Endocrine System Flashcards
179 - Diagnostic Tests:
+ Fasting Blood Glucose (FBG)
+ Oral Glucose Tolerance Test (OGTT)
+ HgbA1c
FASTING BLOOD GLUCOSE: No foods or fluids for 8 hours before test.
+ Normal levels < 100 mg/dL
ORAL GLUCOSE TOLERANCE TEST: Fast for 10-12 hours before test. Take fasting blood glucose. Patient consume specific amount of glucose. Blood samples taken every 30 minutes for 2 hours. Normal levels < 140 mg/dL
HgbA1C: BEST INDICATOR of average blood glucose levels over the past 3-4 months.
+ <= 5.7% indicates no diabetes
+ Between 5.7 - 6.4% indicates pre-diabetes
+ > 6.5% INDICATED DIABETES
181 - Diabetes Insipidus:
+ What is it?, S/S and Labs
DIABETES INSIPIDUS: Deficiency of ADH, resulting in kidneys being unable to concentrate urine.
S/S: Large amounts of diluted urine, polydipsia, dehydration (tachycardia, hypotension, sunken eyes, dry mucus membranes, weakness, fatigue).
LABS:
+ URINE: DECREASED SPECIFIC GRAVITY (< 1.005), DECREASED OSMOLALITY (< 200 MOSM/L), DECREASED SODIUM.
+ BLOOD: INCREASED SERUM OSMOLALITY (> 300 mOsm/L), INCREASED SODIUM
DIAGNOSIS: Water deprivation test, Vasopressin test.
MEDS: ADH replacements (desmopressin or vasopressin). For intranasal administration, clear nasal passageway before inhalation.
182 - Syndrome of Inappropriate ADH (SIADH):
+ What is it? Causes and S/S
SIADH: Excessive release of ADH from the posterior pituitary gland, resulting in increased reabsorption of water (not sodium) by the kidneys.
CAUSES: Brain tumor, head injury, meningitis, medications.
S/S: SMALL AMOUNTS OF CONCENTRATED URINE. Fluid volume excess (tachycardia, hypertension, crackles, distended neck veins, weight gain), headache, weakness, muscle cramping, confusion, seizures, coma.
183 - Syndrome of Inappropriate ADH (SIADH)
+ Labs, Nursing care, Medications
LABS:
+ URINE: INCREASED SPECIFIC GRAVITY (> 1.030), OSMOLARITY, SODIUM
+ BLOOD: DECREASED SERUM OSMOLARITY (< 270 mEq/L), sodium
NURSING CARE:
+ Fluid restriction
+ Monitor I&Os (watch for hyponatremia!)
+ Weight patient daily
+ Provide hypertonic IV fluids (ex: 3% NaCl)
+ Administer furosemide (diuretic) as ordered.
185 - Hyperthyroidism:
+ What is it? Causes
HYPERTHYROIDISM: Excess thyroid hormones (T3 and T4) released from thyroid glands, resulting in hyper metabolic state.
CAUSES:
+ PRIMARY (Issue w/thyroid gland): Graves disease (most common cause, autoimmune issue) or thyroid nodule causes hypersecretion of T3/T4.
+ SECONDARY (Issue with pituitary gland): Anterior pituitary gland produces too much ?TSH (due to tumor),
+ TERTIARY (issue with hypothalamus): Hypothalamus produces too much TRH.
186 - Hyperthyroidism:
+ S/S, Labs, Nursing care
HYPERTHYROIDISM
S/S: Tachycardia, hypertension, heat intolerance, exophthalmos, weight loss, insomnia, diarrhea, warm/sweaty skin.
LABS: Increased T3/T4, decreased TSH (in primary hyperthyroidism).
NURSING CARE:
+ Nutrition: INCREASE PATIENT’S CALORIES, PROTEIN INTAKE. Monitor I&Os, weight.
+ Exophthalmos: Tape eyelids closed, provide eye lubricant.
187 - Hyperthyroidism: Meds, Complications, Surgery
HYPERTHYROIDISM
MEDS:
+ Propylithiouracil (PTU)
+ Beta Blockers (ex: propranolol)
+ Iodine solutions (mix w/juice to mask taste)
+ Radioactive iodine: Stay away from children for 2-4 days, flush toilet 3 times, do not share toothbrush, use disposable plates/utensils.
COMPLICATIONS: Thyroid Storm - excessively high levels of thyroid hormones, with high mortality rate.
+ CAUSES: infection, stress, DKA
+ SYMPTOMS: hypertension, chest pain, dysrhythmias, dyspnea, delirium.
SURGERY: Thyroidectomy (removal of thyroid gland). PATIENT WILL NEED THYROID REPLACEMENT THERAPY FOR THE REST OF THEIR LIFE.
188 - Thyroidectomy: Post-Procedure Nursing Care
POST-PROCEDURE NURSING CARE:
+ Place patient in high-Fowler’s position.
+ Prevent (and monitor for) hemorrhaging. Check dressing and back of neck for bleeding. Support patient’s head and neck with pillows/sandbags. Teach patient to avoid neck flexion or extension.
+ Have tracheostomy supplies available at bedside.
+ MONITOR FOR SIGNS OF PARATHYROID GLAND DAMAGE (i.e. S/S of hypocalcemia): numbness/tingling around mouth or toes, muscle twitching, positive Chvostek’s or Trousseau’s signs. Administer calcium gluconate for treatment of hypocalcemia.
+ Administer steroids (ex: prednisone) to decrease post-op edema.
189 - Hypothyroidism: What is it? Causes, S/S, Labs, Nursing care
HYPOTHYROIDISM: Inadequate production of thyroid hormones (T3/T4) by the thyroid gland.
CAUSES:
+ PRIMARY (issue w/thyroid gland): Most common type. Ex: Hashimoto’s disease (autoimmune disorder), cretinism (severe hypothyroidism in infants).
+ SECONDARY (issue w/pituitary gland): Anterior pituitary gland produces insufficient TSH (due to tumor).
+ TERTIARY (issue w/hypothalamus): Hypothalamus produces insufficient TRH.
S/S: Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle fingernails, depression.
LABS: Decreased T3 (< 79ng/dL), decreased T4 (<4mcg/dL), increased TSH (with primary hypothyroidism), anemia.
190 - Hypothyroidism: Nursing Care, Meds
NURSING CARE:
+ Encourage frequent rest periods
+ Encourage low-calorie, high-fiber diet and increased activity to promote weight loss and prevent constipation. No fiber laxatives (interferes with levothyroxine absorption).
+ Provide extra blankets, increase room temperature. No electric blankets.
MEDS: Levothyroxine - Start with low dose, gradually increase. Take 1 hour before breakfast w/full glass of water.
191 - Hypothyroidism: Complications
COMPLICATIONS:
HYPERTHYROIDISM (due to too much levothyroxine).
MYXEDEMA COMA - Severe hypothyroidism
+ CAUSES: Untreated hypothyroidism, infection/illness, abrupt discontinuation of levothyroxine.
+ SYMPTOMS: Hypoxia, decreased cardiac output, decreased LOC, bradycardia, hypotension, hypothermia.
+ NURSING CARE: Maintain patent airway, monitor ECG, warm patient, administer large doses of levothyroxine.
192 - Cushing’s syndrome: What is it? Causes, S/S, Labs
CUSHING’S SYNDROME: over-production of cortisol by the adrenal cortex.
CAUSES:
+ PRIMARY (Adrenal dysfunction): Over-secretion of cortisol by the adrenal cortex (r/t adrenal hyperplasia, tumor).
+ SECONDARY ( Pituitary dysfunction): Over-secretion of ACTH by the anterior pituitary gland (r/t tumor).
+ Long-term use of steroids for chronic conditions.
S/S: Increased infections, thin/fragile skin, edema, weight gain (moon face, buffalo hump, increased abdominal girth), hypertension, tachycardia, bone pain/fractures, hyperglycemia, gastric ulcers, hirsutism, acne.
LABS:
+ Elevated cortisol levels in saliva
+ INCREASED GLUCOSE, SODIUM LEVELS
+ DECREASED POTASSIUM, CALCIUM LEVELS]
193 - Cushing’s Syndrome:
+ Diagnosis, Nursing care, Medications, Therapeutic procedures/surgeries
CUSHING’S SYNDROME
DIAGNOSIS: Dexamethasone suppression test
NURSING CARE:
+ DIET: DECREASE SODIUM INTAKE, INCREASE INTAKE OF POTASSIUM, CALCIUM, AND PROTEIN.
+ Maintain safe environment due to increased risk of fractures.
+ Prevent infection.
+ Protect patient’s skin from breakdown.
MEDS: Ketoconazole (adrenal corticosteroid inhibitor), spironolactone (potassium sparing diuretic).
PROCEDURES/SURGERIES:
+ Cytotoxic agents for tumors causing condition.
+ Hypophysectomy (removal of pituitary gland)
+ Adrenalectomy (removal of adrenal gland): Hormone replacement therapy needed, monitor for adrenal crisis r/t drop in cortisol levels.
194 - Hypophysectomy: Post-procedure Nursing Care
HYPOPHYSECTOMY >> Monitor for signs of CSF Leak: \+HALO SIGN IN DRAINAGE (CLEAR IN CENTER, YELLOW ON EDGES). \+ SWEET-TASTING DRAINAGE. \+ CLEAR DRAINAGE FROM THE NOSE. \+ HEADACHE.
> > Teach patient to AVOID activities that increase ICP; coughing, sneezing, blowing nose, bending at waist, straining during bowel movements (increase fiber intake).
Decrease sense of smell expected for 3-4 months.
Do not brush teeth for 2 weeks (flossing and rinsing mouth OK).
195 - Addison’s disease:
+ What is it?
+ Causes, S/S, Labs
Addison’s disease: Inadequate secretion of hormones by adrenal cortex (aldosterone, cortisol, sex hormones).
CAUSES:
+ PRIMARY (adrenocortical insufficiency): damage or dysfunction of adrenal cortex (r/t autoimmune dysfunction, tumors).
SECONDARY ( pituitary dysfunction): pituitary tumor or hypophysectomy.
S/S: Weight loss, hyperpigmentation (bronze skin), lethargy, n/v, hypotension, dehydration.
LABS: INCREASED POTASSIUM AND CALCIUM. DECREASED SODIUM, GLUCOSE, CORTISOL.
196 - Addison’s disease:
+ Diagnosis, Nursing Care, Complications
Addison’s disease
Diagnosis: ACTH stimulation test. Administer ACTH, measure cortisol response after 30 minutes, 1 hour.
+ Primary Addison’s –> cortisol levels do not rise.
+ Secondary Addison’s –> cortisol levels DO rise.
NURSING CARE:
+ Administer steroids (hydrocortisone, prednisone).
+ Administer fluids, electrolytes as ordered.
+ Treat hyperkalemia; sodium polystyrene sulfonate, insulin (with glucose), calcium, bicarbonate.
+ Treat hypoglycemia: food, supplemental glucose.
COMPLICATIONS: Addisonian crisis - rapid onset, medical emergency. Due to infection/trauma or abrupt discontinuation of steroids.
197 - Diabetes Mellitus: What is it? 3 Types
DIABETES MELLITUS: Chronic hyperglycemia due to insufficient insulin production by the pancreas and/or insulin resistance of cells in the body..
3 TYPES OF DIABETES:
+ Type 1 DM: Destruction of beta cells in pancreas due to autoimmune dysfunction. Patients are insulin-dependent. usually starts at younger age.
+ Type 2 DM: Progressive insulin resistance and decreased insulin production r/t obesity, inactivity, and heredity. Usually starts later in life.
+ Gestational DM: High blood glucose during pregnancy.
198 - Diabetes Mellitus: Risk factors, S/S
DIABETES MELLITUS
RISK FACTORS: Obesity, hypertension, hyperlipidemia, smoking, genetics, race (African American, American Indian, Hispanic populations), inactivity.
S/S: 3 Ps (POLYURIA, POLYDIPSIA, POLYPHAGIA), hyperglycemia, weight loss, dehydration (decreased skin turgor, weak pulse, hypotension, dry mucus membranes), fruity breath odor, Kussmaul respirations (Increased rate and depth of respirations), n/v, headache, decreased LOC.
199 - Diabetes Mellitus:
+ Diagnosis
+ Best indicator of treatment compliance
+Medications
DIABETES MELLITUS
DIAGNOSIS: Two or more of the following on separate days:
+ Casual blood glucose > 200 mg/dL
+ Fasting blood glucose > 126 mg/dL
+ Glucose > 200 mg/dL with oral glucose tolerance test
+ HgbA1C > 6.5%
HgbA1C test: Best indicator of treatment compliance. GOAL FOR PATIENTS WITH DIABETES IS HGBA1C <7%.
MEDS: INSULIN * rapid-acting = lispro * short-acting = regular * intermediate acting = NPH * long-acting = glargine Oral hypoglycemic agents (Type II DM only): metformin, glipizide, repaglinide, pioglitazone, acarbose.
200 - Diabetes Mellitus: Patient teaching
- Rotate subcutaneous injection sites to prevent lipohypertrophy.
- Mixing insulins: Draw up clear (shorter-acting insulin) before cloudy (longer-acting insulin).
- Never mix long-acting insulins (i.e. insulin glargine) with other insulins.
- Monitor for signs of hypoglycemia (confusion, diaphoresis, headache, shakiness, blurred vision, decreased coordination).
201 - Hypoglycemia:
+ What blood glucose levels indicate hypoglycemia?
+ Management of hypoglycemia in conscious and unconscious patients
HYPOGLYCEMIA: blood glucose , <= 70 mg/dL
CONSCIOUS PATIENTS:
+ Consume 15-20g quickly absorbed carbohydrate (ex: 4-6oz juice or soft drink).
+ Recheck blood glucose in 15 minutes. If still <= 70 mg/dL, repeat above step and check again in 15 minutes.
+ Once blood glucose is > 70 mg/dL, consume a snack containing a protein and carbohydrate.
UNCONSCIOUS PATIENTS:
+ Administer IM or subcutaneous glucagon.
+ Repeat in 10 minutes if patient is still not conscious.
+ Once patient is conscious (and can swallow safely), have patient consume a carbohydrate snack.
203 - Diabetes Mellitus: Complications
DIABETES MELLITUS COMPLICATIONS:
+ Cardiovascular disease: MI, hypertension
+ Cerebrovascular disease: Stroke
+ Diabetic retinopathy: Impaired vision
+ Diabetic neuropathy: Nerve damage, leading to neuropathic pain, numbness, ischemia, infection.
+ Diabetic nephropathy: Kidney damage
+ DIABETIC KETOACIDOSIS (DKA): Life-threatening condition with blood glucose > 300mg/dL and KETONES in blood and urine. Rapid onset. More common with Type I DM.
+ HYPERGLYCEMIC-HYPEROSMOLAR STATE (HHS): Life- threatening condition with blood glucose > 600 mg/dL, no ketosis, severe DEHYDRATION. Gradual onset. More common with Type II DM.
204 - Diabetic complications:
+ DKA, Risk factors, symptoms, labs
+ HHS: Risk factors, symptoms, labs
DIABETIC COMPLICATIONS
DKA:
+ RISK FACTORS: INFECTION, stress/illness, untreated or undiagnosed type I DM, missed insulin dose.
+ SYMPTOMS: Polyuria, Polydipsia, Polyphagia, weight loss, fruity breath odor, Kussmaul respirations, GI upset, dehydration (resulting in hypotension, headache, weakness).
+ LABS: BLOOD GLUCOSE > 300mg/dL, KETONES IN BLOOD AND URINE, METABOLIC ACIDOSIS.
HHS:
+ RISK FACTORS: Older adults, inadequate fluid intake, decreased kidney function, infection, stress.
+ SYMPTOMS: Polyuria, polydipsia, polyphagia, dehydration (resulting in hypotension, headache, weakness).
+ LABS: BLOOD GLUCOSE > 600 mg/dL, NO KETONES IN BLOOD OR URINE. NO METABOLIC ACIDOSIS.
205 - DKA AND HHS:
+ Nursing care and Patient teaching
DKA AND HHS
NURSING CARE:
+ Treat underlying cause (ex: infection)
+ Administer IV fluids and IV insulin
+ Check blood glucose hourly (goal < 200 mg/dL)
+ Monitor potassium levels. Insulin causes K to move back into cells (risk of hypokalemia)
+ Administer Bicarb for metabolic acidosis
PATIENT TEACHING
+ Monitor blood glucose more frequently when sick (every 1-4 hours)
+ DO NOT SKIP INSULIN WHEN SICK
+ Wear a medical alert bracelet
+ Drink 2-3 L of water per day
+ Notify doctor if illness lasts for more than 1 day, or for temperature >= 38.6 degrees C.
+ Notify doctor for blood glucose > 250 mg/dL, or for urine positive for ketones.
