NUR 106

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stjpanther7
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170329
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NUR 106
Updated:
2012-09-12 21:43:07
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ENDOCRINE DIABETES
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ENDOCRINE & DIABETES
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  1. What salt is necessary to secrete thyroid hormone?
    Iodine
  2. What medication is used with a patient with hypothyroidism?
    Start Synthroid at a low dose to start and give the medication in the morning on an empty stomach.  This medication must be taken for life
  3. What do T4 and T3 do in the body?
    regulate metabolism
  4. Decreased T3 in the body does what?
    • (everything isslowing) 
    • slows down metabolism
    • lower VS 
    • slower reflexes
    • dry skin
    • constipation
    • respiratory rate
  5. Weight gain no matter how little you eat is seen
    with what?
    hypothyroidism
  6. What major factors contribute when determining whether a patient has hypothyroidism?
    bowel elimination and their need for sleep
  7. Extreme hypothyroidism causes what
    myxedema coma
  8. Goiter 
    • Seen in Hashimotos and hyperthyroidism
    • Sometimes seen in regular hypothyroidism
  9. When is hypothyroidism caused by autoimmune disease? 
    The body destroys the thyroid gland is called Hashimotos’s Thyroiditis. 
  10. When are patients at most risk for hypothyroidism? 
    winter, after surgery, and while using CNS depressants 
  11. Calcitonin
    • Secreted by the thyroid gland
    • Decreases excess calcium in the blood
  12. What laboratory values are seen with hypothyroidism 
    • High T3
    • High T4
    • Low TSH
  13. How would you teach your patient that the Synthroid is working? 
    Have the patient check their pulse.  It should be going up.  The patient should also be wearing a medic-alert
  14. Increased T3 in the body does what
    Diaphoresis (excessive sweating), flushed skin,warm skin, weight loss with increased eating, high temp, increased HR, tremors, restlessness, delirium, seizures, coma.
  15. Graves Disease is seen with what?
    Hyperthyroidism.
  16. Exophthalmos
    Seen with hyperthyroidism, corneal abrasions.
  17. What laboratory values would you see with hyperthyroidism 
    • High T3
    • High T4
    • TSH = Low levels
  18. What is the treatment for hyperthyroidism
    Partial or total thyroidectomy surgery
  19. How often are VS given to a post-operative thyroid patient
    • Every 15 minutes; you may delegate this to a
    • CNA, but only after stabilization.
  20. What are the most important VS with a post-surgical thyroidectomy patient? 
    • Temperature, internal or external bleeding
    • Patient may have a horse voice; which will eventually subside.
  21. What might be next to the bed for a post-operative thyroidectomy patient? 
    Calcium gluconate to treat hypocalcemic tetany
  22. What type of environment is important to remember for a patient with hyperthyroidism
    restful environment
  23. What does the adrenal cortex release
    • glucocorticoids/glucose/blood sugar
    • mineralocorticoids  
    • Aldosterone; which maintains water and sodium imbalance.  Cortex is the most important.
  24. What does the adrenal medulla release
    epinephrine and norepinephrine; which increases gastric acid, BP, and cardiac output (fight or flight)
  25. What are the adrenal cortex diseases
    Cushing’s disease and Addison’s disease
  26. What is the adrenal medulla disease
    Pheochromocytoma
  27. Pheochromocytoma
    benign tumor that produces excessive amounts of epinephrine and norepinephrine stimulating the sympathetic nervous system increasing VS
  28. Diagnostic tests for Pheochromocytoma
    CT showing increased atrophy of the adrenal medulla, blood and urine catecholamine levels. 
  29. Treatment of Pheochromocytoma
    removal of adrenal gland, and post operative BP monitoring.
  30. Cushing’s Disease
    excess production of glucocorticoids; adrenal or pituitary gland tumors.
  31. Cushing’s Syndrome
    more common; has do with chronic glucocorticoid therapy. 
  32. What is a glucocorticoid medication
    • Prednisone
    • Decadron 
  33. Who is at most risk for Cushing’s syndrome
    People with COPD and asthma.
  34. S/S: Cushing’s?
    Buffalo hump, thin legs, stretch marks, bruising, muscle weakness because of altered protein metabolism, decreased calcium, potassium loss, increased retention of sodium and H2O, increased gastric acid production (gastric ulcers),
  35. What are the diagnostic test are seen with Cushing disease
    elevated plasma cortisol level, elevated plasma ACTH, elevated serum sodium, elevated serum glucose.
  36. Treatment for Cushing’s
    Suppresses/inhibit adrenal cortex activity Cytadren - inhibits cortisol by the adrenal cortex.
  37. What type of surgery is available for a patient
    with Cushing’s disease– 
    adrenalectomy, radiation therapy.
  38. What is important to monitor a patient who has Cushing’s? 
    fluids and electrolytes, blood sugars, infection, daily weight.
  39. Addison’s Disease
    • adrenal cortex autoimmune disease that decreases
    • production of glucocorticoids and mineralocorticoids; however, symptoms do not present themselves until 90% of the cortex is destroyed.
  40. Signs and symptoms of Addison’s disease
    • Skin hyperpigmentation, orthostatic hypotension, a
    • craving for salt because of decreased aldosterone, fluid volume deficit
  41. What are some diagnostic labs for Addison’s disease
    low serum cortisol, low serum aldosterone, low serum sodium/glucose, high potassium level
  42. What is the treatment for Addison’s disease
    glucocorticoids in the morning and mineralocorticoids in the evening, high salt diet, daily weight
  43. Addison’s Crisis
    the patient abruptly stops taking their medication; which can be life threatening.
  44. S/S of Addison’s Crisis?
    Rapid thready pulse, extreme weakness, hypotension
  45. What type of diabetes will show ketoacidosis
    Type I diabetes
  46. Type II Diabetes
    • Body produces
    • insulin; however, it is an insufficient amount and the body is resistant to the
    • insulin.  You do have enough insulin in
    • your system to prevent ketoacidosis.
  47. At what age does the body naturally rise in blood sugars?
    Over the age of 50 
  48. What are the risk factors/causes for type II diabetes?
    • Obesity
    • Decrease in physical activity
    • Increased age
  49. S/S of diabetes type II?
    • Polyuria – excessive urination
    • Polydipsia – excessive thirst
  50. S/S of diabetes type I
    • Polyuria - excessive urination
    • Polydypsia - excessive thirst
    • Polyphasia - excessive hunger
  51. Manifestations of Early signs/symptoms of diabetes:
    blurred vision, recurrent infection, numbness and tingling, slow healing
  52. Fasting blood sugar levels
    • no caloric intake for 8 hours
    • Levels should be less than 100 (normalperson w/o diabetes)
  53. Postprandial blood sugars 
    (after meals) = below 140
  54. Fasting blood sugar on a diabetic should be?
     lessthan 125
  55. 2 hours after a meal on a diabetic should be 
    above 200
  56. Oral glucose tolerance test if diabetes will be
    above 200
  57. Oral glucose tolerance test w/o diabetes will be
    around 140
  58. What is a normal Hemoglobin A1c level? 
    3.5% – 5.2%
  59. What is a good level for a Hemoglobin A1c for newly diagnosed diabetics?
    over 6.5%
  60. What is a normal Cholesterol level?
    over 200
  61. What type of urine test will be used when determining diabetes?
    Urine test for ketones and sugar BUN and createnine
  62. What is the main treatment for a person with diabetes?
    Diet and exercise and carb counting.
  63. What dietary change should a person with diabetes?
    • Low fat protein
    • 20 – 35 grams of fiber in their diet
    • Calorie counting/balanced diet
    • Vitamin C and zinc
    • Moderate alcohol consumption 
  64. What does exercise do for type II diabetic?
    • Decreases insulin resistance
    • Decreases stress
    • Burns excess glucose
  65. Which inulin is never mixed?
    Lantus
  66. Byetta
    Sub-Q injection that stimulates insulin release from the pancreas  (type II)
  67. Symlin 
    Sub-Q injection that decreases blood glucose levels after meals (type I & II)
  68. Oral type II diabetic medicaitons 
    • Glucophage 
    • Glipizide
    • Avandia
  69. Glucophage
    class of drugs which calms glycogen so reduces glucose production from the liver and allows glucose get into the cells (type II)
  70. Glipizide
    (type II) causes the release of insulin from the beta cells of the pancreas
  71. Avandia
    causes the cells to become more permeable.  This will not cause hypoglycemia if this is the only medication that the patient is on.
  72. Diabetes can cause what? 
    • atherosclerosis
    • Peripheral vascular disease
    • Venous-stasis ulcers
    • CAD
    • Retinal detachment
    • Kidney failure
    • Neuropathy
    • Gangrene 
  73. Osteopenic
    osteoporosis (swiss-cheesy bones)
  74. Bone Density Test 
    test for osteoporosis 
  75. How is Fosamax taken 
    8 oz of H20 and sit up while taking this med
  76. Fosamax 
    prevention of osteoporosis
  77. What labs would be drawn with a broken hip injury?
    • H&H
    • BMP
    • I&R
  78. What are the assessments to be made when a patient is post-operative and has a cast?
    • Pain
    • Pulses
    • Pallor
    • Paralysis
    • Parenthesis 

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