Adult Medical-Surgical Nursing

Endocrine nursing: diabetes, DKA & HHS, thyroid & adrenal emergencies

Insulin safety, hypoglycaemia, DKA versus HHS, thyroid storm and myxoedema, adrenal crisis, SIADH and diabetes insipidus — with the priority action for each.

Must-know for the exam

Hypoglycaemia (blood glucose below about 4 mmol/L or 70 mg/dL) is the true bedside emergency; treat a conscious patient with 15 g fast-acting oral carbohydrate and recheck in 15 minutes (the rule of 15).
Give IM/SC glucagon or IV dextrose if the hypoglycaemic patient is unconscious or cannot swallow — never give oral fluids to someone who cannot protect their airway.
In DKA insulin drives potassium into cells; monitor potassium closely and do not start insulin if K+ is below about 3.3 mmol/L until it is replaced.
Only short-acting (regular) insulin is given IV; the DKA priority is IV fluids first, then an insulin infusion, with hourly glucose and potassium monitoring.
Thyroid storm presents with high fever, tachycardia/arrhythmia and agitation; myxoedema coma with hypothermia, bradycardia and reduced consciousness — both are emergencies.
Addisonian (adrenal) crisis causes hypotension, hyponatraemia, hyperkalaemia and hypoglycaemia; treat with IV hydrocortisone and saline, and never stop steroids abruptly.
SIADH causes fluid retention and dilutional hyponatraemia (restrict fluids); diabetes insipidus causes massive dilute diuresis and hypernatraemia (replace fluids) — opposite problems.

In this note

1.How the exam frames endocrine questions
2.Diabetes mellitus — the essentials the exam assumes
3.Insulin therapy — types, timing and safety trapsPremium
4.Hypoglycaemia — the true endocrine emergency at the bedsidePremium
5.Diabetic ketoacidosis (DKA) — priorities and the potassium trapPremium
6.Hyperosmolar hyperglycaemic state (HHS) & DKA versus HHSPremium
7.Thyroid disorders — hyper, hypo and their crisesPremium
8.Adrenal disorders — Cushing's, Addison's & adrenal crisisPremium
9.Pituitary water balance — SIADH versus diabetes insipidusPremium

How the exam frames endocrine questions

Endocrine items usually hand you a cluster of signs and ask you to name the disorder, choose the FIRST nursing action, pick the finding to report, or handle a medication safely. The endocrine system works by opposing pairs — too much hormone versus too little — so most conditions come in mirror-image pairs (hyper- versus hypothyroid, SIADH versus diabetes insipidus, hyper- versus hypoglycaemia). Learn each pair together and half the work is done.

A reliable frame for endocrine scenarios:

•Decide the direction first — is this a state of TOO MUCH hormone or TOO LITTLE? Symptoms usually flip cleanly between the two.
•Protect airway, breathing and circulation before slower metabolic fixes — a seizing, comatose or arrhythmic patient is treated before you chase a lab value.
•For diabetes, the immediate danger is almost always the blood glucose extreme in front of you: treat symptomatic hypoglycaemia at once, and treat the fluid/electrolyte collapse of the hyperglycaemic emergencies.
•When a drug is involved (insulin, levothyroxine, corticosteroids, antithyroid drugs), safe administration and teaching are frequent right answers.

This note states widely accepted nursing principles. Glucose thresholds, drug doses and reference ranges vary by protocol and laboratory; verify local orders and current guidance before applying any figure to a real patient.

Diabetes mellitus — the essentials the exam assumes

Diabetes is a disorder of glucose regulation from absent or ineffective insulin. Type 1 is an autoimmune loss of insulin-producing beta cells — patients make little or no insulin, usually present younger, and ALWAYS need insulin; they are the group who develop diabetic ketoacidosis. Type 2 is insulin resistance with a relative insulin deficiency, strongly linked to obesity and older age, often managed first with lifestyle and oral agents; it is the group who classically develop hyperosmolar hyperglycaemic state.

Recognise the classic hyperglycaemia triad: polyuria (excess urination as glucose spills into urine and drags water with it), polydipsia (thirst) and polyphagia (hunger), often with fatigue, blurred vision, poor wound healing and recurrent infections.

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Traps that cost marks

Starting the insulin infusion in DKA before checking potassium — insulin can drop K+ into a fatal hypokalaemia.
Mistaking the sweaty, shaky, confused hypoglycaemic patient for hyperglycaemia and withholding sugar; when unsure, treat as hypoglycaemia.
Giving oral glucose to a drowsy or unconscious patient (aspiration risk) instead of IM glucagon or IV dextrose.
Holding all insulin when a diabetic patient is NPO or not eating — basal insulin is still needed to prevent DKA; only nutritional/correction doses are adjusted.
Mixing up SIADH (fluid restriction) with diabetes insipidus (fluid replacement) and managing the sodium in the wrong direction.

Endocrine nursing: diabetes, DKA & HHS, thyroid & adrenal emergencies

Insulin safety, hypoglycaemia, DKA versus HHS, thyroid storm and myxoedema, adrenal crisis, SIADH and diabetes insipidus — with the priority action for each.

Must-know for the exam

Hypoglycaemia (blood glucose below about 4 mmol/L or 70 mg/dL) is the true bedside emergency; treat a conscious patient with 15 g fast-acting oral carbohydrate and recheck in 15 minutes (the rule of 15).
Give IM/SC glucagon or IV dextrose if the hypoglycaemic patient is unconscious or cannot swallow — never give oral fluids to someone who cannot protect their airway.
In DKA insulin drives potassium into cells; monitor potassium closely and do not start insulin if K+ is below about 3.3 mmol/L until it is replaced.
Only short-acting (regular) insulin is given IV; the DKA priority is IV fluids first, then an insulin infusion, with hourly glucose and potassium monitoring.
Thyroid storm presents with high fever, tachycardia/arrhythmia and agitation; myxoedema coma with hypothermia, bradycardia and reduced consciousness — both are emergencies.
Addisonian (adrenal) crisis causes hypotension, hyponatraemia, hyperkalaemia and hypoglycaemia; treat with IV hydrocortisone and saline, and never stop steroids abruptly.
SIADH causes fluid retention and dilutional hyponatraemia (restrict fluids); diabetes insipidus causes massive dilute diuresis and hypernatraemia (replace fluids) — opposite problems.

In this note

1.How the exam frames endocrine questions

2.Diabetes mellitus — the essentials the exam assumes

3.Insulin therapy — types, timing and safety trapsPremium

4.Hypoglycaemia — the true endocrine emergency at the bedsidePremium

5.Diabetic ketoacidosis (DKA) — priorities and the potassium trapPremium

6.Hyperosmolar hyperglycaemic state (HHS) & DKA versus HHSPremium

7.Thyroid disorders — hyper, hypo and their crisesPremium

8.Adrenal disorders — Cushing's, Addison's & adrenal crisisPremium

9.Pituitary water balance — SIADH versus diabetes insipidusPremium