Endocrine Flashcards
Describe the epidemiology and etiology of diabetes mellitus.
- 7th leading cause of death in US
- Affects approximately 8-10% of US population.
- Affects each ethnic population differently.
Describe the pathophysiology of DM Type 1.
- Lack of total insulin
- destruction of beta cells
- occurs after viral illness
- childhood/young onset
- abrupt onset
- immune component
- 10% of diabetics
Describe pathophysiology of DM Type II.
- 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
What are the manifestations of DM?
- Polyuria
- Polydipsia
- Polyphagia
- Bleeding gums/gingivitis
- Infections
- Nonhealing wounds
- Fatigue/lack of energy
What is a potential acute complication of both DM I and DM II?
Hypoglycemia - important to know symptoms, treatment and protocols
Describe DKA.
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
Describe HHS.
Hyperglycemia-Hyperosmolar State
- Type 2
- Very high glucose, >600 ml/dl
- Dehydration
- Very high serum osmolarity
- no ketones
What are chronic complications of diabetes?
- Hypertension
- Hyperlipidemia
- Retinopathy
- Nephropathy
- Neuropathy: Peripheral, autonomic: cardiac, GI, orthostatic hypotension, tachycardia, gastroparesis, urinary
- Macrovascular: CAD, PVD (amputations), CVA
- Foot ulcers/wounds
How is diabetes diagnosed?
- 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
What are considerations for nutrition for DM?
- Carb Counting: 15 grams=1 exchange
- Glycemic Index
- ADA
- Low fat, carb controlled, controlled protein if proteinuria.
What biguanide medication can be used for DM II and how does it work?
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
What sulfonylurea drugs can be used with DM and how do they work?
Glipizide (Glucotrol), Glimepiride (Amaryl) (2nd gen)
- Stimulates insulin production and release
- Take 30 min prior to meals
- Hypoglycemia
- Wt gain
What Meglitinide Analogs can be used with DM and how do they work?
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
What Thiazolidinediones (TZDs) can be used with DM and how do they work?
- (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
What GLP-1 Agonists can be used for DM and how do they work?
- 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
What DDP-4 Inhibitors can be used in DM and how do they work?
- Sitagliptin, Saxagliptin
- Inc insulin secretion
- NO hypoglycemia unless used with other antidiabetic agents
- Assess: may cause pancreatitis & precancerous cellular changes
What are the insulins that can be given in DM?
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
Describe pt teaching of DM.
- 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
Describe nursing considerations for DM.
- 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
What are thyroid disorders?
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.
What are some causes of hypothyroidism?
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
What are some causes of hyperthyroidsim/Grave’s disease?
Excessive secretion leads to increased metabolism, excessive heat production, and increased responsiveness to catecholamines.
- Commonly autoimmune
- Hashimoto
- Hyper-secretion of thyroid hormones
- Goiter
What are the manifestations of hyperthyroidism?
- 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
What are the manifestations of hypothyroidism?
- periorbital edema
- husky voice
- goiter
- bradycardia
- carpal tunnel syndrome
- menorrhagia
- constipation
General: low metabolic rate, weight gain, sensitivity to cold, lethargy, mental impairment, depression
What is the plan to treat thyroid issues?
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
What is a thyroid storm and how does it present?
- Medical emergency
- Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachyarrhythmias
What is the treatment for a thyroid storm?
Control temperature! Reduce stimulation and promote comfort Antithyroid drugs-Methimazole preferred Surgical removal may be necessary --> Post operative monitor calcium levels
What is a myxedema coma?
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
How do you treat a myxedema coma?
Airway
IVF
IV levothyroxine, steroids, and glucose
Aspiration precautions, maintain temp and bp
What is the patient teaching for thyroid issues?
Nutrition Medication is life-long - When to take, follow up labs, drug interactions, brand specifics Follow ups s/s opposite effects Post op care
Is goiter more common in hypo/hyperthyroidism and why?
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.
What is the treatment of hyperthyroidism?
Surgical and iodine
antithyroid meds chart 63-3
Propylthiouracil, methimazole, lugol’s solution, SSKI (saturated solution of potassium iodide)
Assess temperature often
What is the treatment of hypothyroidism?
Levothyroxine
Nutrition
What insulin is the only IV option? What is onset, peak and duration?
Regular - short acting
onset: 15 mins
peak: 1-2 hours
duration: 3-5 hours
What insulin is rapid acting?
Lispro - less pro, less time
onset: 15 mins
peak: 1-2 hours
duration: 3-5 hours
What insulins are intermediate acting?
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
Which are the long-acting insulins?
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
