Glossary of Endocrine Alterations
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- When should Levothyroxine (Synthroid) be administered?
- First thing in the morning
Or two hours BEFORE meals.
- What is Synthroid used for?
-Treatmen/Prevention of Euthyroid goiter
-Manage hypothyroidism secondary to thyroid cancer
-TX of myxedema coma
- What are adverse effects of synthroid?
-tachycardia (to much given)
- Nurses should monitor what with Synthroid?
- Thyroid Function Test
Serum lab analysis
skin color, temp, and texture
- What is a big risk with Synthroid use?
- Pt at surgical risk for bleeding.
- What is used to treat hyperthyroidism?
- Propylthiouracil (PTU)
- PTU treats what?
-adjunct therapy in prep for surgery or radioactive iodine therapy
-control thyrotoxic crisis
- Potential adverse effects of PTU are what?
- most serious are: hepatitis and idiosyncratic agranulocytosis
- What is a goiter?
- An enlarged gland that occurs in hypothyroid, hyperthyroid, or euthyroid states.
- What are signs and symptoms of goiter?
-stridor (crowing sound)
-distention of neck veins
-edema of eyelids and conjunctiva
-syncope with coughing
- Types of hypothyroidism.
- Congenital- must be tx to prevent cretinism
neonatal screenings done
Acquired- decreased metabolic rate
most common- Hashimoto's throiditis s/s decreased metaboliam, fatique, weight gain, dry/puffy skin, mental dullness, constipation.
- What is cretinism?
- characterized in childhood by dwarfed stature, mental retardation, dystrophy of the bones, and a low basal metabolism. Also called congenital myxedema.
- What is myxedematous coma?
- life threatening disorder characterized by:coma, hypothermia, cardiovascular collapse, hypoventalation, hyponatremia, hypoglycemia, lactic acidosis
- Management of myxedematous coma?
- thyroid replacement therapy
slow rewarming of hypothermia
- Hyperthyroidism aka thyrotoxicosis
- s/s nervousness, irritability, fatigability, weight loss, tachycardia, palpatations, SOB, muscle cramps, sweating, (skinny people) fine hair and skin, diarrhea.
- What is the most common form of hypertyhroidism?
- Graves Disease
- What are manifestations of Graves Disease?
- onset 20-40 years old
severe eye problems (tissue behind eyes) bulging
- What is thyroid storm?
- life threatening, rarely seen.
precipitated by stress, diabetic ketoacidosis, physical/emotional trauma
- What are mainfestations of thyroid storm?
- High Fever
Extreme Cardiovascular Effect
Extreme CNS effects
- TX of thyroid storm is what?
- peripheral cooling
replace fluids, glucos, electrolytes
- Why should you avoid ASA in thyroid storm?
- It increases levels of free thyroid hormone.
- What should you suspect in surgery pt after thyroidectomy that spikes a fever of 103 of higher?
- Thyroid Storm
- How can a goiter be treated?
- eating saltwater fish
- What shoul you never give to hyperthyroid pt?
- Tx of choice in thyroid storm is what?
- What insulin can be given IV?
- What IV fluids can be given to insulin pt?
- 0.9% normal saline
- What is normal Blood Sugar?
- Which insulin may be used alone or in combination?
- All insulins may be given SQ except __________ which can be given IV.
- How do you draw up two insulins?
- Clear to cloudy
Regular to NPH
- How do you store insulin?
- Keep cool in fridge
- How do you warm insulin?
- by rolling in hands
- How is DM diagnosed?
- clinical signs:
alterations in weight loss
- How is weight alterations differ in DM?
- weight loss in Type 1
obeisity in Type 2
- Diagnosis of DM
- Fasting Blood Glucose >126 times two
GTT should return to normal in 2-3 hours.
- HbA1c is what?
- index over time (last 3 months)
goal is <8%
above 5 is elevated
- Complications of DM
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)
- often mistaken for stroke in elderly
dehydration w/ thirst
absense of ketosis
- Tx of HHNK
- correct fluid/electrolyte imbalance
- Complications of DM
Diabetic Ketoacidosis (DKA)
- occurs when ketone production exceeds cellular use.
- DKA manifested by what?
ketosis and metabolic acidosis
1-2 day history of polyria, polydipsia, nausea, and vomiting, marked fatigue
- Definitive diagnosis of DKA
- blood glucos >250
serum bicarb <15
serum pH < 7.3
- In DKA bicarb less than 15 causes what?
- Kusmals Resps to blow off CO2 and raise pH
- Hypoglycemia symptoms
- related to altered cerebral function
difficulty problem solving
cool clammy skin
- TX of hypoglycemia
- Treat with concentrated carbohydrate source
peanut butter good
- Somogyi effect
- insulin induced hypoglycemic episode results in stimulation of other hormones, often during night especially 2:00 am
- Dawn Phenomenon
- Increased BS or insulin requirements between 5-9:00am
- leading cause of end-stage renal disease associated with glomular changes.
- acquired blindness
- Where is insulin produced?
- In the pancreas in the Beta cells in Isle of Longerhauns
- What is the most common type of DM?
- Type 2
- What is diabetes?
- A disorder of carb, fat, and protein metabolism- inability of tissue to use glucose.
- What are different cells in pancreas?
- Beta cells-insulin
Alpha cells- glucagon
Delta cells- somatostatin
- Insulin is based on how many units?
- 100 Units
- What is the best type of insulin?
There is also beef and pork
- Insulin levels rise _____ after eating, peak in ____to______ min, and level in ______to______ hours.
- What does glucagon do?
- REgulates blood glucose between meals and when fasting.
- What is the most common oral anti diabetic?
Does not cause weight gain
- What is NPH insulin?
- basal or background insulin, given as bolus at mealtimes.
- What is 70/30 insulin?
- Humulin 70/30 is a mixture of 70% Human Insulin Isophane Suspension and 30% Human Insulin Injection. It is an intermediate-acting insulin combined with the more rapid onset of action of regular insulin.
- What type DM is probably associated with elevated triglycerides?
- Type 2
- Type 2 DM
- usually overweight
80% are older pts
- Diabetics usually die from what?
- From complications, not DM itself. (Amputation)
- Diabetic Foot ulcer
- Most common complication leading to hospitilization in DM.
- DM has increased risk for infection.
- Glaucoma and blindness often a problem.
- What is done for BS less than 40?
- IV glucose
- What should be monitored with HgA1c?
- blood sugar
- If a pt is active, what happens to his/her insulin needs?
- There is a decrease in insulin needs if a pt is active
- TX of ketoacidosis
- 0.9% normal saline soln
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