Week 1: endocrine ( altered hormone regulation ) Flashcards
afib for digoxin afib for digoxin mjust a refresh what is this describing ? :
the physiological mechanism that regulate the secretion and action of hormones associated with the endocrine system.
hormone regulation
True or false. Hormone regulation : variations and context : hormone imbalance can lead to many problems/symptoms
true
concept extension : hormone regulation two major issues are hormone insufficiency and excess . true or false.
true
concept extension : hormone regulation : variations and context
what are some causes ?
trauma, congenital, genetic, inflammatory, tumors
endocrine glands are not working properly when hormone are not regulated.
true
what are the five cues of clinical judgement model
recognize cues
analyze cues
plan/prioritize
take action
evaluate
what do you do first when you see a patient ( clinical judgement model ) ?
visualize ( recognize cues )
what is this describing : on going assessments : gathering data what is the clinical judgement is this describing ?
analyze cues
recognize cues : what are some disorders and match it with the hormones
posterior pituitary disorders
Thyroid disorders
Adrenal Gland disorders
diabetes
ADH
Thyroid hormone
Corticosteroids
Insulin
does concentrated mean diluted or not diluted
it means that it is diluted
analyze data : what question are you asking?
what are the different things you’re looking for ?
what does it mean ?
assessment :
vital signs
inspection
palpation
diagnostic tests
- hormone levels
-stimulation/suppression
-testing
-imaging
-biopsy
plan and prioritize
what description are we thinking in this case ?
consider all possibilities and determine urgency
what undergoes the plan & prioritize
( consider all possibilities and determine urgency )
- What happens with extreme highs/lows of this hormone? (DM, Thyroid, Adrenal Glands, Post Pituitary)
- ABCs/vital signs stable?
- Neurological status affected?
- Are you concerned about electrolyte imbalances?
- Impact of patient’s past medical history?
is this true or false. this is the stuff we should recognize in planning and prioritize
consider all possibilities and determine urgency :
* What happens with extreme highs/lows of this hormone? (DM, Thyroid, Adrenal Glands, Post Pituitary)
* ABCs/vital signs stable?
* Neurological status affected?
* Are you concerned about electrolyte imbalances?
* Impact of patient’s past medical history?
true
what can detect changes ?
vital signs
take action :
nursing intervention for hormone imbalance
what undergoes this ?
- Nutrition therapy
- Fluid and electrolyte
management - Monitoring response to treatments*
what else is a part of taking actions as a nursing interventions for hormone imbalance
preventing complications
patient education
psychosocial support
ADH, adrenal glands, corticosteroids have big impact there what else is important ?
blood work is important
what type of treatment of taking action is included in the slides
meds
surgery radiation
what is meds used for when talking abt endocrine
may replace or suppress glands to produce too much
what is surgery used for
removing hyper active glands
- monitor response to treatment : surgery
for example : hyperthyrodism
what are we doing during pre-op
optimize hormone levels ( meds )
optimize weight
- monitor response to treatment : surgery
for example : hyperthyroidism
post-op what undergoes this
- Monitor for complications*
- Vital Signs per policy (ex q15 until stable, then q30)
- Pain control
- Positioning
- DB+C q1h/ oral and tracheal suction PRN
sending somone with sky high thyroid for surgery - what is currently the state of the patient ?
** where is this occurring post or pre op **
- state of hypermetabollic, their heart is working very heart
- blood pressure is also high ( want to control as much as possible )
normalize their thyroid levels
what is one thing we need to leave behind when it comes to surgery in a hormone imbalance
parathyroid gland ( we do not want to get rid of this )
what does DB + C stand for when talking about post op surgery treatment ?
deep breathing and coughing
what did the prof mentioned in class about parathyrpid hormone and it’s contribution?
parathyroid has a big role in managing calciumia and a pt may experience hypocal
what is a thyroidectomy ?
removal of thyroid
what are the different complications of surgery as a treatment
hemorrhage ( high risk in 1st 24 hours )
swelling
injury/loss of function to surronding
thyroid storm
true or false. when someone had a surgery ( throidectomy ) you should keep an eye on the nutrional status ?
true
explain swelling further as a complication in surgery
trauma or surgery to the throat even if its in the tranchea ior esopahgus ( swelling can impact another)
true or false. surgery :
Calcium is low and as a result muscle cramping may occur, additionally what is this called?
true , this is called tetani
recall that thyroid storm serves as a complications in surgery , what else are the signs and symptoms ?
high blood pressure. high temp, and tatchy
sodium associates with part of the body ?
the brain
not a question but just read :
in this section we are evaluating
Evaluate
Did your 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?
yessss sir
typically in a hypothyroidism patient what do we see ?
weight gain, mixed edema ( geenralized pitting edema over the body ) or in the face, cooling ( bundled up usually ), thyroid is low = cold intolerance , neurologically tired , slower
below are lab values what do u think this will be ( increased, decreased or normal ) provide the answers ( this is a patient with hypothyroidism )
TSH
↑
T4
↓
TPO
↑
Serum Osmol
N
Urine Osmol
N
ACTH
N
Cortisol
N
what other blood work should be checked for someone who has hypothyrodism ?
hemoglobin
cholesterol
increased in tsh - refers to what scientific term /
haishomoto
issue in teh brain - tsh produced in the brain ( injury in the brain )
what is the worst state that can happen with hypothyrodism ?
myxedema coma ( hypothyroid crisis)
given that the worst state that can happen with hypothyrodism is myxedema coma ( hypothyroid crisis )
what are the characteristics ( name 3 (
serious complications of untreated or poorly treated hypothyroidism
characterized by reduced cardiopulmonary and neurological functioning
pt ca experience decrease in LOC , decrease temp, and even decrease in BP/HR, RR
true or false. Myxedema coma ( hypothyroid crisis) is often precipitated by infection, medication, exposure to cold, and trauma
true
what can we do for hypothyrodism ?
nutrition therapy
monitoring response to treatments ( med/surgery) ( any special considerations in cardiac cardiac pts
hypothyrodism : what can we do ?
preventing complications
patient education
psychosocial support
are apart of what we could do to keep a hypothyrodism patient in danger.
true
what type of diet should a hypothyrodism be on?
high fiber for the constipation, low fat = healthy diet
in essence, healthy diet and controlled carbs and salt
true or false. Levothyroxine is a lifelong management ( once the thyroid is destroyed by autoimmune, it doesn’t get better, have to take medication for the rest of their life )
true
someone who has hypothyrodism has a complication of what ? ( name what she mentioned in class )
increased risk for cvd ( astrovastatin )
hypothyrodism : what can we do for myxedema coma ?
this is a med emergency, in which is often precipitated by what?
infection, exposure to cold, or trauma
hypothyrodism : what can we do for myxedema coma ?
complications :
lethargy progresses to coma
hypotension
hypothermia
hypoventilation
true or false. hypothyrodism : can lose conciousness.
true
someone with hypothyroidism may need critical care
what undergoes this
oxygen
IV fluid
BP medication
cardiac monitoring
IV thyroid replacement
Diabetes : what is the worst state that can happen with this condition? ( what is the first one ) there is two that could happen
hypoglycemia
BS<4 autonomic nervous sytem activated
neuroglycopenic signs occur if BS conitnues to fall ( brain not getting enough glucose )
hypoglycemic unawareness can occur in pts with neuropathy, older patients, those taking beta blockers
diabetes: what is the worst state that can happen with this condition
recall we already know hypoglycemia is one
hyperglycemia in DM1
hyperglycemia in DM2
diabetes: what is the worst state that can happen with this condition
recall we already know hypoglycemia is one
what undergoes Hyperglycemia in DM1
diabetic ketoacidosis
lack of insulin leads to hyperglycemia ( BS>14 )
fat is used for fuel leading to ketones
S&S of metabolic acidosis and dehydration
diabetes: what is the worst state that can happen with this condition
recall we already know hypoglycemia is one
what undergoes Hyperglycemia in DM2
hyperosmolar hypeglycemia
low insulin but enough to prevent ketoacidosis
BS can climb over 34 mmol/L
S&S of severe dehydration
true or false. the sugar is not going into the cells , starting to use fats as a resource in hyperglycemia in DM1
true
type 1 diabetes is more seen in older adults. True or false.
false seen in younger children
what is the major symptom of hyperglycemia in DM2
dehydration
recall that severe dehydration udnergoes hyperglycemia in DM2, which means what?
causing vs changes along with being unstable
diabetes ( taking action )
nutrition therapy
what do we control here?
controlled carbohydrate diet
timing of food & insulin
N&V or NPO
it is a must the pt blood sugar and be careful with insulin : eating their food: wait until they actual do.
true or false.
true
recall that nutrition therapy is important in a pt who has diabetes when it comes to taking action
what else?
include the description in the class
fluid and electrolyte management
angiogram very disturbed: osmotic diuresis
- so much sugar in urine causing a lot of urine production and loss of fluid
diabetes: monitoring response to treatments
which one is the most effective?
med surgery or radiation?
med
diabetes taking action what undegoes this ?
recall we already know nutrition therapy
fluid and electrolyte management
monitoring response to treatments
what else?
preventing complications
pt education
psychosocial support
what should we check when we are trying to prevent complications in someone who has diabetes?
blood sugar control
monitor bp skin, sensation, vision, kidney
hypertension( peripheral vascular disease, check skin, and vision )
what udnergoes pt education when are talking abt someone who has diabetes
teach importance of BS control
signs of abnormal blood sugar
what undergoes pyschosocial support
when we are talking abt diabetes
empower pt toward self management
when monitoring repsonse to treatment what should we be careful of hypoglycemia
insulins and insulin secretagenous
when someone is having hypoglycemia what should we do ?
follow hypoglycemia treatment protocol
recall we follow hypoglycemic treatment protocol , when talking about diabetes
name what undergoes this
BS<4 give 15 gm oral CHO ( glucose tabs )
BS<4 with altered LOC give 1 amp d50 IV
push or if no IV access give 1 mg glucagon
re-check blood sugar after 15 minutes
true or false. vein is better than the gut, because vein is faster.
false, gut is better although vein is faster.
DKA and HHS
goal is to restore blood glucose to a normal to rehydrate, and to reverse any electrolyte and acid/base imbalances.
what might be the signs and symptoms of metabolic acidosis
kausmal repsirations- deep breathing,
nausea, vomitting and diarrhea,
neurological: drowsy and confused
hydrogen ( too much acid ) intracellular potassium comes out and leaves with that urine getting lose depleted of potassium = which can lead to dysrhmia
diabetes : DKA and HHS
patients are usually cared for on a medical ward will require
frequent assessment of ?
continuous administration of ?
1) blood glucose levels
vital signs
mental status
2) IV fluids and IV insulins ( is an infusion, rehydrating before insulin)
true or false. Potassium goes down with insulin as well so you need to watch closely.
true
which electrolyte should you monitor closely once the pt begins the insulin infusion?
potassium
review: what is Addisons and what gland does it link to?
Addisons disease is where there is an insufficient amount of cortisol and aldosterone and this involves the adrenal gland
what re the signs and symptoms of Addisons?
hypoglycemia, weight loss, postural hypotension, weakness, gi disturbances, change in distribution of body hair, bronze pigmentation of skin
what are the risk factors of Addisons?
adrenal crisis can happen without warning, stress, sudden corticosteroid withdrawal, sudden pituitary gland destruction
what are some potential complications with SIADH?
hyponatremia - GI disturbances, loss of appetite, N/V neuro symptoms
what are the assessment findings with SIADH?
low serum sodium, high urine osmolality, low urine volume, signs of fluid overload
what are the assessment findings for Diabetes insipidius?
high serum sodium, low urine osmolality, high urine volume, monitor for sings of dehydration
what are the potential complications of DI?
dehydration
what are some nursing interventions for SIADH?
fluid restrictions, measure I/o daily weights, drug therapy with vasopressin receptor antagonists (vaptans) ex. tolvaptan, hypertonic saline (ex. 3% NaCl) bc of low sodium levels, monitor response to treatment - prevent fluid overload (PE and HF) look for neuro worsening (sodium not improving)
what are some nursing interventions for DI?
assess for signs of dehydration, - drug therapy with desmopressin, I/O - check urine specific gravity, recording the patient’s weight daily
encourage fluid intake
The patient with permanent DI requires lifelong drug therapy, dose adjusted based on symptoms
Teach that polyuria and polydipsia indicate the need for another dose.
Drug therapy for DI induces water retention and can cause fluid overload (teach pt to weight themselves OD)
