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FOLLICULAR PHASE: (Ovarian Changes ..Cycle Days: Endocrine System NCLEX
FOLLICULAR PHASE: (Ovarian Changes ..Cycle Days: Endocrine System NCLEX
In addition, LH helps the Graaifan follicle that LUTEAL PHASE (ovary changes….cycle day 15-28)
released the egg turn into theCORPUS LUTEUM. The
corpus luteum will be responsible for releasing Goal: prepare the endometrium for a potential
progesterone and estrogen to maintain a potential fertilized egg
pregnancy until the placenta can take over. NOTE: the
Begins when the egg is releases from the ovary.
development of the corpus luteum occurs in the
LUTEAL Phase…note why it is called The corpus luteum forms which developed from the
LUTEAL…the LUTE of luteal corresponds with the Graaifan follicle that released the ovum. The corpus
word corpus LUTEum). luteum acts as a temporary endocrine structure
that secretes progesterone and estrogen.
*The last 5 days of the follicular phase and during Progesterone prepares the endometrium for
ovulation is the most fertile time for a woman to get
implantation of the embryo, if the ovum is fertilized.
pregnant…sperm live approximately 5 days and the
egg lives for 24 hours (so fertile cycle days would be Role of Progesterone:
days 9 -16).
stimulates estrogen production
PROLIFERATIVE Phase (uterine changes…cycle
days 7-14) allows the endometrium to receive the fertilized
ovum for implantation
Goal: to rebuild the stratum functionalis layer that
was just shed during the menstrual phase (in case the stops production of LH and FSH (so possible
ovum is fertilized) so it can implant into the uterus. pregnancy can be maintained) and estrogen inhibits
the hypothalamus from releasing GnRH (hence new
What causes the layer to rebuild? Remember how reproductive cycle….if the ovum is fertilize you want
during the follicular phase the maturing follicles are to prevent another menstrual cycle from occuring so
secreting estrogen? The estrogen from the secretion pregnancy can occur).
of the maturing follicles is ALSO causing the stratum
functionalis layer to rebuild. In addition, it causes This will help prevent the hypothalamus from
cervical mucous to thin which allows sperm to releasing GnRH which will prevent LH and FSH from
migrate easier to the egg. being secreted in case fertilization has occurred.
OVULATION: Cycle day 14 Corpus luteum stays in place for about 14 days and if
fertilization hasn’t occurred it disintegrates. It will
The egg is released from the ovary. The ovum enters turn into the corpus albicans. When the corpus
into the PERITONEAL CAVITY . It makes it journey luteum dies, estrogen and progesterone will
to the fallopian tube with the help of the fimbria decrease and this leads to a new reproductive
which have cilia to help sweep the ovum into the cycle….the hypothalamus will release GnRH which
fallopian tube. If sperm are present to fertilize the will cause the anterior pituitary gland to release FSH
and LH and the woman will shed the uterine lining Adrenal Medulla: found in the adrenal gland and is
and new follicle will be stimulated to produce a new within the adrenal cortex. Its role is to secrete
egg etc. epinephrine (adrenaline), norepinephrine
(noradrenaline), and low amounts of dopamine in
However, if fertilization occurs the fetus will start to response to the body’s sympathetic nervous system
produce HcG Human chorionic (fight or flight system) via chromaffin cells.
gonadotropin (hence what a pregnancy test picks
up) and this will prevent the corpus luteum from Chromaffin Cells: founds in the adrenal medulla and
dying. So, until the placenta becomes fully functional, secrete catecholamines. This is what the tumor is
the made up of (tumors tend to be benign). These cells
are also found in the heart, head, neck, bladder, spine,
corpus luteum will help maintain steady levels of abdomen. If a tumor(s) develops in this area it is
progesterone and estrogen to maintain the known as paragangliomas rather than
endometrium for the fetus. The placenta will take pheochromocytoma
over will progesterone and estrogen production at
approximately 8 weeks. Catecholamines: have a huge influence on how
organs and tissues work. They cause the body to do
SECRETORY Phase: (uterine changes….cycle days 15- the following:
28)
increase heart rate and blood pressure
Goal: endometrium is receptive to the implantation
of a fertilized ovum increase glucose (stimulates the liver to release it
stores of glucose in the blood and blocks the role of
The progesterone being released from the corpus insulin)
luteum is allowing the endometrium to be receptive
for implantation of the fertilized ovum. increases fat metabolism for energy (breaking down
of fats for fuel)
pheo: dark chromo: color cyt: —All of this is produced because of stimulation of the
cell oma: tumor sympathetic nervous system in response to fight or
flight mechanism and happens normally in the body
Definition: It is a tumor found on the adrenal medulla when stiumalated to do so. However, in
of the kidneys that secretes excessive amounts of pheochromocytoma a patient is experiencing these
catecholamines. signs and symptoms due to a tumor.
*Increased blood pressure & heart rate Nursing Interventions for Pheochromocytoma
*Headaches (sudden and severe) Monitor for hypertensive crisis: >180 systolic or
>120 diastolic…if blood pressure is too high for a
Tremors long period of time this can cause damage to vital
organs…kidneys, eyes, brain, heart.
*Frequent sweating (from hypertension)
Signs and symptoms of this: headache, vision
Loss of weight changes, neuro changes, seizures, shortness of breath
Increase anxiety and fear Monitor for chest pain (risk for MI), neuro status
Growing tumor can cause back or abdominal (stroke), EKG changes, hyperglycemia
pressure or pain Provide a calm and cool environment….no
Heat intolerance overstimulation!
Tired and weak (from the constant stimulation) Per MD order: Administer pre-opt (prior to
adrenalectomy) alpha-adrenergic
*=most common signs and symptoms blockers (Cardura, Minipress, Hyrtin): work
by blocking noradrenaline, reduces catecholamines.
***Signs and symptoms can happen in episodes or These medications help decrease blood pressure and
triggered after an event: prevent a hypertensive crisis during surgery.
Eating foods with Tyramine (plays a role in pressure Alpha-adrenergic blockers can cause reflex
blood): foods that areaged, pickled, fermented like tachycardia (due to the decrease in blood pressure).
cheeses, red wine, smoke/dried meat, bananas, The heart rate increases in an attempt to increase the
sauerkraut, chocolate. blood pressure as a “reflex” response, and these
Surgery, trauma injury, emotional stress, medications medications can causes orthostatic hypotension.
such as Monoamine Oxidase Inhibitors: MAOIs Doctor may also be prescribe patient a beta-
Diagnosed adrenergic blockers like Labetalol or Inderal to help
with hypertension and tachycardia
24-hour urine for catecholamines and
metanephrines (are metabolites formed when the Education for patient with pheochromocytoma:
body breaks down catecholamines)….if too many Eat high calorie diet: burning fats at a rapid rate
metabolites are found then there are too many
catecholamines being produced). If this test comes Avoid stimulant substances: energy drinks, caffeine
back positive the doctor may order a MRI or CT scan products, or smoking (due to vasoconstriction)
of the adrenal glands to inspect for tumors.
For patient going for an adrenalectomy: educate fertility
about having to take hormone replacement
medications after surgery and taking alpha- regulates TSH (thyroid-stimulating hormones
adrenergic prior to surgery (usually 2 weeks before through the negative feedback loop)
surgery) TSH: produced from the anterior pituitary gland
If patient is having a bilateral adrenalectomy (both that stimulates T3 and T4 production
glands removed ): will have to take glucocorticoids Negative Feedback Loop of Thyroid Hormone
and mineralocorticoid for life. Production
If patient is having a unilateral Hypothalamus produces -> TRH (Thyrotropin-
adrenalectomy (only one gland removed): will have releasing hormone)…this causes the Anterior
to tak Pituitary Gland to produce ->TSH (thyroid-
stimulating hormone)….this cause the thyroid
gland to produce-> T3 & T4
Hyperthyroidism
There can be problems with the feedback system
Definition: High secretion of thyroid hormone where the pituitary gland is not stimulating the
thyroid gland enough so hormones are not produced
Key Players: or the thyroid is not receptive to the TSH from the
Thyroid: produces thyroid hormones that play a big pituitary gland.
role in body metabolism, regulation of body Thyroid problems diagnosed with blood tests that
temperature, and growth/development. look at T3, T4 (free) levels, and TSH to make a
These hormones are known conclusive diagnosis.
as: T3 Triiodothyronine, T4 Thyroxine (most Signs & Symptoms Hyperthyroidism
important when talking about hypo/hyper
thyroidism), and Calcitonin. Let the word of the condition help
you: HYPERthyroidism…everything is going to be
Thyroid can NOT make thyroid hormones working at an accelerated or high of a rate.
without iodine which comes from foods (if you don’t
have enough iodine in your diet…low t3 and t4…this Depending on how high the levels are and what is
leads to hypothyroidism and if you have too much causing the condition signs and symptoms can vary:
hyperthyroidism)
Weight loss (burning calories increased)
T3 & T4: plays a huge role in:
Heat intolerance (feel extremely hot…sweaty)
burning calories
Tachycardia (sympathetic system in overdrive)
how new cells replace dying cells
Hypertension (sympathetic system in overdrive)
how fast we digest food
Diarrhea (GI system working harder and faster)
stimulate sympathetic nervous system (alertness,
quick responsiveness/reflexes) Skin smooth (from increased blood flow)
Toxic Nodular Goiter (TNG): not PTU “Propylthiouracil” (safer during first trimester
autoimmune…growths of nodular goiters that are of pregnancy)….liver failure
independently functioning to cause hypersecretion of
thyroid hormones Other side effects of both medications:
agranulocytosis and aplastic anemia
S & S: won’t see ophthalmic signs like the protruding
eye balls but the classic signs and symptoms of Education for Antithyroid medications:
hyperthyroidism Never stop taking abruptly (takes a while before the
TX: antithyroid meds, beta blockers (block the effect patients start seeing results)
of the high thyroid hormones on the body…slows Take at same time every day
heart, decrease sweating) radioactive iodine therapy,
or thyroidectomy Signs and symptoms of thyroid storm
Thyroiditis: inflammation of the thyroid gland and Avoid iodine rich foods (sea foods like seaweed, dairy
this can cause T3 and T4 leak into the body eggs) or supplements
Too much iodine: remember iodine helps make T3 No aspirin (increases thyroid hormone)
and T4
Signs and symptoms of hypothyroidism (toxicity)
Nursing Interventions for Hyperthyroidism
Beta Blockers:” Inderal” to treat patient signs and
Keep the patient comfortable: cool, quiet symptoms (help decrease heart rate, blood pressure,
environment, calm (administer prescribed sedatives and decrease heat intolerance)
as needed)
Treatment for Hyperthyroidism
Obtain daily weights (need to watch weigh due to
weight loss from the increased metabolic rate) Radioactive iodine: destroys the thyroid gland
overtime and is a permanent cure compared to
Monitor EKG, heart rate, blood pressure medications….not for pregnant or nursing women
Educate about medications and treatment Side Effects: Iodism: taste changes “metal taste”,
(radioactive iodine therapy and thyroidectomy) nausea, and swollen saliva glands
Surgical Treatment: how new cells replace dying cells
Watch for thyroid storm due to the manipulation of stimulate sympathetic nervous system (alertness,
the gland causing extra T3 and T4 to leak into the quick responsiveness/reflexes)
body….prevent by prepping with medications
of:antithyroid meds, sodium iodide solution, beta increases body temperature and heart rate
blockers, glucocorticoids brain development
Educate about post-opt care: coughing and deep muscle contraction
breathing and splinting neck when coughing
fertility
Monitor for parathyroid destruction problems
(common when a thyroid procedure is performed regulates TSH (thyroid-stimulating hormones
due to the close proximity of the parathyroid to the through the negative feedback loop)
thyroid gland)…watch calcium levels
“hypocalcemia”…parathyroid responsible for TSH: produced from the anterior pituitary gland
calcium regulation) that stimulates T3 and T4 production
Watch for respiratory distress due to the nature of Negative Feedback Loop of Thyroid Hormone
the surgical site…keep patient in semi-fowler’s to Production
help with swelling and drainage at the site (keep at
Hypothalamus produces -> TRH (Thyrotropin-
bedside trach kit and supplies) releasing hormone)…this causes the Anterior
Pituitary Gland to produce ->TSH (thyroid-
stimulating hormone)….this cause the thyroid
gland to produce-> T3 & T4
T3 & T4: plays a huge role in: Heat intolerance (feel extremely hot…sweaty)
Personality changes: irritable, moody, insomnia Educate about medications and treatment
(radioactive iodine therapy and thyroidectomy)
Irregular menstruation in women
Monitor for Thyroid Storm: life-threatening that
Causes of Hyperthyroidism presents with exaggerated signs/symptoms of
hyperthyroidism, such as fever, fast heart rate,
Grave’s Disease (most common cause): autoimmune HTN
disorder due to the production of an
antibody/immunoglobulin TSI (thyroid stimulating Cause of thyroid storm: complication from
immunoglobulin) that has the same effect as uncontrolled hyperthyroidism or due to
TSH…this stimulates the body to produce high thyroidectomy (caused from excessive thyroid
amounts of thyroid hormones (genetic). hormones leaking into the bloodstream after
removal)
NOTE UNIQUE S & S: Protruding eyeballs, goiter,
pretibial myxedema: waxy orange peel appearance of Medications for Hyperthyroidism
the skin found in the feet and legs
Antithyroid medication: stops the thyroid from
TX: antithyroid meds, beta blockers (block the effect synthesizing T3 and T4, doesn’t damaged thyroid
of the high thyroid hormones on the body…slows gland like radioactive iodine therapy
heart, decrease sweating) radioactive iodine therapy,
or thyroidectomy Methimazole “Tapazole” (most common…fewer
side effect)…common treatment for Grave’s Disease
Toxic Nodular Goiter (TNG): not
autoimmune…growths of nodular goiters that are PTU “Propylthiouracil” (safer during first trimester
independently functioning to cause hypersecretion of of pregnancy)….liver failure
thyroid hormones Other side effects of both medications:
S & S: won’t see ophthalmic signs like the protruding agranulocytosis and aplastic anemia
eye balls but the classic signs and symptoms of Education for Antithyroid medications:
hyperthyroidism
Never stop taking abruptly (takes a while before the
TX: antithyroid meds, beta blockers (block the effect patients start seeing results)
of the high thyroid hormones on the body…slows
heart, decrease sweating) radioactive iodine therapy, Take at same time every day
or thyroidectomy
Signs and symptoms of thyroid storm
Thyroiditis: inflammation of the thyroid gland and
this can cause T3 and T4 leak into the body Avoid iodine rich foods (sea foods like seaweed, dairy
eggs) or supplements
Too much iodine: remember iodine helps make T3
and T4 No aspirin (increases thyroid hormone)
Surgical Treatment:
Key Points to Remember about SIADH and DI Damage to the pituitary gland and/or hypothalamus
Each condition is related the secretion of ADH (anti- Brain trauma through stroke or head trauma
diuretic hormone also called vasopressin) which
plays a major role in how the body RETAINS water. Tumors
Each condition presents oppositely of each other (ex: Drugs… ex: Declomycin: this is a part of the
in SIADH the patient retains water vs. DI where the tetracyline antibiotic family and has properties to
patient loses water)—-Remember they are opposite inhibit ADH production and is also a treatment for
of each other! SIADH
Diabetes Insipidus and Diabetes Mellitus are two Gestational due to the placenta producing
separate conditions and are not related although they vasopressinase….too much vasopressinase causes
share the name “Diabetes”. ADH to breakdown
Diabetes Insipidus Key Concepts Mild cases: Chlorpropamide aka Diabinese (used in
type 2 diabetes…not used as much now but it has
Causes of Diabetes Insipidus: properties that increases ADH hormone…watch
for hypoglycemia (blood glucose) and educate Nursing Management of SIADH
patient about photo-sensitivity to the sun (mild)
Daily weights and watch for weight gain, strict intake
Extreme cases: Desmopression (form of vasopressin and output, fluid restrictions, safety (confused from
that naturally occurs in the body which the ADH) also brain swelling and low sodium)
called Stimate or DDAVP…given PO, IV, nasally, or
subq. Side Effects: Watch for the patient to become Medical treatment per md order:
hyponatremic too and water intoxication Loop Diuretics (Lasix): to remove the extra fluids
Syndrome of Inappropriate Antidiuretic Hormone through the kidneys…watch K+ levels
(SIADH) Hypertonic IV solutions (3% Saline) to remove fluid
Try to remember it by this: from the cell back into the vascular system so it can
be urinated out (watch for causing fluid volume
S- Samatha’s overload..give slowly and through central line per
I- Increased hospital protocol)****NOTE: Loop Diuretics &
A- Anti Hypertonic Solutions are usually order together.
D- Diuretic
H- Hormone Declomycin (tetracycline family) ADH inhibitor and
allow for diuresis…don’t give with calcium
Causes of SIADH containing foods like milk or antacids because it
affects absorption.
Lung cancer (may be a first sign a patient gets…then
finds out they have lung CA)
Hypertension
Fast HR
Seizures
Skin fragile
Cushing’s (Syndrome & Disease) If this is done educate pt about cortisol replacement
therapy after surgery
Cushing’s: hyper-secretion of CORTISOL (watch
video for clever ways to remember this) Risk for infection and skin breakdown
Cushing’s Syndrome vs Cushing’s Disease Monitor electrolytes blood sugar, potassium, sodium,
and calcium levels
Addison’s Disease Education: Patient needs to report if they are having
stress such as illness, surgery, or extra stress in life (
Addison’s: Hyposecretion of Aldosterone & will need to increase dosage), take medication exactly
Cortisol (watch the video for a clever way on how to as prescribed….don’t stop abruptly without
remember this and not get it confused with consulting with MD.
Cushing’s)
For replacing aldosterone:
Signs & Symptoms of Addison’s Disease
ex: Fludrocortisone aka Florinef
Remember the phrase: “Low STEROID Hormones”
(remember you have low production of aldosterone Education: consume enough salt..may need extra salt
& cortisol which are STEROID hormones)
Wearing a medical alert bracelet
Sodium & Sugar low (due to low levels of cortisol
which is responsible for retention sodium and Eat diet high in proteins and carbs, and make sure to
increases blood glucose), Salt cravings consume enough sodium
Autoimmune due to the adrenal cortex becoming Severe vomiting, diarrhea and headache
damaged due to the body attacking itself:
NEED IV Cortisol STAT:
Tuberculosis/infections
Solu-Cortef and IV fluids (D5NS to keep blood sugar
Cancer and sodium levels good and fluid status)
Hemorrhaging of the adrenal cortex due to a trauma Watch for risk for infection, neuro status (confusion,
agitation), electrolyte levels (sodium and potassium,
Nursing Management of Addison’s Disease glucose)
Watching glucose and K+ level
Adrenalectomy:
Shock
Glucagon:
Pancreas:
Liver:
Decrease blood sugar -> pancreas release glucagon -> Risk Factors: Lifestyle- being obese, sedentary, poor
causes the liver to release glycogen which turns into diet (sugary drinks), stress AND genetic
glucose to increase the low blood sugar level
What do patients look like clinically? Patients are
What happens in diabetes mellitus? overweight, it happens overtime, rare to have
ketones (remember issues with carb metabolism)
The body is unable to use glucose due to either adult aged
the absence of insulin or the body’s resistance to
use insulin. Therefore, the patient Gestational: similar to type 2 diabetes where the
becomesHYPERGLYCEMIA (the glucose just hangs cells are not receptive to insulin…typically goes away
out in the blood stream which affects major organs of after birth
the body)
Complications of Diabetes Mellitus
The body starts to metabolize FATS for energy
(since it can’t get to the glucose…remember glucose Hypoglycemia:
can NOT enter the cell without the help of Blood glucose less than 60 mg/dL or drops rapidly
INSULIN)….which happens in Type 1 diabetics OR from an elevated level.
there is a moderate amount of insulin to deal with
fats and proteins BUT carbs cannot be used (Type 2). Remember the mnemonic: “I’m sweaty, cold, and
clammy….give me some candy”
Causes of Diabetes Mellitus
Signs and Symptoms: Sweating, clammy, confusion,
Divided into types: light headedness, double vision, tremors
Type 1: the beta cells located in the islet of Treatment: Need simple carbs if they can eat, or if
Langerhans don’t work (been destroyed) therefore unconscious IV D50
the body doesn’t release anymore insulin. For
treatment, the patient MUST USE INSULIN. Simple carbs include: hard candies, fruit juice,
graham crackers, honey
Risk factors: Genetic, auto-immune (virus) NOT
RELATED TO LIFESTYLE (like type 2) Organ Problems:
What do patients look like clinically? Patients are Hardens the vessel (atherosclerotic….makes vessels
young and thin….happens suddenly; ketones will be hard from all the glucose that sticks on the proteins
present in the urine of the vessels and it forms plaques). So the patient
can develop heart disease, strokes, hypertension,
Type 2: cells quit responding to insulin (won’t let neuropathy, poor wound healing (FROM DECREASE
insulin do its job by taking the glucose into the cell). circulation), eye trouble, infection.
Therefore, the patient has INSULIN RESISTANCE.
This leaves all the glucose floating around in the DKA (Diabetic Ketoacidosis):
blood and the pancreas senses there’s a lot of glucose
present in the blood so it releases even more insulin. Happens in Type 1 diabetics (rare to happen in type
Due to this the patient starts to 2)
experience hyperinsulinemia which caused There is no insulin in the body and the body starts to
metabolic syndrome
burn fats for energy since it can’t get to the glucose
Due to this the ketones, which are acids, start to enter *The 3 P’s present mainly in Type 1 Diabetics
into the body and this causes life-threatening
situation, such as acid/base imbalances Other Assessment findings of the Diabetic Patient
Assessment Findings of DM
Why? elevated levels of glucose in the body causes Nurse’s role: educating, monitoring, and
the body to remove the water from inside the cell administering (medications)
(remember in the hypertonic, hypotonic video about
OSMOSIS). The water will move to an area of higher Teach patient to follow the Triangle of Diabetes
concentration which will be the blood stream and Management
this causes more fluid to enter the blood stream. The
kidneys will secrete the extra water. HOWEVER,
normally your kidneys could handle all of the glucose **Diet, medications, and exercise all work together
by reabsorption but there is too much so it leaks into while monitoring blood glucose
the urine…. GLYCOSURIA
Example: Patient wants to make sure their diet is
Polydipsia: very thirsty balanced with their medication (insulin/oral meds)
and they use exercise to manage glucose levels (doing
Why? the blood is trying to prevent the body from all this while monitoring blood glucose).
becoming dehydrated from the excessive urination so
it signals to the patient to drink more water…but it As the nurse you will be educating the diabetic…so
doesn’t work because the kidneys will remove the for the NCLEX know education pieces like:
excess water
Diet, exercising, oral medications, giving insulin
Polyphagia: very hunger (peak times), drugs that increase blood glucose and
lower glucose etc.
Why? the body is burning FAT for energy since it
doesn’t have any glucose to use so the body signals to Diabetic Diets
the person to keep eating so there will be food to use
for energy. The patient will have WEIGHTLOSS!
DIET: Diets are individualized due to physical activity ****If patient plans on exercising for an extended
and medication therapy (they always need period of time, check glucose prior, during, and after.
tweaking)…recommend following American Diabetic
Association Diet (ADA) ****If blood glucose is higher than 250 with ketones
present in urine prior to exercise avoid exercise until
Limitation of the following: glucose and ketones stabilize.
Fats (<20 %)….limit unhealthy fats saturated, trans Oral medications (for patients with Type 2 diabetes
fats, cholesterol: lard, gravies, whole milk, bologna, when exercise and diet doesn’t work to control blood
hot dogs, sausage, processed foods hydrogenated glucose):
oils…concentrate on mono & polyunsaturated Sulfonylureas: ides zides, mides, rides” (most
avocadoes, olives, peanuts, nuts common) stimulate beta cells in pancreas to make
Proteins (15-20%) meats don’t increase the insulin (Glyburide, Glipizide, Diabinese,
glycemic index: meats chicken, turkey, fish, plant Amaryl)AVOID ETOH….extreme hypoglycemia
based beans, peas, low fat cheese, eggs whites Meglitinides: “glinide” Ex: repaglinide “Prandin”
Exercising Management stimulate beta cells in pancreas to make
insulin…instruct pts to take first bite with meal
Exercise: Aerobic the best (helps the body use
insulin) ex: cardio running, walking, swimming etc. Biguanides: Metformin (Glucophage)….causes the
liver to decrease its stores of glucose. Watch out if
Teach patient signs of hypoglycemia & patient is scheduled for surgery/procedure (heart
hyperglycemia cath)…stop for 48 hours and watch renal
function…diarrhea
Signs of Hypoglycemia:
Alpha-glucoside inhibitors: Precose, Glyset lower
“I’m sweaty, cold, and clammy….give me some candy” blood sugar by slowly down the breakdown of
“Sweating, clammy, confusion, light headedness, starchy foods in the GI system which helps slowly
double vision, tremors” rise the blood sugar… instruct pts to take first bite
with meal
Signs of Hyperglycemia: Three P’s
Thiazolidinedione: “glitazone” reduce glucose
Polyphagia production in the liver: Actos/Avandia watch liver
function and heart function increase risk of MIs
I’m hot and dry…I must be on a sugar high!
Medications that cause hypoglycemia
Polydipsia
Remember from the hypertension lecture that Beta
Polyuria Blockers (mask symptoms of hypoglycemia)
Always check blood sugar prior to exercising: Other medication that cause it: ETOH, ASA,
if lower than 100 eat a small carb snack and Sulfonylureas (medications used to treat type 2:
carry SIMPLE carbs with you while exercising in case Glyburide, Glipizide, Diabinese), and MAO inhibitors
of hypoglycemic attack (meds for depression) , Bactrim (common antibiotic)
Example of simple carbs: hard candy, honey, Medications that cause hypergycemia
crackers/graham crackers, fruit juice
Thiazide diuretics (HCTZ), Glucocorticoids Duration: 16 hours
(Prednisone, Hydrocortisone), estrogen therapy
Long-Acting Insulin:
Insulin
“The two long nursing shifts never peaked but
It is used for Type 1 regularly, and sometimes for lasted 24 hours.”
Type 2 diabetics if the patient is experiencing
stress on the body like surgery or illness. Onset: 2 hours
“Short-staffed nurses went from 30 patient to Treatment: may need a night time dose of NPH to
(2) 8 patients.” counteract.
Hyperglycemia (intracellular to extracellular Acetone Smell of the Breath “fruity”: due to the
shifting takes place which will lead to electrolyte breakdown of ketones
imbalances)
Ketones present in the urine
Ketones in the blood (leads to metabolic acidosis,
weight loss because of all the fat burning, electrolyte Tachycardia, hypotension, confusion, fatigue
shifting as well) Nursing Interventions of DKA
Metabolic Acidosis (blood pH <7.35 and HCO3 <15 *Get treatment early because DKA is fatal*
mEq/L)
Teach patient early signs and when to seek
Happens suddenly (there may be warning signs treatment:
present if the patient is monitoring their blood
glucose which will be elevated consistently (>300 Monitor glucose and ketones during illness every 4
mg/dL) hours, especially if dealing with illness/infection
Polyuria: due to the extreme levels of glucose in the If vomiting and cannot eat food or drink liquids notify
body that causes the water inside the cells to shift to doctor (if can tolerate drink liquids every hour)
the extracellular area. The kidneys try to compensate
by increasing urinary production to eliminate this Notify medical doctor if blood sugars are higher than
extra fluid but the kidneys cannot reabsorb all the normal or greater than 300 mg/dL consistently
glucose so it leaks into the urine. This Ketones present in the urine
causes OSMOTIC DIURESIS which causes SODIUM
AND POTASSIUM (along with calcium, phos) TO BE Excessive thirst, frequent urination, abdominal pain,
EXCRETED. nausea and vomiting, acetone breath
Tip for insulin administration: when priming tubing Kidneys: plays a role in reabsorbing glucose in the
for insulin infusion waste 50cc to 100cc (per renal tubules. However, there is too much glucose to
institution protocol) because insulin absorbs into the be reabsorbed so it leaks into the urine. This
plastic lining of the tubing. causesOSMOTIC DIURESIS which causes polyuria and
excretion of electrolytes (sodium, potassium,
Watch potassium levels very closely because insulin chloride). This leads to MAJOR DEHYDRATION.
causes K+ to move back into the cell
Important take-aways: NO KETOSIS or
Administer Potassium solution IV to combat ACIDOSIS in HHNS because there is just enough
this….note renal function before administering. insulin present that prevents the body from breaking
down fats for energy; therefore there is no build-up
of ketones.
Hyperglycemic Hyperosmolar Nonketotic Patients are going to present with HYPERGLYCEMIA
Syndrome (HHNS) NCLEX Review and DEHYRDATION.
A.K.A: Hyperosmolar Hyperglycemic State (HHS) CAUSES of Hyperglycemic Hyperosmolar Nonketotic
Definition of HHNS: a life-threatening condition of a Syndrome:
hyperglycemic state that affects patients Illness or infection (the patient isn’t aware their
with diabetes mellitus. It presents with an extreme blood glucose is high because they haven’t been
high blood glucose which causes the blood to become monitoring it)…most common in OLDER ADULTS
very concentrated “hyperosmolar” but without the
breakdown of KETONES (fats)
IMPORTANT: Happens gradually….remember Typically started out by giving unit IV bolus…then
glucose is going to be VERY VERY high (higher than start an infusion (checking blood glucose levels
glucose levels in DKA) around the clock…hospital protocols)…you will be
titrating the insulin base on blood glucose checks.
Remember the Mnemonics: HHNS (Heavy-
duty HYPERGLYCEMA) NOTE: if you rapidly bring a patient’s blood glucose
down (or up) the brain can’t cope and water will be
Signs & Symptoms of HHNS moved from the blood to the CSF and you will get
High glucose >600 mg/dL cerebral edema and increased intracranial pressure.
Dehydrated: dry mucous membranes Watch potassium levels very closely because insulin
causes K+ to move back into the cell
Fever
Administer Potassium solution IV to combat
Fatigue this….note renal function before administering.
Mental status changes (confusion, seizures) DKA vs HHNS
Coma Diabetic Ketoacidosis
Nursing Interventions for HHNS Affects mainly Type 1 diabetics
Goal: Hydrate, decrease blood glucose, monitor Ketones and Acidosis present
potassium levels and for cerebral edema, correct
acid-base imbalance (similar to the treatment of Hyperglycemia presents >300 mg/dL
DKA)
Variable osmolality
However, HYDRATION will helps just as well as
insulin due to the severe hydration experienced in Happens Suddenly
HHNS. The fluids will help hydrate the cell which will Causes: no insulin present in the body or
decrease glucose levels and help with electrolyte illness/infection
balance.
Seen in young or undiagnosed diabetics
Administering IV fluids: (depending on MD order)
such as 0.9% Normal Saline (start out with a bolus of Main problems are hyperglycemia, ketones,
this) and progress with 0.45% NS to hydrate the cells and acidosis (blood pH <7.35)
(depends on how dehydrated the patient is)…see the
lecture on hypotonic, isotonic, and hypertonic Clinical signs/symptoms: Kussmaul
solutions. breathing, fruity breath, abdominal pain
5% dextrose may be added to the 0.45% NS when Treatment is the same as in HHNS (fluids,
glucose is around 250 to 300 mg/dL. This will help electrolyte replacement, and insulin)
gradually bring the blood sugar down and help the Watch potassium levels closely when giving insulin
insulin do its job by removing the ketones. and make sure the level is at least 3.3 before
Administered insulin REGULAR (only type given administrating.
IV) and make sure K+ is normal >3.3 Hyperglycemic Hyperosmolar Nonketotic Syndrome
Affects mainly Type 2 diabetics Thyroid Storm
More likely to have mental status changes due to got an illness or experienced trauma/stress (septic,
severe dehydration due to hyperosmolarity DKA, surgery, trauma to the gland)
Treatments are the same as in DKA, however, fluid suffers from Grave’s Disease that is under treated or
administration helps just as much as insulin therapy they became sick
because of the correction of osmolarlity issue. not taking antithyroid medications properly
Blood pH will be normal (remember no acidosis as taking medications that increase thyroid hormones
in DKA) (Salicylates: ASA)
No Kussmaul breathing and fruity breath (because pregnancy
there is no KETOSIS)
radioactive iodine therapy (CT scan or as treatment)
remember the thyroid loves iodine and uses it to
make thyroid hormone
Tylenol NO Salicylates or cooling blankets Diarrhea (GI system working harder and faster)
Irritable Inderal: prevents the hyperthyroidism effects on
the body by blocking peripheral conversion of T3 and
Smooth skin/hair (increase blood flow) T4. This medication will help decrease heart rate,
UNIQUE S&S: blood pressure, and decrease heat intolerance (not
for people with asthma or history of
Ophthalmopathy: protruding eye balls bronchospasm…watch in diabetics…. can mask signs
and symptoms of hypoglycemia).
Goiter: overstimulation of the thyroid gland which
causes it to swell Treatments for Grave’s Disease
Pretibial Myxedema: red, swelling on the skin, Radioactive iodine: destroys the thyroid gland
lower legs, and feet that has an orange peel overtime and is a permanent cure compared to
texture…can advance to face, chest, arms medications….not for pregnant or nursing women
Nursing Interventions for Grave’s Disease Side Effects: Iodism- taste changes “metal taste”,
nausea, and swollen saliva glands
Monitor HR, BP, EKG, weight (at risk for weight loss
and will need a high calorie diet) Surgical Treatment: Thyroidectomy (removal of
the thyroid gland)
Keep patient in a cool, quiet environment
Watch for thyroid storm due to the manipulation of
Pharmacology Management: the gland causing extra T3 and T4 to leak into the
body….prevent by prepping with medications of:
Antithyroid medication: stop the thyroid from
synthesizing t3 and t4, doesn’t damage thyroid gland antithyroid meds, sodium iodide solution, beta
like radioactive iodine therapy blocker, glucocorticoids
Tapazole “Methimazole” (most common…fewer Educate about post-opt care: coughing and deep
side effect) common treatment for Grave’s Disease breathing and splinting neck when coughing
not taking thyroid replacement medications (some ****Watch for signs and symptoms of Synthroid
patient will abruptly stop them because they think toxicity which would present as signs and symptoms
they are not helping…medications take a while to see of hyperthyroidism (fast heart, feeling hot, sweating)
effects) Administered glucose IV for hypoglycemia
Thyroidectomy (removal of the thyroid gland) Keep patient warm with warming blankets as
Signs and Symptoms of Myxedema Coma prescribed
HCO3: increases >26 alKali ingestion of food (baking soda, milk, antacids)
increases bicarb level in the blood
Blood pH: increases >7.45
CO2: >45 or normal (may be normal but if Anticoagulant “citrate” (used as a storage agent in
increased this is the body’s way of trying to blood and during continuous forms of renal
compensate. Remember the respiratory replacement therapy) Caused from a massive
system tries todecrease the pH from its transfusion of whole blood (patient needs several
alkalotic state by causing hypoventilation ( bags of blood) and the body metabolizes the citrate
bradypnea). The respiratory system hopes that used in the blood as bicarb which increases the HCO3
if the CO2 increase enough it will cause the pH level in the body. Also, patients who undergo
to decrease and the kidneys will start to continuous forms of renal replacement therapy
excrete the bicarb which will hopefully (CRRT) (an alternative therapy for patients who can’t
decrease the overall HCO3. undergo hemodialysis) are affected by the citrate
used in the therapy.
Remember what normal values are:
HCO3 22-26 increase the bicarb level, Low potassium levels cause
reabsorption of HCO3-
Causes of Metabolic Alkalosis
Based on the cause: vomiting (give antiemetic Lab values expected in Metabolic Acidosis:
When this acidic phenomena is taking place in the work (such as electrolytes (chloride, bicarbonate,
body other systems will try to compensate to sodium) and calculates them to see the difference
increase the bicarb back to normal. One system that between the anions and cations.
In order to compensate, the respiratory system will is: 10-14 mEq/L) there is high anion gap metabolic
cause the body tohyperventilate by increasing acidosis going on. In other words the anion gap tells
Diarrhea (normal anion gap): profuse diarrhea leads EXCEPT with diarrhea or with Diamox usage
to loss bicarbonate, DKA (diabetic ketoacidosis) body which causes hypokalemia), n & v
is breaking down ketones and is not metabolizing Nursing Interventions for Metabolic Acidosis
extracellular to intracellular shift of K+ back branches into the bronchioles and ends in
Watch neuro status, safety, and place in seizure *The alveolar sacs are where gas exchange takes
What’s involved:…let’s look at normal breathing: decrease the blood’s pH back to normal…..so
HCO3 becomes <22.
1. Oxygen enters through the mouth or nose
REMEMBER (memorize) these lab values:
pH 7.35-7.45 Pain…rapid breathing (blowing off too much carbon
dioxide), Pregnancy (especially in 3rd trimester due
PaCO2 35-45
to changes of the respiratory tract), Pneumonia
HCO3 22-26
Neurological injuries from a head injury or stroke
(affects the respiration system of the brain which is
located in the medulla and pons)
metabolic needs of the body which causes the Neuro changes: Tired, lethargy, fast heart rate
respiratory center (medulla and pons) to try to
**Tetany, dysrhythmias, muscle cramps,
compensate by making the respiratory rate
positive Chvostek’s sign due
increased…hence exhaling too much carbon dioxide
tohypocalcemia and hypokalemia
(CO2)
Nursing Interventions for Respiratory Alkalosis
Aspirin toxicity: too much aspirin in the body leads to
hyperventilation due to the stimulation of the Teach patient breathing techniques to slow
Hyperventilation (excessive respirations) expelling signs and symptoms of low calcium and
Note: if there is any problem with the patient Drugs (opioids (fentanyl, morphine), sedation
breathing rate (too slow), alveolar sacs (damaged), or (versed), ….causes respiratory depression
diaphragm (weak) the patient can experience “hypoventilation….retain carbon dioxide….increase
respiratory acidosis. PaCO2 and decreased pH” ) & Diseases of the
neuromuscular system…Myasthenia gravis, Guillain–
*Main cause of respiratory acidosis
Barré syndrome (weakness of voluntary muscles
is bradypnea (slow respiratory rate <12 bpm which
affects the diaphragm….can’t expelled the carbon
causes CO2 to build-up in the lungs)
dioxide)
suction (pneumonia)
Stored mainly in the bones. The kidneys and
may need respiratory treatment (asthma) parathyroid play a role in the regulation of calcium
Causes of Hypophosphatemia
Pulmonary issues such as respiratory alkalosis
(under alkalotic conditions phosphate moves out of
Remember phrase: Low “Phosphate”
the blood into the cell which causes phosphate blood
Pharmacy: drugs such as aluminum hydroxide-based levels to decrease)
or magnesium based antacids cause malabsorption in
Hyperglycemia leads to symptoms of glycosuria,
the GI system, so no phosphate is absorbed through
polyuria, ketoacidosis which causes the kidneys to
the GI track and the lack of vitamin d (which plays a
waste phosphate
role in phosphate absorption).
Hyperphosphatemia
Osteomalacia (softening of the bones) fractures and
decreased bone density (alteration in bone shape),
Hyper: “excessive”
cardiac Output decreased
Phosphat: prefix for phosphate
Kills immune system with immune suppression and
decreases platelet aggregation (which leads to Emia: blood
increased bleeding)
Meaning of Hyperphosphatemia: High levels of
Extreme weakness, Ecchymoses from decreased phosphate in the blood
platelets
Normal Phosphate levels: 2.7 to 4.5 mg/dL (>4.5 is
Neuro status changes (irritability, confusion, hyperphosphatemia)
seizures)
Role of phosphate in the body: helps build bones
Nursing Interventions for Hypophosphatemia
and teeth and nerve/muscle function.
levels causing hypocalcemia or increase phosphate (calcium acetate) which is prescribed for patients in
levels (Hyperphosphatemia). ***Also, assess renal end stage renal failure (ESRF) to help keep phosphate
status (BUN/creatintine normal) before levels low. Phoslo is a phosphate binder and it
administering phosphorous because if the kidneys prevents the GI system from absorbing phosphate.
Phospho-soda overuse: phosphate containing Remember CRAMPS (same mnemonic used for
laxatives or enemas (Sodium Phosphate/Fleets hypocalcemia)
Enema) ….do not administer to patients with renal
Confusion
failure
Reflexes hyperactive
Hypoparathyroidism due to under secretion of
parathyroid hormone. The parathyroid plays a role in
Anorexia
maintaining calcium and phosphate levels and it
normally inhibits reabsorption of phosphate by the Muscle spasms in calves or feet, tetany, seizures
kidneys. In hypoparathyroidism, there is under
secretion of PTH which causes phosphate to become Positive Trousseau’s Signs, Pruritis
Will have many of the same symptoms as Magnes: prefix for magnesium
hypocalcemia because remember phosphate and
Emia: blood
calcium function oppositely.
Signs & Symptoms Hypermagnesemia
Meaning of Hypermagnesemia: High levels of
magnesium in the blood
Remember: Every system of the body is “Lethargic”
Normal Levels of Magnesium: 1.6 to 2.6 mg/dL (>2.6 (opposite of hypomagnesemia where the body
Magnesium plays a role in: major cell functions like Note: You will typically only see symptoms in severe
transferring and storing energy, regulation of cases of hypermagnesemia (mild cases patient will be
include:
Monitor cardiac, respiratory, neuro system,
Magnesium containing antacids and renal status. Put patient on cardiac monitor
laxatives***(Mylanta, Maalox) (watch for EKG changes)
3. Withhold foods high in magnesium, such as: Normal Levels of Magnesium: 1.6 to 2.6 mg/dL (<1.6
hypomagnesemia)
Remember:
“Always Get Plenty Of Foods Containing Large Numb
Magnesium plays a role in: major cell functions like
ers ofMagnesium”
transferring and storing energy, regulation of
parathyroid hormone PTH (which also plays a role
Avocado
incalcium levels). In hypomagnesemia, the release of
Green leafy vegetables calcium is inhibited and that is why you will see
Peanut Butter, potatoes, pork hypocalcemia if you have low magnesium level.
Magnesium also plays a role in the metabolism of
Oatmeal
carbs, lipids, and proteins, and blood pressure
Fish (canned white tuna/mackerel) regulation.
Administer diuretics that waste magnesium (if Limited intake Mg+ (starvation)
patient is not in renal failure) such as Loop and
Other electrolyte issues cause low mag levels
Thiazide diuretics
(hypOkalemia, hypOcalcemia)
Patient in renal failure patient prep for dialysis
Wasting Magnesium kidneys (loop and thiazide
IV calcium may be order to reverse side effects
diuretics & cyclosporine…stimulates the kidneys to
of Magnesium (watch IV for infiltration…prefer
waste Mag)
central line)
Hypomagnesemia Malabsorption issues (Crohn’s, Celiac, proton-pump
inhibitors drugs “Prilosec, Nexium, Protonix”…drug
Hypo: “under”
family ending in “prazole” Omeprazole,
Glycemic issues (Diabetic Ketoacidosis, insulin EKG changes prolonging of PR interval and
Hypertension, hyperreflexia
Avocado
Oranges
Hypercortisolism (Cushing’s Syndrome),
Milk hyperventilation
Hypernatremia
Increased intake of sodium (oral or IV route)
Hyper: “excessive”
GI feeding (tube) without adequate water
Meaning of Hypernatremia: excessive sodium in Sodium excretion decreased (body keeping too much
Normal sodium levels: 135 to 145 mEq/L (>145 Aldosterone overproduction (Hyperaldosteronism)
sodium is hypernatremic)
Loss of fluids (dehydrated) infection (fever),
Hypernatremia is a water problem rather than a sweating, diarrhea, and diabetes insipidus
Role of sodium in the body: It’s an important Remember: “No FRIED foods for you!” (too much
electrolyte that helps regulate the amount of water salt)
inside and outside of the cell (water and sodium
Fever, flushed skin
loves each other).
Doctor may order to give isotonic or hypotonic Sodium also play a role in muscle, nerves, and organ
solutions such as 0.45% NS (which is function.
hypotonic and most commonly used). Give Types of Hyponatremia
hypotonic fluids slowly because brain tissue is
at risk due to the shifting of fluids back into the Euvolemic Hyponatremia is where the water in the
cell (remember the cell is dehydrated with body increases but the sodium stays the same. The
hypernatremia) and the patient is at risk causes include: SIADH (Syndrome of inappropriate
for cerebral edema. In other words, the cell antidiuretic hormone secretion) which is due to the
can lyse if fluids are administered too quickly. increased amount of secretion of antidiuretic
hormone. This hormone retains water in the body
Educate patient and family about sign and
which dilutes sodium. Other causes: diabetes
symptoms of high sodium level and proper
insipidus, adrenal insufficiency, Addison’s disease etc.
foods to eat.
Hyponatremia
Hypovolemic Hyponatremia is where the patient
has lost a lot of fluid and sodium. Causes: vomiting,
Hypo: “under/beneath”
diarrhea, NG suction, diuretic therapy, burns,
Watch cardiac, respiratory, neuro, renal, and GI Meaning of Hypercalcemia: excessive calcium in the
status blood
Hyperparathyroidism (high parathyroid hormone Monitor cardiac, GI, renal, neuro status
causes too much calcium to be released into the Assess for complaints of flank or abdominal
blood) pain & strain urine to look for stone formation
Increased intake of calcium (excessive use of oral Decrease calcium rich foods and intake of
calcium or Vitamin D supplements) calcium-preserving drugs likethiazides,
supplements, Vitamin D
Glucocorticoids usage (suppresses calcium
To help you remember foods high in calcium
absorption which leaves more calcium in the blood)
remember the phrase:
Hyperthyroidism
“Young Sally’s calcium serum continues to randomly
Calcium excretion decreased mess-up”
with Thiazide* diuretics & renal failure, cancer of the
Yogurt
bones
Sardines
Adrenal insufficiency (Addison’s Disease)
Cheese
Lithium usage (affects the parathyroid and causes
phosphate to decrease and calcium to increase)
Spinach
Signs & Symptoms of Hypercalcemia
Collard greens
“The body is too WEAK”
Tofu
Weakness of muscles (profound)
Rhubarb
EKG changes shortened QT interval (most common)
Milk
and prolonged PR interval
Moderate cases of Hypercalcemia
In addition, phosphorus and calcium affect each
other in the opposite way. For instance, if
Administer calcium reabsorption
phosphorus levels are high in the blood, calcium will
inhibitors: Calcitonin, Bisphosphonates,
decrease and vice versa. They are always doing the
prostaglandin synthesis inhibitors (ASA, NSAIDS)
opposite (remember this because it is important for
Severe cases of Hypercalcemia the causes of hypocalcemia.
Causes of Hypocalcemia
and stored in the bones and then excreted by the (phosphorus and calcium do the opposite of each
kidneys. other)
Vitamin D helps play a role in calcium absorption. Using medications such as magnesium supplements,
laxatives, loop diuretics, calcium binder drugs
Nursing Interventions for Hypocalcemia
Mobility issues
Signs & Symptoms of Hypocalcemia Safety (prevent falls because patient is at risk
for bone fractures, seizures precautions, and
Remember “CRAMPS”
watch for laryngeal spasms)
arm where the blood pressure is being taken will Young Sally’s calcium serum continues to randomly
start to contract involuntarily (see the teaching mess-up.
tutorial on a demonstration).
Yogurt
Signs of Chvostek’s (nerve hyperexcitability of the
Sardines
facial nerves. To elicit this response you would tap at
the angle of the jaw via the masseter muscle and the Cheese
facial muscles on the same side of the face will
Spinach
contract momentarily (the lips or nose will twitch).
Collard greens
Tofu
Rhubarb
Milk
Drugs (laxatives, diuretics, corticosteroids)
Signs & Symptoms (tricks on how to easily (if cortisol levels are excessive enough, they will start
Normal Potassium Level 3.5-5.1 (2.5 or less is very Signs & Symptoms of Hypokalemia
dangerous)
Try to remember everything is going to be SLOW and
Most of the body’s potassium is found in the LOW. Don’t forget potassium plays a role in muscle
intracellular part of the cell compared to the and nerve conduction so muscle systems are going to
extracellular which is where sodium is mainly found. be messed up and effect the heart, GI, renal, and the
Blood tests measure potassium levels via the outside breathing muscles for the lungs.
of the cell (extracellular fluid).
Weak pulses (irregular and thread)
Remember potassium is responsible for nerve
Orthostatic Hypotension
impulse conduction and muscle contraction.
Depression ST, flat or inverted T wave and
Causes of Hypokalemia
prominent u-wave
Oranges
Watch heart rhythm (place on cardiac monitor…most
are already on telemetry), respiratory status, neuro, Tomatoes
Meaning of hyperkalemia: excessive potassium in Respiratory failure (due to the decreased ability to
use breathing muscles or seizures develop)
the blood
Normal Potassium is 3.5 to 5.1. Anything higher 7.0 Decreased cardiac contractility (weak pulse, low
Most of the body’s potassium is found in the Early signs of muscle twitches/cramps…late
Remember that potassium is responsible for nerve Nursing Interventions for Hyperkalemia
Remember the phrase “The Body CARED too much Stop IV potassium if running and hold any PO
Strawberries,
The cell loves to be in an isotonic state and when
something happens to make it unequal (like with
Spinach
hypotonic or hypertonic conditions) it will use
fIsh osmosis to try to equal it out.
Administer a hypertonic solution of The cell has the same concentration on the inside and
glucose and regular insulin to pull the outside which in normal conditions the cell’s
potassium into the cell intracellular and extracellular are both isotonic.
Isotonic, Hypotonic, & Hypertonic Fluids for
Nursing Students It is important to be familiar with what fluids are
isotonic and when they are given.
First, let’s get familiar with the cell and how tonicity
Isotonic fluids
works through osmosis.
0.9% Saline
The cell is divided into two parts: (intracellular &
extracellular). Each part is made up of a solution
5% dextrose in water (D5W)**also used as a for increased cranial pressure(can cause fluid to
hypotonic solution after it is administered shift to brain tissue), extensive
because the body absorbs the dextrose BUT it burns, trauma (already hypovolemic) etc. because
is considered isotonic) you can deplete their fluid volume.
Lactated Ringer’s
Hyper: excessive
Isotonic solutions are used: to increase the
Tonic: concentration of a solution
EXTRACELLULAR fluid volume due to blood loss,
surgery, dehydration, fluid loss that has been loss
The cell has an excessive amount of solute
extracellularly.
extracellularly and osmosis is causing water to rush
Hypotonic out of the cell intracellularly to the extracellular area
which will cause the CELL TO SHRINK.
Hypo: ”under/beneath”
Hypertonic solutions
Tonic: concentration of a solution
3% Saline
The cell has a low amount of solute extracellularly
5% Saline
and it wants to shift inside the cell to get everything
back to normal via osmosis. This will cause CELL 10% Dextrose in Water (D10W)
SWELLING which can cause the cell to burst or lyses. 5% Dextrose in 0.9% Saline
0.225% Saline (1/4 NS) When hypertonic solutions are used (very
cautiously….most likely to be given in the ICU due to
0.33% saline (1/3 NS)
quickly arising side effects of pulmonary edema/fluid
Hypotonic solutions are used when the cell is over load). In addition, it is prefered to give
dehydrated and fluids need to be put back hypertonic solutions via a central line due to the
intracellularly. This happens when patients develop hypertonic solution being vesicant on the veins and
diabetic ketoacidosis (DKA) or hyperosmolar the risk of infiltration
hyperglycemia.