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Advanced Med Surg > Endo/neuro > Flashcards

Endo/neuro Flashcards

1
Q

What are s/s of hypothyroidism?

A 
Extreme fatigue 
Hair loss
Brittle nails 
Dry skin 
Numbness and tingling 
Amenorrhea 
Intolerance to cold 
Bradycardia 
Weight gain 
Slow speech 
Tongue enlarges 
Constipation
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2
Q

What is myxedema coma?

A

Severe hypothyroidism. Pt becomes hypothermic and unconscious. May be precipitated by infection or by the use if sedatives

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3
Q

Pt May experience myxedema coma if they

A

Forget to take their thyroid replacement meds

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4
Q

In myxedema coma the pt may initially show signs of

A 
Depression 
Diminished cognitive status 
Lethargy 
Somnolence 
Respiratory depression
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5
Q

Patient with myxedema coma may also exhibit

A 
Hyponatremia
Hypoglycemia 
Hypo ventilation 
Hypotension 
Bradycardia 
Hypothermia
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6
Q

Myxedema coma is treated with

A

IV T3 and T4

Oral levothyroxine

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7
Q

Nursing interventions for hypothyroidism

A 
Keep room warm 
Give medication 
Apply moisturizer 
Give oxygen 
Cardiac monitor
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8
Q

What kind of diet should a pt with hypothyroidism be on

A

Low fat
High fiber
Low calories
Low carb

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9
Q

With the initial dose of hypothyroidism med a pt May experience

A

Chest pain or angina

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10
Q

There is a decrease in thyroid hormone absorption when pts are also taking

A

Magnesium containing antacids

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11
Q

Doses of anticoagulant meds need to be decreased in the beginning of thyroid replacement because

A

Of the increased risk of bleeding

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12
Q

Angina or dysrhythmias can occur when thyroid replacement is initiated because

A

Thyroid hormones enhance the cardio effects of catecholamines

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13
Q

Thyroid medication should be taken

A

First thing in the morning with a full glass of water

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14
Q

Hyperthyroidism is commonly caused by

A

Graves’ disease

Also by toxic adenoma, thyroiditis and excessive ingestion of thyroid hormone

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15
Q

In hyperthyroidism what are the T3,T4 and TSH levels

A

Increased T3 and T4

Decreased TSH

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16
Q

The presenting sx of hyperthyroidism is often

A

Nervousness

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17
Q

S/S of hyperthyroidism include

A 
Weight loss
Exophthalmos 
Amenorrhea 
Diarrhea 
Tachycardia 
Moist, flushed skin 
Increased sweating 
Heat intolerance
Irritability 
Tremors
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18
Q

When assessing a thyroid for hyperthyroidism what can be pal payed and heard

A

Bruit and thrill

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19
Q

Nursing interventions for hyperthyroidism

A

Quiet, cold environment
High calorie diet
Increase fluid
Cardiac monitor

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20
Q

Anti thyroid meds for hyperthyroid are given to

A

Inhibit one or more stages of thyroid hormone synthesis or hormone release

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21
Q

The most common anithyroid meds given for hyperthyroidism are

A

PTU

Methimazole

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22
Q

Precautions taken when a pt is on radioactive iodine therapy

A

Keep door closed
Pt is isolated
Room is protected with lead

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23
Q

Methimazole is given 4-6wks prior to

A

Administration of radioactive iodine

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24
Q

For radioactive therapy what happens to the anithyroid meds

A

They are stopped 3 days before and restarted 3 days after administering radioactive iodine. And them tapered over 4-6 weeks

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25
Q

What are signs of thyroid storm

A

Cardiac dysrhythmias
Fever
Neuro impairment

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26
Q

What meds are given to treat sx of thyroid storm

A

Beta blockers

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27
Q

Patients who receive radioactive therapy should be informed that

A

They can contaminate their household thru saliva, urine and radiation emitting from their body. Avoid sexual contact, sleeping in the same bed as others, having close contact with children and pregnant women. Avoid sharing utensils and cups.

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28
Q

SIADH is

A

An excessive ADH secretion from the pituitary gland

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29
Q

SIADH cam be caused by

A

Head trauma

Lung cancer

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30
Q

Fluid retention in SIADH leads to

A 
Concentrated urine 
Decreased urinary output 
Hyponatremia
HTN that leads to HF 
Increased specific gravity 
At rush for fluid overload
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31
Q

Nursing interventions for SIADH

A 
Give diuretics 
Treat the cause 
Limit fluids 
Monitor vital signs 
Monitor for signs HF
Monitor urinary output 
Control HTN
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32
Q

Diabetes insipidus is

A

A deficiency of ADH

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33
Q

S/S of DI

A 
Excessive thirst 
Large volumes of dilute urine 
Decreased specific gravity 
Low sodium in urine 
Hypotension
Increased serum osmolarity 
Hypernatremia
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34
Q

DI can be caused by

A

Head trauma
Meningitis
Tumor

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35
Q

ADH is made and stored in

A

Made by the hypothalamus but stored in the posterior pituitary gland

36
Q

Nursing interventions for DI

A

Increase IVF (isotonic)
Cardiac monitor
Desmopressin

37
Q

What is the fluid deprivation test

A

Used to Dx DI. Withhold fluids for 8-12hrs or until 3-5% body weight is lost. Weigh pt frequently

38
Q

The fluid deprivation test is stopped if the pt

A

Develops tachycardia, excessive weight loss, or hypotension

39
Q

Desmopressin is administered

A

Intra nasally

40
Q

If DI is renal in origin, what medication is used to treat it

A

Thiazide diuretics
Mild salt depletion
Prostaglandin inhibitors (ibuprofen, indomethacin and aspirin)

41
Q

Vasopressin must be administered with caution in a pt with coronary disease because

A

Vasopressin causes vasoconstriction

42
Q

Pheochromocytoma is a tumor that originates

A

In adrenal medulla and secretes large amounts of catecholamines (epinephrine and norepinephrine)

43
Q

Triad of sx for pheochromocytoma

A

Headache
Diaphoresis
Palpitations

44
Q

Other sx of pheochromocytoma include

A 
Hypertension
Tremor 
Flushing 
Anxiety 
Vertigo 
Blurring of vision
45
Q

The five F’s of sympathetic nervous system over activity associated with high blood pressure

A 
Hypertension 
Headache 
Hyperhidrosis
Hyper metabolism 
Hyperglycemia
46
Q

What is Hashimoto’s thyroiditis?

A

When the thyroid is invaded by WBC causing inflammation, which leads to a decrease secretion of T3 and T4 and an increase in TSH

47
Q

Severe hypothyroidism is associated with

A

Elevated cholesterol levels, CAD and atherosclerosis

48
Q

Patients with unrecognized hypothyroidism that are undergoing surgery are at risk for

A

Intraoperative hypotension, post op HF, and AMS

49
Q

What are the three main treatments for hyperthyroidism?

A

Radioactive iodine therapy
Surgical removal
Thyroid medications

50
Q

Nursing considerations for PTU

A

Monitor cardiac parameters
Observe for conversion to hypothyroidism
Must be given orally

51
Q

What are s/e of PTU

A

Rash
N/V
Agranulocytosis
SLE

52
Q

Prior to beginning PTU or methimazole what should be done?

A

Take baseline blood tests (complete CBC with differential)

Liver profile

53
Q

Patient teaching for taking PTU and methimazole

A

Should be taken on empty stomach

30 min before eating

54
Q

A thyroidectomy only removes ____ of the thyroid

A

five sixths

55
Q

Before going into surgery a anithyroid medication is given until

A

Sx of hyperthyroidism have disappeared

56
Q

Patients taking iodine medication must be monitored for

A

Iodinism (iodine toxicity)

57
Q

S/S of iodinism

A

Swelling of the buccal mucosa
Excessive salivation
Cold sx
Skin eruptions

58
Q

Nursing interventions for a pt that has undergone a thyroidectomy

A 
Assess airway obstruction and swelling 
Trach kit needed 
Assess for s/s of hypocalcemia
Check incision site
Assess for excessive swallowing 
Ask pt to speak
59
Q

What is used to treat hypocalcemia

A

Calcium gluconate

60
Q

Hyperparathyroidism is characterized by

A

Bone decalcification and the development of renal calculi

61
Q

A deficiency in the parathormone results in

A

Decreased calcium absorption and increased blood phosphate

62
Q

Hyperparathyroidism can be caused by

A 
Renal failure 
Bone disease
Benign adenomas
Tumor of parathyroid gland 
Vit D deficiency/malabsorption
63
Q

S/S of Hyperparathyroidism

A 
Apathy
Fatigue
Muscle weakness
HTN
Cardiac dysrhythmias
64
Q

Treatment for Hyperparathyroidism

A 
Increase fluid intake to prevent calculus
Avoid thiazide diuretics
Avoid dehydration
Encourage mobility 
Oral phosphate 
Restrict Ca in diet
65
Q

Hypoparathyroidism is chracterized by

A

Increased serum phosphate and decreased blood calcium and decreased resorption of calcium from bone

66
Q

Hypoparathyroidism is caused by

A

the inadequate secretion of parathormone after the interruption of the blood supply or surgical removal of parathyroid tissue during thyroidectomy or radical neck dissection

67
Q

Chief sx of Hypoparathyroidism

A

Tetany

68
Q

Other sx of latent tetany include

A

Numbness, tingling, cramps in extremities and stiffness in the hands and feet

69
Q

In overt tetany signs include

A 
Bronchospams
Laryngeal spasm 
Carpopedal spasm 
Dysphagia
Photophobia 
Seizures
Irritability, anxiety and depression
70
Q

When tetany occurs, the immediate administration of what medication needs to be given

A

IV calcium gluconate

71
Q

Nursing interventions for pts with Hypoparathyroidism

A

Environment that is free of noise, drafts and bright lights.
Diet high in calcium and low in phosphorus

72
Q

Addisons disease is characterized by

A

Insufficient secretion of glucorticoid and mineralcorticoids

73
Q

Therapeutic use of corticosteroids is the most common cause of

A

adrenocortical insufficiency

74
Q

S/S of addisons disease

A 
N/V
Hyportension
Muscle weakness
Anorexia
Dark pigmentation of the mucus membranes 
Depression 
Apathy
75
Q

What are the electrolyte imbalances seen in Addison’s disease?

A

Hyponatremia
Hypoglycemia
Hyperkalemia

76
Q

Addisons crisis is charactereized by

A 
Hypotension
Cyanosis 
Fever
N/V
HA
Pallor 
Diarrhea
77
Q

Immediate treatment for a pt with Addisons crisis includes

A 
Administering fluids, corticosteroids 
Monitoring V/S
Place pt in recumbant position with legs elevated 
Hydrocortisone IV
D5W in NS
78
Q

What kind of diet should a pt with Addison’s be on?

A

High Na
High carb
Low K

79
Q

Cushings syndrome results from

A

An excessive secretion of glucocorticoids, particularly cortisol

80
Q

Cushing’s is caused by

A

Use of cortocosteroid meds

81
Q

S/S of Cushing syndrome

A 
Central-type obesity
Buffalo hump 
Thin extremities 
Thin, fragile skin
Weakness
Muscle wasting 
Osteoporosis 
HTN 
Moon face 
Slow wound healing
82
Q

Electrolyte imbalances in Cushing syndrome

A

Hypernatremia
Hyperglycemia
Hypokalemia

83
Q

What are the 3 tests used to diagnose Cushing

A

Serum cortisol
Urinary cortisol
Low dose dexamethasone

84
Q

Serum cortisol levels are usually higher

A

In the morning (6-8am)

85
Q

Diet for a pt with Cushing

A 
High protein
High K+
High Ca+/vit D
Low Na
Low calories

Advanced Med Surg (4 decks)

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