NURS 405: Quiz 2 Endocrinology

Polyuria

excessive urination

polydipsia

extreme thirst

polyphagia

extreme eating

Kussmaul Breathing

Rapid Deep and labored breathing pattern

Body is trying to blow off CO2 and increase blood pH

Betahydroxybutyrate

blood serum levels of ketones

3 P’s of Diabetes

Polyuria

Polydipsia

Polyphagia

Hgb A1C test

average blood sugar over last 3 months

Mild hypoglycemia clinical manifestation

SNS activation due to low BG

• hunger

• diaphoresis

• tremor

• tachycardia

• anxiety

Moderate Hypoglycemia clinical manifestation

brain cells don’t have needed fuel to function

• inability to concentrate/coordinate

• numbness of lips and tongue

• slurred speech

• emotional changes

• diplopia

Severe Hypoglycemia clinical manifestation

CNS function so impaired, pt cannot treat low BG without help

• disoriented behavior

• seizures

• LOC

DKA precipitating event

• omission of insulin

• physiologic stress (infection, surgery, stroke, MI)

DKA onset

rapid (24hrs)

DKA blood glucose levels

over 250 mg/dL

DKA arterial pH level

7.3 (acidity based on severity)

DKA serum and urine ketones

PRESENT

DKA Serum osmolality

300-350 mOsm/L (elevated)

DKA plasma bicarbonate level

less than 18 mEq/L

HHNS precipitating event

physiologic stress (Infection, surgery, stroke, MI)

HHNS onset

Slow (over several days)

HHNS blood glucose levels

over 600 mg/dL; frequently exceeds 1,000 mg/dL

HHNS arterial pH level

NORMAL

HHNS serum and urine ketones

ABSENT

HHNS Serum Osmolality

greater than 350 mOsm/L

HHNS Plasma Bicarbonate level

NORMAL

DKA & HHNS BUN and Creatinine levels

elevated

Rapid Acting Insulin: types

lispro

aspart

glulisine

Rapid Acting Insulin: Indication

rapid reduction of glucose level

• treats postprandial hyperglycemia

• prevents nocturnal hypoglycemia

Rapid Acting Insulin: Onset

5-30 minutes

Rapid Acting Insulin: Peak

30-90 minutes

Rapid Acting Insulin: Duration

3-5 hours

Short Acting Insulin: indication

Usually given 15 minutes before a meal

• can be taken alone or with longer-acting insulin

Short Acting Insulin: Type

Regular Insulin

Short Acting Insulin: onset

30-60 minutes

Short Acting Insulin: Peak

2-3 hours

Short Acting Insulin: Duration

4-6 hours

Intermediate Acting Insulin: Indication

Food should be taken AROUND time of onset and peak

Intermediate Acting Insulin: type

NPH (neutral protamine Hagedorn)

Intermediate Acting Insulin: Onset

1-1.5 hours

Intermediate Acting Insulin: Peak

4-12 hours

Intermediate Acting Insulin: Duration

up to 24 hours

Long-Acting Insulin: Indication

Used for basal dose; keeps BG steady through day, night, and between meals

Long-Acting Insulin: type

Glargine

Long-Acting Insulin: Onset

3-6 hours (unknown)

Long-Acting Insulin: peak

NO PEAK; continuous

Long-Acting Insulin: duration

24 hours

Rapid-acting inhalation powder: Indication

administer at the beginning of a meal

Rapid-acting inhalation powder: Type

Afrezza

Rapid-acting inhalation powder: Onset

< 15 minutes

Rapid-acting inhalation powder: Peak

about 50 minutes

Rapid-acting inhalation powder: Duration

2-3 hours

1 injection Insulin Regime: Description

Before breakfast

• NPH

OR

• NPH with rapid-acting insulin

1 injection Insulin Regime: Advantage

Simple regimen

1 injection Insulin Regime: Disadvantages

• Difficult to control fasting BG

• NPH doesn’t last

2 injection Insulin Regime: Description

Before breakfast and dinner

• NPH

OR

• NPH with rapid-acting insulin

OR

• Pre-mixed Insulin (rapid-acting insulin)

2 injection Insulin Regime: Advantage

simplest regimen to mimic normal pancreas

2 injection Insulin Regime: Disadvantages

• need fixed schedule of meals and exercise

• cannot independently adjust NPH

3-4 injection Insulin Regime: Description

Rapid acting insulin before each meal WITH

• NPH at dinner or bedtime

OR

• Long acting insulin 1-2x a day

3-4 injection Insulin Regime: Advantages

• more closely mimics normal pancreas

• each pre-meal dose decided independently

• more flexible with meals and exercise

3-4 injection Insulin Regime: Disadvantage

• Requires more injections than other regimens

• multiple blood glucose tests on a daily basis

• requires intensive education and follow up

Insulin Pump Regime: Description

Uses ONLY rapid-acting insulin

• infused at continuous low rate (basal rate)

• pre-meal bolus doses

Insulin Pump Regime: Advantages

• most CLOSELY mimics normal pancreas

• decrease unpredictable peaks

• increases meal and exercise flexibility

Insulin Pump Regime: Disadvantage

• Requires intensive training and frequent follow up

• potential mechanical problems

• Multiple blood glucose tests on a daily basis

• increase in expenses

Endocrine System function

regulate critical functions like growth, metabolism, and stress response

3 Complications of endocrine disorder in pediatric patients

1. delayed/acceleration of physical growth

2. delay/acceleration of developmental milestones

3. delayed/advanced puberty

Pituitary Disorders

1. Growth Hormone Deficiency

2. Precocious Puberty

Central Diabetes Insipidus and symptoms

• Insufficient production/release of ADH by the hypothalamus or pituitary gland

• Massive, dilute urine output and extreme thirst

• More common (98%)

Central DI clinical manifestations

• brain trauma/tumor

• intracranial surgery

• congenital

Nephrogenic DI + Symptoms

• Kidneys fail to respond to arginine vasopressin

• Excessive thirst and passing huge amounts of urine

• Less common (2%)

Nephrogenic DI clinical manifestations

• NOT associated with pituitary gland

• Related to renal sensitivity to ADH

High serum osmolality and ADH

• Tells pituitary to release ADH and hold onto water

• High serum osmolality = high concentration of solutes (dehydration)

Urine Specific Gravity

• tells us how much solute is in the urine

• Low specific gravity = not a lot of concentrate in the urine

Symptoms of DI

• weight loss

  • due to drinking so much they feel too full for food

• signs of dehydration

• changes in mood

• fatigue

• fever

• Vomiting/constipation

Desmopressin Acetate (DDAVP)

• synthetic ADH used to control central DI

• SQ, PO, intranasal, Sublingual

SIADH clinical Manifestation

• CNS infection (meningitis)

• head trauma

• tumor

• surgery

• meds/excess vasopressin

Panhypopituitarism

Failure of the pituitary gland to produce sufficient hormones

Panhypopituitarism Clinical Manifestations

• congenital defects

• trauma

• infections

• tumors

Panhypopituitarism Clinical Signs

• Growth failure

• hypothyroidism

• adrenal insufficiency

• delayed or absent puberty

Functions of Thyroid gland (T3 & T4)

• Regulate metabolism, weight, energy, and body temperature

• Regulates HR, CO, and BP

• maintains mood, concentration, and overall brain health

• Regulates Digestive functions

• Support growth and maintenance of skin, hair, and nails

Adrenal Glands Hormones

• Cortisol

• Aldosterone

  • electrolyte and fluid balance

• epinephrine/norepinephrine

• Androgens

  • sexual development

Salt-Wasting CAH

• Severe deficiency in enzyme 21-hyrdroxylase

• inadequate production of cortisol and aldosterone

• EXCESSIVE production of androgens

• Females have ambiguous sexual genitalia at birth

• Organs start shutting down

Non-Classic CAH

• common, milder, and asymptomatic

• Excessive androgen production

• Early pubarche, acne, hirsutism, and rapid growth in childhood/short stature in adults

CAH associated with signs of adrenal crisis

• vomiting

• dehydration

• hypotension

• hypotension

• hyperkalemia

CAH Hydrocortisone (steroid shot)

• high dosing

• stress dosing as fast you can for patient’s in shock

CAH medical administration

• lifelong glucocorticoid