Endocrine Disorders NURS 3010 PDF

Endocrine Disorders NURS 3010- Simple and Stable Disorders ⎯ 010Overview of Normal Functioning Glucose comes from 3 sources ° Carbohydrates ° Glycogenolysis (breaking down glycogen from liver to make glucose) ° Gluconeogenesis (creating new...

Endocrine Disorders NURS 3010- Simple and Stable Disorders ⎯ 010Overview of Normal Functioning Glucose comes from 3 sources ° Carbohydrates ° Glycogenolysis (breaking down glycogen from liver to make glucose) ° Gluconeogenesis (creating new glucose from fat and muscle tissue) When glucose is formed and levels are: ° Too high ̴ Beta cells release insulin ̴ Insulin carries glucose into cell ° Too low ̴ Alpha cells release glucagon ̴ Glucagon causes glycogenolysis ⎯ Diabetes Mellitus Pathophysiology Type 1 DM- insulin deficiency, pancreas is not making insulin Type 2 DM- insulin resistance, pancreas is making insulin but your cells of your body is not taking it, type 2 DM can eventually turn into type 1 ⎯ Diagnosis of DM  Endocrine Disorders NURS 3010- Simple and Stable Disorders Hemoglobin A1c‒ Greater than 6.5% = diabetes; 5.7%-6.4% = prediabetes Fasting blood glucose‒ Greater than or equal to 126 = diabetes; 100-125 = prediabetes Two-hour postprandial glucose test‒ Greater than or equal to 200 = diabetes; 140-199 = prediabetes Random glucose‒ greater than or equal to 200 WITH signs of hyperglycemia = diabetes ⎯ DM Pharmacology Insulin ° Plan is to mimic normal blood glucose control and maximize glycemic control ̴ Table 44.2 and CJ Notes on Slide (Medical management-diagnosis) ° Mimicking normal rhythms ̴ Always low level of insulin made by the pancreas ̴ Increase in insulin with meals because of increase in blood glucose ̴ Basal insulin dosing − Long-acting or intermediate ̴ Prandial insulin dosing − Rapid-acting or short-acting, take with a meal ̴ Correctional insulin dosing − Sliding scale (everyday same time) ° Types of Insulin Oral Antidiabetics ° Sulfonylureas- ° Meglitinides ° Biguanides ° Gliptins  Endocrine Disorders NURS 3010- Simple and Stable Disorders INSULIN RAPID- SHORT INTERMEDIATE LONG MIXED/FIXED NAME Lispro Humalog NPH Glargine Humulin 70/30 ONSET within 30 minutes 30-60 minutes 1-2 hours 1-2 hours Novolin 70/30 Humalog 50/50 PEAK 30-90 minutes 2-5 hrs 4-12 hours none if it ends in lin it is intermediate and short, and if its log it DURATION 3-5 hours 5-8 hours 18-24 hours 20-24 hours is intermediate and rapid Hypoglycemia Hypokalemia( insulin takes potassium into the cell) (look for muscle cramping, cardiac Complications/ dysrhythmias) Side Effects Lipohypertrophy (will not absorb any of the insulin should rotate insulin sites, sites should be 1 inch away from each other if you re use same general site) Oral antidiabetics, beta blockers(generalized not cardiac specific), alcohol (can drop blood glucose)(alcohol messes with liver) Thiazide diuretic, glucocorticoids ( raise blood glucose from cortisol) Interactions Beta blockers( decrease blood glucose, blocking the SNS, what causes the shaking, dizziness, and sweating is the SNS bc your brain cells don’t store glucose so your body always needs a constant supply of glucose) Nursing Storage- in the fridge if unopened, once you open it you can store it at room temp Administration Mixing- NPH(intermediate) that it is the only one that is cloudy, the rest should be clear)  Endocrine Disorders NURS 3010- Simple and Stable Disorders Rolling - clear insulin you don’t have to roll but the NPH you have to roll it don’t shake it SULFONYLUREAS Oral: glipizide glimepiride MOA/Purpose insulin release from the pancreas, give 30 minutes before breakfast if pt states they don’t want breakfast don’t give it to them Complications/S Hypoglycemia E Weight gain Interactions Beta blockers ( renal, hepatic, and HF be very cautious for them) MEGLITINIDES  Endocrine Disorders NURS 3010- Simple and Stable Disorders Oral: BIGUANIDES repaglinide Oral: MOA/Purpose metformin insulin release from the pancreas MOA/Purpose reduce the production of glucose within the liver by suppressing gluconeogenesis increases glucose uptake and use in fat and skeletal muscle decrease glucose absorption in GI tract GI effects (anorexia, N/D) Complications/S Be cautious of kidney issues bc of not wanting to eat and people who drink Alcohol E Vitamin B12 and folic acid deficiency ( take supplements) GLIPTINS Oral: sitagliptin MOA/Purpose promote release of insulin and decrease glucagon secretion, lowers fasting and postprandial BG levels HYPERGLYCEMIC AGENTS subQ, IM, IV: Glucagon MOA/Purpose increasing the breakdown of glycogen into glucose Therapeutic increases blood glucose Effect Complications/S GI distress (NV) (roll person onto side if vomiting persists so they don’t aspirate) E HYPERGLYCEMIC AGENTS  Endocrine Disorders NURS 3010- Simple and Stable Disorders IV: Dextrose(essentially glucose) 50% in water (D50W) Dextrose(essentially glucose) 10% in water (D10W) MOA/Purpose Fluid with high levels of dextrose that will move into the bloodstream and into the cells Therapeutic Raise blood glucose levels Effect Complications/S Hyperglycemia E Fluid overload  Endocrine Disorders NURS 3010- Simple and Stable Disorders ⎯ Hypoglycemia Blood glucose under _65____ ° Causes: ̴ High insulin dose given ̴ Overly high dose of drugs that stimulate insulin release ̴ Renal insufficiency ̴ Decreased nutritional intake ̴ Increased metabolism of glucose ° Results ̴ When blood glucose gets too low: − SNS kicks in and releases epinephrine, norepinephrine, and glucagon to cause: Anxiety Hunger Palpitations Circumoral paresthesia (numbness around the mouth/lips) Sweating Shakiness Irritability − If progresses, can lead to: Difficulty thinking Dizziness Fatigue Sleepiness Weakness/lack of coordination Pharmacologic Treatment ° Glucagon ° 50% dextrose solution (D50)  Endocrine Disorders NURS 3010- Simple and Stable Disorders