lecture 7 Flashcards
what is the endocrine system
glands located all throughout the body that secrete various hormones into the blood stream
hormones produced are secreted to help maintain what
homeostasis
the hormones produced by the endocrine system maintain what things in the body
-fluid balance
-metabolism, energy balance
-contraction of smooth and cardiac muscle
-growth and development
-reproduction
-circadian rhythms
hormones flow through ________
capillaries
what system is used when hormones are needed through out the body
lock & key
the hormones are the ____ in the lock and key system
key
the target cells or receptor sites are the _____ in the lock and key system
lock
receptor site is ______ for one hormone
specific
what is the most common type of endocrine feedback system
negative feedback system/mechanism
what does the negative feedback system/mechanism do
reverse changes that occured in the controlled condition
the negative feedback system will result in the gland increasing or decreasing the _____ of a hormone
release
Hormone secretion usually depends on the body’s need for the final action of the hormone
- Body condition moves away from normal range
- Specific hormone stimulated -> starts chain of events to return body to normal
- Once need is met and body condition normalized, secretion of the hormone will cease
glands of the endocrine system (10)
-pineal gland
-hypothalamus
-anterior and posterior pituitary gland
-thyroid gland
-parathyroid gland
-thymus
-adrenal glands (2)
-pancreas
-ovaries
-testes
what produces regulatory hormones that are either releasing hormones or inhibiting hormones
hypothalamus
what is the function of regulatory hormones
to stimulate or inhibit release of hormones from the anterior pituitary gland
the hypothalamus is responsible for synthesizing what hormones
oxytocin and antidiuretic hormone (ADH)
oxytocin and antidiuretic hormone are made by the hypothalamus but stored and released from where?
the posterior pituitary gland
This is regulated by the hypothalamus by inhibiting or releasing hormones
anterior pituitary gland
the anterior pituitary gland contains ______ hormones
tropic
hormones that send messages to other endocrine glands to release their hormones are called
tropic hormones
what are the 4 tropic hormones
-thyroid stimulating hormone
-adrenocorticotropic hormone
-follicle-stimulating hormone
-luteinizing hormone
what are the other two hormones in the anterior pituitary gland that act directly on final target tissues
-growth hormone
-prolactin
TSH sends messages to what gland to release their hormones
thyroid
ACTH sends messages to what gland to release their hormones
adrenal glands
FSH sends messages to what gland to release their hormones
ovary/testes
LH sends messages to what gland to release their hormones
ovary/testes
the growth hormone affects what
body tissues
prolactin affects what
mammary gland
what is the extension of the hypothalamus that does NOT synthesize hormones
posterior pituitary gland
where are the hormones produced that are in the posterior pituitary gland
the hypothalamus
the posterior pituitary gland stores and releases what hormones
antidiuretic hormone and oxytocin
antidiuretic is also known as what
vasopressin
what is the mnemonic for the hormones of the anterior pituitary gland
flat pig -fsh, lh, acth, tsh, prolactin, ignore, gh
what is the target organ and effects for thyroid stimulating hormone (TSH)
-thyroid gland
-stimulates thyroid gland to secrete thyroid hormones
what is the target organ and effects for adrenocorticotropic hormone (ACTH)
-adrenal gland (cortex)
-stimulates adrenal cortex to secrete glucocorticoids (cortisol)
what is the target organ and effects for follicle-stimulating hormone (FSH)
-ovary and testes
-stimulates secretion of estrogen and the development of ova in women and sperm development in men (control of reproductive function)
what is the target organ and effects for luteinizing hormone (LH)
-ovaries and testes
-stimulates ovulation in women and secretion of sex hormones in both men and women (control of reproductive function)
what is the target organ and effects for growth hormone (GH)
-liver, adipose tissue
-promotes growth (indirectly)
what is the target organ and effects for prolactin
-mammary gland
-stimulates breast development necessary for lactation after child birth
what is the target organ and effects for antidiuretic hormone or vasopressin
-kidney
-regulates fluid volume by stimulating reabsorption of water in the kidneys
what is the target organ and effects for oxytocin
-ovary and testis
-stimulates ejection of milk into mammary ducts and uterine contractions
what gland is anterior to the trachea and consists of two lobes
thyroid gland
what three hormones are produced by the thyroid gland
-triiodothyronine T3
-thyroxine T4
-calcitonin
what is the only gland of the endocrine system that can be palpated
thyroid gland
why must a provider take precaution when palpating the thyroid
because it can release additional hormones and exacerbate symptoms
thyroid hormones are essential for what things
-physical growth
-mental development
-reproductive maturation
-metabolic activity
-life
thyroid hormones increase the metabolic rate of the body utilizing ______ and producing ______
-energy
-heat
if a person is in cold temps will more or less thyroid hormones be released to increase heat production
more
in order for the body to produce T3 and T4 there must be a sufficient intake of what two things
-protein
-iodine
calcitonin is release when serum calcium levels are too _____
high
calcitonin inhibits breaking down bones for calcium and phosphate which does what
-keeps calcium from leaving the bones
-decreases resorption of calcium in the kidneys
calcitonin ____ serum levels of calcium
lowers
how can a nurse assist with palpation of the thyroid
-position them
-giving patients sips of water
what are the four glands that sit on the thyroid gland
parathyroid gland
what does the parathyroid gland produce
parathyroid hormone
parathyroid hormone raises serum _____ levels and _____ levels
-calcium
-phosphate
the parathyroid hormones ____ calcium that is stored in bones
pulls
the parathyroid hormones encourages the _____ and ______ to reabsorb more calcium
kidneys and small intestine
the target organs of the parathyroid hormone include what organs
-bones
-small intestine
-kidneys
where does the adrenal glands sit
on top of the kidneys
the adrenal glands consist of what two sections
-adrenal medulla
-adrenal cortex
what hormones does the adrenal medulla release
epinephrine and norepinephrine
when epinephrine and norepinephrine are released from the adrenal medulla these catecholamines act as ______ not ______
-hormones
-neurotransmitters
hormones from the adrenal medulla are released during what
stress to manage the bodys stress response
the release of epinephrine and norepinephrine from the adrenal medulla causes what SNS response
-increased cardiac contractions
-increased cardiac output
-increased heartrate
-increased BP
-bronchodilation
-enhanced blood flow to muscles
-increased glucose availability
what are the three hormones produced and secreted from the adrenal cortex
-mineralocorticoids (aldosterone)
-glucocorticoids (cortisol)
-gonadocorticoids (androgens)
what do mineralocorticoids (aldosterone) do in the body
-acts on kidneys to conserve sodium and fluid follows
-acts on kidneys to rid the body of potassium
-increased serum sodium, decreased serum potassium, increased fluid volume, increased blood pressure
what do glucocorticoids (cortisol) do in the body
-provides energy sources to the body and ensures glucose is made available for the brain
-acts on liver to convert glycogen to glucose
-released during body’s response to stress - the body requires more energy for stress induced changes
when the body is stressed, the ______ tells the ________ gland to release ACTH, then travels to the adrenal cortex and stimulates release of cortisol
-hypothalamus
-anterior pituitary gland
what do gonadocorticoids (adrogens) do in the body
contribute to libido and reproduction
if a person has hyperkalemia ______ will be released to lower potassium
aldosterone
adrenal cortex mnemonic
Make Good Sweets
saying: salt, sex, sugar
Mineralocorticoids, Glucocorticoids, Sex hormone
mnemonic for adrenal medulla
-men
Medulla
Epinephrine
Norepinephrine
what is both an endocrine and exocrine gland
the pancreas
what is the function of the pancreas as an exocrine gland
release of amylase and lipase for digestion assistance
what is the function of the pancreas as an endocrine gland
secretes insulin and glucagon for glucose homeostasis into the blood stream
cells within the pancreas includes:
alpha and beta cells
what do alpha cells secrete
glucagon
what do beta cells secrete
insulin
alpha and beta cells live within a section of the pancreas called what
islet of langerhans
this is released by the pancreas when serum glucose rise
insulin
Insulin is the ___ to unlock the cells
key
once cells are unlocked ______ can travel inside the cells and be used for energy
glucose
without insulin the cells will starve because they cannot what
metabolize glucose
this is released by the pancreas when serum glucose levels are low
glucagon
glucagon stimulates the liver to turn glycogen to ______
glucose
______ is imperative to combat hypoglycemia because it can lead to brain death
glucagon
causes of endocrine disorders
-overproduction of the hormone
-underproduction of the hormone
-side effects of certain drugs
a primary endocrine disorder means something is wrong with what
the gland itself
a secondary endocrine disorder means something is wrong with what
a different gland/organ affects the endocrine gland
what decreases in the endocrine system as we age
-growth hormone
-decrease in tsh and thyroid hormone
-insulin secretion
as you age and there is a decrease in growth hormone this happens to the body
decrease in muscle mass and increase in fat storage
as you age and there is a decrease in TSH and thyroid hormones this happens to the body
decrease in basal metabolic rate
as you age and there is a decrease in insulin secretion this happens to the body
decrease in glucose tolerance but not diabetes
as we age and the endocrine system functions decrease is causes a decrease in _____
energy
disorder of carbohydrate metabolism
diabetes mellitus
the body is intolerant to glucose for what reasons
-the pancreas has developed faulty production of insulin either decreasing it or ceased completely
-the tissues have become insensitive to the insulin
how is an individual diagnosed with diabetes
various ways but an elevated HbA1C is most common
type 1 dm accounts for what percent of all diabetes mellitus
5%
how many million children and adults have type I DM
1.25 million
when does type I dm usually develop and how is the onset of symptoms
childhood or adolescence and symptoms are abrupt
DM1 is an _______ disease
autoimmune
with type I dm the body’s immune system destroys pancreatic ____ cells that produce ______
-beta
-insulin
how much insulin is produced within the body with type I dm
none
with type 1 dm why is the pancreas unable to secrete insulin
because there are no beta cells to synthesize it
what must a type one diabetic have to live
exogenous insulin
how often should a type I diabetic administer insulin
daily for the rest of their lives
without exogenous insulin, a type I diabetic s blood sugar levels can become critically ______
high
exogenous insulin is what
synthetically made insulin
insulin production is reduced and/or cells are resistant is what
type 2 diabetes
what percentage of diabetics have type 2
95%
when in life does type 2 dm usually occur
middle age and progresses gradually
what are the risk factors for developing DM2
-genetics
-obesity
-poor diet
-sedentary lifestyle
with type 2 dm there are less ____ cells available to synthesize the insulin because they’ve been _____ for so long
-beta
-overworked
with type 2 dm the beta cells that are still aliive have a _____ response to rising glucose levels causing delayed or decreased release of _____ from the pancreas
-decreased
-insulin
______, _______ and _______ tissue dont respond to insulin as quickly or efficiently when a person is a type 2 diabetic
liver, muscle and adipose tissue
DM2 can be managed with _____, ____ and ______
-diet
-oral agents
-insulin
what occurs when glucose available exceeds the amount of insulin available
hyperglycemia
what is a normal blood sugar range
74-106
what are causes of hyperglycemia
-overeating
-stress and illness
-not enough medication or inappropriate medication regimen
why does stress and illness affect blood sugar levels
cortisol is released which causes an increase in glucose levels
chronically high blood glucose levels can to what
long-term complications
what are symptoms of hyperglycemia
-polyuria
-polydipsia
-polyphagia
-glucosuria
-blurred vision
-fatigue, lethargy, headache
-abdominal pain
-eventual coma
hyperglycemia symptoms occur because of what
-the body is attempting to rid the excess glucose from the serum
-the body is reacting from cells starving
treatments of hyperglycemia in the diabetic patient
-dietary changes
-increased physical activity
-education
-non-insulin oral agents
-insulin coverage
this occurs when there is not enough glucose available for the amount of insulin circulating in the blood
hypoglycemia
what are the causes of hypoglycemia
-not enough food
-under eating
-skipping a meal
-too much insulin
-exercise
repeated episodes of hypoglycemia or extremely low blood glucose levels can cause what
neurological damage
initial signs and symptoms of hypoglycemia
-hunger
-shaky, tremors
-sweating
-palpitations
-pallor
-headaches
neurological signs and symptoms that occur if hypoglycemia is left untreated
-irritability
-confusion
-seizures
-coma
-death
what should you always do before treating hypoglycemia
assess the blood glucose level if a glucometer is available
if the blood sugar is less than 74 or a patient has signs and symptoms of hypoglycemia what should you do
provide simple sugar
if a patient is awake, alert, cooperative administer ___ to ____ grams of fast-acting simple-carbohydrates
15 to 20 grams
examples of 15 to 20 grams of fast acting simple carbohydrates
-4-6 oz of juice or regular soda
-6-8 hard candies such as lifesavers
if a patient is lethargic, unconscious, unable to swallow or uncooperative what should you do for hypoglycemia
-administer sub q or IM glucagon
-if they have IV access adminster dextrose
after initial intervention for hypoglycemia what should you do
-stay with patient during this time
-recheck glucose in 15 minutes
if the blood glucose continues to be below 74 or patient remains symptomatic what should you do
-repeat administration of fast acting simple carb or glucagon depending on patients status
you will continue to administer fast acting simple carbs or glucagon until when?
the blood sugar is above 74
once the glucose level has reached 74 or greater what do you do for the patient
provide a snack of complex-carbs
what are examples of a snack of complex carbs
-peanut butter and crackers
-sandwich and chips
-a meal
most deaths from diabetes are dur to what
long-term compications
what are some long term complications of diabetes
-macrovascular damage
-microvascular damage
-neuropathy
-increased risk for infection
-complications with the feet
macrovascular damage that occurs with long term dm
-atherosclerosis and arteriosclerosis develop
-more prone to developing HTN and elevated LDL and triglyceride levels
-increased risk of developing heart attack, stroke & poor circulation of the dependent extremities
microvascular damage that occurs with long term dm
-damage to small blood vessels and capillaries; blood flow decreases from thickening of vessel walls, target organ damage occurs
-retinopathy
-nephropathy
nerve damage due to chronic hyperglycemia
neuropathy
neuropathy causes ______ and _____ or decreased sensation in extremities
numbness and pain
what medications are used to manage pain for neuropathy
gabapentin or antidepressants
why is a person with long term dm at an increased risk for infection
slowed healing due to impaired circulation
what complications occur with the feet in diabetics
-neuropathy causes decreased sensation and unknown wounds
-risk for infection and slowed wound healing
-foot assessment and foot care is extremely important
-amputations of lower extremities common
to prevent long term complications of DM individuals should do what
-control blood glucose levels
-control blood pressure
-control cholesterol levels
-avoid smoking
-maintain appropriate weight
-exercise regularly
treatment of DM
-diet
-exercise
-maintain appropriate weight
-monitor and manage blood glucose levels
-medications
non-insulin oral agents require the pancreas to still have some function so they cannot be used for who
-type 1 diabetics
what two ways do oral agents work in diabetics
-produce more insulin through stimulating the pancreas
-make the tissues/muscles more sensitive to insulin
two non-insulin oral agents
glimepiride (amaryl)
metformin (glucophage)
what drug class is metformin
biguanide
metformin _______ glucose production in the liver and _____ response to insulin by increasing cell uptake of glucose in the tissues
decreases
increases
metformin can cause _____ damage
kidney
what should you check before administration of metformin
EGFR. bun and creatinine
avoid administration of metformin if the patient recently had what
contrast dye
what drug class is glimepiride
sulfonylurea
glimepiride stimulates insulin ______ by the pancreas and _____ response to insulin by increasing cell uptake of glucose in the tissues
production
-increases
when a patient is on glimepiride what should you monitor for and why
hypoglycemia because of the increase of insulin secretion
where can insulin be administered on the body
-tissue of the back fatty part of the arm
-abdomen
-anterior thigh
-buttocks
rotation of sites for insulin is key to avoid complications with what
tissue distribution
what must you know before administering any type of insulin
blood sugar level
insulin is a _____ drug because it can quickly cause
high risk
____ nurses must verify the amount and type of insulin being administered
two
how to perform the double check of insulin
draw up insulin leave the needle and syringe in the insulin vial and ask the nurse to verify the amount by asking what do you see
the nurse should look at the syringe and tell you the _____ of insulin they see along with verifying the ______ from the bottle
amount
medication
what are the four different types of insulin
-rapid acting
-short acting
-intermediate acting
-long acting
insulin is classified by “time coarse” which includes
onset, peak and duration of drug
how long it takes for the insulin to begin working and lowering glucose is the what
onset
when the insulin is working the very hardest to lower glucose levels is the what
peak
how long the insulin continues to work until it is completely used up is the what
duration
mealtime insulin is also known as _____ insulin
bolus
mealtime insulin works quickly in the body to keep blood glucose levels under control after a ____
meal
when is bolus insulin given
at or right before mealtime, or when blood sugars are extremely elevated
insulins in the mealtime or bolus category are what
-rapid acting insulin
-short acting insulin
what are the rapid acting insulins
lispro - humalog
aspart - novolog
how do rapid acting insulins work
they assist in lowering blood glucose levels quickly
what is the onset of rapid acting insulin
5-20 minutes
what is the peak of rapid acting insulin
30 minutes to 3 hours
hat is the duration of rapid acting insulin
2-5 hours
what assessment should be done prior to rapid acting insulin administration
assess blood glucose levels - no sooner than 30 minutes prior to adminstration
do not give rapid acting insulin more than ______ before meal ingestion
15 minutes
what are the short-acting insulins
novolin r
humulin r
how do short-acting insulins work
assist in lowering blood glucose levels quickly
what is the onset of short-acting insulin
30 minutes
what is the peak of short-acting insulin
2-5 hours
hat is the duration of short-acting insulin
5-8 hours
prior to administering short-acting insulin you must do what
assess the blood glucose level no sooner than 30 minutes prior to giving
do not give short-acting insulin more than ______ before meal ingestion
30 minutes
what is the only insulin that can be given by IV
short-acting regular insulin
daily control insulin is also known as _____ insulin
basal
how does daily control insulin also known as basal insulin work in the body
works slowly throughout the day to keep glucose levels consistent
daily control insulin also known as basal insulin mimics what
the pancreas’ secretion of insulin
what levels would the insulin be at to administer basal insulin
within appropriate ranges
when is daily control insulin or basal insulin not given
when the patient is hypoglycemic
which insulins are in the category of daily control insulins or basal insulins
-intermediate-acting insulin
-long-acting insulin
medications that are intermediate acting insulin
-novolin N
-humulin N
how do intermediate acting insulins work
assists in lowering the blood glucose level over the course of the day
what is the onset of intermediate acting insulin
1-2 hours
hat is the peak of intermediate acting insulin
6-12 hours
what is the duration of intermediate acting insulin
18-26 hours
how often is intermediate acting insulin given
one to two times a day
what should you do before giving intermediate acting insulin
assess blood glucose level no sooner than 30 minutes prior to adiministration
what medication is a long acting insulin
insulin glargine - lantus
what is the onset of long-acting insulin
1-2 hours
what is the peak of long acting insulin
no peak
what is the duration of long acting insulin
up to 24 hours
how often is long acting insulin given
one to two times a day
what should you do before giving long acting insulin
assess blood glucose level no sooner than 30 minutes prior to giving
long-acting insulin should be given at ____ time each day
same
sliding scales are only used with ____ insulin
bolus
with a sliding scale the dose of bolus insulin administered is dependent on what
glucose reading
parts of the GI system
-oral cavity
-pharynx
-esophagus
-stomach
-small and large intestines
-liver
-gallbladder
-pancreas
-rectum
-anus
what are the accessory organs of the GI system
liver gallbladder and pancreas
This part of the GI system carries undigested food from the pharynx to the stomach
esophagus
muscle later in the wall off the esophagus propels food forward to the stomach
peristalsis
circular smooth muscle ring at the junction of the stomach is called what
lower esophageal sphincter
the lower esophageal sphincter ____ to allow food to enter and _____ to prevent backflow into the esophagus
-relaxes
-contracts
reservoir for food where digestion begins to take place gets the food ready to be digested other places
stomach
at are the four main regions of the stomach
-cardia
-fundus
-body
-pylorus
the pylorus narrows at the what
pyloric sphincter
the stomach mucosa contains folds (gastric pits) with glands that produce and secrete what
gastric juices
when do gastric juice secretions begin
at the sight or smell of food
when do gastric juice secretions increase
with the presence of food in the stomach
this is released by the stomach mucosa to increase gastric juice secretions
gastrin
ingested food becomes a thick liquid called what
chyme
this relaxes to allow small amounts of chyme to pass into the small intestines/duodenum
pyloric sphincter
what is the hormone of the stomach
gastrin
what are the three sections of the small intestines
-duodenum
-jejunum
-ileum
this secretes bild from the liver/gallbladder for disposal and enzymes from the pancreas to aid in digestion
ampulla of vater
what are the two enzymes from the pancreas
amylase
lipase
this comes from the pancreas and turns starch into maltose
amylase
this comes from the pancreas and turns emulsified fats into fatty acids and monoglycerides
lipase
chyme enters stimulating production/secretion of intestinal enzymes which complete digestion so that the end product can be absorbed and used by the body from the _____
small intestines
what are the enzymes of the small intestines
-sucrase
-maltase
-lactase
absorption of nutrients requires large surface area which is why there are extensive ____ in the small intestines
folds
the liver receives oxygenated blood from the what
hepatic artery
blood enters the liver from the digestive organs by the what
hepatic portal vein
the hepatic portal vein allows the liver to regulate nutrients or remove _____ substances from the blood before circulating back into the system
toxic
all blood leaves the liver via the what
hepatic vein
what does bile do in the liver
-carries bilirubin and excess cholesterol to the intestines for elimination
-emulsifies fats in the small intestines aka breakdown fats
where is the gallbladder located
the undersurface of the liver
the gallbladder ______ and ______ bile until it is needed by the small intestine
-stores
-concentrates
fatty foods entering the duodenum stimulates what hormone and to be released from the intestinal mucosa
cholecystokinin
cholecystokinin stimulates the ______ to contract and release bile into the duodenum
gallbladder
