endocrine 2 Flashcards
Cushing’s disease-4
- hypercortisolism
- from either adrenal cortex, anterior pituitary gland, or hypothalamus
- truncal obesity, buffalo hump, moon face, striae, petechiae
- acne, hirsutism, oligomenorrhea
cushing’s syndrome
caused by glucocorticoid excess from drug tx for another health problem
pheochromocytoma
catecholamine producing tumor in adrenal medulla
-don’t palpate abdomen
Hashimotos ass-5
- graves disease
- goiter overproduces thyroid hormones
- exophthalmos, pretibial myxedema
- heat intolerance, change in vision, photophobia
- high T3 and T4
thyroid storm clinical assessment findings-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
methimazole education-Graves dx
- notify if pregnant, avoid crowds and ill people
- check for wt gain, slow heart rate, and cold intolerance
safety precautions for RAI therapy- graves-5
- 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
thyroid storm treatment-3
- maintain airway, reduce fever, stabilize hemodynamics
- oral antithyroid drugs, sodium iodide, propanolol, glucocorticoids
- monitor hrt, vitals, normal saline
hypocalcemia and parathyroidectomy
- assess for neck trauma, tingling or numbness around mouth/hands/feet to severe muscle cramps/seizure/tetany
- check for Chvostek and Trousseau signs
hypoparathyroidism interventions
calcium, vit D, and magnesium
- eat foods high in Ca but low in Phos
- avoid milk, yogurt, and processed cheese
rapid acting insulin
- insulin aspart-Novolog
- insulin glulisine-Apidra
- insulin lispro-Humalog
- 10 min before meal or immediately after eating when glu in target range
- 3-5hrs
short-acting insulin
Humalin R
- 20-30 min before eat or longer if not in target range
- 5-12 hrs
intermediate acting insulin
Isophane NPH
- used for basal 16-24 hrs
- cloudy
long acting insulin
insulin glargine, insuline detemir
-24 hrs, don’t mix
injection sites
-rotating prevents lipohypertrophy and lipoatrophy
dawn phenomenon
nighttime release of growth hormone resulting in glucose elevations at 5am
somogyi phenomenon
morning hyperglycemia from the counterregulatory response to nighttime hypoglycemia resulting in release of liver glucose
-adequate dietary intake at bedtime
ADA treatment goals
A1C less than 6.5
premeal glu 70-130
postmeal glu under 180
hypoglycemia signs
sweating, irritability, tremors, confusion, seizures, hungry, fatigue, LOC, cold clammy skin
DKA labs-6
glu >300, positive keytones, pH<7.35, bicarb <15, BUN>30, Cr >1.5
insulin drip
bolus of 0.1 unit/kg followed by 0.1unit/kg/hr
DKA resolved
glu less than 200, bicarb higher than 18, pH higher than 7.3, and calculated ion gap less than 12
DKA treatment-5
- assess airway, LOC, hydrtion status, electrolytes, and glu
- fluid tx 0.9% NaCl 15-20mL/kg/hr for first hr
- 0.45% NaCl until glu 250
- 5% dextrose in .45% saline
- K replacement
Differences between DKA and HHS
- DKA sudden onset, HHS grdual
- DKA glu>300, HHS glu>600
- DKA positive urine ketones, HHS negative urine ketones
sick day rules for diabetic-5
- notify HCP
- glu q4hrs
- test for ketones if glu >240
- Take inslin/meds
- drink/eat/rest
