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ENDOCRINE SYSTEM
Main gland
Pituitary gland located at base of brain of Stella Turcica- Master gland of body- Master clock of body
1. Anterior pituitary gland adenohypophysis2. Posterior pituitary gland neurohypophysis
Posterior Pituitary Gland1.) Oxytocin
a.) Promotes uterine contraction preventing bleeding/ hemorrhage.- Give after placental delivery to prevent uterine atony.
b.) Milk letdown reflex with help of prolactin.2.)ADH(vasopressin)
antidiuretic hormone-Prevents urination conserve H2O
Anterior Pituitary Gland adeno
Growth hormone (GH)
- Somatotropic hormone- Elongation of long bones
1. Decrease GH dwarfism children2. Increase GH gigantism3. Increase GH acromegaly adult
Puberty 9 yo 21 yoEpiphyseal plate closes at 21 yo
Square faceSquare jaw
Drug of choice in acromegaly: Ocreotide (Sandostatin)S/E dizziness
Somatostatin Hormone antagonizes the release of of GH
Melanocytes stimulating hormone (MSH)- Skin pigmentation
Prolactin/luteotrpic hormone/ lactogenic hormone- Promotes development of mammary gland
(Oxytocin-Initiates milk letdown reflex)
Adrenocorticotropic hormone (ACTH)- Development & maturation of adrenal cortex
Luteinizing hormoneproduces progesterone
Follicle Stimulating Hormone
- produces estrogen
DIABETIS INSIPIDUS(DI)(DI- dalas ihi)
hyposecretion of ADH* alcohol inhibits release of ADH
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Cause: idiopathic/ unknown
Predisposing Factor:1. Pituitary surgery2. Trauma/ head injury3. Tumor4. Inflammation
Signs & Symptoms:1. Polyuria2. Sx of dehydration
- Excessive thirst (adult) (1st sx of dehydration in children-tachycardia)- Agitation- Poor skin turgor- Dry mucus membrane
3. Weakness & fatigue4. Hypotension if left untreated -5. Hypovolemic shockAnuria late sign hypovolemic shock
Diagnostic Procedure:1. Decrease urine specific gravity- concentrated urine
N= 1.015 1.035
2. Serum Na = increase (N=135 -145 meq/L) Hypernatremia
Nursing Management:1. Force fluid 2,000 3,000ml/day2. Administer IV fluid replacement as ordered3. Monitor VS, I&O4. Administer meds as ordered
a.) Pitresin (vasopressin) IM5. Prevent complications
Most feared complication Hypovolemic shock
SYNDROME OF INAPPROPRIATE ANTI-DIURETIC HORMONE (SIADH)- Increase ADH- Idiopathic/ unknown
Predisposing Factor:1. Head injury2. Related to Bronchogenic cancer or lung caner-Early Sign of Lung Ca - Cough 1. non productive 2. productive
3. Hyperplasia of Pit glandIncrease size of organ
Signs & Symptoms:1. Fluid retention2. Increase BP HPN3. Edema4. Wt gain5. Danger of H2O intoxication6. Complications:
1. cerebral edema increase ICP2. seizure
Diagnostic Procedure:
1. Urine specific gravity increase diluted urine2. Hyponatremia Decreased Na
Nursing Management:1. Restrict fluid2. Administer meds as ordered eg. Diuretics: Loop and Osmotic
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3. Monitorstrictly V/S, I&O, neuro check increase ICP4. Weigh daily5. Assess for presence edema6. Provide meticulous skin care7. Prevent complications increase ICP & seizures activity
PINEAL GLAND1. Secretes Melatonin inhibits lutenizing hormone (LH) secretion
THYROID GLAND (TG)
Question: Normal physical finding on TG:a. With tenderness thyroid never tenderb. With nodular consistency- answerc. Marked asymmetry only 1 TGd. Palpable upon swallowing - Normal TG never palpable unless with goiter
THYROID GLAND HORMONES
1.)Triodothyronine T3- 3 molecules of iodine
Metabolic hormone
2.)Tetraiodothyronine/ Tyroxine T4- 4 molecules of iodine
3.) Thyocalcitonin antagonizes effects of parathormone
Hypo T3 T4 - lethargy & memory impairment Hyper T3 T4 - agitation, restlessness, and hallucination
SIMPLE GOITER enlarged thyroid gland - iodine deficiency
Predisposing Factor:1. Goiter belt area - Place far from sea no iodine. Seafoods rich in iodine2. Mountainous area increase intake of goitrogenic foods (US: Midwest, NE, Salt Lake)
Cabbage has progoitrin an anti thyroid agent with no iodine
Example: Turnips (singkamas), radish, peas, strawberries, potato, beans, kamote, cassava(root crops), all nuts.3. Goitrogenic drugs:
Anti thyroid agents :(PTU) prophylthiouracilLithium carbonate, Aspirin PASACobalt, Phenyl butasone
Endemic goiter cause # 1Sporadic goiter caused by #2 & 3
Signs & Symptoms:
enlarged TG Mild restlessness Mild dysphagia
Diagnostic Procedure:1. Thyroid scan reveals enlarged TG2. Serum TSH increase (confirmatory)3. Serum T3, T4 N or below N
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Predisposing Factor:1. Autoimmune disease release of long acting thyroid stimulator (LATS)
ExopthalmosEnopthalmos severe dehydration depressed eye
2. Excessive iodine intake3. Hyperplasia of TG
Signs & Symptoms:
1. Increase in appetite hyperphagia wt loss due to increase metabolism2. Skin is moist - perspiration3. Heat intolerance4. Diarrhea increase motility5. All VS increase = HPN, tachycardia, tachypnea, hyperthermia6. CNS changes1. Irritability & agitation, restlessness, tremors, insomnia, hallucinations7. Goiter8. Exopthalmos pathognomonic sx9. Amenorrhea
Diagnostic Procedure:
1. Serum T3 & T4 - increased2. Radio iodine uptake increase3. Thyroid scan reveals enlarged TG
Nursing Management:1. Monitor VS & I & O determine presence of thyroid storm or most feared complication:
Thyrotoxicosis
2. Administer medsa. Antithyroid agents
1. Prophylthiuracil (PTU)
2. Methimazole (Tapazole)Most toxic s/e agranulocytosis- fever, sore throat, leukocytosis=inc wbc: check cbc and
throat swab cultureMost feared complication : Thrombosis stroke CVS
3. Diet increase calorie to correct wt loss4. Skin care 5. Comfy & cool environment6. Maintain siderails- due agitation/restlessness7. Provide bilateral eye patch to prevent drying of eyes- exopthalmos8. Assist in surgery subtotal thyroidectomy
Nsg Mgt: pre-opAdm Lugols solution (SSKI) K iodide
2. To decrease vascularity of TG3. To prevent bleeding & hemorrhage
Complication:1. Watch out for signs of thyroid storm or thyrotoxicosis
Triad signs of thyroidstorm;a. Tachycardia /palpitationb. Hyperthermiac. Agitation
Nursing Management Thyroid Storm:
1. Monitor VS & neuro check- Agitated might decrease LOC2. Antipyretic fever
Tachycardia - blockers (-lol)3. Siderails agitated
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Complication2. Watch for inadvertent (accidental) removal of parathyroid gland
Secretes Parath hormone
If removed, hypocalcemiaSigns & Symptoms:
tetany 1. .(+) Trousseau sign 2. Chvostecks sign
Nursing Management:- Adm calcium gluconate slowly to prevent arrhythmia- Ca gluconate toxicity antidote MgSO4
Complication3.Laryngeal (voice box) nerve damage (accidental)Signs & Symptoms:
- hoarseness of voice***Encourage pt to talk or speak post operatively asap to determine laryngeal nerve damage
Notify physician!
4. Signs of bleeding post subtotal thyroidectomy- Feeling of fullness at incision site
Nursing Management:Check soiled dressing at nape area
5. Signs of laryngeal spasma. DOBb. SOB
Prepare at bedside tracheostomy
6. Hormonal replacement therapy - lifetime7. Importance of follow up care
PARATHYROID GLAND pair of small nodules located behind the TG
1.) Parathyroid Hormone promotes Ca reabsorption
Thyrocalcitonin antagonises secretion of parathyroid hormone
1. Hypoparthroidism of parathyroid hormone2. Hyperparathroidsm -
HYPOPARATHYROIDISM decreased parathormone
Hypocalcemia Hyperphosphatemia(Or tetany)
[If Ca decreases, phosphate increases]
Predisposing Factor:
1. Following subtotal thyroidectomy2. Atrophy of parathyroid gland due to
a. Irradiationb. Trauma
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Signs & Symptoms:1. Acute tetany
a. Tingling sensationb. Paresthesiac. Dysphagiad. Laryngospasme. Bronchospasm
f. Seizure complicationg. Arrhythmia
Pathognomonic Sign of TETANY(+) Trousseaus or carpopedial spasm(+) Chvostecks sign
2. Chronic tetanya. Loss of tooth enamelb. Photophobia & cataract formationc. GIT changes anorexia, n/v, general body malaised. CNS changes memory impairment, irritability
Diagnostic Procedure:
1. Serum calcium decrease (N 8.5 11 mg/100ml)2. Serum phosphate increase (N 2.5 4.5 mg/100ml)3. X-ray of long bone decrease bone density4. CT Scan reveals degeneration of basal ganglia
Nursing Management:Administration of meds:
a.) Acute tetany-Ca gluconate IV, slowly
b.) Chronic tetany1. Oral Ca supplementsEx. Ca gluconate
Ca carbonateCa lactate
Vit D (Cholecalceferol)
Drug diet sunlight
Cholecalceferol calcidiol calcitriol 7am 9am
2. Phosphate binder- Alumminum DH gel (ampho gel)
S/E constipation
AntacidAAC MAD
Aluminum containing acids Mg containing antacidsEx. Milk or magnesia
Aluminum OH gel Diarrhea
Constipation Maalox magnesium & aluminum - Less s/e
2. Avoid precipitating stimulus such as bright lights & noise: photophobia leading to seizure3. Diet increase Ca & decrease phosphorus
- Dont give milk due to increase phosphorusExample:a.)anchovies increase Ca, decrease phosphorus + uric acid.
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b.)Tuna & green turnips- Ca.4. Bedside tracheostomy set due to laryngospasm5. Encourage to breath with paper bag in order to produce mild respiratory acidosis to promoteincrease ionized Ca levels7. Hormonal replacement therapy - lifetime8. Important fallow up care
HYPERPARATHYROIDISM- increase parathormone. Complication: Renal failureHypercalcemia can lead to Hypophosphatemia
Bone disease kidney stonesdemineralization
Leading to bone fracture
Ca 99% bones1% serum blood
Predisposing Factor:1. Hyperplasia parathyroid gland (PTG)2. Over compensation of PTG due to Vit D deficiency
Children Rickets Vit DAdults Osteomalacia deficiency
Sippys diet Vit D diet not good for pt with ulcer2 -4 cups of milk & butter
Karrels diet Vit D diet not good for pt with ulcer6 cups of milk & whole cream
Food rich in CHON eggnog combination of egg & milk
Signs & Symptoms:Bone fracture
1. Bone pain (especially at back), bone fracture2. Kidney stone
a. Renal colicb. Cool moist skin
3. GIT changes anorexia, n/v, ulcerations4. CNS involvement irritability, memory impairment
Diagnostic Procedure:
1. Serum Ca increase2. Serum phosphorus decreases3. X-ray long bones reveals bone demineralization
Nursing Management:for Kidney Stone
1. Force fluids 2,000 3,000/day or 2-3L/day2. Isotonic solution3. Warm sitz bath for comfort4. Strain all urine with gauze pad5. Acid ash diet cranberry, plum, grapefruit, vit C, calamansi to acidify urine
6. Administration of meds
a. Narcotic analgesic Morphine SO4, Demerol (Meperidine Hcl)S/E resp depression. Monitor RR)*Narcan/ Naloxone antidote
Naloxone toxicity tremors
7. Siderails
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8. Assist in ambulation
9. Diet low in Ca, increase phosphorus lean meat10.Assist surgical procedure parathyroidectomy11.Impt ff up care12.Hormonal replacement- lifetime
ADRENAL GLAND- Atop of @ kidney
2 Parts
1.)Adrenal cortex outermost layer
a) Zona fasiculata secrets glucocorticoidsEx. Cortisol - Controls glucose metabolism (SUGAR)
b) Zona reticularis secrets traces of glucocorticoids & androgenic hormonesM testosteroneF estrogen & progesterone
Fx promotes development of secondary sexual characteristics
c) Zona glomerulosa - secretes mineralcortisoneEx. Aldosterone
Fx: promotes Na & H2O reabsorption & excretion of potassium (SALT)
2.)Adrenal medulla - innermost layera.)Secrets cathecolaminesb.)Epinephrine / Norephinephrine potent vasoconstrictor adrenaline=Increase BP
Adrenal Medullas only disease:
PHEOCHROMOCYTOMA
- presence of tumor at adrenal medulla
- increase nor/epinephrine- with HPN and resistant to drugs- drug of choice: beta blockers- complication: HPN crisis = lead to stroke
- no valsalva maneuver
ADDISONS DISEASE Steroids-lifetime
Decreased adrenocortical hormones leading to:a.) Metabolic disturbances (sugar)b.) F&E imbalances- Na, H2O, Kc.) Deficiency of neuromuscular function (salt & sex)
Predisposing Factor:1. Atrophy of adrenal gland2. Fungal infections3. Tubercular infections
Signs & Symptoms:
1. Decrease sugar Hypoglycemia Decreased glucocorticoids - cortisol
T tremors, tachycardiaI - irritabilityR - restlessness
E extreme fatigueD diaphoresis, depression
2. Decrease plasma cortisol
Decrease tolerance to stress lead to Addisonians crisis
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2. Stress3. Infection4. Trauma5. Surgery
b.)Prevent complicationsAddisonian crisis & Hypovolemic shock
8. Hormonal replacement therapy lifetime9. Important: follow up care
CUSHINGS SYNDROME
increase secretion of adrenocortical hormone
Predisposing Factor:1. Hyperplasia of adrenal gland2. Tubercular infection milliary TB
Signs & Symptoms:1. Increase sugar Hyperglycemia
3 Ps1. Polyuria
2. Polydipsia increase thirst3. Polyphagia increase appetite
Classic Sx of DM 3 Ps & glycosuria + wt loss2. Increase susceptibility to infection due to increased corticosteroid
3. Hypernatrermiaa. HPNb. Edemac. Wt gaind. Moon face
Buffalo humpObese trunk classic signs
Pendulous abdomenThin extremities
4. Hypokalemiaa. Weakness & fatigueb. Constipationc. ECG (+) U wave
5. Hirsutism increase sex6. Acne & striae7. Increase muscularity of female
Diagnostic Procedure:1. FBS increase (N: 80-120mg/dL)2. Plasma cortisol increase
3. Na increase (135-145 meq/L)4. K- decrease (3.5-5.5 meq/L)
Nursing Management:1. Monitor VS, I&O2. Administer medsa. K- sparing diuretics (Aldactone) Spironolactone
- promotes excretion of NA while conserving potassium
Not lasix due to S/E hypoK & Hyperglycemia!
3. Restrict Na4. Provide Dietary intake low in CHO, low in Na & fats
High in CHON & K
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5. Weigh pt daily & assess presence of edema- measure abdominal girth- notify doc.6. Reverse isolation
7. Skin care due acne & striae 8. Prevent complication
- Most feared arrhythmia & DM(Endocrine disorder lead to MI Hypothyroidism & DM)
9. Surgical bilateral Adrenolectomy10.Hormonal replacement therapy lifetime due to adrenal gland removal- no more corticosteroid!
PANCREAS behind the stomach, mixed gland both endocrine and exocrine gland
Acinar cells (exocrine gland) Islets of Langerhans (endocrine gland ductless)
Secrete pancreatic juices at pancreatic ducts. cells
Aids in digestion (in stomach) secrets glucagon
Fxn: hyperglycemia (high glucose)
Cells
Secrets insulin
Fxn: hypoglycemia
Delta Cells
Secrets somatostatin
Fxn: antagonizes growth hormone
3 disorders of the Pancreas1. DM2. Pancreatic Cancer3. Pancreatitis
PANCREATITIS
- acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to
- Autodigestion self-digestion
Cause: unknown/idiopathic4. Or alcoholism
Pathognomonic sign- (+) Cullens sign - Ecchymosis of umbilicus (bluish color)- pasa(+) Grey turners sign ecchymosis of flank area
Both sx means hemorrhage
PANCREATITIS acute or chronic inflammation of pancreas leading to pancreatic edema,
hemorrhage & necrosis due to auto digestion.Bleeding of pancreas - Cullens sign at umbilicus
Predisposing Factor:1. Chronic alcoholism
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2. Hepatobilary disease3. Obesity4. Hyperlipidemia5. Hyperparathyroidism6. Drugs Thiazide diuretics, pills Pentamidine HCL (Pentam)7. Diet increase saturated fats
Signs & Symptoms:
1. Severe Lt epigastric pain radiates from back &flank area- Aggravated by eating, with DOB2. N/V3. Tachycardia4. Palpitation due to pain5. Dyspepsia indigestion6. Decrease bowel sounds
7. (+) Cullens sign - ecchymosis of umbilicus hemorrhage8. (+) Grey Turners spots ecchymosis of flank area9. Hypocalcemia
Diagnostic Procedure:
1. Serum amylase & lipase increase2. Urine lipase increase3. Serum Ca decrease
Nursing Management:1. administration of Medicines
a.) Narcotic analgesic - Meperidine Hcl (Demerol)Dont give Morphine SO4 will cause spasm of sphincter.
b.) Smooth muscle relaxant/ anti cholinergic- Ex. Papavarine Hcl
Prophantheline Bromide (Profanthene)c.) Vasodilator NTGd.) Antacid Maalox
e.) H2 receptor antagonist - Ranitidin (Zantac) to decrease pancreatic stimulationf.) Ca gluconate
2. Withold food & fluid aggravates pain3. Assist in Total Parenteral Nutrition (TPN) or hyperalimentation
Complications of TPN1. Infection2. Embolism3. Hyperglycemia
4. Institute stress mgt techa.) DBEb.) Biofeedback
5. Comfy position - Knee chest or fetal likeposition6. If pt can tolerate food, give increase CHO, decrease fats, and increase CHON7. Complications: Chronic hemorrhagic pancreatitis
CHRONIC HEMORRHAGIC PANCREATITIS- bangugot
Predisposing Factor:- unknown
Risk factor:1. History of hepatobiliary disorder2. Alcohol3. Drugs thiazide diuretics, oral contraceptives, aspirin, penthan4. Obesity
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1. Asymptomatic2. 3 Ps and 1G
Treatment Management1. Oral Hypoglycemic Agents (OHA)2. Diet3. Exercise
Complication: HONKCH hyperO osmolarN nonK ketoticC coma
GESTATIONAL DM
occurs during pregnancy & terminates upon delivery of child
Predisposing Factor:1. Unknown/ idiopathic
2. Influence of maternal hormones
Signs & Symptoms:Same as type II
1. Asymptomatic2. 3 Ps & 1G
Type of delivery CS due to large babySx of hypoglycemia on infant
1. High pitched shrill cry2. Poor sucking reflex
IV. DM ASSOCIATED WITH OTHER DISORDERa.) Pancreatic tumorb.) Cancerc.) Cushings syndrome
3 MAIN FOOD GROUPSAnabolism Catabolism
1. CHON glucose glycogen2. CHON amino acids nitrogen3. Fats fatty acids free fatty acids (FFA) Cholesterol & Ketones
Pancreas glucose ATP (Main fuel/energy of cell )Reserve glucose glycogenLiver will undergo glucogenesis synthesis of glucagons
& Glycogenolysis breakdown of glucagons& Gluconeogenesis formation of glucose form CHO sources CHON & fats
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HYPERGLYCEMIA
pancreas will not release insulin. Glucose cant go to cell, stays at circulation causinghyperglycemia.
increase osmotic diuresis glycosuriaLead to cellular starvation
Lead to wt loss stimulates the appetite/ satiety center polyuria(Hypothalamus)
Cellular dehydration
Polyphagia Stimulates thirst center(hypothalamus)
Polydipsia
Increased CHON catabolism
Lead to (-) nitrogen balance
Tissue wasting (cachexia)
Increase fat catabolism
Free fatty acids
Cholesterol ketones DKA
Atherosclerosis coma
HPN death
MI stroke
DIABETIC KETOACIDOSIS (DKA)- Acute complication of Type I DM due to severe hyperglycemia leading to CNS depression &
Coma.- Ketones- a CNS depressant
Predisposing Factor:1. Stress between stress and infection, stress causes DKA more.2. Hyperglycemia3. Infection
Signs & Symptoms:
3 Ps & 1G1. Polyuria2. Polydipsia
3. Polyphagia4. Glycosuria5. Wt loss6. Anorexia, N/V
7. (+) Acetone breath odor- fruity odor pathognomonic DKA
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8. Kussmaul's resp-rapid shallowrespiration9. CNS depression10.Coma
Diagnostic Procedure:1. FBS increase, Hct increase (compensate due to dehydration)
N =BUN 10 -20 mg/100ml --increased due to severe dehydrationCrea - .8 1 mg/100ml
Hct 42% (should be 3x high)-nto hgb
Nursing Management:1. Can lead to coma assist mechanical ventilation2. Administer .9NaCl isotonic solution
Followed by .45NaCl hypotonic solutionTo counteract dehydration.
3. Monitor VS, I&O, blood sugar levels4. Administer meds as ordered:
a.) Insulin therapy IV push
Regular Acting Insulin clear (2-4hrs, peak action)b.)To counteract acidosis Na HCO3c.) Antibiotic to prevent infection
Insulin Therapy
A. Sources:1. Animal source beef/ pork-rarely used. Causes severe allergic reaction.2. Human has less antigenecity property
Cause less allergic reaction. Humulin
If kid is allergic to chicken dont give measles vaccine due it comes from chicken embryo.3. Artificially compound
B. Types of Insulin
1. Regular Insulin - Ex. Regular acting I2. Intermediate acting I - Ex. NPH (non-protamine Hagedorn I)3. Long acting I - Ex. Ultra lente
Types of Insulin color & consistency onset peak duration1. Regular clear - 2-4h -2. Intermediate cloudy - 6-12h -3. Long acting cloudy - 12-24h -
Ex. 5am Hemoglucose test (HGT)
250 mg/dlAdm 5 units of RA IPeak 7-9am monitor hypoglycemic reaction at this time- TIRED
Nursing Management:upon injection of insulin:
1.Administer insulin at room temp! To prevent lipodystrophy = atrophy/ hypertrophy of SQtissues2. Insulin is only refrigerated once opened!3. Gently roll vial bet palms. Avoid shaking to prevent formation of bubbles.4. Use gauge 25 26needle tuberculin syringe
5. Administer insulin at either 45(for skinny pt) or 90 (taba pt)depending on the client tissuedeposit.6. Dont aspirate after injection7. Rotate injection site to prevent lipodystrophy8. Most accessible site abdomen
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9. When mixing 2 types of insulin, aspirate1st regular/ clear before cloudy to prevent contaminating clear insulin & to promote
accurate calibration.10. Monitor signs of complications:
a. Allergic reactions lipodystrophyb. Somogyis phenomenon hypoglycemia followed by periods of hyperglycemia or
rebound effect of insulin.
11. 1ml or cc of tuberculin = 100 units of insulin
- - 1 cc = 100 units
- - .5cc = 50 units
- - .1 cc = 10 units
6 units RA
Most Feared Complication of Type II DM
Hyper osmolarity = severe dehydrationOsmolar
Non - absence of lipolysisKetotic - no ketone formation
COMA
Signs & Symptoms: headache, restlessness, seizure, decrease LOC
Nursing Management:- same as DKA except dont give NaHCO3!
1.Can lead to coma assist mechanical ventilation
2. Administer .9NaCl isotonic solution
Followed by .45NaCl hypotonic solution (To counteract dehydration.)
3.Monitor VS, I&O, blood sugar levels4.Administer meds
a.) Insulin therapy IVb.) Antibiotic to prevent infection
Treatment Management
O ralH ypoglycemicA gents
5. Stimulates pancreas to secrete insulin
Classifications of OHA
1. First generation Sulfonylureasa. Chlorpropamide (diabenase)b. Tolbutamide (orinase)c. Tolazamide (tolinase)
2. 2nd generation sulfonylureasa. Diabeta (Micronase)
b. Glipizide (Glucotrol)c.
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Nursing Management:or OHA
1. Administer with meals to lessen GIT irritation & prevent hypoglycemia
2. Avoid alcohol (alcohol + OHA = severe hypoglycemic reaction=CNSdepression=coma) Antabuse-Disufram3.
Diagnostic Procedure:for DM
1. FBS N 80 120 mg/dl = Increased for 3 consecutive times =confirms DM!!+ 3 Ps & 1G
2. Oral glucose tolerance (OGTT) - Most sensitive test3. Random blood sugar increased4. Alpha Glucosylated Hgb elevated
Nursing Management:
1. Monitor for PEAK action of OHA & insulinNotify Doc
2. Monitor VS, I&O, neurocheck, blood sugar levels.3. Administer insulin & OHA therapy as ordered.4. Monitor signs of hyper & hypoglycemia.
Pt DM hinimatay You dont know if hypo or hyperglycemia.
Give simple sugar (Brain can tolerate high sugar, but brain cant tolerate low sugar!)Cold, clammy skin hypo Orange Juice or simple sugar /Warm to touch hyper administer insulin
5. Provide nutritional intake ofdiabetic diet:CHO 50%CHON 30%Fats 20%
-Or offer alternative food products or beverage.-Glass of orange juice.
6. Exercise after meals when blood glucose is rising.
7. Monitor complications of DMa. Atherosclerosis HPN, MI, CVAb. Microangiopathy small blood vessels
Eyes diabetic retinopathy , premature cataract & blindnessKidneys recurrent pyelonephritis & Renal Failure
(2 common causes of Renal Failure : DM & HPN)c. Gangrene formation
d. Peripheral neuropathy1. Diarrhea/ constipation2. Sexual impotence
e. Shock due to cellular dehydration
8. Foot care mgta. Avoid waking barefootedb. Cut toe nails straightc. Apply lanolin lotion prevent skin breakdownd. Avoid wearing constrictive garments
9. Annual eye & kidney exam10.Monitor urinalysis for presence of ketonesBlood or serum more accurate
11.Assist in surgical wound debridement12.Monitor signs or DKA & HONKC13.Assist surgical procedure
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BKA or above knee amputation
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