Addisons
Absent of steroids LOW
Small, weak, Tanned
Low
Small,weak,Tanned
Low Blood pressure "MOST Critical "
Low weight=Water loss
Low Temperature= "Cold intolerance"
Low Hair "alopesia
Low Mood "Depression"
LOW Energy "Fatigue"
LOW sodium BELOW 135 (Normal 135-145)
Low glucose
Slow or absent periods (Amenorrhea)
HIGH
Pigmentation "Bronze Pigment"
(No acanthosis nigricans)
P-Potassium (K+) over 5.0 (Normal 3.5-5.0)
Hyperkalemia
Potassium Pumps
Muscle Spasms
ECG: Peaked T waves,ST elevation
Addison
Absent Steroids LOW
Small,Weak, Tanned
ADDSS
A ADDED Pigmentation + potassium
"Bronze pigmentation" "hyper pigmenation"
"Hyperkalemia" Over 5.0 (Normal 3.5-5.0)
D Decreased weight (Water loss=Weight loss)
NOT TRUNCAL OBESITY
D DECREASED BP,hair, Sugar & energy= Low BP CAN KILL the PATIENT in ADDISONIAN CRISIS
"Fatigue" "Alopesia" "Hypoglycemia" "Hypotension"
S SODIUM loss 135- or LESS
(135-145 NORMAL)
S SALT craving
** NOT hairy NOT "Hirsutism"= Hair suit &
** NOT thin skin is Cushing
...
Cushings
Cushion of steroids HIGH
Big, Round, Hairy
Big Blood pressure (over 140 Systolic )( Normal 120/80)
BIG Glucose & Sodium Na+ NCLEX TIPS
BIG Belly "Truncal obesity" NCLEX TIPS
BIG Face "Moon Face" NCLEX TIPS
BIG Buffalo hump "Fat pad" NCLEX TIPS
BIG HAIR "Hirsutism" NCLEX TIPS
BIG Stretch marks "Purple Striae " NCLEX TIPS
BIG Red Face "Rosy cheeks"
BIG Infections "Slow wound Healing" " NCLEX TIPS
BIG Risk for Fractures Brittle Bones
Cushing
Cushion of Steroids HIGH
Big, Round, Hairy
CUSH
C Cushion
U Unusual HAIR Growth
"Hirsutism" (Hairy suit)
Skin
"Purple Striae" "Butterfly mark"
H HIGH Sugar,BP, Weight
...
Addison VS. CUSHING Causes SHIELDING & PROTECTING
Surgery
STRESS= WORK/SCHOOL,Emotional
SEPSIS= Infection
STRENUOUS Activity
Cushing
HIGH Steroids --> ON! Cushing
S- STEROIDS
S-Sugar (Cortisol)
S-Salt (ALdosterone)= BIG SWELLING TO A BIG ROUND BODY WITH BIG blood pressure BIG SODIUM OR HYPERNATREMIA
S-Sex & Hair (Androgens) Leading to a big hairy body called Hirsutism
Addison CAUSES
Absent LOW Steroids
A-A UTOIMMUNE
(body kills adrenals or Pituitary
D-D ISEASES
Cancer,Infections (TB/HIV)
D- DAMAGE
Adrenal Hemorrhage (Trauma)
...
Cushing
Cushion HIGH Cortisol
STEROIDS- sone Prednisone
Long Term Therapy
Seeing with Asthma , COPD, Rheumatoid arthritis patients
TUMOR
High Cortisol can also come from inside the body called an endogenous cause like -->
(Pituitary,Adrenal)
SMALL CELL LUNG NCLEX TIPS
...
Addison vs Cushing Treatments
Addisons:
ADD some Steroids "-sone"
Increase the Dose!= Teach patients to tell their doctor about increased stress from work, school, or emotions.
We have to increase their steroids doses during stressful time!
STRESS
S-SURGERY
S-Strenuous Exercise
S-Sepsis
DIET
HIGH In Protein,
Carbs & Sodium
DON'T ABRUPTLY
STOP Steroids! (Leads to Addisonian Crisis) BP SO low it will cause DEATH, aka DEATH. NCLEX TIPS
DON'T
Believe this medication will cure you
INDEFINITELY
"Lifelong" hormone replacement NCLEX TIPS
WEAR Medical Bracelet , This is Forever drug
Cushing:
Control Causes
Cut out TUMOR or
Steroids (Slowly decreases)
Addison vs Cushing Treatments
7S's STEROIDS PRECAUTIONS
S-SWOLLEN (Water gain=Weight gain)
Key terms: "Sudden" "Excessive", "Rapid"
REPORT:1 lb in 1 day, or 2-3lbs in a few days
S Sepsis (Infections or Illness)
"LOW WBC" Fever is PRIORITY NCLEX TIPS
Low WBC Leads to slow wound healing which is HUGE risk for a FEVER AND INFECTION 100 OR 37.8 Degree Celsius
S SUGAR INCREASED
"Hyperglycemia" NCLEX TIPS
over 115 steroids increase the sugar
So we increase the INSULIN
S Skinny
Muscle & Bones "Osteoporosis " (R/F FX)
Big Risk for fractures
S SIGHT
(Cataract risk) refer to Optometrist NCLEX TIPS
Addison Treatments
PREVENT CRISIS:
S SLOWLY taper off
(NEVER abruptly stop) NCLEX TIPS
S STRESS or Surgery
(Increase dose) NCLEX TIPS
CUSHING: Cut it out
OUT side body (meds)
EXogenous
S -Slowly DECREASE
S- Steroids "-Sone"
prednisone
Hydrocortisone
INside body
INdigenous
CUT OUT TUMORS
REmoval of organ
REplace these hormones!
"Life Long" Hormone replacement
Addison vs Cushing Causes:
ADDisonian "Adrenal" Crisis
ADDED STRESS
(Surgery, Sepsis)
ABRUPT STOP
of Steroid "-sone prednisone
DROP IN BLOOD PRESSURE
HYPOTENSIVE SHOCK (Normal 120/80)
ADDisonian ADRENAL CRISIS
What to do when a patient has LOW BLOOD PRESSURE ?
WHAT IS THE FIRSTY PRIORITY ACTION AS THE NURSE?
1st ACTION
ADD STEROIDS IV PUSH!
"-sone" Hydrocortisone, Prednisone
DEHYDRATION
(IV NS 0.9% Normal saline)
DEXTROSE
(D50 IV FLUID)
DKA
Diabetic Ketoacidosis TYPE 1
Dry& High sugar 250-500 + NCLEX TIPS
Keytones & Kussmaul respiration
(rapid fruit breath) NCLEX TIPS
Abnormal pain NCLEX TIPS
Acidosis Metabolic Ph 7.35 or LESS
(Normal 7.35- 7.45)
HHS (HHS)
Hyperglycemic Hyperosmolar
Non-ketotic Syndrome Type 2
HHHNS
H HIGHEST SUGAR OVER 600 +
H HIGHTER Fluid Loss
Extreme Dehydration
H Head Change-Neurological
Manifestations "Confusion"
N NO Abdominal Pain, NO ketones
(NO Acid, NO kussmaul)
S Slower Onset & Stable Potassium 3.5-5.0)
Diabetic Ketoacidosis TREAMENTS ?
D Dehydration FIRST (0.9% normal saline) NCLEX TIPS
K Kill the sugar (SLOWLY ) Prevent low sugar
** Hourly Blood Sugar check* land the plane slow & smooth
SUGAR over 250= We give IV Insulin ** Regular Insulin ONLY
BELOW 200 blood sugar (OR Ketones resolve ) = SQ insulin + D50 IV
A add Potassium K + YES even if Normal 3.5-5.0)
During IV Insulin NCLEX TIPS
IN -SULIN =Sugar & Potassium+ IN THE CELL DROP TOGETHER
Potassium pumps the heart
Potassium IV (Normal 3.5-5.0)
1. First Action =Heart Monitor)
2.Never Push= DEATH
3. ONLY 10-20 mg MAX per HR= Full 60 minutes
IV !!! (IV PUMP)
4. Slow infusion (If arm burns)
HIGH POTASSIUM (5.0)+
HIGH PUMP
Peaked T waves, ST elevation
Low Potassium (Below 3.5)
Flat T wave, ST depress
Hyperglycemic Hyperosmolar TREATMENTS!
Non-ketotic Syndrome Type 2
HHHNS
H Hydration FIRST 0.9% Normal saline NCLEX TIPS
S Stabilize sugar (Insulin)
Cautions: Insulin IV =ONLY Regular Insulin NCLEX TIPS
IV drip
IV tiltration
SQ Injection & IV
SQ only
DKA VS. HHNS Nursing Intervention
RE-ASSESSMENT = Blood sugar + Rehydration
Hourly Blood sugar check
RE-HYDRATION
STABLE BLOOD PRESSURE & Cap Refill (Under 3 second)
Skin color & warm temp
Urine output
30 mL/hr +
Urine
Low specific gravity
1.005-1.030
SIADH
"Soaked Inside"
SIADH we STOP Urinating
D-Desmopressin
D- Decrease Urine Output "Pressin" the BP up!
CAUTION"Headache" Priority!
Low Na+ (135 or less)> Seizure> DEATH!
SIADH "Soaked"
Syndrome of Inappropriate Antidiuretic Hormone
1. S Stop urinating ( Low urine output)
2.. S Sticky & THICK "Urine" HIGH Specific Gravity 1.030+
3.. S SOAKED Inside "Low & Liquidy" Labs
HYPOosmolality (LOW) NCLEX TIPS)
HYPOnatremia below 135 Na+ (LOW) Nclex tips
Serum sodium of 125 mEq/L
4. S SODIUM Low ! (Headache Early Sign)
5.S SEIZURES - NCLEX Key word: Headache, Confusion
6. S SEVERE HIGH blood pressure=Since SIADH , we stopped urinating and now we're swelling inside. Blood pressure will be up as well as edema will be up.
7. S STOP ALL FLUIDS + GIVE Salt + Diuretics
to prevent those seizure from the low sodium
(NO IV or drinking) + (IV 3% Saline + Eat Salt)
DI "Dehydrated"
"Die" ADH!
Diabetes Insipidus
1. D DIURESE "Drain" fluid (HIGH urine output)
2. D DILUTED urine low specific Gravity (1.005)
3 D D RY Inside "High & Dry" Labs
HYPER osmolality (HIGH) NCLEX TIPS
HYPERnatremia over 145 Na+ (HIGH)
4. D Drinking a lot "thirsty"
5. D DEHYDRATED Dry Mucosa & skin
6. D DECREASED blood pressure
7. D DESMO pressin "Vasi pressin" (ADH)
Decrease Urine Output= AND also increases blood pressure by pressin on the veins NCLEX TIPS
Death by HEADACHE ! (Low Na+) 135 or less
For example: BLOOD PRESSURE 80/62 mm Hg
So remember since Desmopressin decreases urinary output ,It can also decrease sodium causing deadly headches which again leads to seizure.
SIADH Causes
S Small cell lung cancer NCLEX TIPS
S SEVERE Brain Trauma (trauma/surgery)
S Sepsis infection of brain (meningitis)
DI Diabetes Insipidus
D -Damage to brain
(Tumors,Trauma, Surgery)
SIADH Vs. DI TREAMENTS
DAILY WEIGHTS
(NOT weekly)
W WEIGHT GAIN= Water Gain
What does the nurse expect to find in a patient with syndrome of inappriate antidiuretic hormone ? Select all that apply
1.Low blood osmolality= We have Liquidy labs
2. Increased serum osmolality
3. Low urine Specific gravity = sticky thicky urine
4. Hyponatremia= Low liquidy labs
5.Decreased urine output= SIADH WE STOP urinating
1.Low blood osmolality= We have Liquidy labs
4. Hyponatremia= Low liquidy labs
5.Decreased urine output= SIADH WE STOP urinating
When caring for a patient with SIADH, what does the nurse expect to implement? Select all that apply?
1. IV maintenance fluid 0.9% normal saline
2. Fluid Restriction
3. Sodium restriction= we have low sodium in SIADH very liquidy labs we need to ADD the sodium
4. Seizure precautions
5. Monitor Urine I & O (Intake & output)
6. Mreasure weights weekly
2. Fluid Restriction
4. Seizure precautions
5. Monitor Urine I & O (Intake & output)
A client with a brain tumor develops diabetes insipidus, which data should nurse expect to find ? Select all that apply?
1. Dark urine with increased specific gravity
2. High blood serum osmolality
3. Weight gain with edema
4. Increased thirst
5. Sodium level below 135 = With DI High sodium labs
6. Urine output 30 mL/hr or less
2. High blood serum osmolality
3. Increased thirst
A client is newly prescribed desmopressin nasal spray, which statement by the client indicates further education is needed? Select all that apply
Dead by headache
1. Frequent headaches are normal
2. I will make sure to restrict my water intake
3. This drug is used to decrease my frequner urination
4. I am glad this drug is able to treat my syndrome of inappropriate antidiuretic hormone
5. I will record my output closely while taking this drug
6. I will make sure to weight myself daily
1. Frequent headaches are normal
4. I am glad this drug is able to treat my syndrome of inappropriate antidiuretic hormone
6. I will make sure to weight myself daily