exam 3 endocrine Flashcards
thyroid produces and secretes
T4, T3 and calcitonin
necessary for the synthesis thyroid hormones
iodine
most common form of hyperthyroidism
graves disease
causes of hyperthyroidism
excess iodine intake, thyroid cancer, pituitary tumors.
hyperthyroidism complication
thyroid storm
symptoms of thyroid storm
severe tachy, anxiety, HTN, hyperthermia, restlessness
tx for thyroid storm
fever reduction, fluid replacement, reduce circulating thyroid hormone levels
diagnostics for hyperthyroidism
low TSH, high T3 T4
metabolism and heart rate
t3 and t4
tx for hyperthyroidism
drugs: ptu, tapazole, betablocker, ssri, radioactive therapy, thyroidectomy
if payathyroid glands are removed what is the risk
tetany!! muscle spasms
post thyroid surgery mnemonic
Bleeding; beware of thyroid storm Open airway Whisper Trach set Incision Emergency
post thyroid surgery
avoid flexion of neck
monitor for signs of tetany
laryngeal nerve damage, STRIDOR
most common cause of hypothyroidism
iodine ; Hashimotos thyroiditis
meds for hypothyroid
lithium-blocks hormone production
amniodorone- contains iodine
s/s of hypothyroid
weight gain intolerance to cold constipation bradycardia anorexia
Extreme form of hypothyrodism
Myxedema
Subnormal temp, bradycardia, decreased LOC, Respiratory failure, hypotension,hyponatremia
myxedema
tx for myxedema
levothyroxine/synthroid given IV due to paralytic ileus
hypothyroid diagnostic
increase TSH decrease t3 t4
cushings and addisons are complications of what organ
adrenal glands
Results from excessive adrenocortical activity
cushings
what can cause cushing
chronic use of corticosteriods or tumors
Truncal obesity Moon facies Abdominal straie Hirsutism in women Amenorrhea Edema, Poor wound healing, easy bruising Acne (severe) Hypertension
cushings
acth levels in cushings
elevated
lab findings – hyperglycemia, hypernatremia, hypokalemia, glycosuria, leukocytosis,
cushings
post op adrenalectomy
monitor bp, hr, rr
Adrenocortical insufficiency (hypofunction of the adrenal cortex)
addisons disease
acth addisons
low
which one is autoimmune addisons or cushings
addisons
progressive weakness, fatigue, weight loss, and anorexia, bronze pigmentation, dehydration,
addisons
NA and k in addisons
low Na high K
na and k in cushings
high Na low K
addison crisis
Hypotension Tachycardia Dehydration Fever, weakness Confusion Severe N/V/D
tx for addison crisis
fluids, monitor electrolytes, high dose of hydrocorticoid replacement
hyperkalemia, hypoglycemia, anemia, hyponatremia, hypochloremia
addisons
normal hemoglobin
12-18
mild anemia
10-14
moderate anemia
6-10
severe anemia
less than 6
represents the weight, color, and size of RBC
hemoglobin
heme
iron
globin
protein
bleeding; dont have enough platelet plugs
thrombocytopenia
low platelet count
less than 150,000
what can cause thrombocytopenia
infecitons, ETOH, antibiotics, heparin, infection drug induced
thrombocytopenia internal bleeding
check hr, bp, and blood in stool
where does ITP happen
platelet destruction in the spleen
Most common type of acquired thrombocytopenia
ITP
itp acute
post viral infection
itp chronic
Most common in females, essential thrombocytopenia, autoimmune
ITP treatment
corticosteriods
splenectomy
platelet transfusion- rare and can cause more problems
s/s decreased platelets
nose bleeding
Oral bleeding
Purpura
Petechia
HITTS
allergic reaction to heparin
Platelets will get destroy- causes bleeding
Endothelial damage
Bleeding and clotting at the same time but clotting is WORSE
what to do in HITTS
stop heparin call physician. state that they are allergic to anything with heparin from now on
tx for HITTS
Lepirudin (Refludan)
factor VIII deficiency
hemophilia a
Christmas disease factor IX
hemophilia b
deficiency of Von Willebrand’s coagulation protein
von willebrands
s/s of hemophilia
Hemarthrosis neuro signs GI bleed epitaxis persistent prolonged bleeding uncontrolled hemorrhage
med tx for hemophilia
ddavp -vasopressin
what kind of meds to avoid for person with hemophilia
NSAIDS or any other drugs that can affect bleeding
play a key role in the front-line defense against invading pathogens
neutrophils
what Is considered neutropenic
less than 1000 to 1500/ml
what should people with neutropenia avoid
anything fresh, sushi, no well water because they can carry things that cause infection
immunocompromised patients what needs to be reported
low grade temperature; SEPSIS- infection.
neutropenic fever
100.4
before giving blood what do you need
VITALS
hyperkalemia, hypoglycemia, anemia, hyponatremia, hypochloremia
addisions
what to do for a person with addisons
fluids, steriods, daily weights,
symptoms of severe anemia
fainting, chest pain, angina, heart attack
what to do for a patient post op surgery is having signs of hypocalcemia
calcium gluconate IV
causes of thrombocytopenia
decreased platelet production- infection, ETOH abuse
increased platelet destruction- infection drug induced
abnormal platelet production-antibiotics, heparin
corticosteriods affect
blood glucose levels
adrenal hormones
sugar-glucocorticoids (cortisol)
salt-mineral corticoids (aldosterone)
sex- androgens
BIGUANIDES
metformin; monitor creatinine
Reduces rate of insulin production by the liver – improves glucose transport into the cells
BIGUANIDES
Stimulates the release of insulin by the beta cells of the pancreas and causes tissues to take up and store glucose more readily
SULFONYLUREAS
major side effect of SULFONYLUREAS
hypoglycemia
Glucatrol (Glypizide)
Diabeta/Micronase/Glynase (Glyburide)
Tolinase (Tolazamide)
Amaryl (Glimepiride)
-ide
SULFONYLUREAS
Lowers blood glucose by stimulating beta cells in pancreas to release insulin
meglitinide
pt teaching for meglitinide
take 30 mins before each meal ; if skip meal do not take
types of meglitinides
Repaglinide (Prandin) & Starlex
causes of anemia
bone marrow failure lack rbc production nutrient deficiency rbc damage family history blood loss
triangle for diabetes
exercise, diet, and medication
all counter regulatory hormones
increase glucose
most common complication of diabetes
hypoglycemia
dka needs
Hydration
Insulin
Electrolyte replacement
What level of blood glucose during DKA treatment do you switch from NS to D5 1/2 NS?
• Blood glucose of 250 mg/dL
• So that you can continue to give them insulin without worrying about hypoglycemia
o So you can continue treating the acidosis and anion gap, etc.
high calcium levels
could indicate kidney stones
what med do you administer first for thyroid storm
beta blocker
rebound of too much insulin causing hypoglycemia in PM and hyperglycemia in the AM
som effect
hyperglycemia often due to growth hormone
dawn
what to do for pt with som and dawn
assess glucose at night because pt is often hypoglycemia and may need to eat a snack before bed
levothyrox
take bp and apical pulse before giving med
increases metabolic rate ; before meals
it increases the workload of the heart
adverse reactions
Anxiety, Insomnia, Tremors, Tachycardia, Palpitations, Angina, Dysrhythmias.
