Aemt Endocrine/ Hematology (Mwn)

Front 1

Endocrine system

Back 1

network of glands that produce hormones.
-Regulates other organs and tissues
-Maintains homeostasis
-Promotes permanent structural changes

Front 2

Exocrine glands

Back 2

Excrete chemicals for elimination.
Ducts carry secretions to skin’s surface

Front 3

Major components of endocrine system:

Back 3

Hypothalamus
Pituitary
Thyroid
Parathyroid
Adrenal glands
Gonads
Pancreas

Front 4

Pancreas

Back 4

Digestive gland
Contains islets of Langerhans
Secrete glucagon and insulin to regulate blood glucose
Role of glucose and insulin
-Glucose (dextrose) is one of the basic sugars of body.
-Major source of energy
-Insulin facilitates uptake of glucose.
-Complex and dynamic process

Front 5

Type 1 diabetes

Back 5

Patients do not produce insulin.
Strict diet and daily insulin injections are needed.
Typically affects children.
Constantly balance patient’s need for glucose with available supply of insulin.
Measure blood and urine with glucometer or glucose test strip.

Front 6

“3Ps” of hyperglycemia

Back 6

Polyuria
Polydipsia
Polyphagia

Front 7

DKA

Back 7

Diabetic Ketoacidosis

Body turns to fat as immediate energy source
Causes ketone and fatty acid accumulation
Diabetic ketoacidosis (DKA)
Accumulation of acids; cells cease to function
Can progress to death

Front 8

(HONK) or (HHNC)

Back 8

Hyperosmolar nonketotic coma (HONK) Also called hyperosmolar hyperglycemic nonketotic coma (HHNC)
-Often simultaneous with DKA
-Can cause gradual deterioration of mental status and myocardial infarction

Front 9

diabetic coma S&S

Back 9

Hyperglycemic crisis (diabetic coma) is a state of unresponsiveness resulting from:
-Ketoacidosis
-Hyperglycemia
-Dehydration
-Excess blood glucose
Can occur in diabetic patients:
-Not under medical treatment.
-Who have taken insufficient insulin.
-Who have markedly overeaten.
-Under stress due to infection, illness, overexertion, fatigue, or alcohol consumption.

Front 10

insulin shock S&S

Back 10

Hypoglycemic crisis (insulin shock) is caused by insufficient levels of glucose in the blood.
Mental status declines
Patient may become aggressive or display unusual behavior.

Can occur in insulin-dependent patients who:
-Took too much insulin.
-Took regular dose of insulin but did not eat enough food.
Engaged in vigorous activity.
Vomited a meal after taking insulin

Front 11

skin in diabetic emergencies

Back 11

Dry, warm skin: hyperglycemia
Moist, pale skin: hypoglycemia

Front 12

breathing differences in diabetic emergencies

Back 12

Hyperglycemic: Kussmaul respirations and sweet, fruity breath.

Hypoglycemic: normal or shallow to rapid respirations.

Front 13

Contraindications 50% dextrose adminsitration

Back 13

intracranial pressure or bleeding and patients suspected of hypokalemia

Front 14

Glucagon administration

Back 14

Option when IV access cannot be obtained
Effective if there are glycogen stores to draw from
Indicated when patient has altered mental state
Use in conjunction with 50% dextrose when possible.

Front 15

Management of hyperglycemia and DKA

Back 15

Patient’s glucose level above 300 mg/dL
Goal is to rehydrate and correct electrolyte and acid-base abnormalities.
Maintain airway and administer oxygen.
Start IV line and volume fluid replacement.

Front 16

Management of HONK/HNNC

Back 16

Airway management is a top priority.
Obtain large-bore IV access and blood glucose level as soon as possible.
Patients may require 1 to 2 L fluid in first hour.
Administer 50% dextrose for glucose level below 60 to 80 mg/dL (follow protocol).

Front 17

Components of blood

Back 17

Plasma
Red blood cells
White blood cells
Platelets

Front 18

Blood classifications (ABO system)

Back 18

Red blood cell types are O, A, B, and AB.
Indicates which antigens are found in plasma membrane.
Blood may contain Rh antigen.
Transfusions should be of same blood type.
Type O is universal.

Front 19

Sickle cell disease

Back 19

Inherited disorder, affects red blood cells
Starts with genetic defect of adult-type hemoglobin
Sickle or oblong shape
Patient prone to hypoxia and anemia
Four main types of crises:
-Vasoocclusive crisis (includes acute chest syndrome)
-Aplastic crisis
-Hemolytic crisis
-Splenic sequestration crisis
Complications can be acute or life threatening

Front 20

Thrombophilia Risk factors include:

Back 20

Recent surgery
Impaired mobility
Congestive heart failure
Cancer
Smoking
Oral contraceptive use

Front 21

Sickle cell crisis patients may have ___________ respirations or signs of____________

Back 21

increased respirations

or

signs of pneumonia

Front 22

Physical signs indicating sickle cell crisis include:

Back 22

Swelling of fingers and toes
Priapism
Jaundice

Front 23

A 45-year-old man with type 1 diabetes is found unresponsive. Which question is MOST important to ask his wife?

Back 23

Did he take his insulin today

it is critical to ask if the patient took his insulin. This will help you differentiate hypoglycemic crisis from hyperglycemic crisis. For example, if the patient took his insulin and did not eat, or accidentally took too much insulin, you should suspect hypoglycemic crisis. If the patient did not take his insulin, you should suspect hyperglycemic crisis.

Front 24

A diabetic patient presents with a blood glucose level of 310 mg/dL and severe dehydration. The patient’s dehydration is the result of:

Back 24

In severe hyperglycemia, the kidneys excrete excess glucose from the body. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose, resulting in dehydration.

Front 25

Which combination of factors would MOST likely cause a hypoglycemic crisis in a diabetic patient?

Eating a meal and taking insulin
Skipping a meal and taking insulin
Eating a meal and not taking insulin
Skipping a meal and not taking insulin

Back 25

Skipping a meal and taking insulin

Front 26

A 19-year-old diabetic male was found unresponsive on the couch by his roommate. After confirming that the patient is unresponsive, your treatment should include:

Back 26

Administration of dextrose 50%

Front 27

What breathing pattern would you MOST likely encounter in a patient with diabetic ketoacidosis (DKA)?

Slow and shallow
Shallow and irregular
Rapid and deep
Slow and irregular

Back 27

Rapid and deep

Kussmaul respirations—a rapid and deep breathing pattern seen in patients with DKA—indicates that the body is attempting to eliminate ketones via the respiratory system. A fruity or acetone breath odor is usually present in patients with Kussmaul respirations.

Front 28

A woman called EMS because her 12-year-old son, who had been experiencing excessive urination, thirst, and hunger for the past 36 hours, has an altered mental status and is breathing fast. You should be MOST suspicious for:

Back 28

hyperglycemic crisis.

Hyperglycemic crisis is characterized by a slow onset, excessive urination (polyuria), thirst (polydipsia), and hunger (polyphagia). Other signs include rapid, deep breathing with a fruity or acetone breath odor (Kussmaul respirations); a rapid, thready pulse; and an altered mental status.

Front 29

This type of sickle cell crisis is characterized by an accelerated drop in the patient’s hemoglobin level.

Back 29

Hemolytic crisis

A hemolytic crisis is an acute accelerated drop in the patient’s hemoglobin level. Caused by RBCs breaking down at a faster than normal rate, this type of crisis is common in patients with glucose-6-phosphate dehydrogenase deficiency (a common enzyme deficiency).

Front 30

Patients with diabetic ketoacidosis experience polydipsia because:

Back 30

Severe hyperglycemia—which leads to diabetic ketoacidosis—causes the body to excrete large amounts of glucose and water. As a result, the patient becomes severely dehydrated, which leads to excessive thirst (polydipsia).

Front 31

excess glucose is stored in the __________ and ______ in the form of ________

Back 31

liver

muscles

glycogen

Front 32

a 72 Y/) male with Type 2 diabetes complains of "not feeling well" He is diaphoretic and his blood sugar reading is 110 mg/dl. You should suspect:

Back 32

AMI

Front 33

Normal blood glucose levels

Back 33

80 - 120 mg/dl.

Front 34

Glucogon will not be effective Tx if

Back 34

glycogen stores in liver are depleted

Front 35

Patients with thrombophilia are at an increased risk for

Back 35

pulmonary embolism