exam 3 - endocrine part 2

glucocorticoid - side effects

• infection risk

• hyperglycemia

• gi distress → fluid retention

glucocorticoid - pt teaching

• never stop abruptly → to prevent addisonian crisis

• take in morning = slower gi distress

• take more during times of stress

addison vs. cushing (cortisol and aldosterone)

• addison - low + low

• cushing - high + high

addison vs. cushing (energy)

• addison - fatigue and weakness

• cushing - irritabilty and psychosis

addison vs. cushing (weight)

• addison - weight loss

• cushing - weight gain (truncal obesity, moon face, buffalo hump)

addison vs. cushing (bp)

• addison - dehydration → hypotension

• cushing - fluid retention + edema → hypertension

addison vs. cushing (sodium + potassium)

• addison - hyponatremia + hyperkalemia

• cushing - hypernatremia + hypokalemia

addison vs. cushing (sugar and bone health)

• addison - hypoglycemia + osteopenia

• cushing - hyperglycemia + osteoperosis

adrenal medulla disorder - patho

• benign tumor in chromaffin cells of adrenal medulla

• high levels of catecholamines → epinephrine and norepinephrine

adrenal medulla disorder - symptoms

• pressure (hypertension)

• pain (throbbing)

• perspiration (excessive)

• palpitations (tachycardia)

• pallor

adrenal medulla disorder - extra symptoms

hyperglycemia → glucosuria and heat intolerance

adrenal medulla disorder - diagnostics

• 24-hour urine test: metanephrines

• plasma catecholamines: gold standard → measures blood epi + norepi

adrenal medulla disorder - surgery

adrenalectomy

• alpha-blockers before beta-blockers = to control bp or else hypertensive crisis

• administer pre-op glucocorticoids for dysrhythmias

adrenal medulla disorder - post-operative priority

• monitor blood pressure hourly

• asses for hypotension + shock from loss of catecholamines

• avoid abdominal palpation

thyroid hormones

• t3 and t4

• calcitonin

• tsh

t3 and t4 - functions

• metabolism and muscle tone

• heat and hr

• cognition

calcitonin - functions

lowers blood calcium by stopping bone resorption by osteoclasts

hypothyroidism

• aka hashimoto’s thyroiditis

• ↑ tsh and ↓ t3 + t4

hypothyroidism - “low and slow”

• low hr + bp

• slow metabolism (weight gain + cold intolerance)

• slow bowels (constipation)

• slow brain (fatigue, brain fog, depression)

hypothyroidism - what other symptoms are there?

• muscle weakness

• anxiety

• dry skin + coarse hair

what medication to take for hypothyroidism and teachings?

• levothyroxine - thyroid hormone replacement

• side effects - when dose too high → hyperthyroidism

• take on empty stomach with full glass of water before breakfast

emergency complication from hypothyroidism - myxedema coma

• hypothermia <93, hypotension, hyponatremia, hypoglycemia

• bradycardia and respiratory failure

myxedema coma - nursing intervention

• warm pt slowly using warm blankets

  • do not do rapidly bc vasodilation → hypotension

• iv medications: iv saline, iv levothyroxine, iv glucose, iv corticosteroids

hyperthyroidism

• grave’s disease

• ↑ t3 and t4 + ↓ tsh

• positive tsh receptor antibodies

hyperthyroidism - symptoms

• high (hr, bp, metabolism → weight loss)

• hot (heat intolerance → sweating)

• hurried (anxiety, stools, tremors)

hyperthyroidism - extra symptoms

• exophthalmos (bulging eyes)

• goiter and palpitations

hyperthyroidism - medications

• antithyroid meds - methimazole (tapazole) + propylthiouracil (ptu)

• beta-blockers - propranolol (tachycardia, tremors, anxiety)

hyperthyroidism - surgery

radioactive iodine therapy or surgical thyroidectomy

hyperthyroidism - emergency complication + s/s

• thyroid storm - thyrotoxic crisis

• s/s - hyperthermia, tachycardia, coma, seizures, chf

thyrotoxic crisis - airway and cooling precautions

• airway - prepare for ventilation and ecg

• cooling precautions - apply cooling blankets slowly (prevent shivering)

thyrotoxic crisis - stat medications

• antithyroid medications (methimazole)

• iv iodides, iv beta-blockers (propranolol), iv glucocorticoids

thyrotoxic crisis - pain/fever control

• administer acetaminophen

• NO ASPIRIN → ↑ t3/t4 + worsening storm

parathyroid hormone - physiology

pth increases calcium when low, but lowers phosphate in blood

hypoparathyroidism

↓ pth → hypocalcemia (<8.5) and hyperphosphatemia

hypoparathyroidism - symptoms

• tetany, paresthesia, seizures

• (+) chvostek’s sign - tapping face and facial twitch

• (+) trousseau’s sign - inflating bp cuff and spasm

hypoparathyroidism - emergency symptom

laryngospasm and stridor - airway emergency (might have to do tracheostomy)

hypoparathyroidism - nursing intervention

calcium replacement - 10% IV calcium slowly 10-15 min

hyperparathyroidism

↑ pth → hypercalcemia (>10.5) and hypophosphatemia

hyperparathyroidism - symptoms

• bones: bone pain and osteoporosis

• stones: kidney stones and flank pain

• groans: constipation and pain

• psychic moans: lethargy and confusion

hyperparathyroidism - diuretics and hydration

• administer furosemide → excrete calcium

• do not use thiazide diuretics bc they retain calcium

• hydrate with normal saline 0.9 IV

hyperparathyroidism - pharmacotherapy

• calcimimetics → lower pth

• calcium chelators

• oral phosphate → binds calcium in gi

hyperparathyroidism - care protocols

• strain all urine for kidney stones

• encourage mobility to drive calcium into bones

• low-calcium diet and prevent constipation

what should post-thyroidectomy or parathyroidectomy monitor?

monitored for sudden hypocalcemia

hypoglycemia - fun mnemonics

• cold and clammy = need some candy

• hypogly → brain will die

hypoglycemia - clinical manifestations

• h - headache

• i - irritability

• t - tremor and tachycardia

• w - weakness

• a - anxiety

• s - sweating

• h - hunger

hypoglycemia - management

• pt conscious → give 15-20g carbs (recheck bg in 15 min)

• pt unconscious → IV dextrose (D50W) or IM glucagon

diabetes type 1 - etiology

• autoimmune destruction of pancreatic beta cells

• insulin deficiency

diabetes type 1 - onset and risk factors

• onset - childhood

• risk factor - genetics and family history

diabetes type 1 - symptoms

polyuria, polydipsia, polyphagia, weight loss

diabetes type 1 - primary management

lifelong insulin therapy

diabetes type 2 - etiology

insulin resistance with beta-cell failure

diabetes type 2 - onset and risk factors

• gradual onset - adults

• risk factors - obesity, hypertension, smoking

diabetes type 2 - symptoms

gradual 3 p’s from type 1 and recurrent infections

diabetes type 2 - primary management

• diet and exercise

• metformin (lowers bg)

• insulin needed for stress

diabetes type 2 - metformin

• ↓ glucose in liver → ↑ insulin sensitivity

• side effects: gi upset, metallic taste, lactic acidosis

diabetes type 2 - metformin (pt teaching)

• hold metformin for procedures with contrast dye

• take with meal and do not consume alcohol

diabetes diagnostics

• fasting blood glucose >126 (confirmed twice separately)

• hbA1C: >6.5%

• random bg: >200 with 3 p’s present

dawn phenomenon - cause + what to give

• bedtime (bg normal) → 3 am (normal) → morning (high)

• cause: gh + high cortisol

• what to give: give nph insulin at bedtime

somogyi effect - cause + what to give

• bedtime (bg normal) → 3 am (low) → morning (high rebound)

• cause: overnight hypoglycemia rebound

• what to give: bedtime snack or reduce night insulin

dka vs hhns - reasons and blood glucose

• dka: type 1 diabetes + >250

• hhns: type 2 diabetes + >600

dka vs hhns - acid-base and ketones

• dka - metabolic acidosis + positive ketones

• hhns - no acidosis + no ketones

dka - clinical symptoms

• infection

• abdominal pain

• kussmaul respirations (rapid fruit breath)

hhns - clinical symptoms

• hyperglycemia

• hydration low

• neurological changes → slow

dka vs hhns - potassium

• dka → add potassium

• hhns → monitor sodium and potassium is stable

dka vs hhns - when to add dextrose

when bg 250-300 → prevent acute hypoglycemia