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What salt is necessary to secrete thyroid hormone?
Iodine
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What medication is used with a patient with hypothyroidism?
Start Synthroid at a low dose to start and give the medication in the morning on an empty stomach. This medication must be taken for life
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What do T4 and T3 do in the body?
regulate metabolism
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Decreased T3 in the body does what?
- (everything isslowing)
- slows down metabolism
- lower VS
- slower reflexes
- dry skin
- constipation
- respiratory rate
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Weight gain no matter how little you eat is seen
with what?
hypothyroidism
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What major factors contribute when determining whether a patient has hypothyroidism?
bowel elimination and their need for sleep
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Extreme hypothyroidism causes what
myxedema coma
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Goiter
- Seen in Hashimotos and hyperthyroidism
- Sometimes seen in regular hypothyroidism
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When is hypothyroidism caused by autoimmune disease?
The body destroys the thyroid gland is called Hashimotos’s Thyroiditis.
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When are patients at most risk for hypothyroidism?
winter, after surgery, and while using CNS depressants
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Calcitonin
- Secreted by the thyroid gland
- Decreases excess calcium in the blood
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What laboratory values are seen with hypothyroidism
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How would you teach your patient that the Synthroid is working?
Have the patient check their pulse. It should be going up. The patient should also be wearing a medic-alert
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Increased T3 in the body does what
Diaphoresis (excessive sweating), flushed skin,warm skin, weight loss with increased eating, high temp, increased HR, tremors, restlessness, delirium, seizures, coma.
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Graves Disease is seen with what?
Hyperthyroidism.
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Exophthalmos
Seen with hyperthyroidism, corneal abrasions.
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What laboratory values would you see with hyperthyroidism
- High T3
- High T4
- TSH = Low levels
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What is the treatment for hyperthyroidism
Partial or total thyroidectomy surgery
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How often are VS given to a post-operative thyroid patient
- Every 15 minutes; you may delegate this to a
- CNA, but only after stabilization.
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What are the most important VS with a post-surgical thyroidectomy patient?
- Temperature, internal or external bleeding
- Patient may have a horse voice; which will eventually subside.
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What might be next to the bed for a post-operative thyroidectomy patient?
Calcium gluconate to treat hypocalcemic tetany
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What type of environment is important to remember for a patient with hyperthyroidism
restful environment
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What does the adrenal cortex release
- glucocorticoids/glucose/blood sugar
- mineralocorticoids
- Aldosterone; which maintains water and sodium imbalance. Cortex is the most important.
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What does the adrenal medulla release
epinephrine and norepinephrine; which increases gastric acid, BP, and cardiac output (fight or flight)
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What are the adrenal cortex diseases
Cushing’s disease and Addison’s disease
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What is the adrenal medulla disease
Pheochromocytoma
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Pheochromocytoma
benign tumor that produces excessive amounts of epinephrine and norepinephrine stimulating the sympathetic nervous system increasing VS
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Diagnostic tests for Pheochromocytoma
CT showing increased atrophy of the adrenal medulla, blood and urine catecholamine levels.
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Treatment of Pheochromocytoma
removal of adrenal gland, and post operative BP monitoring.
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Cushing’s Disease
excess production of glucocorticoids; adrenal or pituitary gland tumors.
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Cushing’s Syndrome
more common; has do with chronic glucocorticoid therapy.
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What is a glucocorticoid medication
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Who is at most risk for Cushing’s syndrome
People with COPD and asthma.
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S/S: Cushing’s?
Buffalo hump, thin legs, stretch marks, bruising, muscle weakness because of altered protein metabolism, decreased calcium, potassium loss, increased retention of sodium and H2O, increased gastric acid production (gastric ulcers),
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What are the diagnostic test are seen with Cushing disease
elevated plasma cortisol level, elevated plasma ACTH, elevated serum sodium, elevated serum glucose.
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Treatment for Cushing’s
Suppresses/inhibit adrenal cortex activity Cytadren - inhibits cortisol by the adrenal cortex.
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What type of surgery is available for a patient
with Cushing’s disease–
adrenalectomy, radiation therapy.
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What is important to monitor a patient who has Cushing’s?
fluids and electrolytes, blood sugars, infection, daily weight.
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Addison’s Disease
- adrenal cortex autoimmune disease that decreases
- production of glucocorticoids and mineralocorticoids; however, symptoms do not present themselves until 90% of the cortex is destroyed.
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Signs and symptoms of Addison’s disease
- Skin hyperpigmentation, orthostatic hypotension, a
- craving for salt because of decreased aldosterone, fluid volume deficit
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What are some diagnostic labs for Addison’s disease
low serum cortisol, low serum aldosterone, low serum sodium/glucose, high potassium level
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What is the treatment for Addison’s disease
glucocorticoids in the morning and mineralocorticoids in the evening, high salt diet, daily weight
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Addison’s Crisis
the patient abruptly stops taking their medication; which can be life threatening.
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S/S of Addison’s Crisis?
Rapid thready pulse, extreme weakness, hypotension
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What type of diabetes will show ketoacidosis
Type I diabetes
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Type II Diabetes
- Body produces
- insulin; however, it is an insufficient amount and the body is resistant to the
- insulin. You do have enough insulin in
- your system to prevent ketoacidosis.
-
At what age does the body naturally rise in blood sugars?
Over the age of 50
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What are the risk factors/causes for type II diabetes?
- Obesity
- Decrease in physical activity
- Increased age
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S/S of diabetes type II?
- Polyuria – excessive urination
- Polydipsia – excessive thirst
-
S/S of diabetes type I
- Polyuria - excessive urination
- Polydypsia - excessive thirst
- Polyphasia - excessive hunger
-
Manifestations of Early signs/symptoms of diabetes:
blurred vision, recurrent infection, numbness and tingling, slow healing
-
Fasting blood sugar levels
- no caloric intake for 8 hours
- Levels should be less than 100 (normalperson w/o diabetes)
-
Postprandial blood sugars
(after meals) = below 140
-
Fasting blood sugar on a diabetic should be?
lessthan 125
-
2 hours after a meal on a diabetic should be
above 200
-
Oral glucose tolerance test if diabetes will be
above 200
-
Oral glucose tolerance test w/o diabetes will be
around 140
-
What is a normal Hemoglobin A1c level?
3.5% – 5.2%
-
What is a good level for a Hemoglobin A1c for newly diagnosed diabetics?
over 6.5%
-
What is a normal Cholesterol level?
over 200
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What type of urine test will be used when determining diabetes?
Urine test for ketones and sugar BUN and createnine
-
What is the main treatment for a person with diabetes?
Diet and exercise and carb counting.
-
What dietary change should a person with diabetes?
- Low fat protein
- 20 – 35 grams of fiber in their diet
- Calorie counting/balanced diet
- Vitamin C and zinc
- Moderate alcohol consumption
-
What does exercise do for type II diabetic?
- Decreases insulin resistance
- Decreases stress
- Burns excess glucose
-
Which inulin is never mixed?
Lantus
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Byetta
Sub-Q injection that stimulates insulin release from the pancreas (type II)
-
Symlin
Sub-Q injection that decreases blood glucose levels after meals (type I & II)
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Oral type II diabetic medicaitons
- Glucophage
- Glipizide
- Avandia
-
Glucophage
class of drugs which calms glycogen so reduces glucose production from the liver and allows glucose get into the cells (type II)
-
Glipizide
(type II) causes the release of insulin from the beta cells of the pancreas
-
Avandia
causes the cells to become more permeable. This will not cause hypoglycemia if this is the only medication that the patient is on.
-
Diabetes can cause what?
- atherosclerosis
- Peripheral vascular disease
- Venous-stasis ulcers
- CAD
- Retinal detachment
- Kidney failure
- Neuropathy
- Gangrene
-
Osteopenic
osteoporosis (swiss-cheesy bones)
-
Bone Density Test
test for osteoporosis
-
How is Fosamax taken
8 oz of H20 and sit up while taking this med
-
Fosamax
prevention of osteoporosis
-
What labs would be drawn with a broken hip injury?
-
What are the assessments to be made when a patient is post-operative and has a cast?
- Pain
- Pulses
- Pallor
- Paralysis
- Parenthesis
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