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endocrine Flashcards

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1
Q

thyroid gland

A

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

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2
Q

hyperthyroid s/s

A 
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
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3
Q

hyperthyroid diagnosis

A 
increased T4
decreased TSH
thyroid scan
discontinue iodine containing meds 1 wk prior to scan and wait 6wks to restart meds
ultrasound/MRI/CT
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4
Q

hyperthyroid treatment

A

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

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5
Q

thyroidectomy

A

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

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6
Q

hypothyroid s/s

A 
no energy
fatigue
no expression
slow and slurred speech
increased weight
decreased GI
cold
amenorrhea
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7
Q

hypothyroid diagnosis

A

T4 decreased

TSH increased

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8
Q

hypothyroid treatment

A

levothyroxine: take on empty stomach, worry about MI when starting (BP and HR increase), take forever

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9
Q

parathyroid gland

A 
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
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10
Q

hyperparathyroidism s/s

A 
aka hypercalcemia
aka hypophosphatemia
too much PTH
serum Ca is high
serum phosphorus is low
look sedated
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11
Q

hyperparathyroidism treatment

A

partial parathyroidectomy
PTH secretion decreases
monitor for tight rigid muscles and tetany after (hypocalcemia)

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12
Q

hypoparathyroidism s/s

A 
aka hypocalcemia
aka hyperphosphatemia 
not enough PTH
serum Ca low 
serum phosphorus high
won't look sedated
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13
Q

hypoparathyroidism treatment

A

IV calcium

phosphorus binding drugs

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14
Q

adrenal glands

A

need to handle stress

adrenal medulla and adrenal cortex

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15
Q

adrenal medulla

A

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

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16
Q

adrenal cortex

A

glucocorticoids, mineralocorticoids, sex hormones

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17
Q

glucocorticoids

A 
changes mood 
altered defense mechanisms (immunosuppressed)
breakdown fat and proteins
inhibit insulin (hyperglycemic, blood glucose monitoring)
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18
Q

mineralocorticoids

A

aldosterone
retain sodium and water
lose potassium

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19
Q

sex hormones

A

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

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20
Q

adrenal cortex issues

A

not enough steroids
shock
hyperkalemia
hypoglycemia

addison’s disease (not enough steroids)

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21
Q

adrenal cortex s/s

A 
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)
22
Q

adrenal cortex treatment

A 
combat shock (losing sodium and water)
increase Na in diet (processed fruit/broth)
i and o 
daily weight
BP decreased
losing weight
FVD
23
Q

adrenal cortex meds

A

prednisone
hydrocortisone
cortisone

corticosteroids given 2/3 in Am and 1/3 dose in PM

daily weights and BP

**don’t stop taking abruptly

24
Q

cushing’s s/s

A

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
25
Q

cushings treatment

A 
adrenalectomy
quiet environment
avoid infection
increase K 
decrease Na
increase protein
increase Ca
26
Q

type 1 diabetes

A

little or no insulin
causes: autoimmune response or idiopathic

first sign: DKA
appears abrupt

polyuria, polydipsia, polyphagia

27
Q

normal blood glucose w/o diabetes

A

70-99

28
Q

normal blood glucose w/ diabetes

A

80-130

less than 140

29
Q

type 1 patho

A 
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
30
Q

type 1 s/s

A

polyuria (think shock first)
polydipsia
polyphagia

hyperglycemia = 3 Ps

31
Q

type 1 treatment

A

insulin

32
Q

type 2 patho

A

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

33
Q

type 2 treatment

A

diet and exercise
oral agents
may need insulin

34
Q

type 2 s/s

A

high triglycerides
low hdl
high BP
high fasting blood glucose (greater than 100)
high waist circumference (over 40 for males, over 35 for females)

35
Q

gestational diabetes

A

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

36
Q

gestational diabetes treatment

A

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

37
Q

metformin alert

A

***** undergoing surgery or radiologic procedure that involves contrast dye should discontinue metformin and resume 48 hours after the procedure

38
Q

how is insulin dose determined

A

weight
0.4-1units/kg/day
dose adjusted until glucose is normal or no ketones in the urine

39
Q

insulin

A 
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

40
Q

insulin teaching

A

HbA1c is the average for 3 months

blood sugar increases when sick or stressed

41
Q

HbA1c

A

greater than 6.5 = diabetes
for those with diabetes the goal is less than 7
normal without diabetes = less than 5.7

42
Q

insulin infusion pumps

A

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

43
Q

regular insulin

A

standard insulin

can be given IV

44
Q

rapid acting insulin

A

can be given SubQ insulin infusion pump that provides continuous (basal) dosing of rapid acting insulin and on demand (bolus) dosing

45
Q

hypoglycemic/hyperglycemic episodes

A

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

46
Q

s/s of hypoglycemia

A 
cold and clammy
nervous
confused
shaky
headache
increased pulse
hunger
nausea
47
Q

DKA patho

A

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

48
Q

DKA treatment

A 
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
49
Q

HHNK or HHS

A 
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
50
Q

DKA and HHS

A

caused by hyperglycemia and dehydration

51
Q

vascular problems: macro vascular and micro vascular

A

poor circulation due to vessel damage (sugar decreases vessel lumen size and decreases blood flow)
diabetic retinopathy
nephropathy

52
Q

neuropathy

A

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

NCLEX (17 decks)

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