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Nur 210 > Unit 2 Endocrine > Flashcards

Unit 2 Endocrine Flashcards

1
Q

What are the overall functions of the endocrine system?

A 
Regulate energy metabolism
Sexual development
Fluid/elec balance
Inflam/immune-cytokines (ACH)
*linked closely to the SNS, neurotransmitter epi/NorEPI (adrenal med)
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2
Q

In circadian rhythms endocrine function, when are hormones at their highest?

A

At night, lowest in morning.

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3
Q

What hormones are released at the hypothalamus?

A 
Releasing and inhibiting hormones:
CRH
TRH
GHRH
GnRH
Somatostatin (inhib GH and TSH)
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4
Q

What hormones are from the anterior pituitary?

A 
GH (bone/muscle growth)
ACTH (adrenocortico)
TSH (Thyroid) 
FSH (ovulation, sperm)
LH (testosterone, Estrogen/progesterone)
Prolactin (breast feed)
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5
Q

What hormones are associated with the posterior pituitary?

A

ADH (inc water absorp)

Oxytocin (contraction stimulation)

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6
Q

What hormones are associated with the adrenal cortex?

A 
Mineralocortiocsteroids-
Aldosterone:sod absorp, pot loss
Glucocorticoids-
Cortisol:reg blood glucose/growth/antiinflamm/decrease stress effects
Adrenal androgens-
DHEA
Androstenedione
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7
Q

What hormones are associated with the adrenal medulla?

A

Epinephrine
Norepinephrine

Are neurotransmitters for SNS

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8
Q

What hormones are associated with the thyroid?

A

Follicular cells:TH T3/T4-inc metabolic rate

C cells: Calcitonin-dec calcium and phosphate

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9
Q

What hormones are associated with the parathyroid glands?

A

PTH:reg serum calcium

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10
Q

What hormones are associated with pancreas?

A

Islet cell:
Alpha: glucagon:inc blood glucose by stim glycogen/gluconeo
Beta: insulin:low blood glucose by transport into muscle/liver/adipose cells.
Somatostatin:delay Intest absorp of glucose.

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11
Q

What other sources other than endocrine glands release hormones?

A 
Heart-atrial natriuretic factor (chf)
Kidney-erythropoietin (RBC production)
GI tract-CCK (GB/Pancreas), Secretin (Ducts) *digestive
WBC-cytokines *immune response
Exocrine-sweat glands
Ovaries/Testes
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12
Q

What are the variety of hormone structures?

A

Amines/AA:epi/NorEPI
Peptide/poly/prot/glyco: TRH FSH GH
Steroids: corticosteroid (acts inside of cell)
Fatty acid derivatives: eicosanoids, retinoids

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13
Q

What are some causes to have endocrine hypo function?

A

Congenital: absent/impaired gland or enzyme
Destroyed: disrupted blood flow, infection, autoimmune, neoplasm, inflam.
Age: dec function
Atrophy: meds/idiopathic
Receptor defect: target cell absent, defective, dec cell response
Production: biologically inactive hormone or active hormone destroyed by circ antibody before it can exert effect.

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14
Q

What are some causes for endocrine hyper function.

A 
Inc stimulation of gland (meds/drugs)
Excessive secretion/production
Hyperplasia
Tumor
Ectopic tumor hormone production
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15
Q

Endocrine d/o are classified into three categories. Diff each.

A

Primary: glandular issue in hormone production
Secondary:gland normal function, but altered by levels of stim and release hormone (pituitary system)
Tertiary: hypothalamus dysfunction

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16
Q

What are some specific assessments for the endocrine system?

A 
Energy levels
Heat/cold tolerance
Weight changes
Urination changes
Thirst
Sleep, memory, concentration issue, mood swings
Sexual dysfunction
Joint pain, ha, visual disturbances, skin changes
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17
Q

What stimulates GH secretion?

A

Hypoglycemia, fasting, starvation, stress.

Stims liver, which stims insulin like growth factor

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18
Q

What occurs in hyper secretion of GH (somatotropin)?

A

Acromegaly: small bones/flat enlarged. DX’d: glucose test (GH will still be hi) imaging used for tumors. TX: somatostatin (synthetic) causes GI SE, Bromocryptine (dopamine agonist) dec symptoms.
Gigantism: long bones (before ephiseal plate close)

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19
Q

What occurs in hypo secretion of GH?

A

Dwarfism.
Dec body mass, inc fat mass (hyperlipidemia), dec bone density, metab syndrome-Apple shape (central obesity) with dec visceral fat. Insulin resistant, dyslipidemia, HTN
TX: artificial GH

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20
Q

What d/o occur with ADH? What effects does this hormone have? Stim by?

A

SIADH/DI

vasopressin controls water excretion, vaso constricts.
stim by inc blood concentration (ADH inhib), or dec BP (ADH released)

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21
Q

Diff DI/SIADH

A

DI: hypo ADH, lose fluid, inc Na serum, dilute urine = dehydration.

SIADH: hyper ADH, fluid retained, dec Na serum (diluting), Anuria.

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22
Q

DI s/s, causes, NUR care, TX?

A

Polyuria, polydipsia. Dec spec grav, dec urine concentration, hypovol, tachy, dec BP.

Head trauma, infection, tumor, or renal issue.

Fluids(NS)/weight, n/v, vs, mucous membranes, water intox (hyponat=muscle cramps, confusion). Don’t restrict fluid.
TX: desmopressin (no vasoconstric), clonofibrate (hypolipidemic antidiuretic), thiazides (prox tub Na reabsorb), prostaglandin inhib (NSAID retain fluid), vasopressin (vasoconstriction -caution with cad pt).

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23
Q

SIADH s/s, caused by, NUR care, tx?

A

Scant concentrated urine, dilutional hyponatremia

Malignant tumors (rel ADH), infection (stims pit), meds/nicotine (Stims pit).

I/o, vs, daily weight, BMP, n/v

Tx: water restriction, lasix, hypertonic solution.

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24
Q

What would you expect for serum sodium, serum Osmolality, and urine Osmolality in SIADH, Dehydration, and DI?

A 
SIADH:
Dec serum Na
Dec serum osmo.
Inc urine osmo.
Dehydration:
inc serum Na
Inc serum osmo.
Inc urine osmo.
DI:
Inc serum Na
Inc serum osmo.
Dec urine osmo.
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25
Q

For DI and SIADH, what would the nurse be sure to check and diff?

A

Serum sodium and urine

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26
Q

What are tx’s for pituitary tumors?

A

Transphenoidal through nare
Hypophysectomy

Radiation (during surgery, needs to be precise)

Meds: Bromocryptine (dopamine agonist)
Octreotide (inhib GH)

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27
Q

What are post op care for pituitary tumor removal?

Complications?

A

Corticosteroids (removal of pit elims all SH)

Prevent head pressure: no cough/sneeze/straw/Valsalva’s/blow nose.
Monitor CSF (Save tissues).
V/s, hob up, IandO, spec. Grav., nasal packing, visual acuity, oral care.

CSF leak, meningitis, DI, SIADH, visual disturb (optic nerve).

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28
Q

Pit tumors are typically ______________. And are a result of cell overgrowth: eosinophils, basophils, chromophil.

A

Benign

Eosin:childhood
Baso: hyperendocrine
Chromo: hypoendocrine

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29
Q

What are the hormones of the thyroid? What is their job? How are each of them stimulated?

A

T3/T4 (TH): Inc. metabolism by inc enzyme levels (inc o2 consumption), inc growth/develop. stimulated by the production of iodine and TSH (From pituitary).
Calcitonin: inhibs calcium release from bones. Stim when serum ca is too high.

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30
Q

Increased TH affects metabolism and protein syn in what ways?

A 
Glucose, fat, and protein use increases.
Catabolism of muscle (fatigue)
Blood volume, CO, and vent increase.
Vasodilation.
GI motility increases (diarrhea)
Appetite increase, weight decrease
Neuromuscular (tremors, restlessness, anxiety, insomnia)
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31
Q

What is the best screening for thyroid function? And those regular values?
When are these recommended?

A

TSH (can diff between d/o’s thyroid, pit, and hypothal)
Normal 0.4-4.2
Greater=hypothyroid
Lesser=hyperthyroid

35 y/o and q5years.

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32
Q

If TSH is confirmed abnormal, what is then tested? Normal ranges? What can affect those?

A

Serum Free T4
0.9-1.7
Meds, illness, protein binding changes.

Test of choice when monitoring T4 changes in hyperthyroidism.

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33
Q

What are the normal ranges for T3/T4 serum? (Bound and free)

A

T3: 70-220
T4: 4.5-11.5
(Can also be affected by same as free T4)
These go up and down together.

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34
Q

Thyroid _____________ are commonly found in patients with thyroid dz. The __________ complex can initiate inflam/cytotoxic effects on thyroid follicle.

A

Antibodies

Immune antibody-antigen

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35
Q

Thyroglobulin is use for?

A

Detect persistence or recurrence of thyroid carcinoma.

Inc = ca

36
Q

What are some agents that contain iodine?

A 
Contrast
Thyroid meds
Topical antiseptics
Multivit
Herbals/supps
Cough Syrup
Propranolol and amiodarone
Estrogens
Salicylates
Amphetamines
Corticosteroids
37
Q

What are the d/o’s of hypothyroid? Hyperthyroid?

A 
Hypo:
Mild/advanced (myxedema)
Hashimotos dz
Hyper:
Graves dz
Thyroiditis
Goiter
Cancer
38
Q

What are some clinical manifestations in hypothyroidism?

A

Common in women/elderly.
Lethargy, intol to cold, brittle hair/nails, dry skin, disrupt menses, dull mentation, thick tongue, inc lipid level, inc sensa to opiates, constipation, muscle aches/weakness.

Later: subnormal temp, bradycardia, weight gain, dec LOC, thick skin, cardiac issues. Myxedema, 3rd spacing (heart/lungs too), dec o2 inc co2

39
Q

What are some nursing measures to keep in mind with long term hypothryoidism?

A

No warm blanket (if not nec) may cause vascular collapse. Mon for cardiac issues (chest pain), at risk for CAD, inc cholest, athero.

40
Q

What are some se of synthroid (levothyroxine)?

A

Inc pulse, BP, glucose, bone loss.

Can inc anti coag/ dig activity.

41
Q

What are some meds that will interact with insulin/oral antidiabetics?

A

Dig, anti coag, inducing, Dilantin (phenytoin), tricyclic antidepressant.

42
Q

What is the glucose sodium relationship in hyperglycemia?

A

For every molecule of glucose filtered and reabsorbed, one molecule of sodium is reabsorbed. Leads to sodium retention. (Plays role in insulin resistance)

43
Q

What occurs with sodium with HTN and insulin resistance?

A

Decreased sodium excretion. SNS stimulated. Tone of smooth muscle cells enhanced due to inc. sodium/calcium.
Angio II uptake.

44
Q

Can type 1 diabetes store glucose in the liver? What causes their hyperglycemia?

A

No.

Postprandial hyperglycemia, and uncontrolled glycogenolysis/gluconeogenesis.

45
Q

What is syndrome X? What are the requirements to meet this metabolic syndrome?

A

Insulin resistance syndrome. Must meet 3 or more of the following:
Fasting glucose: 100 (or abnormal glucose tol tests)
Abd obesity (waist circum 35-40 in)
Dyslipidemia (trig over 150, HDL less than 50-40)
BP (greater than 130/85)
Pro inflam state (inc CRP)
Prothrombotic state (inc fibrinogen)
Abn vascular endothelium/macro vascular dz

46
Q

What are normal fasting glucose and postprandial?

A

Less than 110

After 2 hours 65-139

47
Q

What are the ADA normoglycemic values?
HgA1C
Fasting plasma Glucose
Post prandial (2 hour) during OGTT

A

Hga1c: 3.9-5.6
FPG: less than 100
Less than 140

48
Q

What are the ADA’s diagnostic standard for pre diabetics?
A1C
FPG
2 HR OGTT (75g)

A

5.7-6.4
100-125
140-199

49
Q

What are the ADA’s diagnostic criteria for diabetics?
HgA1C
FPG
2hr OGTT

A

Greater than 6.5%
Greater than 126
Greater than 200

50
Q

What is the recommended caloric distribution?

A 
Carbs 50-60%
Whole grains, dec glycemic index, nut dense
Fats 20-30% 
2 or more fish per week
Protein 10-35%
Non animal (lesser w/ renal dz)
51
Q

How can fiber and alcohol affect caloric distribution for the diabetic?

A

Fiber:14g/1000 cal daily
Soluble-lower blood glucose and lipids
Insol-satiety, weight loss

Alcohol:absorbs 1st. Converted to fat (inc DKA risk), hypoglycemia risk, weight gain, inc calories
Limit 1-2 per day

52
Q

What are the 4 steps in reading food labels? Sweeteners?

A

Serving size
Total carbs
Total fiber
Sugar alcohols

Nutritive sweet:calories sim to sucrose-less elevation of blood sugar
Nonnutritive: no cal, no elevation

53
Q

What is glycemic index?

What can lower?

A

Description of how much a food increases blood glucose compared with an equivalent amount of glucose.
Pairing starchy food w/ protein/fat food. (Slows absorption)
Raw/whole foods (rather than cooked/chopped)
Whole fruits (instead of juice)
Sugar foods eaten with slowly absorbed foods lowers response.

54
Q

What are fitness guidelines for diabetics?

A

(FIT)
Frequency (3xweek)
Intensity (60-80% of max HR)
Time (20-30min w/ 10min warm up)

55
Q

What are the exercise precautions for diabetics?

A

DKA or BG over 250 NO EXERCISE!

Insulin dec w/ exer. So type 1 will req carb loading pre/post exer. 15g.
Check BG more often. Hypoglycemic risks. Snack at bedtime.
Adjust insulin.

56
Q

What is the frequency of self monitoring BG levels?

A

Insulin dependent: 2-4 X day (AC, HS)-peak action and 2hr post meal for reg/rap acting
No insulin: 2-3 week (2hr postprandial)
Type 2:daily pre and 2hr post biggest meal
Bedtime insulin/pumps:3am once/week

Anytime hyper/hypo gly suspected
Changes in meds/activity/diet/stress/ illness

57
Q

What is the action and cautions with sulfonylureas?

A

(Glipizide)
Stim pancreas to secrete insulin. Inc insulin sensa in the cells.

Hypoglycemia SE, GI effects, weight gain, avoid alcohol, interactions (NSAIDs, warfarin, sulfonamides), beta adrenergic blocking agents may mask s/s of hypoglycemia

58
Q

What are the actions and cautions of biguinides?

A

(Metformin)
Inhibit gluconeogenesis, improve insulin sensa, dec liver syn of cholesterol.

Weight loss, GI effects, do not use 2 days pre/post contrast. Renal function, lactic acidosis.

59
Q

What are the actions and cautions with alpha glucosidase inhib?

A

(Acarbose/miglitol)
Delay glucose absorption. Lower postprandial glucose.
Need to take with first bite of food.

GI effects (contraindicated w/ GI, renal, liver dz)
Use glucose to treat hypoglycemia
60
Q

What are the actions and cautions w/ non sulfon insulin secretagogues?

A

(Repaglinide/nateglinide)
Stims insulin release
Fast acting/short duration. Take before meals. 3x day.

Hypoglycemia

61
Q

What are the actions and cautions with thiazolidinediones?

A

(pioglitazone/rosiglitazone)
Inc insulin sensa in cells, stim receptor sites.

Fluid retention, CARDIAC black box, liver function.

62
Q

What are the actions of incretin for glucose control?

What actions do drugs take?

A

Incretins (hormones in small intestine after meal to inc insulin secretion, stop liver glucose production, inc satiety, delay glucose absorption by slower gastric emptying).

Mimic incretins or reduce incretin destruction.

63
Q

What is the action and cautions of DDP-4 inhibs (Incretin enhancer)?

A

(Sitagliptin)
Inhib enzyme that breaks down incretin.

This ultimately allows inc insulin release and dec glucagon release.

PO, 1x day

Pancreatitis

64
Q

What are the actions and cautions of GLP-1 receptor agonist (incretin enhancer)?

A

Mimics incretin by activating GLP receptor: lower blood glucose by inc insulin, reduce glucagon action, slowing glucagon absorption.
Sub Q
GI effects, pancreatitis, reduce appetite/weight loss
Exenatide-60min before meals only (morn/eve)
Liraglutide-once daily anytime

65
Q

What are imperative sick day rules for the diabetic?

A

Do not stop insulin, may need to increase.
Check BS q 2-4 hrs
Urine check for ketones
Inc fluids w/ sweetened liquids q 30min-1hr
Replace carbs 50g q3-4hr soft foods 8x day
Call dr

66
Q

What can mask adrenergic response in hypoglycemia?

A

autonomic neuropathy
Beta blockers
Elderly and the unaware (need to check BG more often)

67
Q

What is the rule of 15:15 for use during hypoglycemia (BG 50-60)?

A

Take 15 grams of fast acting concentrated carbs (1/2 cup juice, 4 oz soda, 3 glucose tabs/gel, candy x8)
Wait 15 min, check BG
If less than 70, repeat
If greater than 70 eat complex carb and protein snack (pnut butter, crackers, milk, graham crackers)

68
Q

When would glucagon be administered and how is it given?

A

When unconscious and unable to swallow.
1mg sub q/IM
Mix powder and dilute the right before injection
Onset 8-10 min, duration12-27 min.
Have concentrated carb ready for when pt awakens.

69
Q

When and how would dextrose (D5W) be administered for hypoglycemia?

A

25-50 ml

Effects in minutes (hypertonic)

70
Q

What are common medical managements for hyperthyroidism?

A

Radioactive iodine for Graves DZ
Antithyroid meds
Beta adrenergic blockers (propranolol/indomethacin) dec symptoms
Surgical removal

71
Q

What is a concern with the radioactive iodine tx for hyperthyroidism?
Define.

A

Thyroid storm/thyrotoxicosis

High fever (101.3)
Tachycardia (130)
Exaggerated symptoms of body system
Altered mental status

72
Q

How is thyroxicosis managed?

A 
Tx hyperthermia (no NSAIDs)
O2 status (humidify)
IVF (w/ dextrose)
Antithyroid meds
Hydrocortisone
Iodine
73
Q

What 2 meds block synthesis of thyroid hormone?

What may be given with these?

A

Methimazole
PTU
(Controls vs, goiter shrink, labs) takes weeks

Levothyroxine

74
Q

What are the pre procedure requirement of thyroidectomy?

A 
Dec thyroid gland size
Stop anti coags
Practic neck support
Reduce stress
High calorie diet
Rest
75
Q

What is postop nursing care for thyroidectomy?

Complications?

A

Vs, Bleeding, Voice,Pain,Incision line,Calcium.

Hemorrhage, hematoma, glottis edema, laryngeal nerve damage, parathyroid gland damage.

76
Q

What stims PTH? How does it work?

A

Dec serum calcium.
PTH released: bone releases calcium, kidney dec calcium excretion and inc phosphate elim and activates Vit D inc intestinal calcium absorption.
All 3 lead to inc serum calcium.

77
Q

How is hypercalcemic crisis treated?

A 
(Above 15)
IV fluid rehydration (dilutes)
Diuretic (excrete ca)
Phosphate therapy(inverse relationship)
Calcitonin and corticosteroids
Dialysis
78
Q

What clinical manifestations present during hypoparathyroidism?

A 
(Dec serum CA)
Tetany 
Bronchospams
Dysphagia
Photophobia
Cardiac dysrhythmias
Seizures
Hypotension
Trousseaus sign (wrist flex w/ occluded artery)
Chvosteks sign (tap of facial nerve)
79
Q

What are the 3 S’s of the adrenal glands?

A

Sugar (glucocorticoids)
Salt (Mineralocorticoids)
Sex (androgens)

80
Q

What are the stress adaption steroid hormones of the the adrenal cortex?

A

Glucocorticoids (hydrocortisone)
Mineralocorticoids (aldosterone)
Androgens (sex hormones testos/est)

81
Q

What are the adrenal cortical disorders?

A 
Adrenal cortisol insuff: (inability to secrete all 3)
Primary-insuff (Addisons)
Secondary-insuff
Acute adrenal crisis
Excessive adrenal secretion:
Glucocorticoid excess (cushings)
Hyperaldosteronism
Congenital adrenal hyperplasia:
Dec cortisol syn
Other hormones inc/dec
82
Q

What is pheochromocytoma?

S/s? (5H’s)

A

Benign tumor of adrenal medulla

Ha, palp, diaphoresis, HTN

(HTN, Ha, Hyperhydrosis, hypermetabolism, hyperglycemia)

83
Q

What are the tx’s for pheochromocytoma?

A

Alpha adrenergic blockers: phenoxybenbenzamine
Smooth muscle relaxer: sodium nitroprusside
CCB:nifedipine

Surgical removal
(Corticosteroid replacement)

84
Q

What are s/s of Addisons?

A 
(ACTH insuff)
Bronze skin
Hypotension
Hypoglycemia weight loss vomiting diarrhea urinary loss:water/sodium 
Potassium retention adrenal atrophy
85
Q

What are s/s of Cushing syndrome?

A

Moon face, buffalo hump, sod/water retention, hyperglycemia, weight gain, striae, purpura, poor wound healing, frequent infections, osteoporosis, amenorrhea/hirsutism, CNS irritability, GI distress/inc acid.

86
Q

What causes HHS?

What are the differentiating s/s?

A

Type 2 diabetes
Insulin resistance

*inc sodium
Dec potassium

(Opposite to DKA)

No fat breakdown

Tx similar to DKA

Nur 210 (4 decks)

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