Endocrine Flashcards
SIADH
Syndrome of inappropriate antidiuretic hormone
SI = Soaked Inside
Stop urinating
Sticky and thick urine = high urine specific gravity 1.030 +
Low and liquid labs
Hypo osmolality (low)
Hyponatremia below 135 na+
Sodium low (headache Early sign)
Seizures (from low sodium, headache, confusion)
Server high blood pressure (edema)
stop all fluids + give salt + diuretics
(no IV or drinking) unless it is IV 3% saline + eat salt
SIADH Causes
Pressure on pituitary gland
Small cell lung cancer
Severe brain trauma (surgery)
Sepsis infections of brain (meningitis)
Montior I/O
SIADH Treatment
Monitor I/O
Daily weights
Weight gain = water gain
Anti-Diruetic Hormone
Adds H2O
Created in the pituitary gland
Creates fluid in the body
Synthetic ADH
Synthetic ADH = Demompression, Vasopressin
Given to decrease urine output and increase BP, headaches are huge priory
Labs are low Na+ (135 or less) leading to seizures
Diabetes Insipidus
DI = Dry Inside
Diurese, Drain a lot of fluid
“Die ADH”
Increased urination
Looks dehydrated
Opposite of SIADH
Diluted urine low specific gravity (1.005)
High and dry labs
Hype osmolality (high)
Hypernatremia over 145+ na
Increased thirty
Dry mucosa and skin
Decreased blood pressure
Demopressin “vasopressin” (ADH)
Decrease urine output
Dealth by headache (decreases na+)
DI Causes
Damage to brain
Tumours
Trauma
Surgery
(increased ICP which squeezes pituitary)
Montior I/O
DI Treatment
Montior I/O
Daily weights
Weight loss = water loss
What does the nurse expect to find in a patient with SIADH
Low blood osmolality
Hyponatremia
Decreased urine output
When caring for a patient with SIADH what does the nurse expect to implement
Fluid restriction
Seizure precautions
Monitor urine I/O
A client with a brain tumour develops diabetes insidious which data should the nurse expect to find?
Increased thirst
High blood serum osmolality
A client is newly prescribed demopressin nasal spray, which statement by client indicates further education is needed?
Frequent headaches are normal
Im glad this drug is able to treat my SIADH
I will weight myself weakly
Hypothyroidism
Low and Slow energy
Low T3 and T4
High TSH
Hypothyroidism cause
Iodine deficiency major
Hashimotos
Low dietary iodine
Pituitary tumor
Thyroidectomy (cannot produce any thyroid hormones at all)
Hypothyroidism Signs and symptoms
Hashimoto’s - Low and Slow
Low energy “fatigue weakness, muscle pains and aches
Low metabolism Weight gain/water gain (edema eyes)
Low digestion (Constipation)
Low hair loss “alopecia” not hirsutism
Low mental-forgetful, AlOC (altered)
Low Mood-pression “apathy, confusion)
low libido, low sex drive, infertile
Slow Dry skin turgor
low and slow mensturation “irregular periods”
No period “missed’ = amenorrhea
Slow heavy periods = hypermenorrhea
Hypothyroidism pharmacology
Levothyroxine
leaves T3 and T4 in the body
Life long drug - never stop taking (long slow onset, 3-4 weeks until you see relief)
Early morning x1 daily never at night
Empty stomach
Report S/S of hyperthyroidism (agitation and confusion)
Pregnancy Safe
No FOOD
No cure
No dobling dose
Never abruptly stop taking med
*Avoid narcotics and sedatives (benzodiazepines)
Hypothyroidism Diet
Low calories
Low cholesterol and Sat, Fats
Frequent rest periods
Myxoedema coma extreme low
severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs
Low RR - respiratory failure
Priority place “tracheostomy kit” bedside
Key word: “Endotracheal intubation set up
Low BP and HR “hypotension” “bradycardia” (below 60)
Low temp, cold intolerance, no electric blankets
Risk factors; post thyroidectomy
Abrupt STOP of levothyroxine
Hypothalmus and thyroid hormones
Hypothalamus releases TRH (thyrotropin-relasing hormone) which then tells the anterior pituitary to release TSH (thyroid stimulating hormone)
T4 (thyroid hormone)
T3 (active thyroid hormone)
Calcitonin: (puts a ton off Ca in bone) tones down calcium in the blood by putting it in the bone
Hyperthyroidism
High and Hot energy
Graves Disease (gains disease)
High T3 and T4
TSH low
Hyperthyroidism Signs and Symptoms
Graves disease
Grape Eyes “Exothalamos
Us eyepatch/tape down eyelids
Golf balls in throat “Goiter”
High BP - HtN crisis
(MI, CVA< aneurysm)
High HR tachycardia
Heart palpations + atrial fibrillation
High weight loss (high metbolism)
High temp
Hot sweaty skin (diaphoresis)
Diarrhea
Diet Hyperthyroidism
High calories (4000-5000 per day)
High protein and carbs
Frequent meals and snacks (six to eight meals per day)
AVOID:
NO high fibre
NO caffeine
NO spicy food
Thyroid Storm
Aka thyroid toxicosis this will kill the patient
Agitation and confusion are early signs
High HR, High BP
Increased Temp
thyroid gland suddenly releases large amounts of thyroid hormone in a short period of time. it’s often caused by a sudden and intense (acute) event or situation. Sudden events that can trigger a thyroid storm include: Suddenly stop taking your antithyroid medication. Thyroid surgery (thyroidectomy)
Hyperthyroidism Causes
Excess Iodine
Levothyroxine excess
Hyperthyroidism pharmacology
Stop the thyroid from making T3 and T4, slows the thyroid down
methimazole: not pregnancy safe
PTU propylthiouracil: puts thyroid underground, baby safe
Report fever/sore throat
SSKI: Potassium Iodide
Shrinks the thyroid before removal, stains teeth, keep 1 hour apart from other thryoidism medications
Beta Blockers: lol
HR increased used to lower HR and BP
RAIU: Radioactive iodine Uptake (destroys the thyroid)
Destroys thyroid in one does, monitor for hypothyroidism =extreme lows
Before giving:
Neg preg test
Remove neck jewelry and dentures
5-7 days before hold antithyroid meds
NPO 2-4 hours before, 1-2 hours after
After
Avoid everyone up to 7 days
Not pregnant people
No crowds
Not same restroom (flush 3x)
Not same food utensils
Not same laundry as your family
No cuddling, no kissing
Thyroidectomy
Done for hyperthyroidism
Airway: monitor for
Laryngeal strider
Noisy breathing
Hoarseness and weak voice
#1 priority: Endotracheal tube at bedside
Look for bleeding around pillow and insertion site
Neutral head and neck alignment
NOT supine, HOB 30-45 degrees
no flexing or extending neck
Low calcium (below 8.6)
Remove T check C
First sign of low calcium tingling and numbness around mouth and fingers
Trousseau and Chvostek
Cushing’s Disease
Cushion of steroids HIGH “too much steroids”
Big, round, hairy
High blood pressure
High glucose, high sodium
big belly “truncal obesity”
Moon Face
Fat bad
lots of hair Hirsutism
Stretch marks
Red face
infections ’slow wound healing’
Risk for fractures - brittle bones
Hyperparathyroidism
Parathyroid glands responsible for regulation of blood calcium (9.0-10.5)
Hypercalcimia
Hypoparathyroidism
Hypocalcemia
Addisions disease
Absence of steroids, body does not produce steroids
Low Cortisol
Low BP
Wight loss: Skinny + tan
Low Temp
Low sodium
Hair loss
Low glucose
High Pigmentation and High Potassium
Need to be on life long hormone replacement
Addison vs. Cushing pathophysiology
Hypothalamus release CRH (corticotropin releasing hormone) which tells the pituitary to secrete ACTH (adrenocorticotropic hormone) which simulates adrenal gland to produce steroids which controls the 3 S’s
Sugar (cortisol) = stress hormone, prednisone
S - salt (aldosterone)
S - Sex and hair (androgens)
Addisons Disease Causes
Absent low steroids
Autoimmune (body kills adrenals or pituitary)
Disease: Cancer, infections (TB/HIV)
Damage: adrenal hemorrhage (trauma)
Cushing Causes
High cortisol
Steroids - prednisone long term therapy, makes adrenals think they can stoop producing steroids
Tumor (pituitary adrenal)
Small cell lung cancer
Addison Treatment
add steroids during times off stress to avoid Addisons crisis, teach its to tell doctors about stress
Diet high in protein, carbs and sodium
Don’t stop taking steroids abruptly will cause Addison crisis
Don’t believe medication will cure you
Lifelong hormone replacement therapy
Cushing treatment
Control causes
Cut out tumour or steroids (slowly decrease)
Remove of organ = replace hormone, lifelong hormone replacement therapy
Steroid Precautions
prednisone, hydrocortisone, dexemthasone
Swollen (water gain, weight gain)
Sepsis
Hyperglycaemia - increase insulin
Skinny (muscles and bones “osteoporosis”
Sight - Cataracts
Prevent Adrenal Crisis
Slowly tapper off - never abruptly stop steroids
always increase dose of steroids with increase stress
watch for drop in blood pressure = hypotensive shock
Adrenal Crisis Treatment
Add steroids IV push
Dehydration (IV NS 0.9%)
dextrose (D50 IV fluids)
Type 1 Diabetes Mellitus
Auto immune disease
Body does not make inulin
genetic
Insulin dependent for life
Insulin
Released when blood sugar is high
Puts sugar and potassium in to the cells
= sugar and potassium decrease in the blood
Increase insulin with stress, sepsis, surgery and steroids
If sugar is still high after insulin = critical situation, call doctor
Glucagon
When blood sugar is low (exercise or forget to eat) if we do not have food, used to breakdown stored glucose which increase sugar in the blood
Type 2 Diabetes Mellitus
Insulin resistant
Risk factor based on exercise and diet
Sign of insulin resistance Brownish or dark thickening on the neck and armpits, hyperpigmentation and skin tags (canthosis nigricans)
Diagnosis Diabetes
Normal Glucose 70-115
Fasting under 100
Hemoglobin a1c less than 6.5 (2-3 month sugar test to see if its are compliant with controlling their blood sugars long term)
Compliance
Type 2: Diet and exercise
Type 1: Insulin
Signs and symptoms of Hyperglycemia
Over 115
Polyurea: increased urination
Polydipsia: increased thirst
Polyphagia: increased hunger
Causes of Hyperglycemia
Sepsis (infection)
Stress (surgery, hospital stay)
Skip insulin
Steroids (prednisone)
Signs and symptoms of Hypoglycaemia
Most deadly “brain will die”
Cool
Pale ‘pallor”
sweaty, diaphoretic, clammy
nervous, anxious, trembling
Headache
irritable
weakness
Anxious and trembling
Sweat and diaphoresis
Hunger
Hypoglycemia Treatment
Awake = Ask to eat, juice, soda, crackers, low fat milk or peanut butter
Sleep: not alert, unresponsive to painful stimuli = stab with dextrose IV and always reassess sugars
Hypoglycaemia
under 70
Causes brain death
Causes of Hypoglycemia
Exercise = give extra glucose
Alcohol = lowers sugar
Insulin Peak times = most at risk for low sugar =, give food
A client with type 1 is only responsive to painful stimuli with a blood sugar of 42, what is the first action taken by the nurse
Give dextrose IV push and reassess after 15 minutes
Which medication could cause risk for hyperglycaemia
Prednisone
The non diabetic client is admitted for a kidney infection that has now turned septic. The blood sugars have. increased from 150 to 225, what is the best answer to give a family member who is asking why insulin is used
High sugar is common during infection and stress to the body, the insulin will help lower the sugar until the infection relsoves
Complications off Hyperglycaemia
Blood turns to mud
Scars blood vessels = atherosclerosis
kidneys = renal failure, creatinine over 1.3
Eyes = retinopathy “blind” frequent eye exams are recommended
Nerves = neuropathy (diabetic feet, slow wound healing)
Heart = HTN and atheroscerlosis
Brain = CVA “stroke”
Type 2 diabetes treatment
Diet
Exercise
Oral meds
Insulin (last line)
Insulin Test tips
Give foods during peaks, know peak times
Deadly Hypoglycaemia (70 or less)
No peak, no mix = long acting “old guy”
IVP/IV only = regular insulin
Draw up inulin: clear to cloudy regular first then NPH
Rotate locations, best is abdomen, never aspirate never add eat or massage after sub q infection
DKA type 1 - ’sick days’ - YES give insulin
Long acting Insulin
No peak
No mix = dry up in separate syringes”
Detemir
Glargine
Duration 24 hours +
NPH
Intermediate
Cloudy
Never IV
mix clear 2 cloudy
given 2x per day
Duration 14 hours+
Peak 4-12 hour
Regular
Ready to go IV
Only IV insulin
Duration 5-8 hours
Peak 2-4 hours
Rapid
Aspart/lispro/glulisine
Duration 3-5 hours
Most deadly
15 minute onset
must be eating
Peak 30-90 min
Nurse gives regular insulin at 12pm for lunch but patient doesn’t finish their food
2-4pm
Metabolic Syndrome
3 or more criteria
BP meds or High BP
Blood sugar meds or high blood sugar (100+ fasting)
Obese was it size
35 + female, 45+ male
Lipids “high cholesterol”
All contribute to type 2 diabetes
Insulin Pumps
Steady dose of insulin
Fewer swings in blood sugar
Check 4 times per day
push insulin bolus button at meal times
Always asses pt first and then machine second
Oral agents - Type 1 diabetes
Never take PO meds with
Iron
Calcium
Anti acids
Tums
Metformin
Glipizide and Glyburide: heart can die, slow position changes
Thiazolidinedione (TZD) pioglitazone - one dead heart
Acarbose and precose “flatus and diarrhea
Diabetes Education
Diet low in sugar and low simple carbs
Avoid soda, candy, white bread/rice juices
good carbs: high fibre (complex carbs) Brown (bean, rice, bread, peanut butter“whole wheat/grain/milk
Bad Carbs: Low fibre (simple carbs)
White (bread, rice, pastas, fries)
Unless sugar is less than 70
sugar of 60 or less in am = eat bedtime snack
Diabetic feet
Diabetic feet: Bacteria feasts on sugar, foot protection is huge
Clean, dry and injury free
Avoid flip flops, high heels, nylon, bare feet
Do: clean dry, closed toe, comfortable, supportive, leather shoes
Avoid over the counter corn removal, overly hot (bath pads etc)
Toe injury - daily inspection, always cut toenails straight, dry between toes after shower
No callous removal
No heavy powder
No rubbing feet hard vigorously
No hot baths pr hot pads
Which statement by the patient with diabetes indicates correct understanding
I will use lather shoes with cotton socks
Fasting with Diabetes
Low sugar - hypoglycaemia
Which clients are at risk for developing metabolic syndrome?
48 year old file with fasting blood glucose of 105
55 year old female with waist size of 40 inches
28 year old make with blood pressure 135/85
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect
a blood pressure of 176/88 mm Hg.
Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn’t associated with hypotension, hypoglycemia, or bradycardia.
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
blood glucose level 1,100 mg/dl (61.05 mmol/L)
A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test?
It determines the average blood glucose level in the previous 2-3 months.
What is the most common cause of hyperaldosteronism?
an adrenal adenoma
A nurse is evaluating the effectiveness of teaching a client about how to self-administer insulin. Which action indicates that additional teaching is necessary?
The client:
waits 30 minutes to eat breakfast after injecting rapid-acting insulin
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of
encouraging fluids.The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn’t necessary in hyperparathyroidism.
The adrenal cortex is responsible for producing which substances?
glucocorticoids and androgens
The nurse is developing a teaching plan with a client who is newly diagnosed with Addison disease. Which topic is most important to include in the teaching plan?
the importance of watching for signs of hyperglycemia
The nurse is teaching the client how to administer insulin. Which instruction should the nurse include?
“First withdraw clear, then cloudy insulin when mixing insulins in the same syringe.”
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of
profound neuromuscular irritability.
A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.
numbness
tingling
muscle twitching and spasms
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
blood glucose level 1,100 mg/dl (61.05 mmol/L)
A client is seen in the clinic for newly diagnosed hypothyroidism. Which topics should the nurse include in a client teaching plan? Select all that apply.
high-fiber, low-calorie diet
use of stool softeners
thyroid hormone replacements
Bone resorption is a possible complication of Cushing disease. To help the client prevent this complication, the nurse should make which recommendation to the client?
Maintain a regular program of weight-bearing exercise.
Emergency treatment for acute adrenal insufficiency (addisonian crisis)
Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution
A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate action?
deep, rapid respirations with long expirations
A female client is being successfully treated for Cushing’s syndrome. The nurse should expect a decline in
serum glucose level.
The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addisonian crisis following surgery?
methylprednisolone sodium succinate intravenously
Which findings should a nurse expect to assess in client with Hashimoto’s thyroiditis?
weight gain, decreased appetite, and constipation
A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
tachycardia
A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?
potassium chloride
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?
serum potassium level of 6.8 mEq/L (6.8 mmol/L)
Which finding should the nurse report to the client’s health care provider for a client with unstable type 1 diabetes mellitus? Select all that apply.
systolic blood pressure, 145 mm Hg
diastolic blood pressure, 87 mm Hg
triglycerides, 425 mg/dL (23.6 mmol/L)
Which assessment in a client that has just returned from having a modified radical neck dissection with skin flap would require a nurse to take immediate action?
The skin flap appears white.
One day after a subtotal thyroidectomy, a client begins to have tingling in the fingers and toes. What should the nurse do first?
Notify the health care provider (HCP).
A client with type 1 diabetes takes 15 units of insulin isophane before breakfast and 8 units before dinner. During a follow-up visit, the nurse reevaluates the client’s knowledge about insulin therapy and self-administration skills. The nurse realizes the client requires additional teaching when the nurse discovers the client takes which over-the-counter preparations?
salicylate-containing preparations
A client with diabetes mellitus has a foot ulcer. The physician orders bed rest, a wet-to-damp dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are wet-to-damp dressings used for this client?
They debride the wound and promote healing by secondary intention.
A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next?
Assess for gastrointestinal (GI) bleeding.
The nurse has instructed the client on how to self-administer NPH insulin. Which finding indicates that the client needs additional teaching?
shakes the insulin vial before withdrawing the insulin into the syringe.
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which gland?
adrenal cortex
