Endocrine Flashcards
What 3 hormones does the thyroid gland produce ?
T3, T4, Calcitonin
Calcitonin does what to the serum Ca+ levels and how ?
It can help treat what ?
It can be given as a drug called ?
taking the calcium out of the blood and
pushing it back into the bone. Can help treat Osteoporosis. Can be given as a drug calcitonin
or Calcimar
You need____ to make hormones.
This is dietary iodine
Hashimoto’s thyroiditis, T4 and T3 levels are
typically subnormal and TSH is elevated.
primary hyperthyroidism, T4 and T3 levels are
elevated and TSH is subnormal
Normal thyroid function tests are as follows:
T4____to ____ μg/dl; T3, ____ to ____ ng/dl; TSH ___ to ___ μIU/ml.
Normal thyroid function tests are as follows:
T4, 5 to 12 μg/dl;
T3, 65 to 195 ng/dl;
TSH 0.3 to 5.4 μIU/ml.
Hyperthyroid: TOO MUCH ENERGY!! (Graves Disease)
a. 10 S/S:
- Nervous
- Irritable
- Sweaty/hot =they have a increase heat production they y they have a intolerance to
heat
4.Attention span _________ decrease
- Appetite _____ increase
- Weight _____ DECREASE
- GI _ fast
- BP _________ increase
- Exophthalmos = bulging eye and is irreversible
- Thyroid _____________ enlarge
Dx of Hyperthyroidism
What 2 test?
Clients are discontinuing taking Iodine how long prior to having a thyroid scan?
Dx:
If you drew a serum T4 (thyroxine) level on this client would it be increased or
decreased? ______________ increase… They check blood levels
• Thyroid scan
• Client must discontinue any iodine containing medication 1 week prior to
the thyroid scan.
4Tx for hyperthyroidism
1) Anti-thyroids: Propylthiouracil (PTU®
), Methimazole (Tapazole®
)
• Stops the thyroid from making thyroid hormone .
• It’
s used pre-op to stun the thyroid.
• We want this client to become euthyroid (eu=___________Normal)
2) Iodine Compounds: Potassium Iodine (SSKI®
), Strong Iodine Solution
(Lugol’
s solution®
)
• Decrease the size and the vascularity of the gland
• ALL endocrine glands are VERY VASCULAR! • Give in milk juice, and use straw. Why? _They stain the teeth 3) Beta Blockers: propranolol (Inderal® ) --(DO NOT GIVE BETA BLOCKERS TO ASTHMATICS OR DIABETICS) • Decreases myocardial contractility • Could decrease cardiac output • Decreases HR, BP • Decrease anxiety. 4) Radioactive Iodine (_1_dose) Don’ t _kiss anyone for 24 hours.
• Follow radioactive precautions.
Stay away from _babies for 24_hours.
• Watch for thyroid storm (thyrotoxicosis and thyrotoxic crisis).
It is hyperthyroidism multiplied by 100.
Could be rebounds effect post-radioactive iodine
• Given PO (liquid or tablet form)
Rule out pregnancy first
• Destroys thyroid cells→
_Hypothyroid( is expected because they can’t control have much is
being destroy!)
Why do we give Anti-thyroid medication?
When is it used?
We want this client to become what ?
What do iodine compounds do and why ? what do you give it with ___ and why ?
Why do we give beta blockers?
Who are beta blockers contradicted with ?
What is are the precautions with radiation iodine?
1) Anti-thyroids: Propylthiouracil (PTU®
), Methimazole (Tapazole®
)
• Stops the thyroid from making thyroid hormone .
• It’
s used pre-op to stun the thyroid.
• We want this client to become euthyroid (eu=___________Normal)
2) Iodine Compounds: Potassium Iodine (SSKI®
), Strong Iodine Solution
(Lugol’
s solution®
)
• Decrease the size and the vascularity of the gland
• ALL endocrine glands are VERY VASCULAR! • Give in milk juice, and use straw. Why? _They stain the teeth 3) Beta Blockers: propranolol (Inderal® ) --(DO NOT GIVE BETA BLOCKERS TO ASTHMATICS OR DIABETICS) • Decreases myocardial contractility • Could decrease cardiac output • Decreases HR, BP • Decrease anxiety. 4) Radioactive Iodine (_1_dose) Don’ t _kiss anyone for 24 hours.
• Follow radioactive precautions.
Stay away from _babies for 24_hours.
• Watch for thyroid storm (thyrotoxicosis and thyrotoxic crisis).
It is hyperthyroidism multiplied by 100.
Could be rebounds effect post-radioactive iodine
• Given PO (liquid or tablet form)
Rule out pregnancy first
• Destroys thyroid cells→
_Hypothyroid( is expected because they can’t control have much is
being destroy!)
Surgery for hyperthyroidism
6 points
- • Post op:
a. Positioning:
a. HOB? ELEVATE(to decrease enema)
b. • Check for bleeding where? __behind the neck where the pulling can occur - Teach how to support neck. Because u don’t want tension on the suture lines
- Put personal items CLOSE to them.
- Nutrition (pre & post op) needs _MORE calories.
- Assess for recurrent laryngeal nerve damage by listening for
a. HOARSENESS AND A WEAK VOICE.
b. Could lead to vocal cord paralysis, if there is paralysis of both cords
AIRWAY__obstruction will occur requiring immediate _TRACH. - Teach to report any c/o __PRESSURE.
- Trach set at bedside
- Swelling
- Recurrent laryngeal nerve damage (vocal cord paralysis)
- Hypocalcemia
a. Assess for _PARATHYROID removal.
b. How? S/S of_HYPOCALEMIA
Eye care is important for a client with hyperthyroidism. If the client can’
t close their eyelids,
hypoallergenic tape may be applied to close lid (to help prevent injury or irritation). Dark
glasses may
be worn if photosensitivity is present. Artificial tears are used to prevent drying of the eyes.
Treatment of hyperthyroidism DOES NOT correct any eye or vision problems.
Hypothyroid (Myxedema):
8 S/S
What type of pt may you be dealing with ?
S/S: 1. No _Enegry- W hen this is present at _Birth it’ s called cretinismWith (very dangerous, can lead to slowed mental and physical development if undetected). 2. Fatigue 3. GI \_\_slow 4. Weight \_\_\_\_\_\_\_\_Up 5. Hot or cold? \_\_\_\_COLD, don't give the a heat pad 6. Speech \_\_\_\_\_slow slurred 7. No expression 8. Constipation
You may be taking care of a totally immobile client
Tx for hypothyroidism
What is the treatment ?
Do they take these meds forever? _
• What will happen to their energy level when they start taking these meds?
c. People with hypothyroidism tend to have ?
Tx:
• Levothyroxine (Synthroid®
), Thyroglobulin (Proloid®
), Liothyronine
(Cytomel®
)
• Do they take these meds forever? _YES
• What will happen to their energy level when they start taking these meds?
\_\_\_\_\_\_\_ ITS GOES UP
c. People with hypothyroidism tend to have \_\_\_CADThe parathyroids secrete _____?
What does PTH increase and how ?
The parathyroids secrete __PTH which makes you pull
calcium from the ___BONE and place it in the blood. Therefore, the serum
calcium level goes __UP.
I
Hyperparathyroidism =
How would this pt look?
Hypercalcemia = Hypophosphatemia:
Client will look sedated
Tx for Hyperparathyroidism
What is the treatment?
After treatment PTH does what?
What are you going to monitor post op?
Partial parathyroidectomy –
when you take out 2 of your parathyroids…
. PTH Is
secretion _DECREASE.
• What are you going to monitor post op? __ HYPOCALCEMIA
Hypoparathyroidism =
How will his client look ?
Hypocalcemia & Hyperphosphatemia
Client is not sedated
Signs and symptoms of Hypoparathyroidism
S/S:
Not enough __PTH
Serum calcium is __LOW. Serum phos is ___HIGH.
Other S/S: ___________________ NOT SEDATED
Tx of Hypoparathyroidism
b.Tx: • IV \_\_CALCIUM • Phosphorus binding drugs
Need your adrenals to handle _
STRESS
You have two parts to your adrenal gland:
adrenal medulla and the adrenal cortex.
What is Pheochromocytoma
Benign tumors that secrete epi and norepi in boluses
Signs and symptoms of Pheochromocytoma
Name 4 S and S?
S/S: 1. BP? \_\_\_\_\_UP 2. HR and Pulse? \_\_\_\_\_\_\_\_ UP 3.Flushing/diaphoretic
Dx for Pheochromocytoma
Dx:
• VMA (vanillylmandelic acid) test: a 24 hour urine specimen is done
and you are looking for increased levels of __EPI and NOREPI! Vanilla may alter the test, stay
off off for abt a week! The day of test they should be calm to avoid stress
With a 24 hour urine you should throw AWAY the first voiding and KEEP the last voiding.
Tx for Pheochromocytoma
Tx:
Adrenalectomy
• Surgery to remove __TUMORS
Adrenal cortex section
Glucocorticoids, Mineralocorticoids, and Sex hormones)
Glucocorticoid do what ??
- Change your mood. Example: insomnia, depressed, psychotic, euphoric
- Alter defense mechanisms, Immunosuppressed ,High risk for infections
- Breakdown _FATS and proteins
- Inhibit insulin so blood sugars goes up Now their Hyperglycemic Do blood glucose
monitoring
Mineralocorticoids: Aldosteronedo what ?
To much causes you to lose __ and put you in ___?
Not enough to gain causes you to gain __ and put you in ___?
Make you retain Na & WATER • Make you lose _ potassium • Too Much Aldosterone. Fluid volume excess Serum Potassium: down
• Not Enough Aldosterone.
Fluid volume deficit
Serum Potassium: _increase
