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Adults > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Hypothalamus

A

relay station. Receives all the info from the body and sends message to the pituitary.

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2
Q

Pituitary

A

takes the message and sends it to the gland

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3
Q

Thyroid

A

metabolism, heartrate, contractility, energy, growth

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4
Q

Parathyroid Gland

A

has to do with calcium regulation

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5
Q

Kidneys and endocrine

A

produce erythropoietin and renin

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6
Q

Heart and endocrine

A

produces naturistic peptide

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7
Q

Difference between endocrine and exocrine glands

A
  • Exocrine secretes through ducts
  • Endocrine secrete directly into the bloodstream
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8
Q

Amines & Amino acid derivatives

A

Act immediately
Epinephrine, norepinephrine, & thyroid hormones

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9
Q

Peptides, Polypeptides, Proteins, & Glycoproteins

A

Act within seconds / minutes
TRH, FSH, & GH

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10
Q

Steroids

A

Act in several hours
Corticosteroids

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11
Q

Hormones

A

Regulate organ function
Endocrine system integrated with nervous system (Neuro-endocrine System)
Affect only target cells with specific receptors
Negative feedback loop
Trophic effects on target tissues (hyper or atrophic)

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12
Q

Neuro Stock

A

pathway between the pituitary gland and the posterior

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13
Q

Portal Pathway

A

pathway between the pituitary gland and the anterior

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14
Q

Hypothalamus + Pituitary

A

makes ADH and Oxytocin and sends them to the posterior to store there

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15
Q

Anterior Pituitary Hormones

A

Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin (PRL)
Adrenocorticotropic hormone (ACTH)
Thyroid stimulating hormone (TSH)
Growth hormone (GH)

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16
Q

Posterior Pituitary Hormones

A

ADH
Oxytocin

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17
Q

GH is increased

A

deep sleep, stress, exercise, fasting and malnutrition

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18
Q

GH is decreased

A

by obesity, hypothyroidism, and depression

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19
Q

Causes of Hypopituitarism

A

Trauma, tumor, radiation therapy, or vascular lesion can cause it from working

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20
Q

Acromegaly

A

Too Much Growth Hormone
Growth of all organs and tissues except of central nervous system. This is going to result in shorting out of the nerves because they cannot keep up with the growth

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21
Q

S/SX of Acromegaly

A

o Tremors, paralysis, neuropathies
o Headaches
o Visual disturbances
o Endocrine Disorders

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22
Q

TX of acromegaly

A
  • Do an H+P
  • Visual Acuity test
  • CT or MRI to test for a tumor
  • Hormone levels: what is being affected
  • Surgery to take out the tumors
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23
Q

If we need to take out the Pituitary

A

Monitor BP
Monitor blood sugars (Addisonian crisis)
REPLACE CORTISOL AND THYROID HORMONE (Especially if we took out the anterior)
Monitor for Diabetes Insipidus (having to do with posterior)

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24
Q

transsphenoidal hypovisectomy

A

taking out the pituitary gland

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25
Q

External beam radiation

A
  • Radiation slows down the release of the GH
  • Going up through the nose and putting radiation therapy into the nose. Anything around that radiation is going to be cooked.
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26
Q

Drug Therapy for Acromegaly

A

Somatostatin: stops the growth hormone

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27
Q

Diabetes Insipidus

A

result of lack of ADH

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28
Q

DI causes

A

o Trauma to the head
o Infection in the brain
o Tumor
o Nephrogenic (Kidneys are not responding to ADH)
o Damage to the pituitary gland

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29
Q

Specific Gravity of someone with DI

A

1.001-1.005

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30
Q

Normal Specific gravity

A

1.005-1.030

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31
Q

Clinical Manifestations of DI

A

o High HR
o Weak pulses
o Blood is concentrated
o BP is high
o Sodium level is very high 150 or higher
o Increase H+H
o Increased BUN
o Can cause acute kidney damage
o Urine output: no action of the ADH on the tubules. More than 250 ml per hour. 18,000/day
o Urine is dilute
o Skin turgor: poor
o Tenting of the skin
o Mucous membranes are high
o Dehydration
o Excessively thirsty
o Craving for ice or cold water
o Signs of dehydration
o Lethargy to coma
o Ataxia: uncoordinated movements

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32
Q

Medications for DI

A

Desmopressin (ADH replacement hormone)
o Less output
o Stronger dilute
o Increase BP
o Decrease HR
o Decrease Na+

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33
Q

Nursing Interventions

A

o Monitor I+O hourly
o Weight patient daily
o Monitor specific gravity (higher)
o Blow nose before giving nasal spray
o Avoid alcohol is because it suppresses the ADH!
o Wear medical bracelet

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34
Q

SIAH

A

Syndrome of inappropriate Antidiuretic hormone

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35
Q

Clinical Findings for SIAH

A

o Headache: too much fluid
o N+V (electrolyte imbalance)
o Diarrhea
o Mental sluggishness
o Diminished deep tendon reflexes
o Weight gain
o Blood pressure increase
o Heart rate is going to increase
o Specific gravity is going to be greater than 1.03

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36
Q

Management of SIAH

A

o Treat underlying cause
o Clip aneurism in the brain
o If it is a stroke it will heal on its own
o Caused by tumor, take the tumor out.
o Fluid restriction
o Sodium restriction: salt is going to cells which makes you plump up

37
Q

Medications for SIAH

A

Diuretics

38
Q

Nursing Care for SIAH

A

o Hourly i+o
o Put out enough fluid
o Daily weights
o Urine and blood work
o If sodium is very low: 3% sodium chloride
 This puts the salt right into the bloodstream to pull the water out of the cells
o They are at very high risk for seizures
o Prevent water intoxication
o Correct electrolyte disturbances

39
Q

Thyroid hormone – T3, T4

A

Accelerates cellular reaction in most body cells
Increase BMR
Increases growth
Stimulates protein synthesis
Influences growth, development, and cell differentiation
Mitochondrial membranes bind thyroid hormones, which regulate energy metabolism
Exert chronotropic and inotropic cardiac effects
Increase bone formation and decrease bone reabsorption of calcium
Act as insulin antagonists

40
Q

Iodine

A

required in order for the thyroid gland to make the thyroid hormone

41
Q

Goiter

A

result of overgrowth of thyroid tissue

42
Q

Hyperfunction of thyroid

A

Graves Disease
Receptors on our thyroid gland. Antibodies sit on the receptor sites and the thyroid gland thinks it is TSH so it makes a ton of thyroid hormone without stopping so the thyroid gets bigger and bigger

43
Q

Thyroid toxicosis/Thyroid Storm:

A

critical hyperthyroidism

44
Q

Hashimoto’s

A

excessive hypothyroidism

45
Q

Diagnostic of thyroid disorders

A

 Serum: TSH, T3 and T4
 Serum free T4
 T3 resin uptake test
 Thyroid antibodies
 Radioactive iodine uptake
 Fine needle aspiration biopsy
 Thyroid scan, radio scan
 Serum thyroglobulin

46
Q

Medications known to affect thyroid testing

A

amiodarone
aspirin
cimetidine
diazepam
estrogens
furosemide
glucocorticoids
heparin
lithium
phenytoin and other anticonvulsants
propranolol

47
Q

Causes of Hypothyroidism

A

Autoimmune disease (Hashimoto thyroiditis, post-Graves disease)
Atrophy of thyroid gland with aging
Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma)
Iodine deficiency, iodine excess, and iodine compounds
Medications (e.g., Lithium)
Radioactive iodine (131I)
Therapy for hyperthyroidism
Thyroidectomy

48
Q

Hypothyroidism

A

Deficiency of Thyroid Hormone (TH)
Slowed body metabolism
Decreased heat production
Decreased oxygen consumption by the tissues

49
Q

Primary Hypothyroidism

A

Autoimmune thyroiditis - Hashimoto Disease
95% of cases

50
Q

Secondary Hypothyroidism

A

Overtreatment of hyperthyroidism
Thyroidectomy
Radioactive iodine

51
Q

Hypothyroid Manifestations

A

o Skin: dry, brittle
o Hair: dry and brittle
o Thickened secretions in my lungs
o Slow respirations
o Heart is going to be slower
o BP lower
o Psychologically depressed
o Apathetic
o Constipation
o Muscle aches and weakness
o Neurologically blah
o Metabolically: not metabolize things well

52
Q

Myxedema

A

Elevated serum cholesterol
Rare life-threatening condition
Undiagnosed / under-treated patients
Stressors

53
Q

Myxedema s/sx

A

hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive supportive and hemodynamic therapy if the patient is to survive.

54
Q

Nursing Interventions of Hypothyroidism

A

Administer thyroid hormones
Provide stimulation
Monitor response to increased activity
Monitor for heat/cold intolerance
Monitor neurologic status
Monitor VS
Explain life-long therapy

55
Q

Three hallmarks of Graves Disease

A

goiter, hyperthyroidism, exophthalmos

56
Q

Medicaion for Hypothyroidism

A

Levothyroxine

57
Q

Levothyroxine Considerations

A

o Major adverse effect if given at night: insomnia
o Give it first thing in the morning
o We want to prevent cardiac dysfunction and monitor EKG
o We want to prevent any medication interactions
o Administer the thyroid hormones
o You cannot switch back and forth between brand name or generic because of what they make the pills with
 Synthroid is the name brand.
o Lifelong therapy
o Monitor lab levels
o Provide stimulation

58
Q

Clinical Manifestations of Hyperthyroidism

A

o Skin: oily, hair loss
o Pulmonary
o Cardiovascular: high heart rate high BP
o Psychological: irritable, agitated, anxious restless
o Gastrointestinal: extremely high appetite (can eat 5000 calories a day), diarrhea
o Musculoskeletal: muscle wasting
o Neurological: on edge, premature osteoporosis
o Metabolic: heat intolerance

59
Q

Complications of hyperthyroidism

A

o Exophthalmos: eye drops, tape them shut at night to protect them, keep HOB elevated, diuretics
 Don’t go away after we correct hyperthyroidism until they do a surgical decompression
o Heart disease: high BP and high HR
 Propranolol: asthma patients are contraindicated

60
Q

Thyroid Storm

A

Fatal hyperthyroidism
 s/sx: temp is greater than 101.3
 HR: greater than 130
 BP: high
 Delirium and psychosis

61
Q

Antithyroid medication

A

Propathyroid uracil: Blocks conversion of T4-T3

62
Q

Thyroidectomy

A

o Removal of the thyroid
o They are now on levothyroxine for life

63
Q

Nursing interventions for Hyperthyroidism

A

o Cardiac output
o Maintain a high calorie diet
o Watch weight daily (4.5lbs a day)
o High calorie high protein diet
o Watch body temperature
o Monitor s/sx of cardiac issues

64
Q

Endemic Goiter

A

Enlargement of the thyroid gland due to lack of iodine

65
Q

Nursing Interventions for someone getting thyroidectomy

A

o Pre op: lugals
o Post op: monitor for bleeding. HOB up because there will be swelling and trouble breathing. Stabilize the head with sandbags, check to the back of the head for bleeding
o Extreme swelling in the neck might require suction and a trach insertion kit
o Monitoring for complications

66
Q

Parathyroid gland

A

Cites of actions for hormone: bones, kidneys and gut. Calcium is in the gut to neutralize acid. We are going to have a ton of acid in the gut if the parathyroid is accidentally taken out. Calcium is being pulled from bones, then our bones are going to get weak. Then the kidneys are not able to regulate all of the calcium in the blood

67
Q

Hyperparathyroidism

A

if parathyroid is high in my blood, it is not in my gut or bones or kidneys. This means that the gut will have peptic ulcers, kidneys will develop stones, and then it will cause osteoporosis

68
Q

Hyperparathyroid S/Sx

A

Anorexia
N/V
Constipation
Abdominal pain
Deep bone pain
Muscular weakness
Bone cysts/lesions
Bone fx
Elevated serum calcium levels and parathormone levels
Cardiac dysrhythmias
Renal calculi
Pyelonephritis
Peptic ulcer formation
Fatigue
Complications

69
Q

Hypercalemic Crisis

A

Serum Calcium levels > 13 mg/dL
Need rapid hydration
Calcitonin promotes renal excretion
Bisphosphonates
Cytotoxic agents May need dialysis

70
Q

Nursing Interventions for Hypercalcemia

A

Assess for s/sx renal calculi
VS
Strain the urine
Encourage fluid intake
Assist with ambulation
Limit fluids high in calcium
Provide cardiac monitoring
Medicate for bone pain

71
Q

Hypocalcemia s/sx

A

Muscle Cramps
Mental changes
seizures
excessive muscle contractions
muscle cramps

72
Q

Nursing Management of Hypocalcemia

A

Focus on correcting:
Hypocalcemia
Vitamin D deficiency
Hypomagnesemia
Give IV calcium gluconate
May need long-term therapy
Food high in Calcium and low in phosphorus
Medic alert bracelet

73
Q

Adrenal Medulla

A

Part of Autonomic Nervous System

Secretes catecholamines
Regulate metabolic pathways
Fight-or-flight

74
Q

Pheochromocytoma

A

Tumor of adrenal medulla (usually benign)
Equally common in women and men

Risk factors that stimulate a paroxysm of catecholamine release
Smoking
Micturition
Activities that displace abdominal organs
Drugs

W/O EARLY intervention at risk for cerebral hemorrhage & cardiac failure

75
Q

Diagnosis of Pheochromocytoma

A

History and physical
24-hour urine for vanillylmandelic acid (VMA)
Plasma catecholamine levels
MRI/CT

76
Q

Clinical Manifestations of Pheochromocytoma

A

Hyperglycemia
*HTN with pounding headaches
Headache
Hyperthyroidism
Tachycardia
Nausea / vomiting
Increased basic metabolic rate
Hyperglycemia / glucosuria
Increased urinary catecholamines

77
Q

5 H’s of Pheochromocytoma

A

Hypertension
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia

78
Q

Addison’s Disease

A

Idiopathic atrophy or destruction
Hypofunction
Autoimmune process
Adrenalectomy

79
Q

Addison’s risk factors

A

History of endocrine disorders
Sudden stopping of glucocorticoids
Taking glucocorticoids > once every other day
Adrenalectomy
Tuberculosis

80
Q

Addison’s Disease: Clinical Manifestations

A

Slow insidious onset
Fatigue
Irritability
Weight loss
Nausea/vomiting
Postural hypotension
Symptoms worsen as disease progresses and 90% of adrenal cortices are lost

81
Q

Addison’s Disease: Diagnosis

A

Blood and urine hormonal assays
Serum cortisol
Plasma ACTH
Serum electrolytes
Blood glucose
CBC
CT / MRI

82
Q

Nursing Management

A

Assessing patient
Monitor and manage for Addisonian crisis
Restore Fluid Balance
Improving Activity Tolerance

83
Q

Medical Management of Addisons

A

Combating circulatory shock
Restoring circulation
Administering fluids / corticosteroids
Monitor VS
Place patient lying down with legs elevated

84
Q

Addisonian Crisis

A

Sudden penetrating pain in back, abdomen, or legs
Depressed or changed mental status
Volume depletion
Hypotension
Loss of consciousness
Shock
Hypoglycemia

85
Q

Cushing’s Syndrome

A

Most common cause
Long-term use of corticosteroids
Over-activity of adrenal cortex
Tumor of pituitary producing too much ACTH

86
Q

Cushing’s Syndrome: Clinical Manifestations

A

Moon face
Buffalo hump
Truncal obesity
Weight gain
Malaise/weakness
Mood swings
Hyperglycemia (steroid diabetes)
Hypercalcemia
Hypokalemia
Abnormal fat distribution

87
Q

Cushing’s Syndrome: Diagnostics

A

Labs
Plasma cortisol levels
Blood glucose & serum Na+
↑WBC, but ↓eosinophil and lymphocyte counts
Urinary free cortisol measurement
Low dose dexamethasone suppression tests
X-rays, CT scans, MRI
Arteriography
Overnight dexamethasone suppression test

88
Q

Cushing’s: Medical Management

A

Adrenal enzyme inhibitors
ketoconazole
ACTH-reducing agents: cyproheptadine (Periactin) or somatostatin

89
Q

Bilateral adrenalectomy

A

lifelong glucocorticoid & mineralocorticoid replacement
to treat cushings

Adults (6 decks)

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