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NCLEX > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid gland
• hormones?
• what the hormones do?
• what do we need in our diet to make hormones?

A
  • produces 3 hormones - T3, T4, Calcitonin
  • Calcitonin ↓ serum calcium levels by taking calcium out of blood and push back into bones
  • Thyroid hormones give us ENERGY
  • Need dietary IODINE to make hormones
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2
Q

Hyperthyroid (Graves’ Disease) S/SX

A
  • nervous
  • irritable
  • attention span ↓
  • appetite ↑
  • weight ↓
  • sweaty/hot
  • exophthalmos (bulging eyes, irreversible)
  • GI FAST (diarrhea, hyperactive bowel sounds)
  • BP and Pulse ↑
  • Arrhythmia/palpitations (d/t ↑ workload in heart)
  • Thyroid size ENLARGES
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3
Q

Hyperthyroid (Graves’ Disease) Diagnosis
• serum?
• scan? what to discontinue prior? how long to wait to restart meds?

A

• ↑ Thyroxine (T4), ↓ TSH
• Thyroid scan
—Discontinue any iodine-containing meds 1 WEEK prior to thyroid scan and wait 6 WEEKS to restart meds
• Ultrasound/MRI/CT

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4
Q

Hyperthyroid (Graves’ Disease) treatment

Anti-thyroids

A

methimazole (Tapazole), propylthiouracil (PTU)
• stops thyroid from making thyroid hormones
• used pre-op to stun thyroid
• want client to be EUTHYROID

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5
Q

Hyperthyroid (Graves’ Disease) treatment
Iodine Compounds
• important teaching when taking it?

A

potassium iodine (SSKI and Lugol’s solution)
• DECREASE size and vascularity of gland
• ALL endocrine glands are very VASCULAR
• Give in milk or juice and use a straw because it STAINS the teeth

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6
Q 
Hyperthyroid (Graves' Disease) treatment
Beta Blockers (supportive therapy)
A 
propranolol (Inderal)
• ↓ myocardial contractility
• ↓ cardiac output
• ↓ HR, BP
• ↓ anxiety
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7
Q 
Hyperthyroid (Graves' Disease) treatment
Radioactive Iodine Therapy
• dose? 
• route? 
• action?
• radioactive precautions
A
  • one dose
  • PO (liquid or tablet form)
  • destroys thyroid cells
  • stay away from babies for 1 WEEK and Don’t KISS anyone for 1 WEEK
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8
Q

Do not give BETA BLOCKERS to ____ or ____

A 
asthmatics (cause bronchoconstriction);
or diabetics (mask s/sx of hypoglycemia)
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9
Q

Amiodarone (Cordarone) antiarrhythmic drug, contains high levels of ____ and may affect ____ function

A

iodine, thyroid

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10
Q

HYPERTHYROIDISM MEDICAL EMERGENCY

A

Thyroid storm (thyrotoxicosis and thyrotoxic crisis)
–Hyperthyroidism times 100!!!!
• ↑ temp, BP, HR
• could be rebound effect post-radioactive iodine

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11
Q 
Surgery: Thyroidectomy (partial/complete)
• Post-op PRIORITY?
• Assess?
• Trach set at bedside, why? 
• Teaching/Nursing interventions?
A

• Priority: REPORT feelings of PRESSURE; Check bleeding from front and back

• ASSESS recurrent laryngeal nerve damage → listen for HOARSENESS → could lead to VOCAL PARALYSIS;
when there’s paralysis of both cords = airway obstruction → NEED TRACH!!!

• Trach for:

  • swelling
  • laryngeal nerve damage (vocal cord paralysis)
  • Hypocalcemia – assess for parathyroid removal; s/sx (tight and rigid muscles); NOT SEDATED

• Teach how to support neck; Put personal items close to client; HOB elevated; (pre/post op) client needs MORE CALORIES

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12
Q

Hypothyroid S/SX

A

• no energy
• fatigue
• no expression
• speech slow, slurred
• weight ↑
• myxedema (facial puffiness)
• GI slow (constipation, hypoactive bowel sounds)
• Cold (bring blanket, wear warm clothes–NOT HEATING PAD)
• Amernorrhea
***may take care of totally immobile client

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13
Q

Hypothyroid Diagnosis

A

↓ Thyroxine (T4), ↑ TSH

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14
Q

Hypothyroid Treatment
• med? important thing to know about dosing when starting on these meds?
• do they take these meds forever?
• on empty or full stomach?
• hypothyroidism clients tend to have ____;
• what happens to their energy

A

• levothyroxine (Synthroid), liothyronine (Cytomel)
—start w/ LOW dose then gradually increase
• take on empty stomach
• tend to have CAD (worry about MI when meds are started) – d/t ↑LDL, chest pain/rhythm changes
• YES, take meds forever
• energy ↑

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15
Q

Parathyroid Problems
• secrete what hormone? function?
• too much of this hormone?
• too little of this hormone?

A
  • secrete PTH = pull calcium from bone and place it in blood = serum Calcium ↑
  • too much PTH = serum Calcium ↑
  • don’t have PTH = serum Calcium ↓
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16
Q

Hyperparathyroidism = ____ = ____
S/SX
Treatment (what surgery? what to monitor post-op?)

A

Hyperparathyroidism = HYPERCALCEMIA = HYPOPHOSPHATEMIA

S/SX
• ↑ PTH
• serum Calcium ↑
• serum Phosphate ↓
• SEDATED

Treatment
• Partial parathyroidectomy → take out 2 parathyroids = PTH secretion ↓
• monitor for HYPOCALCEMIA (tight, rigid muscles = tetany)

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17
Q

Hypoparathyroidism = ____ = ____
S/SX
Treatment (what meds? any precautions?)

A

Hypoparathyroidism = HYPOCALCEMIA = HYPERPHOSPHATEMIA

S/SX
• not enough PTH
• serum Calcium ↓
• serum Phosphate ↑
• NOT sedated

Treatment
• IV Calcium (give SLOWLY, put on cardiac monitor)
• Phosphorus binding drug (sevelamer, calcium acetate)

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18
Q

Adrenal glands
• function?
• 2 parts?

A
  • handle stress

* adrenal medulla and adrenal cortex

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19
Q

Adrenal Medulla Problem: Pheochromocytoma
• what is it?
• S/Sx?

A

• benign tumor = secrete epi and norepi in boluses

• S/SX
↑ BP, ↑ HR, Palpitations, Flushing/extremely diaphoretic, Headache

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20
Q

Adrenal Medulla Problem: Pheochromocytoma
Diagnosis
• called what?
• what’s done to screen for high levels of epi and norepi?
• throw away what? keep what?
• avoid what? must be ____?

A
  • Catecholamine levels: VMA (vanillylmandelic acid) test or Metanephrine (MN) test – 24 hour urine test
  • 24 hr urine specimen is done to screen for ↑ levels of epi and norepi (catecholamines)
  • w/ 24 hr urine – throw away FIRST voiding, keep LAST voiding
  • Avoid activites that ↑ epi and norepi (NO STRESS) – nor smoking/running, must be calm
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21
Q

Foods that alter the VMA and MN test

how long to avoid these?

A 
anything w/ vanilla
caffeine
Vitamin B
fruit juices
bananas

***avoid for several days to a week

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22
Q

Adrenal Medulla Problem: Pheochromocytoma

Treatment

A

Surgery to remove tumors

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23
Q

Adrenal Medulla Problem: Pheochromocytoma

ALERT

A

AVOID PALPATING ABDOMEN → cause sudden release of catecholamines (epi, norepi) = SEVERE HTN

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24
Q

Adrenal Cortex

• what steroids are secreted?

A
  • Glucocorticoids
  • Mineralocorticoids
  • Sex hormones
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25
Q

Glucocorticoids

• 4 functions?

A

1) Changes mood (depressed, psychotic, euphoric, insomnia

2) Alter defense mechanisms
- immunosuppressed; high risk for infection

3) Breakdown fats and proteins

4) Inhibit insulin
- Hyperglycemic; Do bg monitoring

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26
Q

Mineralocorticoids

A

Aldosterone

retain SODIUM and WATER, lose Potassium

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27
Q

Sex hormones
• too many?
• not enough?

A

too many
• hirsutism (Facial hair)
• acne
• irregular menstrual cycle

not enough
• ↓ axillary/pubic hair
• ↓ libido

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28
Q

↑ ACTH = ____ level

Too many steroids = Hyper_____

A

Cortisol

Hypercortisolism

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29
Q

Adrenal Cortex problems

A
  • not enough steroids
  • shock
  • hyperkalemia
  • hypoglycemia
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30
Q

Addison’s Disease

• Patho

A

adrenocortical insufficiency–not enough steroids

• not enough glucocorticoids, mineralocorticoids, sex hormones

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31
Q

Addison’s Disease

S/SX

A
  • extreme fatigue
  • N/V/D
  • anorexia/weight loss
  • hypotension (↓ BP)
  • confusion
  • ↓ Na, ↓ bg (hypoglycemia)
  • ↑ K
  • Hyperpigmentation-BRONZING color of skin and mucous membranes
  • white patchy area of depigmented skin (VITILIGO)
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32
Q 
Addison's Disease
Treatment
• combat what?
• diet?
• monitor what?
• losing \_\_\_\_ and \_\_\_\_= \_\_\_ BP = \_\_\_ weight = Fluid Volume \_\_\_
A
  • combat shock (losing sodium and water)
  • ↑ SODIUM, have processed fruit juice/broth
  • monitor I/O, daily weight
  • losing sodium and water = ↓ BP = LOSING weight = Fluid Volume DEFICIT
33
Q 
Addison's Disease
Medications
• Glucorticoid?
• Mineralocorticoid?
• MOST IMPORTANT thing to know about steroids?
A

• prednisolone (Prednisone)
twice a day— 2/3 AM dose, 1/3 PM dose

• fludrocortisone acetate – synthetic aldosterone
monitor daily weights and BP

• NEVER STOP TAKING STEROIDS ABRUPTLY!!!

34
Q

Addisonian Crisis
• what is it?
• occur with?

A
  • severe HYPOTENSION and vascular COLLAPSE

* occur w/ infections, emotional stress, physical exertion or stopping steroids ABRUPTLY

35
Q

Cushing’s S/SX

A 
TOO MANY STEROIDS!
1) too many GLUCOCORTICOIDS
• growth arrest
• thin extremities/skin (lipolysis)
• ↑ risk of infection
• psychosis, depression
• ↑ bg (hyperglycemia)
• moon-faced (fat redistribution/fluid retention)
• truncal obesity (fat redistribution; lipogenesis)
• buffalo hump (fat redistribution)

2) too many SEX HORMONES
• oily skin/acne
• women w/ male traits (hirsutism)

3) too many MINERALOCORTICOIDS
• ↑ Na
• ↑ BP
• CHF
• weight gain
• fluid volume EXCESS

** ↓ K, ↑ cortisol levels

36
Q 
Cushing's Treatment
• surgery?
• what environment?
• avoid what?
• diet pre-treatment?
A
  • Adrenalectomy (unilateral/bilateral)–if both removed = lifetime replacement
  • QUIET environment – away from stress
  • avoid INFECTION
  • ↑ K, ↓ Na, ↑ protein, ↑ Calcium
37
Q

Steroids decrease serum ____ by excreting it thruu GI tract

A

Calcium

38
Q

Long term steroid use cause what in bones?

A

brittle bones or osteoporosis

39
Q

What lab values of a client on long-term steroid therapy are expected to be altered in urine?

A

Glucose and Ketones

  • Protein only in kidney damage
  • RBC and uric acid (has nothing to do w/ steroids–indicates kidney stones)
40
Q 
Type 1 Diabetes
• insulin?
• diagnosed when?
• causes?
• 1st sign?
• onset?
• Classic 3 P's?
A
  • little or no insulin
  • usually dx in childhood
  • causes - Auto-immune response (Type 1A) or Idiopathic (Type 1B)
  • 1st sign = DKA
  • Appears ABRUPTLY
  • 3 Ps - Polyuria, Polydipsia, Polyphagia
41
Q

Type 1 Diabetes
Patho
• normal function of insulin?
• process of type 1 DM?

A
  • normal — insulin carry glucose out of blood and into the cell
  • no insulin → glucose builds up in blood → blood is hypertonic and pulls fluid into vascular space → kidneys filter excess glucose and fluids (polyuria, polydipsia) → cells are starving → cells break down protein and fat for energy (polyphagia) → breakdown fat → get ketones (acids) → client is in METABOLIC ACIDOSIS → Kussmaul RR (lungs compensating = blow off CO2 = ↑ RR)
42
Q

Type 1 Diabetes
• S/SX
• Treatment

A

S/SX
→ Polyuria (excessive UO = losing volume)
→ Polydipsia (drinking too much coz thirsty)
→ Polyphagia (eating a lot coz brain doesn’t have energy)

Treatment
• Insulin
**oral hypoglycemic agents DO NOT work for this client

43
Q

normal Blood Glucose (fasting)

A

70 - 110 mg/dL

44
Q

Type 2 Diabetes
Patho
• insulin?
• weight?
• can’t make enough ____ to keep up with ____?
• onset?
• usually found by accident when client keeps coming back to PHP for?
• clients w/ type 2 should be evaluated for what?

A
  • not enough insulin or insulin they have is NO GOOD
  • OVERWEIGHT
  • can’t make enough INSULIN to keep up w/ GLUCOSE load the client is taking in
  • not abrupt as type 1
  • wound that don’t heal, repeated vaginal infections
  • be evaluated for Metabolic Syndrome (Syndrome X)
45
Q

Type 2 Diabetes

• Treatment

A

diet, exercise, oral agents, sometimes insulin

46
Q

Features of Metabolic Syndrome

A

• Waist Circumference
> 40 in males, >35 in females

• Triglycerides
> 150 mg/dL

• HDL
<40 mg/dL in males
<50 mg/dL in females

• BP
>130/85

• FBS
>100 mg/dL

47
Q

Metabolic Syndrome know to ____ risk factor for developing Type 2 Diabetes and cardiovascular disease

A

INCREASE

48
Q 
Gestational Diabetes
• resembles \_\_\_\_
• Mom needs? when?
• if mom has risk factors for GD, screen when?
• screen all moms when?
• complications to baby?
A
  • resembles TYPE 2
  • Mom needs 2-3X MORE INSULIN; 2nd half of pregnancy b/c hormones of placenta has anti-insulin effect
  • if mom has risk factors for GD, screen 1ST PRENATAL VISIT
  • screen all moms at 24 - 48 WEEKS GESTATION
  • complications to baby: ↑ BIRTH WEIGHT, HYPOGLYCEMIA
49
Q

normal Newborn blood glucose

A

40 - 60 mg/dL

50
Q

Gestational Diabetes

when mom’s insulin dosage needs decreased, what to do?

A

DELIVER BABY d/t placental insufficiency!!

51
Q

Extremes in blood sugar = ____ ____

A

VASCULAR DAMAGE

52
Q

Diabetes: DIET
• Majority of calories should come from?
• why are we worried about carbohydrates?
• High fiber slows down what? causing what?

A
  • Complex carbohydrates (45% of diet) → fats (30-40%) → protein (15-20%)
  • sugar DESTROYS VESSELS just like fat
  • High fiber slows down GLUCOSE ABSORPTION in intestine = eliminate sharp rise/fall in bg
53
Q

Diabetes: EXERCISE
• wait until blood sugar ____ to begin exercise
• what should the client do pre-exercise to prevent hypoglycemia?
• exercise when blood sugar is at highest or lowest?
• exercise _____ time and amount daily

A
  • wait until bg NORMALIZES to begin exercise
  • EAT A SNACK to prevent hypoglycemia
  • exercise when bg is at HIGHEST
  • exercise SAME time and amount daily
54
Q

Diabetes: MEDICATIONS
Oral Anti-diabetics and Non-insulin injectables
• use for what type of Diabetes?
• route?
• action?
• most widely used med? uses? why is it a favorite? if it doesn’t work, what else is ordered? ALERT w/ this med?

A
  • used for Type 2
  • oral, subq
  • improve how body produces insulin; improve how body uses insulin and glucose

• metformin (Glucophage)

  • -used for wt control in type 2 sometimes type 1;
  • -favorite b/c ↓ glucose production and enhances how glucose enters cell;
  • -glargine (Lantus) is ordered if metformin is not controlling bg levels
  • -ALERT: discontinue metformin before surgery/radiologic procedures that involves CONTRAST DYE → resume after 48 hrs after if kidney function and creatinine levels are normal
55
Q

how is the Insulin dose determined?

average adult dose?

A
  • based on body weight

* adult: 0.4 - 1 units/kg/day

56
Q

Insulin dose is adjusted until ____ is normal and there’s no more glucose or ____ in urine

A

blood sugar, ketones

57
Q

INSULIN
Colors:
• Regular?
• NPH

A

Reg (clear)

NPH (cloudy)

58
Q

INSULIN

When drawing up Regular and NPH insulin together, draw up which one FIRST?

A

CLEAR one – Regular!

59
Q

INSULIN

All ____ are also clear but what?

A

All LONG-ACTING INSULINS are also clear but CANNOT be mixed w/ any other insulin or given IV

60
Q

INSULIN

Standard insulin given thru IV?

A
  • Regular

* also, rapid acting insulin

61
Q

INSULIN
• Plan is based on?
• Goal before meal blood glucose?

A
  • lifestyle, diet, activity

* 70 - 130 mg/dL

62
Q

INSULIN

Most common method of daily dosing insulin

A

basal-bolus dosing

63
Q

INSULIN
• total daily dose of insulin w/ Basal/Bolus method are combination of what insulins?
• when are they given?

A
  • long-acting and rapid-acting insulin
  • long-acting insulin — Once a day
  • rapid-acting insulin — given throughout the day before meals
64
Q

INSULIN

Are snacks required w/ Basal-Bolus method?

A

No but client must eat when dosing w/ rapid-acting insulin

65
Q

INSULIN

Clients should eat when insulin is at its?

A

PEAK

66
Q

INSULIN

When insulin is at its PEAK, the blood sugar is at its

A

LOWEST

67
Q

INSULIN

Always monitor a client on insulin for ____

A

Hypoglycemia!

68
Q

INSULIN: Client Teaching/Education
• what’s Glycosylate Hemoglobin (HbA1c) blood test?
• what happens to blood sugar when sick or stressed?
• Illness = ____
• Rotation of sites (Rotate ____ an area first) why? and then?

A
  • average of blood sugar over the past 3 - 4 MONTHS
  • goes UP
  • Illness = DKA
  • Rotate WITHIN an area first to avoid HYPERTROPHY then let HEAL for 2-3 weeks
69
Q

Insulin Infusion Pumps
• what type of insulin is used?
• purpose?

A

• only RAPID

• obtain better control
–receive continuous (basal) level from pump and on-demand (boluses) of additional insulin PRN w/ meals or ↑ blood sugar

70
Q

HbA1c
• diagnostic for diabetes?
• goal for people w/ diabetes?

A
  • dx: ≥ 6.5%

* GOAL: ≤ 7%

71
Q

Hypoglycemic/Hyperglycemic Episodes
• s/sx of hypoglycemia
• if hypoglycemic, what to do?
• snacks should be ____ grams of carbohydrates
• glucose absorption is delayed in foods w/ lots of ____
• what’s the 15-15-15 rule?
• once bg is up, what to do?
• if unconscious, treat this client as (hypo or hyper -glycemic)? what to use?

A 
• s/sx of hypoglycemia (cold and clammy, need some candy)
Tachycardia (↑HR)
Irritability
Restless
Excessive hunger
Diaphoresis

• if hypoglycemic, what to do?
—eat something (simple carb)

  • snacks: 15 GRAMS of carbohydrates
  • glucose absorption is delayed in foods w/ lots of FATS

• what’s the 15-15-15 rule?
—15 g carb → wait 15 mins and check bg → if not fixed, give another 15 g carb

• once bg is up, what to do?
—eat a complex car w/ protein (peanut butter cracker)

• if unconscious, treat this client as (hypo or hyper -glycemic)? what to use?

  • –hypoglycemic
  • –D50W (hard to push; need large bore IV)
  • –Injectable glucagon (GlucaGen) (when no IV access, given IM)
72
Q

Prevention for Hypoglycemic episodes

4 things

A
  1. Eat
  2. Take insulin regularly
  3. Know s/sx of hypoglycemia
  4. Check blood sugar
73
Q

Diabetic Ketoacidosis (DKA)
• what is it?
• Patho

A
  • anything that can increase bg → (ILLNESS, infection, skipping insulin) = DKA!
  • 1st sign of diabetes
  • same s/sx of type 1

Patho
• absent/inadequate insulin = ↑ bg 3 P’s = fat breakdown (acidosis) → Kussmaul RR = LOC ↓
• very little/no insulin and severe HYPERGLYCEMIA = METABOLIC ACIDOSIS

74
Q 
Diabetic Ketoacidosis (DKA)
Treatment
• find the \_\_\_\_
• hourly checks of ?
• IV insulin used for?
• ECG for?
• ABGs for?
• IVFs -- polyuria causes \_\_\_\_\_; what to do about it? how to prevent hypoglycemia?
• anticipate PHP's order of \_\_\_\_\_ at some point; why?
A

Treatment
• find the cause
• hourly blood sugar and potassium levels; hourly output (oliguria/anuria)
• IV insulin ↓ glucose and K (drive them out of vascular space and put into cell)
• ECG for lethal arrhythmias (insulin decreases K, may throw client into hypokalemia = arrhythmias)
• ABGs check for metabolic acidosis
• IVFs – polyuria causes SHOCK;
—start w/ NS → when bg is down to 250-300 mg/dL → switch to D5W to prevent hYPOGLYCEMIA
• anticipate PHP’s order of POTASSIUM at some point
(insulin decreases K, may throw client into hypokalemia)

75
Q

Hyperosmolar Hyperglycemic Nonketosis (HHNK) or Hyperglycemic Hyperosmolar State (HHS)
• like DKA, but no ____
• making just enough insulin so they’re not breaking down ____
• no ___ breakdown = no ___ = no ___
• will they have Kussmaul RR?

A
  • like DKA, but no ACIDOSIS
  • making just enough insulin so they’re not breaking down FAT
  • no FAT breakdown = no KETONES = no ACIDOSIS
  • DO NOT HAVE Kussmaul RR
76
Q

DIABETES Vascular Problems: Macrovascular and Microvascular
• will have what? because of?
• examples?

A

• Will develop POOR CIRCULATION everywhere;
d/t VESSEL DAMAGE (sugar irritates vessel lining → accumulation of sugar = ↓ size of vessel lumen = ↓ blood flow

• examples

  1. Diabetic retinopathy → blindness
  2. Nephropathy → client on dialysis
77
Q 
DIABETES Neuropathy
• sexual problems?
• foot/leg problems? diabetic foot care?
• neurogenic bladder? at risk for?
• gastroparesis? at risk for?
A

• sexual problems
impotence or ↓ sensation

• foot/leg problems - PAIN/PARESTHESIA/NUMBNESS
Diabetic Foot care
--inspect/look at feet on mirror every day
--no lotion between toes
--no harsh chemicals on feet
--cut toenails straight across
--dry completely between toes
--cotton/wool socks
--no open toed shoes or heels

• neurogenic bladder

  • -may empty sponataneously = “incontinence”
  • -may not empty at all = “retention”
  • -at risk for UTI

• gastroparesis

  • -delayed stomach emptying
    • ↑ risk for aspiration
78
Q

DIABETES

Increased risk for ____

A

INFECTION

NCLEX (24 decks)

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