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Unit #3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Desmopressin acetate

A

Anti diuretic
Decreases UO

Establish baseline BP, pulse, weight, electrolytes, check PTT

Side effects:
Pain, redness, swelling at IV site,
HA, abdominal cramps, flushed skin, mild BP elevation.
Nausea with high doses

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2
Q

Levothyroxine

A

Thyroid hormone (T4)

Monitor: pulse (rate, rhythm; >100 or marked ^^ notify MD)
Observe for tremors, anxiety, appetite, sleep.
Can cause reversible hair loss at start for children.
Do not D/C lifelong therapy, take at same time daily (AM)
Full effect in 1-3 wks

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3
Q

Prednisone

A

Glucocorticoid

Monitor bone density, ht/wt in children.
Be alert to infection; Oral candidas

Never give live vaccine
Report s/s of: N/V, sore throat, fever, muscle aches, malaise, sever diarrhea, fatigue

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4
Q

Anti ulcers

A

Gastric acid secretion inhibitors;

Cimetidine
-do not take antacids within 1 hr

Ranitidine

Famotidine

Nizatidine

Assess for GI bleeding, monitor labs
Side effects; headache

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5
Q

Omeprazole

A

Proton pump inhibitor

Evaluate for GI relief.
Question discomfort, nausea, diarrhea
Take before eating.

Report: black, tarry stools

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6
Q

Esomeprazole

A

Proton pump inhibitor; gastric acid inhibitor.

Monitor for occult blood, HA

Take at least 1 hr before eating.
May open capsule, swallow without chewing

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7
Q

Methimazole

A

Anti thyroid

Treats hyperthyroidism

Teach pt take q8h

Avoid crowds & I’ll people, report pregnancy, monitor wt gain, slow heart rate, & cold intolerance

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8
Q

Propylithiouracil

A

Anti thyroid

Take q8h
Education same at Methimazole
Report darkening of urine (s/s of jaundice)

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9
Q

Lithium carbonate

A

Reduced manifestations of hyperthyroidism
TEMPORARILY

take q8h

Decreases UO

Teach pt to drink at least 3-4 quarts water/day

Check for wt gain, slow heart rate

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10
Q

Radioactive iodine therapy

A

Kills thyroid tissue. Pregnancy test must be performed prior to start.

Present in body fluids & stool for a few weeks after therapy.
Use radioactive precautions.

Max effects not seen for 2-3mths

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11
Q

Safety precautions for pt receiving radioactive isotope

A
  • use toilet not used by others for at least 2 wks
  • sit to urinate to avoid splashing
  • flush 3 times
  • if urine is spilled use paper towels to clean it up, bag in sealable bag & take to hospitals radiation therapy department.
  • men with urinary incontinence should have condom cath; not diapers
  • women should use facial tissue layers instead of gel-filled briefs
  • using a laxative in second & third day of tx helps excrete contaminated stool faster
  • wear machine washable clothing, & wash separately
  • after washing clothes, run wash for full cycle with no clothes
  • avoid close contact with pregnant, infants, young children, for 1st wk of therapy. After limit exposure to 1h per day
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12
Q

Safety precautions for radioactive therapy: saliva

A

-do not share toothbrush or toothpaste
-use disposable tissues (collect in ziploc & take to hospital)
-use disposable utensils, played, cups
-select foods that can be eaten completely & do not leave remnence
(Do not eat Fruit with core, meat with bone)

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13
Q

How to avoid ICP after pituitary sx

A

DO NOT:

  • brush teeth
  • cough
  • sneeze
  • blow nose
  • bend at waist
  • bend forward
  • no straining
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14
Q

Care for pt after hypophysectomy

A
  • Monitor neuro status q1h for 24h
  • monitor fluid balance (esp, greater out than in cause Diabetes Insipidus)
  • teach Deep breathing
  • use dental floss & oral mouth rinse (cannot brush teeth until incision is healed)
  • monitor nasal drip pad
  • presence of halo sign may indicate CSF leak
  • admin stool softener
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15
Q

Thyrotoxicosis

A

Condition caused by excessive amounts of thyroid hormone.

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16
Q

What do thyroid hormones do?

A

Stimulate the ❤️, increased stroke volume and heart rate

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17
Q

Goiter

A
  • Hypertrophy of thyroid gland
  • excessive TSH stimulation
  • iodine deficient

Grave’s disease

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18
Q

Nursing care for 1st 24 hours post thyroid surgery

A

Monitor for complications;

  • VS q15 min until stable then q30 min for 24 hrs
  • place pt in semi-fowlers while awake
  • avoid neck extension
  • cough, deep breath q30 min -1h

Hemorrhage:
Most often occurs within 24hrs
Monitor dressing

Respiratory distress;
Can result from swelling, tetany, or damage to laryngeal nerve.

Laryngeal stridor (harsh, high pitched) heard in acute respiratory obstruction.

Keep emergency TRACH kit at bedside

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19
Q

Hypocalcemia

A

tetany can occur if parathyroid is removed.

Ask pt hourly about tingling around mouth, toes, fingers.
Assess for muscle twitching.

Calcium gluconate, or calcium chloride IV should be available in case of emergency

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20
Q

Thyroid storm causes

A

Caused by excessive thyroid hormone release.
Life-threatening event that occurs in pts with uncontrolled hyperthyroidism in Graves’ disease.

Often triggered by stressor;

  • infection
  • DKA
  • pregnancy

Other triggers;

  • over palpating of goiter
  • exposure to iodine
  • RAI therapy
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21
Q

Thyroid storm manifestations

A

-Fever
-Tachycardia
-Systolic HTN
May have GI problems;
-pain, N/V, diarrhea
-anxious, tremors

As crisis progresses:

  • restless
  • confused
  • psychotic

May have
-seizures leading to COMA

Even with treatment, may lead to death

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22
Q

Emergency care of thyroid storm

A
  • maintain airway
  • give antithyroid drugs
  • admin sodium iodide solution (2g)
  • give propranolol (slowly over 3 min, have cardiac monitor, CVC in place)
  • give glucocorticoids
  • monitor for cardiac dysrhythmias (cont)
  • monitor VS q30 min
  • provide comfort measure, cooling blanket
  • give non-salicylate antipyretics
  • correct dehydration with NS
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23
Q

Eye care for hyperthyroidism

Graves’ disease

A

Eye and vision problems not corrected with tx for hyperthyroidism .

With mild symptoms teach pt to elevate HOB at night & use artificial tears

For photophobia use dark glasses, eye patches

If lids do not close completely, recommend using nonallergenic tape at bedtime

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24
Q

Myxedema

A

In HYPOthyroidism
Mucinous, instead of being cause by water.
Changes the pt’s appearance.

Non-pitting edema forms everywhere

25
Q

S/S hyperthyroidism skin

A
  • diaphoresis
  • fine, soft, silky body hair
  • smooth, warm skin
  • thinning of scalp
26
Q

S/S hyperthyroidism;

Pulmonary and cardiovascular

A
  • SOB
  • rapid, shallow respirations
  • ⬇️ vital capacity

Cardio:

  • palpitations
  • chest pain
  • ⬆️sys BP
  • widened pulse pressure
  • tachycardia
  • dysrhythmias
27
Q

S/S hyperthyroidism;

GI and musculoskeletal

A
  • weight loss
  • ⬆️appetite
  • ⬆️stool
  • hypoproteinemia
  • muscle wasting
  • muscle wasting
28
Q

S/S hyperthyroidism;

Neurological

A
  • blurred/double vision
  • eye fatigue
  • corneal ulcers
  • ⬆️tears
  • red conjunctiva
  • photophobia
  • eyelid retraction, lag
  • hyperactive deep tendon reflexes (DTR)
  • tremors
  • insomnia
29
Q

S/S hyperthyroidism;

Metabolic, psychological, reproductive

A
  • ⬆️BMR
  • heat intolerance
  • low grade fever
  • fatigue
  • ⬇️attention span
  • restlessness/irritable
  • emotional lability
  • manic behavior
  • amenorrhea
  • ⬆️libido
  • goiter
  • wide eyed (exophthalmos)
  • ⬇️WBC
  • enlarged spleen
30
Q

Cortisone

A

Glucocorticoid

Take w/meals or snack

Can cause:
Insomnia, heart burn, anxiety, ab distention, increased diaphoresis, acne, mood swings,
Increased appetite, facial flushing, delayed wound healing

31
Q

Hypothyroidism

A

Too little thyroid hormone.

Caused by thyroid sx, RAI tx, little iodide.
Pituitary tumor, trauma, infections

32
Q

S/S hypothyroidism;

Skin

A
  • cool, pale, yellow, dry, scaly, coarse
  • thick brittle nails
  • ⬇️hair growth
  • poor wound healing
33
Q

S/S hypothyroidism;

Pulmonary and cardiovascular

A
  • hypo ventilation
  • pleural effusion
  • dyspnea
  • bradycardia
  • dysrhythmias
  • enlarged ❤️
  • ⬇️activity intolerance
  • hypotension
34
Q

S/S hypothyroidism;

Metabolic and musculoskeletal

A
  • ⬇️BMR
  • ⬇️temp
  • cold intolerance
  • muscle aches/pain
  • delayed contract/relaxation
35
Q

S/S hypothyroidism;

Neuro and psych

A 
-slowing of intellectual functions
Slowed speech, impaired memory
-lethargy, somnolence
-confusion
-hearing loss
-parasthesia
-⬇️DTR
  • apathy
  • depression
  • paranoia
  • withdrawal
36
Q

S/S hypothyroidism;

GI and reproductive

A
  • anorexia
  • weight gain
  • constipation
  • ab. Distention
  • changes in menses
  • ⬇️libido
  • anovulation
  • impotence
37
Q

S/S hypothyroidism;

Other

A
  • peri orbital edema
  • facial puffiness
  • non putting edema
  • hoarseness
  • thick tongue
  • ⬆️ sensitivity to opioids
  • weakness/ fatigue
  • ⬇️UO
  • easy bruising
  • iron deficiency
  • folate & B12 deficiency
38
Q

Emergency care of pt during a myxedema coma

A
  • maintain airway
  • IV hypertonic or NS
  • Levothyroxine sodium IV
  • glucose IV
  • corticosteroids
  • check temp hourly
  • cover with want blankets
  • monitor for changes in mental status
  • turn q2h
  • institute aspiration precautions
39
Q

Acute adrenal insufficiency

A

Addisonian crisis

Too little cortisol and aldosterone

40
Q

S/S Addison’s disease

A
  • muscle weakness, fatigue, joint/muscle pain
  • anorexia, N/V, abdominal pain, constipation/diarrhea, wt. loss
  • salt craving
  • hyper pigmentation
  • anemia, hypotension,
  • hyponatremia,
  • hyperkalemia, hypercalcemia

-depression, low libido, irritability

41
Q

Addison’s diagnostic

A

ACTH stimulation test;
0.25-1mg IV
Check plasma cortisol levels at 30 min and 1 hr intervals

Primary: cortisol response ⬇️ or absent

Secondary: cortisol response ⬆️

42
Q

Emergency care acute adrenal insufficiency

Addison crisis

A

Hormone replacement;

  • rapid infusion NS or D5W
  • initial hydrocortisone sodium succinate (solu-cortef) 100-300mg or dexmethasone 4-12mg IV bolus
  • additional solu-cortef 100mg IV over 8 hrs
  • hydrocortisone 50mg IM q12h
  • give H2 histamine blocker (ranitidine)

Hyperkalemia management;

  • insulin with dextrose in NS
  • admin kayexalate
  • loop or thiazide diuretics
  • initiate K+ restriction
  • monitor I&O
  • monitor EKG & ❤️ for dysrhythmias
43
Q

Cushing’s disease

A

Too MUCH cortisol

Problems with:
adrenal cortex, or anterior pituitary, hypothalamus, ectopic ACTH production

44
Q

Cushing’s disease S/S

A

-moon face, truncal obesity, buffalo hump, weight gain

-HTN, ⬆️ risk for thrombotic events, edema, capillary fragility
(Bruising, petechiae)

  • thin skin, striae, ⬆️pigmentation
  • muscle atrophy, osteoporosis, pathological fx, ⬇️height with vertebral collapse, aseptic necrosis of femur head, slow/poor healing of bone fx
  • neurotic/psychotic behavior, sleep difficulties, fatigue
  • ⬆️ risk of infection, ⬇️ immune function
45
Q

Cushing’s diagnosis

A

Salivary cortisol levels
(At midnight)

Normal: 20 ng/mL
⬆️ indicates hypercortisolism

-24hr urine

⬆️ blood glucose, sodium

⬇️ lymphocyte count, calcium, K+

46
Q

Nutrition therapy for hypercortisolism

A

Restrictions of fluids and sodium intake to control fluid volume.

Level of sodium restriction depends on pt

47
Q

Nursing care for hypercortisolism

A

Monitor for fluid overload
-I/O, daily weight, urine specific gravity (⬇️ 1.005 indicates fluid overload)

Notify HCP if 3lb gain/week or 1-2lbs in 24h

48
Q

Emergency care for hypercortisolism

A

IV hydrocortisone 100 mg

IV NS

Continue IV hydrocortisone until PO can be tolerated.

49
Q

Easy way to remember adrenals

A

Sugar
-glucocorticoids

Salt
-mineralcortocoids

Sex
-androgens

Too little hormone = ⬇️ sugar, salt, sex

Too much hormone = ⬆️ sugar, salt, sex

50
Q

Adrenalectomy post-op

A

watch for addisonian crisis

51
Q

Diabetes insipidus

A

Too little ADH

cause by decrease in ADH synthesis or inability of kidneys to respond to ADH

52
Q

Diabetes insipidus s/s

A

Key manifestations: ⬆️ frequency in urination and excessive thirst

Other:
-hypotension, ⬇️ pulse pressure, tachycardia, weak peripheral pulses

  • dilute, low specific gravity
  • hypo-osmolar
  • poor skin turgor, dry mucous membranes

-⬆️sensation, irritability, ⬇️ cognition, hyperthermia, lethargy ➡️ COMA

53
Q

Diagnostic studies for Diabetes insipidus

A

24 hr fluid I/O without restrictions

DI is considered if UO is >4L during this period or is more than volume ingested

Low specific gravity (

54
Q

Medications given to patients with DI

A

Desmopressin

Vasopressin

Chlorpropamide

All reduce urine output

55
Q

Syndrome of inappropriate ADH

A

Aka SIADH

too much of vasopressin hormone

ADH continues to be released even when plasma is hypo-osmolar.
Occurs with many pathological conditions (cancer therapy), & certain drugs (SSRI’s)

56
Q

SIADH s/s

A

Water retention

  • loss of appetite, N/V
  • weight gain (free water, not salt is retained) dependent edema usually not present
  • hyponatremia

-lethargy, HA, hostility, disorientation, change in LOC, ⬇️ responsiveness, seizures, ⬇️ DTR

57
Q

Diagnostic study for SIADH

A

Radioimmunoassay of ADH

58
Q

Nursing care for SIADH

A

Restrict fluid intake, promote excretion of water.

  • replace Na+
  • interfere with action if ADH
  • monitor for fluid overload, strict I&O
  • pulmonary edema can occur quickly & can lead to DEATH
  • assess orientation q2h, reduce stimulation, noise
  • watch for seizures due to Na+ deficit

Unit #3 (5 decks)

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