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Endocrine 1 Flashcards

1
Q

serum glucose maintained by insulin and glucagon ratio

A

homeostasis

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2
Q

endocirine system is linked with

A

nervous system and immune system

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3
Q

exocrine secretes

A

onto the surface usually though a duct

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4
Q

endocrine secretes

A

hormones into the blood stream

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5
Q

chemical substance synthesized & secreted by a specific organ or tissue

A

hormones

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6
Q

what penetrates the cell membrane and interact with intracellular receptors

A

steroid and thyroid hormones (lipid-solube)

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7
Q

what binds to receptors located on the surface of cell membranes

A

protein hormones

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8
Q

activated by imbalance, the action of a hormone results in changes that negate the inital stimulus for its secretion

A

Negative feedback system

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9
Q

what is an example negative feedback

A

increase in insulin = increase in glucose

decrease in Ca = increase PTH

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10
Q

increase target action beyond normal

A

positive feedback, example oxytocin

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11
Q

what involves hormones among several glands to turn off and on target organ hormone secretion

A

complex feedback

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12
Q

what is an exampe of intrinsic rhythmic secretion of hormones

A

circadian rhythm

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13
Q

ultradian

A

greater than 24 hour cycle

menstral cycle

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14
Q

stress can cause your blood glucose to

A

elevate

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15
Q

integrated chemical, communication and coordination system that enables what

A

growth, development, reproduction and regulation of energy

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16
Q

a chronic multisystem diseas related to abnormal insulin production, imparied insulin utilization or both

A

diabetes mellitus

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17
Q

normal insulin is produced by what

A

the B cells in the islets of langherans of the pancreas

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18
Q

what is the normal glucose range

A

70-120 mg/dl

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19
Q

type 1 diabetics are

A

prior to age 30, need insulin for life bc they no longer can produce insulin

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20
Q

type 2 diabetics are

A

after age 35, change with diet, excercise and insulin

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21
Q

alpha cells secrete

A

glucagon

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22
Q

beta cells secrete

A

insulin

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23
Q

glucagon & insulin play a vital role in the metabolism of

A

carbs, proteins and fats

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24
Q

the primary endocrine function of pancreas is to

A

regulate blood glucose

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25
Q

in a healthy body normal blood glucose level is maintained by

A

insulin and glucagon ratio

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26
Q

insulin is the _____ to unlock cell membrane for glucose to enter

A

the key

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27
Q

what cant enter cell without insulin

A

glucose

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28
Q

insulin unlocks the door to allow

A

glucose to enter the cell

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29
Q

without insuin the body enter serious state of what

A

breaking down of body fat and protein

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30
Q

increase urine, caused by osmotic diuresis caused by excesive glucose in urine

A

polyuria

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31
Q

dehydration stimulates thirst mechanism

A

polydipsia

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32
Q

cells in state of starvation until insulin availble to move glucose into cells

A

plyphagia

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33
Q

what is used for backup energy source

A

stored fats and ketones

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34
Q

what happens with insulin deficiency

A

fats breakdown and rlease free fatty acids
which convert to ketome bodies
ketone accumulate in blood which causes metabolic acidosis

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35
Q

insulin absence causes

A

potassium depletion

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36
Q

what can lead to cardiac arrythmias

A

absence of insulin

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37
Q

what hormone action is opposite of insulin

A

glucagon

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38
Q

what is the primary fuel for the CNS

A

glucose

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39
Q

need continuous supply of glucose is needed for what

A

brain bc cannot produce or store

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40
Q

liver and muscle stores glucose as what

A

glycogen

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41
Q

what inhibits the break down of adipose tissue into fatty acids

A

insulin

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42
Q

as BS rises what happens to the blood

A

becomes viscous and flows less readily which decreases cirulation and hinders the bodies ability to fight infection and heal

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43
Q

excess glucose excreted in urine along with fluid & electrolyes

A

osmotic diuresis

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44
Q

type 1 diabetes is the progressive destruction of what

A

pancreatic B cells (source of insulin)

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45
Q

S/Sx of DM

A

sudden weight loss/hunger, polydipsia, polyuria, polyphagia, fruity breath

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46
Q

what occurs in the absence of exogenous insulin and is a life threatening condition

A

diabetic ketoacidosis

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47
Q

what do all type 1 diabetics require

A

exogenous insulin

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48
Q

what is the most frequently occuring diabetes

A

type 2

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49
Q

insulin produced is either insufficient &/or poorly utilized by the tissue

A

type 2 diabetes

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50
Q

what are the major metabolic abnormalities of type 2 diabetics

A

insulin resistance, pancreas decreases ability to produce insulin, inapooropriate glucose production from liver, alteration in prodction of hormones and adipokines

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51
Q

glucose intolerance during pregnance

A

gestational diabetes

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52
Q

how is gestational diabetes detected

A

detected at 24-28 weeks by OGTT (oral glucose tolorance test)

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53
Q

how long does it take for normal glucose levels to return post partum

A

6 weeks

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54
Q

what is therapy is tried first for DM

A

nutritional

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55
Q

S/Sx of type 2 DM

A

fatigue, reccurent infections, prolonged wound haling, visual changes

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56
Q

fasting plasma glucose level

A

greater than 126 mg/dl must be confirnmed by repeat test

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57
Q

random plasma glucose measurement greater than 200 mg/dl plus symptoms

A

random plasma glucose measurement

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58
Q

2 hour plasma glucose level between 140-199

A

impaired glucose tolerance

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59
Q

fsting blood glucose level greater than 100 but less than 126

A

impaired fasting glucose

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60
Q

useful in determining glycemic levels over a 3 month time

A

A1C test

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61
Q

goal of A1C test is to be below

A

7%

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62
Q

2 hour after meal glucose should return WNL

A

postprandial

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63
Q

intermediate acting insulin

A

NPH insulin, cloudy, Novolin N, Humulin N, onset 1-2 hours, peak 4-8 duration 10-20hrs, usually before am & pm meal

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64
Q

long acting insulin

A

basal, lantus, levemir, given once daily, CANNOT be mixed with other insulins, onset 1-2 hours, duration 24 hours, PEAKLESS, clear

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65
Q

rapid acting insulin

A

humolog, novolog, may be given 15 minutes prior to meal, CANNOT mix with NPH, onset 15 minutes, peaks 1 hour, duration 2-4 hours, clear, bolus

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66
Q

short actinginsulin

A

clear, bolus, regular R insulin, only one given IV, administration 30 minutes prior to meal, onet 30 minutes, peaks 2-4 hours, duration 6-10 hours

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67
Q

prediabetes is from ____-____mg.dl

A

100-126

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68
Q

during teaching what should be told to the pt about self monitoring of

A

blood glucose, nutrition, drug therapy, exercise

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69
Q

what type of insulin is used today

A

human

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70
Q

when reaches blood stream and begins to decrease blood sugar

A

onset

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71
Q

max strength derease BS

A

peak

72
Q

length of time continues to decrease BS

A

duration

73
Q

what can be mixed with regular or rapid

A

intermidiate

74
Q

how long is lantus good for

A

28 days

75
Q

insulin vials currently used be stored at what temperature

A

room temperature for 4 weeks

76
Q

where do we give insulin injections

A

abdomen, arm, thigh, butt

77
Q

why might a insulin pen be used

A

pt with vision problems

78
Q

why is inslun spray exubera off the market

A

due to packing problems

79
Q

continuous subcutaneous infusion battery operated

A

insulin pump

80
Q

atrophy sub q tissue from same site usage

A

lipodystrophy

81
Q

thickening of sub q tissue

A

lipohypertrophy

82
Q

rebound effect in which overdose of insulin causes hypoglycemia usually during sleep when counterregulatory hormones are released, morning hyperglycemia in response to night time hypoglycemia

A

somogyi effect

83
Q

how do you teat the somogyi effect

A

decreasing indulin, increasing night time snack

84
Q

hyperglycemia on awaking in themorning usually normal til 3 am, relase of growth hormone/cotisol

A

dawn phenomenon

85
Q

how do you treat dawm phenomenon

A

adjust timing of insulin or increase dose

86
Q

what oral medications stimulates beta cells to release more insulin

A

sulfonylureas

glipizide, glimepiride

87
Q

what oral medication increases insulin production from pancreas, should not be taken if meal skipped, useful for unusual eating habits

A

meglitinides

repaglinide, nateglinide

88
Q

what oral medication will reduce glucose production by liver without hypoglycemia side effects, hold when testing with IV dyes (48 hours)

A

biguanides

glucophage

89
Q

what oral medication slows down absorption of carbs in small intestine, taken first bite of each main meal to lower post prandial blood glucose

A

a glucosidase inhibitors

acarbose

90
Q

most effective in those with insulin resistance, improves insulin sensitivity, transport, and utilization at target tissues

A

thiazolidinediones

pioglitazone

91
Q

what oral medication is the newest class glucose lowering drugs, increase and prolong incretin levels, absence of weight gain, released by intestine

A

dipeptidyl peptidase inhibitor

januvia

92
Q

hormone secreted by B cells of pancras, cosecreted with insulin, slows gastric emptying

A

amylin analog

symlin

93
Q

synthetic peptide, stimulates release of isulin from B cells, suppress glucagon secretionslows gastric emptying, not to be used with insulin

A

incretin mimetic

byetta

94
Q

may mask symptoms of hypoglycemia

A

B adrenergic blockers (beta blockers)

95
Q

can potentiate hyperglycemia by increasing Potassium loss

A

thiazide/loop diuretics

96
Q

what is the cornerstone of care for person with diabetes

A

nutritional therapy

97
Q

for a type 1 DM pt, what is as important as the amount of food eaten

A

time of the meals

98
Q

for a type 2 DM pt what is the emphasis placed on for goals

A

achieving glucose, lipid and B/P goals

99
Q

what is the goal of diet therapy for a type 2 DM

A

maintain as near a normal BS as possible

100
Q

carbs and monosaturated fats should provide ______ % total energy intake

A

45-65%

101
Q

what kind of diets are not recommended for diabetics

A

low carbohydrate diets

102
Q

about how many carbs are covered by one unit of insulin

A

10-15

103
Q

when does the blood sugar after a meal spike

A

2 hours

104
Q

alcohol can cause what in a DM pt

A

severe hypoglycemia

105
Q

who should be included in diet/DM teaching

A

patients family and significant others

106
Q

what method is used for DM for diet

A

plate method 1200-1400 calories daily

107
Q

what does fiber help with

A

decrease BS and triglycerides

108
Q

exercise does what for a DM pt

A

increases insulin sensitivity, lower blood glucose levels, may need carb snack before exercise

109
Q

can the BS initially increase with excercise?

A

yes

110
Q

when should you check BS levels during excercise

A

before, during and after

111
Q

patients using insluin sulfonylureas, or meglitinides are at increased risk for what during excercise

A

hypoglycemia

112
Q

during stress the body produces adrenalin and cortisol which does what to BS

A

raise BS

113
Q

what is useful for good blood glucose control, enables patient to make self management decisions regarding diet, exercise, and medicaion

A

self monitoring of blood glucose

114
Q

who is a candidate for a pancreas transplant

A

type 1 DM, usually kidney and pancras together

115
Q

what is the #1 predictor of type 2 diabetes

A

obesity

116
Q

rapid deep respirations

A

kussmaul respiration

117
Q

what testing needs to be done if glucose is above 240

A

ketone testing

118
Q

hyperglycemia causes what

A

breakdown of fat which release free fatty acids which convert to ketones, ketones accumulate in blood which causes metaboilc acidosis

119
Q

what needs to be taught about insulin therapy or oral agents

A

education of administratin, adjustment and side effects

120
Q

what is caused by profound deficiency, mostly occurs in type 1 DM, and is characterized by hyperglycemia, ketosis, acidosis, dehydration

A

diabetic ketoacidosis

121
Q

what is the most common precipitating factor in diabetic ketoacidosis

A

illness

122
Q

what is a by product of fat metabolism

A

ketones

123
Q

ketones alters pH balance causing what

A

metobolic acidosis

124
Q

untreated insulin deficiency results in

A

dehydration, electolytes, acidosis

125
Q

dehydration and electrolyte loss, body attempts to excret glucose via kidneys, loses H20 & electrolytes

A

osmotic diuresis

126
Q

fluid shifts from intravascular space to urine as kidneys try to excreted glucose, sweet fruity odor

A

DKA S & Sx

127
Q

what makes the sweet fruity odor

A

excessive fat metbolism

128
Q

blood glucose of greater than 300

A

DKA

129
Q

what diagnositc study confirms DKA

A

ABGs

130
Q

you need potassium replacement for a sodium bicarb if pH is less than

A

7

131
Q

with DKA what is a priority

A

dehydration

132
Q

insulin IV therapy dosage

A

0.1 unit/kg/hr

133
Q

what is the only insulin that can be given IV push

A

regular insulin

134
Q

what do you need to be careful with the elderly and fluid/electrolyte imbalnce

A

fluid overload

135
Q

what do you do if the BS and ketones are both elevated

A

contact MD

136
Q

why would you not want to decrease BS too fast

A

bc you could increase cranial pressure bc glucose goes into cells rapidly & brings in H20 with it

137
Q

what would you use a nursing diagnosis of Risk for injury due to mental confusion for

A

hyperosmolar hyperglycemic syndrome

138
Q

life threatening syndrome, less common than DKA, occurs in PTs over 60years of age with type 2 DM

A

hyperosmolar yperglycemic syndrome

139
Q

S & Sx of BS 600-2,000, none for mild ketonuria, profound dehydration, sticky dry mucous membranes, high mortality rate

A

hyperosmolar hyperglycemic syndrome

140
Q

when you add insulin, glucose enters cell along with potassium so you may need what

A

potassium replacement

141
Q

when you have a BS level of over 250 administer, and monitor for

A

D5W, cardiac dysrhytmias

142
Q

Condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the glucose level reaches a critical point

A

Hypoglycemic unawareness

143
Q

Hypoglycemic unawareness is related to what

A 
Autonomic neuropathy (interfere with secretion of counter regulatory hormones) 
Elderly who use beta blockers
144
Q

Results from thickening of vessel membrane in the capillaries and Arterioles in response to chronic hyperglycemia

A

Micro vascular complication

145
Q

What is the most effected area due to micro vascular complications

A

Eyes (retinopathy)
kidney (nephropathy)
Skin (dermopathy)

146
Q

Most severe form of retinopathy is

A

Proliferative retinopathy

147
Q

Aspiration of blood membranes & fibers from the inside of the eye behind the cornea

A

Vitrectomy

148
Q

Micro vascular complication associated with damage to small blood vessels that supply glomeruli of kidney

A

Diabetic nephropathy

149
Q

How are DM pt’s screened for nephropathy

A

Annually with measurement of albumin to creatinine ratio in urine

150
Q

Nerve damage that occurs bc of metabolic derangements associated with DM

A

Neuropathy

151
Q

Neuropathy that effects the peripheral nervous system

A

Sensory neuropathy

152
Q

Which neuropathy can affect all body systems and lead to hypoglycemic unawearness, bowel incontinence and urinary retention

A

Autonomic neuropathy

153
Q

What should be done yearly to help prevent ulcers and amputation

A

Microfilament screening

154
Q

Dark coarse thickened skin seen in flex urges and on neck

A

Acabthosis nigricans

155
Q

Occurs when too much insulin in proportion to glucose

A

Hypoglycemia

156
Q

If your pt is hypoglycemic and able to swallow what do you give them

A 
15-20g of simple carbs 
Fruit juice
Milk
Soft drink
Recheck bs in 15
157
Q

If you have given your pt 2-3 doses of simple carbs with no improvement what do you do

A

Administer 1mg glucagon IM

158
Q

What is the most common cause of death in type 2

A

Acute MI

159
Q

What has the highest o2 consumption in the body

A

Retina

160
Q

Name the three types of macro vascular diseases

A

CAD
PVD
cerebrovascular disease

161
Q

The most common form of retinopathy, partial occlusion of the small blood vessels in retina

A

Nonproliferative retinopathy

162
Q

The most severe form of retinopathy. Involves retina & vitreous

A

Proliferative retinopathy

163
Q

What is a symptom of hyperosmolar hyperglycemia syndrome

A

Stick dry mucous membrane

164
Q

For diabetic nephropathy standards include yearly screenings for presence of what

A

Microalbuminuria

165
Q

Characterized by abnormal amounts of protein in the urine

A

Diabetic nephropathy

166
Q

Stocking glove syndrome is known as

A

Sensory neuropathy

167
Q

Excess glucose converts to —— in nerves and coats nerve fibers & slows motor conduction

A

Sorbitol

168
Q

What is common for diabetic neuropathy

A

Numbness in hands & feet

169
Q

In autonomic neuropathy what can be affected

A

Erectile desfunction

170
Q

If BS is above 250 what else should you check

A

Ketones

171
Q 
Onset, peak, duration & name of the following insulins: 
Rapid acting 
Short acting 
Intermediate acting
Long acting
A 
15, 30, 2, 1
1, 2, 4, peak less
3, 3, 10, 24
Rapid- humalog
Short- humilin r
Intermediate- humilin n
Long- lantus
172
Q

Which insulin is IV only

A

Short acting (regular)

173
Q

Which insulin is NEVER mixed

A

Long acting

174
Q

Glucose is produced where

A

Liver

175
Q

Characterized by insulin resistance, elevated insulin, high triglyceride, decrease HDL, increase LDL, and HTN

A

Metabolic syndrome

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