Med Surg Endo PDF

Endocrine Diabetes Hyperglycemia Type I DM Insulin deficiency due to destruction of beta cells hot and dry Without insulin, fats are meta...

Endocrine Diabetes Hyperglycemia Type I DM Insulin deficiency due to destruction of beta cells hot and dry Without insulin, fats are metabolized for energy, Hypoglycemia which results in ketones acidosis cold and clammy Diabetic Ketoacidosis Sudden onset, increased ketones and acetone due to inadequate insulin dose Glucose >300, ketones in urine, fruity breath, confusion, Kussmaul’s respirations, increased thirst and urination 1st thing to do → start IV infusion of normal saline Severe dehydration occurs and must be rehydrated before insulin is administered *Expect potassium to drop rapidly, so be ready with potassium replacement Dropping glucose down too fast can cause increased intracranial pressure d/t water being pulled into the CSF Type II DM Resistance or lack of insulin Hyperglycemic Hyperosmolar Non-ketonic Syndrome (HHNS) Glucose >600 Severe dehydration, low potassium due to diuresis, no ketones or acidosis S/sx: altered LOC, increased thirst and urination, lethargy, coma HbA1C Test that averages blood glucose levels over the past 90-120 days 4-6 = blood sugar level around 70-110 7 is ideal for a diabetic Drawing up insulin: Nicole Richie RN Air into NPH, then air into Regular, draw up Regular insulin then NPH Insulin Dawn Phenomenon Early morning hyperglycemia in pts with diabetes Somogyi Effect Occurs when pt takes insulin before bed, has hypoglycemia around 2-3am, and wakes up with hyperglycemia. The insulin lowers the blood sugar too much, causing a rebound effect  Endocrine Additional Notes Fluids are the most important intervention in DKA and HHNS Do NOT give oral hypoglycemic meds to unconscious patients d/t risk of aspiration Additional insulin may be needed for patients on steroids (i.e. prednisone). Steroids increase glucose levels. Diabetic neuropathy Earliest sign is microalbuminuria Diabetes Insipidus: disorder of salt and water metabolism Excessive thirst and urination, dehydration, weakness Decreased ADH NI: monitor electrolytes, I&O’s, give fluids, monitor urine specific gravity and serum osmolality SIADH: water retention and dilutional hyponatremia Body retains water which can lead to water intoxication and hyponatremia Increased ADH Nursing interventions: daily weights (monitor for fluid overload), give diuretics, assess deep tendon reflexes, assess for neurological changes if sodium