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NRSG 230 Thyroid & Diabetes
Terms in this set (66)
Thyroid hormone is essentially ______
What does our thyroid produce?
T3, T4, Calcitonin (lowers calcium levels)
Hair-loss/ brittle nails
Dull blank expression
S/S of HYPOthyroidism
Edema caused by fluid and sodium retention and impairment of lymphatic drainage causing edema
hypothermic, decreased LOC, hypoventilation, hypotension
TX for Myxedema
To support the vital functions of the body and give IV thyroid hormone to boost levels quickly
*HYPOthyroidism that develops in infancy due to thyroid hormone insufficiency during fetal/early neonatal life
**All screened at birth
Diagnostic studies for HYPOthyroid
-*TSH to evaluate function and tx. effectiveness
(checked q6-8 weeks until normalized then checked q3,6,12 months)
-Free T4 to assess gland function
-T4, free T3, T3
Hypothyroidism treatment and education?
*Levothyroxine (low and slow)
-DONT stop abruptly
-Assess for S/S of hypo/hyperthyroid
-Advise them to wear a medical ID
-Carefully monitor patients w/cardiac history
-Report HR >100/min or an irregular beat
-Have pt. report any chest pain, weight loss, nervousness, tremors, and/or insomnia (HYPERthyroid)
-Provide bulk low calorie diet and encourage physical activity
Nursing implementation of HYPOthyroidism
When the thyroid gland is hyperactive and has an increased production in hormone?
*metabolism and tissue sensitivity to stimulation
*HYPERthyroidism w/bulging eyes
-accounts for 80% of hyperthyroidism w/unknown etiology
-patient develops antibodies to the TSH receptor causing it to destroy the thyroid tissue
-Intolerance to heat
-Increased systolic BP
-Fine straight hair
S/S of HYPERthyroidism
A rare life-threatening condition caused by exaggerated hyperthyroidism and hyper-metabolism due to excess T4, T3, or both is called __________.
Thyrotoxicosis (AKA Thyroid Storm)
-decreased TSH levels
-elevated free T4v(free thyroxine) levels
-RAIU shows diffuse, homogenous uptake 35-95%
(I-123 which is harmless to thyroid cells)
*Iodine is necessary for thyroid hormone
When getting this test, you need to:
-limit exposures to others at least 6 feet (2-3 days)
-Use a private toilet and flush 2-3 times (2-3 days)
-DO NOT prepare food for others (2-3 days)
-Avoid being close to pregnant women or children at least 6 feet apart (2-3 days)
When using the I-131 treatment for HYPERthyroid
Medications for HYPERthyroidism
Beta blockers (to decrease HR and BP)
-Administer anti-thyroid meds, BB and iodine (decrease bleeding risk)
-EDUCATE patient on safety, comfort, support head when moving in the bed, and doing ROM exercises of the neck
*Remember beth's story about the new nurse
-Monitor for airway obstruction
-Trach tray should be at bedside
-Monitor for hypothyroidism, hypocalcemia, bleeding, injury to laryngeal nerve, thyrotoxicosis and infection
-Semi-fowler's position (aspiration)
-Avoid neck flexion
4,000-5000 calories a day, 6 small meals, need a dietician, proper macronutrients and avoid caffeine
Enlarged thyroid gland with painless cervical lumps that are firm, palpable and painless
Thyroid cancer symptoms?
Hemoptysis and airway obstruction
*may be slow growing & hard to catch
Ultrasound with guided fine needle aspiration
Thyroid PET scan
Diagnostic studies for thyroid cancer
Collaborative treatment for thyroid cancer?
surgical removal, *RAI therapy (to destroy remaining cancer cells), High dosed thyroid hormone therapy (inhibit TSH) and chemo
Nursing implementation for thyroid cancer?
Similar as thyroidectomy & monitor for hypocalcemia (TETANY)
negative feedback loop?
When the body notices that is is missing something, so it sends a signal to start producing what it is missing
-impaired insulin secretion (pancreas)
-increased hepatic basal glucose production (liver)
-adipokines (can increase insulin resistance)
4 MAJOR metabolic abnormalities that occur in Type II DM
who is as risk for Type II DM?
person w/ family history of DM
person w/metabolic syndrome
high triglyceride levels
low levels of high density lipoproteins (good cholesterol)
Factors of metabolic syndrome
*patient must have 3/5 to be diagnosed
What is metabolic syndrome?
insulin resistance due to an excess in visceral fat
*This is a major risk factor for Type II DM
Modifiable risk factors for metabolic syndrome?
-Nicotine (increases vasoconstriction causing HTN & increases platelet adhesion)
-Carbon monoxide (decreased Hbg sites for O2 transport)
Main focus for patients with metabolic syndrome?
DIET, EXCERCISE & MEDS
Normal triglyceride level
Drug therapy for Metabolic syndrome?
-cholesterol lowering (Lipitor, statins, Zocor)
-anti-hypertensives (BB, aces and arbs)
-metformin (Type II to decrease hepatic glucose production)
Normal HBG A1C?
Prediabetic HBG A1C?
*At this point we advise patient to modify lifestyle and monitor before becoming diabetic
Diabetes HBG A1C?
Normal fasting plasma glucose level (FPC)?
*At least fasting for 6hr
Prediabetic FPC level?
Diabetes FPC level?
Normal Glucose tolerance test level (OGTT)?
*Patient drinks oral glucose liquid
Prediabetes OGTT level?
Diabetes OGTT level?
Patient teaching for Type II DM?
-nutritional therapy (130g carbs, 15-20% protein, <7% fats)
-blood glucose monitoring (can they do it?)
Drug therapy for Type II DM?
Oral and non-insulin injectable
*Main reason why patients quit taking this
Lipodystrophy (rotate sites)
Patient problems that occur with insulin therapy
Effect of Type II DM that causes Hyperglycemia in the morning but has hypoglycemia in the evening
*At night the body will release hormones that work against insulin causing hyper levels
Effect of Type II DM in which the body doesn't release enough insulin throughout the night to maintain steady BS levels causing hyperglycemia
How to assess for somogyi effect and dawns phenomenon?
ASSESS BLOOD GLUCOSE THROUGHOUT THE NIGHT AND IN MORNING
*When the 15g/15min rule doesn't work/pt cant eat
When the sugar is gone and pt. in unarousable we give it reconstituted IV/SQ (assess for S/S hyperglycemia, N/V and hypokalemia)
Stress and illness can cause _________?
*Have pt. check glucose q4hr and report any ketones in urine and BS levels of >300mg/dl (twice)
*Worried about DKA
Type II DM complications?
Gastroparesis (delayed gastric emptying)
HTN (RENAL FAILURE)
Insulin deficiency (sugar cant get into the cell and starves the body)
*insulin causes potassium shifts into the cells causing hypokalemia
Collaborative care for DKA?
ESTABLISH IV ACCESS
Do q4hr lab draws and electrolyte replacement
IV continuous insulin drip (lower glucose/lower potassium)
What type of insulin is used for insulin drip?
Regular (short/fast acting)
Main treatment focus for DKA?
Hyperosmolar Hyperglycemic Syndrome (HHS)
is gradual onset, life-threatening syndrome that can occur in the patient with diabetes with a glucose of >600
*Patient has enough circulating insulin to prevent DKA
HHS leads to _______ & ________
hyperosmolarity and osmotic diuresis
*Osmolarity is 350-450 mOm/kg (concentration of the BS is high)
HHS patients have severe ______ and ________
dehydration and hypovolemia (from polyuria)
*Cerebral edema common (causing mental status changes)
Why are ketones absent or minimal in urine for a patient with HHS?
Because the patient still had enough sugar in the body to where the body didn't need to break down the fats to put them in an acidotic state
Normal anion gap?
*if higher/wider it is likely they have DKA
When does HHS occur?
In newly onset Type II DM
What can cause HHS to occur?
*ALL RELEASES CORTISOL CAUSING HYPERGLYCEMIA
Treatment for HHS?
Same as DKA but we do fluid replacement
Monitor I's & O's & VS
Monitor cardiac, renal and mental status changes
*6-20 L of fluids given within the first 24-48hrs, typically 0.9% NS
Insulin TX for HHS?
Regular insulin given
*If BS level is <200, we would give some glucose so we don't bottom them out
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