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medsurg 2 (: > Exam 3- endocrine, DM, hematology > Flashcards

Exam 3- endocrine, DM, hematology Flashcards

1
Q

Negative feedback mechanism

A

signals an endocrine gland to secrete a hormone in response to a body change to oppose the action of the change and restore homeostasis

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2
Q

Hypothalamus

A

Main boss- controls pituitary glands
Function is to produce regulatory hormones
Hormones:
Corticotropin-releasing hormone (CRH)
Thyrotropin-releasing hormone (TRH)
Gonadotropin-releasing hormone (GnRH)
Growth hormone releasing hormone (GHRH)
Growth hormone inhibiting hormone
Prolactin inhibiting hormone (PIH)

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3
Q

Pituitary gland

A

Divided into anterior and posterior lobes

Releases tropic hormones (hormones that stimulate other endocrine glands) in response to hypothalamus hormones

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4
Q

Anterior pituitary hormones and target organ

A

Thyroid stimulating hormone- thyroid
Adrenocorticotropic hormone- adrenal cortex
Luteinizing hormone- testes and ovaries
Follicle stimulating hormone- testes and ovaries
Prolactin- breast
Growth hormone- bone and soft tissues

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5
Q

Posterior pituitary hormones and target organs

A

Vasopressin (antidiuretic hormone)- kidneys

Oxytocin- uterus and breast

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6
Q

Adrenal gland

A

Tent shaped organs on the top of each kidney

Adrenal cortex and adrenal medulla

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7
Q

Adrenal cortex

A

Composes 90% of gland
Secretions regulated by adrenocorticotropic hormone (ACTH)
Hormones are called corticosteroids (adrenal steroids)
Aldosterone
promotes sodium and water reabsorption and potassium excretion
Regulated by RAAS, serum potassium level, ACTH
Cortisol
Released when you are stressed
Affects carbohydrate, protein and fat metabolism; emotional stability; immune
function; sodium and water balance
Regulated by levels of free cortisol, normal sleep-wake cycle, and stress
Release peaks in the morning

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8
Q

Adrenal medulla

A

1/10 of the gland
Stimulated by sympathetic nervous system (stimulates fight or flight response)
Norepinephrine and epinephrine

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9
Q

Thyroid gland

A

2 lobes on each side of the trachea- looks like a butterfly
Stimulated by TSH (thyroid stimulating hormone)
Iodine is needed to produce the hormones (salt)
Controls metabolism
Affects resp rate, HR and contractility of heart

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10
Q

Thyroid gland hormones

A

Thyroxine (T4)
Made first- converted to T3 with help of table salt (iodine)
Maintains body metabolism in steady state
Triiodothyronine (T3)
T4 converts to T3 in the cell
Increases metabolic rate
Decreases in older persons
Calcitonin (thyrocalcitonin)
Regulates serum calcium and phosphorus
Reduces bone resorption (breakdown)
Secreted when calcium is elevated
Pulls calcium from blood back into the bone

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11
Q

Parathyroid gland

A

4 small glands located close to or with in thyroid
Parathyroid hormone (PTH)
Regulates calcium and phosphorus metabolism
Acts on kidneys, bone, and GI tract
Takes calcium from bone to the blood
Activates vitamin D in kidneys to increase absorption of calcium

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12
Q

Pancreas

A 
Located behind stomach
Insulin from beta cells
     lowers blood glucose
Glucagon from alpha cells
     Increases blood glucose
Somatostatin from delta cells
     Inhibits secretion of glucagon and insulin
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13
Q

Important assessment with endocrine

A

Height, weight, and VS

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14
Q

Laboratory tests for endocrine

A 
Stimulation/suppression test
Assays- measure level of specific hormone in blood and other body fluids
Urine test
Tests for glucose
Imaging- MRI, US, CT
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15
Q

Anterior pituitary hormones

A

Growth hormone
Thyroid stimulating hormone
Adrenocortictropic hormone

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16
Q

Hypopituitarism

A

Deficiency of 1 or more anterior pituitary hormones
Decrease GH in adults- increase rate of bone destruction leading to thinner bones (osteoporosis) and increase risk for fractures

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17
Q

Hyperpituitarism

A 
Over secretion of anterior pituitary hormones
Increase GH in adults- acromegaly
     Thickened lips
     Coarse facial features
     Increase head size
     Lower jaw protrusion
     Enlarged hands and feet
     Joint pain
     Barrel chest
     Hyperglycemia
     Sleep apnea
     Enlarged heart, lungs, and liver
Some changes may be reversible but skeletal changes are permanent
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18
Q

Hyperpituitarism

Treatment

A

Bromocriptine

Hypophysectomy

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19
Q

Bromocriptine

A

dopamine agonists
Stimulates dopamine receptors and inhibits release of GH
Side effects- orthostatic hypotension, headache, nausea, abdominal cramps, constipation
Take with food
If pregnancy occurs stop immediately

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20
Q

Hypophysectomy

A

Surgical removal of pituitary gland
Nasal packing present for 2-3 days after surgery- necessary to mouth breath
Mustache dressing will be placed under the nose
Do not brush teeth, cough, sneeze, blow nose or bend forward after surgery
Monitor neurologic response
Post nasal drip or increase swallowing- cerebrospinal fluid leakage
Keep HOB elevated
Assess nasal drainage
Halo sign indicates CSF- light yellow color at the edge of clear drainage on dressing
Most CSF leaks resolve with bedrest
Deep breathing hourly
Rinse mouth frequently
Apply lubricating jelly to dry lips
Assess for meningitis- headache, fever, neck rigidity!!!!!!!!

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21
Q

Posterior pituitary disease

A

Vasopressin (ADH)
Low- Diabetes insipidus (DI)
High- SIADH

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22
Q

Diabetes insipidus

A

Water loss caused by ADH deficiency or inability of the kidneys to respond to ADH

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23
Q

Diabetes insipidus

Symptoms

A

Polyuria
Dehydration
Increase plasma osmolarity and sodium- stimulates sensation of thirst
Urine is diluted- low specific gravity <1.005
4-30 L of urine/day

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24
Q

Diabetes insipidus

Interventions/treatment

A 
Can't be NPO for more than 4 hours
Daily weight
24 hour urine
Desmopressin- synthetic vasopressin
Maintain adequate hydration
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25
SIADH
ADH continues to be secreted when not needed- water retention Decrease sodium can lead to seizures
26
SIADH | symptoms
``` Decrease urine volume; Increase urine osmolarity Weight gain Changes in LOC VS changes Bounding pulse Increase BP Decrease DTR ```
27
SIADH | interventions/treatments
Fluid restriction- frequent mouth rinsing Monitor for fluid overload- I&Os; daily weights Flushes tubes with NS instead of water (for the sodium) Sodium tablets Tolvaptan (PO) or Conivaptan (IV)- vasopressin antagonists Pull out water- Do not touch sodium- Do not use longer than 30 days When sodium levels are near normal can use normal diuretic
28
Adrenal cortex disease
Aldosterone- Na and H2O retention; K Excretion Cortisol- Cholesterol, protein, and fat metabolism; Glucose Low- Addisons High- Cushings
29
Addisons disease
``` Caused by inadequate secretion of ACTH, dysfunction of hypothalamic-pituitary control mechanism, or dysfunction of adrenal tissue Hyponatremia Hypovolemia Hyperkalemia Hypoglycemia ```
30
Addisons disease | symptoms
Neuromuscular- fatigue, lethargy, joint/muscle pain GI- abdominal pain, N/V, diarrhea, anorexia Salt craving Skin- primary insufficiency; increased pigmentation primary autoimmune; vitiligo (decreased pigmentation) secondary insufficiency; no skin color changes Hypoglycemia- sweating, headache, tachycardia, tremors Hyperkalemia- dysrhythmias, irregular HR Hyponatremia- decreased cognition and BP; often 1st indicator
31
Addisons disease | interventions/treatment
``` Initiate H2 histamine blocker IV for ulcer prevention Administer insulin with dextrose to shift K+ into cells Loop or thiazide diuretics Monitor HR, rhythm, and ECG IV glucose Hourly blood glucose Cortisone Hydrocortisone Prednisone Fludrocortisone ```
32
Cortisone
Take with meal or snack
33
Hydrocortisone
Report s/s of excessive drug therapy (cushing syndrome)
34
Prednisone
Report illness- daily dose not adequate during illness or stress
35
Fludrocortisone
Monitor BP | Report weight gain and edema
36
Cushing syndrome
Increase Na Increase fluid Increase glucose
37
Cushing disease | symptoms
``` Buffalo hump Enlarged trunk with thin arms and legs Round face- moon face Muscle wasting and weakness Thin/translucent skin Full bounding pulse Increase BP Edema ```
38
Cushing disease | intervention/treatment
Focus on pt safety Ketoconazole- decrease cortisol production Fluid and sodium restriction Monitor I&Os- daily weights Hypophysectomy- removal of pituitary gland Adrenalectomy- Removal of adrenal gland
38
Hypothyroidism
Decrease metabolism Water and mucous deposits in the body- myxedema Myxedema come- thyroid crisis
38
Hypothyroidism | symptoms
``` Muscle movement slows Cold intolerance Decreased libido Facial puffiness Goiter (enlarged thyroid) Thick tongue Weight gain Impaired memory Nonpitting edema ```
39
Hypothyroidism | Treatment
Levothyroxine- synthetic hormone replacement Start with low dose and gradually increase Given IV with myxedema coma Final dose determined by levels of TSH Taken in the AM on empty stomach 4 hours before or after meal
40
Hyperthyroidism
Excessive hormone secretion from thyroid Increased metabolism Can be temporary or permanent Graves disease- most common
41
Hyperthyroidism | symptoms
``` Palpitations Photophobia (sensitive to light) Weight loss; increased appetite Heat intolerance Increased libido Low grade fever Manic Exophthalmos- wide eyed/startled look Hyperglycemia ```
42
Hyperthyroidism | treatment
``` Reduce stimulation Promote comfort Drug therapy Beta blockers- treats symptoms Antithyroid drugs- methimazole/propylthiouracil Iodine preparations- Lugol solution Radioactive iodine (RAI) therapy Total or subtotal thyroidectomy ```
43
Methimazole/Propylthiouracil
Avoid crowds and people who are ill Watch for indications of hypothyroidism Do not take when pregnant- birth defects Propylthiouracil- watch for liver failure
44
Lugol solution
Initially can increase production of thyroid hormones | Check for fever, rash, metallic taste, mouth sores, sore throat, GI distress
45
Radioactive iodine (RAI) therapy
Use toilet not used by others for at least 2 weeks Flush toilet 3 times Use a laxative on second or third day Avoid contact with pregnant women, infants, and young children for first week
46
Total or subtotal thyroidectomy
VS every 15 minutes till stable then every 30 minutes Use pillows to support head and neck Avoid neck extension Deep breathing every 30 minutes to 1 hour Keep emergency tracheostomy equipment in room Monitor for thyroid crisis- fever, tachycardia, systolic HTN
47
Hypoparathyroidism
Decrease function of parathyroid | Hypocalcemia; Hyperphosphatemia
48
Hypoparathyroidism | symptoms
tingling and numbness muscle contractions positive chvostek and trousseau sign
49
Hypoparathyroidism | interventions/treatment
Correcting hypocalcemia, vitamin D deficiency, hypomagnesemia High calcium Low phosphorus diet Avoid milk, yogurt, processed cheese
50
Hyperparathyroidism
Increase function of parathyroid | Hypercalcemia; Hypophosphatemia
51
Hyperparathyroidism | interventions/treatment
Diuretics and hydration therapy | Parathyroidectomy
52
Euglycemia
Normal blood glucose
53
Type 1 DM
Insulin dependent- produce no insulin | Insulin given subQ everyday
54
Type 2 DM
Non insulin dependent- produces insulin just not enough
55
Absence of insulin
``` Hyperglycemia Polyuria Polydipsia- excessive thirst Polyphagia Ketone bodies ```
56
Ketone bodies
Acidic breakdown product that collect in the blood when insulin is not available Lead to ketoacidosis Result in kussmal respiration- Increase in rate and depth of respirations to "blow off" carbon dioxide and acids. "rotting citrus fruit" odor.
57
Chronic complications of diabetes
Cardiovascular disease Cerebrovascular disease Reduced immunity- high sugar lowers WBC Retinopathy- should get yearly eye checks Nephropathy- kidneys get damaged due to perfusion problems Neuropathy- become less sensitive to things Sexual dysfunction Cognitive dysfunction
58
Blood test
Glycosylated hemoglobin (A1C) Fasting blood glucose Glucose tolerance test Autoantibody testing
59
Glycosylated hemoglobin (A1C)
Measures how much glucose binds to hemoglobin in last 120 days 4-6% Normal range
60
Fasting blood glucose test
100 mg/dL Normal range | >126 on 2 test indicates DM
61
Glucose tolerance test
Used during pregnancy | <140 mg/dL Normal range
62
Autoantibody testing
Shows if its Type 1 or Type 2
63
Type 2 DM | treatment
Start off with diet and exercise Then med if needed Then insulin if needed
64
Type 1 DM | treatment
Diet and exercise, but still need insulin
65
Oral anti-diabetic agents
Reduce glucose or increase sensitivity to insulin Do not work for type 1 Used when type 2 DM can not be treated with diet and exercise alone Major side effect- hypoglycemia Monitor blood glucose and assess for hypoglycemia Not substitute for diet and exercise
66
Glimepiride
Insulin stimulator Increases insulin production from pancreas Teach pts s/s of hypoglycemia Take with or just before meals Check with HCP before taking any herbs or OTC
67
Metformin/Glucophage
Biguanides Decrease glucose production by the liver Avoid alcohol Stop before imaging testing using contrast and dont start again for 48 hours
68
Acarbose
Alpha-glucosidase inhibitor Slow down absorption of carbs in small intestines Take only with a meal Abdominal discomfort and bloating are common
69
Insulin Aspart
rapid acting | 0.25 hour onset
70
Human lispro
Rapid acting | 0.25 hour onset
71
Regular human
Short acting | 0.5 hour onset
72
Insulin Glargine
Long acting | 2-4 hour onset
73
Insulin Detemir
Long acting | 1 hour onset
74
units of rapid acting/grams of carbs
1 unit of rapid acting for 15 g of carbs
75
Hypoglycemia
Abnormally low glucose level <70 mg/dL
76
Hypoglycemia | causes
Too much insulin/ oral hypoglycemic agent Too little food Excessive physical activity
77
Hypoglycemia | adrenergic symptoms
``` sweating tremors tachycardia nervousness hunger ```
78
Hypoglycemia | CNS symptoms
``` inability to concentrate confusion double vision irrational behavior memory lapse slurred speech ```
79
Hypoglycemia | management
Treatment must be immediate 15 g fast-acting carbs (3-4 glucose tabs, 4-6 oz juice/soda, 6-10 hard candies, 1 TBS of honey) Retest glucose after 15 minutes Retreat if still <70 mg/dL Provide snack with protein and carbs if next meal is not within 1 hour
80
Bone Marrow
Functional site of blood formation in adults and produces RBC, WBC, and platelets
81
Blood comonents
Plasma proteins (albumin, globulins, fibrinogen) RBC/erythrocytes WBC Platelets
82
Accessory organs of blood formation
Spleen- destroys old or imperfect RBCs, breaks down hemoglobin released from these destroyed cells for recycling, stores platelets, and filters antigens Liver- produces prothrombin and other clotting factors, stores whole blood and blood cells
83
Hematologic changes associated with aging
``` Decrease in blood volume with lower levels of plasma proteins Bone marrow produces fewer blood cells RBC,WBC counts lower Decreased immunity Hemoglobin levels fall after middle-age ```
84
Reticulocytes
Immature RBCs Shoot up with decreased oxygen because body thinks its a RBC problem To make into adult cell we need folic acid, vitamin B12, iron, cobalt, nickle If any of these components are missing we become anemic
85
What does hemoglobin need to hold on to oxygen
Iron | which is why we see pallor with iron deficiency anemia
86
How do we lose Iron
bleeding only
87
RBC life span
120 days die in the spleen some go to the liver byproduct of dead RBCs is bilirubin
88
What does bilirubin do
Colors stool and urine
89
Who is at most risk for anemia
Vegetarians
90
RBC normal range
Female: 4.2-5.4 Male: 4.7-6.1
91
Hemoglobin Normal range
females; 12-16 | males; 14-18
92
Hematocrit normal range
females; 37-47 | males; 42-52
93
WBC normal range
5,000-10,000
94
Reticulocyte count normal range
0.5-2.0
95
Iron normal range
females; 60-160 | males; 80-180
96
Platelet count normal range
150,000-400,000
97
Bone marrow aspiration and biopsy
Let patient know we are going into hip bone- iliac crest Given a local anesthesia Side lying position, knees closer to chest, like a C shape Pts needs to stay still during this procedure Last 5-15 minutes Post-op; no aspirin, no contact sports right after procedure, avoid activity for first 48 hours
98
Sickle cell anemia
formation of abnormal Hgb chains that easily clump and stick together Genetic condition African Americans at greater risk Can have the trait (carrier) or active disease Usually diagnosed in childhood
99
Sickle cell anemia | RBC
Sticky- they stick together Do not have good oxygen carrying capacity Fragile break easily Less life span than healthy RBC
100
Sickle call anemia | Diagnostic
``` Hematocrit decreased Bilirubin elevated WBC elevated Reticulocyte elevated X-ray with bone changes CT with soft tissue damage Electrophoresis shows sickled hemoglobin ```
101
Sickle call anemia | Diagnostic
``` Hematocrit decreased Bilirubin elevated WBC elevated Reticulocyte elevated X-ray with bone changes CT with soft tissue damage Electrophoresis shows sickled hemoglobin ```
102
Sickle cell anemia | clinical manifestations
``` inadequate oxygen supply PAIN, especially in joints with edema cyanosis, open sores, darkened areas fatigue, SOB, cool extremities spleen and liver damage respiratory distress episodes are intermittent ```
103
Sickle cell anemia | prevention of crisis
``` drink at least 3-4 liters everyday avoid alcohol and smoking flu shot avoid hot and cold temperature extremes Avoid areas of high altitudes milk, low-impact exercise three times a week ```
104
Sickle cell anemia | treatment
``` pain management- IV analgesics Hydration Oxygen therapy Hydroxyurea Prophylactic antibiotics- penicillin ```
105
Hydroxyurea
reduces sickling episodes and pain by increasing production of HbF Can be given to stop a crisis but can not be used life long or long-term Monitor for toxicity- reduces bone marrow function
106
Anemias caused by decreased RBC production
iron deficiency vitamin b12 deficiency folic acid deficiency
107
Iron deficiency anemia
Occurs when the intake of dietary iron is inadequate for hemoglobin synthesis
108
Iron deficiency anemia | causes
inadequate diet blood loss poor GI absorption
109
Iron deficiency anemia | diagnosis
serum Ferritin <10 ng/mL | low H&H
110
Iron deficiency anemia | clinical manifestations
weakness and pallor brittle, thin, spoon shaped nails angular cheilosis- reddened areas on the corner of lips fatigue and reduced exercise tolerance Pica- desire to eat substances not meant for nutrition (common in pregnant women and children)
111
Iron deficiency anemia | treatment
PO iron supplements- Ferrous sulfate, Feosol IM- Iron Dextran IV- Venofer Monitor for side effects- dyspepsia, constipation, diarrhea, tarry stools, stained teeth
112
Iron deficiency anemia | client teaching
Vitamin C enhances absorption of iron
113
Dietary sources of iron
``` Red and organ meat Raisins Beans Egg yolks Leafy green vegetables ```
114
Vitamin B-12 deficiency | clinical manifestations
``` Big RBCs paresthesia and poor balance Glossitis- beefy red tongue Pallor Fatigue and weight loss Jaundice ```
115
Vitamin B-12 deficiency | treatment
Strict vegans need to supplement with vitamin B12 IM injections weekly, then monthly Oral, nasal spray, or sublingual B12 may be given after initial correction with injection methods
116
Foods rich in B12
meat eggs cheese milk
117
Folic acid deficiency anemia
Inadequate absorption of folic acid GI disease/surgery may alter absorption Alcohol increases folate deficiency Folic acid and vitamin B12 deficiencies can mask each other- when one is messed up so is the other
118
Folic acid deficiency anemia | causes
poor nutrition malabsorption (crohn's disease) drugs
119
Folic acid deficiency anemia | clinical manifestations
Same as vitamin B12 without nervous system involvement | Neural tube defects in infants can be seen if mom deficient during pregnancy (spinal bifida)
120
Folic acid deficiency anemia | treatment
Folic acid supplements | Dietary intake- liver, yeast, legumes, leafy green vegetables, oranges
121
Who needs a transfusion?
``` Blood loss due to trauma or surgery Thrombocytopenia Active bleeding Neutropenic oncology patients Sickle cell disease ```
122
Nursing considerations for blood transfusion
``` Verify order Patient education Make sure consent is signed Has patient had a previous reaction? Assess vital signs Inspect blood product prior to administration Another nurse must co-sign Blood must be transfused within 4 hours of receiving Use normal saline for priming and flushing tubing Dispose of properly Document 19 gauge or bigger ```
123
What can we do if pt has had reaction to blood transfusion before
Give a steroid prior to transfusion
124
What fluid can run with blood
Normal saline
125
What tubing is used for blood transfusion
Y-tubing
126
Universal blood donor
O neg
127
Universal blood recipient
AB neg
128
Types of transfusions
RBC Platelet Plasma WBC
129
RBC transfusion
Often given after surgery, trauma, or anemia Patient with Rh positive blood can receive blood from Rh negative; Rh negative cannot receive Rh positive blood Infuse within 4 hours per unit VS every 30 minutes during infusion
130
Platelet transfusion
Given when platelets are below 10,000 or patient with thrombocytopenia and active bleeding Infused within 15-30 minutes per unit Do not have to be donor matched Comes up frozen; let it thaw
131
Plasma transfusion
Given to replace blood volume and clotting factors Infused over 30-60 minutes per unit Do not have to be donor matched Comes up frozen
132
WBC transfusion
Given to neutropenic patient High risk of reaction- VS every 15 minutes Given over 45-60 minutes Not that common unless absolutely needed
133
Types of transfusion reactions
Febrile Hemolytic Allergic Bacterial
134
Febrile reaction | blood transfusion
Most often occur after multiple transfusions | s/s- chills, tachycardia, fever, hypotension, tachypnea
135
Hemolytic reaction | blood transfusion
Caused by blood type or Rh incompatibility s/s- fever, chills, headache, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom Can happen within 15-30 minutes of infusion beginning
136
Allergic reaction | blood transfusion
Most common if patient has other allergies Reaction may not occur until 24 hours after infusion s/s- urticaria, bronchospasm, itching, anaphlaxis
137
Bacterial reaction | blood transfusion
Contaminated blood product Rapid onset s/s- tachycardia, hypotension, fever, chills, shock
138
Circulatory overload | blood transfusion
Occurs when blood is transfused too quickly | s/s- HTN, bounding pulse, JVD, dyspnea, restlessness, confusion
139
If suspect a reaction.... | blood transfusion
``` Stop infusion immediately Check vital signs Oxygen Benadryl if needed Notify physician Document Send every piece of tubing equipment to the lab to be tested ```

medsurg 2 (: (1 decks)

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