ATI Engage: Alterations in Endocrine Function

Flashcards covering pathophysiology, risk factors, clinical presentation, and nursing management of hyperglycemia, hypoglycemia, Type 1 and Type 2 Diabetes, metabolic syndrome, hypothyroidism, and hyperthyroidism as per the ATI Engage medical-surgical material.

What is the primary function of the glands in the endocrine system?

To store and secrete hormones that regulate homeostasis in the body.

Which part of the brain coordinates the production and release of hormones?

The Hypothalamus.

What is the role of the pituitary gland in the endocrine system?

It secretes hormones that regulate most of the other endocrine glands.

What is the endocrine function of the pancreas?

It secretes insulin or glucagon to regulate blood glucose levels.

What is the exocrine function of the pancreas?

It secretes enzymes for digestion, such as amylase and lipase.

What is the specific function of glucagon?

It is released in response to blood glucose levels to prevent hypoglycemia.

How does insulin facilitate glucose absorption into cells?

It acts as a key hormone that unlocks the cell.

Where is insulin produced within the pancreas?

In the islets of Langerhans by the beta cells.

To which specific receptors does insulin bind to regulate blood glucose concentration?

Receptors on liver, muscle, and fat cells.

What process involves generating glucose from non-carbohydrate sources?

Gluconeogenesis.

What are the non-carbohydrate sources used in gluconeogenesis?

Proteins, lipids, pyruvate, or lactate.

In which specific cells does glycogenolysis primarily occur?

Hepatocytes of the liver and myocytes of the muscles.

List four modifiable risk factors for hyperglycemia.

Obesity, Smoking, Insomnia, and Sedentary lifestyle.

List four nonmodifiable or condition-based risk factors for hyperglycemia.

Genetics, Chronic stress, Illness/Infection, and Medications.

What are two neurological-related complications of hyperglycemia?

Nerve damage and Depression.

What are the names of the three 'polys' that impact overall health in hyperglycemia?

Polyuria, Polydipsia, and Polyphagia.

What clinical manifestation of hyperglycemia is related to a client's breath?

Fruity breath.

What respiratory pattern is characteristic of hyperglycemia clinical presentation?

Fast shallow respirations.

A fasting blood glucose level greater than what value indicates hyperglycemia?

$$125\,mg/dL$$

A postprandial blood glucose level greater than what value indicates hyperglycemia?

$$180\,mg/dL$$

What is the goal for Hemoglobin A1c (HbA1c) for clients with hyperglycemia?

Less than $6\%$

What time period does Hemoglobin A1c represent?

The average blood glucose level over the previous $2$ to $3\,months$.

What should the nurse instruct a client to monitor their urine for during hyperglycemia teaching?

Ketones.

What are the two lifestyle changes recommended for taking action against hyperglycemia?

Diet and Exercise.

What is the blood glucose threshold for hypoglycemia?

$70\,mg/dL$ or less.

What hormones are triggered for release from the adrenal glands during hypoglycemia?

Epinephrine and norepinephrine.

Which six classes of medications are listed as risk factors for hypoglycemia?

Beta-blockers, Insulin, Sulfonylureas, Antiarrhythmics, Nonsteroidal anti-inflammatory pain relievers, and Thiazolidinediones.

What is the condition called when a client no longer experiences the traditional symptoms of low blood sugar?

Hypoglycemia unawareness.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'H' stand for?

Headache.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'S' stand for?

Sweating.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'T' stand for?

Tachycardia.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'I' stand for?

Irritability.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'R' stand for?

Restlessness.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'E' stand for?

Excessive Hunger.

In the 'HE'S TIRED' mnemonic for hypoglycemia, what does the 'D' stand for?

Dizziness.

What amount of fast-acting carbohydrate is recommended for immediate treatment of hypoglycemia?

$15$ to $20\,grams$

What oral liquid options (non-diet) are suitable for treating hypoglycemia, and in what amount?

$4\,ounces$ of non-diet fruit juice or non-diet soda.

How many glucose tablets are equivalent to the standard treatment for hypoglycemia?

$$4\,glucose\,tablets$$

If a hypoglycemic client is unable to swallow, what injectable medication should be given?

Glucagon (IM or SQ).

What is the pathophysiology of Type 1 Diabetes Mellitus (DMT1)?

It is an autoimmune disease involving the destruction of beta cells in the pancreatic islets of Langerhans.

Which two eye conditions are noted as complications of Type 1 Diabetes Mellitus?

Cataracts and Glaucoma.

Type 1 Diabetes Mellitus is linked to what change in life expectancy?

A lower life expectancy.

What musculoskeletal symptoms can impact overall health in DMT1?

Weight loss and muscle wasting.

What is the fasting blood glucose level diagnostic for Type 1 Diabetes Mellitus?

Greater than or equal to $126\,mg/dL$

An HbA1c level of what percentage is diagnostic for Type 1 Diabetes Mellitus?

Greater than or equal to $7\%$

What level of non-fasting blood glucose is diagnostic for DMT1?

$$200\,mg/dL$$

In DMT1, what type of levels for C-peptide are expected?

Decreased.

What blood glucose level is characteristic of Diabetic ketoacidosis (DKA)?

Greater than $250\,mg/dL$

In DKA, the blood beta-hydroxybutyrate level is ________.

Elevated.

A blood gas pH of less than what value indicates DKA?

$$7.3$$

What is the threshold for bicarbonate (HCO3) in the diagnosis of DKA?

Less than or equal to $15\,mEq/L$

What three methods are used for administering injectable insulin?

Vial, Pen, and Pump.

What are the two common strengths of insulin?

U-100 or U-500.

What four categories describe the duration of action for insulin?

Rapid, Short, Intermediate, and Long.

What is the pathophysiology of Type 2 Diabetes Mellitus?

The pancreas produces some insulin but not enough, and cell receptors become insulin resistant.

What are the slow-onset clinical manifestations of Type 2 Diabetes Mellitus regarding the skin?

Skin changes, Gangrene, and Dry skin.

To confirm a Type 2 Diabetes diagnosis, what is required regarding abnormal results?

Two abnormal results on $2\,different\,days$.

What random blood glucose level is diagnostic for Type 2 Diabetes?

Greater than or equal to $200\,mg/dL$

What HbA1c level is diagnostic for Type 2 Diabetes?

Greater than or equal to $6.5\%$

What are three first-line treatments for Type 2 Diabetes?

Nutritional changes, Exercise, and Weight loss.

What drug class does Metformin belong to?

Biguanide.

What are the two main actions of Metformin in the body?

Lowers amount of glucose the liver makes and the amount of glucose absorbed from food.

Metformin is contraindicated in clients with what level of kidney impairment?

Severe kidney impairment.

What metabolic complication can Metformin cause in clients with kidney disease?

Lactic acidosis.

What specific taste is a potential adverse effect of Metformin?

Metallic taste.

What is the drug class for Canagliflozin?

Sodium-glucose cotransporter $2\,inhibitor$.

How does Canagliflozin lower blood glucose?

By increasing the amount of glucose excreted in the urine.

List four side effects of Canagliflozin.

Genital fungal infections, increased urine output, thirst, and urinary tract infection.

When should Canagliflozin be administered?

With the first meal of the day.

What are the five health conditions that form the cluster known as Metabolic Syndrome?

Visceral obesity, Hypertension, Insulin resistance, High triglycerides, and Low HDL cholesterol.

Which tissue secretes adipokines in metabolic syndrome pathophysiology?

Adipose tissue.

How many criteria must be met to diagnose metabolic syndrome?

At least $3$ of $5\,criteria$.

What fasting blood glucose value is used as a criterion for metabolic syndrome?

Greater than or equal to $100\,mg/dL$

What hypertension value is diagnostic for metabolic syndrome?

Greater than or equal to $130/85\,mm\,Hg$

What hypertriglyceridemia level is diagnostic for metabolic syndrome?

Greater than or equal to $150\,mg/dL$

What is the HDL criterion for females in metabolic syndrome?

Less than or equal to $50\,mg/dL$

What is the HDL criterion for males in metabolic syndrome?

Less than or equal to $40\,mg/dL$

What waist measurement criteria are used for metabolic syndrome diagnosis?

Greater than or equal to $35\,inches$ (females) or $40\,inches$ (males).

Which hormones stimulate the thyroid to regulate metabolism?

Triiodothyronine (T3) and thyroxine (T4).

Which gland releases TSH (Thyroid-stimulating hormone)?

Anterior pituitary.

List four medications that are risk factors for hypothyroidism.

Amiodarone, Lithium, Thalidomides, and Anti-cancer medications.

What are four autoimmune disorders associated with hypothyroidism risk?

Hashimoto’s disease, Celiac disease, Lupus, Rheumatoid arthritis, and Sjogren’s syndrome.

How does hypothyroidism affect cardiac function?

It can cause a decreased heart rate, hypertension, and cardiac arrhythmia.

For hypothyroidism diagnostic testing, what TSH and T4 results are expected?

Elevated TSH and low T4 level.

What is the primary goal of the nursing analysis in the care of hypothyroidism?

Prevent myxedema coma.

What is the name of the synthetic thyroid hormone used for treatment?

Levothyroxine.

What are the administration time requirements for Levothyroxine?

Take $1\,hr$ before a meal or $3\,hr$ after a meal.

What hormone does the hypothalamus release when T3 or T4 levels are low?

Thyrotropin-releasing hormone (TRH).

What is the pathophysiology of hyperthyroidism?

Increased production and release of T3 and T4.

What autoimmune disease is a major risk factor for hyperthyroidism?

Graves’ disease.

What adult age group is at a higher risk for hyperthyroidism?

Adults $60\,years$ and older.

In the 'THYROIDSM' mnemonic for hyperthyroidism, what does the 'T' represent?

Tremor.

In the 'THYROIDSM' mnemonic for hyperthyroidism, what does the 'H' and 'Y' represent?

Heart rate up (H) and Yawning (Y).

Hyperthyroidism increases risk during pregnancy for what four outcomes?

Miscarriage, Eclampsia, Premature labor, and Low infant birthweight.

What eye findings are expected in hyperthyroidism clinical presentation?

Tearing, red conjunctiva, swollen eyelids, and Bulging eyes.

What lab results are characteristic of hyperthyroidism?

Decreased TSH level with increased T3 and T4 levels.

What diagnostic scan is used to evaluate hyperthyroidism?

$24-hr$ radioactive iodine uptake scan (RAIU).

List two antithyroid medications mentioned in the text.

Methimazole and Propylthiouracil.

What is a major adverse effect common to both Methimazole and Propylthiouracil?

Low granulocyte count.

What is the normal range for TSH according to the case study labs?

$0.5$ to $5\,umL$