Endocrine Flashcards
What does calcitonin do?
Opposite of PTH
- decreases serum calcium levels by taking calcium out of the blood and putting it back into the bone
(for osteoporosis)
Graves disease…is it HYPER- or HYPOthyroid
Hyperthyroid
With hyperthyroidism, would thyroxine (T4) and TSH be increased or decreased?
Thyroxine (T4) –> increased
TSH –> decreased
Client must d/c any iodine containing meds ___ week prior to a thyroid scan and must wait ___ weeks to restart meds.
1 week
6 weeks
Anti-thyroid meds are used to ___ the thyroid; stops the thyroid from making ___.
Name them…
stun
hormones
methimazole and propylthiouracil (PTU)
Iodine compound med ___ the size and vacularity of the thyroid.
What should we remember about this administration?
Name it…
decreases
Give in milk or juice with a straw…stains teeth
potassium iodine
Beta blockers such as ___ (___) provide supportive therapy. What 4 things do they do?
propanolol (Inderal)
1) decreases myocardial contractility
2) could decrease CO
3) decreases HR, BP
4) decreases anxiety
Who should NOT receive beta blockers? Why not?
Asthmatics - cause bronchial constriction
Diabetics - masks symptoms of hypoglycemia
Myxedema is longterm ___. What are 4 visible signs of this?
hypothyroidsim
1) general puffiness
2) facial edema
3) dull, mask-like expression
4) tongue protusion
With hypothyroidism, what will happen to thyroxine (T4)
and TSH?
Thyroxine (T4) will decrease
TSH will increase
What do we remember with levothyroxine admin?
- take on EMPTY stomach
- start with low dose and work up
Adrenals help you handle ___
stress
Adrenal medulla secretes…
Adrenal cortex secretes…
Medulla –> epi and norepi
Cortex –> glucocorticoids, mineralocorticoids, sex hormones
What tests are used to measure catacholamine levels?
What foods should be avoided prior to these tests?
VMA (vanillylmandelic acid) test
Metanephrine (MN) test
(Avoid several days to a week prior: vanilla foods, caffeine, vit B, fruit juices, banana)
What is an example of a glucocorticoid?
What does it do?
Cortisol
- changes mood
- alters defense mechanisms/immunosuppression
- Breakdown fats and protein
- Inhibit insulin (serum glucose can go up)
Example of mineralocorticoid;
What does it do?
Aldosterone (remember this??)
- makes you retain Na and water
- makes you lose K (b/c Na and K have inverse r’ship)
Too much aldosterone:
- Fluid volume ___
- Serum K ___
Not enough aldosterone
- Fluid volume ___
- Serum K ___
Too much
- fluid volume EXCESS
- K DECREASED
Not enough
- fluid volume DEFICIT
- K INCREASED
Too many steroids = ___
hypercortisolism
Addison’s disease is caused by (too much or not enough) steroids?
Not enough
It’s an adrenocortical insufficiency
Addison’s disease leads to hyperkalemia…why?
K and Na are inversely related
If not enough aldosterone secreted, leads to low Na and water, leads to high K
What 2 things occur during an Addisonian crisis?
- severe hypotension
- vascular collapse
Cushing’s Disease is the opposite of Addison’s, so ___ ___ steroids
too many
Pts must have 3 of these characteristics to be labeled “metabolic syndrome”
Waist circumference:
- Men >40 in
- Women >35 in
Triglycerides: >150
HDL:
- Men <40
- Women <50
BP: >130/85
FBS: >100
Pregnant women need ___-___ x more insulin than normal. Why?
2 - 3
placenta has an anti-insulin-like effect
If not, there’s a possibility that the placenta is not working correctly and there could be a problem with the baby.
Diet recommendations for DM (Type 1 and 2)
Majority of calories from complex carbs (45%)... then fats (30-40%)... lastly protein (15-20%)
Extreme blood sugar = vascular damage –> BAD
High fiber slows down glucose absorption in the intestines, eliminating the sharp rise/fall in blood sugar
Diabetics should wait until blood sugar ___ before exercising.
Pt should ___ pre-exercise to prevent hypoglycemia.
Exercise when blood sugar is at its ___.
Exercise same ___ and ___ daily.
normalizes
eat
highest
time and amount
What is the most widely used anti-diabetic med? How does it work?
metformin (Glucophage)
- Reduces glucose production
- Enhances how glucose enters the cell
- Does not stimulate the release of more insulin, so no hypogycemic response –> good!
Pts on metformin should d/c before surgery or procedure where dye is used. Can resume ___ hours after if ___ ___ is normal. Why?
48 hours
kidney function
The dye and metformin compete for kidney excretion. Metformin wins so the dye will stay in the blood…BAD!
What is the avg adult dose of insulin?
0.4 - 1 unit/kg/day
What color insulin?
Regular ___
NPH ___
Draw up in what order?
Regular –> Clear
NPH –> Cloudy
Put in your air, then draw up CLEAR before CLOUDY
Why is NPH so cloudy?
It is is packed with particles (time release)
The most common method of daily dosing insulin is ___/___ dosing.
basal / bolus
The total daily dose of insulin with the basal / bolus method is a combination of a ___ insulin and a ___ insulin.
long-acting
rapid-acting
Long-acting insulin is given ___ x day.
When does it peak?
Name a long-acting insulin:
1
Doesn’t peak
glargine / Lantus
The rapid-acting insulin is given ___ the day ___ meals in ___ doses. It covers the food eaten at meals.
Name a rapid-acting insulin:
throughout
before
divided
aspart / Novolog (the log rolls down the hill rapidly)
Always have food right there when giving ___ insulin!!!
rapid-acting
Clients should eat when insulin is at its ___; this is when blood sugar is at its ___.
Always monitor a client on insulin for ___.
peak
lowest
hypoglycemia
HbA1c goal for diabetics is ___%
= 7%
Insulin admin: rotate ___ an area first
within
What type of insulin is used in an insulin pump?
What type of dosing does the pump provide?
Only RAPID-acting
Both continuous (BASAL) dosing of RAPID-acting insulin and on-demand (BOLUS) dosing.
(Remember “Basal / Bolus”)
8 signs of hypoglycemia
1) cold and clammy
2) confusion
3) shaky
4) HA
5) nervous
6) tachycardia
7) nausea
8) hunger
If hypoglycemic, the client should consume ___ ___.
Snacks should be ___ g of carbs.
Glucose absorption is ___ in foods with lots of ___.
simple carbs
15g
delayed, fat
What is the 15 - 15 - 15 rule?
15g of simple carbs
Wait 15 min…check blood sugar again
Give 15g of more simple carbs if still low
What is the first line of defense for someone in a hypoglycemic crisis?
If no IV access, can use ___.
D50W
glucagon (IM…or sometimes subq)
What to remember with D50W admin?
Very hard to push b/c so thick
Choose a large bore IV if possible
Treatment for DKA
Hourly blood sugar & K checks ECG (watch for K-induced arrythmias) Hourly output ABGs Isotonic fluids to raise BP (b/c polyuria)
What to remember with DKA IVF regimen:
- Start with NS (isotonic) and IV regular insulin
- When blood sugar gets down to 250-300, switch to D5W to prevent hypoglycemia
- Anticipate MD adding K to IV solution at some point
Diabetics can develop poor ___ everywhere due to vessel damage from elevated ___ over time.
(Sugar ___ the vessel lining; accumulation of sugar will ___ the size of the vessel lumen, therefore ___ blood flow.)
circulation sugar irritates decrease decreasing
What are 2 VASCULAR complications that can occur over time with poorly managed DM?
diabetic retinopathy
nephropathy (dialysis needed)
What are 4 NEUROPATHIC complications that can occur over time with poorly managed DM? (Why?)
- Sexual problems: impotence/decreased sensation
- Foot/leg problems: pain/paresthesia/numbness
- Neurogenic bladder: does not empty properly
- Gastroparesis: delayed stomach emptying, risk for aspiration
Teach pt about foot care:
- cut toenails straight across
- dry in between toes
- always wear shoes
- wear comfy shoes
- inspect feet daily
- avoid harsh chemicals
