Galen - NUR 257 - Chronic - Chp 20
TSH - answer0.5-5 (High = hypothyroid, low = hyperthyroid)
T3 - answer70-220 (low = hypo, high = hyper)
T4 - answer5-12 (low = hypo, high = hyper)
Thyroid Disease (Geriatric Considerations) - answermay mimic "normal" aging
nonspecific, atypical, absent s/s
Often Dx'd when screened for Depression, anxiety, functional/cognitive changes,
cardiac disease
QSEN - amiodarone - monitor for hypothyroidism
Rx centers on pharmacology and Sx or chemical ablation (hyperthyroidism)
tests anytime there may be a concern (even when s/s vague)
those Dx'd with a-fib, anxiety, depression, dementia at risk for thyroid disturbance
little can be done to prevent
iodine and mercury in diet
educate seriousness of disease and following med regimen
acute symptoms and treatment can be life-threatening
labs: TSH, T3, T4
Levothyroxine (RN Considerations) - answertake in am
empty stomach > 30 min before meal
full glass of water (so no dissolve in esophagus)
cannot be taken within 4hrs of mineral (fortified calcium foods, antacids, iron supps)
always dosed in mcgs so watch for mgs
same brand should be used
increasing dose = life-threatening
no rapid replacement b/c toxicity
increases myocardial O2 demand (so a-fib, angina)
Hypothyroidism (S/S) - answerheart palpitations
slowed thinking
gait disturbances
Less common:
fatigue
weakness
depression
dry skin
Significantly less common:
, weight gain
cold intolerance
muscle cramps
Hyperthyroidism (Geriatric Considerations) - answerless common than hypo
sudden onset
women 2-10 X more likely than men
Common cause: Grave's Disease, iodine substances, amiodarone, too much
levothyroxine
Labs: TSH, T3, T4
May be misdiagnosed as depression, dementia
Untreated can lead to bone loss
Hyperthyroidism (S/S) - answerunexplained a-fib
heart failure
constipation
anorexia
muscle weakness
tachycardia
tremors
weight loss
apathetic thyrotoxicosis (rare in young, slowed movement and depressed affect)
Diabetes (General) - answercontinuum: asymptomatic prediabetic insulin resistance >
mild postprandial hyperglycemia > mild fasting hyperglycemia > diagnosable diabetes
Dx: two of three poss. tests on two different days
GTT rarely used in elderly
S/S insidious until end-organ damage
Hyperglycemia well-tolerated (harder to detect) in elder body (until late and severe)
Goals (2): control BG and minimize risk for complications
early detection (e.g. public / communcal screenings) key to care
elev. BP should be screened q3yrs
HgbA1C - answer5.7%-6.4% - prediabetic
>6.5% - diabetic
Fasting Plasma Glucose (FPG) - answer100-125 - prediabetic
>126 - diabetic
A1C - eAG - answer(above 6, each 1% approx. 28 point difference)
6 = 126
7 = 154
8 = 183
9 = 212
10 = 240
11 = 269
TSH - answer0.5-5 (High = hypothyroid, low = hyperthyroid)
T3 - answer70-220 (low = hypo, high = hyper)
T4 - answer5-12 (low = hypo, high = hyper)
Thyroid Disease (Geriatric Considerations) - answermay mimic "normal" aging
nonspecific, atypical, absent s/s
Often Dx'd when screened for Depression, anxiety, functional/cognitive changes,
cardiac disease
QSEN - amiodarone - monitor for hypothyroidism
Rx centers on pharmacology and Sx or chemical ablation (hyperthyroidism)
tests anytime there may be a concern (even when s/s vague)
those Dx'd with a-fib, anxiety, depression, dementia at risk for thyroid disturbance
little can be done to prevent
iodine and mercury in diet
educate seriousness of disease and following med regimen
acute symptoms and treatment can be life-threatening
labs: TSH, T3, T4
Levothyroxine (RN Considerations) - answertake in am
empty stomach > 30 min before meal
full glass of water (so no dissolve in esophagus)
cannot be taken within 4hrs of mineral (fortified calcium foods, antacids, iron supps)
always dosed in mcgs so watch for mgs
same brand should be used
increasing dose = life-threatening
no rapid replacement b/c toxicity
increases myocardial O2 demand (so a-fib, angina)
Hypothyroidism (S/S) - answerheart palpitations
slowed thinking
gait disturbances
Less common:
fatigue
weakness
depression
dry skin
Significantly less common:
, weight gain
cold intolerance
muscle cramps
Hyperthyroidism (Geriatric Considerations) - answerless common than hypo
sudden onset
women 2-10 X more likely than men
Common cause: Grave's Disease, iodine substances, amiodarone, too much
levothyroxine
Labs: TSH, T3, T4
May be misdiagnosed as depression, dementia
Untreated can lead to bone loss
Hyperthyroidism (S/S) - answerunexplained a-fib
heart failure
constipation
anorexia
muscle weakness
tachycardia
tremors
weight loss
apathetic thyrotoxicosis (rare in young, slowed movement and depressed affect)
Diabetes (General) - answercontinuum: asymptomatic prediabetic insulin resistance >
mild postprandial hyperglycemia > mild fasting hyperglycemia > diagnosable diabetes
Dx: two of three poss. tests on two different days
GTT rarely used in elderly
S/S insidious until end-organ damage
Hyperglycemia well-tolerated (harder to detect) in elder body (until late and severe)
Goals (2): control BG and minimize risk for complications
early detection (e.g. public / communcal screenings) key to care
elev. BP should be screened q3yrs
HgbA1C - answer5.7%-6.4% - prediabetic
>6.5% - diabetic
Fasting Plasma Glucose (FPG) - answer100-125 - prediabetic
>126 - diabetic
A1C - eAG - answer(above 6, each 1% approx. 28 point difference)
6 = 126
7 = 154
8 = 183
9 = 212
10 = 240
11 = 269
