Editing Medical-Surgical Nursing – RN Flashcards (section)

== Renal and Endocrine ==

;Most immediately lethal complication of acute kidney injury and the treatment sequence
:Hyperkalemia. Calcium gluconate stabilizes the myocardium but does not lower potassium. Insulin with dextrose, beta agonists, and bicarbonate shift potassium into cells. Binders and dialysis actually remove it.

;Why phosphate binders are given with meals in chronic kidney disease
:They bind dietary phosphorus in the gut so it is excreted in stool rather than absorbed. Given between meals they have no phosphorus to bind and are ineffective.

;Order of treatment in diabetic ketoacidosis
:Isotonic intravenous fluids first, then a regular insulin infusion, with continuous potassium monitoring. Withhold insulin and replace potassium first if the serum potassium is below about 3.3 mEq/L, and add dextrose to the fluids when glucose falls to roughly 200 to 250 mg/dL.

;How hyperosmolar hyperglycemic state differs from diabetic ketoacidosis
:It occurs in type 2 diabetes with glucose often above 600 mg/dL, profound dehydration, and altered mentation, but without significant ketosis or acidosis, because residual insulin is enough to suppress lipolysis. Fluid resuscitation is the mainstay.

;Priorities in the first 24 hours after thyroidectomy
:Airway and hemorrhage. Keep a tracheostomy tray and suction at the bedside, check behind the neck and on the pillow for bleeding, support the head when repositioning, assess voice quality for laryngeal nerve injury, and watch for hypocalcemia from parathyroid injury.

;Findings of Addisonian crisis
:Profound hypotension and shock with hyponatremia, hyperkalemia, hypoglycemia, and hypovolemia, often triggered by stress, infection, or abrupt steroid withdrawal. Treatment is immediate intravenous fluids with sodium and glucose plus intravenous hydrocortisone.