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NURS 517 Week 1: Endocrine and Diabetes - Coggle Diagram
NURS 517 Week 1: Endocrine and Diabetes
Antidiabetic Medications: Insulin
Adverse effects
Hypoglycemia
Nursing considerations
Teach client to rotate sites to prevent lipohypertrophy, fibrofatty masses at injection sites; do not inject into these masses
Only regular insulin can be given IV; all can be given SQ
Indications
Type 1 diabetes
Type 2 diabetes not responding to oral hypoglycemia medications
Gestational diabetes not responding to diet
Herbal interactions
MOA
Reduces blood glucose levels by increasing glucose transport across cell membranes
Enhances conversion of glucose to glycogen
Types of Insulin
Hyperglycemia Reversal Medications
Indications
Acute management of severe hypoglycemia
Adverse effects
Hypotension
Bronchospasm
Dizziness
MOA
Hormone produced by alpha cells of the pancreas to stimulate the liver to change glycogen to glucose
Nursing considerations
May repeat in 15 minutes if needed
IV glucose must be given if client fails to respond
Arouse clients from coma as quickly as possible and give carbohydrates orally to prevent secondary hypoglycemia reactions
Types
glucagon
Adverse effects
N/V
Nursing considerations
Given SQ or IM, onset is 8-10 min with duration of 12-27 min
Should be part of emergency supplies for diabetics
May repeat in 15 min if needed
dextrose
Antidiabetic Medications: Oral Hyperglycemia Medications
Nursing considerations
Monitor serum glucose levels
Avoid alcohol
Teaching for disease: dietary control, symptoms of hypoglycemia and hyperglycemia
Good skin care
Herbal interactions
Basil, bay leaf, chromium, enchinacea, garlic, ginseng may decrease blood glucose
Bee pollen, ginkgo biloba, glucosamine may increase blood glucose
Indications
Type 2 diabetes
Types
Biguanides
metformin
Nursing considerations
No effect on pancreatic beta cells; decreases
Not given if renal impairment
Can cause lactic acidosis
Avoid alcohol
Do not give with alpha-glucosidase inhibitors
Adverse effects
Diarrhea
Abdominal discomfort
Nausea
Gliptins
sitagliptan
Adverse effects
Hypoglycemia
Upper respiratory infections
Nursing considerations
Enhances action of incretin hormones
Sulfonylureas
glimepiride
Adverse effects
GI symptoms and dermatologic reactions
Nursing considerations
Only use if there is some pancreas beta-cell functions
Stimulates release of insulin from pancreas
Many drugs can potentiate or interfere with actions
Take with food if GI upset occurs
GLP-1 Receptor Agonist
MOA
Activates GLP-1 receptors which increases glucose-dependent insulin secretion, decreases glucagon, and slows gastric emptying
Indications
Type 2 diabetes
Reduction of major cardiovascular events
Side effects
N/V
Diarrhea
Constipation
Abdominal discomfort
Adverse effects
Acute kidney injruy
Gallbladder disease
Hypoglycemia
Thyroid tumor warning
Pancreatitis
Nursing considerations
Report signs of pancreatitis
Monitor for dehydration/renal problems
Watch for GI side effects
Assess for hypoglycemia if used with insulin or sulfonylureas
Monitor blood glucose and A1C
Screen for thyroid tumor risk history
Thyroid Replacement Medications
Indications
Hypothyroidism
Adverse effects
Nervousness
Tachycardia
Weight loss
MOA
Increases metabolic rate of body
Nursing considerations
Obtain history of client's medications
Enhances action of oral anticoagulants, antidepressasnts
Decreases action of insulin, digitalis
Obtain baseline vital signs
Monitor weight
Avoid OTC drugs
levothyroxine (Synthroid)
Adverse effects
Nervousness, tremors
Insomnia
Tachycardia, palpitations
Dysrhythmias, angina
Nursing considerations
Tell client to report chest pain, palpitations, sweating, nervousness, shortness of breath to health care provider
Antithyroid Medications
Indications
Hyperthyroidism
Thyrotoxic crisis
Adverse effects
N/V
Diarrhea
Rashes
Thrombocytopenia
Leukopenia
MOA
Antithyroid agents - inhibit oxidation of iodine
Iodine - reduce vascularity of thyroid gland; increase amount of inactive (bound) hormone; inhibit release of thyroid hormones into circulation
Nursing considerations
Changes vital signs or weight and appearance may indicate adverse reactions, which should lead to evaluation of continued
Medications
methimazole (Tapazole)
MOA
↓ thyroid hormone production
Indications
Hyperthyroidism (main choice)
Adverse effects
Leukopenia, fever, rash, sore throat, jaundice
Nursing considerations
Inhibits synthesis of thyroid hormone by thyroid gland
Check CBC and hepatic function
Give with meals
Report fever, sore throat to HCP
propylthiouracil (PTU)
MOA
↓ thyroid hormone + ↓ T4→T3 conversion
Indications
Hyperthyroidism (with pregnancy)
Thyroid storm
iodine-131
MOA
Destroys thyroid tissue
Indications
Hyperthyroidism
Adverse effects
Feeling of fullness in neck
Metallic taste
Leukemia
Nursing considerations
Destroys thyroid tissue
Contraindicated for women of childbearing age
Fast overnight before administration
Urine, saliva, vomit radioactive 3 days
Use full radiation precautions
Encourage fluids