Endocrine Flashcards
Aldosterone does what?
Makes you retain sodium and water
ADH does what?
Makes you retain water
What two diseases are too much aldosterone?
Cushings and hyperaldosteronism
What disease is too little aldosterone
Addisons
What disease is too much ADH
SIADH
What disease is no enough ADH
Diabetes Insipidus
Name 3 Thyroid hormones
T3, T4 and calcitonin
What does calcitonin do?
It decreases serum calcium levels by taking it out of the blood and pushing it back into the bone
What do we need to make thyroid hormones?
Dietary Iodine
Thyroid scan patient teaching…..
Discontinue any iodine containing medications 1 week prior to the thyroid scan
Treatment for Hyperthyroidism
PTU and methimazole (tapazole); they stop thyroid from making hormones and its used preop to stun the thyroid, We want the client to become; Iodine compounds; beta blockers, radioactive; thyroidectomy
why give iodine compounds to hyperthyroidism
decrease the size and vascularity of the gland; give it in milk or juice and use a straw.
Why give beta blockers to hyperthyroid patient
to decrease BP, HR and to decrease anxiety.
How do beta blockers work
They block the release of epinephrine and norepinephrine
How do you give radioactive iodine
Given to hyperthyroid patient. 1 dose ,PO liquid or tablet form, rule out pregnancy first; hypothyroidism is EXPECTED because it destroys thyroid cells. Stay away from babies for 24 hrs; Dont kiss anyone for 24 hrs. Watch for thryoid storm.
Post thyroidectomy nursing care
Put personal items close, elevate HOB, check for bleeding behind neck, need more calories pre and postop, assess for laryngeal nerve damage (hoarse, weak voice, eeeee sound), trach at bedside, report any complaints of pressure (assume worst!!)m hypocalcemia; watch swelling, vocal cord paralysis;
Hypothyroidism at birth…
cretinism
Treatment for hypothyroidism
Levothyroxine (synthroid), thyroglobulin (Proloid), liothyronine (cytomel), take meds forever, tend to have CAD
What does PTH do?
Pulls calcium from the bone and places it in the bone, therefore the calcium level goes up.
Too much parathormone….
Serum calcium high
What do you monitor post partial parathyroidectomy
Monitor for hypocalcemia (be scared the calcium levels drop too low)….watch for tetany, rigid, tight, trosseaus.
Treatment for hypoparathyroidism
IV Calcium and phosphate binding drugs like renagel, phoslo or oscal. they bind phosphorus to decrease phosporus and the serum calcium goes up
What does adrenal medulla secrete
Epinephrine and norepinephrine
What is pheochromocytoma
Benign tumor that secretes epi and norepi in boluses
Diagnose pheochromocytoma
VMA (vanillylmandelic acid) test: 24 hr urine specimed done to look for increased levels or epi and norepi. Anything with vanilla in it can cause false highs on test so no vanilla before test for 1 week. Need a calm and stress free enviro when taking test. Throw away first voiding and keep the last voiding.
What does adrenal cortex release
Steroids (Glucocorticoids, mineralcorticoids, and sex hormones).
Glucocorticoids do what 4 things?
Change your mood (insomia, depresssed, psychotic, euphoric); alter defense mechanisms (immunosuppression); breakdown fats and proteins (children don’t grow quickly); Inhibits insulin (hyperglycemic so do glucose monitoring).
Name the mineralcorticoid & what does it do
Aldosterone, retain Na and water, makes you lose K
Too much aldosterone means what for K
decreased K
What is addisons disease
Not enough steroids, think shock and high potassium, Low Na, Low water
S/sx of addisons disease
Initially s/sx are result of hyperkalemia; anorexia, hyperpigmentation, decreased bowel sounds, GI upset, white patchy areas of skin (viltiligo), hypotension, decreased Na, high K, and hypoglycemia
Treatment for addisons
Increase Na in diet, I&O, daily weights, fluid volume deficit, Give aldosterone fludrocortisone (Florinef), processed fruit juice/broth. Keep the weight within 2-3 lbs of their normal weight. You adjust the meds based on weight. Not on meds the rest of life. Never stop taking steroids abruptly, taper them off. Suddenly stopping can cause addisonian crisis
S/sx of cushings disease
moon face, buffalo hump, growth arrest, skinny arms and legs, hyperglycemia, psychosis to depression, truncal obesity, oily skin/acne, women with male traits, poor sex drive, high blood pressure, CHF, weight gain, FVE, serum K low, cortisol level high on 24 hr urine
Treatment for cushings
Diet: increase K, decrease Na, increase protein, increase Calcium; adrenalectomy; avoid infections, quiet environment,
How do steroids effect calcium levels
They decrease serum calcium levels by excreting it through GI tract. So it can make bones brittle and cause osteoporosis from pulling calcium from bone and putting into blood
What can appear in urine of cushing patient
glucose bc steroids make BS go up and the kidneys get rid of it; Ketones will also appear bc client is breaking down body fat.
Normal Blood glucose level
70-110
First sign of type 1 DM
DKA, appears abruptly
Difference between type 1 DM and type 2….
not breaking down fats to ketones in type 2.
Features of metabolic syndrome
insulin resistance, abdominal obestiy, increased triglycerides, decreased HDL, increased BP, and CAD.
Screen moms for gestational diabetes when?
screen all moms at 24-28 weeks; for risk factors, screen at 1st prental visit.
Gestational DM complication to baby…
increased BW and hypoglycemia
How do oral hypoglycemics work?
They stimulate pancreas to make insulin; work to decrease the amount of circulating glucose
How is insulin determined and given
based on body weight and average dose is 0.4-1.0units/kg/day. Adjusted until the glucose is normal and until there is no more glucose or ketones in urine
Rapid acting onset, peak and duration (n
Onset 15 min, Peak 1-3 hrs, D-3-5 hrs; never give without food at bedside
Regular insulin (hum R, Novolin R)
Onset 30 min, peak 2-4, duration 6-8 hrs; only one can give IV
NPH (intermediate acting) (Novolin N, Humulin N)
Onset is 1.5 hrs, peak 4-12 hr, duration 16-24hrs. It is cloudy insulin.
Long acting (Lantus)
Onset 2-4 hrs, NO Peak, Duration 24hrs. Dont mix with any other insulin.
Name 3 drugs you do not aspirate with
Insulin, heparin, lovenox
S/sx of hypoglycemia
cold, clammy, confused, shaky, headache, nervous, nausea, increased pulse
Treatment for DKA
Treat cause, hourly blood sugar and K+ levels. (IV insulin can cause hypoglycemia and hypokalemia), EKG, hourly outputs, ABGS, IVF–> start with NS then when get to 300 switch to D5W to prevent throwing into hypoglycemia. Use 2 large bore IV, 1 in each arm. Anticipate the MD will want to add K to the IV solution at some point.
What is neurogenic bladder
No bladder tone; the bladder doesn’t empty properly, incontinence or retention.
What is gastroparesis
stomach emptying is delayed; risk of aspiration
