endocrine 2

Question 1

Cushing’s disease-4

Answer 1

• hypercortisolism
• from either adrenal cortex, anterior pituitary gland, or hypothalamus
• truncal obesity, buffalo hump, moon face, striae, petechiae
• acne, hirsutism, oligomenorrhea

Question 2

cushing’s syndrome

Answer 2

caused by glucocorticoid excess from drug tx for another health problem

Question 3

pheochromocytoma

Answer 3

catecholamine producing tumor in adrenal medulla

-don’t palpate abdomen

Question 4

Hashimotos ass-5

Answer 4

• graves disease
• goiter overproduces thyroid hormones
• exophthalmos, pretibial myxedema
• heat intolerance, change in vision, photophobia
• high T3 and T4

Question 5

thyroid storm clinical assessment findings-5

Answer 5

• high fever (report 1 degree), tachycardia, systolic htn
• abdo pain, N/V/D, anxious, tremors
• restless, anxious, confused, tremors, seizures, psychotic
• quick triggered by stress, infection, DKA, trauma, iodine
• can lead to death

Question 6

methimazole education-Graves dx

Answer 6

• notify if pregnant, avoid crowds and ill people

- check for wt gain, slow heart rate, and cold intolerance

Question 7

safety precautions for RAI therapy- graves-5

Answer 7

• not w pregnancy
• private toilet/ sit to pee/ flush x3
• laxative 2nd or 3rd day
• wash clothes seperately, rerun wash
• don’t share toothbrush, disposable dishes, no food scraps

Question 8

thyroid storm treatment-3

Answer 8

• maintain airway, reduce fever, stabilize hemodynamics
• oral antithyroid drugs, sodium iodide, propanolol, glucocorticoids
• monitor hrt, vitals, normal saline

Question 9

hypocalcemia and parathyroidectomy

Answer 9

• assess for neck trauma, tingling or numbness around mouth/hands/feet to severe muscle cramps/seizure/tetany
• check for Chvostek and Trousseau signs

Question 10

hypoparathyroidism interventions

Answer 10

calcium, vit D, and magnesium

• eat foods high in Ca but low in Phos
• avoid milk, yogurt, and processed cheese

Question 11

rapid acting insulin

Answer 11

1. insulin aspart-Novolog
2. insulin glulisine-Apidra
3. insulin lispro-Humalog
   - 10 min before meal or immediately after eating when glu in target range
   - 3-5hrs

Question 12

short-acting insulin

Answer 12

Humalin R

• 20-30 min before eat or longer if not in target range
• 5-12 hrs

Question 13

intermediate acting insulin

Answer 13

Isophane NPH

• used for basal 16-24 hrs
• cloudy

Question 14

long acting insulin

Answer 14

insulin glargine, insuline detemir

-24 hrs, don’t mix

Question 15

injection sites

Answer 15

-rotating prevents lipohypertrophy and lipoatrophy

Question 16

dawn phenomenon

Answer 16

nighttime release of growth hormone resulting in glucose elevations at 5am

Question 17

somogyi phenomenon

Answer 17

morning hyperglycemia from the counterregulatory response to nighttime hypoglycemia resulting in release of liver glucose
-adequate dietary intake at bedtime

Question 18

ADA treatment goals

Answer 18

A1C less than 6.5
premeal glu 70-130
postmeal glu under 180

Question 19

hypoglycemia signs

Answer 19

sweating, irritability, tremors, confusion, seizures, hungry, fatigue, LOC, cold clammy skin

Question 20

DKA labs-6

Answer 20

glu >300, positive keytones, pH<7.35, bicarb <15, BUN>30, Cr >1.5

Question 21

insulin drip

Answer 21

bolus of 0.1 unit/kg followed by 0.1unit/kg/hr

Question 22

DKA resolved

Answer 22

glu less than 200, bicarb higher than 18, pH higher than 7.3, and calculated ion gap less than 12

Question 23

DKA treatment-5

Answer 23

1. assess airway, LOC, hydrtion status, electrolytes, and glu
2. fluid tx 0.9% NaCl 15-20mL/kg/hr for first hr
3. 0.45% NaCl until glu 250
4. 5% dextrose in .45% saline
5. K replacement

Question 24

Differences between DKA and HHS

Answer 24

1. DKA sudden onset, HHS grdual
2. DKA glu>300, HHS glu>600
3. DKA positive urine ketones, HHS negative urine ketones

Question 25

sick day rules for diabetic-5

Answer 25

1. notify HCP
2. glu q4hrs
3. test for ketones if glu >240
4. Take inslin/meds
5. drink/eat/rest