NCLEX PART 2
CH 07. Endocrine, GI, Renal
This chapter is all about Balance.
Endocrine: Balancing hormones (Sugar, Cortisol).
GI: Detoxifying the blood (Ammonia).
Renal: Filtering fluids and electrolytes.
Pay close attention to "Hypoglycemia" peaks and "Hyperkalemia" in renal failure!
1. Endocrine: Diabetes & Adrenals
Knowing your Insulin peaks is non-negotiable for safety questions.
① Diabetes Mellitus (Insulin Safety)
-
Hypoglycemia (< 70 mg/dL):
- Signs: Cold, Clammy, Irritable, Shaky.
- Action (Awake): 15g simple carb (4oz juice/soda).
- Action (Unconscious): IM Glucagon or IV Dextrose (D50).
-
Mixing Insulin:
"Clear before Cloudy" (Regular first, then NPH).
Never mix Long-acting (Glargine) with anything.
② Addison's vs. Cushing's
| Disease |
Pathology |
NCLEX Key Points |
Addison's
(Adrenal Insufficiency) |
"Need to Add" hormones.
Low Cortisol, Low Aldosterone.
|
- Bronze Skin (Hyperpigmentation).
- Crisis Risk: Severe Hypotension (Shock).
- Labs: Low Na+, High K+, Low Glucose.
- Tx: Lifelong steroids. Never stop abruptly!
|
Cushing's
(Hypercortisolism) |
"Cushion" of hormones.
Too much Cortisol.
|
- Moon Face, Buffalo Hump, Truncal Obesity.
- Purple Striae (Stretch marks).
- Labs: High Na+, Low K+, High Glucose.
- Risk: Infection & Bone fractures.
|
2. Gastrointestinal: Liver & Pancreas
-
Cirrhosis (Liver Failure):
- Ammonia Buildup: Causes confusion (Hepatic Encephalopathy) and flapping tremors (Asterixis).
- Tx: Give Lactulose (Oral/Enema) to poop out ammonia.
- Risk: Esophageal Varices (Bleeding) -> Avoid straining!
-
Pancreatitis (Acute):
- Autodigestion: Enzymes eat the pancreas. Pain radiates to back.
- Priority: NPO (Nothing by mouth) to rest the gut. NG tube for suction.
- Cullen's Sign: Blue color around belly button (Bleeding).
3. Renal Failure (CKD) & Dialysis
When kidneys fail, waste builds up. Diet is the treatment.
① The Renal Diet
-
Avoid High Potassium:
No Bananas, Oranges, Potatoes, Spinach.
(High K+ stops the heart!)
-
Other Restrictions:
- Low Protein (unless on dialysis).
- Low Sodium.
- Low Phosphorus (Take Phosphate Binders with meals).
② Hemodialysis Access (AV Fistula)
The patient's lifeline. Protect the arm!
-
Assessment:
- Feel the Thrill (Vibration).
- Hear the Bruit (Swishing sound).
(If absent -> Clotting -> Emergency!)
-
Restrictions (On Fistula Arm):
- NO BP readings.
- NO IV insertions.
- NO heavy lifting or carrying bags.