Topic 1 Flashcards
what is important to monitor when you have a partial or total thyroidectomy
CALCIUM LEVELS; because of the parathyroid glands
hyperthyroidism: autoimmune
Graves
hypothyroidism: autoimmune
hashimotos
other than iodine deficiency, what else can cause hypothyroidism?
*Hypothyroidism may also develop after treatment for hyperthyroidism, specifically a thyroidectomy or RAI therapy.
what food have iodine
seafood, fish, seaweed, dairy
what diagnostics are run to test for hypothyroidism
-Serum TSH and free T4
-total serum T3 and T4
-Thyroid peroxidase (TPO) antibodies
what diagnostics are run to test for hyperthyroidism
-Opthalamic examination
-ECG
-TSH levels
-serum free T4
-Thyroid antibodies (TPO)
-total serum T3 and T4
-Radioactive iodine uptake (RAIU)
what are the clinical manifestations of hypothyroidism
-Systemic effects characterized by a slowing of body processes
-Fatigued
-Lethargic
-Experiences personality and mental change
-Impaired memory
-Decreased initiative
-Somnolence
-Appears depressed
-Weight gain
-Slowed speech
what are the cardiovascular manifestations of hypothyroidism
Decreased cardiac contractility and decreased cardiac output.
-low exercise tolerance
-shortness of breath on exertion
in hypothyroidism TSH is ____ and T4 is _____
increased
normal
what medication is used for hypothyroidism
levothyroxine (Synthroid)
what should the nurse monitor when a patient is taking levothyroxine
-Carefully monitor patients with CV disease who take this drug
-Monitor heart rate and report pulse greater than 100 bats/min or an irregular heartbeat
-Promptly report chest pain, weigh loss, nervousness, tremors, and/or insomnia
what is important to discuss with a patient about thyroid hormone therapy?
-need for life long therapy
-take thyroid hormone in the morning before food
- need for regular follow-up care
what would be a comfortable environment for a patient with hypothyroidism
a WARM environment because the patient would always be cold
since a patient with hypothyroidism has thin/fragile skin, what should the nurse teach
measures to prevent skin breakdown. Soap should be used sparingly and lotion applied to skin.
constiptation is a symptom of hypothyroidism, what should the nurse discuss with the client?
- Gradual increase in activity and exercise
- Increased fiber in diet
- Use of stool softeners
- Regular bowel elimination time
why should patients with hypothyroidism avoid using enemas?
because they produce vagal stimulation, which can be hazardous if cardiac disease is present
(Vagal maneuver: will decrease the HR, constrict and reduce blood flow)
hyperthyroidism clinical manifestations
-increases metabolism
-enlarges thyroid: goiter
-exophthalmos
what are the early signs of hyperthyroidism
weight loss, increased nervousness
what does the nurse teach a patient with exophthalmos for eye and vision care?
-Elevate head of bed at night
-Use eye drops (artificial tears)
-Dark glasses to treat photophobia
if the exophthalmos is severe what canbe done
possible steroid therapy to reduce swelling, diuretics to decrease edema, or surgery (orbital decompression).
Hyperthyroidism Clinical Manifestations: CV
hypertension, bounding rapid pulse, dysrhythmias, angina, CHF, fatigue
Hyperthyroidism Clinical Manifestations: respiratory
dyspnea on mild exertion, increased RR
Hyperthyroidism Clinical Manifestations: GI
wt loss, increased appetite, thirst, increased peristalsis, increased BS
Hyperthyroidism Clinical Manifestations: skin
warm, smooth, moist skin, brittle nails, fine, silky hair, diaphoresis, pretibial myxedema
uDifficulty sleeping, hand tremors,
Hyperthyroidism Clinical Manifestations: MS
fatigue, weakness, dependent edema, osteoporosis
Hyperthyroidism Clinical Manifestations:: NS
nervousness, fine tremor of fingers and tongue, insomnia, lability of mood, delirium, restlessness, personality changes, depression, lack of ability to concentrate
Hyperthyroidism Clinical Manifestations: reproductive
menstrual irregularities, amenorrhea, gynecomastia in men, decreased fertility
Hyperthyroidism Clinical Manifestations: other
intolerance to heat, elevated basal temperature, lid lag, rapid speech
diagnostic studies for Hyperthyroidism
uTSH: low or undetectable levels
uT4 : elevated (free T4)
The RAIU test
The RAIU test
radioactive iodine uptake test; used to differentiate Graves’ disease from other forms of thyroiditis
Radiation Therapy: Radioactive iodine
0RAI damages or destroys thyroid tissue
-maximum effect may not be seen for up to 3 months
what is the patient treated iwth before and for 3 months after starting RAI
with antithyroid drugs and propranolol
why do you give propanolol to a patient who is hyperthyroid
Give propanonolol do you don’t go into hypertensive crisis
what are reasons for an individual to get a thyroidectomy
Lookout ABC, if patient is having hard time breathing, risk for aspiration, then they will get surgery or if meds dont work
hyperthyroidism: nutritional therapy
-High-calorie (4000-5000), high-protein diet
-Frequent meals
-Teach the patient to avoid highly seasoned and high-fiber foods because these foods can further stimulate the already hyperactive GI tract.
-Have the patient avoid caffeine-containing liquids such as coffee, tea, and cola to decrease the restlessness and sleep disturbances associated with these fluids.
drugs for hypothyroidism
levothyroxine
drugs for hyperthyroidism
Methimazole (Tapazole)
Propylthiouracil (PTU)
Iodine (SSKI)
normal blood sugar range
74-106mg/dL
prediabetes
defined as impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both. It is a precursor (happens before) the client gets Type 2 Diabetes Mellitus.(clients are oftern asymptomatic)
client teaching for prediabetes
-Undergo screening
-Manage risk factors
-Monitor for symptoms of diabetes
-Maintain healthy weight, exercise, make healthy food choices
Metabolic Syndrome (Syndrome X)
A genetic metabolic disorder characterized by diabetes, hypertension, atherosclerosis, centrally distributed obesity, and elevated blood lipids
What clinical manifestations will the nurse assess for metabolic syndrome?
-Hypertension
-Elevated blood sugar
-Arteriosclerosis
-Atherosclerosis
-Elevated cholesterol
-Triglycerides
-Pear or apple shaped body
what can metabilic syndrome (syndrome X) lead to?
stroke, heart attack, early death
what are features noticed with metabolic syndrome?
*Abdominal obesity
*Hyperglycemia fasting >100
*Hypertension 130/85
*Hyperlipidemia Trig. >150, HDL < 40-50
what is the difference between T1 and T2 diabetes?
Type 1: autoimmune disease where the B cells in the pancreas does not produce enough insulin. Type I Diabetics ALWAYS requires insulin.
Type 2: Lifestyle diabetes Type II insulin is required only if the Blood Glucose can’t be controlled with the use of 2 or 3 other antidiabetic medications.
what are the classic symptoms of T1 diabetes?
polyuria (frequent urination)
polydipsia (excessive thirst)
polyphagia (excessive hunger)
3P’S
what are comon clinical manifestations of T1 DM?
*Weight loss
*Weakness
*Fatigue
*Increase frequency of infection
*Rapid onset
*Insulin dependent
*Familial Tendency
*Peak incidence from 10 to 15 years
what are common clinical manifestations of T2 DM?
Classic symptoms of type 1 may manifest
*Fatigue
*Recurrent infection
*Recurrent vaginal yeast or candida infection
*Prolonged wound healing
Visual changes
what is normal A1C for a non diabetes patent?
4-5.6%
what is prediabetes A1C?
5.7-6.4%
what A1C indicates good diabetic control?
<7(6.5)%
What A1C reading indicates diabetes?
greater than 6.5%
What fasting plasma glucose level is diagnostic for diabetes?
higher than 126 mg/dL
what Two-hour plasma glucose level during OGTT is diagnostic for diabetes?
200 mg/dL (with glucose load of 75 g)
hyperglycemia is defined as
plasma glucose > 200 mg/dL
what are assessment findings of hyperglycemia
*Warm, moist skin
*Dehydration
*Positive Urine Ketones & Glucose
*Elevated Blood Glucose
*Mental status varies from alert to coma
hypoglycemia is defined as
<70 mg/dL.
what are the assessment findings of hypoglycemia?
-Skin: cool & clammy, sweaty
-Hungry
-Neuro: Blurred or double vision, anxious, shaky, nervous, irritable, mental confusion, seizures, coma…
“rule of 15”
if a patient its CONSCIOUS
have pt. eat or drink 15g of quick acting carbs
wait 15 mins, check BG again
repeat this if needed
When is glucagon/Dextrose 50% used?
when a pt. is hypoglycemic but has worsening symptoms or is unconscious
glucose: SQ
dextrose: if they have IV
what lab values are the nurses goals to keep a diabetic patient in (A1C, premeal BG and after meal BG)
-Hgb AIC Levels maintained at 6.5% or below
-Premeal BG between 70 and 130
-After meal BG less than 180
what are oral antidiabetic medications
*Glipizide (Glucatrol)
Metformin (Glucophage)
*Pioglitazone (Actos)
what medication is used for T1 diabetics
Type I Diabetics ALWAYS requires insulin.
when is insulin used for T2 diabetics
insulin is required only if the Blood Glucose can’t be controlled with the use of 2 or 3 other antidiabetic medications.
What is important about Metformin (glucophage)
it Interacts with contrast material used in CT’s with contrast and other procedures and can cause acute kidney injury. Needs to be held after pt has a CT with contrast. (1-2 days before and 48 hours after)
Basal-bolus regimen
*To mimic the pancreas, provides enough insulin to ensure a steady glucose supply to maintain basic metabolic processes in the body
Mealtime insulin
*to provide additional insulin for glucose absorption after meals
When is rapid acting insulin given?
before meals (within 15 mins of mealtime)
When is short acting insulin given?
30 to 45 mins before mealtime
When is intermediate acting insulin given?
Basal insulin once or twice a day, starts to work in 4 hours
When is long acting insulin given?
at bedtime (once or twice a day)
intermediate acting insulin can
mix with short- and rapid-acting insulins
intermediate acting insulin (NPH) is the only insulin that is
cloudy
How do you mix insulin?
clear before cloudy
where is absorption of insulin the fastest
abdomen, followed by arm, thigh, and buttock
Administration of insulin
-Abdomen is often preferred site
-Do not inject in site to be exercised
pRotate injections within and between sites
What is the only insulin that can be given IV?
regular insulin
Storage of insulin
-Do not heat/freeze
-In-use vials may be left at room temperature up to 4 weeks
-Extra insulin should be refrigerated
-Avoid exposure to direct sunlight, extreme heat or cold
-Store prefilled syringes upright for 1 week if 2 insulin types; 30 days for one
Diabetes Nutritional teaching
*Manage Carbohydrate Intake (45% of Daily Intake) Carb Counting
*Limit Fat and Cholesterol
*Protein (15%-20%)
*Limit High Fructose Corn Syrup and Sugar Sweetened Beverages
*Limit ETOH (Alcohol) Consumption
what is recommened exercise for diabetics
*150 min/week of moderate intensive aerobic exercise or 75 minutes of vigorous aerobic exercise
when should a diabetic not exercise
-If ketone are present in the urine
-Peak time of insulin (within 1 hour of insulin injection)
when exercising what should BG levels be
between 80 and 250 if exercising
Somogyi effect
*Rebound effect in which an overdose of insulin causes HYPOGLYCEMIA, then the release of counterregulatory hormones causes REBOUND HYPERGLYCEMIA
Somogyi effect vs. Dawn phenomenon
Both cause hyperglycemia in the morning in Diabetics
somogyi: pancreas/liver release glucose; rebound from too much insulin
Dawn phenomenon: Release of Growth hormone, coritsol (patient may be stressed)
what interventions can be used for Somogyi effects
A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect.
how do you determine if morning hyperglycemia is caused by the somogyi effect
checking blood glucose levels between 2:00 AM and 4:00 AM for hypoglycemia
dawn phenomemon
*Morning hyperglycemia present on awakening
*May be due to release of counterregulatory hormones (Growth hormone and cortisol) in predawn hours
what interventions can be used for dawn phenomemon
Dawn phenomenon is an increase in insulin or an adjustment in administration time.
what patient teaching is needed for diabetic foot care
-Inspect daily
-Avoid going barefoot
-Proper footwear
-How to treat cuts
Sick Day Management for Diabetics: S
Sugar: Check your blood glucose every 2 to 3 hours or as necessary
Sick Day Management for Diabetics: I
Insulin: Always take your insulin! Not taking it could lead to DKA!
Sick Day Management for Diabetics: C
Carbs: Drink lots of fluids!
If sugars are high drink sugar-free liquids.
If sugars are low drink carb-containing drinks
Sick Day Management for Diabetics: K
Ketones: Check your urine or blood ketones every 4 hours.
Take rapid-acting insulin if ketones are present.
danger signals for sick day management for diabetics
*Persistent Nausea and Vomiting
*Moderate or Large Ketones
*Elevated BG after two supplemental doses of insulin
*High Fever (greater 101.5°), increasing fever, or fever for more than 24 HRS
not managing an illness properly when diabetic can lead to
DKA or HHS (Hyperglycemic Hyperosmolar State)
Alcohol and diabetes
alcohol lowers blood sugar (puts patient at risk for hypoglycemia) TEACH PATIENT to eat something, mix with a carb containing drink, or nt to drink at all
when are glucagon and dextose given
if BG is <20 or patient is unconscious
what are ways to tell if ketones are present?
urine, but also if the patient has abdominal discomfort
if the client is in ketosis, what are they at risk for
metabolic acidosis
how should diabetics wash their feet
clean with a rag BUT HAVE TO DRY!! do not leave anything wet (even with lotion)
-no epsom salt
-test water temp w sensation feeling part of the body
Rapid acting insulin
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
Short acting insulin
Regular (Humulin R, Novolin R)
Intermediate acting insulin
NPH (Humulin N, Novolin N)
Long acting insulin
glargine (Lantus)
detemir (Levemir)
What does post-prandial glucose mean and why is it important?
Post-prandial glucose is the glucose level (plasma glucose) after eating. It is important because it tell you how your body responds to sugar after eating, it tells if insulin is being secreted.
