Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 3512 acute & chronic > Week 1 Endocrine lecture > Flashcards

Week 1 Endocrine lecture Flashcards

1
Q

For Endocrine disorders what are the 3 things we want when we do an intervention?

A
  1. Correct the hormone imbalance
  2. Control their symptoms
  3. protect them from complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 goals of intervention for endocrine disorders?

A
  1. return to normal hormone levels
  2. reduce symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does SIADH stand for?

A

syndrome of inappropriate antidiuretic hormone secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is SIADH too much ADH or too little ADH?

A

Too much ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

is diabetes Insipidus too much ADH or too little ADH?

A

too little ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what’s another way of thinking about ADH?

A

Anti pee hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are 2 consequences of too much ADH?

A
  1. too much intravascular fluid
  2. low Na because it’s diluted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 2 consequences of too little ADH?

A
  1. dehydration
  2. high Na because there’s not enough intravascular fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are 3 causes of SIADH?

A
  1. CNS disorders
  2. pulmonary disorders
  3. drug related
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 causes of diabetes Insipidus?

A

Neurogenic
Nephrogenic
Drug related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the 4 early signs of Hyponatremia?

A
  1. cerebral changes
  2. neuromuscular changes
  3. intestinal changes
  4. Cardio/pulmonary changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 2 early signs of water retention with SIADH?

A
  1. decreased urine
  2. increased osmolarity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we correct hormone imbalance with SIADH and what part does it treat?

A

Tolvaptan (vasopressin receptor antagonist) - blocks ADH receptors so that you stop retaining water and then Na+ osmoality can increase - corrects hyponatermia by getting rid of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a big sign of hyponatrimia?

A

Neuro issues
use pen light
A&O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the 5 interventions we can do to control symptoms of SIADH?

A
  1. Fluid restriction (500-1000 ml/day)
  2. Saline not water to flush & give feeds
  3. I&O daily - 1Kg=1L
  4. oral rinse for dry mouth
  5. Hypertonic saline 3% NS - SLOWLY if Na+ is low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 2 ways we prevent complications of SIADH?

A
  1. Fluid overload esp. if HF patient - diruetics
  2. Prevent falls due to low Na+ . Neuro assess and safe environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long do we tell patients that SIADH lasts?

A

12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the 3 ways patients can manage SIADH?

A
  1. fluid restriction
  2. monitor their weight
  3. take medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Diabetes Insipidus?

A

Not enough ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are patients with DI at greatest risk for and why?

A

Hypovolemic shock b/c they pee out so much water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 4 systems we are worried about with DI and why?

A
  1. Neurologic - thirst is protective to trigger polydipsia. Coma, seizure death.
  2. Cardiovascular - low BP, tachy, weak pulse
  3. GU - polyuria - low SP (not consentrated)
  4. Integumentary - dehydrated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In DI are we worried about hypernatremia or hyponatremia and why?

A

Hypernatremia
b/c water is flushed out so fast so more Na+ than fluid in vascular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what diagnostic tool do we use for DI and what do the results mean?

A

24 hr I&O record
- if >4L output AND is more than what was ingested then we suspect DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what’s the main way we suspect DI?

A

peeing out more than they take in >4L output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does someone’s urine look like with DI in terms of consentration and osmolaity ?

A
  1. Dilute
  2. low osmoality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how do we correct hormone imbalance with DI?

A

Give Desmopressin (synthetic ADH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If we give desmopressin to someone with DI, what will we see in their fluid and electrolytes?

A
  1. increase in volume
  2. decrease in Na+ in vascular system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are 3 nursing interventions (assessment & treatment) for symptoms of DI?

A
  1. get pt to drink fluid equal to output
  2. hypotonic solution (0.45% NS because we want fluid to go into the body)
  3. measure I&O - daily weights- Urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are 2 complications of DI we are always assessing?

A
  1. signs of dehydration
  2. Neuro changes d/t high Na+& lack of perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

why might someone with DI get a headache?

A
  1. water toxicity because of desmopression needing to be titrated down
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what side effect can Desmopressin cause?

A

-mouth ulcers (b/c given internasal)
-water toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the first sign of hyperthyroidism?

A

heat intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are some symptoms of hyperthyroidism?

A
  1. metabolism increase = increase appetite and increase weight loss
  2. increase bowl movement = diarrhea
  3. weak muscles and exhaustion =insomnia
  4. Tachy - arrhythmias
  5. reflex- brisk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which disease is caused by hyperthyroidism and what is a hallmark manifestation of it?

A

graves disease
- exophthalmos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the main thing nurses monitor for with hyperthyroidsim?

A

Thyroid storm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What 4 things increase in thyroid storm?

A
  1. BP
  2. HR
  3. chest pain
  4. temp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Is hyperthyroidsim acute or chronic?

A

Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the initial treatment for Hyperthyroidsim?

A

antithyroid drugs(thyonimides)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are 3 medications given after initial treatment with hyperthyroidism?

A
  1. Iodine (short term/presurgery)
  2. Beta-adrenergic blockers (pre-surgery)
  3. radioactive iodine - takes 6-8 weeks to work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why is Iodine given pre-surgery?

A

because it reduces the vascularity of the thyroid glad - reduce bleeding and reduce release of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the priority with patients who have hyperthyroidsim?

A

prevent the thyroid storm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are the 3 ways that nurses help pt with hyperthyroidsim prevent thyroid storm?

A
  1. monitor for complications - everything increases
  2. reduce stimulation - rest rest rest - bulk nurse care
  3. promote comfort - lower temp, ice water, cool cloth, eye drops (artificial tears)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

who is more susceptible to thyroid storm?

A

stressors like infection, surgery and trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what kind of diet should someone with hyperthyroidism have?

A
  1. high protein
  2. high carb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what lab value should we check in someone with a subtotal or total thyroidectomy and why?

A

calcium levels
b/c parathyroid can get nicked and is responsible for calcium and phosphorus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are the 4 things we need to watch for post-surgery?

A
  1. vitals (q15 then q30)
  2. Pain control
  3. positioning - comfort
  4. DB & C - suction PRN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the main risk in thyroid surgery immediately after and why?

A

bleeding - hemorrhage
b/c it is very vascular esp. first 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are 5 risks to thyroid surgery?

A
  1. hemorrhage
  2. laryngitis spasm - high pitched sound- emergency
  3. parathyroid gland injury - hypocalcemia - leads to tetany (spasm muscle)
  4. Damage to laryngeal nerves - soft voice
  5. thyroid storm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What do we do for people who experience hypocalcemia post surgery?

A
  1. give calcium gluconate
    or
  2. give calcium chloride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is given for hypothyroidism?

A
  1. Levothyroxine (Synthroid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what are the 2 best indicators if levothyroxine is working?

A
  1. sleep improves (less sleepy)
  2. bowel elimination (less constipation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

If someone with hypothyroidism has a decrease in oxygenation and energy what do we give them and monitor?

A
  1. O2
  2. resp status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

If someone with hypothyroidism has muscle weakness and fatigue what meds do we avoid giving them?

A

sedating meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what might need to be increased with a person with hypothyroidism during times of stress?

A

levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are 4 main indicators of Myxedema coma?

A
  1. reduced LOC
  2. resp failure
  3. hypotension
  4. hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are 5 things we can teach our patient with hypothyroidism?

A
  1. meds for life
  2. hypo/hyperthyroid signs
  3. periodic blood tests
  4. no OTC w/o discussion with PCP
  5. pt can monitor sleep/bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what 3 things does adrenal gland hypofunction (Addison’s) and hypercortisolism (cushings) affect?

A
  1. Glucocorticoids (cortisol)
  2. mineralocorticoids (Aldosterone)
  3. Androgen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what 3 things do glucocorticoids (cortisol) affect in the body?

A
  1. glucose & metabolism regulation
  2. stress response
  3. immune function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what 2 things does mineralocorticoids (aldosterone) do in the body?

A
  1. sodium regulation
  2. potassium regulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What 2 things does androgen do in the body?

A
  1. growth and development (both sexes)
  2. sexual desire (females)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What does Addison’s disease make you deficient in?

A
  1. aldosterone
  2. cortisol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

In Addison’s disease what is the status of Na+ and K+

A
  1. Na+ is low because aldosterone helps absorb Na+. Low aldosterone = low Na+
  2. K+ is high because aldosterone helps secrete K+. Low aldosterone = high K+
63
Q

Is BUN high or low with Addison’s and why?

A

BUN is high b/c dehydration and kidney injury due to hypovolemia.
Sodium isn’t retained so water follows it right out the body - kidneys working too hard.

64
Q

What are the 2 most common signs initially of adrenal insufficiency?

A
  1. Hypotension d/t dehydration
  2. decreased cognition d/t increased Na+
65
Q

what are the 2 things nurses can do to help address priority problems of Addison’s?

A
  1. fluid & electrolyte balance - check lytes and heart , I&O
  2. prevent hypoglycemia
66
Q

How is cortisol and aldosterone deficiencies corrected?

A

hormone replacement therapy - ie) prednisone

67
Q

what is another term for Addison’s disease?

A

adrenal gland hypofunction

68
Q

what is the status of the lytes in someone with Addison’s disease?

A
  1. Na+ low
  2. K+ high
  3. BUn high
  4. cortisol : low
69
Q

What do we always give first in someone with and Addison’s crisis?

A

IV access

70
Q

What are the 3 things done to help in Addison’s crisis?

A
  1. Hormone Replacement - hydrocortisone/dexamethasone IV
  2. Hyperkalemia management
    - lower K+ and heart telemetry
  3. Hypoglycemia management
    - BS, IV glucose, IV dextrose is best
71
Q

Why can surgery/trauma cause addison’s crisis ?

A

b/c body can’t keep up with steroid need
- drop in cortisol

72
Q

What is one of the most common causes of hypercortisolism ?

A

glucocorticoid therapy (steroids like prednisone)

73
Q

What sex does hypercortisolism (cushings) occur more often in?

A

Females

74
Q

what is the lab profile of someone with cushings?

A

Na+ - high
K+ - Low
BUN - normal
cortisol (serum) - high

75
Q

What are the 3 major concerns of hypercortisolism and why?

A
  1. Fluid overload b/c hormone -induced water and sodium retention
  2. integumetary issues - thin skin, poor wound healing, bone density loss
  3. infection b/c of high cortisol levels = reduced immunity
76
Q

What is the main goal in cushing’s therapy?

A

reduce plasma cortisol levels

77
Q

What are two other outcomes of cushing’s treatment?

A
  1. removal of tumors
  2. restore normal or acceptable body appearance
78
Q

What are 3 nursing interventions for cushings?

A

1.correct/manage Fluid overload
2. prevent potential for injury
3. prevent potential for infection

79
Q

What type of insulin is Lispro?

A

Short duration, rapid acting

80
Q

What is another name for Lispro insulin?

A

humalog

81
Q

What is the onset of lispro?

A

15-30 min

82
Q

What is the peak of lispro?

A

0.5-2.5 hours

83
Q

What is the duration of lispro?

A

3-6 hours

84
Q

What kind of insulin is Aspart?

A

Short duration, rapid acting

85
Q

What is the onset of Aspart?

A

10-20 min

86
Q

What is the peak of Aspart?

A

1-3 hours

87
Q

what is the duration of aspart?

A

3-5 hours

88
Q

What is another name for insulin aspart?

A

Novolog

89
Q

What type of insulin is Regular (Humulin R)?

A

Short duration, short acting

90
Q

What is the onset of regular insulin?

A

30-60 min

91
Q

What is the peak of Regular insulin?

A

1-5 hours

92
Q

What is the duration of Regular insulin?

A

6-10 hours

93
Q

What kind of insulin is NPH?

A

Intermediate

94
Q

What is the onset of NPH?

A

60-120 min

95
Q

what is the peak of NPH?

A

6-14 hours

96
Q

What is the duration of NPH?

A

16-24 hours

97
Q

What kind of insulin is Glargine?

A

Long acting

98
Q

What is another name for Glargine?

A

Lantus

99
Q

What is the onset of Glargine?

A

70 min

100
Q

What is the peak of Glargine?

A

no peak - it’s basal

101
Q

What is the duration of Lantus?

A

18-24 hours

102
Q

What kind of insulin is Degludec (Tresiba) ?

A

Ultra long

103
Q

What is the onset of insulin Degludec?

A

30-90 min

104
Q

What is the peak of Degludec?

A

none - it’s basal

105
Q

What is the duration of Degludec?

A

greater than 24 hours

106
Q

What kind of insulin is humulin 50/50?

A

Combination insulin - neither basal nor bolus

107
Q

What is the onset of Humulin 50/50?

A

15-30 min

108
Q

What is the peak of Humulin 50/50?

A

0.8-4.8 hours

109
Q

What is the duration of Humulin 50/50?

A

10-16 hours

110
Q

What are the 4 things that mess with DM people’s BG?

A
  1. illness
  2. decline in physical activity
  3. changes to drugs
  4. changes to diet
111
Q

What are the 4 associated complications with hyperglycemia?

A
  1. increased infection rates
  2. increased hospital stay
  3. increased need for ICU
  4. Increased mortality rate
112
Q

If someone is hypoglycemic <4 but mentating, give 15g then check in 15 min. how many times do we do this?

A

repeat until BS is normal then follow up with a complex carb snack to avoid BG dropping

113
Q

If someone is hypoglycemic and not mentating well what do we do?

A
  1. Stop insulin infusion
  2. give IV dextrose (D50 = 1 amp).
114
Q

After giving D50 to someone hypoglycemic, when do we recheck?

A

10 min

115
Q

What can we give to someone subcut after performing D50 IV push?

A

Glucagone

116
Q

What is the most common reason why DM1 people go into Ketoacidosis?

A

Infection

117
Q

What are 3 physiological changes in DKA?

A
  1. Ketones from breakdown of fat for glucose
  2. pH is altered = metabolic acidosis
  3. Electrolytes become depleted
118
Q

What BG level is DKA?

A

> 14

119
Q

What is someone with DKA’s fluid status?

A

Severe dehydration

120
Q

What are 3 symptoms of metabolic acidosis?

A
  1. Kussmaul’s resps
  2. Sweet fruity odour
  3. Ab pain, N&V, diarrhea
121
Q

What are the 4 nursing priorities for DKA?

A
  1. ABC’s
  2. LOC - neuro assess
  3. Hydration status
  4. Electrolyte status
122
Q

What is the first thing we do to intervene for hydration status in someone with DKA?

A

Establish IV access

123
Q

When BG is >14 in DKA, what solution do we administer?

A

D5NS

124
Q

how often do we perform accuchecks for someone with DKA?

A

every hour

125
Q

How often do we monitor urine output for someone in DKA?

A

hourly

126
Q

When do we replace K in someone with DKA?

A

K<3.5mEq/L

127
Q

What lab work do we monitor with DKA?

A

HCO3
pH
Urea/Cr
Glucose
K

128
Q

Why does sugar rise higher in HHS than DKA?

A

because there are less symptoms early on so it goes on for quite a long time and gets very high

129
Q

What 2 things does acute hyperglycemia lead to?

A
  1. sustained osmotic diuresis d/t loss of fluid
  2. Severe dehydration
130
Q

Which has more severe dehydration, DKA or HHS and why?

A

HHS d/t prolonged time with hyperglycemia

131
Q

What are 5 medical contributing factors of HHS?

A
  1. MI
  2. Sepsis
  3. Pancreatitis
  4. Stroke
  5. Some drugs (glucocorticoids, diuretics, phenytoin, beta blockers, and calcium channel blockers)
132
Q

What BG is considered HHS with symptoms?

A

> 33 BG

133
Q

what are 4 signs of severe dehydration with HHS?

A
  1. Somnolence - sleeping too long/too much
  2. coma
  3. seizures
  4. hemiparesis
134
Q

How do we rehydrate someone with HHS?

A

normal saline 1L/hr initially if hypotension or shock

135
Q

Do we check bicarb with DKA or HHS and why?

A

DKA because they are in metabolic acidosis

136
Q

What precipitating factors are different for DKA and HHS?

A
  1. DKA - inadequate insulin dose
  2. HHS - poor fluid intake
137
Q

Which do we see CNS/ Neuro symptoms, DKA or HHS and why?

A

HHS
d/t hyperosmolarity and cellular rehydration. Takes time to re-establish fluid balance in the brain

138
Q

What are the 3-4 interventions for HHS and DKA?

A
  1. rehydration (.45%NS)
  2. IV insulin continuous
  3. Watch K+
  4. bicarb (DKA)
139
Q

How many hours is the goal for rehydration and normal serum glucose levels in HHS?

A

36-72 hours

140
Q

When rehydrating someone with HHS, what solution is used when they are in shock or severe hypotension?

A

Normal saline

141
Q

What solution do we give for someone with HHS to rehydrate them in general?

A

0.45%NS (half normal saline) . rate= 1L/hr
When central venous pressure or pulmonary capillary wedge pressure begins to rise or until blood pressure and urine output are adequate change rate = 100-200mL/hr

142
Q

when rehydrating a patient, how many hours is half fluid replaced and when is the rest of the fluid replaced?

A

12 hrs- 1/2 replaced
36 hours- the rest replaced

143
Q

How do we know our rehydration efforts are working in someone with HHS?

A

improvement in CNS function

144
Q

How do we know when a patient is ready to stop their insulin infusion so they can be discharged in DKA?

A

DKA
1. BHB (beta hydroxybutyrate is low (lower acidosis)
2. anion gap lower (lower acidosis)
3. Oral intake (both)

145
Q

How do we know when a patient is ready to stop their insulin infusion so they can be discharged in HHS?

A

HHS
1. patient is alert and oriented
2. <17.5mmol/L BG
3. Plasma osmolaity is WNL
4. Oral intake (both)

146
Q

How do we know when a patient is ready to stop their insulin infusion so they can be discharged for HHS/DKA and why?

A

tolerate oral intake before giving subcut insulin b/c they need food before subcut insulin

147
Q

What insulins are given to transition a patient off a continuous insulin infusion?

A

Rapid acting subcut insulin + intermediate acting insulin

148
Q

If a patient with DKA is unable to eat do we stop IV insulin infusion or continue it?

A

preferable to continue it

149
Q

For patients with HHS when can subcut insulin be initiatied ? (BG level)

A

<13.9-16.7 mmol/L

150
Q

What are 4 things we should teach patients with DM1 about what to do if they are sick?

A
  1. take diabetic meds (may need more insulin)
  2. monitor BG q4-6hrs
  3. check urine for keytones when BG is >14 (consistently)
  4. Get medical care if:
    - BG not controlled
    - keytones (to avoid DKA)
151
Q

What are 4 things we should teach patients with DM2 about what to do if they are sick?

A
  1. older adults monitor for dehydration
  2. don’t stop diabetic meds
  3. monitor BG q4-6hrs
  4. Get medical care if:
    -BG not controlled
152
Q

Does insulin cause K+ to enter or exit cells?

A

Enter cells - EKG needed

153
Q

What is a potential complication of hypothyroid?

A

Myxedema coma - everything is too slow

154
Q

Which disease is goiter associated with?

A

hyperthyroid

NURS 3512 acute & chronic (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions