endocrine and diabetes- test 1 MS2

anterior pituitary secretes

ACTH, GH, TSH (affects adrenal gland and thyroid gland)

treatment for anterior pituitary tumor

steroid replacement, hormone replacement or surgery (transsphenoidal hypophysectomy)

acromegaly

overproduction of GH as an adult

gigantism

overproduction of GH as a child

transsphenoidal hypophysectomy

to remove pituitary tumor, surgical incision under lip and through sinus cavity, has nose packing (monitor for bleeding)

transsphenoidal hypophysectomy complications

meningitis, CSF leak, diabetes insidious, atelectasis and pneumonia, ICP, hematoma

hematoma with transsphenoidal hypophysectomy

will cause vision changes

ICP with transsphenoidal hypophysectomy

lethargy and confusion, call provider

prevention of ICP from transsphenoidal hypophysectomy

elevate HOB for at least 2 weeks, no cough/sneezes or bend over for at least a month, oral care and saline rinses

meningitis from transsphenoidal hypophysectomy

elevate HOB over 30 degrees, prevented by good oral hygiene, pt cannot cough, sneeze blow nose, call provider if noticed

s/sx of meningitis

stiffness in neck, fever, chills, frontal headache

CSF leak from transsphenoidal hypophysectomy

clean drainage with a yellow halo, headache that worsens when sitting up and better when laying flat, put pt on bedrest if suspected

prevention of atelectasis and pneumonia from transsphenoidal hypophysectomy

turn and deep breath (don't cough)

diabetes insipidus

fluid volume deficit, can be diagnosed with fluid deprivation test, urine specific gravity under 1.010

causes of DI

decreased secretion of ADH from posterior pituitary- infection, headaches, head trauma (transsphenoidal hypophysectomy),

s/sx of diabetes insipidus

polyuria, polydipsia, dehydration, nocturia, hypovolemia, hypernatremia

treatment of diabetes insipidus

1/2NS or NS, desmopressin/vasopressin

nursing considerations of diabetes insipidus

monitor for hypovolemic shock (bp and hr), monitor for sodium imbalance and neurological changes, fall and seizure precautions, daily weights, I/O, urine specific gravity

SIADH

fluid overload, urine specific gravity of 1.030, concentrated urine, hypervolemia, weight gain, hyponatremia

causes of SIADH

increased secretion of ADH from posterior pituitary

treatment of SIADH

demecycline (antibiotic that increases UOP), tolvapan, hypertonic 3% NS (used for low sodium, transfused very slow), fluid restriction, fall and seizure precaution

things to monitor for both SIADH and DI

daily weights, I/O, neurological assessment, specific gravity

s/sx of hashimotos

(hypothyroidism) bradycardia, dry hair and nails, weight gain, constipation, fatigue, cold intolerance, goiter, thick dry skin

tx of hashimotos

levothyroxine- start low dose, taken in the morning on an empty stomach, has a lot of different med interactions, monitor for hyperthyroidism

myxedema

fat deposits in the face, chin protruding can occur when non compliant with meds or hypothyroidism is untreated

myxedema coma s/sx

(slow) decreased temp, unresponsive, lethargy, respiratory problems that require intubation

causes of myxedema coma

stress, cold, infection, not taking meds correctly, undiagnosed hypothyroidism

tx of myxedema coma

IV T3 (triiodothyronine) and/or steroids, monitor temp, intubation

graves s/sx

exopthalamus, tachycardia, tachypnea, heat intolerance, weight loss, goiter, diarrhea, thyroid bruit, insomnia, weakness, nervousness, flushing, increased appetite, dysthymias

tx of graves

PTU, methimazole, regular or radioactive iodine, increase fluid intake, thyroidectomy, beta blockers

complications of graves

stridor (airway swelling), bleeding, hoarseness, vocal changes

what is given prior to a thryoidectomy

thryogen- prevents thyroid storm

nursing considerations of thyroidectomy

give thryogen prior, risk for infection, bleeding and hypocalcemia (accidental removal of parathyroid), airway management, watch for stridor and hoarseness, always ahem trach tray and kit

thyroid storm causes

non compliance with meds in Grave's or taking too much medication in Hashimoto's

thyroid storm s/sx

dysthymias, increased respirations, hypertension, sweating, tremors, fever, abdominal pain, dehydration, tachycardia (over 130), increased temp, cv collapse

goal of thyroid storm treatment

manage temp and heart rate

tx of thyroid storm

D5NS (dehydration), external cooling (fever), cardiac monitor, humidified oxygen, acetaminophen

hypoparathyroidism s/sx

hypocalcemia= tetany, chovsteck's sign, trousseaus sign, numbness and tingling near mouth, stridor (layrngospasms), EKG changes

Chovestek's sign

Twitching of facial muscles near mouth in response to tapping area over facial nerve by ear

trousseaus sign

A sign of hypocalcemia, carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes (occludes blood flow)

tx of hypoparathyroidism

increased calcium and vitamin d intake, decreases phosphate (avoid, chicken, turkey, seafood, nuts and beans), give calcium gluconate to protect the heart (emergency), give calciferol after

nursing considerations from hypoparathyroidism

monitor hypocalcemia, monitor for laryngospams (common with decreased calcium), monitor for stridor/hoarseness, always have trach tray/kit

priority intervention with hypocalcemia

airway

hyperparathyroidism s/sx

hypercalcemia= polyuria, anorexia, bone pain, abdominal pain, risk for fractures

cause of hyperparathyroidism

rare, adenoma tumor releasing calcium

tx of hyperparathyroidism

increase fluids to flush out calcium, remove tumor from parathyroid, place on cardiac monitoring, give calcitonin and corticosteroid (to put calcium in bones) monitor for kidney stones

hypercalcemia crisis

calcium over 13 (very high), concerns for airway and CV crisis, give isotonic fluids, calcitonin and glucocorticosteroid

Addisons electrolyte impact

low sodium, high potassium, low glucose, high calcium

addisions cause

autoimmune, low aldosterone, low cortisol, low androgens

Addisons s/sx

fatigue, bronze skin, weight loss, hypoglycemia, N/V, weakness, hypotension, dysrhythmias, low bp

Addisons tx

daily hydrocortisone

adrenal crisis

(addisons crisis)-life threatening, risk of shock due to hypovolemia, caused by stress- infection, illness or surgery

adrenal crisis s/sx

severe dehydration, hypotension and hypovolemia, fever, N/V, headache, restlessness, abdominal pain, pallor, confusion

tx of adrenal crisis

IV solu cortef (IV corticosteroids), IVF bolus of 3-4L, sent home with IM steroids and education on when/how to use, give D5NS, educate on importance of medical alert bracelet, education on medication compliance

pt education of adrenal crisis

take extra corticosteroids when sick, before surgery or pregnant, wear medical alert bracelet

Cushing's electrolyte imbalances

high sodium, low potassium, high glucose, low calcium

cause of Cushing's

tumor in anterior pituitary, autoimmune origin, or long term steroid use

s/sx of Cushing's

central obesity, thin skin, striae, moon face, buffalo hump, CUSHINGOID

tx of Cushing's

surgery to remove tumor if that's the cause, education on medication compliance

nursing considerations of Cushing's

monitor for GI bleeds (can indicate gastric ulcer), infection risk, hypertension risk, monitor cardiac (hypokalemia), blood sugar check every 6 hours

when are blood sugar checks for a patient with Cushing's

every 6 hours, due to blood glucose rising with medication administration and not due to food intake

pheochromocytoma

rare, tumor in adrenal gland that secretes cathecohlemines, affects people between 20-50

s/sx of pheochromocytoma

(5 H's) hypertension, headache, hyperhydrosis, hyperglycemia, hypermetabolism, can cause hypertensive emergency (paroxysmal HTN), tremors, anxiety, palpations

hypertensive emergency

(seen with pheochromocytoma) risk of hemorrhage due to BO being so high

paroxysmal hypertension

bp is very high like 250/150

tx of pheochromocytoma

surgery to remove tumor, beta blocker before surgery (to lower hr)

pheochromocytoma tumor removal pre-op

ensure BP is controlled (due to epi/norepi being released during surgery), pt is on bed rest, elevate HOB above 45 degrees, calm environment

pheochromocytoma tumor removal post-op

monitor for hypoglycemia, internal bleeding, adrenal crisis, stoke

fluid volume deficit s/sx

loss of 2 lbs in a day or 5lbs in a week, poor skin turgor, hypotension, tachycardia, decreased UOP, flat neck veins, increase in electrolyte concentrations (Na or creatinine)

fluid volume overload s/sx

gain of 2lbs in a day or 5lbs in a week, edema, crackles, hypertension, tachycardia, increased respirations, UOP may or may not change, JVD, K and Na can increase or decrease

interventions for fluid deficit

oral or IV fluids, daily weights, blood replacement (if underlying cause is bleeding)

interventions for fluid overload

daily weight, fluid restrictions, diuretics, sodium restriction

sodium imbalance

neurological symptoms, high or low= seizure and fall precautions, common with endocrine disorders, fluid imbalance or kidney failure

potassium imbalance

cardiac symptoms, high or low= dysrhythmias, always get EKG, common with: DKA, kidney disease, loop or K sparing diuretics

calcium imbalance

neuromuscular symptoms, chovestck's signs, tetany, parathesias, laryngospasms, common with: endocrine (parathyroid) disorders

magnesium imbalance

cardiac, neurological and muscular symptoms, common with alcoholism

uncompensated ABGs

ph is abnormal, and either CO2 or Hco3 matches ph to know cause

partially compensated ABGs

CO2 and HCO3 are always opposite each other, ph is not normal

compensated ABGs

ph is normal, HCo3 and CO2 are opposite and both out of normal range

diabetic preferred diet

3oz lean meat (1/4 plate), 1/4 of plate is carbs, 1/2 plate of veggies, one 'free item' like diet soda

parental nutrition on diabetics

high sugar content so may need IV and SQ insulin, check blood sugar every 6 hours

diabetic foot care

inspect after exercise, wear comfortable shoes, no lotion between toes, not hot water (only warm water), don't soak feet in water

exercise for diabetics

exercise 3 times a week, exercise about the same time everyday, check blood sugar before and have a snack

how often to check blood sugar if hypoglycemia

every 15min until over 70mg/dL

treatment of hypoglycemia if unconscious or less than 54 mg/dL

IM glucagon if at home or IV Amp D50 if at hospital

rapid acting insulin

onset 15-30mins, peak 1 hr, duration 4-5hrs

short acting insulin

onset 30-60min, peak 2-3hrs, duration 4-6hrs

NPH

onset=60-90mins, peak=4-12hrs, duration up to 24hrs

sick day rules

take OHA/insulin as normal, test blood sugar/ketone every 3-4hrs, report elevated blood sugar levels or ketones as specified to doctor, take supplemental doses or regular insulin every 3-4hrs as needed, substitute soft foods 6-8 times a day, drink liquids every 30-60mins, report N/V

importance of sick day rules

when pt is sick cortisol increases which increases glucose

types of liquids sick diabetics should consume

gatorade, juice, water (things with sugar and carbs)

most common cause of goiter

lack of iodine

DKA

type 1 diabetes, caused by stress, illness and missed insulin, rapid onset, blood sugar is over 250 mg/dL, metabolic acidosis, dehydration

importance of prevention dehydration in DKA

to keep bP up and promote circulation/oxygenation

tx for DKA dehydration

fluid bolus NS, potassium can be added fluid fluids once stable, insulin can be primary bag (only regular)

electrolytes in DKA

loss of sodium and potassium, high glucose (most important to replace potassium)

assessments of DKA

blood glucose, lung sounds (crackles from fluid overload), I/O, blood pressure, ECG, weight

HHS

type 2 diabetes, caused by stress or infection, slow onset can take days, blood sugar over 600 mg/dL, no acid base imbalance, dehydration

HHS electrolyte imbalance

sodium and potassium loss, want to replace potassium first

tx for HHS dehydration

IVF bolus NS, insulin drip