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MSII Endocrine
| Question | Answer |
|---|---|
| What is the most common cause of SIADH? | Cancer, esp small cell (oat) lung cancer |
| In DKA, there is no _____ so no ______ which means the body needs a new source of __________ and sources that from _______ and ____ | insulin glycolysis ATP muscles and fat |
| Why do patients in ketoacidosis have fruity breath? | An increase in ketones causes the acetone smell |
| In DKA, the acidosis is caused by ____ | an increase in the anion gap |
| In DKA, patients have osmotic diuresis that can cause: | dehydration, hypokalemia |
| In DKA, what labs will be high and which will be low? K Na Mg Glucose > mg/dL | hypokalemia hyponatremia hypomagnesemia glucose > 250 mg/dL |
| In DKA, what abnormalities would you see on a UA? | ketones high glucose levels (excreting from the body) high potassium (") large output |
| What neuro sx might a pt in DKA exhibit? | confusion lethargy |
| In DKA, what respiratory changes happen | Kussmaul's respirs increased rr fruity breath |
| In DKA, what cardiac changes might you see | decreased BP increased HR |
| In DKA, what do creatinine and BUN look like? | Elevated BUN and creatinine |
| In DKA, what might your patient's skin look like? | dehydrated; poor turgor |
| What nursing interventions will you prioritize in phase I of DKA treatment? (name two) | IV bolus of isotonic fluids (FIRST) Insulin (SECOND; only if K > 3.3) |
| If glucose is < 200-250 after six hours of isotonic fluids, what might you add? | Add dextrose to IV fluids |
| With a DKA patient, how often do you monitor BGLs | Q1hr |
| How would you avoid hypoglycemia when treating a patient with DKA? | Add dextrose containing fluids and/or reduce the rate of insulin infusion |
| Which cluster of symptoms are ALL signs of DKA? a. Poor skin turgor, hypertension, glucose 150mg/dL b. Dry mucous membranes, tachycardia, hypotension c. Kussmaul respirations, bradycardia, lethargy | b. dry mucous membranes, tachycardia, hypotension |
| What are potential causes of HHS? | T2DM infections PNA sepsis acute illness newly diagnosed type 2 DM |
| What does HHS stand for? | hyperosmolar hyperglycemic syndrome |
| What lab value would look different in HHS vs DKA? K Mg Na Glucose | Glucose; levels will be > 600mg/dL |
| If you draw an ABG for a patient with suspected HHS, what do you suspect your findings will be? | No acidosis (just enough insulin to rpevent) |
| Will you find ketones on a UA for a suspected HHS pt? What about a suspected DKA pt? | HHS; no ketones, increased output DKA; ketones, increased output |
| What neuro sx might a pt with HHS exhibit? | Confusion |
| What does respiratory look like for a pt with HHS? Difference between HHS and DKA? | HHS; increased RR DKA; increased RR AND fruity breath (think: ketones) |
| What do cardiac sx look like for a pt with HHS? Are the s/sx different from DKA? | Sx; tachycardia, hypotension Cardiac s/sx are the same for DKA and HHS |
| What will renal tests look like for a pt with HHS? | Increased BUN, increased creatinine |
| What will skin look like for a pt with HHS? | poor skin turgor, tenting (dehydration) |
| decreased UO, fluid retention, polydipsia, dyspnea on exertion, hyponatremia (muscle cramps, headache, seizures, coma), and decreased serum osmo are clinical manifestations of what syndrome? | SIADH |
| Will serum sodium be high or low in a pt with SIADH? | sNa will be low |
| Increased antidiuretic hormone leads to increased ________ reabsorption in renal tubules, which leads to increased _________fluid volume and dilutional hypo______ and decreased _______osmolality | antidiuretic water intravascular serum |
| What hormone regulations water excretion in the urine? | ADH |
| What hormones regulate sodium excretion in the urine? | aldosterone and atrial natriuretic peptide |
| Increased ADH = water __________ in the serum and dilutional _________ | retention hyponatremia |
| What treatment do you anticipate for SIADH? | 1. treat the underlying disease 2. fluid restriction if Na is >125 3. hypertonic solutions 4. salt tablets 5. furosemide (only if Na>125) 6. Demeclocycline 7. Vaptans (for water diuresis, won't affect Na or K) - conivaptan, tolvaptan |
| What are some nursing interventions for the patient with SIADH/ | seizure precautions (low sodium) ice chips or sugarless gum accurate I/O's follow serum Na and osmolality follow urine Na and osmolality |
| Thirst centers are activated in the _____ | hypothalamus |
| Without ADH, the kidney collecting tubules are incapable of concentrating and retaining_______ | water |
| In central DI; ___ ADH is released, or ADH release is _______ | no; insufficient |
| In nephrogenic DI: kidney is ____ taking up ADH | not |
| What is the pathophysiology of DI? Decreased _____ hormone Decreased _________ ______________ in renal tubules Decreased intravascular fluid volume Increased serum ________ (hyper_______) and excessive _____ | ADH water reabsorption osmolality (hypernatremia) urine output |
| How would your patient with DI present? | PDP polyuria nocturia polydipsia low urine SpG elevated osmolality (hypernatremia) |
| What medical interventions do you anticipate for a patient with DI? | DDAVP = desmopressin - nasal spray is preferred SL tab is more effective than tablet |
| Nursing interventions for DI management may include | Drink to thirst provide fluids (hypotonic or D5W) I/O's Labs serum and urine DDAVP neuro assessment |
Created by:
rosegoldberg
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