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EXAM 4 - MED SURG
Diabetes & Thyroid
| Question | Answer |
|---|---|
| Type I Diabetes Mellitus | Destruction of pancreatic beta cells which results in decreased insulin production, increased glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver so it remains in the bloodstream and contributes to after meals hyperglycemia. |
| Risk for Diabetic Ketoacidosis (DKA) | A metabolic derangement that occurs mostly commonly in people with type 1 diabetes and results from a deficiency of insulin, highly acidic ketone bodies are formed, and metabolic acidosis occurs. |
| Client Dietary Education for Home Management of Diabetes Mellitus I | Those who require insulin to help control blood glucose levels, must have consistency as much as possible in the amount of calories, and carbs ingested with each meal, as well as consistency with approx time intervals between smeals, with the addition of snacks as needed. |
| Type I Diabetes Mellitus Basic Definition | Occurs when the body cannot produce enough insulin |
| Type II Diabetes Mellitus Basic Definition | More common and occurs when the body cannot produce enough insulin or the insulin is not working efficiently enough |
| Signs & Symptoms of Hyperglycemia | Polyuria, polydipsia, and marked fatigue. May also have blurred vision, weakness, and headache. |
| Hypoglycemia Treatment | Initial treatment is 15-20g of carbs |
| Signs and symptoms of hypoglycemia | Sweating, tremors, tachycardia, palpitations, nervousness, and hunger. Moderate symptoms include inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness. Severe symptoms include disoriented behavior, seizures, difficulty arousing, or loss of consciousness |
| Basic Gestational Diabetes | Any degree of glucose intolerance with its onset during pregnancy. Hyperglycemia develops in during pregnancy, mostly in the second and third trimesters, due to the secretion of placental hormones that cause insulin resistance |
| Rapid Acting Insulin | Lispro, aspart, glulisine |
| Short Acting Insulin | Regular |
| Intermediate Acting Insulin | NPH (Neutral Protamine Hagedorn) |
| Long Acting Insulin | Glargine, Determir |
| Indications for Rapid Acting Insulin (Lispro, Aspart, Glulisine) | Used for rapid reduction of glucose level. To treat postprandial hyperglycemia, or to prevent nocturnal hypoglycemia |
| Indications for Short Acting Insulin (Regular) | Usually given 15 min before a meal. May be taken alone or in combination with longer acting insulin |
| Indications for Intermediate Acting Insulin (NPH) | Food should be taken around the time of onset and peak |
| Indications for Long-Acting Insulin (Glargine & Detemir) | Used for basal dose |
| Insulin Lispro (onset, peak, duration) | Onset 15-30 mins. Peak 30-90 mins. Duration up to 5 hours |
| Insulin Aspart (onset, peak, duration) | Onset 15 mins. Peak 1-3 hours. Duration 3-4 hours. |
| Insulin Glulisine (onset, peak, duration) | Onset 5-15 mins. Peak 1 hours. Duration 5 hours |
| Insulin Regular (onset, peak, duration) | Onset 30-60 mins. Peak 2-3 hours. Duration 4-6 hours |
| Insulin NPH (onset, peak, duration) | Onset 1-1.5 hours. Peak 4-3 hours. Duration up to 24 hours |
| Insulin Glargine (onset, peak, duration) | Onset 3-6 hours. Peak continuous. Duration 24 hours |
| Insulin Detemir (onset, peak, duration) | Onset unknown. No peak. Duration 24 hours |
| Hypothyroidism Symptoms | Fatigue, weight gain, puffy face, trouble tolerating cold, joint & muscle pain, constipation, dry skin, dry thinning hair, decreased sweating, heavy or irregular menses, fertility problems, depression, slowed HR, goiter |
| Hyperthyroidism Symptoms | Heat intolerance, palpitations, anxiety, fatigue, weight loss, muscle weakness, and, in women, irregular menses. Also may include tremors, tachycardia, lid lag, and warm, moist, skin. |
| Thyroid Gland Hormones | T3 (triiodothyronine), T4 (thyroxine), and calcitonin. |
| Diet/Nutrition Considerations in Thyroid Diseases | Increased fluid intake (within limits of fluid restriction), pick foods high in fiber. |
| What is the Most Reliable Marker of Adequacy in Replacement Therapy. | Thyroid Stimulating Hormone (TSH) |
| Calcitonin | Another important hormone secreted by the thyroid gland. Secreted in response to high plasma levels of calcium and reduces the plasma level by increasing its deposition in bone |
| Thyrotropin (TSH) | Controls the secretions of T3 and T4 by the thyroid gland. TSH controls the rate of thyroid hormone release through a negative feedback mechanism |
| Euthyroid | Refers to thyroid hormone production that is normal |
| Antithyroid Drugs | act by decreasing the production or release of thyroid hormones |
| Thioamide Drugs | inhibit synthesis thyroid hormones. |
| Iodine Preparations | inhibit the release of thyroid hormones and cause them to be stored within the thyroid gland |
| Radioactive Iodine | emits rays that destroy the thyroid gland tissue. |
| Thyroid Disease Prevalence | hypothyroidism increases with age, most often among women. Patients may have few or no symptoms until dysfunction is severe. Depression, apathy, and decreased mobility or activity may be the major initial symptoms and may be accompanied by significant weight loss. Constipation affects one-fourth of older patients. |
| Beta-Blockers | such as propranolol [Inderal], is used as an adjuvant medication to asymptotic hyperthyroidism. |
| Iodine | Essential to the thyroid gland for synthesis of its hormones |
| Goals of treatment in Hypothyroidism | Administer dosage in sufficient amounts to compensate for the thyroid deficit, to resolve symptoms and restore serum TSH and thyroid hormone to normal |
| Goals of treatment in Hyperthyroidism | Reduce thyroid hormone production to relieve symptoms, return serum TSH and thyroid hormone levels to normal, and avoid complete destruction of the thyroid gland |
| Myxedema Definition | Is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious. Often impaired consciousness, precipitated by infection, drugs, cold, trauma. Subnormal temp, hypotension, hypoventilation, cardiovascular collapse |
| Drugs that interact with Levothyroxine | Activating Antidepressants, Asthmatic agents and nasal decongestants all INCREASE the effects of levothyroxine. Antacids (cholestyramine, iron, sucralfate) decrease absorption of levothyroxine. Antihypertensives (propranolol) decrease cardiac-stimulating effects. Estrogens (oral contraceptives) increase thyroxine-binding globulin, thereby increasing the amount of bound, inactive levothyroxine in patients with hypothyroidism. Phenytoin, rifampin induces enzymes, leading to more rapid metabolism |
| Myxedema Interventions | Rewarming should be done gradually, such as with a blanket. Not with active warming like heating pads |
| Myxedema Complications/Considerations | Patients with myxedema coma can also exhibit hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive supportive and hemodynamic therapy if the patient is to survive. |
| Graves Disease Definition | Excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins |
| Grave's Disease Signs & Symptoms | Nervousness, emotionally hyperexcitable, irritable, and apprehensive. Cannot sit quietly , suffer from palpitations, and pulse is abnormally rapid at rest as well as on exertion. Often have a salmon color skin, and it is likely to be warm, soft, and moist. |
| Diagnostic Labs and Information needed before initiating PTU therapy | Baseline CBC, WBC with differential, and liver profile (transaminases, and bilirubin |
| Who is at risk for Thyroid Cancer? | Three out of four cases occur in women. And two of three new cases are in patients under 55 years. External radiation of the head, neck, or chest in infancy/childhood increases the risk |
| Testing use to confirm Thyroid Cancer | Needle biopsy of the thyroid gland is used as an outpatient procedure. Additional studies include ultrasound, MRI, CT scan, Thyroid Scans, Radioactive Iodine Uptake Studies, and Thyroid Suppression Tests. |
| Thyroid Storm Definition | Form of severe hyperthyroidism, usually of abrupt onset. Untreated it is almost always fatal. The patient is critically ill and requires astute observation and aggressive and supportive nursing care |
| Clinical Manifestations of Thyroid Storm | High fever (>101.3 F), extreme tachycardia (>130 bpm), exaggerated symptoms just as GI upset, weight loss, diarrhea, abdominal pain, and cardiovascular problems (edema, chest pain, dyspnea, palpitations), and altered neurological or mental state such as delirium psychosis, somnolence, or coma. |
| Medications & Interventions for Management of Thyroid Storm | Immediate objective is to return body temp and heart rate to baseline to prevent vascular collapse. Use a hypothermia blanket/mattress, hydrocortisone and acetaminophen. Humidified oxygen, IV fluids containing dextrose to replace liver glycogen stores. Propylthiouracil (PTU) or methimazole is given to impede formation of thyroid hormone and block unwanted conversion of T4 to T3. Hydrocortisone is given to treat shock or adrenal insufficiency. Iodine is given to decrease the output of T4. |
| Thyroid Disease Diagnostics | laboratory measurement of thyroid hormones, thyroid scanning, biopsy, and ultrasonography. The most widely used tests are serum immunoassay for TSH and free T4. -- Free T4 levels correlate with metabolic status |
| Patient Education for Myxedema (Long-Term Management) | Any patient who has had hypothyroidism for a long period usually has associated elevated serum cholesterol, atherosclerosis, and coronary artery disease. As long as metabolism is subnormal and the tissues (including the myocardium) require relatively little oxygen, a reduction in blood supply is tolerated without overt symptoms of coronary artery disease. |
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