Endocrine

Question 1

What does calcitonin do?

Answer 1

Opposite of PTH
- decreases serum calcium levels by taking calcium out of the blood and putting it back into the bone
(for osteoporosis)

Question 2

Graves disease…is it HYPER- or HYPOthyroid

Answer 2

Hyperthyroid

Question 3

With hyperthyroidism, would thyroxine (T4) and TSH be increased or decreased?

Answer 3

Thyroxine (T4) –> increased

TSH –> decreased

Question 4

Client must d/c any iodine containing meds ___ week prior to a thyroid scan and must wait ___ weeks to restart meds.

Answer 4

1 week

6 weeks

Question 5

Anti-thyroid meds are used to ___ the thyroid; stops the thyroid from making ___.
Name them…

Answer 5

stun
hormones
methimazole and propylthiouracil (PTU)

Question 6

Iodine compound med ___ the size and vacularity of the thyroid.
What should we remember about this administration?
Name it…

Answer 6

decreases
Give in milk or juice with a straw…stains teeth
potassium iodine

Question 7

Beta blockers such as ___ (___) provide supportive therapy. What 4 things do they do?

Answer 7

propanolol (Inderal)

1) decreases myocardial contractility
2) could decrease CO
3) decreases HR, BP
4) decreases anxiety

Question 8

Who should NOT receive beta blockers? Why not?

Answer 8

Asthmatics - cause bronchial constriction

Diabetics - masks symptoms of hypoglycemia

Question 9

Myxedema is longterm ___. What are 4 visible signs of this?

Answer 9

hypothyroidsim

1) general puffiness
2) facial edema
3) dull, mask-like expression
4) tongue protusion

Question 10

With hypothyroidism, what will happen to thyroxine (T4)

and TSH?

Answer 10

Thyroxine (T4) will decrease

TSH will increase

Question 11

What do we remember with levothyroxine admin?

Answer 11

• take on EMPTY stomach

- start with low dose and work up

Question 12

Adrenals help you handle ___

Answer 12

stress

Question 13

Adrenal medulla secretes…

Adrenal cortex secretes…

Answer 13

Medulla –> epi and norepi

Cortex –> glucocorticoids, mineralocorticoids, sex hormones

Question 14

What tests are used to measure catacholamine levels?

What foods should be avoided prior to these tests?

Answer 14

VMA (vanillylmandelic acid) test
Metanephrine (MN) test

(Avoid several days to a week prior: vanilla foods, caffeine, vit B, fruit juices, banana)

Question 15

What is an example of a glucocorticoid?

What does it do?

Answer 15

Cortisol

• changes mood
• alters defense mechanisms/immunosuppression
• Breakdown fats and protein
• Inhibit insulin (serum glucose can go up)

Question 16

Example of mineralocorticoid;

What does it do?

Answer 16

Aldosterone (remember this??)

• makes you retain Na and water
• makes you lose K (b/c Na and K have inverse r’ship)

Question 17

Too much aldosterone:

• Fluid volume ___
• Serum K ___

Not enough aldosterone

• Fluid volume ___
• Serum K ___

Answer 17

Too much

• fluid volume EXCESS
• K DECREASED

Not enough

• fluid volume DEFICIT
• K INCREASED

Question 18

Too many steroids = ___

Answer 18

hypercortisolism

Question 19

Addison’s disease is caused by (too much or not enough) steroids?

Answer 19

Not enough

It’s an adrenocortical insufficiency

Question 20

Addison’s disease leads to hyperkalemia…why?

Answer 20

K and Na are inversely related

If not enough aldosterone secreted, leads to low Na and water, leads to high K

Question 21

What 2 things occur during an Addisonian crisis?

Answer 21

• severe hypotension

- vascular collapse

Question 22

Cushing’s Disease is the opposite of Addison’s, so ___ ___ steroids

Answer 22

too many

Question 23

Pts must have 3 of these characteristics to be labeled “metabolic syndrome”

Answer 23

Waist circumference:

• Men >40 in
• Women >35 in

Triglycerides: >150

HDL:

• Men <40
• Women <50

BP: >130/85

FBS: >100

Question 24

Pregnant women need ___-___ x more insulin than normal. Why?

Answer 24

2 - 3
placenta has an anti-insulin-like effect
If not, there’s a possibility that the placenta is not working correctly and there could be a problem with the baby.

Question 25

Diet recommendations for DM (Type 1 and 2)

Answer 25

``` Majority of calories from complex carbs (45%)... then fats (30-40%)... lastly protein (15-20%) ``` Extreme blood sugar = vascular damage --> BAD High fiber slows down glucose absorption in the intestines, eliminating the sharp rise/fall in blood sugar

Question 26

Diabetics should wait until blood sugar ___ before exercising. Pt should ___ pre-exercise to prevent hypoglycemia. Exercise when blood sugar is at its ___. Exercise same ___ and ___ daily.

Answer 26

normalizes eat highest time and amount

Question 27

What is the most widely used anti-diabetic med? How does it work?

Answer 27

metformin (Glucophage) - Reduces glucose production - Enhances how glucose enters the cell - Does not stimulate the release of more insulin, so no hypogycemic response --> good!

Question 28

Pts on metformin should d/c before surgery or procedure where dye is used. Can resume ___ hours after if ___ ___ is normal. Why?

Answer 28

48 hours kidney function The dye and metformin compete for kidney excretion. Metformin wins so the dye will stay in the blood...BAD!

Question 29

What is the avg adult dose of insulin?

Answer 29

0.4 - 1 unit/kg/day

Question 30

What color insulin? Regular ___ NPH ___ Draw up in what order?

Answer 30

Regular --> Clear NPH --> Cloudy Put in your air, then draw up CLEAR before CLOUDY

Question 31

Why is NPH so cloudy?

Answer 31

It is is packed with particles (time release)

Question 32

The most common method of daily dosing insulin is ___/___ dosing.

Answer 32

basal / bolus

Question 33

The total daily dose of insulin with the basal / bolus method is a combination of a ___ insulin and a ___ insulin.

Answer 33

long-acting | rapid-acting

Question 34

Long-acting insulin is given ___ x day. When does it peak? Name a long-acting insulin:

Answer 34

1 Doesn't peak glargine / Lantus

Question 35

The rapid-acting insulin is given ___ the day ___ meals in ___ doses. It covers the food eaten at meals. Name a rapid-acting insulin:

Answer 35

throughout before divided aspart / Novolog (the log rolls down the hill rapidly)

Question 36

Always have food right there when giving ___ insulin!!!

Answer 36

rapid-acting

Question 37

Clients should eat when insulin is at its ___; this is when blood sugar is at its ___. Always monitor a client on insulin for ___.

Answer 37

peak lowest hypoglycemia

Question 38

HbA1c goal for diabetics is ___%

Answer 38

= 7%

Question 39

Insulin admin: rotate ___ an area first

Answer 39

within

Question 40

What type of insulin is used in an insulin pump? | What type of dosing does the pump provide?

Answer 40

Only RAPID-acting Both continuous (BASAL) dosing of RAPID-acting insulin and on-demand (BOLUS) dosing. (Remember "Basal / Bolus")

Question 41

8 signs of hypoglycemia

Answer 41

1) cold and clammy 2) confusion 3) shaky 4) HA 5) nervous 6) tachycardia 7) nausea 8) hunger

Question 42

If hypoglycemic, the client should consume ___ ___. Snacks should be ___ g of carbs. Glucose absorption is ___ in foods with lots of ___.

Answer 42

simple carbs 15g delayed, fat

Question 43

What is the 15 - 15 - 15 rule?

Answer 43

15g of simple carbs Wait 15 min...check blood sugar again Give 15g of more simple carbs if still low

Question 44

What is the first line of defense for someone in a hypoglycemic crisis? If no IV access, can use ___.

Answer 44

D50W | glucagon (IM...or sometimes subq)

Question 45

What to remember with D50W admin?

Answer 45

Very hard to push b/c so thick | Choose a large bore IV if possible

Question 46

Treatment for DKA

Answer 46

``` Hourly blood sugar & K checks ECG (watch for K-induced arrythmias) Hourly output ABGs Isotonic fluids to raise BP (b/c polyuria) ```

Question 47

What to remember with DKA IVF regimen:

Answer 47

- Start with NS (isotonic) and IV regular insulin - When blood sugar gets down to 250-300, switch to D5W to prevent hypoglycemia - Anticipate MD adding K to IV solution at some point

Question 48

Diabetics can develop poor ___ everywhere due to vessel damage from elevated ___ over time. (Sugar ___ the vessel lining; accumulation of sugar will ___ the size of the vessel lumen, therefore ___ blood flow.)

Answer 48

``` circulation sugar irritates decrease decreasing ```

Question 49

What are 2 VASCULAR complications that can occur over time with poorly managed DM?

Answer 49

diabetic retinopathy | nephropathy (dialysis needed)

Question 50

What are 4 NEUROPATHIC complications that can occur over time with poorly managed DM? (Why?)

Answer 50

- Sexual problems: impotence/decreased sensation - Foot/leg problems: pain/paresthesia/numbness - Neurogenic bladder: does not empty properly - Gastroparesis: delayed stomach emptying, risk for aspiration

Question 51

Teach pt about foot care:

Answer 51

- cut toenails straight across - dry in between toes - always wear shoes - wear comfy shoes - inspect feet daily - avoid harsh chemicals