Podcast
Questions and Answers
What is the recommended goal for fasting plasma glucose (FPG) levels in diabetes management?
What is the recommended goal for fasting plasma glucose (FPG) levels in diabetes management?
What does hemoglobin A1C measure in patients with diabetes?
What does hemoglobin A1C measure in patients with diabetes?
What indicates the presence of hyperglycemia in urine tests?
What indicates the presence of hyperglycemia in urine tests?
What is the proper order of drawing insulin when mixing NPH and regular insulin?
What is the proper order of drawing insulin when mixing NPH and regular insulin?
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How should in-use vials of insulin be stored if they will be used within four weeks?
How should in-use vials of insulin be stored if they will be used within four weeks?
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Which of the following is true regarding the administration of insulin?
Which of the following is true regarding the administration of insulin?
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What is the target level for LDL cholesterol in diabetic patients to reduce the risk of atherosclerosis?
What is the target level for LDL cholesterol in diabetic patients to reduce the risk of atherosclerosis?
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When should high-risk patients be screened for gestational diabetes?
When should high-risk patients be screened for gestational diabetes?
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What is an appropriate angle for injecting insulin?
What is an appropriate angle for injecting insulin?
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Which of the following is a potential complication of insulin therapy?
Which of the following is a potential complication of insulin therapy?
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Which patients are considered ideal candidates for an insulin pump?
Which patients are considered ideal candidates for an insulin pump?
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What is the primary treatment for severe hypoglycemia after insulin administration?
What is the primary treatment for severe hypoglycemia after insulin administration?
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What characterizes the Dawn Phenomenon?
What characterizes the Dawn Phenomenon?
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What can happen if the same injection sites are frequently used for insulin administration?
What can happen if the same injection sites are frequently used for insulin administration?
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What is the purpose of changing the infusion site for an insulin pump every 24-48 hours?
What is the purpose of changing the infusion site for an insulin pump every 24-48 hours?
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What is a common local reaction to insulin injections?
What is a common local reaction to insulin injections?
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What is the first goal of interprofessional care in cases of ketoacidosis?
What is the first goal of interprofessional care in cases of ketoacidosis?
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Which clinical manifestation is associated with the breakdown of fat cells for glucose?
Which clinical manifestation is associated with the breakdown of fat cells for glucose?
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What lab values indicate hyperosmolar hyperglycemic syndrome (HHS)?
What lab values indicate hyperosmolar hyperglycemic syndrome (HHS)?
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Which age group is more likely to experience hyperosmolar hyperglycemic syndrome (HHS)?
Which age group is more likely to experience hyperosmolar hyperglycemic syndrome (HHS)?
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What role does dehydration play in the symptoms of ketoacidosis?
What role does dehydration play in the symptoms of ketoacidosis?
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What is a distinguishing difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?
What is a distinguishing difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?
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What is a notable respiratory symptom displayed by patients experiencing ketoacidosis?
What is a notable respiratory symptom displayed by patients experiencing ketoacidosis?
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Which intervention is crucial for managing hyperosmolar hyperglycemic syndrome (HHS)?
Which intervention is crucial for managing hyperosmolar hyperglycemic syndrome (HHS)?
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What is the primary function of the thyroid gland?
What is the primary function of the thyroid gland?
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Which hormone is primarily responsible for lowering excess calcium in the blood?
Which hormone is primarily responsible for lowering excess calcium in the blood?
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Which of the following is a cause of primary hypothyroidism?
Which of the following is a cause of primary hypothyroidism?
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A deficiency in which nutrient is most commonly associated with goiter formation?
A deficiency in which nutrient is most commonly associated with goiter formation?
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What clinical manifestation is NOT typically associated with hypothyroidism?
What clinical manifestation is NOT typically associated with hypothyroidism?
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Myxedema coma is characterized by which condition?
Myxedema coma is characterized by which condition?
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Which hormone stimulates the thyroid gland to release T3 and T4?
Which hormone stimulates the thyroid gland to release T3 and T4?
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What is a common characteristic of secondary hypothyroidism?
What is a common characteristic of secondary hypothyroidism?
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What is the primary function of osteoclasts in bone health?
What is the primary function of osteoclasts in bone health?
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Which of the following symptoms may indicate hyperparathyroidism?
Which of the following symptoms may indicate hyperparathyroidism?
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What serious condition can result from severe hypoparathyroidism?
What serious condition can result from severe hypoparathyroidism?
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What is the most common cause of hypoparathyroidism?
What is the most common cause of hypoparathyroidism?
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Which of the following is a common management option for hyperparathyroidism?
Which of the following is a common management option for hyperparathyroidism?
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What effect does active vitamin D have on calcium absorption?
What effect does active vitamin D have on calcium absorption?
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Which diagnostic finding would likely indicate hypoparathyroidism?
Which diagnostic finding would likely indicate hypoparathyroidism?
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Which of the following describes a key symptom of hyperparathyroidism?
Which of the following describes a key symptom of hyperparathyroidism?
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What is the primary goal of managing hypoparathyroidism?
What is the primary goal of managing hypoparathyroidism?
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Which of the following treatments is NOT typically used for hyperparathyroidism?
Which of the following treatments is NOT typically used for hyperparathyroidism?
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Study Notes
Gestational Diabetes
- Develops during pregnancy
- Increases the risk of c-section and perinatal complications
- Screen high-risk patients at the first visit; others at 24-28 weeks
- Usually, glucose levels return to normal 6 weeks postpartum
Diagnostics for Diabetes
-
Fasting Plasma Glucose (FPG)
- Impaired Fasting Glucose: >100 and < 126 mg/dL
- If glucose is greater than 126 mg/dL, diabetes is present
- Goal: Keep FPG at 99 mg/dL or lower
-
Hemoglobin A1C
- Represents an average of glucose levels for the past 3 months
- Glucose "sticks" to red blood cells, which live for approximately 3 months
- Goal: 6.5% - 7%
- 6.5% or greater = Diabetic
-
Estimated Average Glucose (eAG)
- A calculated conversion of HbA1c
- Reported in mg/dL, the same units as home blood glucose tests
- Makes results more meaningful to patients
-
Urine Glucose, Ketone, and Protein Levels
- Presence of glucose in the urine indicates hyperglycemia
- Ketonuria occurs with the breakdown of fats
- Albuminuria may indicate early onset of nephropathy
-
Serum Cholesterol
- Diabetics are at risk for atherosclerosis
- Treatment goal is LDL < 100 mg/dL
Insulin Administration
-
Mixing Insulin (NPH -> Regular)
- Clear then Cloudy
- Wipe off tops of vials with alcohol wipe
- Draw air for NPH dose, inject air into NPH vial
- Draw air for regular insulin, inject air into regular insulin vial
- Draw back regular insulin
- Draw back NPH
-
Storage of Insulin
- Do not heat or freeze
- In-use vials can be left at room temperature for up to 4 weeks
- Extra insulin should be refrigerated
- Avoid exposure to direct sunlight, extreme heat or cold
- Store prefilled syringes upright for 1 week if two insulin types; 30 days for one type
-
Administration of Insulin
- Typically given by subcutaneous injection
- Regular insulin can be given IV when immediate onset of action is desired
- Insulin is NOT taken orally because it is inactivated by gastric fluids
- Absorption is fastest from the abdomen, followed by the arm, thigh, and buttock
- Teach patients to rotate injection sites within and between areas to prevent excess bruising
- Usually available as U100 insulin (1mL contains 100 U of insulin)
- Inject at a 45 to 90-degree angle
- No alcohol swab for self-injection; wash with soap and water - alcohol can dry the skin
Insulin Pump
- Delivers a continuous subcutaneous insulin infusion through a small device worn on the belt, in the pocket, or under clothing
- Delivers short-acting insulin
- Preprogrammed to deliver varying hourly basal rates
- Ideal candidate
- A person who has failed to control diabetes on other regimens
- Pregnant
- Desires increased daily flexibility
- Expensive ($7,000)
- Risk of infection at the site progressing to sepsis
- Change the infusion site every 24-48 hours
Problems with Insulin Therapy
-
Hypoglycemia
- Treatment includes administering glucagon 0.5-2 mg IM. After 20 minutes without improvement, administer again
- When aroused, give 15 grams of carbs and wait 15 minutes
-
Allergic Reaction
- Local inflammatory reactions to insulin may occur, such as itching, and burning around the injection site
- Local reactions may be self-limiting within 1 to 3 months or may improve with a low dose of antihistamine
-
Lipodystrophy
- Changes in subcutaneous tissue
- May occur if the same injection sites are used frequently
-
Somogyi Effect
- Hyperglycemia in the morning may be due to the Somogyi effect
- The patient takes insulin at night, and then in the morning, their blood sugar is very low
- Rebound hyperglycemia occurs because a high dose of insulin causes a decline in glucose levels overnight, and counter-regulatory hormones are released
-
Dawn Phenomenon
- Also characterized by hyperglycemia that is present on awakening
- Due to the release of counter-regulatory hormones
- Unrelated to the amount of insulin given at night
- The treatment for the dawn phenomenon is an increase in insulin or an adjustment in administration time
Acute Complications
-
Diabetic Ketoacidosis (DKA)
- Associated with excessive levels of ketones in the body
- A serious condition that proceeds rapidly and must be promptly treated, and is caused by a profound deficiency of insulin.
- Characterized by hyperglycemia, ketosis, acidosis, and dehydration
- Hyperglycemia: cells don't have insulin to allow glucose in. This forces the body to break down fat cells for glucose.
- Ketoacidosis: an effect of breaking down fat cells for glucose stores
- Dehydration: cells are hungry. They have no food, so the body goes into severe dehydration. Overload of sugar in the ECF leads to vomiting to try to excrete excess sugar.
- Clinical Manifestations:
- Dehydration, lethargy
- Sweet, fruity breath!
- Kussmaul respirations (rapid, deep breathing with dyspnea)
- Labs: Blood Glucose > 250 mg/dL, pH < 7.3
- Interprofessional Care:
- First goal = establish IV for fluid and electrolyte replacement
- Assess renal status, cardiopulmonary system, level of consciousness
-
Hyperosmolar Hyperglycemic Syndrome (HHS)
- Due to insulin deficiency
- Blood sugar over 600 mg/dL, ICU, very life-threatening
- Life-threatening syndrome that can occur in a patient with diabetes who is able to make enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia
- Less common than DKA. Often occurs in patients over 60 years of age with type 2 diabetes
- Often related to impaired thirst sensation and/or a functional inability to replace fluids. There is usually a history of inadequate fluid intake, increasing mental depression or cognitive impairment.
- Lab values in HHS include a blood glucose level > 600 mg/dL and a marked increase in serum osmolality. Ketone bodies are absent or minimal in both blood and urine.
- Nursing Management:
- HHS is a medical emergency and has a high mortality rate
- Immediate IV administration of insulin and either 0.9% or 0.45% NaCl
- Monitor administration of (1) IV fluids to correct dehydration, (2) insulin therapy to reduce blood glucose and serum ketone levels, and (3) electrolytes given.
Parathyroid Hormone
- Osteoclasts: deconstruct bone
- Osteoblasts: build bone
- Regulates how much calcium is:
- Absorbed from the diet
- Excreted by the kidneys
- Stored in the bones
- Increases formation of active vitamin D
- Active vitamin D increases intestinal calcium and phosphorus absorption
Hyperparathyroidism
- Most common disease of the parathyroid glands
- Characterized by excess PTH, leading to excess calcium in the blood
- The parathyroid glands continue to make large amounts of PTH even when the calcium level is normal
- Most common cause: benign tumor called an adenoma on one of the parathyroid glands that secretes too much PTH
- Symptoms
- Kidney stones - due to the kidneys' inability to keep up with the excretion of calcium
- Abdominal pain
- Bone and joint pain - too much calcium in the blood and not in the bone
- Fragile bones (osteoporosis)
- Irritability/Depression/Anxiety
- Heart palpitations/arrhythmias
Hyperparathyroidism Diagnostic Studies
- Serum PTH: ⬆
- Serum Calcium: ⬆ (8.5-10 mg/dL)
- Serum Phosphate: ⬇ (2.5-4.5 mg/dL)
- Urine Calcium: ⬆
- Bone Density: ⬇
Hyperparathyroidism Management
- Depends on the severity of the disease
- Surgical: partial or complete removal of the parathyroid glands
-
Nonsurgical:
- Ongoing measures of lab values
- Exercise
- Increase fluids
- Moderate calcium intake
- Calcimimetic agents, bisphosphonates, and phosphate
-
Severe:
- IV sodium chloride
- Loop diuretics
- IV bisphosphonates: rapidly lower serum calcium in patients with dangerous levels
Hyperparathyroidism Nursing Management
- Patient education
- If postoperative:
- Pain control
- Monitor for bleeding
- Monitor for tetany (due to a sudden decrease in calcium level)
Hypoparathyroidism
- Very rare; characterized by inadequate circulating PTH
- Most common cause: iatrogenic (this may include accidental removal of parathyroid glands or damage to the vascular supply of the glands during neck surgery)
Hypoparathyroidism Symptoms
- Due to hypocalcemia:
- Tetany
- Tingling of the lips and stiffness of the limbs
- Painful spasms of muscles
- Trousseau’s sign:
- Inflate BP cuff above SBP for several minutes
- Positive response: muscle contractions in the hand
- Indicates hypocalcemia
- Chvostek’s Sign:
- Elicited by tapping the patient’s face slightly over the facial nerve anterior to the ear lobe
- Positive finding: facial muscle twitching
- Indicates hypocalcemia
Hypoparathyroidism Diagnostic Studies
- Serum PTH: ⬇ (10-65 pg/mL)
- Serum Calcium: ⬇
- Serum Phosphate: ⬆ (2.5-4.5 mg/dL)
Hypoparathyroidism Management
- Calcium supplements
- Vitamin D
- Magnesium
- High calcium diet
- Teach the patient that it is a lifelong disorder
- Treatment goals are to treat acute complications, such as tetany, maintain normal calcium levels, and prevent long-term complications
- Give IV calcium slowly. USE ECG monitoring when giving calcium (can cause arrhythmias/cardiac arrest)
- Need to be in the ICU
Thyroid Gland
- Located in the front of the neck
- Primary function is to produce thyroid hormone
- Thyroid hormone controls:
- Metabolic rate
- Metabolism
- Growth/development
- Thyroid hormones:
- Calcitonin: controls the body's use of calcium; lowers excess calcium in the blood (calciTONin TONES down calcium in the blood)
- T3: Composed of iodine, regulates metabolism - iodine comes from salt! You can get a goiter from lack of iodine.
- T4: Composed of iodine and regulates metabolism
- With iodine deficiency, the thyroid is unable to secrete sufficient thyroid hormone.
- TSH: Released from the pituitary gland and stimulates the thyroid to release T3/T4
Disorders of the Thyroid Gland
- TSH and T4 levels are measured to determine whether a goiter is associated with normal thyroid function, hyperthyroidism, or hypothyroidism
Hypothyroidism:
- Condition in which the thyroid gland produces inadequate amounts of thyroid hormone
-
Primary hypothyroidism: Thyroid gland malfunction; the thyroid gland fails to produce sufficient thyroid hormone to sustain normal metabolic function.
- Causes:
- Insufficient iodine diet
- Hashimoto’s disease: Autoimmune disease in which the body attacks its own thyroid gland
- Surgical removal of the thyroid
- Therapeutic radiation as a result of hyperthyroidism
- Atrophy of the thyroid gland
- Tumors of the thyroid gland
- Causes:
- Secondary hypothyroidism: Cause is related to pituitary tumors and other pituitary disorders; results from alterations in the hypothalamic-pituitary axis.
Hypothyroidism Clinical Manifestations
- Fatigue
- Weight gain
- Cold intolerance
- Constipation
- Dry skin
- Thinning hair
- Periorbital edema
Myxedema Coma
- Severe Hypothyroidism
- A loss of brain function as a result of severe, long-standing low levels of thyroid hormone
- Life-threatening!
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Description
This quiz covers essential information about gestational diabetes, including its development during pregnancy and the necessary diagnostic tests. You will learn about fasting plasma glucose levels, hemoglobin A1C, and the importance of urine tests in identifying diabetes. Test your understanding of these critical concepts related to maternal and fetal health.
