Endocrine
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| What are the thyroid hormones? | T3, T4, Calcitonin
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| What does Calcitonin do ? | Moves calcium out of blood and back to bone. Decreases serum calcium.
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| What is needed to make hormones ? | Iodine
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| What is the thyroids role in the human body? | Gives us energy.
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| What is Graves Disease? | Hyperthyroidism
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| Hyperthyroidism S&S | Feel anxious, nervous, hot, sweaty, decreased attention span, irritable
GI fast, increased appetite, weightloss
enlarged gland, exophthalmos
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| Hyperthyroidism Dx, and instructions. | Blood test --> Increased serum T4
Thyroid Scan --> stop taking iodine medications 1 week prior to scan.
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| 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.
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| 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
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| Hyperthyroidism and beta blockers | Propanolol ( inderal) --> decrease Anxiety
Decrease myocardial contractility, CO, HR, BP
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| 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!
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| Thyroid Storm ( thyroidtoxicosis, thyrotoxic storm) | Rebound effect from radioactive iodine,
hyperthyroidism X 100 --> Badddd
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| 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
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| 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
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| Exohpthalamus Care | Hypoallergenic tape to shut eyelids--> prevent injury, irriation
Eye drops -> artificial tears
Sunglasses-> photosensitivity
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| What is Myxedema? | Hypothyroidism
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| Myxedema S&S | No energy
Fatigue
GI upset, Weight Gain
Cold intolerance
Slow speech, No expression
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| Hypothyroidism treatments and action short term ? | Synthroid -levothyroxine
Proloid- Thyroglobulin
Cytomel- Liothyronine
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| Whats does the parathyroid secrete? | Parathormone ( PTH) hormone
Takes Ca from bone and puts in blood = increased serum Ca
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| Hyperparathyroidism Treatments | Too much PTH
Hypercalcemia, Hypophospotemia
Patirial parathyroidectomy
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| Hypoparathyroidism Treatments | Too Little
Hypocalcemia, Hyperphospotemia
IV Calcium --> Heart monitor
Phosphate Binders- Sevelemar hydrochloride, Calcium Acetate
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| Adrenal Glands help us ? | Deal with stress
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| What are the two parts of the adrenal glands ? What are there functions ? | Adrenal cortex --> Salt, Sugar, Sex
Adrenal Medula -> epi and norepinephrine
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| 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
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| Adrenal Cortex steroids ? | mineral0corticoids, glucocorticoids, sex hormones
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| Mineralocorticoids too much, too little | Aldosterone -> Retain Na, H20 secrete K
too much -> FVE, Hypokalemia
too little, FVD, hyperkalemia
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| Glucocorticoids | Mood changes - mean
depressed, insomnia,psychotic, euphoric
Insulin inhibited -->Hyperglycemia-> finger sticks
Altered defense mechanisms--> immunosuppressed--> infection
Break down Fats and Proteins
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| Sex Hormones | Oil skin
Female with male traits
Poor libido
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| What is Addison's Disease ? | Not enough steroids, sugar, salt, sex.
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| 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
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| 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
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| 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
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| 24 hour urine on Addison's patient vs Cushings. | Cushings = Cortisol high
Addisons = Cortisol low
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| 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
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| Why do we increase Ca in Cushing's patient ? | Steriods cause secretion through GI tract
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| 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
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| 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
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| 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
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| Type 2 Diabetes treatments | Diet/ Excersise/ Oral Hypoglycemics, Insulin
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| 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
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| 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
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| Why are diabetics at risk for CAD, renal disease, Retinopathy? | Sugar destroys vessels.
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| 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.
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| 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.
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| How is insulin dose determined? | body weight. 0.4-1.0 units/kg daily
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| How do we know if the insulin dose is sufficient? | No more ketones or sugar in urine
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| 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
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| 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
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| 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
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| 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
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| 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.
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| What is the only insulin that can be given IV | Regular - short acting
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| 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.
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| HbA1c | Blood test monitors 3 months glucose levels
4-6% best
6.5 -> diabetic
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| What effect does stress, illness, have on blood sugar ? | Increases it
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| How do you rotate sites with insulin injections | Rotate within site first then go to new site
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| Insulin Infusion pumps | alternative to daily dosing
only rapid acting
better control -> gives basal dose then boluses with meals and increase bs
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| 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
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| 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
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| Hyperosmolar Hyperglycemic Nonketosis ( HHNK) Hyperglycemic Hypersmolar State ( HHS) | Extreme Hypergyicemia without ketones ( fat break down)
dehydrated because hyperosmolar state
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| What are the vascular problems with Diabetes ? | Poor circulation sugar damage vessels, lumen narrowed
Retinopathy -> Blindess
Nephropathy -> Renal damage
Nueropathy
Infection Risk
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| Nueropathy problems with diabetic | Sexual - impotence, decreased sensation
Foot/Leg -> pain, parenthesis, numbness
Nuerogenic bladder--> incontinece or retention
Gastroparesis -> Stomach not empyting = Aspiration
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| Hypoglycemic S&S | Shaking, Cool, Clammy, decreased LOC, headache, nervous, tachycardia
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| 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
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| To prevent hyperglycemic/ hypoglycemic episodes teach | Eat, Monitor BS, Take meds, Know S&S
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