- About 59% laryngeal cancer is originates glottic site.
- Laryngoscopy and biopsy are used to diagnose laryngeal cancer.
- Hoarseness of voice and sore throat, pain less neck mass, dysphagia,
change in voice haemoptysis and foul breath odour are sign of laryngeal cancer.
- Cordal stripping, cordectomy, partial laryngectomy and total
laryngectomy are surgical intervention in laryngeal cancer.
- Nurse place the client in high fowler’s position after laryngectomy.
- Avoid swimming, showering and using aerosol spray after laryngectomy.
- Oesophageal speech; mechanical devices (electrolarynx) and
tracheoesophageal fistula are speech rehabilitation following laryngectomy.
- Prostate cancer is slow growing malignancy; most prostate cancer are adenocarcinomas
arising from androgen dependent epithelial cells.
- The risk of prostate cancer increases in men with each decade after the
age of 50 years.
- Bone metastasis is main concerns in prostate cancer.
- Prostate cancer is asymptomatic in early stage.
- Prostate cancer is diagnosed by biopsy of prostate.
- Luteinizing hormone may be prescribed to slow the rate of growth of
prostate cancer.
- Radical prostatectomy can be performed via a retropubic, perineal and suprapubic.
- Transurethral resection of the prostate (TURP) may be performed for
palliation in prostate cancer.
- Sterility occurs after prostatectomy.
- In suprapubic prostatectomy prostate gland remove by an abdominal
incision with bladder incision.
- In retropubic prostatectomy prostate gland is remove by a low abdominal
incision without opening the bladder.
- In perineal prostatectomy the prostate gland is remove by an incision
made between scrotum and anus.
- In continuous bladder irrigation (CBI) expect red to pink urine for 24
hours, turning to umber in 3 days.
- Continuous feeling of an urge to void is normal in CBI.
- Following TURP nurse monitors client for transurethral resection
syndrome or severe hyponatremia caused by excessive absorption of bladder
irrigation during surgery. (water intoxication)
- If the urinary catheter becomes obstructed turn off the CBI and irrigate
the catheter with 30 to 50 ml of normal saline.
- In bladder cancer chemotherapy the alkylating chemotherapeutic agent is
instilled into the bladder.
- Following instillation, the client position is rotated every 15 to 30
minutes, starting in supine position & avoid lying on a full bladder.
- Gross or microscopic, painless haematuria are sign of bladder cancer.
- Common sites of metastasis of bladder cancer liver, bones and lungs.
- Oncological emergency in cancer patient: (a) Sepsis and disseminated intravascular coagulation (DIC); (b) Syndrome of inappropriate antidiuretic hormone (SIADS); (c) Spinal cord compression; (d) Hypercalcemia; (e) Superior vena cava syndrome (SVC); (f) Tumor lysis syndrome
- In syndrome of inappropriate antidiuretic hormone (SIADS) the water reabsorption increases due to production of cancer
cells substance that are mimic of antidiuretic hormone.
- More serious effects of the SIADS is water intoxication due to low
sodium level in serum.
- Spinal cord compression occurs when tumor directly enters in the spinal
cord.
- Hypercalcemia is the late manifestation of extensive malignancy that
occur when often with bone metastasis, when releases calcium into the
bloodstream.
- Superior vena cava syndrome occurs when the superior vena cava is
compressed or obstructed by tumor growth.
- Superior vena cava syndrome commonly associated with lung cancer and lymphoma.
- Early sign of Superior vena cava syndrome occurs in morning and includes edema of the face
especially around the eyes and tightness of the shirt or blouse collar (Stoke’s
sign).
- Tumor lysis syndrome occur when large quantity of tumor cells are destroyed
rapidly intracellular components such as potassium and uric acid release into
the bloodstream faster than the body eliminate them.
- Hyperkalemia, hyperphosphatemia with resultant hypercalcemia and
hyperuricemia (cause acute renal failure) are features of tumor lysis syndrome.
- In tumor lysis syndrome IV glucose and insulin is given to treat
hyperkalemia.
- In tumor lysis syndrome allopurinol is given to excrete purines.
- The antineoplastic medication are two types cell cycle phage specific
medication and cell cycle phage non-specific medication.
- IV route is most common for administering chemotherapy medication.
- The chemotherapy dosing is usually based on total body surface area
(BSA).
- The side effects of chemotherapy result from the effects of the antineoplastic
medication on normal cells.
- The side effects of chemotherapy are mucositis, alopecia, anorexia,
nausea and vomiting, diarrhoea, anemia low WBC count, thrombocytopenia and
infertility with sexual alterations.
- Cell cycle specific drugs: (a) Antimetabolic agents: affects the S phage. (b) Mitotic inhibitors: affects M phage. (c)Topoisomerase inhibitors: affects G2 and S phage.
- Cell cycle non-specific: Alkylating agents and antitumor antibiotics.
- When platelets count falls below 20000 cells/ mm3 the spontaneous and
uncontrolled bleeding can occur.
- Nurse who are pregnant should avoid chemotherapy preparation and administering
of chemotherapy.
- The chemotherapy client has need for contraception because these drugs
have teratogenic effects.
- Live vaccines should not be administered in chemotherapy client.
- Signs of anaphylactic reaction dyspnea, chest tightness or pain,
pruritus or urticaria, tachycardia, flushed appearance, anxiety or agitation,
hypotension with decrease sensorium.
- If anaphylactic reaction occur nurse immediately assess the client
respiratory status and stop medication immediately.
- Alkylating agents breaks the DNA helix, thereby interfering with DNA
replication.
- Cisplatin is a platinum compound may cause ototoxicity, tinnitus,
hypokalemia, hypocalcemia, hypomagnesemia and nephrotoxicity.
- Cyclophosphamide may cause alopecia, suppression, hemorrhagic cystitis
and hematuria.
- Nurse with hold the antineoplastic medication if the platelet counts
less than 75000 / mm3 or the neutrophils count less than 2000 / mm3 and inform
the doctor.
- Cyclophosphamide and Ifosfamide are medication that cause hemorrhagic
cystitis. So, nurse encourage the client to drink fluid 2 to 3 liter per day
during therapy.
- Interfere with DNA and RNA synthesis of cells by antitumor antibiotics
medication.
- Pulmonary toxicity can occur with bleomycin.
- Antimetabolic medications halt the synthesis of cell protein.
- Antimetabolic medication are cell cycle phage specific and affect the S
phage.
- Nurse when administering fluorouracil or methotrexate instruct the
client to use sunscreen and protective clothing to prevent photosensitivity reaction.
- Leucovorin is prescribed to prevent toxicity of methotrexate. This is
known as leucovorin rescue.
- Mitotic inhibitors are cell cycle phage specific and act on the M
phase.
- Vincristine are neurotoxic manifested as numbness and tingling in the
fingers and toes, constipation and paralytic ileostomy.
- Topoisomerase inhibitor are cell cycle phage specific and act on G2 and
S phases block the enzyme needed for DNA synthesis and cell division.
- Etoposide and Teniposide are topoisomerase inhibitor.
- Hormonal medication and enzyme suppress the immune system and block
normal hormones in hormone sensitive tumors.
- Asparaginase impaired the pancreatic function.
- Hormonal medication altered the sex characteristic masculinizing effect
in women (chest and facial hair, menses stop) and feminine manifestation in men
(gynecomastia).
- Tamoxifen citrate decreases the effects of oestrogen.
- Tamoxifen may cause edema, hypercalcemia and elevated cholesterol and
triglycerides level.
- Immunomodulators stimulate the immune system to recognize cancer cells
and take action to eliminate or destroy them.
- Interferon alfa -2a, interferon alfa -2b, interferon alfa-n3, and
Aldesleukin are the example immunomodulators.
- Colony stimulating factors induce more rapid bone marrow recovery after
suppression by chemotherapy.
- Filgrastim and epoetin alfa are colony stimulating factors.
- Monoclonal antibodies are used in targeted therapies.
- Alemtuzumab, Gemtuzumab and Rituximab are example of monoclonal
antibodies.
- Altretamine is cytotoxic agent used to treat ovarian cancer.
- Addisonian crisis is a life-threatening disorder cause by adrenal
hormone insufficiency.
- Addison’s disease is hyposecretion of adrenal cortex hormone (glucocorticoids
or mineralocorticoids) resulting in deficiency of the corticosteroids hormone.
- Chvostek’s sign is seen in hypocalcemia.
- In Cushing’s disease increase the secretion cortisol due to increase
production of ACTH by pituitary gland.
- Dawn phenomenon: A nocturnal release of growth hormone, which may cause
blood glucose level elevations before breakfast in the client with diabetes
mellitus. Treatment includes administering an evening dose of intermediate acting
insulin at 10 PM.
- Diabetes insipidus is results from hyposecretion of ADH by posterior
pituitary gland.
- Diabetic ketoacidosis is occurred in client with type 1 diabetes
mellitus.
- In hyperglycemia the blood glucose level greater than 250 mg / dl.
- Hyperglycemic hyperosmolar nonketotic syndrome is a complication of
type 2 diabetes mellitus.
- In hypoglycemia blood glucose level is lower than 70 mg / dl.
- Myxedema is seen in severe hypothyroidism.
- Somogyi phenomenon: A rebound phenomenon that occurs in client with
type 1 diabetes mellitus.
- Trousseau’s sign: A sign of hypocalcemia.
- Nurse to treat somogyi phenomenon by decreasing the evening dose of
intermediate acting insulin or increasing the bed time snack.
- Hypothalamus is the portion of the diencephalon of the brain, forming
the floor and part of the lateral wall of the third ventricle.
- Glucocorticoids and mineralocorticoids are hormone of adrenal cortex
and small amount of hormone androgens and oestrogen are also secreted.
- Epinephrine and norepinephrine are hormone of adrenal medulla.
- Thyroxine (T4), Triiodothyronine (T3), and Thyrocalcitonin are hormones of thyroid gland.
- Parathyroid hormone secreted by parathyroid gland and it control
calcium and phosphorus level.
- Oestrogen and progesterone are hormone of ovaries.
- Testosterone produces by testes.
- Glucocorticoids: Cortisol, cortisone and corticosteroid.
- Mineralocorticoids: Aldosterone
- Failure of the hormone level to increase with stimulation test
indicates hypofunction of thyroid gland.
- Failure of hormone production to be suppressed test during standardized
testing indicate hyperfunction.
- Suppression test are indicated when thyroid hormone level is high.
- Radioactive iodine uptake test measures the absorption of the iodine isotopes
to determine how the thyroid gland is functioning.
- Elevated values indicate hyperthyroidism, decreased iodine intake, or
increased iodine excretion.
- Decrease values of iodine uptake indicate a low T4 level, the use of
antithyroid medications, thyroiditis, myxedema or hypothyroidism.
- The normal values of radioactive iodine uptake are 3% to 10% at 2 to 4
hours, and 5% to 30% in 24 hours.
- Radioactive iodine uptake test is contraindicated in pregnancy.
- T3 and T4 is elevated in hyperthyroidism and decrease in hypothyroidism.
- Normal values of thyroid stimulating hormone are 0.2 to 5.4
microunits/mL.
- Elevated level of thyroid stimulating hormone is indicating primary
hypothyroidism and decrease values indicate hyperthyroidism or secondary
hypothyroidism.
- A thyroid scan is performed to identify nodules or growths in the
thyroid gland.
- A radioisotope of iodine or technetium is administered before scanning
the thyroid gland.
- Technetium is administered by the IV route 30 minutes before the scan.
- Thyroid scan is contraindicated in pregnancy.
- Glucocorticoids and mineralocorticoids are hormone of adrenal cortex.
- Aldosterone regulate the electrolyte balance by promoting sodium
retention and potassium excretion.
- Glucose tolerance test help to diagnose diabetes mellitus.
- A 2 hours post load glucose level higher than 200 mg/dL conform the
diagnosis of diabetes mellitus.
- Hyperglycemia in the client with diabetes mellitus is usually the cause
of an increase in the glycosylated hemoglobin (HbA1c).
- Values of glycosylated hemoglobin are expressed as a percentage of the
total hemoglobin.
- The HbA1c values in client with diabetes mellitus is more than 7%.
- The client without diabetes mellitus the normal range is 4% to 6%.
- Glycosylated serum albumin is also called fructosamine.
- Normal values of fructosamine in nondiabetic client 1.5 to 2.7 mmol/L
or in diabetic client 2.0 to 5.0 mmol/L.
- Luteinizing hormone and follicle stimulating hormone are gonadotropin
hormone.
- Hypersecretion of growth hormone by the anterior pituitary gland in an
adult caused primarily by pituitary tumors.
- Hypophysectomy is the removal of pituitary gland.
- Removal of pituitary tumors via craniotomy or transsphenoidal approach.
- Complications of craniotomy includes increase ICP, bleeding, CSF leak,
infection, and hypopituitarism.
- Complications for the transsphenoidal surgery include CSF leak,
infection and hypopituitarism.
- After hypophysectomy nurse elevate the head of the bed.
- Avoid the client sneezing, coughing, and blowing the nose after
hypophysectomy.
- Following transsphenoidal hypophysectomy nurse monitors for any
postnasal drip or nasal drainage which might indicate leakage of CSF.
- Hyposecretion of ADH cause diabetes insipidus. In which Kidney tubules
fail to reabsorb water.
- Polyuria, (4 to 24 L/day) polydipsia, dehydration, low urine specific
gravity (1.006 or lower) and postural hypotension are signs of the diabetes
insipidus.
- Vasopressin tannate or desmopressin acetate (DDAVP) prescribed when the
ADH deficiency severe or chronic.
- Syndrome of inappropriate antidiuretic hormone (SIADH) is results from
excess ADH hormone.
- Trauma, stroke, malignancies, medications and stress are the causes of
SIADH.
- Water intoxication and hyponatremia, fluid overload, weight gain, change
in level of consciousness, hypertension and tachycardia or nausea vomiting are
features of SIADH.
- Diuretics and IV normal saline or hypertonic solution and medication
inhibit ADH is given in SIADH.
- Nurse provides safe environment for client with change level of
consciousness or mental status.
- Addison’s disease is hyposecretion of adrenal cortex hormone
(glucocorticoids and mineralocorticoids)
- Lethargy, fatigue, muscles weakness, GI disturbance, weight loss,
menstrual change in women; impotence in men, hypoglycemia, hyponatremia,
hyperkalemia, hypercalcemia and postural hypotension with hyperpigmentation of
skin are features of Addison’s disease.
- Diet in Addison’s disease: high protein, high carbohydrates with normal
sodium intake.
- Cushing’s disease is characterized by a hypersecretion of glucocorticoids.
- Addisonian crisis is life threatening disorder caused by acute adrenal
insufficiency.
- Addisonian crisis is precipitated by stress, infection, trauma, surgery
or abrupt withdrawal of exogenous corticosteroids use.
- Addisonian crisis can cause hyponatremia, hypoglycemia, hyperkalemia and
shock.
- Addisonian crisis is initially treated by IV infusion of hydrocortisone
sodium succinate then after glucocorticoids and mineralocorticoids given by
orally.
- Cushing’s disease is a metabolic disorder characterized by abnormally
increased secretion (endogenous) of cortisol caused by increased amount of ACTH
secreted by pituitary gland.
- Cushing’s syndrome is a metabolic disorder resulting from the chronic
and excessive production of cortisol by adrenal cortex or by the administration
of glucocorticoids in large dose for several weeks or longer (exogenous or
iatrogenic).
- Truncal obesity, moon face, buffalo hump, hirsutism (masculine
characteristic in female), think extremity, supra clavicular fat pads, weight
gain with muscles wasting and weakness or hyperglycemia, hypernatremia,
hypokalemia, hypocalcemia, hypertension with fragile skin with reddish purple
striae on abdomen and upper thighs are features of Cushing’s disease and
Cushing’s syndrome.
- Nurse monitors blood pressure of Cushing syndrome patient.
- After adrenalectomy glucocorticoid replacement may be required.
- Primary hyperaldosteronism (Conn’s syndrome) is hypersecretion of
mineralocorticoids (Aldosterone) from adrenal cortex.
- Adenoma is most common cause of Conn’s disease.
- Hypokalemia, hypernatremia and hypertension are signs of
hyperaldosteronism.
- Nurse monitors blood pressure and signs of hypokalemia and hypernatremia
in Conn’s syndrome.
- Potassium sparing diuretics and Aldosterone antagonist medication
spironolactone is prescribed in hyperaldosteronism.
- In pheochromocytoma the excessive amount of epinephrine and
norepinephrine are secreted.
- Catecholamine producing tumor of adrenal medulla is cause of
pheochromocytoma.
- Vanillylmandelic acid (VMA) in 24 hours urine sample is used to
diagnose pheochromocytoma.
- VMA is product of catecholamine metabolism.
- The normal range of catecholamine is up to 14 mcg/100mL of urine.
- Surgical removal of the adrenal gland is primary treatment of
pheochromocytoma.
- Complications associated with the pheochromocytoma is hypertensive
crisis including hypertensive retinopathy and nephropathy, cardiac enlargement,
dysrhythmias, congestive heart failure, MI, increase platelets aggregation and
stroke.
- Paroxysmal or sustained hypertension with severe headache and
palpitations flushing and profuse sweating, pain in chest and abdominal or
hyperglycemia are signs of pheochromocytoma.
- For the client with pheochromocytoma avoid stimuli that can precipitate
a hypertensive crisis such as increase abdominal pressure and vigorous abdominal
palpation.
- Lifelong glucocorticoids and mineralocorticoids replacement are
necessary with bilateral adrenalectomy. And up to 2 years in unilateral.
- Hypothyroidism is a state of hyposecretion of T3 and T4.
- Administer thyroid replacement levothyroxine sodium is most commonly
prescribed.
- Lethargy, fatigue, weakness, paraesthesia, intolerance to cold, weight
gain, dry skin and hair loss, bradycardia, constipation, myxedema, loss of
memory, cardiac enlargement and goiter may be present in hypothyroidism.
- Myxedema is rare but serious disorder results from persistently low thyroid
production.
- Hypotension, bradycardia, hypothermia, hyponatremia, hypoglycemia,
generalized edema, respiratory failure and coma are signs of myxedema coma.
- Low calorie, low cholesterol and low saturated fat diet is advised in
hypothyroidism.
- Hyperthyroidism is a state resulting from hypersecretion of T3 and T4.
- Graves disease (toxic diffuse goiter) is main cause of hyperthyroidism.
- Enlarge thyroid gland, palpitations, cardiac dysrhythmias, tachycardia,
exophthalmos, hypertension, heat intolerance, weight loss and diaphoresis,
irritability are signs of hyperthyroidism.
- High calorie diet is advised in hypothyroidism.
- Antithyroid medication propylthiouracil is given in hyperthyroidism.
- Iodine preparation is also given that inhibit release of thyroid
hormone.
- Thyroidectomy is also performed in hyperthyroidism.
- Thyroid storm is acute and life-threatening condition occur in client
with uncontrolled hyperthyroidism.
- Manipulation of thyroid gland during surgery, severe infection and
stress are the cause of thyroid storm.
- Antithyroid medication propylthiouracil, beta blockers (propranolol),
sodium iodide solution and glucocorticoids are used to manage thyroid storm.
(Before thyroidectomy and after)
- Following thyroidectomy nurse maintain the client in a semi-fowler’s
position. Monitor the surgical site for edema and for signs of bleeding and
check the dressing anteriorly and at the back of the neck.
- Hypoparathyroidism is low secretion of parathyroid hormone.
- Hypoparathyroidism can occur after thyroidectomy.
- Hypocalcemia, hyperphosphatemia, muscles cramps, positive trousseau’s sign,
Chvostek’s sign and tetany with hypotension are signs of hypoparathyroidism.
- Bronchospasm, laryngospasm, carpopedal spasm, dysphagia, photophobia,
cardiac dysrhythmias and seizures are sign of tetany.
- Calcium gluconate is given by IV for hypocalcemia.
- Hyperparathyroidism is condition cause by high secretion of parathyroid
hormone.
- Hypercalcemia and hypophosphatemia, muscles weakness, skeleton pain,
bone deformities that cause pathological fracture, hypertension, cardiac
dysrhythmias and renal stone are sign of hyperparathyroidism.
- Removal of the one and more of parathyroid gland is called parathyroidectomy.
- Position
the client in semi Fowler position after parathyroidectomy.
Diabetes mellitus is chronic disorder of impaired carbohydrates,
protein, and lipid metabolism caused by a deficiency of insulin.
Obesity is the major risk factors for diabetes mellitus.
Type 1 diabetes mellitus is a nearly absolute deficiency of insulin (primary
beta cell destruction); if insulin is not given, fat is metabolized for energy,
resulting in ketonemia. (Acidosis)
Type 2 diabetes mellitus is a relative lack of insulin or resistance to
the action of insulin; usually insulin is sufficient to stabilize fat and
protein metabolism but not carbohydrates metabolism.
Macrovascular complications of diabetes mellitus: coronary artery
disease, cardiomyopathy, hypertension, cerebrovascular disease, and peripheral
vascular disease.
Microvascular complications of diabetes mellitus: retinopathy, nephropathy and neuropathy.
If the blood glucose level higher than 250 mg/dL and urinary ketones
are present, the client is instructed not to exercise until glucose level is to
closer to normal and urinary ketones are absent.
Client with diabetes mellitus to monitors blood glucose level before,
during and after exercising.
Oral hypoglycemic medication are prescribed for client with diabetes mellitus
type 2 when diet and weight control therapy have failed to maintain
satisfactory blood glucose level.
Insulin is used type 1 or type 2 diabetes mellitus.
Aspirin, alcohol, oral anticoagulant, oral hypoglycemic medication,
beta blockers, tricyclic antidepressants, tetracycline and monoamine oxidase
inhibitors increase the hypoglycemic effect of insulin, causing a further
decrease in blood glucose level.
Glucocorticoids, thiazide diuretics, thyroid agents, oral
contraceptives and oestrogen increase the blood glucose level.
Illness, infection and stress increase blood glucose level and the need
for insulin, so nurse should not be withheld insulin during illness, infection
and stress.
Regular insulin is only insulin that can be administered intravenously.
It is used in the emergency treatment of diabetic ketoacidosis.
Local allergic reactions, insulin lipodystrophy (lipoatrophy and
lipohypertrophy), insulin resistance, Dawn phenomenon and somogyi phenomenon
are the complications of insulin therapy.
To prevent client from lipoatrophy nurse, use human insulin.
Dawn phenomenon is also called prebreakfast hyperglycemia usually occur
between 5 to 8 AM.
Treatment of dawn phenomenon nurse administering evening dose of
intermediate acting insulin at 10 PM.
Somogyi phenomenon: Normal or elevated blood glucose levels are present
at bedtime; hypoglycemia occurs at about 2 to 3 AM.
Treatment of somogyi phenomenon nurse decreasing the evening dose of
intermediate acting insulin or increasing the bedtime snacks.
Methods of Insulin administration: subcutaneous injections, insulin pump,
insulin pump and skin sensor, jet injectors and pancreatic transplants.
Presence of ketones in urine may indicate impending ketoacidosis.
Hypoglycemia occurs when the blood glucose level fall below 70 mg/dL.
Mild hypoglycemia blood glucose level below 60 mg/dL.
Moderate hypoglycemia blood glucose level below 40 mg/dL.
Severe hypoglycemia blood glucose level below than 20 mg/dL.
Hunger, nervousness, palpitations, sweating, tachycardia, tremors, confusion,
numbness of the lips and tongue, emotional change, drowsiness and inability to
concentrate are signs of hypoglycemia.
Difficulty in arousing, disoriented behavior, loss of consciousness
and seizures are signs of severe hypoglycemia.
In mild hypoglycemia nurse give 10 to 15 gm of a fast-acting simple carbohydrates.
In moderate hypoglycemia administer 15 to 30 gm of a fast-acting simple
carbohydrates.
In severe hypoglycemia client unconscious and can't swallow an
injection of glucagon is administered IM or SC.
Nurse do not attempt to administer oral food or fluids to the client
experiencing a severe hypoglycemic reaction who is semiconscious or unconscious
and is unable to swallow.
In hospital or emergency department the client with severe hypoglycemia
treated with an injection of 25 to 50 mL of 50% dextrose in water.
Diabetic ketoacidosis (DKA) is a life-threatening complication of type
1 diabetes mellitus.
Kussmaul’s respiration, hyperglycemia, fruity breath, nausea, abdominal
pain, dehydration and electrolyte loss due to polyuria, polydipsia and positive
ketones are the signs of diabetic ketoacidosis.
In diabetic ketoacidosis the serum glucose level is more than 300
mg/dL. (16.7 mmol/ L)
In DKA the dehydration is treated with IV infusion of 0.9% or 0.45%
normal saline, and hyperglycemia by IV infusion of regular insulin only in
normal saline.
Nurse monitor the client being treated for DKA closely for signs of increase
intracranial pressure. Because rapidly fall blood glucose level pull water in
CSF and cause cerebral edema and increase intracranial pressure.
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is extreme
hyperglycemia occurs without ketosis and acidosis.
In HHNS the serum glucose level is more than 800 mg/dL (44.5 mmol/ L).
HHNS is more common in type 2 diabetes mellitus client.
The major difference between HHNS and DKA is that ketosis and acidosis
do not occur with HHNS; enough insulin is present with HHNS to prevent breakdown
of fat for energy, thus preventing ketosis.
The treatment of HHNS is similar to DKA.
HHNS, hypoglycemia and DKA is acute complications of diabetes mellitus.
Diabetic retinopathy, diabetic nephropathy and diabetic neuropathy are
the chronic complications of diabetes mellitus.
Diabetic retinopathy is chronic and progressive impairment of the
retinal circulation that eventually causes hemorrhage.
Growth hormone receptor antagonist are used to treat acromegaly.
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
level increase in liver damage.
Antidiuretic hormones are used to treat diabetes insipidus e.g.
desmopressin acetate and vasopressin.
Nurse monitors water intoxication in antidiuretic hormone therapy.
Multivitamins, aluminium hydroxide, magnesium hydroxide calcium
carbonate and iron or sucralfate decrease the thyroid hormone absorption.
Client take the thyroid medication at the same each day, in the morning
without food.
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