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NP2 > Endocrine and GI > Flashcards

Endocrine and GI Flashcards

1
Q

Difference between type I and type 2 diabetes

A

Type 1 pancreas makes 0 insulin

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2
Q

Former name for type 1 and type 2 diabetes

A

juvenile and adult onset

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3
Q

IGT

A

Impaired Glucose tolerance Test

2 hrs after receive glucose if value is 140-199 then indicates pre-diabetes. >200 diabetic

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4
Q

IFG

A

Impaired Fasting glucose test
100-126 = risk for diabetes
best one, no calories for 8 hours.
Must be done twice to diagnose diabetes.

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5
Q

↓ ________and _________ __________ may be enough to keep you from needing meds.

A

stress

lifestyle changes

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6
Q

80-90% of Type 2 diabetes patins are_______

A

overweight

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7
Q

Brittle diabetes

A

unstable, can happen in 1 or 2, fluctuates a lot, hard to control.

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8
Q

Type 2 Diabetes etiology

A

not enough insulin, or insulin resistance

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9
Q

Math formula for insulin your body should make

A

0.6 units per kg body weight per 24 hrs

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10
Q

Diabetes 2 can also be caused by

A

Inappropriate glucose made by the liver (hepatitis, alcoholism)
or, fluctuation of hormone adipokines

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11
Q

Secondary diabetes

A

can be corrected if correct problem, could be:

Cushing’s, hyperthyroidism, pancreatitis

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12
Q

Type 2 Diabetes clinical manifestations

A
  1. wounds that don’t heal
  2. weight loss
  3. thirst (polydipsia) and hunger (polyphagia)
  4. Kussmal respirations - rapid and deep
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13
Q

Ha1C

A

glycosylated hemoglobin test
determines pts blood sugar over last 90-120 days.
Should be ↓ 7% - if higher patient bs has not been kept in the normal range.

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14
Q

3 Therapies for DM 2

A

Drug
Nutritional
Exercise

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15
Q

ADA

A

American Diabetes Association
recommends overall healthy eating plan
Teach: ↓ alcohol

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16
Q

Best way to evaluate compliance for DM2 patients

A

HA1C test

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17
Q

1st action for implementing exercise plan for DM2 patients

A

ask them what they like to do
then teach to exercise after a meal
key to success especially in insulin resistance

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18
Q

Always assess ____________ _______________ before teaching

A

patient perception

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19
Q

7 Signs that BS is ↓↑

A
  1. confusion
  2. irritability - restless, moody
  3. diaphoresis
  4. tremors
  5. hunger
  6. pale
  7. coma
    * check BS immediately
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20
Q

Treatment for very low BS (Hyperglycemia)

A
  1. 4-6 oz of fruit juice (if patient is alert enough) check BS again in 15 minutes
  2. glucagon - subQ or IM. **30 minutes after give, rebound, more severe. So give complex carb like crackers and cheese.
  3. IV dextrose - usually 50% dextrose. Central line would be best but can use 30cc syringe to push . S/B on crash cart. Push as quickly as possible.
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21
Q

Elavil

A

used for nerve pain (neuropathy) in Diabetic patients

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22
Q

Interventions to avoid amputation for diabetics

A
  1. do not soak feet
  2. do not use a heating pad
  3. do not use OTC callous remover
  4. wear good shoes, leather, no sandals, flat
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23
Q

Most common form of thyroid disease

A

Graves

* it is autoimmune, can palpate and feel enlarged thyroid

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24
Q

Clinical Manifestations of Hyperthyroidism (Graves) disease.

A 
↑ appetite
diarrhea
rapid heart beat ↑ CO ↑ BP 
loose hair
fatigue
insomnia
exophtalamos - bulging eyes
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25
Q

Hyperthyroidism (Graves) can go into life threatening crisis. What is this called, its indications, and intervention?

A

thyrotoxosis
highly elevated temp
HR is probably ↑
Call DR. right away (teach pt.)

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26
Q

Three treatment options for Hyperparathyroidism

A
  1. Drugs - most common is PTU propulthiouracil, Tapazole
    both drugs can take 4-8 weeks to see good results. Some relief in 1-2. Cant take forever, will stop in 6-15 months. COMPLICATION: common for patient to go into hypothyroidism
  2. RAI - radioactive iodine therapy
  3. Subtotal thyroidectomy
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27
Q

T Interventions for Hyperparathyroidism (Graves)

A

↓ sodium diet
elevate head of bed to reduce swelling
Sometimes need to tape eyes closed at night

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28
Q

Primary Hypothyroidism

A

r/t destruction of thyroid tissue or defective hormone synthesis

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29
Q

Secondary Hypothyroidism

A

R/T pituitary disease with ↓ TSH

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30
Q

In Hypothyroidism TSH will be

A

↑ if thyroid problem

↓ if pituitary or hypothalamus problem

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31
Q

Clinical manifestations of Hypothyroidism

A

everything slows down ↓ Co ↓ HR
overweight anemia
short of breath fatigue
constipation hair loss
myxedema - mask look to face, hard to have facial expressions
eyes can swell (similar to Grave’s)
mental status change: slows down functioning, can slip into coma, worst thing to take- sedatives - can slip into coma overnight

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32
Q

If patient with hypothyroidism is new on Synthroid…

A

monitor heart - bad sign if have heart problems. Assess apical, not radial pulse.

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33
Q

____ test used most often to adjust thyroid meds

A

T4

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34
Q

Intervention for hypothyroidism - disturbed thought process

A

Give handouts for mental status change, goofy comes and goes.

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35
Q

T Euthyroid state

A

normal range

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36
Q

ACTH

A

adrenocorticotropic hormone in anterior pituatary

too much and have Cushing’s

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37
Q

Cushing is….

A

↑ adrenal usually caused by excess of corticosteroids, particularly glucocorticoids

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38
Q

Cushing Syndrome Clinical Manifestations

A 
skinny arms and legs and big trunk
protein wasting - muscle atrophy
moon face
purple red streaks on belly
hyperglycemia
osteoporosis
protein wasting - muscle atrophy
insomnia
mood disturbances - depressed or psychotic
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39
Q

T Diagnostic Study for Cushing

A
  1. 24 Hour Urine for free cortisol. levels of 80-120 mgs. indicates Cushing’s Syndrome)
  2. Low dose dextramethasone suppression test used for borderline results of 24 Hour UrineTest
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40
Q

Drug used for Cushing’s

A

Mitotane - suppresses the adrenals

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41
Q

T Disturbed Self Esteem brought on by Cushing’s

A

Validate - say, “I see how upset you are but good news, after your sx, all these symptoms will go away and you will look beautiful again.”

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42
Q

Addison’s is the common name for….

A

Low Adrenal Output… opposite of Cushing’s

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43
Q

T classic Addison Symptom

A

Skin hyper pigmentation in areas exposed to sun, pressure joints like knuckles, skin creases, especially palmar creases

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44
Q

S/S of Addisons

A 
skin hyper pigmentation
orthostatic hypotension
hyponatremia
hyperkalemia (steroids regulate electrolytes)
nausea, vomiting, diarrhea
fever, confusion
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45
Q

T Addisonian Crisis

A

Life threatening, everything goes bad fast and then death. Teach pt when symptoms worsen to take more of their steroids. Can also happen when abruptly stop meds of even just miss a dose. (TEACH)

Can also happen if under stress of any kind: sick, surgery physical, mental emotional. Need to take more steroids.

Also - can happen if vomiting and diarrhea, does not need to be excessive to send into Crisis.

46
Q

ACTH Stimulation Test

A

if stimulate and levels fail to rise then have Addison’s

47
Q

Drugs for Addison’s

A

Hydrocortison (prednisone)

Give in am, helps circadian rhythm, able to get out of bed and have energy to get going.

48
Q

Parathyroid Problems =

A

messed up electrolytes, especially Calcium and Phosphates.

*Calcium and phosphates have an inverse relationship (usually)

49
Q

T Hyperparathyroidism

A

Calcium and phosphate levels will be messed up. sully Calcium will be ↑. Our job to bring calcium ↓

50
Q

Normal levels for Ca and Phos

A

Ca 9-1 mg/dL Phos 2.8-4.5 mg/dL

51
Q

Treatment for Hyperparathyroidism

A 
Surgery - watch closely after sx for hypocalcemia (early sign - tingling of lips) Intervention (have breath into paper bag - Resets Calcium.
↑ ambulation
↑ liquids 3-4 L per day
phosphorus supplements
Calcium supplements (depends on patient)
52
Q

Primary Obesity

Secondary Obesity

A 
Primary = too much in, not enough energy our
Secondary = genetics, metabolic, tumor in hypothalamus
53
Q

BMI ranges

A

Underweight: under 18.5

Normal: 18-24.9

Overweight: 25-29.9

Obese: more than or equal to 30

Morbid obese: equal to or more than 40

54
Q

Obese Complications

A

HF(heart problems in general) hypertension especially, need to do good heart assessments

arthritis (joint problems)

respiratory problems

diabetes

55
Q

To help obese patients must get their__________

A

perception - they need to know they do not need to stay this way. 98% can be solved.

56
Q

Meridia

A

appetite suppressant, off the market
↑ BP and HR
palpitations, constipation, death

57
Q

Orlistat or Xenical

A

Nutritional absorption blocking drugs
Problems: vit def especially K, not enough can bleed to death
Early sign: petunia, severe diarrhea, bloating

58
Q

Teach before bariatric SX

A
  1. strict adherence to prescribed diet
  2. recognize s/s of complications of sx
  3. importance of long term follow up
  4. dumping syndrome
59
Q

Rouxen Y

A

most popular gastric bypass surgery

60
Q

Requirement for bariatric sx

A 
BMI 40 or more
tried and failed to lose weight
one or more obesity related complications
18 years of age or older
obese for over 5 years
61
Q

After bariatric sx teach

A
  1. pureed diet 1-2 weeks
  2. Once on normal foods must be ↓ in carb and fluids (with meals) or will have dumping syndrome
  3. ↑ protein ↓ fiber and roughage diet
  4. small frequent meals - 6
62
Q

Common complications to bariatric sx

A

anemia
vit def.
diarrhea
stomach ulcers

63
Q

↑ chance of GERD

A

obesity
smoking
hiatel hernia

64
Q

1 and #2 Cause or factor for GERD is

A
  1. Incompetent LES (lower esophageal sphincter) becomes weak

2. ↓ in gastric motility, slow emptying stomach

65
Q

Foods that make LES weaker

A

caffine, peppermint

66
Q

Drugs that make LES weaker

A

anticholinergics, like Atrovan

67
Q

Reglan

A

drug used for GERD
tells stomach to empty

*must take before meals, if pt does not receive before meal, it is a medical error

68
Q

GERD symptoms

A
  1. heartburn (pyrosis)
  2. dyspepsia - stomach pain
  3. hypersalivation
69
Q

GERD complications

A
  1. Esophogitis - inflammation
  2. Barrett’s Esophogitis- lining scarred and rigid, could lead to perforation
  3. Aspiration - lead to pneumonia
70
Q

Gerd Interventions

A 
↓caffine, peppermint, high fat foods like PB
dont lie down after eat
drink fluids between meals, not with
avoid milk products, especially at night
stop eating 2 hrs before bed
reduce weight
avoid tomatoes and citrus fruits
71
Q

Drugs for GERD

A
  1. Antacids - weakest: 1-3 hrs after meals, not with meds except NSAIDS
  2. H2R Blocker (histamine 2 receptor) - Pepsid, Zantac, Tagamet. TTTTTT occasional confusion with elderly.
  3. PPI’s: Proton Pump Inhibitors Prilosec, Nexium, Aciphex
  4. Acid Protective: coats - Carafate (sucralfate), 30 min b4 meals
  5. Prokinetic Drugs: Reglan (metoclopramide) ↑ motility, give 3 min b4 meals
72
Q

Take PPI’s for long time increases chances of getting

A

Hpylori

73
Q

GERD Nursing Mgt

A 
Have them:
stop smoking
avoid alcohol, caffeine, acidic foods
reduce stress
reduce weight, if appropriate
small frequent meals
put bed on blocks helps
74
Q

2 types of peptic ulcers

A

gastric and duodenal

75
Q

80-90% cause of ulcers

A

Hpylori

76
Q

2 other causes of ulcers

A

NSAIDS (erodes protective coating and allows ulcers to develop)

steroids

77
Q

Western countries have more________than __________ulcers.

A

duodenal (80% of all PUD)

gastric

78
Q

3 Major complications of Peptic Ulcer

A
  1. hemorrhage
  2. perforation (most lethal)
  3. gastric outlet obstruction
79
Q

Perforation symptoms

A

HAPPENS QUICKLY, ONLY FEW HOURS UNTIL DEATH OCCURS.

  1. sudden onset, severe abdominal pain
  2. stomach becomes rigid like a board
  3. bowel sounds absent
  4. shallow, rapid respirations
  5. nausea, vomiting
80
Q

1st Intervention for Perforation

A

Vital signs, will go into hypovolemic shock quickly.
RR↑ HR↑ BP↓

Alert everyone of emergency situation

Peritonitis - will occur 6-8 hrs w/perforation. Be ready to start antibiotics before or after the SX.

81
Q

Peptic Ulcer Disease Collaborative Care

A

Rest the GI tract - foods that do not irritate GI track during acute phase

Find pts trigger foods and eliminate

eliminate smoking and alcohol

manage stress

long term follow up dare

82
Q

Drugs for PUD

A

same as GERD, except on antibiotics- usually amoxicillin and clarithromycin
antibiotics and PPI’s will wipe out in 10 days - PPI used is Prilosec (omprezole)
Also, anticholinergics will decrease gastric motility

83
Q

Foods that Irritate PUD

A

caffeine
spicy foods
alcohol
high fiber - chew food really well, don’t inhale

84
Q

IBS (Irritable bowel syndrome) is diagnosed by

A

differential diagnosis,: rule out everything else like food allergies, cancer IBD, and Crohns

Advise pt, won’t be quick, validate their impatience

Most important need: nurse provide support, will ↓ symptoms

85
Q

IBS Nutritional Therapy

A

Avoid gas producing foods

86
Q

IBS Drugs

A

Antispasmotics like: anticholinergics - sip and suck for dry mouth

antidiarrheals #1 is Imodium (slows motility) #2 is Lamotil _ RX- has narcotic in it (addictive)

Antidepressants - to decrease nerve pain

87
Q

IBD

A

Inflammatory bowel disease, much worse than IBS
chronic recurrant, inflammatory, autoimmune

Enough inflammtion to break down tissues and cause ulcers and necrosis

88
Q

2 Types IBD

A

Crohn’s and Ulcerative Colitis

89
Q

Ulcerative colitis location

A

colon and rectum

90
Q

Crohn’s location

A

anywhere in GI from esophagus to rectum

91
Q

Clinical Manifestations of IBD (Crohn’s and Ulcerative Colitis)

A 
diarrhea - often bloody
fatigue
abdomen pain
fever (due to infection that causes necrosis)
weight loss
malobsorption (from chronic diarrhea)
electrolyte imbalances and vit def
92
Q

IBD Complications

A

hemorhage and perforation
embolisms, arthritis
liver disease
train wreck

93
Q

IBD Collaberative Care

A
  1. prevent weight loss
  2. low residue, low fiber diet
  3. avoid high fat foods
  4. lots of vitamins and supplements

*IN hosp will be NPO to rest bowel

94
Q

IBD Easier to diagnose than IBS due to

A

lesions

95
Q

Most common IBD Drug

A

Azulfadine - categoru: aminosalicylate (anti-inflammatory)

Drug Alert: causes yellow orange discoloration of skin, tears, sweat, urine. Avoid exposure to sunlight.

96
Q

3rd most common cancer in US

A

Colorectal Cancer

97
Q

Colorectal cancer preventable by

A

colonoscopy, start getting at age 50 to find and remove polyps

98
Q

Symptoms of Colorectal cancer

A

Hematochezia - bright red blood from rectum

Melena - thick black tarry stools

99
Q

CEA blood test

A

Carcino Embroyonic antigen - will have antibodies in blood that says there is cancer in the colon

100
Q

Difference between acute and chronic hepatitis

A

chronic : symptoms 1-4 months
acute: more than 4 mod.

No treatment for acute, chronic has some meds

101
Q

Symptoms of Hepatitis

A 
malaise
anorexia
fatigue
nausea
abdominal discomfort
Low Grade Fever
102
Q

Best treatment for hepatitis

A

rest
most recover from acute with no complications - goes dormant.
Still contagious for rest of life, some will get cirrhosis

103
Q

Hepatitis - starts with a vowel, comes from the bowel

A

A and E - oral/fecal exposure

BCD - Blood Exposure

104
Q

What must you do if get needle stick?

A
  1. go to ER to test for antibodies and halt pts checked too.
  2. With in 24 hrs get HBIG (Hep Immunoglobulin)
  3. If not vaccinated, start immediately
105
Q

Cirrhosis

A

chronic, progressive disease of the liver

106
Q

Cirrhosis Clinical Manifestations

A

Early: anorexia, flatulence, dyspepsia,
nausea, vomiting, fever, fatigue, weight loss

Late: Jaundice, every endocrine and blood disorder you can think of, neuropathy

107
Q

Cirrhosis complications

A

Esophagela nd gastric varices- -Perforations - most life threatening, bleed like a volcano.

Peripheral edema and ascites - abdomen, ankles, arms due to low protein albumin in blood

Hepatic Encephalopathy - type of dementia - high levels of ammonia in blood. Watch levels.

108
Q

Common test for hepatic Encephalopathy

A

hold arms out, if have hands will flap up and down

109
Q

Drugs given for high ammonia in Cirrhosis pts

A

lactulose - caused diarrhea and moves ammonia out

110
Q

Cirrhosis patients have risk for __________ ___________

A

skin breakdown

Interventions: air mattress, turn every 2 hours, ↑ protein

NP2 (8 decks)

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