Blueprint Flashcards
What is hyperthyroidism?
A sustained increase in synthesis and release of
thyroid hormones by thyroid gland
What diseases are caused by hyperthyroidism?
Graves’ disease
Thyrotoxicosis (EMERGENT)
What would TSH and T3/T4 lab results show when a patient has hyperthyroidism?
TSH goes down
T3 and T4 goes up
What is Graves disease?
An autoimmune disease
Thyroid enlargement and excess thyroid secretion
What are clinical manifestations of hyperthyroidism?
When thinking of S/S for hyperthyroidism, think speeding up
Five important ones to remember, ten total
Goiter
Exophthalmos (bulging eyes)
Weight loss, increased appetite
Palpations, high BP and heart rate
Heat intolerance
Nervousness, tremors
Hyperreflexive deep tendon reflexes
Diarrhea
Menstrual irregularities
Insomnia
What is an emergent complication of hyperthyroidism?
Acute Thyrotoxicosis (Thyroid Storm)
What are clinical manifestation of Acute Thyrotoxicosis (thyroid storm)?
Severe tachycardia
Heart failure
Shock
High temperature (up to 106)
Abdominal pain, vomiting, diarrhea
Seizures
Coma
What diagnostic studies would you order for hyperthyroidism?
T3 and T4
T4
Radioactive Iodine Uptake (RAIU)
RAIU: Distinguishes Graves’ disease from other forms of thyroiditis
What are treatment options for hyperthyroidism?
There are three
Antithyroid medication
Radioactive Iodine Therapy (RAI)
Surgery
What drug therapies are used for hyperthyroidism?
There are three, one important
Antithyroid drugs
Iodine
β-Adrenergic blockers
What does Potassiume Iodine (SSKI) do for hyperthyroidism?
Think circulatory and how long it is for maximal effect
- Inhibit synthesis of T3 and T4 and block their release into circulation
- Decreases vascularity of thyroid gland, making surgery safer
and easier - Maximal effect within 1-2 weeks
- Mix with water or juice and given after meals.
- Sipping it through a straw decreases the chance of it staining the teeth.
What dietary instruction would you give to a ptient with hyperthyroidism?
High calorie meals (4000-5000 cal/day)
Avoid highly seasoned and high fiber foods. as well as caffeine
What lab results would you expect for a patient with hypothyroidism?
TSH levels go up (greater than 4.5 mlU/L)
T3 and T4 go down
What is primary hypothyroidism?
Caused by destruction of thyroid tissue or defective hormone synthesis
Basically, problem with the thyroid
What is secondary hypothyroidism?
Caused by pituitary disease (decreased TSH) or
hypothalamic dysfunction or (decreased TRH)
Basically, problem with the pituatary gland
What are clinical manifestations of hypothyroidism?
When thinking of S/S of hypo, think slowing down
Six important ones, nine total
Heart failure
High cholesterol
Low appetite, weight gain
Constipation
Fatigue, weakness, slow movements
Depression. sleepiness
Dry skin, pallor
Cold intolerance
Menstrual irregularities
What is an emergent complication of hypothyroidism?
Myxedema coma
What are the clinical manifestations of myxedema coma?
Impaired conciousness/coma
Low temp, low BP, low respirations
Absent or slow reflexes
What medication do you use to treat myxedema coma?
IV thyroid hormone
What diagnostic tests would be ordered for hypothyroidism?
TSH (low for secondary hypothyroidism, high for primary hypothyroidism)
T3/T4
Thyroid antibodies (for Hashimoto thyroiditis)
What medication is given for hypothyroidism?
Levothyroxine (Synthroid): Synthetic T4
What is Cushing syndrome and how does it occur?
Occurs from chronic exposure to excess corticosteroids; Caused by medications or tumors that secrete ACTH (adrenal cortex stimulating hormone)
What are clincial manifestations of Cushing Syndrome
Five important, seven total
Weight gain in the trunk
“moon face”
“buffalo hump”
Muscle wasting
Osteoporosis
Striae (stretch marks, usually purple)
High cortisol levels
What is Addison’s disease?
Low function of adrenal cortex-decreased corticosteroids
Mostly autoimmune–antibodies against adrenal cortex
What are clincial manifestations of Addison’s disease?
There are seven
Anorexia
Nausea
Weakness
Fatigue
Weight loss
Hyperpigmentation
Low cortisol levels
Often these symptoms are late/insidious
What is a complication of Addison’s Disease?
Addisonian crisis; Acute adrenal insufficency
What are clinical manifestations of Addisonian crisis?
Hint: Two involve electrolytes
There are six important ones, eleven total
Hypotension, tachycardia
Dehydration
Decreased sodium, increased potassium, increased glucose
Fever, weakness, confusion
Severe vomiting, diarrhea
Shock may cause cirulatory collapse
These are just estimations of what I think is most important to remember
What is a parathyroidectomy?
- The surgery to remove one or more of the parathyroid
glands in the patient who has hyperparathyroidism. - Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism.
- Monitor calcium levels
What is obesity?
High amount of body fat or adipose
tissue.
What is a major site for regulating appetite?
Hypothalamus
What is the range for underweight, normal, overweight, obese, and extremely obese BMI?
Less than (<) 18.5: Underweight
18.5-24.9: Normal
25-29.9: Overweight
30+: Obese
40+: Extremely obese
How do you calculate BMI?
Weight in kilograms divided by height in meter squared
What are ways to classify obesity/body weight?
There are 4
BMI (Normal: 18.5-24.9 normal)
Waist circumference (Android obesity: women greater 35” waist; men greater 40” waist)
Waist-to-hip ratio (WHR) (Normal: 0.8 or less women, 1.0 or less for men)
Body shape (apple shaped: android obesity) (Pear-shaped: gynoid obesity)
What is bariatric surgery? What are the criteria for surgery
Surgery on the stomach/intestines
BMI greater or equal to 40
BMI greater or equal to 35 with 1 related cormobidity (ex: Diabetes 2, heart failure, sleep apnea, liver failure)
What is the difference between restritive bariatric surgery and malabsorptive bariatric surgery?
Restrictive: Reduces the size of the stomach so less food is eaten
Malabsorptive: Small intestine is shortened or bypassed so less food is absorbed
What are complications of bartiatric surgery?
- GI tract leaks
- Gastric remnant distention
- Ulcers
- Gallstones
- Hernias
What is type 1 diabetes?
An autoimmune disease where insulin-making cells in the pancreas (islet cells) are destroyed
(T/F) The onset of Type 1 diabetes is fast
True
What are the clinical manifestations of Type 1 diabetes
The three Ps
Polyuria (excessive urine)
Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
Diabetic Ketoacidosis (DKA)
Type 1 diabetes manifests once the pancreas can no longer make enough insulin, which then gives the rapid onset of DKA
(T/F) Type 1 diabetics will need exogenous insulin for LIFE
True
(T/F) Insulin unlocks cells for glucose to be used as energy
True
What is Type 2 diabetes?
A combination of inadequate insulin secretion and insulin resistance; Most still make their own insulin
What are clinical manifestations of Type 2 diabetes?
The three P’s + some others
Polyuria
Polyphagia
Polydipsia
Fatigue
Reccurent infection
Vision problems
Weight loss
(T/F) Type two diabetes has a rapid onset of symptoms
False, Slow onset
What is a major distinction between type two and type one diabetes?
Type 2 diabetes has endogenous insulin, type 1 does not.
While type 2 diabetics can make insulin (endogenous), the reason it cannot happen is because a mixture of not enough insulin or too much insulin resistance
What are diagnostic tests for diabetes?
One important
A1C of 6.5% or higher
2 hour glucose of 200 mg/dL or greater during OGTT (oral glucose tolerance test)
Symptoms of hyperglycemia or hyperglycemic crisis AND random glucose level of 200 ,g/dL or higher
What is the goal of A1C for patients with diabetes
7.0 or less
What are the rapid acting insulins?
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
What is the onset, peak, and duration of rapid acting insulin?
Onset: 10-30 minutes
Peak: 30 min-3 hrs
Duration: 3-5 hours
What are short acting insulins?
Humulin R
Novolin R
What are the onset, peak, duration of short-acting insulin?
Onset: 30 min-1 hr
What are intermediate acting insulins?
Humulin N, Novolin N
What is the onset, peak, and duration for intermediate acting insulins?
Onset: 1.5-4 hrs
Peak: 4-12 hrs
Duration: 12-18 hrs
What are long acting insulins?
Glargine (Lantus)
Detemir (Levemir)
Degludec (Tresiba)
What are the onset, peak, and duration of long acting insulin?
Onset: 0.8-4 hrs
Peak: None
Duration: 16-24 hrs
What is the inhaled insulin?
Afrezza
What are the onset, peak, and duration for inhaled insulin?
Onset: 12-15 min
Peak: 60 min
Duration: 2.5-3 hrs
What biguanides medication is used to treat type 2 diabetes?
Metformin (Glucophage)
(T/F) It is safe for a patient usinng metformin to continue taking it when using contrast
False, metformin needs to be stopped 24-48 hours before and at least 48 hrs after
What are clinical manifestations of DKA?
Diabetic Ketoacidosis
Kussmaul respirations
Sweet, fruity breath odor (acetone)
Glucose level of greater than or equal to 250
Moderate to high ketone levels in urine or serum
Abdominal pain, anorexia, nausea/vomiting
Skin dry and loose; eyes soft and sunken
Electrolyte imbalance
Which IV fluids will you adminster to a patient with DKA? At what glucose level will you add 5-10% dextrose?
NaCl 0.45% or 0.9%, glucose level at 250 mg/dL
What urine output level do you want DKA patients to be at?
30 to 60 mL/hr
At what glucose level do you need to use the Rule of 15
Below 70 g/dL
How does the Rule of 15 go?
Consume 15 g of a simple carbohydrate
Recheck glucose level in 15 minutes
Repeat if still <70 g/dL; if remains low after 2 to 3 times, contact HCP
What are skin manifestations of anemia?
Pallor
Jaundice
Itching
What are clinical manifestations of iron-deficiency anemia?
Pallor
Glossitis (inflammation of the tongue)
Cheilitis (inflammation fo the lips)
Headache, paresthesias
For oral iron, what drink should you tell your patients to take along with it for iron deficency anemia?
Vitamin C or orange juice
Oral iron is best absorbed in an acidic enviornment
(T/F) You should drink liquid iron through a straw
True, as it may stain teeth
What are side effects of liquid iron?
There are three
Heartburn, consitpation, diarrhea
What will you assess to evaluate response to iron deficiency anemia therapy?
Hgb and RBC
What can cause a sickle cell episode?
Triggered by low O2 tension in blood
Infection is most common precipitating factor
What are clinical manifestations of sickle cell anemia?
Pain (from tissue hypoxia and damage)
Pallor of mucous membranes
Jaundice
Prone to gallstones (cholelithiasis)
What are nursing managements for sickle cell disease?
O2 therapy
Pain medication and fluids
Transfusion therapy
What level of platelets is considered thrombocytopenia?
Reduction of platelets below 150,000
What are clinical manifestations of thrombocytopenia?
Mucosal or cutaneous bleeding
Petechiae (microhemorrhages)
Purpura (Bruise from numerous petechiae)
Ecchymoses (larger lesions from hemorrhage)
What are diagnostic tests for thrombocytopenia?
Decreased platelet count < 150,000
(Prolonged bleeding <50,000)
(Hemorrhage decreased 20,000)
What drugs should those with thrombocytopenia avoid?
Avoid aspirin and other drugs that affect platelet function or production
What is leukemia?
A group of cancers affecting the blood and blood forming tissues
What is the difference between acute and chronic leukemia?
Acute is from immature hematopoietic cells
Chronic is more mature forms of WBC and onset is more gradual
(T/F) The abnormal WBCs of leukemia still go through normal cell cycle to death
False, they just continue to accumulate which causes bone marrow failure as there is no space
What is an emergent complication of leukemia?
Leukostasis: Caused by high WBC count (greater than 100,000)
What are diagnostic tests for leukemia?
Bone marrow examination
Lumbar puncture
PET/CT scan
What are clinical manifestations of leukemia?
Pallor, jaundice, petechiae, ecchymoses
Tachycardia
Oral lesions or bleeding
Masucle wasting, bone or joint pain
What is lymphoma?
Cancers originating in bone marrow and lymphatic structures
What are the clinical manifestations of Hodgkin’s Lymphoma?
Enlargement of cervical, axillary, or inguinal lymph nodes
Weight loss
Fatigue and weakness
Fever and chills
Tachycardia
Night sweats
What are B symptoms and what do they mean in Hodgkins lymphoma
Inital findings that correlate with a worse prognosis:
Fever greater than 100.4
Drenching night sweats
Weight loss exceeding 10% in 6 months
How many cycles of combination chemotherapy do people go through for hodgkins lymphoma for each classification? Faovrable, unfavorable, and advanced
Favorable early stage: 2-4 cycles
Unfavorable early stage: 4-6 cycles
Advanced stage: 6-8 cycles
What is the difference between Hodgkin’s and non-Hodgkin’s lymphoma
Hodgkin’s lymphoma has the presence of Reed-Sternberg cells while the abscene is non-Hodgkins
What is the difference in spread of Hodgkin’s lymphoma based on origin location?
Disease above diaphragm stays confined to lymph nodes for variable time
Disease below diaphragm often spreads to extralymphnoid sites, such as liver
(T/F) Non-Hodgkins lymphoma is a widespread disease usually present at time of diagnosis
True
Unlike Hodgkins, which is limited to one area at origin and then spreads
(T/F) Non-Hodgkin patients also experience B symptoms
True
Fever, night sweats, weight loss
What are the four stages of abnormal cells?
Grade 1: Differ slightly from normal cells and are well differentiated
Grade 2: More abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)
Grade 3: Very abnormal (severe dysplasia) and poorly differentiated (high grade)
Grade 4: Immature and primitive (anaplasia) and undifferentiated; cell of origin is hard to determine (high grade)
What are the classifications of cancer?
0: Cancer in situ
1: Tumor limited to tissue of origin; localized tumor growth
2: Limited local spread
3: Extensive local and regional spread
4: Metastasis
