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Flashcards in endocrine Deck (139):
1

hormones produced by the thyroid gland x3

T3
T4
calcitonin

2

calcitonin action

decreases serum Ca by taking Ca out of blood and returning it to bone

3

iodine purpose

hormone creation

4

thyroid hormone purpose

energy

5

hyperthyroidism

aka Graves Disease
too much energy!

6

hyperthyroidism: s/s

nervous, irritable
sweaty, hot
exophthalmos
thyroid hypertrophy

decreased
- attention span
- weight

increased
- appetite, gi motility
- bp (workload of heart)

7

hyperthyroidism: dx

increased serum T4
thyroid scan

8

antiarrhythmic drug containing high levels of iodine

amiodarone (Cordarone) - may affect thyroid function

9

prior to thyroid scan...?

discontinue iodine-containing medications 1 week prior

10

hyperthyroidism: tx

anti-thyroid medications
iodine compounds
beta blockers
radioactive iodine
surgery

11

anti-thyroid medications: action

- stops thyroid from making thyroid hormone
- for hyperthyroidism

12

used prepoperatively to stun thyroid

anti-thyroid med

13

iodine compounds: action

- decreases the size and vascularity of thyroid gland
- for hyperthyroidism

14

beta blockers for hyperthyroidism: action

decreases myocardial contractility
- decreases HR, BP, anxiety
- could decrease cardiac output

15

radioactive iodine: administration

- for hyperthyroidism
- 1 dose PO (liquid or tablet form)
-- RULE OUT PREGNANCY FIRST

16

important nursing consideration for radioactive iodine

rule out pregnancy before admin!

17

radioactive iodine: action

destroys thyroid cells resulting in hypothyroidism (not ae - expected)

18

possible rebound effect post-radioactive iodine

thyroid storm

19

thyroid storm

thyrotoxicosis, thyrotoxic crisis
- uncontrollable hyperthyroidism
- can be caused by thyroid manipulation, severe infection, stress

MEDICAL EMERGENCY

20

do not give beta blockers to... x2

asthmatics or diabetics
- block catecholamine sites (epi, NE)

21

thyroid gland regulates

body metabolism and growth

22

use straw with iodine compounds because...?

stains teeth

23

radioactive precautions

no babies or kisses for 24 hours

24

thyroidectomy: positioning

HOB up to decrease risk of edema

25

sign of recurrent laryngeal nerve damage post-thyroidectomy

hoarseness

26

why keep a trach set at the bedside post-thyroidectomy?

- swelling
- recurrent laryngeal nerve damage (vocal cord paralysis)
- hypocalcemia

27

why is hypocalcemia a consideration post-thyroidectomy?

possible parathyroid removal
s/s hypocalcemia: tight, rigid muscles, seizure possiblity

28

hyperthyroidism and eyes

dry eyes, photosensitivity

29

hypothyroidism aka

myxedema

30

hypothyroidism: s/s

no energy!!, fatigue
increased weight
cold
decreased gi motility, speech
no expression

31

cretinism

hypothyroidism present at birth, can lead to slowed mental and physical development if undetected

32

hypothyroidism: tx

meds (levothyroxine, thyroglobulin, liothyronine): take FOREVER

33

common hypothyroidism co-morbidity

CAD - every aspect of metabolism slows down; basement membranes not proliferating = narrower artery walls = CAD

possible to throw clots!

34

hyperthyroidism + hypoglycemia

do not give beta blockers to diabetics because they block signs of hypoglycemia

beta blockers: decrease HR, BP, clammy (sweaty), nervous/anxious

35

hypothyroidism + depression

tired, weight gain, immobility (in bed)

36

parathyroid problem think

calcium!

37

parathyroid hormone: action

pull Ca from bone and into serum - serum Ca goes up

38

hyperparathyroidism =

hypercalcemia = hypophosphatemia

39

hypoparathyroidism =

hypocalcemia = hyperphosphatemia

40

hyperparathyroidism: s/s

too much PTH
serum Ca up
serum P down
SEDATED!

41

hyperparathyroidism: tx

partial parathyroidectomy

42

partial parathyroidectomy

take out 2 parathyroid glands
PTH secretion goes down, serum Ca goes down

43

monitor for what post-parathyroidectomy?

hypocalcemia: tight, rigid muscles, seizures

44

hypoparathyroidism: s/s

not enough PTH
serum Ca down
serum P up
hypocalcemia s/s

45

hypoparathyroidism: tx

IV calcium - give SLOWLY
phosphorous binding drugs

46

ESRD patients tend to retain...

phosphorous therefore serum Ca is down

47

adrenal glands for

stress

48

adrenal medulla hormones

epinephrine
norepinephrine

49

pheochromocytoma

benign tumors on adrenal medulla that secrete epi and NE in boluses

50

pheochromocytoma: s/s

increased BP, HR
flushing, diaphoretic

51

vanillylmandelic acid test

24 hour urine specimen checking for increased levels of catecholamines (epi, NE) - used for dx of pheochromocytoma

52

pheochromocytoma: tx

surgery to remove tumors

53

adrenal cortex hormones

glucocorticoids
mineralocorticoids
sex hormones

54

glucocorticoids: actions x4

- mood
- immunosuppression (decrease inflammation)
- inhibit insulin = hyperglycemic...
- fat, protein metabolism

55

accuchecks + steroids

steroids (glucocorticoids) inhibit insulin

56

major mineralocorticoid

aldosterone

57

aldosterone: retain & lose what?

retain: Na, H2O
lose: K+ (dilutional hypokalemia + urinary excretion)

58

too much aldosterone

fluid volume excess
hypokalemia

59

not enough aldosterone

fluid volume deficit
hyperkalemia

60

major glucocorticoid

cortisol

61

pituitary + cortisol

pituitary secretes adrenocorticotropin hormones (ACTH)

ACTH stimulate adrenal cortex to produce cortisol

ACTH = cortisol

62

adrenocorticotropin hormones (ACTH)

stimulate adrenal cortex to produce cortisol
secreted by pituitary

63

addison's disease

adrenocortical insufficiency: not enough steroids (gluco, mineralo, sex)

ADRENAL CORTEX PROBLEM

64

addison's disease: s/s

majority result from hyperkalemia
- progression: muscle twitching - weakness - flaccid paralysis

other:
gi: gut slows down - anorexia, nausea, decreased bowel sounds, gi upset

hyperpigmentation, vitiligo

hypotension

decreased Na, increased K, hypoglycemia

65

hyperpigmentation

bronzing color of skin and mucus membranes

sign of addison's

66

vitiligo

white patchy area of depigmented skin

sign of addison's

67

addison's + hypoglycemia

addison's = not enough steroids = decreased glucocorticoids

not enough glucocorticoid = not enough glucose
also inhibits insulin

68

addison's + aldosterone

addison's = not enough steroids = decreased mineralocorticoids (aldosterone)

insufficient aldosterone = lose Na = retain K = hyperkalemia

69

addison's + hyperkalemia

addison's = not enough steroids = decreased mineralocorticoids (aldosterone)

insufficient aldosterone = lose Na = retain K = hyperkalemia

70

addison's + shock

addison's = insufficient steroids = insufficient mineralocorticoids (aldosterone)

decreased aldosterone = lose Na and H2O = lose blood volume = SHOCK

71

addison's tx

- combat shock
- increase dietary Na
- i/o + daily weight

72

addison's + hypotension

decreased BP due to loss of Na

73

fludrocortisone (Florinef)

mineralocorticoid replacement - aldosterone
- daily weights very important
- given for addison's disease

74

daily weights + florinef

crucial for adjustment of florinef dose, similar to insulin for diabetics

75

addisonian crisis

severe hypotension and vascular collapse

could result from abrupt d/c of steroids

76

consideration for discontinuation of steroids

taper! never stop abruptly - could result in addisonian crisis

77

cushing's syndrome

too many steroids! glucocorticoids, mineralocorticoids, sex hormones

78

cushing's: s/s due to too many glucocorticoids

growth arrest
thin extremities, lypolysis
increased risk of infection
hyperglycemia, hypoinsulinemia
psychosis to depression
moon face
truncal obesity/lipogenesis
buffalo hump (fat redistribution)

79

buffalo hump due to

glucocorticoid excess
fat redistribution

80

moon face due to

glucocorticoid excess
fat redistribution or fluid retention

81

cushing's: s/s due to too many sex hormones

oily skin/acne
women with male traits
poor libido

82

cushing's: s/s due to too many mineralocorticoids

high BP
CHF
weight gain
fluid volume excess
decreased serum K

83

cushing's: tx

adrenalectomy
quiet environment
avoid infection

pre-treatment diet:
increased K, protein, Ca
decreased Na

84

cushing's: pre-treatment diet

increased K (cushing's = decreased serum K)

increased protein (too many glucocorticoids = breakdown of fat and protein)

increased Ca (steroids decrease serum Ca through GI excretion)

decreased Na (retaining already(

85

how do steroids decrease serum Ca?

via GI excretion

86

cushing's: may appear in urine

glucose and ketones

protein can't come out of glomerulus unless it is damaged!

87

diabetes: type 1

little or no insulin; appears abruptly despite years of beta cell destruction

usually diagnosed in childhood (by age 30)

88

type 1 DM causes

auto-immune response (type 1A)
idiopathic (type 1B)

89

first sign of type 1 DM typically

DKA

90

type 1 diabetes: pathophys

little to no insulin = glucose builds up in vascular space

blood = hypertonic, pulls fluid in

kidneys filter excess glucose and fluids

cells starving and start breaking down protein and fat for energy

breakdown of fat results in ketones

leads to metabolic acidosis (DKA)

91

type 1 diabetes: s/s

polyphagia
polyuria
polydipsia

92

do oral hypoglycemics work for type 1 dm clients?

NOPE - need insulin

93

type 2 diabetes: pathophys

insufficient insulin or bad insulin (usually just enough to prevent fat breakdown, therefore typically overweight)

can't keep up with the glucose load being taken in

not as abrupt as type 1, usually found by accident or client presents with other problems (ulcers, infections, etc)

evaluate for metabolic syndrome!

94

metabolic syndrome featuers

- insulin resistance
- waist circumference 40+ m, 35+ f
- increased triglycerides + decreased HDL
- increased BP
- CAD

95

type 2 diabetes: treatment

start with diet and exercise
then add oral agents
then insulin (especially in presence of non-compliance)

96

gestational diabetes

resembles type 2; mom needs 2-3x more insulin than normal during pregnancy

97

screen all moms when for gestational diabetes?

24 - 28 weeks gestation

1st prenatal visit, if risk factors present

98

gestational diabetes: complications for baby

increased birth weight
hypoglycemia after birth

99

diabetes diet: majority of calories should come from x3

complex carbs
fats
protein (limit 10-20%)

100

why are diabetics prone to CAD?

sugar destroys vessels just like fat

101

diabetics + kidney

tend to have kidney disease

102

diabetes + high fiber

- keeps blood sugar steady (may have to decrease insulin)

- slows down glucose absorption in intestines, which eliminates sharp rise/fall in blood sugar

- sharp rise/fall of blood sugar = vascular damage

103

how do oral hypoglycemics work?

only for type 2. they stimulate the pancreas to make insulin (at least, for the NCLEX)

bottomline: all oral hypoglycemics work to decrease the amount of circulating glucose

104

average adult dose of insulin

0.4 - 1.0 units / kg / day

105

need more insulin if what are present in urine?

glucose, ketones

106

cloudy insulin

NPH

107

clear insulin

regular

also, Lantus (long-acting)

108

long-acting insulin

Lantus

109

what is the only type of insulin you can give IV?

regular

110

long-acting insulin peak

none!

111

rapid acting insulin peak

meal time

112

when insulin is at its peak, blood glucose...

is at its lowest

113

client should eat when insulin is at its

peak

114

how do you draw up regular and NPH insulin together

clear to cloudy
regular then NPH

115

glycosylated hemoglobin HbA1c blood test

gives an average of what your blood sugar has been over the past 3 months

116

HbA1c goal for diabetics

4-6% or less

117

HbA1c level that is diagnostic for diabetes

6.5 - 7%

118

sq infusion pumps are only used for which type of insulin?

rapid acting insulin

119

coverage provided by sq insulin infusion pump

basal (continuous)
and
bolus (on-demand)

rapid-acting insulin!

120

diabetics: illness =

dka

121

s/s hypoglycemia

cold
clammy
headache
nervous
confusion
nause
increased HR
glucose less than 70mg/dL

122

hypoglycemic should eat what?

4-6 oz of simple sugar
followed by complex carb + protein once BG is up

123

hypoglycemia prevention x4

- eat
- take insulin regularly
- know s/s
- check BG regularly

124

glucose absorption delayed in foods with lots of

FATS!

125

D50 W

for unconscious diabetic in hospital

requires large bore IV

126

injectable glucagon (GlucaGen)

for unconscious diabetic in hospital with no IV access

given IM

127

diabetic ketoacidosis pathophys

absent or inadequate insulin = BG sky high = poly(uria, dipsia, phagia) = fat breakdown (acidosis) = kussmaul respirations + more acidotic = LOC decreases

128

kussmaul respirations

diabetic client in dka trying to blow off CO2 to compensate for metabolic acidosis

129

diabetic client + polyuria =

think shock

130

IV insulin action

decreases glucose and K by driving them out of vascular space and into cell

131

dka tx

- find cause
- IV insulin
- hourly BG, K levels (d/t insulin), UOP
- EKG

132

IVF progression for DKA

NS (2 a/c IV if possible)

when BG ~300, switch to D5W
- prevents throwing client into hypoglycemia

133

hyperosmolar hyperglycemic nonketosis (HHNK)
aka
hyperglycemic hyperosmolar state (HHS)

looks like DKA but no acidosis

making just enough insulin so not breaking down fat
no fat breakdown = no ketones = no acidosis = no kussmaul respirations

134

type 1 diabetes can lead to
type 2 diabetes can lead to

dka & HHNK (HHS)

135

diabetic neuropathy issues x4

sexual problems (irreversible so SCREEN)
foot/leg problems: pain, paresthesia, numbness
neurogenic bladder
gastroparesis

136

gastroparesis

stomach emptying is delayed due to decreased mesenteric perfusion s/t diabetes meaning increased risk for aspiration

137

neurogenic bladder

bladder does not empty properly
- may empty spontaneously (incontinence)
- may not empty at all (retention)

138

complications of diabetes x5

dka
HHNK (HHS)
vascular problems
neuropathy
infection

139

vascular problems in diabetes x2

macrovascular (ex: coronary arteries)
microvascular (ex: kidneys)