Endocrine System Flashcards

1
Q

179 - Diagnostic Tests:
+ Fasting Blood Glucose (FBG)
+ Oral Glucose Tolerance Test (OGTT)
+ HgbA1c

A

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

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2
Q

181 - Diabetes Insipidus:

+ What is it?, S/S and Labs

A

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.

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3
Q

182 - Syndrome of Inappropriate ADH (SIADH):

+ What is it? Causes and S/S

A

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.

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4
Q

183 - Syndrome of Inappropriate ADH (SIADH)

+ Labs, Nursing care, Medications

A

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.

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5
Q

185 - Hyperthyroidism:

+ What is it? Causes

A

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.

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6
Q

186 - Hyperthyroidism:

+ S/S, Labs, Nursing care

A

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.

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7
Q

187 - Hyperthyroidism: Meds, Complications, Surgery

A

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.

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8
Q

188 - Thyroidectomy: Post-Procedure Nursing Care

A

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.

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9
Q

189 - Hypothyroidism: What is it? Causes, S/S, Labs, Nursing care

A

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.

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10
Q

190 - Hypothyroidism: Nursing Care, Meds

A

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.

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11
Q

191 - Hypothyroidism: Complications

A

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.

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12
Q

192 - Cushing’s syndrome: What is it? Causes, S/S, Labs

A

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]

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13
Q

193 - Cushing’s Syndrome:

+ Diagnosis, Nursing care, Medications, Therapeutic procedures/surgeries

A

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.

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14
Q

194 - Hypophysectomy: Post-procedure Nursing Care

A
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).

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15
Q

195 - Addison’s disease:
+ What is it?
+ Causes, S/S, Labs

A

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.

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16
Q

196 - Addison’s disease:

+ Diagnosis, Nursing Care, Complications

A

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.

17
Q

197 - Diabetes Mellitus: What is it? 3 Types

A

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.

18
Q

198 - Diabetes Mellitus: Risk factors, S/S

A

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.

19
Q

199 - Diabetes Mellitus:
+ Diagnosis
+ Best indicator of treatment compliance
+Medications

A

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.
20
Q

200 - Diabetes Mellitus: Patient teaching

A
  • 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).
21
Q

201 - Hypoglycemia:
+ What blood glucose levels indicate hypoglycemia?
+ Management of hypoglycemia in conscious and unconscious patients

A

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.

22
Q

203 - Diabetes Mellitus: Complications

A

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.

23
Q

204 - Diabetic complications:
+ DKA, Risk factors, symptoms, labs
+ HHS: Risk factors, symptoms, labs

A

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.

24
Q

205 - DKA AND HHS:

+ Nursing care and Patient teaching

A

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.