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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
What are signs of thyroid storm
Cardiac dysrhythmias Fever Neuro impairment
26
What meds are given to treat sx of thyroid storm
Beta blockers
27
Patients who receive radioactive therapy should be informed that
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.
28
SIADH is
An excessive ADH secretion from the pituitary gland
29
SIADH cam be caused by
Head trauma | Lung cancer
30
Fluid retention in SIADH leads to
``` Concentrated urine Decreased urinary output Hyponatremia HTN that leads to HF Increased specific gravity At rush for fluid overload ```
31
Nursing interventions for SIADH
``` Give diuretics Treat the cause Limit fluids Monitor vital signs Monitor for signs HF Monitor urinary output Control HTN ```
32
Diabetes insipidus is
A deficiency of ADH
33
S/S of DI
``` Excessive thirst Large volumes of dilute urine Decreased specific gravity Low sodium in urine Hypotension Increased serum osmolarity Hypernatremia ```
34
DI can be caused by
Head trauma Meningitis Tumor
35
ADH is made and stored in
Made by the hypothalamus but stored in the posterior pituitary gland
36
Nursing interventions for DI
Increase IVF (isotonic) Cardiac monitor Desmopressin
37
What is the fluid deprivation test
Used to Dx DI. Withhold fluids for 8-12hrs or until 3-5% body weight is lost. Weigh pt frequently
38
The fluid deprivation test is stopped if the pt
Develops tachycardia, excessive weight loss, or hypotension
39
Desmopressin is administered
Intra nasally
40
If DI is renal in origin, what medication is used to treat it
Thiazide diuretics Mild salt depletion Prostaglandin inhibitors (ibuprofen, indomethacin and aspirin)
41
Vasopressin must be administered with caution in a pt with coronary disease because
Vasopressin causes vasoconstriction
42
Pheochromocytoma is a tumor that originates
In adrenal medulla and secretes large amounts of catecholamines (epinephrine and norepinephrine)
43
Triad of sx for pheochromocytoma
Headache Diaphoresis Palpitations
44
Other sx of pheochromocytoma include
``` Hypertension Tremor Flushing Anxiety Vertigo Blurring of vision ```
45
The five F's of sympathetic nervous system over activity associated with high blood pressure
``` Hypertension Headache Hyperhidrosis Hyper metabolism Hyperglycemia ```
46
What is Hashimoto's thyroiditis?
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
Severe hypothyroidism is associated with
Elevated cholesterol levels, CAD and atherosclerosis
48
Patients with unrecognized hypothyroidism that are undergoing surgery are at risk for
Intraoperative hypotension, post op HF, and AMS
49
What are the three main treatments for hyperthyroidism?
Radioactive iodine therapy Surgical removal Thyroid medications
50
Nursing considerations for PTU
Monitor cardiac parameters Observe for conversion to hypothyroidism Must be given orally
51
What are s/e of PTU
Rash N/V Agranulocytosis SLE
52
Prior to beginning PTU or methimazole what should be done?
Take baseline blood tests (complete CBC with differential) | Liver profile
53
Patient teaching for taking PTU and methimazole
Should be taken on empty stomach | 30 min before eating
54
A thyroidectomy only removes ____ of the thyroid
five sixths
55
Before going into surgery a anithyroid medication is given until
Sx of hyperthyroidism have disappeared
56
Patients taking iodine medication must be monitored for
Iodinism (iodine toxicity)
57
S/S of iodinism
Swelling of the buccal mucosa Excessive salivation Cold sx Skin eruptions
58
Nursing interventions for a pt that has undergone a thyroidectomy
``` 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
What is used to treat hypocalcemia
Calcium gluconate
60
Hyperparathyroidism is characterized by
Bone decalcification and the development of renal calculi
61
A deficiency in the parathormone results in
Decreased calcium absorption and increased blood phosphate
62
Hyperparathyroidism can be caused by
``` Renal failure Bone disease Benign adenomas Tumor of parathyroid gland Vit D deficiency/malabsorption ```
63
S/S of Hyperparathyroidism
``` Apathy Fatigue Muscle weakness HTN Cardiac dysrhythmias ```
64
Treatment for Hyperparathyroidism
``` Increase fluid intake to prevent calculus Avoid thiazide diuretics Avoid dehydration Encourage mobility Oral phosphate Restrict Ca in diet ```
65
Hypoparathyroidism is chracterized by
Increased serum phosphate and decreased blood calcium and decreased resorption of calcium from bone
66
Hypoparathyroidism is caused by
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
Chief sx of Hypoparathyroidism
Tetany
68
Other sx of latent tetany include
Numbness, tingling, cramps in extremities and stiffness in the hands and feet
69
In overt tetany signs include
``` Bronchospams Laryngeal spasm Carpopedal spasm Dysphagia Photophobia Seizures Irritability, anxiety and depression ```
70
When tetany occurs, the immediate administration of what medication needs to be given
IV calcium gluconate
71
Nursing interventions for pts with Hypoparathyroidism
Environment that is free of noise, drafts and bright lights. Diet high in calcium and low in phosphorus
72
Addisons disease is characterized by
Insufficient secretion of glucorticoid and mineralcorticoids
73
Therapeutic use of corticosteroids is the most common cause of
adrenocortical insufficiency
74
S/S of addisons disease
``` N/V Hyportension Muscle weakness Anorexia Dark pigmentation of the mucus membranes Depression Apathy ```
75
What are the electrolyte imbalances seen in Addison's disease?
Hyponatremia Hypoglycemia Hyperkalemia
76
Addisons crisis is charactereized by
``` Hypotension Cyanosis Fever N/V HA Pallor Diarrhea ```
77
Immediate treatment for a pt with Addisons crisis includes
``` Administering fluids, corticosteroids Monitoring V/S Place pt in recumbant position with legs elevated Hydrocortisone IV D5W in NS ```
78
What kind of diet should a pt with Addison's be on?
High Na High carb Low K
79
Cushings syndrome results from
An excessive secretion of glucocorticoids, particularly cortisol
80
Cushing's is caused by
Use of cortocosteroid meds
81
S/S of Cushing syndrome
``` Central-type obesity Buffalo hump Thin extremities Thin, fragile skin Weakness Muscle wasting Osteoporosis HTN Moon face Slow wound healing ```
82
Electrolyte imbalances in Cushing syndrome
Hypernatremia Hyperglycemia Hypokalemia
83
What are the 3 tests used to diagnose Cushing
Serum cortisol Urinary cortisol Low dose dexamethasone
84
Serum cortisol levels are usually higher
In the morning (6-8am)
85
Diet for a pt with Cushing
``` High protein High K+ High Ca+/vit D Low Na Low calories ```

Advanced Med Surg (4 decks)

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