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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
Q

SIDAH- management

A

monitor urine specific grav, serum/urine osmolality
diuretics
fluid restriction (1L/24hr)
Mental status
hypertonic sol (caution)(pulls fluid out of cells)

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26
Q

adrenal cortical insuff (addisons)

A

dec secretion corticotropin-releasing horm and ACTH from anterior pit

dec secretion glucocorticoids/mineralocorticoids frm adrenal cortex

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27
Q

adrenal cortical insuff (Addisons)- manifestations

A

low bp, sings potential circ collapse (tired, weak), hypovolemic
fatigue, low Na, hypotensive, High K, dec glucose, dec aldosterone

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28
Q

adrenal cortical insuff (Addisons)- cause

A

after 90% adrenal cortex gone or nonfunctioning frm extended use steroids or withdrawl

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29
Q

adrenal cortical insuff (Addisons)- management

A

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
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30
Q

adrenal cortical insuff (Addisons)-diagnosis

A

cortisol lvl in morning, ACTH

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31
Q

adrenal cortex hyperfunction (cushings)

A

excess glucocorticoids, and aldosterone

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32
Q

adrenal cortex hyperfunction (cushings)- manifestations

A

inc glucose, fluid retention, dec K, abnormal fat distribution, dec musc mass, inc Na, high bp

33
Q

adrenal cortex hyperfunction (cushings)- cause

A

excess horm production from ant pit, excess ACTH, tumors, exogenous steroids

34
Q

adrenal cortex hyperfunction (cushings)- complications

A

inc risk fractures, osteoporosis, infection (educate abt safe environment)
risk fluid retention high
*is reversable

35
Q

adrenal cortex hyperfunction (cushings)-management

A

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
Q

diabetes

A

grp metabolic dis characterized by hyperglycemia resulting frm insulin secretion, insulin action or b

37
Q

insulin characteristics

A

anabolic (storage) horm
secreted by beta cells in pancreas
metabolizes CHO, protein and fat

38
Q

insulin function

A

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
Q

low bg patho

A

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
Q

type 1 diab

A

unproductive eta cells
no insulin secretion (glucose can’t enter cells)
alpha cells damaged- no glucagon to stimulate glycogenolysis (glucose production)

41
Q

causes type 1

A

genetic, immunologic, potential environmental

42
Q

DKA

A

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
Q

precipitating s/s dka

A

n/v, fatigue, polyuria. polydipsia

if untreated= stupor and coma

44
Q

cause dka

A

dec insulin, illness, infection (spikes bg), undiag diab, stress

45
Q

type 2 diab

A

insulin resis
impaired insulin secretion in pancreas
inc basal hepatic glucose production

46
Q

type 2 risk factors

A

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
Q

hyperglycemic hyperosmolar syndrome patho

A

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
Q

hyperglycemic hyperosmolar syndrome s/s early v late

A

early- polyuria, polydipsia

late- hypotension (2-3 wks), dehydration, tachycardia, Altr consciousness, seizures, hemiparesis

49
Q

hyperglycemic hyperosmolar syndrome-cause

A

stress (CVA, MI, infection or surgery)

50
Q

gestational diab- def

A

glucose intol in pregnancy due to placental horm inc insulin resistance

51
Q

gestational diab- risk factors

A

fam hx dm, previous stillbirth, obesity, htn, inc maternal age >35, race/ethnicity (african, native, asian, pacific)

52
Q

gestational diab- hyperglycemia risks

A

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
Q

hypoglycemia

A

low blood glucose
(diluted kool-aid)
<70

54
Q

hypoglycemia s/s

A

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
Q

factors type 1 and 2 (external)

A

alcohol (inc and dec lvls)
exercise (dec)
stress (inc)

56
Q

hyperglycemia s/s

A

polyuria, polydipsia, polyphagia

long term- fatigue, weakness, vision changes, numbness, dry skin, delayed wound healing

57
Q

fasting bg

A

80-110 after fasting at least 8hrs

58
Q

hemoglobin A1c

A 
% glucose attached to hemoglobin in rbc
4-6%
over 3 mon period
<7 for diab good 
< 5.9 for normal ppl
59
Q

postprandial blood glucose

A

after eating 80-110 (can be inc)

usually 2 hrs after eating

60
Q

Kidney function labs/ electrolytes

A

creatinine- 0.6-1.2 mg/dl
bun 7-18 mg/dl
K+ 3.5-5.5
Na 135-145

61
Q

CHO compo

A

ex. sugars, starches, fruits

easily/fast digested macronutr

62
Q

1 carb choice

A

15g of carbohy

1 unit of insulin/ 15g

63
Q

trtment mild hypoglycemia

A

early- 4oz fruit juice, 2-3 glucose tabs of 15g carbs
1 tube glucose gel
later- crackers and cheese or sandwich

64
Q

basal insulin (long acting)

A 
no peak, delayed release
onset- 1hr
duration-24h
base lvl
no mixing!
lantus (glargine) or levermir (dtermir)
65
Q

rapid acting insulin

A 
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
Q

insulin pump advant- disadvan

A

basal rate 0.2-2 units/hr
continuous infusion w/ option for bolus
disadvan- tubing kinks, displaced cath, battery life, cost

67
Q

self monitoring bg

A

used in hospital setting

finger stick w/ meter

68
Q

oral diab meds-overview

A

used for type 2 if diet mod and exercise not work

not replacement for insulin for type 1

69
Q

oral diab meds- sulfonylureas

A

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
Q

oral diab meds- biguanides

A

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
Q

hospital monitoring for ketones

A

ketone body detection in urine or blood

tell if breaking down fat for energy (if not glucose is avaliable)

72
Q

common diab orders

A 
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
Q

factors affecting bg (external)

A 
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
Q

nursing considerations

A

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
Q

specialties assoc w/ diab in care team

A 
ophthalamist
diab educator
nutitionist
endocrinologist
pediatrist
76
Q

microvasc changes w/ diab

A

capill basement mem thickens w/ chem rxn to inc blood glucose
narrow vessles- dec blood/nutr perfusion
ex. extremities, eyes and kidneys

77
Q

macrovasc changes w/ diab

A

thickening, sclerosis, occlusion w/ plaque
CAD
Periph vasc dis
cerebral vasc dis
periph neuropathy
(dec blood, damage nerves, dec sensation)

78
Q

glucagon injection

A

for outpatient type 1 w/ no IV

mix w/ saline or lidocaine

MedSurg 1 (9 decks)

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