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Pathophysiology and Pharmacology > Thermoregulation & Glucose Regulation > Flashcards

Thermoregulation & Glucose Regulation Flashcards

1
Q

What are the hormone levels in Primary Hypothyroidism ?

A

TSH is high and serum T4 is low

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2
Q

What are the hormones levels in Primary Hyperthyrodisim ?

A

Low TSH levels and high free-T4 levels

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3
Q

What are the hormone levels in Secondary Hyperthyroidism ?

A

High levels of TSH when excessive TSH secretion is the cause

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4
Q

How are the hormone levels in Secondary Hypothyroidism ?

A

TSH is decreased or normal due to hypothalamic or pituitary insufficiency

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5
Q

What is the cause of Primary Hypothyroidism ?

A

abnormality in the thyroid gland itself
- most common

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6
Q

What is the cause of Secondary Hypothyroidism ?

A

hypothalamic or pituitary insufficiency
- when hypothalamus is dysfunctional and does not secrete Thyrotropin-Releasing Hormone (TRH)
- anterior pituitary does not secrete Thyroid-Stimulating Hormone (TSH)

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7
Q

What is hypothyroidism ?

A

metabolic processes slow down due to a deficit in T4 and T3

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8
Q

What is Goiter ?

A

can occur with hypo/hyperthyroidism
- enlargement of the thyroid gland
- results from when thyroid hormone fails to meet metabolic demands
- many types: nontoxic, toxic, endemic, and sporadic goiter

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9
Q

What is the goal of hypothyroidism interventions ?

A

restore normal thyroid state as safely and quickly as possible
- main therapy is thyroid hormone replacement

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10
Q

What is the goal of Anti-Thyroid meds ?

A

used to treat hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical tx or during radioactive iodine tx for hyperthyroidism

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11
Q

For hyperglycemia what are the 2 main problems with the body ?

A
  • no insulin present to help glucose enter cells
  • body is resistant to insulin available (insulin is defective and isn’t fitting on the receptor)
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12
Q

What is pre-prandial and post-prandial ?

A
  • before you eat
  • after you eat
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13
Q

What are some long-term complications of both types of diabetes ?

A

Macrovascular
- MI, CVA, PAD
Microvascular
- neuropathy, retinopathy, nephropathy

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14
Q

When we do start screening for diabetes ?

A

every 3 years for all pt’s 45 years and older

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15
Q

How does Type 1 Diabetes work ?

A

your pancreas isn’t producing insulin at all, so you will have glucose floating around in your bloodstream
- beta cells in Islets of Langerhans does not work
- pt’s need exogenous insulin
- body start to metabolize fat instead of carbs
- usually diagnosed in childhood

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16
Q

How does Type 2 Diabetes work ?

A

you are making some insulin and its not enough or you are producing insulin but your receptor isn’t recognizing the insulin, so it doesn’t work
- usually related to lifestyle choices
- body cells quit responding to insulin
- insulin nondependent

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17
Q

What is gestational diabetes ?

A

similar to type 2 but occurs only during pregnancy
- pregnancy hormones cause body cells to be less receptive to insulin
- usually disappear after birth, within 6 months postpartum
- managed similar to type 2 but with input from OB

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18
Q

What are the HbAIC levels ?

A
  • Normal: <5.7%
  • Prediabetic: 5.7-6.4
  • Type 2 Diabetes: >6.5%
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19
Q

What is the fasting blood glucose goal for diabetic pt’s ?

A

70-126 mg/dL

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20
Q

When you give Insulin to a diabetic pt what does it do to their body ?

A

restores their ability to:
- metabolize carbs, fats, and proteins
- store glucose in the liver
- convert glycogen to fat stores
- doesn’t reverse defects in insulin sensitive receptors but increases the amount of insulin in your body

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21
Q

What is recombinant insulin produced by ?

A

bacteria and yeast

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22
Q

What is the onset, peak, and duration of Rapid-Acting insulin ?

A
  • Onset: 15 to 30 mins
  • Peak: 0.5 to 2.5 hr
  • Duration: 3 to 6 hrs
  • to be given to pt’s that are unconscious and severely hyperglycemic
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23
Q

What is the onset, peak, and duration of Short-Acting insulin ?

A
  • Onset: 0.5 to 1 hr
  • Peak: 1 to 5 hrs
  • Duration: 6 to 10 hrs
  • regular (humulin R)
24
Q

What is the onset, peak, and duration of Intermediate-Acting insulin ?

A
  • Onset: 1 to 2 hrs
  • Peak: 6 to 14 hrs
  • Duration: 16 to 24 hrs
25
What is the onset, peak, and duration of Long-Acting insulin ?
- Onset: 70 minutes - Peak: none - Duration: 18 to 24
26
Which insulin is Rapid-Acting ?
Lispro (Humalog) - mimics closely the response your body would react to being hyperglycemic
27
Which insulin is Short-Acting ?
Regular Insulin (Humulin R, Novolin R) - only insulin that can be given IV - often used with DKA - sometimes used in combo with intermediate-acting insulin to decrease amount of injections per day
28
How do you minimize adverse effects of administering Insulin ?
- rotate injection sites to prevent lipodystrophy - assess glucose levels before administration to prevent hypoglycemia
29
What is Lipoatrophy ?
loss of subcutaneous fat and appears as slight dimpling or more serious pitting of subcutaneous fat - using human insulin helps prevent this
30
What is Lipohypertrophy ?
development of fibrous fatty masses at the injection site and is caused by repeated use of an injection site
31
Which insulin is Intermediate-Acting ?
NPH (Humulin N) - is cloudy or opaque - sterile suspension of zinc insulin crystal and protamine sulfate in buffered water - usually mixed with regular insulin to reduce the number of insulin injections per day
32
With Intermediate-Acting Insulin which insulin do you avoid mixing it with ?
don't use in combo with rapid-acting and short-acting - the peak times are too closely together
33
Which insulin is Long-Acting ?
Glargine (lantus) - aka basal insulin - colorless solution that once injected into SubQ tissue it cause tiny crystals to be formed and these crystals will slowly absorb
34
How do we mix insulin ?
clear to cloudy - inject the air needed into both vials first - then draw up the clear insulin and then the cloudy one
35
What is sliding-scale insulin dosing ?
SQ rapid-acting or short-acting insulin is adjusted according to blood glucose test results - testing done several times a day, before meals and at bedtime -SubQ insulin is ordered in an amount that increases as the blood glucose increases
36
For which pt's do we usually use sliding-scale insulin ?
hospitalized diabetic pt's or those on total parenteral nutrition or enteral tube feedings
37
What are some disadvantages of sliding-scale insulin dosing ?
- delays insulin administration until hyperglycemia occurs - results in large swings in glucose control
38
What is basal-bolus insulin dosing ?
mimics a healthy pancreas by delivering basal insulin constantly as a basal and then needed as a bolus - when you give # units of insulin for how many grams of carbs you eat - bolus dose is carb count dose
39
What are some RN implications for giving insulin ?
- check glucose before giving insulin - roll vials instead of shaking to mix suspensions - only use insulin syringes - ensure correct timing of insulin dose with meals - pt education
40
What must be functioning for the use of Sulfonylureas ?
beta cell function must be present - improves sensitivity to insulin in tissues - can cause hypoglycemia
41
When insulin is ordered what do you have to check ?
- correct route - correct type of insulin - timing of the dose - correct dose - insulin order and prepared dosages are 2nd checked with another RN
42
What are early signs of hypoglycemia ?
Sweaty, confused and clammy give them some candy" - confusion - irritability - tremor - sweating
43
What are late signs of hypoglycemia ?
- hypothermia - seizures - coma and death will occur if not treated
44
What are hypoglycemic levels ?
<70 mg/dL - mild cases can be treated with diet - severe is <50
45
What are hyperglycemic levels ?
>140 mg/dL - severe is >180
46
What are euglycemic (normal) levels ?
70-140 mg/dL
47
What are some symptoms of hypothyroidism ?
- intolerant to cold - hair loss - dry skin - edema of face and eyelids - slow speech and thick tongue - ANOREXIA - brittle hair and nails - menstrual disturbances - constipation - muscle weakness and aches - dull, blank expression - apathy
48
What are some symptoms of hyperthyroidism ?
- intolerant to heat - fine, straight hair - facial flushing - bulging eyes - increased HR and RR - weight loss - muscle wasting - finger clubbing - tremors - diarrhea - menstrual changes (amenorrhea)
49
What are some symptoms of myxedema coma ?
occurs from 2ndary hypothyroidism - lethargy, drowsiness, leading to impairment of LOC or coma - Hypo: thermia, tension, and ventilation - treat immediately and support vital functions and IV thyroid hormone replacement
50
What is thyroid crisis (thyroid storm) ?
when T3 and T4 are overproduced causing increased systemic adrenergic activity - body is burning through energy faster then it can be replaced - overproduction of epi and severe hypermetabolism - caused by stress, infection, and surgery
51
What are some symptoms of thyroid crisis ?
- severe CNS effects (restlessness, agitation, delirium) - CVPV effects (angina, heart failure, increased HR) - hyperthermia - GI symptoms (N, V, D, pain) - treat immediately with B-blockers, MMI, corticosteroids, fluids and electrolytes, fever reduction
52
What are some symptoms of hypoglycemia ?
- decreased cognition - tremors - diaphoresis - weakness - hunger - HA - irritability - seizure and hypothermia (late signs)
53
What are some symptoms of hyperglycemia ?
- polyuria & polydipsia - dehydration - fatigue - fruity odor to breath - Kussmauls' breathing - weight loss - hunger - poor wound healing - feel hot - increased risk to infection
54
What is diabetic ketoacidosis (DKA) ?
where glucose is high but there is no insulin to let glucose be used as energy so the body breaks down fatty acids instead - type 1 DM - ketones are the metabolic byproducts) - Tx: rapid IV or NaCl, insulin IV, replace electrolytes
55
What are some symptoms of DKA ?
- hyperglycemia - ketones in serum - acidosis - dehydration - electrolyte imbalance
56
What is hyperglycemia hyperosmolar nonketotic syndrome (HHNS) ?
extreme hyperglycemia without ketosis or acidosis because there is enough insulin to prevent fat breakdown thus prevents ketosis - type 2 DM - Tx: fluid replacement, correct electrolyte imbalance, admin insulin - watch for elderly since they won't know they are in this

Pathophysiology and Pharmacology (13 decks)

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