Exam 1 Endocrine Flashcards
What changes can a patient experience with disruption to hormone function?
energy level
tolerance to heat or cold
weight
thirst
frequency of urination, bowel function
body proportions, muscle mass, fat and fluid distribution
secondary sexual characteristics (e.g., loss or growth of hair)
menstrual cycle
memory, concentration, sleep patterns
mood
vision
joint pain
sexual dysfunction
What is exophthalmos?
abnormal protrusion of one or both eyeballs
What a examples of physical changes d/t hormone disruption that can be assessed?
appearance of facial hair in women
“moon face,”
“buffalo hump,”
exophthalmos
vision changes
edema
thinning of the skin
obesity of the trunk
thinness of the extremities
increased size of the feet and hands
hypo- or hyperreflexia.
What is a pheochromocytoma?
a tumor of the adrenal medulla
What is the MOA of insulin? What are 6 functions of insulin?
Ianabolic, or storage, hormone. When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells.
*Transports and metabolizes glucose for energy
*Stimulates storage of glucose in the liver and muscle (in the form of glycogen)
*Signals the liver to stop the release of glucose
*Enhances storage of dietary fat in adipose tissue
*Accelerates transport of amino acids (derived from dietary protein) into cells
*Inhibits the breakdown of stored glucose, protein, and fat
How does the production of insulin in the pancreas differ during periods of fasting (such as overnight)? What is the purpose of insulin and glucagon working together? What is the function of the liver in the production of glucose? What occurs if fasting last longer than 8-12 hours?
- the pancreas continuously releases a small amount of insulin (basal insulin)
- and glucagon (secreted by the alpha cells of the islets of Langerhans) is released when blood glucose levels decrease
glucagon stimulates the liver to release stored glucose.
2 To maintain a constant level of glucose in the blood by stimulating the release of glucose from the liver.
3 the liver produces glucose through glycogenolysis (the breakdown of glycogen).
4 the liver switches to form glucose from the breakdown of noncarbohydrate substances, including amino acids, through the process of gluconeogenesis.
What is the patho of DM 1? When excess glucose is in the bloodstream, how does it affect the kidneys? What happens when glucose is excreted in urine? without insulin what glucose-producing processes function unhibited?
the destruction of the pancreatic beta cells resulting in decreased insulin production, increased glucose production by the liver, and fasting hyperglycemia, and glucose derived from food cannot be stored in the liver but instead remains in the bloodstream
the kidneys are unable to filter all of the excess glucose; glycosuria then occurs
osmotic diuresis: when excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes
glycogenolysis and gluconeogenesis
contribute further to hyperglycemia
and
fat breakdown occurs excessively in the liver, resulting in an increased production of ketone bodies
What makes ketone bodies problematic when they are in excessive amounts? Result?
They are highly acidic, throws off homeostasis causing metabolic ascidosis
DKA
What are the 2 dysfunctions occurring with type 2 diabetes and their pathos?
insulin resistance and impaired insulin secretion
Insulin resistance refers to a decreased tissue sensitivity to insulin. Normally, insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in glucose metabolism. In type 2 diabetes, these intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver
To overcome insulin resistance and to prevent the buildup of glucose in the blood, increased amounts of insulin must be secreted to maintain the glucose level and can have difficulty keeping up
What is metabolic syndrome? Resulting in what conditions? What constitutes a diagnosis of metabolic syndrome?
Insulin resistance leading to a constellation of symptoms
hypercholesterolemia, abdominal obesity
high blood pressure
high serum glucose (prediabetes)
High triglyceride levels
Low HDL levels
presence of 3 of the conditions
What other conditions can hasten Type 1 diabetes?
Cushing’s syndrome
pancreatitis
When insulin levels is controlled, the risk for developing what 3 complications is improved?
retinopathy (damage to small blood vessels that nourish the retina)
nephropathy (damage to kidney cells)
neuropathy (damage to nerve cells)
What is the therapeutic goal of diabetes management? What are the 5 components to achieving this?
to achieve euglycemia (normal blood glucose levels) without hypoglycemia while maintaining a high quality of life
nutritional therapy
exercise
monitoring
pharmacologic therapy
education
What are clinical manifestations of type 1 or 2 diabetes (essentially manifestations of hyperglycemia)?
3 Ps: polyuria, polydipsia, polyphagia
1: sudden weight loss
N/V
abdominal pain
blurred vision
paresthesia
fatigue
weakness
slow wound healing
dry skin
recurrent infections (bladder, vaginitis)
dehydration
hypotension
sexual dysfunction
What are the goals of dietary management for diabetes? Nurse’s role?
Control of total caloric intake/maintain a reasonable body weight
Control of blood glucose levels
Normalization of lipids and blood pressure to prevent heart disease
Increase fiber in diet which can lower cholesterol levels
Use of artificial sweeteners
Reduce intake of saturated and trans fats
Be knowledgeable about dietary management
Communicate with a dietician
Reinforce client understanding
Support dietary and lifestyle changes
What is lipodystrophy? How can it be prevented? What are the best locations?
localized changes in fatty tissue d/t repeated insulin administration
systemic rotation of injection sites
back of upper arm, belly, upper glute/hip, top of thigh
What are the 4 dysfunctions that can occur and cause type 2 diabetes?
impaired insulin secretion
absorption of glucose from the GI tract
increased hepatic glucose production
decreased insulin-stimulated glucose uptake in the muscles
What are criteria for diabetes diagnosis?
Symptoms : polyuria, polydipsia, polyphagia, eight loss
casual (any time of day regardless of meal) plasma glucose concentration > 200 mg/dL
Or
Fasting (not intake for 8 hrs) plasma glucose >126 mg/dL
Or
Two-hour postload glucose >200 mg/dL during an oral glucose tolerance test
Or
Hemoglobin A1C ≥6.5% (glucose attached to the hemoglobin)
What are some dietary client teaching?
eat small amounts of fresh fruit
fill plate 1/4 of whole grain
Drink skim or 1% milk
fill 1/4 plate with lean protein
fille 1/2 plate with non-starchy vegetables
What are nutritional consideerations for meal planning with diabetes?
Carbohydrates: 45% to 50%
Emphasize whole grains
Non-starchy vegetables
Fat: 20% to 35% unsaturated, low saturated fats to reduce LDL
Non-animal sources of protein: 15%-20%
Legumes
Whole grains
Increase fiber
Increase omega-3 fatty acids
How does the glycemic index measure food sources? What are some findings when evaluating the glycemic index?
A value from 0-100 of any carbohydrate (based on rise of serum glucose at 2 hours after eating)
The lower the index the better for preventing spikes in blood glucose with diabetes
Raw or whole foods tend to have lower glycemic index than cooked, chopped, or pureed foods
Eat whole fruits rather than juices; they have a lowerglycemicindex because of fiber (slowing absorption)
Adding food with sugars may produce a lower glycemic index if eaten with foods that are more slowly absorbed
How does alcohol react with insulin and diabetes?
Do not drink alcohol on an empty stomach
Alcohol doesn’t require insulin to provide the body with energy
Excessive alcohol consumption can lead to dangerous episodes of hypoglycemia
What is the benefit of exercise and managing diabetes? What are considerations to implement to ensure success with exercise and diabetes management?
Lowers blood glucose
Aids in weight loss, easesstress, and maintainsa feeling of well-being
Lowers cardiovascular risk
Exercise when serum glucose is between 80-250 mg/dL, not too high or low
Do not exercise if ketones present in urine
If performing high-intensity activity, consider having a prior snack
Have high quality, comfortable shoes
What are exercise precautions with diabetes?
those who require exogenous insulin should it a 15g carb before moderate exercise
type 2 may not need extra food before exercise
post exercise hypoglycemia can occur up to 24hrs after intense exercise
exercise stress test can be administered prior to starting an exercise program
What are the 4 categories and examples of insulin?
rapid acting: lispro, aspart, gluisine
short acting: regular
intermediate acting: NPH
long acting: no peak glargine, detemir
What are complications of insulin therapy?
local allergic reaction
systemic allergic reaction
insulin lipodystrophy
resistance to exogenous insulin
morning hyperglycemia
What is the major side effect of antidiabetic agents that stimulate insulin secretion?
hypoglycemia
What are the sites of action for the following antidiabetic agents (and examples)?
biguanides and thiazolidinediones
amylin analogs incretins and insulin secrelagogues incretins
glucosidase inhibitors and amylin analogs
Metformin
liver: hepatic glucose output and muscle: peripheral glucose uptake
pancreas: glucagon and insulin secretion
GI: glucose absorption
What are the most common SE with metformin? Most severe? Nursing considerations?
GI upset, nausea, diarrhea
lactic acidosis
does not cause hypoglycemia
hold 24-48hrs prior to IV contrast
What is the MOA of sulfonylureas (glyburide, glipizide)? What is the risk? Who should avid?
Stimulates insulin secretion by pancreas. Often used with metformin to control serum glucose
Risk of significant hypoglycemia
Sulfa antibiotics have similar structure, so can cause hypoglycemia together
Avoid in client allergic to sulfa
Avoid prolonged sunlight since sulfa groups cause photosensitivity
What is the MOA of anagliflozin? Drug class? What is the increased risk with this med?
Prevent the reuptake of glucose in the kidney, lowering serum glucose
sodium-glucose co-transporter inhibitors
The glucose in urine increases risk of UTIs
What is the MOA of pioglitazone/rosiglitazone? Drug class? Side effects? What should be monitored?
Reduces insulin resistance on cells
thiazodinedones
Side-effects are mainly metabolic: weight gain, hyperlipidemia, edema, and liver dysfunction
Monitor LFTs, weight, lipids
What impact does hypoglycemia have on the nervous system? What is the glucose level threshold for hypoglycemia? What can cause hypoglycemia? What is the adrenergic response?
acitvate the sympathetic nervous system (fight or flight)
below 70 mg/dL
Too much insulin or oral hypoglycemic agents
Excessive physical activity
Not enough food
Sweating
Tremors
Tachycardia
Palpitations
Nervousness
Hunger
What is the most significant effect of hypoglycemia? S/S? S/S of severe hypoglycemia?
the brain needs glucose to work so hypoglycemia causes significant CNS interruption
Inability to concentrate
Headache
Confusion
Memory lapses
Slurred speech
Drowsiness
Disorientation
Seizures
Loss of consciousness
Death
How should episodes of hypoglycemia be managed? What is client is unconsious?
Give 15 to 20 g of fast-acting, concentrated carbohydrate if alert/awake
Three or four glucose tablets
4 to 6 ounces of juice or regular soda (not diet soda)
6 to 10 hard candies
1 tbsp honey
Subcutaneous or intramuscular glucagon (1 mg)
25 to 50 mL of 50% dextrose solution IV
What is the dysfunction occurring with DKA? What are the 3 main dysfunctions occuring?
Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate,protein, and fat
Mainly a complication of type 1 diabetes, rarely type 2
Hyperglycemia
Dehydration
Acidosis
What are assessment findings of DKA? ABGs?
blood glucose of 300-800
ketone bodies in the urine from fat breakdown
elevated K, Hg, BUN and Cr
low Na
lower pH, low bi-card
when PCO2 lowers it is d/t respiratory compensation (Kussmaul respirations)
How is DKA managed? what hapens to the potassium with treatment? What should be monitred?
rehydration with NS initially, at glucose of 250 add dextrose
* bolus of regular insulin then continuous IV
* reverse acidosis w/ insulin and bi-carb
* treat hyperkalemia with insulin, bi-carb and albuterol
rehydration increased volume which decreases serum potassium ratio.
Insulin enhances the movement of potassium into the cell because it rides along with the insulin
blood glucose
renal functions and urinary output
ECG
electrolytes
VA
lung assessments for Kussmaul and fluid overload
What are sick day rules with diabetes? When should you call the provider?
Notify healthcare provider if ill
Monitor BS every 2-4 hrs.
Continue taking insulin/oral meds during illness
Consume liquids every hour to prevent dehydration
Meet carbohydrate needs through soft food 6-8 times per day
Test urine for ketones every 3-4 hrs of if BS is >240 mg/dL
Call the provider for:
Moderate to large ketones in urine
BS >250 mg/dL that does not respond to treatment
Fever greater than 101.5°F, does not respond to acetaminophen, or lasts >24 hrs.
Feeling disoriented/confused
Experience rapid breathing
Persistent N/V or diarrhea
Inability to tolerate liquids
Illness lasts longer than 2 days
What is HHS? Patho? 2 manifestations? Differences in lab findings from DKA? Manifestations? Mortality rate?
hyperglycemic hyperosmolar syndrome
lack of sufficient insulin
Ketosis/acidosis is minimal or absent since insulin is still present but not enough
Severe hyperglycemia (greater than 600 mg/dL) causes an osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased serum osmolality
* HHS causes profound dehydration, often up to 10-12 liters of fluid loss
Typically, no hyperkalemia, no acidosis, but increased BUN and creatinine from dehydration
Manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs caused by cerebral dehydration
High mortality rate, more than DKA since it occurs more gradually over days, so clients stay home longer
What are a few differences in lb values between DKA and HHS?
lack of acidosis in HHS
Hyperkalemia is uncommon in HHS
Serum glucose is higher in HHS
Serum osmolality is higher in HHS
