Endocrine (test 11)

studied byStudied by 58 People
5.0(5)
get a hint
hint

Age related changes to the endocrine system

1/75

Tags & Description

Use to study for unit test + final :)

Studying Progress

New cards
75
Still learning
0
Almost done
0
Mastered
0
75 Terms
New cards

Age related changes to the endocrine system

  • Pituitary gland gets smaller

  • hormones decrease (some)

  • changes in sensitivity to insulin

  • baseline glucose increases Medications used to treat hormone issues need lowered doses for older adults

New cards
New cards

Thyroid gland hormones

-thyroxine (T4)

  • triiodothyronine (T3)

  • Calcitonin (stops bone breakdown to lower calcium levels in body)

New cards
New cards

Where is the parathyroid located

On the back of the thyroid (in the neck)

New cards
New cards

Where is the pituitary located?

In the brain

New cards
New cards

Where are the adrenal glands located?

On the kidneys

New cards
New cards

Where is the thyroid gland located

In the neck

New cards
New cards

Parathyroid hormones

  • Parathyroid hormone (PTH). Increases blood calcium by breaking down bones, increases calcium absorption in digestive tract, decreases calcium lost in urine. (by removing phosphorus)

*** release of this hormone is dependant on if calcium levels are high or low. Low calcium signals PTH to be released****

New cards
New cards

Adrenal cortex is the ___

doughnut

New cards
New cards

Adrenal medulla is the ____

jelly

New cards
New cards

Adrenal cortex hormones

  • Mineralocorticoids (aldosterone) which increases sodium and water that the body holds on to

  • Glucocorticoids (cortisol) which raises glucose and lowers inflammation

  • androgens and estrogens which work with ovaries or testes

New cards
New cards

Adrenal medulla hormones

  • Epinephrine/norepinephrine (fight or flight response, increases HR, BP, RR)

  • triggered by sympathetic NS

New cards
New cards

Thyroid gland works by

  • converting iodine into thyroid hormones (T4, T3) (T4 gets converted to T3)

  • requires protein for this conversion

New cards
New cards

Describe a negative feedback loop and how it relates to hormones

If a hormone level is low, a signal will be sent to release more hormone until it is normal. The opposite is also true, if a hormone is high, a signal will be sent to stop releasing said hormone

New cards
New cards

Pituitary hormones

  • Anterior Pituitary (AP) and posterior pituitary (PP)

  • AP: growth hormone

  • AP: thyroid stimulating hormone

  • AP: follicle stimulating hormone (follicles in ovaries, spermatogenesis in men)

  • AP: adrenocorticotropic hormone (ACTH) (cortisol secretion)

  • AP: Luteinizing hormone (LH) (ovulation, progesterone, testosterone)

  • AP: prolactin (milk production)

PP: ADH (increases kidney water and sodium absorption) PP: oxytocin (uterine contractions, milk ejection)

New cards
New cards

Nursing care for post pituitary surgery (or any surgery in neck, head, ect)

  • ensure drainage is bloody/mucus, NOT clear and watery which could indicate cerebral spinal fluid leak

  • do NOT increase ICP, no sneezing, coughing, leaning over

New cards
New cards

If a patient who is not pregnant or breastfeeding comes in with milk production, what lab do you expect to be high?

Prolactin

  • could indicate tumor of pituitary

New cards
New cards

normal calcium

8-10

New cards
New cards

Normal phosphorus

2.8-4.5

New cards
New cards

Describe a radioactive iodine uptake test

  • NOT during OB or lactation

  • Small amount of radioactive iodine put into body to see if thyroid takes it in (assess thyroid function)

New cards
New cards

Why would a provider order an ECG for a patient with a hormone problem?

  • if the hormone problem is leading to suspected dysrhythmias of the heart

New cards
New cards

S/S of pituitary adenoma (tumor)

  • headache

  • visual changes

New cards
New cards

Too much GH (growth hormone) can cause ___

Gigantism in kids (same characteristics as acromegaly) acromegaly in adults (large head, hands,feet)

New cards
New cards

Too much prolactin causes

  • no periods

  • abnormal lactation

  • hair loss + impotence in males

New cards
New cards

Too little GH (growth hormone) can cause

Small stature, bone breakdown

New cards
New cards

Abnormal gonadotropins can cause

infertility/sterility

New cards
New cards

Diabetes Insipidus

  • peeing all the time

  • large amounts of diluted urine

  • caused by too little ADH

New cards
New cards

Syndrome of inappropriate antidiuretic hormone

  • Opposite of diabetes insipidus

  • too much ADH

  • not urinating enough or at all

New cards
New cards

Goiter

Enlargement of the thyroid gland

  • can be caused by not enough iodine in diet (teach patient to increase salt!!)

  • may also be caused by not enough protein in diet

  • can also be caused by lack of TH (thyroid hormone), Ca, nodules

New cards
New cards

Labs for thyroid problems

  • TRH

  • TSH

  • T3

  • T4

  • antibody titers

New cards
New cards

Nursing: administering iodine

  • give through a straw (stains teeth otherwise)

  • give well diluted

New cards
New cards

Hyperthyroidism

  • too much T3 and T4 circulating blood

  • LOW TSH because body is trying to slow thyroid production

  • graves disease causes this often times

  • everything speeds up, metabolism, heart rate, ect.

New cards
New cards

Symptoms of hyperthyroidism

  • weight loss

  • anxiety

  • tremors

  • tachycardia

  • amenorrhea ( older adults may have CP, SOB, palpitations)

New cards
New cards

Treatment of hyperthyroidism

  • Methimazole

  • surgery/ablation (watch for thyroid storm/crisis after surgery, which is when manipluation of the thyroid causes increased levels of t4)

New cards
New cards

Graves disease

  • Autoimmune disorder

  • causes hyperthyroidism

  • causes destruction and enlargement of thyroid so hormones spill out

New cards
New cards

Exophthalmos

bulging of eyeballs, common with graves disease

New cards
New cards

Thyroidectomy

Removal of thyroid, usually a last resort due to risk of

  • hemorrhage

  • loss of parathyroid

  • thyroid storm/crisis Post op: high fowler's, neutral head

New cards
New cards

Thyroid storm/crisis

When manipulation of the thyroid causes release of T4

  • common during surgery to remove thyroid

  • S/S include sudden high fever, pulse increase, RR increase

New cards
New cards

Hypothyroidism

  • LOW T3 and T4

  • HIGH TSH (body trying to get thyroid to produce more)

  • body processes slow down

  • hashimotos is common cause

New cards
New cards

S/S of hypothyroidism

  • Weight gain

  • Constipation

  • hair loss

  • bradycardia

  • low iodine

New cards
New cards

Treatment of hypothyroidism

  • Levothyroxine (Synthroid)

  • Armor (pig hormone!!)

New cards
New cards

levothyroxine for hypothyroidism tx patient teaching

  • take on empty stomach

  • take at same time each day

  • may take 6-8 weeks to see improvement

  • lifelong therapy, do not stop taking

New cards
New cards

Hypoparathyroidism

  • too little parathyroid hormone

  • usually caused by trauma or surgery to remove thyroid causing accidental damage

  • cases low calcium, high phosphorus S/S: numbness, tingling, tatany, convulsions

New cards
New cards

Hyperparathyroidism

  • too much parathyroid hormone High calcium, low phosphorus

  • S/S lethargy, confusion, nausea, arrhythmias, bone fractures

New cards
New cards

Addison's disease

(Adrenal disorder)

  • decrease in adrenal cortex function, less cortisol

  • S/S: low BP, arrhythmias, low sodium, too much potassium, weakness, hypoglycemia

New cards
New cards

Adrenal crisis

Addison's disease with another stressor such as infection

  • can be caused by stopping steroids too fast

  • can cause death, shock

New cards
New cards

Cushing's disease

  • too many hormones from adrenal cortex

  • can be r/t long term steroid use S/S: buffalo hump, moon face, bruising, big body and skinny arms, abnormal hair

New cards
New cards

approximately _% of people have DM

10

New cards
New cards

Normal A1C

Below 5.6: normal 5.7-6.4: pre DM 6.4: DM

New cards
New cards

Type one DM

  • Destruction of pancreas beta cells

  • no insulin is produced

  • requires insulin to survive

New cards
New cards

Type 2 DM

  • Insulin resistance, bodies receptors do not respond to insulin

  • may need insulin eventually

New cards
New cards

Latent autoimmune diabetes

  • Mix of type 1 and type 2 DM (can be called 1.5)

  • partial failure of beta cells, AND insulin resistance

  • positive test for islet cell antibodies

New cards
New cards

Metabolic syndrome

  • cluster of conditions that increase risk for CAD, stroke, DM

  • cluster of conditions include: high B/P, high blood sugar, high high HDL, abd fat

New cards
New cards

Risk factors for diabetes

  • Genes (people closer to you in family tree)

  • race: (Type 1 more common in whites) (Type 2 more common in native americans, blacks)

  • continued stress

  • viral infection triggering type 1

  • apple body shape

  • obesity

New cards
New cards

S/S of Type 1 DM

  • hyperglycemia (very high)

  • polyuria, polydipsia (excessive thirst)

  • weight loss

  • blurry vision

  • excessive hunger

New cards
New cards

S/S of Type 2 DM

  • weight gain

  • slow healing

  • fatigue

New cards
New cards

DM management

  • Diet

  • exercise (lowers insulin resistance)

  • if pre diabetic exercise and diet can stop you from getting full diabetes

  • helps control type 2 DM and reduce insulin needs

New cards
New cards

Biguanides

Metformin

  • Lowers A1C

  • lowers liver release of glucose

  • increases sensitivity to insulin DO NOT USE WITH CIRRHOSIS OR GFR less than 30

New cards
New cards

DPP-4

Gliptins

  • controls hormones that control glucose and insulin

New cards
New cards

Alpha glucosidase inhibitors

  • lowered absorption of CHO in gut

New cards
New cards

Meglitinides

Ends in glutides

  • stimulates insulin production

New cards
New cards

Rapid acting insulin

Aspart (NovoLOg), Lispro (Humalog)

  • acts in 15 min

  • peaks in 1-3 h

  • lasts 3-5 h

New cards
New cards

Short acting insulin

Regular insulin (humulin, novolin)

  • onset in 30 min

  • peaks in 2-4 h

  • lasts 5-8 h

New cards
New cards

Intermediate insulin

(NPH, lente) Onset: 1h Peaks in 4-12 h Lasts 24 h

New cards
New cards

Long acting insulin

Glargine (lantus) Onset: 2-4 h Peaks in: n/a Lasts 24 hours

New cards
New cards

When drawing up insulin go___ to ____

clear to cloudy

New cards
New cards

Insulin best absorbed in

  • Abdomen

  • thighs, arms buttocks most slow

New cards
New cards

What can exercise do to glucose

Lower it

  • lower insulin dose slightly if exercising

New cards
New cards

Diabetic ketoacidosis

  • More common in type 1

  • sugar gets too high for too long, body breaks down fat which produces ketones causing acidosis

  • causes metabolic acidosis, electrolyte imbalance and dehydration

New cards
New cards

DKA s/s

  • high RR

  • fruity breath

  • ketones in urine

  • glucose in urine

  • dry MM

  • low B/P

  • dehydration

New cards
New cards

Hyperglycemic hyperosmolar state

More common in type 2 DM, same as DKA but for type 2

  • s/s same as DKA but with more neurologic symptoms

  • more deadly than DKA

  • NOT breaking down fat like with DKA so no ketones in urine

New cards
New cards

Dawn phenomenon

-Naturally higher glucose in the AM

New cards
New cards

Older adults more susceptible to ____

hypoglycemia

New cards
New cards

Poorly treated DM can cause

  • blindness

  • kidney failure

  • amputation

New cards
New cards

Cortisol is higher in the ____

morning

  • gets lower throughout the day

  • when testing cortisol levels must test 2-3 times in 24 h

New cards
New cards

abnormal fasting glucose

-Over 126= bad

  • over 100 = pre DM

  • random over 200 = bad

New cards