Hyperthyroidism Assessment
- Heat Intolerance
- Exophthalmos
- Warm, Moist Skin and Silky Hair
- Tremors
- Goiter
- Diarrhea
- Weight Loss
- Tachycardia
- Hypertension
- Amenorrhea
- Decreased TSH with Elevated Free T4
- Radioactive Iodine Uptake (RAIU)
Hyperthyroidism Interventions
- Propylthiouracil (PTU)
- Methimazole (Tapazole)
- Iodine
- Beta Blockers
- Radioiodine Ablation
- Thyroidectomy
- Thyrotoxicosis
- Post-Surgery Hypocalcemia
Graves' Disease Characteristics
- Women 20-40 years old
- Anti-TSH Receptor Antibodies
- Ophthalmopathy
- Exophthalmos
- Hyperthyroidism
- Goiter
- Pretibial Myxedema
Graves' Disease Labs and Treatment
- Decreased TSH
- Increased T3
- Increased T4
- Radioactive Iodine Uptake (RAIU)
- Beta blocker
- Methimazole
- Radioiodine Ablation
Thyroid Gland
- TSH Stimulates T3 and T4 Release
- Metabolism Regulation
- Blood Calcium Sensor
- Calcitonin Release
- Blood Calcium Decreases
- Bone Building
Propylthiouracil (PTU) and Methimazole (MMI)
- Hyperthyroidism
- Inhibits Thyroid Peroxidase
- PTU Blocks Peripheral Conversion of T4 to T3
- Agranulocytosis
- Skin Rash
- Hepatotoxicity (PTU)
- Teratogen (MMI)
Parathyroid Gland
- Blood Calcium Sensor
- Parathyroid Hormone
- Bone Resorption
- Blood Calcium Increases
- Vitamin D Activation
- Calcium Absorption From The Small Intestine
Hypocalcemia
- Muscle Spasms
- < 8.5 mg/dL Ca2+
- Decreased Bone Density
- Tetany
- Chvostek's Sign
- Trousseau's Sign
- Increased DTR
- ECG Changes
- QT Prolongation
- Oral and IV Replacement of Ca2+
- Seizure Precautions
Hypothyroidism Assessment
- Weight Gain - Edema
- Lethargy
- Cold Intolerance
- Bradycardia
- Hypertension
- Brittle Nails and Dry Skin
- Constipation
- Goiter
- Prolonged Menses
- Slowed Thinking
- Decreased Free T4
- Increased TSH
Hypothyroidism Intervention
- Levothyroxine (Synthroid)
- Liothyronine (Cytomel)
- Myxedema Coma
- Lifelong Replacement Hormone
- Monitor Vital Signs
- Fluids and Fiber
- Low Calorie, Low Fat Diet
- Medication Education
- No Switching Brands
Hashimoto's Thyroiditis
- Hypothyroidism with Bouts of Hyperthyroidism
- Enlarged, Nontender Thyroid
- Autoimmune
- Anti-Thyroid Peroxidase (TPO)
- Anti-Thyroglobulin
- Hurthle Cells
- Lymphoid Follicles
- HLA-DR5 and HLA-DR3
- Increased Risk Of Non-Hodgkin Lymphoma
Levothyroxine (Synthroid)
- Synthetic T4
- Hypothyroidism
- Thyrotoxicosis
- Tremors
- Heat Intolerance
- Insomnia
- Tachycardia
- Do Not Use for Obesity
- TSH Monitoring
Addison's Disease Assessment
- Deficiency of Cortisol and Aldosterone
- Irritability
- Hyperkalemia
- Muscle Weakness
- Skin Hyperpigmentation
- Hyponatremia
- Hypotension
- Hypoglycemia
- Addisonian Crisis
Addison's Disease Intervention
- Hydrocortisone
- 2/3 Dose in Morning
- 1/3 Dose in Late Afternoon
- Fludrocortisone
- Androgen Replacement Therapy
- Salt Additives
- Increase Dosage During Stress and Infection
- Medic Alert Bracelet
- Lifelong Hormone Therapy
Addisonian Crisis
- Severe Symptoms
- Shock
- High-Dose Hydrocortisone
- Large Volumes of IV Fluid
- Insulin with Dextrose
- Kayexalate
- Loop or Thiazide Diuretics
Prednisone (Glucocorticoids)
- Glucocorticoid
- Inflammatory Conditions
- Organ Transplant Rejection
- Cataracts and Glaucoma
- Cushing's Syndrome
- Osteoporosis
- Immunosuppression
- Hyperglycemia
- Ulcers
- Adrenal Insufficiency
- Taper Gradually
Cushing's Syndrome Assessment
- Increased Cortisol Levels
- Truncal Obesity
- Purple Abdominal Striae
- Buffalo Hump
- Decreased Bone Density
- Moon Face
- Thinning Skin
- Hyperglycemia
- Hypertension
- Long Term Glucocorticoid Use
- Immunosuppression
Diabetes Assessment
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Adult Onset
- Insulin Resistance
- Obesity
- Onset During Pregnancy
- Glucose Intolerance
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
Diabetes Education
- Self-Monitoring (Blood Glucose)
- SubQ Injection Technique
- Lifestyle Changes
- Symptoms of Hyperglycemia and Hypoglycemia
- Sick Day Care
- Foot Care
- Exercise Therapy
- Medication
Interventions for Impaired Skin Integrity
- Signs of Skin Breakdown
- Pain
- Redness
- Decreased Skin Turgor
- Bleeding
- Bony Prominences
- Reposition Q2H
- Pressure Relief
- Maintain Clean and Dry Skin
- Adequate Nutrition and Hydration
Diabetes Insipidus Assessment
- Polyuria
- Nocturia
- Low Specific Gravity (USG)
- Polydipsia
- Dehydration
- Hypotension
- Tachycardia
- Confusion
Central Diabetes Insipidus
- ADH Deficiency
- Increased Serum and Urine Osmolality
- Mental Illness
- Brain Injuries
- Desmopressin
Hyperglycemia
- Insulin Resistance
- Too Little Insulin/Medication
- Infection/Illness
- Corticosteroids
- Elevated Blood Glucose
- Polyphagia
- Polydipsia
- Polyuria
- Hypotension
- Fatigue/Drowsiness
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
- 1st Generation Sulfonylureas
- Stimulate Release of Insulin
- Type 2 Diabetes
- Hypoglycemia
- Possible Cardiovascular Toxicity
- Weight Gain
- Exacerbated Hypoglycemia with Beta-blockers
- Avoid During Pregnancy and Breast Feeding
- Avoid Alcohol
Glyburide and Glipizide (2nd Generation Sulfonylureas)
- 2nd Generation Sulfonylureas
- Blocks Potassium Channels in Beta Cells
- Stimulate Release of Insulin
- Type 2 Diabetes
- Hypoglycemia
- More Potent
- Beta Blockers Reduce Effects
- Avoid Alcohol
- Avoid Breastfeeding
Metformin (Glucophage)
- Decrease Glucose Production
- Increase Insulin Sensitivity
- Type 2 Diabetes
- Polycystic Ovary Syndrome (PCOS)
- GI Distress
- Decreased Appetite
- Lactic Acidosis
- IV Contrast
- Limit Alcohol Consumption
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
- Alpha Glucosidase Inhibitors
- Delays Absorption of Carbohydrates
- Type 2 Diabetes
- Flatulence
- Diarrhea
- Anemia
- Cramps
- Monitor LFTs
- Oral Glucose for Hypoglycemia
Pioglitazone (Thiazolidinediones)
- -glitazones Suffix
- Binds PPAR-Gamma
- Decreases Insulin Resistance
- Type 2 Diabetes
- Weight Gain
- Heart Failure
- Myalgia
- Hypoglycemia
- Upper Respiratory Infection
- Increased Risk of Bladder Cancer
- Increased Fracture Risk in Women
- Monitor Liver Enzymes
Repaglinide and Nateglinide (Meglitinides)
- Meglitinides
- Increased Insulin Release
- Type 2 Diabetes
- Hypoglycemia
- Eat Within 30 Minutes
- Gemfibrozil Increases Risk of Hypoglycemia
- Short Half-Life
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
Mixing NPH and Regular Insulin for Injection
- Verify Order
- Roll NPH Insulin
- Alcohol to Multiuse Vials
- Inject Air into NPH Insulin (Cloudy)
- Inject Air into Regular Insulin (Clear)
- Withdraw Regular Insulin Units
- Withdraw NPH Units
- Verify with 2nd Nurse
- Discard if Error
Exenatide (Byetta)
- Incretin Mimetic
- GLP-1 Synthetic Analog
- Type 2 Diabetes
- Hypoglycemia
- Nausea and Vomiting
- Diarrhea
- Thyroid Cancer
- Pancreatitis
- Renal Failure
- (Give Exenatide) One Hour After Other Medications
- Adjunct Therapy
Pramlintide (Symlin)
- Synthetic Amylin Analog
- Diabetes Type 1 and 2
- Supplement Mealtime Insulin
- Nausea
- Skin Reactions at Injection Site
- Hypoglycemia When Combined with Insulin
- Delayed Absorption of Oral Drugs
Hypoglycemia Assessment
- Too much insulin
- Decreased glucose
- < 70 mg/dL
- Change in LOC
- Lethargic
- Confusion and Irritability
- Tremors
- Diaphoresis
- Tachycardia
- Vision Changes
- Weakness
- Seizures
Hypoglycemia Intervention
- Mild to Moderate Hypoglycemia
- Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)
- Complex Carbohydrate (Whole Grains, Vegetables)
- Severe Hypoglycemia or Unconscious
- 50% Dextrose
- Glucagon
- Monitor Blood Glucose Q 10-15 Minutes
- Give Small Meal After Intervention
- Hypoglycemia Prevention
- Encourage Self-Monitoring