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NCLEX > Endocrine I > Flashcards

Endocrine I Flashcards

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1
Q

List the 3 hormones that the Thyroid Gland produces?

A

Hormones T3, T4 and Calcitonin

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2
Q

What is the action of Calcitonin?

A

Calcitonin decreases serum calcium levels by taking calcium out of the blood and pushing it back into the bone.

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3
Q

What does the body need Iodine for?

A

To make hormones ( This is dietary iodine -what you eat)

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4
Q

What does Thyroid Hormone give us?

A

Energy

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5
Q

What does Hyperthyroid mean?

What is the name of the disease known to hyperthyroidism?

A 
Too Much Energy
Graves Disease ( Think Don Knots)
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6
Q

List the Signs and Symptoms of Hyperthyroidism

A 
Nervous
Irritable 
Decreased Attention Span - wild energy cannot focus
Decreased Weight 
Increased Appetite
Increased G.I. -borborygmi
Increased BP and Pulse - Arrhythmia's/palpitations
Sweaty/Hot
Exophthalmos
Thyroid bigger - Hypertrophy
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7
Q

How is Hyperthyroidism Diagnosed?

A
  1. By checking blood levels - Increased Serum Thyroxine (T4)
  2. Thyroid Scan - Hypertrophy
  3. Ultrasound/MRI/CT
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8
Q

If a Pt. is going for a thyroid scan what must they discontinue and for how long?

A

Discontinue any iodine containing medication, 1 week prior to the thyroid scan and must wait 6 weeks to restart medications.

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9
Q

What Anti-arrithythmic drug contains high levels of iodine and may affect thyroid function?

A

Amiodarone - (Cordarone)

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10
Q

How do we treat Hyperthyroidism?

A 
MEDICATIONS:
1.  Anti-thyroids
2. Iodine Compounds 
3. Beta- Blockers - supportive therapy
4. Radioactive Iodine Therapy
         AND
5. Surgery - Thyroidectomy
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11
Q

Describe the Actions of Anti-thyroids

A

Known as: Methimazole (Tapazole) or Proplthiouracil (PTU)

  • Stops the thyroid from making thyroid hormones.
  • Its used for PRE-OP to stun the thyroid.
  • We want this Pt. to b/c Euthyroid - EU = NORMAL
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12
Q

Describe the Actions of Iodine Compounds

A

-Known as: Potassium Iodine (SSKI and Lugol’s solutions).

  • Given PRE-OP to decrease the chance of bleeding.
  • Decrease the size and vascularity of the gland.
  • All endocrine glands are very vascular.
  • Given in milk or juice , and use straw b/c stains teeth.
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13
Q

Describe the Actions of Beta Blockers (lol) Supportive Therapy.

A

Known as: Propanolol (Inderal)

  • Decreases myocardial contractility
  • Could decrease cardiac output
  • Decreases HR, BP
  • Decreases Anxiety
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14
Q

Describe the Actions of Radioactive Iodine Therapy (One dose):

A
  • Fight or Flight Hormones
  • Given PO - either liquid or tablet form
  • RULE OUT PREGNANCY FIRST
  • Destroys thyroid cells - HYPOTHYROID
  • Expect Hypothyroidism
  • Follow Radioactive Precautions-no babies/kissng for 1 wk
  • THINK: Unsealed Radio Precautions for Oncology.
  • Watch for thyroid storm (thyrotoxicosis /thyrotoxic crisis). It is hyperthyroidism x100. Can be a rebound effect post-radioactive iodine. - Its Emergency = heart attack.
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15
Q

What patients should you not give Beta Blockers to?

A

Asthmatics and Diabetics - can hide hyperglycemia

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16
Q

Describe the Action of Beta Blockers

A

Beta Blockers block EPI and NOR-EPI so you can remain calm. HR and BP do not increase therefore decreasing Myocardial contractility and brain perfusion.

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17
Q

Signs and Symptoms of Thyroid Storm

A

Nervous, Shaky,Jittery
Cold/Clammy
Increased HR
Hyperglycemia

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18
Q

What does the nurse assess after a Thyroidectomy (Partial/Completely)?

A

Post Op: Priority - Hemorrhage

Assess for hemorrage by - reports feelings of pressure in the neck area b/c swelling and bleeding can occur.

Assess for bleeding at incision site and behind neck.

Assess for recurrent laryngeal nerve damage by listening for hoarseness /weak voice. Can lead to vocal cord paralysis.

Paralysis in both vocal cords = airway obstruction and will require immediate tracheotomy.

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19
Q

What is important to have at the bedside of a Thyroidectomy (Partial/Completely) Pt? For what reasons?

A

Trach Set

  • Swelling
  • Recurrent laryngeal nerve damage
  • Hypocalcemia
  • Assess for parathyroid removal by deceased calcium
  • Not sedated
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20
Q

What are the Signs and Symptoms of Hypocalcemia

A
  1. Rigid Tight Muscles
  2. Seizures
  3. Tetany
  4. Laryngeal Spasm
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21
Q

Eye care is important for a client with Hyperthyroidism. What should the nurse teach the patient if they are unable to close their eyes?

A
  • Hypoallergenic tape may be applied to close lids.
  • Dark glasses may be worn if photosensitivity is present.
  • Artificial Tears are used to prevent drying of the eyes.
  • Tx. of hyperthyroidism does not correct eye/vision probs.
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22
Q

What should the nurse teach the Pt. after Thyroidectomy (Partial/Completely)?

A
  • Teach how to support neck-pillows to support neck
  • Put personal items close to them- b/c suture line
  • Positioning: Elevate HOB to decrease edema
  • Nutrition (pre/post op: Pt. needs more calories b/b burning so many.
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23
Q

What are the Signs and Symptoms of Hypothyroidism?

A
  • No Energy- Fatigue
  • No Expression
  • Speech slow, slurred, to tired to talk.
  • Weight Increase
  • G.I. Slow
  • Cold - no heating pad b/c can’t tell if its hot.
  • Amenorrhea (no period)
  • Pt. maybe totally immobile
  • Can be confused with depression
  • Long term S&S
    - puffiness
    - facial edema
    - tongue perfusion
    - myxedema
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24
Q

How is Hypothyroidism diagnosed?

A

Thyroxine (T4) Decrease
TSH Increase
Opposite lab values for Hyperthyroidism

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25
Q

How is Hypothyroidism Treated?

A
  • Levothyroxine (Synthroid) - most common
  • Liothyronine (Cytomel)
  • Take on empty stomach
  • ppl. with Hypothyroidism tend to have CAD.
  • Monitor for rhythm changes
  • Monitor for MI when these medicines are started.
  • Take meds forever
  • Energy increases when start these taking meds
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26
Q

Describe Parathyroid Problems

A

The Parathyroids secrete PTH, which makes you pull calcium from the BONES and place it in the blood. Therefore, the serum calcium level goes up!

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27
Q

If you have too much parathormone in your body, the serum calcium level will be _______?

A

High

28
Q

If you do not have a parathormone in your body, the serum calcium level will be ______?

A

Low

29
Q

Hyperparathyroidism is AKA: _______ and _______?

A

Hypercalcemia and Hypophosphatemia

30
Q

What are the Signs and Symptoms of Hyperparathyroidism?

A 
Too much PTH
Serum calcium is HIGH
Serum phosphorus is low
Sedated - Calcium acts like a sedative.
Too much Calcium = To little Phosphorus
31
Q

How do we treat Hyperparathyroidism?

A

Partial Parathyroidectomy - when you take out 2 of your parathyroids PTH secretions decreases.

Post-Op - Monitor for bottoming out to Hypocalcemia

Monitor for S&S of Hypocalcemia 1

  1. Rigid Tight Muscles
  2. Seizures
  3. Tetany
  4. Laryngeal Spasm
32
Q

Hypoparathyroidism is AKA: _______ and _______?

A

Hypocalcemia and Hyperphosphatemia

33
Q

What are the Signs and Symptoms of Hypoparathyroidism?

A

Not enough PTH
Serum calcium is LOW
Serum phosphorus is HIGH
Not Sedated

34
Q

How do we treat Hyporparathyroidism?

A
  • IV Calcium

- Phosphorus binding drugs - Sevelamer - help increase calcium and decrease phosphorus

35
Q

What do we need adrenal gals for?

A

To handle stress

36
Q

You have 2 parts to your adrenal glands. What are they?

A

Adrenal Medulla

adrenal Cortex

37
Q

What does the Adrenal Medulla do?

Describe a Adrenal Medulla problem?

A

Secretes epinephrine and norepinephrine.

Pheochromocytoma - benign tumors that secrete epi and norepi in boluses. Tend to be familial, so screen the family.

38
Q

What are the Signs and Symptoms of Adrenal Medulla problem?

A 
Increased BP
Increased HR
Increased Palpitations
Flushing/Extremity diaphoretic
Headache
39
Q

How are Adrenal Medulla problems diagnosed?

A

Catecholamine levels: VMA ( vanillylmandelic acid) test or Metanephrine (MN) test.

24 hour urine specimen is done monitor for increased levels of EPI and NOREPI ( AKA: Catecholamines).

With 24 hour urine, throw away the first voiding and keep the last voiding.

Avoid activities that may increase Epi and Norepi - No stress

40
Q

What foods alter VMA and MN tests?

A 
Anything with Vanilla
Caffeine
Vitamin B
Fruit juices
Bananas
41
Q

How do you treat Adrenal Medulla problems?

A

Surgery to remove tumors

42
Q

What must you avoid doing to a Pt. with suspected pheochromocytoma and why?

A

Palpating the Abdomen because may cause sudden release of catecholamine and severe hypertension.

43
Q

What does the Adrenal Cortex consist of?

A

Glucocorticoids
Mineralocorticoids
Sex hormones

Even though the body secretes steroids normally, the adverse effects are going to be more pronounced when the Pt. is receiving oral steriods.

44
Q

What are the 4 major Actions Glucocorticoids?

A
  1. Change your mood - depressed, psychotic, euphoric, insomnia. Can get mean, crazy, depressed etc.
    On Prednazone - betametriazone
  2. Alter Defense Mechanism
    - immunosuppressed - caution when assigning roommates
    - High risk for infection
  3. Breakdown Fats and Proteins
    - help regulate glucose metabolism
  4. Inhibit Insulin
    - help regulate glucose metabolism
    - Hyperglycemic
    - Do blood glucose monitoring
45
Q

Describe Mineralocorticoids: Aldosterone

A
  • Make you retain sodium and water

- Make you lose Potassium

46
Q

What happens when you have to much Aldosterone?

A
  • Fluid Volume Deficit

- Serum Potassium Down

47
Q

What happens when you do not have enough Aldosterone?

A
  • Fluid Volume deficit

- Serum Potassium UP = Hyperkalemic

48
Q

List 3 Sex Hormones

A
  1. Testosterone
  2. Estrogen
  3. Progesterone
49
Q

What happens when you have to many sex hormones?

A

Hirsutism
Atony - muscle loss
irregular menstrual cycle

50
Q

What happens when you don’t have enough sex hormones?

A

Decreased axillary/pubic hair

Deceased libido

51
Q

Adrenocorticotropin hormones ( ACTH) are made in the _________ and they stimulate ________ to be made.

A

Pituitary

Cortisol

52
Q

Cortisol is a hormone of the _________.

A

Adrenal Cortex

53
Q

Increase in ACTH = Increase in ______ ______.

A

Cortisol Level

54
Q

Too many steroids is AKA?

A

Hypercortisolism

55
Q

What causes Adrenal Cortex Problems?

A

Not enough steroids
Shock
Hyperkalemia
Hypoglycemia

56
Q

Describe Addisons Disease

A

Adrenocortical insufficiency - not enough steriods.

They do not have enough Glucocorticoids, Mineralocorticoids and Sex hormones

Aldosterone (Mineralocorticoids).

Lose sodium and water therefore retain potassium

Serum Potassium will be High.

57
Q

What r the Signs and Symptoms of Addisons Disease?

A

Extreme Fatigue
Nausea, Vomiting and Diarrhea
Anorexia/ Weight Loss
Hypotension
Confusion
Decrease sodium, increased potassium and Hypoglycemia
Hyperpigmentation-bronzing color of the skin and mucous membranes
White patchy area of depigmented skin ( Vitiligo)

58
Q

How do you treat Addisons Disease?

A

-Combat shock - losing sodium/water = losing volume
-Increase Sodium in Diet
-Processed fruit Juice/Broth (has lots of sodium).
-I&O and daily weight - b/c FV problem
-Losing Sodium/Water = Low BP
-Decreased weight
-FVD
-Medications: Prednisolone (Prednisone) - given twice a day in split doses. Pt. will take 2/3 of the dose in the morning and 1/3 in the evening.
Fludrocortisone - is aldosterone (need)
-Steriods make Blood Sugar go down.
-Daily weights and BP must be monitored.

59
Q

If Pt. is taking Medications that require weight to be monitored daily keep weight in what range? and report a gain of? Also, report changes in BP____?

A
  • 2-3lbs or 1-2 kgs of their normal weight
  • Report gain > 5lbs ( 2.27 kg)
  • BP Increase
60
Q

Define Addisonian Crisis

A

Can occur with infections, emotional stress, physical exertion or stopping steroids abruptly.

Severe Hypotension

Vascular collapse

61
Q

Describe Cushing’s Disease

A

Too Many Steroids!!!

  • Glucocorticoid
  • Mineralocorticoids (Aldosterone)
  • Sex hormones
62
Q

Signs and Symptoms of Cushings Disease

A

Glucocorticoid:

  • Growth Arrest
  • This extremities/Skin (lipolysis).
  • Hyperglycemia
  • Psychosis to depression
  • Moon faced - fat distribution or fluid retention
  • Truncal Obesity - Fat Redistribution: Lipogenesis.
  • Buffalo Hump - fat redistribution

Sex hormones:

  • Oily Skin/Acne
  • Women with Male Traits
  • Poor Sex Drive (Libido)

Mineralocorticoids (Aldosterone):

  • High Bp
  • CHF
  • Weight Gain
  • FVE
  • since the Pt. has to much Mineralocorticoids (Aldosterone), the serum potassium will be LOW.
63
Q

If you did a 24 HR Urine on a Cushing’s Pt. the

Cortisol (steroid) levels would be High or Low?

A

High

64
Q

How do you Treat Cushing’s Disease?

A

Adrenalectomy ( Unilateral or Bilateral)
* IF both are removed thru lifetime replacement

Quiet Environment - can’t handle stress

Diet:

  • Increase K+
  • Decrease Na
  • Increase Protein
  • Increase Ca

Avoid Infection - steroids suppress immune system

65
Q

The Nurse is monitoring lab values of a client on long-term steroid therapy. Which values would the nurse expect to be altered in the urine? SATA.

  1. Protein
  2. Glucose
  3. Ketones
  4. RBC’s
  5. Uric Acid
A

Gluecose
Ketones

Protien in urine = Kidney damage

RBC’s and Uric Acid = Kidney Stones

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