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Pathophysiology and Pharmacology > Thermoregulation & Glucose Regulation > Flashcards

Thermoregulation & Glucose Regulation Flashcards

1
Q

What are the hormone levels in Primary Hypothyroidism ?

A

TSH is high and serum T4 is low

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2
Q

What are the hormones levels in Primary Hyperthyrodisim ?

A

Low TSH levels and high free-T4 levels

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3
Q

What are the hormone levels in Secondary Hyperthyroidism ?

A

High levels of TSH when excessive TSH secretion is the cause

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4
Q

How are the hormone levels in Secondary Hypothyroidism ?

A

TSH is decreased or normal due to hypothalamic or pituitary insufficiency

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5
Q

What is the cause of Primary Hypothyroidism ?

A

abnormality in the thyroid gland itself
- most common

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6
Q

What is the cause of Secondary Hypothyroidism ?

A

hypothalamic or pituitary insufficiency
- when hypothalamus is dysfunctional and does not secrete Thyrotropin-Releasing Hormone (TRH)
- anterior pituitary does not secrete Thyroid-Stimulating Hormone (TSH)

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7
Q

What is hypothyroidism ?

A

metabolic processes slow down due to a deficit in T4 and T3

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8
Q

What is Goiter ?

A

can occur with hypo/hyperthyroidism
- enlargement of the thyroid gland
- results from when thyroid hormone fails to meet metabolic demands
- many types: nontoxic, toxic, endemic, and sporadic goiter

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9
Q

What is the goal of hypothyroidism interventions ?

A

restore normal thyroid state as safely and quickly as possible
- main therapy is thyroid hormone replacement

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10
Q

What is the goal of Anti-Thyroid meds ?

A

used to treat hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical tx or during radioactive iodine tx for hyperthyroidism

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11
Q

For hyperglycemia what are the 2 main problems with the body ?

A
  • no insulin present to help glucose enter cells
  • body is resistant to insulin available (insulin is defective and isn’t fitting on the receptor)
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12
Q

What is pre-prandial and post-prandial ?

A
  • before you eat
  • after you eat
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13
Q

What are some long-term complications of both types of diabetes ?

A

Macrovascular
- MI, CVA, PAD
Microvascular
- neuropathy, retinopathy, nephropathy

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14
Q

When we do start screening for diabetes ?

A

every 3 years for all pt’s 45 years and older

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15
Q

How does Type 1 Diabetes work ?

A

your pancreas isn’t producing insulin at all, so you will have glucose floating around in your bloodstream
- beta cells in Islets of Langerhans does not work
- pt’s need exogenous insulin
- body start to metabolize fat instead of carbs
- usually diagnosed in childhood

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16
Q

How does Type 2 Diabetes work ?

A

you are making some insulin and its not enough or you are producing insulin but your receptor isn’t recognizing the insulin, so it doesn’t work
- usually related to lifestyle choices
- body cells quit responding to insulin
- insulin nondependent

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17
Q

What is gestational diabetes ?

A

similar to type 2 but occurs only during pregnancy
- pregnancy hormones cause body cells to be less receptive to insulin
- usually disappear after birth, within 6 months postpartum
- managed similar to type 2 but with input from OB

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18
Q

What are the HbAIC levels ?

A
  • Normal: <5.7%
  • Prediabetic: 5.7-6.4
  • Type 2 Diabetes: >6.5%
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19
Q

What is the fasting blood glucose goal for diabetic pt’s ?

A

70-126 mg/dL

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20
Q

When you give Insulin to a diabetic pt what does it do to their body ?

A

restores their ability to:
- metabolize carbs, fats, and proteins
- store glucose in the liver
- convert glycogen to fat stores
- doesn’t reverse defects in insulin sensitive receptors but increases the amount of insulin in your body

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21
Q

What is recombinant insulin produced by ?

A

bacteria and yeast

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22
Q

What is the onset, peak, and duration of Rapid-Acting insulin ?

A
  • Onset: 15 to 30 mins
  • Peak: 0.5 to 2.5 hr
  • Duration: 3 to 6 hrs
  • to be given to pt’s that are unconscious and severely hyperglycemic
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23
Q

What is the onset, peak, and duration of Short-Acting insulin ?

A
  • Onset: 0.5 to 1 hr
  • Peak: 1 to 5 hrs
  • Duration: 6 to 10 hrs
  • regular (humulin R)
24
Q

What is the onset, peak, and duration of Intermediate-Acting insulin ?

A
  • Onset: 1 to 2 hrs
  • Peak: 6 to 14 hrs
  • Duration: 16 to 24 hrs
25
Q

What is the onset, peak, and duration of Long-Acting insulin ?

A
  • Onset: 70 minutes
  • Peak: none
  • Duration: 18 to 24
26
Q

Which insulin is Rapid-Acting ?

A

Lispro (Humalog)
- mimics closely the response your body would react to being hyperglycemic

27
Q

Which insulin is Short-Acting ?

A

Regular Insulin (Humulin R, Novolin R)
- only insulin that can be given IV
- often used with DKA
- sometimes used in combo with intermediate-acting insulin to decrease amount of injections per day

28
Q

How do you minimize adverse effects of administering Insulin ?

A
  • rotate injection sites to prevent lipodystrophy
  • assess glucose levels before administration to prevent hypoglycemia
29
Q

What is Lipoatrophy ?

A

loss of subcutaneous fat and appears as slight dimpling or more serious pitting of subcutaneous fat
- using human insulin helps prevent this

30
Q

What is Lipohypertrophy ?

A

development of fibrous fatty masses at the injection site and is caused by repeated use of an injection site

31
Q

Which insulin is Intermediate-Acting ?

A

NPH (Humulin N)
- is cloudy or opaque
- sterile suspension of zinc insulin crystal and protamine sulfate in buffered water
- usually mixed with regular insulin to reduce the number of insulin injections per day

32
Q

With Intermediate-Acting Insulin which insulin do you avoid mixing it with ?

A

don’t use in combo with rapid-acting and short-acting
- the peak times are too closely together

33
Q

Which insulin is Long-Acting ?

A

Glargine (lantus)
- aka basal insulin
- colorless solution that once injected into SubQ tissue it cause tiny crystals to be formed and these crystals will slowly absorb

34
Q

How do we mix insulin ?

A

clear to cloudy
- inject the air needed into both vials first
- then draw up the clear insulin and then the cloudy one

35
Q

What is sliding-scale insulin dosing ?

A

SQ rapid-acting or short-acting insulin is adjusted according to blood glucose test results
- testing done several times a day, before meals and at bedtime
-SubQ insulin is ordered in an amount that increases as the blood glucose increases

36
Q

For which pt’s do we usually use sliding-scale insulin ?

A

hospitalized diabetic pt’s or those on total parenteral nutrition or enteral tube feedings

37
Q

What are some disadvantages of sliding-scale insulin dosing ?

A
  • delays insulin administration until hyperglycemia occurs
  • results in large swings in glucose control
38
Q

What is basal-bolus insulin dosing ?

A

mimics a healthy pancreas by delivering basal insulin constantly as a basal and then needed as a bolus
- when you give # units of insulin for how many grams of carbs you eat
- bolus dose is carb count dose

39
Q

What are some RN implications for giving insulin ?

A
  • check glucose before giving insulin
  • roll vials instead of shaking to mix suspensions
  • only use insulin syringes
  • ensure correct timing of insulin dose with meals
  • pt education
40
Q

What must be functioning for the use of Sulfonylureas ?

A

beta cell function must be present
- improves sensitivity to insulin in tissues
- can cause hypoglycemia

41
Q

When insulin is ordered what do you have to check ?

A
  • correct route
  • correct type of insulin
  • timing of the dose
  • correct dose
  • insulin order and prepared dosages are 2nd checked with another RN
42
Q

What are early signs of hypoglycemia ?

A

Sweaty, confused and clammy give them some candy”
- confusion
- irritability
- tremor
- sweating

43
Q

What are late signs of hypoglycemia ?

A
  • hypothermia
  • seizures
  • coma and death will occur if not treated
44
Q

What are hypoglycemic levels ?

A

<70 mg/dL
- mild cases can be treated with diet
- severe is <50

45
Q

What are hyperglycemic levels ?

A

> 140 mg/dL
- severe is >180

46
Q

What are euglycemic (normal) levels ?

A

70-140 mg/dL

47
Q

What are some symptoms of hypothyroidism ?

A
  • intolerant to cold
  • hair loss
  • dry skin
  • edema of face and eyelids
  • slow speech and thick tongue
  • ANOREXIA
  • brittle hair and nails
  • menstrual disturbances
  • constipation
  • muscle weakness and aches
  • dull, blank expression
  • apathy
48
Q

What are some symptoms of hyperthyroidism ?

A
  • intolerant to heat
  • fine, straight hair
  • facial flushing
  • bulging eyes
  • increased HR and RR
  • weight loss
  • muscle wasting
  • finger clubbing
  • tremors
  • diarrhea
  • menstrual changes (amenorrhea)
49
Q

What are some symptoms of myxedema coma ?

A

occurs from 2ndary hypothyroidism
- lethargy, drowsiness, leading to impairment of LOC or coma
- Hypo: thermia, tension, and ventilation
- treat immediately and support vital functions and IV thyroid hormone replacement

50
Q

What is thyroid crisis (thyroid storm) ?

A

when T3 and T4 are overproduced causing increased systemic adrenergic activity
- body is burning through energy faster then it can be replaced
- overproduction of epi and severe hypermetabolism
- caused by stress, infection, and surgery

51
Q

What are some symptoms of thyroid crisis ?

A
  • severe CNS effects (restlessness, agitation, delirium)
  • CVPV effects (angina, heart failure, increased HR)
  • hyperthermia
  • GI symptoms (N, V, D, pain)
  • treat immediately with B-blockers, MMI, corticosteroids, fluids and electrolytes, fever reduction
52
Q

What are some symptoms of hypoglycemia ?

A
  • decreased cognition
  • tremors
  • diaphoresis
  • weakness
  • hunger
  • HA
  • irritability
  • seizure and hypothermia (late signs)
53
Q

What are some symptoms of hyperglycemia ?

A
  • polyuria & polydipsia
  • dehydration
  • fatigue
  • fruity odor to breath
  • Kussmauls’ breathing
  • weight loss
  • hunger
  • poor wound healing
  • feel hot
  • increased risk to infection
54
Q

What is diabetic ketoacidosis (DKA) ?

A

where glucose is high but there is no insulin to let glucose be used as energy so the body breaks down fatty acids instead
- type 1 DM
- ketones are the metabolic byproducts)
- Tx: rapid IV or NaCl, insulin IV, replace electrolytes

55
Q

What are some symptoms of DKA ?

A
  • hyperglycemia
  • ketones in serum
  • acidosis
  • dehydration
  • electrolyte imbalance
56
Q

What is hyperglycemia hyperosmolar nonketotic syndrome (HHNS) ?

A

extreme hyperglycemia without ketosis or acidosis because there is enough insulin to prevent fat breakdown thus prevents ketosis
- type 2 DM
- Tx: fluid replacement, correct electrolyte imbalance, admin insulin
- watch for elderly since they won’t know they are in this

Pathophysiology and Pharmacology (13 decks)

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