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endocrine Flashcards

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1
Q

what hormones are produced by the thyroid

A

T3, T4 and calcitonin

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2
Q

what does calcitonin do

A

decreases serum calcium levels by taking calcium out of blood and pushing it into the bone

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3
Q

what do you need to make thyroid hormones

A

iodine

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4
Q

what do thyroid hormones give

A

energy

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5
Q

what disease is hyperthyroid

A

graves disease

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6
Q

signs and symptoms of graves disease

A

nervous
irritable
low attention span
increased appetite
decreased weight
sweaty
exophthalmos (bulging eyes)
Fast GI
BP and pulse increase

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7
Q

what are T4 levels in graves disease

A

increase

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8
Q

what are TSH levels in graves disease

A

decreased

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9
Q

what must pt do prior to thyroid scan

A

discontinue iodine containing meds 1 week prior and wait 6 weeks to restart

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10
Q

why does amiodarone affect thyroid function

A

it contains large amounts of iodine

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11
Q

types of antithyroid meds

A

methimazole
propylthiouracil

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12
Q

what do anti-thyroids do

A

stop the thyroid from making thyroid hormones
used pre-op to stun thyroid

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13
Q

name an iodine compund

A

potassium iodine

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14
Q

what does potassium iodine do

A

decrease the size and vascularity of the gland

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15
Q

what do you give potassium iodine with? why?

A

milk or juice and use a straw. it stains teeth

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16
Q

what do beta blockers do

A

decrease myocardial contractility
could decrease cardiac output
decreases hr pb
decreases anxiety

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17
Q

how do you provide radioactive iodine therapy

A

1 PO dose

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18
Q

what does radioactive iodine therapy do

A

destroys thyroid cells

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19
Q

precautions for radioactive iodine

A

avoid babies for 1 week
dont kiss anyone for 1 week

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20
Q

thyroidectomy post op priority

A

hemorrhage ( feeling of pressure in neck, bleeding or swelling)
check for bleeding at incision site or pooling back of neck.

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21
Q

how do you assess for recurrent laryngeal nerve damage

A

listening for hoarseness and weak voice

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22
Q

what can laryngeal nerve damage lead to

A

vocal cord paralysis

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23
Q

what happens if there is paralysis of both cords

A

airway obstruction, trach needed

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24
Q

signs parathyroid was removed

A

PTH decreased
hypocalcemia

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25
Q

signs of hypothyroid

A

no energy
fatigue
no expression
slow slurred speech
weight gain
slow gi
cold
amenorrhea
(similar to depression)

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26
Q

diagnosis of hypothyroid

A

low t4
increased TSH

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27
Q

treatment of hypothyroid

A

levothyroxine, liothyronine

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28
Q

what does parathyroid do

A

secrete TSH

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29
Q

what does PTH do

A

pull calcium from bone and place in blood, causes serum calcium to go up

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30
Q

what happens if you do not have any parathyroid ormone in your body

A

serum calcium goes down

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31
Q

signs of hyperparathyroidism

A

too much OTH
serum calcium is high, phosphorus is low
sedated

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32
Q

treatment of hyperparathyroid

A

partial parathyroidectomy
monitor for bottoming out, tight rigid muscles

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33
Q

signs of hypoparathyroidism

A

not enough PTH
serum calcium is low
phosphorus is high
not sedated

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34
Q

treatment of hypoparathyroid

A

IV calcium
phosphorus binding drugs

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35
Q

steroids created by adrenal cortex

A

glucocorticoids
mineral corticoids
sex hormones

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36
Q

what do glucocorticoids do

A

change mood (depressed, psychotic, euphoric insomnia
alter defense mechanism (immunosuppressed
break down fats and proteins
inhibit insulin

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37
Q

what do mineral corticoids (aldosterone) do

A

make you retain sodium and water
make you lose potassium

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38
Q

too many sex hormones

A

hirsutism (excess hair)
acne
irregular menstrual cycle

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39
Q

not enough sex hormones

A

decreased axillary/ pubic hair
decreased libido

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40
Q

adrenal cortex problems

A

not enough steroids
shock
hyperkalemia
hypoglycemia

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41
Q

what is Addisons disease

A

adrenocortical insufficiency (not enough steroids)

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42
Q

signs and symptoms of Addisons disease

A

extreme fatigue
nausea, vomiting, diarrhea
anorexia
hypotension
confusion
decreased sodium, increased potassium and hypoglycemia
hyperpigmentation
white patchy area of depigmented skin

43
Q

treatment of addisons

A

increase sodium in their diet
processed fruit juice have sodium
I&O daily weight
BP probably low
probably lose weight
fluid volume deficent

44
Q

how are corticosteroids given

A

2/3 in the morning, 1/3 at night because that is how the body naturally secretes

45
Q

what is fludrocortisone

A

synthetic aldosterone

46
Q

examples of corticosteroids

A

predinisone
hydrocortisone
(must be tapped off)

47
Q

how much weight fluctuation with medication is ok

A

2-3 pounds a day <5 a week

48
Q

What is cushings

A

too many steroids

49
Q

signs and symptoms of too many glucocorticoids

A

growth arrest
thin extremities/skin
increased risk of infection
hyperglycemia
psychosis to depression
moon faced
truncal obesity
buffalo hump

50
Q

signs and symptoms of too many sex hormones

A

oily skin/acne
women with male traits

51
Q

signs and symptoms of too many mineral corticoids (aldosterone)

A

high BP
CHF
weight gain
FVE

52
Q

what happens to potassium with too much mineral corticoid

A

decreases

53
Q

what happens to cortisol levels with too much mineral corticoids

A

high

54
Q

treatment of cushings

A

adrenalectomy
quiet environment (can’t handle stress)

55
Q

Cushing diet pretreatment

A

^K low NA ^protein ^CA

56
Q

what is type 1 diabetes

A

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

57
Q

what happens to blood with uncontrolled diabetes

A

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

58
Q

signs of diabetes

A

polyuria
polydipsia
polyphasic

59
Q

diabetes type two pathophysiology

A

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

60
Q

what should those with type 2 diabetes be evaluated for

A

metabolic syndrome

61
Q

what does metabolic syndrome do

A

increase the risk for developing type 2 diabetes and cardiovascular disease

62
Q

features of metabolic syndrome

A

Waist >40 in men, >35 women
triglycerides >150
HDL <40 males <50 females
blood pressure >135/85
FBS >100

myst have 3 or more

63
Q

treatment for diabetes type 2

A

diet, exercise, oral agents some may need insulin

64
Q

what is gestational diabetes

A

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

65
Q

diet for diabetes

A

45% carbs
30-40%fat
15-20 % protein

66
Q

why worry about carbohydrates

A

sugar destroys vessels like fat

67
Q

what does high fiber do

A

slows down glucose absorption in the intestines eliminating the Sharp rise and fall in blood sugar

68
Q

what does metformin do

A

reduces glucose production and enhances how glucose enters the cell

69
Q

what should patients on metformin do before surgery

A

discontinue metformin until 48 hours after if kidney function returns and creatinine level is normal

70
Q

what color is regular (short) insulin

A

clear

71
Q

what color is NPH

A

cloudy

72
Q

when administering regular and NPH which one do you draw up first

A

Clear

73
Q

what color are long acting insulin, what can you mix it with

A

they are clear and you can’t mix them with anything

74
Q

what do you want the before meal glucose to be

A

80-130

75
Q

what is the most common method of daily dosing insulin

A

basal bulus

76
Q

what is the dotal daily dose of insulin with the basal/bolus method

A

combination of long acting and a rapid acting

77
Q

when should clients eat

A

when insulin is at its peak

78
Q

when insulin is at its peak BS is at its

A

lowest

79
Q

when should someone with diabetes exercise

A

when blood sugar normalizes

80
Q

what should they do pre-exercise to prevent hypoglycemia

A

eat

81
Q

when should they exercise

A

when blood sugar is at its highest

82
Q

what does a glycosylated hemoglobin (HBA1C) test

A

gibes an average of what your blood sugar has been over past 3-4 months

83
Q

what happens to blood sugar when you are sick or stressed

A

increases

84
Q

HBA1c for diagnostic puposes

A

> 6.5

85
Q

HBA1C for people with diabetes

A

<= 7

86
Q

normal non diabetes HBA1C

A

<=5.7

87
Q

what insulin can be given IV or in an infusion pump

A

Rapid acting

88
Q

signs and symptoms of hypoglycemia

A

cold and clammy
confusion
shaky
headache
nervous
nausea
hunger
increased pulse

89
Q

what do you do if hypoglycemic

A

eat 15 grams of carbs

90
Q

what is the 15-15-15 rule

A

15g carbs wait 15 minutes if still low eat 15 more

91
Q

what delays glucose absorption

A

fatty foods

92
Q

what should you do once blood sugar is back up

A

eat a complex carb or protein

93
Q

what fluid do you use for a hypoglycemic emergency

A

D50W large bore IV

94
Q

hypoglycemia client education

A

eat
take insulin regularly
know signs of hypoglycemia
check BS regularly

95
Q

What can throw a client into DKA

A

illness
infection
skipping insulin

96
Q

patho for DKA

A

inadequate insulin
extremely high BS
3P
fat breakdown
kussmaul respirations
metabolic acidosis
low LOC

97
Q

treatment of DKA

A

find cause

98
Q

hyperosmolar hyperglycemic non ketosis (HHNK) or hyperglycemic hyperosmolar state (HHS) happens in what type of patients

A

type 2 diabetes

99
Q

how does HHNK or HHS differ from DKA

A

no acidosis
just enough insulin they dont break down fat
no ketones
no kussmaul repirations

100
Q

what happens to vessels in diabetic patients

A

poor circulation due to damage caused by sugar accumulation decreasing blood flow leads to
diabetic retinopathy
nephropathy

101
Q

neuropathy symptoms

A

impotance/decreased sensation
foot leg problems pain/parathesia/numbness
neurogenic bladder
gastroparesis

102
Q

what is included in diabetic foot care

A

cut nails straight across
not to short
dry between toes
well fitting shoes
daily inspections
no harsh chemicals

103
Q

what is a neurogenic bladder

A

the bladder does not empty properly
the bladder may empty spontaneously
may not empty at all

104
Q

what is gastroparesis

A

stomach emptying is delayed so there is an increased risk for aspiration

Hesi PN (24 decks)

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