1
Q
Describe:
Syndrome of inappropriate anti-diuretic hormone (SIADH)
A
SIADH is increased secretion of antidiuretic hormone (ADH) in the posterior pituitary. It causes the client to hold onto urine (mostly water) and go into fluid volume overload.
It is caused by a type of head injury, stroke, brain tumor, or surgery of the brain.
2
Q
Signs and symptoms:
SIADH
A
These are caused by the client holding onto urine (mostly water) and going into fluid volume overload:
- weight gain
- hypertension
- hyponatremia (diluted from too much water)
- high urine specific gravity >1.030 - dark yellow urine
3
Q
Describe:
Diabetes Insipidus
A
Decreased secretion of antidiuretic hormone (ADH) in the posterior pituitary. It causes the client to urinate a lot and go into fluid volume deficit.
It is caused by a head injury, stroke, brain tumor, or surgery of the brain.
4
Q
Signs and symptoms:
Diabetes insipidus
A
These are caused by the client urinating too much and going into fluid volume deficit:
- polyuria and polydipsia
- dehydration
- low urine specific gravity (<1.005) - urine is pale
- postural hypotension
5
Q
What are the general interventions for diabetes insipidus and SIADH?
A
Focus on assessing and maintaining fluid balance:
- monitor vital signs and electrolyte levels
- monitor intake and output and get daily weights
- fall and seizure precautions
- monitor level of consciousness
6
Q
What are the specific interventions for diabetes insipidus?
A
Focus on increasing fluids:
- give IV fluids
- avoid foods that cause diuresis (coffee and tea)
- give vasopressin or desmopressin (hormone replacement for ADH)
7
Q
What are the specific interventions for SIADH?
A
Decrease fluids and increase sodium level:
- restrict fluids
- give 3% normal saline if sodium is less than 120
- loop diuretics if sodium is at least 125 to get rid of the extra fluids - monitor potassium with loop diuretics
8
Q
What is a hypophysectomy?
A
The removal of the pituitary gland to treat cancerous or benign tumors.
The pituitary gland (also called the hypophysis) is a small, pea-sized gland in the brain behind the eyes.
9
Q
Describe:
Cushing’s syndrome and Cushing’s disease
A
Cushing’s is too many steroids in the body.
- Cushing’s syndrome is caused by taking large doses of steroids for a few weeks or more.
- Cushing’s disease is caused by a release of too many steroids secreted by the pituitary gland or adrenals of the kidney.
10
Q
What are the characteristic signs and symptoms of Cushing’s?
A
These are caused by the client getting too many steroids (hypercortisolism). Steroids control many functions in the body.
- fluid volume overload and obesity
- moon face and buffalo hump
- muscle wasting: thin arms and legs
- hirsutism (facial hair)
- fragile skin that bruises easily
11
Q
What lab values are abnormal with Cushing’s?
A
- elevated cortisol level
- possible elevated white blood cell count
- hyperglycemia - steroids increase blood glucose and WBC count
- hypernatremia - increased aldosterone (one of the steroids) holds onto water and sodium
- hypokalemia - inverse relationship with sodium
12
Q
Interventions:
Cushing’s syndrome
A
Because Cushing’s syndrome is caused by taking large amounts of steroids, the interventions will focus on:
- preventing fluid and electrolyte imbalances
- preventing infection
- preventing high blood sugar
Monitor vital signs, electrolytes, WBC, and glucose level.
13
Q
Treatment:
Cushing’s disease
A
Because Cushing’s disease is caused by a tumor on the pituitary gland or adrenals, the treatment will focus on surgery:
- hypophysectomy (removal of the pituitary)
- adrenalectomy (removal of the adrenals)
Client will need life-long steroid replacement post-surgery.
14
Q
What are the specific post-operative interventions for a hypophysectomy?
A
Focus on preventing increased intracranial pressure:
- no coughing, blowing nose, or using a straw
- assess level of consciousness and vital signs for bleeding and CSF leak
15
Q
What are the post-operative interventions for an adrenalectomy?
A
- focus on fluid and electrolyte balance - monitor I&O, vital signs
- administer glucocorticoids (steroids)
16
Q
Describe:
Addison’s Disease
A
NOT enough steroids in the body.
It is caused by an autoimmune deficiency.
17
Q
What are the characteristic signs and symptoms of Addison’s disease?
A
These are caused by the client not getting enough steroids (primary adrenal insufficiency). Steroids control many functions in the body:
- fluid volume deficit and weight loss
- bronze skin color
18
Q
What lab values are abnormal with Addison’s?
A
- hypoglycemia - due to not having enough steroids
- hyponatremia - decreased aldosterone (one of the steroids) rids the body of water and sodium
- hyperkalemia - inverse relationship with sodium
19
Q
Interventions:
Addison’s disease
A
Because Addison’s disease is caused by a lack of steroids, the interventions are:
- assess for hypotension (due to fluid volume deficit)
- assess for dysrhythmias (due to high potassium)
- give IV fluids and electrolyte replacement
- corticosteroid replacement for life
20
Q
Describe:
Addisonian crisis
(Immediate complication)
A
Can cause severe fluid and electrolyte imbalances.
It is caused by stress, infection, trauma, or abrupt discontinuation of steroids.
21
Q
During times of stress for clients taking life-long steroids, how are steroid needs adjusted?
A
Clients will need an increase in steroid dose.
22
Q
Describe:
Hypothyroidism
A
It’s when the body does not produce enough thyroid hormones which controls metabolism.
This causes the metabolism to be slow.
23
Q
What are the thyroid labs with hypothyroidism?
A
- T3 and T4 are low
- TSH is high (due to compensation)
24
Q
Signs and symptoms:
Hypothyroidism
A
These are due to a slow metabolism:
- lethargy
- intolerance to cold
- weight gain
- dry skin and hair loss
- bradycardia
- constipation
- myxedema (edema around face and eyes)
- menorrhagia or amenorrhea
25
# Interventions:
Hypothyroidism
Focus on **increasing the metabolism**:
* give thyroid hormone: levothyroxine
* assess for overdose such as tachycardia
* encourage healthy diet and exercise
* warm environment
* avoid sedatives
26
# Describe:
Myxedema coma
| (Immediate complication)
Is when the client has an **extremely low metabolism and goes into a coma**.
27
# Describe:
Hyperthyroidism (Grave's disease)
Is when the body **produces too much thyroid hormone** which controls metabolism.
## Footnote
This causes the metabolism to be fast.
28
What are the **thyroid labs** with hyperthyroidism?
* **T3 and T4 are high**
* **TSH is low** (due to compensation)
29
# Signs and symptoms:
Hyperthyroidism
These are due to a **fast metabolism:**
* irritability
* intolerance to heat
* weight loss
* palpitations
* diarrhea
* exophthalmos (protruding eyeballs)
* diaphoresis
* hypertension
* amenorrhea
30
# Interventions:
Hyperthyroidism
Focused on **decreasing the metabolism:**
* cool and quiet environment
* give sedatives
* high calorie diet
31
# Medications:
Hyperthyroidism
Focus on **decreasing the metabolism**:
* methimazole
* propylthiouracil
* iodine
* beta blockers to decrease the heart rate
32
What is **radioactive iodine therapy**?
Used to **destroy the thyroid cells for a client with hyperthyroidism.**
33
What is a **thyroidectomy**?
A surgery to **remove the thyroid** for a client with hyperthyroidism.
34
What are the **post-operative interventions** for a thyroidectomy?
Focuses on **assessing the airway and preventing calcium imbalances**:
* monitor for respiratory distress
* have tracheostomy set, oxygen, and suction at the bedside
* avoid neck flexion and stress on the suture line
* monitor for hypocalcemia and tetany (possible parathyroid trauma)
* monitor for thyroid storm
35
# Describe:
Thyroid storm
| (Immediate complication)
When the client has an **extremely high metabolism** and can get elevated temperature, blood pressure, heart rate, seizures, and then a **coma**.
36
What are the **specific interventions** after a thyroidectomy in regards to airway and bleeding?
* semi-Fowler's position
* check surgical site for edema and bleeding
* check the back of the neck for bleeding
37
# Describe:
Hyperparathyroidism
Hypersecretion of parathyroid hormone.
## Footnote
Parathyroid hormone controls calcium balance in the blood.
The most common cause is from a tumor on the parathyroid gland.
38
# Signs and symptoms:
Hyperparathyroidism
These are caused by **high calcium levels:**
* fatigue and muscle weakness
* bone deformities (calcium has left the bones)
* kidney stones
* dysrhythmias
## Footnote
PTH controls calcium level.
39
# Interventions:
Hyperparathyroidism
Focus on the **problems associated with a high calcium level**:
* monitor for cardiac dysrhythmias
* encourage fluid intake
* move client carefully to prevent fractures
* use light weights to prevent bone deformities
* high-fiber, moderate, calcium diet
40
# Medications:
Hyperparathyroidism
Focus on **decreasing the calcium:**
* **furosemide** - to lower the calcium by urinating
* **calcitonin** - to prevent skeletal calcium release
41
# Describe:
Hypoparathyroidism
Hyposecretion of parathyroid hormone.
## Footnote
It is usually caused by getting a thyroidectomy.
42
# Signs and symptoms:
Hypoparathyroidism
These are caused by **low calcium levels:**
* positive Chvostek's and Trousseau's sign
* muscle tingling and spasms
* cardiac dysrhythmias and seizures
## Footnote
PTH controls calcium level.
43
# Interventions:
Hypoparathyroidism
**Focus on the problems associated with a low calcium level**:
* assess for dysrhythmias
* seizure precautions
* high-calcium, low-phosphorus diet
44
# Medications:
Hypoparathyroidism
Focus on **increasing the calcium**:
* calcium supplements
* vitamin D supplements
* *Vitamin D helps the stomach absorb calcium into the blood - (and eventually into the bone)*
45
What is the **last resort treatment** for hyperparathyroidism?
parathyroidectomy
46
# Describe:
Diabetes mellitus
It is when the **pancreas releases very little insulin or none at all.**
## Footnote
This makes the blood sugar consistently high, since insulin is needed to transfer sugar from the blood to vital organs such as the brain and muscles.
47
What are the **normal lab values** for blood glucose?
* **fasting blood glucose:** 70-110 mg/dL
* 3.9 - 6.1 mmol/L
* **random blood glucose**: \< 200 mg/dL
* \< 11.1 mmol/L
* **HgbA1C:** \<7% indicates good diabetes control
48
What is the **difference** between type 1 and type 2 diabetes?
**Type 1 diabetes** - the pancreas makes **NO insulin:** It is a genetic disorder.
**Type 2 diabetes** - the pancreas makes **a little bit of insulin:** It is a lifestyle disorder associated with obesity.
49
What **lifestyle changes** can prevent acquiring type 2 diabetes?
Eat a healthy diet and exercise daily.
**NO SMOKING**
50
What are the **complications** of untreated diabetes mellitus?
Due to consistently **high blood glucose, this damages nerves and vessels** - the complications are:
* amputations (due to neuropathy)
* blindness (retinopathy)
* kidney failure (nephropathy)
* heart disease, stroke, and hypertension
* erectile dysfunction (due to neuropathy)
51
Why does high blood sugar cause **blurry vision**?
Sugar in the blood **damages the nerves** for vision.
52
Why does consistently high blood sugar cause **delayed wound healing?**
Increased sugar in the blood **prevents nutrients and oxygen** from reaching the cells that need healing.
53
Why does consistently high blood sugar cause **infections**?
**Bacteria feed on sugar** causing bacteria to multiply.
54
Why do consistently high blood sugar levels cause **numbness and tingling** especially in the feet and hands **(peripheral neuropathy)**?
The sugar in the blood **clogs up the small vessels** connected to the nerves **causing damage** to those nerves.
55
Why do consistently high blood sugar levels cause **erectile dysfunction**?
High blood sugar **damages the blood supply** to the penis and the nerves that control an erection.
56
What are the **"3 P's"** of **hyperglycemia**?
1. **polyuria: excessive urination**
* the body is trying to get rid of the extra sugar by peeing
2. **polydipsia: excessive thirst**
* the client is thirsty because they pee a lot
3. **polyphagia: excessive hunger**
* the sugar is "stuck" in the blood and unable to reach the vital organs
## Footnote
Client will be dehydrated.
57
# Teaching:
Diet and exercise for diabetes mellitus
* monitor blood glucose before, during, and after exercise
* may need extra food before exercising
* exercise at the same time each day and when the meal is peaking (not when insulin is peaking)
58
# Medications:
Diabetes mellitus
Meds for diabetes mellitus and **lowering blood glucose levels** are:
* insulins (rapid, short, intermediate and long-acting)
* oral antidiabetic meds
59
When will **insulin doses** need to be **increased**?
During illness, infection, and stress.
## Footnote
These situations cause the blood sugar to increase.
60
What are the **steps** to getting a blood glucose level?
1. wash hands and wear glove
2. check expiration date on the test strips
3. clean area with alcohol and allow to dry
4. prick finger and hold down so blood can drop
5. use a sterile gauze to wipe first drop of blood
6. get second drop of blood for testing in strip
7. use glucometer to read results
8. log results/document
61
In general, **how often** is blood glucose checked?
Before meals and at bedtime or every 6 hours if on parenteral nutrition.
62
# Cause:
**Hypoglycemia** (low blood sugar)
* too much insulin or oral hypoglycemic meds (#1 cause)
* not enough food
* excessive exercise
## Footnote
Brain damage can occur if not treated.
63
What **lab value** indicates **hypoglycemia**?
\< 70 mg/dL (3.9 mmol/L)
64
# Signs and symptoms:
Hypoglycemia (low blood sugar)
1. **Early signs** *("shock-looking symptoms" due to vasomotor problems)*: nervous, cool skin, palpitations, tremor, tachycardia, low BP, diaphoresis (clammy), tachypnea
2. **Moderate signs** *("drunk symptoms due to cerebral compromise")*: anger, confusion, slurred speech, and inability to concentrate, labile
3. **Late signs**: seizure and coma, permanent brain damage
65
What is the teaching to prepare a client for a **hypoglycemic reaction**?
Teach the client **to carry with them a simple carbohydrate** to eat in case of hypoglycemia:
* glucose tablets or gel
* 6 - 10 hard candies
* 4 tsp of sugar
* 1 Tablespoon of honey, syrup, icing, jam/jelly
* 4 oz. of fruit juice or soft drink
* 8 oz. of milk
* 3-6 crackers (give something more sugary if severe hypoglycemia)
## Footnote
Each of these snacks is about 15 grams of carbohydrates.
66
What **medication** can mask the signs of hypoglycemia?
**Beta blockers**
## Footnote
These meds can decrease the heart rate and calm the client down, masking the upper-type symptoms of hypoglycemia.
67
What is the **treatment** for an **alert** client with a **suspected hypoglycemic reaction**?
* if able, check the blood glucose level
* if \<70 (3.9), give a simple carb such as juice or glucose gel
* recheck the blood sugar in 15 minutes
* If blood sugar is still \<70 (3.9) on the 4th check, give 50% dextrose
* After blood sugar has stabilized give a snack such as crackers and peanut butter
68
What is the **treatment** for an **unconscious** client with **hypoglycemia**?
Give **50% dextrose by IV or IM**.
## Footnote
Do not give oral glucose to an unconscious client due to risk of aspiration. Side note: very difficult to get an IV started in a hypoglycemic client due to vasoconstriction.
69
# Describe:
Hyperosmolar hyperglycemic syndrome **(HHS)**
| (Immediate complication)
HHS is **extremely high blood sugar:** 600 mg/dL (33.3 mmol/L) or higher for clients with _type II diabetes_.
## Footnote
There is still a little bit of insulin, so the body doesn't make ketones.
70
# Describe:
**Diabetic ketone acidosis (DKA)**
| (Immediate complication)
DKA is **extremely high blood sugar:** 300 mg/dL (16.6 mmol/L) or higher for clients with _type I diabetes._
## Footnote
The body makes no insulin, so fat breaks down instead for energy making ketones (ketones are an acid).
71
# Risk factors:
HHS and DKA
* infection (especially respiratory infections)
* stress
* inadequate insulin dose
* poor fluid intake
## Footnote
All of these situations increase blood glucose.
72
What is the **pH with DKA**?
\< 7.35 due to acidotic state
## Footnote
An acidotic state will cause a high potassium and Kussmaul's respirations.
73
Are **ketones in the blood** negative or positive with **DKA**?
**Positive** with DKA.
## Footnote
The body is not able to break down sugar for energy. Instead, the fat is broken down, making ketones (ketones are an acid that will be found in the blood and urine).
74
# Interventions:
DKA and HHS
They are similar because the goal is to **decrease the blood glucose level** and **replace lost fluids:**
* give IV fluids such 0.9% NS or 0.45% NS
* add dextrose when blood glucose is between 250 and 300 (3.9 and 16.7)
* give regular insulin IV
* assess for potassium imbalance since insulin can drive the potassium back into the cells causing hypokalemia
* cardiac monitor due to potassium imbalances
75
Why is **foot care** an important aspect for clients with diabetes?
Due to neuropathy (damaged nerves), clients may **not be able to feel trauma to the foot.**
## Footnote
There is increased risk of infection and gangrene can occur causing amputations.
76
How are the **feet inspected** for a client with diabetes?
Inspect **feet daily with a mirror** to check for redness, swelling or a break in the skin.
## Footnote
Report trauma to the HCP.
77
What should be **avoided to prevent trauma** to the feet for a diabetic client?
* avoid hot water, heating pads, and baths
* don't try to treat corns, blisters or ingrown toenails - see the HCP for that
* don't cross legs or wear tight clothing - it prevents blood flow
* don't keep the feet wet
* do not go barefoot
78
What **color** of **socks** are worn for a diabetic client?
Wear **clean, white cotton socks** and change them daily.
## Footnote
It's easier to see blood on white socks, than dark socks.
79
What types of **shoes** should be worn for a diabetic client?
* **wear closed-toed shoes** that are well-fitted and not too tight
* don't wear open-toed shoes or shoes with a strap between the toe
* always check for foreign objects or tears in the shoes before wearing
80
How should **toenails** be cut for a diabetic client?
**Straight across** and smooth nails with an emery board.
81
Are **insulin or oral antidiabetic meds held** before a diabetic client goes to surgery?
**It depends.** Always clarify with the HCP if meds should be held or given.
82
What type of **insulin** is **commonly held** before surgery?
**Long-acting insulin** is commonly held 24 - 48 hours before surgery.
83
What type of **oral antidiabetic** is **commonly held** before surgery?
**Metformin** is commonly held due to risk of kidney failure.
## Footnote
It is restarted once kidney function is normal postoperatively.
84
How is low or high blood sugar **prevented** postoperatively for a diabetic client?
* assessing blood sugar frequently
* giving IV glucose and insulin
* giving subcutaneous insulin if needed
85
What **conditions** is a diabetic client at a higher risk for post-operatively?
* cardiac disease
* kidney failure
* impaired wound healing
86
# Describe:
Metabolic syndrome (Syndrome X)
A condition that includes **risk factors for cardiovascular disease**. Greater than 3 risk factors is a diagnosis:
* hypertension
* low HDL and high LDL
* high triglycerides
* increased fasting blood glucose due to diabetes
* large waist size
* men: > 40" (103 cm)
* women: >35" (89 cm)
NCLEX-PN (5) Adult Health
flashcards
Decks in class (13)
# Cards
