Hypothyroidism/cushings/dm

Front 1

Inadequate production of thyroid hormones causing the thyroid gland(in response to increased levels of TSH) to enlarge in attempt to compensate

Back 1

Hypothyroidism

Front 2

This autoimmune thyroiditis is the most common cause of Hypothyroidism

Back 2

Hashimoto's Disease

Front 3

Pt's who have had the following are at a higher risk for hypothyroidism

Back 3

Hyperthyroidism tx with radio-iodine, antithyroid meds, or thyroidectomy

Front 4

Hypothyroidism occurs more freq in

Back 4

Older women

Front 5

Therapy of Hypothyroidism

Back 5

Medication
RAI
Surgery

Front 6

______% of patients with hypothyroidism have primary or thyroidal hypothyroisism

Back 6

95%

Front 7

Refers to the accumulation of mucopolysaccharides in subcu & other interstitial tissues

Back 7

Myxedema

Front 8

Mask like expression
puffy eyelids
hair loss in eyebrows
thick lips and broad tongue are sx for

Back 8

Myxedema

Front 9

Early sx of hypothyroidism are

Back 9

Nonspecific, but extreme fatigue makes it hard to participate in usual activities.

Front 10

Common pt complaints for hypothyroidism

Back 10

Hair loss
Brittle Nails
Dry Skin
N/T of fingers
Husky Voice/Hoarseness
Menstural changes

Front 11

Hypothyroidism affects women _______times more freq than men & occurs between the ages of

Back 11

5 times
30-60 years

Front 12

Severe hypothyroidism results in

Back 12

SUBnormal temp & pulse rate
Weight gain, thick skin,

Front 13

The skin becomes thick because of an accumulation of mucopolysaccharides in the subcu tissues...aka

Back 13

Myxedema

Front 14

In hypothyroidism all body processes are.....

Back 14

slowed down

Front 15

The primary objective in the mgmt of hypothyroidism is to restore normal metabolic state by__________

Back 15

Replace the missing hormone

Front 16

The preferred medication for tx hypothyroisism

Back 16

Synthetic Levothyroxine
(Synthroid or Levothroid)

Front 17

The dosage for hormone replacement is based on the pt's ________ (Lab)

Back 17

Serum TSH Concentration

Front 18

Advanced hypothyroidism may produce__________

Back 18

Personality & cognitive changes characteristic of dementia.

Front 19

The patient with advanced hypothyroidism is hypothermic and abnormally sensitive to

Back 19

Sedatives, opioids & anesthetics

Front 20

The most extreme, severe stage of hypothyroidism is?

Back 20

Myxedema coma

Front 21

Thyroid hormones may increase ___________ levels

Back 21

Blood Sugar

Front 22

Thyroid hormone levels may be increased by this drug and these agents

Back 22

Dilantin & tricyclic antidepressents

Front 23

Thyroid hormones may increase the effects of the following classes of drugs

Back 23

Cardiac Glycosides
Anticoagulants

Front 24

_______ and _______ may occur with thyroid therapy

Back 24

Bone loss and osteoporosis

Front 25

These two agents may cause profound somnolence in pts with hypothyroidism

Back 25

Hypnotics & Sedatives

Front 26

T3 in hypothyroidism is

Back 26

Decreased

Front 27

This is the best screening of thyroid function

Back 27

TSH

Front 28

This lab is increased in Hypothyroidism

Back 28

TSH

Front 29

Most commonly used to CONFIRM an abnormal TSH and is a direct measurement of free unbound thyroxine

Back 29

Free T4

Front 30

This level is decreased in hypothyroidism

Back 30

Free T4

Front 31

This test measure the rate of iodine uptake by the thyroid gland and is Decreased in hypothyroidism

Back 31

Radioactive Iodine Uptake

Front 32

This test is helpful in determining the location, size & function of thyroid gland

Back 32

Thyroid scan

Front 33

A nursing consideration when pt is recieving thyroid lab tests

Back 33

Has the pt taken meds/agents containing iodine (which alter results)

Front 34

How many weeks does it take before symptoms disappear for pt on tx for hypothyroidism?

Back 34

3 to 12 weeks

Front 35

Signs in geriatric pts with hypothyroidism

Back 35

May be few or none
Depression, apathy, decreased mobility, wt loss, constipation

Front 36

Nursing interventions for pts with hypothyroidism

Back 36

Modify activity, Monitor physical status, Promote physical comfort, Enhance coping, Emotional support for family, warmth

Front 37

In hypothyroidism, the hormone disturbace may contribute to an acceleration of:

Back 37

Atherosclerosis

Front 38

With hypothyroidism, serum cholestrol is:

Back 38

Elevated

Front 39

The metabolic rate may increase to rapidly with thyroid therapy of hypothyroidism causing cardiac complications which include these symptoms:

Back 39

palpatations
chest pain(angina)
SOB(shortness of breath)
Rapid heart rate(tachycardia)

Front 40

Overmedication during hypothyroidism therapy can lead to:

Back 40

Hyperthyroidism

Front 41

s/s of hyperthyroidism are and are important in pt teaching

Back 41

irritability
tremors
tachycardia
palpatations
heat intolerance

Front 42

In hypothyroidism tx, encourage activity to combat constipation and promote weight loss and provide a _____ diet.

Back 42

high bulk & low calorie

Front 43

Pts. with myxedema coma s/s are:

Back 43

respiratory depression
decreased cardiac output
cerebral hypoxia
stupor
hypothermia
bradycardia
hypotension

Front 44

Nursing interventios for myxedema

Back 44

maintain airway
IV fluids
glucose as needed
EKG
ABG's
Monitor temp/give blankets
IV synthroid
vital signs
I&O
daily wt.
Check for infection/cause

Front 45

When T3 and T4 fall the TSH is ____ in hypothyroidism

Back 45

elevated

Front 46

iodine containing medications _____ the release of stored ________

Back 46

inhibit
thyroid hormone

Front 47

The normal value of TSH is

Back 47

0.2 to 5.4 microunit/ml

Front 48

A TSH value above 5.4 would indicate

Back 48

hypothyroidism

Front 49

The patient may have lab values identical to a "normal" hypothyroid state, but a stressful event (infections, MI, CVA, drugs, etc.) precipitates

Back 49

myxedema coma

Front 50

A man admitted to the ER with myxedema coma What nursing action would initially be prepared to carry out

Back 50

maintain a patent airway

Front 51

rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) (known as a lipodystrophy) and a round face often referred to as a "moon face".

Back 51

Cushing's Syndrome

Front 52

Radioactive iodine destroys hyperplastic tissue can result in

Back 52

Hypothyroidism

Front 53

Slowing of the metabolic rate from inadequate secretion of thyroid hormones

Back 53

Hypothyroidism

Front 54

Nursing care problems r/t hypothyroidism are

Back 54

activity intolerance
constipation
risk for imbalanced body temperature

Front 55

Diagnoisis of Cushing's Syndrome is confirmed by an increased plasma ______ level & an elevated 24-hour urine test for 17-ketosteroids & 17-hydroxycorticosteriods.

Back 55

cortisol

Front 56

Hypothyroidism in children, if not tx will result in stunted growth & child may be mentally deficient

Back 56

Cretinism

Front 57

S/S for Cushing's Syndrome

Back 57

Edema
Buffalo hump
Moonface
Muscle weakness
Tissue wasting
Hyperglycemia
Lowered resistance
Development of 2ndary male characteristics in female

Front 58

hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump

Back 58

Cushing's

Front 59

Oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in______

Back 59

Cushing's disease

Front 60

This disorder is commonly caused by use of corticosteroid medications & is infrequently due to excessive corticosteroid production

Back 60

Cushing's Syndrome

Front 61

Central type obesity, a fatty buffalo hump in the neck and supraclavicular areas, a heavy trunk & thin extremities

Back 61

Cushing's syndrome

Front 62

Most widely used & most sensitive screening test for dx of pituitary & adrenal causes of Cushing's

Back 62

Overnight dexamethasone suppression test

Front 63

Is administered orally at 11pm & plasma cortisol level is obtained at 8am the next morning.

Back 63

Dexamethasone 1mg

Front 64

HYPERsecretion=hyperglycemia (increased sugar), hypernatremia (increased salt) so therefore--hypokalemia, hypocalcemia

Back 64

Cushing's

Front 65

-family hx
-obesity
-45+ years old
-HTN
-hx of gestational diabetes OR delivery of 9+lbs baby
-HDL less than or equal to 0.9mmol/L (35mg/dL) AND/OR
triglyceride level more than or equal to 2.8mmol/L (250mg/dL)
-certain races (hispanic, native american, asian, pacific islanders, african americans)

Back 65

Risk factors for DM

Front 66

an autoimmune process destroys victims' beta cells
-acute onset (commonly before 30yo)

Back 66

Type 1 diabetes

Front 67

-insulin resistance and/or impaired beta cell functioning
common among 30+yo, obese
incidence increasing among kiddies

Back 67

Type 2 diabetes

Front 68

an anabolic (storage) hormone
moves glucose into muscle, liver, fat cells
inhibits breakdown of stored glucose, protein and fat
pancreas continuously releases a small amount of basal insulin during fasting periods (b/n meals and overnight)

Back 68

Insulin

Front 69

impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)
blood glucose concentrations fall b/n normal levels and those diagnostic for diabetes

Back 69

Pre-diabetes

Front 70

body type of type 1 diabetes

Back 70

thin, underweight

Front 71

type 1 diabetics prone to : _______ and ________

Back 71

hyperglycemia, and hypoglycemia

Front 72

can manufacture some insulin but do not produce sufficient amounts or do not use insulin efficiently

Back 72

Type 2 DM

Front 73

typical body type of type 2 DM patients

Back 73

obese

Front 74

aka adult onset DM

Back 74

Type 2 DM

Front 75

aka juvenile onset DM

Back 75

Type 1 DM

Front 76

hormones that may cause DM

Back 76

growth hormones
cortisol
glucagon
epinephrine

Front 77

drugs that may cause DM

Back 77

glucocorticoids
thiazides
Vacor (rat poison)

Front 78

diseases that may lead to DM

Back 78

pancreatitis
cystic fibrosis
sx removal of pancreas
cushing's disease

Front 79

is a building (anabolic hormone) that lowers blood glucose

Back 79

Insulin

Front 80

lowers blood glucose by accelerating movement from the blood in to the cells

Back 80

Insulin

Front 81

3 metabolic problems occur without insulin: ___, ____, ____

Back 81

decrease glucose utilization
increased fat mobilization
increased protein utilization

Front 82

The 3 P's

Back 82

polyuria
polydipsia
polyphagia

Front 83

s/s of DM (8)

Back 83

recurrent blurred vision
weight loss
fatigue
vaginitis
skin infections
circulatory problems
paresthesias
impotence

Front 84

normal glucose serum levels

Back 84

60-110 mg/dl

Front 85

fasting blood glucose (DM)

Back 85

>126

Front 86

hemoglobin with glucose, used for measureing long term glycemic control

Back 86

glycosylated HgB

Front 87

indicates that the body is using fat as a major energy source

Back 87

Ketoacidosis

Front 88

proper nutrition in regulating blood glucose

Back 88

50-60% CHO
40-50% starches
10-20% simple sugars

Front 89

medical management of DM

Back 89

proper nutrition
weight management
exercise
medications prn

Front 90

when blood glucose levels > 126 mg/dl

Back 90

Hyperglycemia

Front 91

interventions for hypoglycemia(conscious)

Back 91

ingest 10-15 g of simple CHO

Front 92

interventions for hypoglycemia (unconscious

Back 92

GLucagon 1 mg IM or IV
or 50% dextrose in 1 amp over 1-3 mins iV
start 5% D/W IV solution

accucheck q 15 mins until level is >100 mg/dl ; may need more CHO

Front 93

a result of profound insulin deficiency with glucose levels above 500 mg/dl. Onset is sudden; serious metabolic disturbance in Type 1 DM, can also affect type 2 DM during extreme stress

Back 93

DKA

Front 94

Causes of DKA

Back 94

too little or skipping doses of insulin
body unable to meet increased demand for insulin
developing insulin resistance through the presence of insulin antibodies

Front 95

clinical manifestations of DKA

Back 95

Kussmaul's respirations
fruity odor
ketonurea

Front 96

acid produced during DKA

Back 96

lactic acid

Front 97

clinical s/s of DKA

Back 97

dehydration
F/E imbalance

Front 98

other s/s of DKA

Back 98

abd pain
thirst
warm dry skin
anorexia
impaire LOC
polyuria
tachycardia
visual distrubances
hyperpnea (Kussmaul's)

Front 99

complications of fluid loss during DKA

Back 99

hypovolemic shock
acute tubular necrosis
uremia

Front 100

DKA management

Back 100

I/O
F/C
N/G
Oral Care
Blood, albumin or plasma volume expanders
K balance
correct pH
administer insulin
sodium bicarb when pH less than normal
Vs, CBC, C&S, CXR, EKG

Front 101

is a type 2 DM complication characterized by extreme hyperglycemia

Back 101

HHNS

Front 102

the main difference between HHNS and DKA

Back 102

with HHNS, there's an absence of acidoses,
and mild or undetectable ketonuria

Front 103

signs of hyperosmolality in HHNS (labs)

Back 103

increase concentration of plasma
elevated BUN

Front 104

mortality rate for HHNS

Back 104

10-40%

Front 105

Chronic complications of DM

Back 105

CAD
CV disease
HTN
PVD and infection
retinopathy
nephropathy
peripheral neuropathy

Front 106

numbness and tingling of extremities

Back 106

paresthesias

Front 107

how would ABG look like during DKA

Back 107

low PCO2
low HCO
low pH