MedSurg II Endocrine Exam 4 Review- Az college of nursing- Graded A

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Hormone secretion does what when circulating levels drop? - ANSWER increase Elevation of T3 T4 levels being released means - ANSWER TSH levels drop How would you palpate and assess a tumor on th... e thyroid? - ANSWER ISTHMUS. Stand behind the pt (posterior approach) and palpate anterior neck below chricoid cartilage and have the patient swallow. What is the best indication to determine if someone has hypothyroidism - ANSWER TSH level (high) What would be the difference between thyroid storm and hyperthyroidism - ANSWER thyroid storm will appear with fever, tremors, severe htn, tachycardia, CHANGE IN LOC. What clinical manifestations would we see with hyperthyroidism? - ANSWER tachycardia, weight loss, thyroid bruits, hairloss, bulging eyes (exopthalmus), goiter, anxiety, insomnia, increased appetite Not all hormones need to be imbalanced to - ANSWER diagnose Anytime we have a subtotal or total thyroidectomy pts are at risk for - ANSWER hypoparathyroidism and hypothyroidism Postop complications for total or subtotal thyroidectomies - ANSWER airway (swelling), laryngeal nerve damage (change in voice or tone, stridor), hypocalcemia (hypoparathyroidism), hyperthyroid symptoms (thyroid storms), hyperthermic For hypoparathyroidism we wanna check what type of calcium level - ANSWER ionized calcium level A1C levels should be less than what for diabetics? - ANSWER 7 In A1C lower levels are always - ANSWER better Grave's disease is asscoiated with - ANSWER hyperthyroidism What is hashimotos associated with - ANSWER hypothyroidism Pt education for transsphenoidal hypophysectomy - ANSWER keep low ICP Interventions to lower ICP - ANSWER elevate head of bed, no lifting heavy objects, do not use IS, no straws, monitor CSF leakage (monitor with halo test), no blowing nose or coughing sneezing. If we suspect CSF leakage what is our first priority? - ANSWER notify the surgeon Main cause of hyperpituitarism is - ANSWER tumors What is our go to intervention for hyperpituitarism - ANSWER surgery to remove tumor or even part of the gland Hypothyroidism discharge teaching - ANSWER PT and pharmacy is recommended as a care plan (lifelong medication, and weakness and muscle aches for PT). Pt education for hypothyroidism - ANSWER take meds in the am with no food, report weight loss, report chest pain For severe hypothyroidism our priority will be - ANSWER get VS Hyperparathyroidism priority nursing assessments - ANSWER cardiac monitoring (shortened QT), bowel function (diarrhea is common), pain management, and calcium levels, NOT I&Os Hyperthyroidism will cause in increase in - ANSWER corticosteroid elevation therefore increased glucose and higher risk for seizures Which risk would we address first between seizures and hyperglycemia? - ANSWER seizures What is worse acutely in Diabetes? - ANSWER hypoglycemia Normal blood sugar is - ANSWER 65-99 Insulin is released from - ANSWER beta cells of the pancreas Glucagon is released from - ANSWER alpha cells of the pancreas Insulins job is to - ANSWER "unlock" the cell so it allows glucose to enter, therefore lowering the sugar in the blood Type I diabetes is most commonly diagnosed before - ANSWER 30 DM type I is frelated to - ANSWER beta cells (not able to make insulin) Insulin deficiency is which diabetes - ANSWER type I Diabetes type I results from - ANSWER a destruction of the beta cells of the pancreas as a result of autoimmune or infectious process With type I diabetics which treatment plan is most apprpriate - ANSWER insulin pump Type I insuling therapy is how long? - ANSWER lifelong Manifestations of type I DM - ANSWER polyuria, polydipsia (increased thirst), polyphagia (increased hunger), fatigue and weight loss Diagnosis of DM I includes - ANSWER A1C, fasting blood sugar, two hour postprandial (after meals) glucose tolerance test, rondom blood sugar Hemoglobin A1C value is a - ANSWER long term, time averaged glucose levels Fasting blood glucose must be fasting for - ANSWER 8 hours Treatment for DM I - ANSWER insulin, nutrition management, glycemic control When in the hospital We want a DM I patient to be under - ANSWER 120 Why is it important to have a good blood sugar in the hospital - ANSWER optimal healing Should pts document only bad blood sugars? - ANSWER no, good too Patients with DM are advised to check their sugars at least - ANSWER ACHS When would we want pts too check their sugars more often - ANSWER new illnesses, stress, infection How do we sustain sugars longer (what snack is best to eat for diabetics after sugar) - ANSWER protein Diabetic ketoacidosis - ANSWER the rapid breakdown of fat store, releasing fatty acids from adipose tissue. DKA causes - ANSWER acidosis DKA leads to - ANSWER gluconeogenesis and glycogenolysis, resulting in severe hyperglycemia, hyperosmolaluty and osmotic diuresis Clinical manifestations of DKA - ANSWER hypotensive, tachy, kussmayl RR, fruity breath DKA is also referred to as - ANSWER metabolic acidosis Anion gap is useful in determining - ANSWER the cause of metabolic acidosis Metabolic acidosis is diagnosed by - ANSWER anion gap Anion gap normal range - ANSWER 8-16. Anything higher is metabolic acidosis Hypoglycemia is considered - ANSWER less than 65 Clinical manifestations of hypoglycemia - ANSWER anxiety, diaphoresis, palpitations, hunger, numbness around lips, shakiness, irritable, or change in LOC, slurred speech Hypoglycemia can lead to - ANSWER seizures, coma, death Hypoglycemia tx - ANSWER D50 (50% dextrose solution), 1mg IM glucagon When giving insulin we should - ANSWER rotate sites Angle of administration - ANSWER 45-90 degrees A1C levels for diabetic pts should be - ANSWER less than 7% A1C levels for prediabetic pts is categorized - ANSWER 5.7-6.4% A realistic goal for A1C is - ANSWER pts A1c will go down by 1% in 3 months Type 2 DM risk factors - ANSWER genetics and lifestyle Modifiable risk factors - ANSWER lifestyle Nonmodifiable risk factors - ANSWER genetics and history Increased risk with what BMI? - ANSWER greater than 30 Every race but what is at higher risk for DM - ANSWER caucasians Insulin resistance is which diabetes - ANSWER type II (make the insulin but cell does not accept it) Type II diabetic go to medication is - ANSWER metformin (PO med) In type II diabetic how much BMI should be lost to make it easier for the body to use insulin - ANSWER 5-10% What percent of DM II patients require insulin - ANSWER 30% Clinical manifestations of DM II - ANSWER polyuria, polyphagia, polydipsia, fatigue, poor wound healing, visual disturbances, cardiac issues Microvascular - ANSWER smaller vessels are affected Macrovascular - ANSWER large vessels are affected Example of organs that are affected by microvascular issues - ANSWER eyes, kidneys, neuropathy Example of organs that are affected by macrovascular issues - ANSWER brain, heart, extremities Treatment of DM II - ANSWER education, glycemic control, nutrition, exercise, monitor for complications (micro/macrovascular, infection, neuropathy) DM II has a risk for infection due to - ANSWER decreased perfusion and sensation in distal extremities [Show More]

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