Fall Final Flashcards
What hormones does the thyroid produce?
T3 and T4
(Triiodothyronine and Thyroxine)
Calcitonin-regulates levels of blood Ca. Moves Ca from the blood to the bones.
Where does parathyroid hormone come from?
The parathyroid
What does parathyroid hormone do?
Regulate blood Ca levels by removing Ca from the bones and puts it in the blood
Problem with thyroidectomy
May take out the parathyroid glands too.
Mineral deficiency post thyroidectomy?
Calcium
How to tell if your patient is hypocalcemic.
Muscle cramps and tetany
Hypocalcemia signs to check for:
- Trousseau’s sign (use bp cuff, look for spasm)
- Chvostek’s sign (found in jaw)
Big problem after thyroidectomy?
- Airway swelling
- Active bleeding (accidental major blood vessel involvement)
- Iron deficiency
How to tell which side is swelling in a thyroidectomy or a carotidectomy?
Have patient stick out tongue and see which way it shifts. Do this prior to surgery as well.
Where does TSH come from?
Anterior Pituitary
Why hypocalcemic when in end stage renal failure?
- Kidneys manufacture Vit D, low Vit D levels lead to hypocalcemia
- Phosphorus and Ca work together in the presence of Vit D. No Vit D: the Ca goes down and the Phos goes up
Foods high in phosphorus
- All foods!
- Coke has a lot added
- Meat is phosphorus rich
Meds: Renagel or Phos-lo
- Used for dialysis patients to get rid of excess phos.
- Binds to phos
- Tums is way less effective but cheap
How to maintain healthy Ca levels?
- Vit D supplements
- Avoid phos aka coke
- Wt bearing exercise: bones need stress to maintain their density
Thyroidectomy: sign the airway is not doing well
Hoarseness: the 1st sign of airway obstruction
Ant. Pit Hormones
Growth Hormone TSH FSH LH Prolactin Adrenocorticotropic Hormone
Post. Pit Hormones
ADH (stored)
Oxytocin
Vasopressin
Sulfonylureas
- aka Glipizide (glucotrol, glucotrol XL) and Glyburide (diabeta, micronase)
- Antidiabetic drugs widely used in the management of DM type 2.
- Work by increasing insulin release from the beta cells in the pancreas.
- Metabolized in the liver.
Neutral Protamine Hagdorn (NPH)
- intermediate insulin
- Onset: 2-4 hrs
- Cloudy (due to added protein)
- Can be mixed with reg insulin: always draw clear before cloudy
Ant and Post Pit: same gland?
No, just separate glands that hang out together.
Thyroid and Parathyroid: same gland?
No, different and separate. glands.
TSH:
- made by the ant pit
- stimulates the thyroid to make thyroxine
Humalin R
- Short acting insulin
- Onset: 30-60 mins
- Peak: 2-4 hrs
- Duration: 6-8 hrs
Humalin N
- Intermediate acting insulin
- Onset: 2-4 hrs
- Peak: 6 hrs
- Duration: 10-16 hrs
Humalog
- aka Lispro
- Rapid acting insulin
- Onset: 5-15 mins
- Peak: 30-90 mins
- Do NOT mix ‘logs’ with other insulins
Novolog
- aka Aspart
- Rapid acting insulin
- Onset: 5-15 mins
- Peak: 1-3 hrs
Levemir
- Long-acting insulin
- no peak time
- Duration: 6-24 hrs
Glargine
- Long-acting insulin
- no peak time
- Duration: 20-24 hrs
If patient is NPO and their blood sugar is 35. What’s the best option?
Glucagon IV
Blood sugar was 30 and you treated with cola. What next?
- Take another blood sugar in 15 mins
- Ask if anything diff happened or a cause of the dip in their blood sugar
- Hx: 24 hrs of blood sugars, what happened in the last 24 hrs, insulin or meds givin in last 24 hrs.
Polydipsia
Excessive thirst or excess drinking
Polyuria
- Excessive or abnormally large production or passage of urine (>2.5 or 3 L over 24hrs in adults)
- Frequent urination is usually an accompanying symptom
Polyphagia
- aka hyperphagia
- Excessive or extreme hunger
- Diabetic polyphagia: In uncontrolled diabetes where blood glucose levels remain abnormally high (hyperglycemia), glucose from the blood cannot enter the cells - due to either a lack of insulin or insulin resistance - so the body can’t convert the food you eat into energy. This lack of energy causes an increase in hunger.
Insulin used in an IV or IV push:
Regular insulin only
Diagnostic test for prostate cancer:
PSA
Rhyme for s/s of hyper-/hypo-glycemia
High and dry
Low and slow (aka sweaty)
Biguanide aka Metformin (glucophage)
- Dec person’s ability to breakdown sugar from the liver
- Inc insulin sensitivity in muscle cells
Non-diabetic patients on insulin:
-post op
-big trauma
-steroid use ie. Prednisone
-TPN: given slowly but is ~50% sugar
:bag has ~10 units of insulin added to it
:pancreas takes over and makes a bunch of insulin to handle the extra sugar
:gradually wean to dec likelihood of hypoglycemia (ie 80cc/hr to 40cc/hr for a couple days, ect…)
What is a glomerulus?
A tiny ball-shaped structure composed of capillary blood vessels actively involved in the filtration of the blood to form urine. The glomerulus is one of the key structures that make up the nephron, the functional unit of the kidney.
Pyelonephritis
- Common cause: E. coli (comes up the urethra)
- acute or chronic bacterial infection of the kidney and the kidney pelvis
- geri: m. common cause-urinaty obstruction
Glomerulonephritis
- Common cause: Strep (comes from the blood because the glomeruli are a part of the circulatory system)
- Primary glomerulonephritis occurs independently of other chronic conditions but usually is an acute postinfectious process.
Diet for a dialysis patient?
- Low fluid
- Low protein
- No dairy due to the phosphorus
- Low fruits and veggies b/c of potassium
Post-dialysis concerns:
- Low bp
- wt: to ensure the proper amount of fluid has been taken off
Why weigh someone in end-stage renal failure?
Kidneys do not filter so no urine production = no output
Labs in renal failure
- Creatinine
- BUN
- GFR
- Sodium
- Potassium
- CBC (anemia due to lack of erythropoitein production)
Fistula consideration:
No bp in that arm
Functional unit of the kidney:
Nephron
There are a million in each kidney
AV Fistula
- Artery and vein joined together
- Feel the Thrill
- Listen to the Bruit
Osteodystrophy
- bone breakdown
- caused by low calcium
Pre renal failure
condition that happens before the kidney (ie. shock, infection) no blood going to the kidneys
Intra renal failure
Problem at the level of the Kidney (ie stones, cysts, infection of kidney)
Post renal failure
Problem post kidney effecting the kidney. (ie Bladder isn’t putting out and you have a clogged up catheter forcing fluid back into the kidneys. Prostate problems in guys force the urine back up into the kidneys. Kidney stone in the ureter. )
End stage renal failure:
- the kidneys can’t function
- transplant or dialysis needed
How does urine move down the ureters?
Peristalsis
Major intracellular cation?
Potassium
Two diseases caused by E. coli:
UTI
Pylonephritis
Bladder cancer s/s
Painless hematuria
What action brings urine up the ureter:
Vesicle ureteral reflex
Hydronephritis
Backflow of urine into the kidneys
Kidney stone removal
-aka Lithotripsy
-Nursing interventions
:Filter urine for passed stones
:Encourage fluids
:Monitor output
:Pain meds
Glomerular filtration rate (GFR)
Test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood
Cause of glomerular nephritis
Strep
Gastroparisis
A delay in gastric emptying
Endogenous Insulin
Insulin produced by the body
Glycogenolysis
Breakdown of liver glycogen
Ketoacidosis
An insulin deficit that causes fat stores of the body to break down, resulting in continued hyperglycemia and mobilization of fatty acids
Neuropathy
Neurological damage resulting in an alteration or loss in sensation
Ketosis
An accumulation of ketone bodies produced during oxidation of fatty acids
Gluconeogenesis
Formation of glucose from fats and proteins
Insulin
A metabolic hormone that aids the cells in taking in glucose from the blood
Hyperglycemia
An elevated blood glucose level
Exogenous Insulin
Insulin produced outside the body
Diabetes Mellitus
A metabolic condition in which the body had inadequate insulin to utilize blood glucose levels
Hyperosmolar Hyperglycemic Status (HHS)
A metabolic disorder characterized by plasma osmolarity of 340 mOsm/L or greater (normal range is 280-300 mOsm/L), greatly elevated blood glucose levels (over 600 mg/dL), and altered levels of consciousness
Hypoglycemia
Low blood glucose levels
DM Type 1
A metabolic disorder resulting in hyperglycemia which the body does not produce insulin, resulting in elevated blood glucose levels
DM Type 2
A metabolic disorder resulting in hyperglycemia as a result of inadequate quantities of insulin or the body’s ineffective use of available insulin
Diabetic Ketoacidosis
A condition that develops when there is an absolute deficiency of insulin and an increase in the insulin counterregulatory hormones (ie cortisol)
Pyuria
Pus in the urine
Oliguria
Urine output of less than 400 mL/day. This will result in renal failure if it isn’t reversed
Cytoscopy
- lighted scope inserted into the bladder
- Typically done under anesthesia
- You could expect to see some bleeding after this has been done
Hydronephrosis
The swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys.
Polycystic Kidney Disease (PKD)
An inherited disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys to enlarge and lose function over time. Cysts are noncancerous round sacs containing fluid. The cysts vary in size, and they can grow very large
Azotemia
Medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood.
Stress Incontinence
Occurs when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress.
Urge Incontinence
Occurs when you have a sudden urge to urinate. In urge incontinence, the bladder contracts when it shouldn’t, causing some urine to leak through the sphincter muscles holding the bladder closed. Other names for this condition are: overactive bladder. bladder spasms.
Functional Incontinence
Form of urinary incontinence in which a person is usually aware of the need to urinate, but for one or more physical or mental reasons they are unable to get to a bathroom. The loss of urine can vary, from small leakages to full emptying of the bladder.
Overflow Incontinence
The involuntary release of urine—due to a weak bladder muscle or to blockage—when the bladder becomes overly full, even though the person feels no urge to urinate.
