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Nursing 3910 > Week 4: Endocrine Balance > Flashcards

Week 4: Endocrine Balance Flashcards

1
Q

Islets of Langerhans

A

where insulin is produced in the pancreas

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2
Q

blood glucose homeostasis

A

Normal Eating > secrete insulin > glucose moves from blood into cells (muscle, liver adipose)

Normal Fasting > basal insulin release AND/OR when BG low glucagon is released > liver secretes glucose

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3
Q

what is diabetes?

A

insulin excretion/use is disrupted, glucose isn’t broken down into useable states

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4
Q

types of diabetes

A

type 1
type 2
gestational
diabetes associated with conditions and syndromes

pancreas issues or corticosteroids

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5
Q

Type 1 diabetes

A

complete lack of insulin

autoimmune condition or genetics

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6
Q

S&S of Type 1 diabetes prior to diagnosis

A

Polyuria, polydipsia, polyphagia & weight loss

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7
Q

complication in type 1 diabetes

A

hyperglycemia- Diabetic keto acidosis
hypoglycemia

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8
Q

Type 2 diabetes

A

insulin resistance

risks: Metabolic Syndrome (hypertension, obesity, hyperglycemia, high LDLs and low HDLs)

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9
Q

medications for diabetes

A

type 1: insulin dependent for life
type 2: oral antihyperglycemic agents or insulin

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10
Q

symptoms of diabetes

A

Result of: hyperglycemia, glucose excreted by kidneys, fluid/protein follow by osmosis = fluid volume deficit

neuro-cognitive (dizziness, confusion), weight, polydipsia, hungry, polyuria

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11
Q

complications of diabetes

A

Atherosclerosis (glucose damages blood vessels)
Poor perfusion
Damage to many body systems (ocular, cardiac, renal, integumentary, vascular, immune)

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12
Q

ocular complications

A

damage to micro-vessels in eye = blindness, blurred vision

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13
Q

cardiac complications

A

atherosclerosis = increased risk or MI, coronary artery disease, stroke, hypertension

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14
Q

renal complications

A

Damage to nephrons =increased risk of CKD

Neuropathy in bladder
=neurogenic bladder, UTI

50% of people with kidney disorders have a diabetes diagnosis – the kidneys are exposed to increased glucose

Neurogenic bladder – the nervous system that tells you to urinate can become unresponsive

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15
Q

vascular complications

A

Peripheral Vascular Disease
Peripheral Neuropathy =poor wound healing, numbness in feet/hands, falls risk, mobility

**foot ulcers

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16
Q

immune system complication

A

Impaired perfusion limits ability for immune cells to reach sites of
infection

High blood glucose is a breeding ground for infection

Decreased neutrophil synthesis

Risk for septic shock (compensatory = normal BP, tachycardia,
tachypnea, pale skin)

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17
Q

integumentary complications

A

impaired wound healing
impaired immunity

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18
Q

HBA1C

A

Hemoglobin A1c
Amount of glucose attached to Hb (glycated hemoglobin)

Reflects the average serum glucose level over the previous 2 to 3 months

higher the HBA1C = poorer control of diabetes

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19
Q

Causes of hypoglycemia

A

Too much insulin or oral antihyperglycemic agents

Inadequate food intake

Excessive physical activity

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20
Q

Hypoglycemia

A

Development of autonomic & neuroglycopenic symptoms

Low plasma glucose (< 4.0 mmol/L)

Symptoms that respond to CHO administration

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21
Q

S&S hypoglycemia (most common)

A

Autonomic (neurogenic): Trembling
Sweating
Anxiety
Nausea

Neuroglycopenic:
Poor concentration
Confusion (ofen first sign in older adults)

22
Q

hypoglycemia - mild

A

autonomic symptoms, able to self-treat

23
Q

hypoglycemia - moderate

A

autonomic & neuroglycopenic, able to self-treat

24
Q

hypoglycemia - severe

A

autonomic & neuroglycopenic, BG under 2.8, requires support,
unconsciousness may occur

25
hypoglycemia treatment - mild/moderate
Treat and then notify provider Mild – Moderate: Oral ingestion of 15 g carbohydrate Glucose or sucrose tablets/solution (preferable) OR juice (~ 175 mL) Retest BG in 15 minutes and monitor closely Re-treat with another 15 g carbohydrate if the BG level remains <4.0 mmol/L, according to protocol
26
hypoglycemia treatment: severe conscious
Severe (Conscious): Oral ingestion of 20 g carbohydrate Glucose or sucrose tablets/solution (preferable) OR juice (~ 250 mL) Retest BG in 15 minutes and monitor closely Re-treat with if the BG level remains <4.0 mmol/L, according to protocol
27
hypoglycemia treatment: severe unconscious
Severe (Unconscious): IV Access IV Push 20–50 mL of D50W over 1 – 3 minutes No IV Access SC/IM Glugagon 1 mg **If the patient is not permitted to eat anything – going to go the IV access route
28
hypoglycemia recovery
BG rises above 4.0 Monitor closely (maintaining proper BG levels) When in hypoglycemia, the body releases adrenaline, which causes the rapid uptake of K into cells Eat usual meal/additional snack Find the underlying factor
29
hypoglycemia electrolytes
Hypoglycemia has close relationship with hypokalemia: when in hypo body releases adrenaline, adrenaline causes rapid uptake of K into cells
30
causes of Hyperglycemia
T1D - not enough insulin T2D - lack of effective stimulation (insulin resistance)
31
diabetic hyperglycemia emergency
type 1 - BG greater (>) than 13.9 mmol/ L = diabetic keto acidosis type 2 - BG greater (>) than 33 mmol/L = hyperglycemis hyperosmolar syndrome
32
S&S Hyperglycemia
Early Signs: tiredness, polurea, dehydration, polydipsia
33
health teachings for diabetes
- T1D – insulin administration - T2D – diet Diabetic diet Avoid low simple sugar (pop, juice, candy, white bread, white rice, pasta, French fries) Include healthy fats (peanut butter, whole milk), high fiber CHOs (beans, brown bread, whole grains), eat a bedtime snack - Medication regimen - BG monitoring - Adjusting regimen - Sick day management
34
pharmacological treatments
- insulin, insulin subcut, insulin pump, oral meds - rapid (aspart, lispro, humalog), short acting (toronto, novolin), intermediate, long acting, imsulin pump, oral meds Type 2 starts with oral medications – if doesn’t work then they will supplement with insulin Type 2 diabetics cells are resistant to insulin – so their doses will be far different because they need more insulin to try and get a response
35
Insulin basics: administration
Check BG prior to administration BG < 4.0 then give CHO Administer based on Sliding Scale Food should be given during the peak of the insulin Do not mix long acting and other types of insulin Draw up Regular insulin (clear) first and then NPH insulin (cloudy) S/C Injections
36
Rapid (Aspart, Lispro, Humalog)
Onset: 15 minutes, peak = 30-90 minutes Duration: 3-4 hours Indication: rapid BG decrease (postprandial, hyperglycemia)
37
Short acting (Regular) (Toronto, Novolin R)
only insulin that can be given through IV* Onset: 2-3 hours Duration: 4-6 hours Indication: 20-30 minutes before meal
38
Intermediate (NPH, Humulin N, Novolin N)
Peak: 4-12 hours Duration: 16-20 hours Indication: post meal
39
Long acting (Detemir, Glargine (Lantis)
Peak: NO PEAK Duration: Over 24 hours Indication: basal dose (do not mix)
40
Insulin Pump
Insulin is delivered continuously and in customized doses of rapid-acting insulin 24 hours a day
41
Oral medications (antihyperglycemics)
ONLY for T2D Try diet and exercise first AVOID: Iron, Ca and things that contain Ca, like antacids and dietary sources high in Ca.  impaired absorption
42
Metformin
Pharmacologic class: Biquanides Action: treat hyperglycemia, lower BG Side effects: stomach pain, GI upset, gas, bloating, NVD, constipation (may subside within a few weeks) Nursing considerations: Monitor BG (risk of hypoglycemia) Potentially hepatotoxic Do not give in eGFR under 30 (poor kidney function, cleared by the kidneys) Hold before contrast dye
43
Glyburide
Action: treat hyperglycemia, lower BG Side effects: GI upset, skin reactions (use sunscreen), weight gain Cautions: for heart failure/MI history Nursing considerations: Monitor BG (hypoglycemia) Avoid alcohol (increases risk of hypoglycemia)
44
Rosiglitazone (Avandia), Pioglitazone
Action: treat hyperglycemia, lower BG Side effects: weight gain, edema, macular edema, heart failure Caution: for heart failure/MI history Nursing considerations: Monitor BG (HIGH risk of hypoglycemia) Hepatotoxic (monitor ALT and AST) Associated with increased risk of bladder cancer of genetic origin
45
Acarbose
Action: treat hyperglycemia, lower BG Side effects: gas, diarrhea, bloating, stomach pain, GI upset, NV Caution: for heart failure/MI history Nursing considerations: Monitor BG (risk of hypoglycemia) Avoid in clients with GI issues (ie. IBS, Chrohn’s)
46
Sliding Scale
Combine insulins of different durations e.g. short + long acting Goal: mimic the normal insulin secretion pattern i.e. increases with food Sliding Scales: - Approximate daily insulin requirements - Progressive increase in AC meal or HS insulin dose - Based on predefined blood glucose ranges - Client administered dose based on BG level RISK = HYPOglycemia
47
Key points for Subcutaneous Insulin Administration
Check BG prior to administration Under 4.0 = give CHO Administer based on sliding scale Food should be given during the peak of insulin Do not mix long acting and other types of insulin (do not have a peak) Draw up regular insulin (clear) first, and then NPH insulin (cloudy)
48
Hypothyroidism
too little hormone LOW & SLOW o Cold intolerance o Decreased sweating o Weight gain o Constipation o Depression and irritability o Irregular and heavy periods o Slow heart rate o Brittle nail o Muscle/jointpain o Puffyface
49
Hyperthyroidism
too much hormone HIGH & HOT o Weight loss or gain o Short and light periods o Increased sweating o Nail thickening and flaking o Puffy/bulging eyes o Heatintolerance o Nervousness and anxiety o Racing heart o Muscle weakness o Diarrhea
50
Levothyroxine (Synthroid)
Hypothyroidism medication Side effects: fever/hot flashes, sweating, nervousness, irritability, NVD, headache, insomnia o Nursing considerations:  Monitor toxicity  Risk of hyperthyroidism  Tachycardia, chest pain, palpations  Take in morning without food  Avoid calcium and iron – impacts absorption  Avoid fluctuations in thyroid levels
51
Iodine
Hyperthyroidism medication acts to destroy thyroid hormone in the body
52

Nursing 3910 (12 decks)

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