endocrine Flashcards
thyroid gland
think iodine
produces T3 T4 an calcitonin
gives us energy
calcitonin decreases serum Ca by taking Ca out of the blood and pushing it back into the bone
hyperthyroid s/s
TOO MUCH ENERGY aka Graves' nervous irritable decreased attention span increased appetite decreased weight sweaty/hot exopthalomos (bulging eyes) increased GI increased BP and pulse arrhythmia/palpitations increased thyroid size
hyperthyroid diagnosis
increased T4 decreased TSH thyroid scan discontinue iodine containing meds 1 wk prior to scan and wait 6wks to restart meds ultrasound/MRI/CT
hyperthyroid treatment
Methimazole and Prophlthiouracil (PTU): stops thyroid from making hormones, used preop
potassium iodine: decrease size and vascularity of the gland, ALL endocrine glands are vascular (high risk for bleeding), give in milk/juice and use straw
beta blockers “lol”: decreases myocardial contractility, could decrease CO, decrease HR and BP, decrease anxiety
radioactive iodine therapy: 1 dose, PO, *** rule out pregnancy, destroys thyroid cells (hypothyroidism), stay away from babies for 1 wk and don’t kiss anyone for 1 week, watch for thyroid storm (thyrotoxicosis and thyrotoxic crisis– hyperthyroidism x100
thyroidectomy
post op priority (hemorrhage): report of feeling pressure and check for bleeding at incision site and behind the neck
hoarseness and weak voice (laryngeal nerve damage): can lead to vocal cord paralysis and require immediate trach
trach at bedsite r/t swelling, recurrent laryngeal nerve damage, hypocalcemia (assess for parathyroid removal and s/s of hypocalcemia)
support neck
personal items close to them
increase HOB
increased cals post op
hypothyroid s/s
no energy fatigue no expression slow and slurred speech increased weight decreased GI cold amenorrhea
hypothyroid diagnosis
T4 decreased
TSH increased
hypothyroid treatment
levothyroxine: take on empty stomach, worry about MI when starting (BP and HR increase), take forever
parathyroid gland
think calcium secrete PTH pulls Ca from bones and place in blood so serum Ca goes up increased PTH=increased serum Ca decreased PTH=decreased serum Ca
hyperparathyroidism s/s
aka hypercalcemia aka hypophosphatemia too much PTH serum Ca is high serum phosphorus is low look sedated
hyperparathyroidism treatment
partial parathyroidectomy
PTH secretion decreases
monitor for tight rigid muscles and tetany after (hypocalcemia)
hypoparathyroidism s/s
aka hypocalcemia aka hyperphosphatemia not enough PTH serum Ca low serum phosphorus high won't look sedated
hypoparathyroidism treatment
IV calcium
phosphorus binding drugs
adrenal glands
need to handle stress
adrenal medulla and adrenal cortex
adrenal medulla
epinephrine and norepinephrine
s/s: increase BP and HR, increase palpitations, flushing, sweaty, headache
diagnosis: catecholamine levels (VMA and MN), 24 hr urine specimen, avoid stress
treatment: surgery to remove tumor
*** avoid palpating the abdomen
adrenal cortex
glucocorticoids, mineralocorticoids, sex hormones
glucocorticoids
changes mood altered defense mechanisms (immunosuppressed) breakdown fat and proteins inhibit insulin (hyperglycemic, blood glucose monitoring)
mineralocorticoids
aldosterone
retain sodium and water
lose potassium
sex hormones
testosterone, estrogen, and progesterone
too many: hirsutism (facial hair for females), acne, irregular menstrual
not enough: decreased hair, decreased libido
increased ACTH = increased cortisol level
adrenal cortex issues
not enough steroids
shock
hyperkalemia
hypoglycemia
addison’s disease (not enough steroids)
adrenal cortex s/s
fatigue N/V/diarrhea anorexia/weight loss hypotension confusion decreased Na increased potassium hypoglycemia hyper pigmentation (bronze color skin) white patchy area of depigmented skin (vitiligo)
adrenal cortex treatment
combat shock (losing sodium and water) increase Na in diet (processed fruit/broth) i and o daily weight BP decreased losing weight FVD
adrenal cortex meds
prednisone
hydrocortisone
cortisone
corticosteroids given 2/3 in Am and 1/3 dose in PM
daily weights and BP
**don’t stop taking abruptly
cushing’s s/s
too many steroids
glucocorticoids growth arrest think skin infection hyperglycemia psychosis moon face truncal obesity buffalo hump
sex hormones
oily skin
woman have male traits
mineralocorticoids (aldosterone) high BP CHF weight gain FVE decreased serum K high cortisol levels
cushings treatment
adrenalectomy quiet environment avoid infection increase K decrease Na increase protein increase Ca
type 1 diabetes
little or no insulin
causes: autoimmune response or idiopathic
first sign: DKA
appears abrupt
polyuria, polydipsia, polyphagia
normal blood glucose w/o diabetes
70-99
normal blood glucose w/ diabetes
80-130
less than 140
type 1 patho
no insulin glucose builds up in the blood blood becomes hypertonic and pulls fluid into vascular space kidneys filter excess glucose and fluids cells are starving so protein breakdown and fat breakdown for energy get ketones when you break down fat then they are metabolic acidotic Kussmaul respirations
type 1 s/s
polyuria (think shock first)
polydipsia
polyphagia
hyperglycemia = 3 Ps
type 1 treatment
insulin
type 2 patho
not enough insulin or insulin they have is not good
overweight
found by accident or keep coming in saying wound won’t heal or repeated vaginal infections
type 2 treatment
diet and exercise
oral agents
may need insulin
type 2 s/s
high triglycerides
low hdl
high BP
high fasting blood glucose (greater than 100)
high waist circumference (over 40 for males, over 35 for females)
gestational diabetes
mom needs more insulin
if at risk then screen at first prenantal visit otherwise screen at 24-28 weeks
baby issues: hypoglycemia and high birth weight
gestational diabetes treatment
45% carbs
30-40% fats
15-20% protein
high fiber
eat prior to exercise
wait until blood sugar normalizes before exercising
exercise when sugar is at highest
exercise same time and amount daily
oral meds: Metformin (decreases glucose production and enhances how glucose enters the cell, don’t see hypoglycemia with this drug
Glargine
metformin alert
***** undergoing surgery or radiologic procedure that involves contrast dye should discontinue metformin and resume 48 hours after the procedure
how is insulin dose determined
weight
0.4-1units/kg/day
dose adjusted until glucose is normal or no ketones in the urine
insulin
regular = clear NPH = cloudy
**clear before cloudy
long acting insulins cannot be mixed with any other insulin or given IV
regular rapid acting insulin may be given IV
basal/bolus method: long acting and rapid acting insulin combined
goal is to keep the before meal glucose near 80-130
long acting given once a day
rapid acting insulin is given before meals in divided doses and it covers the food eaten at meals
snacks are not required with basal/bolus insulin but must eat with rapid acting insulin
eat when insulin is at its peak (blood sugar is at its lowest)
**always monitor a client on insulin for hypoglycemia
insulin teaching
HbA1c is the average for 3 months
blood sugar increases when sick or stressed
HbA1c
greater than 6.5 = diabetes
for those with diabetes the goal is less than 7
normal without diabetes = less than 5.7
insulin infusion pumps
alternative to daily insulin injections
only rapid acting insulin
better control: basal from the pump and boluses of insulin as needed with meals or if elevated blood sugar
regular insulin
standard insulin
can be given IV
rapid acting insulin
can be given SubQ insulin infusion pump that provides continuous (basal) dosing of rapid acting insulin and on demand (bolus) dosing
hypoglycemic/hyperglycemic episodes
hypoglycemic: eat/drink simple carb *** don’t choose food with a lot of fat, 15g of carbs, 15g of carbs then 15 mins recheck and 15g of carbs, eat complex carb once blood sugar is up (PB and crackers/protein)
D50W = hard to push
injectable glucagon when there is no IV access (IV, IM, subQ)
prevention: eat, take insulin regularly, know s/s, check glucose regularly
s/s of hypoglycemia
cold and clammy nervous confused shaky headache increased pulse hunger nausea
DKA patho
causes: illness, infection, skipping insulin
first sign of diabetes
have s/s of type 1
very little or no insulin
severe hyperglycemia which leads to fat breakdown and then metabolic acidosis
absent insulin, blood sugar increases, 3Ps, fat breakdown (acidosis), Kussmaul respirations (trying to blow off CO2 to compensate for metabolic acidosis, become more acidotic, LOC goes down
DKA treatment
find cause hourly blood sugar and K level IV insulin (insulin decreases blood sugar and K by driving out of vascular space into the cell) ECG hourly outputs ABGs (metabolic acidosis) IVFs (polyuria causes shock)-- start with NS then when blood sugar gets down to 250-300 switch to D5W to prevent hypoglycemia may add K to IV solution
HHNK or HHS
type 2 looks like DKA but no acidosis making just enough insulin so they are not breaking down body fat no fat breakdown = no ketones no ketones = no acidosis
DKA and HHS
caused by hyperglycemia and dehydration
vascular problems: macro vascular and micro vascular
poor circulation due to vessel damage (sugar decreases vessel lumen size and decreases blood flow)
diabetic retinopathy
nephropathy
neuropathy
sexual issues: impotence/decreased sensation
foot/leg issues: pain, paresthesia, numbness
diabetic foot care: cut nails straight across, dry between toes, wear well fitting shoes all the time, inspect feet everyday, no harsh chemicals
neurogenic bladder: doesn’t empty properly
can empty spontaneously (incontinence) or not at all (retention)
gastroparesis (stomach emptying is delayed so increase for aspiration
risk for infection
