Endocrine and GI Flashcards
Difference between type I and type 2 diabetes
Type 1 pancreas makes 0 insulin
Former name for type 1 and type 2 diabetes
juvenile and adult onset
IGT
Impaired Glucose tolerance Test
2 hrs after receive glucose if value is 140-199 then indicates pre-diabetes. >200 diabetic
IFG
Impaired Fasting glucose test
100-126 = risk for diabetes
best one, no calories for 8 hours.
Must be done twice to diagnose diabetes.
↓ ________and _________ __________ may be enough to keep you from needing meds.
stress
lifestyle changes
80-90% of Type 2 diabetes patins are_______
overweight
Brittle diabetes
unstable, can happen in 1 or 2, fluctuates a lot, hard to control.
Type 2 Diabetes etiology
not enough insulin, or insulin resistance
Math formula for insulin your body should make
0.6 units per kg body weight per 24 hrs
Diabetes 2 can also be caused by
Inappropriate glucose made by the liver (hepatitis, alcoholism)
or, fluctuation of hormone adipokines
Secondary diabetes
can be corrected if correct problem, could be:
Cushing’s, hyperthyroidism, pancreatitis
Type 2 Diabetes clinical manifestations
- wounds that don’t heal
- weight loss
- thirst (polydipsia) and hunger (polyphagia)
- Kussmal respirations - rapid and deep
Ha1C
glycosylated hemoglobin test
determines pts blood sugar over last 90-120 days.
Should be ↓ 7% - if higher patient bs has not been kept in the normal range.
3 Therapies for DM 2
Drug
Nutritional
Exercise
ADA
American Diabetes Association
recommends overall healthy eating plan
Teach: ↓ alcohol
Best way to evaluate compliance for DM2 patients
HA1C test
1st action for implementing exercise plan for DM2 patients
ask them what they like to do
then teach to exercise after a meal
key to success especially in insulin resistance
Always assess ____________ _______________ before teaching
patient perception
7 Signs that BS is ↓↑
- confusion
- irritability - restless, moody
- diaphoresis
- tremors
- hunger
- pale
- coma
* check BS immediately
Treatment for very low BS (Hyperglycemia)
- 4-6 oz of fruit juice (if patient is alert enough) check BS again in 15 minutes
- glucagon - subQ or IM. **30 minutes after give, rebound, more severe. So give complex carb like crackers and cheese.
- IV dextrose - usually 50% dextrose. Central line would be best but can use 30cc syringe to push . S/B on crash cart. Push as quickly as possible.
Elavil
used for nerve pain (neuropathy) in Diabetic patients
Interventions to avoid amputation for diabetics
- do not soak feet
- do not use a heating pad
- do not use OTC callous remover
- wear good shoes, leather, no sandals, flat
Most common form of thyroid disease
Graves
* it is autoimmune, can palpate and feel enlarged thyroid
Clinical Manifestations of Hyperthyroidism (Graves) disease.
↑ appetite diarrhea rapid heart beat ↑ CO ↑ BP loose hair fatigue insomnia exophtalamos - bulging eyes
Hyperthyroidism (Graves) can go into life threatening crisis. What is this called, its indications, and intervention?
thyrotoxosis
highly elevated temp
HR is probably ↑
Call DR. right away (teach pt.)
Three treatment options for Hyperparathyroidism
- Drugs - most common is PTU propulthiouracil, Tapazole
both drugs can take 4-8 weeks to see good results. Some relief in 1-2. Cant take forever, will stop in 6-15 months. COMPLICATION: common for patient to go into hypothyroidism - RAI - radioactive iodine therapy
- Subtotal thyroidectomy
T Interventions for Hyperparathyroidism (Graves)
↓ sodium diet
elevate head of bed to reduce swelling
Sometimes need to tape eyes closed at night
Primary Hypothyroidism
r/t destruction of thyroid tissue or defective hormone synthesis
Secondary Hypothyroidism
R/T pituitary disease with ↓ TSH
In Hypothyroidism TSH will be
↑ if thyroid problem
↓ if pituitary or hypothalamus problem
Clinical manifestations of Hypothyroidism
everything slows down ↓ Co ↓ HR
overweight anemia
short of breath fatigue
constipation hair loss
myxedema - mask look to face, hard to have facial expressions
eyes can swell (similar to Grave’s)
mental status change: slows down functioning, can slip into coma, worst thing to take- sedatives - can slip into coma overnight
If patient with hypothyroidism is new on Synthroid…
monitor heart - bad sign if have heart problems. Assess apical, not radial pulse.
____ test used most often to adjust thyroid meds
T4
Intervention for hypothyroidism - disturbed thought process
Give handouts for mental status change, goofy comes and goes.
T Euthyroid state
normal range
ACTH
adrenocorticotropic hormone in anterior pituatary
too much and have Cushing’s
Cushing is….
↑ adrenal usually caused by excess of corticosteroids, particularly glucocorticoids
Cushing Syndrome Clinical Manifestations
skinny arms and legs and big trunk protein wasting - muscle atrophy moon face purple red streaks on belly hyperglycemia osteoporosis protein wasting - muscle atrophy insomnia mood disturbances - depressed or psychotic
T Diagnostic Study for Cushing
- 24 Hour Urine for free cortisol. levels of 80-120 mgs. indicates Cushing’s Syndrome)
- Low dose dextramethasone suppression test used for borderline results of 24 Hour UrineTest
Drug used for Cushing’s
Mitotane - suppresses the adrenals
T Disturbed Self Esteem brought on by Cushing’s
Validate - say, “I see how upset you are but good news, after your sx, all these symptoms will go away and you will look beautiful again.”
Addison’s is the common name for….
Low Adrenal Output… opposite of Cushing’s
T classic Addison Symptom
Skin hyper pigmentation in areas exposed to sun, pressure joints like knuckles, skin creases, especially palmar creases
S/S of Addisons
skin hyper pigmentation orthostatic hypotension hyponatremia hyperkalemia (steroids regulate electrolytes) nausea, vomiting, diarrhea fever, confusion
T Addisonian Crisis
Life threatening, everything goes bad fast and then death. Teach pt when symptoms worsen to take more of their steroids. Can also happen when abruptly stop meds of even just miss a dose. (TEACH)
Can also happen if under stress of any kind: sick, surgery physical, mental emotional. Need to take more steroids.
Also - can happen if vomiting and diarrhea, does not need to be excessive to send into Crisis.
ACTH Stimulation Test
if stimulate and levels fail to rise then have Addison’s
Drugs for Addison’s
Hydrocortison (prednisone)
Give in am, helps circadian rhythm, able to get out of bed and have energy to get going.
Parathyroid Problems =
messed up electrolytes, especially Calcium and Phosphates.
*Calcium and phosphates have an inverse relationship (usually)
T Hyperparathyroidism
Calcium and phosphate levels will be messed up. sully Calcium will be ↑. Our job to bring calcium ↓
Normal levels for Ca and Phos
Ca 9-1 mg/dL Phos 2.8-4.5 mg/dL
Treatment for Hyperparathyroidism
Surgery - watch closely after sx for hypocalcemia (early sign - tingling of lips) Intervention (have breath into paper bag - Resets Calcium. ↑ ambulation ↑ liquids 3-4 L per day phosphorus supplements Calcium supplements (depends on patient)
Primary Obesity
Secondary Obesity
Primary = too much in, not enough energy our Secondary = genetics, metabolic, tumor in hypothalamus
BMI ranges
Underweight: under 18.5
Normal: 18-24.9
Overweight: 25-29.9
Obese: more than or equal to 30
Morbid obese: equal to or more than 40
Obese Complications
HF(heart problems in general) hypertension especially, need to do good heart assessments
arthritis (joint problems)
respiratory problems
diabetes
To help obese patients must get their__________
perception - they need to know they do not need to stay this way. 98% can be solved.
Meridia
appetite suppressant, off the market
↑ BP and HR
palpitations, constipation, death
Orlistat or Xenical
Nutritional absorption blocking drugs
Problems: vit def especially K, not enough can bleed to death
Early sign: petunia, severe diarrhea, bloating
Teach before bariatric SX
- strict adherence to prescribed diet
- recognize s/s of complications of sx
- importance of long term follow up
- dumping syndrome
Rouxen Y
most popular gastric bypass surgery
Requirement for bariatric sx
BMI 40 or more tried and failed to lose weight one or more obesity related complications 18 years of age or older obese for over 5 years
After bariatric sx teach
- pureed diet 1-2 weeks
- Once on normal foods must be ↓ in carb and fluids (with meals) or will have dumping syndrome
- ↑ protein ↓ fiber and roughage diet
- small frequent meals - 6
Common complications to bariatric sx
anemia
vit def.
diarrhea
stomach ulcers
↑ chance of GERD
obesity
smoking
hiatel hernia
1 and #2 Cause or factor for GERD is
- Incompetent LES (lower esophageal sphincter) becomes weak
2. ↓ in gastric motility, slow emptying stomach
Foods that make LES weaker
caffine, peppermint
Drugs that make LES weaker
anticholinergics, like Atrovan
Reglan
drug used for GERD
tells stomach to empty
*must take before meals, if pt does not receive before meal, it is a medical error
GERD symptoms
- heartburn (pyrosis)
- dyspepsia - stomach pain
- hypersalivation
GERD complications
- Esophogitis - inflammation
- Barrett’s Esophogitis- lining scarred and rigid, could lead to perforation
- Aspiration - lead to pneumonia
Gerd Interventions
↓caffine, peppermint, high fat foods like PB dont lie down after eat drink fluids between meals, not with avoid milk products, especially at night stop eating 2 hrs before bed reduce weight avoid tomatoes and citrus fruits
Drugs for GERD
- Antacids - weakest: 1-3 hrs after meals, not with meds except NSAIDS
- H2R Blocker (histamine 2 receptor) - Pepsid, Zantac, Tagamet. TTTTTT occasional confusion with elderly.
- PPI’s: Proton Pump Inhibitors Prilosec, Nexium, Aciphex
- Acid Protective: coats - Carafate (sucralfate), 30 min b4 meals
- Prokinetic Drugs: Reglan (metoclopramide) ↑ motility, give 3 min b4 meals
Take PPI’s for long time increases chances of getting
Hpylori
GERD Nursing Mgt
Have them: stop smoking avoid alcohol, caffeine, acidic foods reduce stress reduce weight, if appropriate small frequent meals put bed on blocks helps
2 types of peptic ulcers
gastric and duodenal
80-90% cause of ulcers
Hpylori
2 other causes of ulcers
NSAIDS (erodes protective coating and allows ulcers to develop)
steroids
Western countries have more________than __________ulcers.
duodenal (80% of all PUD)
gastric
3 Major complications of Peptic Ulcer
- hemorrhage
- perforation (most lethal)
- gastric outlet obstruction
Perforation symptoms
HAPPENS QUICKLY, ONLY FEW HOURS UNTIL DEATH OCCURS.
- sudden onset, severe abdominal pain
- stomach becomes rigid like a board
- bowel sounds absent
- shallow, rapid respirations
- nausea, vomiting
1st Intervention for Perforation
Vital signs, will go into hypovolemic shock quickly.
RR↑ HR↑ BP↓
Alert everyone of emergency situation
Peritonitis - will occur 6-8 hrs w/perforation. Be ready to start antibiotics before or after the SX.
Peptic Ulcer Disease Collaborative Care
Rest the GI tract - foods that do not irritate GI track during acute phase
Find pts trigger foods and eliminate
eliminate smoking and alcohol
manage stress
long term follow up dare
Drugs for PUD
same as GERD, except on antibiotics- usually amoxicillin and clarithromycin
antibiotics and PPI’s will wipe out in 10 days - PPI used is Prilosec (omprezole)
Also, anticholinergics will decrease gastric motility
Foods that Irritate PUD
caffeine
spicy foods
alcohol
high fiber - chew food really well, don’t inhale
IBS (Irritable bowel syndrome) is diagnosed by
differential diagnosis,: rule out everything else like food allergies, cancer IBD, and Crohns
Advise pt, won’t be quick, validate their impatience
Most important need: nurse provide support, will ↓ symptoms
IBS Nutritional Therapy
Avoid gas producing foods
IBS Drugs
Antispasmotics like: anticholinergics - sip and suck for dry mouth
antidiarrheals #1 is Imodium (slows motility) #2 is Lamotil _ RX- has narcotic in it (addictive)
Antidepressants - to decrease nerve pain
IBD
Inflammatory bowel disease, much worse than IBS
chronic recurrant, inflammatory, autoimmune
Enough inflammtion to break down tissues and cause ulcers and necrosis
2 Types IBD
Crohn’s and Ulcerative Colitis
Ulcerative colitis location
colon and rectum
Crohn’s location
anywhere in GI from esophagus to rectum
Clinical Manifestations of IBD (Crohn’s and Ulcerative Colitis)
diarrhea - often bloody fatigue abdomen pain fever (due to infection that causes necrosis) weight loss malobsorption (from chronic diarrhea) electrolyte imbalances and vit def
IBD Complications
hemorhage and perforation
embolisms, arthritis
liver disease
train wreck
IBD Collaberative Care
- prevent weight loss
- low residue, low fiber diet
- avoid high fat foods
- lots of vitamins and supplements
*IN hosp will be NPO to rest bowel
IBD Easier to diagnose than IBS due to
lesions
Most common IBD Drug
Azulfadine - categoru: aminosalicylate (anti-inflammatory)
Drug Alert: causes yellow orange discoloration of skin, tears, sweat, urine. Avoid exposure to sunlight.
3rd most common cancer in US
Colorectal Cancer
Colorectal cancer preventable by
colonoscopy, start getting at age 50 to find and remove polyps
Symptoms of Colorectal cancer
Hematochezia - bright red blood from rectum
Melena - thick black tarry stools
CEA blood test
Carcino Embroyonic antigen - will have antibodies in blood that says there is cancer in the colon
Difference between acute and chronic hepatitis
chronic : symptoms 1-4 months
acute: more than 4 mod.
No treatment for acute, chronic has some meds
Symptoms of Hepatitis
malaise anorexia fatigue nausea abdominal discomfort Low Grade Fever
Best treatment for hepatitis
rest
most recover from acute with no complications - goes dormant.
Still contagious for rest of life, some will get cirrhosis
Hepatitis - starts with a vowel, comes from the bowel
A and E - oral/fecal exposure
BCD - Blood Exposure
What must you do if get needle stick?
- go to ER to test for antibodies and halt pts checked too.
- With in 24 hrs get HBIG (Hep Immunoglobulin)
- If not vaccinated, start immediately
Cirrhosis
chronic, progressive disease of the liver
Cirrhosis Clinical Manifestations
Early: anorexia, flatulence, dyspepsia,
nausea, vomiting, fever, fatigue, weight loss
Late: Jaundice, every endocrine and blood disorder you can think of, neuropathy
Cirrhosis complications
Esophagela nd gastric varices- -Perforations - most life threatening, bleed like a volcano.
Peripheral edema and ascites - abdomen, ankles, arms due to low protein albumin in blood
Hepatic Encephalopathy - type of dementia - high levels of ammonia in blood. Watch levels.
Common test for hepatic Encephalopathy
hold arms out, if have hands will flap up and down
Drugs given for high ammonia in Cirrhosis pts
lactulose - caused diarrhea and moves ammonia out
Cirrhosis patients have risk for __________ ___________
skin breakdown
Interventions: air mattress, turn every 2 hours, ↑ protein
