Endocrine :1 Flashcards
Thyroid gland produces what hormones?
3 hormones
- T3
- T4
- calcitonin
Calcitonin ____ serum calcium levels by taking calcium out of the blood and pushing it back into the bone.
decrease
You need ____ to make hormones. (dietary)
Thyroid hormones gives you _____!!
iodine
energyy!
Hyperthyroid:
TOO MUCH ENERGY! (graves disease)
s/s of hyperthyroid:
- nervous
- weight loss
- sweaty/hot
- exophthalmos
- attention span decreased
- appetite increased
- irritable
- GI: fast
- bp UP
- thyroid enlargement (hypertrophy)
How is hyperthyroid diagnosed?
- serum T4 (thyroxine) is increase
- thyroid scan
client must discontinue any iodine containing medication ____ week prior to the thyroid scan.
one
what medication contain high levels of iodine and may affect thyroid function?
amiodarone (cardarone), [an antiarrhythmic drug]
treatment for hyperthyroid.
- anti-thyroids (propylthiouracil, methimazole)
- iodine compounds
- beta blocker
- radioactive iodine
- surgery (thyroidectomy)
action of anti thyroid medication?
it is used ____ to stun the thyroid.
STOPs the thyroid from making thyroid hormone.
pre-op
(we want this client to become euthyroid (eu=normal)
iodine compounds?
action?
important to know about this?
potassium iodine, strong iodine solution (lugols solution)
- DECREASES the size and vascularity of the gland
- give in milk or juice and use a straw because it will stain their teeth.
ALL endocrine glands are VERY _____.
vascular
beta-blocker example?
action?
DO NOT give beta blocker to ?
propanolol
- decreases myocardial contractility, could decrease cardiac output, decreases HR, BP, decreases anxiety
- asthmatics or diabetics patients
radioactive iodine. given? action? what are the radioactive precaution to follow? watch for what?
ONE DOSE
Given PO
DESTROYS thyroid cells- reduce thyroid hormones.
-stay away from babies for 24 hours, dont kiss anyone for 24 hours.
-thyroid storm(thyrotoxicosis and thyrotoxic crisis). it is hyperthyroidism times 1000. is an EMERGENCY!
- post op for thyroidectomy?
- positioning?
- check for bleeding where?
- nutrition pre and post op?
- assess for recurrent laryngeal nerve damage by listening for ___.
- could lead to vocal cord paralysis?
- when there is paralysis of both cords ____ obstruction will occur immediately ____.
- teach to report feeling of ___.
- ___ at bedside
- teach how to support neck, put personal items close to them.
- HOB up 30-45degree. (want edema to fall with gravity)
- back of neck
- client needs MORE calories
- listen for hoarseness (weak voice)
- airway / trach
- feeling of pressure (even if a little presssure)
- TRACH
hypothyroid AKA ____
myxedema
s/s of hypothyroid
- NO energy
- when this is present at birth, its called cretinism (very dangerous and can lead to slowed mental and physical development if undetected)
- fatigue
- GI SLOW
- weight UP
- cold (they should layer their clothes)
- amenorrhea
- speech; slowed or slurred
- no expression
treatment for hypothyroid
-levothyroxine, thyroglobin, liothyronine
-you take these meds FOREVER
-
people with hypothyroidism tend to have ___.
coronary artery disease. because of increase LDL
[parathyroid problems]
- the parathyroid excretes ____ which makes you pull calcium from the __ and place it in the blood. therefore, the serum calcium level goes ___.
- if you have too much parathormone in your body, the serum calcium level goes ___.
- if you do not have any parathormone in your body, the serum calcium level goes ____.
PTH bone UP UP DOWN
Hyperparathyroidism = ___=____
hypercalcemia= hypophosphatemia
s/s of hyperparathyroid
- too much PTH
- serum calcium is HIGH. serum phos is LOW
- sedated
treatment for hyperparathyroid
-partial parathyroidism- when you take out 2 of your parathyroids… PTH secretion goes DOWN
you should monitor rigid tight muscle POST OP
hypoparathyroidism = ____=____
hypocalcemia= hyperphosphatemia
s/s of hypoparathyroidism
not enough pth
serum calcium is low and serum phos is high
not sedated
treatment of hypoparathyroidism
- IV calcium
- phos binding drugs
adrenal glands THINK ___.
need you adrenal to handle ___.
steroids!
Stress!
adrenal medulla (____,___) problems are ___.
epinephrine, norepinephrine
pheochromocytoma (benign tumors that secrete epi and norepi in bolus)
s/s of pheochromocytoma
- BP UP
- HR and pulse UP
- flushing/ diaphoretic
diagnosis of phenochromocytoma
VMA (vanillylmandelic acid) test: a 24 hours urine specimen is done and you are looking for increased levels of epi and norepi.
-with a 24 hours urine, you should throw away the first voiding and keep the last voiding.
treatment for pehnochromocytoma
surgery to remove tumors
adrenal cortex (\_\_\_\_\_\_) *even though the body secretes steroids normally, the adverse effect are going to be more pronounced when the client is receiving oral or iv steroids.
glucocorticoids, mineralcorticoids, and sex hormones
what do glucocorticoids do?
(major action!!)-change your mood ex:insomnia, depressed, psychotic, euphoric (feeling intense, excitement,happy)
- alter defense mechanisms (immunosuppressed, high risk for infection)
- breakdown fats and proteins
- inhibit insulin (hyperglycemic, DO blood glucose monitoring)
What do mineralcorticoids (aldosterone) do?
- make you retain sodium and water
- make you lose potassium
TOO much aldosterone?
not enough aldosterone?
too much- fluid volume excess, serum potassium DOWN
not enough- fluid volume deficit, serum potassium UP
____ are made in the pituitary and they stimulate cortisol to be made.
____ is a hormone of the adrenal cortex.
adrenocorticotropin hormone (ACTH) cortisol
___ACTH= ____ cortisol level.
too many steroids= _____
UP,UP
hypercortisolism
adrenal cortex problems:
not enough steriod—___–____.
shock
high potassium
addisons disease:
they do not have enough glucocorticoids, mineralcorticoids, or sex hormones.
-normally, aldosterone makes us retain sodium and water and lose potassium….now we dont have enough (insufficient), so will lose sodium and water and retain potassium.
now the serum potassium will be UP.
s/s of addisons disease:
- initially, the majority of s/s are a result of the hyperkalemia.
- begins with muscle twitching and then proceeds to weakness, followed by flaccid paralysis
- anorexia/nausea
- hyperpigmentation- bronzing color of the skin and mucous membrane
- decreased bowel sounds
- GI upset
- white patchy area of depigmented skin (vitiligo)
- hypotension
- decrease NA, increased potassium and hypoglycemia
treatment for addisons disease:
- combat shock (losing sodium and water)
- increase sodium in their diet
- processed fruit juice/broth (has lots of sodium)
- I&O and daily weight
- if this client is losing sodium and water, their BP will probably be LOw
- losing weight
- fluid volume defict
- willbe placed on mineralcorticoid drug flurocortisone. its aldosterone
- daily weight
acute weight gain think ____ FIRST
heart problems and pulmonary edema
addisonian crisis = ______
severe hypotension and vascular collapse
cushing’s:
s/s-
TOO MANY STEROIDS! -growth arrest -thin extremities/skin (lipolysis) -increased risk for infection -hyperglycemia -psychosis to depression -moon faced -truncal obesity -buffalo hump (all these are TOO many gluco) -oily skin -women with male traits -poor sex drive (all these are TOO many sex drive) -high bp -chf -weight gain -fluid volume excress (these all are tOO many mineral)
if you did a 24 urine on the cushing’s client the cortisol level would be ____.
since the client has too many mineralcorticoids (aldasterone), the serum potassium will be ___.
UP
DOWN
treatment for cushing’s
- adrenalectomy (unilateral or bilateral)
- if both removed—lifetime replacement
- quiet enviroment
- avoid infection
- diet: increase K, decrease NA, increase Protein, Increase CA
- glucose and ketone in their urine
steroid ____ serum calcium by excreting it through the ___.
decrease
GI tract
normal lab values of blood glucose
70-110
diabetes type 1:
- they have little or no insulin
- usually diagnosed in childhood
- causes: auto-immune response (type 1a) or idiopathic (type 1b)
- first sign may be DKA
- appears abruptly, despite years of beta cell destruction
diabetes type 1:
you have to have ___ to carry glucose our of the vascular space into the cell…. since there is no insulin, the glucose just builds up in the ____ space, the blood become hypertonic and pulls fluid into the vascular space… the kidneys filter excess glucose and fluid (polyuria and polydipsia) the cell are straving so they start breaking down protein and fat for energy (polyphagia)…when you break down fat you get ___ (acids)… now this client is ___.
insulin
vascular
ketones
metabolic
diabetes type 1 :
s/s an treatment
-polyuria,polydipsia, polyphagia
- oral hyperglycemic med will NOT work for this pt.
- they have to have insulin!!
hyperglycemia=____
3ps
polyuria,polydipsia,polyphagia
type 2 diabetes:
- these clients dont have enough ____, or the insulin they have is no good
- these clients are usually ___.
- they cant make enough insulin to keep up with the ____ load the client is takin in .
- this type of diabetes is NOT as abrupt as type 1
- it’s usually found by accident; or the client keeps coming back to the physician for things like a wound that wont heal, repeated vaginal ___, etc
- individuals with type 2 should be evaluated for _____.
insulin overweight glucose infection metabolic
the features of metabolic syndrome include:
- insulin resistance
- abdominal obesity
- increased triglycerides
- decreased HDL
- increased bp
- CAD
treatment for diabetes type 2-
start with diet and exercise and then add oral agents. some clients may have to take insulin
gestational diabetes:
- resemebles type 2
- mom need 2-3x more insulin than normal
- screen all mom at 24-28 gestation
- if mom has risk factors for gestational diabetes, sceen at first prenatal visit
complication to baby if mom has gestational diabetes:
increased birth weight
hypoglycemia
extreme blood sugar =___
vascular damage
diet for diabetes:
- majority of calories should come from : complex carbs, then fats and lastly protein (limit protein to 10-20%, why? tend to have renal disease, cant handle protein)
- sugar destroys vessels just like fat; CAD
- high fiber diet (keep blood sugar steady)[high fiber slows down glucose absor[tion i the intestines, therefore,eliminating the sharp rise/fall in blood sugar.
exercise for diabetes:
- wait until blood sugar normalize to begin exercise
- eat before to prevent hypoglycemia
- exercise when blood sugar is the highest
- exercise same time and amount daily
how do oral hypoglycemic agents work?
who do you give this to?
stimulate the pancreas to make insulin!
(best nclex answer! despite whether they stimulate pancreas, all oral hypoglycemic work to decrease the amount of circulating glucose.)
type 2 only!
how is the insulin dose determined?
it is based on body weight. the average adult dose of insulin is 0.4-1.0. the insulin dose is adjusted until te blood sugar is normal and until there is no more glucose or ketone in the urine.
Reg insulin is ___…NPH is ____
clear
cloudy
rapid acting insulin may also be given ___.
IV
lantus is also clear and considered ____.
what is the standard insulin you give in IV?
long acting
regular
the most common method of daily dosing insulin is _____ dosing.
basal/bolus
*you used a combo of long acting insulin and a rapid acting insulin.
long acting insulin is given ___.
the rapid acting insulin is given throughout the day before meals in ____ doses, and it covers the food eaten at meals.
once a day
divided
snack are ___ required with basal/bolus insulin dosing, but clients still must eat when dosing with rapid-acting insulin. so have food available.
client should eat when insulin is at its?
when insulin is at its peak, the blood sugar is at its ?
NOT
peak
lowest
when drawing up regular and NPH insulin together, which one do you draw up first?
regular! (clear to cloudy!)
for people with diabetes, the ideal goal for their hbA1c is ____. hbA1c of _____ is diagnostic for diabetes.
4-6% or less
6.5-7%
