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536 Body Systems > Endocrine > Flashcards

Endocrine Flashcards

1
Q

diabetes defintion

A

impaired metabolism caused by lack of insulin from pancreas or decreased sensitivity of insulin receptors in tissue

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2
Q

causes of diabetes

A
  • type 1 genetic
  • type 2 lifestyle, prolonged high blood sugar
  • gestational
  • CF pancreatic involvement
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3
Q

Type 1 DM prevalence and pathophys

A

5-10%, commonly diagnosed in children
autoimmune destruction of beta cells leading to lack of insulin production

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4
Q

T1DM treatment

A

insulin dependent
insulin injections, diet, exercise

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5
Q

DM prevalence in US

A

11% pop, 37 mil, 8.5 mil undiagnosed
7th leading cause of death
increasing risk with age 65+
more prevalent in valley

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6
Q

rate of amputation in DM patients

A

10-15% experience diabetic ulcer
60% of diabetic amputees have re amputation

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7
Q

diagnose DM by what criteria?

A

A1C
fasting plasma GLC
oral GLC tolerance test (gestational)

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8
Q

A1C levels

A

normal: <5.7
prediabetic: 5.7-6.4
diabetes: 6.5

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9
Q

risk factors for diabetes

A

smoking
1st degree relative
CV disease Hx
hypertension Hx
Hyperlipidemia Hx
sedentary
45+
women: PCOS, gestational diabetes
obesity

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10
Q

gestational diabetes

A

increased insulin resistance, increases blood GLC levels
diagnosed in later 1/2
may normalize after birth or remain
tend to deliver large babies
include complications: respiratory, jaundice, hypoglycemia

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11
Q

obesity risk factors

A

diet
sedentary
genetics
metabolic conditions: hypothyroidism, Cushing, PCOS
poor sleep
meds
prenatal

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12
Q

obesity complications

A

CV: HTN, CAD, hyperlipidemia, L ventricle dysfunction, cardiomyopathy
Pulmonary: restrictive ling disease, obstructive sleep apnea
GI: GERD, gallstones, fatty liver disease
MSK: OA, PF, altered biomechanics
Cancer: increased risk
T2DM

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13
Q

obesity treatment

A

lose adipose tissue while maintaining muscle
5-10% weight loss has clinically significant effects
diet modification
increase activity/exercise
gastric bypass
pharm: ozempic

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14
Q

ACSM recommendations for obesity

A

freq: 5x week aerobic, 2-3 resistance/flexibility
intensity: mod aerobic intensity, 60-70% 1RM
time: 30 min day 150 week aerobic, 2-4 sets 8-12 reps, 10-30 s 2-4x stretch
type: prolonged rhythmic aerobic, resistance machine/free weights, static/dynamic/PNF stretching

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15
Q

metabolic syndrome

A

5 risk factors with 3 or more confirming diagnosis
1. abdominal obesity
2. high triglycerides >150
3. low HDL women <50, Men <40
4. elevated BP >130/85
5. elevated fasting GLC >100

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16
Q

s/s of diabetes

A

frequent urination
increased thirst
extreme hunger
extreme fatigue
blurry vision
irritability
slow healing cuts
frequent infecctions
unusual weight loss
N/T in hands/feet

17
Q

DM complications

A

integumentary: skin infection, wounds
eye: galucoma, cataracts, retinopathy
feet
CVA
nephropathy
CV: HTN
ketoacidosis medical emergency

18
Q

PT considerations for DM wounds

A

daily routine/activites
footwear
foot deformities
prior Hx of infections, surgery
neuropathy
caludications
current wounds location, onset, trauma, history of same location
compare to uninvolved foot
pain response

19
Q

diabetic foot characteristics

A

size/deformity
rounded
deep wounds
maceration around wounds from drainage
callused
red wounds
heavy drainage

20
Q

Wagner ulcer classification

A

0-5
0: intact
1: superficial ulcer, no subcutaneous
2: deep ulcer involving subcutaneous, tendon or bone exposure
3: deep infected ulcer including abscess
4: partial foot gangrene affecting digits
5: full foot gangrene requiring surgery

21
Q

DM MSK examination

A

ROM/strength BL
contractures
foot deformities

22
Q

common foot deformities in DM

A

claw toe: MTP hyperextension, PIP/DIP flexion
hammer toe: MTP hyperextension, PIP flexion, DIP extension
pex cavus/pes planus
prior amputation - altered weight bearing causing deformity

23
Q

Neuro exam for DM

A

coordination in walking, balance
DTR
sensation: semmes weinstein 10g monofilament
vibration. sharp/light sensation
proprioception

24
Q

monofilament testing

A

measure for loss of protective sensation
10 sites on foot: toes 1/3/5, 3 points across ball of foot, triangle around heel, dorsal foot proximal to digit 1
4.17/1g: normal sensation
5.07/10g: protective sensation
6,1/75g: loss of protective sensation
insensate: no perception of 75g

25
Q

diabetic neuropathy

A

related to high blood GLC levels
15% of DM pts develop diabetic ulcer over weight bearing surface
40x more likely to have amputation due to poor wound healing

26
Q

DM neuropathy subjective scales include:

A

NSS: neuropathy symptom scale
modified NSS
Michigan neuropathy screening instrument
diabetic neuropathy symptom score (DNS)

27
Q

CV exam for DM

A

vitals, temperature
skin integrity
posture
pitting edema w circumferential measure/figure 8
cap refill
ankle brachial index
color

28
Q

common gait deviations w DM

A

reduced gait speed
reduced ankle mobility
hip circumduction
increased knee flexion
shorter step length/stride
wide stance width
increased double limb support time

29
Q

pt education w DM

A

daily foot inspection
LEAP monthly sensation screening
daily shoe checks
daily warm foot wash and moisturizer
cut toenails straight across
white socks to check for wounds/drainage
proper shoes
no barefoot walking
no hot water/heating pads
followup w Dr on new wounds

30
Q

LEAP: LE amputation prevention

A
  1. annual foot screening
  2. pt edu
  3. daily foot inspection
  4. footwear
  5. manage simple foot problems
31
Q

recommended shoes for diabetic foot wounds

A

min-no risk factors: athletic shoes
some risk factors: large toe box, inserts
minor deformity/single problem: prescription/off shelf shoes
major deformity: Klenzak brace/AFO, custom molded
uncontrolled deformity: crow boot

31
Q

footwear considerations DM

A

offloading abnormal pressure on ulcer
- contact casting
- modified shoes
- wound dressing

32
Q

charcot foot cause and stages of development

A

cause: severe peripheral neuropathy and repeated trauma with loss of protective sensation; abnormal response to repeated injury causing severe destruction of foot architecture
stages:
0: inflammatory, warmth/swelling/pain
1: destruction, weakened ligaments, joint subluxation
2: bone callus, consolidation of fractures
3: fixed deformity and instability

33
Q

benefits of ther ex for DM

A

improved glycemic control
weight reduction/adipose reduction
decreased hyperlipidemia/HTN
slow down CV disease
reduced stress
improved QOL

34
Q

ACSM recommendations for diabetes

A

aerobic: 3-7x week, no more than 2 days w/o activity; mod-vigorous, 150 min/wk, prolonged rhythmic activities
resistance: 3x week nonconsecutive, 50-85% 1RM, 8-10 major m groups, 1-3 sets 10-15 reps
flexibility/balance: 2-3 x wk, light-mod, 10-30 s 2-4x stretch, static/dynamic/stretching/yoga

35
Q

relative contraindications to exercise for DM

A

blood GLC levels:
70-100: snack every hour of exercise w hydration, or more often for intense
100-300: proceed, 1-2+ hours requires more carbs and water
300+ oral meds: try 10-15min exercise and recheck BG, stop if rising, if not continue monitoring
300+ on insulin: check for ketones, stop if positive, continue if not and monitor

36
Q

absolute contraindications to exercise DM

A

BG: <70, hypoglycemia - s/s shaking, dizzy, hunger, headache, pale, jerky, seizure, tingling
hyperglycemia: >300 w ketones, SOB/fruity breath, nausea/vomiting, dry mouth
both emergency

37
Q

diabetic foot exam

A

examine appearance and wounds at all surfaces/under/between toes, toenails
temperature/color
cap refill
monofilament, 3 types in 10 std positions
shoe examination
barefoot and shoe gait
sensation: light touch, vibration
big toe joint proprioception
achilles DTR
ROM
balance
MMT

536 Body Systems (11 decks)

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