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NURS 401 > Week 6: Endocrine And Immune Disorders > Flashcards

Week 6: Endocrine And Immune Disorders Flashcards

1
Q

What are normal age-related changes to the immune system?

A
  • Total number of T cells don’t change with aging.
  • B cell function decreases with aging
  • Increase in number of immunoglobulins -> decrease in innate immunity
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2
Q

T cells

A

Scan the body for invading substances such as infections and contributes to the body’s immunity.

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3
Q

B cells

A

Secrete antibodies in response to the presence of antigens such as infectious agents and foreign substances.

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4
Q

Decrease in function of B cells results in

A

Reduced ability to produce antibodies leading to a decreased ability to develop adequate immunity after an infection or after an immunization (i.e influenza)

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5
Q

Immunosenescence

A

Gradual deterioration of the immune system brought on by natural aging advancement

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6
Q

Diabetes Mellitus

A

A chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both.

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7
Q

Criteria for diagnosis of DM

A
  • One fasting hemoglobin A1C value >/= 6.5% (or)
  • One random plasma glucose >/= 200 mg/dL (or)
  • Fasting plasma glucose >/= 126 mg/dL (or)
  • Oral glucose tolerance test (OGTT) >/= 200 mg/dL 2 hours after glucose administration (or)
  • When classic symptoms of hyperglycemic or hypoglycemic crisis are present.
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8
Q

The U.S Preventative Services Task Force recommends screening for DM always be done for those whose:

A
  • BP consistently > 135/80 mmHg

- Any risk factors for CV disease

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9
Q

DM is the leading cause of

A
  • Adult blindness
  • End-stage renal disease
  • Non-traumatic lower limb amputations
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10
Q

DM is a major contributing factor for

A

Heart Disease

Stroke

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11
Q

DM Pathophysiology/Etiology

A

-Absent/insufficient insulin and/or poor utilization of insulin.

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12
Q

Insulin

A
  • Produced by -cells in islets of Langerhans (Pancreas).
  • Released continuously into bloodstream in small increments with larger amounts released after food.
  • Stabilizes glucose level in range of 70 to 110 mg/dL.
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13
Q

Type II Diabetes Mellitus

A

Formerly known as adult-onset diabetes (AODM) or non–insulin-dependent diabetes (NIDDM).

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14
Q

Risk factors for type II DM

A
  • Overweight
  • Obesity
  • Advanced age
  • Family history
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15
Q

Type 2 DM Pathophysiology/Etiology

A

-Pancreas continues to produce some endogenous insulin but
1. Not enough insulin is produced
(OR)
2. Body does not use insulin effectively

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16
Q

Signs and symptoms of diabetes mellitus

A
  • Polyuria, polyphagia, polydipsia
  • May have fatigue, weight loss and visual changes.
  • Prolonged wound healing.
  • Woman may present with candidiasis, as first sign.
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17
Q

Complications of Type II DM more common in older adults

A
  • Compounded by the presence of multiple morbid diseases and disorders.
  • Dry mouth, dry eyes, dehydration
  • Incontinence
  • Weight loss, anorexia and nausea
  • Confusion, delirium
  • Delayed wound healing
18
Q

Complications of DM

A 
Mobility impairment, muscle weakness, falls 
Cognitive impairments
Fatigue
Weight loss
Incontinence
19
Q

Type II DM is often a diagnosis not made until evidence of end organ damage becomes visible such as

A
  • Decreased visual acuity
  • Neuropathy
  • Heart disease
  • Stroke
  • Periodontal disease
20
Q

Hypoglycemia Levels in older adults

A

<60

21
Q

Signs of hypoglycemia in older adults

A
  • Tachycardia
  • Palpitations
  • Diaphoresis
  • Tremors
  • Pallor
  • Anxiety
22
Q

Later symptoms of hypoglycemia in older adults include

A
  • Headache
  • Dizziness
  • Fatigue
  • Irritability
  • Confusion
  • Hunger
  • Visual changes
  • Seizures
  • Coma
23
Q

Immediate care for hypoglycemia

A

-Give glucose orally or IV

24
Q

Hyperglycemia levels in older adults

A

200-600 or higher

25
Q

Hyperglycemia

A

-Harder to detect and with aging there is higher tolerance.

26
Q

Hyperglycemia increases the risk for

A

hyperosmolar hyperglycemic nonketotic coma → important in persons who are frail and should be considered in any older adult with diabetes who is difficult to arouse.

27
Q

What is the best measurement for ongoing glycemic control?

A

Hgb A1C

28
Q

Medications for DM

A
  • Anti-glycemics and preventative adjuvant therapy such as ACE inhibitors and aspirin.
  • Metformin is commonly prescribed as first-line therapy.
  • Sulfonylureas may cause hypoglycemia and can only be used in persons who can monitor signs. (Chlorpropamide and glyburide are contraindicated)
  • Insulin is used when all other strategies have failed.
29
Q

Nonpharmacological Management of DM

A
  • Nutrition
  • Weight management
  • Exercise
  • Self-care
30
Q

Self-care for DM

A
  • Glucose self monitoring
  • Medication self-administration
  • Foot care and examination
  • Recognize s/s hyperglycemia and hypoglycemia
31
Q

Cause of hypothyroidism

A
  • Insidious in onset, thought to be most commonly caused by chronic autoimmune thyroiditis (previously called Hashimotos disease)
  • May be iatrogenic (induced inadvertently by provider, surgeon, or treatment) resulting from radioiodine treatment, subtotal thyroidectomy, or a number of medications, especially amiodarone (antiarrhythmic).
32
Q

Subclinical Hypothyroidism

A

Normal serum T4 and somewhat elevated TSH (5-10 IU/mL)

33
Q

Signs and symptoms of hypothyroidism that are probably less common in older adults

A

-Fatigue
-Weakness
-Depression
-Dry skin
Significantly less common include:
-Weight gain
-Cold intolerance
-Muscle cramps

34
Q

Hyperthyroidism is caused by

A

It is most often caused by the autoimmune disorder Grave’s disease with multinodular or uninodular goiter

35
Q

Hyperthyroidism can also result in

A

Ingestion of iodine or iodine-containing substances

36
Q

Clinical manifestations of hyperthyroidism

A
  • Often atypical and may not be diagnosed until the person has unexplained fibrillation, HF or even dementia.
  • Likely to have tachycardia, tremors and weight loss.
37
Q

Complications of Thyroid Disease

A

-Myxedema coma is a serious complication of untreated hypothyroidism in the older adult.

38
Q

Myxedema coma

A

Severe hypothyroidism leading to decreased mental status, hypothermia and other symptoms related to slowing of function in multiple organs.

39
Q

Myxedema coma symptoms

A
  • Delayed DTRss
  • Puffy Skin
  • Bradycardia
  • Hypotension
  • Hypoventilation
  • Stupor
  • Coma
40
Q

Why is rapid replacement of thyroxine in myxedema coma not possible?

A

Due to risk for drug toxicity

Death may occur

41
Q

Over Replacement with thyroxine increases

A

Myocardial oxygen consumption.

May result in exacerbation of angina in those with pre-existing CAD or precipitate CHF.

42
Q

Thyroid Disorders: Promoting Healthy Aging

A

The nurse caring for frail elders can be attentive to the possibility that the person who is diagnosed with anxiety, dementia, or depression may have a thyroid disturbance.

All persons having a depressive disorder must be checked for hypothyroidism.

The nurse works with the person and significant others in the correct self-administration of medications and appropriate timing of monitoring blood levels and signs and symptoms indicating exacerbation (Box 24-15, pg. 316 Touhy & Jett).

NURS 401 (26 decks)

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