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ACVN - MEDICAL NURSING > Endocrinology - Patient Management > Flashcards

Endocrinology - Patient Management Flashcards

1
Q

what are the clinical signs of feline hyperthyroidism?

A

Polyphagia, weight loss, tachycardia, palpable enlarged thyroid gland

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2
Q

what medical treatment can be done for feline hyperthyroidism?

A

anti-thyroid drugs

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3
Q

how can diet treat feline hyperthyroidism?

A

iodine restricted diet

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4
Q

what surgery can be done to treat feline hyperthyroidism?

A

thyroidectomy

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5
Q

what other curative method of treatment can be done for feline hyperthyroidism?

A

radioactive iodine

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6
Q

what does medical management do in terms of giving drugs?

A

they bloxk synthesis of thyroid hormones, more T4 is produced if an adenoma continues to grow

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7
Q

what are examples of drugs that can treat feline hyperthyroidism?

A

methimazole or carbimazole

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8
Q

when will a cat with hyperthyroidism be euthyroid after being given medical management?

A

2-3 weeks

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9
Q

what are the common side effects of anti-thyroid drugs?

A
  • Vomiting, anorexia, lethargy
  • Usually minor and transient * 10-20% of cats
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10
Q

what are the rare side effects of anti-thyroid drugs?

A
  • Persistent GI signs
  • Bone marrow suppression
  • Facial pruritis
  • Hepatopathy
  • Rare (1-5% of cats) but serious- stop treatment
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11
Q

what are the nursing considerations for feline hyperthyroidism?

A
  • Careful handling
  • Often fractious!
  • Concurrent disease- cardiac disease, arthritis
  • Gabapentin?
  • Senior cat clinics- look out for clinical signs of hyperthyroidism as common
    in older cats
  • Often T4 measurement included in senior cat bloods
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12
Q

what treatment monitoring can you do for feline hyperthyroidism?

A
  • Treatment monitoring- often dose increases required over time
  • Recurrence, concurrent disease (CKD particularly)
  • Every 3-12 months
  • Clinical signs
  • Blood tests- T4, haem, biochem
  • Urine and BP
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13
Q

what dietary management can be done for feline hyperthyroidism?

A
  • iodine restricted
  • must be only food they eat for rest of their life
  • less effective than other options
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14
Q

what are the disadvantages of feline hyperthyroid diet management?

A
  • Not suitable if severely hyperthyroid
  • Not suitable if other dietary requirements- IBD, CKD
  • Not suitable for euthyroid cats in household
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15
Q

what is canine hypothyroidism?

A
  • Destruction of thyroid tissue
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16
Q

what are the clinical signs of canine hypothyroidism?

A
  • Weight gain, lethargy, bradycardia, endocrine alopecia, myxoedema
    coma
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17
Q

what are the nursing considerations for canine hypothyroidism?

A
  • weight management clinics
  • treatment monitoring
  • T4 bloods 6-8weeks after starting treatment
  • 6-12 months reviews
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18
Q

what is calcium necessary for?

A
  • Muscle contraction and nerve conduction
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19
Q

where is calcium found?

A
  • Mostly stored in bones (with phosphate)
  • Found in three forms in blood:
  • Ionised- free, biologically active
  • Complexed- inactive
  • Protein-bound- inactive
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20
Q

what are the hormones of calcium balance?

A

parathyroid hormone
calcitriol (vitamin D)
calcitonin

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21
Q

what is primary hyperthyroidism?

A
  • One or more parathyroid glands become hyperfunctional and secrete
    excess PTH
  • Usually due to solitary benign tumour
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22
Q

what are the neurological signs of primary hyperparaythyroidism?

A

weakness, lethargy, exercise intoleracne and trembling

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23
Q

What are the gastrointestinal signs of primary hyperparathyroidism?

A

reduced appetite, nausea, vomiting and constipation

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24
Q

what are the urinary signs of primary hyperparathyroidism?

A

PUPD, urolithiasis, UTI

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25
Q

what are the cardiovascular signs of primary hyperparathyroidism?

A

hypertension and arrythmias

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26
Q

how is primary hyperparathyroidism diagnosed?

A
  • elevated calium often accidental
  • blood gas or extenal lab testing
  • measure PTH is elevated ionised calcium
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27
Q

how do you treat primary hyperparathyroidism?

A

surgery
- ultrasound guided glandular ablation by heat or ethanol injection

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28
Q

what is secondary hyperparathyroidism?

A

chronically low calium leads to eleveated parathyroid hormone leading to renal failure

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29
Q

what are the nutritional causes of secondary hyperparathyroidism?

A
  • dogs and cats fed diet with little or no calium or deficicne tin vitamin D
  • high PTH causes calium to be metabolised from bone
  • home-made diets can cause this
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30
Q

what is hypoparathyroidism?

A

low or absent PTH despite low calcium

31
Q

what causes hypoparathyroidism?

A

surgical excision of the parathyroid, trauma, idiopathic, immue-mediated, others

32
Q

what are the clinical signs of hypoparathyroidism?

A

seizures, muscle fasciculations/ twitching/ cramping, weakness, ataxia, anorexia, vomiting, facial rubbing

33
Q

how is hypoparathyroidism diagnosed?

A

meaure ionised calcium, phosporous and parathyroid hormone

34
Q

how would you treat severely affected hypothyroidism?

A

iv calcium bolus or cri

35
Q

how would you treat mild hypothyroidism?

A

oral calcium supplements and calcitriol (vitamin D)

36
Q

what should you monitor when giving calcium IV?

A

heart rate and ECGw

37
Q

what can happen if you administer calcium IV too quickly?

A

can cause cardiac arrythmias and cardiac arrest

38
Q

what can haappen if calcium IV is given too slowly?

A

bradycardia

39
Q

if caclium IV has got onto the skin what should you monitor for?

A

irritation, necrosis

40
Q

what should you do if calcium has got onto the skin?

A

infiltrate tissue with saline and manage the wound

41
Q

what is hyperadrenocortisism also known as?

A

cushings

42
Q

what is hyperadrenocorticism?

A

excessive production of cortisol from the adrenal gland

43
Q

what types of hyperadrenocorticism are there?

A

pituitary depedent and adrenal dependent

44
Q

what are the clinical signs of hyperadrenocorticism?

A

PUPD, lethargy, endocrine alopecia, pot-belly, thin skin, poor wound healing, panting, polyphagia, calcinosis cutis

45
Q

how do you treat hyperadrenocorticism?

A

trilostane which blocks synthesis of cortisol
surgical

46
Q

what are the side effects of giving trilostane for hyperadrenocorticism?

A

GI signs, iatrogenic hypoadrenocorticism and sudden death

47
Q

what are the nursing considerations for a patient with hyperadrenocorticism?

A
  • senior clinics look for signs
  • treatment monitoring
  • morning doses
48
Q

what can happen if a patient overdoses on trilostane?

A

iatrogenic hypoadrenocorticism, full Addisonian crisis causing weakness, lethargy, anorexia, vomiting, diarrhoea and collpase

49
Q

what is hypoadrenocorticism?

A

addisons disease, lack of adrenal hormones glucocorticoids and mineralcocorticoids

50
Q

what patients are affected by hypoadrenocorticism?

A

young to middle age dogs, any breed more commonly female

51
Q

what would you see with hypoadrenocorticism?

A

vague, waxing and waning illness, not quite right, vomiting and diarrhoea and weightloss

52
Q

what would you see if a patient is in an addisonian crisis?

A

collapse, hypotension, weakness, bradycardia, severe dehydration, hypovolaemia

53
Q

how would you treat addisonian crisis?

A

fluid resuscitation, correct electrolytes, start ACTH stim test

54
Q

what long term treatment would you give to a hypoarenocorticism patient?

A

glucocorticoid replacement and mineralocorticoid replacement

55
Q

what is pancreatitis?

A

disease of the exocrine pacreas which leads to inflammation of the pancreas, usually idiopathic, dietary indiscretion, trauma, surgery

56
Q

what happens during pancreatitis?

A

the pancreatic enxymes are activated prematurely which leads to the pancreas staring to ingest itself

57
Q

what are the clinical signs of mild pancreatitis?

A

anorexia, vomiting, abdominal pain, dehydration, lethargy

58
Q

what are the clinical signs with severepancreatitis?

A

generalised inflammation, DIC, renal failure, muliorgan failure, death

59
Q

what are the clinical signs of pancreatitis in cats?

A

jaundice

60
Q

how would you treat pancreatitis?

A

IVFT, monitoring for systemic signs, analgesia, anti-emetics, feeding tubes, palatable, low fat highly digestible diet

61
Q

what long term treatment would you provide for a patient with pancreatitis?

A

low fat diet for dogs

62
Q

what is diabetes lmellitus?

A

failure for the pancreas to produce insulin

63
Q

what are the clinical signs of diabetes mellitus?

A

PUPD, polyphagia and weightloss, cataracts (dogs) and peripheral neuropathy (cats)

64
Q

what are the clinical signs of diabetic ketoacidosis?

A

vomiting, collapse, dehydration

65
Q

how do you treat diabetes mellitus in cats?

A

insulin injections
low carb high protein diet that is calorie controlled, wet food and consistent feeding schedule
- oral liquid senvelgo

66
Q

how do you treat diabetes mellitus in dogs?

A
  • insulin injections
  • diet - high fibre high carb, consitent schedule, calorie controlled
  • exercise
67
Q

how do yo give an insulin injection?

A

subcut either once of twice a day depending on the patient and the type of insulin

68
Q

how often should a patient be fed on insulin?

A

if twice a day, feed every 12 hours at the same time as the insulin
if once a day feed in the morning before insulin and then again 6 hours later

69
Q

how do you monitor diabetes mellitus?

A
  • measure blood glucose every 1-2 hours using blood glucose curve
  • if using freesytle libre this is continuous monitoring
70
Q

how long does it take for blood glucose levels to stabilise following an insulin dose chage?

A

7 days

71
Q

what are the signs of hypoglycaemia?

A

weakness, ataxia, depression, altered behaviour, muscle twitching and seizures

72
Q

how would you treat a patient who is hypoglycaemia?

A

offer food, rub honey on gums if reluctant to eat, rub honey on gums if unconscious

73
Q

what is impotant to rememebr when measuring blood glucose?

A

take samples from the same location, capillary blood has different glucose level to venous

74
Q

what should you do before giving insulin?

A

mmix the bottle gently

ACVN - MEDICAL NURSING (22 decks)

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