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Introduces the endocrine system and outlines the major disorders to be covered, then begins a broad overview of diabetes mellitus. The speaker explains the difference between type 1 and type 2 diabetes and why diabetes is a key NCLEX topic.
okay so we're going to focus on endocrine and we're just going to group all the endocrine um conditions that's like you know that is most important for you to focus on for the nclex exam so that would bediabetes that would be the thyroid disease that would be the in edison's cushing's disease that will be parathyroid disorder that would be um acid age diabetes insipidus so we're gonna start the first thing i'm gonna start with isdiabetes and then we're gonna roll right into the rest so i did send you the topical outline so i just want you to follow me on that so we're starting with endocrine this is where we're starting so let'stalk about let's do just a quick overall a quick just a quick refresher of uh the endocrine system so now remember the endocrine system has you know it's pretty much has to do with all the major hormones and
the major metabolic processes in the body now we have for the endocrine system we have the endocrine glands and we have the hormones and the hormones comes from the pituitary and it function works and it stimulate the glandsto perform example we have the the posterior pituitary and we have the anterior pituitary so the pituitary is that little p-shaped organ that is inside the hypothalamus remember that one yeah and you have a front and a backand that's why we say posterior and anterior the anterior which is the back that's where most of the hormones are being produced most of the hormones are in the anterior pituitary so to help you remember let's talk aboutthe posterior the posterior pituitary the posterior the back the two hormones from the posterior pituitary or the antidiuretic hormone adh and oxytocinand to remember it i always use this little phrase in my head posterior i say p o a you know like power of attorney yeah posterior and the o is oxytocin and the a is anti-diuretic hormone once you
know once you know that there uh we only have two hormones from the posterior everything else it will be the anterior pituitary okay so the you know it's a thyroid acth all the other growth hormones everything else willbe the anterior pituitary so there's no two hormones from the posterior and they're gonna be able like when we start to talk about them it's only two poa has two posterior pituitary oxytocin and adh so well everything elsewill come from the anterior pituitary so that's a little um just a little quick review also i want you to remember when it comes to the hormones and endocrine we there's something called negative feedback so things are inso it's it's it's we remember it and we try to explain it like the hormones are fluctuating in your system and the the glands will not tell the the pituitary to produce anything unless the numbers get to a
certain level so that's the reason why you only menstruated a certain time of the month because the levels dropping low enough so that's the reason why when your hormones are you know um or low you feel a certainway because it's like a negative feedback so we're gonna go back over that we're gonna come back to that but let's talk about the first endocrine problem the first endocrine disorder and is diabetes diabetes mellitus or sugar diabetesas they call it to remember it that's the one that we want to talk about first dm now diabetes kind of sort of belong to cardiac because although it's an endocrine disorder it causes so much cardiac problems butit belongs in the endocrine system so there is still a war going on between the endocrinologists and the cardiologists as to where diabetes really belongs but we still an endocrine disorder so let's talk about diabetes so we have
two types we have type 1 and type 2 and we're going to talk about them separately so you don't mix them up type 1 and type 2.
Compares type 1 and type 2 diabetes by age, risk factors, insulin dependence, and typical presentation. Emphasizes that type 1 requires lifelong insulin while type 2 is often modifiable.
diabetes type 1 let's talk about those people first so type one is the least common that's the one that's only about five percent of the populationtype one patients tend to be younger
about five percent of the population they tend to be younger they tend to be underweight normal to underweight and most of the time they're diagnosed with type 1 because they are recovering from maybe a viral illness illness somost people believe is autoimmune because with type 1 the pancreas is completely destroyed shot doesn't work anymore it doesn't produce insulin and if it produces insulin it won't be enough to do anything so type 1 is insulin dependentso we tend to so the other name for type 1 beside type 1 is insulin dependent diabetes or because i told you it happened in younger people we also call it juvenile diabetes those were the names before theykeep changing the names so if you know type 1 is insulin dependent or juvenile diabetes juvenile young
type two now it's the most this one is very common most common 95 of the population has type 2.type 2 and make sure you make a note of this is modifiable type one is not you have no control over type one type one it's gonna happen it's usually it could be autoimmune it could be some destructionof the pancreatic cell you have no control over this but type two you have some control because the fact that is is the most common risk factors are obesity sedentary lifestyle hyperlipidemia
and it happens as you get older more common in older adults as well so we call it modifiable because of especially the obesity the sedentary you can control that the high liquids you can control that the only oneyou can control is the age so that tends to be more modifiable
so type two um if they produce insulin but it's um you know it's not enough to control the blood sugar so they will need either insulin and or more see what i said and or so insulin and ororal agent so typically they use oral agent but the insulin will come in if the oral agent is not doing the job enough and you know they're like really brittle they are morally obese we having a hard timecontrolling this glucose so we may have to give them insulin in addition to the oral agent or if they have an infection or they sick and you know usually when you're ill and you're diabetic your body produces morecortisol so your sugar will go up even higher so they may need insulin at that time
so the type type 2 so we use we refer to them as non-insulin dependent that's the other name for them type 2 or non-insulin dependent
Covers the classic symptoms of hyperglycemia, including the three polys and weight loss, and explains how diabetes can damage multiple organ systems. Also highlights the major acute and long-term complications of diabetes.
so remember there are risk factors and know the difference between type one and type two so diabetes whether you type one or type two it's a disease of too much sugar in the blood so basically it's hyperglycemiaso presentation too much sugar in the blood in the blood cells glucose belong in the cells so with hyperglycemia the glucose is not in the cell it's floating around in the blood so with hyperglycemia the classic symptoms thatthey're going to present with what are their type 1 or type 2 are the three polys polyurea poly dyspnea and polyphasia
polydifnia they're drinking a lot they're like they're very thirsty and because of that they drink a lot of fluids they drink a lot of water drink a lot of fluids and they're gonna urinate a lot so the polyureaand usually we see in diabetic in early stage where they get hungry easily because of the increased metabolic demand like they're breaking down you know fats so they that's why they get a polyphasia feeling like they want toeat more and they do eat more their metabolics metabolism goes up and they eat more so type two a lot of times we'll you know early in the diagnosis um they they both type one and type two hasthe three polys and type one will lose weight early in the diagnosis remember they're skinny they'll lose weight so weight loss is common with them
another common symptoms that we see and this is for type one is that they have again the symptoms uh are usually sudden comes on sudden whereas type two is insidious slow most people with type 2 are walking aroundwith high sugar drinking a lot of water peeing a lot and saying i don't know why i'm paying so much these days and they won't seek medical attention um not only that they may be having um some fungalinfection because usually when the sugar is high bacteria love sugar so they you know guys may get valentine's which is the female version of yeast infection women may get yeast infection they may get like more you know feellike they have the flu get a little bit more um they've ingrown toenail and it's any sort of infection and they will blame this on a litany of stuff rather than seek medical attention and that's type two that's
usually you know a lot of time they present with some infection make them decide that they need to go to the doctor and when you do a good assessment it turns out they have diabetes so type 2 isinsidious type 1 comes on suddenly
type 1 going back to type 1 again type 1 they will need insulin for life they produce no insulin so insulin for lifethe only time we can fix that is if they get a transplant a trans um transplant which they're doing now of the inlet of laundry here you remember that cell in the pancreas yeah yes that's the only timethat you can you can treat type 2 without them needing insulin for life but they'll need insulin for life whereas type 2 if they lose weight if they you know let's say they're 180 pounds and they drop 25pounds they may need not need any medicationso that's why it's modifiableokay whereas no matter what you do with type 1 you will need medic you will need insulin for life and remember it's insulin insulin insulin because they don't produce it they need insulin
now i'm not gonna go do it go to this the nursing school style so we're not going to talk about like some emoji effect and all those other things dawn phenomena and all this we're just talking about thesymptoms um so the big problem with diabetes both type 1 and type 2 the complications are they ipo glycemia now remember i always tell you i pull is always worse than i purr okay so complications of diabetes type1 and type 2 is hypoglycemiaand then the other complications we can have is dka which is hyperglycemia which is too much blood sugar in a very bad way and dka usually goes with type 1 or the other complication is hhs which is thetype 2 version of dkaand those are both hyperglycemia hyper too much blood sugar too much sugar but the big the first one is hypoglycemia it goes that's a the biggest complication that we worry about with diabetes
then of course you have the long-term complications of diabetes diabetes mess up everything sugar is is you know sticky and cause constriction so diabetes can cause hypertension if you didn't have it yet it can cause coronary artery diseaseif you didn't get it yet it can cause nephropathy can cause the kidneys to fail it can cause neuropathy the numbness and the tingling it could cause peripheral vascular disease it cause it damages everything it's number one causeof blindness is retinopathy is diet from diabetes diabetes can also cause the um dementia diabetes can also can cause hearing loss sensory neural hearing loss
so with diabetes within the mix it messes up everything
so you really want to keep a tight control of the person who wants to diagnose with diabetes of their blood sugar because tight control will you know lessen all these complications that i just mentioned to you
Explains how diabetes is confirmed using fasting blood glucose, random blood glucose, and glucose tolerance testing. Clarifies the cutoff values that indicate diabetes.
so before we go into the complications let's talk about let's say how do we diagnose diabetes besides the symptoms that patients are going to come in with how do we make the official diagnosis that this is diabetes sowe use two things beside the symptoms beside the patient's subjective data we do what's called a fasted blood glucose we can do a random blood glucose and we can do the glucose tolerance test
now what do you remember the blood sugars to be what did you learn in nursing school for blood sugar so 77 70 to 110 very good so for fasting they should not be more than 110.
if they if you do a fasting blood glucose and they're more than 110 they fail the tests
a random blood sugar is you know any time of day you check someone's sugar if they finish eating uh let's say they finish eating an hour ago their blood sugar should be under 200 so that's a random soif you randomly check me and i'm over and i just finished eating an hour ago and i'm i'm one my blood sugar is 200 210 i gotta work that up a little further that's not good then the nextone is the glucose tolerance test the glucose tolerance test is the one where you give them um a lot of sugar to drink 75 grams of sugar it's like the dng like you know soda mixed with extra sugaris 75 grams of glucose so we can do a one hour glucose tolerance test or three hour glucose tolerance that now please make a note of this for the one hour glucose tolerance that the patient will does not
have to be fasting one hour glucose dollar they don't have to be fasting so you give them some 75 grams of glucose to drink and you wait one hour and then you check a blood sugar if they're over200 they fail to test
if you do the three hour and in this case they probably would follow it up with three hours and that's why most of the endocrinologists or even the primary care will go for the three hour glucose tolerance becausethat gives you more information so again you get is for glucose for the three hour though they need to be fasted three hours needs to be fasted
at the end of the three hours your blood sugar should be back to normal as it should be under what we call the 110.so what i want you to remember what the most important thing is to diagnose diabetes we do the fasting blood glucose and it should be under 100 110 should be under anything over 110 you failed or one hourglucose tolerance test and this should be left after what drinking that's that sweet stuff after one hour your glucose should be less than 200 that's the only two things i really want you to remember and that's how wediagnose it that's that confirmed the diagnosis of diabetes beside all the subjective data and objective they said you need these labs you need to say this is it this is diabetes so we are going to treat them now
Reviews insulin therapy for diabetes, including rapid, regular, intermediate, and long-acting insulin. Covers onset, peak, duration, mixing rules, and safe subcutaneous administration.
so we're going to treat them this type one is insulin
and so an insulin we have three different types we have the rapid actin we have regular we have intermediate and we have long acting
rapid and regular are used as sliding scale it's when the sugar is high we want to lower it they use a sliding scale they intermediate under long acting we call those basal those are used to keep the bloodsugar within them so we use those like to mimic the pancreasokay so they'll they'll be on that so they should only be on in an intermediate like nph no more than twice a day every 12 hours and the long acting which is glargine or lantus however you remember itonce a day because they were using those to mimic the pancreas
and then like so they could be on nph or the basil and the lung actin in addition to the regular or the rapid because these are given you know as sliding scale if the sugar is still high andwe need to cover them
now i sent you um a little sheet with the peak now the onset peak duration of the the rapid regular intermediate and long acting must know for nclex
so let's talk a little bit about um the rapid and those are what do you remember what what are
am i sharing my screen
am i sure in my screen oh no oh that's like okay sorry sorry about that um
okaythis is the these are the rapid this pro the most common one aspart onset peak duration must know onset peak duration so the rapid and onset it starts acting right away so extend to 10 to 15 minutes aroundthere usually how you remember to remember the peak you double the longest time of the onset so let's say it's i start out in um 10 to 15 minutes so the peak would be 30 minutes to an hour30 speak it peaks around 30 minutes we say um so it peaks around yes 30 minutes to an hour and the duration is two usually about two to four hours now what is the most important thing to knowfor nclex the peak because peak is when they're the sugar the insulin is gonna be at the highest level and that's when they're most likely to become hypoglycemic
the peak also remember for rapid acting you don't have a lot of time before this start working so with rapid acting their food should be in front of them before you give this so don't give the rapid don'tgive the aspart don't give the list bro if the tray is on the way give the list bro if the food is in front of the patient
start working right away regular insulin a couple of things about regular insulin we also use that as sliding scale and that start working 30 minutes its onset is 30 minutes to an hour and it again double the lengththe longest part of the onset so you can get your peak so this peak around two to four hours and this can last up to six hours the duration is important but for not not so much for nclexfor nclex is when does it start working when does it peak peak is the biggest issue because this is when they're most likely to drop their blood sugar why am i stressing this so you have someone who's umgetting a ct scan and they're getting a ct scan at 10 a.m and they had breakfast at seven and they had their insulin their regular insulin around seven when do you expect them to become hypoglycemic
at the peak they become hypo rising peak is when they can become hypoglycemic that's when they're more likely to be to drop their sugar really drop their sugar
so you gave it at seven so do three two four five hours later so around you would say around 11 o'clock right that's when they're going to be hypoglycemic and if they have a ct scan and they're goingto be off the floor at that time you may want to give them a snack before they leave or i notified the the radiology nurse that you know they did get insulin and they're like you know at sucha such a time so maybe you want to give them a snack while they're down there
now the other thing about regular insulin and please make a note about this it is the only insulin that we give iv in an emergency we give it some q also all insulin the given sub-q but regular insulinis the only one to this date as you and i have in this conversation that we can give iv so when we talk about when we talk about dka and hyperglycemic episodes regular insulin is going to be theone we give
nph this is basil and i said again this one should only be given twice a day you don't want to give this more often because it's long acting it's intermediate so it's longer acting it's gonna you know soit's not gonna work fast you could see it start working like two to four hours it peaks two to ten hours and then it's on this it's on board for up to 18 hours so this is like basilthey we give this to mimic the pancreas and then we're not going to do no mixing because i'm in an ncx we don't they don't ask about mixed insulin so let's go to the long act the the long-actingone like lanterns glargine or digimere these are the long-acting so these will start working like one to four hours and take a look they have no peak that's enough that's a must know they do not peak because they
mimic the pancreas and they can last up to 24 anywhere from 24 to 36 hours actually only given once a day
another thing about the long acting the atlantis or glargine they're going to ask they're going to say glare gene because guardian is the generic name or a detromare in that you never mix them with any other insulin they'rein their own syringe you don't mix the long acting they're in their own syringe you can give it in the morning you can give it a pm uh maybe five years ago when we were only we were onlygiving it at night but now it's okay because as long as once a day drunk you can give it any time you give it morning or you can give it and in the evening but but you don't mixit with any other insulin
now nph is cloudy and regular is clear rapid is also clear so if you're given if they want you to give you know like there was a question on that test and you're good the patient needs to getnph and they also need to get some coverage of regular insulin you can mix both in one syringe usually you mix we use it the little um mnemonic to remember rn registered nurse regular to nph or clear tocloudy
so in that case where let's say the patient blood sugar is 250 and it's in the morning and they're supposed to get 30 units of nph and 15 units of regular insulin we're gonna give them one shot becausewe can mix it those two insulin can mix clear to cloudy we can mix it so how do we mix it this is an ncx moment here we go first you're going to pull up and i did say30 units of nph let me remind myself and 15 units of regular so first you're gonna you're gonna pull back on your insulin syringe and you're going to pull back the 30 units of nph and you're going toinject the air in the nph vial 30 units of nph air in the nph file and then you're going to pull back on the regular insulin i had said 15 units can inject 15 units of air into the
regular now because we're doing rn regular to nph or clear to cloudy after you inject the air inside the regular you turn this vial around and pull up the regular first and then you go back to the nphput your syringe in there and draw out an nph and so from my exam my example now you should have a total of 45 units of insulin ready to go take a look at this and tell me ifyou have any question
no i think the picture is self text violence right yeah so remember clear to cloudy pool but you but i get asked this question do i need to put air in both yes you do that's in what youdo in reality and what you're with nclex is two different things you need to put air in both so that's your that's your insulin and remember iv is only the regular insulin is given subcutaneously so you can giveit anywhere that there is fat anywhere unlike heparin where you only give it in the abdomen insulin could be given anywhere all you need to do for some cue you need to pinch the skin need to pinch ityou need to go in depending on the size of the patient you can go in 90 if it's a really skinny one it may have to go in 45 but you clean pinch inject your insulin
Describes diabetic ketoacidosis and hyperosmolar hyperglycemic state, including their symptoms, lab patterns, and dehydration risks. Explains treatment priorities such as fluids, regular insulin, potassium monitoring, and ICU-level care.
the oral agent we're going to go over when i talk about the medication part um we're going to talk about metformin and the other oral agent so we'll get back to the oral agent to treat diabetes now let'stalk about dka and hhs these twoand i need to go back um so you can get a better picture of dka and hhs so dka typically a dka is usually type it's called diabetes ketoacidosis
so dka type 1 hhs is type 2
dka is going to be sudden everything for type 1 is sudden
so let's go over the symptoms of dka so dka of course is hyperglycemiaso it's the patient will have high blood sugar normally with dka the blood sugar can go as high as 600 they're not they're not in the thousands like the hhs they you know dka they are anywhere from 250to about 600 dka just like this little chart
they may be they you know normally with dka and hhs in both of these situation the patients are dehydrated they're both dehydrated
potassium is potassium can be affected with diabetes with decay with hyperglycemia let me explain the physiology behind that so remember earlier i said to you glucose belongs in the cell yeah you have hyperglycemia because glucose is floating aroundin in the in the syrup that's the blood okay potassium also belong in the cell right so glucose and potassium are cousin they roll together yeah so whenever one is in there wherever one is you know they ridein the same car one drive and one is a passenger so whenever your patient has high glucose look out they may have high potassium too you drop the glucose look out you may be dropping the potassium too soremember their cousin they ride togetherwith dka uh the symptoms they're going to have common symptoms they go dig of course the sugar is going to be elevated up to about 600.
they usually have acetone or ketones in their urinethat make a note of that they have fruity breath because of the acetone or the ketones
they also have what's called the cosmol respiration they're the one that's breeding very fast because they're in metabolic acidosis they dry the dehydrated so to compensate for that metabolic acidosis they start breathing fast because their ph usually isgoing to be low the ph as you can see here is low so they're in acidosis
and to compensate and it's usually metabolic acidosis to compensate for that they increase their respiration so they have the cosmo the fast breathing and this fast breathing you smell like it's like sugar we call it acetone on theirbreath they have ketones in their urine don't worry about the anion gapand the pco2 remember i told you they're breathing fast so if they're breeding fast they're going to blow off their their co2
don't worry about the other malaria of either because they you know they dehydrated so the urine could be concentrated so don't worry about this part what i want you to classic for dka is one the sugar is offto is over 250 or between 250 and 600.that's enough that's the classic that i want you to know another thing i want you to know is that they have the fast rapid breathinganother thing i want you to know is that they have the low ph
and that they have ketones in their urine
ketosis that's why we call it diabetic ketoacidosis keto acidosis ketone in the urine and the acidotic and another thing that's very common with dka and write this down like three times and circle it they tend to have aright upper quadrant abdominal pain when they're in dka
over the liver now if you don't remember and i'm going to take you back because that's what i'm here for that the that insulin is produced by the pancreas and stored in the liver although they don't they don'tmake insulin they don't have enough insulin you know there's a connection with the liver so that's why they have right upper quadrant pain when they're in dkaso dka gets the right upper quadrant pain their blood sugar is between 250 and 600 they have ketones in their urine they have the fat breathing because more respiration and that's typically them
now hhs usually their blood sugar is over 600 their blood sugar could be as high as some patients could be even 14 1500 i have seen it with my own two eyes so their blood sugar is over 600they are also dehydrated because they both you know hyperglycemia it's like eating a cake you're dehydrated their ph is normal because they're not in acid they're not in um diabetic keto they're not in acidosis so the ph isgoing to be normal the breeding is going to be normal
so the big thing with hhs is that they have that very high blood sugar and then remember also the potassium could be normal or abnormal because potassium again and glucose are in you know cahoots
so they both share this what they both share is that they both severely dehydrated both dka and hhs are dehydratedokaynow and also with with hyperglycemia they can also have some central nervous system symptoms sugar is high they can have headachesyou can even get confused it's not unusual both hypoglycemia and hyperglycemia get central nervous system symptoms and it's the same for dka and hhs those central nervous system symptoms so if you see that on the sadder the centralnervous system symptoms they get it too okay now how do we treat dka
first thing you want to states remember i told you they're severely dehydrated the first thing you want to do is hydrate them
fluids fluids fluids and in this case isotonic so you want to give some normal saline preferably
you would never give them anything with dextrose they already have too much sugar
so hydrate them first and then once after you hydrate them we can start and you can start them on iv insulin drip and what did i say which insulin are we going to give herewhen you put them on um iv it's uh the long acting no no
regular only regular can be given iv only regular so we're giving them so we hydrate them first and then you get then you start them on regular insulin drip insulin drip regular insulin only regular could be given iv
and your monitor and their blood sugar freak very frequently like frequently like 30 to 30 minutes that's why they will be in icu setting because you need to monitor your blood sugar frequently now we're giving them insulin wewhat you're worried about their potassium so you may want to put them on a cardiac monitor because if potassium drops you're going to have some you know irregular rhythm on that cardiac monitor so you want to monitor yourpotassium because you may have to supplement their potassium once you're giving them insulin drip okay so you're keeping them on this insulin drip and they stay on the insulin drip until the blood glucose get to less than 200that's when you can stop the insulin drip
now if you ever have to replete the potassium because the insulin dropped it so much make sure your patient is urinated before you give potassium make sure your patient is urinated
now hhs the treatment for hhs is exactly the same as dka hydrate first with isotonic solution and then start insulin drip regular insulin keep the blood sugar above um you know we don't want to drop the sugar toofast by the way and then once the blood sugar gets below 200 then you can stop the insulin drip and go back to sub-q insulin so hhs and dka gets the same treatment
Explains how to assess diabetes control with A1C and how exercise helps lower glucose. Then reviews hypoglycemia treatment, including oral sugar for alert patients and glucagon or IV dextrose for patients who cannot safely swallow.
now how do we know the patient who's a diabetic and you have them on medication be it type one type two how do we know that they're controlled what blood tests do we do do we use to checkthere to keep that their blood sugar is under control
i would go with the glucose science you remember the immigrant a1c okay yeah exactly yeah yeah exactly and what do you want it to be to say that they control it needs to be less than seven less thanseven very good i have a question so yes the tests that um we do to check the blood glucose um the three main ones you gave right is hbn when c added to it no hb h that futurethat's you know um off the record sometimes they use that but that's not used to diagnose that's used to see how to see how they control okay yeah because yeah you know that's not a test to diagnose torelease diagnose um diabetes uh it's used to see the diabetic if they control or or we can use it to see if they're at risk for diabetes but it's not to diagnose it say okay this is it this
is diabetes because when we do health promotion um part of you know the annual physical we do throw a1c in there just to make sure the person is not pre-diabetic um but you know but that's not what weuse to like you know confirm the diagnosis because if that's the case if they show up that they pre-diabetic they would still do the glucose and blood glucose and they would still do the random or the glucose tolerancetest to confirm okay so we want to keep them like you said you want to keep them under seven and i oh and nowadays i laugh because i said thus people worry about internal chip we all have internalchips that's an internal chip you can't lie you could go to the doctor and say and you're diabetic and the doctors say so what have you built blood sugar been you know running and they give you some really
sweet numbers right and you get an a1c and you can an a1c could be done in the doctor's office randomly you don't need to be fast in nothing they do it by finger stick you get an a1c anda1c said you're 10.is your blood sugar really 120 every morning um no it actually the numbers matches there is a you know you don't need that for nclex but there's a chart that we use to look and we look at thechart and we go if your blood sugar is 150 uh if it means your a1c is probably going to be nine if you're averaging 150.so it's you know it's so they can't lie so that's that's like the chip that they say so might as well you just come clean and say in the morning i'm this and this man and you know when
i take when i eat a drink um a glass of wine you tend to go out whatever it is just you know just be truthful about it because the a1c is going to give you away so that's whatwe use to you know check to see um and you want to and you know that therapy is effective if they're under seven if they're not under seven the therapy is not effective remember also diabetic should exercise becauseexercise moves glucose into the cell exercise open the cell and let insulin goes in there and glucose go in there so especially you type two you know or sedentary more the more you exercise the more likely you'll keepyour sugar under control okay
for hypoglycemia if the hypoglycemic um how do we treat hypoglycemia let's say it's a hypoglycemic person who is awake and alert what's your treatment
um i i honestly don't know which one because i heard some people that work in the hospital say oh give her orange shoes um some people saying uh what you call it iv dextrose okay so let me clarifythat myth if they are awake and alert give them sugar which is orange juice which is soda which is milk anything with sugar in it if they awaken alert if they're not because you can't choke them then yougive the dextrose
how you can give glucagon you've heard of glucagon right yes yes glucagon is the one that all diabetics should carry diabetic should have what i call a little fanny pack with everything in there that means they should havethat institution of glucose tablets they should have the glucagon so if they are not alert they're lethargic they're not even responding properly to you you give them the shot this is when you give the the dextrose or yougive the glucagon but if they alert and they can follow command you give the orange juice you give the soda you give the milk give sugar by mouth
so that's the difference
and always always always for priority remember if you suspect that the patient sugar is low check it what do you do first assess it test their blood glucose if you know someone is a diabetic if you live witha diabetic if you're working with diabetics and you suspect that sugar is they acting strange remember i told you low blood sugar can make you act strange high blood sugar can make you act strange and you're not surewhether they high or they're low and you can't find the glucometer to check treat them like they're low it's better it's better to give them sugar than to give them insulin because if you give them insulin that's gonnabe harder to reverse
any question in diabeteshypoglycemia okay symptoms of hypoglycemia again let's go over that um it's if we call it cold and clammy
cola and clammy needs need a candy coal and clammy need a candy so cool clammy skin cool clammy diaphoretic we call it diaphoresis in your skin cold and clammy boy in reality it's exactly like that diabetes walk likethe textbook they confused they don't know where they are they cold they clammy they're you know all of that that's your diet that's your and and you know as long as they they can follow command you're gonna givethem sugar give them sugar fast we have this 15 for 15 times three rules so you give them 15 grams of carbohydrate um and and you have to recheck them again in 15 minutes if they're still a littlelow you can give another 15 grams and check them again the death nursing school just know that you need if they call and clammy and they awake they can follow command give sugar i'm out if they call and
clammy and they're not following command give the ex give the d50 or glucagon
hyperglycemia now they're gonna be they hot and dry so their skin is going to be hot so they don't want us there's a difference between flush and diaphoretic flush is when you're you know you're you're hot your heartbut you flush and your skin is hot and dry where the the ipo is cold and clammy and the skin is wet
diabetes is a big one now one other thing about diabetes before we move on any further um there's something called sick days now when they are sick when they have diabetics um let's say they they tell you they'revomiting they stick to their stomach all day they just feel they don't feel good they're coming down with a bug they should still take their insulin because whenever they're sick their blood sugar will is likely to shoot upeven higher so seek their rule still take your insulin
Introduces thyroid disease as the body's metabolic thermostat and compares hypothyroidism with hyperthyroidism. Reviews hallmark symptoms, lab patterns, Graves disease, and treatment options including medication, radioactive iodine, and thyroidectomy.
now look at look at diabetes and tell me if you're ready to move on to thyroid
yeah i'm ready okay so let's go to the thyroid so the thyroid gland is what we call the thermostat of the body it regulates everything so you can basically you can best believe if your thyroid is if thethyroid is off one way or the other you're gonna have symptoms all over the place so less juxtapose ipo and hyper thyroidism and i should see if i have yes here we go
so patient comes in with um learn one um kashmir is very easy to learn one and flip than to learn both it's hard to learn both if you were doing that in nursing school i think that was atime to stop if you like so if you feel like i can get all the lows then learn all the lows and then you flip things so with hypo thyroidism so with the thyroid um we need to lookat the labs so of course the patients are going to come in with hypothyroidism these are going to be their symptoms hair loss they're going to be tired with ipo everything is down down down everything down so theytired they cold they constipated they have um the weight gain because everything is down so they're lazy they fat they just lay down and they want to exercise because they don't have the energy they have dry skin um
they have bradycardia they could have hypotension that's the hard part so everything down down down when i pull
everything down they depress so because everything is down in hyper everything is up fast and speedy fine brittle hair they can't sleep this one this this this one as i pre they um hypersonia they always sleeping it's anipo and this one is insomnia they can't sleep because they're in speedy mode to remember it hyper they like manic phase that's the one who goes for a run at 4 a.m in the morning because they're just speedythey have excessive sweating where the other one is cold they have weight loss because they're speedy then hyper hyper mode so they have weight loss they have high blood pressure they have tachycardia they have anxiety because they're inhyper mode moist skin
so they there's their weight loss and they have diarrhea let's get this straight diarrhea where the other one is conservation because everything slows down here everything speeds up over here
by the way i per thyroidism is more common than i pull primary hyperthyroidism it's more common but because they're so speedy and i told you they um they have hyper they have high blood pressure they have um tachycardiaand they're so speedy we can't leave them like that so that's why we knock out the thyroid and make them ipo and give them the levothyroxine for life because it's easier to manage that in that case this isyou know we cannot have someone um can't sleep someone's sleeping one hour one hour for a day someone who's excessively sweating someone whose blood pressure is sky high someone with and with um and not anxiety with tachycardia andi'm talking about the heart rate is like over 150 that someone who's having diarrhea you see all the problem that comes with hyper so this is an and this is more common as a matter of fact hyperthyroidism is
more common in women higher disease coming in women younger woman and uh african american
so we're saying like 30 like you know it's usually like 25 to like 35 years old female african-american most common
excessive version of that you can get graves disease and graves disease is hyperthyroidism with the exothalamus the bulging eyes
so they come in and they have all those symptoms and you suspect that this may be this is this looks like hyperthyroidism it looks like hypothyroidism we're going to get some labs so let's talk about what the labsare going to look like with um so for hyperthyroidism this is where i stress the negative feedback so that tsh thyroid stimulating hormone in hyperthyroidism is going to be low tsh low t3 and t4 go to be high
remember hyperthyroidism tsh lownegative feedback t3 and t4 high and so the opposite would be the same here they would be elevated tsh and low t3 t4 learn one flip it okay so we over here with hyperthyroid now uh the one thingthey both share is um they both have menstrual irregularity so if you were going to do a pie chart what's going to be in the middle of a boat menstrual irregularity all right yeah this one has decreased libidobecause they don't want to do anything and this one has heightened sex um sexual you know orientation but they both have they both have menstrual irregularity
so with hyperthyroidism because um we can't keep them like that with the heart rate and everything else we need to knock out the thyroid so we're gonna do it's depends on the the labs and the symptoms we maydo medications and i'm gonna go over those before we close today the medications for hyperthyroidism and then if the medications because medications take a long time to work it can take like three months to work so if themedications are not going to do the trick fast enough we may do we may give them iodine 131 that's the radioactive iodineand that's gonna work faster
and then we're gonna go over that when i talk about the medication but the next thing we can do if they're you know having like severe grave disease or they're going into a condition called thyroid storm or thyroidtoxicosis we may need to do a thyroidectomy
okay because it's more dangerous so you want it to go to a hypo exactly exactly and then also remember the thyroid gland is very vascular so if you were assessing it and you placed your stethoscope around over ityou would hear like a brewery you know like that murmur is outside of the heart a brewery over it because it's very vascularanother thing about assessing the thyroid gland um remember you you want to go like behind the patient and have them swallow a thyroid gland should just like move up and down with you know bump up against your fingeryou know and it should feel normal it shouldn't be glandular it shouldn't be large it shouldn't be too soft and buggy it should just be like a normal size if you were to get every good question about assessingthe thyroid gland okay now if we do a thyroidectomy let's talk about post-styrotectomy now they're coming back because the thyroid gland is vascular and we are doing it because they were hyper and we try before we take them
to the or to do a thyroidectomy we really want to make their thyroid close to normal because if you take them in a in a hyper hyper state it could be very dangerous so we want to make themclose to normal as normal can get in this case and if you ever see the word eu the the suffix sorry the prefix eu just means normal so we try to get them to you thyroid eu thyroid beforewe go to the or but sometimes you can't get them that close but so post diuretic to me worry about thyroid storm or thyroid toxicosis
Focuses on thyroid storm as an emergency and the immediate interventions used to stabilize the patient. Also covers post-thyroidectomy monitoring, including bleeding, hoarseness, laryngeal stridor, and airway preparedness.
what are the symptoms of thyroid storm that you can remember anything you remember throw it at me i'll fill in the gap
i have attention
i can't remember seizures they get hot temperature should go up really high
oh they couldn't again fever like yeah they get fever yeah elevated temperatureand how do we treat it the fever the the whole um everything you just do at me the tachycardia the hypertension the temperature yeah how do we treat this check the potassium it's like the like cardiac i woulddo like an ecg yes but you have all you you have let's say they didn't stay in svt already and their blood pressure is like 180 over 90.that's your symptom and the temperature is 103.so how do you how are we going to treat that heart rate is 150 temperature is 180 blood pressure is 180 over 90 temperatures 103.what do you expect the provider to order
you cut the hypertension medication okay so we would give them like a beta blocker yeah beta blocker yeah because the beta blocker is going to do two things actually lower the go ahead lower the blood pressure and theheart rate and it also um three things you're also going to get an added benefit it's going to help with the anxiety it does okay especially in this case so it's low in the blood pressure lowering the heartrate and helps with the anxiety do you ever see that on nclex so like that okay and then um you may need to give a lower temperature we can give acetaminophen tylenol is always a safe one for forblowing blood pressure below in temperature in an nclex avoid aspirin avoid silicic acid avoid it aspirin of too many interactions or too many drugs and cause 20 problems so you can give acetaminophen uh you could also do basic
nursing interventions to lower that temperature you can also get like some high specs underneath their armpit the groin you can get a cooling blankets those other things you can always always do your nursing intervention your little nursing interventionthey help if they sound like you're little there's an intervention but they go a long way okay so throw those in there um because we want to get these want to get this temperature down because they can seizelike you said the temperature stays up there like that if you don't have a cooling blanket you can get one um from your manager um we can also give the iv fluids because they're gonna need some fluids tooand you can give the iv fluids like cool that can help cool them down too not cold but coolso cool ivy packs and the growing and of the area and cool oh i've already said cool iv and blanket tylenol and cooling blanking
so this is an emergency so we need to you know work fast so remember graves disease is hyperthyroidism and you've heard of this condition called ashimoto thyroiditisashimoto thyroiditis is a poor thyroidism as she models its name after someone and it means it's a bacteria it's a it's an infection something that you know damage is called damage to the thyroid gland so now they're beingipo so ashimoto thyroiditis your symptoms are going to be symptoms of hypothyroidism
now they come back from the or we took them to the or for thyroidectomy um we're always just think paradic to me i don't want to hear subtotal total this just is total it's a total diuretic to meremember they know they understand because they will be on levothyroxine for the rest of their life they should know that post-op immediately post-op direct to me remember i told you the thyroid is very vascular so you worry aboutbleedingso make sure their neck is in midline you're not moving the head suddenly too fast too jerky um you have the pillow behind them you know and are you you're checking occasionally to see if they're having any bleedingany blood pulling behind their neck um you of course um also remember right inside the thyroid gland if you were to remember so with the thyroid hormone we have the parathyroid parathyroid is those four little buttons right inside
the thyroid gland is sitting right there so post thyroidectomy we can actually you can actually accidentally removed the parathyroid so you should be assessing them for symptoms of hypo that i pull parathyroid that to me and that's symptomsof ipoh that would be symptoms of hypocalcemia i'll go into that a little further later when we do the parathyroid so the thyroid at the parathyroid it's one on the left two on the left on the right twolittle four little buttons smack right in there let me let me let me show you the picture the picture says a thousand words so let's let me show you the picture of that so you can see it
you
okay so you see this is the thyroid gland and you see these right here yes that's the parathyroid okay so you figure if you're going to take this off right this is going to come off too yeah isaid you know we try to save them by going around it as much as possible but possibility it's very high to have the parathyroid removed and so while i'm here let me just say this the parathyroid is incohorts with calcium so wherever the parathyroid is whatever direction the parathyroid is that's where calcium will be so if the parathyroid is if we're in hyper parathyroidism then we have calcium f if we have ipo parathyroidism then ipour calcium here's my thing in cahoots they go together so if we take the thought so once they post your patient is post para thyroidectomy you worry about hypocalthemia and the symptoms of hypoglycemia again are um hypo yeah
hypo calcium
how do you check chuso again i remember what my professor was saying when you put on the blood pressure cuff blood pressure cup exactly yeah and you inflate the arm go up and forms that in the thing withthe hand yeah it kind of curls up like you know like if they get inside them and the chivastic when you touch a part of the person's face and they it's like the face contracts yeah they spat themout yes yeah so those are things you would see um another common thing common thing that you would see pose thyroid diuretic to me is that you you operated on their neck so you could have some laryngeal nervedamage so coarseness is common and expected but severe or worsening well watch those words hoarseness need to be reported also something called laryngeal strider strider you know it's the worst birth sound strider is bad if you ever get
laryngeal strider call the doctor that's a medical emergency you need to for this one you need to notify the provider okay now post direct to me because of all these complications that are possible and you operate on theperson throughout you operate on the airway pretty much what should be at the bedside
suction yes that too something else i want
you're really oxygen yes but something else i want
just in case the airway should cut off completely because it can swell and that's why you get in the worst the worst in hoarseness edema can get too much so you need to have any a tray kit atthe bedside make sure you circle that at the nclex moment
so trick it must be readily be available at the bedside
Explains the relationship between the parathyroid glands and calcium balance. Reviews hypercalcemia and hypocalcemia management, including hydration, diuretics, calcitonin, and calcium replacement.
okay so any other question on thyroid except i'm going to go over the medication so you can you know i can't leave okay wrong question so the thyroid and the parathyroid um you said well for the thyroid youtold me i can remember one and just flip the other it does that go for the parathyroid too absolutely okay absolutely just remember um for you know when calcium is do it with too much with is as inhyperparathyroidism they're gonna have hypercalcemia so too much calcium you're going to have conservation of course it's going to affect the heart as well it could slow down the heart um also with you can have stones right kidney stonesbecause you know so those are the things you remember and with too much calcium we the first thing you want to do is flush flush iv hydrate hydrate hydrate fresh it out see if we can get it out
by them just urinating and then if the that doesn't work by giving them four or five liters of fluid to flush it out then we may give we may have to give a diuretic to help get it outand and the diuretic that we use i'm taping this so i can send this to you after we're done so you can listen to it again if you want the diuretic that we use in this case is usuallythe loop the furathymite some diuretics can cause calcium to go up like the thiazide diuretic so in this in this case we would give a loop diuretics and worst case scenario the loop diuretic doesn't work we may needto do emergency dialysis okay also staying on on the thyroid for again besides the thyroid gland produces the ts the t3 t4 it also produces a um a hormone called calcitonin you remember that one and calcitonin helps regulate
calcium level makes calcium stay down so the patient with the hypercalcemia that i just told you about yeah we could give them calcitonin also calcitonin salmon is the you know and it's usually done by inhalation like they igive it to them as a nasal spray
and then of course if they i pull calcium we give calcium gluconate give iv calcium
okay
got it okay all right so now we're moving on we're going to go to um i want to go to either diabetes insipidus and sadh or questions and addison's where do you want to go
Compares diabetes insipidus and SIADH as disorders of antidiuretic hormone. Covers fluid balance changes, sodium abnormalities, seizure risk, and diagnostic testing such as water deprivation testing.
c-i-n-s-i-a-h okay let's go to d-i-n-f-i-d-hokay so remember uh diabetes antidiuretic hormone where does that come from again with parts of the pituitary the adhis not from the reno no we know this aldosterone remember remember adh comes from the remember i told you p o a posterior pituitary so it's antidiuretic hormone don't confuse it without with aldosterone because antidiuretic hormone the wordsaid that it only makes you retain water it holds nothing to do with no electrolyte just water anti-diuretic hormone retention of w the retention of h2o water water water and that's how you maintain the blood pressure so nowwith and now the reason why i stressed the pituitary is because normally we see problem with siadh and di when patients have like head trauma or neurological issues so let's talk about di first diabetes insipidus and where youknow diabetes insipidus is a condition where they are not they don't have enough antidiuretic hormone so not enough adh so in this case the patient is going to have two poly so they don't have enough adhd so they
are thirsty so they drinking a lot and they peeing a lot so they have polyester polyurea large amount to the water their water look they they pee look like the water they just finish drinking drink it they peethey drink it they pee they drink the pee they drink they pee it large amount of diluted
with diabetes the di diabetes insipidus no adh tpp drink p drink p drink pso of course they're gonna be in food volume deficit they're gonna be dehydratedso they have symptoms of dehydration
low blood pressuretachycardia now let me clear this up with you whenever you have fluid volume deficit you will be tachycardic and hypotensive whenever you have fluid volume excess you'll be tachycardic and i per-tensive so either way your heart is goingto beat fast okay the only the classic difference is when you're dry and dehydrated and hemorrhaging and in fluid volume deficit your heart is beating fast and the pulse is weak and thready so if i'm trying to checkyour pulse you know remember when you were in lab in fundamentals or health assessment and you're doing your classmate um pulse and you couldn't find it and this was probably a girl and she was probably menstruated it's weakand three so it's a it's like a plus onebecause they're dehydrated they dry they you know anemic and when they have too much fluid now the pulse is fast and bounding so you could almost see the pop pop pop pop pop because they have too much on
board where the other one you the pulse is running away from you in dehydration the pulse is sliding away in in overload the pulse is like a plus four so both cases you have tachycardia so di will betachycardic and hypovolemic
and hypotensive
okay and there's sodium because they dehydrated the sodium is gonna be high
but they dry the sodium is high so with di they're um you want to what you know with all these symptoms what do you want how do you treat die
yesyou give them all the fluid in the world they just compete back out so what are they missing
the adh so we got to give them adh and we give this the other name for adh is basopressin that's the synthetic version vasopressin sure you've seen it and they also have another synthetic version called desmopressin
so give them what they're missing because you can give all the fluids they're gonna peed back out so you give them that and then you give them fluids because they need it now one other thing of note thati must mention because the sodium is off whenever sodium is low or sodium is high you worry about the central nervous system so they had increased risk for seizures
sodium high sodium load affects the central nervous system so you can have a converselessness irritability confusion that's the patient you want to have close to the nurse's station and you want to place them on seizure precaution
okay so we say we're going to give them their their dismal person and we're going to you know and and if if this is primary di which which you know that's the case remember they'll be on this medicationfor life as well it's a hormone so they can't just stop it
if you have a patient that uh has head injury like a tbi patient um you know you should also be on the lookout for symptoms of diabetes insipidus because remember smack there pituitary yeah so let's go to fiadh so everything i said here flip it over here
sodium is low where their sodium is high too much fluid they're not urinating they look like someone who's in glomerulonephritis or something they they puffy fluid overload food volume excess edema so they're gonna have hypertension bound in tachycardia
okay now for them um sadh is going to come up again and again for a couple of things most of the time siadh is actually a sigh it's a symptom of some medication some medication can cause it andanti-adh it also um we can we see that in lung cancer some lung cancer can produce too much adh
so for si8h their treatment is a little different now so primary treatment because they have too much fluid the first thing you want to do is fluid restriction cut stop drinking don't give them nofluids do you give them diuretic we yes let's come into that next absolutely now if that doesn't help then we may get need to get some of that fluid off so we can give them diureticswe also if we need to give them fluids we would give them hypertonic solution because they have all the fluid on board but it's in the wrong compartment so we would give them and make a note of thisuh hypertonic saline like salty stuff because one of the hallmark sign or the big problem with siadh is because they have so much water on board they dilute out their sodium so the big problem with them is dilutional
hyponatremia
does that sound familiar yes dilutional hyponatremia
so we can give them salt tablets too to help get that sodium back up and get this the water back where it belongs so if we're going to give them fluid so fluid restriction first and then if thatdoesn't work the second then you would do the diuretics and then we can do um hydration with hypertonic um saline so three percent saline or five percent saline there is such a thing they don't have it in allthe units you may have to get it from central supply
okay and if i adh is common because it's also one of the complications when we do oncology oncological emergency
so remember as adh is just waterso this is this is more of a syndrome this could be a disease
i'll look at sadh and see if you have any questions another question so how how does how do you rule out because a lot of sickness could cause the same fluid um decrease or increase same dehydration like howdo they rule out this part if um if it's the pituitary problem how do we oh good very good questions how do we know it's di um we do a test we do with uh fluid challenge we wegive days a person there is a so to to make the diagnosis very very good question um we actually do we give them a fluid challenge um so we give them the di we give them the hormone andwe assess it so usually this this um water challenge test we call a fluid challenge test we it's a test it's supposed to last no more than six hours so we give them adh and when it started next
like 6 a.m in the morning and we watch to see how they respond now if the patient is like peeing too much and they're dropping the fluids too much we may and you know we we may have tostop the test so that's how we diagnose it we diagnose it with of course they're going to get a ct scan because i told you a lot of time it's a brain issue so we're going to get act scan or we can do the fluid um fluid challenge tests what are the we call it water deprivation tests correction water deprivation tests so we give adh and give them no water and watch to see what happensand in the water deprivation tests you weigh in them like every 15 minutes because they're going to be pnp and p and p and if they start to become light-headed and dizzy and peanut peanut peanut you got to
stop the test because the test is supposed to run for six hours but in in if it's really primary diabetes insipidus that test is not gonna last i have been involved in with two or three of those testsit just never last more than an hour or two okay it's called water deprivation test that's how we make the diagnosis very good question okay all right so now let's go to the good old athens and cushions okay
Reviews Cushing syndrome, Addison disease, and adrenal crisis by contrasting excess and deficiency of adrenal hormones. Also introduces pheochromocytoma, its symptoms, and the surgical risks associated with adrenal tumors.
so athens questions again learn one flip it learn one flip it so with adrenal this is so this is the adrenal dysfunction that's different now that's the adrenal gland and the adrenal gland has to do with the steroidhormones
so it's it's see right up here sitting on here at the adrenal gland and that has to do with all the steroid hormones and steroid hormones will make you retain sodium water sodium water sugar and you get ridof potassium
so in in hyper adrenals or cushions you're holding on to salt water sugar and you do not have enough potassium please make sure you make a note of thatso too much aldosterone too much adrenal too much cortical too much um steroids you will hold on to water salt water goes where salt is
and sodium and you don't have enough potassium so there are classic symptoms for the electrolytes it's hyper bulimia hyperglycemiahypernatremia and i pull calemia not enough potassium so i always say when you think cushions pink prednisone everything you know about prednisone applies to questions
uh pregnancy is a corticosteroid that um basically i think this it increases the sugar in the in the blood and it's used for inflammation
so what's with uh with this now you're gonna have they're gonna have the moon face they're gonna retain fluid so they have the moon face the buffalo hump they're going to have hypertension tachycardia again because they have toomuch fluids they have the stretch mark because they're big
they have menstrual irregularity too amenorrheaum not enough see because i said to you think steroids think think steroids so they'll have calcium will leak out of the bone and they're at risk for osteoporosis they have too much sugar so they have poor woundhealing
so they big and they overweight and when you compare them to the the counterpart so these a day
how do we treat them
like attention we give them a hypertensive med so let's go for the underlying condition first let's find out what's going on in this song yeah because if it's you know most of the time uh cushions is a syndromeso it's side effect of too much corticosteroids so maybe we need to taper off the steroids yes let's taper down the dose can we also give them like a hypertonic um iv solution no they don't they have toomuch water on board already no solution for them okay we wouldn't put them on food restriction we wouldn't you know like we do si adh but you don't want to give them too much water because they have toomuch water water already so no so go for the underlying condition most of the time if the you know if they're on 20 milligrams of prednisone try to get down to five or two that will help
if it's primary and if something else is causing it disease-wise then we can treat it that way um you know with what all the other stuff you were saying um because it's not really a problem of the toomuch steroids but most of the time it's too much steroids so taper down the steroids
now let's go with additives disease this one is a disease so they are the complete opposite so this is the one you just flip they will have menstrual irregularity too though
so there so now they don't have enough salt they don't have enough water they don't have enough sugar and they have too much potassium so this situation is worse over here because per colemia
and i see how they're skinny okay and another so they need fluids lots of fluids and they need sugar fluids because they don't have enough glucose so they need something like d5 normal saline because they don't have enoughsalt so you need to get capture both with one in one shot um and and we need to get rid of that potassium they have too much potassium so we need to lower their potassium alsoprimary additions disease another problem with them too is that they have and this is a hallmark sign they have hyperpigmentation of the skin they look tan
it says classic with them now if someone have if someone is on steroids and it stopped this is why i remember we say we never stop steroids suddenly because if they stop the steroids suddenly they could flip overon this side and go into what we call addison's crisis
and now all those symptoms that i gave to you kind of in a nice way will be in a more you know aggressive fashion so they're going to be hypo tense hypotensive they're going to have hypovolemia they're goingto have hyponatremia and and they're um gonna have hyperkalemia in a full-fledged fashion so we've got to get aggressive with treating themokay
if this is primary addison's disease they'll be on steroids for life
and you always tell me addison's that was worse addison's is worse yeah of courseand you teach them that when they're on steroids they should never stop it suddenly and they should increase it during times of stress and that any stress physiological stress or psychological stress you may need more steroid up thesteroid
all right so look at all that stuff that i just gave for that you this morning and see okay um if you have any questions and one last thing okay so sorry before you go um when you're stressedyour sugar level goes up right yes for this person because they they can produce their own steroid that's why when they're stressed you got to increase their sugar yes but very good point because they can't produce their ownand the other thing is when you're on steroids you kind of tell the adrenal gland not to work because i'm helping you out so the adrenal gland gets sluggish it sleeps and it's like it's like someone who wasa stay-at-home mom and had the babysitter they're not doing anything somebody else is doing it so they don't know what's going on so when they're on the steroids the adrenal gland is not going to do anything because so
they don't know that you're stressed and they should put up more ster more more more cortisol because some you know they haven't been doing the job so now that's why you need to increase the external hormone because theirgland is not aware that they haven't been doing the job okay they gets sluggish they said it's lazy it sleeps
that is something called phenochromocytomathis is a tumor on the adrenal gland and anything on the adrenal gland will cause the adrenal gland to produce too much cortisol
it's a rare condition but it's a condition that you know it's available it's there and they'll ask about it so you know this is only a lot of times we suspect that when someone has hypertension and has noother underlying condition that would make them be hypertensive or they have like a hypertension with a distended abdomen
so the treatment for that one because it's it's the word phenochromocytoma it's a tumor so the treatment is to remove it so we will go to the or and have it removed the big problem though is that inthe adrenal gland remember we have something called the adrenal medulla let's go to vision and the adrenal cortex what goes on in the medulla
you can't run the function but i remember that um
hormones hormone wise
who makes them yeah so the in the adrenal and what are your three quarter saw yes in the medulla inside the medulla you have the catecholamine like the um epinephrine and norepinephrine here we go let me show you
okay so the cortex has the the steroid the hormones the steroid hormones and the medulla of the calcola means so it's a dopamine um epinephrine no epinephrine these are the ones that cause your blood pressure that makes yourblood pressure go up so if they have a penis if they have we're gonna take this thing and this entire thing off so worry that you know you can spill out some of these hormones so we worry abouthypertensive crisis during that surgery so going into the or they're probably going to go into or with some um antihypertensive on board because of the risk of get going into hypertensive crisis post-op they are definitely going to bein the icu so because we need to monitor their labs and monitor their you know um blood pressure and they pulse very closely post adrenal post phenochromocytomas surgery okay so then remember phenochromositoma it's again i told you we
we get suspicious for people with like uh abdominal distension and hypertension with no oil other underlying condition worry about phenochromocytoma not common but enough you know it happens enough for us to to talk about
Covers diabetes medications beyond insulin, especially metformin and other oral agents. Highlights key NCLEX points such as kidney monitoring, contrast precautions, hypoglycemia risk, and heart failure warnings.
all it so let's talk about the medications to match what we just went over so we did actually talk about the insulins already so we don't have to go over that but we need to talk about the oralagents so let's find them and talk about who they are and what they do um so for the whole oral agent the first line drug the oral is metformin
metformin is the first line oral agent glucophage is the other name that metformin is the one nclix gonna ask you you can hit ctrl f and type in that and it's gonna pop up on the on the paperuh um there's something else that's on my in my head that i'm looking forward to yeah um
they don't there's something else that i'm looking for that i you know like i know i don't want to miss this here um
what other um no i sent this to you today already so i don't have to go over that
too okay and we talked about these already so we can so these
so this is the first one this is it metformin first line metformin is um its first line we use it for other things but we're talking about diabetes uh it does not cause hypoglycemia mark that does not causehypoglycemia how does it work how does it work not farming it just allows the cell to utilize the glucose betterwe use it first line because it also helps with weight loss
and what do they really need type two you need um
yeah now um something i want you to make sure you note about metformin is that metformin if they're unmet forming you need to watch the kidneys because metformin can cause lactic acidosis it can damage the kidneys so weneed to watch the kidneys function if the kidneys seem like the function is going like the creatinine is going up we need to stop that metformin
the other thing with metformin is that if they are getting any any tests in a diagnostic test that's just using iv contrast you need to stop the metformin for at least 24 um sorry 48 hours before 48 hoursafter 48 hours
metformin can also cause b12 deficiencies when non-midforming they may need b12 supplements
but the big thing with metformin is the kidney damage so make sure you're watching their kidneys routinely and if they're doing any tests with the contrast medium hold metformin 48 hours before 48 hours after drink a lot offluid resume your metformin
the next one that i need you know are the glitter zones um we have rosy glitter zone prior glycosol so remember this part because they're not going to give you a vanda and branding they're going to give youglycosol these uh no all the other oral agent can cause hypoglycemia except metformin like foramen is the only one that doesn't cause hypoglycemia that's why we like it because it doesn't cause them to get hypoglycemic and it alsohelps to lose weightthey also use it to in in women to stimulate ovulation
so all the other oral agents can cause hypoglycemia so the glycosomes what's unique about them is that they can cause heart failure
because they can cause heart failure you're going to teach the patient to weight himself
every day report more than three pounds in a day five pound in a week
the sulfonylureas this is how you remember them this is all i want you to know for the sulfur neuria is they all have a gl once you see gf l we're talking about a sulfonate urea that's a groupprofound hypoglycemia for the sulfonate areas so much that they're not even prescribing them that much anymore they would rather do insulin because they have a very long half-life like two days and if you're older and your kidneys arenot working properly you're going to have problems with sulfate urease the other things with the fluffanu ureas or the gls is that if you have allergies to any sulfur drug you will have allergies to these
and also another thing with the sulfur sulfonylureas too if you are on a sulfur-based drug and you're on a sulfur and urea it can have profound hypo glycemia
Explains the main treatments for hyperkalemia and when each is used. Distinguishes between potassium binders, IV calcium, and glucose with insulin based on severity and symptoms.
got it yeah okay now let me talk to you about hyperkalemia treatment because we talked about some conditions today that can have hyperkalemia so we have three things that we use to treat hyperkalemia and we have the polycysteinesulfonate which is k excellate we have iv calcium and we have glucose and insulin remember i told you glucan insulin and um and potassium kind of goes together so now let's talk about when you would use one ofthese over the other so if the patient is hyperkalemic potassium is high and it's mildly elevated and they have no symptoms like for instance say 5.5 and they're asymptomatic but you need to lower it then you will dothe polycysteine sulfate or the capsulate because the way they can actually work is that it binds to the potassium and causes diarrhea so that's gonna take some time if they have um high potassium and symptomatic we need to
get a little bit more aggressive than that and that's where the iv calcium will come in for the group iv glucose and on insulin if they're really symptomatic and then you have an ekg changes this is where yougo if they're symptomatic and then they are just having like chest tightness we tend to do this first but in a true emergency is iv calcium
Reviews levothyroxine, antithyroid drugs, and radioactive iodine therapy. Emphasizes medication safety, agranulocytosis warnings, and radiation precautions after treatment.
you see the difference with why you use one over the other yes okay um one other thing um okay so i send ice not i send this to you today the antidote make sure you go over them andi also sent you the vitamins what are the um the the scientific names make sure you know both names for your vitamins so go over those two so you have your hands full please i sent you this aswell all right we talked about levothyroxine but let's just go over it again so the centroid the levothyroxine we would give this after we make them hypo remember this works just like the thyroid hormone so your s yourside effects would be as if they go into hyperkalemia no not chlamy hyperthyroidism
remember levothyroxine should be on an empty stomachso you take it first thing in the morning empty stomach probably keep it with your toothpaste toothbrush so you can remember
all right let's talk about anti-thyroid medication these are the ones that told you to take a little while to work you see beta blockers here yeah that's remember i told you when they are in hyperthyroidism
get anxious and that helps with the heart rate and also also um slows down the blood it slows down the heart rate to put the blood pressure and help with their anxiety now what i want you to makesure you know about these two um metamasal and ptu because we all struggle with pronouncing this one pro pi uracil so we refer to it as ptu they take a little while to work these are anti-thyroid medication thisis for hyperthyroidism they take a few weeks about six to eight weeks to work but what nclex wants you to know about this is that they both can cause agranulocytosis
so you worried so that means that they increase their risk for infection so you tell them to report any low grade fever any sore throat any fatigue any chills any body aches and also another good thing is thatthey should wear a media alert bracelet because they're on this and it's a good idea to teach your patients who are on long term medication through media alert bracelets
and finally let's talk about radioactive iodine remember these patients are going to this is to reduce the vascularity of the thyroid gland which is very vascular so normally they go home radioactive so they should not share room withanybody
they should not share bathroom but if that's not possible they should flush at least twice at least twice the guys should sit down because you don't want them to splash to urinate they should avoid pregnant women and childrenso after and they are radioactive for about two weeks after this treatment
every single everything their saliva touch or their body fluid touches is radioactive so they should use their own disposable utensils
and it should not eat anything that have like bone like remnantsif they do they should double bag that thing and put it in the garbage because you don't want to expose you know um your garbage guys to your radioactive solution eitherif they close they should wash their clothes separately and after they wash their clothes they should run the machine in an empty cycle
Ends with a brief transition into questions and the conclusion of the lesson.
question no that's about