ENDOCRINE #2 Flashcards
Addisons clinical manifestations
muscle weakness wt loss fatigue hypotension anorexia dry skin low Na High P+
Myxedema coma interventions
Give O2
fluids
patent airway
thyroid hormone, levothyroxine IV
Lispro given at 1630, watch for hypoglycemia at…
1830
Intervention of A1C
prevent hyperglycemia
what test measures BGL for 8-10 weeks
HgB A1C
pt is NPO with BGL of 52. what to do?
Call HCP
Diabetes insipidus clinical manifestations
polyuria
polydipsia
SIADH resolving will show specific gravity?
above 1.005
- SATA anything above 1.005
will buffalo hump w cushings resolve?
yes slowly with treatment
Graves disease interventions
high cal diet
monitor VS
keep room quiet
insulin drawn up
Nph to reg
Reg to nph
Nph cloudy
Why calcium after thyroidectomy
treat hypocalcemia with tetany
pt has hoarseness after thyroidectomy
temporary d/t swelling
rest voice
NPH given at 0830 when will pt experience hypoglycemia?
6-14 hours
Lispro onset?
15 minutes
DM foot care
use mild soap
warm water
apply lotion, not between toes
GOITER clinical manifestations?
hoarseness
dysphagia
enlarged thyroid
acromegaly manifestations
sleep apnea
large hand/feet
joint pain
ANDRE THE GIANT
DM has dehydration what check first
BGL
How do sulfonylureas act?
stimulate insulin production
decrease glucose production in the liver
decrease insulin metabolism in the liver
increase insulin sensitivity to target cells
stimulates pancreas to produce greater amounts of insulin
DM pt has nonhealing foot wound what to do?
Wound care consult
Post adrenalectomy what to teach pt
diet activity DB/C incentive spirometer s/s infection prevent incision infection
D/C instructions for Cushing’s
increase k+
decrease Na
check ankles for swelling
no contact sports
Spironolactone does?
decrease BP
increase sodium excretion
increase potassium secretion
lab that shows DM1 might have complication if
Ketonuria
(DKA=ketonuria+BGL > 250
will increase insulin for DM1 if
ketonuria
pt is ill
taking steroids
BGL not controlled
LIpodystrophy
when insilin injected into same site over and over again
New DM diet teaching
healthy snacks
diet drinks with no sugar
balanced meals
fruits for sweets
why abd for insulin injections
Fastest absorption
Hypoglycemia s/s
irritable personality changes tremors shakiness tachy palpitations diaphoretic pallor
Remember DM pts
need more insulin when ill
need to check BGL not urine
Never just stop insulin
check BGL before giving insulin
in order to function properly the parathyroid needs
Vitamin D
Levothyroxine teaching
take in morning on empty stomach
in morning to prevent sleeplessness
in morning to increase absorption
Diabenese (chlorpamide) is effective oral hypoglycemic because?
decrease polyuria
taken orally
decrease polyphagia
keeps BGL under 120
When is Lantus given
at bedtime
QHS Qday
why myxedema feels like hangover
sensitivity to thyroid hormone given IV
PT DM2 does not understand teaching when states?
I can take insulin orally
i can eat more because I take pills to decrease BGL
I can eat more because insulin to cover what I eat
I wont take any pills when I’m sick
Post DKA pt teaching
Check BGL regularly
test for ketonuria
Cushings diet
high K+
low Na
Drink fluids
best canidate for radioactive iodine vs thyroidectomy
not good surgical canidate
cancer+heart disease
RA and Chron’s
DM1 ask when exercise if taking NPH in morning
May exercise in morning
May exercise in early afternoon
NOT in late afternoon as NPH peaks 6-14 hrs after taking
medications for hyperthyroidism
Propylthiouracil
hyperparathyroidism does
increase calcium
can cause polyuria
post parathyroidectomy taught to take calcium
after meals
when pt taking corticosteroids pt should
watch s/s infection
check BGL
Hypocalcemia s/s
tremors shakiness pallor diaphoretic personality changes irritability tachy palpatations
tremors in sign of what in DM
Hypoglycemia
for IDDM taking steroids needs
more insulin
hat factors lead to hypoglycemia in DM1
Illness
exercise- less insulin
NPO - less insulin
pt needs to understand insulin they take and peaks to avoid heavy exercise
Addisons treatment
Mineral corticosteroids
glucocorticosteroids
hydro cortisone has both properties
pt on syntroid still have symptoms of hypothyroidism
does needs to be increased
giving NPH at 10 watch for hypoglycemia at
4 pm
foods high in potassium
ham
apples
bananas
potatoes
DKA s/s
kussmal breathing fruity breath thirst drowsiness confusion polyuria
DI is caused by
Decreased ADH
Glyburide for DM2 because
increases insulin in pancreas
increases insulin sensitivity of target cells
helps prevent insulin resistance
hyperparathyroidism means that serum calcium is
increased
hypoparathyroidism means that serum calcium is
decreased
cushings s/s include
facial hair thin skin moon face large trunk extremety swelling tachy high BP
DI treatment is effective when
urine output decreases
fluid intake remains 2500mL/day
Vassopresson for DI because
it decreases urine output
hypothyroidism diet
low cal to slow wt gain
adverse reaction to synthroid
Tachycardia
Thyroid glad produces
T3
T4
Calcitonin
HHNS need fluid intake of
IV fluids
intake of 2-3 L in 2-3 HRs
Hypovalemia in Addisons disease cases decreased BP by
low sodium
low K+
Treatment for SIADH is effective when
wt decreases
lungs clear
increases urine output
decreased serum osmolality
what does pheochromocytoma do?
increases the release of catecholamines (epinephrine and norepinephrine.)
what controls the release of hormones in body?
NEGATIVE FEEDBACK
nurse priority for pre-op adrenalectomy
monitor VS
Pheochromocytoma diet is?
high cal
high vitamins and minerals
graham crackers and milk
thyroid storm and vasodilation occurs what happens
BP drop
teach about salt restricted diet
Salt substitutes are high in K+
What might thyroid crisis lead to
CHF
Nursing DX for acromegaly
risk for falls
trauma
injury
laryngeal spasms are possible with hypoparathyroidism
what contributes to cushings depression
moon face
facial hair
wt gain
Chvostek and Trousseau sign of
Hypocalicemia
