** Chapter 26: Endocrine Flashcards
Fixed flexion of the hands due to a thickening of the fibrous tissue under the skin of the palm and fingers, a risk for persons with diabetes mellitus
Dupuytren’s contracture
Group of conditions (high triglycerides, low high-density lipoprotein, elevated fasting blood sugar, elevated blood pressure, and central obesity) occurring together that increase the risk of diabetes, stroke, and coronary artery disease
Metabolic syndrome
This complex system consists of glands that ___ and ___
synthesize and secrete hormones
There are two major classes of hormones:
Steroids and Thyronines
Steroids and thyronines are __ __
lipid soluble
Polypeptides and catecholamines are __ __
water soluble
With age, the thyroid gland progressively ___ and thyroid gland activity ___
atrophies
decreases
The thyroid gland atrophying and the thyroid gland activity decreasing results in: (3)
a lower __ __ rate, reduced __ __ uptake, and less secretion and release of ___.
basal metabolic
radioactive iodine
thyrotropin
Thyroid activity can be further reduced by __ __ __
diminished adrenal function
Adrenocorticotropic hormone secretion ___ with age.
decreases
The ___ of the pituitary gland decreases with age; somatotropic growth hormone blood levels may be ___.
volume
reduced
Insulin secretion is also affected by age; there is ___ release of insulin by the β cells in the pancreas and ___ tissue sensitivity to the circulating insulin.
insufficient
reduced
Many older adults have reduced ability to metabolize ___, particularly when:
glucose
a sudden high concentration of glucose is consumed
Type 2 diabetes, the ___ leading cause of death among older adults, affects __% of the older population.
seventh
20
Type 2 diabetes has a particularly high prevalence among __ __ and people who are __ to __ years of age.
African Americans
65-74
__ __ is a common occurrence among older adults, and is due to increase amounts of fat tissue in obese older adults. (diabetes)
Glucose intolerance
What 4 things are the most important contributors to diabetes mellitus?
Obesity, inactivity, an increased amount of fat tissue, and having a first-degree relative with the disease
T/F; Physiologic deterioration of glucose tolerance is no longer considered a risk factor.
True
Screening with the use of fasting blood sugar is recommended every __ years for persons over __ years of age.
3
45
Because the renal threshold for glucose increases with age, ____
older individuals can be hyperglycemic without evidence of glycosuria
Among all the diagnostic measures, the glucose ___ test is the most effective
tolerance
The American Diabetes Association recommends that a minimum of __ g of carbohydrates be ingested daily for several days before the glucose tolerance test; older, malnourished individuals may be prescribed ___ g.
150
300
Nicotinic acid, ethacrynic acid, estrogen, furosemide, and diuretics can ___ glucose tolerance.
decrease
The diagnosis of diabetes is usually established if one of the following criteria exists:
- random blood glucose concentration ≥200 mg/dL.
- Glycosylated hemoglobin (HbA1c) ≥6.5%.(over a 3 month period)
- Fasting is ≥126 mg/dL (8-hour fast).
- 2 hours after an oral glucose intake ≥200 mg/dL
Although the glycemic goals need to be individualized for the patient, the general recommendations are for the patient to achieve a fasting plasma glucose of __ to __ mg/dL, postprandial glucose of less than __ mg/dL, and hemoglobin A1c of less than __%
70 to 130
180
6.5
___ is often used to treat hyperglycemia. 1st line of treatment for Type 2 DM.
Metformin
When should Metformin be administered?
Immediately after meals to avoid gastrointestinal disturbances
If an older person with diabetes must self-inject insulin, one factor that must be considered is:
the patient’s ability to handle a syringe and vial of insulin
Most older persons have some degree of visual impairment, so the nurse must :
evaluate their ability to read the calibrations on an insulin syringe.
The hemoglobin A1c test (also called HbA1c, glycated hemoglobin test, or glycohemoglobin) measures the amount of __ __ in the blood and is used to monitor the effectiveness of disease control.
glycosylated hemoglobin
Hemoglobin A1c provides an average of the patient’s blood glucose control over a ____ period the normal range is between 4% and 6%. For persons with diabetes, the goal is HbA1c below __
6-12 week
7%
The American Diabetes Association recommends that people with diabetes maintain their triglyceride levels below __ mg/dL.
150
A diet high in complex __ and __ controls the release of glucose into the bloodstream and can reduce insulin requirements.
carbohydrates and fibers
When it comes to diabetes, nutritional supplements can reduce the risk of complications; such supplements include ___. (6)
vitamin B6, folic acid, riboflavin (B2), magnesium, zinc, and chromium.
What seems to be a greater threat to older patients? Hypoglycemia or ketoacidosis?
Hypoglycemia
____ is a common complication in the older individual who has diabetes and is influenced by the poorer circulation and atherosclerosis often associated with increased age.
Peripheral vascular disease
Another significant vascular problem of older patients with diabetes is ____
retinopathy with consequent blindness
Individuals who are hypertensive or who have had diabetes for a long time have a greater risk of developing this complication.
retinopathy with consequent blindness
Many older patients taking sulfonylureas experience ___
hypoglycemia
The age-related changes in hepatic and renal functions that alter drug metabolism and excretion increase the risk for __
hypoglycemia
___ is also associated with impairments in the autonomic nervous system and reductions in adrenergic receptor function
Aging
What drugs are known to have drug interactions with diabetes?
β-blockers, salicylates, warfarin, sulfonamides, tricyclic antidepressants, and alcohol
Thyroxine (T4) and triiodothyronine (T3) are essential hormones produced by the ___ ___
thyroid gland
Aging affects the thyroid gland in several ways, including:
- moderate atrophy
- fibrosis
- increasing colloid nodules
- some lymphocytic infiltration
A SUBnormal concentration of thyroid hormones T4 and T3 in the tissues is known as ____.
hypothyroidism
Hypothyroidism is more common in men or women?
women
Primary hypothyroidism has ___ TSH.
elevated
Secondary hypothyroidism has ___ TSH.
low
A subclinical hypothyroidism can exist in which the person is asymptomatic but has an elevated ___ level and normal __.
TSH
T4
Symptoms of \_\_\_: Fatigue, weakness, and lethargy Depression and disinterest in activities Anorexia Weight gain and puffy face Impaired hearing Periorbital or peripheral edema Constipation Cold intolerance Myalgia, paresthesia, and ataxia Dry skin and coarse hair
hypothyroidism
Treatment of hypothyroidism includes replacement of thyroid hormone using a __ __
synthetic T4
Initially, thyroid replacement is prescribed at a __ __ and is gradually ___ under close supervision to prevent cardiac complications
low dose
increased
T/F: Thyroid replacement will most likely be a lifelong requirement.
True
Which is less prevalent: hyperthyroidism or hypothyroidism?
Hyperthyroidism
A potential cause of hyperthyroidism in older patients that should be considered is related to the use of ___.
amiodarone
___ is a cardiac drug containing iodine that deposits in tissue and delivers iodine to the circulation over very long periods of time.
amiodarone
Diagnostic testing can be challenging because blood tests do not always reflect ___
hyperthyroidism
T3 levels can be decreased from ____
decreased nutritional status
Classic symptoms of ____ include diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat intolerance, increased hunger, proximal muscle weakness, and hyperreflexia.
Hyperthyroidism
An autoimmune disorder that leads to the production of an antibody to the TSH receptor that stimulates thyroid growth and overproduction of thyroid hormone
Graves’ disease
Changes that occur to the endocrine system with age include:
- reductions in ___ gland activity
- less radioactive __ uptake
- lower ___ rate
- less secretion and release of ____
- decreased ___ gland volume
- insufficient pancreatic release of ___
- ___ secretion decreases
thyroid iodine metabolic thyrotropin pituitary insulin ACTH
Enables body to metabolize energy, reproduce, grow, develop, maintain homeostasis, respond to stress & injury.
endocrine system
Age-related changes are __ and ___(compensatory response)
diverse
inter-related
Diagnosis of hyperthyroidism includes evaluation of what 3 things? (thyroid stimulating hormone)
T4, free T4, TSH
Disease that destroys tissues in thyroid
primary or secondary
Primary
Insufficient pituitary secretion of thyroid stimulating hormone (TSH)
(primary or secondary)
Secondary
Treatment/management of hypothyroidism: Replacement of thyroid hormones w/ synthetic ___ (Synthroid or thyroxine)
T4
Complications of \_\_\_ includes: Neuropathies Retinopathy leading to blindness Cognitive impairment Coronary artery disease Cerebral arteriosclerosis Urinary tract infections (high level of glucose can do this) Higher risk of developing problems in every body system
Diabetes
Exercise and nutrition has a direct affect on __ __ __.
blood glucose level
Hemoglobin (Hgb or Hb) A1C test measures the amount of ___ ___ in the blood.
glycosylated Hgb
Normal Hgb is __ to ___ %
normal 4-6%
For a diabetic, you want a blood glucose level less than ___%.
6.5%
Hgb is used to monitor effectiveness of disease control over a _____ period of time
6-12 week
Triglyceride monitoring, levels below ___ mg/dL is ideal.
150
Diabetic agents have ___ as a side effect.
hypoglycemia
Management of Diabetes:
- implications of diagnosis
- assessment of self-care capacity
- reassurance and support
General exercise ___ your blood glucose.
lowers
__% of older adults are diagnosed with diabetes.
20
What is metabolic syndrome?
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes
you’re checking the ___ ___ before giving the insulin’s and each insulin has different ___ for their effectiveness.
blood glucose
duration
There is insufficient release of __ and reduced __ sensitivity to ___ insulin
insulin
tissue
circulating
Is 70-130 a normal sugar?
YES- for anytime throughout the day
Hemoglobin (Hgb or Hb) A1C test measures the amount of glycosylated Hgb in the blood. The normal range is:
4.5-6.5
