Endocrine Flashcards
what 3 hormones does the thyroid gland produce
T3, T4 and calcitonin
what does calcitonin do
decreases serum calcium levles by taking calcium out of the blood and pushing it back into the bone
what is calcitonin typically used for treating
osteoporosis
what element do you need to make hormones? does our body make it?
iodine - no need it in diet
what do thyroid hormones give us
energy
when you see hyperthyroid what should you think? what are signs and symptoms
TOO MUCH ENERGY
- S & S associated with too much energy
- bulgy eyes like bucehmi
- sweaty and hot
is your thyroid too big or too small in hyperthyroidism
too big
how is hyperthyroidism diagnosed
T4 and TSH level
thyroid scan - ultrasound/MRI/CT
in hyper throidism is T4 high or low? what about TSH?
T4 high
TSH low
what must a client do prior to a thyroid scan
discontinue any iodine containing meds 1 week prior and wait 6 weeks to restart
what is treatment for hyperthyroidism
medications - anti thyroids -iodine compounds -beta blockers radioactive iodine theraapy sx - thyroidectomy (partial/complete)
what do anti thyroids do? are thye used for hyper or hypothyroidism
hyperthyroidism
stop thyroid from making homrones
used pre-op to stun the thyroid
what do iodine compounds do? are they used for hyper or hypo?
hyper
decrease the size and vascularity of the gland
give in milk or juice and use a straw - can stain teeth
why are beta blockers used in patients with thyroid problems? hper or hypo?
hyper
decrease contractility and co, decrease HR and BP decrease anxiety
what clients should not get a beta blocker
asthmatics or diabetics
what is radioactive iodine therapy? is it for hyper or hypothyroidism
hyperthyroidism
one dose given PO that destroys thyroid cells
if someone does radioactie iodine therapy what should be ruled out? what precautions need to be taken after
need to rule out pregnancy
follow radioactive precations - stay away from babies for 1 week and dont kiss anyone for one week
what is the biggest concern for people with hyperthyroidism especially with radioactive iodine therapy
thyroid storms
what is the biggest concern post thyroidectomy ? what are S & S of this concenr
hemorrhage - feelings of pressure in neck area, can see bleeding at incision site + behind neck
whyis it important to check for a hoarse voice following thyroidectomy sx
indicates laryngeal nerve damage - could lead to vocal cord paralysi
when ther is paralysis of vocal chords what does this mean
airway obstrcution - requries immediate trach
what needs to be at the bedside of a patient who has had neck surgery
trach set
what electrolyte imbalance are we worried about with thyroidectony
hypocalcemia - ptoential removal of parathyroids - look for non sedated and muscle rigidity and seizures
what care is important with hyperthyroid patients
eye care
what are the signs and symptoms of hypothyroidism
no energy symptoms
slow or slurred speech
cold
absence of menstration
hypothyroidism can be mistaken for what
depression
how is hypothyroid diagnosed
low T4
high TSH
what medication is taken with hypothyroidism
levothyroxine - must be taken on an empty stomach
what potential problem are we worried about with people starting levothyroxine
MI - they usually have CAD
does levothyroxine need to be taken forever
yes
what will happen to someones energy level when they start taking levo
increase
what do the parathyroids secrete
PTH
what is the role of PTH
pulls calcium from bone and puts it int he blood increases serum calcium
what will happen to the calcium elvel if you have too much parathromone in your body
increase
what are other names for hyperparathyroidism
hypercalcemia or hypophophatemia
what are the signs and symptoms of hyperparathyroidism
high serum calcium
low serum phosphorus
sedated
what is the treatement for hyperparathyroidism
partial parathyroidectomy - take out 2 of your parathyroids to decrease PTH secretion
what do you monitor for after parthyroidectomy
hypocalcemia - msucle rigidity tetany
what are other wods for hypopartathyroidisim
hypocalcemia - hyperphosphatemia
what are the signs and symptoms of hypopartahtyroidism
not enough PTH
serum calcium is low
serum phosphorus is high
muscle ridgiity
treatment for hypoparathyroidism
IV calcium
phosphorus binding drugs - drop phosphorus elevate calcium
what do we need our adrenal glands to handle
stress
what are the two parts of the adrenal gland
adrenal medulla
adrenal cortex
what does the adrenal medulla secrete
E and NE
what is a problem that can occur with the adrenal medualla
pheochromocytoma - benign tumor that secrete E and NE in boluses
tends to be familial - screen family
what are signs and symptoms of pheochromocytoma?
increased BP, HR palpitations flushing diaphorteitc HA
how is pheochromocytoma diagnosed
catecholamine levels checked - VMA and MN test - cant have anything with vanilla
24 hour urine test - check for increased E and NE
what is important to remember with 24 hour urine test
throw away first void, keep last
avoid activities that increase E and NE
treatment for pheochromocytoma
surgery to remove tumors
what does the adrenal cortex secrete
STEROIDS
glucocorticoids, mineralcorticoids, and sex hormones
what is the role of clucocorticoids
change your mood - extremes
alter defense mechanisms - immunosurppresed
breakdown fat and proteins
inhibit insulin
what is an example of minerocorticoids
aldosterone
what does aldosterone do
retain sodium and water; lose potassium
what is the problem with too much aldosterone
fluid overload
low potassium
what is the problem with not enough aldosterone
dehydration
increased serum potassium
name 3 examples of sex hormones
testosterone, estroge and progesterone
what is the problem with too many sex hormones
hisutism (excessive hair), acne, irregular menstral cycle
what is the problem with not enough sex hormones
decreased axiallary and pubic hair
decreased libido
what should you think of with too much steroids
hypercortisolism –> too many steroids too much stress
what are 3 adrenal cortex problems
not enough steroids
shock
hyperkalemia
hypogylycemia
what disease is associated with too little steroids
addisons (aldosterone is a steroid!)
what are the signs and symptoms of addisons
not enough aldosterone so losing water and sodiumand retaining potassium
extreme fatigue, nasuea, vomiting, anorexia, hypotension, confusion, hypogylcemia, hyperpigmentation, white patchy area of skin
what is the treatment for Addisons
combat shock add sodium in diet processed fruti juice and broth has a lot of sodium in it I & O daily weight
What is the pharmacological treatment for addisons
Steroids
prednisolone
Fludrocortisone - aldosterone
How is Prednisolone given?
BID
2/3 in morning and 1/3 at night (this is how the body usually excretes steroids
What needs to be monitored when giving steroids
BP and weight
what is an addisonian crisis
severe hypotension and vascular collapse
can occur with infectons, emoional stress, physical exertion or stopping sterids abruptly
What is Cushing’s disease
too many steroids
(glucocorticoids, mineralcorticoids, sex hormones
These S & S indicate what steroid is in excess:
growth arrest
thin skin
increased risk of infetion
hyperglycemia
psychosis to depression
moon faced (fat redistribution or fluid retention)
truncal obesity (fat redistribution or fluid retention)
buffalo hump (fat redistribution)
glucorticoids
What steroid is in excess when one has oily skin/acne or when women have male traits
sex hormones
what steroid is in excess with high BP, CHF, weight gain, and fluid volume excess
mineral corticoids (aldosterone)
In a client with cushing’s what will their potassium be
too much aldosterone so they will have low potassium
if you did a 24 hour urine on a patient with cushing’s what would their cortisol level be
high
what is the treatment for cushing’s disease
adrenalectomy (unilateral or bilateral) *if both are removed require lifetime replacement
quiet enviroment
avoid infection
what diet is necessary for a cushing’s client prior to treatment
high potassium
low sodium
high protein
high calcium
What do steroids do with calcium
decrease it by excreting it through the GI tract
If a nurse is monitoring lab values of a client on long-term steroid therapy which values would the nurse expect to be altered in the urine
glucose and ketones - steroids made blood sugar go up body fat broken down so have ketones
What are normal BG levels
3.9-6.1
What nmight be the first sign of DM type 1
DKA
What is the patho of DM type 1
insulin required to move glucose into cells –> no insulin stays in the blood –> blood beocmes hypertonic and pulls fluid –> glucose lost in urine –> cells are starving for glucose so break down fat and proteins –> ketones made (acidic) –> client goes into metabolic acidosis
what type of breathing do diabetics do with high glucose
kussmal respirations to rid CO2
What is th patho for NIDDM
don’t have enough insulin or are insulin resistant –> can’t make enough insulin to keep up with glucose they are taking in
what should Type 2 diabetics be evaluated for
metabolic syndrome
How much more insulin does a mom need in gestational diabetes
2-3X more insuilin than normal
If a mom has risk factors for gestational diabetes when should they be screened
first prenatal vvisit
when are all moms screened for gestational diabetes
24-28 weeks
what complications to baby occur with gestational diabetes
hypoglycemia and increased birth weight
What kind of diet should a diabetic hav
most calories should come from complex carbs and then fats, then proteins
why are we worried about carbohydrates in a diabetics diet
sugar destroys vessels just like fat
high fiber slows down what in diabetics
glucose absoprtion in the intestines
what should diabetics remember with exercise
wait for blood sugar to normalize to begin exercies
eat prior to exercise
exercise when blood sugar is at its highest
exercise same time and amount daily
how do oral antibiotics work
improves how the body produces insulin and how the body uses insulin and glucose
ALL work to decrease amount of circulating glucose
Diabetics undergoing surgery or any radiological procedure that invovles contrast dye should temporarily discontinue what medication? why?
metformin
continue after 48 hours if kindey function returns to normal and creatinine is normal
what is insulin dose based on
weight
what is the standard insulin given IV
regular
what is the most common daily dosing of insulin
basal/bolus
what two insulins are used in basal/bolus dosing
long acting and rapid acting
are snacks requrired with basal/bolus dosing
no
what should you think about diabeitcs when they are ill
DKA
with insulin injections what should you remember
rotate one area firt
what type of insulin is used in an insulin pump
rapid
what are the signs and symptoms of hypoglycemia
cold and clammy confused nervous, nauseated shaky, tachy HA, hungry
what should a client do if they are hypoglycemic
eat or drink a simple carb - snacks should be 15 g of carbohydrates
what delays glucose absorption
fat
whats the rule for hypoglycemics
15-15-15 wait 15 mins if below give 15g sugar wait 15
once a diabetics blood sugar is back up what should they do eat
a complex carb and protein
If you enter a diabetic client’s room and they are unconscious do you treat them as they are hypo or hyper
hypo - its more dangerous
what is the treatment for DKA
find the cause hourly blood sugar and K levels IV insuin ECG hourly outputs ABG's --> metabolic acidosis IVFs --> polyruia causes shock; start with NS then switch to D5W to preven hypogylcemia
Hyperosmolar hyperglycemic nonketois (HHNK) or Hyperglycemic Hyperosmolar State (HHS) differs from DKA how
no acidosis –> making just enough insulin so they are not breaking down body fat so no ketones
what can happen with the GI tract regarding diabetics
stomach emptying delayed so risk for aspiration due to neuropathy
