Endocrine Flashcards

Question

Manifestations of acromegaly

Answer 1

— enlarged tongue, lips, nose, hands, feet, and facial bone growth — skeletal changes are PERMANENT — organ enlargement

Answer 2

— visual acuity and visual field tests = visual acuity can be affected — CT and MRI — lab -> pituitary hormones — also look at thyroid gland labs — measurement and target organ hormones Tx: — surgery — remove/destroy tumor — replacement hormones are required after destruction Medications: — bromociptine — octreotide

Answer 3

Scope through the nose — poke through back of the nasal cavity into the brain — transphynoidal approach Swelling = diabetes insipidus Risk for CSF leakage — LOOK FOR CLEAR FLUID FROM NOSE Visual disturbances Post-op meningitis Pneumocephalus = air in intracranial cavity SIADH

Answer 4

— AVOID ACTIONS THAT INCREASE INTRACRANIAL PRESSURE Do not: — cough — sneeze — blow nose — sucking through straw — bending over or straining during urination/defecation TEACHING: — deep breathing exercises — dressing and packing in nose — nurse will check visual acuity often — need for accurate I&O = early signs for DI or SIADH — head of bed AT LEAST 30 DEGREES FOR 2 WEEKS = reduce increased intracranial pressure

Answer 5

— neuro checks = visual acuity and visual fields — accurate I&O — incision/packing = keep DRY

Answer 6

— DI — SIADH — meningitis -> CSF leakage (clear drainage) — CSF on pillow case -> disperses in halo pattern — make sure to get sample of clear fluid coming from nose to identify type of fluid — monitor for visual disturbances — continuous post nasal drip — swallowing more frequently = CSF leaking to back of throat

Answer 7

Remember = hole has been poked through nasal cavity into the brain — avoid increasing intracranial pressure Report to surgeon: — hunger — thirst — body swelling — mood swings — increased urine output (DI) — weight lost — continuous post nasal drip — excessive swallowing = CSF leakage — pain with bending neck = meningitis — vision loss = damage to optic chia sim Only use nasal medications/rinses as prescribed Keep follow up appt 1 wk after d/c

Answer 8

Regulates blood volume Sodium reabsorption and potassium excretion into renal tubules Water follows sodium Gets rid of potassium and reabsorbs sodium

Answer 9

Stress hormone — increased BG by inhibits insulin secretion promoting gluconeogenesis (metabolism is driven by glucose) — increases breakdown of proteins and lipids = gluconeogenesis — suppresses inflammatory and immune response — increases sensitivity of vascular smooth muscle to norepinephrine and angiotensin II = vasoconstriction — increases breakdown of bony matrix — promotes bronchodilation (fight or flight response)

Answer 10

Hypofunction of adrenal gland — decrease ACTH and acdrenocortical steroids from adrenal cortex Cause: — autoimmune — stopping corticosteroids abruptly (2-4 wk) — taper corticosteroids to avoid

Answer 11

— hyperpigmentation — fatigue — weakness — anorexia — weight loss unexplained — confusion/emotion liability — going back and fourth between happy and sad — hypoglycemia — blood volume depletion HYPERKALEMIA — watch for cardiac arrhythmias — put pt on tele — tall peaked t waves -> vtach HYPONATREMIA

Answer 12

Sudden loss of cortisol and aldosterone — LIFE THREATENING — typically after surgery, trauma, severe infection CM: — vomiting — abd pain -> shunting of blood from GI tract — low glucose — low sodium — HIGH POTASSIUM — severe hypotension -> lack of aldosterone — hypovolemic shock -> dehydration; not enough circulating volume

Answer 13

Early morning plasma cortisol provocation tests — injection of ACTH admin blood draw 60 min later to measure cortisol — performed to differentiate from secondary adrenal insufficiency Secondary cause = distant; pituitary tumor affecting ACTH secretion Primary = greater increase in plasma ACTH and lower than normal cortisol concentration — fasting BG, electrolytes, BUN — GLUCSE, SODIUM AND POTASSIUM

Answer 14

— restore circulation blood volume and prevent shock — replace hormones -> hydrocortisone — REPLACE FLUIDS -> LR — restore volume!! — tx hyponatremia and hyperkalemia = dialysis may be needed — tx hypoglycemia — admin fluids and monitor I&O — monitor VS — vasopressin’s for HYPOTENSION — determine cause

Answer 15

— monitor VS q 1-4 hr — assess dysrhythmia or postural hypotension — daily wt — promote fluid balance — monitor fluid deficit — acute I&O — monitor lab = BUN, creatinine, sodium, potassium — give cortisol and aldosterone replacement therapy — loop diuretics may be given but be careful with low circulating volume Addisons= deficient of salt, sugar + steroid Hyponatremia, hypoglycemia = not having cortisol and aldosterone

Answer 16

Adrenal gland: adrenocortical EXCESS — pheochromocytoma tumor 85% CM: — muscle wasting — weakness — fragile skin — MOON FACE — BUFFALO HUMP — acne — enlarged trunk — small arms and legs — MOST OF THE BODY IS IN THE TRUNK — virilization = male sex hormones; dark facial hair, balding on head, loss of libido, — LOW VOICE IS PERMANENT RETENTION OF SODIUM AND WATER = HTN AND HF — HYPERglycemia — excess fluid volume — EXACT OPPOSITE OF ADDISONS

Answer 17

— 3 tests: 2 must be abnormal for dx — serum cortisol = blood level of cortisol — urinary cortisol = 24 hr collection; proteins excreted vary for different people — low dose dexamethasone suppression test

Answer 18

Surgery: — if cause of pituitary tumor or primary adrenal hypertrophy — adrenal insufficiency 12-48 hr post op — support with HYDROCORTISONE — since we are removing source of steroid = nothing to produce steroid we must give supplment at normal levels Drug therapy: — surgery not an option = not stable enough ** mitotane used to suppress ACTH if tumor cannot be removed

Answer 19

— decrease risk for injury — decrease risk for infection — prep pt for surgery — encourage rest and activity — promote skin integrity — improve body image — improve coping — monitor for potential complications

Answer 20

Caused by functioning tumor excessive production of aldosterone CM: — profound decline in POTASSIUM and hydrogen ions -> ALKALOSIS with increased bicarbonate — HTN IS UNIVERSAL SIGN — muscle weakness — cramping — fatigue — excessive urine volume — polyuria — losing lots of fluid in the urine — excessive thirst

Answer 21

Surgical removal of adrenal tumor — tx HTN with spironolactone — monitor potassium and creatinine for 4-6 wk while on drug therapy — spironolactone -> hypokalemia Nursing: — post op care — monitor surgical site for infections/bleeding — assist with social services or rehab if needed — make sure medications are received upon d/c

Answer 22

Control cellular metabolic activity — influences every major organ system

Answer 23

Regulate calcium and phosphorus metabolism — parathyroid glands are super small compared to the thyroid gland itself — calcium and phos levels are always opposite

Answer 24

Inflammation, fibrosis, lymphotis infiltration Symptoms: neck pain, swelling, dysphagia Three types: — acute = infection — subacute = granulomatous — chronic = hashimoto’s (most common) Surgery only needed when drug therapy is not successful

Answer 25

Thyrotoxcois Excessive output of thyroid hormones Graves’ disease = most common Excess secretion of T3 + T4 Other types: — formation of nodues from iodine deficiency — viral infection of thyroid gland — excessive pituitary secretion of TSH (secondary hyperthyroidism)

Answer 26

— nervous all the time — excessive sweating — poor heat tolerance = hot flashes — cannot sit still — high HR 120-140 at rest — flushed (red) skin — tremors — high appetite but still losing weight — weakness — amenorrhea Exophthalmos = bulging eyes -> permanent change — thyroid enlargement — bruit over thyroid arteries

Answer 27

TSH will be low T3 + T4 is high Negative feedback loop = thyroid is producing more T3 + T4 Radioactive iodine update — measure rate of iodine uptake by thyroid — hyper = exhibit high uptake — hypo = low iodine uptake Fine-needle aspirate biopsy tissue sample to detect cancer Thyroid scan — radionuclide injected and test determines “hot” areas of increased activity and “cold” areas of decreased activity (cancer) — entire body scan to assess for metastasis

Answer 28

EMERGENT — worsening of normal hyperthyroid s/s — fast forward x4 — extremely high HR at rest — develop HF, circulatory collapse, HIGH FEVER — RARE

Answer 29

Fatal if not quickly recognized — anti thyroid mediations — plasmapheresis or dialysis to remove excessive T3 + T4 (methanazole) — ablation or removal of gland — cardiac monitor for dysrhythmias — oxygen to tx dyspnea and possible HF — beta blockers to slow sympathetic activity — acetaminophen to decrease fever — POTENTIAL SEIZURE ACTIVITY

Answer 30

SPECIAL ATTENTION TO FEVER AND HR — monitor VS — provide calm and quiet environment — maintain cool room and reduce stimulation — heat intolerance — provide eye care -> dry eyes — elevate HOB at night — increased risk for seizures — corticosteroids to reduce inflammation — hypermetabolic state -> INCREASE CALORIES — encourage 6 meals per day — need for anti thyroid medications — follow up with HCP — provide support groups — tx photophobia with dark glasses

Answer 31

Ablation/removal — radioactive iodine therapy -> most common tx — surgical removal of thyroid — total thyroidectomy/ablation = will need lifelong thyroid hormone replacement

Answer 32

Ablative dose of I-131 admin — causes acute release of thyroid hormone as it is destroyed — observe for thyroid storm Fever >101.3 and HR >130 AFFECTS ORGANS — abd pain — diarrhea — edema — chest pain — dyspnea — delirium — psychosis Management: — cooling blanket — hydrocortisone — methimazole impedes formation of thyroid hormone

Answer 33

— wear gloves and shoe covers — dosimetry badge = shows how much radiation exposed to — minimize time spent w pt — remain at least 3 ft away — cluster care — contaminated linen must be collected -> laundered separately — pt must stay in room at all times — pt must use disposable utensils — no minors or pregnant visitors allowed — radiation safety must clear the room before another patient gets admitted to the room

Answer 34

Observe for: — hemorrhage — resp distress — ABCs — hypocalcemia and tetany (parathyroid) — laryngeal nerve damage — thyroid storm Admin hormone replacement — Levothyroxine

Answer 35

Low levels of thyroid hormones Autoimmune (hoshimoto’s), thyroid surgery, iodine deficiency, tumors, drugs CM: — fatigue — c/o cold — cold intolerance — low HR — weight gain — poor appetite — constipation HIGH TSH and LOW T3 + T4 Slow motion = complete opposite as hyperthyroid (sped up) Medical management = Levothyroxine

Answer 36

Goiter — abnormal enlargement of thyroid — hypothalamus signals release of TSH binds to thyroid cells and causes thyroid to enlarge in attempt to trigger release of T3 + T4

Answer 37

— modify activity — risk for immobility problems — monitor physical status — VS and mental status (foggy feelings) — keep room warm, NO HEATING PADS — adequate nutrition and hydration — enhance coping mechanism — depressive episodes — teach about medications and seeing provider for labs

Answer 38

EMERGENT 60% MORTALITY RATE — undiagnosed and untreated hypothyroidism — tissue and organs failure due to decreased metabolism CM: — mucinous edema = eyes, hands, feet, all over the body — hypothermic = low body temp — lethargy — stupor — coma — cardiovascular collapse -> shock -> death — “super slow motion” — depressed resp drive — VERY SENSITIVE TO SEDATING DRUGS -> body is already in super slow motion

Answer 39

Infective breathing pattern: — observe and record rate and depth of resp — auscultate lungs — assess for resp distress — assess client receiving sedation for resp adequacy — resp status is adequate to meet oxygen demands Decreased cardiac output: — monitor circulatory status — signs of inadequate tissue oxygenation — assess for cold toes and peripheral pulses — change in mental status — fluid status and HR — admin oxygen and mechanical ventilation as appropriate

Answer 40

Surgery tx = thyroidectomy; removal of cancer tissue — suppressive doses of thyroid hormone for 3 mo after surgery — genetic component

Answer 41

EXCESSIVE SECRETION OF PTH — increased calcium in blood — calcium in blood stream — renal calculi = kidney stones CM: — skeletal pain — HTN — fatigue — muscle weakness — constipation — dysrhythmias — peptic ulcers and pancreatitis Dx: elevated calcium, X-ray to look at bones, scans Medical management: — diuretics — fluids — mobility — diet restriction -> calcium rich foods — MEDS: phosphates, calcitonin — surgery to remove parathyroid glands

Answer 42

Calcium must be stabilized — full CBC Teaching: — limit coughing — deep breathing exercises — neck support — monitor airway

Answer 43

Resp distress — close to airway Hypocalcemia crisis can occur — tetany — seizures — trousseu’s sign -> occurs when BP cuff is on (wrist flops over) Laryngeal nerve damage can occur

Answer 44

Decrease PTH secretion — INCREASE phosphate and DECREASE calcium Give supplemental vitamin D and calcium — quiet environment — free of bright lights to decrease neurological stimuli