Week 10: Metabolic & Endocrine Disorders Flashcards

Question

Thyroid Disorder: Goitre

Answer 1

-Abnormal growth of thyroid gland -Manifestation of thyroid disorders

Answer 2

-Viral, bacterial or fungal infection -Autoimmune (Hashimoto’s)

Answer 3

-↑ thyroid hormone -Grave's disease

Answer 4

-↓ thyroid hormone -Tx with Synthroid

Answer 5

Acute: -thyroid gland is tender & enlarged -Neck pain & fatigue Chronic Autoimmune: -Hashimoto’s thyroiditis -Most common in women -Can lead to hypothyroidism and goitre Treatment: -Depends on type -Salicylates & NSAIDs -corticosteroids

Answer 6

Autoimmune disease of unknown etiology marked by diffuse thyroid enlargement and excessive thyroid hormone secretion -Thyrotoxicosis Signs & Symptoms -Heat intolerance & excessive sweating -Tachycardia -Weight loss -Tremors -Goitre -Exophthalmos Exophthalmos Impaired venous drainage Increased fat deposits & edema behind the eyeball Eyeballs are forced outward & protrude

Answer 7

Goal is to block the adverse effects of thyroid hormones and stop their oversecretion Diagnostics: -Bloodwork -TSH levels * free T4 -24h radioactive iodine uptake (RAIU) test Therapies: -Radioactive iodine -Subtotal thyroidectomy – 90% -Nutritional: frequent, high- calorie, high- protein Medication: -Antithyroid -Tapazole -Propyl-Thyracil -Iodine -Inderal

Answer 8

Indicated When: -A large goitre causes tracheal compression -Condition does not respond to antithyroid therapy -The pt has thyroid cancer Post OP: monitor q2h x 24h -Hemorrhage or tracheal compression -Vital signs -Signs of hypocalcemia & tetany -Check for Trousseau’s & Chvostek’s signs x72h -Pain and nausea control Hypocalcemia is a major post-op complication r/t 2o hypo- parathyroidism following damage to one or more parathyroid glands during surgery.

Answer 9

High serum levels of TSH and insufficient free circulating T4 hormone Causes: -Iodine deficiency (worldwide) -Canada: atrophy of thyroid gland -Hashimoto’s, Graves’ -Thyroidectomy -Radioactive iodine therapy

Answer 10

-Insidious and nonspecific slowing of body processes -Neurological, cardiovascular, GI, reproductive, & hematological systems -Fatigued & lethargic -↓ cardiac output * SOB -Anemia -Personality & mental changes -Impaired memory -Slowed speech -↓ initiative & somnolence; may appear depressed -↓ GI motility & constipation -Myxedema -Menorrhagia

Answer 11

Goal is restoration of normal thyroid function as safely & rapidly as possible with hormone replacement therapy Diagnostics -Blood Work -TSH levels -free T4 -Cholesterol -Triglycerides -Anemia Therapies -Monitor thyroid hormone levels -Nutritional: promote weight loss -Pt & caregiver teaching -Thyroid hormone replacement Medication -Levothyroxine (Synthroid): lifelong Most individuals with hypothyroidism do not require acute nursing care. Myxedema coma does require acute nursing care, often in a critical care setting. Mortality 30-50% With treatment, striking transformations occur in both appearance & mental function. In most adults, both return to normal.

Answer 12

Over Secretion of parathyroid hormone (PTH): -osteoclast activity Ca2+ leached from bones: -↓ Bone density Hypercalcemia & hypophosphatemia: -Renal calculi -Tx goal: relieve the symptoms & prevent complications caused by excessive PTH -Parathyroidectomy – partial or complete via endoscopy (outpatient) -Autotransplantation in forearm -Tetany r/t sudden ↓ in Ca2+ -Unpleasant tingling sensation of the hands and around the mouth -Monitor I&O -Assess Chvostek’s & Trousseau’s signs -Encourage mobility to promote bone calcification

Answer 13

-A metabolic disorder that occurs when the body makes too much cortisol over a long period ~85% of cases result from an ACTH-secreting Most common among pituitary tumour -Most common among women aged 20-40

Answer 14

-Truncal or general obesity -Moon face with facial swelling & redness -Purplish red striae on the abdomen, the breasts, or the buttocks -Hirsutism in women -Amenorrhea, erectile dysfunction, ↓ libido -Hypertension -Unexplained hypokalemia

Answer 15

Tx goal: normalize hormone secretion * If pituitary tumour: surgical removal * If adrenal tumour: bilateral laparoscopic adrenalectomy -Nursing care -VS, daily wt, glucose level -Pre-op & post-op care -↑ risk for hemorrhage -Fluid & electrolyte balance

Answer 16

-Mitotane (Lysodren) -Ketoconazole

Answer 17

Adrenocortical insufficiency: -Glucocorticoids/ Mineralocorticoids/ Androgens Most often among patients < 60 years ↑ antibodies that destroy adrenal tissue Treatment: -Replacement therapy with hydrocortisone -Increased salt in the diet S&S not usually evident until 90% of adrenal cortex is destroyed (very slow onset): -Progressive weakness; fatigue -Wt loss; anorexia -Skin hyperpigmentation over joints Hypotension -Hyponatremia -Hyperkalemia -N&V -Diarrhea -Irritability -Depression

Answer 18

Adrenal Crisis -Refers to acute adrenal insufficiency, a life-threatening emergency caused by insufficient adrenocortical hormones Triggered By: -Stress: infection, surgery, trauma, hemorrhage, or psychological distress -Sudden withdrawal of corticosteroid hormone therapy -Adrenal surgery; or sudden pituitary gland destruction -Hypotension: shock: circulatory collapse Collaborative Care: -Tx focused on shock mgmt, and high-dose IV hydrocortisone replacement -IV 0.9% NS

Answer 19

-11.7 million Canadians are currently living with diabetes or prediabetes -Approximately 65% to 80% of people with DM will die as a result of heart disease or stroke -DM is a contributing factor in the deaths of approximately 41,500 Canadians each year -Adults with DM are twice as likely to die prematurely as people without DM

Answer 20

- Diabetes mellitus is primarily a disorder of glucose metabolism The body either can’t: * produce insulin, * or properly use the insulin it produces Most common endocrine-system disorder -In diabetes, sugar cannot move into the cells: sugar level increases in blood Two Types: Type 1 / 2 Other Types: gestational / prediabetes

Answer 21

-Autoimmune disease: body attacks the pancreas with antibodies; not preventable -Develops in childhood – young adulthood; <30yrs -10% of clients with diabetes have Type 1 -The pancreas is left damaged and does not make insulin -Without the insulin “keys” for the cell receptors, glucose is unable to enter the “doors” into the cell -Without glucose, cells are starved for energy and cannot perform their functions -Meanwhile, glucose levels rise in the blood: severe hyperglycemia

Answer 22

Sudden onset: within weeks -Increased thirst -Increased urination -Increased hunger -Blurred vision -Tiredness/fatigue -Unexplained weight loss Manifestations of type 1 DM develop when the person's pancreas can no longer produce insulin The patient presents to the ER with ketoacidosis (LIFE THREATENING CONDITION)

Answer 23

Insulin injections/pumps -replace insulin not produced by the pancreas Blood Glucose Monitoring -to keep blood glucose within target range -pumps do this automatically

Answer 24

-Body can’t produce enough insulin or is unable to use what it produces effectively -Develops in adulthood; >30yrs -Most common form of diabetes: 90% of clients with diabetes -With fewer insulin “keys” for the cell receptors, glucose is less able to enter the “doors” into the cell -With less glucose, cells receive less energy and their performance is compromised -Meanwhile, glucose levels rise in the blood: hyperglycemia

Answer 25

-Age 30+ -Overweight: poor diet -Family history -Inactivity -History of gestational diabetes

Answer 26

Slow Onset: over many years -Increased thirst -Increased urination -Increased hunger -Blurred vision -Tiredness/fatigue -Numbness, tingling in hands, feet -Sores/wounds that take longer to heal -Weight changes

Answer 27

-Healthy eating -Reducing weight -Exercise -Monitor blood glucose -Medication: may include pills and/or insulin injections

Answer 28

-Individuals already at risk for diabetes and, if no preventive measures are taken, the condition usually will develop within 10 years -Blood glucose high but not high enough to be diagnosed as having diabetes (6.1–6.9 mmol/L) -Long-term damage already occurring – heart, blood vessels -Usually present with no symptoms

Answer 29

-Develops during pregnancy: detected at 24–28 weeks of gestation -Usually back to normal glucose levels at 6 weeks postpartum -Increased risk for developing Type 2 in 5–10 years -Therapy: first nutritional, then insulin if needed

Answer 30

FOUR METHODS OF DIAGNOSIS Glycated hemoglobin (A1C): ≥ 6.5% determining glycemic levels over time (3-4mos) Fasting plasma glucose (FPG) level ≥7mmol/L Random plasma glucose (RPG) ≥11.1mmol/L Two-hour oral glucose tolerance test (OGTT) ≥11.1mmol/L

Answer 31

Goals of Diabetes Management: -Promote well being -Decrease symptoms -Prevent acute complications of hypo- & hyperglycemia -Delay onset & progression of long-term complications

Answer 32

Insulin is inactivated by gastric juices, it cannot be taken orally Exogenous (injected) Insulin: -Insulin from an outside source -Required for type 1 diabetes - Prescribed for client with type 2 diabetes who cannot control blood glucose by other means

Answer 33

Human Insulin- the only type used today -Different types of insulin may be used for combination therapy Types differ with regard to onset, peak action, and duration: -Rapid-acting -Short-acting -Intermediate-acting -Extended long-acting

Answer 34

Administer S/C: -Fastest absorption from abdomen (preferred site), followed by arm, thigh, & buttock -Rotate injections within one particular site Injection Site -The use of an alcohol swab on the site before self- injection is no longer recommended -Hand washing with soap adequate Insulin Pens -preloaded with insulin -provide consistent & accurate dosing -portable & compact, more discreet

Answer 35

-Continuous subcutaneous infusion of rapid- acting insulin -Battery-operated device that holds & delivers insulin -Connected to a catheter inserted into S/C tissue in abdominal wall -User programs the pump to deliver a bolus of insulin during mealtimes ADVANTAGES: -Reduction of hypoglycemic episodes -Allows for more normal lifestyle DISADVANTAGES: -infection at the insertion site -increased risk for Somogyi effect -cost of the pump & supplies

Answer 36

Somogyi effect: rebound effect in which too much insulin causes hypoglycemia -During hours of sleep, too much insulin -Blood glucose drops -Counter- regulatory hormones released to increase blood glucose -Rebound hyperglycemia and ketosis may occur Dawn phenomenon: hyperglycemia present on awakening in the morning -Growth hormone and/or cortisol possible factors -Release of counterregulatory hormones during predawn hours -Hyperglycemia

Answer 37

NOT INSULIN -Work to improve mechanisms by which insulin & glucose are produced and used by the body -Work on three defects of types 2 diabetes: -Insulin resistance -Decreased insulin production -Increased hepatic glucose production

Answer 38

Glyburide Repaglinide: -Stimulates insulin release from pancreas Metformin: -Inhibits glucose production in liver Acarbose: -Delays absorption of glucose in GI tract Pioglitazone: -Increases glucose uptake in muscle & fat

Answer 39

Cornerstone of care for person with diabetes & the most challenging for many people. Best to involve the Diabetic Nurse Educator & Registered Dietitian GOAL: Diet & nutritional energy intake balanced with energy output TYPE 1: -Meal plan is based on individual’s usual food intake and is balanced with insulin & exercise patterns -Insulin regimen is managed day to day TYPE 2: -Emphasis is based on achieving glucose, lipid, and blood pressure goals - Calorie reduction: weight loss is recommended for the overweight & obese

Answer 40

Diet Teaching (Canada's Food Guide) Exercise (regular, consistent physical activity) Monitoring Blood Glucose: -Self-monitoring of blood glucose (SMBG) -Use edges of fingers vs pads -Continuous glucose monitoring -Periphery, around the edges of the fat pad

Answer 41

Nursing Diagnoses: -Ineffective health management -Risk for injury -Risk for unstable blood glucose levels -Risk for peripheral neurovascular dysfunction Goals: -Active client participation -Few or no episodes of acute hyperglycemic emergencies or hypoglycemia -Maintain normal blood glucose levels

Answer 42

It is important for the health care provider to be able to distinguish between hyperglycemia and hypoglycemia because hypoglycemia worsens rapidly and constitutes a serious threat if action is not immediately taken

Answer 43

An acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin. It is caused by a profound deficiency of insulin and is characterized by: -Hyperglycemia -Ketosis -Acidosis -Dehydration

Answer 44

-Illness/Infection -Inadequate insulin dosage -Most likely occurs in type 1 -Poor self management

Answer 45

-Polyuria, polydipsia: S&S of dehydration -Lethargy & weakness -Abdominal pain -N&V -Kussmaul’s respirations -Rapid deep breathing in attempt to reverse metabolic acidosis -Sweet fruity breath due to acetone

Answer 46

Treatment: SERIOUS CONDITION -Must be treated promptly -May or may not need hospitalization -If fluid & electrolyte imbalances are not severe and blood glucose levels can be safely monitored at home

Answer 47

Ensure Patent Airway: -O2 administration FLUID RESUSCITATION: -IV fluids until BP is stabilized and urine output (>30-60 ml/h) -IV potassium for hypokalemia -IV sodium bicarbonate if severe acidosis -IV regular insulin drip to allow water & potassium to enter the cell along with glucose MONITOR: -Breath sounds for fluid overload -Serum glucose & potassium, and pH -LOC -Vital signs, cardiac rhythm -O2 sats -Urine output

Answer 48

-Low blood glucose occurs when there is too much insulin in proportion to available glucose in the blood -This causes the blood glucose level to drop to less than 4 mmol/L -Once plasma glucose drops to this level, neuroendocrine hormones are released and the autonomic nervous system is activated

Answer 49

-Symptoms may occur when a very high blood glucose level falls too rapidly -Can usually be quickly reversed with effective and rapid treatment -Treated by ingesting 15-20g of a simple (fast-acting) carbohydrate such as: 1.) 3-4 glucose tablets 2.) 175 ml of fruit juice or regular pop 3.) 6 Life Savers candies

Answer 50

-Are primarily those of end-organ disease that result from damage to the large and small blood vessels (angiopathy) secondary to chronic hyperglycemia -Angiopathy (blood vessel disease) accounts for the majority of deaths among patients with diabetes -These chronic blood vessel dysfunctions are divided into two categories: a.) macrovascular complications, and, b.) microvascular complications

Answer 51

-Diseases of large & medium-sized blood vessels -Dyslipidemia in contributing to greater risk of cardiovascular disease in clients with diabetes -atherosclerosis -Tight glucose control may delay atherosclerotic process

Answer 52

-Thickening of vessel membranes in capillaries & arterioles -Clinical manifestations usually appear after 10–20 years of diabetes -Areas most noticeably affected * Eyes – retinopathy * Kidneys – nephropathy * Nerves – neuropathy * Skin – dermopathy

Answer 53

-microvascular damage to retina -Reduced vision, -May result in retinal detachment, potentially leading to blindness

Answer 54

-microvascular damage to the small blood vessels that supply the glomeruli of the kidney -Leading cause of end- stage renal disease