Extensive Review

Type 1 Diabetes Mellitus

Autoimmune destruction of pancreatic beta cells leading to little or no insulin production; requires lifelong insulin therapy; high risk for DKA

Type 2 Diabetes Mellitus

Insulin resistance and decreased insulin production; often associated with obesity; may be managed with oral meds and/or insulin

Insulin (Type 1 treatment)

Replaces missing insulin; includes rapid, short, and long-acting types; must coordinate with meals to avoid hypoglycemia

Metformin

First-line medication for Type 2 diabetes; decreases liver glucose production and improves insulin sensitivity; risk of lactic acidosis

Glipizide

Sulfonylurea that stimulates pancreas to release insulin; risk of hypoglycemia

Long-term complications of diabetes

Chronic hyperglycemia leads to microvascular damage (retinopathy, nephropathy, neuropathy) and macrovascular damage (atherosclerosis, MI, stroke)

SIADH (Syndrome of Inappropriate ADH)

Excess ADH causes water retention, dilutional hyponatremia, and concentrated urine; risk for cerebral edema

Diabetes Insipidus (DI)

Deficiency of ADH leads to excessive water loss, hypernatremia, and dilute urine; risk for dehydration

SIADH sodium level

Low due to dilution

DI sodium level

High due to water loss

Desmopressin (DI treatment)

Synthetic ADH used to reduce urine output and treat diabetes insipidus

Vasopressin

Hormone replacement therapy for DI that mimics ADH effects

SIADH treatment

Fluid restriction, hypertonic saline (severe), loop diuretics, ADH antagonists

Aldosterone

Regulates sodium and potassium; increases sodium and water retention and promotes potassium excretion

Cortisol

Stress hormone that increases blood glucose, suppresses immune response, and helps with metabolism

Aldosterone regulation

Controlled by RAAS (renin-angiotensin-aldosterone system)

Cortisol regulation

Controlled by HPA axis via ACTH from pituitary

Cushing’s syndrome

Excess cortisol causing weight gain, moon face, hyperglycemia, and hypertension

Addison’s disease

Adrenal insufficiency with low cortisol causing weight loss, hypotension, and hyperkalemia

Primary endocrine disorder

Problem originates in the gland itself

Secondary endocrine disorder

Problem originates in the pituitary gland

Pressure ulcer stage 1

Non-blanchable redness with intact skin

Pressure ulcer stage 2

Partial thickness skin loss with blister or open sore

Pressure ulcer stage 3

Full thickness skin loss with visible fat

Pressure ulcer stage 4

Full thickness tissue loss with exposed muscle or bone

Pressure ulcer risk factors

Immobility, moisture, poor nutrition, decreased sensation, diabetes

Burn first degree

Red, painful, no blisters; superficial

Burn second degree

Blisters, partial thickness, very painful

Burn third degree

Full thickness, white/charred, painless due to nerve damage

Burn treatment priorities

Airway management first, then fluids, pain control, infection prevention

Age-related skin changes

Thinner skin, decreased elasticity, increased fragility and injury risk

Osteoclasts

Cells that break down bone

Osteoblasts

Cells that build new bone

Osteoarthritis

Degenerative joint disease from wear and tear; pain worsens with activity

Rheumatoid arthritis

Autoimmune inflammatory disorder causing symmetric joint pain and morning stiffness

Osteoarthritis treatment

NSAIDs, weight loss, exercise, joint protection

Rheumatoid arthritis treatment

Immunosuppressants, anti-inflammatory medications

Osteoporosis risk factors

Age, female gender, low calcium/vitamin D, sedentary lifestyle, smoking

Rhabdomyolysis cause

Muscle breakdown due to trauma, extreme exercise, or drugs

Rhabdomyolysis assessment

Muscle pain, dark urine, elevated creatine kinase levels

Rhabdomyolysis complications

Acute kidney injury due to myoglobin release

Rhabdomyolysis treatment

Aggressive IV fluid resuscitation to protect kidneys

Left-sided heart failure

Failure of left ventricle causing pulmonary congestion, crackles, and shortness of breath

Right-sided heart failure

Failure of right ventricle causing peripheral edema, JVD, and ascites

Angina

Chest pain caused by decreased oxygen supply to the heart muscle

Hypertension

Chronic elevated blood pressure leading to vessel damage and increased cardiac workload

Cardiac output

Amount of blood pumped by the heart per minute; heart rate × stroke volume

Atherosclerosis

Plaque buildup in arteries leading to narrowing and reduced blood flow

Digoxin

Cardiac glycoside that increases contractility and slows heart rate; monitor for toxicity (vision changes, bradycardia)

Metoprolol

Beta blocker that decreases heart rate and blood pressure

Carvedilol

Beta blocker that reduces heart workload and blood pressure

Atorvastatin

Statin that lowers cholesterol and reduces cardiovascular risk

Lisinopril

ACE inhibitor that lowers blood pressure and protects kidneys; side effect: cough

GERD

Acid reflux disease causing heartburn

Gastric ulcer

Ulcer in stomach lining causing pain and possible bleeding

Gastroenteritis

Infection causing vomiting, diarrhea, and dehydration

Peptic ulcer disease (PUD)

Ulcers caused by acid or H. pylori infection

IBD

Chronic inflammatory GI disease with structural damage (Crohn’s, UC)

IBS

Functional GI disorder without inflammation

Crohn’s disease

IBD affecting any part of GI tract with patchy lesions

Ulcerative colitis

IBD affecting colon with continuous lesions

Liver failure

Impaired liver function causing toxin buildup, jaundice, and increased ammonia

Senna glycoside

Stimulant laxative that increases bowel motility

Polyethylene glycol

Osmotic laxative that pulls water into stool

Docusate

Stool softener that allows water/fat into stool

Omeprazole

Proton pump inhibitor that reduces stomach acid production