Lecture notes
Adult Health 218A Exam II Study Guide
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Lecture notes of 35 pages for the course adult health at Unitek (Study guide)
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1Exam 2 Concept Review (Ch 56, 59, 61, 62, 65, 67, 69)
Insulin
➢ Usually, insulin is given before meals and based on sliding scale
➢ When do adjust the sliding scale? With doctors order, or when we check the BS such as high before
meals like 200 in the morning and 300 in lunch time → ask doctor to adjust the insulin or high dose
insulin
➢ Abdominal site has the fastest rate of absorption because of blood vessels in the area
➢ Patient can use different areas of thighs
➢ Rotate the sites in one area to decrease chance of having reaction
➢ Changing injection sites from the thigh to the arm will change the absorption rates
➢ Do not mix any other insulin type with insulin glargine, insulin detemir, or any of the premixed insulin
formations such as Humalog Mix 75/25
➢ Teach patient to refrigerate insulin that is not in use to maintain potency, prevent exposure from
sunlight, and inhibit bacterial growth
➢ Insulin in use maybe kept at room temperature for up to 28 days to reduce injection site irritation
➢ Prefilled syringes are stable for up to 30 days when refrigerated. Roll these before use
Hyperglycemia
➢ With hyperglycemia – drip only 1-2 patients – we have to check patient every 30 mins or every hour
, 2
Hypoglycemia
➢ For mild hypoglycemia manifestation, administer oral glucose in the form of orange juice or any other
carbohydrates. If the symptoms do not resolve immediately, repeat the treatment → for awake and
alert patient
, 3
➢ If a patient becomes severely hypoglycemic with BS <20 may be seizing → administer glucagon 1 mg
SQ
➢ Hypoglycemia can also cause nervousness and blurred vision, anxious, and confused
TSH levels
➢ Hypothalamus secreted TRH which then triggers anterior pituitary gland to secrete TSH, which then
stimulate thyroid gland to make and release thyroid hormones
➢ If thyroid hormone levels are high, release of TRH and TSH is inhibited.
➢ If thyroid hormone levels are low, TRH and TSH release is increased
➢ Cold and stress are two factors that cause the hypothalamus to secrete TRH, which then stimulates
pituitary
➢ Excessive thyroid stimulating hormone can cause → increased bone formation
➢ Patients with underactive thyroid gland has a decreased metabolic rate (HYPOTHYRODISM), resulting
in lethargy and lack of energy, weight gain, slowed speech, and decreased VS like low temperature,
bradypnea, dysrhythmias, cold intolerance
➢ Stridor is hallmark with respiratory depression in patients with thyroidectomy
Assessment of Endocrine system
➢ Patient history – demographics (women vs men), S/S, hospitalization, etc.
Symptoms of endocrine disorder can be age related such as sexual effects of hyperpituitarism
and hypopituitarism
Ask about past and current drugs, such as cortisone, levothyroxine, oral contraceptives, and
antihypertensive agents
➢ Nutrition history – diet = diabetes insipidus triggers excessive thirst, adrenal hypofunction triggers salt
craving, hunger & thirst for DM, N/V, abdominal pain,
pt. teaching about well-balanced diet that include less animal intake, fewer concentrated
simple sugars, well balanced diet of 60 g of protein, iodized salt in food preparation
➢ Family history and genetic risk – obesity, growth & development difficulties, DM, infertility, thyroid
disorders
➢ Body function controlled by the endocrine system for homeostasis and regulation are metabolism,
nutrition, elimination, temperature, fluid and electrolyte balance, growth, and reproduction
Aldosterone is the hormone produced by adrenal gland (cortex) that cause water and sodium
ABSORPTION TO MAINTAIN BODY FLUID VOLUME
➢ Current health problems – when, where, how, what
Changes in energy levels (thyroid problems) – ability to perform ADLs
Changes in elimination patterns – elimination frequency, nocturia, BM
Sexual and reproductive function – menstrual cycle, impotence
➢ Endocrine system problems and disorder are usually related to an excess or deficiency of hormone
secretion leads to pathologic conditions affecting many body systems.
➢ Many endocrine problems can cause dysthymias
➢ Physical assessment follows order → inspect, palpate, auscultate
➢ General appearance – wt., height, fat distribution, muscle mass r/t age
Heredity & age rather health problems responsible for short stature
➢ Avoid applying pressure on or palpating the thyroid in a patient who had or is suspected to have
hyperthyroidism because these actions can stimulate a sudden release of thyroid hormones and
cause a thyroid storm
, 4
Propranolol is a beta2-adrergic blocking agent that decreases the rapid heart rate caused by
excessive thyroid stimulation
➢ Skin color & look for areas of pigment loss – hypopigmentation or hyperpigmentation
➢ When examining the head, focus on facial structure abnormalities (SATA)
Prominent forehead of jaw
Round or puffy face (impaired F&E balance)
Dull or flat expression
Exophthalmos (proptosis) – protruding eyeballs & retracted upper lids
➢ Skin and nails – vitiligo (location, color, distribution, size, malformation, thickness
➢ Trunk abnormalities in size, symmetry – truncal obesity & the presence of buffalo hump
➢ Hair distribution – hirsutism on face, chest & center abdominal line, excessive scalp hair loss
If a female patient comes with presents with hirsutism, ask → “How do you feel about
yourself”
This can disrupt body image
➢ Genitalia – size and symmetry (usually done by the NPs)
➢ Generally, look at overall appearance of the person
➢ Assess psychosocial
Their behaviors, personality, psychological responses may be changes
Coping skills, support systems, health-related beliefs, any change in how stress handled, crying
frequency, anger expression & degree of patience
Self-perception from infertility, impotence & other changes in sexual dysfunction
Readiness to learn and ability to carry out specific-management skills
Referral to social services
Diagnostic assessment for Endocrine system
➢ Provocative test – used for underactive endocrine gland where a stimulus used to check normal
hormone production
Measured amounts of selected hormones are given to stimulate the target gland to maximum
production
Hormone levels are then measured and compared with expected normal values
Failure of the hormone level to rise with provocation indicated hypofunction.
➢ Suppression test – used when hormone levels high
Drugs or other substances known to normally suppress hormone production are administered
Failure of suppression of hormone production during testing indicates hyperfunction
➢ Urine tests – 24-hour collection, collection is timed for exactly 24hrs. Glucose does not present in the
urine of healthy individuals
Starting second urine is collected and kept on ice because first one is contaminated
To determine any glucose in the urine
If preservative is added, it is added before at the beginning of the collection
➢ HgA1C – important because it offers an indication of how well controlled the blood glucose has been
over the previous 2-4months
4%-6% expected range, 6.5%-8% for diabetics, <7% target goal; blood level for 120 days,
evaluate & treat
FBG – results >126 mg/dL
Screening for diabetes - >45 years, >BMI
➢ Imaging assessment – Xray, MRI, CT scans
➢ Other diagnostic assessment – needle biopsy for nodules & surgical interventions
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