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
Glucocorticoids | • 4 functions?
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
26
Mineralocorticoids
Aldosterone | retain SODIUM and WATER, lose Potassium
27
Sex hormones • too many? • not enough?
too many • hirsutism (Facial hair) • acne • irregular menstrual cycle not enough • ↓ axillary/pubic hair • ↓ libido
28
↑ ACTH = ____ level | Too many steroids = Hyper_____
Cortisol | Hypercortisolism
29
Adrenal Cortex problems
* not enough steroids * shock * hyperkalemia * hypoglycemia
30
Addison's Disease | • Patho
adrenocortical insufficiency--not enough steroids | • not enough glucocorticoids, mineralocorticoids, sex hormones
31
Addison's Disease | S/SX
* 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)
32
``` Addison's Disease Treatment • combat what? • diet? • monitor what? • losing ____ and ____= ___ BP = ___ weight = Fluid Volume ___ ```
* 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
``` Addison's Disease Medications • Glucorticoid? • Mineralocorticoid? • MOST IMPORTANT thing to know about steroids? ```
• 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
Addisonian Crisis • what is it? • occur with?
* severe HYPOTENSION and vascular COLLAPSE | * occur w/ infections, emotional stress, physical exertion or stopping steroids ABRUPTLY
35
Cushing's S/SX
``` 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
``` Cushing's Treatment • surgery? • what environment? • avoid what? • diet pre-treatment? ```
* Adrenalectomy (unilateral/bilateral)--if both removed = lifetime replacement * QUIET environment -- away from stress * avoid INFECTION * ↑ K, ↓ Na, ↑ protein, ↑ Calcium
37
Steroids decrease serum ____ by excreting it thruu GI tract
Calcium
38
Long term steroid use cause what in bones?
brittle bones or osteoporosis
39
What lab values of a client on long-term steroid therapy are expected to be altered in urine?
Glucose and Ketones - Protein only in kidney damage - RBC and uric acid (has nothing to do w/ steroids--indicates kidney stones)
40
``` Type 1 Diabetes • insulin? • diagnosed when? • causes? • 1st sign? • onset? • Classic 3 P's? ```
* 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
Type 1 Diabetes Patho • normal function of insulin? • process of type 1 DM?
* 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
Type 1 Diabetes • S/SX • Treatment
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
normal Blood Glucose (fasting)
70 - 110 mg/dL
44
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?
* 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
Type 2 Diabetes | • Treatment
diet, exercise, oral agents, sometimes insulin
46
Features of Metabolic Syndrome
• 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
Metabolic Syndrome know to ____ risk factor for developing Type 2 Diabetes and cardiovascular disease
INCREASE
48
``` Gestational Diabetes • resembles ____ • Mom needs? when? • if mom has risk factors for GD, screen when? • screen all moms when? • complications to baby? ```
* 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
normal Newborn blood glucose
40 - 60 mg/dL
50
Gestational Diabetes | when mom's insulin dosage needs decreased, what to do?
DELIVER BABY d/t placental insufficiency!!
51
Extremes in blood sugar = ____ ____
VASCULAR DAMAGE
52
Diabetes: DIET • Majority of calories should come from? • why are we worried about carbohydrates? • High fiber slows down what? causing what?
* 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
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
* 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
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?
* 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
how is the Insulin dose determined? | average adult dose?
* based on body weight | * adult: 0.4 - 1 units/kg/day
56
Insulin dose is adjusted until ____ is normal and there's no more glucose or ____ in urine
blood sugar, ketones
57
INSULIN Colors: • Regular? • NPH
Reg (clear) | NPH (cloudy)
58
INSULIN | When drawing up Regular and NPH insulin together, draw up which one FIRST?
CLEAR one -- Regular!
59
INSULIN | All ____ are also clear but what?
All LONG-ACTING INSULINS are also clear but CANNOT be mixed w/ any other insulin or given IV
60
INSULIN | Standard insulin given thru IV?
* Regular | * also, rapid acting insulin
61
INSULIN • Plan is based on? • Goal before meal blood glucose?
* lifestyle, diet, activity | * 70 - 130 mg/dL
62
INSULIN | Most common method of daily dosing insulin
basal-bolus dosing
63
INSULIN • total daily dose of insulin w/ Basal/Bolus method are combination of what insulins? • when are they given?
* long-acting and rapid-acting insulin * long-acting insulin --- Once a day * rapid-acting insulin --- given throughout the day before meals
64
INSULIN | Are snacks required w/ Basal-Bolus method?
No but client must eat when dosing w/ rapid-acting insulin
65
INSULIN | Clients should eat when insulin is at its?
PEAK
66
INSULIN | When insulin is at its PEAK, the blood sugar is at its
LOWEST
67
INSULIN | Always monitor a client on insulin for ____
Hypoglycemia!
68
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?
* 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
Insulin Infusion Pumps • what type of insulin is used? • purpose?
• 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
HbA1c • diagnostic for diabetes? • goal for people w/ diabetes?
* dx: ≥ 6.5% | * GOAL: ≤ 7%
71
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?
``` • 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
Prevention for Hypoglycemic episodes | 4 things
1. Eat 2. Take insulin regularly 3. Know s/sx of hypoglycemia 4. Check blood sugar
73
Diabetic Ketoacidosis (DKA) • what is it? • Patho
* 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
``` 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? ```
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
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?
* 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
DIABETES Vascular Problems: Macrovascular and Microvascular • will have what? because of? • examples?
• 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
``` DIABETES Neuropathy • sexual problems? • foot/leg problems? diabetic foot care? • neurogenic bladder? at risk for? • gastroparesis? at risk for? ```
• 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
DIABETES | Increased risk for ____
INFECTION