ENDOCRINE 2 Flashcards

Question

H2 receptor blockers cimetidine, famotidine, nizatidine, ranitidine

Answer 1

* used in cushings disease where there is hypercortisolism * cortisol inhibits production of the thick, gel-like mucus that protects the stomach lining, decreases blood flow to the ares and triggers the release of excess hydrochloric acid * h2 receptor blockers inhibit the gastric proton pump and prevent the formation of hydrochloric acid.

Answer 2

* Used in hyperaldosteronism. * a potssium sparing diuretic and aldosterone antagonist * when surgery cannot be performed, spironolactone therapy is continued to control hypokalemia and hypertension. * Because spironolactone is a potassium sparing diuretic, hyperkalemia can occir in patients who have impaired kidney function or excessive potassium intake. * Advise the patient to avoid potassium supplements and food rich in potassium. * hyponatremia can occur with spironolactone therapy, and the patient may need to increase dietary sodium. * Instruct patients to report symptoms of hyponatremia, such as mouth dryness, thirst, lethargy or drowsiness. * Teach them to report any additional effects of spironolactone therapy, including gynecomastia, diarrhea, drowsiness, headache, rash, urticaria (hives), confusion, erectile dysfunction, hirutism, and amenorrhea.

Answer 3

* to correct hypoparathyroidism caused by hypomagnesemia * acute hypomanesemia is corrected with 50% magnesium sulfate in 2-mL doses (up to 4 g daily) IV.

Answer 4

* used before therapy for pheochromocytoma * the patient's blood pressure is stabilized using adrenergic blocking agents such as phenoxybenzamine (Dibenzyline) starting 7 to 10 days before surgery because of the increased risk for severe hypertension during surgery. * drug dosages are adjusted until blood pressure is controlled and hypertensive attacks do not occur.

Answer 5

* Hypoparathyroidism * treats acute vitamin D deficiency/hypocalcemia * promotes the absorption of calcium and decreases parathyroid hormone concentrations * side effects: pancreatitis, headache, weakness, abdominal pain * avoid concurrent use of antacids containing Mg * observe client for hypocalcemia.

Answer 6

* treatment of hyperparathyroidism * decreases the release of skeletal calcium and increases kidney excretion of calcium. * it is not effective when used alone because of its short duration of action. * therapeutic effects are enhanced if calcitonin is given with glucocorticoids.

Answer 7

* Treatment of hypercortisolism (Cushing's disease) * decreases cortisol production * , is a medication which is used in the ... Metyrapone test may aid in verifying the cause of Cushing's syndrome.

Answer 8

* Thyroid stimulating hormone (TSH), also known as thyrotropin * Adrenocorticotropic hormone (ACTH, corticotropin) * Luteinizing hormone (LH), also known as Leydig cell-stimulating hormone (LCSH) * Follicle-stimulating hormone (FSH) * Prolactin (PRL) * Growth Hormone (GH) * Melanocyte-stimulating hormone (MSH)

Answer 9

* vassopressin (antidiuretic hormome [ADH]) * oxytocin

Answer 10

* triiodothyronine (T3) * thyroxine (T4) * calcitonin

Answer 11

* Parathyroid hormome (PTH)

Answer 12

Glucocorticoids (cortisol) mineralocorticoids (aldosterone)

Answer 13

estrogen progesterone

Answer 14

testosterone

Answer 15

insulin glucagon somatostatin

Answer 16

targets the thyroid stimulates synthesis and release of thyroid hormones

Answer 17

targets the adrenal cortex stimulates synthesis and release of corticosteroids and andrenocortical growth

Answer 18

* targets the ovary and testes * stimulates ovulation and progesterone secretion * stimulates testosterone secretion

Answer 19

* targets the ovary and testis * stimulates estrogen secretion and follicle maturation * stimulates spermatogenesis

Answer 20

* targets the mammary glands * stimulates breast milk production

Answer 21

* Targets bones and soft tissue * promotes growth through lipolysis, protein anabolism, and insulin antagonism

Answer 22

* targets melanocytes * promotes pigmentation

Answer 23

* Targets the kidneys * promotes water reabsorption

Answer 24

* targets the uterus and mammary glands * stimulates uterine contractions and ejection of breast milk

Answer 25

* Prevent hypoglycemia by increasing liver production (gluconeogenesis) and inhibiting peripheral glucose use. * maintain excitability and responsiveness of cardiac muscle * increase lipolysis, releasing glycerol and free fatty acids * increase protein catabolism * degrade collagen and connective tissue * increase the number of mature neutrophils released from bone marrow * exert anti-inflammatory effects that decrease the migration of inflammatory cells to sites of injury * maintain behavior and cognitive functions

Answer 26

* Heart, beta 1 receptors, increased heart rate and increased contractility * blood vessels, alpha & beta 2, vasoconstriction and vasodilation * GI tract, alpoha and beta, increased sphincter tone and decreased motility * Kidneys, Beta2, increased renin release * bronchioles, beta2, relaxation; dilation * bladder, alpha, beta2, sphincter contractions, relaxation of detrusor muscle * skin, alpha, increased sweating * fat cells, beta, increased lipolysis * liver, alpha, increased gluconeogenesis and glycogenolysis * pancreas, alpha, decreased glucagon and insulin release, beta, increased glucagon and insulin release * eyes, alpha, dilation of pupils

Answer 27

* Control metabolic rate of all cells * Promote sufficient pituitary secretion of growth hormone and gonadotropins * regulate protein, carbohydrate, and fat metabolism * exert effects on heart rate and contractility * increased red blood cell production * affect respiratory rate and drive * increase bone formation and decrease bone resorption of calcium * act as insulin antagonists.

Answer 28

* Urine is more dilute and may not concentrate when fluid intake is low * The patient is at greater risk for dehydration. * assess the older patient more frequently for dehydration. * if fluids are not restricted because of another health problem, teach UAP to offer fluids at least every 2 hours while awake.

Answer 29

* Bone density decreases * skin is thinner, drier, and at greater risk for injury * perineal and vaginal tissues become drier, and the risk for cystitis increases. * Teach the patient to engage in regular exercise and weight bearing activity to maintain bone density. * Handle the patient carefully to avoid injury from pathologic fractures. * Avoid pulling or dragging the patient. * use minimal tape on the skin * help patients confined to bed or chairs change positions at least every 2 hours * Teach the patients to use skin moisturizers * perform or assist the patient to perform perineal care at least twice daily. * unless another health problem requires fluid restriction, encourage all women to drink at least 2 liters of fluids daily. * teach sexually active older women to urinate immediately after sexual intercourse. * teach sexually active women that using vaginal lubricants with sexually activity can reduce discomfort and the risk for tissue damage.

Answer 30

* weight becomes greater than ideal along with: * elevated fasting blood glucose level * elevated random blood glucose level * slow wound healing * frequent yeat infections * polydipsia * polyuria * obtain a family history of obesity and type 2 diabetes. * encourage the pt to engage in regular exercise and to keep body weight within 10 lb of idea. * teach patients the signs and symptoms of diabetes and instruct them to report any of these to the PHCP * suggest diabetes testing for any patient with: * persistent vaginal candidiasis * failure of a foot or leg skin wound to heal in 2 weeks or less * increased hunger and thirst * noticeable decrease in energy level *

Answer 31

* There is less tolerance for cold * appetite is decreased * heart rate and BP are decreased * can be difficult to distinguish from hypothyroidism. Check for additional signs and symptoms of: * lethargy * constipation (as a change from usual bowel habits) * decreased cognition * slowed speech * body temperature consistently below 97 degree F. * Heart rate below 60 bpm * Teach patients to dress warmly in cool or cold weather.

Answer 32

who has or is suspected to have hyperthyroidism because vigorous palpation can stimulate a sudden release of thyroid hormones and cause a thyroid storm.

Answer 33

assess height, weight, fat distribution, and muscle mass in relation to age.

Answer 34

* Prominent forehead or jaw * round or puffy face * dull or flat expression * exophthalmoas (protruding eyeballs and retracted upper lid)

Answer 35

a visible enlargement of the thyroid gland.

Answer 36

pigment loss (hypopigmentation) or excess (hyperpigmentation). Fungal iskin infections, slow wound healing, bruising, and petechiae are often seen in patients with adrena hyperfunction.

Answer 37

(patchy areas of pigment loss) is seen with primary hypofunction of the adrenal glands and is caused by autoimmune destruction of melanocytes in the skin.

Answer 38

all of which may suggest thyroid gland problems. Examine the extremities and the base of the spine for edema, which suggests impaired fluid and electrolyte imbalance.

Answer 39

Truncal obesity and the presence of a "buffalo hump" between the shoulders on the back may indicate adrenocortical excess.

Answer 40

(reddish-purple stretch marks) on the breasts or abdomen are often seen with adrenocortical excess.

Answer 41

Changes include hirsutism (excessive body hair growth, especially on the face, chest, and center abdominal line of women), excessive scalp hair loss, or changes in hair texture.

Answer 42

hypogonadism.

Answer 43

Palpate the thyroid gland by standing either behind or in front of the patient. The posterior approach may be easier. Having the patient swallow sips of water during the examination helps you palpate the thyroid gland, which is not easily felt when normal.

Answer 44

as a means of assessing treatment effectiveness. Some endocrine problems include dysrhythmias.

Answer 45

Hypertrophy of the thyroid gland causes an increase in vascular flow, which may result in bruits.

Answer 46

Assess the patient;s coping skills, support systems, and health-related beliefs.

Answer 47

accurately reflect blood levels of these hormones. Protein hormones, such as those from the pituitary gland and thyroid gland, cannot be accurately assessed using saliva.

Answer 48

* An assay measures the level of a specific hormone in blood or other body fluid. * The most common assays for endocrtine testing are antibody-based immunologica assays and chromatographic assays, which include mass spectrometry. * It is a substance, usually a peptide or steroid, rpoduced by one tissue and conveyed by the bloodstream to another to effect physiological activity. * It is also a synthetic compound that acts like a hormone in the body.

Answer 49

between the normal and the abnormal.

Answer 50

* For patients who might have an underactive endocrine gland, a stimulus may be used to determine whether the gland is capable of normal hormone production. * This method is called provocative testing. * Measured amounts of selected hormones are given to stimulate the target gland to maximum production. * Hormone levels are then measured and compared with expected normal values. * Failure of a hormone level to rise with provacation indicates hypofunction.

Answer 51

Gonads Endocrine pancreas Thyroid gland

Answer 52

* Suppression tests are used when hormone levels are high or in the upper range of normal. * Example to determine Cushing's, dexamethasone is given in pill form. The next morning a blood test is done to see if the medication decreased the hormone level. * Failure of suppression of hormone production during testing indicates hyper function.

Answer 53

* check your laboratory's method of handloing the hormone test samples for tube type, timing, drugs to be administered as part of the test, etc. For example, blood samples drawn for catecholamines must be placed on ice and taken to the laboratory immediately. * Explain the procedure and any restrictions to the patient. * If your are drawing blood sampples from an IV line, clear the line throughly. Do not use a double- or triple-lumen line to obtain samples; contamination or dilution from another port is possible. * Emphasize the importance of taking a drug prescribed for the test on time. Tell the patient to set an alarm if the drug is to be taken during the night.

Answer 54

* Instruct the patient to being the urine collection (whether for 2, 4, 8, 12 or 24 hours) by first emptying his or her bladder. * Remind the patient to not save the urine specimen that begins the collection. The timing for the urine collection begins after this specimen. * Tell the patient to note the time of the discard specimen and to plan to collect all urine from this time until the end of the urine collection period. * To end the collection, instruct the patient to empty his or her bladder at the end of the timed period and add that urine to the collection. * Check with the laboratory to determine any special handling of the urine specimen (e.g. Is a preservative needed? Does the container need to be kept cold? * If needed, make sure that the preservative has been added to the collection container at the beginning of the collection. * Tell the patient about any preservative and the need to avoid splashing urine from the container because some preservatives make the urine caustic. * if the specimen must be kept cool or cold, instruct the patient to place the container in an inexpensive cooler with ice. The specimen container should not be kept with food or drinks.

Answer 55

* hormone levels and the metabolites of specific hormones in the urine are often measured to determine endocrine function * many endocrine hormones are secreted in a pulsatile fashion. * a 24 hour urine collection better reflects the overall function of certain glands, such as the adrena gland.

Answer 56

* Anterior, posterior, and lateral skull x-rays may be used to view the sella turcica. * Erosion of the sella turcica indicates invasion of the wall from an abnormal growth. * MRI with contrast is the most sensitive method of imaging the pituitary gland. * CT scan can evaluate the pituitary gland, but it is also used to evaluate the adrenal glands, ovaries, and pancreas. * Ultrasound evaluates the thyroid, parathyroid glands, ovaries and testes.

Answer 57

* Needle biopsy is used to indicate the composition of thyroid nodules. * Should check with MD if blood thinners should be stopped. * It is a relatively safe and quick outpatient procedure to determine if surgical intervention is needed.

Answer 58

* If one hormone is affected, it is called selective hypopituitarism. * If decrease in production of all the anterior pituitary hormones (rare condition) it is called panhypopituitarism. * It is divided into two lobes at the base of the brain * anterior lobe: adenohypophysis * posterior lobe: neurohypophysis

Answer 59

* Most life-threatening deficiencies- ACTH and TSH * Deficiency of gonadotropins * Growth hormone stimulates liver to produce somatomedins that enhance growth activity.

Answer 60

* Benign or malignant pituitary tumors can compress and destroy pituitary tissue. * Pituitary function can be impaired by malnutrition or rapid loss of body fat. * Shock or severe hypotension reduces blood flow-hypofunction and infarction. * Other-hed and brain trauma, brain tumors or infection, radiation or surgery of head and brain and AIDS. * Idiopathic hypopituitarism has an unknown cause.

Answer 61

* Look for changes in physical appearance * Assess changes in vision (especially peripheral vision for changes or loss) * Limited eye movement. * DECREASED Anterior Pituitary HORMONES * growth hormone: decreased bone density, pathological fractures, decreased muscle strength, increased serum cholesterol levels * Gonadotropins (Luteinizing hormone [LH}0, follicle-stimulating hormone [FSH]) : women; amenorrhea, anovulation, low estrogen levels, breast atrophy, loss of bone density, decreased axillary and pubic hair, decreased libido. Men; decreased facial hair, decreased ejaculate volume, reduced muscle mass, loss of bone density, decreased body hair, decreased libido and impotence. * thyroid-stimulating hormone (thyrotropin) (TSH): decreased thyroid hormone levels, weight gain, intolerance to cold, scalp alopecia, hirsutism, menstrual abnormalities, decreased libidio, slowed cognition, lethargy. * Adrenocorticotropic hormone (ACTH); decreased werum cortisol levels, pale, swallow complexion, malaise and lethary, anorexia, postural hypotension, headache, hypoglycemia, hyponatremia, decreased axillary and pubic hair (women) * Decreased Posterior Pituitary Hormones * Vasopressin (antidiuretic hormone [ADH]): Diabetes Insipidus: greatly increased urine output, low urine specific gravity (\<1.005), hypotension, dehydration, increased plasma osmolarity, increased thirst, output does not decrease when fluid intake decreases.

Answer 62

* lifelong replacement of dificient hormones * androgen therapy for virulization "Men" * most effective is parenteral & transdermal * Estrogens and progesterone - "Women" * Risk for hypertension and thrombosis. * Growth hormone * may be treated with subcutanceous injection of human GH at night to mimic normal GH release.

Answer 63

* Anterior Pituitary * Hyperpituitarism * Hypopituitarism * Posterior Pituitary * These problems can be caused by damage to the posterios pituitary or hypothalamus: * Diabetes Insipidus * Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 64

* Hormone oversecretion occurs with pituitary tumors or hyperplasia * pituitary adenoma (benign tumor) : most common are prolactin secreting tumors * One hormone is produced in excess PRI, ACTH, or GH

Answer 65

* Onset of growth hormone hypersecretion occurs before puberty * painful bones and joints

Answer 66

* Onset may be gradual with slow progression * Early detection and treatment are essential to prevent irreversible changes in soft tissues * Some changes are reversible but skeletal changes are permanent.

Answer 67

* Ask about family history * asku about any changes in hat, glove, ring, or shoe size and the presence of fatigue * ask specifically regarding headaches & changes in vision * Hypersecretion of PRL often reports sexual function difficulties * changes in appearance and target organ function occur with excessive anterior pituitary hormones

Answer 68

* Thickened Lips * coarse facial features * increasing head size * lower jaw protrusion * enlarged hands and feet * joint pain * barrel-shaped chest * hyperglycemia * sleep apnea * enlarged heart, lungs and liver

Answer 69

* hypogonadism (loss of secondart sexual characteristics) * decreased gonadotropin levels * galactorrhea (milky nipple discharge) * increased body fat * increased serum prolactin levels

Answer 70

* elevated plasma cortisol levels * weight gain * truncal obesity * moon face * extremity muscle wasting * loss of bone density * hypertension * hyperglycemia * striae and acne

Answer 71

* elevated plasma TSHA dn thyroid hormone levels * weight loss * tachycardia and dysrhythmias * heat intolerance * increased GI motility * fine tremors

Answer 72

* Men: * elevated LH and FSH levels * hypogonadism or hypergonadism * Women: * normal LH and FSH levels

Answer 73

* surgical removal of the pituitary gland and tumor is the most common treatment for hyperpituitarism. * successful surgery decreases hormone levels, relieves headaches, and may reverse changes in sexual functioning,

Answer 74

* nonsurgical * drug therapy * dopamine agonists: bromocriptine mesylate and cabergoline * other drugs: somatostatin analogs especially octreotide and lanreotide * octreotide inhibits GH release through negative feedback * Pevisomant blocks GH receptor activity and blocks production of insulin-like growth factor (IGF). * Radiation Therapy * does not have immediate effects in reduction

Answer 75

* abnormally high liner growth due to the excessice action of IGF-1 before the closure of the epiphyseal growth plates in childhood

Answer 76

* disorder of the IGF-1 which causes excessive growth of the hands, feet, jaw and internal organs in adulthood * mri shows pituitary tumor in 90% of acromegalic patients * the best confirmatory test for acromegaly is the oral glucose suppression test. * in acromegaly, glucose does not suppress growth hormone

Answer 77

* selective adenomectomy leaves normal pituitary tissue undisturbed. * surgical removal of pituitary gland and tumor through a transphenoidal approach.

Answer 78

* teach client that the procedure will decrease hormone levels * relieve headaches * may reverse changes in sexual function * Procedure will not reverse body changes, organ enlargement or visual changes. * client will have packing for 2-3 days * client will need to breathe through mouth * may have a mustache dressing under the nose * no brushing teeth, coughing, sneezing, blowing nose or bending forward is allowed.

Answer 79

* client is in a semi-sitting position * transsphenoidal incision just above the upper lip * if an endoscopic or tesnsphenoidal approach can not be done a craniotomy is required.

Answer 80

* assess * vision, mental status, altered LOc, decreased strength in extremities * diabetes insipidus * CSF leakage * infection * increased ICP (intercranial pressure) * avoid bending * avoid constipation * frequent mouth care every 4-6 hours * no brushin teeth for 2 weeks * expect numbness in area of incision * will experience decreased sense of smell for 3-4 months * hormone replacement with vasopression to maintain fluid balance to prevent diabetes incipidous.

Answer 81

* Monitor the patient's neurologic status hourly for the first 24 hours and then every 4 hours. * monitor fluid balance, especially for output greater than intake. * encourage the patient to perform deep-breathing exercises. * instruct the patient not to cough, blow the nose, or sneeze * instruct the patient to use dental floss and oral mouth rinses rather than toothbrushing until the surgeon gives permission. * instruct the patient to avoid bending at the waist to prevent increasing intercranial pressure. * monitor the nasal drip pad for the type and amount of drainage. * Teach the patient methods to avoid constipation and subsequent straining. * teach the patient self-administration of prescribed hormones.

Answer 82

MEN1 has an autosomal-dominat inheritance pattern and may result in a benign tumor of the pituitary, parathyroid glands, or pancreas. In the pituitary, this problem causes excessive production of growth hormone and acromegaly. Ask a patient with acromegaly whether either parent also had this problem or has had a tumor of the pancreas of parathyroid glands.

Answer 83

chest pain, dizziness, or watery nasal drainage occurs because of the possibility of serious side effects, including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage.

Answer 84

* Assess cardiovascular status: * vital signs, including apical pulse, pulse pressure, presence or absence of orthostatic hypotension, and the quality/rhythm of peripheral pulses. * Assess cognition and mental status. * Assess condition of operative site: * Observe nasal area for drainage: * if present, note color, clarity and odor * test clear drainage for the presence of glucose * Assess neuromuscular status: * Reactivity of patellar and biceps reflexes * oral temperature * handgrip strength * steadiness of gait * distant and near visual acuity * pupillary responses to light * Assess kidney function: * Observe urine specimen for color, odor, cloudiness, and amount. * Ask about: * headaches or visual disturbances * ease of bowel movements * 24-hour fluid intake and output * over-the-counter and prescribed drugs taken * Assess patient's understanding of illness and adherence with treatment: * symptoms to report to health care provider * drug plan (correct timing and dose)

Answer 85

* The posterior pituitary gland secretes: * Vasopressin * Antidiuretic hormone (ADH) * Two common disorders * Diabetes Insipidus * Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Answer 86

* Lithium can cause DI * Water metabolism problem cause by an ADH deficiency * either decrease in ADH synthesis or * inability of the kidneys to respond to ADH * Classifications * nephrogenic-inhertied disorder * primary-defect in hypothalamus or pituitary * secondary * drug-related

Answer 87

* Symptoms of dehydration * increase in frequency of urination and excessive thirst * dehydration and hypertonic saline tests used for diagnosis * urine diluted with low specific gravity (\<1.005)

Answer 88

* Oral chlorpropamide * desmopressin acetate * early detection of dehydration and maintenance of adequate hydration * lifelong vasopressin therapy with permanent condition * teach patients to weigh themselves daily to identify weight gain

Answer 89

deprived of fluids for more than 4 hours because he or she cannot reduce urine output and severe dehydration can result.

Answer 90

The result is poor water reabsorption by the kidney, although the actual amount of hormone produced is not deficient. The problem is most commonly inherited as an X-linked recessive disorder in which the AVPR2 gene coding for the ADH receptor is mutated and only males are affected. There is also an autosomal form of the disorder in which the AQP2 gene is mutated and both males and females are affected. When assessing a patient with DI, always ask whether anyone else in the family has ever had this disorder.

Answer 91

* hypotension * tachycardia * weak peripheral pulses * hemoconcentration * increased urine output * dilute, low specific gravity * poor turgor * dry mucous membranes * decreased cognition * ataxia * increased thirst * irritability

Answer 92

than the oral form, and the dosage must be reduced.

Answer 93

* vasopressin secreted even when plasma osmolarity is low or normal * fedback mechanisms does not function properly * water is retained, results in hyponatremia (decreased serum sodium levels)

Answer 94

* small cell lung cancer * pancreatic, duodenal, and GU carcinomas * thymona * hodgkin's lymphoma * non-Hodgkin's lymphoma * viral and bacterial pneumonia * lung abscesses * active tuberculosis * pneumonthorax * chronic lung diseases * mycoses * positive-pressure ventilation * trauma * infection * tumors (primary or metastatic) * strokes * porphyria * systemic lupus erythematosus * Exogenous ADH * chlorpropamide * Vinccristine * Cyclophosphasmide * Carbamazepine * Opioids * Tricyclic antidepressants * General anesthetics * Fluoroquinolone antibiotics

Answer 95

so serum sodium levels can be monitored closely for the development of hypernatremia.

Answer 96

* Recent head trauma * cerebrovascular disease * TB or other pulmonary disease * Cancer * All past and current drug use * decrease in serum sodium levels

Answer 97

* Fluid restriction * drug therapy (diuretics, hypertonic saline, demeclocycline) * monitor for fluid overload * safe environment * neurologic assessment

Answer 98

* Adrenocortical steriods may decrease from inadequate secretion of ACTH (adrenocorticotropic hormone) * dysfunction of hypothalmic-pituitary control mechanism * direct dysfunction of adrenal tissue * manifestations may develop gradually or quickly with stress. * adrenal crisis is a life threatening manifestation that may occur without warning (adrenocortical insufficiency)

Answer 99

* Life Threatening Event; need for cortisol and aldosterone is greater than available supply. * Usually occurs in response to stressful advent * Na will fall, K will increase, and hypotension develops. Watch for hypoglycemia.

Answer 100

* Autoimmune disease * Tuberculosis * metastatic cancer * fungal lesions * AIDS * hemorrhage * gram-negative sepsis * adrenalectomy * abdominal radiation * drugs & toxins

Answer 101

* Pituitary tumors * Sheehan's syndrome (postpartum pituitary necrosis) * hypophysectomy * High-dose pituitary radiation * high-dose whole brain radiation

Answer 102

* Assess s/s of: * hypoglycemia * hyperkalemia * lethargic, depressed, confused or psychotic * Diagnostic * Low serum cortisol * Low blood glucose * Low Na * Elevated K & ACTH * Stimulation test is most definitive test for adrenal insufficiency.

Answer 103

* Adrenal gland may oversecrete just one hormone or all adrenal hormones causing: * Cushing's-hypercortisolism * Hyperaldosteronism-excessive mineralcorticoid production * excessive androgen production * Pheochromocytoma results in excessive secretion of catecholamines (epinephrine and norepinephrine). * Bone apin

Answer 104

* Exaggerated secretion of cortisol from the adrenal cortex. * Incidence/prevalence * most common cause is pituitary adenoma * women more than men

Answer 105

* Clinical manifestations * skin changes * Cardiac changes * musculoskeletal changes * glucose metabolism * immune changes

Answer 106

* Cushing syndrome is caused by exogenous corticosteriods in drugs to control asthma, other respiratory problems, rheumatoid arthritis. It is more common than the disease and it effects both genders equally.

Answer 107

* Increased boy fat-truncal obesity * buffalo hump & moon face * decreased muscle mass * thin skin with fragile capillaries * bone density loss * shrinks organs containing lymphocytes * Hirustism

Answer 108

* Psychosocial Assessment * Laboratory tests: blood, salivary, urine cortisol levels * Imaging Assessment * Surgical Management: hypophysectomy & adrenalectomy

Answer 109

* Preoperative * electrolye imbalances are corrected * cardiac monitoring * control hyperglycemia * prevent infection * decrease risk of falls.

Answer 110

* unilateral adrenalectomy (one gland) * bilateral adrenalectomy (both glands) * abdominal cavity or lateral flank * laparoscopic adrenalectomy is increasing.

Answer 111

* critical care after surgery * bilateral adrenalectomy-client on life-long glucocorticoid and mineralocorticoid replacement, starting immediately after surgery.

Answer 112

* Primary hyperaldosteronism- caused by benign adrenal tumor : hypersectrion of aldosterone * results in Na and K excretion * Secondary hyperaldosteronism- causes high levels of angiotensin II- high serum renin levels * complications: hypertension, brain attach (stroke), kidney disease.

Answer 113

* Is a catecholamine producing tumor which causes release of epinephrine & norepinephrine * tumor is usually benign * do not maniuplate the tumor as it can cause release of epinephrine & norepinephrine * Once surgery is performed it can result in a sudden drop in cortisol levels.

Answer 114

* Has a rich blood supply * approximately 5 times the blood flow to the liver * 5 ml/min per gram of thyroid tissue * iodine is essential for thyroid to synthesize it hormones

Answer 115

* Thyrotoxicosis - is hyperthyroidism regardless of origin * hyperthyroidism causes hypermetabolsim and increased sympathetic nervous system activity.

Answer 116

* May be due to overproduction originating outside the thyroid * loss of storage function and leakage from the glands

Answer 117

* goiter * exophthalmos (bug eyes) * pretibial myxedema

Answer 118

* monitoring * reducing stimulation * promoting comfort * drug therapy (antithyroid drugs, iodine preparations, lithium, betaadrenergic blocking drugs)

Answer 119

* Total or subtotal thyroidectomy * monitor client for hoarseness or stridor, hypocalcemia & tetany, and thyroid storm * postoperative complications: * hemorrhage * respiratory distress * hypocalcemia and tetany (chvoteks & Trousseaus) * laryngeal nerve damage * thyroid storm or thyroid crisis * eye and vision problems of Graves disease

Answer 120

* Differentiating: Aging vs. hypothyroidism * decreased metabolism from low thyroid hormone levels

Answer 121

* Factors leading to myxedema coma include: * acute illness * surgery * chemotherapy * use of sedative or opioids

Answer 122

* Coma * Respiratory failure * hypotension * hyponatremia * hypothermia * hypoglycemia

Answer 123

* Is Rare * The heart muscle becomes flabby and the chamber size increases. * decreased cardiac output and perfusion * slowed perfusion * mucus and water under the skin * makes cellular metabolism worse * mortality rate is high and is a life-threatening emergency. * it can be caused by a variety of events, drugs, or conditions.

Answer 124

* Caused by excessive thyroid hormone release: which dramatically increases the metabolic rate. * even with treatment, thyroid storm may lead to death.

Answer 125

* Inflammation of thyroid gland * Three Types: * acute * subacute (granulomatous) * chronic (Hashimoto's disease-most common type) * Thyroiditis vs: hyperthyroidism or hypothyroidism * nonsurgical management: drug therapy * surgical management

Answer 126

* Parathyroid glands-calcium and phosphate balance * Hypercalcemia and hypophosphatemia * nonsurgical vs. surgical management

Answer 127

* decreased function of parathyroid gland * latrogenic * idiopathic * hypomagnesemia * Intervention * correcting hypocalcemia * vitamin D deficiency * hypomagnesemia

Answer 128

* Maintenance and regulation of vital functions * response to stress and injury * growth and development * energy metabolism * reproduction * fluid, electrolyte and acid-base balance

Answer 129

* adrenal * hypothalamus * ovaries * pancreas * parathyroid * pituitary * testes * thyroid

Answer 130

* Corticotropin-releasing hormone (CRH) * Gonadotropin-releasing hormone (GnRH) * Growth hormone-inhibiting hormone (GHIH) * Growth hormone-releasing hormone (GHRH) * Melanocyte-inhibiting hormone (MIH) * Prolactin-inhibiting hormone (PIH) * Thyrotropin-releasing hormone (TRH)

Answer 131

* Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle. * activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep and appetite.

Answer 132

* adrenocorticostropic hormone (ACTH) * follicle-stimulating hormone (FSH) * Growth Hormone (GH) * Luteinizing Hormone (LH) * Melanocyte-stimulating hormone (MSH) * Prolactin (PRL) * Somatotropic growth-stimulating hormone * Thyroid-stimulating hormone (TSH)

Answer 133

* These hormones are produced by the hypothalamus, stored in the posterior lobe, and secreted into the blood when needed. * oxytocin * vasopressin, antidiuretic hormone (ADH)

Answer 134

* The master gland; located at the base of the brain. * Influenced by the hypothalamus; directly affects the function of the other endocrine glands. * Promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function.

Answer 135

* Glucocorticoids: Cortisol, Cortisone, Corticosterone * Responsible for glucose metabolism, protein metabolism, fluid and electrolyte balance, suppression of the inflammatory response to injury, protective immune response to invasion by infectious agents, and resistance to stress * Mineralocorticoids: Aldosterone * Regulation of electrolyte balance by promoting sodium retention and potassium excretion.

Answer 136

* one adrenal gland is on top of each kidney * regulates sodium and electrolyte balance; affects carbohydrate, fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight or flight response. * adrenal cortex: * the cortex is the outer shell of the adrenal gland * the cortex synthesizes glucocorticoids and mineralocorticoids and secretes small amounts of sex hormones. * adrenal medulla * the medulla is the inner core of the adrenal gland * the medulla works as part of the sympathetic nervous system and produces epinephrine and norepinephrine.

Answer 137

* Located in the anterior part of the neck * controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin.

Answer 138

* located on the thyroid gland * controls calcium and phsophorus metabolism; produces parathyroid hormone

Answer 139

* located posteriorly to the stomach * influences carbohydrate metabolismm indirectly influences fat and protein metabolism, and produces insulin and glucagon.

Answer 140

* the ovaries are located in the pelvic cavity and produce estrogen and progesterone * the testes are located in the scotum, control the development of the secondary sex characteristics, and produce testosterone.

Answer 141

* Regulates hormone secretion by the hypothalamus and pituitary gland * increased amounts of target gland hormones in the bloodstream decrease secretion of the same hormone and other hormones that stimulate its release.

Answer 142

* In the client with suspected underactivity of an endocrine gland, a stimulus may be provided to determine whether the gland is capable of normal hormone production. * Measured amounts of selected hormones or substances are administered to stimulate the target gland to produce its hormone. * Hormone levels produced by the target gland are measured. * failure of the hormone level to increase with stimulation indicates hypofunction.

Answer 143

* Suppression tests are used when hormone levels are high or in the upper range of normal * agents that normally induce a suppressed response are administered to determine whether normal negative feedback is intact. * failure of hormone production to be suppressed during standardized testing indicates hyperfunction. *

Answer 144

* used to distinguish between Cushing's syndrome and Cushing's disease * In Cushing's disease the source of excess cortisol is the pituitary gland rather than the adrenal cortex or exogenous corticosteroid administration. * Dexamethasone, a potent long-acting corticosteriod given at bedtime, should suppress the morning cortisol in clients without Cushing's disease by suppressing adrenocroticotropic hormone (ACTH) production; in the client with Cushing's disease, this suppression will not occur.

Answer 145

* This thyroid function test measures the absorption of an iodine isotope to determine how the thyroid gland is functioning. * a small dose of radioactive iodine is given by mouth or IV; the amount of radioactivity is measured in 2 to 4 hours and again at 24 hours. * Normal values are approximately 3% to 10% at 2 to 4 hours. and 5 % to 30% in 24 hours. * Elevated values indicate hyperthyroidism, decreased iodine intake, or increased iodine excretion. * Decreased values indicate a low T4 level, the use of antithyroid medications, thyroiditis, myxedema, or hypothyroidism. * The test is contraindicated in pregnancy.

Answer 146

1. Blood tests are used to diagnose thyroid disorders. 2. T3 and T4 regulate thyroid-stimulating hormone. 3. Normal values (normal findings vary between laboratory settings) 1. Triiodothyronine, Total T3: 110.4 to 447.7 ng/dl 2. Thyroxine, total T4: 5 to 12 mcg/dl 3. Thyroxine, free (FT4): 0.8 to 2.8 ng/dL 4. The T4 level is elevated in hyperthyroidism and decreased in hypothyroidism.

Answer 147

1. Blood test is used to differentiate the diagnosis of primary hypothyroidism. 2. Normal value is 2 to 10 mclU/mL. 3. Elevated values indicate primary hypothyroidism. 4. Decreased values indicate hyperthyroidism or secondary hypothyroidism.

Answer 148

1. A thyroid scan is performed to identify nodules or growths in the thyroid gland. 2. A radioisotope of iodine or technetium is administered before scanning the thyroid gland. 3. Reaasure the client that the level of radioactive medication is not dangerous to self or others. 4. Determine whether the client has received radiographic contrast agents within the past 3 months, because these may invalidate the scan. 5. Check with the primary health care provider regarding discontinuing medications containing iodine for 14 days before the test and the need to discontinue thyroid medication before the test. 6. instruct the client to maintain NPO status after midnight on the day before the test; if iodine is used, the client will fast for an additional 45 minutes after ingestion of the oral isotope and the scan will be performed in 24 hours. 7. If technetium is used, it is administered by IV route 30 minutes before the scan. 8. The test is contraindicated in pregnancy.

Answer 149

1. Needle aspiration of thyroid tissue is done for cytological examination. 2. No client preparation is necessary; NPO status may or may not be prescribed. 3. Light pressure is applied to the aspiration site after the procedure.

Answer 150

1. Diagnostic tests for pheochromocytoma include a 24 hour urine collection for VMA, a product of catecholamine metabolism, metanephrine, and catecholamines, all of which are elevated 2. The normal range of urinary catecholamines: 1. Epinephrine: less than 20mcg/day 2. Norepinephrine: less than 100mcg/day

Answer 151

* anterior pituitary * hyperpituitarism * hypopituitarism * posterior pituitary * these problems can be caused by damage to the posterior pituitary or hypothalamus: * Diabetes insipidus * syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 152

1. Hyposecretion of 1 or more of the pituitary hormones caused by tumors, trauma, encephalitis, autoimmunity, or stroke. 2. Hormones most often affected are growth hormone (GH) and gonadotropic hormones (luteinizing hormone, follicle-stimulating hormone), but thyroid stumulating hormone (TSH), adrenocorticotropic hormone (ACTH), or antidiuretic hormone (ADH) may be involved. 3. assessment: 1. mild to moderate obesity( GH, TSH) 2. reduced cardiac output (GH, ADH) 3. Infertility, sexual dysfunction (gonadotropins, ACTH) 4. Fatigue, low blood pressure (TSH, ADH, ACTH, GH) 5. Tumors of the pituitary also may cause headaches and visual defects ( the pituitary is located near the optic nerve) 4. Interventions: 1. client may need hormone replacement for the specific deficient hormones. 2. Provide emotional support to the client and family. 3. Encourage the client and family to express feelings related to disturbed body image or sexual dysfunction. 4. Cleint education is needed regarding the signs and symptoms of hypofunction and hyperfunction related to insufficient or excess hormone replacement,

Answer 153

* hormones= ACTH, TSH, Gonadotropins, GH * Assessment/Labs * changes in physical appearance * temporal headache * diplopia, occular muscle paralysis * stimulating test * Interventions/Drugs * CT or MRI with contrast * testosterone/androgen replacement * surgical procedure: hypophysectomy

Answer 154

* Hormones: excessive PRL, ACTH, GH * Assessment/Labs: gigantism, acromegaly * intervention/drugs: * Bromocriptine (parlodel) * octreotide (Sandostatin) * hypophysectomy

Answer 155

* hormones: ADH deficiency * Assessment/labs: * lithium use * head trauma * polyuria * dilute urine (decreased specific gravity) * 24 hour urine collection * interventions/drugs: * strict I&O * daily weight : call MD \>2.2 lb gain * call if persistant headache or acute confusion * desmopressinacetate DDAVP * Vasopressin (Pitressin * chlopropamide (diabinese)

Answer 156

* hormones: vasopressin in response to low osmolarity * Assess/labs: * assess pulmonary edema * decreased tendon reflexes * bounding pulse * hyponatremia * water intoxication * Interventions/drugs * fluid restriction 500-1000 ml in 24 hours * strict I&O * daily weights * hypertonic IV * monitor Na and change to 0.9 NS * tolvaptan (Jynarque) * demeclocycline

Answer 157

* hormones: aldosterone & cortisol * assessment/labs: * Na & water excretion causing hyponatremia & hypovolemia * k retention * lactic acidosis * check for hypoglycemia * hyperkalemia * increase potassium and ACTH * decreased serum cortical * stimulation test * Interventions/drugs * fludrocortisone * deltasone * check for addisonian crisis * correct hypogycemia * utilize lift sheet to prevent fractures

Answer 158

* hormones: cortisol * assess/labs: * increased blood glucose * increased appetite * blood, saliva and urine tests * cortisol levels are high * hursutism (masculine characteristics in females) * buffalo hump * fat pads * weight gain * Interventions/drugs * weight * lifelong (bilateral adrenalectomy) glucocorticoid replacement/in unilateral hormone replacement continues until the remaining adrenal gland increases hormone production, may be needed for up to 2 years after surgery. * H2 receptor blockers: GI bleeding is common with hypercortisolism. * cimetidine * famotidine * ranitidine * nizotydine * Metyrapone

Answer 159

* hormones: aldosterone & increased angiotensin II * Assess/labs: * Na Retention * Potassium exretion * metabolic acidosis * increased BP * Headache * Interventions: * Prep Adrenalectomy * Glucocorticoid replacement * Spironalactone (Aldactone)

Answer 160

* Hormones: Catecolamine (tumor-adrenal medulla) * Assess/Labs * intermittent hypertension * severe headache * profuse diaphoresis * flushing * Intervention/drugs * do not palpate abdomen * 24 hr urine * Phenoxybenzamine

Answer 161

1. hypersecretion of growth hormone by the anterior pituitary gland in an adult; caused primarily by pituitary tumors. 2. Assessment: 1. large hands and feet 2. thickening and protrusion of the jaw 3. arthritic changes and joint pain, inpingement syndromes 4. visual disturbances 5. diaphoresis 6. oily, rough skin 7. organomegaly 8. hypertension, atheroscelerosis, cardiomegaly, heart failure 9. dysphagia 10. deepening of the voice 11. thickening of the tongue, narrowing of the airway, sleep apnea 12. hyperglycemia 13. colon polyps, increased colon cancer risk. 3. inteventions: 1. provide pharmacological interventions to suppress GH or block the action of GH 2. prepare the client for radiation of the pituitary gland or or stereotactic radiosurgery if prescribed. 3. prepare the client for hypophysectomy if planned. 4. provide pharmacological and nonpharmacological interventions for joint pain. 5. provide emotional support to the client and family, and encourage the client and family to express feelings related to disturbed body image.

Answer 162

1. removal of a pituitary tumor via craniotomy or a sublabial transsphenoidal (endscopic transnasal) approach (the latter approach is preferred because it is associated with fewer complications). 2. Complications for craniotomy include increased intracranial pressure, bleeding, meningitis, and hypopituitarism. 3. complications for the sublabial transsphenoidak surgery include cerebrospinal fluid leak, infection, diabetes insipidus, and hypopituitarism. 4. if the sublabial approach is used, an incision is made along the gum line of the inner upper lip. 5. Postoperative interventions 1. monitor vital signs, neurological status, and level of consciousness. 2. Elevate the head of the bed. 3. monitor for increased intracranial pressure. 4. Instruct the client to avoid sneezing, coughing and blowing the nose. 5. Monitor for bleeding. 6. Monitor for and report signs of temporary diabetes insipidus; monitor intake and output, and report excessive urinary output. 7. If the entire pituitary is removed, clients will require lifelong replacement of ADH, cortisol, and thyroid hormone. 8. monitor for and report signs of infection and meningitis. 9. administer antibiotics, analgesics, and antipyretics as prescribed. 10. Administer oral mouth rinses as prescribed. Clients may be instructed to avoid using a toothbrush or to brush teeth gently with an ultrasoft toothbrush fo 10 days to 2 weeks after surgery. 11. Instruct the client in the administration of prescribed medications.

Answer 163

Clear drainage should be checked for glucose.

Answer 164

1. hyposecretion of ADH by the posterior pituitary gland caused by stroke, trauma, or surgery, or it may be idiopathic. 2. Kidney tubules fail to reabsorb water 3. in central diabetes insipidus there is decreased ADH production. 4. In nephrogenic diabetes insipidus, ADH production is adequate, but the kidneys do not respond appropriately to the ADH. 5. Assessment 1. excretion of large amounts of dilute urine 2. polydipsia 3. dehydration (decreased skin turgor and dry mucous membranes) 4. inability to concentrate urine 5. low urinary specific gravity; normal is 1.005 to 1.030 6. fatigue 7. muscle pain and weakness 8. headache 9. postural hypotension that may progress to vascular collapse without rehydration 10. tachycardia 6. Interventions 1. Monitor vital signs and neurological and cardiovascular status. 2. Provide a safe environment, particularly for the client with postural hypotension. 3. monitor electrolyte values and for signs of dehydration. 4. maintain client intake of adequate fluids; IV hypotonic saline may be prescribed to replace urinary losses. 5. monitor intake and output, weight, serum osmolality, and specific gravity of urine for excessive urinary output, weight loss, and low urinary specific gravity. 6. instruct the client to avoid foods or liquids that produce diuresis. 7. vasopressin or desmopressin acetate may be prescribed; these are used when the ADH deficiency is severe or chronic. 8. Instruct the client in the administration of medications as prescribed; desmopressin acetate may be administered by subcutaneous injection, intravenously, intranasally, or orally; watch for sings of water intoxication indicating overtreatment. 9. Instruct the client to wear a medicalert bracelet.

Answer 165

1. Condition of hyperfunctioning of the posterior pituitary gland in which excess ADH is released, but not in response to the body's need for it. 2. causes include trauma, stroke, malignancies (often in lungs or pancreas), medications, and stress. 3. The syndrome results in increased intravascular volume, water intoxication, and dilutional hyponatremia. 4. May cause cerebral edema, and the client is at risk for seizures. 5. Assessment: 1. signs of fluid volume overload 2. changes in level of consciousness and mental status changes 3. weight gain without edema 4. hypertension 5. tachycardia 6. anorexia, nausea and vomiting 7. hyponatremia 8. low urinary output and concentrated urine. 6. Interventions 1. Monitor vital signs and cardiac and neurological status. 2. provide a safe environment, particularly for the client with changes in level of consciousness or mental status. 3. Monitor for signs of increased intracranial pressure. 4. Implement seizure precautions 5. Elevate the head of the bed a maximum of 10 degrees to promote venous return and decrease baroreceptor-induced ADH release. 6. Monitor intake and output and obtain weight daily. 7. Monitor fluid and electrolyte balance. 8. Monitor serum and urine osmolality. 9. Restrict fluid intake as prescribed. 10. Administer IV fluids (usually normal saline [NS] or hypertonic saline) as prescribed; monitor IV fluids carefully because of the risk for fluid volume overload. 11. Loop diuretics may be prescribed to promote diuresis, but only if serum sodium is at least 125 mEq/L; potassium replacement may be necessar if loop diuretics are prescribed. 12. Vasopressin antagonists may be prescribed to decrease the renal response to ADH

Answer 166

* adrenal cortex * addison's disease * primary hyperaldosteronism (Conn's syndrome) * Cushing's disease * Adrenal Medulla * Pheochromocytoma

Answer 167

* lethargy, fatigue, and muscle weakness * gastrointestinal disturbances * weight loss * menstrual changes in women; impotence in men * hypoglycemia, hyponatremia * hypotension * hyperpigmentation of skin (bronze) with primary disease

Answer 168

1. general muscle wasting and weakness 2. moon face, buffalo hump 3. truncal obesisty with thin extemities, supraclavicular fat pads; weight gain 4. hirutism (masculine characteristics in females) 5. hyperglycemia, hypernatremia 6. hypokalemia, hypocalcemia 7. hypertension 8. fragile skin that bruises easily, reddish-purple striae on the abdomen and upper thighs

Answer 169

1. Primary adrenal insufficiency 1. also known as Addison's disease, refers to hyposecretion of adrenal cortex hormones (glucocorticoids, mineralcorticoids, and androgen); autoimmune destruction is a common cause. 2. requires lifelong replacement of glucocorticoids and possibly of mineralcorticoids if significant hyposecretion occurs; the condition is fatal if left untreated. 2. Secondary adrenal insufficiency is caused by hyposecretion if ACTH from the anterior pituitary gland; mineralocorticoid release is spoared. 3. Loss of glucocorticoids in Addison's disease leads to decreased vascular tone, decreased vascular response to the catecholamines epinephrine and norepinephrine, and decreased gluconeogenesis. 4. In addison's disease, loss of the mineralocorticoid aldosterone leads to dehydration, hypotension, hyponatremia, and hyperkalemia. 5. Interventions: 1. monitor vital signs (particularly for hypotension), for weight loss, and intke and output. 2. Monitor WBC count, blood glucose; and potassium, sodium, and calcium levels. 3. administer glucocorticoid and/or mineralocorticoid medications as prescribed. 4. Observe for addisonian crisis caused by stress, infection, trauma, or surgery.

Answer 170

* need for lifelong glucocorticoid replacement and possibly lifelong mineralcorticoid replacement. * corticosteroid replacement will need to be increased during times of stress. * avoid individuals with an infection * avoid strenous exercise and stressful situations * avoid over the counter medications * diet should be high in protein and carbohydrates; clients taking glucocorticoids should be prescribed calcium and vitamin D supplements to maintain normal levels and to protect against corticosteroid-induced osteoporosis; some clients taking mineralocorticoids may be prescribed a diet high in sodium. * wear a medicalert braclet * report signs and symptoms of complications, such as underreplacment and overreplacement of corticosteroid hormones.

Answer 171

1. a life threatening disorder causes by acute adrena insufficiency 2. precipitated by stress, infection, trauma, surgery, or abrupt withdrawal of exogenous corticosterioid use. 3. Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock. 4. Assessment: 1. severe headache 2. severe abdominal, leg, and lower back pain 3. generalized weakness 4. irritability and confusion 5. severe hypotension 6. shock 5. Interventions: 1. prepare to administer glucocorticoids intravenously as prescribed. 2. administer IV fluids as prescribed to replace fluids and restore electrolyte balance. 3. Following resolution of crisis, administer glucocorticoid and mineralcorticoid orally as prescribed. 4. monitor vital signs, particularly blood pressure. 5. monitor neurological status, noting irritability and confusion. 6. monitor intake and output. 7. monitor laboratory values, particularly sodium, potassium, and blood glucose levels. 8. Protect the client from infection. 9. Maintain bed rest and provide a quiet environment.

Answer 172

establish a plan with their PHCPs or endocrinologist for increasing their corticosteroids during times of stress.

Answer 173

1. A metabolic disorder resulting rom the chronic and excessive production of cortisol by the adrenal cortex or from the administration of glucocorticoids in large doses for several weeks or longer (exogenous or iatrogenic (meds). 2. ACTH secreting tumors (most often of the lung, pancreas, or gastrointestinal [GI] tact) can cuase Cushing's syndrome.

Answer 174

1. Is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the pituitary gland.

Answer 175

1. Monitor vital signs, particularly blood pressure 2. Monitor intake and output and weight. 3. Monitor laboratory values, particularly WBC count and serum glucose, sodium, potassium, and calcium levels. 4. Prepare the client for radiation as prescribed if the condition results from a pituitary adenoma. 5. Administer chemotherapeutic agents as prescribed for inoperable adrenal tumors. 6. Prepare the client for removal of the pituitary tumor (hypophysectomy, sublabial transsphenoidal adenectomy) if the condition results from increased pituitary secretion of ACTH. 7. Prepare the client for adrenalectomy if the condition results fro an adrenal adenoma; glucocorticoid replacement may be required following adrenalectomy. 8. Clients requiring lifelong glucocorticoid replacement following adrenalectomy should obtain instructions from their PHCPs about increasing their glucocorticoid during times of stress. 9. Assess for and protect against postoperative thrombus formation; Cushing's syndrome predisposes to thromboemboli. 10. Allow the client to discuss feelings related to body appearance. 11. instruct the client about the need to wear a MedicAlert bracelet.

Answer 176

are characterized by a hypersecretion of glucocorticoids.

Answer 177

1. Hypersecretion of mineralcorticoids (aldosterone) from the adrenal cortex of the adrenal gland. 2. Most commonly caused by an adenoma. 3. Excess secretion of aldosterone causes sodium and water retention and potassium secretion, leading to hypertension and hypokalemic alkalosis.

Answer 178

* symptoms related to hypokalemia, hypernatremia, and hypertension. * headache, fatigue, muscle weakness * cardiac dysrhythmias * paresthesia, tetany * visual changes * glucose intolerance * elevated serum aldosterone levels

Answer 179

1. Monitor vital signs, particularly blood pressure. 2. monitor potassium and sodium levels. 3. monitor intake and output and urine specific gravity. 4. Monitor for hyperkalemia, particularly for clients with impaired renal function or excessive potassium intake, because potassium retaining diuretics and aldosterone antagonists may be prescribed to promote fluid balance and control hypertension. 5. Administer potassium supplements as prescribed to treat hypokalemia; clients taking potassium-retaining diuretics and potassium supplementation are at risk for hyperkalemia. 6. Prepare the client or adrenalectomy. 7. Maintain sodium restriction, if prescribed, preoperatively. 8. Administer glucocorticoids preoperatively, as prescribed, to prevent adrenal hypofunction and prepare for sgtress of surgery. 9. Monitor the client for adrenal insufficiency postoperatively. 10. Instruct the client regarding the need for glucocorticoid therapy following adrenalectomy. 11. Instruct the client about the need to wear a MedicAlert bracelet.

Answer 180

1. catecholamine-producing tumor usually foundin the adrenal medulla, but extraadrenal locations include the chest, bladder, abdomen, and brain; typically is a benign tumor but can be malignant. 2. Excessive amounts of epinephrine and norepinephrine are secreted. 3. Diagnostic test includes a 24-hr urine collection for VMA. 4. Surgical removal of the adrenal gland is the primary treatment. 5. Symptomatic treatment is initiated if surgical removal is not possible. 6. The complications associated with pheichromocytoma include hypertensive crisis; hypertensive retinopathy and nephropathy, cardiac enlargement, and dysrhythmias; heart failure; myocardial infarction; increased platelet aggregation; and stroke. 7. death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting arotic aneurysm.

Answer 181

1. Paroxysmal or sustained hypertension 2. palpitations 3. severe headache 4. flushing and profuse diaphoresis 5. pain in the chest or abdomen with nausea and vomiting. 6. heat intolerance 7. weight loss 8. tremors 9. hyperglycemia.

Answer 182

1. Monitor vital signs, particularly blood pressure and heart rate. 2. Monitor for hypertensive crisis; monitor for compliactions that can occur with hypertensive crisis, such as stroke, cardiac dysrhythmias, and myocardial infarction. 3. Instruct the client not to smoke, drink caffeine-containing beverages, or change position suddenly. 4. Prepare to administer alpha adrenergic blocking agents and Beta adrenergic blocking agents as prescribed to control hypertension. Alpha adrenergic blocking agents are started 7 to 10 days before beta adrenergic blocking agents. 5. Monitor serum glucose level. 6. Promote rest and a nonstressful environment. 7. Provide a diet high in calories, vitamins, and minerals. 8. Prepare the client for adrenalectomy.

Answer 183

such as increased abdominal pressure and vigorous abdominal palpation.

Answer 184

1. surgical removal of an adrenal gland. 2. Lifelong glucocorticoid and mineralcorticoid replacement is necessary with bilateral adrenalectomy. 3. Temporary glucocorticoid replacement, ususally up to 2 years, is necessary after a unilateral adrenalectomy. 4. Catecholamine levels drop as a result of surgery, which can result in cardiovascular collapse, hypotension, and shock, and the needs to be monitored closely. 5. Hemorrhage also can occur because of the high vascularity of the adrenal glands.

Answer 185

Preoperative 1. Monitor electrolyte levels and correct electrolyte imbalances. 2. Assess for dysrhythmias 3. Monitor for hyperglycemia 4. Protect the client from infections. 5. Administer glucocorticoids as prescribed. Postoperative 1. monitor vital signs. 2. Monitor intake and output; if the urinary output is lower than 30ml/hr, notify the PHCP or nephrologist, because this may result in acute kidney injury and indicate impending shock. 3. Monitor weight daily. 4. Monitor electrolyte and serum glucose levels. 5. Monitor for signs of hemorrhage and shock, particularly during the first 24 to 48 hours. 6. Monitor for manifestations of adrenal insufficiency. 7. Assess the dressing for drainage. 8. monitor for paralytic ileus. 9. Administer IV fluids as prescribed to maintain blood volume. 10. Administer IV fluids as prescribed to maintain blood volume. 11. Administer glucocorticoids and mineralocorticoids as prescribed. 12. Administer pain medication as prescribed. 13. Provide pulmonary interventions to prevent atelectasis (coughing and deep breathing, incentive spirometry, splinting of incision). 14. Instruct the client in the importance of hormone replacement following surgery. 15. Instruct the client regarding signs and symptoms of complications such as underreplacement and overreplacement of hormones. 16. Instruct the client regarding the need to wear a medicalert bracelet.

Answer 186

1. lethargy and fatigue 2. weakness, muscle aches, paresthesia 3. intolerance to cold 4. weight gain 5. dry skin and hair l oss of body hair. 6. bradycardia 7. constipation 8. general puffiness and edema around the eyes and face (myxedema) 9. forgetfulness and loss of memory 10. menstrual disturbances 11. goiter may or may not be present 12. cardiac enlargement, tendency to develop heart failure.

Answer 187

1. Personality changes such as irritability, agitation, and mood swings. 2. Nervousness and fine tremors of the hands. 3. weakness, muscle aches, paresthesias. 4. Heat tolerance. 5. Weight loss 6. Smooth, soft skin and hair. 7. Palpitations, cardiac dysrhythmias, such as tachycardia or atrial fibrillation 8. diarrhea 9. protruding eyeballs (exophtalmos) may be present 10. Diaphoresis 11. hypertension 12. enlarged thyroid gland (goiter)

Answer 188

1. Hypothyroid state resulting from hyposecretion of thyroid hormones and characterized by a decreased rate of body metabolism. 2. The T4 is low and the TSH is elevated. 3. In primary hypothyroidism the source of dysfunction is the thyroid gland, and the thyroid can not produce the necessary amount of hormones. In secondary hypothyroidism, the thyroid is not being stimulated by the pituitary to produce hormones.

Answer 189

1. Monitor vital signs, including heart rate, and rhythm. 2. Administer thyroid replacement; levothyroxine sodium is most commonly prescribed. 3. Instruct the client about thyroid replacement therapy and about the clinical manifestations of both hypothyroidism and hyperthyroidism related to underreplacement or overreplacement of the hormone. 4. Instruct the client in a low-calorie, low choleterol, low-saturated fat diet; discuss a daily exercise program such as walking. 5. Assess the client for constipation; provide roughage and fluids to prevent constipation. 6. Provide a warm environment for the client. 7. Avoid sedatives and opioid analgesics because of increased sensitivity to these medications; may precipitate myxedema coma. 8. Monitor for overdose of thyroid medications, characterized by tachycardia, chest pain, restlessness, nervousness, and insomnia. 9. Instruct the client to report episodes of chest pain or other signs of overdose immediately.

Answer 190

1. This rare but serious disorder results from persistently low thyroid production. 2. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, or the use of sedatives and opioid analgesics.

Answer 191

1. Hypotension 2. bradycardia 3. hypothermia 4. hyponatremia 5. hypoglycemia 6. generalized edema 7. respiratory failure 8. coma

Answer 192

1. Maintain a patent airway. 2. Institute aspiration precautions. 3. Administer IV fluids (normal or hypertonic saline) as prescribed. 4. Administer levothyroxine sodium intravenouslhy as prescribed. 5. administer glucose intravenously as prescribed. 6. administer corticosteroids as prescribed. 7. assess the client's temperature hourly. 8. monitor blood pressure frequently. 9. keep the client warm. 10. monitor for changes in mental status. 11. monitor electrolyte and glucose levels.

Answer 193

1. Hyperthyroid state resultig from hypersection of thyroid hormones (T3 and T4) 2. Characterized by an increased rate of body metabolism. 3. A common cause is Grave's Disease, also known as toxic diffuse goiter. 4. Clinical manifestations are referred to as thyrotoxicosis. 5. The T3 and T4 are usually elevated and the TSH level is low.

Answer 194

1. Provide adeqaute rest. 2. administer sedatives as prescribed. 3. Provide a cool and quiet environment. 4. Obtain weight daily. 5. Provide a high-calorie diet. 6. Avoid the administration of stimulants. 7. Administer antithyroid medications, such as methimazole or propylthiouracil, that block thyroid synthesis as prescribed. 8. Administer iodine preparations that inhibit the release of thyroid hormone as prescribed. 9. Administer propranolol for tachycardia as prescribed. 10. Prepare the client for radioactive iodine therapy, as prescribed, to destroy thyroid cells. 11. Prepare the cliet for subtotal thyroidectomy if prescribed. 12. Elevate the head of the bed of a client experiencing exophthalmos; in addition, instruct on low-salt diet, administer artificial tears, encourage the use of dark glasses, and tape eyelids closed at night if necessary. 13. Allow the client to express concerns about body image changes.

Answer 195

* This acute and life threatening condition occurs in a client with uncontrollable hyperthyroidism. * It can be caused by manipulation of the thyroid gland during surgery and the release of thyroid hormone into the bloodstream; it also can occur from severe infection and stress. * Antithyroid medications, beta blockers, glucocorticoids, and iodides may be administered to the client before thyroid surgery to prevent its occurrence.

Answer 196

1. Elevated temperature (fever) 2. tachycardia 3. systolic hypertension 4. Nausea, vomiting, and diarrhea 5. agitation, anxiety, tremors. 6. Irritability, agitation, restlessness, confusion, and seizures as the condition progresses 7. Delirium and coma

Answer 197

1. Maintain a patent airway and adequate ventilation. 2. Administer antithyroid medications, iodides, propranolol, and glucococorticoids as prescribed. 3. Monitor vital signs. 4. Monitor continually for cardiac dysrhythmias. 5. Administer nonsalicylate antipyretics as prescribed (salicylates increase free thyroid hormone levels). 6. Use a cooling blanket to decrease temperature as prescribed.

Answer 198

1. Cardiac dysrhythmias 2. carpopedal spasm 3. dysphagia 4. muscle and abdominal cramps 5. numbness and tingling of the face and extremities 6. Positive Chvostek's sign 7. Positive Trousseau's sign 8. Visual disturbances (photophobia) 9. Wheezing and dyspnea (bronchospasm, laryngospasm) 10. Seizures

Answer 199

* Removal of the thyroid gland * Performed when persistent hyperthyroidism exists * Subtotal thyroidectomy, removal of a portion of the thyroid gland, is the preferred surgical intervention. * PreOp: * Obtain VS and weight * assess electrolyte levels * assess for hyperglycemia * instruct the client in how to perform coughing and deep-breathing exercises and how to support the neck in the posoperative period when coughing and moving. * administer antithyroid medications, iodides, propranolol, and glucocorticoids as prescribed to prevent the occurrence of thyroid storm. * Postoperative interventions * Monitor for respiratory distress * have a tracheotomy set, oxygen, and suction at the bedside. * limit client talking and assess level of hoarseness. * Avoid neck flexion and stress on the suture line. * Monitor for laryngeal nerve damage, as evidenced by airway obstruction, dysphonia, high-pitched voice, stridor, dysphagia, and restlessness. * Monitor for signs of hypocalecemia and tetany, which can be caused by trauma to the parathyroid gland. * Prepare to administer calcium gluconate as precribed for tetany. * Monitor for thyroid storm

Answer 200

Monitor for inflammation, which may block the airway. An emergency tracheostomy kit should be at the bedside.

Answer 201

* Condition caused by hyposecretion of parathyroid hormone by the parathyroid gland. * Can occur following thyroidectomy because of removal of parathyroid tissue.

Answer 202

1. hypocalcemia and hyperphosphatemia 2. numbness and tingling in face 3. muscle cramos and cramps in the abdomen or in the extremities. 4. Positive Trousseau's sign or Chvostek's sign. 5. Signs of overt tetany, such as bronchospasm, laryngospasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias, seizures 6. hypotension 7. anxiety, irritability, depression

Answer 203

* Monitor vital signs * monitor for signs of hypocalcemia and tetany. * Initiate seizure precautions. * Placed a tracheotomy set, oxygen, and suctioning equipment at the bedside. * Prepare to administer calcium gluconate intravenously for hypocalcemia. * Provide a high-calcium diet, low phorphorus diet. * Instruct the client in the administration of vitamin D supplements as prescribed; vitamin D enhances the absorption of calcium from the GI tract. * Instruct the client in the use of thiazide diuretics if prescribed, to protect the kidney if vitamin D is also taken. * Instruct the client in the administration of phosphate binders as prescribed, to promote excretion of phosphate through the GI tract. * Instruct the client to wear a MedicAlert bracelet.

Answer 204

Condition caused by hypersectrion of parathyroid hormone (PTH) by the parathyroid gland

Answer 205

1. hypercalcemia and hypophosphatemia 2. fatigue and muscle weakness 3. skeletal pain and tenderness 4. bone deformities that result in pathological fractures. 5. Anorexia, nausea, vomiting, epigastric pain. 6. weight loss 7. constipation 8. hypertension 9. cardiac dysrhythmias 10. renal stones

Answer 206

1. Monitor vital signs, particularly blood pressure. 2. Monitor for cardiac dysrhythmias. 3. monitor intake and output and for signs of renal stones. 4. Monitor for skeletal pain; move the client slowly and carefully. 5. Encourage fluid intake. 6. Administer furosemide as prescribed to lower calcium levels. 7. Administer NS intravenously as prescribed to maintain hydration. 8. Adminster phosphates, which interfere with calcium reabsorption, as prescribed. 9. Administer calcitonin as prescribed to decrease skeletal calcium release and increase renal excretion of calcium. 10. Administer IV or oral biphosphonates to inhibit bone resorption. 11. Monitor calcium and phosphorus levels. 12. Prepare the client for parathyroidectomy as prescribed. 13. Encourage a high-fiber, moderate calcium diet. 14. Emphasize the importance of an exercise program and avoiding prolonged inactivity.

Answer 207

1. Removal of 1 or more of the parathyroid glands. 1. endoscopic radioguided parathyroidectomy with autotransplantation is a common procedure. 2. Parathyroid tissue is transplanted in the forearm or near the sternocleidomastoid muscle, allowing PTH secretion to continue. 2. Preoperative Interventions 1. monitor electrolytes, clacium, phosphate, and magnesium levels. 2. endure that calcium levels are decreased to near-normal values. 3. Inform the client that talking may be painful for the first day or two after surgery. 3. Postoperative Interventions: 1. Monitor for respiratory distress. 2. Place a tracheotomy set, oxygen, and suctioning equipment at the bedside. 3. Monitor vital signs. 4. Position the client in semi-fowler's position. 5. Assess neck dressing for bleeding. 6. Monitor for hypocalcemic crisis, as evidenced by tingling and twitching in the extremities and face. 7. Assess for positive Trousseau's sign or Chvostek's sign, which indicates tetany. 8. Monitor for changes in voice pattern and hoarseness. 9. Monitor for laryngeal nerve damage. 10. Instruct the client in the administration of calcium and vitamin D supplements as prescribed.

Answer 208

1. Treats Hyperthyroidism 2. antithyroid medicine 3. used less often because of liver toxicity 4. teach patient to avoid crowds and people who are ill because the drug reduces the immune response, increasing the risk for infection.

Answer 209

1. A calcimimetic 2. when taken orally, the drug bonds to calcium-sensitive receptors

Answer 210

1. prevent hypoglycemia by increasing liver glucose production (gluconeogenesis) and inhibiting peripheral glucose use. 2. Maintain excitability and responsiveness of cardiac muscle. 3. Increase lipolysis, releasing glycerol and free fatty acids. 4. Increase protein catabolism 5. Degrade collagen and connective tissue 6. Increase the number of mature neutrophils released from bone marrow. 7. Exert anti-inflammatory effects that decrease the migration of inflammatory cels to site of injury. 8. Maintain behavior and cognitive functions.

Answer 211

1. Control metabolic rate of all cells 2. promote sufficient pituitary secretion of growth hormone and gonadotropins 3. Regulate protein, carbohydrate, and fat metabolism. 4. Exert effects on heart rate and contractility. 5. increase red blood cell production 6. affect respiratory rate and drive 7. increase bone formation and decrease bone resorption of calcium 8. act as insulin antagonists.

Answer 212

1. Check you laboratory's method of handling hormone test samples for tube type, timing, drugs to be administered as part of the test, etc. For example, blood samples drawn for catecholamines must be placed on ice and taken to the laboratory immediately. 2. Explain the procedure and any restrictions to the patient. 3. If you are drawing blood samples from an IV line, clear the line thoroughly. Do not use a double- or triple- lumen line to obtain samples; contaimination or dilution from another port is possible. 4. Emphasize the importance of taking a drug prescribed for the test on time. Tell the patient to set an alarm if the drug is to be taken during the night.

Answer 213

1. Instruct the patient to begin the urine collection (whether for 2,4,8,12 or 24 hours) by first emptying his or her bladder. 2. Remind the patient to not save the urine specimen that begins the collection. The timing for the urine collection begins after this specimen. 3. Tell the patient to note the time of the discarded specimen and to plan to collect all urine from this time until the end of the urine collection period. 4. To end the collection, instruct the patient to empty his or her bladder at the end of the timed period and add that urine to the collection period. 5. Check with the laboratory to determine any special handling of the urine specimen (e.g. Is a preservative needed? Does the container need to be kept cold?) 6. If needed, make sure that the preservative has been added to the collection container at the beginning of the collection. 7. Tell the patient about any preservative and the need to avoid splashing urine from the container because some preservatives make the urine caustic. 8. If the specimen must be kept cool or cold, instruct the patient to place the container in an inexpensve cooler with ice. The specimen container should not be kept with food or drinks.

Answer 214

1. decreased bone density 2. pathologic fractures 3. decreased muscle strength 4. increased serum cholesterol levels

Answer 215

1. women: 1. amenorrhea 2. anovulation 3. low estrogen levels 4. breast atrophy 5. loss of bone density 6. decreased axillary and pubic hair 7. decreased libido 2. Men: 1. decreased facial hair 2. decreased ejaculate volume 3. reduced muscle mass 4. loss of bone density 5. decreased body hair 6. decreased libido impotence

Answer 216

1. decrease thyroid hormone levels 2. weight gain 3. intolerance to cold 4. scalp alopecia 5. Hirsutism 6. menstrual abnormalities 7. decreased libido 8. slowed cognition 9. lethargy

Answer 217

1. decreased serum cortisol levels 2. pale, sallow complexion 3. malaise and lethargy 4. anorexia 5. postural hypotension 6. headache 7. hypoglycemia 8. hyponatremia 9. decreased axillary and pubic hair (women)

Answer 218

1. Diabetes Insipidus: 1. Greatly increased urine output 2. low urine specific gravity (\<1.005) 3. hypotension 4. dehydration 5. increased plasma osmolarity 6. increased thirst 7. output does not decrease when ffluid intake decreases

Answer 219

1. Prolaction PRL: 1. hypogonadism (loss of secondary sexual characteristics) 2. decreased gonadotropin levels 3. galactorrhea 4. increased body fat 5. increased serum prolactin levels 2. Growth hormone GH: 1. Acromegaly 1. thickened lips 2. coarse facial features 3. increasing head size 4. lower jaw protrusion 5. enlarged hands and feet 6. joint pain 7. barrel-shaped chest 8. hyperglycemia 9. sleep apnea 10. enlarged heart, lungs and liver 3. Adrenocorticotropic Hormone (ACTH) 1. Cushing's Disease (Pituitary) 1. Elevated plasma cortisol levels 2. weight gain 3. truncal obesity 4. "moon face" 5. extemity muscle wasting 6. loss of bone density 7. hypertension 8. hyperglycemia 9. striae and acne 4. Thyrotropin (Thyroid-Stimulating Hormone [TSH]) 1. Elevated plasma TSH and thyroid hormone levels 2. weight loss 3. tachycardia and dysrhythmias 4. heat intolerance 5. increased GI motility 6. fine tremors 5. Gonadotropins (LH and FSH) 1. Men: 1. Elevated LH and FSH levels 2. hypogonadism or hypergonadism 2. Women: 1. Normal LH and FSH levels

Answer 220

nasal discharge occurs because of the possiblity of serious side effects, including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage.

Answer 221

1. Monitor the patient's neurological status hourly for the first 24 hours and then every 4 hours. 2. Monitor fluid balance, especially for output greater than intake. 3. encourage the patient to perform deep-breathing exercises. 4. Instruct the patient not to cough, blow the nose, or sneeze. 5. instruct the patient to use dental floss and oral mouth rinses rather than toothbrushing until the surgeon give permission. 6. instruct the patient to avoid bending at the waist to prevent increasing intracranial pressure. 7. Monitor the nasal drip pad for the type and amount of drainage. 8. Teach the patient methods to avoid constipation and subsequent "straining". 9. Teach the patient self-administration of the prescribed hormones.

Answer 222

1. Assess Cardiovascular status: 1. Vital signs, including apical pulse, pulse pressure, presence or absence of orthostatic hypotension, and the quality/rhythm of peripheral pulses. 2. Assess cognition and mental status. 3. Assess condition of operative site: 1. Observe nasal area for drainage: 1. If present, note color, clarity, and odor. 2. Test clear drainage for the presence of gluchose 4. Assess neuromuscular status: 1. reactivity of patellar and biceps reflexes 2. oral temperature 3. handgrip strength 4. steadiness of gait 5. distant and near visual acuity 6. pupillary responses to light 5. Assess kidney function: 1. Observe urine specimen for color, odor, cloudiness, and amount. 2. Ask about: 1. headaches or visual disturbances 2. ease of bowel movements 3. 24-hour fluid intake and output 4. over-the-counter and prescribed drugs taken. 6. Assess patient's understanding of illness and adherence with treatment: 1. Symptoms to report to health care provider. 2. Drug plan (correct timing and dose)

Answer 223

The problem is most commonly inherited as an X-linked recessive disorder in which the AVPR2 gene coding for the ADH receptor is mutated and only males are affected. There is also an autosomal form of the disorder in whihc the AQP2 gene is mutated and both males and females are affected. When assessing a patient with DI, always ask whether anyone else in the family has ever had this dosorder.

Answer 224

1. Hypotension 2. tachycardia 3. weak peripheral pulses 4. hemoconcentration 5. increased urine output 6. dilute, low specific gravity 7. poor skin turgor 8. dry mucous membranes 9. decreased cognition 10. ataxia (slurred speech, stumbling, uncooridnated) 11. increased thirst 12. irritability

Answer 225

is 10 times stronger than the oral form, and the dosage must be reduced.

Answer 226

1. malignancies: 1. small cell lung cancer 2. pancreatic, duodenal, and GU carcinomas 3. Thymoma 4. Hodgkin's lymphoma 5. non-Hodgkin's lymphoma 2. Pulmonary Disorders 1. viral and bacterial pneumonia 2. lung abscesses 3. active tuberculosis 4. pneumothorax 5. chronic lung disease 6. mycoses 7. positive-pressure ventilation 3. CNS disorders 1. tauma 2. infection 3. tumors (primary or metastatic) 4. Strokes 5. Porphyria 6. systemic lupus erthematosus 4. Drugs 1. exogenous ADH 2. chlorpropamide 3. vincristine 4. cyclophosphamide 5. carbamazepine 6. opioids 7. tricyclic antidepressants 8. general anesthetics 9. fluoroquinolone antibiotics

Answer 227

in the hospital setting so serum sodium levels can be monitored closely for the development of hypernatremia.

Answer 228

Hormone Replacement * start rapid infusion of NS or dextrose 5% normal saline. * Initial dose of hydrocortisone sodium (SOlu-Cortef) is 100 to 300 mg or dexamethasone 4 to 12 mg as an IV bolus. * Admini inster additional 100 mg of hydrocortisone sodium by continuous IV infusion over the next 8 hours. * Give hydrocortisone 50 mg IM concomitantly with hydration every 12 hours. * Initiate an H2 histamine blocker (eg. ranitidine) IV for ulcer prevention. Hyperkalemia Management * administer insulin (20 TO 50 UNITS) WITH DEXTROSE (20 TO 50 MG) in normal saline to shift potassium into cells. * Administer potassium binding and excreting resin (e.g., kayexalate) * Give loop or thiazide diuretics, as prescribed. * Initiate potassium restriction. * Monitor intake and output. * Monitor heart rate, rhythm, and ECG for signs and symptoms of hyperkalemia (slow heart rate; heart block; tall, peaked T waves; fibrillation; asystole). Hypoglycemia Management * Administer IV glucose as prescribed. * Administer glucagon as needed and prescribed. * Maintain IV access. * Monitor blood glucose level hourly. *

Answer 229

1. Muscle weakness 2. Fatigue 3. Joint/Muscle pain 4. anorexia 5. nausea/vomiting 6. abdominal pain 7. constipation or diarrhea 8. weight loss 9. Salt craving 10. Vitiligo 11. hyperpigmentation 12. anemia 13. hypotension 14. hyponatremia 15. hyperkalemia 16. hypercalcemia

Answer 230

* sodium is decreased * potassium increased * glucose normal to decreased * calcium increased * bicarb increased * BUN increased * cortisol (serum) decreased * cortisol (salivary) decreased

Answer 231

* sodium is increased * potassium is decreased * glucose is normal to increased * calcium is decreased * bicarb is decreased * BUN normal * cortisol (serum) increased * cortisol (salivary) increased.

Answer 232

Although both are corticosteroids, they are not interchangeable because prednisolone is several times more potent than prednisone and dosages are not the same.

Answer 233

1. Cortisone : instruct the patient to take the drug with meals or a snack to avoid gastric irritation. 2. hydrocortisone (cortef, Hycort): Instruct the patient to report the following symptoms of excessive drug therapy, which indicate Cushing's syndrome and a possible need for a dosage adjustment: rapid weight gain, round face and fluid retention 3. Prednisone (Winpred): Instruct the patient to report illness because the usual daily dosage may not be adequate during periods of illness or severe stress. 4. Fludrocortisone (Florinef): Monitor the patient's blood pressure to assess for the potential side effect of hypertension. Instruct the patient to report weight gain or edema because sodiumintake may need to be restricted.

Answer 234

Endogenous Secretion (Cushing's Disease) * Bilateral adrenal hyperplasia * Pituitary adenoma increasing the production of ACTH (pituitary Cushing's disease) * Malignancies: carcinomas of the lung, GI tract, pancreas * Adrenal adenomas or carcinomas Exogenous Adminisration (Cushing's Syndrome) * Therapeutic use of ACTH or glucocorticoids-most commonly for treatment of: * asthma * autoimmune disorders * organ transplantation * cancer chemotherapy * allergic responses * chronic fibrosis

Answer 235

* Moon face * buffalo hump * truncal obesity * weight gain * hypertension * frequent dependent edema * bruising * petechiae * muscle atrophy (most apparent in extremities) * osteoporosis (bone density loss) * pathologic fractures * decreased height with vertebral collapse * aseptic necrosis of the femur head * slow or poor healing of bone fractures * thinning skin * striae and increased pigmentation * increased risk for infection * reduced immunity * decreased inflammatory responses * signs and symptoms of infection/inflammation possible masked.

Answer 236

during pregnancy because it also blocjs progesterone receptors and would cause termination of the pregnancy.

Answer 237

The drug should be tapered gradually under the care of the PHCP\>

Answer 238

1. Take your medication in divided doses, as prescribed (e.g. the first dose in the mornin and the second dose between 4pm and 6pm) 2. take your medication with snacks or meals. 3. Weigh yourself daily and keep a record to show your primary health care provider. 4. Increase your dosage as directed by your PHCP for increased physical stress or severe emotional stress. 5. Never skip a dose of medication. If you have persistent vomiting or severe diarrhea and can not take your medication by mouth for 24 hour to 36 hours, call your physician. If you can not reach your PHCP, go to the nearest emergency department. You may need an injection to take the place of your oral medication. 6. Always wear your medical alert bracelet or necklace. 7. Make regular visits for health care follow-up. 8. Learn how to give yourself an intramuscular injection of hydrocortisone.

Answer 239

because this action could stimulate a sudden release of catecholamines and trigger severe hypertension.

Answer 240

* diaphroesis (excessive sweating) * fine, soft, silky body hair * smooth, warm, moist skin * thinning of scalp hair * palpitations * chest pain * increased systolic blood pressure * tachycardia * dysrhythmias * rapid, shallow respirations * weight loss * increased appetite * increased stools * blurred or double vsion * eye fatigue * increased tears * injected (red) conjunctiva * photophobia * exophtalmis * eyelid retraction, eyelid lag * globe lag * hyperactive deep tendon reflexes * tremors * insomnia * increased basal metabolic rate * heat intolerance * low-grade fever * fatigue * decreased attention span * restlessness and irritability * emotional instability * manic behavior * amenoohea * increased libido * goiter * wide-eyed or startled appearance (exophthalmos) * enlarged spleen * muscle weakness and wasting

Answer 241

Grave's disease is associated with other autoimmune disorders, such as diabetes mellitus, vitiligo, and rheumatoid arthritis and often occurs in both members of identical twins. Ask the patient with Grave's disease whether any other family members also have the problem.

Answer 242

* 0 There is o palpable or visivle goiter * 1 Mass is not visible with neck in the normal position. Goiter can be palpated and moves up when the patient swallows. * 2 Mass is visible as swelling when the neck is in the normal position. Goiter is easily palpated and is usually asymmetric.

Answer 243

* Serum T3 (70-205) hyperthyroidism increased, hypothyroidism decreased * serum T4 (4-12) Hyperthyroidism increased, hypothyroidism decreased * Free T4 index (0.8-2.28) hyperthyroidism increased, hypothyroidism decreased * TSH stimulation test (\>10) test differentiates between primary hypo and secondary hypo, no response in primary. * Thyroid-stimulating immunoglobulins (TSI) (\<130% of basal activity) hyperthyroidism: elevated in Grave's disease, normal in other types of hyperthyroidism,; hypothyroidism: no change * Thyrotropin receptor antibodies (TRAb), Titer (0%), hyperthyroidism: 80-95% indicates Graves' Disease; hypothyroidism: no response * TSH (2-10mU/mL) Hyperthyroidism: low in Grave's disease, high in secondary or tertiary hyperthyroidism; Hypothyroidism: high in primary disease and low in secondary or tertiary disease

Answer 244

* Propylthiouracil (PTU, PropylThyracil), Methimazole (Northyx, Tapazole) : * Teach the pagtient to avoid crowds and people who are ill becaue the drug reduces the immune responsed, increasing the risk for infection. * Teach patients to check for weight gain, slow heart rate, and cold intolerance, which are indications of hypothyroidism and the need for a lower drug dose. * Teach patients taking propylthiouracil to report darkening of the urine or a yellow appearance to the skin or whites of the eyes, which indicate possible liver toxicity or failure, a serious side effect of propylthiouracil. * Remind women taking methimazole to notify their primary health care providers if they become pregnant because the drug causes birth defects and should not be used during pregnancy. * , Lugol's solution, saturated solution of potassium iodide (SSKI): * Administer these drugs orally 1 hour after a thionamide has been given because initially the iodine agents can cause an increase in the production of thyroid hormones. Giving a thionamide first prevents this inital increase in thyroid hormone production. * Check patient for a fever or rash and ask about a metallic tast, mouth sores, sore throat, or GI distress as these are indications of iodism, a toxic effect of the drugs, and may require that the drug be discontinued.

Answer 245

The dosages for propylthiouracil are much higher than those for methimazole.

Answer 246

especially during the first trimester. Instruct women to notify their primary health care provider if pregnancy occurs.

Answer 247

* Use a toilet that is not used by others for at least 2 weeks after receiving the radioactive iodine. * Sit to urinate (males and females) to avoid splashinh the seat, walls, and floor. * Flush the toilet three times after each use. * If urine is spilled on the toilet seat or floor, use paper tissues or towels to clean it up, bag them in sealable plastic bags, and take them to the hospital's radiation therapy department. * Men with urinary incontinence should use condom catheters and a drainage bag rather than absorbant gel-filled briefs or pads. * Women with urinary incontinence should use facial tissue layers in their clothing to catch the urine rather than absorbent gel-filled briefs or pads. These tissues should be flushed down the toilet exclusively used by the patient. * Using a laxative on the second and third days after receiving the radioactive drug helps you excrete the contaminated stool faster (this also decreases the exposure of your abdominal organs to radiation). * Wear only machine-washable clothing and wash these items separately form others in your household. * After washing your clothing, run the washing machine for a full cycle on empty before it is used to wash the clothing of others. * Avoid close contact with pregnant women, infants, and young children for the first week after therapy. Remain at least 3 feet (about 1 meter) away from these people and limit your exposure to them to no more than 1 hour daily. * Some radioactivity will be in your saliva during the first week after therapy. Precautions to avoid exposing others to this contamination (both household members and trash collectors) include: * not sharing toothbrushes or toothpaste tubes. * using disposable tissues rather than cloth hankerchiefs and either flushing used ones down the toilet or keeping them in a plastic bag and turning them in to the radiation department of the hospital for disposal. * Using disposable utensils, paltes and cups. * Selecting foods that can be eaten completely and that do not result in saliva-coated remnant (Foods to avoid are fruit with a core that can be contaminated, meat with a bone [e.g. chicken wings, or legs, ribs]). Consider preparing these foods by cutting out the core and removing the bone before eating.

Answer 248

TPP is most common in men of Chinese and Japanese descent. Emergency management involves treating the thyrotoxicosis and the hypokalemia. In addition to antithyroid drug therapy, potassium is replaced IV. This condition is increasing in frequency in North America and is not always recognized. Be alert to any adult male of Asian descent who has lower limb paralysis or weakness along with signs and symptoms of hyperthyroidism.

Answer 249

If any indications of obstruction are present, respond by immediately notifying the Rapid Response Team.

Answer 250

may indicate an impending thyroid crisis. If an increase occurs, respond by reporting it immediately to the PHCP\>

Answer 251

* is a life threatening event that occurs in patients with uncontrolled hyperthyroidism, most often with Grave's disease. * Symptoms develop quickly and the problem is fatal if left untreated. * It is often triggered by stressors such as trauma, infection, diabetic ketoacidosis, and pregnancy. * Symptoms of thyroid storm are caused by excessive thyroid hormone release, which dramatically increases metabolic rate. * Key symptoms include fever, tachycardia and systolic hypertension. * Even with treatment thyroid storm can lead to death.

Answer 252

* Maintain a patent airway and adequate ventilation. * Give oral antithyroid drugs as prescribed: methimazole (Tapazole), up to 60 mg daily; propylthiouracil (PTU, Propyl-Thyracil), 300 to 900 mg daily. * Administer sodium iodide solution, 2g IV daily as prescribed. * Give propranolol (Inderal, Detensol), 1 to 3 mg IV as prescribed. Give slowly over 3 minutes. The patient should be connected to a cardiac monitor and a central venous pressure catheter should be in place. * Give glucocorticoids as prescribed: hydrocortisone, 100 to 500 mg IV daily; prednisone, 4 to 60 mg oral daily; or dexamethasone, 2 mg IM every 6 hours. * Monitor continually for cardiac dysrhythmias. * Monitor vital signs every 30 minutes. * Provide comfort measures, including a cooling blanket. * Give nonsalicylate antipyretics as prescribed. * Correct dehydration with normal saline infusions. * Apply cooling blanket or ice packs to reduce fever.

Answer 253

* cool, pale or yellowisj, dry coarse, scaly skin * thick, brittle nails * dry, coarse, brittle hair * decreased hair growth, with loss of eyebrow hair * poor wound healing * hypoventilation * pleural effusion * dyspnea * bradycardia * dysrhythmias * enlarged heart * decreased acitivity tolerance * hypotension * decreased basal metabolic rate * decreased body temperature * cold intolerance * apathy * depression * paranoia * anorexia * weight gain * constipation * abdominal distention * slowing of intellectual functions: * slowness or slurring of speech * impaired memory * inattentiveness * Lethargy or somnolence * confusion * hearing loss * paresthesia (numbness and tingling) of the extremities * decreased tendon reflexes * muscle aches and pain * Women: * changes in menses (amenorrhea or prolonged menstrual periods) * anovulation * decreased libido * Men: * decreased libido * impotence * Periorbital edema * facial puffiness * nonpitting edema of the hands and feet * hoarseness * gotier (enlarge thyroid gland) * thick tongue * increased sensitivity to opioids and tranquilizers * weakness, fatigue * decreased urine output * easy bruising * iron dificency anemia * vitamin deficiencies

Answer 254

* cellular energy is decreased and metabolites that care compounds of proteins and sugars called glycoaminoglycans (GAGs) build up inside cells. * This GAG build up increases the mucus and water, forms edema, and changes organ texture. * The edema is mucinous and called myxedema, rather than edema caused by water alone. * This edema changes the patient's appearance. Non pitting edema forms everywhere, especially around the eyes, in the hands and feet, and between the shoulder blades. The tongue thickens; and edema forms in the larynx,making the voice husky. General physiologic function if decreased. * Sometime called hypothyroid crisis is a rate serious complication of untreated or poorly treated hypothyroidism and has a mortality rate of 60%. * The decreased metabolism cause the heart muscle to become flabby and the chamber size to increase. * the result is decreased cardiac output with decreased perfusion and GAS exchange in the brain and other vital organs, which makes the already slowed cellular metabolism worse, resulting in tissue and organ failure. * The mortality rate for myxedema coma is extremely high and this condition is a life-threatening emergency.