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AH1 - Exam II > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Describe the epidemiology and etiology of diabetes mellitus.

A
  1. 7th leading cause of death in US
  2. Affects approximately 8-10% of US population.
  3. Affects each ethnic population differently.
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2
Q

Describe the pathophysiology of DM Type 1.

A
  • Lack of total insulin
  • destruction of beta cells
  • occurs after viral illness
  • childhood/young onset
  • abrupt onset
  • immune component
  • 10% of diabetics
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3
Q

Describe pathophysiology of DM Type II.

A
  • insufficient amount of insulin relative to need
  • Ineffective use of insulin due to resistance
  • Dysfunctional beta cells
  • Dysfunctional alpha and beta cell relationship
  • Insidious onset, adult population
  • Genetic component
  • 90% of diabetics
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4
Q

What are the manifestations of DM?

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Bleeding gums/gingivitis
  • Infections
  • Nonhealing wounds
  • Fatigue/lack of energy
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5
Q

What is a potential acute complication of both DM I and DM II?

A

Hypoglycemia - important to know symptoms, treatment and protocols

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6
Q

Describe DKA.

A

DKA diabetic ketoacidosis

  • Type 1 mostly, occ type 2
  • Hyperglycemia, uncontrolled, >250 mg/dl
  • Metabolic acidosis
  • Ketone production incr
  • Polydipsia, polyuria
  • Dehydration
  • Hypokalemia
  • n/v
  • Kussmaul respirations
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7
Q

Describe HHS.

A

Hyperglycemia-Hyperosmolar State

  • Type 2
  • Very high glucose, >600 ml/dl
  • Dehydration
  • Very high serum osmolarity
  • no ketones
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8
Q

What are chronic complications of diabetes?

A
  • Hypertension
  • Hyperlipidemia
  • Retinopathy
  • Nephropathy
  • Neuropathy: Peripheral, autonomic: cardiac, GI, orthostatic hypotension, tachycardia, gastroparesis, urinary
  • Macrovascular: CAD, PVD (amputations), CVA
  • Foot ulcers/wounds
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9
Q

How is diabetes diagnosed?

A
  • HGBA1C : > 6.5% indicative of DM
  • Fasting Blood Glucose : two FBG >126 mg/dl
  • Lytes: hyponatremia, hypokalemia
  • BUN/CR : testing renal fx & dehydration
  • eGFR: most sensitive test of renal function: important since diabetics at high risk for renal failure
  • TG - thyroglobulin?
  • Lipids: most have hyperlipidemia which must be treated to prevent vascular complications
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10
Q

What are considerations for nutrition for DM?

A
  • Carb Counting: 15 grams=1 exchange
  • Glycemic Index
  • ADA
  • Low fat, carb controlled, controlled protein if proteinuria.
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11
Q

What biguanide medication can be used for DM II and how does it work?

A

Metformin/Glucophage:

  • Decreases hepatic glucose production
  • Increases cell sensitivity to insulin
  • GI upset, may aid with cravings/wt loss
  • Lactic acidosis: CONTRAINDICATED for pts with renal failure & CHF
  • Hold x48 hrs s/p radiographic testing utilizing iodine contrast
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12
Q

What sulfonylurea drugs can be used with DM and how do they work?

A

Glipizide (Glucotrol), Glimepiride (Amaryl) (2nd gen)

  • Stimulates insulin production and release
  • Take 30 min prior to meals
  • Hypoglycemia
  • Wt gain
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13
Q

What Meglitinide Analogs can be used with DM and how do they work?

A

Repaglinide & Nateglinide

  • Rapidly absorbed w/short duration of action
  • Prevents postprandial hyperglycemia
  • Hypoglycemia if taken without food
  • If not eating, don’t take
  • Take with meal
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14
Q

What Thiazolidinediones (TZDs) can be used with DM and how do they work?

A
  • (Pioglitazone, Rosiglitazone)
  • Improves tissue sensitivity to insulin
  • Monitor LFT’s-teach to monitor for abd pain & dark urine
  • Can reduce effectiveness of contraceptives
  • Assess for edema/sob-CAUSES FLUID RETENTION-can cause or exacerbate CHF
  • Full therapeutic response takes 2-3 months
  • Avandia-black box warning for CHF
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15
Q

What GLP-1 Agonists can be used for DM and how do they work?

A
  • Exenatide, Liraglutide
  • Given SQ
  • Prefilled syringes
  • Hypoglycemia if given with other antidiabetic agents
  • Monitor for abd pain: Acute pancreatitis
  • These agents work by activating GLP-1 receptors in the pancreas
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16
Q

What DDP-4 Inhibitors can be used in DM and how do they work?

A
  • Sitagliptin, Saxagliptin
  • Inc insulin secretion
  • NO hypoglycemia unless used with other antidiabetic agents
  • Assess: may cause pancreatitis & precancerous cellular changes
17
Q

What are the insulins that can be given in DM?

A

Lispro - rapid acting

Regular - short acting

NPH - intermediate acting

70/30 - 70% NPH and 30% regular (intermediate and regular)

Glargine - long-acting

Detemir - long acting

18
Q

Describe pt teaching of DM.

A
  • Pt teaching :protect feet: always wear shoes with protective sole
  • No heels higher than 2 inches
  • Inspect feet with mirror daily
  • Use potholder when cooking
  • Use gloves when gardening, using hot water
  • No area rugs
  • Always use handrails on stairs
  • Wear new shoes for 2 hours at a time
  • No tight socks with constricting bands
19
Q

Describe nursing considerations for DM.

A
  • Charcot’s foot: foot deformity common in diabetics: have fitted shoes
  • Must have foot exam at every MD visit
  • Yearly eye exam
  • Microalbuminuria at every MD visit
  • Smoking cessation
  • Medication compliance
  • SMBG
  • HGB A1C q3-6 months along with lipids, LFT’s
  • Sick Days
  • Insulin management
  • Medication, lifestyle, diet compliance
20
Q

What are thyroid disorders?

A

The thyroid hormone affects whole-body metabolism, cellular regulation, nutrition, gas exchange, electrolyte balance and excitable membrane activity, so symptoms occur in many body systems.

21
Q

What are some causes of hypothyroidism?

A

Inability to secrete enough hormone leads to decreased metabolism, dec O2 consumption, and dec heat production.

  • Surgery and iodine tx
  • Autoimmune
  • Amiodarone and lithium use
  • Low intake of iodine
  • Cancer
  • radiation
22
Q

What are some causes of hyperthyroidsim/Grave’s disease?

A

Excessive secretion leads to increased metabolism, excessive heat production, and increased responsiveness to catecholamines.

  • Commonly autoimmune
  • Hashimoto
  • Hyper-secretion of thyroid hormones
  • Goiter
23
Q

What are the manifestations of hyperthyroidism?

A
  • exophthalmos, ophthalmoplegia (Grave’s disease)
  • Goiter (with bruit in Grave’s)
  • Tachycardia, angina, atrial fibrillation
  • systolic hypertension
  • Oligomenorrhea
  • diarrhea
  • sweaty, tremulous, warm hands
  • proximal myopathy
  • pretibial myxedema (in Grave’s disease)
  • ankle swelling (in heart failure)
    General: weight loss despite incr in appetite, heat intolerance, anxiety, irritability, fast, fine tremor
24
Q

What are the manifestations of hypothyroidism?

A
  • periorbital edema
  • husky voice
  • goiter
  • bradycardia
  • carpal tunnel syndrome
  • menorrhagia
  • constipation

General: low metabolic rate, weight gain, sensitivity to cold, lethargy, mental impairment, depression

25
Q

What is the plan to treat thyroid issues?

A

Lab-Thyroid function tests Chart 63-2
Monitor-production of T3T4, thyroid stimulating hormone (TSH)
Diagnostic studies-thyroid scan, ultrasound

Hyper Treatment
Surgical and iodine
antithyroid meds chart 63-3
Propylthiouracil, methimazole, lugol’s solution, SSKI
Assess temperature often

Hypo treatment
Levothyroxine
Nutrition

26
Q

What is a thyroid storm and how does it present?

A
  • Medical emergency

- Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachyarrhythmias

27
Q

What is the treatment for a thyroid storm?

A 
Control temperature!
Reduce stimulation and promote comfort
Antithyroid drugs-Methimazole preferred
Surgical removal may be necessary
--> Post operative monitor calcium levels
28
Q

What is a myxedema coma?

A

Dec metabolism causes heart muscle to be flabby and chambers to increase in size=dec CO and dec perfusion
Monitor mental status for acute changes
Hypotension, hypoglycemia, hypoventilation, hypothermia, hyponatremia, stupor progressing to coma

29
Q

How do you treat a myxedema coma?

A

Airway
IVF
IV levothyroxine, steroids, and glucose
Aspiration precautions, maintain temp and bp

30
Q

What is the patient teaching for thyroid issues?

A 
Nutrition
Medication is life-long
- When to take, follow up labs, drug interactions, brand specifics
Follow ups
s/s opposite effects
Post op care
31
Q

Is goiter more common in hypo/hyperthyroidism and why?

A

We tend to classify any growth as a goiter. The secretions make it so overgrowth (goiter) is more common in hyperthyroidism. When it is with hypothyroidism, it’s usually more common for something like a cancer.

32
Q

What is the treatment of hyperthyroidism?

A

Surgical and iodine
antithyroid meds chart 63-3
Propylthiouracil, methimazole, lugol’s solution, SSKI (saturated solution of potassium iodide)
Assess temperature often

33
Q

What is the treatment of hypothyroidism?

A

Levothyroxine

Nutrition

34
Q

What insulin is the only IV option? What is onset, peak and duration?

A

Regular - short acting

onset: 15 mins
peak: 1-2 hours
duration: 3-5 hours

35
Q

What insulin is rapid acting?

A

Lispro - less pro, less time

onset: 15 mins
peak: 1-2 hours
duration: 3-5 hours

36
Q

What insulins are intermediate acting?

A

NPH (cloudy)

onset: 60-120 mins
peak: 4-6 hrs
duration: 10-18 hrs

70/30

onset: 60-120 mins
peak: 4-8hrs
duration: 10-18 hrs

37
Q

Which are the long-acting insulins?

A

Glargline (LARge lasting)

onset: 60-120 mins
peak: no peaks
duration: 24 hrs

Determir “lasts all year” “no mix”

onset: 60-120 mins
peak: no peaks
durations: 24 hours

AH1 - Exam II (7 decks)

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