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HA oral > endocrine > Flashcards

endocrine Flashcards

1
Q

DM s/s

A

polys: dipsia, phagia, uria

need BGL

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2
Q

DM: ANS neuropathy symptoms 7

A

Cardiac: resting tachy, dec variability to HR, arrhythmias, orthostatic hypotension
GI: gastroparesis
peripheral neuropathies
altered regulation of breathing

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3
Q

Labs and test for DM

A

*BGL!!!!!!! even if have one on labs

HbA1c

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4
Q

intraop BGL control: ask…

intra op stuff needed

A 
ask: take insulin day of? PO hypoglycemic? 
need glucometer, how often monitored 
fluid with glucose
insulin gtt
how managed post- op
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5
Q

Labs and test for DM

A

Elytes–GLUCOSE
BUN/cr
ECG
(HbA1c)

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6
Q

Cushings

A

High cortisol

s/s: wt gain, Moon face, buffalo hump, HTN, gluc intolerance, hypoK, hyperNa

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7
Q

Addisions

A

s/s: wt loss, hypotension, hypoglycemic, weakness, abd and back pain, hypERk, hypOna

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8
Q

Addisions steroids

A

25mg for minor surg
major: 25mg + 100mg IV over 24hrs
100mg q8 or pre intra post op

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9
Q

Pheochromocytoma

A

catecholamine releasing tumor: in adrenal medulla
in kids adrenal and multiple sites
s/s: HA, diaphoresis, palpitation, anxiety, CP
episodes: frequency (daily to month), duration (~1hr)
touch tumor and INC INC SNS release–INC BP

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10
Q

Pheochromocytoma tx

A 
**inc BP
test alpha block before OR
alpha block restores insulin release 
**must alpha block first then beta block
if beta first lose compensation for inc SVR
beta for persistent tachy 
DRUGS:
phentolamine, phenoyxbenzamine, esmolol
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11
Q

DM acute complications

A

HYPOGLYCEMIA: worse than hyper
under anesthesia symptoms are masked
DKA: don’t take to OR: kussmals, Inc BGL, lethargic, dehydrated

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12
Q

Parathyroid dx asmt

A 
hyperCa     >7.5mEq/L most likely CA
MSK: muscle weakness, fx, 
GU:kidney stones, polyuria, dec GFR
CV: HTN, prolonged PR
GI: Vomiting, abd pain, PUD, pancreatitis 
Anemia
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13
Q

Parathyroid mgmt/test

A

**avoid nephrotoxic drugs
dec dose NMB
RSI-vomiting
labs: H&H, ECG, 5 lead during

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14
Q

Med mgmt hyperCa

A

Saline: 150ml/hr
Lasix
Bisphosphonates-life threatening hyperCa–inhibits osteoclasts
Mithramycin -also inhibits osteoclasts

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15
Q

Hypoparathyroid

A

low Ca

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16
Q

Hypoparathyroid tx

A

infusion of Ca gluconate 10ml of 10% until neuromuscular irritability dissipates
HCTZ- deletion of K and Na get Inc Ca

17
Q

Chvostek sign

“trastick”

A

tap facial nerve in front of ear: contraction of eyes, nose, mouth

18
Q

Trousseau

“trueso”

A

compression of FA leads to spasm of head and wrist, adduction and bunching fingers, wrist flexed

19
Q

Thyroid chart review

A

VS, labs, Meds, endocrinologist

20
Q

Hyperthyroid

A

hypermetabolic: anxiety, tachydysrhythmias, wt loss, diarrhea-elyte changes, heat intolerance, diaphoresis, exophthalmos, goiter
labs inc T3T4, dec or n TSH
meds: bblockers,
antithyroid-methimaxole, carbimazole, PTU,
Iodine containing compounds- lugols solution
PREOP concerns: eyes and airway

21
Q

Hypothyroidism

A

primary: DESTRUCTION of thyroid: hashimotos, thyroidectomy
secondary: CNS dysfunction, Hypothalamic DYSFUNCTION (TRH deficiency) Anterior pit dyscintion (TH deficieny)
**Dec metabolic activity: cold intolerance, brady, HTN, gastroparesis
Considerations: keep warm, steroids, ECH, give PEEP( lower surfactant) dec response to hypoxia, hypercapnia- don’t give too much narcs
Cardiac: Brady- ecg
Resp: hypoxia, hypercapnia, give PEEP for lower surfactant
Renal: inappropriate ADH- hypoNa- elyte

22
Q

Chronic hypothyroidism asmt

A

Cardiac: brady, dec CO, inc SVR, HTN, poss CHF *need ECG
Resp: dec responce to hypoxia abd hypercapnia
Renal: inappropriate ADH– hypoNa *check elytes
Tx: oral admin of T4, if ischemic heart disease may not tolerate so have to give nitro first

23
Q

ROS for DM 6

A

CV: HTN, CAD, retinopathy
GU: renal function, nephropathy CRF
GI: delayed gastic emptying: aspiration risk
MSK: Type 1: stiff joints, difficulty airway: prayer sign, can’t get hands together then probably have problems with TMJ and Atlantooccipital joint
CNS: strokes, peripheral neuropathy, visual, ANS neuropathy
*RAVENS: Renal, Aspiration (gi), Vascular, Eyes, Neuropathy, Stiff joint

**ANS neuropathy: affects CV and GI

24
Q

Cushings asmt

A

BGL: can control with sm ant insulin
HTN
*NMB doesn’t work as well
*Know fluid status:
inc blood volume bc of Na retention: CHF- can be on diuretics *check K, elytes
m Alkalosis
*blood loss: T&S, T&C major, consider invasive monitoring

25
Q

Addisions asmt

A

need volume, keep hydrated
pressors+steroids? invasive monitoring?
BGL-glucose needed?
are the on steroids? if yes take day of. cortisol bridging

26
Q

Conns

A

excess production of aldosterone
no specific s/s , some asymptomatic
**HTN: may be resistant to tx, PRBC ready, Aline?
aldosterone induced Na retention..polyuria?
HypoK=muscle cramps and weakness
*low NMB dose

HA oral (9 decks)

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