endocrine Flashcards
(139 cards)
1
Q
hormones produced by the thyroid gland x3
A
T3
T4
calcitonin
2
Q
calcitonin action
A
decreases serum Ca by taking Ca out of blood and returning it to bone
3
Q
iodine purpose
A
hormone creation
4
Q
thyroid hormone purpose
A
energy
5
Q
hyperthyroidism
A
aka Graves Disease
too much energy!
6
Q
hyperthyroidism: s/s
A
nervous, irritable
sweaty, hot
exophthalmos
thyroid hypertrophy
decreased
- attention span
- weight
increased
- appetite, gi motility
- bp (workload of heart)
7
Q
hyperthyroidism: dx
A
increased serum T4
thyroid scan
8
Q
antiarrhythmic drug containing high levels of iodine
A
amiodarone (Cordarone) - may affect thyroid function
9
Q
prior to thyroid scan…?
A
discontinue iodine-containing medications 1 week prior
10
Q
hyperthyroidism: tx
A
anti-thyroid medications iodine compounds beta blockers radioactive iodine surgery
11
Q
anti-thyroid medications: action
A
- stops thyroid from making thyroid hormone
- for hyperthyroidism
12
Q
used prepoperatively to stun thyroid
A
anti-thyroid med
13
Q
iodine compounds: action
A
- decreases the size and vascularity of thyroid gland
- for hyperthyroidism
14
Q
beta blockers for hyperthyroidism: action
A
decreases myocardial contractility
- decreases HR, BP, anxiety
- could decrease cardiac output
15
Q
radioactive iodine: administration
A
- for hyperthyroidism
- 1 dose PO (liquid or tablet form)
- RULE OUT PREGNANCY FIRST
16
Q
important nursing consideration for radioactive iodine
A
rule out pregnancy before admin!
17
Q
radioactive iodine: action
A
destroys thyroid cells resulting in hypothyroidism (not ae - expected)
18
Q
possible rebound effect post-radioactive iodine
A
thyroid storm
19
Q
thyroid storm
A
thyrotoxicosis, thyrotoxic crisis
- uncontrollable hyperthyroidism
- can be caused by thyroid manipulation, severe infection, stress
MEDICAL EMERGENCY
20
Q
do not give beta blockers to… x2
A
asthmatics or diabetics
- block catecholamine sites (epi, NE)
21
Q
thyroid gland regulates
A
body metabolism and growth
22
Q
use straw with iodine compounds because…?
A
stains teeth
23
Q
radioactive precautions
A
no babies or kisses for 24 hours
24
Q
thyroidectomy: positioning
A
HOB up to decrease risk of edema
25
sign of recurrent laryngeal nerve damage post-thyroidectomy
hoarseness
26
why keep a trach set at the bedside post-thyroidectomy?
- swelling
- recurrent laryngeal nerve damage (vocal cord paralysis)
- hypocalcemia
27
why is hypocalcemia a consideration post-thyroidectomy?
possible parathyroid removal
| s/s hypocalcemia: tight, rigid muscles, seizure possiblity
28
hyperthyroidism and eyes
dry eyes, photosensitivity
29
hypothyroidism aka
myxedema
30
hypothyroidism: s/s
```
no energy!!, fatigue
increased weight
cold
decreased gi motility, speech
no expression
```
31
cretinism
hypothyroidism present at birth, can lead to slowed mental and physical development if undetected
32
hypothyroidism: tx
meds (levothyroxine, thyroglobulin, liothyronine): take FOREVER
33
common hypothyroidism co-morbidity
CAD - every aspect of metabolism slows down; basement membranes not proliferating = narrower artery walls = CAD
possible to throw clots!
34
hyperthyroidism + hypoglycemia
do not give beta blockers to diabetics because they block signs of hypoglycemia
beta blockers: decrease HR, BP, clammy (sweaty), nervous/anxious
35
hypothyroidism + depression
tired, weight gain, immobility (in bed)
36
parathyroid problem think
calcium!
37
parathyroid hormone: action
pull Ca from bone and into serum - serum Ca goes up
38
hyperparathyroidism =
hypercalcemia = hypophosphatemia
39
hypoparathyroidism =
hypocalcemia = hyperphosphatemia
40
hyperparathyroidism: s/s
too much PTH
serum Ca up
serum P down
SEDATED!
41
hyperparathyroidism: tx
partial parathyroidectomy
42
partial parathyroidectomy
take out 2 parathyroid glands
| PTH secretion goes down, serum Ca goes down
43
monitor for what post-parathyroidectomy?
hypocalcemia: tight, rigid muscles, seizures
44
hypoparathyroidism: s/s
not enough PTH
serum Ca down
serum P up
hypocalcemia s/s
45
hypoparathyroidism: tx
IV calcium - give SLOWLY
| phosphorous binding drugs
46
ESRD patients tend to retain...
phosphorous therefore serum Ca is down
47
adrenal glands for
stress
48
adrenal medulla hormones
epinephrine
| norepinephrine
49
pheochromocytoma
benign tumors on adrenal medulla that secrete epi and NE in boluses
50
pheochromocytoma: s/s
increased BP, HR
| flushing, diaphoretic
51
vanillylmandelic acid test
24 hour urine specimen checking for increased levels of catecholamines (epi, NE) - used for dx of pheochromocytoma
52
pheochromocytoma: tx
surgery to remove tumors
53
adrenal cortex hormones
glucocorticoids
mineralocorticoids
sex hormones
54
glucocorticoids: actions x4
- mood
- immunosuppression (decrease inflammation)
- inhibit insulin = hyperglycemic...
- fat, protein metabolism
55
accuchecks + steroids
steroids (glucocorticoids) inhibit insulin
56
major mineralocorticoid
aldosterone
57
aldosterone: retain & lose what?
retain: Na, H2O
lose: K+ (dilutional hypokalemia + urinary excretion)
58
too much aldosterone
fluid volume excess
| hypokalemia
59
not enough aldosterone
fluid volume deficit
| hyperkalemia
60
major glucocorticoid
cortisol
61
pituitary + cortisol
pituitary secretes adrenocorticotropin hormones (ACTH)
ACTH stimulate adrenal cortex to produce cortisol
ACTH = cortisol
62
adrenocorticotropin hormones (ACTH)
stimulate adrenal cortex to produce cortisol
| secreted by pituitary
63
addison's disease
adrenocortical insufficiency: not enough steroids (gluco, mineralo, sex)
ADRENAL CORTEX PROBLEM
64
addison's disease: s/s
majority result from hyperkalemia
- progression: muscle twitching - weakness - flaccid paralysis
other:
gi: gut slows down - anorexia, nausea, decreased bowel sounds, gi upset
hyperpigmentation, vitiligo
hypotension
decreased Na, increased K, hypoglycemia
65
hyperpigmentation
bronzing color of skin and mucus membranes
sign of addison's
66
vitiligo
white patchy area of depigmented skin
sign of addison's
67
addison's + hypoglycemia
addison's = not enough steroids = decreased glucocorticoids
not enough glucocorticoid = not enough glucose
also inhibits insulin
68
addison's + aldosterone
addison's = not enough steroids = decreased mineralocorticoids (aldosterone)
insufficient aldosterone = lose Na = retain K = hyperkalemia
69
addison's + hyperkalemia
addison's = not enough steroids = decreased mineralocorticoids (aldosterone)
insufficient aldosterone = lose Na = retain K = hyperkalemia
70
addison's + shock
addison's = insufficient steroids = insufficient mineralocorticoids (aldosterone)
decreased aldosterone = lose Na and H2O = lose blood volume = SHOCK
71
addison's tx
- combat shock
- increase dietary Na
- i/o + daily weight
72
addison's + hypotension
decreased BP due to loss of Na
73
fludrocortisone (Florinef)
mineralocorticoid replacement - aldosterone
- daily weights very important
- given for addison's disease
74
daily weights + florinef
crucial for adjustment of florinef dose, similar to insulin for diabetics
75
addisonian crisis
severe hypotension and vascular collapse
could result from abrupt d/c of steroids
76
consideration for discontinuation of steroids
taper! never stop abruptly - could result in addisonian crisis
77
cushing's syndrome
too many steroids! glucocorticoids, mineralocorticoids, sex hormones
78
cushing's: s/s due to too many glucocorticoids
```
growth arrest
thin extremities, lypolysis
increased risk of infection
hyperglycemia, hypoinsulinemia
psychosis to depression
moon face
truncal obesity/lipogenesis
buffalo hump (fat redistribution)
```
79
buffalo hump due to
glucocorticoid excess
| fat redistribution
80
moon face due to
glucocorticoid excess
| fat redistribution or fluid retention
81
cushing's: s/s due to too many sex hormones
oily skin/acne
women with male traits
poor libido
82
cushing's: s/s due to too many mineralocorticoids
```
high BP
CHF
weight gain
fluid volume excess
decreased serum K
```
83
cushing's: tx
adrenalectomy
quiet environment
avoid infection
pre-treatment diet:
increased K, protein, Ca
decreased Na
84
cushing's: pre-treatment diet
increased K (cushing's = decreased serum K)
increased protein (too many glucocorticoids = breakdown of fat and protein)
increased Ca (steroids decrease serum Ca through GI excretion)
decreased Na (retaining already(
85
how do steroids decrease serum Ca?
via GI excretion
86
cushing's: may appear in urine
glucose and ketones
protein can't come out of glomerulus unless it is damaged!
87
diabetes: type 1
little or no insulin; appears abruptly despite years of beta cell destruction
usually diagnosed in childhood (by age 30)
88
type 1 DM causes
auto-immune response (type 1A)
| idiopathic (type 1B)
89
first sign of type 1 DM typically
DKA
90
type 1 diabetes: pathophys
little to no insulin = glucose builds up in vascular space
blood = hypertonic, pulls fluid in
kidneys filter excess glucose and fluids
cells starving and start breaking down protein and fat for energy
breakdown of fat results in ketones
leads to metabolic acidosis (DKA)
91
type 1 diabetes: s/s
polyphagia
polyuria
polydipsia
92
do oral hypoglycemics work for type 1 dm clients?
NOPE - need insulin
93
type 2 diabetes: pathophys
insufficient insulin or bad insulin (usually just enough to prevent fat breakdown, therefore typically overweight)
can't keep up with the glucose load being taken in
not as abrupt as type 1, usually found by accident or client presents with other problems (ulcers, infections, etc)
evaluate for metabolic syndrome!
94
metabolic syndrome featuers
- insulin resistance
- waist circumference 40+ m, 35+ f
- increased triglycerides + decreased HDL
- increased BP
- CAD
95
type 2 diabetes: treatment
start with diet and exercise
then add oral agents
then insulin (especially in presence of non-compliance)
96
gestational diabetes
resembles type 2; mom needs 2-3x more insulin than normal during pregnancy
97
screen all moms when for gestational diabetes?
24 - 28 weeks gestation
1st prenatal visit, if risk factors present
98
gestational diabetes: complications for baby
increased birth weight
| hypoglycemia after birth
99
diabetes diet: majority of calories should come from x3
complex carbs
fats
protein (limit 10-20%)
100
why are diabetics prone to CAD?
sugar destroys vessels just like fat
101
diabetics + kidney
tend to have kidney disease
102
diabetes + high fiber
- keeps blood sugar steady (may have to decrease insulin)
- slows down glucose absorption in intestines, which eliminates sharp rise/fall in blood sugar
- sharp rise/fall of blood sugar = vascular damage
103
how do oral hypoglycemics work?
only for type 2. they stimulate the pancreas to make insulin (at least, for the NCLEX)
bottomline: all oral hypoglycemics work to decrease the amount of circulating glucose
104
average adult dose of insulin
0.4 - 1.0 units / kg / day
105
need more insulin if what are present in urine?
glucose, ketones
106
cloudy insulin
NPH
107
clear insulin
regular
also, Lantus (long-acting)
108
long-acting insulin
Lantus
109
what is the only type of insulin you can give IV?
regular
110
long-acting insulin peak
none!
111
rapid acting insulin peak
meal time
112
when insulin is at its peak, blood glucose...
is at its lowest
113
client should eat when insulin is at its
peak
114
how do you draw up regular and NPH insulin together
clear to cloudy
| regular then NPH
115
glycosylated hemoglobin HbA1c blood test
gives an average of what your blood sugar has been over the past 3 months
116
HbA1c goal for diabetics
4-6% or less
117
HbA1c level that is diagnostic for diabetes
6.5 - 7%
118
sq infusion pumps are only used for which type of insulin?
rapid acting insulin
119
coverage provided by sq insulin infusion pump
basal (continuous)
and
bolus (on-demand)
rapid-acting insulin!
120
diabetics: illness =
dka
121
s/s hypoglycemia
```
cold
clammy
headache
nervous
confusion
nause
increased HR
glucose less than 70mg/dL
```
122
hypoglycemic should eat what?
4-6 oz of simple sugar
| followed by complex carb + protein once BG is up
123
hypoglycemia prevention x4
- eat
- take insulin regularly
- know s/s
- check BG regularly
124
glucose absorption delayed in foods with lots of
FATS!
125
D50 W
for unconscious diabetic in hospital
requires large bore IV
126
injectable glucagon (GlucaGen)
for unconscious diabetic in hospital with no IV access
given IM
127
diabetic ketoacidosis pathophys
absent or inadequate insulin = BG sky high = poly(uria, dipsia, phagia) = fat breakdown (acidosis) = kussmaul respirations + more acidotic = LOC decreases
128
kussmaul respirations
diabetic client in dka trying to blow off CO2 to compensate for metabolic acidosis
129
diabetic client + polyuria =
think shock
130
IV insulin action
decreases glucose and K by driving them out of vascular space and into cell
131
dka tx
- find cause
- IV insulin
- hourly BG, K levels (d/t insulin), UOP
- EKG
132
IVF progression for DKA
NS (2 a/c IV if possible)
when BG ~300, switch to D5W
- prevents throwing client into hypoglycemia
133
hyperosmolar hyperglycemic nonketosis (HHNK)
aka
hyperglycemic hyperosmolar state (HHS)
looks like DKA but no acidosis
making just enough insulin so not breaking down fat
no fat breakdown = no ketones = no acidosis = no kussmaul respirations
134
type 1 diabetes can lead to
| type 2 diabetes can lead to
dka & HHNK (HHS)
135
diabetic neuropathy issues x4
sexual problems (irreversible so SCREEN)
foot/leg problems: pain, paresthesia, numbness
neurogenic bladder
gastroparesis
136
gastroparesis
stomach emptying is delayed due to decreased mesenteric perfusion s/t diabetes meaning increased risk for aspiration
137
neurogenic bladder
bladder does not empty properly
- may empty spontaneously (incontinence)
- may not empty at all (retention)
138
complications of diabetes x5
```
dka
HHNK (HHS)
vascular problems
neuropathy
infection
```
139
vascular problems in diabetes x2
macrovascular (ex: coronary arteries)
| microvascular (ex: kidneys)
