Thermoregulation & Glucose Regulation Flashcards
What are the hormone levels in Primary Hypothyroidism ?
TSH is high and serum T4 is low
What are the hormones levels in Primary Hyperthyrodisim ?
Low TSH levels and high free-T4 levels
What are the hormone levels in Secondary Hyperthyroidism ?
High levels of TSH when excessive TSH secretion is the cause
How are the hormone levels in Secondary Hypothyroidism ?
TSH is decreased or normal due to hypothalamic or pituitary insufficiency
What is the cause of Primary Hypothyroidism ?
abnormality in the thyroid gland itself
- most common
What is the cause of Secondary Hypothyroidism ?
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)
What is hypothyroidism ?
metabolic processes slow down due to a deficit in T4 and T3
What is Goiter ?
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
What is the goal of hypothyroidism interventions ?
restore normal thyroid state as safely and quickly as possible
- main therapy is thyroid hormone replacement
What is the goal of Anti-Thyroid meds ?
used to treat hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical tx or during radioactive iodine tx for hyperthyroidism
For hyperglycemia what are the 2 main problems with the body ?
- no insulin present to help glucose enter cells
- body is resistant to insulin available (insulin is defective and isn’t fitting on the receptor)
What is pre-prandial and post-prandial ?
- before you eat
- after you eat
What are some long-term complications of both types of diabetes ?
Macrovascular
- MI, CVA, PAD
Microvascular
- neuropathy, retinopathy, nephropathy
When we do start screening for diabetes ?
every 3 years for all pt’s 45 years and older
How does Type 1 Diabetes work ?
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
How does Type 2 Diabetes work ?
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
What is gestational diabetes ?
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
What are the HbAIC levels ?
- Normal: <5.7%
- Prediabetic: 5.7-6.4
- Type 2 Diabetes: >6.5%
What is the fasting blood glucose goal for diabetic pt’s ?
70-126 mg/dL
When you give Insulin to a diabetic pt what does it do to their body ?
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
What is recombinant insulin produced by ?
bacteria and yeast
What is the onset, peak, and duration of Rapid-Acting insulin ?
- 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
What is the onset, peak, and duration of Short-Acting insulin ?
- Onset: 0.5 to 1 hr
- Peak: 1 to 5 hrs
- Duration: 6 to 10 hrs
- regular (humulin R)
What is the onset, peak, and duration of Intermediate-Acting insulin ?
- Onset: 1 to 2 hrs
- Peak: 6 to 14 hrs
- Duration: 16 to 24 hrs
What is the onset, peak, and duration of Long-Acting insulin ?
- Onset: 70 minutes
- Peak: none
- Duration: 18 to 24
Which insulin is Rapid-Acting ?
Lispro (Humalog)
- mimics closely the response your body would react to being hyperglycemic
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
How do you minimize adverse effects of administering Insulin ?
- rotate injection sites to prevent lipodystrophy
- assess glucose levels before administration to prevent hypoglycemia
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
What is Lipohypertrophy ?
development of fibrous fatty masses at the injection site and is caused by repeated use of an injection site
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
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
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
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
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
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
What are some disadvantages of sliding-scale insulin dosing ?
- delays insulin administration until hyperglycemia occurs
- results in large swings in glucose control
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
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
What must be functioning for the use of Sulfonylureas ?
beta cell function must be present
- improves sensitivity to insulin in tissues
- can cause hypoglycemia
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
What are early signs of hypoglycemia ?
Sweaty, confused and clammy give them some candy”
- confusion
- irritability
- tremor
- sweating
What are late signs of hypoglycemia ?
- hypothermia
- seizures
- coma and death will occur if not treated
What are hypoglycemic levels ?
<70 mg/dL
- mild cases can be treated with diet
- severe is <50
What are hyperglycemic levels ?
> 140 mg/dL
- severe is >180
What are euglycemic (normal) levels ?
70-140 mg/dL
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
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)
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
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
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
What are some symptoms of hypoglycemia ?
- decreased cognition
- tremors
- diaphoresis
- weakness
- hunger
- HA
- irritability
- seizure and hypothermia (late signs)
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
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
What are some symptoms of DKA ?
- hyperglycemia
- ketones in serum
- acidosis
- dehydration
- electrolyte imbalance
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
