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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
What is thyroidtoxicosis | causes
Thyroid storm, hyperthyroidism, emergency, | Infection, trauma, stress, thyroidectomy-#1 from release of hormones when removing it.
26
Manifestations of thyrotox 7
Severe Hyperthyroid s.s, heart fail, shock, seizure, delirium, coma, ab pain,
27
Management with thyrotox- | 6 with examples.
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
28
S/S of hyperthyroidism
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,
29
drugs for hyperthyroidism 4 and about them
Antithyroid meds-zoles, Iodine-not long term just for surg beta blockers Radioactive iodine-not for preg, destroys tissue, can cause hypt, radioactive precautions.
30
Care for hyperthyroid 5
Surgery, meds, decrease temp, increase fluids, increase cal,
31
S/s for iodine tox 4
Swelling of bucccal mucosa, and mucus membranes, increase saliva, N/V and skin reactions. STOP TX
32
Tx for hypothyroidism
33
Myedexema coma
Long standing hypothyroidism from acculumulation of hydrophilic monopolysacerides, in dermis and tissue
34
Myedex coma s/s 5 | caused by?
Puffy face and peri orbital, coma-mentally slow, drowsy, lathargic infection, drugs, cold, trauma, stopping tx
35
Manifestaions of My coma 4
Subnormal temp, hypotn, hypovolemia, cardiac collapse- hypovent, hypona hypogly lactic acidosis,
36
Care for myex coma | two drugs
Mechanical respiration, cardiac monitoring, temp, skin care, vitals weights i LOC IV thyroid hormone vassopressors
37
Cushings cause types Common
Over exposure to corticosteroids, iatrogenic- prednisone, ACTH Secreting pituitary adneoma or adrenal tumor Ectopic-Tumors somewhere else- lungs and pancreas women 20-40
38
Manifestations that you don't know of chushings
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
How to diagnose cushings
increased serum cort, midnight saliva, 24 hour urine- greater than 80
40
What tests would you expect with cushings.
MRI or CT for tumor, Plasma ACH- low or high, blood penias-white, glucose in urine, hyperca, hypo k and alkolosis
41
TX for cushings
Radiation- for those who can't have surg, surgery drugs-destroy adrenal-ketoconazole and mitotane Mifepristone0 for hypergly
42
TX for cushings
Radiation- for those who can't have surg, surgery drugs-destroy adrenal-ketoconazole and mitotane Mifepristone0 for hypergly Change steroid dose
43
What to watch for with cushings
Thrombolytic event, medical alert bracelet, no extreme temps, may need more steroids for stress, watch for infection and OSHTN
44
Addisons disease four about it
Not enough corticosteroid decrease of medula of adrenals all steroids decreased usually autoimmune
45
Addisons causes
TB, amylodisis, fungal infection, AIDS, meta cancer. chemo, ketoconazole, bilat adrenoectomy, Anticoag therapy
46
secondary addison
Pituitary issues with ACTH
47
Manifestations of addisons
late diagnosis, all the ab stuff, weak, weight loss, bronze skin hyperpig-primary, HA, ORTHOHTN, Salt craving, joint pain
48
What is the risk for addisons
Addisonian crisis- tx-high fluids ds5 Hypotn and shock, curculatory collapse hypo na hyper k hypogly, fever, weak, back pain N/V/D
49
Diagnosis with ad
ACTH and corts measured, inject iv of ACTh recheck 30 mins, addisons is little to no change and primary has high ACTH levels
50
One difference between primary and secondary addisons
Primary is all of the steroids and secondary has mineral still
51
Tx for addisons 8
``` 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
Drugs that interact with steroids 5
hypogly, glucosides, contraceptives, anticoag, NSAIDS
53
pheochromcytoma
Tumor in the medulla affecting chromaffin cells aka catecolamines
54
pheochromcytoma s/s 7
Severe pounding HA, High BP, tachy, chest pain, diaphoresis ab pain
55
Causes of pheochromcytoma 10
direct trauma, stress, sex, alcohol, smoking, drugs antihypertensives, opioidsm contrast, tri antidepressants,
56
tx of pheochromcytoma
Alpha and beta blockers sin and lol surg decrease bp and dysr watch orthp
57
``` Kidney lab values Urine osmo BUN Creatinine GFR Urine output SG ```
``` 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
``` Blood gas O2 CO2 Bicarb pH ```
80-100 35-45 bi-22-28 7.35-7.45
59
ANION GAP
(na+-k+)- (Cl+HCO3) | normal 8-10
60
``` Normal na k cl ca ```
na-135-145 K-3.5-5 98-106 9-10.5
61
Serum osmololity
278-300
62
Thyroid TSH t3 t4
0.5-4.5 5.4-11.5 80-100
63
Micro vs Macro angiography
Micro- Damage to cap and arterioles causes thickening Retinopathy, neuropathy, neohropathy Micro-Cerebro, Cardio, stroke, heart attack, PAD and PVD
64
What are the risks for angiography 5
obesity, smoking, HTN, increased fat intake, sedentary
65
``` Rentinopathy Why? Causes one Types one more risk it causes ```
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
s/s of retinophaphy 6 | one for cateracts and one for glaucoma
Cotton wool spots, hard exudate, hemorrhages, aneurysm, abnormal vessles, black and red spots Cateracts-cloudy lense Glaucoma-fluid and damage to optic nerve
67
tx for retinophathy 6
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
Nephropathy 2 | 4 inducers
blood vessles supply the glumatuli leading cause of end stage renal Genetic link with kid disease, hypertn, smoking, hyperglycemia
69
Nephropathy s/s
Grnular surface, decresed kid finction, sm size, increase urine prots, sclerotic vessles, ischemic pyramids
70
Nephropathy care 4
watch Albumin and creatinine, bp control ace inhibitors-prill
71
Neuropathy
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
dermaplphys
for neuropathy, red bown spots nothing to worry about
73
TX for neuropathy
Monofil testing on feet foot care, Empty bladder, Drugs
74
Dibetic risk for infection
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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