endocrine Flashcards
Diabetic ketoacidosis
a life-threatening problem that affects people with diabetes. a life-threatening problem that affects people with diabetes. acute, lack of insulin with type 1 diabetes. DKA is a life-threatening emergency caused by a relative or absolute insulin deficiency. The condition is characterized by hyperglycemia, ketosis, metabolic acidosis, and dehydration. The most likely contributing factors in this client include stress associated with illness and infection (elevated temperature) and inadequate insulin dosage and self-management.
Thyroidectomy
the surgical removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that control every aspect of your metabolism, from your heart rate to how quickly you burn calories. aiway compromise - neck swelling, hypocalcemia and nerve damage. assess for hypocalcemia - facial or extremity numbness or tingling, stridor, trosseau and chvostek signs. airway equipment at bedside. semi fowler.
Nursing care following thyroidectomy
includes assessing for and immediately reporting signs of hypocalcemia, keeping airway equipment at the bedside in case respiratory distress develops, maintaining the client in semi-Fowler position to promote drainage, and assessing for new or worsening changes in voice strength and quality to monitor for laryngeal damage.
Graves’ disease
an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).
Thyroid storm
a life-threatening complication of Graves’ disease (hyperthyroidism). Assessment findings include a rapid increase in temperature, heart rate, and blood pressure in response to stress. FEVER ALTERED MENTATION, AND EXCESSS AUTONOMIC ACTIVITY.
hypothryoidism clinical manifestations
cardio - bradycardia, gastro - weight gain and constipation. musculoskeletal - fatigue, muscle aches, and joint pains. nervous - lethargy, apathy, forgetfulness, depression. reproductive - infertility, decreased libido, integumentary - cold intolerance, dry and thick skin, brittle skin and hair, hair loss, hematology - anemia (pallor)
ketosis
a process that happens when your body doesn’t have enough carbohydrates to burn for energy
acidosis
a condition in which there is too much acid in the body fluids.
diuresis
increased or excessive production of urine
hyperkalemia
a potassium level in your blood that’s higher than normal
diaphoretic
sweating heavily
normal triglyceride levels
Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L) Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L) High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L) Very high — 500 mg/dL or above (5.7 mmol/L or above)
HDL cholesterol
HDL cholesterol levels greater than 60 milligrams per deciliter (mg/dL) are high. That’s good.
HDL cholesterol levels less than 40 mg/dL are low. That’s not so good.In general, people with high HDL are at lower risk for heart disease. People with low HDL are at higher risk.
blood glucose levels
A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.
Metabolic syndrome
Abdominal obesity: Waist circumference ≥40 in (102 cm) in men, ≥35 in (89 cm) in women
High serum triglycerides: >150 mg/dL (1.7 mmol/L) or hypertriglyceridemia drug treatment
Low HDL cholesterol: <40 mg/dL (1.04 mmol/L) in men, <50 mg/dL (1.3 mmol) in women or hyperlipidemia drug treatment
High blood pressure: ≥130/85 mm Hg or hypertension drug treatment
Increased fasting blood glucose: ≥100 mg/dL (5.6 mmol/L) or hyperglycemia drug treatment
potassium level
Normal levels of potassium for an adult range from 3.5 to 5.2 mEq/L
sodium level
A normal blood sodium level is between 135 and 145 milliequivalents per liter
Type 1 diabetes mellitus
is an endocrine disorder characterized by the absence of insulin production in the pancreas, causing hyperglycemia and intracellular energy deficits. Clients with type 1 diabetes mellitus require consistent insulin administration, typically of both short- or rapid-acting and intermediate- or long-acting insulins, to prevent hyperglycemia and provide energy to the cells.
addison disease aka adrenal insufficiency
occurs when the adrenal glands do not produce adequate amounts of steroid hormones (mineralocorticoids, glucocorticoids, androgens). Symptoms include weight loss, muscle weakness, low blood pressure, hypoglycemia, and hyperpigmented skin (skin folds, buccal area, palmar crease). Hyperpigmented skin is a characteristic universal finding; this results from increased adrenocorticotropic hormone which is due to a decrease in cortisol negative feedback. Treatment consists of replacement therapy with oral mineralocorticoids and corticosteroids. Addison’s disease (chronic adrenal insufficiency) leads to hyperpigmented skin, low blood pressure, weight loss, and muscle weakness.
Syndrome of inappropriate antidiuretic hormone
is a condition that results in increased ADH. Too much ADH causes increased total body water, resulting in a low serum osmolality and low serum sodium. As ADH is secreted and water is retained, urine output is decreased and concentrated, resulting in a high specific gravity.
Addisonian crisis
a potentially life-threatening complication of Addison’s disease and commonly presents with abdominal pain, hypotension, and hypoglycemia saline and 5% dextrose, and administration of high-do. Emergency management includes shock management with fluid resuscitation using 0.9% normalse hydrocortisone replacement IV push. Signs and symptoms include hypotension, tachycardia, hyperkalemia, hyponatremia, hypoglycemia, fever, weakness, and confusion; these should be reported to the PHCP immediately.
common causes of SIADH
CENTRAL NERVOUS SYSTEM DISRUPTION ( STROKE, INFECTION, TRAUMA, NEUROSURGERY ), MALIGNANCIES ( SMALL CELL LUNG CANCER) DRUGS - DESMOPRESSIN, CARBAMAZEPINE ), PULMONARY DISORDERS ( PNEUMONIA ).
hyperthyroidism
refers to sustained hyperfunctioning of the thyroid gland due to excessive secretion thyroid hormones (T3, T4); this leads to an increased metabolic rate.
hyperthyroidism teaching
Adherence to a high calorie diet (4000-5000 calories per day).
Consumption of approximately 6 full meals and snacks per day. These should be packed with protein(1-2 g/kg of ideal body weight), carbohydrates, and be full of vitamins and minerals (Option 1).
Avoidance of high-fiber foods due to the constant hyperstimulation of the gastrointestinal (GI) tract. High-fiber foods may increase GI symptoms (eg, diarrhea) (Option 2). However, high-fiber diets are recommended if the client with hyperthyroidism has constipation.
Avoidance of stimulating substances (eg, caffeinated drinks: coffee, tea, soft drinks).
Avoidance of spicy foods as these can also increase GI stimulation.
hemoglobin a1c range
A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes..
Hemoglobin A1C is a diagnostic test used to measure the percentage of glycosylated hemoglobin in the blood over a period of 2-3 months. A normal hemoglobin A1C is 4%-6% in clients without diabetes; the goal is to keep the level <7% in clients with diabetes.
radioactive iodine uptake (RAIU) test
RAIU measures the metabolic activity in the thyroid gland in order to differentiate between the many types of thyroid disorders. For an accurate measurement, medications affecting the thyroid should be held 7 days prior to the test date and clients are NPO for 4 hours prior to iodine administration. Premenopausal women must take a pregnancy test. Dentures, metal, and jewelry should be removed.
NPH insulin
is an intermediate-acting insulin that peaks in 4-12 hours. In asymptomatic clients, the best intervention to prevent low blood glucose levels related to an evening dose of NPH is to consume a bedtime snack of protein and complex carbohydrates.
polydipsia
abnormally great thirst as a symptom of disease (such as diabetes) or psychological disturbance.
polyuria
Excessive urination volume (or polyuria) occurs when you urinate more than normal
Diabetes insipidus
a condition in which antidiuretic hormone is insufficiently produced or suppressed, resulting in polydipsia and polyuria (up to 20 L/day). Urine is copious and dilute with a low specific gravity (<1.003). Fluid volume deficit can lead to dehydration, hypernatremia, high serum osmolality, and weight loss.
treated with ADH replacement drugs - desmopressin monitor for urine output, urine specific gravity, and serum sodium.
Diabetes insipidus vs diabetes mellitus
Diabetes insipidus (DI) is a rare condition in which the kidneys are unable to retain water, whereas diabetes mellitus is a condition characterized by the inability of the body to produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high.
serum creatinine level
The normal serum creatinine for an adult is 0.6-1.3 mg/dL (53-115 µmol/L). Serum creatinine provides an estimation of the glomerular filtration rate and is an indicator of kidney function.
tetany
tingling of hands toes and circumoral region
Acromegaly
is an uncommon condition caused by growth hormone overproduction leading to overgrowth of soft tissues of the face, hands, feet, and organs. The nurse should monitor the client for signs and symptoms of acute complications (eg, heart failure) and report findings to the health care provider.
exophthalmos
blunging eye due to grave
graves exophthalmos teaching
Regular visits to the ophthalmologist are necessary to measure eyeball protrusion and evaluate condition.
If recommended, anti-thyroid drugs should be taken to prevent further exacerbation of exophthalmos.
Smoking cessation is necessary as smoking increases the risk of Graves’ disease and associated eye problems.
Restrict salt intake to decrease periorbital edema.
Use dark glasses to decrease glare and prevent external irritants and infection.
Perform intraocular muscle exercises (turning the eyes using complete range of motion) to maintain flexibility.
myxedema coma
is a state of severe hypothyroidism and decreased level of consciousness that may progress to coma and respiratory failure. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation.
Clinical features of myxedema coma
HypothermiaHypoventilationBradycardiaHypertensionor hypotension with narrow pulse pressureDecreased mental status, psychosis, seizure & comaNonpitting edema of hands, face & tonguePericardial effusionHyponatremia & hypoglycemiaPossible concurrent adrenal insufficiency or hypothalamic/pituitary dysfunction
Pheochromocytoma
a condition caused by a tumor in the adrenal medulla that causes release of catecholamines such as epinephrine and norepinephrine, resulting in paroxysmal hypertensive crisis. Hypertensive crisis puts the client at risk for stroke and should be treated promptly with intravenous nitroprusside or another vasodilator (eg, phentolamine, nicardipine). Abdominal palpation should be avoided in these clients.
Cushing manifestations
Clinical manifestations of Cushing syndrome include weight gain, truncal obesity, moon face, skin atrophy, easy bruising, purple striae on the abdomen, muscle weakness, hypertension, and hyperglycemia. Associated androgen excess can result in acne, hirsutism, and menstrual irregularities.
cushing
the result of prolonged exposure to excess corticosteroids, especially glucocorticoid steroids. The most common cause is the administration of corticosteroids, such as prednisone or hydrocortisone, for other conditions. However, pituitary adenomas can secrete adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands to produce too much cortisol.
diabeetic foot care
Wash feet daily with warm water and mild soap; test water temperature with thermometer beforehand. Gently pat feet dry, particularly between the toes (Option 2). Use lanolin to prevent dry and cracked skin, but do not apply between the toes.
Inspect for abrasions, cuts, or sores. Have others inspect the feet if eyesight is poor.
To prevent injury, use cotton or lamb’s wool to separate overlapping toes. Cut toenails straight across and use a nail file to file along the curves of the toes. Avoid going barefoot and wear sturdy leather shoes. Use mild foot powder to absorb perspiration and wear clean, absorbent socks with seams aligned (Options 1, 3, and 4).
Avoid using over-the-counter products (eg, iodine, alcohol, strong adhesives) on cuts or abrasions (Option 5).
To improve circulation, do not sit with legs crossed or for extended periods, avoid tight-fitting garments, and perform daily exercise.
Report other types of problems such as infections or athlete’s foot immediately.
thyroid stimulating hormone level
TSH 2-10
thyroid hormone levle
FREE T4 0.8-2.8
primary hypothyroidism clinical manifestion
Weakness & fatigueWeight gainBradycardiaDelayed deep tendon reflexesConstipationCognitive slowingCold intolerance
Coarse, dry skinHoarsenessNonpitting edema (myxedema)Macroglossia
DepressionMyalgia & arthralgiaHypercholesterolemia
