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NCLEX-RN (5) Adult Health > Endocrine > Flashcards

Flashcards in Endocrine Deck (87)
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1
Describe:

Syndrome of inappropriate anti-diuretic hormone (SIADH)

SIADH is increased secretion of antidiuretic hormone (ADH) in the posterior pituitary. It causes the client to hold onto urine (mostly water) and go into fluid volume overload.

It is caused by a type of head injury, stroke, brain tumor, or surgery of the brain.

2
Signs and symptoms:

SIADH

Signs and symptoms of SIADH are caused by the client holding onto urine (mostly water) and going into fluid volume overload:

  • weight gain
  • hypertension
  • hyponatremia (diluted from too much water)
  • high urine specific gravity >1.030 - dark yellow urine

3
Describe:

Diabetes Insipidus

Diabetes inspidus is decreased secretion of antidiuretic hormone (ADH) in the posterior pituitary. It causes the client to urinate a lot and go into fluid volume deficit.

It is caused by a head injury, stroke, brain tumor, or surgery of the brain.

4
Signs and symptoms:

Diabetes insipidus

Signs and symptoms of diabetes insipidus are caused by the client urinating too much and going into fluid volume deficit:

  • polyuria and polydipsia
  • dehydration
  • low urine specific gravity (<1.005) - urine is pale
  • postural hypotension

5

What are the general interventions for diabetes insipidus and SIADH?

Focus on assessing and maintaining fluid balance:

  • monitor vital signs and electrolyte levels
  • monitor intake and output and get daily weights
  • fall and seizure precautions
  • monitor level of consciousness

 

6

What are the specific interventions for diabetes insipidus?

Focus on increasing fluids:

  • give IV fluids
  • avoid foods that cause diuresis (coffee and tea)
  • give vasopressin or desmopressin (hormone replacement for ADH)

7

What are the specific interventions for SIADH?

Decrease fluids and increase sodium level:

  • restrict fluids
  • give 3% normal saline if sodium is less than 120
  • loop diuretics if sodium is at least 125 to get rid of the extra fluids
    • monitor potassium with loop diuretics

8

What is a hypophysectomy?

A hypophysectomy is the removal of the pituitary gland to treat cancerous or benign tumors. 

The pituitary gland (also called the hypophysis) is a small, pea-sized gland in the brain behind the eyes.

9
Describe:

Cushing's syndrome and Cushing's disease

Cushing's is too many steroids in the body.

  • Cushing's syndrome is caused by taking large doses of steroids for a few weeks or more.
  • Cushing's disease is caused by a release of too many steroids secreted by the pituitary gland or adrenals of the kidney.

10

What are the characteristic signs and symptoms of Cushing's?

Signs and symptoms of Cushing's are caused by the client getting too many steroids (hypercortisolism). Steroids control many functions in the body. 

  • fluid volume overload and obesity
  • moon face and buffalo hump
  • muscle wasting: thin arms and legs
  • hirsutism (facial hair)
  • fragile skin that bruises easily

11

What lab values are abnormal with Cushing's?

  • elevated cortisol level
  • possible elevated white blood cell count
  • hyperglycemia - steroids increase blood glucose and WBC count
  • hypernatremia - increased aldosterone (one of the steroids) holds onto water and sodium
  • hypokalemia - inverse relationship with sodium

12
Interventions:

Cushing's syndrome

Because Cushing's syndrome is caused by taking large amounts of steroids, the interventions will focus on:

  • preventing fluid and electrolyte imbalances
  • preventing infection
  • preventing high blood sugar

Monitor vital signs, electrolytes, WBC, and glucose level.

13
Treatment:

Cushing's disease

Because Cushing's disease is caused by a tumor on the pituitary gland or adrenals, the treatment will focus on surgery:

  • hypophysectomy (removal of the pituitary)
  • adrenalectomy (removal of the adrenals)

Client will need life-long steroid replacement post-surgery.

14

What are the specific post-operative interventions for a hypophysectomy?

Hypophysectomy post-op interventions focus on preventing increased intracranial pressure:

  • no coughing, blowing nose, or using a straw
  • assess level of consciousness and vital signs for bleeding and CSF leak

15

What are the post-operative interventions for an adrenalectomy?

  • focus on fluid and electrolyte balance - monitor I&O, vital signs
  • administer glucocorticoids (steroids)

16
Describe:

Addison's Disease

Addison's disease is NOT enough steroids in the body.

It is caused by an autoimmune deficiency.

17

What are the characteristic signs and symptoms of Addison's disease?

Signs and symptoms of Addison's are caused by the client not getting enough steroids (primary adrenal insufficiency). Steroids control many functions in the body:

  • fluid volume deficit and weight loss
  • bronze skin color

18

What lab values are abnormal with Addison's?

Abnormal labs for Addison's:

  1. hypoglycemia
    • due to not having enough steroids
  2. hyponatremia
    • decreased aldosterone (one of the steroids) rids the body of water and sodium
  3. hyperkalemia
    • inverse relationship with sodium

19
Interventions:

Addison's disease

Because Addison's disease is caused by a lack of steroids, the interventions are:

  1. assess for hypotension (due to fluid volume deficit)
  2. assess for dysrhythmias (due to high potassium)
    • give IV fluids and electrolyte replacement
  3. corticosteroid replacement for life

20
Describe:

Addisonian crisis

Immediate complication

An Addisonian crisis can cause severe fluid and electrolyte imbalances.

It is caused by stress, infection, trauma, or abrupt discontinuation of steroids.

21

During times of stress for clients taking life-long steroids, how are steroid needs adjusted?

During times of stress, clients will need an increase in steroid dose.

22
Describe:

Hypothyroidism

Hypothyroidism is when the body does not produce enough thyroid hormones which controls metabolism. 

This causes the metabolism to be slow.

23

What are the thyroid labs with hypothyroidism?

  • Tand Tare low
  • TSH is high (due to compensation)

24
Signs and symptoms:

Hypothyroidism

Signs and symptoms of hypothyroidism are due to a slow metabolism:

  • lethargy
  • intolerance to cold
  • weight gain
  • dry skin and hair loss
  • bradycardia
  • constipation
  • myxedema (edema around face and eyes)
  • menorrhagia or amenorrhea

25
Interventions

Hypothyroidism

Hypothyroidism interventions focus on increasing the metabolism:

  • give thyroid hormone: levothyroxine
    • assess for overdose such as tachycardia
  • encourage healthy diet and exercise
  • warm environment
  • avoid sedatives

26
Describe:

Myxedema coma

Immediate complication

Myxedema coma is when the client has an extremely low metabolism and goes into a coma.

27
Describe:

Hyperthyroidism (Grave's disease)

Hyperthyroidism is when the body produces too much thyroid hormone which controls metabolism. 

This causes the metabolism to be fast.

28

What are the thyroid labs with hyperthyroidism?

Labs for hyperthyroidism:

  • Tand Tare high
  • TSH is low (due to compensation)

29
Signs and symptoms:

Hyperthyroidism

Signs and symptoms of hyperthyroidism are due to a fast metabolism:

  • irritability
  • intolerance to heat
  • weight loss
  • palpitations
  • diarrhea
  • exophthalmos (protruding eyeballs)
  • diaphoresis
  • hypertension
  • amenorrhea

30
Interventions:

Hyperthyroidism

Hyperthyroidism interventions are focused on decreasing the metabolism:

  • cool and quiet environment
  • give sedatives
  • high calorie diet

31
Medications:

Hyperthyroidism

Hyperthyroid meds focus on decreasing the metabolism:

  • methimazole
  • propylthiouracil
  • iodine
  • beta blockers to decrease the heart rate

32

What is radioactive iodine therapy?

Radioactive iodine therapy is used to destroy the thyroid cells for a client with hyperthyroidism.

33

What is a thyroidectomy?

A thyroidectomy is a surgery to remove the thyroid for a client with hyperthyroidism.

34

What are the post-operative interventions for a thyroidectomy?

Post-op interventions for a thyroidectomy focuses on assessing the airway and preventing calcium imbalances:

  • monitor for respiratory distress
  • have tracheostomy set, oxygen, and suction at the bedside
  • avoid neck flexion and stress on the suture line
  • monitor for hypocalcemia and tetany (possible parathyroid trauma)
  • monitor for thyroid storm

35
Describe:

Thyroid storm

Immediate complication

Thyroid storm is when the client has an extremely high metabolism and can get elevated temperature, blood pressure, heart rate, seizures, and then a coma

36

What are the specific interventions after a thyroidectomy in regards to airway and bleeding?

Intereventions for airway and bleeding concerns following a thyroidectomy:

  • semi-Fowler's position
  • check surgical site for edema and bleeding
  • check the back of the neck for bleeding

37
Describe:

Hyperparathyroidism

Hyperparathyroidism is hypersecretion of parathyroid hormone.

  • parathyroid hormone controls calcium balance in the blood

The most common cause is from a tumor on the parathyroid gland.

38
Signs and symptoms:

Hyperparathyroidism

Signs and symptoms of hyperparathyroidism are caused by high calcium levels:

  • fatigue and muscle weakness
  • bone deformities (calcium has left the bones)
  • kidney stones
  • dysrhythmias

PTH controls calcium level.

39
Interventions:

Hyperparathyroidism

Interventions for hyperparathyroidism focus on the problems associated with a high calcium level:

  • monitor for cardiac dysrhythmias
  • encourage fluid intake
  • move client carefully to prevent fractures
  • use light weights to prevent bone deformities
  • high-fiber, moderate, calcium diet

40
Medications:

Hyperparathyroidism

Meds for hyperparathyroidism focus on decreasing the calcium:

  • furosemide - to lower the calcium by urinating
  • calcitonin - to prevent skeletal calcium release

41
Describe:

Hypoparathyroidism

Hypoparathyroidism is hyposecretion of parathyroid hormone.

It is usually caused by getting a thyroidectomy.

42
Signs and symptoms:

Hypoparathyroidism

Signs and symptoms of hypoparathyroidism are caused by low calcium levels:

  • positive Chvostek's and Trousseau's sign
  • muscle tingling and spasms
  • cardiac dysrhythmias and seizures

PTH controls calcium level.

43
Interventions:

Hypoparathyroidism

Interventions for hypoparathyroidism focus on the problems associated with a low calcium level:

  • assess for dysrhythmias
  • seizure precautions
  • high-calcium, low-phosphorus diet

44
Medications:

Hypoparathyroidism

Meds for hypoparathyroidism focus on increasing the calcium:

  • calcium supplements
  • vitamin D supplements
    • Vitamin D helps the stomach absorb calcium into the blood - (and eventually into the bone)

45

What is the last resort treatment for hyperparathyroidism?

parathyroidectomy

46
Describe:

Diabetes mellitus

Diabetes mellitus is when the pancreas releases very little insulin or none at all.

This makes the blood sugar consistently high, since insulin is needed to transfer sugar from the blood to vital organs such as the brain and muscles.

 

47

What are the normal lab values for blood glucose?

  • fasting blood glucose: 70-110 mg/dL
    • 3.9 - 6.1 mmol/L
  • random blood glucose: < 200 mg/dL
    • < 11.1 mmol/L
  • HgbA1C: <7% indicates good diabetes control

48

What is the difference between type 1 and type 2 diabetes?

Type 1 diabetes - the pancreas makes NO insulin: It is a genetic disorder.

Type 2 diabetes - the pancreas makes a little bit of insulin: It is a lifestyle disorder associated with obesity.

49

What lifestyle changes can prevent acquiring type 2 diabetes?

Eat a healthy diet and exercise daily.

NO SMOKING
 

50

What are the complications of untreated diabetes mellitus?

Due to consistently high blood glucose, this damages nerves and vessels- the complications are:

  • amputations (due to neuropathy)
  • blindness (retinopathy)
  • kidney failure (nephropathy)
  • heart disease, stroke, and hypertension
  • erectile dysfunction (due to neuropathy)

 

51

Why does high blood sugar cause blurry vision?

Sugar in the blood damages the nerves for vision.

52

Why does consistently high blood sugar cause delayed wound healing?

Increased sugar in the blood prevents nutrients and oxygen from reaching the cells that need healing.

53

Why does consistently high blood sugar cause infections?

Bacteria feed on sugar causing bacteria to multiply.

54

Why do consistently high blood sugar levels cause numbness and tingling especially in the feet and hands (peripheral neuropathy)?

The sugar in the blood clogs up the small vessels connected to the nerves causing damage to those nerves.

55

Why do consistently high blood sugar levels cause erectile dysfunction?

High blood sugar damages the blood supply to the penis and the nerves that control an erection.

56

What are the "3 P's" of hyperglycemia?

  1. polyuria: excessive urination
    • the body is trying to get rid of the extra sugar by peeing
  2. polydipsia: excessive thirst
    • the client is thirsty because they pee a lot
  3. polyphagia: excessive hunger
    • the sugar is "stuck" in the blood and unable to reach the vital organs

Client will be dehydrated.

 

 

 

57
Teaching:

Diet and exercise for diabetes mellitus

  • monitor blood glucose before, during, and after exercise
  • may need extra food before exercising
  • exercise at the same time each day and when the meal is peaking (not when insulin is peaking)

 

58
Medications:

Diabetes mellitus

Meds for diabetes mellitus and lowering blood glucose levels are:

  • insulins (rapid, short, intermediate and long-acting)
  • oral antidiabetic meds

59

When will insulin doses need to be increased?

Insulin dose is increased during illness, infection, and stress.

These situations cause the blood sugar to increase.

60

What is the Dawn Phenomenon?

The dawn phenomenon is when the client has hyperglycemia in the morning caused by early morning release of growth hormone and cortisol (both of these hormones increase insulin).

Treatment is to increase the insulin dose at bedtime or change the time insulin is given.

61

What is the Somogyi phenomenon?

The Somogyi phenomenon is when hypoglycemia occurs around 2 - 3 a.m. Then the body compensates by rebounding with hyperglycemia in the morning

Client may report night sweats and nightmares from hypoglycemia. Treatment is to decrease the insulin or give a bedtime snack (or both).

62

What are the steps to getting a blood glucose level?

  1. wash hands
  2. check expiration date on the test strips
  3. clean area with alcohol and allow to dry
  4. use a lancet to get a blood sample
  5. use glucometer to read results
  6. log results

63

In general, how often is blood glucose checked?

Before meals and at bedtime

64
Cause:

Hypoglycemia (low blood sugar)

Causes of hypoglycemia:

  • too much insulin or oral hypoglycemic meds (#1 cause)
  • not enough food
  • excessive exercise

Brain damage can occur if not treated.

65

What lab value indicates hypoglycemia?

hypoglycemia: < 70 mg/dL (3.9 mmol/L)

66
Signs and symptoms:

Hypoglycemia (low blood sugar)

Signs and symptoms of hypoglycemia are:

  1. Early signs ("shock-looking symptoms" due to vasomotor problems):
    • nervous, cool skin, palpitations, tremor, tachycardia, low BP, diaphoresis (clammy), tachypnea
  2. Moderate signs ("drunk symptoms due to cerebral compromise")
    • anger, confusion, slurred speech, and inability to concentrate, labile
  3. Late signs:
    • seizure and coma, permanent brain damage

 

67

What is the teaching to prepare a client for a hypoglycemic reaction?

Teach the client to carry with them a simple carbohydrate to eat in case of hypoglycemia:

  • glucose tablets or gel
  • 6 - 10 hard candies
  • 4 tsp of sugar
  • 1 Tablespoon of honey, syrup, icing, jam/jelly
  • 4 oz. of fruit juice or soft drink
  • 8 oz. of milk
  • 3-6 crackers (give something more sugary if severe hypoglycemia) 

Each of these snacks is about 15 grams of carbohydrates.

68

What medication can mask the signs of hypoglycemia?

Beta blockers

These meds can decrease the heart rate and calm the client down, masking the upper-type symptoms of hypoglycemia.

69

What is the treatment for a alert client with a suspected hypoglycemic reaction?

Treatment for a hypoglycemic reaction for an alert client:

  • if able, check the blood glucose level
  • if <70 (3.9), give a simple carb such as juice or glucose gel
  • recheck the blood sugar in 15 minutes
  • If blood sugar is still <70 (3.9) on the 4th check, give 50% dextrose
  • After blood sugar has stabilized give a snack such as crackers and peanut butter

70

What is the treatment for an unconscious client with hypoglycemia?

GIve 50% dextrose by IV or IM

Do not give oral glucose to an unconscious client due to risk of aspiration. Side note: very difficult to get an IV started in a hypoglycemic client due to vasoconstriction.

71
Describe:

Hyperosmolar hyperglycemic syndrome (HHS)

Immediate complication

HHS is extremely high blood sugar: 600 mg/dL (33.3 mmol/L) or higher for clients with type II diabetes.

There is still a little bit of insulin, so the body doesn't make ketones. 

72
Describe:

Diabetic ketone acidosis (DKA)

Immediate complication

DKA is extremely high blood sugar: 300 mg/dL (16.6 mmol/L) or higher for clients with type I diabetes.

The body makes no insulin, so fat breaks down instead for energy making ketones (ketones are an acid). 

73
Risk factors:

HHS and DKA

Risk factors for HHS and DKA are:

  • infection (especially respiratory infections)
  • stress
  • inadequate insulin dose
  • poor fluid intake

All of these situations increase blood glucose.

74

What is the pH with DKA?

DKA is pH < 7.35 due to acidotic state

An acidotic state will cause a high potassium and Kussmaul's respirations.

75

Are ketones in the blood negative or positive with DKA?

Ketones in the blood are positive with DKA.

The body is not able to break down sugar for energy. Instead, the fat is broken down, making ketones (ketones are an acid that will be found in the blood and urine).

76
Interventions:

DKA and HHS

DKA and HHS interventions are similar because the goal is to decrease the blood glucose level and replace lost fluids:

  • give IV fluids such 0.9% NS or 0.45% NS
  • add dextrose when blood glucose is between 250 and 300 (3.9 and 16.7)
  • give regular insulin IV
  • assess for potassium imbalance since insulin can drive the potassium back into the cells causing hypokalemia
  • cardiac monitor due to potassium imbalances

 

77

Why is foot care an important aspect for clients with diabetes?

Due to neuropathy (damaged nerves), clients may not be able to feel trauma to the foot.

There is increased risk of infection and gangrene can occur causing amputations.

78

How are the feet inspected for a client with diabetes?

Inspect feet daily with a mirror to check for redness, swelling or a break in the skin. 

Report trauma to the HCP.

79

What should be avoided to prevent trauma to the feet for a diabetic client?

To avoid trauma to feet:

  • avoid hot water, heating pads, and baths
  • don't try to treat corns, blisters or ingrown toenails - see the HCP for that
  • don't cross legs or wear tight clothing - it prevents blood flow
  • don't keep the feet wet
  • do not go barefoot

80

What color of socks are worn for a diabetic client?

Wear clean, white cotton socks and change them daily.

It's easier to see blood on white socks, then dark socks.

81

What types of shoes should be worn for a diabetic client?

Shoes for diabetic clients:

  • wear closed-toed shoes that are well-fitted and not too tight
  • don't wear open-toed shoes or shoes with a strap between the toe
  • always check for foreign objects or tears in the shoes before wearing

82

How should toenails be cut for a diabetic client?

Cut toenails straight across and smooth nails with an emery board.

83

Are insulin or oral antidiabetic meds held before a diabetic client goes to surgery?

It depends. Always clarify with the HCP if meds should be held or given.

84

What type of insulin is commonly held before surgery?

Long-acting insulin is commonly held 24 - 48 hours before surgery.

85

What type of oral antidiabetic is commonly held before surgery?

Metformin is commonly held due to risk of kidney failure.

It is restarted once kidney function is normal postoperatively.

86

How is low or high blood sugar prevented postoperatively for a diabetic client?

Prevent low or high blood sugar postoperatively by:

  • assessing blood sugar frequently
  • giving IV glucose and insulin
  • giving subcutaneous insulin if needed

87

What conditions is a diabetic client at a higher risk for post-operatively?

Diabetic clients are at higher risk for these conditions post-operatively:

  • cardiac disease
  • kidney failure
  • impaired wound healing