endocrine test Flashcards
overweight bmi
25 to 29.9
obese bmi
exceeding 30
severe/extreme bmi
exceeding 40
metabolic syndrome criteria
Waist circumference >35 in women and >40 in men
High LDL level — 150 mg/dL
Less than 40 mg/dL in men or less than 50 mg/dL in women HDL
Increased blood pressure — 130/85 or higher
high fasting blood glucose
Orlistat education
educate the patient that they need to take a multivitamin and eat a nutrient rich diet
Liraglutide education
important to educate the patient on how to give sub Q injections. Demonstration with teach back
Naltrexone and Bupropion combination purpose and contraindications
Can help with obesity when combined. Contraindications: HTN, epilepsy, SI, hx eating disorders, alcohol or substance abuse
Intragastric balloon therapy s/s to look for
Increased abd girth, abd pain, constipation > Indicates balloon rupture
effects of obesity
Mechanics of ventilation and circulation
Pharmacokinetics and pharmacodynamics
Skin integrity
Body mechanics and mobility
Roux-en-Y Gastric Bypass Notes
Involves restrictive and malabsorption components. EDUCATE: Food intake needs to be limited. Absorption of calories and nutrients will be limited.
Gastric Banding Education
EDUCATE patient not to eat like normal. Very very small amounts of water
Biliopancreatic Diversion with Duodenal Switch notes
Nutrient dense foods in small, frequent meals. Keep at LOW fowler during meal time and for 20-30 minutes after meal time to delay stomach emptying and can decrease risk of dumping syndrome.
Beverages should be consumed 30 minutes before or 60 minutes after meals
gastric surgery and female patients of childbearing age
After bariatric surgery female clients of childbearing age should use contraceptives for at least 18 months after surgery to prevent pregnancy.
potential complications of bariatric surgery
anastomotic leak – a leaking of gastric content into peritoneal space that can lead to sepsis. Risk includes older age males, greater body mass (stage 3 obesity), nonspecific s/s including fever, abdominal pain, tachycardia, leukocytosis
Dumping syndrome s/s: nausea, weakness, diaphoresis, palpitations, syncope, diarrhea, hypoglycemia (priority assessment after immediate symptoms)
dumping syndrome s/s
nausea, weakness, diaphoresis, palpitations, syncope, diarrhea, hypoglycemia (priority assessment after immediate symptoms)
anastomotic leak s/s
fever, abdominal pain, tachycardia, leukocytosis
gestational diabetes cause
Gestational diabetes happens during pregnancy due to secretions of placental hormones that causes insulin resistance
exocrine glands go into the
glands and ducts (includes salivary glands)
endocrine glands go into the
bloodstream
Over secretion of acth or gh leads to
Cushing’s syndrome, gigantism, acromegaly
Under secretion of acth or gh leads to
dwarfism, panhypopituitarism
Before during and after hypophysectomy
blood glucose monitoring and monitor the stools for blood
notes on diabetes insipidus
ENOURMOUS amount of very clear urine. With a specific gravity of 1.00-1.05
Calcitonin helpful hint
tone the calcium down
Parathormone regulates
calcium and phosphorus balance
aldosteronism (conn’s syndrome)
when the adrenal glands make too much aldosterone. Monitor BP and K+. Potassium will be low
hypertension, headache, hyperhidrosis (excessive sweating), hyper-, hyperglycemia**
what is essential for thyroid hormone production
iodine.
TSH stimulates the release of T3 and T4
classic manifestation of hypothyroidism
Constipation
Educate to increase fiber, water, movement
Hashimoto disease symptoms
facial edema, cold intolerance, bradycardia, constipation
Thyroid storm aka thyrotoxic crisis
promote relaxation – insomnia, heat intolerance, tachycardia, nervousness, tremors, warm soft and moist skin, increased appetite, cardiac dysrhythmias, weight loss
can occur with an acute overdose of levothyroxine (insomnia, heat intolerance, tachycardia)
most common drug to reduce heart rate
beta blockers
Tetany
general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements
Chvostek sign
a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye – hypocalcemia -
Trousseau sign
carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff
If a patient gets a thyroidectomy and reports sores on feet and around the lips
it means the calcium is probably low because loss of calcitonin. Check for hypocalcemia. – always check electrolytes –
Addison’s disease
characterized by weight loss, muscle weakness, fatigue, low blood pressure, loss of body hair, vitiligo, hyperpigmentation in both exposed and non exposed parts of the body.
hypotension is a big component in Addison’s disease. Get a daily weight
Cushing’s Syndrome education
Educate: when a pt is on corticosteroid watch for osteoporosis, hyperglycemia, can mask signs of infection
Thyroidectomy
can lead to hypocalcemia
Priority is ABCs – can lead to airway problems
Diagnostic Findings of Diabetes
Very viscous, honey like blood
Keep A1c less than 6.5%
Diabetes management has five components:
Nutritional therapy
Exercise
Monitoring
Pharmacologic therapy
Educationi
insulin and periods of stress
during periods of high levels of stress such as surgery and trauma BG tends to increase.
Before adrenalectomy
pre-treat with solumedrol (corticosteroids) and continue treatment after surgery
Diabetic pt is sick
in order to prevent DKA instruct the patient to drink fluids every hour eat frequent small meals, blood glucose and urine ketones must be assessed every 4 hours when sick, take the usual doses of insulin
DKA manifestations
hyperglycemia, acidosis, dehydration, hypotension
DKA hydration guidelines and treatment
N/S 15 mL/kg/hour
Rehydration with IV fluid
IV continuous infusion of regular insulin
Reverse acidosis and restore electrolyte balance
DKA things to monitor
Monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload
Management of HHS
Rehydration
Insulin administration
Monitor fluid volume and electrolyte status
long term complications of diabetes
Keep bg under control is the best protection against long term effects. Can lead to neuropathy, microvascular problems and CAD, cerebrovascular disease
acute overdose of levothyroxine s/s
insomnia, heat intolerance, tachycardia, sweating, hyperthermia
treatment for thyroid storm
reduce heart rate, reduce temperature
relaxation techniques, beta blockers, ice packs, cold washcloths, remove blankets.
