Test 4 endocrine shi Flashcards
What are the classifications of Diabetes?
1
2
Gestational
Prediabetes
LADA
Diabetes associated w other conditions
Function of insulin
Transport and metabolize glucose for energy
Stimulates storage of glucose in liver and muscle as glycogen
Singals liver to stop release of glucose
Enhance storage of dietary fat in adipose tissue
Accelerates transpor of amino acids into cells
Inhibits the breakdown of stored glucose, protein, and fat
What is type 1 diabetes?
Beta cells in pacreas are destroyedd by a combination of genetic, immunologic, and environmental factors
Results in decreased insulin productino
What is type 2 diabetes?
Insulin resistance and impaired insulin secretion
Slow, progressive glucose intolerance
Obesity usualy present in diagnosis
What is latent autoimmune diabetes of adults?
Subtype of diabetes, beta cell destrution in pancreas is slower than in type 1 and 2
IS NOT INSULIN DEPENDENT in the initial 6 months of disease onset
Manifestations are smiliar to type 1 and 2
R
Risk factors of type 1 and 2 diabetes
1: Early onset (<30), familial, genetic, race/ethnicity
2: Obesity, over 30, HTN, HDL less than or equal to 35, triglycerides over 250, history of gestational diabetes or baby over 9 pounds
Clinical Manifestations of Hyperglycemia
3 P’s: Polyuria, Polydipsia, Polyphagia
Fatigue
Weakness
VIsion changes
TIngling or numbness in hands or feet
Dry skin
Wounds slow to heal
Recurrent infections
Type 1: sudden weight loss, NV, abdominal pains
Diagnostic findings of diabetes
Fasting blood glucose: 126 or more
Casual Glucose exceeding 200
Why is a glucose tolerance test more effective in diagnosing diabetes than urine testing for glucose?
Glucose tolerance test has higher renal threshold for glucose
What is the medical management of diabetes?
Normalize insulin activity and blood glucose levels to reduce the development of complications
ADA recommends an HgBA1c (determines average blood glucose over 3 months) less than 6.5%
Management has 5 components
* Nutritional therapy
* Exercise
* Monitoring
* Pharmacoligical Therapy
* Education
Dietary management of diabetes
Control calories
Control blood glucose
Normalization of lipids and blood presure to prevent heart disease
Nurse role: Be knowledgeable about dietary management
Communicate with dietician or other management specialties
Reinforce patient understanding
Support dietary and lifestyle changes
Meal planning for diabetes
Consider food preferences, lifestyle, usual eating times, culture and ethnic shi too
Review diet history and need for weight loss, gain , or maintenece
Carbs: 50-60% emphasize whole grains
Fat: 20-30 %
Nonanimal protein sources like legumes, whole grains, increase fiber too
Glycemix index
Combining starchy foods with protein and fat slows absorption any glycemic response
Raw or whole foods tend to have lower response than cooked, chopped, or pureed foods
Eating whole fruits rather than juices ; decreases glycemic response because of fiber
Adding foods with sugars may produce lower response if eaten with foods that are more slowly absorbed
Exercise precautions for diabetes
Insulin normally decreases with exercise ; patients on exogenous insulin should eat a 15- g carbohydrate snack before moderate exercise to prevent hypoglycemia
Patients with type 2 diabetes not taking insulin or an oral agent may not need exra food before exercsie
Potential postexercise hypoglycemia
Monitor blood glucose levels
Insulin therapy
Blood glucose monitoring
Individualize treatment
Categories of insulin
Rapid: 15-30 min
Short acting: Regular insulin ; 30-60
Intermediate acting: NPH ; 4-12 hours
Long acting: no peak
Complications of insulin therapy
ALlergic reactions
Insulin lipodystrophy
Resistance to injected insulin
Morning hyperglycemia
Oral Antidiabetic agents
Used only for type 2 diabetes who require more than diet and exercise alone
Major side effect: Hypoglycemia and GI shi
Nursing interventionsL Monitor glucose
Acute complications of Diabetes
Hypoglycemia
DKA
Hyperglycemic hyperosmolar syndrome
Signs of hypoglycemia
Andrenergic: Sweating, tumors, tachycardia, palpitations, nervousness, hunger
Central: Inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness
Severe: Disorientation, seizures, loss of consiousness, death
What can cause hypoglycemia?
70 or below
Too much insulin or oral hypoglycemic agents
Excessive physical activity
Not enough food
Management of hypoglycemia
Give 15-20 g of fast acting concentrating carbs
* 4-6 ounces of juice or regular soda
Emergency measures, if pt cant swallow, or unconsiousness
* Subq or IM glucagon 1 mg
* 25 to 50 mL of 50% dextrose solution IV
What is DKA?
Absence or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, and fat
Clinical features: hyperglycemia, dehydration, acidosis
Clinical Features of DKA
Altered mental status
Fruity odor
Kussmal breathings
Dry axilla
NV
Abdominal pain
Polyuria
Assessment of DKA
Blood glucose of 250 and 800
Severity of DKA not only due to blood glucose
Keoacidosis is reflected in low serum bicardbonate, low pH; low PCO2 reflects respiratory compensation (Kussmaul respirations)
Keton bodies in blood and urine
Electrolytes vary according to degree of dehydration ; increase in creatinine, HCT, BUN
Management of DKA
Rehydration with IV fluids
IV continous infusion of regular insulin
Reverse acidosis and restore electrolyte balance
Note: Rehydration leads to increase plasma volume and decreased K ; insulin enhances movement of K into cells
Hyperglycemic hyperosmolar syndrome
Caused by lack of sufficient insulin ; ketosis is minimal or absent
Hyperglycemia causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolality
Manifestations: Hypotension, profound dehydration, tachycardia, and variable neruologic signs caused by cerebral dehyration
High mortality rate
Usually is the patients that come in w/ 3 P’s
Management of HHS
Rehydration
Insulin administration
Monitor fluid volume and electrolyte status
Prevention
* Diagnosis and management of diabetes
* Assess and promote self care management skills
Long term complication of diabetes
Macrovascular: Accelerated athersclerotic changes ; coronary artery disease, cerebrovascular disease, peripheral artery disease
Microvascular: Microangiopathy ; diabetic retinopathy , nephropathy
Neuropathic: Peripheral neuropathy, autonomic neuropathies, hypoglycemic, unawareness, neuropathy, sexual dysfuntion
What kind of feedback mechonism is the endocrine system?
Negative
Anterior Pituitary secretes what?
FSH
LH
Prolactin
ACTH
TSH
GH
Hyper pituitary can cause?
Cushing’s Syndrome
Gigantism
Acromegaly
SIADH
Hypo pituitary can cause?
Dwarfism
Panhypopuitarism
DI
What does posterior pituirary secrete?
ADH
Vasopressin
Oxytocin
Whar causes Cushings Syndrome?
Overproduction of ACDH
What does thyroid secrete?
T3
T4
Calcitonin
Where is iodine contained?
In thyroid hormone
What controls the release of thhyroid hormone?
TSh from anterior pituirary gland
Parathyroid secretes what?
Parathormone
What does parathormone do?
Regulates calcium and phosphorus balance
Increased parathormone elevates blood calcium by increasing caclium absorption from the kidney, intestine, and bone
Lowers phosphorus levels
What does adrenal medulla secrete?
Catecholamines ; epi and norepi
This functions as part of autonomic nervouns system
What does adrenal cortex secrete?
Glucocorticoids
Mineralcorticoids
Androgens
What kinds of thyroid diagnostic tests are there?
TSh
Serum free T4
T3 and T4
T3 resin uptake
Thyroid antibodies
Radioactive iodine uptake
Fine needle biopsy
What kinds of thyroid disorders are there?
Cretinism
Hypothyroidism
Hyperthyroidism
Thyroiditis
GOiter
Thyroid cancer
CLinical manifestations of hypothyroidism
Coarse, dry, brittle hair
Loss of lateral eyebrows
Pallor
Large tongue
Lethargy and impaired memory
Deep, coarse voice
Diminished perspiration and cold intolerance
Slow pulse, enlarged heart
Constipation
Weight gain
Peripheral Edema
Muscle weakness
What is hyperthyroidism?
Graves disease
Thyrotoxicosis ; excessive output of thyroid hormone (thyroid storm)
AUtoimmune disorder
Women 8x more likely to get
Hyperthyroidism clinical manifestations
Fine hair
Exophthalamos
Goiter
Sweating, heat intolerance
Muscle wasting
Tachycardia, palpitations, high output failure
Weight loss
Bulging of eyes
Thyroid Storm
Severe hyperthyroididm ; abrupt onset usually precipitated by stress
Untreated it can be fatal, but with proper treatment the mortality rate is reduced a lot
Manifestations: Hyperpyrexia (over 101)
Extrememe tachycardia (>130)
Exaggerated symptoms of hyperthyrpoidism
Altered nuerologic or mental state, which frequently appears as delerium psychosis, somnolence, or coma
Treatment for thyroid storm
Hypothermia
O2
IV fluids
Medications : Iodine, methimazole, propylthiouracil, hydrocortisone
What is hyperparathyroidism?
May have no symptoms or experience signs and symptoms resulting from involvment of several body systems
Mannifestations: Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias
Treatment: Surgical removal
Hypoparathyrooidism causes
Abnormal parathyroid develiopment
Destruction of parathyroid glands
Vitamin D deficiency
Clinical manifestations of hypoparathyroidism
Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchonchospasms, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes
Tetany, Chvostek and Trousseau sign
Tetany: General muscle hypertonie with remor and spasmodic or uncoordinated contractions occuring with or without efforts to make voluntary movements
Chvostek: Sharp tapping over facial nerce in front of parotid gland and anterior to ear causes spasm or twitching of mouth , nose, and eye
Trousseau sign: Carpopedal spasm is induced by occluding the blood flow to arm for 3 minutes with a blood pressure cuff
Adrenocortical insufficiency
Addisons disease ; adrenal suppression by exogenous steroid use
Muslce weakness, anorexia, GI , fatigue, dark pigmantation of skin and mucousa, hypotension, low blood glucose, low serum sodium, high serum potassium, apathy, emotional liability, confision
Diagnostic tests: adrenocortical hormone levels, ACTH levels, ACTH simulation test
What is Cushing’s Syndrome?
Excessive Adrenocortical Activity or corticosteroid medications
Hyperglycemia: Central type obesity with buffalo hump. heavy trunk and thin extremities ; fragile skin, thin skin, ecchymosis, striae, weakness, lassitude, sleep disturbances, osteoperosis, muscle wasting, HTN, moon face, acne, infection, slow healing, virililization in women, loss of libido, increase sodium decreased potassium
Medical Management of Hypo and Hyperthyroidism
Hypo: Supportive
Hyper: Radioactive therapy , Medications: Propylthiouracil and methimazole , sodium or potassium iodine solutions, dexamethasone, beta blockers
Preooperative thyroidectomy
Avoid caffeine and other stimulants, explanation of tests and procedures and head and neck support used after surgery
What does methimazole do?
Block synthesis of thyroid hormone
What do dexamethasone, potassium iodine, and sodium iodine do?
SUppress release of thyroid hormone
Management of hypoparathyroidism
Increase serum calcium level to 9 or 10
Calcium gluconate IV
Pentobarbital to decrease neuromuscolar irritability
Parathormone may be administered
Quiet enviroment; no drafts, bright lights, or sudden movement
Diet high in calcium and low in phosphorus
Vitamin D
Management if Hyperparathyroidism
Parathyroidectomy
Hydration therapy ; fluids of 2000 mL or more
Maintain mobility
Don’t restrict calcium
Hypercalcemic Crisis
Occurs when extreme elevation of serum calcium levels
Results in nuerologic, cardiovascular, and kidney symptoms that can be life threatening
Treatment: Rapid rehydration with large volumes of IV isotonic saline fluids , combination of calcitonin and corticosteroids is administered in emergencies to reduce serum calcium level by increasing calcium deposition in bone
Nursing interventions for patient w hyperparathyroidism
Maintain adequate cardiac output
Improve nutritional status
Enhance coping
Self esteem
Normal body temp
Nursing interventions for cushing’s syndrome
Maintain cardiac outpiut
Decrease infection and injury risk
Promote skin integrity
Improve body image
Improve coping
Monitoring and manageing potential complications : Addisonian crisis
