CCRN Review – Endocrine Questions and Answers 100% Pass

CCRN Review – Endocrine Questions and Answers 100% Pass Disease process in which too much ADH is being produced? SIADH ADH is produced in the ___ and stored in the ___? Hypothalmus; Posterior pituitary ADH has what effect on the distal convoluted tubules of the kidneys? Makes them hold on to too much water Whenever the kidneys hold onto water it decreases what electrolyte? and leads to dilutional ___? Sodium; Dilutional hyponatremia How does SIADH affect osmolarity? It decreases it causing a patient to become "hypo-osmolar" Normal serum osmolarity? 2(Na) + BUN/5 + Glucose/20 = 275 - 295 How will ADH affect UOP? Decrease it Causes of SIADH? Oat cell carcinoma, Viral Pneumonia, Structural head problems, Cancer (bronchogenic, prostatic, pancreatic), and chemotherapy SIADH elevates ADH levels which leads to what 3 things? decrease in sodium levels, decrease in serum osmolarity, and a decrease in UOP What is a major complication of SIADH? Why? Seizure activity; Dilutional hyponatremia leading to a fluid shift into brain cells. What are the treatments for SIADH? 1. Treat the Cause. 2. Fluid restriction. 3. Hypertonic soultions (3% sodium chloride), do not give 1/2 NS or D5W (hypotonic solutions). 4. Dilantin Disease process in which not enough ADH is being produced? Diabetes Insipidus (DI) DI has what effect on the kidneys? Causes kidneys to loose too much water (6 - 24L/day) How does DI affect sodium levels? Increases sodium levels (hypernatremia) How does DI affect osmolarity? Increases osmolarity (hyper-osmolar) Causes of DI? 1. Head problems. 2. Dilantin. DI decreases ADH levels which leads to what 3 things? increase in sodium levels, increase in serum osmolarity, and an increases in UOP (specific gravity = 1.001-1.005) What is a major complication of DI? Hypovolemia leading to shock What are the treatments for DI? 1. Give ADH (pitressin). 2. Give fluids to increase intravascular volume. 3 Monitor urine specific gravity. 4. Monitor EKG for ischemia (ADH is a vasoconstrictor) Hypoglycemia causes what cardiovascular signs? Tachycardia, palpatations, diaphoresis, irritable, restlessness Hypoglycemia causes what central nervous system signs? Confusion, lethargy, slurred speech, seizure, coma, death (in that order) What is the bodies response to hypoglycemia? The adrenal medulla produces adrenaline that goes to the liver and causes the liver to convert glycogen to glucose. What are the effects of hypoglycemia on a patient taking a beta blocker? Beta blockers negate the cardiovascular effects leaving only the CNS effects (confusion, lethargy, slurred speech, seizure, coma, death) DKA stands for? Diabetic Ketoacidosis HHNK stands for? Hyperglycemic Hyperosmolar Non-ketotic Coma What patient populations get HHNK? 1. Old age. 2. Diet controlled diabetics. 3. Patients on TPN. 4. Pancreatitis. Patients with DKA present with a blood glucose range of? BS (400 - 900) Patients with HHNK present with a blood glucose range of? BS () A DKA patient can present with dehydration and a fluid loss of? 4 - 6 L (osmotic dehydration) A HHNK patient can present with severe dehydration and a fluid loss of? 6 - 8 L (osmotic dehydration) Does a DKA patient produce insulin? No. Patients with DKA go into a coma and are usually brought to the hospital early into DKA; after several days. Does a HHNK patient produce insulin? Yes. HHNK usually develops over weeks. Patients with HHNK have a ___% mortality rate? Why? 95%. Misdiagnosis secondary to cerebral dehydration. It appears the patient is having a neurological problem Patients with DKA are in a state of? Acidosis or Alkalosis? Acidosis; secondary to the body attempting to break down fat as an energy source which releases ketones leading to metabolic acidosis. A respiratory pattern seen in DKA defined as an increase in rate and depth in order to blow off what gas? Kussmaul; Carbon dioxide Does a patient with HHNK develop acidosis? Why or Why not? No acidosis secondary to some production of insulin that prevents the breakdown of fats as an energy source. What is the treatment for patients in DKA? Insulin gtt and IV Fluids (NS to start, then 1/2NS to rehydrate the cells, then after the BS decreases to around 250 switch to D51/2NS to prevent BS dropping too fast leading to cerebral edema). What is the treatment for patients in HHNK? IV Fluids and insulin What electrolyte is imperative to follow in patients with DKA? Potassium pH and Potassium have an inverse relationship. True/False? True Every change (decrease) in pH by 0.1 will have a change (increase) in K+ by ___? Why? 0.6, in a state of acidosis there are extra hydrogen ions (H+) in circulation. H+ will tend to go into the cell forcing potassium out of the cell. See Reverse side for table showing changes in K+ levels as pH decreases. pH K+ 7.45 4.5 7.35 5.1 7.25 5.7 7.15 6.3 7.05 6.9 As acidosis resolves during the treatment of DKA (Insulin gtt, IV fluids, Sodium Bicarb) you would expect K+ to? Go back into the cell. The most common cause of death from DKA is? Hypokalemia