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List three specifically endocrine organs
Pituitary, thyroid, parathyroid, adrenal, pineal
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What does thyroid hormone do?
- Controls metabolism, glucose, fat,
- protein utilization,
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What does PTH do?
Demineralizes bone to raise serum Calcium
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Differentiate between gluco corticoids and mineral corticoids
- G- metabolism, inflammation, stress,glucose
- M- fluid/electrolytes
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Name two endocrine changes that occur with aging
Inc. hypothyroidism, thyroid CA, type II DM, osteoporosis
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What systemic problems occur with acromegaly?
Organs & skeleton can't support enlarged structures
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Name three s/sx of Diabetes Insipidus
Polyuria, low SG (>and equl to 1.002), thirst weakness, dehydration
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Name 2 tx for Diabetes Insipidous
Replace volume, DDAVP, pitressin
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What neuro sx may accompany SIADH?
HA, muscle twitching, changes in LOC, Sz
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What labs would support SIADH?
Hyponatremia, low serum osmolarity
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List three sx of hyperthyroidism
Restless, weakness, fatigue, tachycardias, tremors, appetite heat intolerance, diarrhea, exophthalmos, goiter, weight loss
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What medications are ordered for hyperthyroidism?
PTU, methimazole, beta blockers, eye drops
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Name 2 nursing precautions for thyroidectomy pts
Support head with hands, don't hyperextend, elevate HOB, monitor for bldg, sxn/trach/ suture remover in room, protect voice, monitor calcium
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What electrolyte imbalance may be associated with thyroidectomy?
Hypocalciumia
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List three sx of thyrotoxicosis
Hyperthermia, tachycardia, restlessness, CP, exophthalmos, severe weight loss
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Name three tx for thyrotoxicosis
Antithyroid meds, beta blockers, IV corticosteroids, IV fluids, 02, supportive care
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List three sx of hypothyroidism
Sluggishness, cold intolerance, apaty, fatique, constipation, dry, thin, brittle hair, edema, menstural disorders, elevated TSH, low HR, RR, T
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Name two teaching points for thyroid replacement therapy
Take in am, don't stop suddenly, avoid Increase iodine foods, monitor thyroid levels, monitor for sx thyroid toxicity
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What electrolyte is regulated by parathyroid hormone?
Calcium
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List three sx of hypoparathyroidism
Tetany, muscle cramps, carpopedal spasm, laryngospasm, N/V diarrhea, hypotension, bradycardia, sz, paresthesias, bleeding, +Chvostek & Trousseau's signs
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Describe the treatment for hypoparathyroidism
Calcium supplement, Vit D, high Calcium, low Phos.diet
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Name three sx of hyperparathyroidism
Hypercalcemia, osmotic diuresis, sx dehydration bone pain, pathologic fx, weakness, arrhythmias, N/V constipation, clots
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Name two treatments for hyperparathyroidism
IV fluids, diuretics, biphosphonates, parathyroidectomy, salmon calcitonin
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Name two teachings for fosamaax
Take alone with water, in am, before breakfast, upright for 30"
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List three sx of adrenal insufficiency
Hyponatremia, loww of extra cellular fluid, dec. cardiac output, hyperkalemia, orthostatic hypotension, hypoglycemia, dehydration, hyperpigmentation
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List two tx for adrenal insufficiency
Hydrocortisone or fludrocaortisone (lifelong), consider DHEAS
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Name four side effects from glucocorticoids
Fluid retention, mood changes, hyperglycemia, GI ulceration, fragile skin, osteoporosis, immunosupression, inc. intraocular pressure, wt gain, cushingoid appearance
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List two teaching points for adrenal insufficiency pts.
When to call MD, reg. schedule for meals/exercise, immediate attention to infection/trauma, medic alert bracelet, don't dc meds suddenly, call MD for N/V/D
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What are two sx of pheochromocytoma?
HTN, palpitations, sweating, HA, fainting, increased glucose
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What med is used to treat pheochromocytoma?
Phentolamine (Regitine) or other alpha blockers
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List three sx of Cushing's syndrome
Body changes, muscle wasting, thin skin, osteoporosis, renal calculi, hyperglycemia, hypokalemia, HTN, Immunosuppression, ulcers, hirsuitism, acne, mood changes , menstrual disorders
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List two tx for Cushing's syndrome
Remove pituitary/radiation, adrenalectomy sx management(diuretics, antihypertensives, low sodium/carb diet, abx)
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List two sx of hyperaldosteronism
HA, weakness, fatigue, HTN, dysrhthymias, hypokalemia, hypernatremia
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List two treatments for hyperaldosteronism
Adrenalectomy, corticosteroids, spironalactone, Na restriction
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List three classic sx of DM
Polyphagia, polydypsia, polyuria
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Why does polyuria occur in DM?
Glucose exceeds renal threshold, glucosuria occurs, osmotic diuresis
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What lab would indicate a risk for acidosis in a pt. with DM?
Ketones
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How does type II differ from type I DM?
In type II DM some endogenous insulin exists, does not always require exogenous insulin
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What should be tried first to control type II DM?
Diet, exercise
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What does A1C measure?
Average blood sugar over 3 months
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List three health promotion strategies to avoid DM
Normal wt, balanced diet, regular exercise, CBG q3y after 45 in high risk
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List 4 dietary guidelines for DM pts
Normalize CBG, 60-70% carbs, 12-20% protein, 10% fats, inc. fiber, low sodium, cautious ETOH, time meals w/insulin/exercise, monitor with sickness
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How do sulfonylureas work?
Stimulate pancreas to secrete insulin-can cause hypoglycemia
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What is a benefit of biguanides?
Doesn't cause hypoglycemia
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How should injection sites be rotated?
rotate sites within one general area - abdomen preferred
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Which insulin should be drawn up first?
Short or rapid acting
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What is unique about lantus insulin
No peak, lasts 24 hrs
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Name three filndings that would differentiate DKA from hyperglycemia
Ketones, kussmauls respirations, acidotic pH, acetone breath
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Name three tx for DKA
IV insulin, IVF, potassium replacements, I/O's cardiac monitoring
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Name three ways HHNS differs from DKA
Usually in type 2, CBG higher, pH normal, osmolarity higher, more neuro sx
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Name two causes of hypoglycemia
Glucose lowering agents, inadequate calories, excess exercise, ETOH
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List three sx of hypoglycemia
Hunger, irritability, tremors, perspiration, double vision, HA, sz
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List three sx of hyperglycemia
Polys
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Differentiate b/w Dawn & Somogyi phenomenon
- Dawn - CBS rises b/w 0400 & 0800.
- Somogyi- hypoglycemia results in rebound hyperglycemia in am, insulin resistance for 12-48 hr
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What are common sx of diabetic neuropathy?
Pain, numbness, sweating/pupil, HR/BP changes, gastroparesis/constipation, GU dysfunction
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How should DM pts monitor for sx of renal pathology?
Monitor urine for protein
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List three vascular disturbances assoc. with DM
PVD, CAD, CVA
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List three reasons why pts with DM are at greater risk for infection
Vascular/neurologic changes (nutrition/sensation), hyperglycemia (medium), neutrophilic changes, delayed bladder emptying, glucosuria
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