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Genitourinary & Endocrine > Endocrine & Endocrine > Flashcards

Endocrine & Endocrine Flashcards

1
Q

what is the function of the kidneys?

A

regulate the volume and composition of ECF
excrete waste products from the body
control BP
erythropoietin production
vitamin d activation
acid base regulation

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2
Q

what are the cortex of the kidneys?

A

loop of henle
collecting tubes

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3
Q

where is blood filtered in the kidneys?

A

glomeruli

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4
Q

how is blood filtered in the glomeruli?

A

filtered by hydrostatic pressure
passess through the bowman’s capsule
glomerular filtrate passes down the tubule

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5
Q

what is the normal GFR?

A

125 ml/min

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6
Q

decreased kidney capillary, increases what to get through?

A

protein

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7
Q

where is absorption mostly done?

A

GI

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8
Q

ADH is needed for?

A

it is important for water balance
regulated by posterior pituitary gland

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9
Q

what is Aldosterone needed for?

A

reabsorption of sodium and water
released from the adrenal cortex

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10
Q

what is the kidneys major role?

A

water balance
electrolyte balance
acid-base balance
control bp

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11
Q

what do ureters do?

A

carry urine from renal pelvis to the bladder

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12
Q

true or false the ureteral lumens are narrow?

A

true

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13
Q

what is the bladder?

A

reservoir for urine (600-1000ml)
the bladder is a muscle (detrusor)

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14
Q

how long is the female and male urethra?

A

female: 1-2 inches (3-5 cm)
male- 8-10 in (20-25 cm)

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15
Q

who is at most risk for UTI?

A

female

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16
Q

what is the urethrovesical unit?

A

-formed by bladder, urethra, and pelvic floor muscles

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17
Q

voluntary control of the urethrovesical unil is defined as continence, true or false?

A

true

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18
Q

how is the urethrovesical unit stimulated?

A

impulses are sent to the brain to the sacral area to the spinal cord to control the tubule

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19
Q

what is stress incontience?

A

something is pushing on it to where you can’t control

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20
Q

what is the assessment (history collection)

A

gender/age
socioeconomic/occupation
dietary/personal habit
previous surgeries/hospitalization
family/personal health history

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21
Q

what is anuria?

A

inability to urinate

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22
Q

what is olguiria?

A

small amounts of urine

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23
Q

what is polyuria?

A

too much urine

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24
Q

what is the objective data assessment for genitourinary?

A

inspection
ausculation
palpation
percussion

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25
Q

what is normal BUN?

A

7-21

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25
Q

what is normal creatinine?

A

0.6-1.3

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26
Q

what are the blood diagnostics for kidney eval?

A

serum creatinine
blood urea/nitrogen
BUN/creatinine ration
estimated GFR

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27
Q

what does the BUN indicate?

A

renal function and hydration status

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28
Q

what are the urine diagnostic studies for kidney eval?

A

urinalysis
urine studies
creatinine clearance

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29
Q

how to preform a urinalysis?

A

first morning void
examine urine within 1 hour

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30
Q

what is a urine studies?

A

urine culture and sensitivity
looking for infection

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31
Q

what is a creatinine clearance? and how to perform it?

A

collect 24 hours specimen
discard the first urination
collect for 24 hour hours into a large container and place on ice
have pt urinate at end of 24 hours and add specimen to collection

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32
Q

with renal impairment serum creatinine goes up but the urinary clearance will go down?

A

true

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33
Q

what does the KUB radiographic diagnostic show?

A

exams of abd and pelvis
delineates size, shape, and position of kidneys, ureter, and bladder. can see radioplaque and foreign bodies

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34
Q

what does IVP ct scan show?

A

see urinary tract after IV contrast media is inserted. evaluates shape of kidney, ureters, bladder. Cysts, tumors, and ureteral obstruction distort normal appearance of these structures

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35
Q

why should patients with decreased renal function not have an IVP?

A

contrast media can be nephrotoxic

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36
Q

what should be seen before patient goes in for IVP?

A

BUN and creatinine

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37
Q

what does the ct scan show?

A

visualizes kub. can detect tumors, abscesses, and obstruction.

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38
Q

what are the renal surgical diagnostic studies?

A

renal biopsy
cystoscopy
renal arteriogram

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39
Q

how and what is a renal biopsy?

A

obtains tisse for examination to determine the type of disease
-usually done as a skin biopsy through needle insertion into lower lobe of kidney under CT or ultrasound guidance

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40
Q

what are the contraindications of a renal biopsy?

A

bleeding disorders
single kidney
uncontrolled hypertension

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41
Q

what is renal biopsy’s #1 risk factor?

A

bleeding

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42
Q

what is done before a renal biopsy?

A

-type and crossmatch patient for blood
-ensure consent is signed
-assess coagulation status
-pt history and medication history
-review labs (CBC & H&H) (clotting factors)

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43
Q

what to do after renal biopsy?

A

apply pressure
keep pt positioned on affected side for 30-60min
bed rest for 24 hours
vs q5-10 min for the first hour
assess frequently for signs of bleeding or infection

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44
Q

what to do before a renal arteriogram (angiogram)?

A

-cathartic or enema may be used the night before
-before injection of the contrast material, assess for iodine sensitivity
-prior to contrast media injection, notify pt of possible transient warm feeling along the course of blood vessels
-look at the kidney function before procedure

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45
Q

what to do after the renal arteriogram (angiogram)

A

-place pressure dressing over femoral artery injection site
-observe site for bleeding and inflammation
-have pt maintain bed rest with affected leg straight
-take peripheral pulses in the involved leg every 30-60 min to detect occlusion of blood flow (from thrombus or emboli)

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46
Q

what is a UTI?

A

bacteria enters the sterile bladder causing inflammation

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47
Q

what is the common bacterial infection in a UTI?

A

escherichia coli (E. coli)

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48
Q

what can cause a CAUTI?

A

e.coli
prseudomonas species

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49
Q

what are the lower UTIs?

A

urethritis
cystitis

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50
Q

what is the upper uti?

A

pyelonephritis

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51
Q

what are the different type of UTIs

A

lower uti
upper uti
urosepsis

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52
Q

what are the risk factors of UTI?

A

immunosuppressed/immunocompromised
diabetes
Hx of kidney problems
have undergone multiple antibiotic courses
have traveled to developing countries
catheterization
cystoscopy examination
occupation/habitual delay
STI

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53
Q

what is urethritis?

A

inflammation in the urethra

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54
Q

what is cystitis?

A

inflammation of the bladder

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55
Q

what are signs and symptoms of urethritis?

A

pain/burning/dysuria
frequency
urgency
nocturia
males: clear mucous like discharge
females: lower abd discomfort

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56
Q

what are the signs and symptoms of cystitis?

A

bladder irritability
hesitancy
suprapubic pain
incontinence
nocturnal enuresis

pain/burning/dysuria
frequency
urgency
nocturia

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57
Q

what are the diagnostic studies for LOWER UTI?

A

-H&P
-UA (get before antibiotics)
+nitrates
+WBC
+Leukocyte esterase
-urine culture and sensitivity (determine the bacteria and susceptibility to antibiotic drug)
-imaging studies

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58
Q

what is pyelonephritis?

A

inflammation of renal parenchyma and collecting system

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59
Q

how does pyelonephritis occur?

A

usually begins with lower UTI
preexisting factor may present
vesicoureteral reflex
-retrograde movement or urine from lower to upper urinary tract

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60
Q

what are the causes of pyelonephritis?

A

dysfunction of lower UTI
obstruction from BPH
stricture
urinary stone
CAUTI
-recurring episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis

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61
Q

what are the typically signs and symptoms of pyelonephritis

A

fever
chills
flank pain

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62
Q

what are other clinical manifestations of pyelonephritis?

A

fever/chills
N/V
fatigue/malaise
flank pain
may also have s/s of cystitis

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63
Q

what are the diagnostic studies of pyelonephritis?

A

H&P
UA
urine culture/sensitivity
imagine studies (US, CT scan, cystoscopy)
CBC
blood culture
percussion for flank pain

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64
Q

what is urosepsis?

A

UTI has spread systemically
life-threatening condition requiring emergent treatment
usually begins lower tract and ascends urethral route

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65
Q

what are frequent causes of urosepsis?

A

escherichia coli
proteus
klebisiella
enterobacteria

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66
Q

what are the clinical manifestations of urosepsis?

A

shiver, fever, or very cold
extreme pain or general discomfort
pain or discolored skin
sleepy difficult to rous confused
i feel like i might die
short of breath
N/V
malaise/fatigue
fever, hr increase
bp decrease

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67
Q

what are uti preventions/treatment

A

antibiotics
NSAIDS or antipyretic drugs
vit c
urinary analgesics
phenazopyridine (pyridium)
fluids
IV/PO
cranberry juice

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68
Q

what are the antibiotics for a UTI?

A

Nitrofurantoin, ampicillin, amoxicillin, cephlasporins, fluoroquinolones

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69
Q

what are the analgesic for a UTI?

A

Phenazopyridine/pyridium

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70
Q

what are the antifungals for UTI

A

amphotericin or fluconazole

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71
Q

what is nitrofirantoin (macrodantin)

A

antibiotic
given 3 or 4 times a day
long-lasting preparation (macrobid) is taken twice daily

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72
Q

what is Ampicillin, amoxicillin, cephalosporins?

A

antibiotic
treats uncomplicated UTI no stricture, normal bacteria

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73
Q

what are fluoroquinolones?

A

antibiotic
treat complicated UTI
ex. ciprofloxacin (Cipro)
active against broad spectrum bacteria
po or iv route

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74
Q

what are the adverse effects of Fluoroquinolones

A

tendon rupture
phototoxicity
N/V/D abd pain
dizziness, HA, restlessness, confusion

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75
Q

what are the antifungals?

A

amphotericine or fluconazole

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76
Q

what are antifungals?

A

UTIs secondary to fungi
harder on the veins, more toxic
not compatible with NS, have to hang with D10, no flushing with NS

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77
Q

what os glomerulonephritis?

A

inflammation of the glomeruli
destruction of glomeruli

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78
Q

when is glomerulonephritis commonly seen?

A

after strep infection or untreated strep infection

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79
Q

what are the risk factors of glomerulonephritis?

A

kidney infection
nephrotoxic drugs
immunocompromised system
systemic disease

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80
Q

what are the clinical manifestations of glomerulonephritis?

A

general body edema
decreased urine output
oliguria/hematuria/proteinuria
hypertension
increase BUN/creatinine
history of group A strep
evidence of immune-mediated response

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81
Q

what are the nurse management of glomerulonephritis?

A

-daily wt and i&o
-measure abd girth
-medications
antihypertensive
diuretics
corticosteroids
dietary
-low in sodium/low to moderate protein/fluid restriction

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82
Q

what are nephrotoxic drugs?

A

nsaids
antibiotics
contrast media

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83
Q

HADSTREP

A

hypertension
Asa titer(+) this is for strep
decreased gfr
swelling in face/eyes
tea colored urine
recent strep infection
elevated BUN and creatinine
proteinuria

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84
Q

what is renal calculi?

A

occurs in the kidneys, ureters, and bladder, with renal stones being the most prevelant
-calcification in the urinary system
-microscopic crystals in the urinary tract aggregate together causing a stone to occur

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85
Q

what are renal calculi clinical manifestation?

A

pain (pain meds)
n/v
urinalysis (blood in urine)
+rbc
uti like symptoms (blocking and developing UTI

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86
Q

What is the #1 symptom of renal calculi?

A

pain

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87
Q

what are the medication nursing management for renal calculi?

A

narcotics and nsaids
antimetic
alpha-adrenergic blockers

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88
Q

what are the lab nursing management for renal calculi?

A

increased BUN/creatinine
UA
cbc-infections, increased WBC

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89
Q

what are the teaching nursing management for renal calculi?

A

strain urine
symptoms of infection/obstruction
prevention

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90
Q

what nutrition should a patient with kidney stones take?

A

encourage hydration
lemons/limes/grapefruit

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91
Q

what should patients limit in nutrition with kidney stones?

A

caffeine/alcohol
calcium
sugar
oxalate (chocolate)
uric acid

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92
Q

what a bladder cancer?

A

tumor formation is attributed to genetic changes in target cells

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93
Q

what cancer is the 4th common in males and 8th in females?

A

bladder cancer

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94
Q

what is the most important risk factor of bladder cancer?

A

smoking

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95
Q

what are the clinical manifestations of bladder cancer?

A

painless hematuria

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96
Q

what is the nurse managements with patients who have bladder cancer?

A

vital signs
medication
chemo
immunotherapy
continuous bladder irrigation
i&o
superficial or low grade-bladder cancer
invasive bladder cancer
radial cystectomy
combined with neoadjuvant or adjuvant chemo

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97
Q

what is renal cancer?

A

renal cell carcinoma is most common
usually found in the cortex or pelvis of the kidney

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98
Q

what are the male ages of renal cancer?

A

50-70

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99
Q

what are the renal cancer manifestations?

A

initially asymptomatic
classic triad (flank mass, flank pain, hematuria)
wt loss
hypertension
fever
anemia

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100
Q

what are the diagnostic studies for renal cancer?

A

ivp
ultrasound
ct/mri
urine cytology

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101
Q

what are the treatments of renal cancer?

A

biological immunotherapy or cytokinesis
radical nephrectomy

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102
Q

what are the nurse managements for renal cancer?

A

pain management
iv hydration

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103
Q

what are the post op nursing management for renal cancer?

A

bleeding
incision
patency of tubes/catheters
i&o

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104
Q

what is incontinence?

A

involuntary or uncontrolled loss of urine in any amount

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105
Q

what is stress incontinence?

A

due to increase abd pressure under stress (weak pelvic floor muscles)

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106
Q

what is urge incontinence?

A

due to involuntary contraction of the bladder muscles

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107
Q

what is overflow incontinence?

A

due to blockage of the urethra

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108
Q

what is neurogenic incontinence?

A

due to disturbed function of the nervous system

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109
Q

what are the nursing managements for incontinence?

A

assessment
lab

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110
Q

what are the teachings for incontinence?

A

medication
kegal excercises
skin care
voiding diary
emotional support

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111
Q

why should patients with incontinence use anticholinergics?

A

reduces overactive bladder contractions; improve storage capacity of bladder

oxybutymin (ditropan)

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112
Q

why should patients with incontinence use alpha-adrenergic blocker?

A

reduce urethral resistance to urinary overflow
-doxazosin (cardura)
-tamsulosin (flomax)

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113
Q

why should patients with incontinence use tricyclic antidepressants?

A

reduce sensory urgency and burning pain
-amitriptyline (elvail)

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114
Q

when age is renal trauma seen in males?

A

less than 30

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115
Q

what can cause a renal trauma?

A

stabbing
gunshot wound
object piercing the abd wall
blunt force trauma

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116
Q

what is kidney failure?

A

inability of the kidney to excrete waste products and water from the bloodstream through filtration

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117
Q

what is the patho of AKI?

A

acute, rapid loss of renal function
oliguria may be present
uremia may be present

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118
Q

what are the AKI manifestations?

A

-rapid decrease in renal function
-increase in serum creatinine, BUN, K+
-decrease in urine output
-azotemiz

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119
Q

what is prerenal AKI?

A

due to decreased blood flow into the kidneys

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120
Q

what causes prerenal AKI?

A

absolute loss of fluid
relative loss of fluid
renal artery issue
(hemorrhage, vomiting, diarrhea, burns)

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121
Q

what is postrenal AKI?

A

obstruction from the outflow of the kidney
-1ureter obstructed, unilateral obstruction
-both ureters obstructed, bilateral obstruction

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122
Q

what can cause postrenal AKI?

A

-compression
intra-abd tumors
bph (benign prostatic hyperplasia)
-blockage
kidney stones

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123
Q

what is intrarenal AKI?

A

damage to the tubules, the glomerulus or the intersititium

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124
Q

what are the causes of AKI?

A

acute tubular necrosis
glomerulonephritis
acute interstitial nephritis

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125
Q

what is acute tubular necrosis?

A

most common cause of intrarenal AKI

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126
Q

what is glomerulonephritis (GN)

A

inflammation of the glomerulus

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127
Q

what is acute interstitial nephrtis?

A

damage to the kidney interstitium

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128
Q

what are the 4 phases of AKI?

A

initiating phase
oliguric phase
diuretic phase
recovery phase

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129
Q

what is the initiating phase of AKI?

A

renal blow flow decrease to a lever resulting in severe cellular depletion, that intern leads to acute cell injury and dysfunction

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130
Q

what is the oliguric phase of AKI?

A

<400ml/day occurs within 1-7days of kidney injury
-increase K+ and decrease Na+
-elevated BUN and creatinine
-fatigue and malaise
-metabolic acidosis

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131
Q

what is the diuretic phase of AKI?

A

gradual increase in urine output 1-3 L/day
-hypovolemia, dehydration
-hypotension
-BUN and creatinine levels begin to normalize

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132
Q

what is the recovery phase in AKI?

A

1-2 weeks can take up to years
-begins when GFR increases
-BUN and creatinine levels plateau, then decrease

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133
Q

what are the signs and symptoms of AKI?

A

-decrease urine output
-swelling of the legs, ankles, and feet
-sob
-fatigue
-loss of appetite
-n/v
-irregular heartbeat (arrythmias)
-chest pain or pressure
-easy or unusual bleeding
-confusion

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134
Q

what are the nursing management of AKI?

A

eliminate cause, prevent complications and assist recovery
-vital signs
-i&o, daily wt
-oxygenation
-manage fluid balance
-positioning
-skin care
-dialysis may be considered

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135
Q

what are your nurse managements of medications for AKI?

A

diuretics
avoid nephrotoxic agents
sodium polystyrene sulfonate-kayexalate

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136
Q

what are the nutrition nursing managements of AKI

A

high calorie
low sodium
low potassium

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137
Q

what are the drug therapies for AKI?

A

fluid challenges
loop diuretics (furosemide)
sodium polystryene (kayexalate)
calcium channel blockers
renal replacement therapy
diet therapy

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138
Q

what are the gerontological complications of AKI?

A

-GFR declines with age
-other organ impairment increases risk for AKI
-CVD or diabetes
-older kidney does not compensate as well for fluid volume, solute food, and cardiac output
-increase risk for dehydration

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139
Q

what is long term chronic kidney disease?

A

progressive, irreversible loss of kidney function
-most common cause are diabetes and hypertension

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140
Q

what are the leading causes of CKD?

A

diabetes
hypertension

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141
Q

what are the risk factors of CKD?

A

age >60
cardiovascular disease
diabetes
ethnicity (black, native americans)
exposure to nephrotoxic drugs
family hx of CKD
hypertension

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142
Q

how many stages of CKD are there?

A

5 stages

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143
Q

what is the 1 stage of CKD?

A

kidney may have normal function
-GFR of 90 or greater
-BUT there are structural changes that indicate renal damage

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144
Q

what is the stage 2 of CKD?

A

kidney damage with mild decrease in GFR
GFR of 60-89

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145
Q

what is stage 3 CKD?

A

stages 3a and 3b
moderate to poor kidney function
GFR 30-59

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146
Q

what is stage 4 of CKD?

A

moderate to poor kidney function
GFR 15-29

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147
Q

what is stage 5 of CKD?

A

end stage renal disease (ESRD)
GFR is 15 or less
renal replacement needed if there is buildup of toxins in the blood, and if the patient desires treatement

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148
Q

what are the clinical manifestation for CKD?

A

-devastating effect on every body system
-sodium and fluid balance alteration
-altered potassium excretion
-impaired metabolic waste elimination
- neuro symptoms
-altered calcium and phosphorus levels
-metabolic acidosis
-chronic anemia

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149
Q

what are the lab values of CKD?

A

-increase serum creatinine/BUN/potassium
-decrease creatinine clearnace
-decrease or increase serum sodium
-decrease serum calcium
-decrease CO2/hemoglobin and hematocrit

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150
Q

what are the nursing management of CKD?

A

-preserve existing kidney function
-reduce risk of cardiovascular disease
-prevent complications
-provide for patients comfort
-fluid management
-monitor V/S and lab values
-monitor i&o and daily wt
-skin care
-medication (diuretics, CCB, antihypertensives)

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151
Q

what is the nutritional therapy for CKD?

A

-monitor/restrict protein
-fluid restriction
-sodium/potassium restriction
-phosphate restriction
-citrus juice contrainticated
-designed to maintain good nutrition
-DASH
-monitor laboratory parameters
-protein intake
-should be carefully monitored
-normal for HD patients
-increased for PD patient

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152
Q

what are some foods that patients with CKD can eat?

A

fruits
vegetables
fat-free or low-fat milk
milk products
whole grain
fish
poultry
beans
seeds
nuts

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153
Q

what drug therapy can patients with CKD take with hyperkalemia?

A

-restrict high potassium foods and drugs
-IV glucose and insulin
-IV 10% calcium gluconate
-sodium polystyrene sulfonate
-dialysis may be needed

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154
Q

what antihypertensive drugs can patients with CKD take?

A

ace inhibitors
arb agents

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155
Q

what is mineral and bone disorder in CKD?

A

calcium and phosphorus levels out of balance

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156
Q

who does MBD affect more in CKD?

A

kidney failure receiving dialysis

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157
Q

what are some interventions with patients with MBD)

A

-phosphate not restricted until patient requires renal replacement therapy
-phosphate binders
-avoid aluminum preparations
-supplementing vit D

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158
Q

what is the drug therapy for MBD?

A

-phosphate binders
-calcium acetate (PhosLo)/Calcium carbonate (Caltrate)
-bind phosphate in bowel and then excreted
-sevelamer hydrochloride (renagel)
-lowers cholesterol and LDL levels

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159
Q

what are drug therapy medications for CKD?

A

erythropoiten (EPO)
iron supplements

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160
Q

what is erythropoietin?

A

-glycoprotein hormone
-used for anemia
epo stimulates the bone marrow to increase RBC
-in response to anemia or hypoxia, circulating levels of epo rise dramatically triggering an increase in erythrocyte synthesis
epoetin alfa (epogen, procrit/darbepoeitin, alfa (aranesp)

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161
Q

what other supplements should be taken with EPO?

A

iron
folic acid
vit b12

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162
Q

what does lasix do for CKD?

A

-acts in thick segement of the ascending loop of henele to block reabsorption of water
-can promote diuresis even when renal blood flow and GFR are low
-administered PO, IV, or IM
-oral admin: diu5resis begins within 60 min; persists for 8 hours
-IV admin: diuresis begins within 5 min; persists for 2 hours
-IV is used in critical situations

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163
Q

what are the drug therapy complications?

A

digoxin
diabetic agents
antibiotics
opioid medications

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164
Q

what is dialysis?

A

artificial process for removing waste and water from the body when kidney no longer function

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165
Q

who needs dialysis?

A

acid base problems
electrolyte problems
intoxications
overload of fluids
uremic symptoms

166
Q

what is hemodialysis?

A

-obtaining a vascular access is one of the most difficult problems

167
Q

what are the types of hemodialysis?

A

arteriovenous fistulas and grafts

168
Q

created in forearm between artery and vein they connect directly

A

fistula

169
Q

what are the hemodialysis complications?

A

hypotension
muscle cramps
loss of blood
hepatitis
systemic infection
dialysis dementia
disequilibrium syndrome
av fistula complications

170
Q

what can be given when patient has hemodialysis and has hypotension?

A

administer albumin

171
Q

what is CCRT?

A

for acutely ill with AKI or severe fluid overload

172
Q

what is peritoneal dialysis?

A

-peritoneal membrane acts as the semipermeable membrane
-peritoneal access is obtained by inserting a catheter through the anterior abd wall

173
Q

what is the catheter placement requirements for peritoneal dialysis?

A

-technique for catheter placement varies
-usually done via surgery
-prep for placement include emptying bladder and bowel

174
Q

what are the different types of peritoneal dialysis?

A

-automated peritoneal dialysis
-continuous ambulatory peritoneal dialysis
-intermittent peritoneal dialysis

175
Q

what are the 3 phases of PD?

A

inflow (fill)
dwell (equilibration)
drain (15-30 min depending on pt)

whole process is called exchange

176
Q

what are the contraindications of PD?

A

history of mulitple abd surgeries
chronic or abd conditon
recurrent hernias
obesity
pre-existing back problems
severe chronic obstructive pulmonary diease
exit site infection
peritonitis
hernias
lower black problems
bleeding

177
Q

what are PD complications?

A

atelectasis
pneumonia
bronchitis
protein loss

178
Q

what are the nursing management for PD?

A

vital signs
daily wt
nutrition
lab values

179
Q

what to look for in HD?

A

bruit/thrill, neuro assessment, post dialysis (fistula,hypotension)

180
Q

what to look for in CCRT?

A

frequent v/s, fluid assessment (ICU, trauma, AKI, something fast)

181
Q

what to look for in PD?

A

ABD girth, monitor for outflow (home, peritoneium, move back and fourth )infection

182
Q

what are the different renal transplantation sources?

A

-cadaver donors with compatible blood type
-blood relatives
-emotionally related living donors
-altruistic living donors (friends)
-paired organ donation

183
Q

renal transplantation is a cure, true or false?

A

false

184
Q

what are the renal transplantation contradictions?

A

malignancies (advanced cancer)
refractory/untreated cardiac disease
chronic respiratory failure
extensive vascular disease
chronic infection
unresolved psychosocial disorders

185
Q

what is the goal of immunosuppressive therapy for renal transplantation?

A

-adequately suppress the immune response to prevent rejection
-maintain sufficient immunity to prevent infection

186
Q

what are the renal transplantation immunosuppressive therapies

A

corticosteroids (prednisone)
calcineurin inhibitors (cyclosporine)
cytoxic (antiproliferative drugs)

187
Q

identical immune cells

A

monoclonal antibodies

188
Q

several immune cells

A

polyclonal antibodies

189
Q

1st choice to help organ rejection

A

mycophenolate (cellcept)l

190
Q

lifelong medication

A

tacrolimus (prograf)

191
Q

help to prevent rejection of the transplanted organ

A

monoclonal antibodies
polyclonal antibodies
myciphenolate (cellcept)
tacrolimus (prograf)

192
Q

what is hyperacute antibody?

A

no cure
onset with 48 hours
malaise, high fever
graft tenderness
organ must be removed to decrease s/s

193
Q

what is acute occur?

A

-first 6 months after transplant, 1 week to 2 years
-oliguria, anuria
increase temp
increase bp
flank tenderness
lethargy
increase BUN/creatinine
fluid retention
-reversible
increase immunosuppressive therapy

194
Q

what is chronic process?

A

occurs over months or years
increase BUN/creatinine
imbalances in proteinuria electrolytes
-fatigue
irreversible

195
Q

what are the renal transplantation nursing managements

A

prevent infection
watch for s/s of infection
-fever/chills
-tachypena
-tachycardia
-increase/decrease in WBCs indicating leukocytosis or leukopenia

196
Q

what are the precautions patients with a renal transplantation should take?

A

avoid crowds
wash hands
good nutrition
vitamin c

197
Q

what are the s/s of transplant rejection?

A

high fever
malaise
organ must be removed to help decrease these symptoms

198
Q

what is benign prostatic hyperplasia (BPH)

A

-condition in which the prostate gland increases in size
-outflow of urine from the bladder to the urethra is disrupted

199
Q

what is the percentage of problems with BPH in men on 40 years old?

A

25%

200
Q

what is the percentage of problems in BPH with men of 70 years old?

A

75%

201
Q

what are the risk factors of BPH?

A

age
obesity (epecially increased waist circumference)
lack of physical activity
high amount of dietary animal protein
alcohol consumption
ED
smoking
diabetes

202
Q

what are the irritative clinical manifestations of BPH?

A

nocturia (often firs recognized symptom)
frequency
urgency
dysuria
bladder pain
incontinence

203
Q

what are the obstructive clinical manifestations of BPH?

A

decreased urinary stream caliber and force
intermittency
hesitancy
dribbling

204
Q

what are complications of BPH?

A

urinary retention
bladder distention
sudden pain and inability to urinate
post void residual (>100-200cc)
UTI
overflow incontience
hydronephrosis
AKI
decrease GFR
increased BUN/Creatinine

205
Q

what are the diagnostic studies for BPH?

A

detailed H&P
digital rectal exam (DRE)
urinalysis/culture
prostate specific antigen (PSA)

206
Q

what is digital rectal exam (DRE)

A

estimates prostate size, symmetry, and consistency

207
Q

what is normal DRE in BPH?

A

symmetrical, large, smooth

208
Q

what is prostate-specific antigen (PSA)

A

screens for prostate cancer

209
Q

what age should men do DRE?

A

men past 50

210
Q

what are the treatments for BPH?

A

catheter insertion if possible
pharmacological interventions
possible surgery

211
Q

what are the interprofessional care goals for patients with BPH

A

restore bladder drainage
relieve the patients symptoms
prevent or treat the complication of BPH

212
Q

what are the nursing managements for BPH?

A

active surveillance
bladder scan
dietary changes
avoid anticholinergics and decongestants
limit fluids at night
bladder re-training
annual follow ups

213
Q

why should patients with BPH avoid anticholinergics and decongestants?

A

they can cause urinary retention (used for overactive bladder)

214
Q

what are the dietary changes that patients with BPH should do?

A

decrease caffeine, alcohol, carbonated drinks, artificial sweeteners, spicy or acid foods
AVOID: processed sugar, processed foods

215
Q

what does alpha-adrenergic blockers do to help patients with BPH?

A

relax smooth muscle that surrounds the urethra
-facilitates urinary flow through the urethra
symptoms improve days to weeks

216
Q

what are the adverse effects of alpha adrenergic blockers

A

abnormal ejaculation
caution using when going for cataract surgery

217
Q

how long does alpha-adrenergic blockers take to improve symptoms?

A

weeks

218
Q

what are 5 alpha reductase inhibitors

A

shrink enlarged tissue
reduce the size of the prostate gland

219
Q

how long does it take 5-alpha reductase inhibitors to help improve symptoms?

A

3-6 months

220
Q

what are the adverse effects of 5-alpha reductase inhibitors?

A

increase risk of high-grade prostate tumor
ED/decrease libido
gynecomastia (breast enlargement)

221
Q

what is finasteride (proscar), dutasteride (avodart), jalyn (finasteride plus tamsulosin)?

A

-blocks enzyme necessary for conversion of testosterone to DHT
-decrease size of prostate gland
-more effective for larger prostates with bothersome symptoms

222
Q

what is the TURP?

A

transurethral resection of the prostate

223
Q

what to assess for complications for TURP?

A

hemorrhage
bladder spasms
urinary incontinence
infection

224
Q

what is continuous bladder irrigation (CBI)

A

remove blood clots
ensure drainage of urine
use aseptic technique

225
Q

what are the post of care for TURP?

A

-stool softeners and high fiber diet to prevent straining
-treat bladder spasms-muscle relaxer
-catheter care
-teach kegel exercise
-observe for signs of infection v/s changes increase temp, resp, BP, HR

226
Q

what the #1 complaint post op after TURP?

A

bladder spasms

227
Q

whats the patho of prostate cancer

A

slow growing cancer
cause of 9% of cancer-related deaths of males
-most common cancer in men

228
Q

what are the clinical manifestations for prostate cancer?

A

BPH symptoms
PSA elevated
DRE abnormal
dysuria/hematuria
pain
perineal
suprapubic
rectal

229
Q

how to detect prostate cancer with DRE?

A

enlarged, asymmetrical, and lumpy

230
Q

what are the diagnostic studies for prostate cancer?

A

PSA screening
DRE
Biopsy

231
Q

what age should prostate cancer screening be done?

A

55-69 every 2 years

232
Q

whats the nursing management treatment for prostate cancer?

A

-radiation
-brachytherapy
-cryotherapy and ablative hormone therapy
-chemotherapy

233
Q

whats the surgical management for prostate cancer?

A

radical prostatectomy

234
Q

what the post op care for prostatectomy?

A

indwelling catheter
surgical site drain
hospital stay for 1-3 days

235
Q

what are the major complications of prostatectomy

A

ED
incontinence, urinary retention
hemorrhage
infection
wound drainage
wound dehiscence
DVT/PE

236
Q

what is erectile dysfunction?

A

inability to achieve or maintain an erection sufficient for sexual intercourse

237
Q

what are the erectile dysfunction common causes?

A

diabetes, vascular disease, side effects of medications, result of surgery, trauma, stress, depression, smoking, alchol

238
Q

if having ED what medication should not be taken with 5(PDE-5) INHIBITORS?

A

nitrates (nitrogen)

239
Q

what are contraindications when taking medications for ED?

A

Nitrates
alpha blockers

240
Q

what causes testicular cancer?

A

-abnormal testical development
-exposure to certain chemicals
-HIV infection
-history of testicular cancer
-history of undescended testicles
-infertility
-tobacco use
-down syndrome

241
Q

what is are the common ages of testicular cancer?

A

15-39

242
Q

tumors on right side may spread to what side in testicular cancer?

A

right side of lymph nodes

243
Q

tumors on the left side may spread to what side with testicular cancer?

A

back of the abdomen

244
Q

what are the clinical manifestations of testicular cancer?

A

painless mass in scrotum
nontender and firm
dull ache or heavy sensation in lower abdomen, perineal area or scrotum

245
Q

what are the diagnostic studies for testicular cancer?

A

palpation of scrotal content (firm and does not transilluminate
ultrasound
lab (tumor markers)
-AFP (a-fetoprotein)
-LDH (lactate dehydrogenase)
hCG (human chorionic gonadotropin)

246
Q

what is treatment for testicular cancer?

A

surgery
chemo
radiation

247
Q

what is orchiectomy?

A

surgical removal of affected testis, spermatic cord, and regional lymph nodes

248
Q

what is seminomas?

A

radiation and or chemotherapy
-very sensitive to radiation therapy

249
Q

what is nonseminomas?

A

not responsive to radiation
removal of lymph nodes
chemo

250
Q

whats the patho of male breast cancer?

A

uncontrolled growth of abnormal cells in breast tissue

251
Q

what are the risk factors of male breast cancer?

A

hyperestrogensim-high estrogen
family history of breast cancer
radiation exposure

252
Q

what are the clinical manifestations of male breast cancer?

A

swelling/lump in breast area
dimpling of skin or nipple erythema
nipple discharge
nipper inversion
ultrasonography and MRI

253
Q

what are the diagnostics for male breast cancer?

A

MRI
Ultrasound
lab studies
biopsy

254
Q

what are the treatment nursing management for male breast cancer

A

surgery
chemo
hormone therapy
radiation therapy

255
Q

what are the patient teaching for male breast cancer?

A

men who test positive for BRCA gene mutation should be aware of what breast look and feel
-report any changes to PCP
-self breast exams
-clinical breast exams starting at age 35
monitor for signs of infection

256
Q

what is testicular trauma?

A

result from sport injuries, kick to groin, motor vehicle accidents, or falls and injury

257
Q

what are the categories of injury for testicular cancer?

A

blunt trauma
penetrating trauma
degloving trauma

258
Q

what are the functions of the endocrine system?

A

-maintain and regulate vital functions
-respond to stress and injury
-growth and development
-energy metabolism
-reproduction
-balance of fluid, electrolytes, acid-base

259
Q

what are the risk factors for endocrine disorders?

A

age
heredity
trauma
environmental factors
consequence of other disorders or surgery

260
Q

what is known as the master gland and is influenced my the hypothalamus?

A

master gland
pituitary

261
Q

what is disorders are on the anterior pituitary?

A

hyperpituitarism (acromegaly)
hypopituitarism

262
Q

what disorders are located on the posterior pituitary?

A

diabetes insipidus (DI)
syndrome of inappropriate antidiuretic hormone (SIADH)

263
Q

what is hypopituitarism?

A

hormones most affected are growth hormone and gonadotropic hormone

264
Q

what is hyperpituitarism (Acromgaly)

A

hypersecretion of growth hormone
primary cause of pituitary tumors

265
Q

what is antiduretic hormone?

A

-made in the hypothalamus secreted in the posterior pituitary

266
Q

what does the antidiuretic hormone do?

A

regulates the amount of water in the body

267
Q

what does increased ADH lead to?

A

increased water retention and decrease serum Na+

268
Q

what are the causes of SIADH

A

-hypothalamus or pituitary damage from trauma
-RECENT stroke or infection like meningitis
-malignant tumor secreting ADH
-lung, pancreas, or hodgkin lymphoma

269
Q

is the serum osmolality with SIADH high or low?

A

low

270
Q

is the urine specific gravity high or low with SIADH?

A

high

271
Q

what is the normal specific urine gravity

A

1.030

272
Q

what is the SIADH assessment?

A

fluid volume overload
wt gain without peripheral edema
change in LOC, seizure risk
concentrated amber urine
hypertension, tachycardia

273
Q

what are additional complications with SIADH?

A

water intoxication

274
Q

what are the signs and symptoms of water intoxication?

A

mild headache
confusion
anorexia
seizures
N/V

275
Q

what are the labs with SIADH?

A

increase urine osmolality and specific gravity

decrease serum sodium and serum osmolality

276
Q

what are interventions for SIADH?

A

-monitor: VS, CV and neuro status, daily wts
-strict i&o’s, fluid restriction
-daily labs
-seizure precautions
-medications

277
Q

what fluids should be used for SIADH?

A

3% NS in severe cases

278
Q

what medications can be used for SIADH?

A

vasopressin antagonist (demeclocycline)
diuretics
sodium po or iv

279
Q

what is do decreased ADH lead to?

A

DI
decreased water retention
increased serum Na+

280
Q

what are the causes of Diabetes insipidus (DI)

A

-malfunction of posterior pituitary
-hypothalamus or pituitary damage due to stroke, trauma, or surgery
-nephrogenic- kidneys dont respond to ADH

281
Q

what are the DI assessments?

A

polyuria
polydipsia
dehydration
hypotension

282
Q

what are labs in DI?

A

decrease urine osmolality and specific gravity
increase serum sodium, serum osmolality

283
Q

what are the diagnostic studies for DI?

A

fluid deprivation test
synthetic vasopressin trial

284
Q

what is the fluid deprivation test?

A

-withhold water for 8 to 12 hours
-give patient DDAVP
-monitor if urine osmolality increases and urine volume decreases

285
Q

what is synthetic vasopressin trial?

A

-distinguish nephrogenic DI from central DI

286
Q

what are the DI interventions?

A

-identify and correct underlying cause
-daily wt, strict i&o’s, V/S, CV, neur status
-fluid replacement oral or iv
-safety-fall precautions
-restrict foods that diurese

287
Q

what foods diurese?

A

watermelon, grapes, caffeine

288
Q

what is demopressin acetate (DDAVP)

A

synthetic vasopressin
decrease urine output therefore increase urine osmolality

289
Q

what are the adverse effects of DDAVP?

A

flushing, water retention, water intoxication, nasal irritation, injection site irritation

290
Q

what are the contraindications for DDAVP?

A

no concurrent use of loop diuretic or glucocorticoids, hold if creatinine clearance <50ml/min

291
Q

what are the interventions of DDAVP?

A

monitor wt
I/O’s
electrolytes
VS
signs of water intoxication

292
Q

what is hypophysectomy?

A

done to remove pituitary tumors or the entire pituitary gland

293
Q

what is transsphenoidal

A

through the nose and sphenoid sinus located in the back of the nuse

294
Q

what is the post op care of hypophysectomy?

A

-elevate HOB 30º or more to decrease IOP and reduce headaches
-check dressing for drainage
(clear drainage should be checked for glucose)
-monitor I&O’s, electrolyte, labs
-access patients vision and pupils

295
Q

what are the hypophysectomy discharge teachings?

A

-avoid blowing nose, straining, coughing, sneezing, heavy lifting
-corticosteroid and thyroid replacement
-(sublabial approach- avoid brushing teeth for 10 days)
-AVOID ANYTHING THAT COULD INCREASE ICP

296
Q

what do thyroid hormones regulate?

A

energy metabolism
growth and development

297
Q

what does the hypothalamus secrete?

A

TRH (thyrotropin-releasing hormone)

298
Q

what does the pituitary gland release?

A

TSH (thyroid stimulating hormone)

299
Q

what does the thyroid secrete?

A

T3, T4, calcitonin

300
Q

is the thyroid palpable?

A

no

301
Q

what is the thyroid assessment?

A

-physical exam
-laboratory (serum TSH, free T4, serum T3, and T4)
-ultrasound
-radioactive iodine uptake test

302
Q

what is the radioactive iodine uptake test?

A

diagnose hyperthyroidism

303
Q

what is a goiter?

A

abnormal enlargement of thyroid gland

304
Q

why can goiter occur?

A

hyperthyroidism
hypothyroidism
euthyroidism

305
Q

what is the most common cause of goiter US?

A

chronic lymphocytic thyroiditis (Hashimoto)

306
Q

what are the interventions for goiter?

A

measure the neck to have baseline of growth
-monitor for compromised airway

307
Q

what is thyroiditis?

A

inflammation of thyroid gland
frequent cause of goiter
acute, subacute, chronic (hashimoto’s)

308
Q

what is acute thyroiditis?

A

due to bacterial or fungal infection
-abrupt onset with pain in thyroid area radiating to throat, ears, or jaw
s/s: fever, chills, sweat, fatigue
treat: antibiotics or antifungal

309
Q

what is subacute thyroiditis?

A

due to viral infection
brupt onset with pain in thyroid area radiating to throat, ears, or jaw
s/s: fever, chills, sweat, fatigue

310
Q

what is chronic lymphatic thyroiditis? (hashimoto’s)

A

destruction of thyroid tissue by antibodies

311
Q

do patients with chronic thyroiditis need thyroid replacement for life?

A

yes

312
Q

what is hyperthyroidism?

A

elevated T3 and T4
low TSH

313
Q

what causes hyperthyroidism?

A

-autoimmune reaction (grave’s disease)
-excess dose of thyroid replacement
-thyroiditis
-too much iodine

314
Q

what is they hyperthyroidism assessment?

A

increased metabolic rate
increased HR, BP, Temp
Wt loss
diarrhea
restless, insomnia, tremors
heat intolerance, diaphoresis
may have goiter, exophthalmos, dermopathy

315
Q

what is exophthalmos?

A

protrusion of the eyeballs from the orbit
-result from fat deposit and fluid in the orbital tissue and ocular muscles

316
Q

what is they hyperthyroid patient education?

A

-avoid spicy and high fiber foods to decrease diarrhea
-eat 4000-5000 calories/day
-good protein intake
-avoid caffeine or nicotine
-eye protection for exophthalmos
-ensure patient has adequate rest in quiet, cool environment
-lower simulation

317
Q

what medication is for hyperparathyroidism?

A

propylthiouracil and methimazole

318
Q

what does propylthiouracil and methimazole for?

A

-keep from making T3 and T4
-inhibit thyroid hormone synthesis

319
Q

which medication is given to pregnant women with hyperthyroidism?

A

PTU (propylthiouracil)

320
Q

what are the adverse effects of Propylthiouracil & Methimazole

A

hypothyroidism, agranulocytosis, N/V

321
Q

what is agranulocytosis?

A

extremely low white blood cell count that causes a very high risk for infection

322
Q

what are the patient teachings on taking Propylthiouracil & Methimazole?

A

-take medication with meals
-report signs of hypothyroidism
-importance of medication compliance

323
Q

what are the patient teachings when taking Propylthiouracil & Methimazole?

A

-take medication with meals
-report signs of hypothyroidism

324
Q

what is radioactive iodine?

A

destroys thyroid tissue

325
Q

what are the adverse effects of radioactive iodine?

A

Hypothyroidism, Radiation Thyroiditis and Parotitis, dryness and irritation of mouth and throat

326
Q

what is parotis?

A

swelling of parotid gland located between ear and jaw

327
Q

what are the patient teachings with radioactive iodine?

A

-private toilet facilities, flush twice after each use
-sleep alone, avoid physical contact
-launder towels and linens and clothes seperatly
-do not prepare food for others with bare hands
-avoid being around pregnant women and young children for 7 days

328
Q

what are the causes of acute thyrotoxicosis “thyroid storm”

A

severe infection/stress
manipulation of thyroid gland

329
Q

what are the assessments for acute thyrotoxicosis “thyroid storm”

A

-elevated temp 106º
-tachycardia, systolic hypertension
-n/v/d, abd pain
-agitation, tremors, confusion, seizure

330
Q

what are the medical management for acute thyrotoxicosis?

A

-stabilize CV function
-BETA BLOCKERS #1 INTERVENTION
-oxygen
-replace fluid and electrolytes
-anti-thyroid medication
-treat hyerthermia
-calm environment

331
Q

what is thyroidectomy?

A

removal of thyroid gland

332
Q

what is the preop intervention for a thyroidectomy?

A

-beta blockers, anti-thyroid meds, and iodine may be fiver to decrease risk of thyroid storm
-iodine also reduces risk for post-op hemorrhage

333
Q

what are the post op care and education for thyroidectomy?

A

head and neck support
incision and airway
thyroid hormone

334
Q

what are the signs and symptoms of hypocalcemia?

A

bronchospasms
numbness and tingling in face
postive chvesteks
trousseau’s signs

335
Q

what is hypothyroidism

A

low t3 and t4
elevated TSH

336
Q

what are the causes of hypothyroidism

A

-antibody destruction of thyroid
-iodine deficiency
-hyperthyroidism treatement

337
Q

what is they hypothyroid assessment

A

-decreased metabolic rate
-decreased hr
-wt gain
-constipation
-lethargy and fatigue
-cold intolerance, dry skin, and hair
-may have goiter

338
Q

what are the hypothyroid management?

A

-thyroid hormone replacement
-nutrition therapy to promote wt loss
-patient education

339
Q

what is the drug choice for hypothyroidism?

A

levothyroxine

340
Q

what are the drug effects of levothyroxine?

A

nausea and decreased appetite
s/s: hyperthyroidism

341
Q

what are the patient teaching for levothyroxine

A

medication will be lifelong
take med on empty stomach at the same time each morning
monitor for signs of hyperthyroidism

342
Q

levothyroxine decreases the action of what?

A

insulin and oral hypoglycemics

343
Q

what are the hypothyroidism patient education?

A

-exercise, low calorie and low-fat diet
-increase fiber in diet, stool softener
-avoid sedative and opioids if possible
-take thyroid hormone even while pregnant
-s/s: hypo/hyerpthyroidsim

344
Q

what is myxedema coma?

A

severe hypothyroidism

345
Q

what are the causes of myxedema coma?

A

-sudden withdrawal of thyroid medication
-acute illness, trauma, anesthesia, sedative/opiod use
-hypothermia

346
Q

what are the assessments of myxedema coma?

A

hypotension, bradycardia
hypothermia
hypoventilation>respiratory failure
hypoglycema, hyponatremia
generalized edema
-puffy eyes, double chin, thick tongue, mask-like face from edema

347
Q

what are myxedema managements?

A

respiratory and cardiovascular support
administer levothyroxine IV
administer IVF, glucose, corticosteroids
keep patient warm
monitor vs hourly
monitor LOC

348
Q

what is the parathyroid gland?

A

-four pea sized endocrine glands
-located on the back of the thyroid gland
-parathyroid hormone regulates Ca+ balance in the body

349
Q

what is primary hyperparathyroidism

A

increased PTH secretion, most commonly from benign tumor

350
Q

what is secondary hyperparathyroidism

A

compensatory response to low Ca+

351
Q

what is tertiary hyperparathyroidism

A

-enlargement of parathyroid gland
-PTH secreted regardless of Ca+ levels

352
Q

what is the hyperparathyroid assessment

A

labs: increased Ca+ and PTH, decreased phosphate
CV: increased BP, dysrhythmias
MS: fractures (osteoporosis) muscle weakness
GI: abd pain, N/V, constipation
GU: kidney stones
CNS: decreased reflexes, poor coordination
depression, psychosis, irritability, confusion

353
Q

what are some mild hyperthyroid managments?

A

increase fluid and weight bearing excersie
moderate Ca+ intake

354
Q

what are the severe hyperparathyroid managements?

A

IVF, loop diuretics, Biophosphates, calcimimetics
surgery parathyroidectomy

355
Q

what are bisphosphonates

A

aldendronate and risedronate
work by slowing the action of osteoclasts
monitor serum Ca+, phos, PTH and bone density

356
Q

what are the patient education of bisphosphonates

A

swallow tablet whole, take 30 min prior to breakfast
do not lie down 30 min after taking
do not take with Ca+ supplements, antacids, caffeine or OJ

357
Q

what is parathyroidectomy

A

-endoscopic radio-guided parathyroidectomy with autotransplantation
-autotransplantation done to continue PTH secretion

358
Q

what are the post op instructions for parathyroidectomy

A

watch for respiratory distress
assess neck for dressing for hemorrhage, voice may be hoarse
do not flex neck, elevate HOB, avoid straining

359
Q

what symptoms should you watch out for after parathyroidectomy

A

hypocalcemic crisis: tingling/twitching in extremities and face
positve trousseau’s sign
chvostek’s sign

360
Q

what is hypoparathyroidism

A

deficienty of PTH leads to decrease Ca+

361
Q

what are the causes of hypoparathyroidism

A

latrogenic
idiopathic
severe hypomagnesemia

362
Q

what is latrogenic?

A

accidental removal during thyroidectomy

363
Q

what is idiopathic

A

absence or atrophy of glands

364
Q

what are the hypoparathyroid assessment

A

lab: decreased Ca+, and PTH, increased phosphorus
CV: decreased BP, dysrhythmias
Resp: bronchospasm, laryngealspasm, difficulty breathing
GI: abd cramps, dysphagia
CNS: tetany, seizures, hyperflexia, +Chvostek/Trousseau
Ms: weakness, painful muscle cramp/spasm
personality changes, irritability

365
Q

what are the management of hypoparathyroid?

A

increase calcium level and treat acute complication
immediate treatment: IV calcium gluconate
long-term treatment:PO calcium supplements, vit D supplement

366
Q

what are the hypoparathyroidism nursing interventions

A

patient needs to be on telemetry until Ca+ level normalize
seizure precautions

367
Q

what are the hyperparathyroidism patient education?

A

-educate patient on long-term supplemental therapy
-educat patient on high calcium and high vit d foods
-avoid food containing oxalic acid:inhibit Ca+ absorption
-followup app for calcium monitoring

368
Q

what are the oxalic foods?

A

spinach and rhubarb

369
Q

why should patients with hypoparathyroidsm take vit d?

A

enhance intestinal calcium absorption

370
Q

what disorders are in the cortex?

A

addison’s disease
cushing’s syndrome

371
Q

what disorders are located in the medulla?

A

pheochromocytoma

372
Q

what does the adrenal cortex hormones release?

A

-corticosteroids
-mineralocorticoids
-glucocorticoids
-androgens

373
Q

what are mineralcorticoids?

A

regulate sodium and potassium balance, fluid balance
aldosterone

374
Q

what are glucocorticoids?

A

regulate metabolism, increase glucose levels, physiologic stress response
cortisol

375
Q

what do androgens do?

A

growth and development

376
Q

what is cushing’s syndrome

A

chronic exposure to excess corticosteroids, especially glucocorticoids
-corticosteroids used for conditions such as COPD, asthma, certain cancers

377
Q

what is the cushing’s assessment?

A

labs: increase glucose, cortisol Na+ decrease K+
general appearance: truncal obesity, rounding of face (moon face) fat on back of neck (buffalo hump)
CV: hypertension, fluid retention
GI: increased risk for peptic ulcer disease
MS: muscle wasting, osteoporosis
integument: thin and fragil skin straie, poor wound healing, acne, hirsutism
pysch: mood changes, euphoria
reproductive: development of male characteristics in women and vice versa

378
Q

what are the cushing syndrome diagnostic studies

A

-confirmation of increased plasma cortisol levels
midnight or late-night salivary cortisol
low dose dexamethasone suppression test
24-hour urine cortisol
-plasma ACTH levels
low or undetectable with cushing syndrome

379
Q

what is the latrogenic cushing syndrome management

A

-decrease corticosteroid dose
-change to every other day schedule
-taper off gradually

380
Q

what medications can be used but is rarely used for cushing syndrome?

A

ketoconazole and mitotane

381
Q

what are the nursing interventions for cushing syndrome?

A

-monitor vs, daily wt, and glucose level
-assess for infection
-emotional support
-pre/post op teaching for hypophysectomy and adrenalectomy

382
Q

what patient education should be given for cushing syndrome?

A

-sodium restriction, high K+, Ca+, protein diet
-adrenalectomy will require lifelong glucocorticoid replacment
-medical altert bracelet

383
Q

what is addison’s disease?

A

-adrenocorical insufficiency
-hypofunctional of adrenal cortex
-decrease in glucocorticoids, mineralcorticoids, and androgens

384
Q

what are the causes for addison’s disease?

A

-sudden D/C of high dose steroids
-destruction of adrenal cortex

385
Q

what are the addison’s assessment

A

lab: decrease aldosterone, cortisol, Na+, glucose
increase in K+
general appearance: wt loss, emaciation
CV: hypotension, hypovolemia, tachycardia
GI: anorexia, N/V/D
integument: bronze hyper-pigmentation, vitiligo, alopecia
psych: depression, irritability, delusion

386
Q

what does addison’s disease not have enough of?

A

glucocorticoid-cortisol
mineralocorticoid-aldosterone

387
Q

what are the diagnostic studies

A

ACTH stimulation test
corticotropin releasing hormone stimulation test

388
Q

what are the managements for addison’s disease?

A

lifelong hormone replacement therapy
glucocorticoids and mineralocortioids
women need androgen replacement

389
Q

treatment that has both glucocorticoid and mineralocorticoid properties

A

hydrocortisone

390
Q

only mineralocorticoid properties

A

fludrocortisone

391
Q

how is hydrocortisone given?

A

given in divided doses 2/3 dose in the morning and 1/3 in the afternoon

392
Q

what are the adverse effects of hydrocortisone?

A

hyperglycemia, osteoporosis, cushing syndrome, increase risk for infection

393
Q

what are the patient teaching for hydrocortisone?

A

do not stop abruptly, do not take live virus vaccine, patient may need additional doses during periods of stress, medical alert ID, emergency kit

394
Q

what are examples of stress dosing?

A

fever, flu, tooth extraction, rigorous physical activity

395
Q

what are the adverse effects of fludrocortisone

A

Na+ and H2O retention, hypokalemia, osteoporosis

396
Q

what are the patient teaching of fludrocortisone?

A

take medication with food or milk in the morning, eat high potassium diet, report signs of illness, do NOT stop abruptly, medical alert ID

397
Q

what are the addison’s disease management

A

-v/s, daily wt, i&o’s, electrolytes, BG
monitor for s/s of cushing syndrome, addisonian crisis
protect pt from infection
-calm environment, no loud noise, bright light, temp extreme balance rest and activity

398
Q

what medications can interact with corticosteroids?

A

oral hyperglycemics, cardiac glycosides, oral contraceptives, anticoagulants, NSAIDS

399
Q

what is addisonian crisis?

A

life-threatening emergency requiring aggressive treatement
-caused by acute adrenal insufficiency
precipitated by:
stress
trauma
infection
surgery
abrupt withdrawal of exogenous corticosteroid use

400
Q

what are the signs and symptoms of addisonian crisis?

A

severe headache
severe abdominal, leg, back pain
severe hypotension
low BG,
high K+
weakness
irritability and confusion
shock

401
Q

what are the addisonian crisis management

A

IV glucocorticoid (hydrocortisone)
IVF
shock management
monitor neuro checks, vs
monitor lab, especially Na+, K+, and glucose
provide quiet, stress-free environment

402
Q

what does the adrenal medulla hormone release?

A

catecholamines
-epinephrine
-norepinephrine
function as part of autonomic nervous system

403
Q

what is pheochromocytoma?

A

hyperfunction of adrenal medulla

404
Q

what are the causes of pheochromocytoma?

A

catecholamine producing tumor in adrenal medulla
increase epinephrine and norepinephrine

405
Q

what are the pheochromocytoma assessment?

A

increase catecholamines (blood and urine)
severe hypertension
classic triad: severe pounding HA, tachycardia, profuse sweating
unexplained abd/chest pain

406
Q

why should you not palpate patient with pheochromocytoma?

A

can cause sudden release of catecholamines and severe HTN

407
Q

what are the pheochromocytoma complications?

A

hypertensive crisis: renal and retinal damage
acute MI
CVA
dysrhythmias

408
Q

what are the diagnostic studies of Pheochromocytoma?

A

24 hour urine for VMA
Vanillylmandelic Acid
Biproduct of Epi and Norepi metabolism

Plasma-Catecholamine levels

CT/MRI to detect tumor

409
Q

what are the management of Pheochromocytoma?

A

medication: alpha blocker then beta blocker
monitor: BP, electrolytes, EKG
manage: rest and activity, stress
surgery: adrenalectomy
educate: medication and diet

410
Q

what is adrenalectomy?

A

surgical removal of one or both adrenal glands
typically done laparoscopically

411
Q

what are the adrenalectomy postop

A

Bilateral Adrenalectomy- lifelong glucocorticoid and mineralocorticoid replacement
Unilateral Adrenalectomy- temporary glucocorticoid replacement, up to 2 years
Sudden decrease in catecholamine levels:
Cardiovascular collapse, hypotension, shock
Monitor vital signs
Risk for Acute Kidney Injury
Monitor I/O’s closely
Risk for hemorrhage

412
Q

what are the adrenalectomy discharge teachings?

A

lifelong replacement therapy
teach: med adjucement and stress dosing
avoid: extreme temp, infection, and stress
medical alert bracelet

Genitourinary & Endocrine (1 decks)

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