Lecture 11 Endocrine

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Lecture 11 Endocrine
2012-11-30 11:25:28

Lecture 11 Endocrine
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  1. What is diabetes
    A chronic, progressive disease characterized by the body's inability to metabolize carbs, fats and proteins.
  2. What is Type 1 Diabetes
    • Also known as Insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus
    • destruction of the beta cells of the pancreas
    • absolute insulin deficiency
    • produces no insulin
  3. What is a normal blood glucose range?
  4. How do you want to maintain health with type 1 diabetes
    • diet and exercise
    • daily foot care
    • stress and illness control
    • remove and treat coexisting risk factors such as smoking, HTN, etc
  5. What is caused by destruction of beta cells in the pancreas, requires complete external insulin dependence.
    Type 1 diabetes
  6. What is it when an Antidiuretic Hormone (ADH) deficiency results in the body's inability to conserve water.
    Diabetes Insipidus
  7. Caused when body becomes resistant/desensitized to insulin resulting in increased blood glucose levels.
    Type 2 diabetes
  8. Glucose intolerance that occurs or develops during pregnancy.
    Gestational Diabetes
  9. Occurs when blood glucose levels drop below 70 mg/dl. May lead to coma or death if not treated promptly.
  10. The most appropriate diet for a person with Type 1 diabetes would be:
    3 medium sized meals per day with several snacks throughout the day
  11. Your diabetic patient has orders for 3 units of regular insulin to be taken before meals as well as 1 additional unit of regular insulin to be given for every 15 gms of carbohydrate. You calculate that the patient's dinner will have 45 gms of carbohydrate. How much TOTAL insulin would you administer?
    6 units
  12. Long-term complications of diabetes include the following
    • Cardiovascular disease
    • Retinopathy (leading to blindness)
    • Chronic kidney problems
    • Poor wound healing
  13. A diabetic patient calls the doctor's office complaining of an acute illness (nausea/vomiting). You would advise the patient to do what?
    • Take sips of fluid every 15-30 minutes as tolerated in order to prevent dehydration.
    • Try to eat 10-15 g of carbs every 1-2 hours as tolerated.
  14. Sick day management of diabetes includes
    • checking blood sugar levels more frequently
    • don't stop taking insulin, even if unable to eat
    • eat 10-15g of carbs every 1-2 hours as tolerated
    • take sips of fluid every 15-30 minutes as tolerated
  15. What are we going to see with Type 1 Diabetes
    • Polydipsia (excess thirst)
    • polyphagia (excess appetite)
    • polyuria (excess urine)
    • weakness and fatiuge
    • dizziness
    • blurred vision
    • ketonuria
    • weight loss
  16. how is type 1 diabetes dx?
    • presence of sytmpoms
    • fasting blood glucose level above 125
    • hemoglobin A1C levels
  17. what does the hemoglobin A1C level measure
    represents an average blood glucose level for the past 1-3 months (better indicator of control)
  18. what should hemoglobin A1C levels be?
    • 2-5% in adults
    • 1.5-4% in kids
  19. What is the leading cause of new blindness and renal failure in adults
    type 2 diabetes
  20. What does an exocrine gland do?
    Secretes substances onto a surface, usually through a duct
  21. What does an endocrine gland do?
    Secretes substances into the bloodstream
  22. What organs make up the endocrine system
    • hypothalamus
    • pituitary gland
    • thyroid/parathyroid
    • adrenal glands
    • pancreas
    • ovaries/testes
  23. What does the hypothalamus do?
    secretes hormones that trigger other endocrine glands
  24. what does the pituitary gland do?
    • the master galnd
    • most of the hypothalamic hormones trigger the pituitary gland
    • makes hormones that affect growth and function of other glands in the body (GH, ACTH, TSH, ADH, LH, FSH)
  25. What do the adrenal glands do
    secrete cortisol, corticosterone, androgen sex hormones, epinephrine and norepinephrine
  26. What does an increase in GH cause
  27. What does an increase in vasopressin cause
  28. What does a decrease in vasopressin cause
    diabetes insipidus
  29. What are some s/s of acromegaly
    • decreased muscle strength
    • excessive height
    • joint pain
    • large feet
    • large hands
    • large jaw
    • widely spaced teeth
  30. What are some s/s of hyperproactinemia
    • abnormal lactation in non-lactating breast
    • amenorrhea
    • decreased libido in men
    • impotence
    • depression/anxiety
    • headache/visual loss
  31. What is cushing's syndrome
    • adrenal cortex hyperfunction
    • too much cortisol
  32. what are some s/s of cushing's syndrome
    • HTN
    • "moon face"
    • thinning scalp hair
    • striae and truncal obesity
    • thin limbs
    • insulin resistance¬†
  33. True or False: After a sphenoidectomy to remove a
    pituitary tumor you should advise your patient to NOT brush his or her teeth for up to 2 weeks following the surgery.
  34. What is cushing's syndrome usually caused by?
    70% caused by pituitary secretion and tumors
  35. what is the treatment for cushing's syndrome
    surgery to remove pituitary tumor (transphenoidal - through nose)
  36. what is the nursing care for a post-op transphenoidal
    • monitor for cerebral edema/increased ICP (inc BP, widened pulse pressure, low pulse, pupil changes)
    • strict I/O
    • oral care - no teeth brushing for 2 weeks
  37. What are the causes of hypopituitarism
    • invasion (tumors)
    • infarction (postpartum necrosis)
    • infiltration
    • injury
    • immunologic
    • iatrogenic (surgery, radiation)
    • infectious
    • idiopathic
    • isolated
  38. what are the s/s of hypopituitarism
    • short stature
    • sexual and reproductive disorders
    • hypothyroidism
    • prolactin deficiency
  39. what is the treatment for hypopituitarism
    remove tumor, permanent hormone replacement
  40. What are the causes of diabetes insipidus
    • idiopathic
    • tumors
    • head injury
    • cranial surgery
  41. What are the S/S of diabetes Insipidus
    • cool, dry skin
    • dry mucous membranes
    • tachycardia
    • polyuria
    • weight loss
    • polydipisa
    • electrolyte imbalances
  42. what is the treatment for DI
    • remove pituitary tumor
    • ADH replacement
    • IV fluids
    • vasopressin meds
  43. what is caused by excessive ADH secretion (inability to excrete water)
    syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
  44. what are the S/S of SIADH
    • water retention
    • hyponatremia
    • dec GI motility/N/V
    • weight gain w/o edema
    • JVD/Tachycardia/tachypnea/rales
  45. what is the tx for SIADH
    • hypertonic IV fluids
    • sodium restriction
    • diuretics
  46. A nursing student is preparing to administer insulin to a client with a blood sugar level of 124 mg/dL. The student compares the result to the medication record and physician's order and notes that the client is ordered NovoLog insulin. The student draws the appropriate amount of insulin and then goes to the client's room to administer the injection. The meal tray is due in 30 minutes. What should the nursing student do next?
    Hold the medication until the tray is in front of the client, because onset is 5 minutes.
  47. What are the rapid-acting insulins
    • Humalog (inlusin lispro)
    • Novolog (insulin aspart)
    • Apidra (insulin glulisine)
  48. What is the onset time for rapid-acting insulins?
    5-15 min
  49. What is a short acting-insulin
    regular (also known as Humulin R, Novolin R)
  50. what is the onset time for short-acting insulin
    30 min
  51. what are some intermediate acting insulins?
    • NPH (also known as humulin N, Novolin N)
    • Lente (also known as humulin L, Novolin L)
  52. What is the onset time for intermediate-acting insulin?
    1-2 hours
  53. What are some long-acting insulins?
    • Ultralente
    • Lantus (insulin glargine)