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MedSurg 1 > Endocrine/Diabetes > Flashcards

Endocrine/Diabetes Flashcards

1
Q

glands and hormones excreted- pancreas, thyroid, parathyroid, pituitary, adrenal

A

pancreas- insulin, Glucagon
thyroid gland- T3 and T4
parathyroid- PTH
Pituitary- ADH, oxytocin
Adrenal cortex- cortisol, aldosterone, glucacorticoids (steroids)
adrenal medulla- norepinephrine, epinephrine

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2
Q

T3-t4

A

thyroid- regulates metab activity
t3- rapid metab changes
t4- steady metab (ex. thyroid horm replacement)

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3
Q

metabolic activity controllers

A

t3- triiodothyronine
t4- thyroxine- main source table salt
range 0.4-4

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4
Q

TSH

A

thyroid-stimulating hormone
inc if t3/t4 low (hypothyroidism)
dec if t3/t4 high (hyperthyroidism)

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5
Q

hypothyroidism- def and types

A 
common type- Hashimoto's thyroiditis
caused by disord affecting anter pit or hypothal
primary hypothyroidism- thyroid
secondary- ant pit
tertiary- hypothal
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6
Q

hypothyroidism s/s

A

tired, dry skin, extreme fatigue, constipation, impaired physical mobility, dec rr

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7
Q

hypothyroidism acute illness s/s- myxedmea

A 
myxedmea- slows all metab processes
low temp, hr, rr, dec LOC,
dec Na
inc TSH
low t3/t4
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8
Q

hypothyroidism acute illness- myxedema considerations

A

cardiac complications

dec respir r bc inc cdo2 accum, secondary to hypoventilation (requires lower dose meds)

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9
Q

hypothyroidism acute illness- myxedema treatment

A

passive rewarming (if inc too fast have circ collapse due to excessive vasodil)
oral thyroid horm replacement (levothyroxine)(TITRATE, inc dose too fast inc O2 demand)
can inc o2 demand (report SOB and chest pain)
take 30/60 min before eating

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10
Q

hypothyroidism acute illness-management

A

diagnosis confirmed through lab (t3-t4, TSH)
oral replacement meds
montior abg’s (hypoxia, metabolic acidosis)
assess all vitals- dis affects entire body

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11
Q

hyperthyroidism- def

A

inc metab, autoimmune
inc t3/4, dec TSH
“Graves disease”

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12
Q

hyperthyroidism- diagnosed

A

radioactive iodine uptake test- inc amnt iodine uptake show in imagery= hyperthyroidism
* check for shellfish allergy- (contained in iodine)
labs- inc t3-4, dec TSH

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13
Q

hyperthyroidism- s/s

A

inc hr, rr, bp, temp, hair loss, diff sleeping, anxiety, exophthalmos (BULGING EYES), inc appetite
complications- dec cardiac output

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14
Q

hyperthyroidism- treatment

A

thyroid suppressing meds (inhib horm production)
subtotal/total thyroidectomy
if too aggressive- risk for hypothyroidism
during surgery can damage parathyroid gland (leads to dec Ca lvls)

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15
Q

hypocalcemia and hyperthyroidism

A

from damage to parathyroid during thyroidectomy
s/s numbness, tingling, twitching, tetany
diagnosed w/ serum lvls, facial twitching (chvosteks)or rigid hand curling w/ inflated bp cuff (trousseau’s)

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16
Q

hyperthyroidism- treatment

A

cool environment, O2 therapy, iv fluid w/ dextrose, high protein nutrition

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17
Q

hyperthyroidism- complications

A

thyroid storm
thyrotoxicosis
life threatening
risks- stress, trauma, infection (common in elderly)
s/s- alt CNS (inc anxiety/delerium), cardiac dysrhyth

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18
Q

thyroid storm-treatment (meds)

A

beta blockers (dec o2 demands cardiac tissue, dec bp/hr)

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19
Q

hypoparathyroidsim- cause

A

cause- removal parathyroid glands (total thyroidectomy/ neck Ca surgery)
lack PTH

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20
Q

PTH and Ca

A 
direct relationship
pth dec = Ca dec
hypoparathyroidism=hypocalcemia
Ph inverse relations Ca
      inc Ca= Low phosphorus
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21
Q

hypoparathyroidism- manifestations

A

dec Ca, numbness, tingling, musc cramps, spasms, tetany

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22
Q

hypoparathyroidism-management

A

raise Ca lvls
Iv Ca gluconate- stabalize airway spams
inc foods high Ca, and low in Ph (meat/eggs)

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23
Q

SIDAH- cause

A 
inc ADH(pit gland)= fluid vol excess
brain/lung tumor, meds (anti-dep, NSAIDs)
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24
Q

SIDAH- s/s

A

syndrome of inappropriate antidiuretic hormone

hyponatremia-altered mental status, headache, dizzy, fatigue, nausea, thirst

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25
SIDAH- management
monitor urine specific grav, serum/urine osmolality diuretics fluid restriction (1L/24hr) Mental status hypertonic sol (caution)(pulls fluid out of cells)
26
adrenal cortical insuff (addisons)
dec secretion corticotropin-releasing horm and ACTH from anterior pit dec secretion glucocorticoids/mineralocorticoids frm adrenal cortex
27
adrenal cortical insuff (Addisons)- manifestations
low bp, sings potential circ collapse (tired, weak), hypovolemic fatigue, low Na, hypotensive, High K, dec glucose, dec aldosterone
28
adrenal cortical insuff (Addisons)- cause
after 90% adrenal cortex gone or nonfunctioning frm extended use steroids or withdrawl
29
adrenal cortical insuff (Addisons)- management
monitor vs, fluid status, signs of shock hydrocortisone, iv (cortisol replacement), iv replacement fluids (D5NS)- dec glucose and Na ``` orthostatic vitals (bp especially, drop 15-20), body unable to compensate - inefficient tissue perfusion *if low bp when laying, put in recumbent position w/ legs elevated promote blood return cardiac tissues inc steroid dosage ```
30
adrenal cortical insuff (Addisons)-diagnosis
cortisol lvl in morning, ACTH
31
adrenal cortex hyperfunction (cushings)
excess glucocorticoids, and aldosterone
32
adrenal cortex hyperfunction (cushings)- manifestations
inc glucose, fluid retention, dec K, abnormal fat distribution, dec musc mass, inc Na, high bp
33
adrenal cortex hyperfunction (cushings)- cause
excess horm production from ant pit, excess ACTH, tumors, exogenous steroids
34
adrenal cortex hyperfunction (cushings)- complications
inc risk fractures, osteoporosis, infection (educate abt safe environment) risk fluid retention high *is reversable
35
adrenal cortex hyperfunction (cushings)-management
monitor bp, heart rhythm for irreg, monitor Na, K, WBC, s/s infection (delayed wound healing due to think skin, impaired circ and inc glucose) diabetic, low cal, high protein, low sodium/fat diet meds- tapper off steroids (stopping at once = adrenal insuffciency- addisons) surgically remove tumor
36
diabetes
grp metabolic dis characterized by hyperglycemia resulting frm insulin secretion, insulin action or b
37
insulin characteristics
anabolic (storage) horm secreted by beta cells in pancreas metabolizes CHO, protein and fat
38
insulin function
transport/ metaboli glucose assists K+ into cells inc. movement amino acids from protein consumed into the cells discourages decomposition of the stored glucose, protein and fat
39
low bg patho
low bg triggers hormone called glucagon created in the pancreas liver breaks down glucagon into glycogen to create glucose through process called glycogenolysis w/8-12 hrs liver will breakdown noncarbs (ex. aa)
40
type 1 diab
unproductive eta cells no insulin secretion (glucose can't enter cells) alpha cells damaged- no glucagon to stimulate glycogenolysis (glucose production)
41
causes type 1
genetic, immunologic, potential environmental
42
DKA
no insulin, glucose accum in blood, fat broken down for energy, ketone bodies (acidic) produced kidneys attempt to dec glucose by inc excretion -elevated bg -ketosis- metabolic acidosis
43
precipitating s/s dka
n/v, fatigue, polyuria. polydipsia | if untreated= stupor and coma
44
cause dka
dec insulin, illness, infection (spikes bg), undiag diab, stress
45
type 2 diab
insulin resis impaired insulin secretion in pancreas inc basal hepatic glucose production
46
type 2 risk factors
diet and lifestyle changes age 45 older (can happen in kids) obesity, fam hx, race/ethnicity (african, hispanic, native, asian, pacific) htn > 140/90 high chol hx gestational diab or delivery baby >9 lbs
47
hyperglycemic hyperosmolar syndrome patho
assoc w type 2 not enter DKA, only hyperglycemia no insulin/ lack of inc bg stimulate osmotic diuresis (loses h20 and electrolytes) act. osmotic balance- fluid shift from ICF to ECF (blood s) ends in- inc Na, glycosuria, dehydration
48
hyperglycemic hyperosmolar syndrome s/s early v late
early- polyuria, polydipsia | late- hypotension (2-3 wks), dehydration, tachycardia, Altr consciousness, seizures, hemiparesis
49
hyperglycemic hyperosmolar syndrome-cause
stress (CVA, MI, infection or surgery)
50
gestational diab- def
glucose intol in pregnancy due to placental horm inc insulin resistance
51
gestational diab- risk factors
fam hx dm, previous stillbirth, obesity, htn, inc maternal age >35, race/ethnicity (african, native, asian, pacific)
52
gestational diab- hyperglycemia risks
baby- inc insulin lvlvs, macrosomia (lrg size), birth trauma, delayed lung dev, fetal hypoxia screen btw 24-48 wks measures post prandial blood sugar to test insulin receptiveness
53
hypoglycemia
low blood glucose (diluted kool-aid) <70
54
hypoglycemia s/s
mild <70- affect sympath nervous system sweating, tremors, tachycardia, palpitations, nervousness, hunger severe <40- CNS lightheaded, slurred speech,x2 vision, impaired coord, confusion, numbness, irritable, drowsy
55
factors type 1 and 2 (external)
alcohol (inc and dec lvls) exercise (dec) stress (inc)
56
hyperglycemia s/s
polyuria, polydipsia, polyphagia | long term- fatigue, weakness, vision changes, numbness, dry skin, delayed wound healing
57
fasting bg
80-110 after fasting at least 8hrs
58
hemoglobin A1c
``` % glucose attached to hemoglobin in rbc 4-6% over 3 mon period <7 for diab good < 5.9 for normal ppl ```
59
postprandial blood glucose
after eating 80-110 (can be inc) | usually 2 hrs after eating
60
Kidney function labs/ electrolytes
creatinine- 0.6-1.2 mg/dl bun 7-18 mg/dl K+ 3.5-5.5 Na 135-145
61
CHO compo
ex. sugars, starches, fruits | easily/fast digested macronutr
62
1 carb choice
15g of carbohy | 1 unit of insulin/ 15g
63
trtment mild hypoglycemia
early- 4oz fruit juice, 2-3 glucose tabs of 15g carbs 1 tube glucose gel later- crackers and cheese or sandwich
64
basal insulin (long acting)
``` no peak, delayed release onset- 1hr duration-24h base lvl no mixing! lantus (glargine) or levermir (dtermir) ```
65
rapid acting insulin
``` absorbed w/in 5-15 min subq peak-40min duration 2-4hr ac and Hs (post prandial/ nocturnal) give while eating eat w/in 15 minof admin Humalong (lispro), Novolog (aspart) ```
66
insulin pump advant- disadvan
basal rate 0.2-2 units/hr continuous infusion w/ option for bolus disadvan- tubing kinks, displaced cath, battery life, cost
67
self monitoring bg
used in hospital setting | finger stick w/ meter
68
oral diab meds-overview
used for type 2 if diet mod and exercise not work | not replacement for insulin for type 1
69
oral diab meds- sulfonylureas
glyburide, glimepiride 2nd gen sulfonylureas- stim beta cells to secrete insulin and aid in bonding of insulin-insulin receptors side e- hypogly, weight gain, GI sympt
70
oral diab meds- biguanides
metformin, Glucophage ihibit production glucose by liver, inc body sensitivity to insulin pancreas alrdy producing insulin that isn't working, liver producing more has no benefit side e- hypoglyc, kidney damage (beware w/ contrast dye), lactic acidosis, drug-drug intractions
71
hospital monitoring for ketones
ketone body detection in urine or blood | tell if breaking down fat for energy (if not glucose is avaliable)
72
common diab orders
``` check blood g ac/hs (check w/ provider and look at prev trends if unable to check b4 pt starts eating) lab values for glucose and K skin assessment q shift monitor I and Os ```
73
factors affecting bg (external)
``` surgery (npo- dec) meds (steroids spike bg (prednisone)) stress (inc) K+ lvls- follow glucose, inc glucose=dec K (K leaves cells) exercise (dec lvls) ```
74
nursing considerations
auscul heart sounds (inc lvls alter vessels) ECG (can have irreg. rhythm) mental status assessment (drowsiness) pedal pulse (diab assoc w peripheral vasc dis) fluid status
75
specialties assoc w/ diab in care team
``` ophthalamist diab educator nutitionist endocrinologist pediatrist ```
76
microvasc changes w/ diab
capill basement mem thickens w/ chem rxn to inc blood glucose narrow vessles- dec blood/nutr perfusion ex. extremities, eyes and kidneys
77
macrovasc changes w/ diab
thickening, sclerosis, occlusion w/ plaque CAD Periph vasc dis cerebral vasc dis periph neuropathy (dec blood, damage nerves, dec sensation)
78
glucagon injection
for outpatient type 1 w/ no IV | mix w/ saline or lidocaine

MedSurg 1 (9 decks)

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