Endocrine

Question 1

What is Pheochromocytoma

Answer 1

A benign tumor in the the adrenal medulla which causes an excessive release of Epi and Norepi.

Question 2

S/S of Pheochromocytoma

Answer 2

HTN
Diaphoresis 
Palpitation
Headache
Hyperhidrosis (excessive sweating)

Question 3

DX of Pheochromocytoma

Answer 3

The five H’s
24hr urine collection to measure increased amount of catecholamines
Clonidine Suppression test
Plasma Catecholamine level

Question 4

What is the Clonidine suppression test?

Answer 4

It suppresses the CNS to release catecholamines if the symptoms still persist it isn’t the CNS, instead it is the adrenal gland that causes the excessive release of Catecholamines.

Question 5

Nursing responsibilities for the 24hr urine collection test

Answer 5

Don't have anything of the following for 48-72hrs prior to urine collection:
Coffee (included Decaff)
Tea
Bananas
Chocolate
Vanilla
Aspirin

Question 6

Nursing responsibilities for plasma level test

Answer 6

The pt needs to rest in supine position for 30min prior to specimen collection.
Don't have anything of the following for 48-72hrs prior to urine collection:
Coffee (included Decaff)
Tobacco
Amphetamines
Decongestants
Cold medication 
Bronchodilators

Question 7

Nursing management of Pheochromocytoma

Answer 7

Bedrest with HOB elevated to decrease BP

Anti hypertensive meds (Ca channel, nitroprusside, B-blockers, alpha adrenergic blockers)

Question 8

Post OP management for patient Pheochromocytoma removal

Answer 8

Corticosteroid replacement for a couple weeks

Monitor for Hypotension due to sudden decrease in Catecholamines

Question 9

Function of Mineralocorticoids and what happens if you have too little or too much of it?

Answer 9

Aldosterone regulates water, Na, and K.
Holds on to water and Na and releases K into the urine.
Decreased level of Aldosterone: Addison
Water and Na is excreted by the kidney and K is retained causing dehydration, hyponatremia, and hyperkalemia.
Increased level of Aldosterone: Cushing
Kidney holds on to water and Na and releases K into the urine causing Hypernatremia, fluid overload, and hypokalemia.

Question 10

Function of Glucocorticoids and what happens if there is too much or too little of it.

Answer 10

Cortisol is used to managing stress.
Inhibits uptake of glucose by the muscle/adipose tissue.
Decreased level: 
Causes Hypoglycemia 
Increase level:
Causes Hyperglycemia

Question 11

Explain Addison’s Disease

Answer 11

Decreased production of cortisol and aldosterone.

Question 12

Explain Primary and secondary adrenal insufficiency

Answer 12

Primary - high level of ACTH but inadequate corticosteroid synthesis = Adrenal gland is the problem
Secondary - low or absent ACTH level, which cause inadequate adrenal stimulation and therefore leads to decreased amount of corticosteroid production = Pituitary gland is the problem

Question 13

S/S of Addison

Answer 13

Skin is bronze color
Hypotension, Hypovolemia, Dehydration (fluid loss)
Hyponatremia l/t mood changes, delusions)
Hyperkalemia l/t peak T wave and wide QRS complex
Electrolyte imbalance l/t N/V, Diarrhea, Abd pain.
Weakness, fatigue d/t decreased cortisol

Question 14

Nursing care for insufficient corticosteroids (addison)

Answer 14

Adhere to corticosteroid therapy (don’t stop abruptly)
Diet high in protein and Na (3g), low K
Monitor BP
Risk for infection (r/t steroid use which depresses the immune system)
Notify HCP if epigastric pain occurs

Question 15

What is Florinef Acetate (aldosterone replacement) used for ?

Answer 15

Is used when pt cannot maintain BP with increased salt intake.
If pt is on this med do NOT increase salt intake

Question 16

Explain adrenal crisis and S/S

Answer 16

Severe glucocorticoids and mineralcorticoid deficiency l/t severe dehydration
Hyperkalemia
Hyponatremia
May l/t vascular collaps, renal shut-down, coma, or death

Question 17

Management of Adrenal Crisis

Answer 17

1 IV fluids to restore blood volume and Na

#2 decrease level of K
Hemodynamic support with Vasopressors
Replace corticosteroids and mineralcorticoids.

Question 18

Explain Cushing’s disease and syndrome

Answer 18

Cushing’s disease is an overproduction of ACTH in the pituitary gland which l/t an increase in adrenal stimulation and production of steroids
Cushing Syndrom may be d/t increased administration of corticosteroids.

Question 19

S/S of Cushing’s

Answer 19

Thin extremities
Moon face
Na and water retention d/t increase aldosterone
Hyperglycemia d/t overproduction of steroids
Osteoporosis and muscle wasting d/t excessive protein catabolism
Fatty neck and in the supraclavicular area

Question 20

DX of Cushing’s

Answer 20

Serum cortisol (increased in cushings)
Plasma ACTH
Dexamethasone Suppression test to distinguish between pituitary or adrenal cause of cushing’s (if the problem is the adrenal gland the pituitary should decrease the production of ACTH)

Question 21

Pharmacological management of cusing’s

Answer 21

Metapryone - inhibits cortisol production
Octreotide (Sandostatin) - suppresses ACTH secretion
Mitotane - suppresses fx of adrenal cortex and decreases metabolisms of corticosteroids

Question 22

Nursing Management

Answer 22

Emotional support (pt can become psychotic with overproduction of steroids)
High protein, low Na, low simple carb diet.