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Med Surg II > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are the symptoms of hyperpituitarism

A

overproduction of growth hormone, giantism, acromegaly, altered neurological and sexual function

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2
Q

Describe giantism

A

usually before puberty, proportional growth in length of all bones, HTN, enlarged tongue, voice deepening

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3
Q

What are the symptoms of acromegaly

A

usually after puberty, skeletal thickness, enlarged face, jaw, extremities, enlarged organs (heart and liver), HTN, enlarged tongue, voice deepening

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4
Q

What medications are used to treat Acromegaly

A

Pegvisomant (Somavert)

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5
Q

What medical treatments can be performed to treat Acromegaly

A

radiation

surgery (transsphenoidal hypophysectomy)

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6
Q

After transsphenoidal hypophysectomy, pt should avoid

A

coughing/sneezing, nose blowing. bending over, brushing teeth for 10days,

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7
Q

What are the post op complications of transsphenoidal hypophysectomy

A
  1. CSF leakage: glucose in leakage greater than 30 indicates CSF
  2. diabetes insidious: due to loss of ADH from removal
  3. infection
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8
Q

What actions do we take if CSF is suspected post transsphenoidal hypophysectomy

A

HOB above 30

monitor nasal packing, report drip to MD, report persistent headache, client remain on bedrest

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9
Q

Define Diabetes Insipidus

A

Deficiency of production or secretion of ADH

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10
Q

What are the symptoms of diabetes Insipidus

A

polydipsia,
polyuria: 2-20Liters a day
below normal specific gravity: less than 1.005

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11
Q

What are the symptoms of SIADH

A

sudden weight gain w/o edema, thirst, N&V, muscle cramping, seizures (due to hyponatremia) changes in mental status

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12
Q

How is diabetes insidious managed

A

monitor hydrations, lifelong vasopressin (usually nasal spray), daily weights, monitor specific gravity

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13
Q

What three hormones are produced by the thyroid gland

A

T4(thyroxine), T3 (tri-iodothyroxine, Calcitonin (lowers calcium and phosphate levels)

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14
Q

Explain the relationship b/w iodine and the thyroid gland

A

Iodine is essential to thyroid gland synthesis of its hormone, if iodine is deficient this causes thyroid dysfunction

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15
Q

Poor thyroid functioning causes

A

decrease in metabolic activity, decrease in o2 consumption, decrease heat production, decrease in liver function, decrease in cell replication, infertility increase in cholesterol levels

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16
Q

Define cretinism

A

deficiency in thyroid hormone during fetal development causing stunted physical and mental growth

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17
Q

Define Myxedema

A

advanced hypothyroidism, causing lethargy, slow mentation, slowing of body function, brittle hair, thick skin, expressionless face

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18
Q

t/f myxedema affects women more than men

A

true

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19
Q

What are the cardiovascular complications that can occur is hypothyroidism is left untreated

A

decreased pulse rate, develop atherosclerosis, coronary heart disease

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20
Q

What is a goiter

A

enlargement of thyroid tissue

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21
Q

What are the causes of a goiter

A

most common is iodine deficiency
toxic goiter hyperthyroidism (graves)
overgrowth
normal non toxic

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22
Q

Define goitrogens

A

substances (drugs, chemicals, food) that disrupt production of thyroid hormones by interfering with iodine uptake. this triggers release of TSh which promotes growth of goiter

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23
Q

What are some goitrogen foods

A

large amounts of turnips, cabbage, carrots, broccoli, Brussel sprouts, cauliflower, peanuts

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24
Q

T/F pt with myxedema should not be given sedatives of hypnotics

A

true, may cause respiratory failure

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25
Q

Nursing management for hypothyroidism includes

A

caution with meds, no heating pads or blankets (cause rapid vasodilation and shock), monitor VS

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26
Q

What is Graves disease

A

hyperthyroidism,autoimmune disorder with excessive thyroid hormone secretion

27
Q

What are some of the signs and symptoms of hyperthyroidism (graves)

A

Heat intolerant, flushed face, rapid pulse, bulging eyes, increase appetite, wt. loss, diarrhea, may have chest pain and rapid HR

28
Q

What medications are used to treat hyperthyroidism

A
  1. anti-thyroid drugs:methimazole (tapazole)propylthiouracil (PTU)
  2. Beta-blockers
  3. iodine
29
Q

What are the major side effects of anti-thyroid therapy

A

agranulocytosis- decrease in granulocytes

thrombocytopenia

30
Q

What is thyroid storm

A

Also called thyrotoxicosis, occurs when excessive amount of thyroid hormones in circulation. Sudden hyperthermia (100 up), tachycardia (130 up), heart failure, delirium, and chest pain life-threatening

31
Q

Post radioactive iodine therapy pt should be mindful that

A

urine and feces are radioactive of 24-48hrs (flush 2-3x)
avoid coughing or expectorating
no pregnant personnel
limit contact to 30min a shift for 1st day (no visitors)
if the immediately go home they should avoid small children and sleep alone

32
Q

How is thyroid storm managed

A

ice packs, hypothermia blanket, humidified oxygen, IV w/dextrose, propranolol-give 1st (b-blocker, decrease HR, irritability, tremors), anti-thyroid drugs, hydrocortisone, SSKI & lugol

33
Q

Post-op management of thyroidectomy

A

semi-fowlers, narcotics for pains, humidified o2, check dressing in dorsal position for bleeding, check for complaints of fullness @ incision site- subcu hemorrhage
keep trach kit near bedside (noisy or cyanosis call MD)

34
Q

Complications of thyroidectomy

A

hemorrhage, edema of glottis, injury to laryngeal nerve, injury or removal of parathyroid gland (calcium levels drop)

35
Q

Characteristics of hyperparathyroidism

A

calcification of tissues, demineralization of bones, increase calcium, increase parathormone, decrease phosphate levels

36
Q

Interventions for hyperparathyrodism

A

strain urine for calculi, 2000ml fluid day, cranberry juice to lower urine pH, limit foods high in calcium, mobilize pt to prevent bones from releasing calcium

37
Q

Interventions for hyoercalcemic crisis

A

(serum greater than 15) large amounts of fluid, diuretics, oral phosphate, calcitonin and dialysis for emergencies

38
Q

What is hypoparathyroidism

A

Uncommon condition associated with inadequate circulating PTH characterized by hypocalcium, decrease parathormone, increase phosphate

39
Q

Diagnosis of hypoparathyroidism is confirmed through

A

positive Trousseau’s sign- carpopedal spasm (low calcium)

Positive Chvostek’s sign- sharp tapping over facial nerve causes mouth, nose, and eye to twitch

40
Q

Clinical manifestations of hypoparathyrodism

A

tetany(muscular spasm)is chief complaint,
latent: numbness, tingling, cramps, stiffness in hands and feet.
Overt: bronchospasm, dysphagia, photophobic, cardiac arythmies, convulsions

41
Q

What medications are used for hypoparathyroidism

A

calcium gluconate (IV in 100ml over 15min), calcium oral supplements.

42
Q

A pt who has hypoparathyroidism should include/exclude what from diet

A

include, dark green veggies, soy beans tofu

exclude, milk, egg yokes, spinach (high in phosphorus), rhubarb, bran whole grains. can decrease calcium absorption

43
Q

What are the three major types of steroids produced by the adrenal glands

A

Mineralocorticoids (aldosterone)- conserves sodium
Glucocorticoid (Cortisol)- affects glucose metabolism
Androgens - precursor to testosterone/estrogen

44
Q

What is Aldosteronism (Conn’s syndrome)

A

Excessive aldosterone secretion

45
Q

What are the main affects of aldosterone

A
  1. Sodium retention (HTN & hypernatremia)

2. Potassium and hydrogen excretion (hypokalemic alkalosis)

46
Q

What are the signs of primary aldosteronism

A

HTN, headache (hypernatremia)
Weakness, fatigue, cardiac dysrhythmias, glucose intolerance (hypokalemia)
tetany and parathesis (hypocalcimia)

47
Q

What is Cushing’s syndrome

A

Results from chronic exposure to excess corticosteroid particular glucocorticoids (cortisol)

48
Q

Signs of Cushing’s syndrome

A

muscle weakness, obesity (pendulous abdomen), facial redness, purple stria, slender extremities, slow wound healing, mood disturbances, breast atrophy, low libido, bruise easily

49
Q

What are some of the 2ndary problems from Cushing’s syndrome

A
  1. impaired glucose tolerance 50% develop DM. (increased cortisol, increase hepatic glucogenisis and decrease in glucose uptake by muscles)
  2. peptic ulcer formation (increase cortisol, increase in gastric acid, decrease in gastric mucous)
  3. HTN related to increase in Na, and water retention
  4. osteoporosis- increase in cortisol increase in calcium reabsorption from the bones leads to compression of spinal fractures
50
Q

What are nursing interventions for a pt with Cushings Syndrome

A

maintain fluid & electrolyte balance
monitor VS
prevent injury
monitor for risk of infections

51
Q

Describe Addison’s disease

A

All three classes of adrenal corticosteroids are reduced. adrenal insufficiency (opposite of cushing), auto-immune problem- adrenal tissue destroyed by antibodies formed against the clients own tissue

52
Q

What are the classic symptoms of Addison’s disease

A

progressive muscle weakness, anorexia, N/S, hyperkalemia (Na is secreted and potassium is saved), hypoglycemia (decrease in cortisol), hyponatremia, hyper pigmentation, hypotension

53
Q

What are the nursing interventions for a pt with Addison’s disease

A

maintain balance, assess skin, monitor weight, report increased thirst, monitor orthostatic VS

54
Q

What teaching instructions should be given for a pt with Addison’s disease

A

eat foods high in sodium in hot months and when having GI upset, avoid stressful situations, lifelong supplementation of adrenal cortex hormone to avoid acute crisis (vascular collapse), must carry injectable Solu-cortef for emergency and wear Medi-alert tag.

55
Q

What is Phenochromocytoma

A

benign tumor of the adrenal medulla

56
Q

What are the symptoms of Phenochromocytoma

A

high BP, tachycardia, palpations, headache, flushed face, nervousness, excessive perspiration

57
Q

How is pheochromocytoma managed

A

pt in high fowlers (decrease BP), Nitroprusside to lower BP, surgical removal of tumor

58
Q

What is Acromegaly

A

Overproduction of growth hormone caused by benign pituitary tumor (hypopituitarism)

59
Q

What is the hypophysis

A

Another name for pituitary gland, master gland of the endocrine system

60
Q

What are the hormones of the posterior pituitary

A

ADH and oxytocin

61
Q

What is SIADH

A

Overproduction of oversecretion of ADH

62
Q

What are the symptoms of Hypothyrodism

A

“Sloth like”: depression like affect, forgetful, loss of energy, loss of appetite w/weight gain, dry skin, sensitivity to cold, elevated cholesterol

63
Q

What is hyperparathyroidism

A

Increased secretion of PTH (regulates calcium and phosphorus)

64
Q

What is panhypopituitarism (Simmonds disease)

A

Deficiency of all pituitary hormones

Med Surg II (4 decks)

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