• Abnormal infrequency or irregularity of defecation
• Causes - medications, chronic laxative use, immobility, fatigue, weakness, diet, lack of exercise
• Increased risk in elderly

• Person's elimination problem is not consistent with what he or she believes to be normal

• <3x bowel movements per week
• Abdominal distension, indigestion
• Headache, fatigue
• Straining of elimination, results of small, hard, or dry stool

• Hypertension - forceful strain causes increase to high BP levels --> can cause rupture to major brain arteries
• Impaction - stool cannot be expelled
• Hemorrhoids - dilated anal veins
• Fissures - grooves or cracks in body tissues
• Megacolon - loss of normal tone that obstructs passage of colon --> can lead to perforation

• Polyethylene glycol and electrolytes (i.e. Colyte)

• Increased frequency of bowel movements, >3x a day
• Increased amounts of stool and altered consistency
• S/S - perianal discomfort, incontinence, urgency
• Causes - infections, medications (i.e. antibiotics), tube feeding, various disease processes

• Increased frequency and content
• Abdominal cramps or distension
• Borborgymus noise, movement of gas
• Painful spasmodic contractions of anus
• Powerful straining, sometimes painful

• Watery stool - disorders of small bowel
• Loose, semi-solid - disorders of large bowel
• Blood, mucus, or pus - inflammator enteritis, colitis
• Voluminous, greasy - instestinal malabsorption
• Stool with oil droplets - pancreatic insufficiency
• Nocturnal diarrhea - diabetic neuropathy
• Unexplained diarrhea - possible C-Diff

• Fluid and electrolyte imbalance, dehydration
• Metabolic acidosis
• Hypotension, cardiac dysrhythmias
• Skin care issues and dermatitis

• Constipation - usually 65+ with loose fitting dentures choosing foods that are soft, processed and low in fiber
• Diarrhea - elderly become dehydrated quickly, develop low potassium levels; client on Digoxin at risk of Digoxin toxicity if hypokalemia develops

• Trauma
• Neurologic disorders
• Inflammation/infection
• Chemo/Radiation
• Impaction
• Laxative abuse/medications
• Age

• Bowel training: set schedule to establish bowel regularity
• Skin care: maintain integrity; skin protective products
• Emotional support

_____% to _____% suffer from Irritable Bowel Syndrome (IBS) symptoms in the United States

• 12% to 14%
• Also known as "spastic colon"
• More common in women than in men

• Heredity
• psychological stress
• Depression/anxiety
• High-fat diet
• Alcohol/Smoking use

• May be related to serotonn signaling (present in GI mucosa, vasoconstrictor)
• Infection/irritation
• Vascular/metabolic disturbance
• There is no evidence of inflammation or tissue changes in intestinal mucosa

• Alterations in bowel patters
• Pain
• Bloating/abdominal distension

• The inability of the digestive system to absorb one or more major vitamins, minterals or nutrients

• Keyfind: diarrhea or frequent, loose, bulky and foul-smelling stool with high fat content and often gray in color
• S/S - similar to IBS
• Manifested by weight loss, vitamin and mineral deficiency

• Acute Inflammatory Intestinal disorder
• Small, fingerline appendage attached to cecum
• If empties inefficently and lumen is small --> prone to obstruction and infection
• usually occurs b/t ages of 10-30 y/o
• Appendix becomes inflamed, kinked, or occluded --> fills with pus and leads to bacterial overgrowth, ischemic appendix --> gangrene can occur

• Appendicitis

• pain in the lower right quadrant
• low grade fever, N/V
• loss of appetite
• constipation may occur - avoid constipations

• 50% of presenting cases tenderness is lovated at McBurney's point: use rebound tenderness to see if pain is intensified when pressure is released
• Psoas sign - pain that occurs on slow extension of right thigh when client lays on left side
• Obturator sign - pain occurs with passive internal rotation of flexed right knee

• pain is more diffused
• Abdominal distension r/t paralytic illeus
• client condition worsens

• Perforation of the appendix occurs w/in 24 hrs; fever 100 F or greater; toxic appearance; abdominal pain and tenderness
• Abscesses can occur localized of purulent material
• Immediate surgery is needed; laproscopic approach; if perforation occurs with antibiotics, drains can be placed

• Sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
• Most common site is the sigmoid colon (95%)
• Associated with age and low-fiber diet
• Usually Rx by colonoscopy, or CT scan

• Diverticulosis: multiple diverticula without inflammation or symptoms
• Diverticulitis: infection and inflammation results from food and bacteria retained in diverticulum

• rigid, boardlike abdomen, loss of bowel sounds
• Peritonitis - S/S of shock can occur, fever
• Abscess formation
• Bleeding of the diverticula may erode areas of arterial branches --> rectal bleeding
• Colovesical fistula can occur and create abdominal passage between the bowel and bladder

• immediate surgical intervention for perforation, hemorrhage or obstruction
• 2 types of surtical intervention:
• stage resection of inflammed area removed with end to end anastomosis
• stage resection diseased colon resected, no anastamosis; end of bowel brought out of abdomen (colostomy)

• CT-guided drainage procedure with IV antibiotics
• 6 wks recovery; further surgery can be performed to prevent future episodes

• Fluid intake of 2L/day
• soft foods with increased fibers
• Daily intake of bulk laxatives
• Opiod analgesics

• increased abdominal pain
• abdominal rigidity
• elevated WBC (sign of inflammation
• hyperpyrexia
• tachycardia/hypotension

• Inflammation of the peritoneum, serous membrane lines and abd. cavity and viscera
• Cause - bacterial infection or can occure secondary to fungal or mycobacterial infection, organisms from GI, or reproductive organs
• Most common sources: E-coli, Klebsiella, Streptococcus

• leakage of contents from abd. organs into abd. cavity usualy r/t inflammation, infection, trauma, perforation
• Can cause edema in tissues, cavity fills with WBC, debri and protein and blood

• Isotonic fluid replacement by IV and IV colloid replacement
• NGY to relieve abd. distension and promote intestinal fxn
• Analgesic meds
• Antibiotic therapy of broad spectrum until organisms are identified

• Ex. Chron's Disease and Ulcerative Colitis
• Occurs in people 15-30 y/o and 50-70 y/o; most prevalent in Jewish descent
• Most important risk factor: positive family history

• chronic inflammation of GI tract through all layers
• Most commonly found in ascending color, distal ileum
• Has periods of remission
• Begins with edema and thickening of mucosa; ulcers begin to appear with a "cobblestone" look

• prominent right lower quadrant abd. pain and diarrhea unrelieved by defecation
• Abd. tenderness and spasms
• weight loss, malnutrition, anemia
• Excessive fat in the feces (steatorrhea)

• Ulcerative and inflammatory disease of mucasol and submucosal layers of colon and rectum
• seen in caucasians and people of Jewish decent more commonly
• 5% develop colon cancer

• Diarrhea, passage of mucus and pus, left lower quadrant abd. pain, rectal bleeding
• Anorexia, wt. loss, N/V, dehydration
• passage of stool 10/12x times a day

• Toxic megacolon - inflammation extends to muscularis --> no longer can contract
• S/S - fever, abd. pain, distension, N/V
• Rx - NGT suction, antibiotics, ileostomy, colectomy

• high protein, high calorie
• supplements for iron and vitamins
• IV therapy for electrolyte balance

• Sctrictureplasty - laparoscopic guided, blocked or narrow sections are widened and intestines remain intact
• Small Bowel resection - diseased areas of small intestines are resected remaining portions are anastomised

• protocolectomy w/ ileostomy - complete resection of colon, rectum and anus
• " " with ileal pouch - procedure of choice
• Colectomy with ileostomy - surgical opening into ileum or small intestine that drains fecal matter from the ileum
• Continent ileostomy - creation of continent ileal reservoir and create a stoma

• Manifestations - increased gas secretions, edema and necrosis, perforation of intestinal wall and peritonitis, fluid and gas accumulate above blockage
• S/S - no fecal matter, no flatus, may pass blood or pus, abd. pain, fecal vomitting, shock and septic

• Manifestations - obstruction comes from build up of fluid and gas, distension, perforation, strangulation of blood supply, necrosis
• S/S - shape of stool is altered passing through obstruction, blood loss in stool, anemia, wt. loss, anorexia

• Manifestations - blood in stool, symptoms of obstruction, abd. pain or rectal pain
• > 85 y/o, family history, obesity, alcohol use, smoking
• May start as polyp and spread

• Adjuvant therapy - administer to pt with Duke's class C (positive nodes), chemo therapy
• Surgical management - segmental resection with anastamosis, abdominal perineal resection, temp colostomy or permanenyt colostomy

• A mass of tissue protruding in the bowel; can occur anywhere, most common in large intestines
• S/S - rectal bleeding, large obstructive symptoms
• Removal of polyp and microscopic exam should be used

• light weight, stronger, water resistant; reaches rigidity within 30 minutes
• More commonly used for simple fractures of upper and lower extremities

• less costly, better molding, heavy, not water resistant
• take 24-27 hrs to dry
• When moving pt with a wet cast, only use the palms of the hands to prevent indentation
• Cast is hard, firm, white and shiny in appearance when fully dry
• Use petaling for sharp edges of the cast

• use for simple and stable fractures, sprains, tendon injuries
• far easier to apply than casts
• easily removed, do not compromise circulation

• used to provide support, control movement and prevent additional injury
• custom fitted
• can be custom made
• using brace allows for more movement of the body part, injury is not as well stabilized as with a cast

• Pain - relieved by analgesics, hot or cold packs and elevation
• Pallor - compromised blood flow may be related to contriction of cast or splint
• Pulselessness - circulation has been compromised
• Parasthesia - numbness and tingling, or absence of feeling
• Paralysis - loss of fxn to the body part

• tight casting or constrictive splinting occurs when increased pressure within confined space compromises blood flow/tissue perfusion
• can cause ischemia and neuromuscular damage
• Manifestations - dusky, pale appearance, cool temp, delayed cap. refill, unrelenting pain, pain that occurs or intensifies with passive ROM

• surgical incision into the fascia to rlieve the pressure in the muscle compartment

• deterioration of body systems as a result of musculoskeletal inactivity and can cause atrophy or loss of strength

• used for femoral fractures or after hip joint surgeries
• remain in place for several weeks to several months
• monitor bowel sounds, distension, N/V

• manage open fractures with soft tissue damage, pins hold position of the fracture
• elevate above the level of the heart
• avoid osteomyelitis

• Buck's extension traction - immobilize fractures of the femur and hip before surgery
• Cervical head halter - chronic neck pain
• Pelvic traction - treat lower chronic back pain
• Skeletal traction - immobilize, position a gracture of the femur, tibia, or cervical spine

• inspect site every 8hrs, cleanse the pins according to policy
• if there is crusting at the site, do not remove; acts as barrier from bacteria

• used to treat severe joint pain and disability, management of fractures, and joint necrosis
• common replacements - knee, hip, fingers

• open reduction

• internal fixation

• Athroplasty

• replacement of one of the articular surfaces

• removal of a body part

• bone scan, CT, MRI
• clients need a hep lock/saline lock placed to administered to place IV contrast
• MRI, CT can be done without it

• evaluates bone mineral density, use xray or ultrasound
• client must lie still during test performance

• to detect bone tumors, fractures, necrosis and degenerative disease
• requires injection of radioisotope
• clients can experience flushing when isotope is injected, no radioactive hazard; drink plent of fluids to help with elimination

• direct vizualization of a joint thru endoscope
• treat joint disorders, tears, disease
• takes pace in OR with local anesthetic
• DSD to cover the sutures
• compress to control swelling, use ice to control edema
• keep joint extended and elevated

• Circulation: the color is pale, cyanotic, temperature is cool and the capillary refill is 3+ seconds
• Motion: weakness and paralysis
• Sensation: paresthesia (numbness), unrelenting pain, pain on stretch

• joint aspiration of synovial fluid for examination or to relieve pain
• helps diagnosis septic/inflammatory conditions
• alleviate discomfort and pain, use ice to reduce edema
• look for infection, bleeding, fever, cool skin

• provides info on muscle and nerve response
• used to look at nerve damage
• needle electrodes are inserted into muscles
• assess if pt is taking anticoagulant; avoid lotions and creams

• determines the structure and composition of bone marrow, bone, muscle or synovium
• sample taken and analyzed
• give analgesics, assess for edema, bleeding, pain, fever, and infection

• disorder of rapid bone turnover
• more common in men, risk increases with age
• bone reabsorption by bone cells with increased bone cell activity
• risk for fractures, arthritis

• inadequate mineralization of bone
• skeleton is soft, weak, tender
• failed calcium absorption from excessive loss of calcium
• loss of vitamin D

• bone turnover is altered and bone resoprtion is greater than rate of bone formation = loss of bone mass
• bones become brittle, fragile and breaks easily under stress
• results in compression fractures of the spine, neck, wrist, femur

• postural changes such as protruding abdomen, kyphosis
• fatigue
• loss of height

• diet rich in calcium, vitamin D; increase calcium during adolescence
• daily intake of at least 3 glasses of milk or other calcium foods (broccoli, salmon, cheese)
• calcium intake should be 1,000-1,3000 mg daily
• 20-30 minutes of aerobic exercise daily, weight bearing exercise

• impaired movement of the rotator cuff of the shoulder
• occurs from repetitive overhead movement overhead
• S/S - edema, pain, tenderness, limited movement, atrophy
• Rx - oral NSAIDS, corticosteroid INJ, hot and cold applications, exercise

• median nerve at the wrist is compressed by flexor tendon, edema, soft tissue mass, or skeletal encroachment
• usually wome 30-60 y/o
• causes - repetitive hand and wrist movements, RA, diabetes, trauma

• collection of gelatinous material near the tendon sheaths and joints
• appears as round, firm bump
• frequent in women 50 y/o>
• Rx - corticosteroid INJ, surgical excision

• progressive contracture of fascia causing flexion of fourth, fifth and third fingers
• autosomal dominant
• more prominent in males Scandinavian, Celtic heritage; 50+ y/o
• S/S - dull ache, morning numbness, cramping, stiffness
• Rx - surgery

• soft tissue injury by blunt force
• S/S - pain, swelling, and discoloration

• Pulled muscle injury to muscolotendinous unit
• S/S - pain, edema, muscle spasm, loss of function in muscle

• injury to ligaments and supporting muscle fiber around the joint
• S/S - joint is tender, movement is painful, edema; pain increases 2 to 3 hours after injury

• articular surgaces of the joint are not in contact
• traumatic dislocation is an emergency with pain change in contour, axis, and length of limb and loss of mobility

• Rest, Ice, Compression, Elevation
• after the inflammatory stage (24-72 hrs), heat can be applied to relieve muscle spasm
• severe sprains can take 3-6 weeks before exercises are initiated

• True. Testing for crepitus can produce further tissue damage and should be avoided.

• Complete - break across the section of bone
• Incomplete - break through only part of the bone
• Closed/Simple - does not break in the skin
• Open or compound/complex - skin or mucous membrane extends to the fractured bone

• Grade I - clean wound less than 1 cm
• Grade II - larger wound w/o extesive soft tissue damage or tearing
• Grade III - contaminated, soft tissue damage, traumatic amputation

• immobilize body part
• splint the joints proximal and distal to suspected fracture site
• open fracture - cover with sterile dressing
• do not attempt to reduce the fracture

• True - phantom limb pain is perceived in the amputated limb, caused by the severing of the peripheral nerves.

• relief of pain, absence of altered sensory perceptions
• wound healing
• acceptance of body image, resolution of grieving processes
• restoration of physical mobility

• removal of body part, limb
• necessary due to vascular disease (i.e. diabetes); account for 82% of amputations
• amputation is to relieve symptoms, and improve quality of life

• False - avascular necrosis is death of tissue secondary to poor perfusion and hypoxemia. Delayed union is prologation of expected healing time for a fracture.

• elbow fractures - monitor for signs of compartment syndrome; active exercises and ROM are encouraged to prevent limitation of joint movement (4-6 weeks)
• Radial, ulnar, wrist and hand fractures - early fxnal rehab exercises; active ROM exercises of fingers and shoulders

• acute compartment syndrome resulting from swelling or damage to brachial artery

• pelvic - management depends on type and extent; treated with bedrest and symptom management; early mobilization
• hip - surgery to fixate fracture; care similar to pt undergoing hip replacement

• stable fx - bedrest until comfortable; encourage fluids, fiber, exercise; anti-embolism stockings; skin care; monitor bowel sounds
• unstabe fx - immediate treatment in ER, stabilize pelvis, compress bleeds; client at risk for shock

• edema, deformed thigh, cannot move hip or knee
• clients can develop shock from blood into tissues
• assess same as any other fracture; compare with unaffected leg
• management: fracture is immobilized, weight bearing limits, PT including ROM, knee exercises

• lower leg, foot and hip exercises to preserve muscle fxn
• early ambulation, PT, weight bearing
• knee exercises

• leg is shortened and adducted and externally rotated
• client will report hip and groin pain in the medial side of the knee
• lay client on uninjured side with pillow between the legs to keep affected side in abduction

• closed - bone fragments put into alignment through traction; extremity held in position to apply cast, splint
• open - surgical approach, fragments aligned; insertion of pins, wires, screws to hold bone fragments in place till healing occurs; require prophylactic antibiotics; closure is delated to permit wound drainage and debridment

• shock - hemorrhage noted in trauma w/ pelvic and femoral fx near femoral artery
• fat embolism - after fx of long bones
• compartment syndrome - severe decrease in blood flow to tissues
• delayed union/nonunion - healing does not occur within expected time frame

• painful SNS problem
• occurs infequentily, most often in upper extremities after trauma
• S/S - severe burning pain, edema, flushing, sweaty, fluctuates cold to hot
• elevate the extremity after injury or surgery

• abnormal formation of bone near bone
• usually resorbs over time

• insulin-producing cells in pancreas are destroyed by autoimmune process
• little or no insulin is produced; onset is acute before 30 y/o
• affects 5-10% of those with diabetes
• genetic predisposition

• decreased sensitivity to insulin; impaired cell fxn results in decreased production
• 90-95% of those with diabetes; onset 30+ y/o
• treated with diet and exercise

• polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased appetite)
• fatigue, weakness, sudden vision changes, numbness, dry skin, slow wound healing
• Type 1 may have sudden weight loss

• True - if the concentration of glucose in the blood exceeds this renal threshold, the kidneys may not reabsorb all of the filtered glucose the glucose will then appear in the urine (glycosuria)

• more common in Type 1
• reult of deficiency of insuline, high acidic ketones are formed, metabolic acidosis occurs
• preceded by polyuria, polydipsia, dehydration, N/V, coma if not treated
• breath has fruity otor r/t ketoacids

• glucose intolerance with its onset during pregnancy
• secretion of placental hormones, causing insulin resistance
• should be tested at 24-28 wks
• management - diet, blood glucose monitoring
• blood glucose levels during pregnancy = 105 mg/dL

• normalize insulin activity and blood glucose levels
• 3-4 insulin injections per day or SUBQ infusion plus blood glucose monitor
• educate the client

• caused by lack of insulin; ketosis is minimal or absent
• loss of water and electrolytes, hypernatremia
• manifestations - hypotension, dehydration, tachycardia
• high mortality rate - 10-20%

• rehydration, insulin administration
• monitor fluid volume and electrolyte status
• educate the patient

• BGL >300-1,000
• ketone bodies in blood and urine
• electrolytes vary with dehydration

• low blood glucose level 50-60 mg/dL
• too much insulin, excessive physical activity, not enough food

• 15 g of fast-acting carbohydrate glucose tablets
• 4-6 oz of juice and regular soda, provide snack with protein and carbs (peanutbutter, graham crackers)
• restest blood glucose in 15 minutes

• if patient cannot swallow or is unconscious, SUBQ or intramuscular glucogon
• 25-50 ml of 50% Dextrose solution IV

• headache, N/V, tremors, sweating
• confusion, hunger, slurred speech
• tingling around mouth
• nursing action - usually occurs rapidl, must give 15 g of fast acting carbohydrate, 4-6oz juice, soda

• 40>
• seizures

• polydipsia, polyuria, polyphagia, weakness, weight loss, syncope
• nursing action - encourage water intake, check BGL, assess for DKA

• Rapid Acting: Lispro (Humalog), Aspart (NovoLog); onset 5-15 mins, peak 30 mins-1 hr, duration 2-4 hrs
• Short Acting: (Humalog R, Novolin R) onset 1-1 1/2 hr, peak 2-3 hrs, duration 4-6 hrs
• Intermediate Acting - NPH (Humulin N, Novolin N), onset 2-4 hrs, peak 4-12 hrs, duration 16-20 hrs
• Long acting: Glargine (Lantus), Detemir (Levemir), onset 1 hr, no peak, duration 24 hrs

• client needs to be instructed to eat no more than 5-15 minutes; expected to cover the increase in glucose after meals

• called Regular insulin (marked R on the bottle)
• administered 20-30 before meal, alone or with long acting
• only insulin approved for IV use

• called NPH or Lente
• not crucial to be taken 30 minutes before meal, but should eat some food around the time of onset and peak

• also called peakless
• insulin absorbed very slowly over 24 hrs, given once a day, cannot be mixed
• must be given at the same time each day to prevent overlap

• rapid and short acting insulins cover increase in glucose after meals, immediately after the injection
• intermediate insulins cover subsequent meals
• long acting insulins cover 24 hrs

• deep, rapid, long expirations - "Kussmaul"
• can lead to DKA

• Obesity due to insulin resistance

• Synthroid before breakfast

• weight gain

• Calcium gluconate

• T - temperature
• R - ropes hang freeling
• A - alignment
• C - circulation check
• T - type/location of fx
• I - increase fluids
• O - overhead trapeze
• N - no weights on bed or floor

• elevate residual limb
• discuss phantom limb pain
• evaluate healing
• compresion dressing to prevent edema
• observe for bleeding

• promote good circulation
• promote comfort
• promote level of mobility

• ovaries - estrogen, progesterone
• testes - testosterone, inhibin

• parathormone deficiency caused by surgery
• results in hypocalcemia, hyperphosphatemia
• S/S - tetany, numbess, tingling, bronchospasm, anxiety, irritability, depression
• positive Chvostke's and Trousseau's signs

• extreme elevation of calcium levels > 13 mg/dL
• Rx - rapid dehydration - IV isotonic saline fluids; urine 100-150 mL/hr; administer calcitonin
• if edema occurs - stop saline, administer loop diuretic

• S/S - elevated serum calcium, bone decalcification, N/V, dysrhythmia, HTN, constipation, fatigue
• Rx - hydration therapy, encourage mobility, fluids, restrict calcium
• more women than men
• can cause hypercalcemic crisis

• surgery performed after thyroid fxn has returned 4-6 wks
• Beta-adrenergic blocking agent (ie. propranolol) to reduce heart rate
• medications to prolong clotting stopped before surgery
• subtotal thyroidectomy results in prolonged remission with goiter

• thyroidectomy treatment of choice for thyroid cancer
• modified or radical neck dissection; radioactive iodine for metastasis
• preoperative - reduce stress and anxiety to avoid thyroid storm
• preoperative education - dietary guidance, avoid caffiene, explanation of tests, head and neck support

• may occur with dose of radioactive iodine is administered
• life threatening - high fever, tachycardia, altered mental state, coma, weight loss, diarrhea
• management - reduce body temp/heart rate, IV fluids with dextrose, iodine to decrease T4 from thyroid gland

• contraindicated in pregnancy, should be given a test 48 hrs previous to treatment
• do not conceive for 6 months after treatment
• goal: eliminate hyperthyroid state with administration of radiation; iodine is retained in thyroid and the cells are then destroyed over several weeks
• clients at high risk - older adults w/ cardiac disease - give Methimazole 4-6 wks prior to treatment, stop 3 days before treatment and start 3 days after treatment

• take on an empty stomach, 30 minutes before eating
• dose based on patient's baseline tests (CBC, WBC, liver profile)
• inhibits stages in thyroid hormone synthesis or hormone release
• most common: Propylthiuracil, MMI, Tapazole

• posterior lobe of pituitary gland, deficiency in ADH
• S/S - excessive thirst, dilute urine, occurs secondary to trauma or infection, hypokalemia, hypercalcemia
• withold flluids for 8-12 hrs, replace ADH, give Desmopressin (can cause abd. pain)

• excessive secretion from pituitary gland
• S/S - cannot excrete urine, retain fliuds, develop sodium deficiency
• Rx - eliminate underlying cause, restrict fluids, Lasix, monitor I/O, daily wt, mental status

• thyroid hormone deficiency
• S/S - extreme fatigue, hair loss, brittle nails, dry skin
• severe - low body temp, elevated cholesterol, CAD, atherosclerosis
• Rx - Synthroid or Levothroid, dosage based on TSH levels

• excessive synthesis and secretion of thyroid hormone
• cause - Grave's disease, inflammation
• S/S - nervousness, irritable, heart palpatation, heat sensitive, sweating, flushed, tremors
• Rx - depends on cause, radioactive idoine

• severe life threatening hypothyroidism
• S/S - hypothermic, hyponatremia, hypoglycemia, bradycardia, shock
• Rx - maitain vital fxns, administer Thyroxine

• adreocortical insufficiency
• S/S - muscle weakness, anorexia, fatigue, dark pigment of mucous membranes, low BGL, depression
• Rx - direct towards combating shock, restore circulation, admin fluids and corticosteroids, legs elevated

• Hypothyroidism

• hypoglycemia b/c it is life threatening; look for tremors

• normal blood glucose level until around 3 AM, and the level then rises
• body has greater need for insulin in early morning
• Rx - change the time of insulin injection of evening intermediate/long acting insulin

• progressive increase in blood glucose from bedtime to morning
• frequently seen if evening NPH dose is administered before dinner
• prevented bymoving the evening dose of NPH insulin to bedtime
• Rx - increase the evening pre-dinner or bedtime dose of insulin before evening meal

• nocturnal hypoglycemia or elevated glucose at bedtime; decrease around 2-3 AM followed by AM rebound
• Rx - decrease evening or bedtime dose of intermediate acting insulin, increase snack at bedtime

• high glucose levels contribute to damage of small blood vessels
• causes scarring which inhibits activity of capillaries
• promotes poor wound healing

• lowers blood glucose by decreasing the insulin resistance of body tissues
• stimulates insulin receptor sites to lower blood glucose
• adverse reactions: hypoglycemia, edma, impaired platelets, possible liver fxn, hyperlipidemia
• implications - monitor liver fxns, tell patient about decrease in efficacy of contraceptives

• drugs blunt the sugar levels after meals, delays absorption of carbs in intestines and slow glucose into circulation
• adverse rxns: hypoglycemia, abd. pain, distension, diarrhea
• must be taken with first bite of food to be affective

• stimulate pancreas to secrete insulin; rapid action short half-life
• can be used alone or in combination with Metformin or thiazolidinediones to improve glucose control
• adverse rxns: hypoglycemia, drug interactions
• should be taken only if able to eat a meal immediately

• lowers blood sugar by stimulating release of insulin by bate cels of the pancreas
• adverse rxns: hypoglycemia, N/V, weight gain, dermatitis
• give once a day with first meal, avoid in patients with allergy to sulfa

• action the same as the first generation
• more potent
• adverse rxns the same as first generation
• if taken with beta-adrenergic blocking agent, can mask hypoglycemia
• avoid sulfa allergies

• lowers serum glucose by inhibiting hepatic glucose production and increased sensitivity of peripheral tissue to insulin
• adverse rxn: lactic acidosis, hypoglycemia if used with insulin, GI disturbance
• Metformin

• acute kidney failure and lactic acidosis with use of iodine contrast agent
• Metformin should be stopped 48 hrs prior and 48 after use of contrast agen or until kidney fxn is normal

• bedtime snack; carbohydrates with protein should be taken to prevent unexpected hypoglycemia

• stabilize rapid bone turnover and increase bone mass
• given orally daily or weekly
• oral preparations need to be given on an empty stomach upon getting up in the morning with full glass of water
• must remain sitting upright for 30-60 minutes after administrating
• adverse effects: can develop esophageal or gastric ulcer

• serum calcium levels

• hypoparathyroidism
• decreased activity leads to decreased calcium concentration and increased phosphorus concentration

• hyperglycemia