NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
1. WEEK 5 ...
2. Thyroid -TSH - used primarily for screening and diagnosing hypothyroid and for moni-
o Diagnosis & toring replacement therapy in hypothyroid patients
Evaluation
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for
What labs are thyroid dysfunction
used to diag-
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 any dosage change;
o Diagnosis & Check TSH at least once a year after serum TSH is stabilized
Evaluation
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.
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
-Thyroid Enlargement may occur if reduced levels of T3
and T4
Mentation may be impaired.
5. Thyroid o Elevated Heart rate and strong, and dysrhythmias and angina may develop
o Diagnosis & o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow,
Evaluation and rapid speech, hyperreflexia, tremors
o Skeletal muscles may weaken and atrophy
Signs and symp- o Metabolic rate is raised, resulting in health and skin that is warm and moist
toms of hyper- o Feeling Hot + Heat intolerance
thyroidism? 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 F or higher), severe tachy-
o Treatment cardia, restlessness, agitation, and tremor.
Unconsciousness, coma, hypotension, and heart failure may ensure.
Treatment of These symptoms are produced by excessive levels of thyroid hormone
thyroid storm? 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
7. Thyroid Can result in permanent neuropsychological deficits in the child - decrease child's
o Treatment IQ
The effect of hypothyroidism is limited largely to the first trimester, a time during
Result of not which the fetus is unable to produce thyroid hormone of its own
treating hypothy- Some authorities currently recommend routine screening for hypothyroidism as
roidism during soon as pregnancy is confirmed
pregnancy?
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
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 who are pregnant or
o Treatment breastfeeding)
o Methimazole blocks synthesis of thyroid hormone.
Medication to 1) Prevents the oxidation of iodine, therefore inhibiting incorporation of iodine
treat symptoms 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 hyperthyroidism
symptoms and
not the hyperthy-
roidism itself)
9. Thyroid Absorption of levothyroxine is reduced by food - it should be taken on an empty
o Treatment stomach in the morning, at least 30-60 minutes before breakfast
Drugs that reduce absorption include: H2 receptor blockers, PPIs, Carafate,
Drug/Food/Sup- Questran, Colestid, Maalox/Mylanta, Tums, iron, Mag salts, Xenical
plement inter- Drugs that accelerate levothyroxine: Phenytoin, Carbamazepine, rifampin, Sertra-
actions with line, and phenobarbital
levothyroxine Patients taking the following drugs may need to increase their dose of levothy-
roxine: 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, unexplained weight loss) OR
or to beginning Oral glucose tolerance test (OGTT): 2-hour plasma glucose >/= 200mg/dl OR
treatment 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
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
11. Diabetes To keep A1C below 7%
o A1C o <8% is less stringent for those with hx. Of severe hypoglycemia, limited life
expectancy, pr advanced microvascular or macrovascular complications
General goals
12. Diabetes Recommended goal for A1C in the geriatric population is 7.5-8% in older patients
o A1C with moderate comorbidities and life expectancy less than 10 years
o 8-8.5% for older patients with complex medical issues
Older Adult goal
13. Diabetes Recommendation: A GLP-1 should be considered before starting insulin
o A1C Insulin is introduced in Step 3 which includes a 3-drug combination which
includes insulin.
When should in- A1C of 9% of greater would start at Step 2 with dual med therapy
sulin be consid- A1C of 10% or greater or fasting glucose of 300 or greater and is symptomatic
ered? would start on combination injectable therapy immediately (Step 4)
14. Diabetes Should be monitored every 3 months until value drops to 7% and at least every 6
o A1C months thereafter
At what time in-
terval should it
be re-checked?
15. Diabetes Metabolic actions of insulin are primarily anabolic - Insulin promotes conservation
o Action of In- of energy and buildup of energy stores, such as glycogen and the hormone also
sulin 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
Study online at https://quizlet.com/_cdtlkd
1. WEEK 5 ...
2. Thyroid -TSH - used primarily for screening and diagnosing hypothyroid and for moni-
o Diagnosis & toring replacement therapy in hypothyroid patients
Evaluation
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for
What labs are thyroid dysfunction
used to diag-
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 any dosage change;
o Diagnosis & Check TSH at least once a year after serum TSH is stabilized
Evaluation
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.
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
-Thyroid Enlargement may occur if reduced levels of T3
and T4
Mentation may be impaired.
5. Thyroid o Elevated Heart rate and strong, and dysrhythmias and angina may develop
o Diagnosis & o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow,
Evaluation and rapid speech, hyperreflexia, tremors
o Skeletal muscles may weaken and atrophy
Signs and symp- o Metabolic rate is raised, resulting in health and skin that is warm and moist
toms of hyper- o Feeling Hot + Heat intolerance
thyroidism? 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 F or higher), severe tachy-
o Treatment cardia, restlessness, agitation, and tremor.
Unconsciousness, coma, hypotension, and heart failure may ensure.
Treatment of These symptoms are produced by excessive levels of thyroid hormone
thyroid storm? 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
7. Thyroid Can result in permanent neuropsychological deficits in the child - decrease child's
o Treatment IQ
The effect of hypothyroidism is limited largely to the first trimester, a time during
Result of not which the fetus is unable to produce thyroid hormone of its own
treating hypothy- Some authorities currently recommend routine screening for hypothyroidism as
roidism during soon as pregnancy is confirmed
pregnancy?
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
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 who are pregnant or
o Treatment breastfeeding)
o Methimazole blocks synthesis of thyroid hormone.
Medication to 1) Prevents the oxidation of iodine, therefore inhibiting incorporation of iodine
treat symptoms 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 hyperthyroidism
symptoms and
not the hyperthy-
roidism itself)
9. Thyroid Absorption of levothyroxine is reduced by food - it should be taken on an empty
o Treatment stomach in the morning, at least 30-60 minutes before breakfast
Drugs that reduce absorption include: H2 receptor blockers, PPIs, Carafate,
Drug/Food/Sup- Questran, Colestid, Maalox/Mylanta, Tums, iron, Mag salts, Xenical
plement inter- Drugs that accelerate levothyroxine: Phenytoin, Carbamazepine, rifampin, Sertra-
actions with line, and phenobarbital
levothyroxine Patients taking the following drugs may need to increase their dose of levothy-
roxine: 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, unexplained weight loss) OR
or to beginning Oral glucose tolerance test (OGTT): 2-hour plasma glucose >/= 200mg/dl OR
treatment 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
, NR 565 Final Study Guide
Study online at https://quizlet.com/_cdtlkd
11. Diabetes To keep A1C below 7%
o A1C o <8% is less stringent for those with hx. Of severe hypoglycemia, limited life
expectancy, pr advanced microvascular or macrovascular complications
General goals
12. Diabetes Recommended goal for A1C in the geriatric population is 7.5-8% in older patients
o A1C with moderate comorbidities and life expectancy less than 10 years
o 8-8.5% for older patients with complex medical issues
Older Adult goal
13. Diabetes Recommendation: A GLP-1 should be considered before starting insulin
o A1C Insulin is introduced in Step 3 which includes a 3-drug combination which
includes insulin.
When should in- A1C of 9% of greater would start at Step 2 with dual med therapy
sulin be consid- A1C of 10% or greater or fasting glucose of 300 or greater and is symptomatic
ered? would start on combination injectable therapy immediately (Step 4)
14. Diabetes Should be monitored every 3 months until value drops to 7% and at least every 6
o A1C months thereafter
At what time in-
terval should it
be re-checked?
15. Diabetes Metabolic actions of insulin are primarily anabolic - Insulin promotes conservation
o Action of In- of energy and buildup of energy stores, such as glycogen and the hormone also
sulin 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
