Foundations - Exam 6 - Unit 11 & 12

Clinical manifestations Diabets Type ___: Quick Onset •Polyuria •Polydipsia •Polyphagia •Hyperglycemia •Weight loss •Weakness/fatigue/irritability •Initial diagnosis may present as DKA:( nausea, abd pain, ketones, s/s's of dehydration)

1

DKA death rate HHS death rate

1-5 10-20

Pre-Diabetes •___% of U.S. adults aged 20 years or older had prediabetes(__% of those aged 65 years or older). •Estimated ___ million Americans aged 20 years or older with prediabetes. Without weight loss and moderate physical activity - 15-30% of people with prediabetes will develop type 2 diabetes within ____ years

37% 51% 86 5

The most common cause of Addison disease is: •A. an autoimmune reaction. •B. dietary deficiency of sodium and potassium. •C. cancer •D. viral infection of the pituitary gland.

A. an autoimmune reaction.

Glycosylated hemoglobin reflects blood glucose concentrations over which period of time? A - 1 month B - 3 months C - 6 months D - 9 Months

B - 3 months

Which group is at the greatest risk for osteoporosis? A - Asian american women B - European american women C - African american women D - Men

B - European american women

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? A - I always carry hard candy to eat in case my blood sugar level drops B - I skip lunch when I dont feel hungry C - I avoid exposure to the sun as much as possible D - I always wear my medical identification bracelet

B - I skip lunch when I dont feel hungry

The Basal metabolic rate is unusually ____ with hypothyroidism. A. High B. Low C. Steady D. Variable

B. Low

Question 1: A 34 year old female is diagnosed with hypothyroidism. Which signs and symptoms would the nurse expect to assess?( Select all that apply) A.Rapid pulse B.Decreased energy and fatigue C.Weight gain of 10 lbs. D.Fine, oily hair E.Constipation

B.Decreased energy and fatigue C.Weight gain of 10 lbs. E.Constipation

The nurse is completing a health assessment of a 42 year old female with suspected Graves disease. The nurse should assess the client for: A.Anorexia B.Tachycardia C.Weight gain D.Cold skin

B.Tachycardia A.graves is a hypermetabolic state( hyperthyroidism) All the other conditions are symptoms of hypothyroidism

Which statement is true regarding gestational diabetes? A - There is a low risk for perinatal complications B - It occurs in the majority of pregnancies C - Onset usually occurs in the first trimester D - A glucose challenge test should be performed between 24 to 28 weeks

D - A glucose challenge test should be performed between 24 to 28 weeks

Glucose - 33.6-66.6 Na - 135-145 Osmolarity : 330-380 Plasma ketones : + Serum HCO3 - Normal to slightly down arterial pH : >7.3 Is this DKA or HHS

HHS

______ Surgery •Preoperative ______ •Reduction of stress and anxiety to avoid precipitation of thyroid storm •Preoperative __________ •dietary guidance to meet patient metabolic needs •avoidance of caffeinated beverages and other stimulants, • explanation of tests and procedures, •demonstration of support of head to be used postoperatively •___________ care: •Monitor dressing for potential bleeding and hematoma formation; check posterior dressing •Monitor respirations; potential airway impairment •Assess pain and provide pain relief measures •Semi-Fowler's position, support head •Assess voice but discourage talking •Potential hypocalcaemia related to injury or removal of parathyroid glands; monitor for __________

Thyroid Goals Teaching Postoperative Hypocalcemia

Other specific types: _______ associated with other conditions or syndromes like Cystic Fibrosis / Steroid use IFG(impaired fasting glucose) IGT(impaired glucose tolerance)

diabetes

Older clients with __________ seldom present with the classic symptoms seen in younger clients, but older clients may develop cardiac dysrhythmias, weight loss, fatigue, and apathy, and do require treatment

hyperthyroidism

Metabolize drugs slower : watch : narcotics anesthesia etc ___________ : signs and symptoms #1 cause ./ removal of thyroid due to hyperthyroidism and autoimmune = hashimotos Can be confused with normal aging issues

hypothyroidism

Hypothyroidism or Hyperthyroidism Severe exacerbaton: Myxedema Coma / Life Threatening Severe exacerbaton: Thyroid Storm/Life Threatening

hypothyroidism hyperthyroidism

Administering _____ •Subcutaneous with insulin syringe ( orange cap)/ 50 or 100 units / ml. •Insulin injection pen/ dial a dose and pre-filled •Insulin pump •Inhaled insulin Nasal form /( inhaled) of insulin was pulled from market...due to lack of use......no one willing to try or switch over.../ now its back Dispensed as: 100 unit/mL (U-100) 500 unit/mL (U-500) Used in cases of insulin resistance

insulin

CDC: 2014 statistics report ____ developed diabetes at lower BMIs than ______ ... ____ may be more likely to develop type 2 diabetes than _______,

men women men women

•________ •Osteoporosis: metabolic bone disorder in which the rate of bone resorption increases and the rate of bone formation decreases

parathyroid

Body does not make enough insulin - Can develop at any age - no known way to prevent it More than 18,000 youth diagnosed each year in 2008 and 2009 In adults, type ____ diabetes accounts for approximately 5% of all diagnosed cases of diabetes What type of diabetes

type 1

Body cannot use insulin properly - can develop at any age - most cases can be prevented Currently at least one out of three people will develop the disease in their lifetimes. Consider screening patient with type I diabetes for autoimmune thyroid disease and celiac disease soon after diagnosis. What type of diabetes is this?

type II diabetes

A client with hyperthyroidism says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily, " Which of the following responses by the nurse would give the client the most accurate explanation of her behavior. •1. "Your behavior is caused by temporary confusion brought on by your illness." •2. "Your behavior is caused by the excess thyroid hormone in your system." •3. "Your behavior is caused by your worrying about the seriousness of your illness." •4. "Your behavior is caused by the stress of trying to manage a career and cope with illness.

•2. "Your behavior is caused by the excess thyroid hormone in your system." • a typical sign of hyperthyroidism is irritability caused by the high levels of circulating thyroid hormones in the body . This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her illness, and stress may influence her mood; however, irritability is a common symptom of thyrotocxicosis and the client should be informed of that fact rather than blamed

•Patricia Fowler, a 55 year old patient, is admitted to the medical unit for complications of long-term, poorly controlled type 2 diabetes mellitus (DM). In addition to alterations in the serum glucose, you would expect to see which of the following lab abnormalities? •A. Elevated serum lipids •B. Metabolic alkalosis •C. Elevated liver enzymes •D. Low red blood cells count

•A. Elevated serum lipids

An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. A nurse provides instructions regarding the interaction of alcohol and metformin. When the nurse evaluates the client's understanding she notes that learning is evident because the client makes which of the following statements? 1." If I know I'll be having alcohol, I must not take metformin: I could develop lactic acidosis." 2. " If my physician approves, I may drink alcohol with my metformin" 3. Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain and rapid heartbeat." 4. " If I feel bloated, I should call my physician"

1." If I know I'll be having alcohol, I must not take metformin: I could develop lactic acidosis." • A rare but serous adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are fatal. Ideally, one should stop metfomin for 2 days before and 2 days after drinking alcohol. Signs and symptoms of lactic acidosis are weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or lightheadedness, and bradycardia or cardiac arrhythmias. •Bloating is not an adverse effect of metformin

Signifigance - Osteoporosis •___ million affected •__._ million Osteopenia: precursor to osteoporosis •_._ million osteoporotic fractures every year •__% are older women/ when 80 50% have •One in ___ women and one in ____ men will have an osteoporosis-related fracture Older people absorb Calcium calcium less effeciently

10 33.6 1.5 80 two four

Acute complications : preventing, detecting and treating / hypoglycemia •Foods that provide __-__ g of CHO •2-3 glucose tablets •½ cup juice •¼ cup reg. pudding •½ cup pop •Glass of milk •1 cup gatorade •1 double stick popsicle •½ cup reg. soft drink •6-10 hard candies •4 sugar cubes •6 saltines or 3 graham •TBSP of cake frosting

10-15

Pre-Diabetes / Impaired fasting glucose-IFG/ impaired glucose tolerance-IGT an opportunity to halt or delay progression: •Blood glucose levels: HIGHER than normal ......but not high enough for a diagnosis of diabetes ( ___-___ FBS)(HgbA1C-5.7-6.4) •Previous history of hyperglycemia ( during preg. or illness) •Risk for heart disease/ stroke. •Prevention/ Delay •Modest weight loss (5- 7%) •Moderate physical activity 150 min week (5 x 30 min) •Lowers risk of heart disease and stroke 125 & 6.5 by ADA Prediabetes: may be called (impaired fasting glucose) (impaired glucose tolerance) Ethnic disparities for children: More common in certain ethnic groups Hispanic boys Non-Hispanic Black girls

100-126

Pre-Diabetes / IFG/IGT an opportunity to halt or delay progression: •Blood glucose levels: HIGHER than normal ......but not high enough for a diagnosis of diabetes ( ___-___ FBS)(HgbA1C-_._-_._) •Risk for heart disease/ stroke. •Prevention/ Delay •Modest weight loss (5- 7%) •Moderate physical activity 150 min week (5 x 30 min) •Lowers risk of heart disease and stroke

100-128 5.7-6.4

Thyroid disease Prevalence and Impact of Thyroid Disease •More than __ percent of the U.S. population will develop a thyroid condition during their lifetime. •An estimated __ million Americans have some form of thyroid disease. •Up to __ percent of those with thyroid disease are unaware of their condition. •Women are five to eight times more likely than men to have thyroid problems. •One woman in eight will develop a thyroid disorder during her lifetime. •Most thyroid cancers respond to treatment, although a small percentage can be very aggressive. •The causes of thyroid problems are largely unknown. •Undiagnosed thyroid disease may put patients at risk for certain serious conditions, such as cardiovascular diseases, osteoporosis and infertility. •Most thyroid diseases are life-long conditions that can be managed with medical attention.

12 20 60

Lab Values : Diabetes for Diagnosis •Fasting plasma glucose (FPG) at or above ___ mg/dL •Pre-diabetes greater than ___ mg/dl • 2-hour oral glucose tolerance test at or above ___ mg/dL or random glucose or casual glucose ( not fasting) •HgbA1C: ( glycosylated Hemoglobin ) 6.5% for dx. •6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; •The current recommended goal for HbA1c in patients with diabetes is <7.0%, •some guidelines are stricter (<6.5%). /significantly lower incidence of complications from diabetes, including retinopathy or diabetic nephropathy • BUT: new study did show higher death rate. • • •Repeating testing of the above on a different day to confirm ADA - 126 and 6.5 Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also referred to as being Hb1c or HGBA1C) is a form of hemoglobin that is measured to primarily to identify the 2-3 month average of plasma glucose concentration.

126 100 200

Lab Values : Diabetes for Diagnosis •Fasting plasma glucose (FPG) at or above ___ mg/dL •Pre-diabetes greater than ___ mg/dl • 2-hour oral glucose tolerance test at or above ____ mg/dL or random glucose •HgbA1C: ( glycosylated Hemoglobin ) _._% for dx. •6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; •The current recommended goal for HbA1c in patients with diabetes is <_._%, •some guidelines are stricter (<6.5%). /significantly lower incidence of complications from diabetes, including retinopathy or diabetic nephropathy • BUT: new study did show higher death rate.

126 100 200 6.5 7.0

Acute complications : preventing, detecting and treating Sick Day care for Diabetics •Increased BG monitoring •Monitor for ketones in urine if blood glucose is greater than ___ mg/dl •Continuing to take the usual insulin dose or oral hypoglycemic •MD/ER if BGs >250 and ketonuria for >24 hours/Call healthcare provider if client unable to eat for more than 24 hours, vomiting and diarrhea last for more than 6 hours •Substitute liquid CHOs in nausea/vomiting/ sipping 8-12 oz of fluid each hour sick, you're under stress To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood sugar levels and interfere with the blood sugar-lowering effects of insulin. Instruct client on a sick day , for any of the following: •you've been sick or have had a fever for a couple of days and aren't getting better •you've been vomiting or having diarrhea for more than 6 hours you have moderate to large amounts of ketones in your urine •your glucose levels are higher than 250 even though you've taken the extra insulin your sick-day plan calls for •you take pills for your diabetes and your blood sugar level climbs to more than 240 before meals and stays there for more than 24 hours •you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked) •you aren't certain what to do to take care of yourself

240

Hypothyroidism metabolic processes slow down./ deficiency in T__ or T__/TSH which regulate Manifestations: _____ ones (may be vague)-energy loss, fatigue, forgetfulness, sensitivity to cold, unexplained weight gain constipation, puffiness of the face and hands. affects almost every organ system in the body, signs and symptoms vary according to the organs involved as well as the duration and severity of the condition. The client experiencing hypothyroidism has rough, dry skin. Smooth skin is associated with hyperthyroidism. As the disease progresses-anorexia, decreased libido, menorrhagia, paresthesias, joint stiffness, muscle cramping, CNS-psychiatric disturbances, ataxia, intention tremor, carpal tunnel syndrome, benign intracranial hypertension, behavioral changes ranging from slight to severe Enlargements: _____ ______ goiter: compensates by becoming larger to produce more harmone:which usually overcomes mild deficiencies of thyroid hormone.. _____ goiters groups of people living in geographical areas with iodine-depleted soil, usually regions away from the sea coast/ might not get enough iodine in their diet (iodine is vital to the formation of thyroid hormone). iodized table salt in the United States prevents this deficiency TX: take meds...for life..monitor wt....etc./ labs to see levels sufficient

3 and 4 early goiters simple endemic

•A client with Graves' disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works? • •1. "The radioactive iodine stabilizes the thyroid hormone levels before thyroidectomy." •2. "The radioactive iodine reduces uptake of thyroxine and thereby improves your condition." •3. The radioactive iodine lowers the levels of thyroid hormones by slowing your body's production of them." •4. The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced

4. The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced •Common Procedure: Radioactive Sodium iodide. Destroys the thyroid follicular cells, and thyroid hormones are no longer produced. RAI is commonly recommended for clients with Graves disease especially the elderly/ and Hyperthyroidism in general. The treatment result is a "medical " thyroidectomy. RAI is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAI

Type I Diabetes : children/teens _-__% of all DM •Auto immune disorder/destruction of pancreatic ___ cells •Usually associated with absolute insulin deficiency • _____ - lifelong requirement •Acute Onset: Children with type 1 DM seen first in the hospital •Emergency and critical care interventions •Etiology unknown: Idiopathic •Possible: genetic & environmental factors •Risk factors: family history, race, ethnicity •Future: regenerating human beta cells/ targeting autoimmune response to prevent / identify disease before all beta cells loss

5-10 B insulin

245 billion total medical costs and lost work and wages for people with diagnosed diabetes Risk of death for adults with diabetes if _____ high than adults without diabetes Medical costs for people with diabetes are twice as high as for people without diabetes People who have diabetes are at higher risk of serious health complications such as blindness, kidney failure, heart disease, stroke, and loss of toes feet or legs.

50

Oral corticosteroids administration: i.e.(prednisone ) •Take early am __-___am/ keeps with the natural secretion of _____ large does take at 8am when the adrenal gland is most active also physiologic because it allows the body to escape effects of the steroids from 4p to 6am when serum levels are normally low thus minimizing cushingoid effects •Take with _____ ! Hard on stomach! The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in _____ with limited fat. Changes in appearance ( side effects of meds ) usually disappear when therapy is no longer necessary.

7-8 cortisol food protein

Which client would the nurse identify as having the greatest risk for osteoporosis? A - A small framed, thin 45 year old white woman B - a 40 year old overweight african american women C - a 20 year old male athlete with repeated injuries D - A 16 year old male with a history of asthma

A - A small framed, thin 45 year old white woman

A client with diabetic ketoacidosis has been brought into the ED. Which intervention is not a goal in the initial medical treatment of diabetic ketoacidosis? A - Administer glucose B - administer potassium replacements C - Monitor serum electrolytes and blood glucose levels D - Administer isotonic fluid at a high volume

A - Administer glucose

A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? A - Deficient fluid volume related to osmotic diuresis B - Imbalanced nutrition : Less than body requirements related to insulin deficiency C - decreased cardiac output related to elevated heart rate D - Ineffective thermoregulation related to dehydration

A - Deficient fluid volume related to osmotic diuresis

A client has gained 55 lb in the last 3 years and is concerned about developing type 2 diabetes mellitus. Additionally, the client's healthcare provider has diagnosed metabolic syndrome. What are the conditions contributing to the development of metabolic syndrome? Select all that apply. A - Elevated blood glucose levels B - Elevated high density lipoproteins (HDL) C - Abdominal obesity D - Decreased low density lipoproteins (LDL) E - Hypertension

A - Elevated blood glucose levels C - Abdominal obesity E - Hypertension

The nurse is caring for a client receiving insulin isophane suspension (NPH) at breakfast. What is an important dietary consideration for the nurse to keep in mind? A - Encourage midday snack B - Make sure breakfast is not delayed C - Delay dinner meal D - Provide fewest amount of carbohydrates at lunch meal

A - Encourage midday snack

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. A - Fatigue and irritability B - Polyuria and polydipsia C - Wounds that heal slowly or respond poorly to treatment D - Blurred or deteriorating vision E - Sudden weight loss and anorexia

A - Fatigue and irritability B - Polyuria and polydipsia C - Wounds that heal slowly or respond poorly to treatment D - Blurred or deteriorating vision

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? A - I may stop taking this medication when I feel better B - I will avoid friends and family members who are sick C - I will see my ophthalmologist regularly for a check up D - I will eat lots of chicken and dairy products

A - I may stop taking this medication when I feel better

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: A - Protruding eyes and a fixed stare B - Dry, waxy swelling and abnormal mucin deposits in the skin C - A wide, staggering gait D - More than 10 beats/minute difference between the apical and radial pulse rates

A - Protruding eyes and a fixed stare

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? A - Serum potassium level B - serum chloride level C - Serum calcium level D - Serum sodium level

A - Serum potassium level

The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A - Teach the client about actions to slow the progression of nephropathy B - Ensure that the client receives a comprehensive assessment of liver function C - Administer a fluid challenge and have the test repeated D - Determine whether the client has been using expired insulin

A - Teach the client about actions to slow the progression of nephropathy

A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. A - Thin extremities B - moon face C - buffalo hump D - truncal obesity E - purple striae

A - Thin extremities B - moon face C - buffalo hump D - truncal obesity E - purple striae

A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet? A - Vitamin D Fortified milk B - red meat C - green vegetables D - bananas

A - Vitamin D Fortified milk

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? A - Weight loss B - Blood glucose level C - Protein metabolism D - Carbohydrate intake

A - Weight loss

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? A - calcium gluconate B - potassium chloride C - Sodium phosphorus D - Sodium bicarbonate

A - calcium gluconate

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? A - control blood glucose levels B - drink plenty of fluids C - eat a high fiber diet D - Take the anti diabetic regularly

A - control blood glucose levels

The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis? A - ensuring the adequate calcium and vitamin D intake B - Having a DXA beginning at age 35 years C - engaging in non weight bearing exercises daily D - Undergoing assessment of serum calcium levels every year

A - ensuring the adequate calcium and vitamin D intake

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? A - rotate injection sites within the same anatomic region, not among different regions B - Inject insulin into healthy tissue with large blood vessels and nerves C - Administer insulin into sites above muscles that you plane to exercise heavily later that day D - administer insulin into areas of scar tissue of hypertrophy whenever possible

A - rotate injection sites within the same anatomic region, not among different regions

The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? A - small, frequent meals, high in protein and calories B - a reduced calorie diet, high in nutrients C - A diet high in fiber and plant sourced fat D - three large, bland meals a day

A - small, frequent meals, high in protein and calories

A home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food or medication has been consumed for 36 hours. Which additional statement by the client indicates a need for further teaching? A."I need to stop my insulin." B."I need to increase my fluid intake." C."I need to call the physician because of these symptoms." D."I need to monitor my blood glucose every 3 to 4 hours

A."I need to stop my insulin."

What category of insulin is rapid acting? A.Humalog B.Humalog R C.Humulin N D.Glargine (Lantus)

A.Humalog Aspart is a rapid-acting insulin, Humalog R is a short-acting insulin, Humulin N is an intermediate-acting insulin, and Glargine (Lantus) is a very long-acting insulin.

Robert Jacobsen is seen at a community clinic for complaints of a wound on his foot that will hot heal. Upon examination, the wound appears to be infected. He indicates that he didn't even realize the wound was there until he removed his shoe and found his foot was bloody. Mr. Jacobsen is obese and is being treated for type 2 diabetes mellitus. Why is Mr. Jacobsen at risk for developing infections? Mark all that apply A.Vascular changes reduce blood flow to lower extremities B.Hyperglycemia promotes bacterial growth C.Impaired function of WBC D.Hyperglycemia causes alterations in skin integrity E.Decreased peripheral sensation reduces early warning signs

A.Vascular changes reduce blood flow to lower extremities B.Hyperglycemia promotes bacterial growth C.Impaired function of WBC E.Decreased peripheral sensation reduces early warning signs

A client with type 1 diabetes is to receive a short-acting insulin and an intermediate-acting insulin subcutaneously before breakfast. The nurse would administer the insulin at which site as the preferred site? A - Thighs B - Abdomen C - Upper buttock D - Arms

B - Abdomen

A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? A - Avoid the use of moisturizing lotions B - Avoid hot water bottles and heating pads C - dry feet vigorously after each bath D - Examine feet weekly for redness, blisters, and abrasions

B - Avoid hot water bottles and heating pads

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density A - Hypertension B - Compression fractures C - Cardiac disease D - Diabetes

B - Compression fractures

A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau sign. What does the nurse observe to verify this finding? A - Bulging forehead B - Hand flexing inward C - Cardiac dysrhythmia D - Moon face and buffalo hump

B - Hand flexing inward

A client with diabetes mellitus is receiving an oral antidiabetic agent. When caring for this client, the nurse should observe for signs of: A - Polydipsia B - Hypolgymeia C - Polyuria D - Blurred vision

B - Hypolgymeia

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? A - Cholesterol B - Ketones C - Hemoglobin D - Creatinine

B - Ketones

The preferred preparation for treating hypothyroidism includes which of the following? A - Propylothiouracil (PTU) B - Levothyroxine (synthroid) C - Methimazole (tapazole) D - Radioactive iodine

B - Levothyroxine (synthroid)

A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does this syndrome most often occur? A - Adolescents with type 2 diabetes and sporadic use of antihyperglycemics B - Middle aged or older people with either type 2 diabetes or no known history of diabetes C - Client with type 1 diabetes and poor dietary control D - Clients who are obese and who have no know history of diabetes

B - Middle aged or older people with either type 2 diabetes or no known history of diabetes

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: A - Hashimotos Thyroiditis B - Myxedema coma C - Cretinism D - Thyroid Storm

B - Myxedema coma

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? A - Review the clients first hemoglobin A1C, result after discharge B - Observe the client drawing up and administering the insulin C - Provide a health education session reviewing the main points of insulin delivery D - Ask the client to describe the process in detail

B - Observe the client drawing up and administering the insulin

Which of the following factors should the nurse take into consideration when planning meals and selecting the type and dosage of insulin or oral hypoglycemic agent for an elderly patient with diabetes mellitus? A - Patients history B - Patients eating and sleeping habits C - Cognitive problems D - Patients ability to self administer insulin

B - Patients eating and sleeping habits

An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? A - Autonomic neuropathy B - Peripheral neuropathy C - Sudomotor neuropathy D - A faulty heater

B - Peripheral neuropathy

A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called: A - Anorexia B - Polyphagia C - polyuria D - Polydipsia

B - Polyphagia

A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? A - Management of diabetic ketoacidosis B - Recognition of hypoglycemia and hyperglycemia C - Effects of surgery and pregnancy on blood sugar levels D - Signs and symptoms of diabetic nephropathy

B - Recognition of hypoglycemia and hyperglycemia

What is the only insulin that can be given intravenously? A - Ultralente B - Regular C - NPH D - Lantus

B - Regular

A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? A - Type 2 diabetes B - Type 1 diabetes C - Non-insulin dependent diabetes D - Prediabetes

B - Type 1 diabetes

The nurse is reviewing the initial laboratory test results of a client diagnosed with DKA. Which of the following would the nurse expect to find? A - Blood glucose level of 250 mg dl B - blood pH of 6.9 C - Serum bicarobanate of 19 mEq/L D - PaCO2 of 40 mm Hg

B - blood pH of 6.9

A nurse is caring for a client with an abnormally low blood glucose concentration. What glucose level should the nurse observe when assessing laboratory results? A - between 70 and 75 mg dL (3.9 to 4.16 mmol/L B - less than 70 mg/dL (3.7 mmol/L) C - Between 75 and 90 mg/dL (4.16 to 5.00 mmol/L D - 95 mg/dL (5.27 mmol/L

B - less than 70 mg/dL (3.7 mmol/L)

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? A - Hypotension B - moon face C - pale thick skin D - weight loss

B - moon face

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: A - walk barefoot at least once each day B - wash and inspect the feet daily C - use commercial preparations to remove corns D - cut the toenails by rounding edges

B - wash and inspect the feet daily

The nurse counseling a client in the prevention of goiter in Hypothyroidism would suggest an increased intake of A. calcium B. iodine C. potassium D. protein

B. Iodine or (salt where it is found) Hyperthyroidism side note: BUT: Avoid food with high Salt or iodine for HYPERTHYROIDISM / it can interfere with the meds being used to treat (the meds may be trying to block uptake of iodine)& heavy use can contribute to hyperthyroidism / particularly iodine supplements.

Which of the following is a desired outcome in evaluating a new diabetic's understanding of teaching about insulin usage? A.After drawing up insulin from a vial, he adds an air bubble so as to clear the needle after injection. B.He carries some form of simple carbohydrate at all times. C.He recognizes that hunger and tremor signal a need for additional insulin. D.He knows that adding carbohydrate to the diet can produce an insulin reaction.

B.He carries some form of simple carbohydrate at all times.

Question 2: Situation: Mrs. Bergstrum is a 60 year old client who has been newly diagnosed with noninsulin dependent diabetes ( Type II diabetes). She is 70 pounds overweight. What information should the nurse include in a teaching plan for Mrs. Bergstrum? A.Emphasize controlling her weight through a high protein diet. B.The role of exercise in improving blood glucose control. C.Oral hypoglycemic agents are less effective than insulin in managing blood glucose levels. D.Reaching her optimal weight will cure her disease.

B.The role of exercise in improving blood glucose control. Exercise will improve insulin resistance and assist in controlling her disease, in addition it will help with weight loss, and use excess glucose in her body.

Question 2: The most appropriate diet for the client with Grave's disease would be: A.soft B.high calorie C.low sodium D.high roughage

B.high calorie

Polyuria in the client with diabetes is caused by A.a high renal threshold. B.osmotic diuresis. C.increased thirst. D.dehydration.

B.osmotic diuresis. diuresis due to a high concentration of osmotically active substance (Sugar)in the renal tubules, which limit the reabsorption of water. Kidneys can only reabsorb so much (sugar) rest is released and it pulls water with it.

Question 1: Frank has been noncompliant with his diabetic regimen in the past. What test will give the best information regarding his compliance? A.random blood sugar B.test urine for glucosuria C.glycosylated hemoglobin/ Hgb A1C D.glucose tolerance test

C Hemoglobin A1c (HbA1c) provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring/When glucose is high it combines with Hemoglobin, becoming "glycated." normal A1c test: 4% and 5.6%. / 5.7% and 6.4% indicate increased risk of diabetes 6.5% or higher indicate diabetes Goal for people with diabetes is less than: 7%

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? A - 7.5% B - 8.5% C - 6.5% D - 8.0%

C - 6.5%

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? A - Thyroid function B - Parathyroid function C - Adrenal function D - Thymus function

C - Adrenal function

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? A - Once insulin injection are started in the treatment of type 2 diabetes, they can never be discontinued B - Sugar is found inly in desert foods C - An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision D - The only diet change needed in the treatment of diabetes is to stop eating sugar

C - An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? A - Addison disease B - graves disease C - Cushing syndrome D - hashimoto disease

C - Cushing syndrome

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: A - Exophthalmos and conjunctival redness B - Flushed, warm, moist skin C - Decreased body temperature and cold intolerance D - Systolic murmur at the left sternal border

C - Decreased body temperature and cold intolerance

A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? A - Reduce food intake and insulin doses in times of illness B - Eat three substantial meals a day, if possible C - Do not eliminate insulin when nauseated and vomiting D - Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L

C - Do not eliminate insulin when nauseated and vomiting

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? A - Have you experienced any headaches or sinus problems B - Can you describe the amount of stress in your life C - Do you experience fatigue even if you have slept a long time D - Do you have to get up at night to empty your bladder

C - Do you experience fatigue even if you have slept a long time

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? A - Forearm B - Upper Arm C - Finger D - Thigh

C - Finger

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? A - Hydrocortisone B - Epinephrine C - Glucagon D - 50% dextrose

C - Glucagon

What does a positive Chvostek's sign indicate? A - Hypokalemia B - Hyponatremia C - Hypocalcemia D - Hypermagnesemia

C - Hypocalcemia

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? A - No matter how much sleep I get, it seems to make me hours to wake up B - When I went to the washroom the last few days, my urine smelled odd C - Lately, I drink and drink and cant seem to quench my thirst D - I've always been a fan of sweet foods, but lately i'm turned off by them

C - Lately, I drink and drink and cant seem to quench my thirst

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? A- Sleep wake cycles B - Growth C - Metabolic rate D - fluid/electrolyte balance

C - Metabolic rate

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? A - Evaluate the quality of the clients voice postoperatively, noting any drastic changes B - Observe for swelling of the neck , tracheal deviation, and severe pain C - Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes D - Monitor laboratory values daily for elevated thyroid stimulating hormone

C - Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which of the following findings has the greatest effect on fluid loss? A - hypotension B - Decreased serum potassium level C - Rapid, deep respirations D - Warm, dry skin

C - Rapid, deep respirations •3. •Due to the rapid, deep respirations, the client is losing fluid from vaporization form the lungs and skin (insensible fluid loss). Normally, about 900 ml of fluid is lost per day through vaporization . • • Decreased serum potassium level has no effect on insensible fluid loss. Hypotension occurs due to polyurea and inadequate fluid intake. It may decrease the flow of blood to the skin, causing skin to be warm and dry.

A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? A - The client is at a decreased risk for development of thrombophlebitis and thromboembolism B - The clients diet should be low protein with ample fat C - The client is at an increased risk for developing infection D - The client may experience short term changes in cognition

C - The client is at an increased risk for developing infection

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A - Diabetic Ketoacidosis B - Tetany C - Thyroid crisis D - Hypogylcemia

C - Thyroid crisis

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? A - To stimulate her appetite B - To decrease the possibility of nausea and vomiting C - To restore liver glycogen and prevent secondary hypoglycemia D - To decrease the amount of glycogen in her system

C - To restore liver glycogen and prevent secondary hypoglycemia

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? A - Diarrhea B - Bone spurs C - decreased height D - increased heel pain

C - decreased height

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? A - An allergy to iodine is inherited B - it helps determine the clients general status C - endocrine disorders can be inherited D - Diet and drug histories are related to the family history

C - endocrine disorders can be inherited

The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids? A - In the evening between 4 pm and 6 pm B - Prior to going to sleep at night C - in the morning between 7 am and 8 am D - At noon ever day

C - in the morning between 7 am and 8 am

Bobby Davies a 12 year old male is newly diagnosed with type 1 diabetes mellitus. Bobby's pathophysiologic state is most probably the result of: A. A familial, autosomal dominant gene defect B. Obesity and lack of exercise C. Immune destruction of the pancreas D. Hyperglycemia from eating too may sweets

C. Immune destruction of the pancreas

Situation: Andrea Pitt's mother, Mary Vanderbush, was brought to the emergency department. Ms. Pitt found her mother at home unresponsive. Her pulse was very slow and her skin was cool and dry. She had been increasingly depressed and confused over the last six to eight months. She suffered a heart attack about two years ago, but seemed to recover well. The physician had lab tests done, and made a tentative diagnosis of myxedema coma. She was admitted to the medical intensive care unit. •The physician plans to return Ms. Vanderbush to a normal thyroid state very gradually. What is the risk of a too rapid restoration to normal thyroid hormone levels? A.Serum electrolytes may be restored to normal too quickly, resulting in cerebral edema. B.Renal function may not be able to keep up with the increased need for fluid excretion as the edema resolves. C.If improved thyroid status causes a too rapid increase in demands for oxygen by the peripheral tissues, her compromised coronary circulation may be inadequate, causing another myocardial infarction. D.Too rapid a correction of her altered mental status may result in agitation and combative behavior.

C.If improved thyroid status causes a too rapid increase in demands for oxygen by the peripheral tissues, her compromised coronary circulation may be inadequate, causing another myocardial infarction.

Julia Perez a 35 year old female is admitted to a medical surgical unit with Graves disease. Which of the following signs would the nurse expect to see upon admission? A.Weight gain, cold intolerance B.Slow heart rate; rash C.Skin hot and moist, rapid heart rate D. Constipation, confusion

C.Skin hot and moist, rapid heart rate symptoms of hyperthyroidism

•Situation: Andrea Pitt's mother, Mary Vanderbush, was brought to the emergency department. Ms. Pitt found her mother at home unresponsive. Her pulse was very slow and her skin was cool and dry. She had been increasingly depressed and confused over the last six to eight months. She suffered a heart attack about two years ago, but seemed to recover well. The physician had lab tests done, and made a tentative diagnosis of myxedema coma. She was admitted to the medical intensive care unit. •Ms. Vanderbush's physician prescribed a broad spectrum IV antibiotic. The most likely reason for this medication is that A.she is at great risk for aspiration and a subsequent chemical pneumonia. B.she now has an indwelling Foley catheter, and is at risk for urinary tract infections. C.many patients in myxedema coma have an infection as the stressor that precipitated the coma. D.she is in an area of the hospital where iatrogenic infections are a common problem.

C.many patients in myxedema coma have an infection as the stressor that precipitated the coma.

C.D., who is a diabetic, wears heavy, well constructed shoes. At work, he stepped on a nail and it pierced his foot right through his leather shoe. He didn't notice the nail until later that evening when he was changing his shoes. What type of problem does this indicate? A.retinopathy B.nephropathy C.neuropathy D.peripheral vascular disease

C.neuropathy may present as numb, tingling, burning, pain sensation / feeling is stunted

Steroids and ______: _______ disease: Adrenal cortex ( excess cortisol) prednisone pills (corticosteroids) or Solu-Medrol (methiprednisolone sodium succinate) / IV form

Cushings

A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What are the current recommendations that the nurse would describe? A - 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein B - 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein C - 10% of calories from carbohydrates, 50% from fate, and the remaining 40% from protein D - 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

D - 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: A - Weight gain in arms and legs B - Hypotension C - Thick, coarse skin D - Deposits of adipose tissue in the trunk and dorsocervical area

D - Deposits of adipose tissue in the trunk and dorsocervical area

A 30-year-old client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse prioritize when planning the client's care? A - Powerlessness related to disease progression B - Decisional conflict related to treatment options C - Spiritual distress related to changes in cognitive function D - Disturbed body image related to changes in physical appearance

D - Disturbed body image related to changes in physical appearance

Which information should be included in the teaching plan for a client receiving glargine, which is "peakless" basal insulin? A - Draw up the drug first, then add regular insulin B - glargine is rapidly absorbed and has a fast onset of action C - Administer the total daily dosage in 2 doses D - Do not mix with other insulins

D - Do not mix with other insulin

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? A - how to monitor ketones daily B - How to self inject insulin C - How to recognize signs of diabetic ketoacidosis D - How to control blood glucose lifestyle modification with diet and exercise

D - How to control blood glucose lifestyle modification with diet and exercise

The most common type of goiter is caused by lack of which of the following? A - Calcium B - Sodium C - Potassium D - Iodine

D - Iodine

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? A - Liothyronine (cytomel) B - Thyroid USP desiccated (Thyroid USP enseals) C - Methimazole (Tapazole) D - Levothyroxine (Synthroid)

D - Levothyroxine (Synthroid)

A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? A - Stop using tobacco in any form B - Undergo eye examinations regularly C - Have blood glucose levels checked annually D - Lose weight, if obese

D - Lose weight, if obese

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? A - Deficient knowledge about osteoporosis and the treatment regimen B - Risk for constipation related to immobility C - Acute pain related to fracture and muscle spasm D - Risk for injury related to fractures due to osteoporosis

D - Risk for injury related to fractures due to osteoporosis

Which is a strategy for lowering risk for osteoporosis? A - Increase age B - low initial bone mass C - Diet low in calcium and vitamin D D - Smoking cessation

D - Smoking cessation

Which may be a potential cause of hypoglycemia in the client diagnosed with diabetes mellitus? A - The client has not complied with the prescribe treatment regime B - The client has eaten but has not taken or received insulin C - The client has not been exercising D - The client has not eaten but continues to take insulin or oral antidiabetic medications

D - The client has not eaten but continues to take insulin or oral antidiabetic medications

Which of the following hormones would the nurse identify as being secreted by the thyroid gland? A - somatotropin B - parathormone C - Thymosin D - Thyroxine

D - Thyroxine

The greatest percentage of people have which type of diabetes? A - Type I B - Gestational C - Impaired glucose tolerance D - Type 2

D - Type 2

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? A - Reduce stress B - Increase fiber in the diet C - Decrease the intake of vitamins A and D D - Walk or perform weight bearing exercises

D - Walk or perform weight bearing exercises

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? A - Exophthalmos, diarrhea, and cold intolerance B - Diaphoresis, fever, and decreased sweating C - Weight gain, constipation, and lethargy D - Weight loss, nervousness, and tachycardia

D - Weight loss, nervousness, and tachycardia

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? A - An eye examination B - maintenance of blood glucose levels between 190 and 200 mg dl C - smoking reduction but not complete cessation D - Weight reduction through diet and exercise

D - Weight reduction through diet and exercise

A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action? A - Gradually replace the prednisone with an over the counter alternative B - Take each dose of prednisone with a dose of calcium chloride C - take the drug concurrent with levothyroxine D - slowly taper down the dose of prednisone, as prescribed.

D - slowly taper down the dose of prednisone, as prescribed.

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? A - Blood pressure of 90/58 mm Hg B - Oxygen saturation of 96% C - heart rate of 62 D - temperature of 102 F

D - temperature of 102 F

A client comes to the emergency department with diabetic ketoacidosis. The nurse should identify which of the following nursing diagnoses as a priority problem? A. Insomnia B. Ineffective health maintenance C. Imbalanced nutrition: Less than body requirements D.Deficient fluid volume

D.Deficient fluid volume Increased osmolality from glucose leads to a fluid shift form the intracellular to the extra cellular space. The fluid shift leads to increased renal excretion of glucose and fluid. Severe dehydration, possible hypovolemic shock is a medical emergency ....

Susan less has type 1 diabetes mellitus. She is admitted to the hospital with the following lab values: serum glucose 500 mg/dl ( high) , urine glucose and ketones 4+, arterial ph 7.20. her parents state that she has been sick with the "flu"for a week. Which of the following statements best explains her state. A.Increased insulin levels promote protein breakdown and ketone formation B.Her uncontrolled diabetes has led to renal failure C.low serum insulin promotes lipid storage and corresponding release of ketones D.Insulin deficiency promotes lipid metabolism and ketone formation

D.Insulin deficiency promotes lipid metabolism and ketone formation

Who of the following is at highest risk for Type II diabetes mellitus? A.a nine year old boy with a history of repeated viral infections B.a 20 year old man whose mother has Type II C.a 32 year old woman in her third trimester of pregnancy D.a 52 year old woman who is 30 pounds overweight

D.a 52 year old woman who is 30 pounds overweight •Being overweight and having a large waist-hip ratio ( central abdominal obesity) increases insulin resistance, making control of diabetes more difficult. • The ADA recommends a yearly referral to an ophthalmologist and podiatrist. • • Exercise and weight management decrease insulin resistance.

Which of the following is priority in patient education for all persons with diabetes regarding the prevention of hypoglycemia? A.instructions in the use of glucagon B.use of a fast acting carbohydrate C.need to increase caloric consumption D.peak time of glucose lowering medication/s

D.peak time of glucose lowering medication/s Do you want to give Aspart/ Lispro insulin an hour before breakfast?

Glucose - 13.9-33.3 NA : 125-135 Osmolarity : 300-320 Plasma ketones : ++++ Serum HCO3 <15 meql Arterial pH 6.8-7.3 Is this DKA or HHS

DKA

(a)Manifestations of ____ result from severe _______ and acidosis - require immediate medical attention (i)8-10 L fluid to replace losses (ii)IV fluids with 0.9% NS to 0.45% saline (b)Regular insulin used (c)Electrolyte imbalance requires monitoring à potassium depletion with aggressive rehydration The clinical manifestations of all forms of diabetes in children include blurred vision but the clinical hallmarks of diabetic ketoacidosis are dehydration and electrolyte imbalance. An irregular heartbeat can occur with an electrolyte imbalance. Sunken eye sockets and dry mucous membranes are seen in dehydration.

DKA dehydration

DM E. Acute complications: preventing, detecting and treating _______: Precipitating Factors: Strenuous physical exercise, stress, infection, missed insulin, new onset DM •4 ______ problems •Hyperosmolarity from hyperglycemia/ dehydration •Metabolic acidosis from Ketoacids ( by-products from fats metabolism consumption) •Volume depletion from osmotic diuresis •Electrolyte imbalances from osmotic diuresis •______: •Fatigue, visual disturbances, altered level of consciousness (such as hostility and mania, confusion and lethargy)coma may follow •Rapid, deep respirations (Kussmaul respirations)/Fruity or "acetone" breath •Flushed dry skin, dry mucous membranes •Abdominal cramps, nausea, vomiting •Tachycardia, hypotension •Glucosuria, ketonuria, polyuria •pH<7.3 HCO3 <15 mEq/L

DKA metabolic symptoms

These are signs and symptoms of what? Signs and Symptoms you might see? •Breathing/ rapid deep (kussmal resp.)/ fruity smell •Flushed face •Nausea/ vomiting / abd. pain •Frequent urination/ thirst •Ketones present in urine !!!!!! •Irregular heartbeat- acidosis & electrolytes/ put on ECG monitor •Blurred vision due to high B.S. •Symptoms of FVD / dehydration •V/S •Sunken eyes •Dry mucous membranes •Confusion

DKA or HHS

This is the significance/disparities for what disease? •Non-Hispanic whites 7.6 •Asian Americans 9.0 •Hispanics 12.8 •Non-Hispanic blacks 13.2 •American Indians/Alaska Natives 15.9

DM

Type 1 diabetes is treated initially with diet and exercise. T or F

False Type 2 diabetes is treated initially with diet and exercise

Diabetic Diet Monitoring of carbohydrate/ counting, exchanges, experience based gestimation remains a key strategy achieving glycemic control Dietary fiber Helpful in treating, preventing constipation Recommended 20-35 g/day Some studies show benefit to glucose control _______ _____ and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is conside •Combining starchy foods with protein and fat slows absorption and glycemic response. •Raw or whole foods tend to have lower responses than cooked, chopped, or pureed foods. •Eat whole fruits rather than juices; this decreases glycemic response because of fiber (slowing absorption). •Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed. •red alone • Other concerns: •Alcohol •Nutritive and nonnutritive sweeteners •Reading labels

Glycemic index

____ or _____: Precipitating Factors: Infection, stress, therapeutic procedures, acute or chronic illness •Hyperglycemic Hyperosmolar Non-ketosis or S for state or syndrome •Slow Onset/ Serious / life threatening / higher mortality rate than DKA •Significantly elevated plasma glucose levels/ No acidosis pH>7.3 HCO3 >15mEq/L •Treatment: correct underlying problem / fluid and electrolyte imbalance /insulin to lower blood glucose levels •Symptoms from metabolic process: •Hyperosmolarity from hyperglycemia = severe dehydration from increased urine output •Volume depletion from osmotic diuresis •Electrolyte imbalances from osmotic diuresis •NO ACIDOSIS •Polyuria, polydipsia, •Dehydration=weakness, lethargy to altered level of consciousness, dry mucous membranes/ skin, orthostatic hypotension Type 2 DM. ( because still some insulin NO KETOSIS & fatty acids not utilized)/ can be inconjuction with renal insufficiency or ht. failure/. Causes: Illness or stress can triggers: stress response and liver with cortisol / epi and other factors SE's of medications : glucocorticoids, thiazide diuretics and phenytoin. Hypertonic solutions for TPN / enteral feedings like DKA t hyperglycemia / plasma osmolalityup/ osmotic diuresis, dehydration Neurological changes result as they do in DKA. First line treatment is to re-hydrate (fluid deficit can be 8-10 liters) NS

HHNK HHNS

Thyroid Hypothyroidism _______ Thyroiditis/ also known as chronic lymphocytic thyroiditis , •Lymphocytic infiltration of gland, inflammation, fibrous tissue •Autoimmune •Most common cause of primary hypothyroidism in US •Accounts for many of enlarged thyroid glands ( Goiter) •Usually symmetrical/ Firm/ freely movable/ nontender •Hoarseness •Dysphagia •Sense of fullness Can progress to ________..more severe and a medical emergency... Between 1908 and 1912, Hashimoto took an interest in thyroid tissue while working in a surgical department. It was during this time that he extracted thyroid tissue samples from four patients and discovered new pathological characteristics.

Hashimotos Myexedema

Risk factors •Women •Genetic •Age (20-40) •Increased iodine intake - pregnancy - family histroy of graves disease - 30-40 years of age - certain viral infections Are these risk factors for hyperthyroidism of hypothyroidism?

Hyperthyroidism

Medical Management of ________ •Synthetic levothyroxine-replacement therapy ( Synthroid) •SAME TIME, EVERY MORNING on empty stomach /WAIT 30 MINUTES TO 1 HOUR BEFORE BREAKFAST •Take Synthroid once a day at the same time every day./TAKE SYNTHROID ALONE •Take Synthroid 4 hours before or after taking iron or calcium supplements, or antacids. Soy, cottonseed meal, walnuts, fiber, and grapefuit juice can affect the absorption . If you eat any of these on a regular basis, talk to your doctor to see if your Synthroid dose should be adjusted. •Effects of hypnotic and sedative agents; reduce dosage Taking too much levothyroxine has been associated with increased bone loss, especially in women after menopause •Support of cardiac function and respiratory function •Prevention of complications

Hypothyroidism

Thyroid/_________ Myxedema/ prolonged _________ or exacerbation i.e stressor / manipulation of gland during surgery Myxedema Coma /Severe •Skin changes •Hypotension •Hypothermia •Bradycardia •Mental depression •Hyponatremia •Hypoglycemia •Coma •Respiratory Failure •Treat •IV thyroxine •IV fluids, glucose, •Replacement steroids •Support airway ________ may result from impaired water excretion and from poor regulation of ADH secretion. Myxedema coma is a medical emergency and management is to reverse the condition to save the client's life keeping the patient warm and closely monitoring the VS event that precipitated the coma (surgery, infection, noncompliance) must be evaluated and treated. _________ coma Life-threatening Severe metabolic disorder Precipitated by Trauma CNS depressants Failure to take medication Infection Exposure to cold

Hypothyroidism Hypothyroidism Hyponatremia Myexedma

Type __ diabetes •Characterized by insulin resistance ( sensitivity to insulin) alone or in conjunction with Insulin synthesis and secretion •Slow, progressive glucose intolerance/ treated initially with diet & exercise/ Progress to oral hypoglycemic agents to insulin /or both •Risk Factors: •Age 45 or older/ 90-95% over age 30 years ( increasing in children due to obesity) •BMI greater 25 •Sedentary •Family History( parents or siblings) •Ethnic/ Race •HTN ( hypertension) •Elevated cholesterol ( HDL, triglycerides) •Impaired Glucose tolerance •Polycystic ovarian syndrome •Hx. Gestational Diabetes/ baby 9#'s •Metabolic syndrome •Smoking

II

You can prevent or delay type ___ diabetes - lose weight, eat healthy, be more active you can manage diabetes - work with a health professional, eat healthy , stay active

II

DM type ___ in children •On the rise in _____ •Hypoglycemic agents •Not first-line therapy •Diet and exercise effective for control in less than 10% •______ is adjunct to diet and exercise •Insulin may precede metformin after stability in glycemic control •Metformin takes 4 weeks to take effect Type II diabetes mellitus rates are greater among youth ages 10-19 with higher rates among U.S. minority populations than in non-Hispanic Whites.

II children metformin

This is the ______ _____ for DM •Planning Goals may include that •Client describes how to administer medications, respond to side effects •Client demonstrates meal planning compliant with the ADA •Client demonstrates proper foot care and inspection •Client demonstrates proper procedure for monitoring blood sugar levels •Client describes strategies for reducing risk of infection •Client will describe strategies to maintain A1C below 7 Evidence that care provided to a school-age child with type 1 diabetes mellitus has been effective include documentation of blood glucose readings with associated insulin dosages, demonstrating the correct technique to draw and self-inject daily insulin dosages, and having an emergency glucagon kit available for use if necessary. Attending school, doing homework and watching family members participate in sports are not meeting the client's needs for physical activity and would indicate that care has not been effective.

Nursing process

______ _____ for DM •Assessment •Health history •Hypertension •Change in vision or speech •Change in weight, appetite, infections, healing •Frequent voiding •Physical assessment •Height/weight ratio •Vital signs •Sensory ability of extremities, peripheral pulses, skin mucous membranes •Older adults - be aware of normal aging changes •Children •Assess physiologic status •Hydration •Vital signs, LOC •Assess family - coping mechanisms, strengths, resources, ability to manage disease, educational needs

Nursing process

•Thyroid hormones: T3, T4 also produces calcitonin -- __ is more potent and more rapid-acting than __. Iodine is contained in thyroid hormone -- _______ is secreted in response to high plasma calcium level and increases calcium deposition in bone •___ from the anterior pituitary controls the release of thyroid hormone •___ from the hypothalamus controls the release of TSH •Thyroid hormone controls cellular metabolic activity

T3 T4 calcitonin TSH TRH

Etiology : Insulin resistance with relative insulin secretory defect Clinical manifestations : - obesity, little or no weight loss, or possible significant recent weight loss - acanthosis nigricans - slow onset of symptoms - polyuria, polydipsia - glycosuria without ketonuria on initial presentation in 33% of cases - ketoacidosis on initial presentation in 5025% or cases - lipid disorders - hypertension - androgen mediated problems (ex acne, hirsutism, menstrual disturbances, polycystic ovary disease) - excessive weight gain and fatigue caused by insulin resistance - hyperglycemia Clinical therapies - diet with low fat foods and decreased calories - decrease sedentary activity time, or increased routine physical activity - blood glucose monitoring - oral medication (metformin) to improve insulin sensitivity Is this type I or type II diabetes?

Type II

______.....what is it? adrenocortical insufficiency Not enough glucocorticoids •RARE /chronic endocrine system disorder •Etiology: •Autoimmune or idiopathic atrophy of adrenal glands •Removal of adrenal glands •Most common cause of adrenal cortical insufficiency: is use of medication (corticosteroids) When the body is under stress (e.g. fighting an infection), this deficiency of cortisol can result in a life threatening _______ crisis characterized by low blood pressure.

addison's addisonian

_______ Crisis/ exacerbation of disease In addition: Addisonian crisis can occur if steroids are stopped abruptly or surgical removal of adrenal glands with NO supplemental corticosteroids i.e. methiprednisolone sodium succinate (solu-Medrol) IV. oral: prednisone •Life threatening shock •Volume depletion •Severe hypotension •Severe electrolyte abnormalities •Hypoglcemia •Inability to respond to stress •Treated with IV fluids, electrolyte replacement and administration of IV steroids

addisonian

_______ crisis •An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, severe infection or illness; death may quickly follow. •______ crisis can occur if steroids are stopped abruptly Tx : IV fluids, glucose, sodium, corticosteroids, electrolytes, manage hypotension with vasopression / fluids

addisonian

•______ crisis can be fatal. It is a medical emergency, usually requiring hospitalization. Occurs when more than 90% of both adrenal glands are destroyed •Characteristic symptoms are: •Sudden penetrating pain in the legs, lower back or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure Loss of consciousness/Syncope Hypoglycemia Confusion, psychosis Severe lethargy Convulsions •. Massive destruction usually results from an autoimmune process whereby circulating antibodies attack adrenal tissue. May also be idiopathic. Other causes include-tuberculosis, removal of both adrenal glands, hemorrhage in the adrenal gland, neoplasms, infections(such as HIV). • Signs and symptoms may develop slowly and stay unrecognized if production is adequate for the normal demands of life. It may progress to crisis when trauma, surgery or other severe stress completely exhausts the body's store of glucocotricoids. •It is the most serious complication of Addison's disease • Destruction of the adrenal cortex leads to a rapid decline in the steroid hormones cortisol and aldosterone. This directly affects the liver, stomach, and kidneys. •During periods of stress in the body, the activity of the adrenal medulla is increased.

addisonian

Adrenal - hypofunction - _______ disease •Abd pain/nausea /vomiting/ anorexia/diarrhea/weight loss •Fatigue/muscle weakness &pains •Headache/sweating •Mood & personality changes, depression, emotional liability, apathy, confusion: present 20-40% •Dark pigmentation of the mucous membranes and skin ( knuckles, knees & elbows, skin folds, vitiligo •Hypotension •Hypoglycemia / Hyperkalemia/ Hyponatremia •May progress to Addisonian OR acute exacerbation to a stressor • crisis, a severe illness which may include very low blood pressure and coma Diagnosis: lab tests for hormone levels Treatment: lifelong corticosteroid replacement/ may need to increase dosage during periods of stress

addisons

•Adrenal Glands (Hypo/Hyper) •________ Disease: Hyposecretion of cortisol and often insufficient levels of aldosterone as well. •________ Syndrome : Hypersecretion of cortisol by the adrenal gland / or externally taken corticosteroid medication. •Acute Pancreatitis

addisons cushings

_______ disease •Rare disorder •occurs in people of all ages and in both sexes and can progress to adrenal crisis. • Addison's disease is the result of insufficiencies of the mineralocorticoids (aldosterone) and glucocorticoids (cortisol) •adrenal insufficiency, occurs in two forms-primary and secondary. . •________ -originates with the adrenal glands. It is characterized by decreased mineralocorticoid, glucocorticoid and androgen secretion. •_______ -caused by a disorder outside the gland, such as a pituitary tumor with corticotropin deficiency. Aldosterone secretion may be unaffected. May result from hypopitiutarism, removal of a nonendocrine corticotropin-secreting tumor, disorders in the hypothalamic-pituitary function that diminishes the production of corticotropin. •Manifestations- ABOVE:common symptoms are fatigue, muscle weakness, weight loss, vomiting, diarrhea, headache, sweating, changes in mood and personality and joint and muscle pains • Some have marked cravings for salt or salty foods due to the urinary losses of sodium. confusion, fatigue, orthostatic hypotension light-headedness when rising from a chair or bed, cravings for salty foods.GI disturbances, weight loss, hyperkalemia causing vulnerability to cardiac arrhythmias, hyperpigmentation, hypoglycemia, hypotension, muscle weakness and pain. Be aware and report any sudden drop in BP. •Patient history may reveal synthetic steroid use, adrenal surgery or recent infection. •Treatment includes lifelong corticosteroid replacement is the main treatment for patients with primary or secondary Addison's disease. In stressful situations, including acute illness, injury, or psychologically stressful episodes, the patient may need to double or triple his usual dose. •_______ : patchy areas of skin that lack pigmentation. Possibly due to decreased melanocye-stimulating hormone activity Signs of conditions that often occur together with Addison's: goiter and vitiligo

addisons primary secondary vitiligo

_______ glands •Adrenal _______ •Functions as part of the autonomic nervous system •Catecholamines: epinephrine and norepinephrine •Adrenal _____ •Glucocorticoids: major effects on the metabolism of almost all organs •Cortisol •Mineralocorticoids •Aldosterone •Male sex hormones: Androgens Survival without functioning adrenal cortex is only possible with replacement adrenocortical hormones ACTH anterior lobe pituitary gland affects release of hormones

adrenal medulla cortex

Endocrine _____ _____: Secretes catecholamine's of epinephrine and norepinephrine. Items for assessment for the Nurse: •Stimulates the Heart •Increased respirations •Constrict Blood vessels / increase BP •Tumor on adrenal medulla called: pheochromocytoma: cause severe HTN / sporadic: Present with diaphoresis Headache palpitation and HTN •Can be life-threatening

adrenal medulla

•Endocrine systems: pancreas produces hormones •______ cells of the islet cells •Glucagon •_____ cells •Insulin •______ cells ( also in stomach/ intestine) •Somatostatin

alpha beta delta

•Less talked about: but... now being used in synthetic form to treat type II •_____ ( a peptide hormone) •_______ is a peptide of 37 amino acids, which is also secreted by the beta cells of the pancreas. •Some of its actions: •inhibits the secretion of glucagon; slows the emptying of the stomach; sends a satiety signal to the brain. •All of its actions tend to supplement those of insulin, reducing the level of glucose in the blood.

amylin amylin

Provide information : Smoking Cessation program •Stop smoking intervention/ explain how it accelerates ___________ which is already heightened due to DM

arterosclerosis

Type I diabetes Dr. Piganelli is looking for ways to prevent type 1 diabetes by interrupting the _______ process. He has found that antioxidants, molecules that reduce overall inflammation, also specifically target and increase the expression of a factor found on immune cells that diminishes their ability to attack the body's healthy cells. By increasing the amount of this factor on immune cells, he has been able to keep immune cells in check and prevent the development of autoimmune diabetes in animal models. - See more at: http://www.diabetes.org/research-and-practice/we-are-research-leaders/type-1-research-highlights/targeting-the-autoimmune_response_type1.html#sthash.oA58TdcU.dpuf Type 1 diabetes is thought to progress without symptoms for several years in most patients prior to diagnosis. During this critical time, while beta cells are destroyed, the disease is often not detected until beta cell loss is substantial enough for the patient to notice symptoms of advanced disease. By that time, it is typically too late to effectively intervene with therapies that may preserve beta cells.

autoimmune

Implementation - osteoporosis •Promote ______ nutrition •Teach women, men through age 35 about calcium needs •Encourage postmenopausal women to maintain calcium intake •Teach clients about medication use •Inform clients that calcium absorption requires sufficient levels of vitamin D •Relieve _____ pain •Suggest application of heat •Suggest OTC anti-inflammatories •Promote ________ behaviors •Smoking cessation •Avoid/limit alcohol, •Limit caffeine intake

balanced acute healthy

Diabetes Type I Multiple approaches to ____ cell replacement have been developed, including regeneration of an individual's own ____ cells, induction of human ____ cells from stem cells, reprogramming of beta cells from other differentiated cell types, use of nonhuman beta cell sources (pig or non-human primate islets), and, finally, expansion of human beta cells from deceased donors. Regardless of the origins, there is a clear need for more beta cells for cellreplacement therapies for diabetes. - See more at: http://www.diabetes.org/research-and-practice/we-are-research-leaders/type-1-research-highlights/regenerating-human-beta-cells.html#sthash.cPRgQX2R.dpuf

beta beta beta

Type I Diabetes Dr. Hessner is investigating so-called "______," which are components in blood or tissue samples that can be measured to predict which individuals are most likely to develop type 1 diabetes. His work is unique, because it aims to detect biomarkers that are present before beta cell destruction progresses to clinical symptoms, -See more at: http://www.diabetes.org/research-and-practice/we-are-research-leaders/type-1-research-highlights/identifying-type-1-diabetes_before_beta_cell_loss.html#sthash.LQs18NEv.dpuf Type 1 diabetes is thought to progress without symptoms for several years in most patients prior to diagnosis. During this critical time, while beta cells are destroyed, the disease is often not detected until beta cell loss is substantial enough for the patient to notice symptoms of advanced disease. By that time, it is typically too late to effectively intervene with therapies that may preserve beta cells.

biomarkers

Type I Diabets Dr. Hessner is investigating so-called "______," which are components in blood or tissue samples that can be measured to predict which individuals are most likely to develop type 1 diabetes. His work is unique, because it aims to detect biomarkers that are present before beta cell destruction progresses to clinical symptoms, - See more at: http://www.diabetes.org/research-and-practice/we-are-research-leaders/type-1-research-highlights/identifying-type-1-diabetes_before_beta_cell_loss.html#sthash.LQs18NEv.dpuf

biomarkers

Monitor _____ _______ •Knowledge of current BG levels •Need #'s to obtain control •May be required several times a day •Caution with neuropathic or retinopathy patients •Precise procedure •Chart / graph results Urine testing: Primarily utilized to test for ketones in anticipation of ketoacidosis (0-4+)/ utilize on sick days / especially type ___ Diabetics Factors that affect glucose meter performance Clients with higher hematocrit Falsely low blood glucose Medications may cause inaccurate results Be sure test strips compatible with meter

blood sugar one

Family history age gender female and high cholesterol is this a risk factor for hypothyroidism, hyperthyroidism, or both

both

Diabetes Diets •a very small breakfast with little carbohydrate, such as 8 oz milk with one slice of toast and an egg or peanut butter for protein •3 small meals and 2-3 small snacks (smaller meals cause lower blood sugars) •avoidance of concentrated sweets and sugars, including fruit juice •plenty of non-starchy vegetables •low-fat protein foods such as chicken, tuna, or lean meat •lower-fat food choices in general, to keep weight gain at a healthy level •low-fat or non-fat milk, yogurt or cheese for adequate calcium Study: _____ Interferes with Diabetes Control •Caffeine could interfere with the body's ability to handle blood sugar, thus worsening type 2 diabetes/ some research supports •The team at Duke University Medical Center in North Carolina found a strong correlation between caffeine intake at mealtime and increased glucose and insulin levels among people with type 2 diabetes. Try these seven steps to get started: 1.Using your dinner plate, put a line down the middle of the plate. Then on one side, cut it again so you will have three sections on your plate. 2.Fill the largest section with non-starchy vegetables. 3. Now in one of the small sections, put grains and starchy foods. . 4.And then in the other small section, put your protein. 5.Add a serving of Fruit, a serving of dairy or both as your meal plan allows. 6.Choose healthy fats in small amounts. For cooking, use oils. For salads, some healthy additions are nuts, seeds, avacado and vinaigrettes. 7.To complete your meal, add a low calorie drink like water, unsweetened tea or coffee. - See more at: http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/#seven

caffeine

Removal of thyroid gland - damage parathyroid gland Decrease in ______ ________ : The hand adopts a characteristic posture when the sphygmomanometer cuff is inflated above the systolic blood pressure within 3 minutes ______ : This clinical sign refers to a twitch of the facial muscles that occurs when gently tapping an individual's cheek, in front of the ear.

calcium Trousseau chvostek

Osteoporosis : pathophysiology •After peak Bone Mass is reached: slightly more bone is lost than is gained : accelerated if diet low in ______ and vitamin ____. •Risk depends on how much bone mass is achieved between ages __ and ___ .....and how much is lost afterwards •HOW are you doing at building bone mass NOW?

calcium D 25-35

Teaching for client taking _____ supplements - osteoporosis Take with meals or within 1 hour of meals. It is recommended that adults 50 years of age and over obtain at least 1,000 -1200 mg per day of elemental calcium. Watch for signs and symptoms of ________ :Symptoms of : lethargy, drowsiness, weakness, headache, anorexia, nausea and vomiting increased urination and thirst Adequate levels of ________ in the body are essential for the absorption and metabolism not only of vitamin D but of _____ as well. ________ converts vitamin D into its active form so that it can help ______ absorption. So many times calcium is given in a form that has magnesium added to it.

calcium hypercaclemia magnesium calcium magnesium calcium

Osteoporosis _______ •Care focuses on •Stopping or slowing the process •Alleviating symptoms •Preventing complications •Proper nutrition and exercise

collaboration

Endocrine System _________ : is when the hypothalamus receives feedback from target glands, the mechanism is more complicated.

complex

Endocrine system ________ feedback occurs through an axis established between the hypothalamus, pituitary gland, and target organ. For example, secretion of the hypothalamic corticotropin-releasing hormone stimulates release of pituitary corticotropin, which in turn stimulates cortisol secretion by the adrenal gland (the target organ). A rise in serum cortisol levels inhibits corticotropin secretion by decreasing corticotropin-releasing hormone.

complex

Monitor Blood Glucose : _______ for children •Glucose monitoring •Children require more frequent monitoring •Different targets due to erratic oral intake, activity •Age, weight, stage of puberty •Nutritional intake/distribution •Exercise patterns and daily routine

considerations

_________ therapy : Teaching •Suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection •Patient education: •Timing of doses •Need to take as prescribed, tapering required to discontinue or reduce therapy •Potential side effects and measures to reduce side effects

corticosteroid

_______ : can create Cushing's disease/ syndrome symptoms: •Most ______ cause of adrenal cortical insufficiency •Stops function of adrenocortical •May suppress for up to ___ year even after a short 2 week course of the med •Wean off meds so adrenal glands will start functioning on own •Do not stop suddenly : may create a Addisonian like Crisis: •Life threatening shock •Volume depletion/Severe hypotension •Severe electrolyte abnormalities •Hypoglycemia •Inability to respond to stress •Treated with IV fluids, electrolyte replacement and administration of IV steroids Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiencyT The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should be instructed to always have an adequate supply of the corticosteroid medication to avoid running out. Could cause acute _______ disease if dose's missed. . Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2 weeks' duration.

corticosteroids common one addisons

In cushing disease there is excess _______

cortisol

______ Syndrome: Excessive adrenocortical activity or corticosteroid medications •Central-type obesity with "buffalo hump;" heavy trunk and thin extremities, "moon-face", acne, water retention, fragile, thin skin; ecchymosis, striae; •Weakness, lassitude, sleep disturbances, •Osteoporosis, muscle wasting •Hypertension, Heart Failure •Infection ( also masks infection), slow healing •Virilization in women; loss of libido; impotence, menstrual irregularities •Mood changes, psychoses, insomnia •Hypokalemia, Hypernatremia, Hyperglycemia= risk diabetes •Risk DVT, thromboembolism •Glaucoma, corneal lesions

cushing

Facial hair, buffalo hump, and moon face are all symptoms of what?

cushings

A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client is ill by stating: a) I will stop taking my insulin if I'm too sick to eat b) I will decrease my insulin dose during times of illness and check my urine for WBC's. c) I will adjust my insulin dose according to the amount of food I eat d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones.

d) I will notify my physician if my blood glucose level is higher than 250 mg/dL and check my urine for ketones.

A client with diabetes mellitus has a glycosylated hemoglobin level of 9%. Based on this result, the nurse plans to teach the client about the need to: a) avoid infection b) take in adequate fluids c) prevent and recognize hypoglycemia d) prevent and recognize hyperglycemia

d) prevent and recognize hyperglycemia •- In the test result for glycosylated hemoglobin A1c, 7% or less indicates good control, 7% to 8% indicates fair control, and 8% or higher indicates poor control. This test measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. Thus, the test is useful in identifying clients who have periods of hyperglycemia that are undetected in other ways. Elevations indicate continued need for teaching related to the prevention of hyperglycemic episodes.

DM ________ is about twice as common in women as it is in men, and may take a greater toll on women with diabetes than on men with the disease. A landmark 2010 study of women in Archives of Internal Medicine suggested that

depression

These are all types of what? •Type I •Type II •Gestational •Other specific types •Pre-diabetes / IGT/ IFG •Metabolic Syndrome

diabetes

These are nutritional recommendations for ______ For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat and following a food plan. There is not a one-size-fits-all eating pattern for individuals with diabetes. Nutrition therapy has an integral role in overall diabetes management, and each person with diabetes should be actively engaged in education, self-management, and treatment planning with his or her health care team, including the collaborative development of an individualized eating plan . All individuals with diabetes should receive individualized medical nutrition therapy (MNT), preferably provided by a registered dietitian who is knowledgeable and skilled in providing diabetes-specific MNT. MNT delivered by a registered dietitian is associated with A1C decreases of 0.3-1% for people with type 1 diabetes (38-40) and 0.5-2% for people with type 2 diabetes Goals: •Achieve and maintain BMI <25 •Prevent wide fluctuations of blood glucose levels •Decrease serum lipids, if elevated Nurse: •Be knowledgeable about dietary management •Communicate important information to the dietician or other management specialists •Reinforce patient understanding •Support dietary and lifestyle changes

diabetes

_______ : disorder of metabolism related to the body's production and use of insulin •Type 1: absolute deficiency of insulin •Type 2: relative deficiency of insulin/ resistance to use of

diabetes

29.1 million people have ______ ___ out of 4 do not know they have diabetes 86 million - more than one out three adults have ______ ____ out of 10 do not know they have prediabetes

diabetes 1 prediabetes nine

Nutritional Management ______ diet •Individualized to the client •Protein(10-20%) •Controlled CHO(45-60%) and fat (20-30%) •ADA diet has changed from calorie counting to more of a carb counting/ but aware of protein & fat •Remember lifestyle, culture, socioeconomics •No need for fancy, low-cal foods •Need to eat on a regular basis •Glycemic index •Modest additional benefit •Use breakfast cereals based on oats, barley and bran •Use breads with wholegrains, stone-ground flour, sour dough •Reduce the amount of potatoes you eat •Enjoy all other types of fruit and vegetables •Use Basmati or Doongara rice •Enjoy pasta, noodles, quinoa •Eat plenty of salad vegetables with a vinaigrette dressing

diabetic

Endocrine assessment Sample of _________ tests available: •Serum blood sugar A1c •T3, T4, TSH •Individual hormone levels •Serum electrolytes •Liver enzymes •Bilirubin serum albumin •Serum calcium

diagnostic

Hypothalmus, pineal, pituitary (hypophysis), thyroid, parathyroid (posterior), thymus, adrenals, islet of langerhans in pancreas These are all glands of what system>

endocrine

these are all specific diagnostics tests to assess the structure and function of the glands of the ________ system : - hemoglobin A1c - T3, T4, TSH - individual hormone levels - parathyroid, catecholamines, estrogen, progesterone, growth hormone, and so on - serum electrolytes - liver enzymes (AST< ALT< SGOT, LDH) - bilirubin - serum albumin - serum calcium

endocrine

______ system •Affects most cell, organ, and body functions : full body assessment •Closely linked with neurologic and immune systems •Negative feedback mechanism •Hormones: •Amines and amino acids •_______ (protein): act on cell surface •______: act inside the cell •Fatty acid derivative

endocrine peptide steroid

_________ - Osteoporosis •Expected outcomes may include: •Client identifies, implements strategies •Lifestyle modification •Client achieves adequate calcium intake •Client identifies, eliminates safety hazards •Client experiences relief from acute pain

evaluation

DM Visit ___ doctor/ ___ doctor Regularly for check up and toe-nail care:Multiple pathways to amputation: Neuropathy: pathophysiology pathways are unclear: long term exposure to high B.S. is a contributing factor Caution patients on: High protein diet/ can exacerbate or accelerate neuropathy Amputation= possible loss of independence

eye foot

_____ _____ of the endocrine system •Body sends neural message to hypothalamus •Hypothalamus stimulates the pituitary •Pituitary sends factors to primary gland •Primary gland releases hormone until cell satisfied, then message sent to turn off

feedback mechanism

Diabetic _____ care •Inspect feet daily/ use mirror for bottom •Wash with lukewarm water and mild soap/dry/ between toes too •No soaking feet •Do not self-treat corns, calluses, ingrown nails •No crossing legs or constrictive clothing/ avoid anything that constricts blood flow •Moisturize, but not between toes •Avoid thermal injury/ check bath water •Good fitting shoes, no holes, cracks, tears, ridges /No open-toed shoes/ socks •Cut nails straight across and file/ see podiatrist regularly •Don't smoke •Immediate care/ break in skin integrity A study shows that diabetic patients with neuropathic symptoms such as numbness or tingling in feet or hands are twice ore likely to b unemployed than those without the symptoms The toenails of the client with diabetes require close care. If the nails are thick or ingrown, they require the attention of a podiatrist. Cutting the nails across after the bath is correct for toenails that do not demonstrate the complications listed. The client with diabetes is at an increased risk for infection and should avoid situations in which this risk is increased, such as the nail shop pedicure. The nurse should not cut the client's toenails.

foot

_________ Diabetes According to a 2014 analysis by the Centers for Disease Control and Prevention, ADA 2017: The recommendation to test women with gestational diabetes mellitus for persistent diabetes was changed from 6-12 weeks' postpartum to 4-12 weeks' postpartum to allow the test to be scheduled just before the standard 6-week post- partum obstetrical checkup so that the results can be discussed with the patient at that time of the visit or to allow the test to be rescheduled at the visit if the patient did not get the test.

gestational

______ Diabetes •_._% of all pregnancies •Hormones from the placenta block the action of mother's insulin / insulin resistance •2nd/ 3rd trimester •Higher incidence go on to type 2 diabetes later in life ( __% within 15 years) •Neonate complications if not controlled •Macrosomia ( ____ birth weight) •Breathing issues •Other

gestational 9.2 55% high

DM _______ is the principal counter regulatory hormone that opposes the anabolic effects of insulin, notably on the liver and a relative excess of glucagon is a hallmark of all forms of diabetes. However, failure to secrete adequate quantities of glucagon in response to insulin-induced hypoglycemia characterizes longstanding type 1 diabetes and is an important contributor to mortality in this disease, accounting for 2-4% of all deaths

glucagon

DM ______ is stored alongside insulin in the islet, albeit in a discrete cellular compartment, the pancreatic α-cell. Just as the metabolic actions of glucagon oppose those of insulin, the regulators of insulin's release 1) tend to exert opposing effects on glucagon secretion .. Thus, elevated concentrations of glucose suppress glucagon release, while catecholamine's stimulate the secretion of this hormone. Acting independently of these mechanisms, neuronal inputs into the islet exert a further important level of control over glucagon release

glucagon

DM Despite being a subject under investigation for more than 35 years, just how the effects of ______ are achieved at the level of individual α-cells is still disputed and has become an area of vigorous research in recent times . As yet, however, a consensus has not been reached.

glucose

When we eat, food is broken down into chemicals and ______ enters blood stream . In response to elevated serum glucose, _____ cells of pancrease secrete insulin into bloodstream. ______ combines with insulin receptors on cell wall activating glucose transporter allowing glucose to enter cell

glucose beta Insulin

Hyperthyroidism signs /symptoms: #1 cause/Autoimmune=_______ disease

graves

•Thyroid Disease ( Hypo/Hyper) •________ :autoimmune disorder that results in hyperthyroidism •________: autoimmune disorder that results in hypothyroidism

graves hasimotos

Diabets - Diagnosis Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also referred to as being Hb1c or HGBA1C) is a form of ______ that is measured to primarily to identify the 2-3 month average of plasma glucose concentration. mean A1C nationally among people with diabetes has declined from 7.6% (60 mmol/mol) in 1999-2002 to 7.2% (55 mmol/mol) in 2007-2010 based on the National Health and Nutrition Exam- ination Survey (NHANES), with younger adults less likely to meet treatment targets than older adults (2). This has been accompanied by improvements in cardiovascular out- comes and has led to substantial reductions in end-stage microvascular complications. Nevertheless, 33-49% of patients still do not meet targets for glycemic, blood pressure, or cholesterol control, and only 14% meet targets for all three measures while also avoiding smoking (2). Evidence suggests that progress in cardiovascular risk factor control (particularly tobacco use) may be slowing (2,3).

hemoglobin

Alterations of ______ secretion and / or action result in the abnormal function of specific body organs and the loss of the body's ability to regulate itself in response to both internal and external changes. Because of the interaction between hormones and the nervous system in maintaining hemostatic balance, loss of hormones results in serious, even fatal, problems. The nurse's role in caring for patients of all ages with endocrine and / or metabolic alterations includes assistance with physical care, monitoring and provider of information

hormone

E. Acute complications: preventing, detecting and treating: ______: •Hyperglycemia results from: •An alteration in insulin secretion •Impaired insulin action •Combination of both •Can lead to: DKA/ HHNK •Dawn Phenomenon •Somogyi Effect •Acute complication can be life threatening and require immediate treatment. In contrast the chronic complication appear to be due to prolonged hyperglycemia. •Hyperglycemia promotes an osmotic diuresis with loss of both fluid and electrolytes demonstrated by both polyuria and nocturia. This stimulates thirst and polydipsia. Decreased responsiveness in the satiety center of the hypothalamus promotes polyphagia. Increased osmolality can promote changes in the water content of the lens of the eye leading to blurred vision. •_____ Phenomenon is characterized by increased levels of fasting blood glucose or insulin requirements between 0400-0900. It has been suggested that a change in the normal circadian rhythm for glucose tolerance is altered in persons with DM. GH (grow3th harmone)has been suggested s a possible factor •_____ effect: In a person with diabetes, insulin-induced hypoglycemia produces a compensatory increase in blood levels of counter regulatory hormones causing blood glucose to become elevated. •The cycle begins when the increase on blood glucose and insulin resistance are treated with larger insulin doses. • The hypoglycemic episode often occurs during the night.

hyperglycemia dawn somogyi

For those who want to know more about why increased iodine intake can cause _________/ note below: In some susceptible patients, an excess iodine load provides a rich substrate for increased production of thyroid hormones. Iodine-induced hyperthyroidism (the Jod-Basedow phenomenon) was first described in the early 1800s, when thyrotoxicosis was observed to be more common among patients with endemic goiter treated with iodine supplementation than in individuals without goiter. IIodine-induced hyperthyroidism might be transient or permanent, and risk factors include nontoxic or diffuse nodular goiter, latent Graves disease and long standing iodine deficiency.7 In addition, iodine-induced hyperthyroidism in euthyroid patients with nodular goiter in iodine-sufficient areas has also been reported when iodine supplementation is excessive.

hyperthyroidism

Hair loss Bulging eyes Sweating enlarged thyroid goiter rapid heartbeat Difficulty sleeping, heat intolerance, infertility, irritability, muscle weakness, nervousness, scant menstrual periods weight loss frequent bowel movements warm, moist palms tremor of fingers soft nails Is this hyperthyroidism or hypothyroidism

hyperthyroidism

________ in older clients is most often caused by Graves disease or toxic nodular goiter, which is diagnosed by subnormal or undetectable levels of TSH (thyroid-stimulating hormone). The treatment of choice is the ingestion of radioactive iodine, which is picked up by the thyroid tissue and then destroys the tissue. This treatment avoids surgery, anesthesia, and hospitalization. Surgical removal is reserved for clients with symptoms too severe for treatment with radioactive iodine or nodules suspicious for malignancy. Foods high in iodine, such as soy sauce, can influence the effectiveness of medication therapy for clients who are diagnosed with hyperthyroidism. High-calorie foods are important for clients with hyperthyroidism in order to meet metabolic demands. There is no reason to restrict caffeine-free soda. Milk products should be included in the diet for the client with hyperthyroidism because they are high in protein and calcium. . A partial thyroidectomy is a surgical procedure, for which the client is not a candidate

hyperthyroidism

•Pathophysiology •Caused by excessive delivery of TH •Increases metabolic rate •Increased HR and SV = Increased CO = hyperdynamic circulatory state. •Protein synthesis and degradation are increased = negative nitrogen balance d/t breakdown exceeds buildup •Hyperglycemia results d/t decrease glucose tolerance •Fat metabolism increased •Heightens sympathetic nervous system's response •Etiology ( many factors) •Thyroiditis •Viral infection •Acute disorder that may become chronic •Autoimmune stimulation ( Graves Disease) •Excess secretion of thyroid- stimulating hormone (TSH) •Excessive intake of thyroid medications Is this hyperthyroidism or hypothyroidism?

hyperthyroidism

Treatment: ________/ Collaboration •Relapse of disorder is common/Disease or treatment may result in hypothyroidism •Pharmacologic therapies •Antithyroid medications •Reduce TH production •Therapeutic effects in several weeks •Radioactive iodine (RAI) therapy •Thyroid gland takes up iodine •RAI concentrates in thyroid •Destroys thyroid cells •Results in __-___ weeks •Surgery •Thyroid gland enlarged •Pressure on esophagus, trachea/Problems with breathing, swallowing •_________ •Remainder of gland produces adequate TH •Total thyroidectomy for cancer à requires lifelong hormone replacement

hyperthyroidism 6-8 thyroidectomy

Thyroid _________ •Enlarged gland •Intolerance to heat •CV: ( common elderly)Tachy at rest/afib/arrhythmias, cardiac insufficiency •CNS: difficulty concentrating/ anxiety, nervousness/ Irritability/mood swings/ fine tremor/clumsiness/ Restlessness •INTEGUMENTARY: sweating, flushing, hyperpigmentation, velvety texture, fine soft hair, premature graying, hair loss, fragile nails, •EYES: Exophthalmia •RESPIRATORY: Dyspnea •GI: N/V/D Weight loss/ appetite> •REPRODUCTIVE: Menstrual changes, impotence, decreased libido in men •_______ disease •Autoimmune •Multiple systemic changes, enlarged thyroid, exophthalmos •Cause: several causes / Genetic: occurs in identical twins •Immunologic ( occasionally coexists with other auto immune endocrine abnormalities ( like DM I) GRAVES is most common: Auto immune ( age 30-60) DX: TSH/ T3 & T4 levels drawn: help determine if primary secondary(TSH will be normal, slightly low or high) Clinical Manifestations: Enlarged thyroid might be called a goiter but usually goiter refers to hypothroidism

hyperthyroidism Graves

Endemic Goiter - related to geographical area ________ _________: Overstimulation of sympathetic nervous system: eye muscles enlarge/ they do NOT decrease when condition corrected

hyperthyroidism exophthalmia

Parathyroid Glands Potential _________ related to injury or removal of parathyroid glands; monitor for _________ Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as _______ and must be reported to the physician immediately, as laryngospasm may occur and obstruct the airway.

hypocalcemia tetany

Headache, imparied vision, hunger, irritability, weakness/fatigue, sweating, dizziness, fast heartbeat, shaking, anxiety Are these symptoms of hypoglycemia of hyperglycemia

hypoglcemia

Acute complications : preventing, detecting and treating _______ •<__mg/dL/ Mild 40-60mgdL/ Mod. 20-40 mg/dL •Severe-unconsciousness or seizures •Risk Factors: •Too much insulin or not enough food •Exercise, sleeping late •Nausea, vomiting, eating less •Ingestion of medications or ETOH •Hypoglycemic unawareness à person does not experience symptoms when epinephrine counter regulatory response to hypoglycemia blunted/ occurs in approximately 40% of people with type 1 diabetes mellitus, less often in type 2 Hypoglycemia is a complication of treatment for diabetes It is most frequently a result of administration of insulin, or rarely, oral hypoglycemic agent in an amount greater that the glucose load requires. Inability to concentrate, slurred speech, blurred vision, confusion, irrational behavior, lethargy severe Treatment:.amt of carbs related to severeity of symptoms: If the patient cannot swallow or is unconscious: Subcutaneous or intramuscular glucagon (1 mg) 25 to 50 mL of 50% dextrose solution IV

hypoglycemia 60

- autoimmune disease in family - anti-thyroid meds - iodine deficiency - previous thyroid surgery - 50 and older are these risk factors for hyperthyroidism or hypothyroidism?

hypothyroidism

: In all patients with ________ , the effects of analgesic agents, sedatives, and anesthetic agents are prolonged; special caution is necessary in administering these agents to elderly patients because of concurrent changes in liver and renal function

hypothyroidism

Are these risk factors for hypothyroidism or hyperthyroidism Risk factors Women over 50 years Close relative with autoimmune condition Thyroid surgery, radiation to neck Iodine deficiency Hashimoto thyroiditis

hypothyroidism

Dry, coarse hair loss of eyebrow hair puffy face enlarge thyroid goiter Slow heart beat arthritis, cold intolerance, depression, dry skin, fatigue, forgetfulness, heavy menstraul periods, infertility, muscle aches weight gain constipation brittle nails Is this hypothyroidism or hyperthyroidism

hypothyroidism

The underlying mechanism of iodine-induced _______ remains unclear, but could be attributable to failure to adapt to the acute Wolff-Chaikoff effect, probably because of a damaged thyroid as a result of previous pathological insults. Exposure to high concentrations of iodine might also decrease the release of thyroid hormone, as reported in several small studies that show mild decreases in serum levels of thyroid hormone and increases in the serum level of TSH to the upper limit of the normal range.10-12Administration of iodine to patients with severe hyperthyroidism or thyroid storm is efficacious, as it results in an acute decrease in the release of thyroid hormones.13

hypothyroidism

Thyroid - ________ - Clinical Manifestations •Goiter/Thyroid tissue may not be easily palpable unless goiter is present •Slow speech and hoarseness from thick dry tongue CNS: •Decreased mentation/ forgetfulness/ mood changes CV: •Bradycardia/ weak pulse hypotension INTEGUMENTARY: •Edema: periorbital,sacral, peripheral,lungs, face, hands •Dry,pale, cold, scaly, inelastic skin, • hair dry & sparse with patchy hair loss, loss of the outer third of the eyebrow, •Nails: thick/ brittle/visible transverse and longitudinal grooves GI: •Anorexia, constipation,Wt. gain/ unexplained REPRODUCTIVE: •Heavy, irregular menses, decreased libido MUSCSKELETAL •Backache, weak muscles METABOLIC •Cold intolerance, Fatigue /energy loss •Effects of hypnotic and sedative agents; reduce dosage

hypothyroidism

Severe exacerbation : ______ - Myxedema Coma / life threatening • _______: •severe, long-standing hypothyroidism •exacerbation by an acute event/ stressor •infection/myocardial infarction/cold exposure/administration of sedative drugs/ especially opioids •Clinical _________s: •All organ / metabolic functions are significantly slowed •mental status decreased •hypothermia/hypotension/ bradycardia/hypoventilation •hyponatremia/hypoglycemia •Long standing hypothyroidism: puffiness of the hands and face, thickened nose, swollen lips, and an enlarged tongue may occur secondary to nonpitting edema with abnormal deposits of mucin in the skin and other tissues (myxedema).

hypothyroidism etiology manifestations

Thyroid: _________ : Overview / Common in Women __-__ years •Primary •Gland itself: loss of thyroid tissue, antithyroid medication, thyroiditis, endemic iodine deficiency •_______ •Failure to stimulate normal thyroid function or failure of target tissue to respond to normal blood levels of thyroid hormones/ i.e. pituitary TSH or peripheral resistance to TH •Either type may lead to myxedema •Deficiency of T3 or T4 / TSH •Metabolic processes slow down •Pregnant women with undiagnosed or inadequately treated hypothyroidism have an increased risk of miscarriage, preterm delivery, and severe developmental problems in their children. •Treatment: levothyroxine (on an empty stomach)

hypothyroidism 30-60 secondary

Hypothyroidism Hyperthyroidism - Metabolism •__________ •Monitor cardiac output/ depending on hypo or hyper •Monitor blood pressure, pulse, rhythm •Respiratory rate, breath sounds •Suggest keeping environment cool •Free of distractions •Encourage balance of activity with rest •Monitor BP, apical, peripheral pulses •Monitor respiratory rate, breath sounds •Suggest client avoid becoming chilled •Explain need to alternate periods of rest, activity

implementation

Hypothyroidism Hyperthyroidism - Metabolism •__________ •Promote visual health/ if exophthalmia present ( hyper) •Monitor visual acuity, photophobia •Teach measures for protecting eye •Tinted glasses, shields •Artificial tears •Cool, moist compresses •Cover, tape eyelids shut at night if they don't close •Elevate head of bed 45° •Have client report pain, vision change

implementation

Metabolism •_________ •Promote balanced nutrition •Monitor nutritional status •Have client weigh daily •Teach about diet needs of Hypo •High-carbohydrate, high-protein diet •Between-meal snacks •Improve ______ ______ •Establish trusting relationship •Encourage client to verbalize feelings

implementation body image

Diabetic Mellitus E. Manage Chronic Complications: preventing, detecting, treating :Increase risk of ______ and decreased ______ •Hypoxia •HA1c Hgb binding in RBC impedes release of oxygen to tissue •Pathogens •Grow better in higher blood sugar/ increase source of energy •Blood supply •Macro and micro changes to blood vessels / •WBC •Impaired function / chemotaxis defective/ phagocytosis, A client with diabetes mellitus is at a great risk for infection: Increased susceptibility to infection •Vascular, neurological impairments •Nephrosclerosis, urinary retention Blood supply: AG E's - advanced glycoslation end products / binding to protein and lipids •Thicken the vessel basement membrane •Increase permeability blood vessels •Oxygen free radicals? Lose vasodilation and increase coagulation Periodontal disease •Progresses more rapidly if poorly controlled Complications involving the feet •Result of angiopathy, neuropathy, infection •Vascular changes usually bilateral

infection healing

Endocrine _______ is usually chronic, often resulting in glandular secretion of hormones. However, it may be acute or subacute as in thyroiditis. ______ can occur within a gland or in other areas of the body causing abnormal hormone production. For example, certain lung tumors secrete ADH or PTH.

inflammation tumors

Diabets _______ sites •New recommendations •Stick with one site •Different absorption rates •Muscle activity may affect uptake Numbered in patient chart form/ put where given The rate of absorption and peak of action of insulin differ according to the site. The site that allows the most rapid absorption is the abdomen, followed by the deltoid muscle, then the thigh, and then the hip...unless there is muscle activity Because of the rapid absorption, the abdomen is the recommended site.

injection

Implementation - Osteoporosis •Prevent ______ •Implement safety precautions •Avoid restraints on hospitalized or LTC client •Encourage use of assistive devices •Teach older client about safety, fall precautions •Encourage ______ •Ensure safety before starting exercise program •Teach clients about weight-bearing exercise •Determine client's interests •Plan exercise regimen in sync with preferences Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury and should not be used. A nightlight is useful but is not the best means to prevent injury.

injury exercise

Functions of ______: •Transports and metabolizes glucose for energy •Stimulates storage of glucose in the liver and muscle as glycogen •Signals the liver to stop the release of glucose •Enhances storage of fat in adipose tissue •Accelerates transport of amino acids into cells •Inhibits the breakdown of stored glucose, protein, and fat

insulin

DM ______ control, defined as three or four insulin injections per day or continuous subcutaneous insulin infusion, insulin pump therapy plus frequent blood glucose monitoring, and weekly contacts with diabetic educators, dramatically decreases development and progression of complications such as retinopathy, nephropathy, and neuropathy.

intensive

Clinical manifestations of _______ hypothyroidism - Decelerate growth - Less when acquired at later age - Myxedematous skin changes - dry skin - puffiness around eyes - sparse hair - constipation - sleepiness - mental decline

juvenile

______ Hypothyroidism •One of the most common endocrine problems of childhood = congenital or acquired •Decreased secretion of TH

juvenile

_________ hyperthyroidism •Propylthiouracil (____) levels must be checked frequently •Carefully monitor for side effects of drug •If sore throat and fever arise may indicate _______, should be seen by practitioner.

juvenile PTU leukopenia

Diabetes Question:I read that metformin (Glucophage)(Biguanide category)could cause ____ _____. What is this and how would I know if I had it? I was told to never drink alcohol while taking this medication...why? RARE but lethal! Lactic acid is a substance that is normally produced by your body in small amounts and removed by your liver and kidneys. Lactic acidosis occurs when this substance builds up in the bloodstream. The overall risk of developing lactic acidosis is very small, but the risk is greater if you have other health conditions, such as heart failure and lung, kidney, or liver problems. Your doctor should do a blood test prior to starting metformin to assess your liver and kidney function. If you have any of the above health problems or if you drink alcohol heavily, you probably shouldn't take metformin. Otherwise, you are at a very low risk for developing lactic acidosis from metformin. You should, however, contact your doctor immediately if you suddenly develop diarrhea, fast and shallow breathing, muscle pain or cramping, tiredness, weakness, or unusual sleepiness. These can be symptoms of lactic acidosis. You should also let your doctor know if you get the flu or any illness that results in severe vomiting, diarrhea, and/or fever, or if your intake of fluids becomes significantly reduced. This is because severe dehydration can affect your kidney or liver function and increase your risk of lactic acidosis from metformin... ______: new evidence showing an association between B12 deficiency and long-term metformin use, a recommendation was added to consider periodic lab tests

lactic acidosis metformin

Medication - General Insulin facts •Primary treatment Type I/ Type 2 if failure of oral meds, diet & exercise •Rapid, short, intermediate and long acting •Knowledge of peak action is imperative ( watch for hypoglycemic episodes at these times) •Increased need during illness, infection, and stressors •Agitate vial to mix NPH and suspensions •Never mix ____ ph of 4=precipitation when mixed •Avoid temp. extremes / vials non-refrigerated -1 month •New guidelines/ alcohol prep not necessary ( follow protocol in your facility)

lantus

Some are from release of epinephrine and others because of decrease of glucose to brain. Blood sugar related: ..can ____ to : , loss of consciousness, coma , seizure, death

lead

Risk factors for osteoporosis •Depends on bone mass achieved, lost •Peak adult bone mass is achieved between ages of 18-25 years •______ habits •Sedentary; Lack of weight bearing exercise but female athlete at risk •Low weight and body mass index •Smoking, alcohol, caffeine •Lack of exposure to sunlight •Medications •Low calcium, vit D intake, high phosphate intake ( carbonated beverages) low calorie intake _____ Disease: •Hyperthyroidism, kidney failure, anorexia nervosa, malabsorption syndrome •Unmodifiable risk factors •Family history •Post menopausal, Age , gender, small frame •Ethnicity •Caucasian / Asian •Other chronic diseases •Current low bone mass in children . Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis but predisposes the woman to osteoarthritis.

lifestyle chronic

Are you at risk for gestation diabetes _____ risk - normal weight before pregnancy - under age 25 - no history of unexplained stillbirth - no diabetes in immediate family ____ risk - at risk ethnicity : African american, hispanic, native american, alaskan, pacific islander - high blood pressure - high cholesterol - baby weighing over 9 lbs - GD during previous pregnancy - obestiy, older than 30, family history

low high

•ASA •ETOH/excess •Anticoagulants •Oral hypoglycemic •Beta blockers (Inderal) •Tricyclic/MAO inhibitors antidepressants •Tetracycline These are medications that will ______ blood sugars

lower

DM •______. There is an acceleration in the development of arteriosclerosis and an alteration in the balance between thromotic (increased) and fibrinolytic (decreased) factors. The combination of all of these factors promotes the cardiovascular disease that is seen in DM. • •________ is the increased cognitive decline and risk of dementia observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself/ elevated glucose levels • •_______ disease affects the smallest blood vessels, the capillary and the precapillary arterioles. •______ in diabetes is the leading cause of end stage renal disease in the U.S.leading to dialysis. This results is an alteration in glomerular function. And is characterized by proteinuria, hypertension and progressive renal insufficiency. The thickening of the basement membranes of the glomerular capillaries leads to glomerular sclerosising: • Retinopathy growth of friable and poor-quality new blood vessels in the retina as well as macular edema which can lead to severe vision loss or blindnessRetinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US. • •______ appears to be a combination of altered metabolism and vascular insufficiency. Changes in the cellular osmolality compromised neuronal function. In addition to this impaired blood flow reduces oxygen delivery to the nerves. The neuropathy seen in diabetic patients is most probably due to a combination of these and other factors. abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot . Alterations in the peripheral and autonomic nervous systems Visceral neuropathies Sweating dysfunction Abnormal pupillary function Cardiovascular dysfunction Gastrointestinal dysfunction Genitourinary dysfunction •Diabetic amyotrophy is muscle weakness due to neuropathy •Cardiomyopathy: damage to the heart , leading to diastolic dysfunction and eventually heart failure •Stroke à older adults with type 2 DM 2-6 times more likely to have a stroke Alterations in mood Strains of living with complex self-care Risk of depression

macrovascular encephalopathy microvascular nephropathy neuorpathy

Chronic complications : preventing, detecting and treating of DM •______ •Cardiovascular: = ___ % of all deaths in DM clients •Atherosclerosis & abnormalities in platelets, RBC's, Clotting factors/ changes in arterial walls •Stroke •MI •Peripheral vascular disease •Encephalopathy •Hypertension •Hyperlipidemia •Myonecrosis (muscle wasting) •________ •Peripheral vascular disease •Retinopathy •Cardiomyopathy •Nephropathy •Presence of albumin in urine •HTN accelerates process •Thickening of basement membrane of glomeruli eventually impairs renal function •Neuropathy •amyotrophy ( muscle weakness due to neuropathy) •Visceral neuropathies: •Sweating dysfunction •Abnormal papillary function •Cardiovascular, Gastrointestinal, Genitourinary dysfunction •Diabetic foot •Increase risk of infection / decreased healing

macrovascular 80 Microvascular

Elevated waist circumference : - Waist measurement of 40 inches or more in men - 35 inches or more in women Elevated levels of Triglycerides - 150 mg/dL or higher or - taking medication for elevated triglyceride levels Low levels of HDL (good) cholesterol - below 40 mg/dL in men - below 50 mg/dL in women or taking medication for low HDL cholesterol levels Elevated blood pressure levels - 130 mm Hg or higher for systolic blood pressure - 85 mm Hg or higher for diastolic blood pressure or taking medication for elevated blood pressure levels Elevated fasting blood glucose levels - 100 mg/dL or higher or taking medcation These are symptoms of _____ syndrome : Lab values

metabolic

The most prevalent _________ disorders have modifiable risk factors 2. Diabetes : encourage healthy lifestyle, screenings 3. Liver disease : avoid alcohol 4. Obesity " encourage less food intake, increased activity, screenings 5. Osteoporosis : encourage balanced nutrition, activity

metabolic

_____ syndrome : Syndrome ___ •grouping of traits/ medical conditions •At risk: heart disease & type __ diabetes. •three of the five •Pro—inflammatory conditions Symptoms - central obesity - HTN - high triglycerides - Low HDL cholesterol - insulin resistance

metabolic X II

Diabetes •Disorder of _______ —the way our bodies use digested food for energy. • Most of the food we eat is broken down into ________. _____ is the body's main source of fuel. •After digestion, glucose enters the bloodstream. Then glucose goes to cells throughout the body where it is used for energy. However, a hormone called ______ must be present to allow glucose to enter the cells. ______ is a hormone produced by the pancreas •In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, diabetes develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Resulting in Hyperglycemia •Over time, high blood glucose levels damage nerves and blood vessels, leading to complications.

metabolism glucose glucose insulin insulin

After nutrients are ingested, digested, absorbed, and transported across cell membranes - must be metabolized into individual chemicals that can be used by cells to maintain life 1._______ —processes of biochemical reactions occurring in the body's cells that are necessary to produce energy, repair cells, maintain life 2.________—chemical messengers secreted by various glands that exert controlling effects on cells of body

metabolism hormones

Diabetes influenced by •Gut ______ : • Affects inflammation • Immunity • Insulin sensitivity •Nutrient absorption •Possibly even appetite

microbes

DM Atherosclerosis When the _______ is disturbed (dysbiosis) there is a translocation of an endotoxin through the epithelial barrier of the gut and this which encourages mucosal inflammation. The increase of inflammation then leads to impaired insulin signaling. One study completed in 2019 focused on changes in the gut microbiota. In the study, fecal material was transplanted from lean donors into patients with metabolic syndrome. The results an increase in insulin sensitivity (Santulli, 2019). It then referred to another preclinical study where, in reverse healthy mice were given fecal transplants from mice that had glucose intolerance. The healthy mice developed glucose intolerance as a result. Another factor in why diabetes increases the risk for CVD has to do with the PCSK9 gene. With gut dysbiosis the increased insulin resistance is thought to lead to an increased expression of the gene PCSK9. To put it simply, this gene regulates the amount of cholesterol in the blood stream and specifically influences the levels of LDL (NIH, 2019). Santulli and associates indicate that insulin appears to regulate PCSK9 levels. To offset the effect of this response to dysbiosis a new class of drug, PCSK9- inhibitors that were approved in 2015, has been developed. When these drugs are used in combination with statin drugs it lowers the LDL by up to 60% (NIH, 2019).

microbiota

This is the ______ process for DM •Promote healthy behaviors •Use and teach meticulous hand washing •Monitor for manifestations of infection •Discuss importance of skin care •Teach dental health measures •Dental examination every 4-6 months •Maintain careful oral hygiene •Be aware of symptoms requiring dental health •Monitor for need to make adjustments in insulin if dental surgery necessary •Teach women with diabetes the symptoms and preventive measures for vaginitis caused by Candida albicans

nursing

Endocrine system 1.Endocrine gland functions assessed using findings from diagnostic tests, health assessment interview, physical assessment 2.______ assessment a)Health assessment interview (1)Consider genetic influences on health of adult (a)Assess for manifestations of genetic disorder (2)Endocrine system may be focus of assessment or part of screening (3)Client's medical history (4)Family history (5)Social and personal history (6)Changes in normal growth, development, height, weight (7)Injuries 3. ________ assessment (1)Part of total health assessment or focused assessment (2)Thyroid gland à only one palpable

nursing physical

These are ______ ______ for DM •Maintaining Fluid Balance •Dietary Intake •Reduction of Anxiety •Improving Self-Care •Managing Potential Complications/ Fluid Overload •Hypokalemia •Hyperglycemia •Ketoacidosis •Hypoglycemia •Cerebral edema Planning for care of children with diabetes depends on the assessment findings. Planning should begin at the time of diagnosis and move forward to prepare the child and the family for self-management of glucose monitoring and medications, signs and symptoms of hypoglycemia, and actions to take. Before discharge, the child and the family should be linked to the resources in the community that will support care of the child with diabetes. Minimizing the number of school days missed and activities that limit exposure to injuries are not immediate priorities for this client's plan.

nursing interventions

This is the ____ ______ for DM •Maintain sexual health •Changes in sexual function, sexuality have been identified in both men and women with diabetes •Include a sexual history as part of the initial ongoing assessment of the client with diabetes •Provide information about the actual and potential physical effects of diabetes on sexual function •Provide counseling, or make referrals as appropriate •Promote effective coping •Client with diabetes faced with lifelong changes •Assess client's psychosocial resources •Explore with client, family effects of diagnosis and treatment of diabetes on finances, occupation, energy levels, and relationships •Teach constructive problem-solving techniques •Provide information about support groups and resources

nursing process

This is the _____ _____ for DM •Diagnosis •Knowledge Deficit •Risk for Impaired Skin Integrity •Risk for Infection •Risk for Injury •Risk for Deficient Fluid Volume •Sexual Dysfunction •Ineffective Coping With smalll children: Mom or Dad will need to learn how to provide the insulin injections; and should be concerned with this diagnosis Finances need to be addressed and the costs involved in obtaining medication...if and issue /a diagnosis of: Risk for Unstable Blood Glucose would be in order Families with multiple children with needs/ asses for family coping issues

nursing process

This is the ______ ______ for DM •Implementation •Individualized—focuses on teaching client, family about disease, management •Information about normal metabolism, diabetes, how diabetes alters metabolism •How diets help keep blood glucose in the normal range •Exercise helps lower blood glucose •Self-monitoring of blood glucose •Medications à insulin, oral agents •Manifestations of acute complications of hypoglycemia, hyperglycemia •Hygiene, including skin care, dental care, foot care •What to do about food, fluids, medications when client is sick •Helpful resources •Adapt teaching to special needs, developmental level •Older adult •Changes in diet may be difficult to implement for many reasons •Exercise of any type may not have been part of activities of daily living •Diagnosis of chronic illness threatens a client's independence and self-worth •Money to purchase medications, supplies often taken out of fixed income •Visual deficits may make insulin administration difficult or impossible

nursing process

This is the ______ ______ for DM •Maintain skin integrity •Client at increased risk for altered skin integrity à baseline, ongoing assessments •Musculoskeletal assessment that includes foot and ankle joint range of motion (ROM), bone abnormalities, gait patterns, use of assistive devices for walking, abnormal wear patterns on shoes •Neurologic assessment •Vascular examination •Assessment of hydration status •Assessment for lesions •Peripheral neuropathies and vascular disease may cause or contribute to many complications •Teach foot hygiene •Discuss importance of not smoking if client smokes •Discuss importance of maintaining blood glucose levels •Conduct foot care teaching sessions as often as necessary •CLIENT TEACHING:

nursing process

This is the ________ _____ for DM •Evaluation • •Client will demonstrate an age-appropriate understanding of self-management through medication, diet, exercise, blood glucose self-monitoring activities •Skin integrity will remain intact •Client will remain free of infection •Client will remain free of injury

nursing process

_____ _____ - The care of the patient with Cushing syndrome - Assessment •Activity level and ability to carry out self-care •Skin assessment •Changes in physical appearance and patient responses to these changes •Mental function •Emotional status •Medications

nursing process

_____ _____ - The care of the patient with cushing syndrome - diagnosis •Risk for injury •Risk for infection •Self-care deficit •Impaired skin integrity •Disturbed body image •Disturbed thought processes

nursing process

______ ______ : The Care of the Patient With Cushing Syndrome/ Addisons —Planning and Interventions •Goals may include decreased risk of injury, decreased risk of infection, increased ability to carry out self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications •Patient and family education:

nursing process

_______ ______ : the care of the patient with adrenal insufficiency - diagnosis •Disturbed body image •Self-care deficit related to weakness, fatigue, muscle wasting, altered sleep patterns •Risk for injury related to weakness •Risk for fluid volume deficit •Activity intolerance and fatigue •Risk for infection •Knowledge deficit

nursing process

_______ _______ •Assessment •Health history •Physical assessment: all systems: see Clinical Manifestations •Diagnosis •Hypothyroidism/ Hyperthyroidism affects all organ systems •Cardiovascular function •Elimination •Skin integrity •Disturbed Body Image

nursing process

G. Developing personal strategies to address psychosocial issues and concerns/ promote health and behavior changes/ nursing implications Diabetic Teaching/ Utilize Diabetic educators & ______: team approach (camps for kids) •Pathophysiology •Complication of the disease/ Acute & Chronic •BG monitoring •Medications and technique •Diet •Exercise •Foot care / Eye care •Sick day care •When to notify MD & visist •Individualization of regimen •Coping strategies/Identify psychosocial issues/ concerns •EN-power/ must make own decisions & choices/patient goal setting •LIFE •L: learn how affects patient •I:Identify 3 guiding priniciples: •Role/ flexibility/ targets •F: formulate personal self-management plan •E: evaluate and experiment with the plan • • • •At increased risk for Depression! •Self management behavior change is the key outcome and should be measured and monitored as part of care. • Studies show Emotional well being is strongly associated with positive diabetes outcomes... • screen for: attitudes about the illness, expectations for medical Management, outcomes, affect and mood, general diabetes related quality of life, resources: (financial, social, and emotional) and psychiatric history) •Screen for psychosocial problems such as depression, anxiety, eating disorders and cognitive impairments when adherence to the medical regimen is poor. ADA recommends three levels of teaching Survival skills à basics Home management àself-reliance, independence in daily management of diabetes Improving lifestyle, educating clients à individualize self- management of illness

nutritionist

Type ____ Diabetes The diabetic client is unable to obtain the needed glucose for the body's cells, due to the lack of insulin. Patients diagnosed with type ___ diabetes mellitus experience polyphagia, and are often thin. ..Although It is not impossible for Type ____ diabetics to gain weight.

one one one

C. Nutritional management: of Diabets Maintain the pleasure of eating; include personal and cultural preferences •Type ___ •Increased calories may be necessary •Diet and insulin for control •Daily consistency •Uniform timing of meals •Snacks may be necessary •Supplement exercise •Low-fat •Type ___ •Reduction in calories necessary •Weight reduction/Exercise •Diet alone may be sufficient for control •Equal distribution not as necessary •Snacks not desirable •Low-fat

one two

Dietary Management of what? •Choose healthy foods •Those high in calcium, vitamin D •Calcium-rich foods •Dairy, vegetables, beans •Enriched OJ, breakfast cereals, breads •Foods with vitamin D •Fish •Enriched milk, cereal, bread •Supplements of calcium, vitamin D A diet that includes dairy products will have calcium and vitamin D, which are nutrients needed to prevent the onset of the disorder. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. For those with milk/ lactose allergies and issues it would be a priority to focuse on diet and to identify alternate foods high in Calcium and vit D. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout although good for lean protien .

osteoporosis

Pharmacologic therapy for what? •Calcium supplementation •Hormonal agents •Calcitonin—human, salmon •Raloxifene hydrochloride •Teriparatide •Bisphosphonates •Alendronate sodium •Etidronate disodium •Others

osteoporosis

Physical Therapy for what? •Physical therapy •Design appropriate exercise program •Especially important for those with comorbid conditions: COPD, asthma •Clients with balance problems •Tai chi Clients who have problems with balance may benefit from tai chi or yoga, both of which can benefit individuals with osteoporosis. •Yoga •Female athletes: discuss amenorrhea, eating disorders One causative factor is lack of weight-bearing activity. Weight bearing helps to move calcium back into the bone, thereby strengthening them. A standard intervention for those attempting to prevent or reverse osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bed rest may well make the osteoporosis worse because there is no weight-bearing activity.. Assisted range of motion exercises are not weight-bearing and do not help delay or reverse osteoporosis.

osteoporosis

These are all diagnostic tests for what? •Dual-energy x-ray absorptiometry (DEXA) •Measures bone density in lumbar spine or hip •Considered highly accurate •Ultrasound of heel to measure bone density •Not as accurate as DEXA •Alkaline phosphatase •Serum bone Gla protein

osteoporosis

These are all risk factors for what? - alcohol intake of 3 or more drinks daily - current use of tobacco products - family history - history of bone fracture during adulthood - inactive or sedentary lifestyle - inadequate calcium and vitamin D intake - low body mass index - malabsorption disorders (ex eating disorder, celiac disease, bariatric surgery) - men older than 60 years of age - women who are postmenopausal - prescribed corticosteroids ex prednisone for longer than 4 months

osteoporosis

diagnosis/planning for _______ •Nursing diagnoses may include: -Risk for Injury -Imbalanced Nutrition: Less Than Body Requirements -Acute Pain •Goals may include that client will •Participate in weight-bearing exercise for 30 min/day 4x/week •Have bone density evaluated every other year •Get sufficient nutrition •Be able to discuss risk factors •Modify home, work environments to avoid injury

osteoporosis

Nursing process Assessment for what? •Health history •Age •Risk factors •Physical examination •Height •Spinal curves A client with ________ will often present with low back pain as well as a decrease in height.

osteoporosis osteoporosis

These are all clinical manifestations of what? •Loss of height •Progressive curvature of the spine •Low back pain - fractures •Fractures of forearm, spine, hip •Risk for fractures!!!! Nursing : safety! . A client with __________ will often present with low back pain as well as a decrease in height.

osteoporosis osteoporosis

•_______ - metabolic bone disorder •Loss of bone mass - ___________ •Increased bone fragility •Increased risk of fractures •Reduced bone mass is caused by imbalance in the processes that influence bone growth and maintenance •Most often associated with aging and inadequate calcium intake

osteoporosis demineralization

Age 60+ are more affected and Females are more affected What is this disease?

ostoporosis

Oral Hypoglycemic Drugs/These are not insulin/ Type 2 Diabetes Watch for _______: severe side effect of some of these/ most common SE: _______ •Sulfonylureas (no alcohol) •Increase insulin release •meglitinides •Increase insulin release •Strengthen receptor response •Biguanides •Increase skeletal muscle uptake •Decrease hepatic glucose production •Metformin most common •( serious SE/ lactic acidosis, alcohol increases risk of) •Studys show: best bet for safety and effectiveness, controlling DM as well as others without causing weight gain or hypoglycemia/ less expensive than newer drugs •Alpha-glucosidase inhibitor •Decreases the rate of CHO absorption •Thiazolidinediones •Decreases insulin resistance •Glimepiride, glipizide, glyburide, repaglinide :most likely to cause hypoglycemia •Metformin and acarbose more likely to cause gastrointestinal adverse reactions. NEW: •Exenatide ( Byetta( ( subcut )synthetic peptide •GLP-1 receptor agonists ( Subcut x1/2week) •DPP-4 inhibitors ( oral)( available as a combination pill with metformin) •Amylin mimetic ( Subcut with each meal)

pancreatitis hypoglycemia

DM ______ activity : Exercise •Decreases cholesterol / triglycerides / help HDL •Decreases blood pressure •Helps burn excess sugar •Improves circulation •Encourages weight loss for Type 2 •Decreases need for meds •Increases insulin sensitivity •Enhances ability to store glucose •Need to instruct on dietary intake when exercising/ prior to •ADA recommendation: 150 min a week/50-70 max Heart Rate/ resistance training 3 times per week Note: Intense exercise can elevate blood sugar levels; Exercise is an effective means to decrease stress, and increases positive feelings of self Exercise increases the effectiveness of insulin therefore increases the risk of hypoglycemic episodes/ and uses excess sugar Check blood glucose before starting exercise and during exercise period Take a 15 gram carbohydrate snack or a carbohydrate and protein snack (1/2 of a peanut butter sandwich) before exercise Use proper footwear and if appropriate other protective equipment Avoid exercise in extreme heat or cold Inspect feet daily after exercise Avoid exercise during periods of poor metabolic control

physical

Hypothyroidism Hyperthyroidism - Metabolism •_______ •Goals may include that client will •Report improvement •Describe situations requiring contact with provider •Explain how to take prescribed medications •Have pulse and BP remain WNL •Not exhibit arrhythmias •Have skin that remains intact, warm, dry •Remain free of edema •Maintain visual acuity •Participate in activities and have normal HR •Have elimination return to normal

planning

_______: may be called (impaired fasting glucose) (impaired glucose tolerance) Ethnic disparities for children: More common in certain ethnic groups Hispanic boys Non-Hispanic Black girls

prediabetes

Types of Endocrine Disorder •________ •Problem with the gland itself in releasing or creating hormone •_________ •Problem with the pituitary and the releasing factors •_______ •Problem is with cellular receptors or the cells themselves •______ •Other than the normal site of hormone production

primary secondary tertiary ectopic

This is the nursing ______ for DM •Maintain safety •Assess for presence of contributing or causative factors that increase risk of injury •Reduce environmental hazards in the healthcare facility, teach client about safety in the home •Monitor for and teach client, family to recognize and seek care for manifestations of •DKA in the client with type 1 DM •HHS in client with type 2 DM •Monitor for and teach client, family to recognize and treat manifestations of hypoglycemia •Recommend wearing a medic alert bracelet or necklace

process

Insulin Administration _____ sites Do not _______ site after injection Pressure may be applied Techniques for minimizing painful injections Lipodystrophy, lipoatrophy

rotate massage

Endocrine System A negative feedback system regulates the endocrine system. simple or complex. _______ feedback:when the level of one substance regulates the secretion of hormones. For example, a low serum calcium level stimulates the parathyroid gland to release parathyroid hormone. PTH in turn, promotes resorption of calcium. A high serum calcium level inhibits PTH secretion.

simple

Type II Diabetes Tobacco use can increase blood sugar levels and lead to insulin resistance. The more you ____, the greater your risk of diabetes. Heavy ______ — those who smoke more than 20 cigarettes a day — almost _____ their risk of developing diabetes, when compared with nonsmokers. Another large study found that the risk of incident type 2 diabetes among those who quit smoking actually increased in the short term but fell to that of never-smokers by 12 years after cessation, while another found that the risk fell to that of never-smokers after 5 years for women and 10 years for men.

smoke smokers double

Type II Diabetes _____ is especially unhealthy for diabetic clients because smoking accelerates the arteriosclerotic effects that occur in blood vessels from elevated levels of blood glucose. Smoking is not associated with weight gain; in fact, people use weight gain as an excuse not to quit smoking. _____ cells of the body release insulin. Their actions are hindered as the amount of adipose tissue in the body increases. The amount of food taken in is not the issue as much as the excess body weight. The body does require more insulin with a greater food intake, but that does not necessarily result in diabetes. _______ is directly linked to obesity, but it does not present a direct tie to the production of insulin.

smoking beta inactivity

DM _________ is classified as an inhibitory hormone with many actions in the body.... also known as growth hormone-inhibiting hormone (GHIH) In the context of diabetes, it acts mainly in two ways: It inhibits the release of insulin. Interesting note: Somatostatin is homologous with cortistain and suppresses the release of gastrointestinal hormones/ Decrease rate of gastric emptying, and reduces smooth muscle contractions and blood flow within the intestine Suppresses the release of pancreatic hormones/Somatostatin release is triggered by the beta cell peptide Urocortin3 (Ucn3) to inhibit insulin release/ Inhibits the release of glucagon Suppresses the exocrine secretory action of pancreas

somatostatin

Acute complications : prevenitng, detecting and treating Hypoglycemia ______: •Tremors, shakiness •Tachycardia •Cool, clammy, diaphoretic •Paresthesias •Hungry •Pallor treatment : __-__ g. of carbohydrates •Headache •Mood swings, nervous •Irritability •Inability to concentrate, confusion •Drowsiness •Slurred speech •Blurred vision __-__ g. of carbohydrates •lethargy severe •Seizures •Unconsciousness IV __% dextrose __ g. glucagon, 1 mg. IM or IV If Blood sugar still low after 15 minutes and treatment: repeat. Once BS returns to normal the client should consume a meal or snack to prevent recurrence of hypoglycemia •Should have between 15 -20g. Of carbs is preferred treatment for conscius individuals •Glucagon should be prescribed for all individuals at significant risk of severe hypoglcemia, and caregivers or family members of these individuals should be instructed in its administration. • •Individuals with hypoglycemia unawareness ( cannot detect the signs and symt]ptoms) should be advised to raise their glycemic targets to strictly avoid further episodes for at least several weeks in order to partially reverse hypoglcemia unawareness and reduce risk of future episodes First group of symptoms: 10-15 g. carbos i/2 of oj 6 oz of soda 8 oz of mild 6-8 lifesavers candy 1 small tube of cake icing 4 tsp of sugar and it more severe...20-30 g. of carbs... may follow with protien or complex carbs or can rebound quickly for severe: glucagon injection 1 mg. im or iv corrected with iv glucose 5% dextrose solution or IV glucose push bolus ...

symptoms 10-15 20-30 50 25

Excessive ____ can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus. Fatigue that responds to a short nap, having some muscle aches at night, and being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older client.

thirst

These are all ______ tests •TSH •Serum free T4 •T3 and T4 •T4 resin uptake •Thyroid antibodies •Radioactive iodine uptake •Fine-needle biopsy •Thyroid scan, •Serum thyroglobulin Tg: test used as a tumor marker • (Tg) is a storage form of thyroxine (T4) and triiodothyronine (T3)

thyroid

•Anterior trachea of neck •Right/ Left Lobe connected by a narrow isthmus •Difficult to palpate on exam •Altered production or use of thyroid hormone affects all major organs •Thyroid disorders: among most common endocrine disorders This is the ______ gland

thyroid

With ______ Surgery:possibility of damage to Parathyroid= control of Calcium Other option: "Medical surgery": radioactive iodine is picked up by the thyroid tissue and destroys the tissue avoiding surgery , anesthesia and hospitalization/ Used often with ________

thyroid hyperthyroidism

Thyroid / hyperthyroidism ______ storm - Thyrotoxicosis ____ •Acute exacerbation of hyperthyroidism •Caused by acute stress, infection, surgery or untreated hyperthyroidism •Treat symptoms: •Sedation, cooling,steriods,IV fluids, maintain airway •Administer thyroxin blocking meds: •Strong iodine solutions •Propylthiouracil •inderal(propranolol) beta block sympathetic affect/ help Ht. rate •NO ASA Clinical Manifestations •High fever/Diaphoresis •Restlessness/tremor •Agitation/ •Tachy/Dysrhythmia/CHF •Delirium/Coma

thyroid crisis

_____ storm (Thyrotoxicosis _____) medical emergency: may lead to life-threatening cardiac, hepatic or renal failure/. Left untreated it is usually fatal CAUSE: Inadequately treated hyperthyroidism stressful conditions: surgery, infection, toxemia of pregnancy and DKA T3 and T4 are overproduced, systemic adrenergic activity increases. epinephrine overproduction and severe hypermetabolism leading rapidly to cardiac, GI and sympathetic nervous system decompensation. Onset is abrupt/evoked by a stressful event Treatment administer thyroxin blocking meds: Strong iodine solutions/ to block the release of thyroid hormones Propylthiouracil corticosteroid to inhibit the conversion of triiodothyronine to T4 and replace depleted cortisol NO ASA/ which can increase free T3 and T4 by interfering with protein binding ... Avoid ASA, Michelle Paynkewicz at the age of 18. Michelle passed away December 31, 2004 from thyroid storm

thyroid storm

Pathophysiology and Etiology - osteoporosis •Exact pathophysiology unclear •It is known to involve •Imbalanced osteoblast, osteoclast activity •Affects diaphysis, metaphysis •Trabeculae lost from cancellous bone: (_______ of bone provide structural support to the spongy bone found at the ends of long bones)= porous/ fragile/ brittle bone

trabeculae

_____ for Diabetes A.Medication B.Monitor Blood Glucose C.Nutritional Management D.Manage Acute Complications: preventing, detecting, treating E.Manage Chronic Complications: preventing, detecting, treating F.Develop Personal Strategies to address psychosocial issues, concerns/ promote health and behavior changes

treatment

Hormones and depression can have overlapping side effects. T or F

true

Hypothyroidism and hyperthyroidism and depression have a lot of overlapping symptoms T or F

true

True or False Is the following statement true or false? The renal threshold for glucose is 180 to 200 mg/dL

true

Clinical Manifestations Diabets Type ___: Slow Onset •All of Type 1 but...3-P's less pronounced & wt. loss/ DKA less often •Frequent infections •Skin, gums/ bladder •Slow wound healing/ bruises •Blurred vision •Paresthesia: tingling , pain numbness •Sexual dysfunction

two

DM Type ___ in children •On the Rise in children •Hypoglycemic agents •Not first-line therapy •Diet and exercise effective for control in less than 10% •Metformin is adjunct to diet and exercise •Insulin may precede metformin after stability in glycemic control •Metformin takes 4 weeks to take effect

two

•Most cases: treated and cured. If due to medications, these can often be slowly stopped if caused by a tumor, it may be treated by a combination of surgery, chemotherapy, and/or radiation. If the pituitary was affected, other medications may be required to replace its lost function. With treatment, life expectancy is usually normal. Some in whom surgery is unable to remove the entire tumor have an increased risk of death. •About ___ to ____ people per million are affected each year. It most commonly affects people who are 20 to 50 years of age. _____ are affected three times more often than ___. A mild degree of overproduction of cortisol without obvious symptoms, however, is more common. •________ syndrome was first described by Harvey ______ in 1932. _______ syndrome may also occur in other animals including cats, dogs, and horses.

two to three women men Cushings

Etiology : Immune mediated insulin deficiency caused by pancreatic beta-cell destruction clinical manifestation : - polyuria, polydipsia - recent weight loss, but client may be overweight - ketoacidosis on initial presentation in 30-40% of cases and continued risk for ketoacidosis - rapid onset of symptoms - ketosis - initial period of decreased insulin requirement, then need of insulin for survival - hyperglycemia Clinical therapies : - blood glucose monitoring - insulin - dietary management, balancing carbohydrate intake to insulin - exercise Artificial pancreas : FDA has approved a few of these Is this type I DM or type 2 DM

type I

•Characterized by insulin resistance ( body decreased sensitivity to insulin) alone or in conjunction with Insulin synthesis and secretion •Slow, progressive glucose intolerance/ treated initially with diet & exercise/ Progress to oral hypoglycemic agents to insulin /or both •Risk Factors: •Age 45 or older/ 90-95% over age 30 years ( increasing in children due to obesity) •BMI greater 25 •Sedentary •Family History( parents or siblings) •Ethnic/ Race •HTN ( hypertension) •Elevated cholesterol ( LDL, triglycerides) •Impaired Glucose tolerance •Polycystic ovarian syndrome •Hx. Gestational Diabetes/ baby 9#'s •Metabolic syndrome •Smoking Tobacco use can increase blood sugar levels and lead to insulin resistance. The more you smoke, the greater your risk of diabetes. Heavy smokers — those who smoke more than 20 cigarettes a day — almost double their risk of developing diabetes, when compared with nonsmokers. Is this type I or Type II

type II

Osteoporosis ______ risk factors •80 % are women •Thin •Small frame •Family history •European Americans/ Asians •Chronic disease •Endocrine, asthma/ allergies, other _______ •Sedentary •Weight bearing exercises HELPFUL to reduce risk •Substance abuse/ alcohol /smoking •Moderate alcohol ok and may even help/ heavy use is associated with nutritional deficiencies that contribute to it •Female athlete •Disordered eating, low bone mass, amenorrhea •Calcium deficiency •Diet high in CA and Vit D •Acidosis •High protein diet •Menopause •Estrogen •Medications •Anticonvulsants, glucocorticoids (steroids) , aluminum containing antacids

unmodifiable modifiable

DM What compounds the female predicament is that heart disease is more deadly in _______ with diabetes than it is in men with the disease. A 2007 study published in the European Heart Journal found that the association between diabetes and death by heart failure was stronger for women than it was for men. A Finnish study also found that in people with diabetes, heart attacks are more often fatal for women than they are for men. "For an older woman with diabetes, if she has a heart attack, it's a big deal," says Deborah Wexler, MD, MSc, an endocrinologist at Massachusetts General Hospital. This greater risk, Wexler says, may stem in part from biological differences in how women and men experience heart attacks. For both, the most common warning sign of a heart attack is chest pain or discomfort in the upper body. However, women are more likely than men to experience only nausea, shortness of breath, and back or jaw pain during a heart attack. If a woman experiences these but doesn't recognize them as heart attack warning signs, she may not seek treatment, lowering her chances of recovery.

women

Actual Cushing disease more common in ______ age __-__ 5X more likely than men Virilization is a condition in which women develop male-pattern hair growth and other masculine physical traits. When medications are given (glucocorticoids), adrenal cortex atrophy and it suppresses the adrenal glands to produce their own hormones. Excessive protein catabolism occurs producing muscle wasting and osteoporosis / kyphosis backache compression fractures of vertebrae may result. - thinning of hair - red cheeks - buffalo hump - supraclavicular fat pad - thin extremities with muscle atrophy - thin skin and subcutaneous tissue - acne - moon face - increased body and facial hair - weight gain - purple striae - pendulous abdomen - ecchymosis resulting from easy bruising - slow wound healing

women 20-40

DM Another diabetes complication, kidney disease, is also worse for _______ than _____. In general, men have a higher risk for kidney disease, but that distinction again disappears with the appearance of diabetes. "Kidney disease generally doesn't affect women until they get to menopause," a time when estrogen levels fall and women, at least hormonally speaking, become more like men, says Christine Maric-Bilken, PhD, associate professor at the University of Mississippi Medical Center. "Yet, women with diabetes are just as likely to get kidney disease as men regardless of age."

women men

•Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus. Select all that apply •1. A major risk factor for complications is obesity and central abdominal obesity. •2. Supplemental insulin is mandatory for controlling the disease •3. Exercise increases insulin resistance •4. The primary nutritional source requiring monitoring in the diet is carbohydrates •5. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

•1. A major risk factor for complications is obesity and central abdominal obesity. •4. The primary nutritional source requiring monitoring in the diet is carbohydrates •5. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA)

•A client with Graves' disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works? •1. "The radioactive iodine stabilizes the thyroid hormone levels before thyroidectomy." •2. "The radioactive iodine reduces uptake of thyroxine and thereby improves your condition." •3. The radio active iodine lowers the levels of thyroid hormones by slowing your body's production of them." •4. The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced

•4. The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced •Sodium iodide. Destroys the thyroid follicular cells, and thyroid hormones are no longer produced. RAI is commonly recommended for clients with Graves disease especially the elderly. The treatment result is a "medical " thyroidectomy. RAI is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAI

Mental status changes and muscle weakness in people with Addison disease are primarily cause by: •A. hyperkalemia •B. hypoglycemia •C. severe metabolic acidosis •D. glucose intolerance

•B. hypoglycemia

The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions? •A. Low levels of cortisol •B. High levels of ACTH •C. Hypersecretion of ADH •D. Aldosterone deficiency

•D. Aldosterone deficiency •A deficiency of aldosterone in particular causes the body to excrete large amounts of sodium and retain potassium, leading to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to retain sodium easily, so when a person with Addison disease drinks too much water or loses too much sodium, the level of sodium in the blood falls, and the person becomes dehydrated. Severe dehydration and a low sodium level reduce blood volume and can lead to shock. •Corticosteroid deficiency leads to an extreme sensitivity to insulin so that the level of sugar in the blood may fall dangerously low (hypoglycemia). The deficiency prevents the body from manufacturing carbohydrates from protein, fighting infections properly, and controlling inflammation. Muscles weaken, and even the heart can become weak and unable to pump blood adequately. In addition, the blood pressure may become dangerously low. •People with Addison disease are not able to produce additional corticosteroids when they are stressed. They therefore are susceptible to serious symptoms and complications when confronted with illness, extreme fatigue, severe injury, surgery, or, possibly, severe psychologic stress.

Jerry Green is a 13 year old who uses insulin to control his type 1 diabetes. During his gym class, he experiences hunger, light headedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: • •a. hyperglycemia resulting from incorrect administration. •b. dawn phenomenon caused by eating a snack before gym class. •c. hypoglycemia caused by increased exercise. •d. Somogyi effect caused by insulin sensitivity

•c. hypoglycemia caused by increased exercise.