Unit 11 Endocrine and Metabolic Screening Flashcards
What are the Neuromuscular S/S of Endocrine Disorders?
- Carpal Tunnel Syndrome
- Periarthritis
- Adhesive Capsulitis
- Chondrocalcinosis: (A type of arthritis that typically affects the knees and causes flare-ups of pain and inflammation)
- Spondyloarthropathy: (Forms of arthritis that usually strike the bones in your spine and nearby joints)
- Osteoarthritis
What are the Systemic S/S of Endocrine Disorders?
- Polydipsia
- Mental changes
- Changes in hair
- Changes in skin
- Changes in vital signs
What are the Principal Causes of Carpal Tunnel Syndrome?
- Median nerve compression @ the wrist
- Endocrine disorder (Diabetes, hyperthyroidism, hypothyroidism, gout, and acromegaly)
- Liver disease
What is Periarthritis and Calcific Tendinitis?
An inflammation of periarticular structures, including the tendons, ligaments and joint capsule. Most frequent in the shoulder of people who have endocrine disease
What is Chondrocalcinosis?
Refers to the deposition of calcium salts in the cartilage of joints. When accompanied by attacts of gout-like symptoms, it is called pseudogout
Hypercalemia especially hyperparathyroidism
What is the difference between Spondyloarthropathy and Osteoarthritis?
- Spondyloarthropathy refers to any joint disease of the vertebral column
- Osteoarthritis is the inflammation of joints and degeneration of joint cartilage and the underlying bone
What are the Main Hormones for the Posterior Pituitary Glands?
Oxytocin and Vasopressin
What is the Main Hormone for the Anterior Pituitary Glands?
Adrenocorticotrophic Hormone (ACTH)
What are the Primary, Secondary and Tertiary causes of Endocrine Pathophysiology?
- Primary: Excess or Deficiency of secretion of the gland itslef
- Secondary: Excess of Deficiency of secretion of the pituitary gland
- Tertiary: Excess or Deficiency of secretion by the Hypothalamus
With the Posterior Pituitary, what is the role of Vasopressin?
This is an Antidiuretic Hormone
- This regulates the absorption of water by the kidneys
What is Diabetes Insipidus?
Lack of vasopressin secretion, decreased capacity to absorb water by the kidney
Can cause polyuria, nocturia, polydipsia, etc
With the Anterior Pituitary, what is the role of Growth Hormone?
To stimulate long bone growth in children. In adults helps with the body metabolism
Anterior Pituitary Disorder
With Growth Hormone disorders, what is Acromegaly and Gigantism?
This is the result from excess GH in adults and in children, repectively. These diseases are associated with multiple system problems
With Growth Hormone disorders, what is Dwafism?
This is the result form insufficint GH in children, while decresed GH in adults is usually cryptic
What are the Clinical S/S of Acromegaly?
- Bony Enlargement
- DM
- Profuse sweating
- Back Pain, Degenerative changes
With the Adrenal Gland, what is the role of Cortisol and Aldosterone?
- Cortisole: Regulates metabolism response to stress and inflammation; glucose metabolism
- Aldosterone: Regulates sodium and water balance
Adrenal Dysfunction
What is Cushing Syndrome?
Hypercortisolism
- This may happen in patients that received large doses of cortisol such as hydrocortione or dexamethasone
Adrenal Dysfunction
What is Addison’s Disease?
Hypocortisolism and Low Aldosterone
What is the role of the Thyroid Hormones?
Regulates metabolism rate and increase protein synthesis
What is Graves Disease?
Hyperthyroidism
- Thyroid hormone inceased metabolism
What is Hashimoto’s Disease?
Hypothyroidism
- Thyroid hormone deceased metabolism
This is an autoimmune disease
What is the role of the Parathyroid Glands?
These glands secrete parathyroid hormone (PTH), which regulates calcium and phosphorus metabolism
What is Hypoparathyroidism (Hypofunction)?
Decreased PTH causes hypoclaemia. This is less common
What is Hyperparathyroidism (Hyperfunction)?
Elevation PTH causes release of calcium by the bone and accumulation of calcium in the bloodstream
What is the role of the Pancreas?
- The pancreas has dual functions
- It acts as both as an endocrine gland, secreting the hormones insuline and glucagon and a exocrine gland, producing digestive enzymes
What is the Role of Glucagon?
This helps insulin maintain normal blood glucose by working in the opposite way of insulin.
- It stimulates your cells to release glucose, and this raises you blood glucose levels
What is the Role of Insulin?
This hormone regulates blood glucose by allowing many of your body’s cells to absorb and use glucose.
- In turn, this drops blood glucose levels
How is a person diagnosed with Diabetes Mellitus?
A person must have fasting plasma glucose (FPG) reading of 126 mg/dL or higher on 2 different days
Which type of DM has a more Gradual type of onset?
Type 2
- Type 1 is more abrupt
What type of DM has a higher incidence?
Type 2
What are the Clinical S/S of DM?
- Polyuria
- Hyperglycemia
- Fatigue and weakness
- Blurred Vision
- Numbness and Tingling in hands and feet (Diabetic Neuropathy)
What are Physical Complicatins of Diabetes Mellitus?
Blood Vessels:
- Coronary Arterial Disease (CAD)
- Cerebrovascular Disease (CVD)
- Peripheral Vascular Disease (PVD)
- Renal Artery Stenosis
Nerves:
- DIabetic Neuropathy (Polyneuropathy)
- Carpal Tunnel Syndrome (Mononeuropathy)
- CNS Changes (Cognition deficits/dementia)
What are characteristics of Charcot Joints?
- Severe unilateral swelling
- Increased skin warmth
- Redness
- Deep pressure sensation, but less pain than anticipated
What is considered “Safe” Glucose Level?
Between 100-250 mg/dL
What is considered the Caution Zone for Glucose?
Between 250-300 mg/dL
With exercise, what should happen if the patients Glucose is above 300 mg/dL?
Exercise needs to be postponed (risk of ketoacidosis; Immediate medical attention
With exercise, what should happen if the patients glucose is below 100 mg/dL?
10-15g carbohydrate snack should be given and the glucose retested in 15 min to ensure an appropriate level
What should be done if the patient shows any signs of hypoglycemia during exercise?
The activity must be discontinued and blood glucose should be tested
Should patients with active retinopathy and nephropathy exercise?
They should avoid high-intensity exercise that causes significant increase in blood pressure because such increase can cause further damage to retinas and kidneys
Type 2 Diabetes
What are the Clinical Symptoms of Diabetic Ketoacidosis (DKA) ~ Type 1?
- Thirsty
- Hyperventilation
- Lethargy/Confusion
- Blood glucose level >300 mg/dL
Type 2 Diabetes
What are the Clinical Symptoms of Hyperosmolar, Hyperglycemic State (HHS) ~Type 2 - Elderly?
- Gradual onset
- Renal Indufficiency
- Severe Dehydration
- Lethargy / Confusion
- Blood glucose level >300 mg/dL
Type 2 Diabetes
What are the Clinical Signs of Hypoglycemia, with Sympathetic activity?
- Weakness and Shakiness
- Pallor and Perspiration
Type 2 Diabetes
What are the Clinical Signs of Hypoglycemia with CNS activity?
- Headache, Double/blurred vision
- Confusion
- Blood Glucose level <70 mg/dL
What should you do if your patient is in a Hyperglycemic state?
If anyone with DM arrives in a confused or lethargic state or is exhibiting changes in metal function, fingerstick glucose testing should be performed. Immediate Physician referral is necessary
What should you do if your patient is in a Hypoglycemic state?
This can be treated in the conscious client by immediate administration of sugar.
- Half cup of fruit juice or sugared cola, 8 oz of milk, two packets of sugar, a 2 oz tube of honey or cake decorating gel
- Report the episode to the clients physician
What regulates the Body Metabolism?
Regulated by Endocrine and Nervous Systems
- All metabolic functions require fluid and acid-base balance
If a patient has a Fluid Imbalance, what would Dehydration or Fluid Loss cause?
Causes of the losss of both water and solutes include Hemorrhage (Surgeries) and loss of GI Tract secretions (Vomiting and diarrhea)
With Fluid Imbalance, what populations deal with Water Intoxication?
- Older Adults, who drink additional water after having the flu, with its associated vomiting and diarrhea
- Athletes, who have lost a large amount of body fluid during exercise that has been replaced with only water
What are different Metabolic Disorders?
- Metabolic Syndrome
- Gout
- Metabolic Bone Disease
Metabolic Disorders
What are the Risk Factors for Metabolic Syndrome?
- Large Waistline: Less than or equal to 40 in for men and 35 in for women
- High Triglyceride Level: 150 mg/dL or greater
- Low High Density Lipoprotenin (HDL) Cholesterol: < 40mg/dL for men, < 50mg/dL for women
- High Blood Pressure: 130/85 mmHg or greater
- High Fasting Blood Sugar: 100 mg or greater
Diagnosis: Any 3 of the 5 features above
Metabolic Disease
What is Gout?
When there is elevated Serum Uric Acid, this can result in the formation of tiny uric acid crystals that collect in joints, triggering a painful inflammatory response
Metabolic Bone Disease
What is Osteoporosis?
Bone Loss (Unbalance Hormones)
Metabolic Bone Disease
What is Osteomalacia (Vitament D deficiency)?
Reduced rate of bone formation - softening of the bones
Metabolic Bone Disease
What is Paget’s Disease (Osteitis Deformans)?
Inflammatory Condition - Genetic Factors
What are the Guidelines for Immediate Medical Attention?
- Any person with DM who is confused, lethargic, exhibiting changes of metal state profuse sweating or is in Hyperglycemic state
- Patients that show signs of potassium depletion (e.g Lethal cardiac arrhythmia) or fluid dehydration in those who take non-potassium-sparing diuretics
- Signs of Thyroid Storm (Severe Tachycardia)
What are the Guidelins for Physican Referral?
- Any unexplained fever w/o other symptoms in a person taking corticosteriods
- Palpable Nodules
- Any episode of hypoglycemia
- The presence of muliple xanthomas on the extensor tendons
- Signs of fluid loss or dehydration
- Recurrent arthritic symptoms in a client with gout who is taking urate-lowering drugs
