Endocrine and metabolic systems Flashcards
1
Q
Endocrine disorders
A
Pts with endocrine disorders may have decreased strength and energy to participate in therapy activities
2
Q
Endocrine system components
A
Endocrine glands are scattered throughout the body
- pituitary glands
- adrenal glads
- thyroid glands
- parathyroid glad
- pancreas
- gonads
- pineal gland
- thymus
3
Q
Endocrine system
A
Endocrine glands secrete hormones into blood which circulate to target cells in glands or tissues
- hormones: chemical messengers classified by action, source, or chemical structure (steroid and non-steroid)
- after acting on specific receptors/target cells, hormones are metabolized (excreted by kidneys) preventing excessive accumulation over time
- the release of hormones is negative feedback mechanism
- works with nervous systme to regulate metabolic activities
- the maintain well-controlled blood level of a substance a balance of several hormones is required (amount)
- the rate or timing of hormone secretions will affect overall hormone levels (when)
4
Q
Causes of hormonal imbalance
A
Adenomas (most common cause) may be
- secretory - excess hormone
- destructive to gland - hormonal deficit
- resistant target cells - create a hormone deficit
- congenital/infection/vascular defects
5
Q
Treatment
A
Depends on the cause of the problem
- hormone replacement therapy: may treat hormone deficits
- surgery/radiation: to treat adenomas causing excessive secretions
6
Q
Insulin
A
From pancreas
- controls amount of blood sugar
- controls cellular uptake of glucose and liver glycogensis
- assists in synthesis of proteins and fats
- deficient insulin results in abnormal carbohydrate/protein/fat metabolism d/t the impaired transport of glucose and amino acids into cells
- adversely affects many tissues/organs
7
Q
Diabetes mellitus
A
- blood sugar (glucose) levels are abnormally high
- the body does not produce enough insulin to meet its needs
- adversely affects many tissues and organs
8
Q
Type 1
A
Insulin dependent (more severe form)
- the body does not produce insulin (autoimmune)
- typically diagnosed in children and young adults
- typically occurs around age 12
- autoimmune: body destroys B cells from islets of langerhans
- pathogensis: sudden onset
9
Q
Type 2
A
Non-insulin dependent (more common)
- either thebody does not produce enough insulin or the cells ignore the insulin
- d/t decreased production of insulin and decreased cellular sensitivity
- a milder form of diabetes
- gradual onset in older adults
- majority of these adults are overweight
10
Q
Initial stage type 1
A
- decreased transport and use of glucose in many cells
- blood glucose levels rise (hyperglycemia)
- excess glucose spills into the urine as glucose level exceeds absorption capacity of the renal system
- increased urin production = loss of fluid from body tissues, leading to dehydration and thirst
- leach of nutrients entering cells stimulates appetite
11
Q
Later stage type 1
A
- lack of glucose in cells results in catabolism of fats and proteins, leading to excessive fatty acids and ketones in the blood
- some diabetic patients test their urine for ketones
- as dehydration develops, excretion of acids becomes more limited which may lead to a diabetic coma
- occur more frequently in persons with type 1 diabetes
12
Q
Signs of diabetes
A
- weight gain
- glycosuria
- polyuria
- weight loss
- fluid loss
- non-healing infections
- neuropathy
- gastroparesis
13
Q
Symptoms of diabetes
A
- frequent urination
- constant thirst
- increased hunger
- fatigue
- tingling toes
- blurred vision
- dry mouth
- N&V
14
Q
Diagnostic tests diabetes
A
- fasting blood glucose level: >126 mg/dL taken on > one occasion confirms diagnosis of diabetes
- glucose tolerance test
- glycosylated hemoglobin test (HA1c): monitors long term control of blood glucose levels (normal 5-6%)
- urine tests
15
Q
Treatment diabetes
A
- goal: 70-130 mg/DL * blood glucose levels before meals (normal range)
- 3 levels of control
1. Diet and exercise
2. Oral medication to increase insulin secretion or reduce insulin resistance
3. Insulin replacement
16
Q
Diet and exercise diabetes
A
- Diet: based on maintaining optimum body weight - control of blood glucose levels - important for both types of diabetes - meal planning
- Exercise benies: increases muscle glucose uptake without increasing insulin utilization - weight control - reduces stress - improves fitness
17
Q
Exercise prescription in DM
A
- low to moderate intensity 3-5x/wk including resistance and aerobic exercise is recommended
- at least 170 min/wk (40-80% vo2 max) increased cell sensitivity to glucose
- 180 min/wk including cycle ergo entry, treadmill, resistance exercises (leg press, seated abs, etc) improved vascular function
- ACSM: type 1: aerobic health and weight loss
18
Q
Oral meds diabetes
A
- anti-diabetic agents or oral hypoglycemic drugs are useful in the treatment of type 2 diabetes
- certain drugs may help to reduce insulin resistance
- metformin, glucophage
19
Q
Insulin replacement therapy
A
- injected subcutaneously
- biosynthetic form of insulin most frequently used
- continuous monitoring to prevent complications
- large fluctuation in blood glucose levels
- d/t variations in diet, physical activity level, the presence of infection, or alcohol use
- stable blood glucose levels reduce the risk
- complications may be acute or chronic
20
Q
Hypoglycemia
A
Insulin shock
- acute complication d/t excess of insulin, causes deficit of glucose in the blood
- type 1 diabetes pats are most often affected
- occurs suddenly following: strenuous exercise, dosage error, vomiting, skipping a meal after taking insulin
- lack of glucose quickly affects nervous system
21
Q
What to look for (diabetes)
A
- Impaired CNS: slurred speech - poor/lack of coordination - staggering gait
- Sympathetic system: increased pulse - pale/moist skin, anxiety, tremors
22
Q
Treatment of diabetes
A
- immediate administration of concentrated carbohydrate
- hypoglycemia can be life threatening if it is not treated promptly
23
Q
Diabetic ketoacidosis
A
Insufficient insulin
- high blood glucose levels and mobilization of lipids
- more common in type 1
- develops over a few days
- may be initiated by an infection or stress
24
Q
Diabetic ketoacidosis S&S
A
- rapid, deep respiration’s
- an acetone breath (sweet, fruity smell)
- thirst N&V
- decreased urine output related to dehydration, metabolic acidosis, and electrolyte imbalances
25
Q
Electrolyte imbalances
A
- includes imbalances of sodium, potassium, and chloride
- signs include primarily abdominal cramping, nausea and vomiting
- the individual may also experience lethargy and weakness
- treatment: administration of insulin and replacement of fluid/electrolytes
26
Q
Chronic complications
A
- degenerative changes occur in many tissues with both types of diabetes
- several of the more common chronic complications associated with diabetes
- vascular problems
- neuropathy
- infections
- cataracts
27
Q
Pic
A
Pic
28
Q
Neuropathy
A
- impaired sensation, numbness, tingling, weakness, and mm wasting
- symptoms dont follow typical dermatomes or myotome patterns (glove and stocking)
- results from ischemia and altered metabolic processes
- degenerative changes occur in both myelinated and unmyelinated nerve fibers
- increased risk of tissue trauma and infection
29
Q
Infections
A
- due to vascular impairment, infections tend to be more common in this pt population
- healing is delayed due to the insulin deficit - increased glucose levels support infection
30
Q
PT intervention
A
- Foot care: inspect feet, show wear, educate patient
- Balance training: proprioception, vestibular, and vision
- Cardiovascular exercise
- time of treatment will be important
31
Q
CV exercise
A
- Short term:
- increased glucose uptake into skeletal muscles
- lower level of glucose in the blood for 48 hrs after exercise - Long term:
- increased insulin receptors on target cells
- increased affinity of receptors for insulin
- decrease CV complications
32
Q
Pituitary hormones
A
- growth hormone (tissue growth)
- TSH: stimulates thyroid gland to produce T3 and T4 (tri-iodothyronine and thyroxine: protein synthesis and metabolic regulation)
- calcitonin: calcium and phosphorus balance
- need to determine the source of the imbalance in hormaones controlled by the pituitary
- benign adenomas are most common cause of pituitary disorder
33
Q
Pituitary mass
A
- enlarges and causes pressure on skull
- signs of pressure include increasing headaches, seizures, and drowsiness
- visual defects are also common
- tumor cells may secrete an excessive amount of a particular hormone
- the adenomas may destroy an area of pituitary cells, causing a deficit of a particular hormone
- tumors usually removed by surgery or radiation therapy
34
Q
Growth hormone
A
- dwarfism: may be caused by deficit of growth hormone
- gigantism: results from excess growth hormone prior to puberty and fusion of the epiphyses
- acromegaly: the effects of excess growth hormone secretion in the adult, usually by an adenoma
35
Q
Thyroid disorders
A
- disorders may result from pituitarty thyroid gland dysfunction
- goiter
- hyperthyroidism (grave’s disease)
- hypothyroidism
36
Q
Hyperthyroidism
A
- autoimmune condition in which the thyroid gland makes too much thyroid hormone
- antibodies: an overproduction of thyroid hormones (T3 and T4)
- the condition is often referred to as an overactive thyroid
- related to an autoimmune factor
37
Q
Graves
A
- hyperthyroidism
- autoimmune and genetic
- goiter, nervousness, heat intolerance, palpitations, diarrhea, decrease weight, eye protrusion
- Rx: meds, radioactive iodine, surgery
38
Q
Goiter
A
- enlargement of thyroid gland
- often visible on the anterior neck
- caused by various hypothyroid and hyperthyroid conditions
- can become very large, compressing the esophagus and interfering with swallowing, or it can cause pressure on the trachea
39
Q
Hypothyroidism
A
- hormone resistant or hormone deficit
- slows basal metabolic rate, bradycardia, decreased heat production, slowed neurological function
- Rx: meds (synthryoid)
- hashimotos’ disease
- thyroid inflammation
- decrease thyroid hormone
- fatigue, increased weight, cold sensitivity, difficulty with concentration, dry skin/hair/nails, muscle soreness, drowsiness
40
Q
Adrenal dysfunctions
A
Idiopathic or autoimmune
- Hypercortisolism: cushing’s, excessive cortisol. -etiology meds or adenoma. - S&S hyperglycemia, HTN
- Adrenal insufficiency: addison’s, decreased cortisol. - etiology autoimmune or idiopathic. - S&S hypoglycemia, low BP
