,Met. Alkalosis
Interventions: #1 Hydration, #2 LOC
Admin Insulin restoring glucose w/I 72hrs
Evaluate Fluid Volume / Daily Weights
Teaching: store unopened insulin vials in refrigerator or room temp
for 28 days
Draw regular insulin into syringe first when mixing insulins
Exercise decreases blood sugar levels
Sick Days: keep taking insulin
monitor glucose more frequently
watch for signs of hyperglycemia
**If in doubt if hyper / hypo glycemic, treat for hypoglycemia
Hypoglycemia - Answer- Glucose <70, rapid decline
Excess Insulin, wrong time / type
Manif: #1 early -Neurogenic (Cholinergic / Adrenergic)
#2 Central Neuroglycopenic: confusion, seizure, coma
Interv: Mild - admin carbs / protein
Severe -admin Glucagon
Teach: avoid exercise / alcohol
New bottle Insulin / more potent
Change injection site
Med Alert Bracelet / Carry carb snack
Drink alcohol with food / after meal
**Taking Beta Blockers: manif less intense
**Does not always experience warning symptoms
DI Pituitary (Hypothalamus) - Answer- Lack ADH - Vasopressin
Fluid Deficit / ^ Output
Causes: Lithium, Trama, Surgical, Tumors, Hemorrhage, Cerebral
Aneurysm, Hypophesectomy (pituitary removal)
Manif: dehydration, polyuria, thirst, hyperthermia, coma, ataxia, hypotension, tachy,
hypovolemia / shock, ^Hct / Hgb / BUN
Interv: Admin Desmopressin (nasal, 10x stronger, long acting)
Admin Vasopressin (oral, short acting, use for upper
respiratory infection)
*Never deprive fluids more than 4 hrs
Accurate I&O, daily weights
Drugs: Lifelong Therapy
Addisons (Adrenalcorticol) - Answer- Low Cortisol / Aldosterone
Occurs gradually / quickly due to stress; life threatening
Cortisol - anti inflammatory / histamine
Cause: #1 tumor necrosis / hypophysectomy / radiation
#2 Cessation on glucocorticoid therapy, immunodeficient
(TB / Cancer / Aids / Toxins), hemorrhage, adrenalectomy
Manif: Hypo GNVT - glycemia / natremia / volemia / tension
Hyperkalemia
Salt cravings, GI / menstrual / impotence changes
hyperpigmentation, shock, loss of body hair
Interv: Fludrocortison (Florinef) - maintain K+ / Na, like aldosterone
(Reabsorbs Na / Excrete K+)
Hydrocortison - corrects glucocorticoid deficiency
Prednisone - corticol replacement
#1 Rapid Infusion Normal Saline
#2 Solucortef - glucocorticoid hydrocortisone
Kayexalate - hyperkalemia
Glucose / Glucagone - Hypoglycema
Weigh Daily
Monitor hemoconcentration - Hct / BUN
Diet: ^ sodium / carbs, low potassium
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