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Med Surg Michaela > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the anterior pituitary gland control?

A

growth, metabolic activity, sexual development

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2
Q

What are the hormones are involved?

A 
Growth hormone
Thyroid stimulating hormone
corticotrophin
FSH
LH
MSH
PRL
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3
Q

Diabetes insipidus is?

A

water loss problem caused by either an ADH deficiency or an inability for the kidneys to respond to ADH.

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4
Q

What is the result of diabetes insipidus?

A

excretion of large volumes of dilute urine because the distal kidney tubules and collecting ducts do not reabsorb water. which leads to excessive water loss.

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5
Q

What is the result of the excessive water loss?

A

polyuria, dehydration and disturbed fluid and electrolyte balance.

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6
Q

`What is the most common increased electrolyte?

A

Serum sodium levels.

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7
Q

What is stimulated from the dehydration?

A

the increase in the serum osmolality stimulates the excessive thirst sensation.

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8
Q

What happens if the thirst mechanism is poor?

A

they will be unable to obtain water, dehydration becomes more severe and can lead to death.

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9
Q

As the nurse you need to make sure that the patient is not deprived of fluids for how many hours?

A

4 hours is the max they cant have fluids because they cannot have decreased urine output.

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10
Q

What is primary DI?

A

defect in the hypothalamus or posterior pituitary gland resulting in lack of AHD production or release

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11
Q

What is secondary DI?

A

most often results from tumors in or near the hypothalamus or pituitary gland, head trauma, infectious process, brain surgery or metastatic cancers.

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12
Q

What is drug related DI?

A

Usually cause by lithium and demeclocycline. these drugs interfere with the response of the kidneys with ADH.

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13
Q

What are the Cardiovascular manifestation of DI?

A

hypotension
tachycardia
weak peripheral pulses
hemoconcentraion

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14
Q

What are the kidney/urinary manifestations of DI?

A

increased urine output

dilute, low specific gravity

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15
Q

What are the skin manifestations of DI?

A

poor turgor

dry mucous membranes

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16
Q

What are the neurologic manifestations of DI?

A 
decreased cognition
Ataxia
increased thirst
irritability
* occurs when access to water in limited and rapid dehydration results.
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17
Q

What to ask your patients with DI?

A

ask about a increase in thirst and urination
recent surgery
head trauma
drug use (lithium)
watch for shock from fluid lose r/t unable to hydrate

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18
Q

Manifestations of dehydration with DI?

A

poor skin turgor, dry cracked mucous membranes

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19
Q

First step in diagnosis of DI?

A

measure 24 hour fluid I&O without restricting food or fluid.

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20
Q

What is the urine output considered for DI?

A

more the 4L during 24 hours and is greater then the volume digested.
4 to 30L/day of urine may be excreted.

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21
Q

What is urine specific gravity you will see in DI?

A

less than 1.005

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22
Q

What will the osmolality be? High or low? And level?

A

low (50-200 mOsm/kg)

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23
Q

What drug therapy is used for DI?

A 
desmopressin acetate (DDAVP) orally or intranasally 
During severe dehydration it may be give IV or IM
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24
Q

SE of DDAVP intranasally occur or if they have a respiratory infection what should be done?

A

oral or subq rout is used.

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25
Q

What should be done with parenteral route in regards to dose of DDaVP?

A

it is 10 times stronger then the oral and intranasal forms and the dosage must be reduced.

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26
Q

Intervention when in the hospital for DI?

A

detecting early dehydration, measuring accurate I&O, urine specific gravity and recording pts daily weight.

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27
Q

What should you do as the nurse for DI?

A

urge the pt to drink fluids in the amount equal to urine output.
Ensure patency of IV catheter and monitor hourly amount infused.

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28
Q

What should you teach the pt with life long DI?

A

1st asses ability to follow instruction and adjust dosage.
teach about polyuria and polydipsia are indicators for another dose.
Weigh themselves daily with the same scale, same time, same clothing if 2.2 lbs. is gained that is an indicator of water toxicity. (family must call 911 and wear a medical alert bracelet)

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29
Q

What is syndrome of inappropriate antidiuretic hormone (SIADH)?

A

vasopressin is secreted even when plasma osmolarity is low or normal. Normally a decrease in plasma osmolarity inhibit ADH production and secretion.
water is retained.

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30
Q

What does SIADH lead to?

A

disturbances in fluid and electrolyte imbalances.

water is retained which results in hyponatremia (decrease in serum sodium level) and fluid overload.

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31
Q

What happens with the kidneys in SIADH?

A

increase in blood volume increased the kidney filtration and inhibits the release of renin and aldosterone which increases the serum sodium loss and leads to greater hyponatremia.

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32
Q

Cancer Malignancies that cause SIADH?

A

Small cell lung cancer.
Pancreatic, duodenal and GU carcinomas.
Thymoma.
Hodgkin’s/Non-Hodgkin’s lymphoma

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33
Q

Pulmonary disorders that cause SIADH?

A 
Viral and bacterial PNA.
Lung abscesses.
Active TB.
Pneumothorax.
Chronic lung disease.
Mycoses.
Positive pressure ventilation.
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34
Q

CNS disorders that cause SIADH?

A 
Trauma
infection
tumors (primary or metastatic)
strokes
porphyria
systematic lupus erythematosus
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35
Q

Drugs the cause SIADH?

A 
Exogenous ADH
Chlorpropamide
Vincristine
Cyclophosphamide
Carbamazepine
Opioids
Tricyclic antidepressants
General anesthetics
Fluorquinolone antibiotics.
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36
Q

What should you ask your patient about with SIADH?

A 
recent head trauma.
cerebrovascular disease.
TB or pulmonary disease.
Cancer.
all past and current drug use.
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37
Q

What are early manifestation with SIADH?

A

They are related to water retention.
Loss appetite and N/V may occur first.
weigh the patient and document the recent weight.
Dependent edema is usually not present even though water is retained.
Effects the CNS especially when sodium is below 115.

38
Q

What will the pt present with low sodium below 115?

A

lethargy, headaches, hostility, disorientation, and change of LOC. can progress to decreased responsiveness, seizures and coma.
Assess deep tendon reflexes (usually decreased).

39
Q

What are the VS changes with SIADH?

A

full and bounding pulses (caused by increased fluid volume).

Hypothermia (caused by CNS disturbances).

40
Q

With SIADH will the urine sodium be increased or decreased?

A

elevated urine sodium levels and urine specific gravity.

41
Q

What is the main focus with SIADH for interventions?

A

restricting fluid intake and promoting the excretion of water and replacing sodium loss. teach family and prevent injury.

42
Q

What should you restrict fluid intake to with SIADH?

A

This is important cause the more fluid intake the more the plasma sodium levels are diluted.
500-1000 mL/24 hr.
If on tube feedings dilute with saline vs water. and use saline to irrigate tubes.

43
Q

What are concerns you would look with SIADH?

A

weight gain of 2.2 lbs. in a day or gradual increase.

keep the mouth moist, remind patient not to swallow rinses.

44
Q

What is 2.2 lbs. equal to in mL?

A

1000ml (1L)

45
Q

What is the drug therapy for SIADH?

A

tolvapta Oral (Samsca) or conivaptan IV (Vaprisol) when hyponatremia is present.
They are vasopressin antagonist that promote water excretion without causing sodium loss.
Monitor serum sodium levels very closely can cause liver failure and death.

46
Q

Can diuretic be used to manage SIADH?

A

Yes when serum sodium levels are near normal and hear failure is present.

47
Q

What can Demeclocycline do for SIADH?

A

it is an oral ABX that may help correct the disturbed fluid and electrolyte imbalance.

48
Q

What type of fluid should be used for SIADH?

A

Hypertonic Saline (3% NaCl)
monitor closely cause it can add existing fluid overload and promote HF.
Saline IV fluids are prescribe vs water solutions

49
Q

What are s/s of fluid overload?

A

bounding pulse, increasing neck vein distention, crackles in the lungs, and reduced urine output.
Monitor every 2 hours.
Pulmonary edema can occur very quickly and lead to death.

50
Q

What should you assess your patient for in regards to changes with SIADH?

A

neurological changes (seizures)
subtle changes, muscle twitches before they progress to seizures.
Check orientation to person, place and time q 2 hours.
reduces noise and lighting to prevent overstimulation.
Check q 4 hours if are hyponatremic but alert and awake etc.
Any changes in LOC, neuro checks etc. check q 1 hours.

51
Q

What is Adrenal Gland Hypofunction?

A

adrenocortical steroid production may decrease as a result of inadequate secretion of adrenocorticotropic hormone (ACTH).
Dysfunction of hypothalamic pituitary control mechanism.
Adrenocortical steroids cause problems through the loss of aldosterone and cortisol action.

52
Q

What is an Adrenal Crisis?

A

An acute adrenocortical insufficiency, life threatening manifestation may occur without warning.

53
Q

A decrease in cortisol levels result in what?

A

poor glucose control regulation with hypoglycemia.

54
Q

Reduced aldosterone secretions cause disturbances of?

A

fluid and electrolyte balance especially potassium, sodium and water. Hyperkalemia, sodium and water excretion is increased. hyponatremia. Acidosis may occur.

55
Q

What does a low adrenal androgen level decrease?

A

The body axillary and pubic hair, especially in women (because this is produced more in women).

56
Q

Addisonian crisis is ?

A

A life threatening event in which the need for cortisol and aldosterone is greater than the available supply.

57
Q

When does an Addisonian crisis occur?

A

In response to a stressful event (surgery, trauma, severe infection).
If interventions are not initiated promptly sodium levels will fall and potassium levels will rise rapidly. Severe hypotension can result from the blood volume depletion that occurs with aldosterone.

58
Q

What to do in Emergency care for a patient with acute adrenal insufficiency with hormone therapy?

A

Hormone replacement

  • start rapid infusion of normal saline or dextrose 5% in normal saline.
  • initial dose of hydrocortisone sodium (solu-cortef) is 100-300 mg or dexamethasone 4-12mg as an IV bolus.
  • administer additional 100 mg of hydrocortisone sodium by continuous IV infusion over the next 8 hours.
  • Give hydrocortisone 50 mg IM continuously every 12 hours.
  • Initiate an H2 histamine blocker (ranitidine) IV for ulcer prevention
59
Q

What to do in Emergency care for a patient with acute adrenal insufficiency with Hyperkalemia management?

A
  • administer insulin (20-50 units) with dextrose (20-50mg) in normal saline to shift potassium into cells.
  • administer potassium binding and excreting resin (kayexalate).
  • Give loop diuretics.
  • avoid potassium sparing diuretics
  • initiate potassium restriction
  • Monitor intake and output
  • monitor heart rate, rhythm, and ECG for manifestations of hyperkalemia ( slow heart rate, heart block, tall, peaked T waves, fibrillation, asystole)
60
Q

What to do in Emergency care for a patient with acute adrenal insufficiency with hypoglycemia management?

A
  • administer IV glucose
  • administer glucagon
  • Maintain IV access
  • monitor BS hourly
61
Q

Adrenal insufficiency (Addison disease) primary causes?

A 
autoimmune disease
TB
metastatic cancer
AIDs
hemorrhage
Gram negative sepsis
adrenalectomy
abd radiation therapy
drugs (mitotane) and toxins
62
Q

Adrenal insufficiency (Addison disease) secondary causes?

A

pituitary tumors
postpartum pituitary necrosis
hypophysectomy
high dose pituitary or whole brain radiation
sudden cessation of long term high dose steroids.

63
Q

Adrenal insufficiency neuro key features?

A

muscle weakness
fatigue
joint/muscle pain

64
Q

Adrenal insufficiency skin key features?

A

vitiligo

hyperpigmentation

65
Q

Adrenal insufficiency GI key features?

A 
anorexia
N/V
abdominal pain
constipation or diarrhea
weight loss
salt craving
66
Q

Adrenal insufficiency cardio key features?

A 
anemia
hypotension
hyperkalemia
hyponateremia
hypercalcemia
67
Q

What questions to ask your patients with adrenal insufficiency?

A

about salt cravings, they occur with hypofunction.
ask about weight loss.
women my have menstrual changes and men may report impotence.
Ask about radiation.
all past drugs steroids, anticoagulants, opioids and cancer drugs.
elevated levels of MSH may result in hyperpigmentation with primary, secondary skin pigmentation not changed.

68
Q

what are the s/s of hypoglycemia?

A

sweating, headaches, tachycardia and tremors.

69
Q

What are the s/s of fluid depletion?

A

postural hypotension and dehydration

70
Q

What are the Lab test for adrenal insufficiency?

A 
low serum cortisol
low fasting blood glucose
low sodium
elevated potassium
increased BUN
71
Q

Medication treatment?

A

prednisone, generally divided doses are given with two thirds given in morning and one third in the late afternoon to mimic normal release of this hormone.
Hydrocortisone correct glucocorticoid therapy.
Fludrocortisone to restore fluid and electrolytes
salt restriction and diuretics not used without consideration it could lead to a adrenal crisis.

72
Q

What is adrenal gland hyperfunction?

A

Cushing disease from the hypersecretion by the adrenal cortex specifically cortisol from the adrenal cortex.
Glucocorticoid therapy can lead to this problem, it effects all metabolism and all body system.

73
Q

What may you see in cushings disease body wise?

A

fat redistribution producing trincal obesity, buffalo hump, and moon face and abdominal striae.
decreased muscle mass and strength
thin skin
fragile capillaries
decreased bone density
spleen and lymphnodes are shrunk related to the high levels of corticosteroids kill lymphocytes and shrink organs.
decreased inflammatory and immune response.

74
Q

Related to the increased androgen production what s/s may you see?

A 
acne
hirsutism
clitoral hypertrophy 
decreased ovarian production, decrease in estrogen and progesterone
Add to dictionary
75
Q

What to ask your patient in regards to cushing disease?

A

ask about weight gain and increased appetite.
change in sleep pattern, weakness, fatigue.
bone pain or history of fractures.
frequent infections and easy bruising.

76
Q

What cardiac changes will be seen in cushings?

A

both sodium and water are reabsorbed and retained, so monitor for hypovolemia and edema formation.
BP is elevated
Pulses are full and bounding.

77
Q

What Glucose changes will be seen with cushing?

A

BS will be high r/t the liver releases glucose and the insulin receptors are less sensitive so blood glucose does not move as easily into the tissue.
Risk for infection is higher.

78
Q

What Lab test are done with Cushings?

A 
blood, salivary (normal below 2.0 usually higher with cushing) and urine cortisol levels (elevated)
Dexamethasone suppression testing.
Plasma ACTH levels. 
increased BS
decreased lymphocytes
increased sodium levels
decreased serum calcium
79
Q

What are the indicators that fluid volume balance are within or close to normal range?

A

blood pressure
stable body weight
serum electrolytes

80
Q

Patient safety for hypercortisolism?

A

preventing fluid overload from becoming worse and leading to pulmonary edema and HF. Any age is at risk for fluid overload. any one with coexsisting cardiac, renal, liver, pulmonary problems at a greater risk.

81
Q

What are indicators of fluid overload?

A

bounding pulse, increased edema, reduced urine output

82
Q

What preventative measures should be done with fluid overload?

A

watch skin breakdown cause they are at an increased risk.
Change position q 2 hours.
monitor weight best indicator of fluid retention
check urine specific gravity if below 1.005
500mL = 1lb.

83
Q

What drug therapy is used for hypercortisolism?

A

decreased cortisol production
metyrapome
aminoglutethimide
ketoconazole

Used is they have an increased ACTH
cyproheptadine

84
Q

What nutrition interventions should be done with hypercortisolism?

A

restriction of both fluid and sodium.
Normally the diet consist of “no added salt” to ordinary table food.
Restriction of 2 mg/4mg of salt a day

85
Q

What are the names of the surgical management for Hypercortisolism?

A

hypophysectomy (removal of pituitary)

adrenalectomy (removal of adrenal gland)

86
Q

What is the preop care for hypercortisolism surgery?

A

continue to monitor sodium, chloride and potassium levels.
make sure they are on a cardiac monitor for dysrhythmias r/t potassium.
make sure glucose regulation is in place and hyperglycemia is controlled.
prevent infection with hand washing/aseptic technique.
side rails up and ask for help to prevent falls.
high calorie high protein diet
glucocorticoid preparations are given before therapy to prevent adrenal crisis after removal.

87
Q

What post-op care is needed after surgery?

A

Pt sent to critical care unit.
assess the pt every 15 minutes for shock (hypotension, rapid weak pules, decreasing urine output) r/t insufficient glucocorticoid replacement
monitor venous pressure, weights, electrolytes, pulmonary wedge pressure.
require life long steroid/mineralocorticoid therapy replacement.
if unilateral surgery replacement is only needed until the other adrenal gland increases production (2 years)
avoid activities that increase ICP

88
Q

What are some ways to prevent injury with hypercortisolism?

A

asses for skin breakdown q 2 hours
soft toothbrush
electric shaver
avoid the skin to become excessive dry.
Use tape sparingly.
After venipuncture, they have increased bleeding risk so apply pressure longer.
Decreased bone density r/t decreased cortisol levels make sure they are educated on how to prevent falls.
high calorie diet and increase in vit d and calcium
avoid caffeine and alcohol to prevent ulcers and may promote bone density loss

89
Q

Hypersortisolism increase the risk for GI bleed why? and what treatments to do?

A

Cortisol 1. inhibits the production of the thick gel like mucus that protects the stomach lining. 2. decreases blood flow to the area 3. triggers the release of excess hydrochloric acid.

Treatment
even after surgery it takes weeks to return to normal
-antacid and taken on a regular basis
-H2 receptors Prilosec, ranitidine, Nexium, Pepcid.
-decrease smoking, drinking, caffeine, NSAIDs containing aspirin, and fasting

90
Q

How to prevent infection in hypercortisolism?

A

glucocorticoids (do not stop abruptly)
hand washing
anyone with URI needs to wear a mask
aseptic techniques with dressing changes
monitor for s/s of infection (they may not be obvious cause hypercortisolism suppresses infection manifestations) May only have a low grade fever.
temp 1 degree elevation is significant
assess urine for odor and color ask about burning or pain.
encourage cough and deep breath, Insensitive spirometer.

91
Q

What will be seen after discharge of hypercortisolism?

A

Muscle weakness continue for a while after surgery, may need to be set for one floor living at home.
call provider in more then 3 lbs. are gained in a week or more then 1-2 lbs. are gained in a 24 hour period.
Protection from infection is the most important immediately notify if fever arises.

92
Q

The guideline for cortisol replacement therapy?

A
  • Take first dose in the morning and second dose between 4pm-6om
  • take with meals or snacks
  • weigh self daily and keep record
  • increase dosage as prescribed by provider (stress or physical may indicate)
  • never skip a dose
  • if you have persistent vomiting for 24-36 hours call PCP if can not reach go to nearest ER.
  • always wear medic bracelet
  • regular visits
  • lean how to give yourself IM injections of hydrocortisone

Med Surg Michaela (2 decks)

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