Week 1 Endocrine lecture Flashcards
For Endocrine disorders what are the 3 things we want when we do an intervention?
- Correct the hormone imbalance
- Control their symptoms
- protect them from complications
What are the 2 goals of intervention for endocrine disorders?
- return to normal hormone levels
- reduce symptoms
what does SIADH stand for?
syndrome of inappropriate antidiuretic hormone secretion
Is SIADH too much ADH or too little ADH?
Too much ADH
is diabetes Insipidus too much ADH or too little ADH?
too little ADH
what’s another way of thinking about ADH?
Anti pee hormone
what are 2 consequences of too much ADH?
- too much intravascular fluid
- low Na because it’s diluted
What are 2 consequences of too little ADH?
- dehydration
- high Na because there’s not enough intravascular fluid
what are 3 causes of SIADH?
- CNS disorders
- pulmonary disorders
- drug related
What are the 3 causes of diabetes Insipidus?
Neurogenic
Nephrogenic
Drug related
what are the 4 early signs of Hyponatremia?
- cerebral changes
- neuromuscular changes
- intestinal changes
- Cardio/pulmonary changes
What are 2 early signs of water retention with SIADH?
- decreased urine
- increased osmolarity
How do we correct hormone imbalance with SIADH and what part does it treat?
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
What is a big sign of hyponatrimia?
Neuro issues
use pen light
A&O
what are the 5 interventions we can do to control symptoms of SIADH?
- Fluid restriction (500-1000 ml/day)
- Saline not water to flush & give feeds
- I&O daily - 1Kg=1L
- oral rinse for dry mouth
- Hypertonic saline 3% NS - SLOWLY if Na+ is low
What are 2 ways we prevent complications of SIADH?
- Fluid overload esp. if HF patient - diruetics
- Prevent falls due to low Na+ . Neuro assess and safe environment
How long do we tell patients that SIADH lasts?
12 months
what are the 3 ways patients can manage SIADH?
- fluid restriction
- monitor their weight
- take medication
What is Diabetes Insipidus?
Not enough ADH
What are patients with DI at greatest risk for and why?
Hypovolemic shock b/c they pee out so much water
What are the 4 systems we are worried about with DI and why?
- Neurologic - thirst is protective to trigger polydipsia. Coma, seizure death.
- Cardiovascular - low BP, tachy, weak pulse
- GU - polyuria - low SP (not consentrated)
- Integumentary - dehydrated
In DI are we worried about hypernatremia or hyponatremia and why?
Hypernatremia
b/c water is flushed out so fast so more Na+ than fluid in vascular system
what diagnostic tool do we use for DI and what do the results mean?
24 hr I&O record
- if >4L output AND is more than what was ingested then we suspect DI
what’s the main way we suspect DI?
peeing out more than they take in >4L output
What does someone’s urine look like with DI in terms of consentration and osmolaity ?
- Dilute
- low osmoality
how do we correct hormone imbalance with DI?
Give Desmopressin (synthetic ADH)
If we give desmopressin to someone with DI, what will we see in their fluid and electrolytes?
- increase in volume
- decrease in Na+ in vascular system
what are 3 nursing interventions (assessment & treatment) for symptoms of DI?
- get pt to drink fluid equal to output
- hypotonic solution (0.45% NS because we want fluid to go into the body)
- measure I&O - daily weights- Urine
what are 2 complications of DI we are always assessing?
- signs of dehydration
- Neuro changes d/t high Na+& lack of perfusion
why might someone with DI get a headache?
- water toxicity because of desmopression needing to be titrated down
what side effect can Desmopressin cause?
-mouth ulcers (b/c given internasal)
-water toxicity
what is the first sign of hyperthyroidism?
heat intolerance
What are some symptoms of hyperthyroidism?
- metabolism increase = increase appetite and increase weight loss
- increase bowl movement = diarrhea
- weak muscles and exhaustion =insomnia
- Tachy - arrhythmias
- reflex- brisk
Which disease is caused by hyperthyroidism and what is a hallmark manifestation of it?
graves disease
- exophthalmos
What is the main thing nurses monitor for with hyperthyroidsim?
Thyroid storm
What 4 things increase in thyroid storm?
- BP
- HR
- chest pain
- temp
Is hyperthyroidsim acute or chronic?
Chronic
What is the initial treatment for Hyperthyroidsim?
antithyroid drugs(thyonimides)
what are 3 medications given after initial treatment with hyperthyroidism?
- Iodine (short term/presurgery)
- Beta-adrenergic blockers (pre-surgery)
- radioactive iodine - takes 6-8 weeks to work
Why is Iodine given pre-surgery?
because it reduces the vascularity of the thyroid glad - reduce bleeding and reduce release of thyroid hormone
What is the priority with patients who have hyperthyroidsim?
prevent the thyroid storm
what are the 3 ways that nurses help pt with hyperthyroidsim prevent thyroid storm?
- monitor for complications - everything increases
- reduce stimulation - rest rest rest - bulk nurse care
- promote comfort - lower temp, ice water, cool cloth, eye drops (artificial tears)
who is more susceptible to thyroid storm?
stressors like infection, surgery and trauma
what kind of diet should someone with hyperthyroidism have?
- high protein
- high carb
what lab value should we check in someone with a subtotal or total thyroidectomy and why?
calcium levels
b/c parathyroid can get nicked and is responsible for calcium and phosphorus)
what are the 4 things we need to watch for post-surgery?
- vitals (q15 then q30)
- Pain control
- positioning - comfort
- DB & C - suction PRN
what is the main risk in thyroid surgery immediately after and why?
bleeding - hemorrhage
b/c it is very vascular esp. first 24 hrs
what are 5 risks to thyroid surgery?
- hemorrhage
- laryngitis spasm - high pitched sound- emergency
- parathyroid gland injury - hypocalcemia - leads to tetany (spasm muscle)
- Damage to laryngeal nerves - soft voice
- thyroid storm
What do we do for people who experience hypocalcemia post surgery?
- give calcium gluconate
or - give calcium chloride
what is given for hypothyroidism?
- Levothyroxine (Synthroid)
what are the 2 best indicators if levothyroxine is working?
- sleep improves (less sleepy)
- bowel elimination (less constipation)
If someone with hypothyroidism has a decrease in oxygenation and energy what do we give them and monitor?
- O2
- resp status
If someone with hypothyroidism has muscle weakness and fatigue what meds do we avoid giving them?
sedating meds
what might need to be increased with a person with hypothyroidism during times of stress?
levothyroxine
what are 4 main indicators of Myxedema coma?
- reduced LOC
- resp failure
- hypotension
- hypothermia
What are 5 things we can teach our patient with hypothyroidism?
- meds for life
- hypo/hyperthyroid signs
- periodic blood tests
- no OTC w/o discussion with PCP
- pt can monitor sleep/bowel
what 3 things does adrenal gland hypofunction (Addison’s) and hypercortisolism (cushings) affect?
- Glucocorticoids (cortisol)
- mineralocorticoids (Aldosterone)
- Androgen
what 3 things do glucocorticoids (cortisol) affect in the body?
- glucose & metabolism regulation
- stress response
- immune function
what 2 things does mineralocorticoids (aldosterone) do in the body?
- sodium regulation
- potassium regulation
What 2 things does androgen do in the body?
- growth and development (both sexes)
- sexual desire (females)
What does Addison’s disease make you deficient in?
- aldosterone
- cortisol
In Addison’s disease what is the status of Na+ and K+
- Na+ is low because aldosterone helps absorb Na+. Low aldosterone = low Na+
- K+ is high because aldosterone helps secrete K+. Low aldosterone = high K+
Is BUN high or low with Addison’s and why?
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.
What are the 2 most common signs initially of adrenal insufficiency?
- Hypotension d/t dehydration
- decreased cognition d/t increased Na+
what are the 2 things nurses can do to help address priority problems of Addison’s?
- fluid & electrolyte balance - check lytes and heart , I&O
- prevent hypoglycemia
How is cortisol and aldosterone deficiencies corrected?
hormone replacement therapy - ie) prednisone
what is another term for Addison’s disease?
adrenal gland hypofunction
what is the status of the lytes in someone with Addison’s disease?
- Na+ low
- K+ high
- BUn high
- cortisol : low
What do we always give first in someone with and Addison’s crisis?
IV access
What are the 3 things done to help in Addison’s crisis?
- Hormone Replacement - hydrocortisone/dexamethasone IV
- Hyperkalemia management
- lower K+ and heart telemetry - Hypoglycemia management
- BS, IV glucose, IV dextrose is best
Why can surgery/trauma cause addison’s crisis ?
b/c body can’t keep up with steroid need
- drop in cortisol
What is one of the most common causes of hypercortisolism ?
glucocorticoid therapy (steroids like prednisone)
What sex does hypercortisolism (cushings) occur more often in?
Females
what is the lab profile of someone with cushings?
Na+ - high
K+ - Low
BUN - normal
cortisol (serum) - high
What are the 3 major concerns of hypercortisolism and why?
- Fluid overload b/c hormone -induced water and sodium retention
- integumetary issues - thin skin, poor wound healing, bone density loss
- infection b/c of high cortisol levels = reduced immunity
What is the main goal in cushing’s therapy?
reduce plasma cortisol levels
What are two other outcomes of cushing’s treatment?
- removal of tumors
- restore normal or acceptable body appearance
What are 3 nursing interventions for cushings?
1.correct/manage Fluid overload
2. prevent potential for injury
3. prevent potential for infection
What type of insulin is Lispro?
Short duration, rapid acting
What is another name for Lispro insulin?
humalog
What is the onset of lispro?
15-30 min
What is the peak of lispro?
0.5-2.5 hours
What is the duration of lispro?
3-6 hours
What kind of insulin is Aspart?
Short duration, rapid acting
What is the onset of Aspart?
10-20 min
What is the peak of Aspart?
1-3 hours
what is the duration of aspart?
3-5 hours
What is another name for insulin aspart?
Novolog
What type of insulin is Regular (Humulin R)?
Short duration, short acting
What is the onset of regular insulin?
30-60 min
What is the peak of Regular insulin?
1-5 hours
What is the duration of Regular insulin?
6-10 hours
What kind of insulin is NPH?
Intermediate
What is the onset of NPH?
60-120 min
what is the peak of NPH?
6-14 hours
What is the duration of NPH?
16-24 hours
What kind of insulin is Glargine?
Long acting
What is another name for Glargine?
Lantus
What is the onset of Glargine?
70 min
What is the peak of Glargine?
no peak - it’s basal
What is the duration of Lantus?
18-24 hours
What kind of insulin is Degludec (Tresiba) ?
Ultra long
What is the onset of insulin Degludec?
30-90 min
What is the peak of Degludec?
none - it’s basal
What is the duration of Degludec?
greater than 24 hours
What kind of insulin is humulin 50/50?
Combination insulin - neither basal nor bolus
What is the onset of Humulin 50/50?
15-30 min
What is the peak of Humulin 50/50?
0.8-4.8 hours
What is the duration of Humulin 50/50?
10-16 hours
What are the 4 things that mess with DM people’s BG?
- illness
- decline in physical activity
- changes to drugs
- changes to diet
What are the 4 associated complications with hyperglycemia?
- increased infection rates
- increased hospital stay
- increased need for ICU
- Increased mortality rate
If someone is hypoglycemic <4 but mentating, give 15g then check in 15 min. how many times do we do this?
repeat until BS is normal then follow up with a complex carb snack to avoid BG dropping
If someone is hypoglycemic and not mentating well what do we do?
- Stop insulin infusion
- give IV dextrose (D50 = 1 amp).
After giving D50 to someone hypoglycemic, when do we recheck?
10 min
What can we give to someone subcut after performing D50 IV push?
Glucagone
What is the most common reason why DM1 people go into Ketoacidosis?
Infection
What are 3 physiological changes in DKA?
- Ketones from breakdown of fat for glucose
- pH is altered = metabolic acidosis
- Electrolytes become depleted
What BG level is DKA?
> 14
What is someone with DKA’s fluid status?
Severe dehydration
What are 3 symptoms of metabolic acidosis?
- Kussmaul’s resps
- Sweet fruity odour
- Ab pain, N&V, diarrhea
What are the 4 nursing priorities for DKA?
- ABC’s
- LOC - neuro assess
- Hydration status
- Electrolyte status
What is the first thing we do to intervene for hydration status in someone with DKA?
Establish IV access
When BG is >14 in DKA, what solution do we administer?
D5NS
how often do we perform accuchecks for someone with DKA?
every hour
How often do we monitor urine output for someone in DKA?
hourly
When do we replace K in someone with DKA?
K<3.5mEq/L
What lab work do we monitor with DKA?
HCO3
pH
Urea/Cr
Glucose
K
Why does sugar rise higher in HHS than DKA?
because there are less symptoms early on so it goes on for quite a long time and gets very high
What 2 things does acute hyperglycemia lead to?
- sustained osmotic diuresis d/t loss of fluid
- Severe dehydration
Which has more severe dehydration, DKA or HHS and why?
HHS d/t prolonged time with hyperglycemia
What are 5 medical contributing factors of HHS?
- MI
- Sepsis
- Pancreatitis
- Stroke
- Some drugs (glucocorticoids, diuretics, phenytoin, beta blockers, and calcium channel blockers)
What BG is considered HHS with symptoms?
> 33 BG
what are 4 signs of severe dehydration with HHS?
- Somnolence - sleeping too long/too much
- coma
- seizures
- hemiparesis
How do we rehydrate someone with HHS?
normal saline 1L/hr initially if hypotension or shock
Do we check bicarb with DKA or HHS and why?
DKA because they are in metabolic acidosis
What precipitating factors are different for DKA and HHS?
- DKA - inadequate insulin dose
- HHS - poor fluid intake
Which do we see CNS/ Neuro symptoms, DKA or HHS and why?
HHS
d/t hyperosmolarity and cellular rehydration. Takes time to re-establish fluid balance in the brain
What are the 3-4 interventions for HHS and DKA?
- rehydration (.45%NS)
- IV insulin continuous
- Watch K+
- bicarb (DKA)
How many hours is the goal for rehydration and normal serum glucose levels in HHS?
36-72 hours
When rehydrating someone with HHS, what solution is used when they are in shock or severe hypotension?
Normal saline
What solution do we give for someone with HHS to rehydrate them in general?
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
when rehydrating a patient, how many hours is half fluid replaced and when is the rest of the fluid replaced?
12 hrs- 1/2 replaced
36 hours- the rest replaced
How do we know our rehydration efforts are working in someone with HHS?
improvement in CNS function
How do we know when a patient is ready to stop their insulin infusion so they can be discharged in DKA?
DKA
1. BHB (beta hydroxybutyrate is low (lower acidosis)
2. anion gap lower (lower acidosis)
3. Oral intake (both)
How do we know when a patient is ready to stop their insulin infusion so they can be discharged in HHS?
HHS
1. patient is alert and oriented
2. <17.5mmol/L BG
3. Plasma osmolaity is WNL
4. Oral intake (both)
How do we know when a patient is ready to stop their insulin infusion so they can be discharged for HHS/DKA and why?
tolerate oral intake before giving subcut insulin b/c they need food before subcut insulin
What insulins are given to transition a patient off a continuous insulin infusion?
Rapid acting subcut insulin + intermediate acting insulin
If a patient with DKA is unable to eat do we stop IV insulin infusion or continue it?
preferable to continue it
For patients with HHS when can subcut insulin be initiatied ? (BG level)
<13.9-16.7 mmol/L
What are 4 things we should teach patients with DM1 about what to do if they are sick?
- take diabetic meds (may need more insulin)
- monitor BG q4-6hrs
- check urine for keytones when BG is >14 (consistently)
- Get medical care if:
- BG not controlled
- keytones (to avoid DKA)
What are 4 things we should teach patients with DM2 about what to do if they are sick?
- older adults monitor for dehydration
- don’t stop diabetic meds
- monitor BG q4-6hrs
- Get medical care if:
-BG not controlled
Does insulin cause K+ to enter or exit cells?
Enter cells - EKG needed
What is a potential complication of hypothyroid?
Myxedema coma - everything is too slow
Which disease is goiter associated with?
hyperthyroid
