Chapter 45 Endocrine Flashcards
Negative Feedback is where an increase of a hormone causes ______ to be produced and a decrease in hormone causes ________ to be produced
less
more
The endocrine system is a ____________ feedback system
negative
Endocrine disorders are caused by a __________________ or ________________ of hormones
overproduction or underproduction
**Diagnostic tests for hormone levels
* Blood and _______
*S___________ or S____________ testing
* Genetics
* Radiology including
**P___ and Dexa— measures bone mineral density
urine
Stimulation, suppression
PET
The ________ gland is referred to as the “master gland”; it secretes hormones into the bloodstream
Pituitary
The _____________ is the coordinating center of the brain
Hypothalamus
Suppression tests are used to detect ____________ of an endocrine organ
HYPERsecretion
What are the hormones that the anterior pituitary gland secretes: 6
Follicle Stimulating Hormone
Lutenizing Hormone
Adrenocorticotropic Hormone
Thyroid Stimulating Hormone
Prolactin
Growth Hormone
What are the hormones that the posterior pituitary secretes:
Antidiuretic Hormone
Oxytocin
Too much GH can cause what?
Gigantism (before puberty) or Acromegaly (after puberty/ adult)
Hyperpituitarism is most often caused by what ?
Tumors or hyperplasia
- Increased Growth Hormone causes :
- Increased ACTH causes:
- Increased TSH causes:
- Increased ADH causes:
Gigantism/Acromegaly
Cushing’s
HYPERthyroidism
SIADH
- Decreased Growth Hormone causes :
- Decreased ACTH causes:
- Decreased TSH causes:
- Decreased ADH causes:
Dwarfism
Addison
HYPOthyroidism
DI
_________ therapy may be used alone or in combination with surgery and or radiation
Drug
____________ removal of the pituitary gland and tumor, called ______________ is the most common treatment for hyperpituitarism
Surgical, hypophysectomy
Immediately after surgery, advise pt to avoid activities that increase ICP such as:
Brushing teeth (2weeks)
Bending over
Straining
Coughing
Blowing nose
What is the most common surgical method for a hypophysectomy?
Oronasal transsphenoidal approach
Nursing Interventions post Hypophysectomy
Q___H Neuro Checks
Assess for ___________drip and assess drainage for ___________
Elevate _____
Avoid __________ and ___________ ________
Assess for meningitis
____________ replacement
Avoid bending/ straining/ brushing teeth
Education: decreased sense of ________
1
postnasal , glucose
HOB
coughing, blowing nose
Hormone
Smell
Growth Hormone is regulated by the ________________ based on __________
hypothalamus
glucose
an _________ in BS causes the release of GH
a _____________ in BS inhibits release of GH
increase
decrease
______________ occurs if tumor formation is pre-puberty (rapid growth)
_____________ occurs if tumor formation is after puberty (in adult)
Gigantism
Acromegaly
Common Manifestations of TOO MUCH GH
* HA and _______ changes (r/t compression of optic nerve)
* Widened _________ bone
* Growth and thickening of ______, _______, _______.
* HTN, HF, CAD, _____________ (enlargement of organs)
* ______glycemia
visual
brow
hands, face, feet
organomegaly
HYPER
What is administered for Acromegaly/ Gigantism?
Somatostatin analogs (synthetic somatostatin) I — inhibits the release of GH
The thyroid gland is stimulated by the __________ ____________ gland
anterior pituitary
TSH controls the release of :
T3, T4
The thyroid gland produces 3 hormones, they are:
T3
T4
Calcitonin
______________ decreased serum calcium by increasing its deposition in the bone
Calcitonin
The _____________ gland produces the parathormone
Parathyroid
__________________ increases bone breakdown and increases serum calcium
Parathormone
What is the most common cause of Hyperthyroidism?
Grave’s disease : autoimmune disorder that produces thyroid stimulating immunoglobulins
What are the most common manifestations of Hyperthyroidism? 9
High metabolic rate
Increase temp, SBP, HR
Cardiac dysrhythmias
Goiter
Weight loss
Heat intolerance
Exopthalmos
What is the most common treatment for hyperthyroidism?
Radioactive Iodine (common to especially for Graves’ disease)
** some radioactivity is present in the patient’s body fluids and stool
Patients taking medication for Hyperthyroidism are able to take their medication whenever they would like, no specific time. (True or False)
False — Patients who are taking medication for hyperthyroidism should take their medication at the same time every day
Total or subtotal Thyroidectomy is the treatment of choice for thyroid _________ and treatment for ________
cancer
goiter
Preoperative goals for thyroidectomy is the reduction of _______ and _______ to avoid precipitation of thyroid storm
stress
anxiety
Nursing Care Post Thyroidectomy
* A_________ and B_____________
- Keep emergency _______ kit, suction ambu bag at bedside
- HOB elevated
- Watch for stridor, hoarseness, laryngospasm (hoarseness = sign of laryngeal nerve damage)
- Humidified air for moisture
* Diet as tolerated —clear ________ then advance
* Activity as tolerated; ______ prophylaxis
Airway, Breathing
Trach
liquids
DVT
Complications of Thyroidectomy
- Hemorrhage/ bleeding
* Monitor labs — especially ____________ (watch for tetany)
* Have __________ gluconate at bedside
- Monitor pain
- Watch for s/s of infection
- Avoid tension to neck incision
calcium — 1st signs of tetany are numbness/ tingling in lips, mouth fingers,toes
calcium
Patients who have a thyroidectomy only had to take hormone replacement for 3 months before their body will start making it again (true or false)
FALSE— patients who have a thyroidectomy have to take hormone replacement for the rest of their life
A thyroid storm is a life threatening situation where hyperactive _______ caused excessive TH release, which leads to extremely high BP, Temp, HR.
thyroid
Manifestations of thyroid storm include
* Increased _____________
* Increased ___________ _________ _________
* Increased ________ _______
temperature (even a 1 degree increase should be reported, this could indicate thyroid storm is on the way)
systolic blood pressure
heart rate
One of the MAJOR nursing priorities for a patient who is at risk for thyroid storm is:
AIRWAY
Common treatment for thyroid storm is :
- B_____ B_________
- __________ blanket and antipyretics
- Anti_________ medications
Beta Blockers
Cooling
Antithyroid
One of the most common causes of Hypothyroidism is _____________ disease and __________ surgery
Hashimoto
thyroid
T3 and T4 levels are ______________ in Hypothyroidism. But TSH levels are ______________ to try to get the body to make more thyroid hormone
decreased
increased
Patients with Hypothyroidism have to take a lifelong _____________ hormone replacement
thyroid
** Hypothyroidism Nursing Process**
*Recognize cues: change in ____, __________ vitals, lethargy
*Analyze cues and form priorities : _____________ function, neurological, vitals, _______glycemia
*Interventions: Monitor for increasing severity of s/s , administer meds as ordered, turn Q__H, avoid ______________
*Patient education: Life-long ____________,a void extreme cold, manifestations, avoid infection risks, follow up appts, and support system
LOC, decreased
Respiratory , HYPO
2, sedatives
medication
Myxedema Coma is rare but life-threatening disorder of severe __________________
Hypothyroidism
s/s of Myxedema Coma
- _____thermic
- unconscious
- ______natremia
- _______glycemia
-_____ventilation
- _____tension
- _______cardia
Hypo
Hypo
Hypo
Hypo
Hypo
Brady
EVERYTHING WITH HYPOTHYROIDISM WILL BE LOW
Hyperparathyroidism is where there is an abnormal increase of _____, causing ______calcemia and _____phosphatemia
PTH
Hyper
Hypo
Patients with hyperparathyroidism are at an increased risk of injury with falls (true or false)
TRUE
Patients who have hypothyroidism and are taking hormone replacement need to take their medication ____ minutes before eating
30
A Hypercalcemic Crisis is where there is an extreme elevation of serum calcium which results in neurological, cardiovascular, and renal symptoms that can be life threatening!! This is treated by rapid ____________ with large volumes of IV isotonic saline fluids. It is also treated with a combination of ___________ and _________________ to reduce the serum calcium level by increasing calcium deposition in the bone
rehydration
calcitonin, corticosteroids
Causes of Hypoparathyroidism
- Abnormal _______________ development
- Destruction of parathyroid glands from surgery or autoimmune response (Most common)
- Vitamin ___ deficiency
parathyroid
D
For a patient who has hypoparathyroidism, IV __________ __________ should be kept at the bedside
calcium gluconate
Positive _____________ and _____________ signs for hypoparathyroidism
Chvostek — face spasm from tapping side of cheek
Trousseau — carpopedal spasm induced by occluding the blood flow to the arm for.3 min with a blood pressure cuff
The adrenal medulla cortex produces :
Epinephrine: adrenaline; fight or flight
Norepinephrine: mobilized body and brain activity
What does the adrenal cortex produce?
Glucocorticoids (Cortisol; energy replenishment)
Mineralocorticoids (aldosterone for F&E balance )
Sex hormones
Glucocorticoids provide a source of energy during a __________ situation
stressful
Adrenal cortex hyper function =
Adrenal Cortex Insufficiency=
cushing’s syndrome
addison’s disease
Cushing’s Syndrome is due to an increased ______ leading to increased cortisol secretion
ACTH
Cushing’s can also be due to _______________ use or production of androgens
corticosteroid
Manifestations of Cushing’s Syndrome
- _______ skin
- ______ face
- _________ hump
- edema
Nursing Priorities
- Monitoring/ addressing _______ ________ excess
thin
moon
buffalo
fluid volume
Patients who have Cushing’s syndrome have thin fragile skin, causing them to have an ___________ risk of __________
increased
infection
Virilization is when a condition in which a _______ develops characteristics associated with _______ hormones (androgens)
female
male
Top 3 nursing interventions for Cushing’s syndrome
- _________ and ________ restriction
- __________ prevention
- _______!!!!!
Sodium, water
infection
safety
In cushing’s syndrome, labs such as __________ are often low. This should be. monitored and replaced as needed
potassium
Excess cortisol reduces the number of circulating lymphocytes,inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals = high risk of _________
infection
The primary cause of Addison’s disease is a _________ __________ malfunction. Not enough cortisol to meet needs
adrenal cortex
Risk factors of Addison’s Disease
- Surgical removal of infection of _________
- ____ is a common cause
- Abrupt cessation of _________ —> TAPER
adrenals
TB
steroids
Patients with Addison’s will need _________ replacement therapy for life
hormone
Addison disease causes an increase in the ______________ stimulating hormone, which results in an abnormal dark pigmentation of the skin. The knuckles, knees, and elbows are especially prone to dark pigmentation
melanocyte
What is an adrenocorticotropic hormone (ACTH) test?
This test measures how much ACTH is in the blood
Common manifestations of Addison’s is:
- Darkened, bronzed _______
- ______tension and postural _____tension
- Weakness, fatigue
- Weight _____
skin
Hypo, Hypo
loss
Addisonian Crisis is a life threatening emergency!! S/S include:
- Profound __________
- Dehydration
- Vascular Collapse (____tension)
- ______volemic shock
- AKI
- _____ sodium
- _______ potassium
fatigue
Hypo
Hypo
Low
High
Patients with Addison’s disease have to take Corticosteroids (mineralcorticoids and glucocorticoids) for life. Some of the medications include:
Fludrocortisone (Florinef)
Prednisone (cortisol replacement)
With addison’s treatment, you are monitoring for improvement in symptoms of Addison’s, but getting too much cortisol could cause sx of __________
Cushing’s
Addison’s patients are able to stop taking medications after 3 months (true of false)
False— patients with Addison’s have to take their medication for life. They should also not ABRUPTLY stop taking their medications
Aldosteronism occur when the adrenal glands produce to much ______________. This leads to increases in sodium and water retention and loss of potassium
aldosterone
Treatment for aldosteronism includes potassium sparing diuretics, and potassium supplements. *** Won’t perform surgery until ______________ levels are normal
potassium
Pheochromocytoma is a tumor that produces, stores, and releases excess ___________ and __________
epinephrine
norepinephrine
Manifestation of pheochromocytoma
5 Hs
- H__________
- HTN
- Hyperhidrosis (___________)
- Hypermetabolism (______cardia, palpitations, ______ pain, tremors)
- ______glycemia
headache
sweating
tachy, chest
Hyper
