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34 Cards in this Set
- Front
- Back
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What are the symptoms of thyroid crisis?
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Too much thyroid hormone causes fever, inc. HR, HTN, sweating, and GI problems.
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If someone is having thyroid storm, what should you never do?
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Palpate the thyroid gland
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In terms of medications, what are available to manage thyroid storm?
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Large doses of IV propranolol control tachycardia.
Antithyroid drugs like PTU and methimazole block Thyroid hormone synthesis. Iodine preps like SSKI and Lugol's solution inhibit release of Thyroid hormone. |
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What is Graves Disease?
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hyperthyroidism + goiter (enlargement of thyroid gland)
These people have increased metabolism, are intolerant to heat, and have frequent mood swings. |
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What is exopthalmos?
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Fluid build up around the eye sockets causing eyeballs to protrude; commonly seen in Graves Disease
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What is the most common cause of adrenal crisis?
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Sudden cessation of long term high dose glucocorticoids
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What is the honeymoon phase?
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In Type 1 Diabetes the symptoms decrease and are in remission for a short time before coming back.
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What types of drugs can cause hyperglycemia?
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steroids, thiazide diuretics (do accuchecks with these drugs)
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What is Dawn phenomenon?
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BS normal until 3am when it starts rising.
Fix it by altering the time and dose of evening insulin by 1-2 units |
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What is Somogyi phenomenon?
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Low BS at night followed by high BS in morning.
Fix this by decreasing the amount of intermediate acting insulin OR by eating more at night when hypoglycemic |
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What is Charquo Syndrome?
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You put your foot down on the floor or something and the bones break bc they are brittle. Swelling occurs after break.
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What are the 3 p's of diabetes?
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polyuria, polydipsia, polyphagia
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Fasting Blood glucose tests
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You are diabetic if you take 2 tests and they are both over 126.
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Oral glucose tolerance test
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Done during pregnancy. Give them a glucose drink and measure BS 2 hours later. If over 200 they are diabetic.
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Glycosylated hemoglobin assays
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Shows long term glucose control; Anything over 7% means you have diabetes.
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What do you look for in the urinalysis of a diabetic?
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Ketones, protein, glucose
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What should you be careful with for sulfonylureas?
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they can cause hypoglycemia. Also, if you drink alcohol and take the med it will cause an antabuse effect.
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What is the caution with biguanides like metformin?
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can cause lactic acidosis
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Rapid acting insulins:
a.) Examples b.) onset c.) peak time |
a.) Humalog, Novolog
b.) within 15 minutes c.) 1-2 hours |
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Short-acting insulins:
a.) Examples b.) onset c.) peak time |
a.) Regular Insulin
b.) within 30 minutes c.) 2-4 hours |
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Intermediate-acting insulins:
a.) Examples b.) peak time |
a.) NPH
b.) 4-12 hours |
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How do you draw up mixed combination insulins?
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Clear (regular) before cloudy (NPH)
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Long-acting insulins:
a.) Examples b.) onset c.) peak time |
a.) Lantus
b.) 2-4 hours c.) No peak: lasts 24 hours NEVER MIX LANTUS WITH ANYTHING ELSE!!! |
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Why do you rotate insulin sites?
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To prevent hard deposits
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What site has fastest absorption rate?
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abdomen
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What is the injection depth for insulin?
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SubQ at 90 degrees or if they are really skinny go at 45 degrees.
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If you are on insulin how can you become hypoglycemic?
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taking too much insulin or by not eating
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What is lipoatrophy caused by?
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Repeated injections in same place.
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Hypoglycemia vs Hyperglycemia
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HYPOGLYCEMIA:
-Cool, clammy -Anxious, nervous, irritable, confused, drowsy -Weak, double or blurry vision -Hungry, increased HR, palpitations -BS 50 or below -No ketones! HYPERGLYCEMIA: -hot, dry, dehydrated -Fast deep Kussmaul respirations with acetone breath -Abdominal cramping, N/V -Increased HR -BS>250 -Ketones present! |
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what type of medication is protective to the diabetic kidney?
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ACE inhibitor
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If a diabetics's BS is over 250 and urine ketones are present they should not _____.
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Exercise.
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DKA vs. HHNK
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DIABETIC KETOACIDOSIS
-Sudden onset -Cause: not enough insulin -BS>300 -Positive urine ketones -pH<7.35 -Kussmaul respirations -GI symptoms HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME: -Gradual Onset -Cause: poor fluid intake -BS>800 -Negative urine ketones -pH>7.45 |
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What are the nursing interventions for a patient with DKA?
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1.) Give 1L NS over 1 hour, followed by a 2nd liter to hydrate.
2.) When BS gets down to 150 give D5 and 1/4NS to prevent bottoming out and cerebral edema. 3.) Rinse tubing with main line solution. Give bolus of 0.1 unit/kg regular insulin and start regular insulin drip at 0.1unit/kg/hr. 4.) If you need to give IV potassium the patient MUST have urine output of 30cc/hr. |
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What are the nursing interventions for a patient with HHNK?
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-Maintain safety because these patients (unlike DKA) can have seizures, jerking, or reversible paralysis
1.) Infuse 0.5NS aat 1L/hr until BP and urine output are okay, then lower the rate to 200cc/hr. 2.) If hydration isn't sufficient then IV regular insulin drip at 10 units/hr until BS drops by 10%. |
