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!
What is it?
TOO MUCH ENERGY
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
- 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
*Pt must discontinue any iodine containing med 1 wk prior to thyroid scan and wait 6 weeks to restart
What anti arrhythmic drug could effect thyroid function?
- contains high levels of iodine and may affect thyroid function
Medications for hyperthyroidism:
How they help
- 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.
What pt should NOT be given beta blockers?
Asthmatics as they wont feel oncoming asthma attack
Diabetics as it blocks feelings of hypoglycemia
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
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
Partial parathyroidectomy - take out 2 of your parathyroids = PTH secretion decreases
Want to monitor for s/s of hypocalcemia post-op
What is hypoparathyroidism?
Hypoparathyroidism = Hypocalcemia = Hyperphosphatemia
- S/S: NOT ENOUGH PHT
- Serum calcium is low, phosphorus is high
- NOT SEDATED!
- IV calcium
- Phosphorus binding drugs (Sevelamer, calcium acetate)
Why do you need them?
Need adrenals to handle stress
- Two parts:
- Adrenal medulla and adrenal cortex
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
- Flushing, extremely diaphoretic
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
What does the adrenal cortex secrete?
What is the action of each?
- Glucocorticoids - 4 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.
What medication can be given to treat Addison's disease?
Fludrocortisone = is aldosterone
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.
S/S of too much glucocorticoids?
- Growth arrest
- Thin extremities
- Buffalo hump (fat redistribution)
- Moon faced (fat redistribution)
- Psychosis to depression
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
Diabetes Type I:
What's usually first sign?
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
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
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.
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.
Rapid Acting insulin:
Onset, Peak, Duration
- Onset at 15 mins
- Peak at 1-3 hrs
- Duration 3-5 hr
Onset, Peak, Duration
- Regular is a short acting insulin
- Onset is 30 mins
- Peak is 2-4 hrs
- duration is 6-8 hours
Onset, Peak and duration
- Onset: 1.5 hr
- Peak: 4-12 hrs
- Duration: 16-24 hr
Long acting insulin:
- Onset: 2-4 hr
- NO PEAK
- Duration: 24 hr
antus = L
Often used in combination with rapid acting