RNSG 1533 Raising the Bar for Success

Concept: Metabolism

Diabetes Type 1/Diabetes Type 2

 What is the definition of type 1 diabetes? Chronic endocrine disease characterized by
absence of insulin production by the pancreas resulting from autoimmune destruction of
the beta cells
 When is the most common age range for diagnosis of type 1? Most often occurs in those
younger than 40 years
 What is the definition of type 2 diabetes? Endocrine disorder that results from a
combination of resistance to insulin action and impaired insulin secretion, which
produces hyperglycemia and related complications to many systems of the body. The
insulin produced is insufficient or poorly utilized by tissues.
 Name the complications associated with diabetes. Atherosclerotic CV and peripheral
vascular disease, peripheral neuropathy, retinopathy, glaucoma, cataracts, hearing
impairment, stroke
 What are A1C levels? What is meant by “overall glucose control”? Levels that show the
amount of glucose attached to Hb on RBCs over a 3-month period. Overall glucose
control is maintaining a euglycemic blood glucose level
 Medications for this exemplar:
o Insulins – rapid-acting, short-acting, intermediate-, long-acting, pre-mixed
o Oral antidiabetic drugs – page 633 pharmacology book
 Know your classes of insulin medications. (onset, peak, duration)
o Rapid-acting
 What should it be combined with? Longer-acting insulin
 What is nursing priority with rapid acting?
o Short-acting
 When is it usually given? 30-60 minutes before meals
o Intermediate-acting
o Long acting
 Nursing interventions for
o Exercise in the diabetic patient?
o Diabetic diet?
o Infection in a diabetic?
o Avoiding injury?
o Prep for surgery?

Gestational Diabetes
 When is gestational diabetes diagnosed? Between 24 and 28 weeks
 What are nursing concerns/complications for the infant? Macrosomia (i.e. large body
size), hypoglycemia, respiratory distress syndrome, hypocalcemia, polycythemia,
hyperbilirubinemia
 What teaching would you provide for the mother during pregnancy? Diet, exercise,
monitor blood glucose, oral hyperglycemic patients, insulin prn, fetal surveillance, carry
snacks as hypoglycemia may occur between meals
  What medication is used to treat women with gestational diabetes? Insulin and
antidiabetic drugs
 Medications for this exemplar:
o Insulin
o Oral antidiabetic drugs

Graves’ Disease – Hyperthyroidism

 Name the signs and symptoms of Graves’ Disease. Weight loss, nervousness,
palpitations, rapid HR, feeling hot, sweating; emotionally hyperexcitable, irritable,
apprehensive; can’t sit quietly, palpitations, rapid HR at rest and on exertion, poor heat
tolerance, perspire unusually freely; continuously flushed skin; increased appetite, weight
loss, fatigability, weakness, amenorrhea, changes in bowel function
 What lab values would the nurse be concerned with for Graves? Increased T3 and T4,
serum protein-bound iodine is increased, cholesterol and total lipids are decreased, TSH
is decreased, thyroid autoantibodies are significantly elevated
 What teaching should be included in a diet?
 What medications are used to manage Graves’ disease? Antithyroid, radioactive iodine
therapy,
 Medications for this exemplar:
o Antithyroid – Thioamides, iodine solutions (page 610 pharmacology book)
o Beta blockers – propranolol (Inderal)
o What are the complications/side effects of these medications?
 Antithyroid – medication sensitization, fever, rash, urticaria,
agranulocytosis, thrombocytopenia
 Beta blockers – abrupt withdrawal may exacerbate hyperthyroidism
symptoms, including thyroid storm
 Nursing interventions
o Decrease the effects of excessive thyroid hormone
 Decrease environmental stress (lights, visitors, noise)
 Cool environment
 Well balanced meals (high in calorie/small meals 4-6 times per day)
 Protect eyes of patient with complications-
 Artificial tears
 Excess for tearing or dry cornea
 Eye patches at night
 Salt restrictions and elevate head of bed to reduce periorbital
edema
o Prevent complications of thyroid storm
 Identify risk factors leading up to thyroid storm
 Inadequate pre-op preparation
 Infection
 Increased emotional lability
 Surgical removal of thyroid gland
o After first radioactive ablation
 Assess for increase in hyperthyroid state
  Increase temperature, dehydration
 Tachycardia
 Pulmonary edema
 Nausea, vomiting, diarrhea
 Increase agitation
o Maintain homeostasis in patient experiencing thyroid storm
 Decrease body temperature
 Keep room cool
 Acetaminophen to decrease fever
 Propranolol to treat cardiac issues
 Oxygen to meet metabolic demands
 IV fluids
 Hydrocortisone for shock and adrenal insufficiency
 Iodine preparations to decrease T4 output
 Propylthiouracil or methimazole to inhibit formation of thyroid hormone
o Provide pre-op nursing interventions if surgery is indicated:
 Demonstrate neck support for after surgery
 Administer iodine preparations to decrease vascularity of the thyroid gland
 Baseline for post-op comparison
o Nursing care after thyroidectomy
 Maintain Semi-Fowlers position to avoid tension on the suture line
 Pain medications for pain
 IV fluids until nausea and swallowing difficulties subside
 Check dressing for bleeding
 Assess for hematoma around wound
 Evaluate calcium levels – parathyroid damage
 Evaluate temperature – increase might be sign of thyroid storm
o To prevent respiratory distress
 Assess for noisy breathing and increased restlessness
 Evaluate voice changes (laryngeal edema)
 Keep suction and tracheotomy set near by
o Decrease radiation side effects-
 Treat throat dryness with sips of water and ice chips
 If continues, use saltwater gargle
 Home care
o Have thyroid levels checked every 6-12 months
o Lifelong thyroid replacement medications
o Notify MD if excessive fatigue or tachycardia and tremors become a problem

Hypothyroidism
 Name the signs and symptoms of hypothyroidism.
o Extreme fatigue, hair loss, brittle nails, dry skin, numbness and tingling of fingers
may occur; menorrhagia, amenorrhea, loss of libido; subnormal body temp and
HR; weight gain; thinning hair; cold intolerance
 What lab values would the nurse be concerned with hypothyroidism? Decreased serum
T3 and T4 values, serum TSH increases with thyroid insufficiency, total cholesterol,
alkaline phosphatase, and triglycerides are elevated
 Why use caution in administering sedative and hypnotics? They may induce profound
somnolence, lasting far longer than anticipated, leading to narcosis. They may lead to
respiratory depression, which can be fatal
 What medications are used to manage hypothyroidism? Synthetic levothyroxine
(Synthroid, Levothroid),
 Medications for this exemplar:
o Synthroid (levothyroxine)
o Thyroid hormone
o What are the complications/side effects of these medications? Skin reactions and
hair loss sometimes seen; symptoms of hyperthyroidism as drug dosage is
regulated; less predictable effects are associated with cardiac stimulation
(arrhythmias, HTN), CNS effects (anxiety, sleeplessness, headache), and
difficulty swallowing and atresia
 Nursing interventions
o Assist to return to normal balance
 Begin thyroid replacement
 About 7 days before patient will feel better
 Provide warm environment
 Prevent/treat constipation
o Assess
 Decrease body weight
 Intake and output
 Decrease visible edema
 Energy level and mental alertness should increase in 7-14 days
 Evaluate cardiac response to medications
o Teach requirements for health maintenance
 Need for lifelong drug therapy
 Pts with diabetes need to evaluate blood glucose more frequently