Podcast
Questions and Answers
What is a common respiratory complication associated with severe acute pancreatitis?
What is a common respiratory complication associated with severe acute pancreatitis?
Which of the following lab values can indicate acute pancreatitis?
Which of the following lab values can indicate acute pancreatitis?
Which condition is a risk factor for the development of pancreatitis?
Which condition is a risk factor for the development of pancreatitis?
In the context of acute pancreatitis, what does 'hyperlipidemia' refer to?
In the context of acute pancreatitis, what does 'hyperlipidemia' refer to?
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Which nursing assessment is least relevant when caring for a patient with pancreatitis?
Which nursing assessment is least relevant when caring for a patient with pancreatitis?
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Type 1 diabetes is primarily characterized by what condition?
Type 1 diabetes is primarily characterized by what condition?
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What is a common metabolic outcome of acute pancreatitis related to calcium levels?
What is a common metabolic outcome of acute pancreatitis related to calcium levels?
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Which type of diabetes is most likely to present with ketoacidosis?
Which type of diabetes is most likely to present with ketoacidosis?
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What condition is characterized by a serum glucose concentration greater than 56 mmol/L with little to no ketosis present?
What condition is characterized by a serum glucose concentration greater than 56 mmol/L with little to no ketosis present?
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Which electrolyte imbalance should be monitored due to the risk of cerebral edema in hyperglycemic emergencies?
Which electrolyte imbalance should be monitored due to the risk of cerebral edema in hyperglycemic emergencies?
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What is a common precipitating cause of Diabetic Ketoacidosis (DKA)?
What is a common precipitating cause of Diabetic Ketoacidosis (DKA)?
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Which of the following symptoms indicates hyperosmolarity in a hyperglycemic emergency?
Which of the following symptoms indicates hyperosmolarity in a hyperglycemic emergency?
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What nursing assessment is critical when managing acute pancreatitis?
What nursing assessment is critical when managing acute pancreatitis?
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What is a potential complication associated with acute pancreatitis?
What is a potential complication associated with acute pancreatitis?
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Which renal assessment finding is important in patients with hyperglycemic emergencies?
Which renal assessment finding is important in patients with hyperglycemic emergencies?
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Which hormonal response is typically diminished in hyperglycemia hyperosmolar state (HHS)?
Which hormonal response is typically diminished in hyperglycemia hyperosmolar state (HHS)?
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What is the primary cause of Type 1 Diabetes?
What is the primary cause of Type 1 Diabetes?
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Which of the following is not a typical characteristic of Type 2 Diabetes?
Which of the following is not a typical characteristic of Type 2 Diabetes?
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Gestational Diabetes is most likely to develop in which of the following populations?
Gestational Diabetes is most likely to develop in which of the following populations?
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Which complication is classified as a macrovascular complication of diabetes?
Which complication is classified as a macrovascular complication of diabetes?
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What plasma glucose level characterizes hypoglycemia?
What plasma glucose level characterizes hypoglycemia?
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What is a common neuroglycopenic symptom of hypoglycemia?
What is a common neuroglycopenic symptom of hypoglycemia?
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What is a potential complication of diabetic ketoacidosis (DKA)?
What is a potential complication of diabetic ketoacidosis (DKA)?
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Which of the following describes the clinical presentation of DKA?
Which of the following describes the clinical presentation of DKA?
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Which factor is not a risk factor for gestational diabetes?
Which factor is not a risk factor for gestational diabetes?
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What is the anion gap associated with metabolic acidosis in DKA?
What is the anion gap associated with metabolic acidosis in DKA?
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What characterizes the severity of mild hypoglycemia?
What characterizes the severity of mild hypoglycemia?
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Which physiological response is typically triggered by stress in diabetic patients leading to DKA?
Which physiological response is typically triggered by stress in diabetic patients leading to DKA?
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What is a common nursing assessment finding for a patient in diabetic ketoacidosis?
What is a common nursing assessment finding for a patient in diabetic ketoacidosis?
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What condition is often associated with both Type 2 Diabetes and metabolic syndrome?
What condition is often associated with both Type 2 Diabetes and metabolic syndrome?
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Study Notes
Endocrine Function Alterations
- The lecture covers alterations in endocrine function, specifically focusing on pancreatic dysfunction, acute pancreatitis, acute endocrine dysfunction, and diabetes (including Diabetic Ketoacidosis (DKA) and Hyperglycemia Hyperosmolar State (HHS)).
Topics for This Lecture
- Structure and function of the pancreas
- Acute pancreatic dysfunction (including acute pancreatitis)
- Acute endocrine dysfunction (including diabetes)
- Diabetic Ketoacidosis (DKA)
- Hyperglycemia Hyperosmolar State (HHS)
By the End of This Lecture
- Students will critically analyze the anatomy and physiology of the endocrine system and how dysfunction impacts the body systemically.
- Students will describe the pathophysiology and effects on the body associated with acute pancreatitis, diabetes, DKA, and HHS.
- Students will begin to prioritize patient conditions based on nursing assessment and clinical manifestations, and how this relates to other body systems.
Objectives for This Lecture
- Students will identify at least two causes for pancreatitis and describe how they affect the body.
- Students will describe the pathophysiology of type 1 and type 2 diabetes.
- Students will differentiate between DKA and HHS.
Pancreatic Dysfunction
Pancreas, Structure and Function
- The pancreas has both endocrine and exocrine functions.
- Endocrine: secretes hormones such as insulin, glucagon, somatostatin, and pancreatic polypeptide.
- Exocrine: acinar cells secrete enzymes, & ducts secrete alkaline fluids important for digestion. Aqueous secretions contain potassium, sodium, bicarb, and chloride.
- Alkaline pancreatic juice neutralizes acidic chime, aiding in enzyme action & nutrient absorption (fats).
- Pancreatic enzymes break down proteins (proteases), carbohydrates (amylases), and fats (lipases).
- Pancreatic juice secretion regulated by hormonal & vagal stimuli (secretin, cholecystokinin, acetylcholine).
Acute Pancreatitis
- Risk factors include, obstructive biliary tract disease (cholelithiasis), alcoholism, obesity, peptic ulcers, trauma, hyperlipidemia, hypercalcemia, smoking, certain drugs, and genetic factors.
- Pathophysiology usually begins mild but can progress to necrotizing or hemorrhagic inflammation.
- The process is often caused by the obstruction of pancreatic digestive enzyme outflow, leading to pancreatic cell autodigestion. Vascular damage, coagulation necrosis, fat necrosis, and edema can result.
- Ethanol injures acinar cells leading to toxic metabolites and activation of enzymes.
- Chronic alcoholism leads to protein plugs in pancreatic ducts, sphincter of Oddi spasm and inflammation/pancreatitis.
Clinical Manifestations of Acute Pancreatitis
- Severe, mid-epigastric or upper left quadrant (LUQ) pain, nausea, vomiting (paralytic ileus), jaundice, fever, leukocytosis, abdominal distension, hypovolemia, hypotension, tachycardia, myocardial insufficiency, and shock.
- Possible complications include severe respiratory issues (tachypnea, hypoxemia, pulmonary edema, atelectasis, or pleural effusions) and multi-system organ failure (hypocalemia, renal failure).
Nursing Assessment of Acute Pancreatitis
- GI assessment: bowel sounds, distension, nausea, and vomiting, guarding
- Respiratory
- Cardiovascular
- Renal (hyperlipidemia, hyperglycemia, hypocalcemia)
- Lab values: Lipase & Amylase (3x normal), WBC, bilirubin, sodium, potassium, creatinine, BUN, lipids (TC, TG, HDL, LDL), calcium, troponin, ABGs)
Endocrine Dysfunction
- This section focuses on the regulation of blood glucose
- Includes diagnosing diabetes and prediabetes
- Outlines different types of Diabetes Mellitus (type 1, type 2, other, gestational)
- Classification of diabetes
Diagnosing Diabetes and Prediabetes
- Prediabetes means impaired fasting glucose and/or impaired glucose tolerance on two separate test occasions
Types of Diabetes Mellitus
- The category of metabolic diseases includes: Type 1, Type 2, other, and gestational diabetes.
Classification of Diabetes
- Type 1 diabetes: results primarily from pancreatic beta cell destruction leading to insulin deficiency. Prone to ketoacidosis. Autoimmune or unknown etiology. Requires exogenous insulin.
- Type 2 diabetes: range from insulin resistance to a secretory defect with or without insulin resistance. Ketosis is not as common
- Gestational diabetes: glucose intolerance during pregnancy.
So... What's Your Type?
- TYPE 1 diabetes: Pancreas doesn't produce insulin; complete loss of beta cells; unknown etiology (may be autoimmune or idiopathic); requires exogenous insulin
- TYPE 2 diabetes: Pancreas doesn't produce enough insulin or insulin resistance; usually diagnosed in adults; progressive loss of beta cell function
- OTHER SPECIFIC TYPES: genetic defects of beta-cell function, genetic defects in insulin action, diseases of exocrine pancreas, endocrinopathies, drug-or-chemical-induced beta cell dysfunction, infections, uncommon forms of immune-mediated DM, other genetic syndromes associated with DM.
- GESTATIONAL diabetes: Insulin resistance combined with inadequate insulin secretion; common in obese women older than 25, family history of diabetes.
Etiology Type 1 and 2 DM
- Type 1 DM: Autoimmune (genetic, environmental trigger, plus environmental triggers leading to cell destruction). Idiopathic (cell destruction but without markers). 10% of patients with diabetes.
- Type 2 DM: Genetic, metabolic syndrome, insulin receptor substrate proteins, sedentary lifestyle, visceral obesity. 90% of patients with diabetes; potentially preventable.
Gestational Diabetes
- Affects 1-2% of pregnancies
- Caused by placental hormones that cause insulin resistance.
- Often resolves postpartum.
- 20-50% of affected women will develop type 2 diabetes later.
Complications Associated With Diabetes
- Microvascular: retinopathy, neuropathy, nephropathy, CKD
- Macrovascular: cardiac ischemia, CAD/ACS, angina, MI, peripheral arterial disease, cerebrovascular/carotid disease, TIA, stroke.
Hypoglycemia
- Defined by autonomic or neuroglycopenic symptoms with a low plasma glucose level (<4.0 mmol/L).
- Symptoms respond to carbohydrate administration.
- Complications of hypoglycemia include prolonged coma, paresis, convulsions, encephalopathy, mild intellectual impairment, and impaired ability to sense hypoglycemia.
Symptoms of Hypoglycemia
- Neurogenic/Autonomic: trembling, palpitations, sweating, anxiety, hunger, nausea, tingling
- Neuroglycopenic: difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness
Severity of Hypoglycemia
- Mild: autonomic symptoms present, patient can self-treat
- Moderate: autonomic and neuroglycopenic symptoms present, patient can self-treat
- Severe: unconsciousness, needs assistance, glucose typically < 2.8 mmol/L
Diabetic Ketoacidosis (DKA)
- Hyperglycemia
- Gluconeogenesis, Glycogenolysis (use of glucose by the liver, muscle, and fat)
- Serum glucose concentration may be >27.8-44 mmol/L
- Anion gap with metabolic acidosis
- Ketonemia
- Develops within 1-24 hours
Pathogenesis of DKA
- Relative insulin deficiency (fasting, starvation)
- Dehydration
- Stress Hormone Excess
Clinical Presentation of DKA
- Dehydration
- Hypotension or shock (systolic <90 mmHg)
- Tachycardia (HR > 125 b/min)
- Kussmaul respiration/ tachypnea
- Fruity breath
- Altered level of mental status
- Signs of precipitating cause
- Dry mouth and thirst
- Weakness, dehydration, nausea/vomiting
Clinical Presentation of HHS
- Hyperglycemia (>56 mmol/L), endogenous insulin not effective, severe dehydration, hyperosmolarity, neurologic abnormalities, little to no ketosis. Develops over days rather than hours as with DKA.
Priorities to be Addressed in the Management of Adults Presenting with Hyperlycemic Emergencies
- Metabolic ECFV contraction; potassium deficit and abnormal concentration; metabolic acidosis; hyperosmolality
- Precipitating cause of DKA/HHS
- New diagnosis of diabetes; insulin omission; infection; myocardial infarction
- ECG changes; hyperkalemia; small increase in troponin (with or without ischemia), thyrotoxicosis; trauma; drugs (medications)
- Other complications of DKA/HHS
- Hyper/hypokalemia; ECFV overexpansion; cerebral edema; hypoglycemia, pulmonary embolus, aspiration, hypocalcemia
Other Considerations
- Airway management
- Cerebral edema
- Increased incidence of thrombotic events (anticoagulation)
- Phosphate
- Magnesium
Key Points to Remember
- Assessing renal and endocrine status using anatomy/physiology
- Understanding the "why" of endocrine assessment, connecting it to other systems
- Knowing concepts of normal endocrine function (and how dysfunction can lead to issues)
- Knowing the pathophysiology, clinical manifestations, and nursing assessment of acute pancreatitis, diabetes (and DKA/HHS)**.
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Description
This lecture explores alterations in endocrine function, with a focus on pancreatic dysfunction and diabetes-related conditions such as Diabetic Ketoacidosis and Hyperglycemia Hyperosmolar State. Students will analyze the anatomy, physiology, and pathophysiology related to these critical conditions, prioritizing nursing assessments accordingly.
