Diabetes Insipidus Review Excessive water loss due to hyposecretions of ADH
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| diabetes insipidus may be caused by | radiation for cancerous brain tumor
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| which symptoms do diabetes mellitus and diabetes insipidus have in common | polydipsia and polyuria
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| a pt has jut started taking desmopressin acetate (DDAVP). The nurse is on the outlook for what signs of overdose? | weight gain and concentrated urine
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| a pt has been dx with SIADH. The nurse knows that the priority nursing dx for this pt is | fluid volume excess and LOC alteration in
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| the pt with SIADH is at risk for seizures | cerebral edema and excretion of sodium
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| a pt with SIADH suddenly is vomitting is disoriented and complains of a severe headache what is the nurse priority intervention? | notify the physician
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| the pt who has SIADH has a foley draining clear urine. The nurse would expect the urine | to be concentrated
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| The pt with SIADH is given 3% normal saline. In addition the nurse gives the pt furosemide (lasix). | to prevent fluid overload
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| the nurse knows that the adrenal gland is hyperfunctioning in cushing disease to cause | a increased cortisol production and hyperglycemia
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| the nurse knows the report abdominal pain in the patient with cushing disease bc | it could be a sign of visceral perforation
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| a pt with cushing diseae is coming to the inic. the nurse would expect the pt appearance to be | fat on the face, trunk and back. thin arms and thin legs.
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| to mx the patient with addisons diese th enurse | take orthostatic vitals, watch for signs of hypoglycemia, mx for hypoatremia and dehydration
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| the nurse recognizes the following symptoms suggests addisons disease | hypoglycemia, hypoatremia and hyperkalemia
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| the nurse should questions which of the following nursing interventions for the pt with addisons disease | administration of insulin to treat acute hypokalemia
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| the pt with pheochromocytoma secretes catecholamines. these catecholamines cause two processes in the body | vasoconstriction, hypertension
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| at report you hear that pt a has pheochromocytoma you instruct the CNA to make sure to do all | give the pt more blankets
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| you are giving report to a CNA caring for a patient with pheochromocytoma. You know the pt is producing catecholamines that affect the BP what do you tell the CNA to be on the outlook for | HTN
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| which intervention below does the nurse teach the pt to prevent DKA | if ill take your insulin and drink clear liquids with carbohydrate
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| which of the following s/s is least likely to occur in HHNS? | Abdominal pain
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| when caring for pt with DKA, which of the following nursing dx take priority? | fluid volume deficit
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| the pt comes into the clinic with bronchitis and sinusitis. He has a hx of type 1 diabetes.. The nurse observes deep, rapid, unlabored respirations, fruity odor on the pt clothes and dry skin. what should the nurse do next? | measure blood glucose level for hyperglycemia and check urine for ketones
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| a pt who was admitted with hyperglycemic hyperosmolar nonketonic coma (HHNS) asks how she can prevent this from happening again. the nurse would instruct the pt that which of the following are preventative measures? | detect and treat infection early,maintain hydration and use stress management techniques.
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| the pt with diabetes mellitus requests a medication for a headache soon after returning fr. an early morning xray procedure. the nurse observes the pt is upset about the headache, angry at missing breakfast and has moist hands. | check the blood glucose level and be prepared to give four oz of juice immediately
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| type I DM | autoimmune disorder with beta cell destruction
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| type II | resistance to endogenous insulin
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| Secondary causes of DM | pancreatitis and Cushing disease
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| Diabetes Diagnostic Criteria | blood glucose > 200
Fasting blood glucose >126
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| hypoglycemia | <50 mg/dl, cool clammy skin, diaphoresis, anxiety, irritability, confusion, blurred vision, hunger, general weakness
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| hyperglycemia | >250 mg/dl, hot dry skin, absence of diaphoresis, alert to coma, rapid deep respiration's.
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| Review DM food | count carbs 1 unit insulin/15 g carb, plan intake according to inactivity/ activity
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| Hypoglycemia | cause: too much insuin, inadequate intake, exercise without replacement
SX: low blood gluclose, diaphoresis, tremors, hunger, weakness, pallor, dizziness, somnolence, coma, seizures, death
TX: replacement of glucose
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| Hyperglycemia with ketoacidosis | cause: insufficient insulin, infection or other disease. SX: BS>250; bloodpH<7.2; bicarbonate <15 mEq/L; glucosuria, elevated serum K+, decrease serum NA phosphate, calcium and mg; Kussmaul respirations; acetone breath dehydrations, wt loss, tachycardia
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| describe diabetic ketoacidosis | onset rapid, life threatening, hyperglycemia>300 mg/dl, breakdown of body fat-> ketones in blood and urine, more common in type 1 diabetes
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| hyperglycemic - hyperosmolar nonketonic syndrome (HHNS) | onset over several days, life threatening, hyperglycemia >600 mg/dl, no ketones in blood and urine, more common in older adults with untreated or undiagnosed type 2 diabetes mellitus
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| How are DKA and HHNS alike? | lack of sufficient insuline (new onset, noncompliance), an increased need for insulin (stress, illness, infection, surgery, trauma), serum NA up, Serum K decrease, creatinine and Bun increase, serum osmolarity high dka/very high HHNS
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| how are DKA and HHNS not alike? | DKA - more common in pts with type 1 diabetes, >300 mg/dl, ketones present, high serum osmolarity, metabolic acidosis with respiratory compensation kussmaul respirations.
HHNS: more common in older pts, ketones absent, very high serum osmolarity
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| what are the DI (diabetes insipidus) s/s? | excessive thirst (Polydipsia) 4-30 L/day, nocoturia, fatigue, dehyration, exessive urine output (polyuria) five to 20 L/day
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| what r are the causes of DI? | neurogenic: defect in hypothalamus or pituitray
Nephrogenic:inherited, renal tubules do not respond to ADH, Drug induces: Lithium and democlocycline, radiation induced damage to the pituitary, decreased ADH
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| what happens to the urine with DI? | decrease urine specific gravity (less than 1.005), decrease urine pH
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| what happens 2 the blood with DI? | increase serum sodium, increase serum potassium
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| symptoms DI and DB have in commons | polydipsia and polyuria
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| desmopressin acetate (DDAVP) | pituitary hormone, be alert for fluid overload as with weight gain and concentrated urine.
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