scc med/surg 2
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| s/s of rapid hypoglycemia | tachy, tremors, diaphoretic, dilated pupils, pale, clammy
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| s/s of prolonged hypoglycemia | restlessness, difficulty thinking, trouble speaking, visual disturbances, paresthesia change in LOC, convulsions
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| BS levels for mild, moderate, severe hypoglycemia | < 70 mg/dL -Mild
<55mg/dL -Moderate
<40mg/dL-Severe
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| Sz precautions- | suction device, padded side rails, oral airway, o2 use, anything that could harm or strangle
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| HgA1c norm | <5% /7% in DM
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| differnece between DKA & HHS | HHS-hyperosmolality 350, DM2,older adults,slow Insidious Onset, HYPERNATREMIA, BS >1000, incr glucose production
DKA- DM1,young,quick onset, ketones formed, aidosis, kussmaul respirations, HYPERKALEMIA
fruity breath,330 osmolality,BS avg.675
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| comparison of DKA & HHS | Insulin deficiency in production & reaction; dehydration, hyperglycemia, osmotic diuresis, fluid volume deficit, electrolyte imbalance, tachy, hypotension
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| DKA & HHS interventions | 1.montior respiratory status
2.Redhydrate (bolus hypertonic)
3. establish K+ levels
4. administer insulin (bolus; then insulin drip)
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| normal plasma osmolality | 275-295 ml osmol/kg
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| ADH effects | vasoconstriction
distal & collecting tubules reabsorb water
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| Diabetes Insipidus neurogenic patho | trauma to pos. pituitary or hypothalamus from surgery/trauma; more common
pituitary can’t release ADH
↓ release ADH → free H2O loss
Low urine osmolality w/ hi serum osmolality (r/t hypernatremia), decr in urine specific gravity
4-40 L/24hrs
Sudden
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| Diabetes Insipidus nephrogenic patho | adequate ADH but kidneys not responding to it (or extreme H20 intake/2ndary DI)
impaired renal conservation
collecting ducts & distal tubules unresponsive to ADH
slow onset
HYPOKALEMIA/HYPERCALCEMIA
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| s/s DI | XS poliuria>3L/24hr sometime 4-6L
s/s if awake-polydipsia/if unconscious signs of hypovolemia- tachy, hypotension, dry mucous, wt loss
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| DI labs | Low urine osmolality < 100 mOsm/kg H20
w/High serum osmolality > 295 mOsm/kg H20
Decr. urine specific gravity < 1.005
Elevated serum Na+ > 145 mEq/L
Decreased plasma volume (xs urine low BP)
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| DI interventions | Volume replacement r/t hypovolemia
I & O, wt. Q Day VS Qhr
monitor Hemodynamics, urine Sp. Gr., Neuro's
Hypotonic D5W or isotonic NS
Hormone replacement
Exogenous ADH- help kidneys reserve water
Desmopressin- most common-
then Monitor for fluid xs
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| SIADH Patho | Too much ADH; Problem of stimulation of hypothalamic/pituitary system or both
malignant &,Non malignant,CNS disorders,Meds
Secretion of adh unrelated to plasma volume
feedback system not working properly
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| S/S SIADH | s/s of H2O intoxication
CNS - ICP, Weak, confused, Sz, coma
GI- decr motility r/t low Na, n/v anorexia, muscle cramps
Cardio -pulm artery & central venous pressure incr , wt gain, incr BP
Resp - s/s fluid overload, advent lung sounds, pink frothy sput
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| labs for SIADH | hynatremia, hypo-osmolality, hi urine Na+, hemodilution
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| Adrenal gland medulla- where?, releases?affects? | inner layer-secretes cathecomline-epihephrine, norepinephrin, dopamine- incr metabolic rate,incr. insulin levels,fight/flight
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| Adrena gland cortex- where?, releases?, affects? | outer-glucocorticoids-CORTISOL-help w/stress, suprress inflammation, incr BS, regulate metabolism of carbs, fats, protein, synthesis protein; ALDOSTERONE- Na & h20 retention; MINERALCORTICOIDS- K+ retention/excretion; ANDROGENS- growth & development
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| Addisons Disease patho | Decr corticosteroids/ dysfunction in hypothalamus or adrenal gland
LOW CORTISOL L/T hypoglycemia
LOW ALDOSTERONE L/T low blood volume
Decr K+ excretion (hyperkalemia)
Reabsorption of hydrogen ions acidosis
Incr Na+ and H2O excretion (hyponatremia)
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| Addisons cause | Primary-idiopathic
Secondary- abrupt steroid stop
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| s/s Addisons Disease | confusion, fatigue, hi K+, Hi BS, muscle spasms, hypotension, hyperpigmentation, hyponatremia, GI imbalance, wt loss, hypovolemia
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| Addisons Disease Tx | fluid balance
Freq check wts, vs I&O’s,dysrhythmia
labs- Na+, K+,pH (acidosis)
Cortisol, aldosterone,Mineralocorticoid replace
Meds-Solucortex,flucortisol, hydrocortisone
h2 blockers/ K+ d5ns / diet restrict (k+)/ ECG/ IV glucose(hypoglycemia)/ fre
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| Cushing’s Disease patho | Produce too much steroids- xs secretion of cortisol/glucocorticoids from adrenal
Altered nitrogen, mineral,fat metabolism
redustributed fat
decr in muscle mass D/T tissue protein breakdown
hi BS liver stimulated to make glucose & insulin receptors de
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| Cushing's Disease cause | Primary-D/T adrenal or pituitary tumor
Secondary- (little release of ACTH)
Disorders of the pituitary or hypothalamus
Iatrogenic- (most common cause)
Long-term steroid therapy, xs cortisol levels
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| Cushing’s Disease s/s | buffalo hump, moon face, decr muscle mass, capillary bleeding, decr bone density at risk for fx, high BS,acne, lenugo, hypervolemia, edema, incr hr/BP r/t cardiac hypertrophy, trunkal obesity, emotional
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| Cushings Disease LAbs | Na incr, K+ decr, BS norm - incr, Ca decr, bicarb decr, BUN norm
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| Addison's Labs | Na decr,K+ incr, BS norm-decr, Ca incr, Bicarb incr, BUN incr
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| Pheochromocytoma patho, causes | Catecholamine-producing tumor on adrenal gland
tumors store & release epi & norepi
causes-=Triclycic, theophylizine, aged cheese , red wine
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| Pheochromocytoma s/s | recurrent episodes w/ severe super HA, diaphoertic, flushed, htn, angina, gi symptoms, n/v, cramping, heat intolerance, wt loss, tremors, easily go into htn crisis
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| Pheochromocytoma diagnosis/ treatment | Test 24 hr urine to measure catecholimines;Lab and radiography-ct or MRI- to confirm tumor
Surgery
Monitor BP
Hydration and diet
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| Chronic Renal Failure patho | Insidious, progressive, irreversible destruction of kidneys
Continues until nephrons are replaced with scar tissue
Abnormal urine production hyperosmole
Electrolyte /Metabolic abnormalities
Isothenuria
↑ BUN and ↓urine output/Risk for fluid overload
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| Chronic Renal Failure cause | infection dm, htn, kidney damage/trauma
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| Chronic Renal Failure stages | At risk => 90 ml/min
Mild CKD =60-89 ml/min
Moderate CKD=30-59 ml/min
Severe CDK=15-29 ml/min
ESKD=< 15 ml/min
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| Chronic Renal Failure s/s | Hypertension
Hyperlipidemia
Health failure
Pericarditis
Anemia
Halitosis and stomatitis
Anorexia, n/v from uremia
Peptic ulcer disease
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| Peritonitis types | Primary peritonitis-Common with cirrhosis
Secondary peritonitis-Surgical peritonitis, gastric/intestinal ruptures appendix, perforated peptic ulcers, IBD
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| Peritonitis patho | Inflammatory response L/t massive fluid shifts (peritoneal edema) & adhesions as the body attempts to wall off the infection; hypovolemia-> shock
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| peritonitis s/s | acute severe distress pain, sudden onset, rebound tenderness, muscular rigidity, guarding, spasm, restlessness, n/v, anorexia, fever, altered bowel habits
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