Endocrine Part 1 Flashcards
What does thyroid produce??
T3, T4, Calcitonin
How does calcitonin work?
Decreases serum calcium by taking it from the blood and putting it back in the bone
Tx osteoporosis
What do you need to make hormones?
Dietary Iodine
What hormone gives us energy?
Thyroid hormone
S/S Hyperthyroidthyroidism (Graves)
Energy? Wt: Temp: Attention: Constipation or diarrhea? BP:
TOO MUCH energy Wt: Loss Temp: Hot/sweaty Attention span decreases (can't focus) Nervousness / irritable GI: fast - Diarrhea BP ^ Thyroid enlarges/hypertrophy
How do we diagnose hyperthyroidism?
T4 count (Increased) Thyroid scan
What must a patient do before obtaining a thyroid scan?
DC any iodine containing medication 1 week prior to the scan
What drug contains high levels of iodine?
Amiodarone - may affect thyroid function
5 ways to treat hyperthyroidism
- Anti-thyroids
- Iodine compounds
- Beta blockers
- Radioactive Iodine
- Surgery
What are 2 examples of anti-thyroid medications?
How do they work?
When is it used?
propylthiouracil, methimazole
Stops the thyroid from making hormones
Used preoperatively to stun the thyroid (decrease bleeding risk)
2 examples of iodine compounds
Are these the same as dietary iodine?
How does it work?
How do we give it?
Potassium iodine, strong iodine solution (Lugol’s)
NO
These decreases the size and vascularity go the gland - all endocrine glands are VERY VASCULAR
Give in milk or juice and use a star because it stains teeth
How to BB work in regards to hyperthyroidism?
Who do we not give these to?
Decrease HR, BP, contractility, CO generally, but especially decrease anxiety in these patients
Asthma, DM (masks glucose changes)
How does radioactive iodine work? What does this lead to? Is this adverse?
Destroys the thyroid cells
Hypothyroidism
This is expected, not adverse
How many doses of radioactive iodine are given?
How are they given?
1
PO (liquid or tablet) after pregnancy is ruled out
Precautions to taking radioactive iodine
Stay away from babies and no kissing for 24 hours
What is a thyroid storm?
Also called thyrotoxicosis and thyrotoxic crisis, it is like hyperthyroidism x 100
Could be a rebound effect after radioactive iodine (But can occur without it)
EMERGENCY - ICU: could lead to MI
Post-op teaching of thyroidectomy (total or partial)
Support the neck to avoid any tension on the suture line
Put personal items close by
How do we position a patient after a thyroidectomy?
Where do we check for bleeding?
Elevate HOB to prevent edema in the neck
Check for bleeding behind the neck
Nutrition after thyroid removal
Increased calories because they are burning do many
What would hoarseness indicate after thyroid removal?
What could this lead to?
Damage of the laryngeal nerve
Vocal cord paralysis or airway obstruction & immediate trach if both cords have paralysis
Do we want thyroidectomy patients to speak much?
No, but we need to listen for hoarseness and teach them to report ANY feelings of pressure
ASSUME THE WORST
Why do we keep a trach at the bedside?
Swelling
Laryngeal nerve damage
Hypocalcemia
What could have been removed when removing the thyroid?
How would we know?
Some of the parathyroid glands (there are 4 total)
Assess for LOW CALCIUM - *not enough sedation (think about laryngospasm especially here)
What is not fixed when removing the thyroid?
What do we do about it?
Eye or vision problems
Hypoallergenic tape if they can’t close their lids
Dark glasses for photosensitivity
Artificial tears
Another name for hypothyroidism
What is this called when it is present at birth?
Myxedema
Cretinism - can lead to slowed mental status and physical development if undetected
S/S hypothyroidism
Energy? GI Weight Temp - precautions? Women Speech Face
No energy - Could be so bad they are BEDRIDDEN Slow GI Increased weight Amenorrhea Slowed/slurred speech No expression
Cold - can’t tell if something is too hot.. don’t give them things like heating pads
Hypothyroid and Hyperthyroid could be mistaken for what?
Depressed or Manic
Psych - Need a thyroid profile
Medication for hypothyroidism
How often taken?
What effect will they have on the patient?
Levothyroxine, thyroglobulin, liothyronine
Once a day for life
Increased energy, BP, HR
Common comorbidity with hypothyroidism
CAD - worry about heart trouble and chest pain!
Too much PTH will cause _____ while too little PTH will cause _____
Too much PTH = ^ serum Ca
Too little PTH = low serum Ca
Hyperparathyroidism = what 2 things
Increased calcium - sedated
Low Phosphorus
HypOparathyroidism = what 2 things
Low Ca - rigid
Increased Phosphorus
How to treat Hypoparathyroidism
IV calcium to increase Ca
Phosphate binders to lower phosphorus
What do adrenal glands help us do?
Deal with stress
What does adrenal medulla have vs adrenal cortex?
Problems associated with each?
Medulla: Epi and NE; pheochromocytoma
Cortex: Glucocorticoids, Mineralocorticoids, Sex hormones; Addisons, Cushings
What is Pheochromocytoma
Benign tumors that secrete epi and NE in boluses
S/S pheochromocytoma
^BP, ^HR
Flushing/sweaty
How do you diagnose pheochromocytoma?
How is it done?
What are we looking for?
What will alter results?
VMA (vanillylmandelic acid test)
24 urine - throw away the first void and keep the last - can’t miss a single mL or else start over
Look for epi and NE
No stress the day before to prevent any boluses
VANILLA WILL ALTER THIS
How to treat pheochromocytoma?
Surgery to remove tumors
PO/IV vs biologic GC, MC and sex hormones?
Even though our body secretes these normally, adverse effects are more pronounced when the patient receives PO/IV steroids
What are the 4 functions of glucocorticoids?
- Change mood
- Alter defense mechanisms (Suppress immune system)
- Breakdown fats and proteins (alter growth)
- Inhibit insulin (hyperglycemic)
What does aldosterone do to the body?
Makes you retain Na and water and LOSE K
Too much aldosterone = ___ K
Too little aldosterone = ___ K
Too much: low K, fluid excess
Too little: high K, fluid deficit
Other “fancy words” NCLEX lady will use for increased steroids
Adrenocorticotropin (ACTH)
Cortisol
Hypercortisolism
