endocrine Flashcards
what hormones are produced by the thyroid
T3, T4 and calcitonin
what does calcitonin do
decreases serum calcium levels by taking calcium out of blood and pushing it into the bone
what do you need to make thyroid hormones
iodine
what do thyroid hormones give
energy
what disease is hyperthyroid
graves disease
signs and symptoms of graves disease
nervous
irritable
low attention span
increased appetite
decreased weight
sweaty
exophthalmos (bulging eyes)
Fast GI
BP and pulse increase
what are T4 levels in graves disease
increase
what are TSH levels in graves disease
decreased
what must pt do prior to thyroid scan
discontinue iodine containing meds 1 week prior and wait 6 weeks to restart
why does amiodarone affect thyroid function
it contains large amounts of iodine
types of antithyroid meds
methimazole
propylthiouracil
what do anti-thyroids do
stop the thyroid from making thyroid hormones
used pre-op to stun thyroid
name an iodine compund
potassium iodine
what does potassium iodine do
decrease the size and vascularity of the gland
what do you give potassium iodine with? why?
milk or juice and use a straw. it stains teeth
what do beta blockers do
decrease myocardial contractility
could decrease cardiac output
decreases hr pb
decreases anxiety
how do you provide radioactive iodine therapy
1 PO dose
what does radioactive iodine therapy do
destroys thyroid cells
precautions for radioactive iodine
avoid babies for 1 week
dont kiss anyone for 1 week
thyroidectomy post op priority
hemorrhage ( feeling of pressure in neck, bleeding or swelling)
check for bleeding at incision site or pooling back of neck.
how do you assess for recurrent laryngeal nerve damage
listening for hoarseness and weak voice
what can laryngeal nerve damage lead to
vocal cord paralysis
what happens if there is paralysis of both cords
airway obstruction, trach needed
signs parathyroid was removed
PTH decreased
hypocalcemia
signs of hypothyroid
no energy
fatigue
no expression
slow slurred speech
weight gain
slow gi
cold
amenorrhea
(similar to depression)
diagnosis of hypothyroid
low t4
increased TSH
treatment of hypothyroid
levothyroxine, liothyronine
what does parathyroid do
secrete TSH
what does PTH do
pull calcium from bone and place in blood, causes serum calcium to go up
what happens if you do not have any parathyroid ormone in your body
serum calcium goes down
signs of hyperparathyroidism
too much OTH
serum calcium is high, phosphorus is low
sedated
treatment of hyperparathyroid
partial parathyroidectomy
monitor for bottoming out, tight rigid muscles
signs of hypoparathyroidism
not enough PTH
serum calcium is low
phosphorus is high
not sedated
treatment of hypoparathyroid
IV calcium
phosphorus binding drugs
steroids created by adrenal cortex
glucocorticoids
mineral corticoids
sex hormones
what do glucocorticoids do
change mood (depressed, psychotic, euphoric insomnia
alter defense mechanism (immunosuppressed
break down fats and proteins
inhibit insulin
what do mineral corticoids (aldosterone) do
make you retain sodium and water
make you lose potassium
too many sex hormones
hirsutism (excess hair)
acne
irregular menstrual cycle
not enough sex hormones
decreased axillary/ pubic hair
decreased libido
adrenal cortex problems
not enough steroids
shock
hyperkalemia
hypoglycemia
what is Addisons disease
adrenocortical insufficiency (not enough steroids)
signs and symptoms of Addisons disease
extreme fatigue
nausea, vomiting, diarrhea
anorexia
hypotension
confusion
decreased sodium, increased potassium and hypoglycemia
hyperpigmentation
white patchy area of depigmented skin
treatment of addisons
increase sodium in their diet
processed fruit juice have sodium
I&O daily weight
BP probably low
probably lose weight
fluid volume deficent
how are corticosteroids given
2/3 in the morning, 1/3 at night because that is how the body naturally secretes
what is fludrocortisone
synthetic aldosterone
examples of corticosteroids
predinisone
hydrocortisone
(must be tapped off)
how much weight fluctuation with medication is ok
2-3 pounds a day <5 a week
What is cushings
too many steroids
signs and symptoms of too many glucocorticoids
growth arrest
thin extremities/skin
increased risk of infection
hyperglycemia
psychosis to depression
moon faced
truncal obesity
buffalo hump
signs and symptoms of too many sex hormones
oily skin/acne
women with male traits
signs and symptoms of too many mineral corticoids (aldosterone)
high BP
CHF
weight gain
FVE
what happens to potassium with too much mineral corticoid
decreases
what happens to cortisol levels with too much mineral corticoids
high
treatment of cushings
adrenalectomy
quiet environment (can’t handle stress)
Cushing diet pretreatment
^K low NA ^protein ^CA
what is type 1 diabetes
little to no insulin
diagnosed in childhood
autoimmune response or idiopathic
first sign usually DKA
appears abruptly, despite years of beta cell destruction
3p’s
what happens to blood with uncontrolled diabetes
blood becomes hypertonic and pulls fluid into vascular space, kidneys filter excess glucose and fluids, cells breakdown protein and fat for energy because they are starving creating ketones and metebolic acidosis
signs of diabetes
polyuria
polydipsia
polyphasic
diabetes type two pathophysiology
not enough insulin or insulin is no good
usually over weight
can’t make enough insulin to keep up with glucose
not as abrupt
found by accident, wounds that dont heal, repeated vaginal infection
what should those with type 2 diabetes be evaluated for
metabolic syndrome
what does metabolic syndrome do
increase the risk for developing type 2 diabetes and cardiovascular disease
features of metabolic syndrome
Waist >40 in men, >35 women
triglycerides >150
HDL <40 males <50 females
blood pressure >135/85
FBS >100
myst have 3 or more
treatment for diabetes type 2
diet, exercise, oral agents some may need insulin
what is gestational diabetes
resembles type 2 diabetes
mom needs 2-3 types insulin than normal
screen at 1st visit if diabetes
screen all at 24-28 weeks
baby may have increased birth weight and hypoglycemia
diet for diabetes
45% carbs
30-40%fat
15-20 % protein
why worry about carbohydrates
sugar destroys vessels like fat
what does high fiber do
slows down glucose absorption in the intestines eliminating the Sharp rise and fall in blood sugar
what does metformin do
reduces glucose production and enhances how glucose enters the cell
what should patients on metformin do before surgery
discontinue metformin until 48 hours after if kidney function returns and creatinine level is normal
what color is regular (short) insulin
clear
what color is NPH
cloudy
when administering regular and NPH which one do you draw up first
Clear
what color are long acting insulin, what can you mix it with
they are clear and you can’t mix them with anything
what do you want the before meal glucose to be
80-130
what is the most common method of daily dosing insulin
basal bulus
what is the dotal daily dose of insulin with the basal/bolus method
combination of long acting and a rapid acting
when should clients eat
when insulin is at its peak
when insulin is at its peak BS is at its
lowest
when should someone with diabetes exercise
when blood sugar normalizes
what should they do pre-exercise to prevent hypoglycemia
eat
when should they exercise
when blood sugar is at its highest
what does a glycosylated hemoglobin (HBA1C) test
gibes an average of what your blood sugar has been over past 3-4 months
what happens to blood sugar when you are sick or stressed
increases
HBA1c for diagnostic puposes
> 6.5
HBA1C for people with diabetes
<= 7
normal non diabetes HBA1C
<=5.7
what insulin can be given IV or in an infusion pump
Rapid acting
signs and symptoms of hypoglycemia
cold and clammy
confusion
shaky
headache
nervous
nausea
hunger
increased pulse
what do you do if hypoglycemic
eat 15 grams of carbs
what is the 15-15-15 rule
15g carbs wait 15 minutes if still low eat 15 more
what delays glucose absorption
fatty foods
what should you do once blood sugar is back up
eat a complex carb or protein
what fluid do you use for a hypoglycemic emergency
D50W large bore IV
hypoglycemia client education
eat
take insulin regularly
know signs of hypoglycemia
check BS regularly
What can throw a client into DKA
illness
infection
skipping insulin
patho for DKA
inadequate insulin
extremely high BS
3P
fat breakdown
kussmaul respirations
metabolic acidosis
low LOC
treatment of DKA
find cause
hyperosmolar hyperglycemic non ketosis (HHNK) or hyperglycemic hyperosmolar state (HHS) happens in what type of patients
type 2 diabetes
how does HHNK or HHS differ from DKA
no acidosis
just enough insulin they dont break down fat
no ketones
no kussmaul repirations
what happens to vessels in diabetic patients
poor circulation due to damage caused by sugar accumulation decreasing blood flow leads to
diabetic retinopathy
nephropathy
neuropathy symptoms
impotance/decreased sensation
foot leg problems pain/parathesia/numbness
neurogenic bladder
gastroparesis
what is included in diabetic foot care
cut nails straight across
not to short
dry between toes
well fitting shoes
daily inspections
no harsh chemicals
what is a neurogenic bladder
the bladder does not empty properly
the bladder may empty spontaneously
may not empty at all
what is gastroparesis
stomach emptying is delayed so there is an increased risk for aspiration
