3/30 Flashcards
A nurse should know which of the following hormones are produced the pituitary gland? SATA
A. ADH
B. TSH
C. ACTH
D. Aldosterone
E. GH
Answer: A, B, C, E
Rationale: know which hormones come from ant pit and post pit
Ant - FSH, LH, growth hormone, prolactin, TSH, ACTH
Post - ADH, oxytocin
Hormones that help regulate BP - from kidneys
Aldosterone - adrenal glands
A nurse should know that DI and SIADH have which of the following in common?
A. They both cause greater than 205mL of urine produced/hour
B. they both can be caused by neurologic issues
C. they both cause extreme thirst
D. they both require treating the underlying cause
Answer: B
Rationale: neuro pts - at risk for both SIADH and DI - opp disorders
Both can be caused by trauma - risk for intracranial swelling - swelling - weird pressure on pit - SIADH/DI - trauma (esp head trauma)
Pit tumor: removed - hypophysectomy - trauma to the brain area that could result in swelling - risk for both
If can treat underlying cause - genetic variant of DI - not fixing that - give supplemental drugs
SIADH
DI
Too much ADH
Lower Na
Correct Na over long period time - not correct too period time - can end up with brain herniation - correct slowly
Water intoxication
Too much fluid retaining
Fluid volume overload - see decrease Na and potential confusion for pt
Do not correct Na quickly - dangerous shift - can cause brain herniation - correct slowly
Retain fluid
SIADH
Diabetes - sweet urine
Polyuria and polydipsia - voiding a lot and thirsty
Extreme thirst
Too little ADH - diuresis any fluid that comes into it
Drinking 100-200 sometimes 300 oz fluid - all urinated out
Clear and dilute urine
Greater than 205 mL
Dry inside - all leaves the body - high Na
Diuresis a lot - high Na
Risks: drinking that much fluid: electrolyte imbalances - esp Na
May have genetic cause
Replace with synthetic version - vasopressin
Not fixing underlying cause - fix with supplementation
DI
The nurse is caring for a client post total hypophysectomy with a transsphenoidal approach. Which of the following are clinical manifestations of adverse events caused by the surgery? SATA
A. SIADH
B. meningitis
C. DI
D. pneumocephalus
E. CSF leakage
Answer: A, B, C, D, E
Rationale: poke through nose and remove part pit/whole with this approprach
Can cause ICP
Can cause SIADH and DI
Can cause meningitis - poked hole through skull
Pneumocephalus - air in the head/skull where it should not be - finite amt face - weird pressures and not like that and not do job effectively - more happen in OR with this
CSF leakage - brain surgery; drainage - test for glucose; clear drainage unless there is an infection; pt complain continuous postnasal drip but sweet - high in glucose - down back throat and taste; postnasal drip; notice halo sign - additional testing; complaining of a headache
Halo sign: diff color separation as fluid separates out with more clear in middle - not definitive - says need do further testing
EDU not have CSF leakage: not blow nose, not cough, not strain, not bend over, not less than 30 degrees, not drink through straw, not prone; nothing increase ICP - lots EDU BEFORE PROCEDURE; AVOID ICP
Come up - mustache dressing - do not mess with it much: not chage it routinely - assess gauze itself and see if dressing clean, dry, intact - saturated - prob: is a leak
The nurse should know that which of the following are manifestations of Adrenocortical Excess? SATA
A. hyperglycemia
B. trunk enlargement
C. sodium wastage
D. Moon face
E. Buffalo hump
Answer: A, B, D, E
Rationale: AKA Cushing’s disease, hypercortisolism
Monitoring BG; may have them on insulin - get adrenal issue under control - may be temp - esp if in crisis
Trunk enlargement - cortisol babies - too much stress hormone causes abdominal weight gain
Moon face - classic and extreme manifestations
Buffalo hump - classic and extreme manifestations
Excess of salt, sugar, steroids
Na wastage - with Addison’s; low cortisol; hypocrotisolism
Addison’s
Deficient of salt, sugar, steroids
Heat can bring on crisis
Overarching issue: not enough steroids - replace
Replace fluids
Presents on crisis priorities:
Addison’s
Monitor Na - make changes gradually
Dehydrated as well
Not always conscious
Sugar - D50 IV
Replace fluids - D5 NS - dextrose in it - gradually replace Na as well; Na too low - diff fluid give: hypertonic saline - 2% or 3% - high alert med - typ ICU or high acuity PCU - monitored closely because do not want brain herniations
Overarching issue: not enough steroids - replace
Temp also an issue - too hot is a trigger - not let me too warm/over stimulated
Presents on crisis priorities:
A nurse should know that the difference between hypothyroidism and hyperthyroidism is which of the following statements?
A. hypothyroidism causes increased T3 and T4
B. hyperthyroidism causes increased T3 and T4
C. only hyperthyroidism requires medication to treat
D. hyperthyroidism is more likely to affect men
Answer: B
Rationale: hyperthyroidism - too much thyroid hormone - anticipate: TSH to be - low because negative feedback sys - test TSH unless thyroid panel - TSH points to if hypo or hyperthyroid
Hyperthyroidism aka thyrotoxicosis and Grave’s disease - with extended exposure - get exophalomus and correct thyroid issue is permanent change to eyes
Grave’s disease and after surgery - number one priority - issue is airway - norm for swelling - worried about breathing - circ concerned - carotid and jugulars
Treat hyperthyroidism - surgery or radioactive iodine - overproduction and enlarged gland - want to remove it; total thyroidectomy - induced hypothyroidism - give synthroid/levothyroxine - sometimes take portion but often take whole thing
Hypothyroidism - TSH: high; T3 and T4 would be low - thyroid cannot meet the demands - give synthroid/levothyroxine - synthetically replace
Women more likely to suffer from thyroid issue
A homeowner purchases flood insurance because they live in a flood plain, but it has not flooded in over 50 years. What phase of disaster management does this speak to?
A. Mitigation
B. Preparedness
C. Response
D. Recovery
Answer: A
Rationale: mitigation - reduce damage occurred before an event occurs; insurance is always mitigation; basements for tornadoes; building codes for earthquakes based on location - withstand earthquakes; reduce damages in terms finances, life, infrastructure; hospital - disaster preparedness plan; plan; steps to reduce damage
Preparedness - fire drill; hospital - diff weather codes vs triaging; tornado sirens go off; drill or immediate preceding event; review what do in severe weather or do stuff before event
Response - event is happening or just happened; sending a team down to help; incident command sys; hospital functioning in tents; IV functioning in truck beds; tagging of pts; triage; time right after to a few weeks after where still dealing with issues from incident; temporary housing post-issue
Recovery - more long-term; brought in trailers to live in while build-in homes; return to some level of normalcy
The same homeowner is placing sandbags in the low areas around their home after hearing that record-breaking rains will be occurring. What phase of disaster management does this speak to?
A. Mitigation
B. Preparedness
C. Response
D. Recovery
Answer: B
Disaster situation - coding situation
Triage pts
Black
Red
Yellow
Green
Tagging
Bluish discoloration to posterior side and no pulse - already passed
Already passed or no chance for them to recover
Have pulse - 20 bpm - pale - no OR - cannot do anything to help them
Not already expired - at least give them decent pain medication provided have that
Black
ICU pt
Alive but may not be much longer if not do something about it
While trying to evacuate fam - struck by falling debris and has intracranial swelling - RR is 7 and having some decorticate positioning - needs intervention - ideally like have OR but tent hospital might be able suffice - need help quickly
Red
Telemetry pt or low acuity PCU - keep overnight
Chest pain - stress of situation - getting to them - not feel good esp when try do activity - indigestion and SOB - EKG - no ST elevation but elevation troponin in labs - NSTEMI heart attack - do something about - more time - Cath lab in morning and follow serial troponin
Yellow
