Hypothyroidism Patient Education Thyroid crisis or storm Hyperparathyroidism Immediate post op

1.Lifelong thyroid therapy stress, infection, unprepared surgery Hemorrhage, airway obs, laryngeal
Classification 2.How and when to take med Etiology nerve, tetany, Ca Gluconate
1.Primary; Thyroid gland 3.s/s of insufficient and excess med Clinical Manifestations Primary; adenoma, hyperplasia, carcino Post op
2.Secondary; Pituitary Gland 4.Blood evaluation, thyroid levels Hyperpyrexia, Diarrhea, Dehydration, Secondary; Chronic kidney, Renal Fail Aggressive Ca, Hungry Bone, 1mo
3.Tertiary; Hypothalamus 5.energy conservation, gradual increase Tachycardia, Dysrhythmia, Tremor Ambulate immediately x decalcify
4. Congenital Cretinism ↑BP, RR,Irritate, delirium, coma, shock ↑PTH, osteoclast, hypercalcemia,
a,severe iodine deficiency by mother Hyperthyroidism Hypercalciuria, renal stone, fracture Hypoparathyroidism
b.error in metabolism and T3/T4 synth Nursing Management
c. absence or malformation of thyroid Grave’s disease; TSI, autoimmune 1.Hyperthermia: acetaminophen,blanket Clinical Manifestation -Iatrogenic; Thyroidectomy,
-↑meta, gluco, o2,heat, hypocal, repro 2.Dehydration: IV fluid and electrolyte 1. Bone decalcification parathyroidectomy, neck surgery
Etiology -↑Catecholamine, neuro, cardio, SNS 3.Airway: oxygen therapy a.bone pain, backache, frac, deform -Idiopathic; autoimmune/familial
-Hashimoto’s thyroiditis (autoimmune) 4.propylthiouracil, methimazole (IV) b. Calcium renal calculi
l- destruction or removal, thyroidectomy Clinical Manifestation Nursing Management 2.Renal symptoms ↓PHT, ↓Ca, renal, gastro, bone. ↑Ph
-radioactive iodine/antithyroid drug 1.Restless, nervous, irri,agi, hyperact 1.nutrition a. Sand, gravel stone in urine Tetany, laryngeal spasm, air obs, HF
2.fine tremor a.↑ calorie, protein, fluid b. uremia
↓meta, o2 cons, x oxidation of nutrients 3.tachycardia, palpitation b. Quiet and calm c. Hypertension due to renal damage Clinical Manifestation
for energy, less heat, hypercalcemia 4.hypertension c. ↓stimulant; coffee, tea,alcohol 3. GI Manifestation 1. Neuromuscular Irritability
5.↑appetite, weight loss, diarrhea d. Weigh, I&O a. Nau, ano, cons, ab pain, ileus a.+Chvostek’s & Trousseau’s
Clinical Manifestation 6.muscle fatigue/weakness e. fluid changes; v/s 4.Neuromuscular depression b.Muscle cramps, paresthesia
1.Fatigue, lethargy, exercise intolerance 7.heat into, diaphoresis, flushed skin f. Turgor, mucous, neck vein a. Muscle weakness and fatigue c.Laryngo/bronchospasm, seizure
2.Weight gain, anorexia, obesity 8.exophthalmos/proptosis 2. Skin integrity b. Memory loss, emotional instability 2. Neuro; Irritability, confusion,anxious
3.Cold intolerance, subnormal temp 9.Thyroid storm a. Bath cool water, change wet linen c. change in LOC, stupor, coma 3. Cardio; Arrhythmia, CHF→HF
4.bradycardia b. x soap, apply lotion d. Cardiac arrhythmia, standstill, brady
5.↓attention, short term, apathy, deprsn Diagnostic Evaluation 3. Thought process, rest Diagnostic Evaluation
6.Hyperlipidemia/cholesterolemia 1.Phys exam: palpable, bruit, thrill, sns a. Limit visitor, conversation, tv Diagnostic Evaluation 1.↓Ca ↑Ph, ↓PTH, Radio: ↓bone density
7.constipation ↓ peristalsis 2.↑ T3/T4 , ↓TSH, TSI b. x stress, noise, light ↑Ca ↓Ph, ↑Ca and Ph in urine,↑ PTH
8.coarse,dry lip, ; eyebrow loss, c. sleep, relax, medication, ,massage X-ray / DEXA; bone demineral,changes Medical Management
9dry .skin,brittle nail Medical Management d. Cluster ni, x rest/sleep disruption 1.Bedside; syringe Ca sol, x digoxin
10. Menorrhagia, Amenorrhea, ↓ libido 1.Antithyroid: Thionamides, iodide ssk e. x trauma and fall Medical Management 2.Oral Vit D after crisis
11.Thick puffy skin,swell hand, feet, lid 2.x Hypertension: beta, glucocorticoid 4. Other 1 Hydration IV NSS x Ca stone. 3. Phosphate binder ↓Ph ↑Ca
12.↑sensitivity sedative, narcotic,anes 3.Radioactive iodine therapy i-131 a. Cool environment x fever 2. Loop Diuretics, Ethacrynic acid xRnl
b. Antipyretic, ice pack, ↓temperature 3.Oral phosphate ↓Ca Nursing Management
Diagnostic Evaluation Surgical Management c. protect eyes x exophthalmos 4.Calcitonin, Bisphosphonate 1. Normal serum calcium
↑ T3/T4, TSH, cholesterol, antibody Subtotal thyroidectomy(5th-6th gland) d. ↓energy; assist, altern rest & activity 5.Cilciminetics ↓ PTH a.Report +Chvostek & Trousseau
b.Assess respiratory fxn, acute/postop
Medical Management Pre-Op Patient Education Surgical Management c. monitor Ca and Ph levels
T3-Levothyroxine, T4-Liothyronine 1.Euthyroid: thionamide, Vital signs 1.when to take medication Parathyroidectomy d.↑Ca diet, s/s hypo-hypercalcemia
2.x storm: iodide ↓size, glucocorticoid 2.s/s of insufficient or excess med 2.Promote safety
Nursing Consideration; pharma 3.ECG: x hpn/tachycardia 3.blood evaluation - neutropenia Nursing Management (pre-op) a. v/s, seizure precaution,
Morning, BP PR B4, low dose, gradual 4.signs of agranulocytosis 1.Fluid and electrolyte b. tracheostomy, o2 and suction set
Post-Op 5.s/s & predisposing of thyroid storm a. I&O, ↓calcium c. ↓Ph ↑Ca diet, x environment stimuli
Nursing Management 1.Semi-fowler, erect neck and head b.↑ Fluid; x dehydration, stone, constip d. IV Ca gluconate and Vit D
1. Cardiac Output 2.check dressing (bleeding/edema) Goiter c.x dehydration; vomiting etc.
a. v/s , angina, cardio status, stress resp 3.tracheostomy,o2,suction, Iodine deficiency 2. Urinary elimination Education
b. ECG arrhythmia laryngospasm -↓thyroid hormone,↑TSH, hypertrophy a. Strain urine, observe calculi Regimen, lifelong therapy, ↓↑Ca level
c. provide warm environment 4. Laryngeal damage, hoarseness Types b. ↑ fluid 3L/day x dehyde/calculi
d.↓ calorie, ↑ fiber 5.Ca Gluconate, Trousseau, Chvostek’s 1.Endemic- nutritional iodine deficit c.UTI, renal colic, Hematuria Myxedema- bradycardia,hypotension,
e. ↓ weight 6.Temperature(↑crisis) 2.Sporadic - goitrogenic foods d. BUN , creatinine hypoven,acidosis, hypother,stupor,coma
2. ↑ Exercise intolerance 7.Teaching: support neck, ROM, chkup -Genetic defect (x synthesis) 3. Physical Mobility -infection,opioid,sedative withdrawal,
a.uninterrupted rest between activities Medical Management a. Assist in bone pain and weakness Intervention- airway, IV fluid,thyroid,
b.gradual activity 1.Drug: levothyroxine, lugol’s K iodine b.x fall/injury, low bed, handle gently ↓loc, v/s, wake, monitor and manage
3.Normal Bowel 2.x Goitrogenic foods c.analgesia, correct body mechanics hypotension Treat precipitating;
A.↑ fluid, fiber, activity as tolerated 3. Subtotal thyroidectomy d.mild exercise gradual activity inc. Infection,Cold, Narcotic
Cushing’s Syndrome Addison’s Disease Pheochromocytoma Diabetes Insipidus ↑ ↓ Syndrome of inappropriate
Etiology Antidiuretic Hormone
P. Hyperplasia of cortex , ↑ ACTH, 1. Adrenal (autoimmune) Catecholamine releasing neoplasm ↓ADH, x kidney to retain water
Pituitary adenoma/hyperplasia 2. Pituitary ↓ACTH, steroid treatment hyperfunction of adrenal medulla ↑ADH by pituitary gland, ↑ water consv
A.Tumor of adrenal cortex Pathophysiology Etiology
A. ↓Na, H2o, ECF, BP, CA, heart size Pathophysiology 1. Idiopathic Etiology
Clinical Manifestations ↑K, arrhythmia ↑Catecholamine, SNS hyperactivity 2. Trauma, injury, surgery affects PPG Bronchogenic carcinoma
G Hyperglycemia → DM G. ↓gluconeogenesis, hypoglycemia Hypertension, Headache, hyperhidrosis, 3. Nephrotic CNS trauma, injury, surgery, tumor, inf
G Muscle/bone wasting, skin, capillary Weak, anorexia, nausea, vomit, WL Hypermetabolism, Hyperglycemia 4. Drugs (lithium,demeclocycline) Drugs, vincristine, phenothiazine,
G Edema/Abnormal fat distribution Emotional disturbance,x resist stress tricyclic, thiazide, nicotine, vasopressin
G Emotional/Mental changes ↑ACTH, MSI, hyperpigmentation Clinical Manifestations Clinical Manifestations
A↑ susceptibility to infection ↓ healing S. less hair Hypertension, Headache, vision Polyuria 6-20L, SG 1.001-1.005 Clinical Manifestations
A ↑Na, ↓K, Hypertension, Edema, CA Hypermetabolism, ↑sweat, tremor, flush Polydipsia 2-20L, Dehydration, WL Oliguria
AOliguria, Hypervolemia, ↑weight Clinical Manifestations nervous, anxiety, Hyperglycemia Hypovolemia,↓BP, LOC, ↑Na Urine ↑ osmolarity, Specific gravity
S Opposite sex characteristics G. Hypogly, ↓brm, weak, fatigue Edema, weight gain
Irri, anxi, depress by hypoly/hypovo Diagnostic Evaluation Diagnostic Evaluation Hypervolemia, hypertension
Diagnostic Evaluation x cope to stress, bronze/eternal tan 1.Vanillylmandelic acid test History polydipsia, polyuria. ↑Osm↓SG Dilutional hyponatremia
Hyperglycemia, hyperkalemia, ↑ACTH A. ↓Na↑K, fluid, polyuria, arrhythmia 2.Metanephrine Water deprivation test,↑ADH, Na Altered mental status
↓eosinophil and lymphocyte,↑cortisol24 Dehyd, WL, ano, nau, vom, dia. pain 3. CT Scan/MRI (tumor)
S. less hair, impotence Medical Management Diagnostic Evaluation
Surgical & Radiation Management Medical Management Desmopressin acetate ↑urine Specific gravity/osmolarity
1.Adrenalectomy Diagnostic Evaluation 1.antihypertension Chlorpropamide ↓blood osmolarity
2.Transsphenoidal hypophysectomy Hypogly, ↓Na,↑K,↓cortisol, aldosterone Alpha Blocker, -amine Thiazide diuretics (nephrogenic) ↑ADH
3.Radiation therapy Alpha 1 blocker, -zosin ↓ sodium
Medical Management Beta blocker, -olol Nursing Management
Medical Management 1. Cortisone,prednisone, hydrocortisone Ca blocker, -ipin Input & output Medical Management
1.Mitotane(lysodren) 2. Fludrocortisone- mineralocorticoid 2.Sedative- relaxation/rest daily weight Diuretics
2.Metyrapone(metopirone) Blood pressure ↓ Declomycin
3.Aminoglutethimide(cytadren) Nursing Management Surgical Management: Heart rate ↑ Antihypertensive (beta, alpha, calcium)
- i&o, daily weight, bp(↓crisis), Na, K Adrenalectomy Central venous pressure
Nursing Intervention - turgor(dehyd), ↑Na↓K diet, IV Na,glu IV Fluids Nursing Management
- assess Redness, breakdown, tear, - ↓stress, infection, x contact, cold, tired Nursing Management Self administration of drugs Restrict fluid
infection ,edema, abrasion,hypertension - crisis- ↓bp 20mmHg , nau, vom, fever - accompany on hypertension Monitor input and output
- Gentle to skin and extremities, turning - assist, rest/activity, ↑calorie, protein CVA, MI, Cardiac dysrhythmia Patient Education Daily weight
,ambulate, ↓Na↑K diet , i&o, weighing - rest. 45 degrees elevated x limiting fluid Electrolyte status
- avoid fatigue, falls, injury, depression, Addisonian crisis - drug - relax, calm, quiet, Signs and symptoms of dehydration Regular assess Vital signs, mental &
invection, skin break, ✓body withdrawal/ dose Stress, infection, - ↓visitor, stress, noise, stimulant(caf) ↓weight, urine output, ↑ thirst, dry cardiac status
mechanics surgery, trauma, dehydration - x physical exertion, emotional upset Signs and symptoms of overhydration
- gradual increase in activity, verbalize - v/s, ECG, bp, neuro stress, urine ↑weight, edema
- ↓Cal, carb, fat, ↑protein, K, Ca Clinical Manifestations output x coffee, tea (diuresis)
Extreme weakness, hyperpyrexia - IV (x hypotension, peri vasodilation) Lifelong hormone replacement, demo
Post Operative Severe hypotension, hypovolemia → - i&o, BUN, creatinine, glucose level
- s/s of shock vascular collapse, coma, death
- Urine output oliguria
- x infection, sterile, clean, hand wash Intervention
- Thyroid fxn test (↓tsh) NaCl, glucose, hydrocortisone
- Coughing, breathing, turning x (IV→oral), epinephrine
respiratory infection
- i&o, spec gravity, DI ↓ADH Patient Education
1.Lifelong therapy, x withdrawal/
misdose,
2.Hormone under stress
3.Signs and symptoms of insufficient
and excess hormone replacement
Drug summary Addison’s Syndrome Diagnostic Evaluation
Medical Management
1. Cortisone,prednisone, hydrocortisone (glucocorticoid and mineralocorticoid ) summary
Goiter 2. Fludrocortisone- (mineralocorticoid) after meal/ w/ antacid,gi irri, uncer
Medical Management
Hypothyroidism
1.levothyroxine, (synthroid) hormone replacement
Pheochromocytoma ↑ T3/T4, TSH, cholesterol, antibody
Lugol’s K iodine, ice, juice, straw
Medical Management
2.x Goitrogenic foods
1.antihypertensive - block catecholamine Hyperthyroidism
3. Subtotal thyroidectomy
Alpha Blocker, -phentolamine, phenoxybenzamine 1.Phys exam: palpable, bruit, thrill, sns
Alpha 1 blocker, -prazosin, terazosin (fewer side effects) 2.↑ T3/T4 , ↓TSH, TSI
Hypothyroidism Beta blocker, -propranolol
Medical Management Ca blocker, -(relax heart/vasodi.↓bp)nifedipine, nicardipin, amlodipin Hypoparathyroidism
T3-Levothyroxine, (synthroid, levothroid) IM then IV then oral. (diuresis, inc 2.Sedative- relaxation/rest 1.↓Ca ↑Ph, ↓PTH, Radio: ↓bone density
pulse, strength, bp)
T4-Liothyronine Diabetes Insipidus Hyperparathyroidism
Medical Management ↑Ca ↓Ph, ↑Ca and Ph in urine,↑ PTH
Hyperthyroidism Desmopressin acetate. Synthetic vasopressin X-ray / DEXA; bone demineral,changes
Medical Management Chlorpropamide (diabinese) potentiate adh action, improve efficacy
1.Antithyroid: inhibit prod, euthyroid state op Thiazide diuretics (nephrogenic) Cushing
Thionamides, (propylthiouracil, methimazole) agra,neutrop: fever, sore throat, res Hyperglycemia, hyperkalemia, ↑ACTH
Lugol’s solution, sski inhibit release Syndrome of inappropriate Antidiuretic hormone ↓eosinophil and lymphocyte,↑cortisol24
2.x Hypertension: relieve sympathomimetic symptoms Medical Management
beta,(propranolol, nadolol, reserpine-apha) Diuretics Addison
Glucocorticoid (dexamethasone) less effective prevent conversion to t3 Declomycin inhibit adh Hypogly, ↓Na,↑K,↓cortisol, aldosterone
3.Radioactive iodine therapy i-131 (thioamides bec of toxicity\not working) x preg Antihypertensive (beta, alpha, calcium)
Iodide & glucocorticoid- ↓vascularity/action Pheochromocytoma
Diabetes 1.Vanillylmandelic acid test,
Thyroid storm/crisis Medical Management Metanephrine
Medical Management a. Oral Hypoglycemic Agents (only type II Diabetes) 3. CT Scan/MRI (tumor)
Acetaminophen fever o Sulphonylureas: stimulate the pancreas to secrete insulin
Propylthiouracil § 1st gen: chlorpropamide (Diabinese); tolbutamide (Orinase) Diabetes Insipidus
methimazole (IV) § 2nd gen: glyburide (Micronase/Diabeta); glipizide (Glucotrol) History polydipsia, polyuria. ↑Osm↓SG
o Biguanide: ↓ glucose production liver, ↑insulin sensitivity cholesterol Water deprivation test,↑ADH, Na
Hypoparathyroidism synthesis
Medical Management § metformin (Glucophage, Glucophage XL, Fortamet) Syndrome of inappropriate
1.Bedside; syringe Ca sol, x digoxin o Alpha-Glucosidase Inhibitors: delays glucose absorption systemic circulation, antidiuretic hormone
2.Oral Vit D after crisis GI ↑urine Specific gravity/osmolarity
3. Phosphate binder ↓Ph ↑Ca § acarbose (Precose) miglitol (Glyset) ↓blood osmolarity ↑ADH ↓ sodium
o Thiazolidinediones: ↑insulin sensitivity, receptivity to sites, ↑ action
§ Rosiglitazone (Avandidia) Pioglitazone (Actos) Daibetic Ketoacidosis
Hyperparathyroidism
o Non-Sulfonylurea Insulin Secretagogues: stimulate the pancreas rapid,short. 1. Serum glucose ↑250mg/dl, ketone
Medical Management
§ Repaglinide (Prandin) categorized as meglitinide analogs 2. ↓ Serum bicarbonate, PaCO2 & pH,
1 Hydration IV NSS x Ca stone. Replenish fluid, ↓calcium
§ Nateglinide (Starlix) categorized as amino acid derivatives 3. Serum Na and K may be ↓,↑, N
2. Loop Diuretics,(furosemide, Ethacrynic acid) not Renal (x thiazide ,inc Ca)
b. Insulin (Type 1 and type 2 diabetes). 4. ↑BUN, creatinine, Hemo, Hema
3.Oral phosphate (aluminum hydroxide) ↓Calcium
o Rapid-acting insulin Lispro (Humalog); Aspart (Novolog); Glulisine (Apidra) 5.Glucosuria, ↑Specific gravity &
4.Calcitonin (miacalcin), Bisphosphonate (pamidronate, etidronate)
Onset:5-15 minutes Peak:1-2 hours Duration: 2-4 hours osmolarity
5.Cilciminetics (cinacalcet)↓ PTH
o Short-acting: (Clear insulin Regular) Humulin-R, Novolin-R
x Ca carbonate (antacid)
Onset: 30 min – 1hour Peak: 2- 4 hours Duration: 4- 6 hours Hyperglycemic, Hyperosmolar,
o Intermediate-acting: (cloudy/ turbid) NPH-Neutral Protamine Hagedorn Nonketotic, Syndrome
Cushing’s Disease
(Humulin-N, Novolin-N) 1. Serum ↑glucose 600 mg/dl,
Medical Management
Onset: 2-4 hours Peak: 4-12 hours Duration: 16-20 hours osmolarity
1.Mitotane(lysodren) cortex toxic, kill tissue, atrophy
o Very Long-acting: (cloudy/ turbid)Ultralente (Humulin-U) Glargine (Lantus) 2. ↓ Serum bicarbonate, PaCO2 & pH,
2.Metyrapone(metopirone) inhibit cortisol production (if mitotane cant work)
Detemir (Levemir) 3. No to little ketone in urine
3.Aminoglutethimide(cytadren) block cortisol production
Onset: 1 hour Peak: Continuous Duration: 24 hours 4. ↑BUN, creat,Specific gravity, Na & K
Islets of Langerhans- hormone producing cells of T1DM,IDDM,Juvenile,brittle,unstable Diabetes 3. Neuropathy, capillary basement thickened, ↓ Diagnostic Evaluation
the pancreas containing; destruction of beta cells, complete lack of insulin blood supply to brain, demyelination 1. Serum ↑glucose 600 mg/dl, osmolarity
Alpha cells- produce glucagon (hyperglycemic) -polydipsia, polyphagia, polyuria, weight loss a. Paralysis 2. No to little ketone in urine
Beta cells- Produce insulin (hypoglycemic) -juvenile onset, before 30, no langerhans cells b. Gastroparesis 4. ↑BUN, creatinine,Specific gravity, Na & K
Delta cells- somatostatin (inhibitory) ,gastrin -thin, utilization of protein and fats for energy c. Neurogenic bladder, retention, ↓sensation full
-Diabetic Ketoacidosi (DKA) d. ↓ libido, impotence, Medical Management -Correct fluid & electrolyte
Glucagon- promotes conversion of glycogen to -Diet, regular meals Medical Management -control hyperlipidemia, Insulin IV , evaluate drip, stupor, seizure, shock,
glucose. Triggered by hypoglycemia -Daily exercise, ↑insulin action and sensitivity ↓fat, small frequent meal, drugs ↑GI motility, identify and treat precipitating/underlying cause
-Drugs, Insulin bladder train, estrogen lubricant, penile injection
Insulin triggered by hyperglycemia Patient education
1. Promotes passage of glucose to cells D2DM ,NIDM, Adult-onset diabetes mellitus 4. Peripheral Neuropathy- distal nerve,in lower 1. Diet, meet nutritional requirements, maintain
2. conversion of glucose to glycogen for storage Insulin deficiency or resistance,- fatigue, poor extremities weight, blood glucose/lipid, x high sugar & fat.
3. conversion of fatty acids to fat for storage wound healing, recurrent infection, weight loss -paresthesia- prickling, tingling, numbness, ↓ - complex carbs (50-60%), high fiber, ↓fruits
4. Stimulate protein synthesis & inhibit breakdown -adult-onset, over 30, w/ insulin but ↑ in demand proprioception, sense of light tough, temperature, - ↓fat (20-30%), protein (10-20%), 3 or more meal
-obese, Hyperglycemic, Hyperosmolar, Nonketotic pain, gait, ↑ risk for injury and foot infection
Diabetes Mellitus Syndrome (HHNS) Medical Management -control hyperlipidemia, 2. Exercise, ↑utilize carb, sensitivity to insulin
A group of metabolic diseases. hyperglycemia from -Diet non-opioid for pain - ↑glucose uptake, ↓insulin requirement
defects of insulin secretion, action or both -Daily exercise, ↑HDL, weight loss, insulin - maintain body weight, serum lipid, ↓vascular risk
sensitive Acute complications of Diabetes - ↓bp, stress, tension, 1-2 hours to x hypoglycemia
Diagnostic Tests -Drugs, Oral hypoglycemic agent, insulin (stress, 1. Diabetic Ketoacidosis (DKA) hyperglycemia, - regular >sporadic, 30-60 minutes, ,in 3x a week
Fasting blood glucose/sugar-blood glucose at fast surgery, infection, pregnancy) ketonuria, acidosis, dehydration, electrolyte loss,
- NPO 8 hours, sips of water, x smoking -Infection mis/underdose, stress, surgery, untreated 3. Medication
- venipuncture, N-70-110mg/dl, Ab ≥126mg/dl. 2x Pathophysiology Pathophysiology a. Oral hypoglycemic agent
Insulin deficiency or resistance, glucose gets - ↓ insulin, fat metabolism for energy (lipolysis) Sulphonylureas
Postprandial blood glucose- BG following a meal locked out of cell, hypoglycemia - fat→free fatty acids→ketones→ketonemia Biguanides
- withdraw initial blood specimens, give 100g carb 1. ↑ blood osmolarity, ICF dehydration - ↓ blood pH, metabolic acidosis Alpha-glucosidase inhibitor
- withdraw blood 2 hours after meals 2. Glucosuria, exceeds 180mg/dL - ketonuria (excrete excess ketone), dehydration Thiozolidinediones
- N= ≤120mg/dL Ab =>200mg/dL after 2 hours 3. Polyuria, osmotic diuresis, Hypovolemia - Kussmaul, acetone breath, altered LOC Non-sulfonylureas
4. Polydipsia, (from polyuria) - ↑glucose, osmotic diuresis, ↓ electrolyte, b. Insulin
Oral glucose tolerance test- determine the 5. ↑blood viscosity, ↓ circulation, microorganism polyuria, polydipsia, hypotension, nausea, - Rapid-acting P:1-2 D:5-15
response to measured dose of glucose (↑glucose) pyorrhea, UTI, vasculitis, vaginitis, vomiting, weak rapid pulse, weakness - Short-acting (regular) P:2-4 D:4-6
- x smoking, contraceptives, salicylates, diuretic, furuncle, carbuncle, retard healing, gangrene. - Intermediate-acting (cloudy) P:4-12 D:16-20
phenytoin, and nicotinic acid 6. Polyphagia, cellular starvation Diagnostic Evaluation - Long acting (cloudy) P: ∞ D:24
- NPO 8 hours, initial FBS & urine specimen 7. Weight Loss, fat & muscle breakdown 1. Serum glucose ↑250mg/dl, ketone serum
- 75g glucose diluted in lemon juice/IV 8. Fatigue weakness 2. ↓ Serum bicarbonate, PaCO2 & pH, Nursing responsibility
- obtain blood and urine 30m,1,2,3,4,5 hours after 3. Serum sodium and potassium may be ↓,↑, N -Subq, IV in DKA, 90°, G27-29, ½”long and apart
-N= peak of 140 mg/dL 1st hour, returns after 2-3h Lipolysis→hyperlipidemia→atherosclerosis→thic 4. ↑BUN, creatinine, Hemoglobin, Hematocrit -abdomen, thigh, arm, buttocks, don’t massage
-Ab= does not return after 2 to 3 hours kened capillary walls→↓gas & nutrient exchange 5.Glucosuria, ↑Specific gravity & osmolarity -x lipodystrophy, room temperature, rotation site
- room temperature, x hot, roll, x shake
Glycosylated hemoglobin- measures percentage of 1. Macroangiopathy- thickened, narrowed/occlud Medical Management
glycosylated hemoglobin for the past 3-4 months -CVA, MI, Peripheral vascular disease, gangrene -Maintain patent airway, administer oxygens asp Redness, swelling,tenderness, induration- betadine
-Normal= less than 6% Abnormal= 6.5% Medical Management -nutrition, control -IV fluid 0.9 or 0.45, Electrolyte replacement Morning hyperglycemia
hypertension & hyperlipidemia, smoking (sodium/potassium bicarbonate, chloride,) Dawn- HPN bedtime
Predisposing factors: stress -Regular insulin/IV drip, sodium bicarbonate (pH) Somogyi- Decrease dose of HPN/ bedtime snack
Type 1- Viral infecting, autoimmune disorder 2. Microangiography- biological response Waning- HPN bedtime, ↑dose of intermediate/long
Type 2- Heredity, Obesity, lifestyle, diet a. Neuropathy, renal failure 2. Hyperglycemic, Hyperosmolar Nonketotic
Medical Management -control hypertension, Syndrome (HHNS) hyperglycemia, dehydration, Hypoglycemia- <70mg/dL, insulin, skip, activity
hyperglycemia, x UTI, nephrotoxic meds, contrast hyperosmolarity, w/ little to no ketosis, Infection. Clinical manifestation- cool moist skin, pallor,
dye. ↓Sodium, Protein diet Pathophysiology weakness, confusion, nervousness, tachycardia,
Prolonged hyperglycemia, glucosuria, osmotic palpitation, headache, LOC
b. Retinopathy of cataract- blindness diuresis, ↓water, electrolyte, severe dehydration, Management- orange juice, candy, 1tbsp sugar/
Medical Management -contr ol hypertension, hypovolemia, hemoconcentration, cell shrink/ honey, 50ml 50% glucose IV or 1L, 5%-20%
hyperglycemia, cessation of tobacco dehydration, hyperosmolarity, ↓flow, hypoxia glucose in water; monitor blood glucose
Nursing Management
1.Nutrition
-meal timing & content, 5% weight loss, reduce carb, exercise
2.Teaching about insulin- fear, demo
3.Prevent injury- closely monitor blood glucose, ,treat, snack
Adrenergic- sweating, tremor, nervousness, tachycardia, pallor
Neurologic- lightheadedness, confusion, headache, irritability,
slurred speech, lack of coordination, staggering gait
4.Activity- plan, snack before activity, x strenuous/prolong, ↓250mg
5.Skin integrity
-sensation, corns, calluses, hammertoe, dryness, bunion deformation
- heel protector, mattress, foot cradles,moisturizer, x drying agent
-foot care, x smoking

Discharge Plan
-rest/sleep, carb during exercise period
-follow regimen, monitor blood glucose, treat reaction
(carb),ophthal

Foot
- inspect daily for redness, swelling, break in integrity, s/s injury
- avoid thermal injury (hot water, heating pads/bath)
-wash warm, mild soap pat, x rub, x moisture on toes
-consult corn, blister, ingrown. Loose sock & shoes (x open toes)
- moisturizer (x between toes), x smoking
-