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Med Surge 1 > Test 4 endocrine shi > Flashcards

Test 4 endocrine shi Flashcards

(64 cards)

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1
Q

What are the classifications of Diabetes?

A

1
2
Gestational
Prediabetes
LADA
Diabetes associated w other conditions

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2
Q

Function of insulin

A

Transport and metabolize glucose for energy
Stimulates storage of glucose in liver and muscle as glycogen
Singals liver to stop release of glucose
Enhance storage of dietary fat in adipose tissue
Accelerates transpor of amino acids into cells
Inhibits the breakdown of stored glucose, protein, and fat

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3
Q

What is type 1 diabetes?

A

Beta cells in pacreas are destroyedd by a combination of genetic, immunologic, and environmental factors
Results in decreased insulin productino

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4
Q

What is type 2 diabetes?

A

Insulin resistance and impaired insulin secretion
Slow, progressive glucose intolerance
Obesity usualy present in diagnosis

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5
Q

What is latent autoimmune diabetes of adults?

A

Subtype of diabetes, beta cell destrution in pancreas is slower than in type 1 and 2
IS NOT INSULIN DEPENDENT in the initial 6 months of disease onset
Manifestations are smiliar to type 1 and 2
R

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6
Q

Risk factors of type 1 and 2 diabetes

A

1: Early onset (<30), familial, genetic, race/ethnicity
2: Obesity, over 30, HTN, HDL less than or equal to 35, triglycerides over 250, history of gestational diabetes or baby over 9 pounds

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7
Q

Clinical Manifestations of Hyperglycemia

A

3 P’s: Polyuria, Polydipsia, Polyphagia
Fatigue
Weakness
VIsion changes
TIngling or numbness in hands or feet
Dry skin
Wounds slow to heal
Recurrent infections
Type 1: sudden weight loss, NV, abdominal pains

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8
Q

Diagnostic findings of diabetes

A

Fasting blood glucose: 126 or more
Casual Glucose exceeding 200

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9
Q

Why is a glucose tolerance test more effective in diagnosing diabetes than urine testing for glucose?

A

Glucose tolerance test has higher renal threshold for glucose

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10
Q

What is the medical management of diabetes?

A

Normalize insulin activity and blood glucose levels to reduce the development of complications
ADA recommends an HgBA1c (determines average blood glucose over 3 months) less than 6.5%
Management has 5 components
* Nutritional therapy
* Exercise
* Monitoring
* Pharmacoligical Therapy
* Education

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11
Q

Dietary management of diabetes

A

Control calories
Control blood glucose
Normalization of lipids and blood presure to prevent heart disease

Nurse role: Be knowledgeable about dietary management
Communicate with dietician or other management specialties
Reinforce patient understanding
Support dietary and lifestyle changes

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12
Q

Meal planning for diabetes

A

Consider food preferences, lifestyle, usual eating times, culture and ethnic shi too
Review diet history and need for weight loss, gain , or maintenece
Carbs: 50-60% emphasize whole grains
Fat: 20-30 %
Nonanimal protein sources like legumes, whole grains, increase fiber too

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13
Q

Glycemix index

A

Combining starchy foods with protein and fat slows absorption any glycemic response
Raw or whole foods tend to have lower response than cooked, chopped, or pureed foods
Eating whole fruits rather than juices ; decreases glycemic response because of fiber
Adding foods with sugars may produce lower response if eaten with foods that are more slowly absorbed

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14
Q

Exercise precautions for diabetes

A

Insulin normally decreases with exercise ; patients on exogenous insulin should eat a 15- g carbohydrate snack before moderate exercise to prevent hypoglycemia
Patients with type 2 diabetes not taking insulin or an oral agent may not need exra food before exercsie
Potential postexercise hypoglycemia
Monitor blood glucose levels

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15
Q

Insulin therapy

A

Blood glucose monitoring
Individualize treatment

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16
Q

Categories of insulin

A

Rapid: 15-30 min
Short acting: Regular insulin ; 30-60
Intermediate acting: NPH ; 4-12 hours
Long acting: no peak

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17
Q

Complications of insulin therapy

A

ALlergic reactions
Insulin lipodystrophy
Resistance to injected insulin
Morning hyperglycemia

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18
Q

Oral Antidiabetic agents

A

Used only for type 2 diabetes who require more than diet and exercise alone
Major side effect: Hypoglycemia and GI shi
Nursing interventionsL Monitor glucose

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19
Q

Acute complications of Diabetes

A

Hypoglycemia
DKA
Hyperglycemic hyperosmolar syndrome

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20
Q

Signs of hypoglycemia

A

Andrenergic: Sweating, tumors, tachycardia, palpitations, nervousness, hunger
Central: Inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness
Severe: Disorientation, seizures, loss of consiousness, death

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21
Q

What can cause hypoglycemia?

A

70 or below
Too much insulin or oral hypoglycemic agents
Excessive physical activity
Not enough food

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22
Q

Management of hypoglycemia

A

Give 15-20 g of fast acting concentrating carbs
* 4-6 ounces of juice or regular soda
Emergency measures, if pt cant swallow, or unconsiousness
* Subq or IM glucagon 1 mg
* 25 to 50 mL of 50% dextrose solution IV

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23
Q

What is DKA?

A

Absence or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, and fat
Clinical features: hyperglycemia, dehydration, acidosis

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24
Q

Clinical Features of DKA

A

Altered mental status
Fruity odor
Kussmal breathings
Dry axilla
NV
Abdominal pain
Polyuria

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25
Assessment of DKA
Blood glucose of 250 and 800 Severity of DKA not only due to blood glucose Keoacidosis is reflected in low serum bicardbonate, low pH; low PCO2 reflects respiratory compensation (Kussmaul respirations) Keton bodies in blood and urine Electrolytes vary according to degree of dehydration ; increase in creatinine, HCT, BUN
26
Management of DKA
Rehydration with IV fluids IV continous infusion of regular insulin Reverse acidosis and restore electrolyte balance Note: Rehydration leads to increase plasma volume and decreased K ; insulin enhances movement of K into cells
27
Hyperglycemic hyperosmolar syndrome
Caused by lack of sufficient insulin ; ketosis is minimal or absent Hyperglycemia causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolality Manifestations: Hypotension, profound dehydration, tachycardia, and variable neruologic signs caused by cerebral dehyration High mortality rate Usually is the patients that come in w/ 3 P's
28
Management of HHS
Rehydration Insulin administration Monitor fluid volume and electrolyte status Prevention * Diagnosis and management of diabetes * Assess and promote self care management skills
29
Long term complication of diabetes
Macrovascular: Accelerated athersclerotic changes ; coronary artery disease, cerebrovascular disease, peripheral artery disease Microvascular: Microangiopathy ; diabetic retinopathy , nephropathy Neuropathic: Peripheral neuropathy, autonomic neuropathies, hypoglycemic, unawareness, neuropathy, sexual dysfuntion
30
What kind of feedback mechonism is the endocrine system?
Negative
31
Anterior Pituitary secretes what?
FSH LH Prolactin ACTH TSH GH
32
Hyper pituitary can cause?
Cushing's Syndrome Gigantism Acromegaly SIADH
33
Hypo pituitary can cause?
Dwarfism Panhypopuitarism DI
34
What does posterior pituirary secrete?
ADH Vasopressin Oxytocin
35
Whar causes Cushings Syndrome?
Overproduction of ACDH
36
What does thyroid secrete?
T3 T4 Calcitonin
37
Where is iodine contained?
In thyroid hormone
38
What controls the release of thhyroid hormone?
TSh from anterior pituirary gland
39
Parathyroid secretes what?
Parathormone
40
What does parathormone do?
Regulates calcium and phosphorus balance Increased parathormone elevates blood calcium by increasing caclium absorption from the kidney, intestine, and bone Lowers phosphorus levels
41
What does adrenal medulla secrete?
Catecholamines ; epi and norepi This functions as part of autonomic nervouns system
42
What does adrenal cortex secrete?
Glucocorticoids Mineralcorticoids Androgens
43
What kinds of thyroid diagnostic tests are there?
TSh Serum free T4 T3 and T4 T3 resin uptake Thyroid antibodies Radioactive iodine uptake Fine needle biopsy
44
What kinds of thyroid disorders are there?
Cretinism Hypothyroidism Hyperthyroidism Thyroiditis GOiter Thyroid cancer
45
CLinical manifestations of hypothyroidism
Coarse, dry, brittle hair Loss of lateral eyebrows Pallor Large tongue Lethargy and impaired memory Deep, coarse voice Diminished perspiration and cold intolerance Slow pulse, enlarged heart Constipation Weight gain Peripheral Edema Muscle weakness
46
What is hyperthyroidism?
Graves disease Thyrotoxicosis ; excessive output of thyroid hormone (thyroid storm) AUtoimmune disorder Women 8x more likely to get
47
Hyperthyroidism clinical manifestations
Fine hair Exophthalamos Goiter Sweating, heat intolerance Muscle wasting Tachycardia, palpitations, high output failure Weight loss Bulging of eyes
48
Thyroid Storm
Severe hyperthyroididm ; abrupt onset usually precipitated by stress Untreated it can be fatal, but with proper treatment the mortality rate is reduced a lot Manifestations: Hyperpyrexia (over 101) Extrememe tachycardia (>130) Exaggerated symptoms of hyperthyrpoidism Altered nuerologic or mental state, which frequently appears as delerium psychosis, somnolence, or coma
49
Treatment for thyroid storm
Hypothermia O2 IV fluids Medications : Iodine, methimazole, propylthiouracil, hydrocortisone
50
What is hyperparathyroidism?
May have no symptoms or experience signs and symptoms resulting from involvment of several body systems Mannifestations: Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias Treatment: Surgical removal
51
Hypoparathyrooidism causes
Abnormal parathyroid develiopment Destruction of parathyroid glands Vitamin D deficiency
52
Clinical manifestations of hypoparathyroidism
Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchonchospasms, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes
53
Tetany, Chvostek and Trousseau sign
Tetany: General muscle hypertonie with remor and spasmodic or uncoordinated contractions occuring with or without efforts to make voluntary movements Chvostek: Sharp tapping over facial nerce in front of parotid gland and anterior to ear causes spasm or twitching of mouth , nose, and eye Trousseau sign: Carpopedal spasm is induced by occluding the blood flow to arm for 3 minutes with a blood pressure cuff
54
Adrenocortical insufficiency
Addisons disease ; adrenal suppression by exogenous steroid use Muslce weakness, anorexia, GI , fatigue, dark pigmantation of skin and mucousa, hypotension, low blood glucose, low serum sodium, high serum potassium, apathy, emotional liability, confision Diagnostic tests: adrenocortical hormone levels, ACTH levels, ACTH simulation test
55
What is Cushing's Syndrome?
Excessive Adrenocortical Activity or corticosteroid medications Hyperglycemia: Central type obesity with buffalo hump. heavy trunk and thin extremities ; fragile skin, thin skin, ecchymosis, striae, weakness, lassitude, sleep disturbances, osteoperosis, muscle wasting, HTN, moon face, acne, infection, slow healing, virililization in women, loss of libido, increase sodium decreased potassium
56
Medical Management of Hypo and Hyperthyroidism
Hypo: Supportive Hyper: Radioactive therapy , Medications: Propylthiouracil and methimazole , sodium or potassium iodine solutions, dexamethasone, beta blockers
57
Preooperative thyroidectomy
Avoid caffeine and other stimulants, explanation of tests and procedures and head and neck support used after surgery
58
What does methimazole do?
Block synthesis of thyroid hormone
59
What do dexamethasone, potassium iodine, and sodium iodine do?
SUppress release of thyroid hormone
60
Management of hypoparathyroidism
Increase serum calcium level to 9 or 10 Calcium gluconate IV Pentobarbital to decrease neuromuscolar irritability Parathormone may be administered Quiet enviroment; no drafts, bright lights, or sudden movement Diet high in calcium and low in phosphorus Vitamin D
61
Management if Hyperparathyroidism
Parathyroidectomy Hydration therapy ; fluids of 2000 mL or more Maintain mobility Don't restrict calcium
62
Hypercalcemic Crisis
Occurs when extreme elevation of serum calcium levels Results in nuerologic, cardiovascular, and kidney symptoms that can be life threatening Treatment: Rapid rehydration with large volumes of IV isotonic saline fluids , combination of calcitonin and corticosteroids is administered in emergencies to reduce serum calcium level by increasing calcium deposition in bone
63
Nursing interventions for patient w hyperparathyroidism
Maintain adequate cardiac output Improve nutritional status Enhance coping Self esteem Normal body temp
64
Nursing interventions for cushing's syndrome
Maintain cardiac outpiut Decrease infection and injury risk Promote skin integrity Improve body image Improve coping Monitoring and manageing potential complications : Addisonian crisis

Med Surge 1 (12 decks)

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