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What are the thyroid hormones? T3, T4, Calcitonin
What does Calcitonin do ? Moves calcium out of blood and back to bone. Decreases serum calcium.
What is needed to make hormones ? Iodine
What is the thyroids role in the human body? Gives us energy.
What is Graves Disease? Hyperthyroidism
Hyperthyroidism S&S Feel anxious, nervous, hot, sweaty, decreased attention span, irritable GI fast, increased appetite, weightloss enlarged gland, exophthalmos
Hyperthyroidism Dx, and instructions. Blood test --> Increased serum T4 Thyroid Scan --> stop taking iodine medications 1 week prior to scan.
What are anti thyroids, what do they do, when can they be given ? PTU ( propylthiouracil), Methimazole ( Tapazole) - stop making thyroid hormones. Can be given pre op to stunt growth.
What are the iodine compounds, actions, and teaching points ? K+ iodine ( SKKI), and Strong iodine Solution ( Lugol's Solution) Decrease Vascularity of the thyroid gland Give with milk, juice, and with a straw
Hyperthyroidism and beta blockers Propanolol ( inderal) --> decrease Anxiety Decrease myocardial contractility, CO, HR, BP
Radioactive Iodine, route, action, safety instructions, expected outcome. Kills thyroid cells--> hypothyroidism Give PO -> solution or tablet Dont Kiss Anyone for 24 Hours, Stay away from babies for 24 hours!
Thyroid Storm ( thyroidtoxicosis, thyrotoxic storm) Rebound effect from radioactive iodine, hyperthyroidism X 100 --> Badddd
Thyroidectomy ( partial or complex) post op, positioning, nutrition assessment, teach. what needs to be at bedside ? For hyperthyroidism, support neck, keep personal items close HOB elevated decrease swelling, Check for bleeding behind neck Increase calories before and after surgery
Thyroidectomy teach ? what needs to be at bedside any why ? Teach to report pressure Assess laryngeal nerve damage - hoarseness, weak voice obstruct airway Trach - for swelling, laryngeal nerve damage, hypocalcemia
Exohpthalamus Care Hypoallergenic tape to shut eyelids--> prevent injury, irriation Eye drops -> artificial tears Sunglasses-> photosensitivity
What is Myxedema? Hypothyroidism
Myxedema S&S No energy Fatigue GI upset, Weight Gain Cold intolerance Slow speech, No expression
Hypothyroidism treatments and action short term ? Synthroid -levothyroxine Proloid- Thyroglobulin Cytomel- Liothyronine
Whats does the parathyroid secrete? Parathormone ( PTH) hormone Takes Ca from bone and puts in blood = increased serum Ca
Hyperparathyroidism Treatments Too much PTH Hypercalcemia, Hypophospotemia Patirial parathyroidectomy
Hypoparathyroidism Treatments Too Little Hypocalcemia, Hyperphospotemia IV Calcium --> Heart monitor Phosphate Binders- Sevelemar hydrochloride, Calcium Acetate
Adrenal Glands help us ? Deal with stress
What are the two parts of the adrenal glands ? What are there functions ? Adrenal cortex --> Salt, Sugar, Sex Adrenal Medula -> epi and norepinephrine
Pheochromocytoma S&S Dx Tx Tumor on adrenal gland secretes epi and nor eli High BP, P, Flushing, and Diaphoretic Vanillymandelic Acid test ( VMA) avoid vanilla 1 week 24 hour urine test looking for increased eli or norepi throw out first void, keep rest Surgery remove tumors
Adrenal Cortex steroids ? mineral0corticoids, glucocorticoids, sex hormones
Mineralocorticoids too much, too little Aldosterone -> Retain Na, H20 secrete K too much -> FVE, Hypokalemia too little, FVD, hyperkalemia
Glucocorticoids Mood changes - mean depressed, insomnia,psychotic, euphoric Insulin inhibited -->Hyperglycemia-> finger sticks Altered defense mechanisms--> immunosuppressed--> infection Break down Fats and Proteins
Sex Hormones Oil skin Female with male traits Poor libido
What is Addison's Disease ? Not enough steroids, sugar, salt, sex.
Addison's S&S Lack aldosterone -->Lose Na and H20, Retian K Hypotension hyperkalemia = muscle symptoms, arrhythmia Hypoglycemic Anorexia. Nausea, GI Upset, Decreased Bowel sounds Hyperpigmentation -> bronzing of skin Vitiligo= white patchy depigmented
Addison's Nursing Dx and Treatments and Drug * Crisis symptoms Combat shock, increase BP, Increase Na, Water Na-> processed fruit juice, broth I&O daily weights Fludrocortisone- aldostone * monitor daily weight 2-3 lbs up or down ok Severe hypotension and vascular collapse
What is Cushings Disease and Signs and Symptoms To much steroid Sugar thin extremitie, growth stunt, hyperglycemia, infectio truncal obesity, buffalo hump, moon face, psychosis, depression Salt Retain Na, H2o, Hypokalemia, CHF, HTN, Weight gain, FVE Sex poor libido, oily skin, female w/ mail traits
24 hour urine on Addison's patient vs Cushings. Cushings = Cortisol high Addisons = Cortisol low
Pre treatment, what will be in their urine and Tx for Cushing's Adrenalectomy ( unilateral or bilateral) lifetime replacement steroids Quiet environment -> can't deal with stress avoid infection Urine- ketones (lypolysis), sugar Pre treatment low Na, low H20, increase K. increase protein ,increase Ca
Why do we increase Ca in Cushing's patient ? Steriods cause secretion through GI tract
Type 1 Diabetes insulin, idiopathic vs, autoimmune, age, first sign, occurrence No insulin or little to none, Type 1A vs Type 1B, Young, DKA, Abrubt
Type I S&S and why ? treatment Polyuria --> too much glucose in blood, kidneys diurese Polydypsia--> Kindeys diurese = Thirsty Polyphagia--> Cells not getting glucose hungry so break down fat = ketones = DKA - Metabolic Acidosis Insulin for life
Type II Diabetes insulin, onset, body characteristics, what is metabolic syndrome? Insulin not enough , or not good, Overweight, Not abrupt, Metabolic Syndrome - hyperlipidemia - increase tryglycerides,decrease hdl, hyperglycemia -> insulin resistance, heart disease -> CAD, HTN, abdominal obesity -> over 40inches
Type 2 Diabetes treatments Diet/ Excersise/ Oral Hypoglycemics, Insulin
Gestational Diabetes screenings, treatments, complication to baby? like type 2 mom needs 2-3 times more insulin screen at 24 weeks or 1st visit if risk factors big baby, hypoglycemic
Diet for Type 1 and Type 2 Diabetics complex carbs, fats, proteins ( 10-20%) at risk renal disease High Fiber - > decrease glucose absobtion helps with peak/ fall may need to decrease insulin
Why are diabetics at risk for CAD, renal disease, Retinopathy? Sugar destroys vessels.
When should a diabetic excersise, do before excersise-> why, routine ? When blood sugar is normal. Eat b/c excersie drops BS, Same amount, and time daily.
Who takes Oral Hypoglycemics ? What are they ? What do they do ? Type 2 diabteic Glibizide, Metformin, Pioglitazone, Sitagliptin Some stimulate pancreas to secrete insulin, some inhibit liver from gluconeogenesis, and some increase sugar receptors in tissue.
How is insulin dose determined? body weight. 0.4-1.0 units/kg daily
How do we know if the insulin dose is sufficient? No more ketones or sugar in urine
Rapid acting Insulin Aspart Novolog, Lispro (Humalog) Glulisine (Apidra) * administer with meals * carb needs to be available Onset 5-15 min Peak 1-3 hours Duration 3-5 hours * Monitor hyoglycemia, hypokalemia, lipodystophy * May be given short term IV with close monitor
Short Acting ( Regular) Humilin R, Novolin R - have Carb available Onset 30 mins - hour, Peak 2-4 hours, Duration 6-8 Hours * used for patients on sliding scale * Adminsiter IVP of Cont. Infusion * Monitor for low sugar, low K, lipidostrophy
Intermediate Acting ( NPH) NPH, Humulin N, Novilin N- have carb available Onset 1- 1.5 hours, Peak 6- 12 hours, Duration 18-24 hours Cloudy, mixed with Regular monitor for hypoglycemia, hypokalemia, lypidostrophy
Long Acting Glargine ( Lantus)-> carb available Onset 2-4 hours, No peak-> insulin steady, Duratioin 24 hours Once daily Subq - *monitor for hypoglycemia, hypokalemia, lipidostrophy *Never mix with other inulin
Pre Mixed Insulin Humulin 70/30, NovoLog Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50, * Intermediate Acting Insulin combined with either Rapid Acting or Short Acting (Regular) Insulin. * All provide 24 hour duration. * Monitor for hypoglycemia, hypokalemia, lipodystrophy. * Always have oral carbohydrate available.
What is the only insulin that can be given IV Regular - short acting
What is basal/bolus insulin dosing? Do they need snacks ? Pateint receives a basal dose of a long acting insulin and bolus dose of rapid acting insulin before meals to cover food eaten.
HbA1c Blood test monitors 3 months glucose levels 4-6% best 6.5 -> diabetic
What effect does stress, illness, have on blood sugar ? Increases it
How do you rotate sites with insulin injections Rotate within site first then go to new site
Insulin Infusion pumps alternative to daily dosing only rapid acting better control -> gives basal dose then boluses with meals and increase bs
What causes DKA ? S&S Treatment Illness, stress, Not enough insulin. Polyuria, Polydipsia, Polyphagia--> Fat breakdown- > Ketones-> Metabolic Acidosis --> Kussmaul's respiration --> blow of CO2 --> decrease LOC
Treatments for DKA Find the cause, hourly K and blood glucose levels Insulin -> decreases BS and K --> puts into cell ECG , Hourly output, ABG IVF's NS first, Glucose 300 switch to D5W may add K
Hyperosmolar Hyperglycemic Nonketosis ( HHNK) Hyperglycemic Hypersmolar State ( HHS) Extreme Hypergyicemia without ketones ( fat break down) dehydrated because hyperosmolar state
What are the vascular problems with Diabetes ? Poor circulation sugar damage vessels, lumen narrowed Retinopathy -> Blindess Nephropathy -> Renal damage Nueropathy Infection Risk
Nueropathy problems with diabetic Sexual - impotence, decreased sensation Foot/Leg -> pain, parenthesis, numbness Nuerogenic bladder--> incontinece or retention Gastroparesis -> Stomach not empyting = Aspiration
Hypoglycemic S&S Shaking, Cool, Clammy, decreased LOC, headache, nervous, tachycardia
How to treat hypoglycemia ? Unconscios patient Glucose absorbtion delayed with ? 4 oz juice, 4 glucose tablets, once BS raised give complex carb -> peanut butter crackers D50W --> hard to push give with Large IV Bore Injectable glucogon --> when no Iv no access give IM Fat
To prevent hyperglycemic/ hypoglycemic episodes teach Eat, Monitor BS, Take meds, Know S&S
Created by: Emvilsaint
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