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endocrine Flashcards

(52 cards)

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1
Q

thyroid gland

A

think iodine
produces T3 T4 an calcitonin
gives us energy
calcitonin decreases serum Ca by taking Ca out of the blood and pushing it back into the bone

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2
Q

hyperthyroid s/s

A 
TOO MUCH ENERGY
aka Graves'
nervous
irritable
decreased attention span
increased appetite
decreased weight
sweaty/hot
exopthalomos (bulging eyes)
increased GI
increased BP and pulse
arrhythmia/palpitations
increased thyroid size
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3
Q

hyperthyroid diagnosis

A 
increased T4
decreased TSH
thyroid scan
discontinue iodine containing meds 1 wk prior to scan and wait 6wks to restart meds
ultrasound/MRI/CT
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4
Q

hyperthyroid treatment

A

Methimazole and Prophlthiouracil (PTU): stops thyroid from making hormones, used preop

potassium iodine: decrease size and vascularity of the gland, ALL endocrine glands are vascular (high risk for bleeding), give in milk/juice and use straw

beta blockers “lol”: decreases myocardial contractility, could decrease CO, decrease HR and BP, decrease anxiety

radioactive iodine therapy: 1 dose, PO, *** rule out pregnancy, destroys thyroid cells (hypothyroidism), stay away from babies for 1 wk and don’t kiss anyone for 1 week, watch for thyroid storm (thyrotoxicosis and thyrotoxic crisis– hyperthyroidism x100

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5
Q

thyroidectomy

A

post op priority (hemorrhage): report of feeling pressure and check for bleeding at incision site and behind the neck

hoarseness and weak voice (laryngeal nerve damage): can lead to vocal cord paralysis and require immediate trach

trach at bedsite r/t swelling, recurrent laryngeal nerve damage, hypocalcemia (assess for parathyroid removal and s/s of hypocalcemia)

support neck
personal items close to them
increase HOB
increased cals post op

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6
Q

hypothyroid s/s

A 
no energy
fatigue
no expression
slow and slurred speech
increased weight
decreased GI
cold
amenorrhea
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7
Q

hypothyroid diagnosis

A

T4 decreased

TSH increased

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8
Q

hypothyroid treatment

A

levothyroxine: take on empty stomach, worry about MI when starting (BP and HR increase), take forever

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9
Q

parathyroid gland

A 
think calcium 
secrete PTH 
pulls Ca from bones and place in blood so serum Ca goes up
increased PTH=increased serum Ca
decreased PTH=decreased serum Ca
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10
Q

hyperparathyroidism s/s

A 
aka hypercalcemia
aka hypophosphatemia
too much PTH
serum Ca is high
serum phosphorus is low
look sedated
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11
Q

hyperparathyroidism treatment

A

partial parathyroidectomy
PTH secretion decreases
monitor for tight rigid muscles and tetany after (hypocalcemia)

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12
Q

hypoparathyroidism s/s

A 
aka hypocalcemia
aka hyperphosphatemia 
not enough PTH
serum Ca low 
serum phosphorus high
won't look sedated
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13
Q

hypoparathyroidism treatment

A

IV calcium

phosphorus binding drugs

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14
Q

adrenal glands

A

need to handle stress

adrenal medulla and adrenal cortex

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15
Q

adrenal medulla

A

epinephrine and norepinephrine
s/s: increase BP and HR, increase palpitations, flushing, sweaty, headache

diagnosis: catecholamine levels (VMA and MN), 24 hr urine specimen, avoid stress
treatment: surgery to remove tumor

*** avoid palpating the abdomen

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16
Q

adrenal cortex

A

glucocorticoids, mineralocorticoids, sex hormones

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17
Q

glucocorticoids

A 
changes mood 
altered defense mechanisms (immunosuppressed)
breakdown fat and proteins
inhibit insulin (hyperglycemic, blood glucose monitoring)
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18
Q

mineralocorticoids

A

aldosterone
retain sodium and water
lose potassium

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19
Q

sex hormones

A

testosterone, estrogen, and progesterone
too many: hirsutism (facial hair for females), acne, irregular menstrual

not enough: decreased hair, decreased libido

increased ACTH = increased cortisol level

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20
Q

adrenal cortex issues

A

not enough steroids
shock
hyperkalemia
hypoglycemia

addison’s disease (not enough steroids)

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21
Q

adrenal cortex s/s

Study These Flashcards
A 
fatigue
N/V/diarrhea
anorexia/weight loss
hypotension
confusion
decreased Na
increased potassium
hypoglycemia
hyper pigmentation (bronze color skin)
white patchy area of depigmented skin (vitiligo)
22
Q

adrenal cortex treatment

Study These Flashcards
A 
combat shock (losing sodium and water)
increase Na in diet (processed fruit/broth)
i and o 
daily weight
BP decreased
losing weight
FVD
23
Q

adrenal cortex meds

Study These Flashcards
A

prednisone
hydrocortisone
cortisone

corticosteroids given 2/3 in Am and 1/3 dose in PM

daily weights and BP

**don’t stop taking abruptly

24
Q

cushing’s s/s

Study These Flashcards
A

too many steroids

glucocorticoids
growth arrest
think skin
infection
hyperglycemia
psychosis
moon face
truncal obesity 
buffalo hump

sex hormones
oily skin
woman have male traits

mineralocorticoids (aldosterone)
high BP
CHF
weight gain
FVE
decreased serum K
high cortisol levels
25
cushings treatment
``` adrenalectomy quiet environment avoid infection increase K decrease Na increase protein increase Ca ```
26
type 1 diabetes
little or no insulin causes: autoimmune response or idiopathic first sign: DKA appears abrupt polyuria, polydipsia, polyphagia
27
normal blood glucose w/o diabetes
70-99
28
normal blood glucose w/ diabetes
80-130 | less than 140
29
type 1 patho
``` no insulin glucose builds up in the blood blood becomes hypertonic and pulls fluid into vascular space kidneys filter excess glucose and fluids cells are starving so protein breakdown and fat breakdown for energy get ketones when you break down fat then they are metabolic acidotic Kussmaul respirations ```
30
type 1 s/s
polyuria (think shock first) polydipsia polyphagia hyperglycemia = 3 Ps
31
type 1 treatment
insulin
32
type 2 patho
not enough insulin or insulin they have is not good overweight found by accident or keep coming in saying wound won't heal or repeated vaginal infections
33
type 2 treatment
diet and exercise oral agents may need insulin
34
type 2 s/s
high triglycerides low hdl high BP high fasting blood glucose (greater than 100) high waist circumference (over 40 for males, over 35 for females)
35
gestational diabetes
mom needs more insulin if at risk then screen at first prenantal visit otherwise screen at 24-28 weeks baby issues: hypoglycemia and high birth weight
36
gestational diabetes treatment
45% carbs 30-40% fats 15-20% protein high fiber eat prior to exercise wait until blood sugar normalizes before exercising exercise when sugar is at highest exercise same time and amount daily oral meds: Metformin (decreases glucose production and enhances how glucose enters the cell, don't see hypoglycemia with this drug Glargine
37
metformin alert
***** undergoing surgery or radiologic procedure that involves contrast dye should discontinue metformin and resume 48 hours after the procedure
38
how is insulin dose determined
weight 0.4-1units/kg/day dose adjusted until glucose is normal or no ketones in the urine
39
insulin
``` regular = clear NPH = cloudy ``` ****clear before cloudy long acting insulins cannot be mixed with any other insulin or given IV regular rapid acting insulin may be given IV basal/bolus method: long acting and rapid acting insulin combined goal is to keep the before meal glucose near 80-130 long acting given once a day rapid acting insulin is given before meals in divided doses and it covers the food eaten at meals snacks are not required with basal/bolus insulin but must eat with rapid acting insulin eat when insulin is at its peak (blood sugar is at its lowest) ****always monitor a client on insulin for hypoglycemia
40
insulin teaching
HbA1c is the average for 3 months | blood sugar increases when sick or stressed
41
HbA1c
greater than 6.5 = diabetes for those with diabetes the goal is less than 7 normal without diabetes = less than 5.7
42
insulin infusion pumps
alternative to daily insulin injections only rapid acting insulin better control: basal from the pump and boluses of insulin as needed with meals or if elevated blood sugar
43
regular insulin
standard insulin | can be given IV
44
rapid acting insulin
can be given SubQ insulin infusion pump that provides continuous (basal) dosing of rapid acting insulin and on demand (bolus) dosing
45
hypoglycemic/hyperglycemic episodes
hypoglycemic: eat/drink simple carb *** don't choose food with a lot of fat, 15g of carbs, 15g of carbs then 15 mins recheck and 15g of carbs, eat complex carb once blood sugar is up (PB and crackers/protein) D50W = hard to push injectable glucagon when there is no IV access (IV, IM, subQ) prevention: eat, take insulin regularly, know s/s, check glucose regularly
46
s/s of hypoglycemia
``` cold and clammy nervous confused shaky headache increased pulse hunger nausea ```
47
DKA patho
causes: illness, infection, skipping insulin first sign of diabetes have s/s of type 1 very little or no insulin severe hyperglycemia which leads to fat breakdown and then metabolic acidosis absent insulin, blood sugar increases, 3Ps, fat breakdown (acidosis), Kussmaul respirations (trying to blow off CO2 to compensate for metabolic acidosis, become more acidotic, LOC goes down
48
DKA treatment
``` find cause hourly blood sugar and K level IV insulin (insulin decreases blood sugar and K by driving out of vascular space into the cell) ECG hourly outputs ABGs (metabolic acidosis) IVFs (polyuria causes shock)-- start with NS then when blood sugar gets down to 250-300 switch to D5W to prevent hypoglycemia may add K to IV solution ```
49
HHNK or HHS
``` type 2 looks like DKA but no acidosis making just enough insulin so they are not breaking down body fat no fat breakdown = no ketones no ketones = no acidosis ```
50
DKA and HHS
caused by hyperglycemia and dehydration
51
vascular problems: macro vascular and micro vascular
poor circulation due to vessel damage (sugar decreases vessel lumen size and decreases blood flow) diabetic retinopathy nephropathy
52
neuropathy
sexual issues: impotence/decreased sensation foot/leg issues: pain, paresthesia, numbness diabetic foot care: cut nails straight across, dry between toes, wear well fitting shoes all the time, inspect feet everyday, no harsh chemicals neurogenic bladder: doesn't empty properly can empty spontaneously (incontinence) or not at all (retention) gastroparesis (stomach emptying is delayed so increase for aspiration risk for infection

NCLEX (17 decks)

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