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NR 565 FINAL STUDY GUIDE EXAM week 5
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NR 565 FINAL STUDY GUIDE EXAM week 5
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NR 565 Final Study GuideStudy online at https://quizlet.com/_cdtlkd
1. WEEK 5 ...
2. Thyroid -TSH - used primarily for screening and diagnosing hy-
o Diagnosis & pothyroid and for monitoring replacement therapy in hy-
Evaluation pothyroid patients
What labs are -T4 - Used to monitor thyroid hormone replacement ther-
used to diag- apy and to screen for thyroid dysfunction
nose?
-T3 - Useful in the diagnosis of hyperthyroidism; can also
be used to monitor hormone replacement therapy
-TSH low
-T4 normal
-T3 is high = hyperthyroidism
3. Thyroid Recheck TSH 6-8 weeks after initiating therapy and after
o Diagnosis & any dosage change; Check TSH at least once a year after
Evaluation serum TSH is stabilized
Timeframe for
re-check of labs
after starting
levothyroxine?
4. Thyroid Hypothyroidism: Depend on severity.
o Diagnosis & o Mild: subtle and may go unrecognized
Evaluation o Moderate to severe:
-Face is pale, puffy, and expressionless.
Signs and symp- -Skin cold and dry.
toms of hypothy- -Hair is brittle and hair loss occurs.
roidism? -Slowed Heart rate.
-Patient may complain of lethargy, fatigue, and
-Temperature is lowered & intolerant to cold.
-Thyroid Enlargement may occur if reduced levels of T3
and T4
Mentation may be impaired.
5.
, NR 565 Final Study Guide
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Thyroid o Elevated Heart rate and strong, and dysrhythmias and
o Diagnosis & angina may develop
Evaluation o The CNS is stimulated, resulting is nervousness, insom-
nia, rapid thought flow, and rapid speech, hyperreflexia,
Signs and symp- tremors
toms of hyper- o Skeletal muscles may weaken and atrophy
thyroidism? o Metabolic rate is raised, resulting in health and skin that
is warm and moist
o Feeling Hot + Heat intolerance
o Appetit is increased but fails to match metabolic rate
resulting in weight loss
o All of these signs are referred to as thyrotoxicosis
o Also usually present with exophthalmos - bulging of the
eyes
6. Thyroid Characterized by profound hyperthermia (105 degrees
o Treatment F or higher), severe tachycardia, restlessness, agitation,
and tremor.
Treatment of thy- Unconsciousness, coma, hypotension, and heart failure
roid storm? may ensure.
These symptoms are produced by excessive levels of
thyroid hormone
Thyroid crisis can be life threatening and requires imme-
diate treatment.
o High doses of potassium iodide or strong iodine solution
are given to suppress thyroid hormone release.
o Methimazole is given to suppress thyroid hormone syn-
thesis
o A beta blocker is given to reduce heart rate
o Additional measures include sedation, cooling, and giv-
ing
glucocorticoids and IVF
7. Thyroid Can result in permanent neuropsychological deficits in
o Treatment the child - decrease child's IQ
The effect of hypothyroidism is limited largely to the
Result of not first trimester, a time during which the fetus is unable to
treating hypothy- produce thyroid hormone of its own
Some authorities currently recommend routine screening
, NR 565 Final Study Guide
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roidism during for hypothyroidism as soon as pregnancy is confirmed
pregnancy? Women already taking thyroid hormone replacement will
need to increase dose by 50% max between weeks 4-8
of gestation and the levels will level out by week 16
8. Thyroid Methimazole - first line drug of choice (not given to women
o Treatment who are pregnant or breastfeeding)
o Methimazole blocks synthesis of thyroid hormone.
Medication to 1) Prevents the oxidation of iodine, therefore inhibiting
treat symptoms incorporation of iodine into tyrosine.
of hyperthy- 2) prevents iodinated tyrosine from coupling
roidism (notice Propylthiouracil - preferred treatment for thyroid storm
this is treating Beta blockers - help with tachycardia experienced with
symptoms and hyperthyroidism
not the hyperthy-
roidism itself)
9. Thyroid Absorption of levothyroxine is reduced by food - it should
o Treatment be taken on an empty stomach in the morning, at least
30-60 minutes before breakfast
Drug/Food/Sup- Drugs that reduce absorption include: H2 receptor block-
plement inter- ers, PPIs, Carafate, Questran, Colestid, Maalox/Mylanta,
actions with Tums, iron, Mag salts, Xenical
levothyroxine Drugs that accelerate levothyroxine: Phenytoin, Carba-
mazepine, rifampin, Sertraline, and phenobarbital
Patients taking the following drugs may need to increase
their dose of levothyroxine: Warfarin and catecholamines
Levothyroxine can also increase requirements for insulin
and digoxin
10. Diabetes Fasting plasma glucose >/= 125mg/dl OR
o How to confirm Random plasma glucose >/= 200mg/dl
a diagnosis pri- plus symptoms of diabetes (polyuria, polydipsia, unex-
or to beginning plained weight loss) OR
treatment Oral glucose tolerance test (OGTT): 2-hour plasma glu-
cose >/= 200mg/dl OR
HgbA1C pf 6.5% or greater - (a test that provides an es-
timate of glycemic control over the previous 2-3 months)
is now considered a standard test as well
, NR 565 Final Study Guide
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11. Diabetes To keep A1C below 7%
o A1C o <8% is less stringent for those with hx. Of severe hypo-
glycemia, limited life expectancy, pr advanced microvas-
General goals cular or macrovascular complications
12. Diabetes Recommended goal for A1C in the geriatric population is
o A1C 7.5-8% in older patients with moderate comorbidities and
life expectancy less than 10 years
Older Adult goal o 8-8.5% for older patients with complex medical issues
13. Diabetes Recommendation: A GLP-1 should be considered before
o A1C starting insulin
Insulin is introduced in Step 3 which includes a 3-drug
When should in- combination which includes insulin.
sulin be consid- A1C of 9% of greater would start at Step 2 with dual med
ered? therapy
A1C of 10% or greater or fasting glucose of 300 or greater
and is symptomatic would start on combination injectable
therapy immediately (Step 4)
14. Diabetes Should be monitored every 3 months until value drops to
o A1C 7% and at least every 6 months thereafter
At what time in-
terval should it
be re-checked?
15. Diabetes Metabolic actions of insulin are primarily anabolic - Insulin
o Action of In- promotes conservation of energy and buildup of energy
sulin stores, such as glycogen and the hormone also promotes
cell growth and division
Stimulates cellular transport (uptake) of glucose, amino
acids, nucleotides, and potassium
Insulin promotes synthesis of complex organic molecules
In all: Under the influence of insulin - glucose is converted
into glycogen, amino acids are assembled into proteins,
and fatty acids are incorporated into triglycerides
16. Diabetes
o Pioglita-
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