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Med surg 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what causes keto acidosis

A

Type 1 diabetes,
or type 2 with neglect, illness stress
It is from lack of insulin

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2
Q

MEtabolic acidosis 8

A

HA, hyper k, mm twitching, warm flushed skin, NV, decreased mm tone, decreased reflexes, kussumal

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3
Q

MEtabolic acidosis 8 why?

A

HA, hyper k, mm twitching, warm flushed skin, NV, decreased mm tone, decreased reflexes, kussumal
DKA

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4
Q

what causes signs and symptoms of DKA

5

A

Metabolic acidosis, dehydration, glucose. metabolic, hypo electrolytes

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5
Q

What labs would you want for DKA

A

anion gap, BMP-Glucose,electro,kideney, art gas,BP, Serum osmolality, urine stuff, cbc

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6
Q

Can DKA be outpatient

A

yes if they do not have an infection and no serious s/s

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7
Q

how do we treat right away for DKA?

A

O2, then IV- 0.45-0.9 NS, add dextrose if below 250-SLOWWW, short acting insulin, and k+ because of insulin at 0.1 units and increased output, possibly bicarb, Cardiac monitor, labs

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8
Q

What is hyperosmolar hyperglycemia

A

Its an emergency with 600+ BG levels, and severe osmotic diuresis caused by infection or newly diagnosed DM11

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9
Q

What are we concerned about hypersomolar hyperglycemia

What can that lead to

A

Hypovolemia, Hypoelectrolytes, dehydration, Hemoconcentraition, renal perfussion, tissue anoxia (Lactic levels increased)
Seizure, shock, coma, death

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10
Q

S/s of hyperos hypergly

A

Hypovolemia s/s, dehydration s/s, shock s/s, high urine output to low urine output, seizure, high bg, stroke- similarities. LOV issues, s/s of hypoglycemia- mimic alcohol.

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11
Q

Management of Hyperos hypergly

A

Similar to DKA, more fluid, might need a foley, breath sounds, IV- normal half normal, add dextrose at 250, insulin electrolytes, watch cardiac, renal, Mental status.

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12
Q

What is the number for hypoglycemia

A

less than 70

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13
Q

s/s for hypoglycemia

what happens if you dont get help?

A

Shaky, palp, nervous, diaphoretic, hunger pallor
Neuroglycopenia- Diff speaking, visual disturbances, stupor, confusion, coma
loss of c. seizures, coma, death

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14
Q

What is the rule of 15?
and 2 things to remember
2 pharm interventions

A 
take 15g of simple carbs or gels or tabs, check in 15, repeat.
If no change in 2-3 times call HCP 
No foods with fat-slows glucose
Don't over do it
20-50ml 50% DEXTROSE 
Glucogon
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15
Q

To remember about diabetic care

A

A1c Every 3 months, Stop smoking- circulation, check for dry skin or callus, use lotion but not in-between toes.

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16
Q

causes of SIADH and what is it and more common in

A

Its over production of ADH
sm lung cancer, brain trauma, brain surg, Drugs, ICP
males

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17
Q

How do we diagnose SIADH 3

A

High consentrated urine so increased Special gravity, Low serum osmolality, and hypona+

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18
Q

S/s

6 OF SIADH

A

Low urine output 10/ml.hr or less, increased circulating volume THiRST, Increased GFR, Hypona+ s/s, sudden weight gain without edema,

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19
Q

S/S Of hypona+

A

mm cramps, irritablity, fatigue, HA, Twitching, mm weak, cerebral edema vomiting, confusion, seizures, coma,

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20
Q

What are we focused on with SIADH how do we do that? 6

A

Dilutional Na+- Seizure and fall precautions, watch s/s give 3% if supper low very slow too fast causes permanent brain nerve damage
FVOL-Heart and lung sounds, Is and OS, daily weights, BP, fluid restriction maybe 500 skin, rom, loops( watch K)
watching neurofunction
Thirst- Ice chips gum oral care tin drugs
Dont increase ADH- no drugs- vassopressin, DDAVP flat bed
decrease ADH- Vassopressin antag demecylocine

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21
Q

Types of DI and about them

A

Central- Interference with ADH production tumors, infections, brain surgery
Neph-kidneys wont respond- Lith, renal damage
primary- Thirst issues

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22
Q

Manifestations of di 5 causes with with r/t s/s

A

polydipsia, polyuria,- 2-20 l a day with low SG
Increased plasma osmolality
Sleepy from nocturia
dehydration-thirst, hypo, tachy, shock
Hyperna+ irritable, mental dullness, coma

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23
Q

DI and three things to watch for one thing to teach

Specific tx for neph and central-

A

Hyperna+-Watch s/s, hypotonic solutions, dextrose-watch glucose and its diuretic effect.
Increase fluids-DDAVP and aqueous vassopressin
FVD- Thirst- CLor and carban, I and O, Vitals-esspecially volume rt, Specific gravity, daily weights, flushed skin- sign of FVD
Long term mat
Nephro-Fluids and decrease Na+ no hormones, thiazides, indometh-NSAID and increases kid sensitivity.

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24
Q

Explain test for DI

A 
Water deprivation test 
before test measure body weight, urine osmo, volume, and sg
no water for 8-12 hr
Give presser 
Central-increse urine osmo
nephro- no increase in urine osmo
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25
Q

What is thyroidtoxicosis

causes

A

Thyroid storm, hyperthyroidism, emergency,

Infection, trauma, stress, thyroidectomy-#1 from release of hormones when removing it.

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26
Q

Manifestations of thyrotox 7

A

Severe Hyperthyroid s.s, heart fail, shock, seizure, delirium, coma, ab pain,

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27
Q

Management with thyrotox-

6 with examples.

A

Agressive tx
Help heart- beta blockers, monitor, VA ECHMO, Balloon pump
Get thyroid hormone decreased- meds- Iodine, RA iodine, PTU drugs, glucosteroids, IV isotonic with Dex, surg if goiter or unresponsive to meds
Watch for complications-DysR, give 02, Watch dehydration and listen to lungs
diet-Increase cals, prots and fiber, no season, no stimulants
tx exo- prevent cornal injury, tears, no salt, increase HOB. tape, dark glasses, tepez drug
REST

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28
Q

S/S of hyperthyroidism

A

Edema. Increase activity, menstrual issues, decreased libito, decreased firtility. impotence, dyspnea, warm smooth moist skin, thin brittle nails, hair loss, decreased LDL, cardiac changes, clubbing, red palms, premature grey, fine silky hair, vertigo, into to heat, increased temp,

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29
Q

drugs for hyperthyroidism 4 and about them

A

Antithyroid meds-zoles,
Iodine-not long term just for surg
beta blockers
Radioactive iodine-not for preg, destroys tissue, can cause hypt, radioactive precautions.

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30
Q

Care for hyperthyroid 5

A

Surgery, meds, decrease temp, increase fluids, increase cal,

31
Q

S/s for iodine tox 4

A

Swelling of bucccal mucosa, and mucus membranes, increase saliva, N/V and skin reactions. STOP TX

32
Q

Tx for hypothyroidism

A
33
Q

Myedexema coma

A

Long standing hypothyroidism from acculumulation of hydrophilic monopolysacerides, in dermis and tissue

34
Q

Myedex coma s/s 5

caused by?

A

Puffy face and peri orbital,
coma-mentally slow, drowsy, lathargic
infection, drugs, cold, trauma, stopping tx

35
Q

Manifestaions of My coma 4

A

Subnormal temp, hypotn, hypovolemia, cardiac collapse- hypovent, hypona hypogly lactic acidosis,

36
Q

Care for myex coma

two drugs

A

Mechanical respiration, cardiac monitoring, temp, skin care, vitals weights i LOC
IV thyroid hormone vassopressors

37
Q

Cushings cause
types
Common

A

Over exposure to corticosteroids, iatrogenic- prednisone, ACTH Secreting pituitary adneoma or adrenal tumor
Ectopic-Tumors somewhere else- lungs and pancreas
women 20-40

38
Q

Manifestations that you don’t know of chushings

A

hyperglycemia, mm weak and atrophy, osteoporosis, weak skin, delayed wound healing, hypoK, hypertn, acne, buffalo hump edema, awkward gate, CNS changes, GI increased Acid, bruise and petechiae

39
Q

How to diagnose cushings

A

increased serum cort, midnight saliva, 24 hour urine- greater than 80

40
Q

What tests would you expect with cushings.

A

MRI or CT for tumor, Plasma ACH- low or high, blood penias-white, glucose in urine, hyperca, hypo k and alkolosis

41
Q

TX for cushings

A

Radiation- for those who can’t have surg,
surgery
drugs-destroy adrenal-ketoconazole and mitotane
Mifepristone0 for hypergly

42
Q

TX for cushings

A

Radiation- for those who can’t have surg,
surgery
drugs-destroy adrenal-ketoconazole and mitotane
Mifepristone0 for hypergly
Change steroid dose

43
Q

What to watch for with cushings

A

Thrombolytic event, medical alert bracelet, no extreme temps, may need more steroids for stress, watch for infection and OSHTN

44
Q

Addisons disease four about it

A

Not enough corticosteroid
decrease of medula of adrenals
all steroids decreased
usually autoimmune

45
Q

Addisons causes

A

TB, amylodisis, fungal infection, AIDS, meta cancer. chemo, ketoconazole, bilat adrenoectomy, Anticoag therapy

46
Q

secondary addison

A

Pituitary issues with ACTH

47
Q

Manifestations of addisons

A

late diagnosis, all the ab stuff, weak, weight loss, bronze skin hyperpig-primary, HA, ORTHOHTN, Salt craving, joint pain

48
Q

What is the risk for addisons

A

Addisonian crisis-
tx-high fluids ds5
Hypotn and shock, curculatory collapse hypo na hyper k hypogly, fever, weak, back pain N/V/D

49
Q

Diagnosis with ad

A

ACTH and corts measured, inject iv of ACTh recheck 30 mins, addisons is little to no change and primary has high ACTH levels

50
Q

One difference between primary and secondary addisons

A

Primary is all of the steroids and secondary has mineral still

51
Q

Tx for addisons 8

A 
Usually life long hydrocortisone 
watch hyperka and hypo everything else women need andregen replacement 
increase salt to diet 
give cortisol in divided does
They need a medical alert bracelet 
increases dose for stressful situations 
any GI upset needs to be reported
watch for chushing
52
Q

Drugs that interact with steroids 5

A

hypogly, glucosides, contraceptives, anticoag, NSAIDS

53
Q

pheochromcytoma

A

Tumor in the medulla affecting chromaffin cells aka catecolamines

54
Q

pheochromcytoma s/s 7

A

Severe pounding HA, High BP, tachy, chest pain, diaphoresis ab pain

55
Q

Causes of pheochromcytoma 10

A

direct trauma, stress, sex, alcohol, smoking, drugs antihypertensives, opioidsm contrast, tri antidepressants,

56
Q

tx of pheochromcytoma

A

Alpha and beta blockers sin and lol surg decrease bp and dysr
watch orthp

57
Q 
Kidney lab values
Urine osmo
BUN
Creatinine
GFR
Urine output
SG
A 
Urine osmo- 300-900
BUN-10-20
Creatinine 0.5-1.1
GFR 125
Urine output 1.5-2ml/kg/hour
SG-1.005-1.030
58
Q 
Blood gas
O2
CO2
Bicarb 
pH
A

80-100
35-45
bi-22-28
7.35-7.45

59
Q

ANION GAP

A

(na+-k+)- (Cl+HCO3)

normal 8-10

60
Q 
Normal 
na
k
cl
ca
A

na-135-145
K-3.5-5
98-106
9-10.5

61
Q

Serum osmololity

A

278-300

62
Q

Thyroid
TSH
t3
t4

A

0.5-4.5
5.4-11.5
80-100

63
Q

Micro vs Macro angiography

A

Micro- Damage to cap and arterioles
causes thickening Retinopathy, neuropathy, neohropathy
Micro-Cerebro, Cardio, stroke, heart attack, PAD and PVD

64
Q

What are the risks for angiography 5

A

obesity, smoking, HTN, increased fat intake, sedentary

65
Q 
Rentinopathy 
Why?
Causes one
Types
one more risk it causes
A

Hyperglycemia causing damage to the retina
can cause blindness
2 types
Proli-new blood vessles black and red spots, and retinal detachment
non-prolif-most common weak walls=retinal edema and microanurisms maybe blind
Increased risk fot Cateracts and gluacoma

66
Q

s/s of retinophaphy 6

one for cateracts and one for glaucoma

A

Cotton wool spots, hard exudate, hemorrhages, aneurysm, abnormal vessles, black and red spots
Cateracts-cloudy lense
Glaucoma-fluid and damage to optic nerve

67
Q

tx for retinophathy 6

A

lasor photo coagulation- destroys ischemia
eye exams
vitectomy-take out fluid and stuff helps with vison issues
manage glucose and hypertn
fluinolone acetonide- implant for 36 moths-steroid
VEGF-watch

68
Q

Nephropathy 2

4 inducers

A

blood vessles supply the glumatuli
leading cause of end stage renal
Genetic link with kid disease, hypertn, smoking, hyperglycemia

69
Q

Nephropathy s/s

A

Grnular surface, decresed kid finction, sm size, increase urine prots, sclerotic vessles, ischemic pyramids

70
Q

Nephropathy care 4

A

watch Albumin and creatinine, bp control ace inhibitors-prill

71
Q

Neuropathy

A

nerve damage demylenation of the nerve
sensory-Loss of senses in sensation in lower extremeties Or super sensitive, cramping burning, numb feet
or autonomic - non vol structures

72
Q

dermaplphys

A

for neuropathy, red bown spots nothing to worry about

73
Q

TX for neuropathy

A

Monofil testing on feet foot care, Empty bladder, Drugs

74
Q

Dibetic risk for infection

A

Decreased bf so fewer WBC and inflam cells glucose can go septic fast
neuropathy decreases s/s of infection

Med surg 2 (18 decks)

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