w4 notes Flashcards
ADH patho:
Patho
1. When there is an ___crease in plasma osmolality or ___crease in blood volume
2. ADH is released from _________ (AND thirst is increased)
3. ______ is excreted within the body (AND the body’s thirst mechanism prompts them to consume fluids)
4. the kidneys _______ the fluid so the water is retained within the body
- retaining pure water = ___crease in plasma volume and ___crease in plasma osmolality
5. the blood volume ___creases, and when normal blood _________ is achieved = ADH release is stopped (AND thirst mechanism stops)
(this is another example of ________ feedback cycle)
Patho
1. When there is an increase in plasma osmolality (concentrated blood) or decrease in blood volume (concentrated blood)
2. ADH is released from posterior pituitary (AND thirst is increased)
3. water is excreted within the body (AND the body’s thirst mechanism prompts them to consume fluids)
4. the kidneys reabsorb the fluid so the water is retained within the body
- retaining pure water = increase in plasma volume and decrease in plasma osmolality (blood concentration)
5. the blood volume increases, when normal blood osmolality is achieved = ADH release is stopped (AND thirst mechanism stops)
(this is another example of negative feedback cycle)
hyperthyroidism = overactive thyroid
TSH =
T4 =
T3 =
Caused by
- ______________ – most common, autoimmune
- toxic multi-_________ goiter
hyperthyroidism
overactive thyroid
TSH low
T4 low
T3 high
Caused by
- grave’s disease – most common, autoimmune
- toxic multi-nodular goiter
Teaching DM pt: what to do when sick
- notify provider when you are _____
- monitor BS more frequently
- keep taking meds
- prevent dehydration
- meet __________ needs – food, Gatorade, Pedialyte
- rest
- call provider when:
- ______ in urine
- BS >250
- Fever >101.5 and not _______
- Feeling confused, ______ breathing
- Persistent n/v/d
- Cant tolerate liquids
- Illness lasting longer than ___ days
Teaching DM pt: what to do when sick
- notify provider when you are sick
- monitor BS more frequently
- keep taking meds
- prevent dehydration
- meet carbohydrate needs – food, Gatorade, Pedialyte
- rest
- call provider when:
- ketones in urine
- BS >250
- Fever >101.5 and not responding to Tylenol
- Feeling confused, rapid breathing
- Persistent n/v/d
- Cant tolerate liquids
- Illness lasting longer than 2 days
Adrenal (cortex):
- responds to _______
- regulates ____
- adrenal gland sits on _______
- Adrenal ________ – 3 S’s
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- Adrenal ________
- Epinephrine
- Norepinephrine
Adrenal (cortex) Disorders
- responds to stress
- regulates Na
- adrenal gland sits on kidney
- Adrenal cortex (covers) – 3 S’s
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- Adrenal medulla (middle)
- Epinephrine
- Norepinephrine
Major regulator of water supply in body
(2)
- ADH
- thirst mechanism
Pituitary studies: _________ test
- used to differentiate the cause/the why behind diabetes insipidus
- Neurogenic – head trauma
- Nephrogenic – kidney issue
- Psychogenic – psychological issue
how does it work?
- stimulates ______ by administering ______
- monitor urine output, specific gravity, and serum osmolality every 1-2 hours during test (reaction to ADH)
Pituitary studies: water deprivation test
- used to differentiate the cause/the why behind diabetes insipidus
- Neurogenic – head trauma
- Nephrogenic – kidney issue
- Psychogenic – psychological issue
- stimulates ADH by administering ADH/vasopressin
- monitor urine output, specific gravity, and serum osmolality every 1-2 hours during test (reaction to ADH)
Hyp____glycemia
- sweating
- blurry vision
- dizzy
- anxiety
- hunger
- irritability
- shakiness
- tachycardia
-h/a
- weakness, fatigue
Hyp___glycemia
s/s – weak, fatigue, blurry vision, h/a, n/v/d
hypo BS < 70
hyper
cushings syndrome/disease treatment:
- depends on cause
- If ________ tumor = adrenalectomy
- If ectopic ACTH-secreting tumor = removal of _______
- Drug therapy to suppress ______
- If prolonged ________ = gradual d/c of drugs, reduction of dose, conversion of alternate-day regimen
teaching diet – ___creased protein and potassium, ___creased calories and sodium
cushings syndrome/disease treatment:
- depends on cause
- If adrenal tumor = adrenalectomy
- If ectopic ACTH-secreting tumor = removal of tumor
- Drug therapy to suppress cortisol
- If prolonged steroids = gradual d/c of drugs, reduction of dose, conversion of alternate-day regimen
teaching diet – increased protein and potassium, decreased calories and sodium
addisons Treatment
- hormone replacement therapy
- Hydrocortisone (daily) – exogenous ________
- 2/3 dose AM/PM?
- 1/3 dose AM/PM?
- Fludrocortisone (daily) – exogenous ________
- Salt additives for heat/humidity
- ___creased doses when stress
- Frequent vs
- stress free environment – low noise, light, temp
Treatment
- hormone replacement therapy
- Hydrocortisone (daily) – exogenous cortisol
- 2/3 dose AM – naturally higher cortisol in body upon wakening
- 1/3 dose PM
- Fludrocortisone (daily) – exogenous aldosterone
- Salt additives for heat/humidity
- Increased doses when stress
- Frequent vs
- stress free environment – low noise, light, temp
Cushing’s disease/syndrome = too much 3 S’s/cortisol
- Glucocorticoids - _______ (steroids)
- Mineralocorticoids – _________ (salt)
- Sex steroids – testosterone (sex)
(syndrome = collection of _____)
Common cause
- PO systemic __________
Cushing’s disease/syndrome
too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
(syndrome = collection of s/s)
Common cause
- PO systemic steroids long term
DI
s/s
- 3 P’s?
- high or low urine specific gravity?
- high or low urine osmolality?
- high or low serum osmolality?
- hyp___natremia
- fatigue from nocturia
- weakness from Na imbalance
s/s
- Polydipsia (r/t high serum osmolality)
- polyuria – 5-20 L/day
- (not polyphagia)
- Urine low specific gravity (not concentrated, diluted urine)
- low urine osmolality (not concentrated urine b/c it is very diluted with fluid that the kidneys are excreting)
- high serum osmolality (concentrated blood b/c there is no water in the body, the kidneys are excreting everything)
- hypernatremia (pure water loss in kidney, sodium is concentrated)
- fatigue from nocturia
- weakness from Na imbalance
Hypoglycemia Treatment
- check BS
- rule of 15
- conscious and able to swallow:
- 15g simple carbs – ______ or ______, avoid ______
- unconscious/unable to swallow:
- IM ______
- IV ______
- check BS again in 15 mins
- if > 70 = eat regular meal
- if < 70 = repeat rule of 15 until > 70
Hypoglycemia Treatment
- check BS
- rule of 15
- conscious and able to swallow:
- 15g simple carbs – 4 oz juice or regular soda, avoid sugars w/ fat like candy bar b/c delayed absorption
- unconscious/unable to swallow:
- IM glucagon
- IV D50
- check BS again in 15 mins
- if > 70 = eat regular meal
- if < 70 = repeat rule of 15 until > 70
Insulin deficit and F/E balance
1. increased serum glucose levels
2. __creased plasma oncotic pressure
3. fluid shifts ______ cells and _______ intravascular (to fix the pressure/concentration issue)
4. cells swell or shrink ?
Insulin deficit and F/E balance
1. increased serum glucose levels
2. increased plasma oncotic pressure (r/t balance/concentration of blood sugar in blood vessels)
3. fluid shifts out of cells and into intravascular (to fix the pressure/concentration issue)
4. intracellular dehydration, cells are dehydrated and shrink
TSH low
T4 low
T3 high
TSH high
T4 low
T3 low
hyper
hypo
hypothyroidism = underactive thyroid
TSH ____
T4 _____
T3 _____
Caused by
(1)
hypothyroidism
underactive thyroid
TSH high
T4 low
T3 low
Caused by
- Hashimoto’s thyroiditis
T___ s/s
- younger people – most common
- abrupt
- not common in DM cases
- no endogenous insulin production – must have insulin replacement
- 3 p’s = excessive thirst (polydipsia), excessive hunger (polyphagia), excessive urination (polyuria)
- Weight loss
- fatigue
- weakness
- recurrent infections
- prolonged wound healing
- pruritis
- vision changes
- paresthesia
- CV symptoms
T___ s/s
- adults with risk factors
- can be undx for years b/c s/s not as evident
- insulin resistant – PO/SQ meds, maybe insulin replacement
- fatigue
- increased thirst and urination
- recurrent infections and slow wound healing
- vision changes
- pruritus (itching)
- symptoms of neuropathy like paresthesias or weakness
- overweight w/ unexpected weight loss
T1 s/s
- younger people – most common
- abrupt
- not common in DM cases
- no endogenous insulin production – must have insulin replacement
- 3 p’s = excessive thirst (polydipsia), excessive hunger (polyphagia), excessive urination (polyuria)
- Weight loss
- fatigue
- weakness
- recurrent infections
- prolonged wound healing
- pruritis
- vision changes
- paresthesia
- CV symptoms
T2 s/s
- adults with risk factors
- can be undx for years b/c s/s not as evident
- insulin resistant – PO/SQ meds, maybe insulin replacement
- fatigue
- increased thirst and urination
- recurrent infections and slow wound healing
- vision changes
- pruritus (itching)
- symptoms of neuropathy like paresthesias or weakness
- overweight w/ unexpected weight loss
Pharmacotherapy for SIADH or DI?
- Desmopressin/DDAVP
DI
Desmopressin/DDAVP is a synthetic form of vasopressin/ADH for replacement (DI has a lack of ADH)
Goiter = ________
can be caused by
- hyperthyroid (toxic)
- hypothyroid
- thyroiditis
- benign thyroid nodules
- malignancy
- _______ deficiency
- iodine is necessary for synthesis of _______
- only the thyroid gland can uptake _______
- most iodine needs are met through _____
- (4)
- iodine deficiency is an issue in ______, and not an issue in _____
Toxic goiter – goiter with hyp___thyroidism
________ goiter – goiter with normal thyroid levels, d/t autoimmune problems
Goiter
Enlarged thyroid gland
can be caused by
- hyperthyroid (toxic)
- hypothyroid
- thyroiditis
- benign thyroid nodules
- malignancy
- iodine deficiency
- iodine is necessary for synthesis of thyroid hormones,
- only the thyroid gland can uptake iodine,
- most iodine is consumed through diet
- (yogurt, milk, eggs, and iodinized salt),
- issue in some parts of the world, not an issue in US
Toxic goiter – goiter with hyperthyroidism
Non-toxic goiter – goiter with normal thyroid levels, d/t autoimmune problems
Pancreatic disorders
diabetes mellitus
T___
- autoimmune
- immune system attacks and destroys insulin producing beta cells in the pancreas
- without beta cells body can’t make insulin = hyperglycemia
T____
- body’s cells wear out and become resistant to the effects of insulin = hyperglycemia
T1
T2
- A hypertonic solution/medium has a _______ osmolality/concentration of solutes compared to normal body fluids or cells.
- A hypotonic solution/medium has a ________ osmolality/concentration of solutes compared to normal body fluids or cells.
- When a hypertonic solution is administered IV, it causes water to move ______ the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
- When a hypotonic solution is administered IV, it causes water to move ______ the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
- Hypertonic solutions are useful in treating conditions like hyp___natremia
- Hypotonic solutions are useful in treating conditions like hyp___natremia
A hypertonic solution/medium has a higher osmolality/concentration of solutes compared to normal body fluids or cells.
A hypotonic solution/medium has a lower osmolality/concentration of solutes compared to normal body fluids or cells.
- When a hypertonic solution is administered IV, it causes water to move out of the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
- When a hypotonic solution is administered IV, it causes water to move into the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
- Hypertonic solutions are useful in treating conditions like hyponatremia
- Hypotonic solutions are useful in treating conditions like hypernatremia
ADH
Regulator of __________
- loss of pure water r/t ADH will not effect _________
Increase in ADH = ___crease in water retention
___crease in blood volume
___crease in BP
Regulator of pure water supply
- loss of pure water r/t ADH will not effect POTASSIUM
(will not cause hypokalemia)
Increase in ADH = Increase in water retention
Increase in blood volume
Increase in BP
hyperthyroidism s/s:
- ___creased HR
- 4 heart things?
- __creased RR
- breathing?
- ___creased appetite and thirst
- weight _____
- __creased peristalsis
- diarrhea or constipation?
- memory lapses, short attention span
- warm/cold?, dry/moist?, smooth skin
- hair amount?
- ________ erythema
- hair texture?
- diaphoresis
- hyper or depigmentation of skin
- goiter?
- bruit over ________
- _________ - abnormal protrusion/bulging of the eyeballs from the eye sockets
metabolism is turned up
- increased HR, murmurs, dysrhythmias, palpitations, angina
- increased RR,
- DOE
- increased appetite and thirst
- weight loss
- increased peristalsis,
- diarrhea
- memory lapses, short attention span
- warm, moist, smooth skin
- hair loss
- palmar erythema (red palm)
- fine silky hair
- diaphoresis
- vitiligo (autoimmune, depigmentation of skin)
- goiter
- bruit over thyroid gland – d/t increased vascularity
- exophthalmos - abnormal protrusion/bulging of the eyeballs from the eye sockets
ADH disorders:
________ = too much ADH (holding onto water)
_______ = not enough ADH (losing water like crazy)
Adrenal cortex disorders:
__________ = not enough 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
__________ = too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
Adrenal medulla disorders:
___________ = too much epinephrine and norepinephrine
Thyroid disorders:
_________(_______) = overactive thyroid
__________(______) = underactive thyroid
Pancreatic disorders:
___________ = hyperglycemia due to the body’s inability to produce or effectively use the hormone insulin
ADH disorders:
- SIADH (syndrome of inappropriate ADH) = too much ADH (holding onto water)
- diabetes insipidus) = not enough ADH (losing water like crazy)
Adrenal cortex disorders:
- addisons disease = not enough 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- cushing disease/syndrome = too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
Adrenal medulla disorders:
- pheochromocytoma = too much epinephrine and norepinephrine
Thyroid disorders:
- hyperthyroidism (grave’s disease) = overactive thyroid
- hypothyroidism (Hashimoto’s thyroiditis) = underactive thyroid
Pancreatic disorders:
- diabetes mellitus = hyperglycemia due to the body’s inability to produce or effectively use the hormone insulin
Negative feedback cycle and the thyroid gland:
hyperthyroidism = T3/T4 will be ______ and TSH will be _______
Negative feedback cycle and the thyroid gland:
- hyperthyroidism = T3/T4 will be high and TSH will be low
hyperthyroidism treatment: surgical therapy
endoscopic vs subtotal?
1. _________ thyroidectomy
- Removal of a _________ of the thyroid gland
- If too much is taken = __________
- Indications – not responsive to ________ therapy, very large ______, possibility of _________
2. __________ thyroidectomy – less invasive, used for __________
Post op interventions:
- Assess for s/s _________
- Assess for ______ compression
- would these signs be concerning? Irregular breathing, neck swelling, frequent swallowing, choking, blood on dressing, sensations of fullness at incision site
- Place in _________ with head on pillow
- Avoid flexion or any tension on ________
- Monitor vs
- parathyroid close to thyroid - Monitor serum ________ levels, tetany, “AMB?”, tingling in toes/fingers/mouth, muscular twitching, apprehension, trousseaus sign and chvosteks sign
- Subtotal thyroidectomy
- Removal of a large portion of the thyroid gland
- If too much is taken = hypothyroidism
- Indications – not responsive to anti-thyroid therapy, very large goiter, possibility of malignancy - Endoscopic thyroidectomy – less invasive, used for small nodules
Post op interventions:
- Assess for s/s hemorrhage (thyroid very vascular)
- Assess for tracheal compression (thyroid close to airway)
- Irregular breathing, neck swelling, frequent swallowing, choking, blood on dressing, sensations of fullness at incision site
- Place in semi fowlers with head on pillow
- Avoid flexion or any tension on suture lines
- Monitor vs
- parathyroid close to thyroid - Monitor serum calcium levels, tetany, “AMB?”, tingling in toes/fingers/mouth, muscular twitching, apprehension, trousseaus sign and chvosteks sign
hyperthyroid Treatment: drug therapy
1. anti-thyroid meds = _________
- improvements in 1-2 weeks, good results 4-8 weeks
2. _______ therapy = SSKI and Lugol’s solution
- used to prep pt for __________
- when given in _____, _______ doses - inhibits synthesis of T3 and T4, lowers the vascularity of the thyroid gland, makes surgery easier and safer
3. beta blockers
- used for s/s relief of ________
4. radioactive iodine therapy – 1st line for non-pregnant adults
- route?
- require hospitalization?
- The radioiodine is rapidly incorporated into the thyroid and its beta emissions result in extensive local tissue damage
- ________ is radio active for a period of time
- Delayed response – _______ of thyroid function over a period of 6-18 weeks
- Anti-thyroid drugs and ______ given together to help s/s management
- Radioactivity is gone within______ days
- Radioactivity precautions –
minimize ________ for 2-3 days,
__________ toilet,
separately _______ clothes
Treatment
- drug therapy
- anti-thyroid meds = methimazole
- improvements in 1-2 weeks, good results 4-8 weeks
- idodine therapy = SSKI and Lugol’s solution
- used to prep pt for thyroidectomy
- when given in rapid large doses - inhibits synthesis of T3 and T4, lowers the vascularity of the thyroid gland, makes surgery easier and safer
- beta blockers
- used for s/s relief of thyrotoxicosis
- radioactive iodine therapy – 1st line for non-pregnant adults
- PO solution/capsule
- Doesn’t require hospitalization
- The radioiodine is rapidly incorporated into the thyroid and its beta emissions result in extensive local tissue damage
- Excretions are radio active for a period of time
- Delayed response – ablation of thyroid function over a period of 6-18 weeks
- Anti-thyroid drugs and beta blockers given together to help s/s management
- Radioactivity is gone within a few days
- Radioactivity precautions –
minimize direct contact for 2-3 days,
double flush toilet,
separately launder clothes and towels
ADH disorders:
which one are you holding onto water?
which one are you losing water like crazy?
ADH disorders:
- SIADH (syndrome of inappropriate ADH) = too much ADH (holding onto water)
- diabetes insipidus) = not enough ADH (losing water like crazy)
SIADH Patho
1. ___creased ADH
2. ___creased water reabsorption in kidneys
3. ___creased intravascular fluid volume
4. dilutional hyp___natremia and ___creased serum osmolality
Patho
1. increased ADH
2. increased water reabsorption in kidneys
3. increased intravascular fluid volume
4. dilutional hyponatremia and decreased serum osmolality
- parathyroid gland (buried in the _______ gland)
Parathyroid regulates
(2)
If the parathyroid is removed = hyp___calcemia = check for what?
- parathyroid gland (buried in the thyroid gland)
Parathyroid regulates
- calcium
- phosphorus
If the parathyroid is removed = hypocalcemia = treuseaus and chovsteks signs
Negative feedback cycle
Example:
- stress occurs
- triggers release of ______ from hypothalamus
- reaches target organ: _______ gland
- releases _______
- reaches target organ: __________
- releases ________
- blood sugar _______ and body prepares for fight or flight in response to stress
Negative feedback cycle
Example:
- stress occurs
- triggers release of CRF from hypothalamus
- reaches target organ: pituitary gland
- releases ACTH
- reaches adrenal cortex
- releases cortisol
- blood sugar rises and body prepares for fight or flight in response to stress
