Endocrine Flashcards
Trousseau sign is to determine presence of
Assessment to determine for hypocalcemia before
and after thyroidectomy.
Symptoms of hepatic coma (Select all apply)
Impaired memory, attention, oncentration
hallucination, and dapcing tremor upon dorsiflexion of
hand.
Signs of Laennec’s cirrhosis due to alcohol abuse
Abdominal distention, protruding umbilicus, icteric
sclera
Esophageal varices (food to avoid)
Eating raw vegetables and food must be chewed well
and to eat slowly, No alcohol ingestion.
For liver biopsy which is significant assessment to the site,
Ecchymosis - bruising
A common complaints of patient who had laparoscopic
cholecystectomy
Right shoulder pain (due to irritation to the diaphragm
after carbon dioxide insufflation)
Hepatic Encephalopathy - On Lactulose to decrease
ammonia level so expect for diarrhea
On Lactulose (Duphalac) to decrease ammonia level
so expect for diarrhea.
Sengstaken Blakemore tube, nurse to keep at the bedside
A pair of scissors
Trousseau bedside application before surgery as baseline
after to determine?
Check serum level of Calcium (hypocalcemia)
Positive sign for hypocalcemia?
(+) Trousseau and Chvostek’s signs
Positive sign for hypomagnesemia?
(+) Trousseau and Chvostek’s signs
Predisposing factor associated with Type 2diabetes
Obesity
What would be the effect to a diabetic client of taking
alcohol when on Sulfonylurea
Disulfiram (Antabuse) like symptoms
(flushing, vertigo, tachycardia, and palpitations)
Insulin glargine (Lantus) is administered at what time?
At bedtime and is indicated for Type Il diabetes
mellitus.
Lispro (Humalog) insulin teaching when to start eating?
Eat within 5-15 minutes of Lispro administration
Signs and symptoms of hypoglycemia.
Cold clammy skin, diaphoresis, tremors, tachycardia
palpitation, and lethargy.
What to administer to reverse acidosis in Diabetic
Ketoacidosis (DKA)?
potassium shift back into intracellular compartments.
Nurse alert: oral hypoglycemic medication is
contraindicated in Diabetic Ketoacidosis.
Normal value of Glycosylated hemoglobin HbA1c
Less than 7% for diabetic
Less than 6% for non-diabetic *
Greater than 8% is considered poorly controlled
Effect of insulin and alcohol, may cause fast reaction in
Hypoglycemia
In DKA, potassium level is initially high or low?
High
Hyperkalemia
Client teaching on client with DKA when activity is being
planned.
Avoid exercise, rest and take plenty of fluids.
When a ketone is check?
When blood sugar is 250mg/dl or when acetone
breath is present.
Nursing intervention when the bedside glucose monitoring
is read as critically high or critically low.
Obtain a stat venous blood draw. Most agencies
May have a protocol order in this case.
Nursing alert for Protamine Zinc
Long acting, check insulin reaction early in the
morning, and give milk or carbohydrate foods at
bedtime
Denver shunt is inserted to client with cases of
Cirrhosis - to divert ascetic fluid from the abdomen
into the jugular vein or to the vena cava
Chronic idiopathic jaundice with pigments in the liver
Dubin-Johnson syndrome
Amount of ascitic fluid drawn during paracentesis
Slow removal of 2 to 3 liters to relieve acute symptoms.
Electrolyte imbalance resulting in patient with DKA
Hyperkalemia
Medication used to sterilize the bowel by reducing the
number of bacteria in the GIT (as in cirrhosis of the liver)
Neomycin
It lowers the pH and traps ammonia in the colon; diarrhea is
a common side effect. It is also used for constipation.
Lactulose (is a synthetic sugar), used as a cathartic.
Used to reduce ammonia level (hepatic encephalopathy).
Lactulose (a laxative-osmotic effect).
Drug of choice for pancreatic, gallbladder pain
Demerol (meperidine)
Reason for taking Neomycin among clients with cirrhosis of
the liver.
To reduce ammonia level by enteric bacteria.
Nursing intervention when pt is eating with a T tube post
cholecystectomy
Clamp the tube during meal hours to assist in fat
digestion.
An autoimmune disorder where body’s own antibodies
attack the cells of the body. Most common cause of
hypothyroidism.
Hashimoto’s thyroiditis
Thyroid Storm or Thyroid Crisis
Extreme form of hyperthyroidism, fever spikes to 106.
How to administer SSK1 (Saturated Solution of Potassium
lodide)
Dilute well with milk, water, carbonated drinks or
water to disguise the bitter taste. KKSl is taken with a
straw to avoid staining to the teeth.
It helps to control the amount of calcium in the blood.
Normal calcium levels help maintains muscle control and
the blood’s ability to clot.
Parathyroid gland
Patient teaching undergoing
parathyroidectomy avoid:
Milk, seafood, green fruits, green leafy vegetable,
turkey or chicken. Answer: Milk or milk products.
Signs of Addisonian “crisis”
What is the Diagnostic test for Addison crisis?
Decreased urine output, hypotension, dry skin, dry
mucous membrane, altered LOC.
ACTH stimulation test .
SIADH is defined as.
Excessive release of antidiuretic hormone or
vasopressin from posterior pituitary gland.
Signs and symptoms of SIADH
- Hyponatremia, fluid overload
(not causing edema and hypertension) - Fluid retention
- Decreased urinary output
- Decreased LOC (due to cerebral edema and
increased intracranial pressure) - Normal or increased plasma volume
Treatment for SIADH
Fluid restriction
Diuretic (Lasix-furosemide), a loop diuretic
Sodium replacement
What is diabetes Insipidus?
Profound deficiency of an antidiuretic hormone
(ADH), causing excessive diuresis,
Treatment for Diabetes insipidus
Desmopressin
Treatment for nephrogenic diabetis insipidus
Thiazides ( diuretics) for paradoxical effect
What do you seen on Anterior and Posterior gland?
Anterior Pituitary gland:
ACTH
FSH, LH, prolactin
Growth hormones
TSH
Posterior gland:
Vasopressin (ADH)
Oxytocin
The endocrine system is made of glands, hormones, & organs.
Billary-Tree
_______ is the largest gland/ internal organ.
It produces two (2) pints of bile (digestive enzyme) daily.
_____ stores and concentrates bile.
_______releases pancreatic juices, enzymes, and secretes insulin.
Liver
Gall bladder
Pancreas
Ammonia
Cirrhosis of the liver what electrolyte imbalance
Hypo or hyper?
Natremia
What do you reduced?
Complications?
Cirrhosis. at the Uver is a chronic liver disease secondary to destruction of hepatic cells from chronic alcoholism but It is only one of the causes.
May progress to liver failure and obstruction of portal circulation,
Signs and symptoms:
Early symptoms: fatigue, anorexia, and weight loss, to edema, elevated liver enzymes, electrolyte imbalance primarily hyponatremia.
Reduced albumin causing edema and ascites,
Complications: fluid retention, esophageal varices, and upper Gl bleeding.
Paracentesis: Nursing alert : May require “ albumin”
Paracentesis
What
Liver biopsy
Patient Teaching
Pre liver biopsy
Post liver biopsy care
Pancreas
Gland hormone action
Pancreatitis
Signs
Cullen and Grey turner
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216450/
Gall bladder - stores and concentrates bile to digest fast and oils.
Chole - Gall bladder
____ is inflammation of the gallbladder (acute or chronic). Primarily affecting obese female.
______ is the presence of one or more calculi (gallstones) in the gallbladder.
_____ cholecystitis is a sudden inflammation of the galibladder that causes severe abdominal pain.
_____ cholecystitis is long-standing swelling and irritation of the gallbladder.
Diagnostic procedures for Chole cyctography
Cholesintigraphy or HIDA (Hydroxy. Imino Diacetic Acid).-
is a study of gallbladder through imaging to detect: Biliary obstruction
(gallbladder stone or cancer).,
HIDA Scan determines any blockage
If there is an obstruction, the radioactive tracer will not be able to reach the gallbladder coming from the liver.
Preparation: NP0 after midnight lor the procedure and resume to low fat meal.
____ is a useful tool in establishing the diagnosis of cholecystitis, Confirmation of the diagnosis depends on a
combination of physical findings by palpation and ultrasound,
Murphy’s sign
Client complaint after laparoscopic cholecystectomy:
irritate the diaphragm and cause referred shoulder pain.
Pain last for 24-48 hours or may take several days.
Diabetes Mellitus
Type 1 and Type 2
Hyper glycemic Vs Hypo glycemia
Optic click insulin Pen
Lantus is for?what type of diatebetes?
How many times a day?
What is levemir for?
_____ Normal or elevate blood glucose at bedtime, a decrease of
glucose level between “2-3 am” to hypoglycemic levels,
and a subsequent rise of the sugar due to the production of
counter- regulatory hormones,
Somogyi effect
Nursing teaching:
Decrease evening dose (pre-dinner or bedtime) of
intermediate-acting insulin or increased bed time snack,
Injection
DKA vs HHNK
____ an uncommon initial manifestation in patients with diabetic ketoacidosis.
Aggressive potassium repletion to correct other metabolic abnormalities, including hyperglycemia and hyperosmolality.
Profound hypokalemia ( DKA) Initial
Potassium loss is caused by a shift of ____ from the _______ to the extra cellular space exchange with hydrogen ions that
accumulate extracellularly in acidosis. Much of the shifted extracellular potassium is lost in urine because of osmotic diuresis.
Potassium
Intracellular
What is hemoconcentration?
What is hemodilution?
BUN?
Creatinine?
Peripheral Neuropathy
Mixing insulins
D/S x Q
Metformin : Side Effects
Metallic taste, abdominal discomfort, diarrhea, anorexia, nausea or vomiting.
Monitor for : Hypo or Hypperglycemia?
Contraindicated?
When lasix and metformin? Whats gonna happen?
/Oral Drug Combinations to treat Type 2 Diabetes & Non-insulin injections
Glucagon - used for hypoglycemia and administered IM, IV, subcutaneous. Usual dose 1-2 mg.
Do not administer anything orally when patient is lethargic or ALOC..
> Diagnostic test for Pheochromocytoma (will induce increased BP)
but contraindicated in known Pheochromocytoma.
Hemoglobin A1c
Diabetic Foot care
Insulin onset test:
DI VS SIADH
DI and SIADH treatment and Nursing alert
Addison and Cushing Syndrome
Addison and Cushing Syndrome
Addisonian Crisis (Adrenal Crisis)
Pheochromocytoma
Side Effects of Steroids
Thyroid Gland
Thyroid Diagnostic Test
Thyroid Ultrasound
Thyroid Scan
Serum Thyroid Panel
Hyperthyroidism and Hypothyroidism
Hyperthyroidism/Hypothyroidism
Treatment
Nursing Action
Chvostek’s Sign and Trousseau Signs
(+*) for hypocalcemia and hypomagnesemia
Thyroid Levels Interpretation
T3 T4 Low TSH High - Hypothyroidism
T3 T4 High TSH Low - Hyperthyroidism
Hyperthyroidism also known as ________.
Grave’s Disease ( toxic goiter)
Radioactive Iodine Teaching And Administration:
Thyroidectomy
Available at the bedside prior to receiving client from PACU:
Thyroidectomy set, suction machine
Oxygen inhalation, Calcium chloride IV
Post thyroidectomy Care :
Semi-Fowler’$ position or 2-3 pillows.
Avoid hyperextending the neck, head in neutral position.
No Aspirin or NSAIDs within 10 days,
No lifting 20 pounds within 10 days after surgery.
Follow up with the surgeon after a week,
Para thyroid gland
Hypo para thyroidism and Hyper parathyroidism
Treatment
See pictures:
Hypo physectomy - Removal of pituitary gland to treat Cushing Syndrome or tumor.
Client Teaching to decrease Addisonian crisis:
Most important is “ Steriod in Addison crisis”
Acgromegaly
Treatment : Sando”statin”
Hepa B -
Vertical Transmission
When is the vaccine treatment?
0,1 and 6 months
Hepatitis D
(Delta Hepatitis)
Transmission?
Bloody fluids, excretion of infected person or maybe acquired from infected HBV.
AIDS and HIV
Hepatitis A
Post Exposure: Gamma globulin injection
_______ - Presence of a virus in the bloodstream
Viremia
