1. What does the thyroid gland do:
    What does it produce?
    What do you need for it to produce?
    What does it's products do for us?
    Produces 3 hormones: T3, T4, and calcitonin

    Calcitonin decreases serum levels by pushing serum calcium back into the bone

    You need iodine to make hormones (dietary iodine)

    Thyroid hormone gives us energy!
  2. Hyperthyroid:
    What is it?
    Common cause?

    Commonly caused by Graves disease (thyroid produces too much hormone)

    • S/S include:
    • Nervousness, irritable, Decreased attention, etc.
    • Exophthalmos = bulging eyes which can become irreversible. 
    • Appetite up, weight down
    • Thyroid size is BIG - working overtime

    • Dx:
    • TSH would be decreased - it is hormone secreted by pituitary to secrete thyroid hormone. 
    • T4 would be increased cause thyroid is putting out too much
    • Thyroid scan
    • Ultrasound/MRI,CT

    *Pt must discontinue any iodine containing med 1 wk prior to thyroid scan and wait 6 weeks to restart
  3. What anti arrhythmic drug could effect thyroid function?
    • Amiodarone
    • contains high levels of iodine and may affect thyroid function
  4. Medications for hyperthyroidism:
    How they help
    • Anti-thyroids:
    • Stops thyroid from making hormone. Used preoperatively to stun thyroid. 

    • Iodine Compounds: 
    • Will decrease size and vascularity of gland
    • ALL endocrine glands are very vascular.
    • *Give with milk or juice and USE STRAW as it will stain your teeth.

    • Beta Blockers (for SUPPORTIVE therapy)
    • Decreases myocardial contractility, HR, and BP
    • Decreases anxiety! Could decreases cardiac output.

    • Radioactive Iodine therapy (only need one dose)
    • Given PO, but RULE OUT PREG FIRST!!
    • Destroys thyroid cells = becomes hypothyroid
    • Follow radioactive precautions: stay away from babies for 1 week, don't kiss anyone for 1 week.
  5. What pt should NOT be given beta blockers?
    Asthmatics as they wont feel oncoming asthma attack

    Diabetics as it blocks feelings of hypoglycemia
  6. What thyroid levels will you find with hypothyroid pt?
    DECREASED T4 - not getting put out

    Increased TSH - trying to get thyroid to put out

    *Just the opposite of hyper - duh
  7. What is hyperparathyroidism
    SS of hyper
    Treatment for hyperparathyroidism
    What should be monitored?
    Hyperparathyroidism = hypercalcemia

    • S/S: TOO MUCH PTH!
    • Serum calcium is increased, phosphorus is decreased
    • SEDATED!

    Partial parathyroidectomy - take out 2 of your parathyroids = PTH secretion decreases

    Want to monitor for s/s of hypocalcemia post-op
  8. What is hypoparathyroidism?
    Hypoparathyroidism = Hypocalcemia = Hyperphosphatemia 

    • Serum calcium is low, phosphorus is high

    • Tx:
    • IV calcium
    • Phosphorus binding drugs (Sevelamer, calcium acetate)
  9. Adrenal Glands:
    Why do you need them?
    Two parts?
    Need adrenals to handle stress

    • Two parts:
    • Adrenal medulla and adrenal cortex
  10. Adrenal medulla:
    What does it secrete?
    What problem can you have with your medulla?
    S/S of problem?
    Adrenal medulla secretes epi and norepi

    • Prob: Phenochromocytoma = benign tumor that secrete epi and norepi in boluses.
    • Tend to be familial so screen family

    • S/S include:
    • Increased BP and RR
    • Palpitations
    • Flushing, extremely diaphoretic
    • HA
  11. Dx of pheochromocytoma
    • Test catecholamine levels:
    • VMA (Vanillylmandelic acid)
    • Metanephrine (MA) test
    • *These test epi/norepi levels. Foods that can alter these test include anything with vanilla in it, caffeine, vit B, fruit juices and bananas.

    24 hr urine specimen - looking at epi and norepi levels

    Will need to educate pt to avoid any activities that can increase epi or norepi = No stress!!

    Treatment: Surgery to remove tumor
  12. What does the adrenal cortex secrete?
    What is the action of each?
    • Glucocorticoids4 actions:
    • Change you mood
    • Lower immune system
    • Inhibit insulin
    • Break down fats and proteins
    • *Can cause hyperglycemia, will monitor blood sugars

    • Mineralocorticoids = Aldosterone
    • Makes you retain water and sodium
    • Makes you lose potassium

    • Sex hormones: Testosterone, estrogen, and progesterone.
    • Too much: Hirsutism, acne, irregular period

    • Too little: Decreased axillary/pubic hair
    • Decreased libido.
  13. What medication can be given to treat Addison's disease?
    Fludrocortisone = is aldosterone

  14. What disease is "too many steriods"?
    What will potassium level look like?
    What will cortisol level look like?

    Since pt has too much mineralocorticoid (aldosterone), serum potassium will be low. 

    Cortisol is just a fancy word for sterioids. Therefore, will be high.
  15. S/S of too much glucocorticoids?
    • Growth arrest
    • Thin extremities
    • Buffalo hump (fat redistribution)
    • Moon faced (fat redistribution)
    • Hyperglycemia
    • Psychosis to depression
    • Immunocompromised
  16. Treatment for Cushings
    Adrenalectomy (unilateral or bilateral = if bilateral will be on lifetime replacement)

    Quiet environment = can't handle stress

    • Diet: increased potassium, calcium and protein, decreased sodium
    • Avoid infection
  17. Diabetes Type I:
    What's usually first sign?
    Classic symptoms?
    First sign is usually DKA, comes on abruptly even after years of beta cell destruction

    Classic P's: Polyuria, Polydipsia, and Polyphagia

    They will have to be on insulin
  18. Diabetes Type 2:
    Who gets it?
    • Usually overweight, can't make enough insulin to keep up with glucose load client takes in
    • Usually found by accident.

    Don't usually see DKA, as they don't break down fat. 

    Should be evaluated for metabolic syndrome

    • Treatment begins with diet and exercise
    • Some may have to take insulin
  19. Gestational Diabetes:
    Which type does it resemble?
    What does mom need?
    How can it affect baby?
    Resembles Type 2

    Mom needs 2-3 x more insulin than normal

    If mom has risk, then screened at FIRST prenatal visit. All moms screened at 24-28 gestation.

    Complications for baby include hypoglycemia - since after delivery, baby no longer exposed to moms sugar. Baby pancreas has been in overdrive. Takes time to slow down to normal. Will resolve in few days.
  20. Who can take oral anti-diabetic meds?
    What kind is mostly used?
    Type 2 diabetics! (Type one needs insulin)

    Most commonly used is metformin. It reduces release of more insulin, so wont see hypoglycemia with this drug.
  21. Rapid Acting insulin:
    Onset, Peak, Duration
    • Onset at 15 mins
    • Peak at 1-3 hrs
    • Duration 3-5 hr

  22. Regular insulin:
    Onset, Peak, Duration
    • Regular is a short acting insulin
    • Onset is 30 mins
    • Peak is 2-4 hrs
    • duration is 6-8 hours
  23. NPH Insulin:
    Onset, Peak and duration
    • Onset: 1.5 hr
    • Peak: 4-12 hrs
    • Duration: 16-24 hr
  24. Long acting insulin:
    • Onset: 2-4 hr
    • NO PEAK
    • Duration: 24 hr

    Lantus = Long acting

    Often used in combination with rapid acting
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