Endocrine Flashcards
thyroid gland produces what 3 hormones:
T3, T4, calcitonin
calcitonin decreased serum calcium levels how?
by taking calcium out of the blood and pushing it back into the bone
you need _____ to make thyroid hormones
dietary iodine
thyroid hormone gives us _____
energy
hyperthyroidism AKA
graves disease
sx of hyperthyroidism
nervous irritable decreased attention span increased appetite decreased weight sweaty/hot exopthalamos increased GI motility increased BP and Pulse
T4 and TSH level with hyperthyroidism
T4 increased
TSH decreased
the client must discontinue any iodine containing medications ____ week prior to the thyroid scan and must wait _____ weeks to restart medications
1 week
6 weeks
treatment for hyperthyroidism
anti-thyroid meds iodine BBs radioactive iodine therapy surgery
example of anti-thyroid meds
PTU and methimazole
anit-thyroid meds are used to ?
stun the thyroid pre-op
decrease the size and the vascularity of the gland
iodine compounds
why do you give iodine compounds through a straw?
stains teeth
decreases myocardial contractility
could decrease CO
decreases HR and BP
decreased anxiety
Beta Blocker
propranolol
do not give beta blockers to _____ or ____
diabetics or asthmatics
radioactive iodine therapy is given _____ to destroy the thyroid cells
PO
what is the expected outcome after radioactive iodine therapy
they will become hypothyroid
post-op priority for thyroidectomy
hemorrhage
post-op thyroidectomy we should tell our patients to report feelings of ______
pressure
where to check for bleeding post-op thyroidectomy
back of the neck
assess for recurrent laryngeal nerve damage by listening for ______ post-op thyroidectomy
hoarseness
if their parathyroid was removed would you monitor for hypo or hypercalcemia?
hypo
hypothyroid symptoms?
no energy fatigue no expression slowed speech weight gain slowed GI motility cold amenorrhhea
T4 and TSH levels with hypothyroid
decreased T4
increased TSH
treatment for hypothyroid
levothyroxine
people with hypothyroidism tend to have ____
CAD
the parathyroids secrete ____, which makes you pull calcium from the ___ and place it into the blood
PTH
bones
when PTH is secreted…serum calcium goes up or down?
up
if you have too much PTH in your body, the serum calcium level will be ___-
high
if you do not have any PTH in your body, the serum calcium level will be ___-
low
hyperparathyroidism is the same thing as which other 2 diseases?
hypercalcemia
hypophosphatemia
sx of hyperparathyroidism
too much PTH
serum Ca+ increased
serum phosphorus decreased
sedation!!!!!
treatment for hyperparathyroidism
partial parathyroidectomy
what do monitor for post op parathyroidectomy
sx of hypocalcemia (rigid muscles)
hypoparathyroidism is the same as which two other diseases?
hypocalcemia
hyperphosphatemia
sx of hypoparathyroidism
not enough PTH
serum Ca low
Serum Phosphorus high
NOT sedated!!!
tx of hypoparathyroidism
IV calcium
phosphorus binding drugs
you need your adrenal glands to handle _____
stress
the adrenal medulla secrete _____ and _____
epinephrine and norepinephrine
benign tumors that secrete epi and norepi in boluses
tend to be familial
pheochromocytoma
sx of adrenal medulla problems
increased BP and HR
heart palpitations
flushing
HA
how to diagnose an adrenal medulla problem?
vanillylmandelic acid test
foods that alter the vanillylmandelic acid test
anything with vanilla in it caffeine vitamin B fruit juices bananas
treatment for adrenal medulla problems
surgery to remove tumor
avoid palpating the abdomen of a client with a suspected pheochromocytoma as it may cause sudden release of ____ and severe _____
catecholamines and severe HTN
the adrenal cortex secretes which 3 steroids?
glucocorticoids
mineralocorticoids
sex hormones
4 functions of glucocorticoids
change your mood
alter defense mechanisms
breakdown fats and proteins
inhibit insulin
the most common minearlocorticoid secreted by the adrenal cortex
aldosterone
aldosterone makes you retain ___ and ____
Na and Water
aldosterone makes you lose ____
potassium (K+)
too much aldosterone = fluid volume ____
excess
too much aldosterone makes serum K+ go down or up?
down
not enough aldosterone is fluid volume ____
deficit
not enough aldosterone makes serum K+ go down or up?
up!
too many sex hormones
hirsutism
acne
irregular menstrual cycle
not enough sex hormones
decreased axillary/pubic hair
decreased libido
are made in the pituitary and they stimulate cortisol to be made
Adrenocorticotropin hormones (ACTH)
increased ACTH =
increased cortisol level
4 adrenal cortex problems
hyperkalemia
hypoglycemia
not enough steroids
shock
addison’s disease has a ______ insufficiency
adrenocortical
since you don’t have enough aldosterone with addison’s you will lose ___ and retain ____
lose Water and Na+
retain K+
serum K+ with addison’s
increased
sx of addison’s
extreme fatigue NVD anorexia/weight loss hypotension confusion bronze skin vitiligo
labs with addison’s
decreased Na
increased K+
hypoglycemia
treatment for addison’s disease
combat shock
increase Na+ in diet
drink juice/broth
I/O daily weight
addison’s is in a fluid volume ___-
deficit
meds for addisons
prednisolone
fludrocortisone
how is prednisolone administered?
take 2/3 in the morning
1/3 in the evening
fludrocortisone is ______
aldosterone
report a weight gain of >___ lbs per week
5
addisonian crisis can occur with?
infections
emotional stress
physical exertion
stopping steroids abruptly
addisonian crisis has severe _____ and ______ collapse
hypotension
vascular
cushion’s disease has to many _____
steroids
since the client with cushion’s has too much aldosterone, the serum K+ will be _____
low
if you did a 24 hour urine on the client with cushings the cortisol levels would be ____
increased
tx of cushing’s
adrenalectomy
quiet environment
diet prior to treatment of cushing’s dx
increased K+, protein, and calcium
decreased NA+
steroids decrease serum ____ by excreting it through the GI tract
calcium
urine from a life long steroid use patient
glucose
ketones
normal BG
70-110
in type 1 DM they have little or no ____
insulin
first sx of type 1 DM is usually _____
DKA
3Ps with type 1 DM
polyuria
polydipsia
polyphagia
why do type 1 DM have kussmaul respirations?
compensation for metabolic acidosis
with polyuria think ____ 1st!!!
shock!
treatment for type 1 DM
insulin only!!!
type 2 DM don’t have enough ___, or the ___ they gave is no good
insulin
type 2 DM is usually found by accident; or the client keeps coming back to the primary healthcare provider for things like?
wounds that won’t heal
repeated vaginal infections
individuals with type 2 DM should be evaluated for _____ syndrome
metabolic
features of metabolic syndrome
Waist circumference >40 triglycerides >150 HDL <50 BP > 130/85 FBS >100
treatment for type 2 DM
start with diet and exercise and then add oral agents
some need insulin
in gestational diabetes the mom needs ___-___ x more insulin than normal
2-3
if mom has r/f gestational diabetes, screen her at which visit?
1st
screen all moms for gestational diabetes at __-____ weeks gestation
24-48
complication for baby with gestational diabetes
increased birth weight
hypoglycemia
oral anti-diabetic agents improve 2 things:
how the body produces insulin
how the body uses insulin and glucose
all oral anti-diabetics work to decrease the amount of circulating _____
glucose
most widely used oral anti-diabetic
metformin
why is metformin a favorite anti-diabetic drug?
reduces glucose production and enhances how glucose enters the cell
patients after procedures can resume their dose ___ hrs after contrast dye is used
48
insulin dose is initially based on ____
body weight
the average adult dose of insulin is ___-___ units/kg/day
0.4-1
clear insulin
regular
cloudy insulin
NPH
only insulin that can be given IV
regular
the goal is to keep the before meal glucose near normal at ____-____
70-130
the most common method of daily dosing insulin is ___ ____ dosing
basal bolus
clients should eat when insulin is at its _____
peak
HbA1C gives an average blood sugar over the past ___-___ months
3-4
what happens to your BG when you are sick or stressed?
increased
HbA1C > ____% is diagnostic for diabetes
6.5%
for people with diabetes, the ideal goal for their HbA1c is <
7%
which type of insulin is used in infusion pumps
rapid acting
sx of hypoglycemia
cold clammy confused HA hungry increased HR
if hypoglycemic, what should client do?
eat/drink simple carb
snacks should be ____ g of carbohydrates
15
glucose absorption is delayed in foods with lots of ___
fat
once the blood sugar is up, what should they do?
eat complex carb/protein
you enter a diabetic client’s room and they are unconscious…treat this as if they are ____
hypoglycemic
if they are unconscious give ____ IVP through a large bore IV
D50W
for prevention of hypogemia teach our clients what 4 things?
eat
take insulin regularly
sx of hypoglycemia
check BG regularly
best choice for low BG
skim milk
apple juice
handful of raisins
in DKA you have very little or no insulin and severe ____ which leads to fat breakdown and ____ acidosis
hyperglycemia
metabolic
treatment of DKA
IV insulin
ECG
IVP
insulin decreases ____ and ___ by driving them out of the vascular space into the cell
BG and K+
fluid replacement with DKA starts with ___ until the BG reaches 250-300 then switch to ___ to prevent hypoglycemia
NS
D5W
HHNK look like DKA without _____
acidosis
with the HHNK patient have kussmaul respirations
NO
DKA and HHS are both hyperosmolar states caused by _____ and _____
hyperglycemia and dehydration
vascular damage in Diabetes causes
diabetic retinopathy
nephropathy
a condition in diabetics in which the stomach emptying is delayed so there is an increased r/f aspiration
gastroparesis
