Flashcards in Endocrine Deck (51):
What does calcitonin do?
Opposite of PTH
- decreases serum calcium levels by taking calcium out of the blood and putting it back into the bone
Graves disease...is it HYPER- or HYPOthyroid
With hyperthyroidism, would thyroxine (T4) and TSH be increased or decreased?
Thyroxine (T4) --> increased
TSH --> decreased
Client must d/c any iodine containing meds ___ week prior to a thyroid scan and must wait ___ weeks to restart meds.
Anti-thyroid meds are used to ___ the thyroid; stops the thyroid from making ___.
methimazole and propylthiouracil (PTU)
Iodine compound med ___ the size and vacularity of the thyroid.
What should we remember about this administration?
Give in milk or juice with a straw...stains teeth
Beta blockers such as ___ (___) provide supportive therapy. What 4 things do they do?
1) decreases myocardial contractility
2) could decrease CO
3) decreases HR, BP
4) decreases anxiety
Who should NOT receive beta blockers? Why not?
Asthmatics - cause bronchial constriction
Diabetics - masks symptoms of hypoglycemia
Myxedema is longterm ___. What are 4 visible signs of this?
1) general puffiness
2) facial edema
3) dull, mask-like expression
4) tongue protusion
With hypothyroidism, what will happen to thyroxine (T4)
Thyroxine (T4) will decrease
TSH will increase
What do we remember with levothyroxine admin?
- take on EMPTY stomach
- start with low dose and work up
Adrenals help you handle ___
Adrenal medulla secretes...
Adrenal cortex secretes...
Medulla --> epi and norepi
Cortex --> glucocorticoids, mineralocorticoids, sex hormones
What tests are used to measure catacholamine levels?
What foods should be avoided prior to these tests?
VMA (vanillylmandelic acid) test
Metanephrine (MN) test
(Avoid several days to a week prior: vanilla foods, caffeine, vit B, fruit juices, banana)
What is an example of a glucocorticoid?
What does it do?
- changes mood
- alters defense mechanisms/immunosuppression
- Breakdown fats and protein
- Inhibit insulin (serum glucose can go up)
Example of mineralocorticoid;
What does it do?
Aldosterone (remember this??)
- makes you retain Na and water
- makes you lose K (b/c Na and K have inverse r'ship)
Too much aldosterone:
- Fluid volume ___
- Serum K ___
Not enough aldosterone
- Fluid volume ___
- Serum K ___
- fluid volume EXCESS
- K DECREASED
- fluid volume DEFICIT
- K INCREASED
Too many steroids = ___
Addison's disease is caused by (too much or not enough) steroids?
It's an adrenocortical insufficiency
Addison's disease leads to hyperkalemia...why?
K and Na are inversely related
If not enough aldosterone secreted, leads to low Na and water, leads to high K
What 2 things occur during an Addisonian crisis?
- severe hypotension
- vascular collapse
Cushing's Disease is the opposite of Addison's, so ___ ___ steroids
Pts must have 3 of these characteristics to be labeled "metabolic syndrome"
- Men >40 in
- Women >35 in
- Men <40
- Women <50
Pregnant women need ___-___ x more insulin than normal. Why?
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.
Diet recommendations for DM (Type 1 and 2)
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
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.
time and amount
What is the most widely used anti-diabetic med? How does it work?
- Reduces glucose production
- Enhances how glucose enters the cell
- Does not stimulate the release of more insulin, so no hypogycemic response --> good!
Pts on metformin should d/c before surgery or procedure where dye is used. Can resume ___ hours after if ___ ___ is normal. Why?
The dye and metformin compete for kidney excretion. Metformin wins so the dye will stay in the blood...BAD!
What is the avg adult dose of insulin?
0.4 - 1 unit/kg/day
What color insulin?
Draw up in what order?
Regular --> Clear
NPH --> Cloudy
Put in your air, then draw up CLEAR before CLOUDY
Why is NPH so cloudy?
It is is packed with particles (time release)
The most common method of daily dosing insulin is ___/___ dosing.
basal / bolus
The total daily dose of insulin with the basal / bolus method is a combination of a ___ insulin and a ___ insulin.
Long-acting insulin is given ___ x day.
When does it peak?
Name a long-acting insulin:
glargine / Lantus
The rapid-acting insulin is given ___ the day ___ meals in ___ doses. It covers the food eaten at meals.
Name a rapid-acting insulin:
aspart / Novolog (the log rolls down the hill rapidly)
Always have food right there when giving ___ insulin!!!
Clients should eat when insulin is at its ___; this is when blood sugar is at its ___.
Always monitor a client on insulin for ___.
HbA1c goal for diabetics is ___%
Insulin admin: rotate ___ an area first
What type of insulin is used in an insulin pump?
What type of dosing does the pump provide?
Both continuous (BASAL) dosing of RAPID-acting insulin and on-demand (BOLUS) dosing.
(Remember "Basal / Bolus")
8 signs of hypoglycemia
1) cold and clammy
If hypoglycemic, the client should consume ___ ___.
Snacks should be ___ g of carbs.
Glucose absorption is ___ in foods with lots of ___.
What is the 15 - 15 - 15 rule?
15g of simple carbs
Wait 15 min...check blood sugar again
Give 15g of more simple carbs if still low
What is the first line of defense for someone in a hypoglycemic crisis?
If no IV access, can use ___.
glucagon (IM...or sometimes subq)
What to remember with D50W admin?
Very hard to push b/c so thick
Choose a large bore IV if possible
Treatment for DKA
Hourly blood sugar & K checks
ECG (watch for K-induced arrythmias)
Isotonic fluids to raise BP (b/c polyuria)
What to remember with DKA IVF regimen:
- 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
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.)
What are 2 VASCULAR complications that can occur over time with poorly managed DM?
nephropathy (dialysis needed)
What are 4 NEUROPATHIC complications that can occur over time with poorly managed DM? (Why?)
- Sexual problems: impotence/decreased sensation
- Foot/leg problems: pain/paresthesia/numbness
- Neurogenic bladder: does not empty properly
- Gastroparesis: delayed stomach emptying, risk for aspiration