NR565 Midterm Study Guide with Complete Solutions APRN prescribing role Prescriptive authority for nurse practitioners also regulates prescribing rights beyond medications and controlled substances. These rights include therapeutic devices and services

NR 565 Final Study Guide Latest Update Rated A+ Thyroid o Diagnosis & Evaluation What labs are used to diagnose? -TSH - used primarily for screening and diagnosing hypothyroid and for monitoring replacement therapy in hypothyroid patients -T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction -T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone replacement therapy -TSH low -T4 normal -T3 is high = hyperthyroidism Thyroid o Diagnosis & Evaluation Timeframe for re-check of labs after starting levothyroxine? Recheck TSH 6-8 weeks after initiating therapy and after any dosage change; Check TSH at least once a year after serum TSH is stabilized Thyroid o Diagnosis & Evaluation Signs and symptoms of hypothyroidism? Hypothyroidism: Depend on severity. o Mild: subtle and may go unrecognized o Moderate to severe: -Face is pale, puffy, and expressionless. -Skin cold and dry. -Hair is brittle and hair loss occurs. -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. Thyroid o Diagnosis & Evaluation Signs and symptoms of hyperthyroidism? o Elevated Heart rate and strong, and dysrhythmias and angina may develop o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow, and rapid speech, hyperreflexia, tremors o Skeletal muscles may weaken and atrophy 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 Thyroid o Treatment Treatment of thyroid storm? Characterized by profound hyperthermia (105 degrees F or higher), severe tachycardia, restlessness, agitation, and tremor. Unconsciousness, coma, hypotension, and heart failure may ensure. These symptoms are produced by excessive levels of thyroid hormone Thyroid crisis can be life threatening and requires immediate 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 synthesis o A beta blocker is given to reduce heart rate o Additional measures include sedation, cooling, and giving glucocorticoids and IVF Thyroid o Treatment Result of not treating hypothyroidism during pregnancy? Can result in permanent neuropsychological deficits in the child - decrease child's IQ The effect of hypothyroidism is limited largely to the first trimester, a time during which the fetus is unable to produce thyroid hormone of its own Some authorities currently recommend routine screening for hypothyroidism as soon as pregnancy is confirmed 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 Thyroid o Treatment Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself) Methimazole - first line drug of choice (not given to women who are pregnant or breastfeeding) o Methimazole blocks synthesis of thyroid hormone. 1) Prevents the oxidation of iodine, therefore inhibiting incorporation of iodine into tyrosine. 2) prevents iodinated tyrosine from coupling Propylthiouracil - preferred treatment for thyroid storm Beta blockers - help with tachycardia experienced with hyperthyroidism Thyroid o Treatment Drug/Food/Supplement interactions with levothyroxine Absorption of levothyroxine is reduced by food - it should be taken on an empty stomach in the morning, at least 30-60 minutes before breakfast Drugs that reduce absorption include: H2 receptor blockers, PPIs, Carafate, Questran, Colestid, Maalox/Mylanta, Tums, iron, Mag salts, Xenical Drugs that accelerate levothyroxine: Phenytoin, Carbamazepine, 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 Diabetes o How to confirm a diagnosis prior to beginning treatment Fasting plasma glucose >/= 125mg/dl OR Random plasma glucose >/= 200mg/dl plus symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) OR Oral glucose tolerance test (OGTT): 2-hour plasma glucose >/= 200mg/dl OR HgbA1C pf 6.5% or greater - (a test that provides an estimate of glycemic control over the previous 2-3 months) is now considered a standard test as well Diabetes o A1C General goals To keep A1C below 7% o <8% is less stringent for those with hx. Of severe hypoglycemia, limited life expectancy, pr advanced microvascular or macrovascular complications Diabetes o A1C Older Adult goal Recommended goal for A1C in the geriatric population is 7.5-8% in older patients with moderate comorbidities and life expectancy less than 10 years o 8-8.5% for older patients with complex medical issues