Chapter 45 Endocrine Flashcards by Makieah Mack

Negative Feedback is where an increase of a hormone causes ______ to be produced and a decrease in hormone causes ________ to be produced

less
more

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The endocrine system is a ____________ feedback system

negative

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Endocrine disorders are caused by a __________________ or ________________ of hormones

overproduction or underproduction

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**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

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The ________ gland is referred to as the “master gland”; it secretes hormones into the bloodstream

Pituitary

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The _____________ is the coordinating center of the brain

Hypothalamus

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Suppression tests are used to detect ____________ of an endocrine organ

HYPERsecretion

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What are the hormones that the anterior pituitary gland secretes: 6

Follicle Stimulating Hormone
Lutenizing Hormone
Adrenocorticotropic Hormone
Thyroid Stimulating Hormone
Prolactin
Growth Hormone

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What are the hormones that the posterior pituitary secretes:

Antidiuretic Hormone
Oxytocin

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Too much GH can cause what?

Gigantism (before puberty) or Acromegaly (after puberty/ adult)

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Hyperpituitarism is most often caused by what ?

Tumors or hyperplasia

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Increased Growth Hormone causes :
Increased ACTH causes:
Increased TSH causes:
Increased ADH causes:

Gigantism/Acromegaly
Cushing’s
HYPERthyroidism
SIADH

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Decreased Growth Hormone causes :
Decreased ACTH causes:
Decreased TSH causes:
Decreased ADH causes:

Dwarfism
Addison
HYPOthyroidism
DI

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_________ therapy may be used alone or in combination with surgery and or radiation

Drug

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____________ removal of the pituitary gland and tumor, called ______________ is the most common treatment for hyperpituitarism

Surgical, hypophysectomy

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Immediately after surgery, advise pt to avoid activities that increase ICP such as:

Brushing teeth (2weeks)
Bending over
Straining
Coughing
Blowing nose

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What is the most common surgical method for a hypophysectomy?

Oronasal transsphenoidal approach

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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

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Growth Hormone is regulated by the ________________ based on __________

hypothalamus
glucose

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an _________ in BS causes the release of GH
a _____________ in BS inhibits release of GH

increase
decrease

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______________ occurs if tumor formation is pre-puberty (rapid growth)
_____________ occurs if tumor formation is after puberty (in adult)

Gigantism
Acromegaly

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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

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What is administered for Acromegaly/ Gigantism?

Somatostatin analogs (synthetic somatostatin) I — inhibits the release of GH

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The thyroid gland is stimulated by the __________ ____________ gland

anterior pituitary

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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

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