WEEK 1 :Altered hormone regulation Flashcards
Hormone imbalance can lead to many problems/symptoms
yes this is true
what are the two major issues of hormone
hormone insufficiency, and excess
what are the causes of hormone irregulation ?
trauma ( such as trauma to the gland ) – hitting their head can cause endocrine injury
congenital
genetic
inflammatory ( underlying poor inflammatory cause )
tumours ( secreting hormones )
what does this undergo to when it comes ton clinical judgement model ?
gather ( investigate process )
diagnostics
blood work/scans/head to toe
annalyze cues
when it comes to planning and prioritizing what are we thinking?
what is the worst thing that could happen
for example : with diabetes worst thing that could happen is hypoglycemia and hyperglycemia
in terms of clinical judgement what should we know when it comes to hormone regulation:
recognize cues of altered hormone balance leading to loss of homeostasis
analyze assessment findings and interpret laboratory data to determine the severity of hormone imbalance
understand non and pharmacological approaches used to restore normal hormone balance
prioritize nursing actions to address hormone imbalance
evaluate the effectiveness of nursing interventions used to care for patients with hormone imbalance
educate patients and their families about management of chronic hormone imbalance
just read
recall that recognizing cues :
posterior pituitary disorders : adh
thyroid disorders : thyroid homrone
adrenal gland disorders : corticosteroids
diabetes : insulin
where is the adh located and what do we think abt when we think atb this hormone ?
what electrolytes are we thinking abt ?
located base on the brain and secretes adh
adh - think abt fluid - expect abnormality in fluids and electrolyte imbalance
think abt sodium and water
what is another word for buffalo hump ?
suprascapular fat
recall that corticosteroids are the hormones for adrenal gland disorders
what is mineralcorticosteroids
retaining water and sodium , and androgens ( sex hormones ) - facial hair, they have amenorrhea –> could occur with cushing syndrome
diabetes - problems of production or use of insulin
is this true amongst it
this is true
what is the hormone secreted for posterior pituitary ?
adh
what is the hormone secreted for thyroid
t3 and t4
what is the hormone secreted for adrenal gland
corticosteroids
what are the s and s ( too little ) of adh
Diabetes insupidus
what are the s and s ( too little ) of t3 and t4
hypo metabolism ( hypothyroid )
what are the s and s ( too little ) of corticosteroids
Addison disease
what medication do we use for diabetes insipidus ( if there is little adh )
we use desmopressin
what medication do we use for hypothyrodism ( hypometabolism )
we use synthroid ( levothyroxine )
what medication do we use for addisons disease
prednisone
s and s of too much adh
water retention ( siadh )
too much of t3 and t4
hypermetabolism ( hyperthyrodism )
too much corticosteroid = ?
cushing
s and s too much ( water retention ) siadh
tolvaptan ( this is use to treat low level of sodium )
what is used to treat hypermetabolism ?
tapazole and beta blockers
what do we use to treat cushing ?
drugs that interfere with acth production
what is serum osmolality ?
blood osmolality test : often used to check balance between water and certain substances in ur blood
when they have siadh, would they have hyponatremia or hypernatremia?
hyponatremia
sodium and potassium - think abt aldosterone hormone ( slightly abnormal ) addisions
yes this is true
when thinking abt sodium what hormone are we thinking ?
adh
whenever you see a history of a cardiac damage
( more damage of extra fluid , faster rates, and abnormal potassium levels )
this is something we should look upon
yes this would be correct
in terms of taking action : nursing interventions for hormone imbalance
what should we look upon
nutrition therpahy
fluid and electrolyte management
monitor response to medical and surgical treatments
non pharmacological inteventions
take action :
nursing interventions for hormone imbalance
nutrition therapy
determine calorie/carb/nutrient needs ( dietician )
monitor dietary intake ( calorie count )
consider need for adequate fiber/fluids ( constipation )
true or false. never run and iv with no doctors orders
true
take action : nursing interventions for hormone imbalance
fluid and electrolyte management
dehydration : iv fluid and oral fluid
fluid overload: restrict fluid and diuretics
electrolyte imbalance : replace electrolytes that are low/deficient ( oral pill/liquid/ or iv )
restrict electrolytes that are high
ALWAYS think abt loc :
severe dehydration: what are the signs and symptoms
dry skin, confused, neurological changes
- vital signs are big ones
- they are hypotensive and tatchy
when someone has a good functioning heart- they can give receive fluid too quickly which can lead and develop into symptoms such as
not tolerating well
- peripheral edema
-circulator vein distention
-increase rr
-decrease sats
-crackles
in terms of monitor response to medical/surgical treatments
nurses will monitor for resolution of symptoms such as
vs
physical assesment
daily wts
ins and outs
accu checks
lab values
hypothyroid: beta blocker
if giving diuretics wehn they haev too muhc fluid ( are they peeing more )
less signs of edema and crackles
true or false. this would be considered as a resolution of symptoms and monitoring that.
true
another word for expiratory wheeze?
stridor
what is wheezing ?
air moving to a narrow airways
audible wheezing coarse vice/lose voice - changes to voice if they have injury to the laryngeal nerve
recall that deep breathing and coughing is essential when it comes to post op thyrodectomy why is that ?
to avoid atelactasis, deep breathing and coughing after surgery
if not encouraged can lead to pneumonia
what should the position be for a thyroidectomy patient ?
elevate the head of the head, this increases the venous return and get rid of extra fluid
if they have thyroidectomy : what should u think ?
protect the airway
think abt the swelling in the neck- harder to breathe in surgery
gas exchange should be increased
complications for thyroidectomy
what signs should u look for ?
look for signs that airway is compromise
02 sats- breathing
swelling is common
what is the symptoms and sign of thyroid storm
heart rate ( beating fast, temperature becomes high, this is rare but possible )
take action : nursing interventions for hormone imbalance
non pharmacological interventions for symptom relief and disease management
what undergoes this
control environmental factors
( room temp, noise )
psychological support
education on long term management
- recognize signs of hormone imbalance
-decision making ( dose adjustment )
-importance of compliance ( potential complications )
just read *** evaluate : did ur intervention help ?
* Re-assess your patient’s condition
* Have symptoms improved or resolved?
* Is there any evidence of the opposite problem occurring? (ex: low hormone levels becoming too high or vice versa)
* Is there a need for changes to current treatment plan?
exemplar #1 : hypothyrodism
what is going on ?
which hormone is involved?
is there too little or too much ?
which symptoms occur ?
( think abt the diagram )
hormone : t3 and t4
there is too little
symptoms : weight gain, constipatin, myxedema ( generalized non pitting edema over the body ) in the face, cooling ( bundled up ) goitre
in hypothyroidism polysaccharide doesn’t get broken down which results in what?
cellular edema
patients who have hypothyroidism, are what ?
neurologically tired ( slowing down the process thoughts )
what would be the head to toe examination for a person with hypothyroidism ?
neuro
cvs
resp
gi
neuro : tired, takes a while to answer questions A&Ox3
CVS: low bp, low hr, edema to face and periphery, angina with exertion
resp: rr could be low, sob with exertion
gi: poor appetite, constipation
why would a person with hypothyroidism be experiencing angina with exertion
because cholesterol doesn’t get broken down thats why this is occurring
true or false. with constipation, nausea could occur with hypothyrodism.
this is true, stays in the stomach causes symptom of nausea
what is the gu and integ with someone who has hypothyrodism
gu : no concerns everything is normal
integ : skin is dry, nails are brittle
with thyroid, what do u HAVE to remember ?
remember the heart
what is the number one cause of hypothyroidism ?
high TSH
TPO is what ?
it is an antibody, release from autoimmune
true or false. hypercholesteromia leads to heart disease .
yes this is true
why could gaining weight be seen as dangerous ?
gaining weight is dangerous, contributing to atecholerosis and worsening heart disease
what can u do with hypothyroidism ?
nutrition therapy
fluid and electrolyte management
monitor response to medical and surgical treatments
non pharmacological interventions
what will make the biggest difference when it comes to myexdema critical care
iv thyroid replacement
recall that patient who is experiencing myxoedema coma needs critical care since this is an emergency situation : what are the interventions
oxygen
iv fluid
bp meds ( to raise bp )
cardiac monitoring
iv thyroid replacement
An assistive personnel reports that a nursing home client who has hypothyroidism has a pulse of 48 beats/min this morning. Which assessments have the highest priority for the nurse to perform immediately? Select all that apply.
A. Checking body temperature
B. Testing deep tendon reflex responses
C. Measuring oxygen saturation by pulse oximetry
D. Checking blood pressure, heart rate, and rhythm
E. Determining level of consciousness and cognition
F. Identifying presence or absence of the swallowing reflex
G. Examining feet and ankles for indications of peripheral edema
C and D
A patient is receiving scheduled Desmopressin for DI. The nurse sends a urine sample to evaluate the effectiveness of the treatment. Which result would indicate that the medication is effective?
A. A decrease in urine osmolality
B. An increase in urine osmolality
B
what does a decrease in urine osmolality vs increase in urine osmolality mean ?
increase in urine osmolality means that your urine is more concentrated, meaning it has less water and more substances like salt, urea, or other chemicals. This usually happens when your body is trying to save water, like when you’re dehydrated or not drinking enough.
A decrease in urine osmolality means that your urine is less concentrated, meaning it has more water and fewer dissolved substances like salts, urea, and other chemicals.
how else would you describe : drowsy, lethargy ( not necessarily sleeping or aware )
listless: staring at the face, not paying attention
lethargic
who has more high risk when it comes to hhs
older adults
higher risk , less awareness, cognitively and physically cannot go to adequate hydration
what is our goal for dka and hhs?
bring vital signs back to normal
Goal is to restore blood glucose to a normal range, to rehydrate, and to reverse any electrolyte and acid/base imbalances.
what can we do for hhs and dka
what undergoes abc’s
level of conciousness
fluid and electrolyte management
abcs
- frequent vital signs
-administer oxygen as needed ( keep above 92)
level of conciousness
- frequent neuro assesments
fluid and electrolyte management
-establish iv access
administer iv fluid ( ns –> dex added when glucose >14 mol/L )
fluid and electrolyte management
what can we do for dka and hhs
* Establish IV access
* Administer IV fluid (NS -> Dex added when glucose >14 mmol/L
what else ?
- Insulin IV (continuous infusion), acu cheks!
- Monitor urine output hourly
- Monitor electrolytes (replace K if serum level < 5 mEq/L)
- Monitor HCO3, pH, Urea/Crea
how can we improve oxygen saturation for dka and hhs patients?
hob, sit upright, deep breathing, and coughing
alot of bloodwork ( replace potassium if needed, since it goes down if insulin is being used )
where would large iv needle establishment be placed?
ACF
for someone who has dka and hhs
do we use iv or subcut ?
we use iv , subcut insulin might cause a different control of insulin, if someone is initially admitted insulin ( regular insulin only )
how often do we check accucheck ?
every hour
true or false. do not add oxygen unless it is required ( its like a medication ) do not need to introduce if not needed .
true
how would u know if a dka or hhs is stable?
if they are eating and drinking
what is an example of diabetic ketoacidosis order set
diet :
tests:
iv therapy
npo until normal anion gap and pt is able to eat
none
once serum glucose is less than 14 mml change iv fluids to d5W/0.45% sodium chloride with added potassium as per chart below.
sodium bicarbonate - help with ketones
types of insulin
short duration, short acting
short duration, rapid acting
intermediate duration
long duration
ultra long duration
combination insulin
what undergoes short duration, rapid acting and short acting
rapid acting : lispro ( humalog ), aspart (novolog )
short acting : regular insulin ( humulin R )
intermediate duration what undergoes it
long duration
NPH
insulin glargine ( lantus )
what is the ultra long duration, what abt combination insulin ?
insulin degludec
humulin 50/50
what undergoes insulin sensitizers
biguanides ( metformin )
tzds ( rosi )
what undergoes incretin agents
GLP 1 receptor agonists ( Lira )
DPP 4 inhibitors (sitagliptin )
what undergoes insulin secretegogues
sulfonylureas ( glyburide )
meglitinides (repa )
what undergoes miscellaneous
sglt 2 inhibitors ( canagflozin )
alpha glucosidase inhibitors ( acarbose )
for diabetes recall that you can do nutrition theraphy and fluid and electrolyte management
controlled carbohydrate diet
timing of food and insulin
are they n and v or npo?
( this is something to recognized , if not eating, let the charge nurse know )
not enough intake of oral can lead to what?
hypoglycemia
diabetes : monitor response to medical/surgical treatments
non pharmacological interventions:
insulin and oral meds to control bg
meds to reduce long term complications
educating on lon term management inclusing monitoring for signs of complications ( acute and chronic )
hyperglycemia : teach patients with DM , that when they become sick ( at home they should :
continue to take their diabetic meds as precribed ( including insulin - may need more )
increase frequency of blood sugar monitoring ( q 4-6 hrs )
for DM1 what should you check ? for DM2 what should you check ?
for dm1: check urine for ketones when blood sugar >14
for dm2: should monitor for dehydration
what would you do if unable to control blood glucose ?
seek medical help
what are the two adrenal dysfunction
cushing disease/syndrome
addison’s disease
which diagnostics tests would be done in adrenal dysfunction?
labs :
cortisol
blood glucose
sodium
potassium
most important thing is replace hormone for addisions : what are we using
hypercortisone
route is iv ( has to be fast )
again sodium and potassium imbalance
low levels of aldosterone helps us to retain sodium and get rid of potassium
just read
for addision’s disease potassium is building up, what do we use to treat it ?
what do u need to have before giving this med
keyaxelate
u need to have bowel sounds
what is the worst case scenario for addison’s disease?
adrenal insufficiency
what are the nursing interventions for adrenal insufficiency ?
hormone replacement
- rapid infusion of iv fluid ( BP _
-hydrocortisone IV
hyperkalemia management
- k binding med
-diuretics
-k restriction
-monitor ins and outs, vitals
hypoglymecia managemen : what undergoes this for adrenal insufficiency
monitor blood glucose hourly
adminsiter iv glucose
maintain iv access
adrenal dysfunction
take action : nursing interventions
nutrition theraphy
both conditions cause lead to wt loss
ensure good nutrition, weigh daily
adrenal dysfunction
take action : nursing interventions
fluid and electrolyte management
monitor for fluid overload and deficit
adminsiter fluid or restrict
monitor electrolytes ( Na/K )
adrenal dysfunction : take action : nursing interventions
monitor response to medical and surgical treatments
replace cortisol or suppress production
surgery may be required ( remove homrone secreting gland/tumor )
non pharmacological interventions
risk for skin breakdown/infection
pyschological support for distressing symptoms
