Endocrine System S.G Test 1- DONE Flashcards
- Cushing syndrome manifestations (PP slide 21, ATI pg.480, pg.682)
*Too much cortisol secretion
Manifestations:
-hyperglycemia
-central type-obesity w/buffalo hump, heavy trunk w/thin extremities, moon face, acne
-fragile/thin skin, ecchymosis(bruising), striae
-sleep disturbances
-osteoporosis, muscle wasting
-HTN
- infection, slow healing
-virilization in women (too much male hormone in the body), loss of libido, mood changes
-increased serum sodium, decreased serum potassium
- Cushing’s Syndrome interventions(PP slide 21, ATI pg.480, pg.682)
Interventions:
-monitor electrolytes & Blood sugar,
-monitor for infection, monitor WBC count w/differential daily
-monitor I&O’s & daily weight
-monitor for hypervolemia (edema, distended neck veins, HTN, tachy)
-monitor changes in physical appearance & patient responses to these changes
- Addison’s disease manifestations (pg.680, PP slide 19)
*Too little cortisol secretion
-muscle weakness
-anorexia
-GI symptoms,
-fatigue
-dark pigmentation of the skin & mucosa,
-hypotension,
-hypoglycemia,
-hypovolemia
-hyperkalemia, low serum sodium(hyponatremia)
-emotional lability, confusion
- Hyperthyroidism manifestations (table 50-1 pg.670 & PP slide 6)
graves disease/methimazole
-restless despite feeling fatigued and weak
-highly excitable, constantly agitated, mood changes
-exophthalmos (bulging eyes), enlarged goiter
- Fine tremors of the hands occur, causing unusual clumsiness, nervousness, anxiety, insomnia
- heat intolerance, elevated body temp
-increased appetite but lose weight
-tachycardia, HTN
-irregular or scant menses
-flushed, warm & moist skin
-increased urine output
-diarrhea
-blurred vision
- Hypothyroidism manifestations (table 50-1 pg.670,675 & PP slide 4,ATI pg.476)
Hashimotos disease
Manifestations: “hypo think low” levothyroxine
-lethargy, sleepiness (sleeping up to 16hrs)
-weight gain w/out overeating
-dry skin-brittle hair/hair loss
-menstrual disorders (heavy menses, may be unable to conceive)
- bradycardia
-cold intolerance
-depression
- constipation
-enlarged heart
- atherosclerosis (plaque of fatty material on inner walls of the arteries)
-anemia
- Hypothyroidism client education (table 50-1 pg.670,675 & PP slide 4,ATI pg.476)
Client Education:
-don’t take levothyroxine w/in 4 hrs of GI meds & vitamins(calcium)
-take meds in the AM, empty stomach
-Report slowing down, hypothermia, extreme drowsiness, respiratory failure, bradycardia (myxedema coma)
-report low blood glucose & sodium levels (can progress to coma)
-increase fiber & fluids
- weekly weigh-ins
-report chest pain or discomfort immediately
-avoid fiber laxatives, interferes w/absorption of levothyroxine, avoid narcotics & sedatives
-don’t use electric blankets or other heating devices
-check thyroid levels every 6 mos
- Post-op nursing interventions for thyroidectomy (pp slide 10, pg.672, ATI pg.471)
-monitor respirations/potential airway impairment
-have suctioning equipment near the bed
-fowler’s position, support head & neck
-monitor for potential bleeding & hematoma formation, check posterior dressing
-assess pain & provide pain relief measures
-assess voice: some hoarseness expected, discourage talking
-Potential hypocalcemia: symptom= tetany (intermittent muscular spasms), circumoral paresthesia(numbness around the mouth) (positive chvosteks sign & trousseaus sign)
- Medications for hyperthyroidism-METHIMAZOLE- (pg.671, ATI pg.471)
Methimazole: (hyperthyroidism)
-agranulocytosis
-monitor for flu-like symptoms, at risk for infections
-stop if pregnancy occurs, not baby safe
-give w/meals, don’t stop abruptly
- medications for hyperthyroidism- PROPYLTHIOURACIL- (pg.671, ATI pg.471)
Propylthiouracil (PTU) :
- numbness, headache, hair loss, skin rash, n/v, baby safe
-monitor labs for agranulocytosis
-give w/meals, don’t stop abruptly
- Medications for hypothyroidism-LEVOTHYROXINE- (pg.671, ATI pg.471)
lifelong treatment
-take in the AM, on an empty stomach
-report high HR, HIGH BP, TEMP (thyroid storm)
- life long treatment
-don’t stop abruptly
-slow onset, 3-4 wks to work
-pregnancy safe
- Medications for hyperthyroidism -RADIOACTIVE IODIONE (pg.671, ATI pg.471)
-n/v, tachycardia, gland tenderness
-use separate toilet facilities 2-4 days after dosing or flush 2-3 times after each use
-stay away from children & pregnant women 2-4 days after dosing
-take w/meal, mix the solution into juice to mask the taste & use straw to avoid staining the teeth.
-take 1hr after an antithyroid med
-report fever, sore throat, metallic taste & mouth ulcers
- Medications for hyperthyroidism- BETA BLOCKERS-(pg.671, ATI pg.471)
Propranolol, atenolol, metoprolol:
-nausea, dizziness, hypotension, masks hypoglycemia symptoms
-monitor for cardiac symptoms (bradycardia), monitor ECG
-check pulse prior to taking each dose (hold if HR less than 60), check BP prior to taking each dose
(Symptoms can worsen when med is stopped suddenly)
- Diabetes insipidus manifestations (pp slide 15)
-polyuria
-weight loss
-thirst, dehydration
-weakness
-hypotension
-tachycardia
-low specific gravity (Normal specific gravity:1.005-1.030)
-high sodium level (Normal sodium level:135-145)
- Diabetes insipidus interventions (pp slide 15)
-monitor I&o’s
-administer desmopressin = helps w/reabsorption of water
-monitor urine specific gravity
-monitor sodium
- Nursing actions for SIADH (PP slide 17)
pituitary gland disorder
-restrict oral fluids
-safety(risk for falls), hyponatremia > lead to seizures
-administer diuretics/hypertonic solutions
-check neuro status (can cause loss of consciousness)
- Manifestations of hyperparathyroidism (pp slide 12)
-renal calculi (kidney stones)
-bone decalcification
-fatigue, muscle weakness
-n/v, constipation
-HTN, cardiac dysrhythmias
-psychological manifestations
- Complications of hyperparathyroidism (pp slide 12, 14)
-osteoporosis (bone fractures)
-kidney stones (calculi formation)
-hypotonic muscles (weak muscle tone)
-hypercalcemic crisis
- blood sugar lab values (pp slide 3)/ how often checking bs when sick
Blood Glucose Goal : 70-110mg/dL
Impaired Fasting Glucose(IFG) : 100-126mg/dL
Impaired Glucose tolerance(IGT) : 140-199mg/dL
Random blood sugar (RBS): over 200
HBA1C: 5.5-6.0
*if pt is sick(sepsis),under stress, surgery, steroids > check BS every 2-4 hrs. Severe illness every 2 hrs.
- Manifestations of DKA (pg.702, pp slide 16)
-Weakness, drowsiness
-thirst
-vomiting, anorexia
-abdominal pain
-low BP
-Kussmaul’s respirations (fast deep breathing)
-fruity breath
- Medical and nursing management of DKA (pg.702, pp slide 16)
Medical management:
Reduce elevated blood glucose >Regular Insulin IV, glucose
Correct Fluid & electrolyte imbalances > isotonic fluid
Clear the urine & blood of ketones >potassium replacements
Nursing management:
-monitor Iv infusions closely & take vital signs frequently
-insert indwelling urinary catheter & monitor urine output
-Check serum electrolyte findings, attach cardiac leads & observe the clients heart conduction pattern to detect evidence of hyperkalemia (tall T waves & brady cardia), monitor potassium levels
-Measure blood glucose level frequently, urine is checked for Prescence of ketones.
- manifestations of hyperglycemia (pp slide 11)
-polyuria
-polydipsia (excessive thirst)
-polyphagia (excessive eating)
-poor wound healing
-hot & dry skin “sugar high”
-dry mouth (dehydration)
-weakness, feeling tired
-numbness & tingling
-vision changes
-weight loss
-fruity breath, deep rapid breaths
- manifestations of hypoglycemia (pg.703, pp slide 11)
-tachycardia
- weakness
-headache
-nausea
-drowsiness
-nervousness
-hunger
-tremors
-excessive perspiration, cold & clammy,
-behavioral changes, confusion & dizziness.
- onset and peaks of insulin
Rapid acting: (lispro, aspart, glulisine) onset 15-30 mins peak ½ -3 hrs
Short acting: (regular) onset ½ -1hr peak 1-5hrs
Intermediate: (NPH, detemir) onset 1-2hrs peak 4-14hrs
Long Acting: (glargine) onset 1-4hr no peak
- diabetic plate
45% of diet = complex carbs
15-20% = protein
10-35% = total fats
- client education for long-term complications of diabetes: retinopathy (ATI Pg.493,494)
-perform eye exams every 1-2 years
-visit ophthalmologist
-conduct management of blood glucose levels
-Hypoglycemia causes temporary blurred vision, report other vision changes that don’t fluctuate with w/glucose levels
- client education for long-term complications of diabetes: neuropathy (ATI Pg.493,494)
-conduct annual exams w/podiatrist, -check feet daily
-regular follow-ups w/provider to monitor & treat neuropathy
-report numbness & tingling, joint problems
-no lotion in between toes, no long -bath soaks
-closed toed shoes only, check temp of water w/thermometer
- insulin administration instructions
-When combining 2 types of insulin always draw the clear (regular)short acting insulin first and then the intermediate (NPH) cloudy insulin second.
- Administer mixture w/in 15 mins to ensure that the onsets, peaks, and durations of each separate insulin remain intact.
-Do not mix Glargine insulin w/other types of insulin in the same syringe.
-do not shake insulin, roll in hands
- Inject in the abdomen, arms, thighs, or buttocks rotating sites.
-Discard regular insulin if its cloudy (contaminated)
Hypoparathyroidism
Tingling or burning if fingers, toes, lips
Muscle aches cramps
Twitching spasms of muscles around mouth
