virus (HSV)

Preexposure Prophylaxis (PrEP)

• A daily HIV prevention pill that someone who is HIV-negative but at a higher risk for HIV can take

• Before use, there is screening for kidney and liver function, STIs and Hepatitis A,B, and C

• Someone with active hepatitis B can’t use PrEP (can cause a dangerous flare)

Postexposure Prophylaxis (PEP)

• A treatment given after a potential exposure to HIV to prevent infection

• Used in emergency situations such as unprotected sex, needle-sharing, and occupational exposure like needlestick injuries

• Must be taken within 36 hours, is best when taken within 2 hours

• You must take it for 28 days

Labs for Detecting HIV

• CBC

• WBC < 3500 = leukopenia

• Lymphocytes < 1500 = lymphopenia

• CD4 and CD8 (normal ratio is 2:1), CD4 will drop

• Antibody/Antigen Tests

• Viral load → measures amount of HIV RNA