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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)
-increased sweating
Nurses should monitor what with Synthroid?
Thyroid Function Test
Serum lab analysis
skin color, temp, and texture
muscle tone
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
increased TSH
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
antithyroid drug
avoid asa
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?
propylthiouracil (PTU)
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
blurred vision
skin infections
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
hyperglycemia >600
hyperosmolarity >310
dehydration w/ thirst
absense of ketosis
Babinskis reflex
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
disturbed behavior
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
regular insulin

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