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HURST > Endocrine > Flashcards

Endocrine Flashcards

1
Q

The Thyroid Gland produces what 3 hormones?

A

T3
T4
Calcitonin

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2
Q

What does calcitonin do?

A

decreases serum calcium by taking calcium out of blood and putting it back into bones

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3
Q

What do you need to make hormones?

A

dietary iodine

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4
Q

Thyroid hormones are responsible for what?

A

us having energy

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5
Q

HYPERthyroid

A

Grave’s Dz

too MUCH energy

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6
Q

HYPERthyroid S/sx

A 
nervous 
irritable
decreased attention span
increased appetite
decreased weight
sweaty / hot
exophthalmos (bulging eyes)
fast GI 
increased BP and HR
arrhythmia / palpitations
increased thyroid size (goiter)

** everything speeds up

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7
Q

Diagnosis for HYPERthyoidism

A

increased serum thyroxine (t4) level

TSH decreased

thyroid scan (must discontinue iodine meds 1 week prior to scan and stay discontinued for 6 wks after)

Ultrasound / MRI / CT

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8
Q

What is a medication that contains iodine and must be discontinued one week prior to a thyroid scan?

A

amiodarone - an antiarrhythmic drug that affects thyroid function

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9
Q

Treatment for HYPERthyroidism

A

anti-thyroids

iodine compounds

beta blockers

radioactive iodine therapy

surgery

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10
Q

Anti-thyroids

A

methimazole (drug of choice) –> single daily dose / less SEs

- stops thyroid from making hormones
- used pre-op to stun thyroid

propylthiouracil

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11
Q

iodine compounds

A

potassium iodine and Lugol’s solution

  • decrease size and vascularity of gland
  • given in milk or juice with a straw to prevent staining of teeth
  • different from dietary iodine
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12
Q

beta-blockers and hyperthyroidism

A

used as supportive therapy

Propanolol

decreases myocardial contractility, anxiety, CO, HR, and BP

blocks epi and norepinephrine

**do not give beta blockers to asthmatics or diabetics

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13
Q

radioactive iodine therapy

A

1 dose given PO

rule out pregnancy first

destroys thyroid cells (hypothyroid)

  • *follows radioactive precautions
  • stay away from babies for 1 wk and don’t kiss anyone for 1 wk
    • watch for THYROID STORM ** Med emergency (thyrotoxicosis and thyrotoxic crisis)
  • could be rebound effect post-radioactive iodine
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14
Q

thyroidectomy

A

Done w goiters, thyroid cancer or if thyroid did not respond to anti-thyroid therapy

assess for recurrent laryngeal nerve damage by listening for hoarseness
* could lead to vocal cord paralysis = airway obstruction = need for trach (will not be able to intubate)

keep trach try at bedside incase of swelling or vocal cord paralysis

Hypocalcemia due to parathyroid removal (look for tight, rigid muscles and laryngeal spasms / not sedated)

teach to support neck

put stuff close to them / elevate HOB to reduce edema

nutrition = more calories

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15
Q

HYPOthyroid

A

no energy / mistaken for depression

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16
Q

HYPOthyroidism S/sx

A 
no energy
fatigue
no expression
slow / slurred speech
increased weight
slow GI
cold (never offer heating pad)
amenorrhea
may be totally immoble due to fatigue
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17
Q

Diagnosis of HYPOthyroidism

A

decreased T4 (thyroxine)

increased TSH

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18
Q

Treatment for HYPOthyroidism

A

levothyroxine
liothyronine

take on empty stomach
clients w hypothyroidism tend to have CAD (worry aobout MI)
** start slow and titrate up bc meds increase HR and BP
** if they complain of chest pain, think MI

they take these forever

meds will increase energy levels

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19
Q

Parathyroid

A

secretes PTH which makes you pull calcium from the bone and place it in the blood

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20
Q

HYPERparathyroidism

A

HYPERparathyroidism = HYPERcalcemia = HYPOphosphatemia

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21
Q

HYPERparathyroidism s/sx

A

too much PTH
serum calcium is increased and phosphorus is decreased

sedation (and other hypercalcemia s/sx)

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22
Q

HYPERparathyroidism Treatment

A

partial parathyroidectomy (take out 2 parathyroids) which decreases PTH

monitor for hypocalcemia (watch for rigid / tight muscles)

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23
Q

HYPOparathyroidism

A

HYPOparathyroidsim = HYPOcalcemia = HYPERphosphatemia

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24
Q

HYPOparathyroidism S/sx

A

not enough PTH

serum calcium is low and phosphorus is high

not sedated

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25
Q

HYPOparathyroidism Treatment

A

IV calcium

phosphorus binding drugs

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26
Q

Adrenal Medulla secretes

A

epinephrine / norepinephrine

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27
Q

Pheochromocytoma

A

benign tumors that secrete epi and norepi in boluses

familial

don’t do things to increase stress (smoking)

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28
Q

Pheochromocytoma s/sx

A 
increased BP
Increased HR
palpitations
flushed / extremely diaphroetic
headache

Triad of Symptoms: **pounding headache, tachycardia, profuse sweating

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29
Q

Pheochromocytoma Diagnosis

A

Catecholamine levels (VMA - vanillylmandelic acid test)
Metanephine (MN) test
** these tell if epi or norepi levels are elevated

A CT scan and MRI can be done to detect tumor

treatment is surgery = to remove tumor

30
Q

Vanillylmandelic acid test and Metanephrine test

A

test catecholamine levels (epi / norepi)

Foods that alter VMA - vanilla, vit B, fruit juices, bananas

Foods that alter MN - caffeine

*24 hr urine specimen (throw away first and keep last)

31
Q

Catecholamine

A

epi and norepi

32
Q

Avoid what with pheochromocytoma patients?

A

palpating the abdomen = can cause sudden release of catecholamines and severe HTN

33
Q

Adrenal Cortex

A

glucocorticoids
mineralocorticoids
sex hormones

  • all of above are steroids
34
Q

Glucocorticoids

A

Change mood (depressed, psychotic, euphoric, insomnia)

alter defense mechanisms (immunosuppressed)
- don’t put someone on steroids next to person w active infection

Breakdown fats and proteins

inhibit insulin (Hyperglycemia common / monitor glucose)

35
Q

Mineralocorticoids

A

aldosterone

make you retain sodium and water

makes you lose potassium

36
Q

Sex Hormones

A

testosterone, estrogen, and progesterone

Too many sex hormones: irregular menstrual cycle, acne, hirsutism (female facial hair)

Not enough sex hormones: decreased axillary / pubic hair, decreased libido

37
Q

Adrenocorticotropin hormones (ACTH)

A

made in pituitary

stimulate cortisol to be made

38
Q

Hypercortisolism

A

too many steroids

too much ACTH and cortisol

39
Q

Adrenal Cortex Problems

A

not enough steroids
shock
hyperkalemia
hypoglycemia

Addison’s Dz
Cushing’s Dz

40
Q

Addison’s Dz

A

adrenocoritcal insufficiency (not enough steroids)

decreased glucocorrticoids, mineralocorticoids, and sex hormones

41
Q

Addison’s Dz s/sx

A

extreme fatigue
N/V/D
anorexia / wt loss
hypotension
confusion
decreased sodium / increased potassium / hypoglycemia
hyperpigmentation-bronzing color of the skin and mucous membranes
white patchy area of depigmented skin (vitiligo)

42
Q

Addison’s Dz Treatment

A

combat shock (losing sodium and water)

increase sodium in their diet
** processed fruit juice / broth have tons of sodium

I&O / daily wt

decreased BP

losing wt

fluid volume deficit

MEDICATIONS:

  • corticosteroids - given BID - 2/3 of dose in morning and 1/3 of dose in evening
  • fludrocortisone acetate is synthetic aldosterone
  • dose is always changing (BP and daily wts must be monitored)
43
Q

Examples of corticosteroids

A

prednison
hydrocortisone
cortisone

44
Q

addisonian crisis

A

severe HYPOtension and vascular collapse

can occur with infections, emotional distress, physical exertion or stopping steroids abruptly

45
Q

steroids inhibit ____ = _____ increased

_______ = no steroids = ______ decreased

A

steroids inhibit insulin = increased glucose

addison’s = no steroids = decreased glucose

46
Q

Cushing’s Dz

A

too many steroids

47
Q

Cushing’s S/sx

A

Glucocorticoids:

  • Growth arrest
  • thin extermities / skin (lipolysis)
  • increased risk of infection
  • hyperglycemia
  • psychosis to depression
  • moon faced (fat redistribution or fluid retention)
  • truncal obesity (fat redistribution / lipogenesis)
  • buffalo hump (fat redistribution)

Sex hormones:

  • oily skin / acne
  • women with male traits

Mineralocorticoids (aldosterone):

  • high BP
  • CHF
  • Wt gain
  • fluid volume excess

** since client has too much mineralocorticoid (aldosterone), potassium will be LOW (bc too much sodium)

** 24 hr urine would show very high cortisol levels

48
Q

Cushing’s Treatment

A

adrenalectomy (unilateral or bilateral)
- if both are removed = lifetime replacement

quiet environment - can’t handle stress

diet pre-treatment should be high potassium, decreased sodium, increased protein, and increased calcium

(steroids decrease calcium by excreting it through GI tract) (steroids breakdown fats and protein)

**avoid exposure to infections

49
Q

risk for long term use of steroids

A

osteoporosis

50
Q

Type I Diabetes

A

genetic / auto-immune
appears abruptly
first sign may be DKA (metabolic acidosis = Kussmaul respirations = increased RR)

Polyuria, Polydipsia, Polyphagia
*Polyuria = shock

treatment = insulin ONLY

51
Q

Type II Diabetes

A

not abrupt / signs are wounds that won’t heal, repeated vaginal infections, etc.

evaluate for metabolic syndrome (Syndrome X)

  • increased waist circumference
  • tiglycerides > 150 mg/dL
  • HDL < 40 mg/dL
  • BP >130/85

Tx: start w diet and exercise and then add oral agents (some need insulin)

52
Q

Gestational Diabetes

A

resembles type II
mom needs 2-3x more insulin than normal

If mom has risk factors screen at first prenatal and retest at 24-28 weeks
Screen all moms at 24-28 weeks

Complications to baby: increased birth wt and hypoglycemia

53
Q

Diagnosis of Diabetes

A

requires 2 abnormal tests

A1C 6.5% or above
Fasting plasma glucose 126 or above
oral glucose tolerance test 200 or above

Prediabetes
A1C 5.7 to 6.4
Fasting plasma glucose 100 to 125
oral glucose tolerance test 140 to 199

Normal
A1C about 5
Fasting plasma glucose 99 or below
oral glucose tolerance test 139 or below

54
Q

Pre-diabetics should be screened for diabetes _____

A

yearly

55
Q

extremes in blood sugar =

A

vascular damage

56
Q

Diet for Diabetes

A

carbs like fruit, veg, whole grains, and low fat dairy

high fiber (slows down glucose absorption)

MyPlate - 1/2 w non-starchy veg - 1/4 w carbs - 1/4 w protein

57
Q

Exercise and Diabetes

A

regular, consistent exercise

wait until blood sugar normalizes to begin exercise

eat before hand and exercise when sugar is at its highest

exercise same amount and same time daily

58
Q

Metformin

A

oral antidiabetic
reduces glucose production and enhances how glucose enters the cell

don’t see hypoglycemia with this drug

Hypoglycemia destroys vessels

** discontinue before contrast dye surgeries. Can continue after 48 hrs if kidney functin and creatinine levels are normal

59
Q

Glargin

A

another antidiabetic used in conjunction with metformin if it is not effective on its own

60
Q

Non-insulin injectable meds for diabetes

A

dulaglutide / semaglutide / pramlintide

** taken once a day, once every two days, or once a week

** wt loss

61
Q

What insulin is clear and cannot be mixed with any other insulin or given IV?

A

long acting (Lantus)

62
Q

Goal is to keep before meal glucose near normal. What ranges?

A

80-130

63
Q

Goal HbA1C for diabetics is

A

less than 7%

64
Q

Glycosylated Hemoglobin (HbA1c)

A

blood test

gives average of what pts blood sugar has been over past 3-4 months

65
Q

S/sx of hypoglycemia

A

Hypoglycemia is 70 mg/dL or less

cold/clammy
confusion
shaky
headache
nervous
nausea
taachycardia
hunger
66
Q

Treatment of hypoglycemia

A

+15 grams of carbs (4-6oz of soda / 8-10 lifesavers)

glucose absorption is slowed in foods with lots of fat

15-15-15 rule - 15 g - wait 15 min - 15 more gram if still low

once blood sugar is up, they need to eat a complex carb and protein snack (peanut butter crackers)

  • *D50W
    • injectable glucagon (subQ, IM, IV)

To prevent, teach client to eat, take insulin regularly, know s/sx, and check blood glucose regularly.

67
Q

DKA

A

causes: illness, infection, skipping insulin

Type 1

Polyuria, polydipsia, polyphagia –> fat breakdown (acidosis) –> Kussmaul respirations (trying to blow off CO2) –> decreased LOC

68
Q

DKA Tx:

A

Treat cause (infection)

hourly blood sugar and potassium levels
IV insulin (insulin decreases glucose and potassium)
ECG
hourly outputs
ABGs
IVFs - polyuria causes shock / start w NS then when blood sugar gets down to 250-300, switch to D5W to prevent hypoglycemia
potassium will most likley be put into IVF eventually

69
Q

Hyperosmolar Hyperglycemic Nonketosis (HHNK) or Hyperglycemic Hyperosmolar State (HHS)

A

Type II

looks like DKA, but no acidosis or ketones
making just enough insulin to avoid breaking down fats
no kussmaul respirations or fruity breath

70
Q

Vascular problems with DM

A

diabetic retinopathy

nephropathy (may need dialysis)

71
Q

Neuropathy and DM

A

sexual problems (impotence / decreased sensation)

foot/leg probs (pain / paresthesia / numbness)

Neurogenic bladder (incontinence / retention)

Gastroparesis (aspiration risk due to delayed stomach emptying)

Risk for Infection

72
Q

Foot Care with Diabetics

A 
cut toenails straight across
dry in b/w toes
always wear well-fitting shoes
inspect feet daily
no chemicals
no lotions

HURST (15 decks)

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