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162 Exam #2 > 2.1 Metabolism > Flashcards

2.1 Metabolism Flashcards

1
Q

Endocrine glands: (9)

A
  • Pituitary
  • Hypothalamus
  • Thyroid
  • Parathyroid glands
  • Thymus
  • Adrenal glands
  • Pancreas
  • Ovary
  • Testis
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2
Q

What is metabolism

A

-Processes of biochemical reaction in
body’s cells
•Hormones
–Chemical messengers secreted by various glands

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3
Q

Pituitary Gland
Location
Function
Parts involved

A 
Located in skull beneath hypothalamus
• Master gland‖
• Its hormones regulate many body functions
•Two parts:
 – Anterior pituitary
 –Posterior pituitary
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4
Q

Anterior pituitary does what

A 
•Several types of endocrine cells
•Secretes at least 6 major hormones
 –Growth hormone
 –Prolactin
 –Thyroid-stimulating hormone (TSH)
 – Adrenocorticotropic hormone (ACTH)
 –Gonadotropin, follicle-stimulating hormone (FSH) and Luteinizing hormone (LH)
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5
Q

Posterior Pituitary does what

A
  • Composed of nervous tissue

* Stores and releases antidiuretic hormone (ADH) and oxytocin

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6
Q

Thyroid
Location
Parts involved
Function

A 
Location
 –Anterior to upper trachea
 –Inferior to larynx
•Glandular tissue with follicles
•Initiated by TSH from anterior pituitary
•Secretes hormones
 –T3, T4 (thyroid hormone)
 –Calcitonin
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7
Q

Parathyroid Glands

A

•4 –6 glands
•Secrete parathyroid hormone (PTH)
–Maintains calcium levels
–Phosphate metabolism

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8
Q

Adrenal Glands
Location
Parts
Function

A 
•Two pyramid-shaped organs
•Sit on top of kidneys
•Two organs within each gland
 – Adrenal medulla
 – Epinephrine
 – Norepinephrine
 – Adrenal cortex
 – Mineralcorticoids
 – Glucocorticoids
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9
Q

Pancreas
Location
Function
Parts

A

•Behind stomach
–Between spleen and duodenum
•Endocrine gland and exocrine gland
•Endocrine cells produce hormones that regulate carbohydrate metabolism
–Clustered in pancreatic islets (islets of Langerhans)
–4 cell types: alpha, beta, delta, F cells

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10
Q

What are hormones?

A

•Chemical messengers secreted by endocrine organs

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11
Q

How are hormones transported?

A 
•Transported in 4 ways
 –Endocrine glands
 –Neurons
 –Hypothalamus
 –Paracrine method 
 •Released into bloodstream
 –Free unbound molecules or
 –Hormones attached to transport carriers
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12
Q

Hormones are controlled by the_______ _______ through ________ & __________ feedback

A

-Pituitary gland

through positive and negative feedback

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13
Q

Stimuli for hormone release

A

–Hormonal (hypothalamic hormones stimulate release)
–Humoral (fluctuations in serum levels)
–Neural (nerve fibers stimulate release)

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14
Q

What is positive feedback mechanism?

A

Increasing levels of hormones cause another gland to release hormones too.
-Examples include - follicular stage of menstrual cycle and childbirth

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15
Q

What is negative feedback mechanism?

A

Sensors in endocrine system detect changes in hormone levels and adjust hormone secretion to maintain homeostasis.

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16
Q

Age-related changes

A 
•Endocrine system responsible for
 –Sexual differentiation during fetal development
 –Stimulating growth and development
 –Childhood
 –Adolescence
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17
Q

Older age-related changes

Table 18-2 pg. 982 Bob

A 
•Pituitary decreases production of ACTH, FSH, TSH
•Thyroid decreases in gland activity 
•Adrenal medulla increases norepinephrine, decreases beta-adrenergic response
•Pancreatic blood vessels calcify
•Pancreatic ducts distend and dilate
•Pancreatic release of insulin
 –Delayed
 –Decreased
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18
Q

Metabolism alterations -

A 
•Disorders of structure and function
 –Alter normal hormone levels and use
–Diabetes mellitus
–Obesity
–Graves’ disease
–Hypothyroidism
–Osteoporosis
–Cirrhosis
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19
Q

Endocrine Assessments

A
  • Skin: inspect, palpate
  • Nails & hair: texture, distribution, condition
  • Facial: symmetry, form, position of eyes
  • thyroid gland - enlarged, nodules…
  • motor function - deep tendon reflexes
  • Sensory function: pain, temperature, touch
  • Musculoskeletal: size & proportion of body structure
  • Hypocalcemic tetany: Trousseau’s sign or Chvostek’s sign = decreased calcium
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20
Q

Hormone diagnostic tests

A
  • Serum blood sugar A1c
  • T3, T4, TSH
  • Individual hormone levels
  • Serum electrolytes
  • Liver enzymes
  • Bilirubin
  • Serum albumin
  • Serum calcium
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21
Q

Pharmacologic interventions for hormone

A 
•Goals vary widely
•Hormone administered as replacement
 –Insulin
 – Antithyroid agents
 –Thyroid agents
 –Hormonal agents
 –Biphosphonates
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22
Q

________ is a disorder of hyperglycemia resulting from defects in insulin secretion.

A

Diabetes mellitus

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23
Q

What are the 4 major types of diabetes?

A
  • DM I
  • DM II
  • Gestational DM
  • Other
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24
Q

Pancreas role in hormones (diabetes related)

A 
–Alpha cells of the islet cells
            -Glucagon
–Beta cells
        -Insulin
–Delta cells
          -Somatostatin
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25
Q

Blood glucose Homeostasis

A
  • Body requires constant supply of glucose
  • Not all tissues require resulting insulin
  • Normal blood glucose in healthy clients regulated by insulin and glucagon
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26
Q

DM I

Pathophysiology

A

–Result of pancreatic cell destruction
–Total deficit of circulating insulin
–Autoimmune
–Idiopathic

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27
Q

DM I

Etiology

A

–Most often occurs in childhood
–Genetic predisposition
–Environmental factors

28
Q

DM I

Clinical Manifestations

A 
–Hyperglycemia 
–Breakdown of body fats, proteins
–Development of ketosis
–Polyuria 
–Glycosuria
–Polydipsia
–Polyphagia
–Weight loss, malaise, fatigue

•Lack of insulin =hyperglycemia

  • Glucose cannot enter cell without insulin
  • Requires exogenous insulin
29
Q

DM II

definition

A

• Adult onset
–Non-insulin-dependent diabetes mellitus (NIDDM)
•Results from insulin resistance
–Defect in compensatory insulin secretion

30
Q

DM II

Pathophysiology

A

–Function of insulin impaired by resistance

–Demand for insulin exceeds supply

31
Q

DM II

Etiology

A

•Can occur at any age
–Usually middle age and older
•Major factor is cellular resistance
–Increased by obesity, inactivity, meds, illness, age

32
Q

DM II Risk Factors

A
  • Diabetes in parents or siblings
  • Obesity
  • Physical inactivity
  • Race/ethnicity
  • History of gestational diabetes
  • Polycystic ovary syndrome
  • Hypertension
  • Metabolic syndrome
33
Q

Abdominal obesity risk factor for DMII
Men
Women

A

Men >40”

Women >35”

34
Q

DM II Clinical Manifestations

A 
•Slow onset of manifestations
•Symptoms similar to type 1
•Treatment begins with
 –Weight loss
 –Increased activity
35
Q

Acute complications of Diabetes

A

–Hyperglycemia

  • Diabetic ketoacidosis
  • Hyperosmolar hyperglycemic state
  • Dawn phenomenon
  • Somogyi phenomenon
36
Q

Diabetic Ketoacidosis
about
-involves 4 metabolic problems

A

-Happens with DM I

  • Hyperosmolarity
  • Metabolic acidosis
  • Extracellular volume depletion
  • Electrolyte imbalances from osmotic diuresis
  • Increased glucagon levels
37
Q

Somogyi Phenomenon

A

combo of hypoglycemia during the night with a rebound morning rise in blood glucose to hyperglycemic levels.

38
Q

Diabetic Ketoacidosis Clinical Manifestations

A

•Manifestations result from severe dehydration, acidosis
–Requires immediate medical attention
–8–10 L fluid to replace losses
–IV fluids with 0.9% NS to 0.45% saline
•Regular insulin used
•Electrolyte imbalance requires monitoring

39
Q

Hyperosmolar Hyperglycemic State (HHS)

A 
-Occurs in DM II
 •Plasma osmolarity ≥ 340 mOsm/L
 •Blood glucose levels > 600 mg/dL
•Serious, life-threatening
•Precipitating factors
•Slow onset
•Results in severe dehydration
40
Q

HHS treatment

A

Treatment
–Correct fluid, electrolyte imbalances
–Lower blood glucose levels with insulin
•Admit to ICU if blood glucose > 700mg/dL
–Establish, maintain ventilation
–Correct shock with adequate IV fluids
–If client is comatose NG suction
–Maintain fluid volume
–Administer insulin to reduce blood glucose

41
Q

Hypoglycemia
Treatment?
Symptoms to watch for?

A

-low blood sugar
-common in DM I
•15 g of rapid-acting sugar
•Hospitalized if
–Blood glucose <50 mg/dL
• Administer 25
–50% glucose solution
•Glucagon SC, IM or IV
–Coma, seizures
– Altered behaviors
–Caused by sulfonylurea drug

42
Q

Chronic complications of diabetes

A
  • CAD
  • HTN
  • Stroke
  • PVD
  • Retinopathy
  • Nepthropathy
  • Neuropathy
43
Q

Retinopathy

A
  • alterations in blood flow to the retina
  • Stage 1 nonproliferative - microaneurysms & edema
  • Stage 2: preproliferative - retinal ischemia
  • Stage 3: proliferative - possible hemorrhage or retinal detachment
44
Q

Nephropathy

A

Disease of kidneys - presence of albumin in urine, HTN, edema & progressive renal insufficiency.

45
Q

Diabetic Neuropathy (2 kinds)

A

Peripheral and visceral neuropathies.

  • Thickening of walls of blood vessels
  • Decreased nutrients to nerves
  • Demyelination of Schwann cells slows nerve conduction
  • Formation, accumulation of sorbitol within Schwann cells impairs nerve conduction
46
Q

Visceral neuropathy

A 
Autonomic neuropathy.
Ex: - sweating dysfunction
-abnormal pupillary function
-cardiovascular dysfunction
-GI dysfunction
-genitourinary dysfunction
47
Q

Peripheral neuropathy

A

Somatic neuropathy

  • polyneuropathy - distal parasthesias
  • mononeuropathy - isolate peripheral neuropathy (carpal tunnel)
48
Q

DM Complications involving the feet

A
  • Result of angiopathy, neuropathy, infection
  • Vascular changes usually bilateral
  • Diabetic neuropathy produces multiple problems
  • —-Most common trauma
  • Cracks, fissures from dry skin
  • Blisters, pressure
  • Ingrown toenails
  • Begins as superficial ulcer
  • Extends deeper
49
Q

Diagnostic tests for diabetes

A

•Symptoms of diabetes + plasma glucose (PG) > 200mg/dL
–Fasting plasma glucose (FPG) >126 mg/dL
–Two-hour PG > 200 mg/dL
-oral glucose tolerance test (OGTT)

•Following levels for FPG:
–Normal FG: 100 mg/dL
–Impaired FG: > 100 < 126 mg/dL

50
Q

Prediabetes levels

A

–100 – 126 mg/dL

At increased risk of developing diabetes

51
Q

Fasting blood glucose range

A

70 –110 mg/dL

52
Q

Insulin lispro (Humalog)

A
  • Human insulin analog
  • derived from genetically altered E. coli
  • Rapid-acting or Ultra-short insulin.
  • Rapid onset (<15 min)
  • Peak (30-60 min)
  • duration (3-4 hrs)
53
Q

Regular insulin

A
  • unmodified crystalline insulin
  • short-acting insulin
  • also used to treat DKA
  • clear
  • ONLY insulin that may be given IV
  • onset 30 min - 1hr
  • peak 2-3 hrs
  • duration 4-6 hrs
54
Q

Insulin glargine (Lantus)

A
  • 24 hour long-acting rDNA human insulin analog
  • sub Q qd at bedtime
  • Used for DM I & DM II
  • No peak time
55
Q

Which insulin can be administered through an IV?

A

Regular Insulin

56
Q

How is insulin dispensed?

A

-100unit/mL (U-100)
or
-500unit/mL (U-500)

57
Q

When would U-500 insulin be used?

A
  • In rare cases of insulin resistance when clients require very large doses.
  • requires perscription
58
Q

DM II clients receive what kind of diabetic medication in the hospital?

A
  • parenteral

- NO oral medications for diabetes is administered in the hospital due to the slow response of the meds.

59
Q

Which insulin injection sites have the most rapid absorption?

A 
#1 Abdomen 
#2 Deltoid
#3 Thigh
#4 Hip
60
Q

Don’ts of administration of a insulin injection:

A
  • Don’t Rub/massage injection site

- Don’t inject into an area to be exercised

61
Q

Lipodystrophy (or lipoatrophy)

A
  • atrophy of subcutaneous tissue
  • Hardened tissue, may have orange-peel texture, at injection site that is overused.
  • happens more with pork and beef insulins
  • refrigerated insulin may also trigger
62
Q

DM II Hypoglycemic agents

A
  • used to stimulate/increase insulin secretion
  • prevents breakdown of glycogen to glucose in liver
  • increases peripheral uptake of glucose
63
Q

Exenatide (Byetta)

A
  • only injectable hypoglycemic
  • signals pancreas to make insulin
  • stops liver conversion of glycogen to glucose
  • decreases absorption of sugar from intestines.
64
Q

Recommended carbohydrate intake

A

45-65% of daily diet
–Plant foods, milk, some dairy
–Sucrose substituted for other carbohydrates

65
Q

Recommended protein intake

A

15-20% of daily diet
–Low in fat, cholesterol
–Lower than most people consume

66
Q

Recommended Dietary Fats

A

–Less than 10% saturated fat total kcal/day
–Cholesterol <300mg/day

  • Saturated fat (meat, butter, lard)
  • Polyunsaturated (oils)
  • Monosaturated (olive oil)
67
Q

Diabetic diet plan

A 
–Restrict refined sugars
 –Nutritive sweeteners with caution
 –Alcohol consumption
-Signs of intoxication and hypoglycemia similar
-Light beer recommended alcoholic drink

162 Exam #2 (8 decks)

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