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Foundations 2 > Unit 3- Endocrine > Flashcards

Unit 3- Endocrine Flashcards

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1
Q

diabetes mellitus

A

•chronic hyperglycemia due to inadequate insulin secretion and/or insulin resistance

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2
Q

Type 1 diabetes

A
  • autoimmune dysfunction involving destruction of beta cells of pancreas
  • inadequate nutrient metabolism
  • (rapid) juvenile onset (hereditary)
  • insulin dependent
  • no interventions to prevent
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3
Q

beta cells

A
  • produce insulin

* in pancreatic islet

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4
Q

s/s of diabetes

A
  • hyperglycemia
  • hyperketonemia
  • polyurea (w/ ketones)
  • polydipsia r/t FVD
  • polyghagia
  • weightloss
  • fatigue/lack of energy
  • frequent infections
  • fruity breath
  • n/v; abd pain
  • hyperventilation
  • LOC
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5
Q

glucose level hyperglycemia

A

> 250 mg/dl

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6
Q

polyureia

A
  • excess urine production and frequency

* due to osmotic diuresis

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7
Q

polydipsia

A
  • excessive thirst due to dehydration
  • loss of skin turgor
  • skin warm and dry
  • dry mucous membranes
  • weakness/malaise
  • hypotension -> rapid weak pulse
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8
Q

polyphagia

A
  • excessive hunger and eating due to inability of cells to receive glucose (starving)
  • many have weight loss
  • ketone accumulation -> met. acidosis
  • kussmaul respirations
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9
Q

kussmaul respirations

A

•increased respiratory rate and depth (hyperventilation) in attempt to excrete CO2 and acid due to met. acidosis

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10
Q

diagnostic criteria for diabetes

A 
*must have 2 findings on separate days
•fasting glucose > 126 mg/dl
•2 hr postprandial > 200 mg/dl
•2 hr oral glucose tolerance test > 200 mg/dl
•random blood glucose > 200 mg/dl
•Hgb A1c > 6.5% ng/dl (target)
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11
Q

impaired fasting glucose (IFG)

A
  • pre-diabetes

* 110-125

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12
Q

oral glucose tolerance test (OGTT)

A

•fasting drawn at start
•pt then consumes certain amnt of glucose
•glucose levels obtained every 30 min for next 2 hrs
*must assess for hypoglycemia throughout

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13
Q

glycosylated hemoglobin (HgbA1c) levels

A
  • 4%-6% in non-diabetic
  • 6%-8.5% in diabetic (<7 target for diabetic)
  • best indicator of avg blood glucose for pat 120 days
  • used to evaluate effectiveness of tx
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14
Q

hypoglycemia

A

•rapid onset of low blood sugar

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15
Q

hypoglycemia etiology

A
  • insufficient food
  • excess exercise
  • excess insulin
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16
Q

s/s hypoglycemia

A 
•anxious/irritable
•diaphoresis 
•hungry
•confused
•blurred/double vision
•shaky
*cool and clammy
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17
Q

hypoglycemia tx

A
  • 15-20 g of readily absorbable carbs (juice, coke, tabs)
  • recheck glucose in 15 min
  • if still not normal, give more juice
  • when normal, give snack w/ protein and complex carb
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18
Q

tx for hypoglycemia in unconscious pt

A

•admin glucagon IM or SQ
•repeat every 10 min and call 911
•don’t force food in mouth
*glucagon when sugar’s gone

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19
Q

A/E glucagon

A
  • n/v
  • hyperglycemia
  • hypokalemia
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20
Q

diabetic sick day

A
  • extra SMBG
  • hydration
  • check urine for ketones
  • more insuline?
  • positive ketone and BS > 300 -> ED
  • monitor temp
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21
Q

rapid acting insulin

A

•Lispro (fastest) and Regular
•matched w/ sliding scal and admin according to SMB
•adjusted to calorie intake
*have food ready (10-30 min onset)

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22
Q

regular insulin

A
  • can mix w/ all insulins

* can be given IV

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23
Q

Lispro insulin

A
  • can only mix w/ NPH, Lente, and ultralente
  • faster than rapid
  • can’t admin IV
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24
Q

short acting insulin

A
  • can be given IV (except U-500)
  • 30-60 minutes before meals
  • can ONLY be mixed with intermediate (NPH)
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25
intermediate insulin
•given between meals and at night •not given before meals •ONLY insulin that can be mixed with short acting **Detemir CANT be mixed w/ any
26
long-acting insulin
* once daily * anytime (same) everyday * absorbed over 24 hr * only SQ; NEVER IV
27
mixing insulin
•draw up clear (short) before cloudy (long)
28
tx for hyperglycemia
* admin insulin as prescribed * keep hydrated * restrict exercise
29
insulin effects to monitor
* glucose levels * drug interactions * skin integrity * neuropathy- sensory alterations (numb) * retinopathy-visual alteration * nephropathy
30
honeymoon
* compensated state diabetic pt may revert to after stressful event * pancreas starts working again temporarily * can last 3-12 months * more beta cells lost -> less insulin
31
Somogyi effect
* hypoglycemia followed by rebound hyperglycemia * If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released, which help reverse the low blood sugar level, but may lead to blood sugar levels that are higher than normal in the morning * tx by dec. intermediate insulin evening dose and having bedtime snack
32
dawn phenomenon
•normal rise in blood sugar as a person's body prepares to wake up •In the early morning hours, hormones (growth hormone, cortisol, and catecholamines) cause the liver to release large amounts of sugar into the bloodstream •For most people, the body produces insulin to control the rise in blood sugar •If the body doesn't produce enough insulin, blood sugar levels can rise *no preceding hypoglycemia
33
type 2 diabetes (NIDDM)
•progressively increasing inability of cells to respond to insulin and decreased production of insulin by beta cells •onset later in life *tx w/ OHAs (20-30% insulin)
34
type 2 diabetes etiology
* sedentary * obese * Hx of HTN * > 50 y/o * genetics * recurrent infections
35
acanthosis nigricans
•velvety, light-brown-to-black markings on neck, axillary, or groin •s/s of insulin resistance *aka: dirty neck syndrome
36
anti-diabetic medications
* tx for NIDDM | * pt MUST have some pancreatic fxn
37
sulfonylureas
* glipizide, glimepiride, glyburide * increase insulin release * increase tissue sensitive to insulin
38
sulfonylurea considerations
* admin 30 min before meals * monitor for hypoglycemia, altered taste, dizziness, drowsiness, weight gain, constipation * avoid etoh
39
biguinides
•metromin HCl •reduces production of glucose by liver (gluconeogenesis) •increases tissue sensitivity to insulin *first med for new type 2
40
biguinide considerations
* take w/ food * don't crush/chew * stop 48 prior to x-ray w/ contrast * need B12/folic supp. * safe for preggo * monitor for GI distress and lactic acidosis (sluggish, myalgia, hypervent)
41
meglitinides
* Repalinide, nateglinide | * stimulate insulin release from pancreas
42
meglitinide considerations
* admin 15-30 min before meal for post meal hyperglycemia * monitor Hgb A1c every 3 months * monitor for hypoglycemia
43
thiazolidinediones (TZDS)
* Pioglitazone * reduces gluconeogenisis * increases tissue sensitivity to insulin
44
TZDS considerations
* take w/ first bite, so can interfere w/ carb absorption * reduces effect of contraceptives * liver fxn every 2 months * monitor for fluid retention, high LDL/triglycerides, GI issues
45
FIT
•exercise guide for diabetics Frequency: 3-4x/week Intensity: 60-80% max HR Time: aerobic 20-30
46
diabetic diet
* high risk for CVD * high fiber * low sat fat/cholesterol
47
s/s diabetic ketoacidosis (DKA)
``` •Kussmaul respirations •thirst/dehydration •tachycardia •BG > 240 mg/dl •hyperkalemia (weak) •polyuria (FVD -> hyPOtension) •fruity breath •n/v •visual disturbances •somnolence (diabetic coma) *seem like under influence of etoh ```
48
DKA tx
•hydration •insulin (regular) IV (0.1 unit bolus) followed by continuous 0.1 kg/hr •electrolyte replacement •monitor K+ and for FV overload •correct pH w/ NaHCO3 *Hi...E (hydration, insulin, electrolytes)
49
potassium levels in acidosis...
•HYPERkalemic
50
why add glucose to IV fluids when serum levels < 250 ng/dl?
* prevent hypoglycemia | * gradually bring back into normal range
51
treating hypokalemia w/ IV K+
•urine output must be at least 50 cc/hr •20 mEq KCl in 1000 mL @ 125 cc/hr *at risk for hypokalemia as blood sugar levels lower
52
when can you discontinue insulin tx for DKA
•blood glucose stable and below 200 ng/mL for at least 24-48 hrs *have to wean off IV infusion/injections
53
hyperglycemic hyperosmolar state (HHS)
* blood sugar levels rise excessively, and your body tries to get rid of the excess sugar by passing it into your urine * You make lots of urine at first, and you have to go to the bathroom more often * Later you may not have to go to the bathroom as often, and your urine becomes very dark * leads to dehydration and absence of ketones -> coma
54
characteristics of HHS
* extreem hyperglycemia (600-2000 mg/dl) * most common in elderly NIDDM * high mortality * no ketosis
55
risk factors for HHS
* dehydration * decreased kidney fxn (BUN > 30) * medical conditions- MI, CVD, sepsis * meds- glucocorticoids, diuretics, phenytoin, propranolol, CCBs * infection/stress
56
major clinical features of HHNK
* thirst * altered LOC * dehydration
57
tx HHNK
* fluid replacement * electrolyte replacement * IV regular insulin (low dose) * dextrose added when glucose at 250 mg/dl
58
rehydration for DKA/HHNK
* isotonic (.9%) followed by hypotonic (.45%) * monitor I/O and weight * listen to lungs/bowel sounds * place N/G tube * oral care
59
why tx HHNK and DKA w/ hypotonic solution
•will cause fld to shift from intravascular to intracellular
60
long term diabetes complications
``` •coronary artery dz •cerebrovascular dz •HTN •peripheral vascular dz •infections (UTI/foot) •retinopathy •nephroapthy •sensorimotor neuropathy •gastroparesis *impacts on small vessels and nerves ```
61
foot infections in diabetic
``` •most common infection •40% require amputation •caused by neuropathy *always wear shoes *foot and nail care important ```
62
if BG > 300 and there are ketones in blood...
•considered medical emergency
63
gastroparesis
•delayed gastric emptying •damage to nerves innervating GI system •complication of diabetes due to damaged vagus nerve when glucose levels too high for long *important to assess bowel sounds
64
difference b/t DKA and HHS
* DKA- type 1 * HHS- type 2 * HHS no ketones, so no need for NaHCO3 * HHS present with much higher glucose level (up to 2000)
65
hypothyroidism
* inadequate amnt of circulating thyroid hormones | * results in decreased metabolic rate
66
s/s hypothyroidism
* hair loss/receding line * apathy/lethargy * dry cool skin * muscle aches/weakness * constipation * cold intolerance * facial/eyelid edema * anorexia * brittle nails/hair * bradycardia * weight gain * thick skin * LOC
67
labs of hypothyroidism
* increased TSH * increased cholesterol * anemia * decreased T4; T3
68
ECG hypothyroidism
* sinus bradycardia | * flat/inverted T waves
69
nursing care hypothyroidism
* monitor CV changes * frequent rest * anti-embolism stockings * low cal; high bulk diet * stool softener * skin care * warm * cough and deep breathe
70
hypothyroidism in elderly
•often undiagnosed b/c mimics aging process | *OA have slow metabolism, so have to be careful when admin sedatives, opioids, and anesthetics
71
hypothyroidism medication
•Levothyroxine (Synthroid)
72
nursing considerations for Synthroid
``` •incr. Warfarin effects •incr. need for insulin/dig •soy dec. absorption •take in AM 1-2 hr before meal •monitor for CV issues/hyperthyroidism *use caution w/ sedatives, opiates, anesthetics ```
73
signs of CV compromise during Synthroid tx
* SOB * chest pain * palpitations
74
signs of hyperthyroidism during Synthroid tx
* irritability * tremors * tachycardia * palpitations * heat intolerance
75
Myxedema
* life-threatening coma and loss of brain fxn * complication of hypothyroidism if left untreated * also can be caused by stressors (infection, HF, CVA, surgery)
76
s/s myxedema
* hypoxia * hypercapnia (not breathing enough) * dec. CO * lethargy/stupor coma * bradycardia * hypotension * hyponatremia
77
RN care myxedema
* maintain airway * ECG monitoring * ABGs * warming blankets * IV Synthroid * hypoglycemia tx * corticosteroids
78
What should nurse teach pt about Synthroid medication
* expected side effects: nervousness, heat tolerance, diarrhea * med shouldn't be discontinued w/o advise of physician * TSH levels should be monitored
79
nurse recognizes that the client’s TSH is a reliable indicator of the efficacy of the levothyroxine Sodium because...
•The TSH will return to its normal reference range when an euthryoid state (normal) is re-established
80
The client who has been taking Synthroid for 3 months. Which condition indicates to the nurse that the drug dosage may need to be adjusted?
•difficulty sleeping
81
Which is the nurse’s MOST IMPORTANT assessment before giving the first dose of levothyroxine (Synthroid)
•measure HR and rhythm
82
normal TSH levels
0.3-5.0 ng/dL
83
normal free T4 levels
4.0-12.0 mcg/dl
84
normal free T3 levels
70-205 ng/dl
85
s/s hyperthyroidism
* heat intolerance * fine/thin hair * moist skin/flushing * bulging eyes * enlarged thyroid * tachycardia * increased BP * weight loss/muscle wasting * finger clubbing * tremors * diarrhea * bruit over gland
86
labs hyperthyroidism
* Serum TSH↓ * ↑ Free T4, T3 * TRH stimulation test = Failure of TSH levels to rise
87
Graves dz
* autoimmune antibodies mimic TSH and lead to hyper secretion of thyroid hormones * most common cause of hyperthyroidism
88
RN interventions hyperthyroidism
* Minimize energy expenditure * Provide High Calorie Diet * Eye Protection for Exopthalmus * Monitor Vital Signs, CV Status, ECG and Temperature * Admin Anti-thyroid Med * Prep for Thyroidectomy or Radioactive Iodine * Monitor Mental Status
89
medications for hyperthyroidism
•Propylthiouracil (PTU) •Methimazole (Tapazole)- stronger •Propranalol (Inderal) *slow down metabolism
90
thyroid med considerations
* AE of leukopenia, thrombocytopenia, hypothyroidism * take w/ meals * report fever, sore throat, bruising (low platelet) * decrease iodine intake
91
thyroidectomy
* surgical removal of part or all of thyroid gland * tx for hyperthyroidism when meds/radiation insuff. * also used to correct goiter/cancer
92
post thyroidectomy hormone fxn
* if subtotal, remaining tissue supplies enough hormone for normal fxn * if total, require hormone replacement for life
93
pre-thyroidectomy RN intervention
* anti-thyroid meds 4-6 weeks prior * iodine 10-14 days prior (dec. gland) * Propranolol
94
post-thyroidectomy RN interventions
* high fowlers * check laryngeal nerves (speak) * pain control * monitor for blood, swelling, redness * stabilize neck * cough/deep breathe * monitor for signs of hyper/hypo * hoarse voice common
95
Propranolol
•opposite of synthroid •treats SNS effects of tachycardia, palpitations •important to monitor HR and BP *check apical pulse prior to admin
96
if pt develops stridor/obstruction s/s after thyroidectomy...
* notify rapid response team | * make sure O2/suction at bedside
97
dangerous AEs post-thyroidectomy
•hypocalcemia •tetany •s/s of muscle tingling *due to possible parathyroid removal
98
thyroid storm
* sudden surge of large amnts of thyroid hormones into bloodstream * drastic increase in metabolism * high mortality rate
99
thyroid storm etiology
``` •infection •trauma •emotional stress •DKA •thyroidectomy complications *anything that puts high demands on metabolism ```
100
thyroid storm s/s
* hyperthermia * hypertension * delirium * N/V * abd pain * hyperglycemia * tachycardia/palpitations * chest pain * dyspnea
101
RN interventions thyroid storm
* patent airway/O2 * Cardiac Monitoring * Acetominophen * ool pt * PTU/Propranolol * IV flds * admin insulin * monitor for hypocalcemia
102
goiter
* occurs in both hypo/hyper thyroid | * due to overproduction of thyroid hormone
103
goiter classification
* 0- none * 1- not visible; palpable when swallow * 2- visible; easily palpable
104
A nurse is assessing a client who is 12 hours post-op following a thyroidectomy. What findings are indicative of thyroid crisis?
* tremors * abd pain * mental confusion
105
A nurse if reviewing the clinical manifestations of hyperthyroidism with a client. What findings should the nurse include?
* heat intolerance * palpitations * weight loss
106
The client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next?
* encourage the pt to rest * pt with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior * accept the client's behavior, and provide a calm, quiet, and comfortable environment
107
The nurse reviews the vital signs of the client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next?
•assess cardiac system completely

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