Endocrine System Made Easy

we're going to go and get started since it's right on time so my name is Kendall Wyatt I'm the instructional content strategist here at big monic I'm an RN I'm also a paramedic that's how I started out but I also I actually am a third year of medical school doing my rotations here in Phoenix Arizona and the valley so I work at pick banach as our instructional content strategist and that's not a completely made-up title but what does that mean that I do and what that means is I kind of act as the person who goes through a lot of our content and make sure that it's actually relevant to what you guys need to learn for NCLEX and in your nursing school but most importantly is that I'm the liaison for all of the I'm the intercept page basically for all your quests request rather that you write in and you say I need to see this what about this or do I need to know that I'm the person who makes sure that we have those things in our product and that they are available for you if we need to maybe create them as well I also do some things with our with our iOS app and whatnot some of our design things and user interface stuff so we're here in the Phoenix Valley now I'm we're in Tempe Arizona it is I you are inside of our pick monic sound booth where we actually record our pick monix and of course it's afternoon here so it's 115 degrees lovely so what is pick monic if you haven't heard about pick malonic pick monic is a picture it means picture mnemonic so we use images and which is what we're going to go over today we're going to cover pharmacology and go over endings so that you know exactly what to learn and memorize ton of information very fast so you can see that right here in this image that I've shown you is a pencil villain here and we that stands for penicillin and you'll see that we use characters and imagery to stand for medical facts so right beside him you see this armored ox and that stands for amoxicillin and you see this cute little bacterial guy not having such a great day with these antibiotics around and that's how you know that that's a bacteria we have all of the subjects you need to know during nursing school so let's say you need to memorize all of those drugs everyone loves memorizing all of the drugs in nursing school I know I still love memorizing even more details about the drugs and that is like warfarin so you always could remember the war fairy and you know that Warren you need to monitor what pt ninr so in Pequannock we're going to show you a war fairy and we're going to show you a PT iin our factories and you can always remember that warfarin you monitor pt/inr we have all the other ones bipolar bipolar Bayer foresight disorders and OB and pediatrics and things like that as well we've covered over 700 different topics for nursing that all the stuff you need to know during nursing school and for the NCLEX so let's go and get started are we going to go over today we are going to blow the endocrine system away for sure we're going to talk about the endocrine system itself we're going to talk about the organs we're going to talk about the hormones and kind of a basic function for each and we're going to talk about feedback systems we're going to talk about all the disorders like hypo hyperthyroidism and after we go over the concepts of each of the hormones you're going to find it really easy to just be able to immediately come in and just know which one goes with what because you've learned the concept and that's where so many students all the time they don't learn the concepts in the beginning for sure and if you learn the concepts then you can reason through this stuff really easy so much easier to really understand which ones up which ones down which ones where and then how it works and then feedback which what we'll go over is too simple we'll do a quick review and then we'll do a Q&A so if you have any questions you can you can type in the questions and let us know so as you are going through a webinar today if you have a question as we go through you can type it in as well I like to ask a lot of questions as we go through one to see if you're sleeping I guess but also so that you can we can interact and you can I thought a lot of high-yield points that you need to know and you can always type that into the question box there as we go through if you know the answer if not is no big deal maybe you'll get it next time so all the things you need to learn in the entire body can all be brought down to all of the body systems together and this is kind of the way I teach you if you've seen any of our webinars before we just keep adding to them and we've got this entire system that you need to know and how all these things work and I like to teach it as this body is this giant fish tank everybody's probably had a fish tank I know I had several fish tanks as a kid and I I don't have one now but I will have another one once I get a get done with crazy crazy med school rotations but I don't you think of the bots this the body and how it works all is this big giant fish tank so here's the tank this giant body like to think about the veins and arteries kind of as the pipes and it just like an efficient like you have pipes you have these tubes that move things around as well then there's always a pump on every good fish tank there's a there's a pump that moves all this stuff through those pipes and that's in the body the heart right and also with each and every fish tank a good fish tank you need an aerator to put oxygen into whatever that fluid is and that's what the lungs do in the body for sure and as we know inside of a fish tank you have to have fluid and that's what the blood is in the body moves around inside of this fish tank all the time sometimes the blood has more oxygen and ever less oxygen and sometimes the blood moves around faster or slower just like the body does just like a fish tank you can circulate that more or less and you always know that every single fish tank sometimes gets dirty and we keep it from getting dirty by having a nice filter and the filter in the human body or the kidneys that's where you always need to think up if all this muck is just building up in the body it's probably because the kidneys aren't filtering everything out very well and just like every single great fish tank it has fish in it and those fish stay alive by giving them some type of food or gas and that's why our GI system it you take some sustenance in and it gets digested and turns into fuel to keep everything alive and keep everything going and then of course every good pump every good lungs all this stuff has to work and the only way all this stuff is able to work because it needs all this these electrical impulses to actually work and that's where we talk about the nervous system and I like to think about it is kind of like the electric plug in or the you know the electrical impulse is all firing through everything to make it all work all these this these um you know firing neurons I always have a little battery so what does all this all mean I mean this is all just a you know a whole bunch of pictures right but we put all this together and here you go you can see as I build this veins and arteries inside the tank the pump the lungs aerating things the body fluid the kidneys filtering it all out the GI with the tank and here's the electric keeping it all together and this is where all of our systems all tie in together so that no matter what we're teaching you can think about these concepts these are big concepts of how the body works it all works exactly like this it all goes in and they all compensate so if there's a problem with maybe you're bleeding and you're bleeding out your veins and arteries what happens is electrical impulses then fire and it tells your system hey make the pump beat harder make it work faster so the pump increases and then that it moves this cardiac output and makes compensation actually function so that's definitely kind of a quick overview of everything everything we go through in all these webinars we have one for every single one of these systems so overviews via the endocrine system itself I mean we're going to go over all these organs pathways hormones and we're going to talk about the basic function that's what I'm going to really harp on and spend the time because you know it's I always like to you know teach them you know the porridge is too too much or too little or too hot or too cold and that's exactly what you need to think about with the endocrine system everything's owing this homeostasis balance it's always in this beautiful balance but what happens sometimes is that balance get off kilter and it's unbalanced and that's where we see all of these problems is when that balance is just tweaked just a little bit and then when it's not balanced perfectly you have endocrine abnormalities you see all these syndromes and that's exactly how you need to think about it so here's a just an image telling you all of the different glands we're not going to go over some of the glands like the thymus and the pineal gland pineal you know is for sleep and melatonin and thymus really is for maturing t-cells we're not going to go over those today as much in detail for sure and so you know the hypothalamus is at the top and it sits and then we have the anterior and posterior pituitary come down we see that we have our thyroid here and behind the thyroid of the parathyroid for those little suckers behind the thyroid famous of course adrenal glands on top the kidneys and then in this drawing we have both ovaries and testes in this particular drawing and we now showed you that we've kind of yeah altered it a little bit so we could put everything in here but this is what we're going to be talking about all of these different organs and what we want to do is talk about what all of these organs actually do oops I skipped too far what are these organs actually do and when I think about all these we're going to we're going to run through some scenarios of exactly some pathways through all these so we have this hypothalamus and it's at the top and I always think the thing about the hypothalamus here it is the kind of at the in the the base of the brain and I always like to think of us as general it's it to the top of city in the brain and it's kind of this general of an army I mean I'm sorry the president and the president is kind of a high-level just always always watching things you know the president doesn't actually get out and fight battles but he's always watching and what does he do as he commands armies of generals like the anterior pituitary gland in the posterior pituitary gland so we have an anterior pituitary in the front and a posterior pituitary is post pit bull and an ant pit bull in the front anterior front posterior in the back and when you think about which one of these you'll have to think I'll memorize all the the secretions that's that's true but we have the ant I always think the anterior pituitary is like the ant ant pit and the ant pit is kind of where all the ants are and that's where all a big ant pit is more of the the hormones and anterior pituitary posterior pituitary is in the back and it's the EM the less we're going to talk about these in just a second so we come down we have the thyroid parathyroid there right there in the neck there's thyroid hormones and this parathyroid hormones and it's just like I said here's the adrenal glands and the adrenal glands sit on top of each kidney and I always teach these kind of a I always remember the adrenal glands as these little Smurf hats kind of on top of each kidney they're just like perched right on top of there they are connected aside from some fashio they're not you know there's not no Anasta Moses between them per se but they're just kind of set they rest right on top of each kidney I think this little Smurfs at they could come off we could get rid of an adrenal gland if we had to but they just kind of sit right on any of you have ovaries in the testes and I don't think I need to go to that pancreas as well pancreas is an interesting one endocrine and exocrine we're going to talk about that in a second so what we're going to do first is we're going to talk about the overarching the giant system of pathways and we're going to run through examples and it's everyone's favorite part I know and so what you need to remember for the pathways here's just the thyroid thyroid is probably one of the most high-yield things you're going to heat you're going to have on the inkless you've got an O hyper and hypo thyroidism so let's actually look at the thyroid pathway here so you're going to see three different types of hormones and most of the the pathways we talked about you have this really thyrotropin-releasing hormone trh thyroid stimulating hormone and you have thyroid hormones and every time I always them what you need to remember is that you need to remember that they go in exactly the same order in almost all of them so where is Zaira tropic releasing hormone where would you where would you expect to find that you can type it in your little answer box is where I really started hitting lots of questions so that's right Smith a fiber tropic releasing hormone comes from the the main the main dude right and it fiber tropic releasing hormone comes from the hypothalamus it comes at the very top and that's the the first part all of the releasing hormones come from the hypothalamus it comes from the main the top it comes from top down you always hear about you know the things were all downhill well that's exactly right and the releasing hormone is what actually starts and it says okay release let's start releasing hormone and it comes to the hypothalamus and it comes down through the pituitary stalk into where comes down into the anterior pituitary and in the pituitary gland there are stimulating hormones and you know everyone always asked me well how do I remember releasing versus stimulating if I say release the hounds right I'm giving an order to release hounds but am I actually opening the gate no if i stimulate someone and i if i stimulate the gate myself then I'm gonna I'm gonna actually like Electrify it to open or I'm going to stimulate it and push the button I'm actually stimulating it release the hormone and that's what happens is with a stimulating hormone they come down and then they actually they go to the actual organs most often and then cause a release of or an increase or of hormones and what happens is in absence of the stimulator the hormone secretion should go down and that's how you need to think about that so you have a TR H in the hypothalamus it comes down to the anterior pituitary and reproduces whoa lots of releasing hormone we're going to release stimulating hormone and what happens is the action it releases out to the body and then the thyroid gland itself then actually produces releases more thyroid hormones like t3 and t4 so we're going to go back to this and we're going to talk about feedback at the very end with this exact example so you can kind of see it again so excuse me here is one part of the image we're going to work through this exact same image top-to-bottom as we go through and what I go to see up here is at the very top level we're just talking about here we see on the top level we see hormones right Rama at the top and on the left-hand side we see the exact same organs all the way down only we've characterized all of them using our pic monic characters and one of the things that you see pretty much through the our entire webinars and everything is we characterize it means the exact same image that's you're going to find inside of our actual inside of our product as well so let's just actually look through these let's run through these examples so we have up here there's the hypothalamus just like I was talking about right and look at the top as we have here we have Gennady tropen releasing hormone or sorry growth hormone releasing hormone up my and it goes and actually releases growth hormone we have prolactin releasing hormone releases prolactin thyrotropin-releasing hormone corticotropin-releasing Marlon ganado tropen releasing hormone all releasing hormones that's exactly what all those are they're all releasing hormones and you see they're releasing hormones growth hormone releasing hormone and prolactin releasing hormone are a little bit we are going to talk about those in a second so but we can see is that we have mostly we're all releasing hormones up at the very top and the hypothalamus and they all come down so what happens when they come down is then in the second level you can see here we have the anterior pituitary here in this second level and what happens now what happens is now you actually have a second level mostly of of stimulating hormones so we have over here on the right-hand side we have follicle stimulating hormone luteinizing hormone we have Audrina Audrina cortico trophic hormone ACTH with thyroid thyroid stimulating hormone TSH we have prolactin and we have growth hormone we have those always the way they come down into the anterior into the pituitary so then we actually come down let's look at hope I skipped skipped ahead sorry hit hit hit the wrong button what happens is then we see that they come down into all of these different pathways and we're going to talk about these as we go through and we see over here I just threw this in here so I don't I always um I get always get somebody says oh you skipped over you know what about the pineal gland this pineal pinecone over here you can remember the pineal pikelet pinecone the pineal gland actually releases melatonin so what does melatonin actually actually kind of really relate to you should know this it's pretty common you should see it on a lot of a lot of things that's this right Eric is sleep melatonin is asleep for sure and looks like Jen - that's right that's all about sleep so I also have so here I have this anterior pituitary I have these anterior pituitary hormones and over here on the right I've got my post pit over here all by himself and why do I have it all by myself and this is something that most people get so confused with and that's because what happens is the hypothalamus actually creates it's the creator of oxytocin and antidiuretic hormone another name for antidiuretic hormone or a DHS vasopressin and they're actually created in the hypothalamus but what happens is they come down from the hypothalamus through the the neural hypothesis they come down and then they're actually this is the stalk of the pituitary they come down and actually they're stored in this posterior pituitary that's why there's only two then posterior pituitary doesn't actually make anything but it stores oxytocin and ADH and then it causes them to actually be released out so it releases them out but there's just just stored there that's for sure and we're going to talk about the pancreas glucagon insulin and somatostatin in all these as we go through so here we are looking at all of these characterizations again go through the exact same thing again is to try to help you see how it goes we put more lines on here so I always get students there watching this and watching me teach and they they say I'm still confused I'm still confused I'm still confused and what we're doing is we're actually repeating it over and over and going back over the exact same concept so that you're going to get it so here we are at the hypothalamus now we have highlighted this on this one line here of the hypothalamus so here we have our Argan addit rope and releasing hormone this giant release we have our prolactin releasing hormone this pro lactating released we have our thyroid releasing hormone our corticotropin-releasing hormone and organ edit Ropin releasing hormone all these things at the top oh and this hypothalamus and what happens is those get released out and they act on the anterior pituitary right and the anterior pituitary growth hormone prolactin TSH ACTH and FSH and what you know and just like we're going to talk through each one as we go in a vertical level so you can see how they go vertically so we're talking about corticotropin-releasing factor well we said releasing factor so we know that corticotropin-releasing hormone is probably going to have something to do with cortico troponin or corticosteroids exactly this is where we're tying things in quartic oh and that goes to adrenocorticotropic hormone here in this in the anterior pituitary so it's all pattern so if you have something from the hypothalamus almost always it goes to the pituitary if you have something put pituitary most almost always goes straight to an organ and that's kind of how you have to think about it and then it released then actually causes a change in hormones there's a couple exceptions as we know you know FSH and LH I'm sorry I got a little guy that posterior pituitary is a little different itself so once we actually have the hype anterior pituitary here again is the posterior pituitary just like I said it's a little it's a little weird and we know that the posterior pituitary it comes from that hypothalamus into the posterior pituitary it's actually creating the hypothalamus and comes down the posterior pituitary and that's where it's stored and then in the posterior pituitary oxytocin and ADH are then released out for sure and that's something that so many students get confused with and I don't want you to get confused with them so to keep you from getting confused let's look at tyroid let's look at the thyroid itself we're going to talk now each vertical pathway so the thyroid we know thyroid we're at the hypothalamus thyrotropin-releasing hormone thyroid stimulating hormone from the anterior pituitary and then that comes down to the actual thyroid or thyroid here it's right there in your neck and it causes t3 and t4 and calcitonin to be released so t3 and t4 which one's more potent t3 or t4 is anybody know so what happens is t4 gets converted into t3 and that's why you have t3 is a powerful such a potent such a potent just potent thing in the body to change your heart rate or causes them you know thyroid changes or metabolism so that's for sure so when you think about the thyroid gland exactly can you've already said the answer but thyroid itself the thyroid itself the overarching function of the entire thigh would is to run your basal metabolic rate and that's exactly how you need to think about that sigh roid is it just manages your basal metabolic rate well what does that mean well that means my basal heart rate my basal respiratory rate my base my baseline basal metabolic rate BMR what my body does at rest now it also actually acts in the cells and axon you know your tissues your heart your blood pressure works on everything so we could see somebody with way too much way too much thyroid hormone and we what does anybody know what that what that cause is that's right bill so what happens is you've way too much thyroid hormone that's caused a thyroid storm and it causes this way increased heart rate way increased basal metabolic rate so these people increased heart rate they have all this hypertension they fever they're basically they oh they imagine that they've just taken a whole bunch of speed if you think about tyroid hormone you ever thought you see a lot of those diet pills sometimes you know lose 30 pounds in 30 days or your money back sometimes sometimes very often those those types of weight loss programs actually a synthetic thyroid hormone in them because it's basically speed it speeds your entire basal bottom block rate up and then so you're you know you're you're running around you've lots of energy or you're awake all the time you can't sleep and you see you hyperthyroidism like symptoms and that's where we see that type of thing so Jen asks about there's less t3 than t4 and that's true t3 is more potent and that's for sure it's more of a potency thing for sure so when we actually look at the hyper and hypo thyroidism who are the pick monix and hyper and hypo thyroidism so if i if i just talk about basal metabolic rate and i say hypothyroidism well that means a low thyroid or inactive thyroid or for some reason a low amount of thyroid hormone what are these people's basal metabolic rate are they running around crazy and speed or they vegetating as i like to say that's right these people are vegetating what happens these people are i like to think it was kind of as a basal metabolic rate meaning they're not out there not being active they're sitting on the couch that doesn't mean they're lazy but their weight gain right they weight they gain weight they have think this excuse me i lost lost my place today so they gain weight and we see hypothyroidism gain weight they they're just their basal metabolic rate they met hypotension they may have a slow heart rate all these things you see if see a snail heart you see weight gain and they can't tolerate cold they can't tolerate cold but why can't they tolerate cold well the reason is because they can't tolerate cold is because their basal metabolic rate is slow and so what happens is I want you to think about like a snake you take a snake and you put a snake in in a in a cold environment what happens is it slows down it can't tolerate that because it cells the cells themselves can't they can't work and create heat they can't create to heat at all their hypo thyroidism so they just kind of vegetate and become nothing I mean they go dormant things you know everything you see but on the opposite side hyperthyroidism if I give you tons of speed basically hyperthyroidism these people are skinny they lose weight they've tachycardia they've hypertension all of those things that you see and they are basically they can't sleep they're in something they have insomnia and they can't tolerate heat that's because these people's their cells the cells is a basal metabolic rate the cells themselves are just running like crazy they're also really excited and when they get really excited and they rub up against each other they generate heat just like when you rub your hands you generate heat and that's what your cells are actually doing at the cellular level and they get too hot and it's the exactly how you need to think of it so next we're going to talk about parathyroid gland this is one that a lot of students a lot of students um a lot of students get confused and Sarah made a good point is another really important point it's in the pic monic with them hypothyroidism is that you have this brittle hair you you have a really a thin fine brittle hair and that's actually a really common really how you'll point on for NCLEX and if you're nursing exams as well so that that's a good that's a good point so parathyroid so as soon as I say parathyroid you guys should be thinking what in result of parathyroid what is parathyroid what is parathyroid a controller of let's think of that that's right parathyroid immediately as soon as you think of parathyroid you should think of calcium you have to have to have a thing of calcium so I have the parathyroid here now a pair of thyroid parathyroid itself actually controls mmm calcium and where's a pair of thyroid we know the parathyroid here we have our parachuting thyroid here any new actions parachute is in a wonderful shape of a thyroid gland but he has these yellow little circles and those yellow circles indicate the four parathyroid glands and what happens is most commonly you always see this a patient is a thyroidectomy they have their thyroid taken out what do we watch with a thyroidectomy we watch for hypocalcemia for sure that's what we're worried about that's all we're worried about is right tiara and what happens is if you parathyroid itself so parathyroid the parathyroid it has parathyroid releasing peptide this PTH RP or parathyroid hormone itself and parathyroid hormone actually goes and it stimulates the actual the the osteoclasts to break down bone to increase the calcium level so happens is if you a lot of PTH you're going to have really brittle bones because PTH is up there just breaking it all down so here's an issue just a little tidbit for you there's osteo class but everyone knows that there's also osteoblasts and I had a student write in and they were telling me about you know they had a question on and how do they remember between osteoclasts and osteoblasts and the way I remember is osteoblasts are builders so anything that's a blast is in process of getting bigger so osteoblasts builds bone and osteoclast breaks down bone so when osteoblast is a builder of bone and there are lots of different types of blast cells that involve building and that's how you need to remember that for sure so here it is PTH stimulates osteoclast to break down bone and and to increase the calcium level because we know all the bum there's free calcium but one of the things you may have may not have heard of as calcium is monitored but we have to watch ionized calcium calcium actually binds to albumen and circulates in the body so albumin is kind of just like this filler substance you know it's a it's a protein that everything kind of latches onto its back and rides around in the body for sure so we always watch for we have somebody who's way too much PTH or hyperparathyroidism what is their calcium going to be well their calcium is going to be what here here are the hyperparathyroidism the hypoparathyroidism pick monic so here's hyperparathyroidism here just look at it where's the calcium cow so here's our calcium Cal right here and he's increased and what you see if you've hyperparathyroidism we learn the concept the parathyroid gland releases parathyroid hormone which stimulates osteo class to increase calcium that's all you need to remember right there and it should give you all of the answers so if you have way too much PTH releasing peptide or hyperactive parathyroid gland you are going to have an increased in calcium levels and because of that you're going to have osteoporosis or this ostrich here with these porous bones osteoporosis because all the bones are breaking down if you break down all those builders of bones you're not going to have any bones left that's a fact and here's an interesting tidbit most students actually especially nursing students aren't aware of this when I teach when I go over it but you have Aussie calcium and phosphorus and phosphorus itself is it is directly inverse of calcium this is an important point because that's how we we check if calcium is going up phosphorus should be going down because they have an inverse relationship in a normal normal scenario so here we are hyperparathyroidism will see kidney stones we'll see brittle bones so we have to worry about the injuries and things like that so hypoparathyroidism what do we see a hypoparathyroidism OC exactly the opposite exactly the opposite and this is hypoparathyroidism we took your thyroid out if we took your thyroid out then here we are we're seeing hypocalcemia we're seeing you lethargic you see all the signs of hypocalcemia that's how should definitely be thinking about these types of disorders we learn the concept learn the general idea what it does and now we put it together and we just memorized these two disorders really easy and you can see here you can use the pic monix to help you remember exactly what's going on which one was up calcium which one was down phosphorus here's our phosphorus P and has our calcium Cao up and an interesting point is in pic monic we always use an up arrow for a blue are all of our pairs are always blue all of our down arrows are always red so that really helps you unless you're colorblind like Ericka in her office and she's pretty much just screwed when the collars of the arrow so that doesn't help her but sometimes just for people like her we put a little increased on there and we put a little decreased but we're definitely picture people so hopefully you're not colorblind on the collars as well so let's look at the adrenal glands this is when I see lots of students they absolutely do not get whatsoever the adrenal glands and the adrenal glands maybe there's little Smurfs ATS I love Smurfs I wish they would have Smurfs all the time and they're probably going to you know since there's a letter and say I can't say the word Smurfs anymore but they haven't yet so Smurfs Smurfs Smurfs anyway so corticotropin-releasing packed way up there in the hypothyroid hypothalamus here it is hypothalamus what happens is it comes down it says where does it go well corticotropin-releasing vector it's a release er release ORS come from the hypothalamus that the president of their bark and these orders are talking to them the lead of whatever as Steve has corrected me in the office the joint the chief of staff or Joint Chiefs of Joint Chiefs I don't know I'm not sure but it comes down it comes down to the the general the anterior pituitary and it comes down it causes this release of adrenocorticotropic or decock tropic a Drina cortico tropic hormone i get that one a little tongue-tied every time I can't remember all this stuff I get tongue-tied adrenocorticotropic hormone so ACTH is why they abbreviate this stuff because it's easier oh sorry oh sorry hope you can hear me I'm so adrenocorticotropic hormone and it comes down what happens is adrenocorticotropic adrenocorticotropic hormone where does it go it goes in the adrenal gland and the adrenal gland is on top of the kidneys and it causes these three releases of things it releases cortisol court to saw aldosterone and catecholamines but mostly cortisol and aldosterone for sure that's definitely definitely important to remember the pathway we just went over Drina cortical tropic adrenal cortical trophy that's how you remember adrenal gland it all ties together so as you come down to your cortisol and aldosterone so more thinking about these what do we need to remember which diseases which diseases addresses the Addison's disease and Cushing's syndrome and Addison Addison's disease and Cushing's syndrome you need to think of those as way too much for one and way too little for the other so one has too much and one has not enough is your porridge too hot you have too much or is it too cold and not enough they're they're different they're opposites that's what you need to think of this so we have Addison's disease here's Addison's disease so Addison's disease what happens in Addison's disease here we are we have a decrease of cortisol and aldosterone and we see what types of scenarios and we see all things that are decreased these adrenocorticotropic what our adrenal cortical tropics they are cortico tropics are essentially steroids so you think of no steroids decrease steroids that's how you should think about a quarter cut robux they are glucocorticoids and that's how you should think about it it's basically this general idea of steroids and when you think about that here we have a decreased amount of steroids well we have no steroids what happens is these people they have decreased blood pressure decreased sodium and they end up with this decreased glucose level so let's just think about this enticing concepts in if I'm talking about the opposite of decreased steroids you guys are smart what's the opposite of decreased what's too much steroids and that's something called Cushing syndrome so here're Cushing sin we got this really sexy Cushing right here for you to help you remember Cushing syndrome for cushion always nice so this is our assessment pick Monica we have a hold another one for on the interventions so we have this increased up arrow on this court court son judge so you can remember cortisol and I'm sorry is this courts Aldridge Cushing's syndrome cushion and what do we see this with what do we see with Cushing syndrome you absolutely must know Cushing syndrome and Addison's disease before you walk in you're in cliques if you don't you're shooting yourself in the foot because their likelihood that you're going to get a question on one or the other is pretty high it's very very high yield that you know the differences but especially Cushing's syndrome because here you see you see this abdominal striae see a Buffalo Hump chins naming it off like crazy moon face here we got all this stuff in your moon face osteoporosis hypertension hyperglycemia and why do you see all that stuff it's because you have a generalized increase in glucocorticoids now if I said glucocorticoids you should be thinking of and I have it right here on you so I'm kind of giving you these ahead of time and ice maybe it just because I skipped ahead today I'm not sure but what do I need to actually associate that with what already to associate an increase of glucocorticoids and all these signs and symptoms with what what is the order that what I need to associate with what is it the same has basically if I memorized Cushing syndrome I memorized what else anybody know hmm I'm advertising you might pick monic cup today love my pick Monica hmm think about it think think think oh Emily that's right um we have to think about giving steroid medications and that is exactly right so what happens like prednisone yeah I kind of gave it to you so prednisone here's our prednisone pick monic here's our predator prednisone what happens if you give us steroid what is prednisone prednisone is a glucocorticoid medication corticoid cortisol all of these things these things mean the exact same if you're learning these root words you can figure it out and reason through it put your nursing thinking cap on and you say wow Cushing's syndrome abdominal striae um moon face Buffalo Hump thinning skin you see all this stuff but you also see this if you put somebody on long-term steroids you see the exact same side effects you see immunosuppression you see adrenal atrophy you see all of these things in um in prednisone and here what do you see in this prednisone pick monic you see the sexy little cushion down here on the on the right and the bottom right this cushion because it causes Cushing's syndrome has a side effect of giving too much glucocorticoids you know exogenously so if I you know you can create all of these symptoms so exactly the same point so let's say I back up a couple of slides and I say I'm going to give you way too much what medication do we give for hypothyroidism what medication don't give me the trade name because trade names are not on the in clicks anymore trade names are not allowed what is the true what what medication do we give for hypothyroidism think about it if you don't know the name what is it what do you need to be thinking about it's right tiara levothyroxine you give thyroid hormone to a patient with hypothyroidism because those people are vegetables right they sit or they don't sit they have their their I think about it cuz they you know I think about basal metabolic rate being slow so their veggies later so they kind of they gain weight think you know they slow their heart rate slow that hypotension everything slows down and but if I give them synthetic hormone I could give them levothyroxine what happens to everything what increases what happens if I do too much hyperthyroidism what happens if I'm normal and I take levothyroxine I induce hyperthyroidism in a patient so exactly what happens in this scenario this is where you need to think about this prednisone and this is how you can also remember Addison's between Cushing's if I give prednisone which is a glucocorticoid I'm going to increase steroids I'm going to increase these in the body which is similar to cortisol which is going to imitate Cushing's syndrome and that's how you need to think about it and that's how you can member Cushing's syndrome is too much cortisol and that's how you should always remember that and then Addison's disease always the opposite and that's why Addison's disease you think Cushing's syndrome you let's think about thinning skin nice thing about that right thinning skin and prednisone long term well that's why Addison's disease what happens in Addison's disease we get thick skin yeah okay that's not the question the question is always dark pigmented skin and right here in this Addison's disease Peck monic we got this beautiful hiker pig on a platter here so you can remember hyper pigmentation you can always remember it's so simple right here it is hyper pigmentation so what happens sometimes if you remember Addison's disease is a lack of aldosterone and cortisol what happens if you put somebody on prednisone and they're on prednisone for weeks and weeks we see you stop it all the ones what happens in that's right I gave you the answer it's right here it's the last pick Monica we haven't went over its add a sodium crisis so anything we need crisis we think crisis it's right now they're freaking out they're having a problem right now acutely and that's because they have absolutely zero absolutely zero cortisol and aldosterone in their system mostly cortisol is absolutely no cortisol and it's most likely because that they had prednisone long term and if I'm giving you these glucocorticoids through an IV or my mouth um that means what happens is your your adrenal gland stop making cortisol this thing then we don't need any we got plenty it's coming in from somewhere else let's stop we don't overload the system make us give us too much of a Buffalo Hump so what happens is if you stop medications all at once then you end up with this absolutely none all at once so you don't get hyper pigmented slowly over time you're thin the skin doesn't get thick slowly over time it happens in like six hours as soon as that pregnant last bit of prednisone stops you have a crisis and here we have a de Sounion crisis so we see all the signs and symptoms of a dystonia crisis hypotension hyponatremia hypoglycemia all at once hyperkalemia muscle weakness all this stuff immediately right away and these patients are in big trouble so we give them lots and lots and lots of lots and lots of IV fluids and we give them kayexalate to definitely drop that drop that potassium right away because they're getting lots of lots of problems this is kind of a cute because it condition you're always going to see those patients acutely so moving on some of these I want to skip through because I really a little bit I'm a skip rather I just want to go a little bit faster here we are at the pancreas the pancreas is an interesting one so it both has endocrine functions and exocrine functions so endo Crenn endocrine means inside the body or inside the blood rather an exocrine means outside of the blood so inside of the blood is endo Crenn exocrine is outside of the blood specifically the GI tract so endo Crenn functions in fact pancreas are what we're going to talk about today and that includes three little nuggets that you need to know glucagon insulin and somatostatin so here they are glucagon we have our glue king kong insulin and our somatic stem so these are pretty easy to remember there's a couple things you have to remember with glucagon insulin and somatostatin you have to remove that glucagon increases blood glucose insulin decreases blood glucose somatostatin is just kind of the stopper of everything we have our sumo Santa here he's is like anything about a sumo he comes in Matis and he comes in and just kind of boom boom boom nothing really gets past him some about a statin every time you see somato statin it really just means stop or it's an arrest er or a stop of something somato stemming us you know stop or a slowing of something so it's kind of stop saying regulates both glucagon and insulin so let's think about glucagon and insulin let's talk about just those glucagon we could give to do what to the blood glucose increase the blood glucose if your blood glucose is too high then I'm going to give you insulin and it decreases your blood glucose seems like a pretty simple concept but hundreds if not thousands of students definitely hundreds of students I ever had trouble explaining this to and going over and over and over and over to make sure that they understand exactly the difference here so insulin we have to remember that there are alpha cells and beta cells and Delta cells as well I mean if you think about it glucagon increases blood sugar and I always think about that is alpha cells because if it's an increase or it's probably an alpha and if you think I'm an alpha you think of alpha and alpha is like the alpha male I'm the alpha male is the increase or of the blood sugar it's the glucagon and we think about glue King Kong is our character right here glue King Kong jeez dude this one looks a little sad but our other ones look pretty good maybe it's cuz glue King Kong here's just a little baby one but we have some bigger ones and there are the alpha male and what happens is they increase the blue blood sugar alpha cells and the insulin it decreases the blood sugar and it's the beta cells so you think about the you know decreasing the blood sugar bringing things down we have this little insects syringe and they just you know they bring it down a buzzing around what happens sometimes sometimes the cells the cells in the human body they don't really give a crap about insulin anymore what's that called well that's called diabetes so the patient is diabetic man yeah they don't care about the insects anymore they don't care about them you know they just they have insulin they have decreased insulin sensitivity or decreased insects syringe sensitivity the cells they don't really listen to it anymore what happens is when you can't decrease the insulin anymore then you end up with diabetes and you end up with a low blood sugar or a high blood sugar you end up with a high blood sugar because the cells are not able to react as well to insulin so they can't lower the blood sugar well enough now another high yield factor very high yield is what else do we give insulin for what else could I give in some I can give it for a hyper glycaemia high blood sugar but what else could I give insulin for this is really I yield fat act should know this don't want to go knowing not knowing this one maybe I went over it yet early in the year so insulin not only how does it decrease Pletcher whoa insulin works on the beta cells yeah yeah yeah yeah me I do yeah insulin actually drives glucose into the cells into the cells that's what we're talking about cellular sensitivity so insulin um it drives it into the cells well what does it take with it into the cells what electrolyte nobody's got this one today I'm surprised usually people get this so there's a there's an electrolyte we can give insulin for it really really high yield you absolutely open there you go Maryann insulin is very often given for hyperkalemia for high potassium if you have a high potassium patient one of the things you can give for a elevated potassium is insulin you give this patient insulin why do you give them insulin will you give them insulin because what happens with insulin it decreases blood glucose that's absolutely right but what insulin draws how does it decrease blood sugar what drives the blood glucose out of the out of the the blood and it pushes it into the cells I mean you can't just give insulin let's think about this you can't just there's no medication that just go and just gobble up the the sugar and just be like wow this sugars mine and now it's not sugar anymore poof it's gone no it has to go somewhere and what happens is there's always cellular shifts so what happens is it takes that glucose and it pushes it into the cells and if it's in the cells it's not in the blood anymore it's not in the serum so the blood glucose is now essentially and the way it also does it as it takes potassium with it into the cells and it takes a lot of potassium because what we know is that there are all these ion shifts which are beyond the whet scope of what I want to go into for nursing and even pathophysiology for nursing but with insulin it takes that potassium with it so it grabs some potassium and it takes the Buccos and it goes hey sugar we're going into the cell let's go and there it goes that's why also because we have a patient hyperkalemia they probably don't also have a high blood sugar so we also may give insulin for high potassium but we give them dextrose as well because they need more sugar and that's not know that you know anybody giving insulin does not always get sugar because the primary use of insulin of course is to decrease blood glucose and somatostatin works in the Delta cells what not the extra exocrine functions which is not endocrine today that's going to be in our GI in a couple of weeks having a GI webinar that's going to be digestive and that's where we talk about the pancreas and the actual islets of langerhans and the digestive enzymes that's the exocrine functions of the pancreas so here we have our pic monix on diabetes of course so just like we talked about here is we have a glucagon pick monic we have all the insulins and you need to know the insolence and it's really really high yield here's the bottom we have this pic monic on insulin you've got to know this insulin pick morning you must must must know it you've got to know all these little insects syringes like the back of your hand and if there's one thing I could teach you they that even if you don't subscribe to pick monic you need to know that Nova logs Novolog I always think it's like this way Nova log here we write here we have these these little Nova logs look at this log and these these little logs here at the top they're rapid-acting but why are they rapid acting with a rapid acting because log is roll really fast that's what you need to remember but what else here we have this rapid acting this is like the log River I always think about this this is actually inside of our pick monic as well I helped to concept this one so I love this story if you go on in this insulin thick monic but so here's a we there's an entire story of all this entire race that's going on but also what which which insulin is also wrapped rapid-acting and that's humulin so you here you have this one on side of a human log humulin because that's what's also rapid-acting of course we go into all the other ones in atlantis here being long a lance long acting whatnot we don't go into all the details but you need to remember all that because it's very very important we give you all those all those nitty gritty details and going all over those stuff the stuff that you do need to memorize yes like the types of insulin and all these nitty-gritty tick tips and tricks that you need to know like Novolog we're going to show you this logon oh if there's a high-yield fact that I mentioned trust me it's already inside of these nursing Pig monix because I helped come up with most of this to help tie and everything that I knew in all these high-yield tips and you just got it no insulin don't go into in clicks without knowing insulin so let's go on down to ovaries and testes everyone loves talking about the ovaries and testes right so we have FSH and LH so FSH follicle stimulating hormone luteinizing hormone is LH and we have this this luge or with the the bobsleigh luge things you know them and even I don't have the other word for it right now so FSH and LH so up in the hypothalamus we have Gennady trope and releasing Norman I'm Anne and I'm actually um uh this is supposed to be a tiny little in so I'm sorry about that so Gooden add a trope and releasing we're gonna add a trip and gonads always think about go dad's here has some gonads and they come down to the anterior pituitary I'm ELISA a physician LH and FSH and LH is always something that everyone struggles with especially when you get to OB everyone hates it right so here are some tips and tricks to help you with emphasis on LH that I can definitely say you will make your life a lot easier with so FSH and LH yeah FSH can go down and LH go down and they work with the testes too and they create testosterone everyone knows that whoop-dee-doo that doesn't even matter right you should know that what's important here is progesterone and estrogen because everyone knows women are insanely complicated and everyone always makes a couple comments with that and I'd love to say it because it's true only it's true this is a medical fact I'm not making this stuff up and I know this you know I Steve works here in the office who helps me with all the webinars works in the background most definitely does all the background work with the webinars always gives me a bunch of crap because 95% of all nurses are women and I know that and my work with all of the women all the time but it's just such a great time to always say that women are complicated and here's where I love to talk about it with estrogen and progesterone so let's think about estrogen and progesterone what I want you to always think about if there's one thing I could teach you is progesterone Pro progesterone is a promoter of pregnancy promoter of pregnancy so if progesterone decreases no more pregnancy that's what I want you to remember estrogen well just this weird Easter egg here it is we got you we have an easter egg and it's the character throughout entire pic monic platform so whoops let's get back sorry so here we have progesterone here it is bigger so this pregnant gesture progesterone Pro pregnancy pregnant gesture Pro for pregnancy they're pro pregnancy estrogen not so much estrogen easter egg and here's why so it's actually just um look at our ovulatory hormones pic monic now here's one here are two big monix if you're in your OB rotation right now you definitely need to know both of these because it goes over all these those awful details you need to know about LH surge and all that stuff so what is the LH surge mean well we have this up at the top we're going back to our original image we talked about the hypothalamus right effort and it comes down and we have FSH and LH we have FSH follicular stimulating hormone the lick Euler stimulating hormone works directly on the follicles or the ovaries and your the ovaries they come up and they both they kind of have these on these follicles that then they kind of they're not connected to the ovary but they're right there that catch whatever is going on so the a follicular stimulating hormone what it works on the follicles here right and if you have luteinizing hormone you kind of think of it was working here with the ovary as well with the ovary so luteinizing hormone causes luening hormone causes this surge right and causes a surgeon that causes the actual egg to mature and break three break free and it catch it it gets caught by the follicles and if it doesn't get caught that you know it ends up in the peritoneum or somewhere else or it gets implanted awkward it's an ectopic pregnancy and we're going to go of that in our OB OB lecture that we're going to go over but what happens at the exact same time you see right here in obviou the Tori hormones one and here's the little chart just to help you here's where LH surge you have this estrogen LH surge boom there goes estrogen it's crazy all the way up and then it drops and what happens is estrogen surges but progesterone is going up at the same time and progesterone only stays elevated if what happens and that's this is where you this is this is the highest yield point here because here's ovulatory hormones to pick Monica be on the other side what happens is if progesterone doesn't stay elevated what happens there's no promotion of the pregnancy come come on ladies is ninety five percent of your women what happens if you don't get pregnant twenty-eight days what happens a day twenty twenty-five twenty seven you have a period that's right you have a period because what happens is progesterone drops right here if you don't actually get pregnant if there's no pregnancy there's no there's no luteal stimulation and promotion progesterone creation from inside of that that that stimulation then the progesterone drops and if progesterone drops there is no promotion of the pregnancy and therefore a termination of whatever is going on inside of the uterus ie period and the shedding of uterine lining and then you have a period and that's where you end up with that lovely 28-day cycle that makes all those ladies so lovely to deal with all the time I always get a bunch of crap from them you so Michelle says she's tired so I'm sorry I'm sorry to show you should wake up maybe you need some synthetic thyroid hormone to increase your metabolic rate and that's where we're going to talk about right now and feedback so let's actually look at this right now for feedback so we talked about all these hormones and there's so much with hormones that you could know and what I want you to know is that the idea of each one so what does each one really do and if you took one at each woman the general idea of what it does then you should know that there's a release er and where is that release or Woods probably in the hypothalamus I almost guarantee it's Anaya thalamus because it's only places releasers these releasers in the hypothalamus and it comes down to the pituitary we're talking about PT a thyroid here comes down to the anterior pituitary and it has TSH thyroid stimulating hormone and then thyroid stimulating hormone so lots of releasing hormone I'm gonna do whatever you say president I'm the general I'm going to go out and send out the troops so we increased t3 t4 and calcitonin we increase it and an important point or a side note in case I didn't say it was it calcitonin you think calcitonin you think calcium and that is true it does help play a part in calcium but mostly when you're an adolescent mostly when you're growing not as much when you're an adult so I don't want to want to get that too too confused so let's actually just look at this so what happens is here is this wonderful feedback system so the hypothalamus up here here's the president this hypo that way up here it's kind of watching everything sitting bags and hey are you doing I'm watching big big long-term long-term planner right and what happens is it's always listening to see how many troops are out in the field and when I say troops I mean how many of the actual hormones it's listening to them that's called feedback and what happens to that feedback is let's actually look at it so if I have way too much t3 and I weigh too much let's imagine t3 some coffee or tea or whatever substance eating one imagines comes into these pipes remember the pipes we're talking about the body and the pipes and these hormones everything goes in the pipes as well as blood and all that go in these pipes and comes back what circulates through the body comes up and actually comes back to the hypothalamus Ivan Alamos is listening it's looking for all those troops how much is out there whoa I'm drowning in so much t3 and t4 and what happens is the hypothalamus is way there's way too much stop giving thyroid releasing hormone stop putting it out there too much when it stops putting it out says decrease well then it stops telling thyroid stimulating hormone to release to create and if there's no thyroid stimulating hormone then it stops creating t3 and t4 and calcitonin this is exactly what happens in all of those feedback mechanisms exactly the same way something is listening and it stops the chain of creation and exactly in the same scenario so that same listen to sings near what happens if I'm taking a exogenous or I'm taking my mouth sigh roid homeowner levothyroxine right levothyroxine taking me some levothyroxine because Kendal gained six pounds because they have free food at the hospital and I need to lose some weight so I take some levothyroxine well what happens is I have too much thyroid hormone so I'm actually not creating the thyroid hormone by my thyroid what happens is my my hypothalamus doesn't know the difference so my epithalamus still has the exact same reaction his way there's too much there's too much thyroid hormone stop the train here stop the thyroid releasing hormone which stops the thyroid stimulating hormone which stops the creation of thyroid hormones so what happens with every single patient is taking these weight-loss drugs they take them for 30 days and then they stop there's nothing left there's nothing there to stimulate them these people get hungry because there's no thyroid hormone and it takes a while for the hypothalamus to catch back up and these people eat like crazy and of course because they're they can never get to that extent I rate of thyroid hormone that's too much they gain weight and and they end up they end up becoming a low basal metabolic rate and of course it regulates over time and this is not permanent but this is always watching it's always a system how it all works and how it all goes together and this is how you should think about i'm adrenocorticotropic hormone and corticotropin-releasing hormone so if I had corticotropin-releasing hormone up here in the top for CRH and then I said adrenocorticotropic hormone here in the adrenal anterior pituitary gland and then I said cortisol exactly the same thing happens if I'm over here given in if I'm given prednisone if I'm given prednisone as an example I'm dumping prednisone in the body which shuts off these systems it shuts off all the actual hormones the body is creating normally and when it shuts them off normally hypothalamus says no we don't need to make any core to control them to the normal no and that says to the interior pituitary hey friend how you doing no I don't need any adrenocorticotropic hormone or adrenal toward ACTH rather and when you have no ACTH you have no cortisol you have no aldosterone you have a decreased amount of catecholamines so what happens if you stop taking that prednisone all at once which is an absolutely horrible idea that's why we taper the dose when that happens there are no single there are no actual hormones in the body and you have a data Sounion crisis and that's why it's so important to taper to tape or tape or taper steroids it's very very important it's really really I appoint don't do that so that's on on feedback mechanism one of the things with all these treatments everything I've talked about on everything I went over today is all about all these medications and everything all these interactions today we I mean pic Manik has over a hundred and fifty medications alone inside of our product and it's definitely one of the hardest things that I hear a lot of nurses actually it is the hardest thing I hear a lot of nurses really struggle with aside from putting together the concepts that we talked about talked about today putting the concepts again I always hear about they didn't really get that explained that well to me I didn't get a good story I mean what we actually know at thick monic more than anything we're we like to learn as well that's one thing I love more than anything is to learn something new so we're constantly researching and understanding things and one of the things we're understanding is how people learn and as many associations as I can make as many awkward things whether it's my own stories which are always tied into all these webinars or it's a pic monic story I can tie in it's definitely something that will give you more associations to remember something so maybe you're going to remember hypothyroid or hyperthyroidism because of those weight loss drugs and taking synthetic levothyroxine from India or wherever it comes and remember hypothyroidism increasing raise amount of metabolic rate as many associations that I can give you the more likely you are to understand so let's put everything we just talked about together let's just talk about it for a second what you need to do is remember the basic function of all of the hormones what does insulin do again insulin decreases blood glucose by pushing a sugar into the cells and it just happens to take a long potassium with it and that's where it's like that extra little tidbit the PICC monocle help you remember that's what you need to remember the basic function but what you need to know is what happens if I have too much insulin and a really common question I see especially at the med school level and I saw it I saw it once in the nursing level is I see them the question where a nurse injection is injecting insulin to herself what happens if you have too much insulin well you end up with a pain you know somebody who is purposely making them sick and when you purposely make yourself purposely give yourself too much insulin you end up with hypoglycemia because I know what insulin does and that's how you need to actually think about things I know what insulin does so if I have too much well then I'm gonna have AIBO glycemia what if I don't have enough or my cells don't listen to the insulin they say hey insulin have a nice day then I'm gonna hyperglycemic way too much blood sugar in my blood we don't want too much i sugar in your blood you're gonna end with this sludgy sludgy blood and that's never fun so if you know what happens with a function of each then you can always think it through too much or too little and if there's one thing that we had a really hot debate on on one of our questions speaking of blood glucose and I love I love to read our questions we have a question of the day every day we post a question but a really nice good debate on our hypoglycemia pit monic I'm any patient is hypoglycemic right they're hypoglycemic we you know you need to get them some sugar and if you know you need to get them some sugar into their into their blood you need to give them what medication or you need to give them what well you can give them sugar you can give them oral glucose you give them out candy or you give them anything but any patient who is not able to take anything by mouth they're not able to swallow anything where they are at a risk for aspiration we would never give any that patient anything until someone says it's okay for them to swallow and who's that someone a speech therapist so unless someone a speech therapist or a doctor says a you can give this patient something by mouth it's okay anybody who's at risk for aspiration receives nothing by mouth and how do we know somebody who can't swallow somebody who's lethargic confused those types of things and that's where we in the answer to our question of the day was you give them I am glucagon and the high up point here is when you think about the in clicks and these questions I'm just kind of went off on a ramp you always imagine and clicks questions with like a perfect world there's a perfect world out there it's a perfect world of the NCLEX and you have everything in your back pocket for sure if you have any questions now you can type them into our into our question box there if you have something else that I didn't get to I think I answered all the questions as we went through day which was really good and I went a couple minutes over but that's that's okay so Erin says can you describe or can you explain why why hypocalcemia and thyroid ectomy again so that means that's a super super high yield point and we actually had a question of the day on it I wrote a question on the day on and it was if you have a patient who has a thyroidectomy so they're the thyroid taken out well that's great I mean the obviously you could have a you're going to have hypothyroidism and you're going to have you're going to need to replace their thyroid hormones with levothyroxine but what are you most concerned about what are you most concerned about right away acutely after surgery and that is a low calcium level but why well that's because in the back of the thyroid gland there are these four little nuggets on the back of there and those are the parathyroid glands and if you remember the basic function of each of each organ and each thing parathyroid glands create parathyroid hormone genius genius naming system I understand and that actually releases parathyroid releasing peptide which increases calcium so if you accidentally nicked the parathyroid hormone or you a surgeon took them all out what I can tell you is actually it's really hard you got to get down in there and it's like it's like milk and a cat a cat I don't know if anybody's ever milked a cow but it's really are they're really tiny you gotta be able to see which one is which and they're you know pick monic we've made the parathyroid gland this beautiful yellow but in reality they're not yellow you find them you have to take them off and leave the parathyroid gland take out the thyroid it's pretty hard um Steve's giving me some crap about talking about milking a cat but I always try to throw that reference and as many times as I can or something awkward just to see if people are paying attention but um if you take that out what happens if you have no parathyroid gland then no parathyroid gland means a drop in calcium and a severe drop in calcium but why does calcium matter I mean that's that's the question here why does calcium matter well if you have low potassium you have a run the risk of increasing the QT interval and anytime we have a problem with prolonging that QT interval on the ECG prolong in the QT interval what happens prolong the QT interval well you have arrhythmias and most likely v-tach and death I mean you have a very high risk of arrhythmias and that's a serious problem hypocalcemia so what are some things we see in high because I mean what we we monitor for in our patient we're going to matter for them shop shops Shostak sign always pronounced and say that a little bit wrong but how do I remember shop sex time well we know that we have our chops and pick monic but we have a little twitch when you tap here on the facial nerve and to where I can't wait that side twitch when you tap on the facial nerve and we also see trousseau syndrome or trousseau sign which is the curling in of the hands curling in something else you see when you have somebody hyperventilating because of a calcium shift as well ionization so rosemary says why do we need potassium when taking insulin and rosemary this is really rose me sorry why do we need potassium when we take insulin well what does insulin do insulin decreases what is a function overall function of of insulin and decreases blood sugar right that that's true great that you're right but how does it increase blood sugar what increases or decreases lecture it decreases blood sugar by pushing blood glue to pushing glucose from the blood into the cells into the interstitial spaces into the cells themselves and how does it do that well it works is with these ions and it takes potassium it takes them yeah I'm sorry wait no it yeah it takes some it takes potassium with it so if you give insulin it's going to take potassium with the end of this into the cells so if you're giving insulin you don't have to give potassium at the same time you have to give dextrose or sugar if you're giving insulin for high potassium so let's just stop and back up a second there on on what we're giving it for so we the indication of why are you giving insulin to this patient I'm giving this patient insulin because they have a high potassium because I know I'm going to push that potassium into the cells along with glucose so then I know that if I'm giving it to a patient who has a normal blood glucose because they have a high potassium then I need to give blood then I need to give glucose or dextrose along with the insulin to push that potassium into the cells nearly of a kayexalate in in a Monde things like that as well but if I'm giving insulin because they have a high blood sugar you do not need to give potassium as a supplement unless I mean unless this patients 1200 of blood sugar or something insane and you have to give an insane amount of insulin but that's that's so you're not going to get that kind of scenario when you're questioning Sam for sure so um I'm not seeing any questions that I haven't really got to today so it looks like I went through all of them as we went through that's good so if you have any questions one thing for sure reach out to us you can send send us an email at feedback pick mana calm you have any questions so just reach out to us send us an email we'll get to it right away and if I don't answer it right away Steve hits me with a cattle prod he says hey Kendal you got an answer got an answer bethenny right away or I'm going to shock you so I do a pretty quick so feedback at peak mana calm otherwise we have several webinars coming up and the only thing we could ask is if you know to share the webinars with your friends and know hundreds of people come to many of our webinars we appreciate it so share with your classmates and your friends and let us know if you have any questions reach out to us as always have a good night and good luck study you

Channel: PicmonicVideo

Views: 278,850

Keywords: Pharmacology (Field Of Study), endocrine, Endocrinology (Medical Specialty), nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics

Id: CgYHU2SptTo

Length: 74min 31sec (4471 seconds)

Published: Fri Sep 18 2015