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NCLEX ( fundamentals/MegSurg) > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

Pancreas ( anatomy, where is its location ? )

A
  • Pancreas is posterior to liver and behind the stomach
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2
Q

What is the pancreas function ?

A

Releases

  • Pancreatic juices
  • Enzymes
  • Insulin ( secreted by cells of the islets of Langerhans
  • Neutralizes stomach acid ( because it contains sodium bicarbonate)
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3
Q

What is a normal glucose level

A

70-110 mg/dL 60-110 mg/dL is acceptable

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4
Q

What are 3 major pancreatic enzymes ?

A
  • Lipase
  • Amylase
  • Trypsin
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5
Q

What is the pancreas endocrine function ?

A
  • Produces Insulin

- Produces glucagon

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6
Q

How does insulin work ?

A
  • Glucose can enter freely into the cells

- Helps muscle and tissue oxidation of glucose (combine)

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7
Q

How does glucagon work ?

A
  • Increases glyconeogenesis in liver
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8
Q

What is the exocrine function (digestive enzyme?)

A
  • Fat digestion
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9
Q

What does lipase do ? What is the normal level ?

A
  • Fat digestion

- 25-125 IU/dL or 60 - 160 somogyi units/dL

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10
Q

What does amylase do ? What is the normal level ?

A
  • Carbohydrate digestion

- 22-51 U/L

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11
Q

What does trypsin do ? What is the normal level ?

A
  • Protein digestion
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12
Q

Pancreatitis is it a priority medical condition ?

A
  • Hyperglycemia with or without diabetes

- Priority medical condition, it is emergent

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13
Q

Cullen’s sign (Pancreatitis)

A 
- Discoloration to around belly area 
    Blue- black 
    Greenish to brown or yellow 
- Abd pain 
- Indicates necrosis ( dead tissue)
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14
Q

Grey Turner’s Sign ( Pancreatitis )

A
  • Blue discoloration of the flanks ( lumbar area)

- Bruising and ecchymosis ( retroperitoneal hemorrhage)

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15
Q

What are complications in pancreatitis ?

A
  • Hypovolemia
  • Hyperglycemia
  • Tachycardia
  • Hypocalcemia
  • Shock
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16
Q

What is the diet for pancreatitis ?

A
  • Limited fat
  • Protein intake
  • High calorie
  • Bland
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17
Q

What are signs of having pancreatic tumors ?

A
  • Jaundice ( initial or advanced )
  • Anorexia/nausea/vomiting
  • Indigestion
  • Flatulence
  • Weight loss
  • Dark urine ( due to bile being reabsorbed)
  • Clay colored stool
  • Ascites and dull abd pain ( absent in early stage )
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18
Q

What is Whipple Surgery? what is It done for ?

A
  • Whipple’s surgery is done for cancer of the
    Head of the pancreas
    Duodenum ( first section of the small intestine )
    Jejunum ( Between duodenum and ileum )
    Gallbladder and common bile duct
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19
Q

How long does it take for the resected liver to regenerate ?

A

6- 8 weeks

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20
Q

What treatment is given post op to Whipple’s Surgery or Pancreatitis ? what are these also used in ?

A
  • Pancrease ( aids in digestion of food )
  • Panncreatin ( pan 2400 ), used to treat malabsorption
  • Pancrealipase (Creon)
  • Viokase
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21
Q

Gallbladder

A
  • Stores and concentrates bile to digest fats and oils
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22
Q

Cholecystitis (related to gallbladder)

A
  • Inflammation of gallbladder ( acute or chronic )

- Primary effects obese women

23
Q

What are the 5 Fs in cholecystitis ? (pneumonic)

A
  • Female
  • Fat
  • Fair
  • Forty
  • Fertile
24
Q

Murphy’s sign ( assessment for cholecystitis)

A
  • Unable to take a deep breath when fingers are pressed below hepatic margin
25
Q

Cholelithias

A
  • Presence of one or more calculi (gallstones) in the gallbladder
26
Q

Acute Cholecystitis

A
  • Sudden inflammation of he gallbladder and causes severe abd pain
27
Q

Chronic Cholecystitis

A
  • Long standing swelling and irritation of the gallbladder
28
Q

What diet should Pt. with gallbladder problems have ? and which medication is used for pain ?

A
  • Low fat
  • Morphine or Meperidine (Demerol)

If for pancreatitis answer Morphine
If for cholecsystitis or pancreatitis answer Demerol

29
Q

Cholecystography ( Gallbladder series ) Explain.
Prepping
Diet

A

Prepping Pt.

  • Explain
  • Check iodine allergies
  • If oral cholecystogram is to be done ( administer bilopaque or telepaque tablets as ordered
  • If IV cholecystogram is to be done the dye will be given just before exam in radiation department

Diet

  • Low fat meal in the evening before test
  • No further food after evening meal
  • Black coffee, tea, or water may be taken for breakfast
  • Give prescribed laxatives or enemas
30
Q

Post Cholecystography diet

A
  • Low fat
  • High protein
  • High calorie ( low calorie if overweight)
31
Q

Cholangiography

A
  • Endoscope study of biliary disorders to visualize bile ducts, presence of stones, strictures, or tumors or patency of common bile duct after surgery (Vit C after surgery)
32
Q

Percutaneous Transhepatic Cholangiography (PTC)
Explain procedure
(percutaneous meaning through the skin)

A
  • Dye injected through skin and abdominal wall into vessel or bile duct
  • X-ray liver and bile ducts
  • Thin needle is inserted through the skin below ribs and into the liver
  • Dye injected into liver and bile ducts and X-ray is taken
33
Q

What will you do if there is a blockage while doing a PTC ?

A
  • If there is a blockage, a thin flexible tube (stent) is left in liver to drain bile into the small intestines or collection bag outside the body
34
Q

Surgical cholangiography

A
  • Dye is inserted through a needle or catheter into common bile duct
35
Q

What must the nurse tell the Pt. Pre procedure

A
  • Explain procedure
  • CONSENT must be obtained
  • NPO night before the procedure
  • Administer laxative as prescribed
36
Q

Gallbladder Ultrasound

A
  • Determines the cause of upper abd pain ( RUQ)
  • Jaundice
  • Blockage of bile duct tubes leading from liver to gallbladder and duodenum and leakage of bile after surgery or an injury
  • No NPO/NO FULL BLADDER
37
Q

Cholecintigraphy or HIDA (Hydroxy Imino Diacetic Acid)

A
  • Study of gallbladder through imaging

- Indicates biliary obstruction ( gallbladder stone or cancer )

38
Q

HIDA Scan

A
  • Determines any blockage in the tubes (bile ducts) that lead from the liver to the gallbladder and small intestine ( duodenum )
  • Radio active tracer substance is injected into a vein in the arm
  • Liver removes the tracer from the bloodstream and adds it to the bile that normally flows through the bile ducts to the gallbladder
  • Gallbladder releases tracer into the beginning of the small intestine
  • Camera ( gamma ) takes pictures of the tracer as it moves through the liver, bile ducts, gallbladder, and small intestine
    If obstructed the radioactive tracer will not be able to reach the gallbladder coming from the liver
39
Q

Prep before procedure (HIDA SCAN)

A
  • Low fat diet night before

- NPO after midnight

40
Q

ERCP (Endoscopic Retrograde Cholangio Pancreatography )

A
  • x-ray ducts (tubes) that carry bile from liver to gallbladder and from gallbladder to small intestine using a fiberscope
  • Gallbladder cancer causes these ducts to narrow and block or slow flow of bile ( will cause jaundice )
41
Q

Where is the endoscope passed through ? (ERCP)

A
  • Passed through the mouth, esophagus, and stomach into the first part of the small intestine
  • Catheter is inserted through the endoscope into bile ducts
  • Dye injected through catheter into the ducts and x- ray taken
42
Q

What happens if there is an obstruction during an ERCP ? ( tumor blockage )

A
  • Fine tube is inserted into the duct to unblock it
  • Tube or stent may be left in place to keep the duct open
  • Tissue samples may also be taken
43
Q

Peritonoscopy

A
  • Direct visualization of peritoneum and liver (sometimes combined with liver biopsy, air sufflation may be used )
44
Q

Laparoscopic Cholecystectomy ( what is a helpful finding and how can you confirm diagnosis )

A
  • Murphy’s is useful in establishing diagnosis of cholecystitis
  • Confirmation of diagnosis depends on combination of physical finds ( palpation and ultrasound )
45
Q

Laparoscopic cholecystectomy ( Explain this procedure )

A
  • Carbon dioxide is insufflated into the abd during laparoscopic cholecystectomy
  • May irritate the diaphragm and cause referred shoulder pain (this complaint is common ) pain to right shoulder is common due to irritated nerve in diaphragm from the air insufflation of carbon dioxide
  • Pain in right shoulder lasts for 24-48 hours or may take several days
46
Q

Diabetes Mellitus (Type I )

A
  • Body’s pancreas doesn’t produce any insulin
  • Onset usually in childhood or adolescence but can happen at any age
  • Insulin dependent diabetes mellitus (IDDM) or Juvenile- onset diabetes
47
Q

In type one what is not being metabolized ? and what is being used for energy ?

A
  • Carbohydrates
  • Lipids
  • Protein

Fats are being metabolized for energy results in Ketonemia (Acidosis)

48
Q

Type II Diabetes

A
  • Onset is after the age of 30
  • Deficient in insulin or resistant ( body’s cells ignore insulin/body does not respond properly to insulin)
  • Can develop in elderly women population
49
Q

Risk factors of diabetes ( What can cause it ? )

A
  • Obesity
  • Metabolic syndrome
  • Gestational diabetes
  • Baby weighing more than 9 lbs
  • Low activity level
  • Hypertension
  • Cholesterolemia
  • Polycystic ovarian syndrome
50
Q

Frequency of blood sugar check for Type I Diabetes ?

A
  • 3x a day

- Before each meals

51
Q

Frequency of blood sugar check for Type II Diabetes ?

A
  • 2x a day

- Before breakfast and bedtime

52
Q

What are signs of Hyperglycemia ?

A
  • Increase in urination (polyuria)
  • Increase Thirst
  • Blurry vision
  • Extreme fatigue
  • Dry skin
  • Sleepy
  • Slow healing injury or infection
53
Q

Signs of Hypoglycemia

A
  • Shaky
  • Sweaty
  • Dizzy
  • Sudden behavior change
  • Hungry
  • Weak or tired
  • Headache
  • Nervous or upset
54
Q

Onset
Peak
Duration of insulin

A
  • Onset is how soon insulin starts to lower blood glucose after taking it
  • Peak is the time insulin is working the hardest to lower your blood glucose
  • Duration is how long the insulin lasts, length of time it keeps lowering your blood glucose

NCLEX ( fundamentals/MegSurg) (8 decks)

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