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NSG 470 > Endocrine lecture EXAM 3 > Flashcards

Endocrine lecture EXAM 3 Flashcards

1
Q

Is the endocrine system positive or negative feedback

A

Negative feedback

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2
Q

Anterior pituitary hormone production (just the stuff for the lecture)

A

-ACTH )Adrenocorticotropic hormone
-TSH , Thyroid stimulating hormine

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3
Q

Thyroid hormone production

A

T3: Tri-iodothyronine
T4: Thyroxine
Calcitonin

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4
Q

Parathyroid hormone production

A

-PTH: Parathyroid hormone

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5
Q

Adrenal gland hormone production (For this lecture)

A

-Cortisol (Glucocorticoid)
-Aldosterone (Mineralcorticoid)

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6
Q

Endocrine pathway for hormones

A

-Hypothalamus -> Pituitary -> hormone site

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7
Q

Hypothalamus

A

-Primarily maintains homeostasis in the body
-Links the nervous system with the endocrine system via the pituitary gland
-Secretes inhibiting or releasing hormones which stim/inhibit the anterior pituitary

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8
Q

Adrenocorticotrophic hormone (ACTH)

A

-Stims the adrenal cortex, making cortisol
-If there isnt enough cortisol in circulation, ACTH levels will rise

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9
Q

Thyroid stimulating hormone (TSH)

A

Stimulates the thyroid gland to make t3 and t4
-Negative feedback system
-Iodine is needed too, for the production of TH
-Thyroid hormone controls metabolic activity
-TH is made in the follicular cells in the thalamus

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10
Q

Calcitonin

A

-Made in C cells
-Secreted when there is a high plasma calcium level, leading to a reduction in Ca in the blood
-Works opposite to PTH
-Moves the Ca back into the bone

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11
Q

Hypothyroidism

A

-Inadequate amounts of T3/T4
-Decreases the metabolic rate of all body systems
-Primary secondary and tertiary

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12
Q

Primary hypothyroidism

A

-Dysfunction of the thyroid gland

-Caused by:
-Autoimmune
-Surgical removal of part or the entire thyroid gland
-Radiation to thyroid gland
-Meds
-Thyroiditis, viral infection, iodine (too much too little), congenital

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13
Q

Hashimoto’s thyroiditis

A

Auto immune attack of the thyroid causing primary hypothyroidism

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14
Q

Meds causing hypothyroidism

A

-Amiodarone
-Lithium
-Interferon, Interleukin-2, Immunotherapy (Cancer drugs)

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15
Q

Secondary hypothyroidism

A

-Failure of ant pituitary to stimulate the thyroid gland by inadequate secretion of TSH (tumor or radiation)

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16
Q

Tertiary hypothyroidism

A

-Hypothalamus doesnt produce Thyroid release hormone (TRH)

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17
Q

Hypothyroidism S+S

A

-Everything slows down

-Fatigue (Most common)
-Forgetful
-Depression
-Thinning of hair
-Dry flaky skin and brittle nails
-Constipation
-Intolerance to cold (feel cold all the time)
-Abnormal menstraual cycles
-Weakness
-Bradycardia
-Hypotension
-Edema
-Accelerated atherosclerotic disease

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18
Q

Hypothyroidism diagnostics

A

-Radioisotope I-123: Uptake will be slow in hypothyroidism (Slow absorption=low thyroid)
-EKG: Sinus brady, cardiac dysrhythmias (Later sign)

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19
Q

What labs are decreased in hypothyroidism

A

T3/T4

TSH in SECONDARY hypothyroidism

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20
Q

What labs are increased in hypothyroidism

A

-TSH in primary
-Antibody test if there is a disease process involved

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21
Q

Hypothyroidism treatment

A

-Meds: Essentially TH

-Need to take meds for life
-Take in the morning on empty stomach with water (8 oz)
-NPO except water for 60 min after taking thyroid meds, no other meds at the time
-No supplements (Ca, vitamin D, Mg, minnerals, iron) for at least 4 hrs from levothyroxine
-Take at the same time every day
-Start dose low and titrate up based on blood work
-Can affect levels of digoxin, warfarin, and may need increased insulin (Increased blood sugar)

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22
Q

Hypothyroidism in elderly

A

-Only treat if symptomatic, with lowest dose possible

-Huge risk of A-fib, Tachycardia

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23
Q

Hypothyroidism meds (T4)

A

-Levothyroxine (Synthroid, Euthyrox, Euthyroid)
-Synthetic T4

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24
Q

Amour Thyroid

A

-Dried pig thyroid
-Contains T3+T4, hard to regulate serum levels as a result

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25
Q

Liothyronine

A

-T3, may be used with T4
-Short acting

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26
Q

What supplements cant you take with levothyroxine

A

-Ca
-Vitamin D
-Mg
-Minerals
-Iron

-For at least 4 hrs after

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27
Q

Inpatient mgmt of hypothyroidism

A

-Cardio changes: (Low BP/HR dysrhythmias), Chest pain edema
-Monitor weight
-Monitor mental status changes, Safety? (long time without treatment)
- Gradual activity with lots of rest periods
-Anti-embolism stockings
-Resp monitoring, Lung sounds, RR, ABG
-*Low cal high bulk diet, fluids (Gaining weight from disease)
-Monitor bowel movements
-Reassure pt, symptoms are reversible and they take time
-Med admin
-Activity intolerance

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28
Q

Hypothyroidism teaching

A

-Meds might take a couple weeks: Pt cannot adjust meds in the mean time to feel better
-Avoid certain supplements with meds
-Follow up with provider
-Diet and weight loss promotion and improve bowel function
-When to call provider

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29
Q

When to call provider hypothyroidism

A

-S+S pf hyperthyroidism (Too high of dose)
-Risk of thyrotoxicosis

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30
Q

A nurse is collecting data from a client who is suspected of having an endocrine disorder and is scheduled for diagnostic testing that involves the use of a contrast medium. The nurse would inform the physician if the client stated which of the following?
A. “My father had diabetes when he got older.”
B. “I have an allergy to shrimp and shellfish.”
C. “I take a multivitamin every day.”
D. “Years ago, I took a steroid for my asthma.”

A

B. “I have an allergy to shrimp and shellfish.”

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31
Q

Radioscope I-123

A

-Slow absorption=hypothyroidism
-Contraindicated in preg, iodine or shellfish allergy (Depending on the extent they can pre med)
- if had a recent radiology exam with iodine containing contrast, need to wait 8 weeks to preform this
-Low iodine diet for best results

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32
Q

Myxedema Coma

A

-Life threatening hypothyroidism coma
-Occurs if hypothyroidism isnt treated properly or a major stressor occurs

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33
Q

Myxedema coma: Cardinal signs

A

-Hypothermia
-Altered mental status
-Cardio depression (Hypotension and bradycardia)

-Also resp failure
-Hyponatremia
-Hypoglycemia
-Coma

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34
Q

Myxedema coma mgmt

A

-ABC first and foremost
-Monitor for MI and acute coronary syndrome
-ECG: Bradycardia
-Monitor mental status
-ABG (hypoxia, hypercapnia, respiratory acidosis)
-Monitor body temp, Blankets are fine, do NOT apply direct heat

-Fluid replacement, NS (I+O)
-IV bolus levothyroxine -> IV until stable then oral
-Monitor for hypoglycemia
-Monitor for sources of infection and stress which can cause this (UTI, stress, Sepsis)

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35
Q

Why dont you apply direct heat Myxedema coma

A

-Vasodilation causing vascular collapse

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36
Q

Hyperthyroidism

A

-Everything is fast
-Too much TH
-Increased metabolic rate and o2 consumption

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37
Q

Causes of hyperthyroidism

A

-Graves disease: Autoimmune disease caused by excessive stim of thyroid by circulating immunoglobulins
-Thyroid storm: Excessive output of TH
-Thyroiditis
-Toxic Nodular Goiter: Thyroid nodules cause excessive secretion of T3 and T4, more area more hormone
-Exogenous Hyperthyroidism

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38
Q

Graves disease

A

-Autoimmune causing hyperthyroidism
-Eyes popin out (Opthalmopathy)

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39
Q

Graves opthalmopathy

A

-Eyes poppin out
-Not equal, lids are retracted
-pt looks down, lid lags behind
-Needs to be referred to a specialist

-Affects cranial nerves 3/6

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40
Q

Main hyperthyroidism S+S

A

-Nervousness, jittery, anxious
-Tachycardia/palpitations
-Tremors
-Heat intolerance
-Excessive sweating
-Frequent stools
-Insomnia

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41
Q

Other S+S hyperthyroidism

A

-Increased appetite
-Weight loss
-Exophthalmos: edema in the extra-ocular muscles and fat tissue behind eye (Graves)
-Elevated systolic BP
-Cardiac dysrhythmias, A-fib

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42
Q

Labs decreased Hyperthyroidism

A

TSH

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43
Q

Labs increased hyperthyroidism

A

-T3/T4
-Thyroid stimulating immunoglobulins (TSI), For graves
-Thyrotropin receptor antibodies (TRAB) also graves

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44
Q

Nursing mgmt: Hyperthyroidism

A

-Report temp increase greater than 1 degree
-Monitor EKG for cardiac stuff
-Dont palpate the thyroid, makes more TH
-Minimize activity, lots o rest periods (Fast metabolism)
-Calm, cool environment, cool showers, reduce room temp
-High cal high protein meals and snacks
-I+O
-Eye protections for the bulgin eyes
-Prepare for surgery
-Dosing for the drugs

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45
Q

Methimazole (Tapazole)

A

-Treatment of choice for hyperthyroidism
-Thionamide
-Inhibits the synthesis of TH
-Does not remove hormone already present

-Need to monitor CBC for agranulocytosis (Severe WBC drop), Thrombocytopenia, and increased LFT for liver tox

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46
Q

Propylthiouracil (PTU)

A

-Thionamide
-Used of methimazole is not tolerated
-Liver tox (elevated LFT, dark urine, jaundice)
-Inhibits synthesis of TH
-Used in hyperthyroidism

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47
Q

Sodium or potassium Iodine (Lugol’s soln, SSKI)

A

-Inhibits release of TH
-Used short term before surgery in hyperthyroidism

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48
Q

Beta Blockers (Thyroid)

A

Used in hyperthyroidism for treating tachycardia palpitations

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49
Q

Only true hyperthyroidism treatment

A

-Radioactive I-131 therapy
-Surgery

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50
Q

Radioactive I-131 therapy

A

Used in hyperthyroidism to ablate the thyroid into not producing TH
-Will become hypothyroid after, and will require meds
-After the procedure you need to avoid preg women, children for a week
-Also need to use another toilet and wash clothes separate, dont share saliva

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51
Q

Surgery, thyroid

A

Can be subtotal or total thyroidectomy
-Need some or full thyroid hormone replacement

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52
Q

Post op thyroidectomy care

A

-ABC (Airway impairment, laryngeal spasm, swelling)
-Bleeding and hematoma formation, check the dressing
-Semi fowlers position, supporting the head and neck
-NPO until cleared by speech patho
-Assess voice, hoarseness, laryngeal nerve injury (Vocal cord paralysis )

53
Q

Patient education: post op thyroidectomy

A

-Check S+S of hypocalcemia related to destruction of parathyroid gland
-Check Chvostek sign
-Check Trousseau sign
-Assess for c/o numbness/ tingling around mouth and distal extremities (LET PROVIDER KNOW)
-Muscle cramping or spasm

54
Q

Trousseau Sign

A

-Puff Bp cuff up for 1-4 min
-Hand and fingers spasm, in palmar flexion= positive
-Shows early tetany, hypocalcemia if positive

-Italian hand

55
Q

Chvostek sign

A

-Tappin the face below below and infront of the ear
-Face twitching occurs on one side of the mouth, nose and cheek is positive

56
Q

Thyroid storm

A

-Thyrotoxicosis, Thyroid crisis
-Surge of TH in the blood which further increases metabolism
-Medical emergency, needs treatment
-High mortality rate

57
Q

Thyroid storm causes

A

-Uncontrolled hyperthyroidism (Graves disease, infection, trauma, emotional stress, DKA, Dig toxicity, after RAI)

58
Q

Thyroid storm findings

A

-Hyperthermia
-Hypertension
-Delirium
-Vomiting, ab pain
-Tachydysrhythmias
-Chest pain
-Dyspnea
-Palpitations

-Hyperthyroid symptoms but accelerated

59
Q

Thyroid storm mgmt

A

-ABC (Airway and oxygenation)
-Treat hyperthermia with cooling blanket, icepacks , Tylenol
-Trach tray in room for emergency intubation
-Cont ECG monitoring
-IV hydration to prevent vascular collapse, I+O
-Give meds

60
Q

Why cant you give aspirin with thyroid storm

A

It increases free T4 making the issue worse

61
Q

Meds thyroid storm

A

-IV fluids
-Methimazole or PTU to prevent further synthesis or release of hormone
-Sodium Iodine to decrease the output of T4 from the thyroid gland, 1 hour after methimazole or PTU
-Admin Beta blockers to block symp nervous system effects
-Glucocorticoids if adrenal insufficiency is suspected or to treat the shock

62
Q

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)

A. Acetaminophen
B. Iodine
C. PropylthiouracilPTU
D. Synthetic levothyroxine
E. Dexamethasone (Decadron)

A

A. Acetaminophen
B. Iodine
C. PropylthiouracilPTU
E. Dexamethasone (Decadron)

Ya just dont give TH during hyperthyroidism
Treatments for thyroid storm: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.

63
Q

The nurse is assessing the endocrine system of a client. Which statement indicates to the nurse that the client is experiencing a condition that affects endocrine function? Select all that apply.

A. “I cannot stand to be in hot weather.”

B. “I do not have any energy to do what I normally do.”

C. “I do not know why my skin has gotten so dry lately.”

D. “It seems like the fat on my legs moved to my stomach.”

E. “I get up in the middle of the night to void only occasionally.”

A

A. “I cannot stand to be in hot weather.”

B. “I do not have any energy to do what I normally do.”

C. “I do not know why my skin has gotten so dry lately.”

D. “It seems like the fat on my legs moved to my stomach.”

E is normal

64
Q

Parathyroid glands

A
  • 4 glands on the posterior thyroid gland
    -Only make parathyroid hormone to maintain Ca levels in blood
65
Q

Parathyroid hormone (PTH)

A

-Causes bone to release calcium, raising blood levels
-Helps intestines absorb Ca from food
-Helps kidneys retain Ca instead of urinating it
-Works opposite to Calcitonin

66
Q

Increased Phosphorus

A

Decreased Calcium, they have an inverse relationship

67
Q

Hypoparathyroidism

A

-Parathyroid glands secrete too little PTH
-Low ca levels, low PTH levels, HIGH phosphorus levels

68
Q

Hypoparathyroidism causes

A

-Destruction or injury to parathyroid glands during surgery
-Autoimmune
-Congenital
-Radiation to neck
-Vitamin D deficiency

69
Q

Hypoparathyroidism manifestations

A

-Muscle twitching or spasm
-Laryngospasm/stridor/ wheezing
-Numbness and tingling around mouth fingers, hands , toes feet
-Confusion and seizures
-HF and arrhythmia (Heart needs Ca for contraction)

70
Q

Severe hypocalcemia progression

A

Tetany, chovstek and trousseau signs -> CNS and neuromuscular irritability

71
Q

Tetany

A

-Hypocalcemia
-General muscle hypertonia with tremor and spasmodic or uncoordinated contractions

72
Q

Severe hypocalcemia signs

A

Tetany,
-Chvostek sign
-Trousseau sign

73
Q

mgmt of hypoparathyroidism

A

-Restore Ca levels
-Supportive care for acute life threatening attack or tetany
-Cardiac monitoring
-Recombinant human PTH: Normalizes PTH level which will increase Ca in blood (only in emergent situation)

-Calcium gluconate IV, given in emergent situation
-Vitamin D for Ca absorption (Calcitriol)
-Mg replacement (If the cause is related to low magnesium)
-Quiet environment (No drafts, no bright lights, no sudden movement)

-Diet high in Ca and low in P
-Oral Calcium and Vitamin D for life

74
Q

Hyperparathyroidism

A

-One or more of the parathyroid glands are overactive and PTH levels are high
-Elevated PTH -> hypercalcemia -> bone thinning and kidney stones

75
Q

Hyperparathyroidism causes

A

-Adenoma (Benign tumor)
-Hyperplasia of the parathyroid glands (Not technically cancerous)
-Multiple endocrine neoplasia type 1
-Familial hypocalciuric hypercalcemia

76
Q

Hyperparathyroidism manifestations

A

-Asymp/ vague if there is only a slight elevation

-At severe levels: Apathy, fatigue, muscle weakness, nausea, vomiting , constipation, hypertension, cardiac dysrhythmias

77
Q

Hyperparathyroidism treatment

A

-Surgical removal of abnormal parathyroid tissue
-Hydration
-Biphosphonates (P is opposite of Ca)
-Cincalcet decreases the amount of PTH the parathyroid glands make and lowers levels in the blood

78
Q

Hypercalcemic Crisis

A

-Occurs from hyperparathyroidism
-Occurs from an elevation of serum Calcium levels
-Elevated Calcium= CNS depression
-Neuro, cardio and kidney symptoms that can be lifethreatening-
-Risk of osteoporosis

79
Q

Hypercalcemic crisis mgmt

A

-Rapid rehydration with large volumes of IV isotonic saline fluids (dilute the blood)
-Calcitonin and corticosteroids are admin in emergencies
-Bisphosphonates
-Goals are to reduce the serum calcium level by increasing calcium deposition back into the bone

80
Q

Hypercalcemic crisis diagnostics

A

-Serum calcium, ionized calcium, PTH level, Vitamin D level, renal function
-Ultrasound of neck
-CT scan
-Bone mineral density

81
Q

Vitamin D role

A

Calcium absorption

82
Q

Adrenal cortex

A

-Outer layer of the adrenal gland

-Secretes
Mineralocorticoids
Glucocorticoids

Androgens/Estrogen

83
Q

Mineralocorticoids

A

-Aldosterone
-Reabsorption of Na and excretion of K by the kidneys
-Adrenal cortex

84
Q

Glucocorticoids

A

-Cortisol: suppression of the immune response, assist in the stress response, assist with BP maintenance and CV function, glucose , protein and fat metabolism
-Adrenal cortex

85
Q

Adrenal medulla

A

-Inner portion
-Secretes Catecholamines: Epi and NE
-Causes vasoconstriction

86
Q

Epinephrine

A

Fight or flight response (bronchial dilation, increased BP , increased glucose, increased HR)
-Causes vasodilation

87
Q

Addison’s disease

A

-Destruction of the adrenal cortex , No hormone production (aldosterone and cortisol)
-Primary and secondary causes

88
Q

Primary Addison’s disease

A

-At the site
-Auto immune disorder
-Infection
-Bilateral adrenalectomy
-Hemorrhage into the gland
-Neoplasms, radiation

89
Q

Secondary Addison’s disease

A

-Pituitary tumor, hypophysectomy, hypopituitarism, immunotherapy, radiation

-**Abrupt cessation of long term steroid use **

90
Q

Addison’s disease symptoms

A

-Fatigue/ muscle weakness (main symptom)
-Weight loss/appetite loss/ abdominal pain, N+V diarrhea
-Dehydration, decreased urine output, salt craving
-Confusion/ decreased coordination, anxiety, irritability
-Hypotension, orthostasis

-Dark bronze pigmentation of skin and mucosa, vitiligo

91
Q

Addison’s disease labs

A

-Hypoglycemia (Loss of Glucocorticoids)
-Hyponatremia (Loss of aldosterone )
-Hyperkalemia (Loss of aldosterone)
-Hypercalcemia
-Increased WBC
-Increased renal function (Worse)

92
Q

Addison’s disease test

A

-Serum ACTH
-AM cortisol levels
-1mg dexamethasone suppression test
-ACTH stimulation test

93
Q

Most serious complication of addison’s

A

Adrenal Crisis

94
Q

Adrenal Crisis

A

-Life threatening condition
-Rapid decline of cortisol and aldosterone
-Critical hypotension, hypoglycemia, hyponatremia, hyperkalemia
-Like regular addison’s but exadurated

-Essentially its an abnormality that leads to shock/death

95
Q

Adrenal crisis: Decreased Cortisol

A

-Liver: Decreased hepatic glucose output –> Hypoglycemia –> Coma/death
-Stomach: Decreased digestive enzymes–> Vomiting, cramps, diarrhea –> Hypoglycemia/ hypotension –> shock –Coma and death

96
Q

Adrenal crisis: Decreased aldosterone

A

-Kidney: Na+Water loss, K retention –> Hypoglycemia/hypotension –> shock –> coma/death
-Heart: Arrhythmia, and decreased CO –> hypotension –> shock –> coma/death

97
Q

Causes of adrenal crisis

A

-Abrupt cessation of steroids **
-Infection/sepsis
-Stress: MI, surgery, anesthesia , volume loss, hypoglycemia
-Adrenal trauma –> hemorrhage
-Adrenal gland thrombosis

98
Q

mgmt of adrenal crisis

A

-Immediate IV steroids (start with 100mg and taper)
-IV fluids, bolus of NS for fluids and salt wasting
-Hypoglycemia: D50 if needed (Also cause insulin)
- Treat hyperkalemia (Insulin/Kayexalate)
-Vasopressors for hypotension
-Add fludrocortisone when stable (BP/orthostasis)
-Antibiotics
-VTE prohylaxis

-Small frequent meals high in Na, protein, low K foods

99
Q

Med mgmt of addison’s: Glucocorticoids

A

-Oral hydrocortisone/prednisone/cortisone
-Used in adrenocorticoid replacement therapy
-Physiological dose when stabilized (20 mg in am and 10 in afternoon)
-Double dose in periods of sick or stress
-Severe deficit give IM dose and go to hospital
-Give with food

100
Q

Physiological dose, Addison’s

A

Mimics the normal hormonal pattern
-large dose in morning small in afternoon to mimic the boost of cortisol when you first wake up

101
Q

Med mgmt of addison’s: Mineralocorticoid

A

-Fludrocortisone (Prevent dehydration and hypotension)
-Hypotension is a huge concern
-Observe for signs of cushing’s syndrome
-Increase dose in times of stress

102
Q

Addison’s disease patient centered care

A

-Priorities physical care, prevent shock
-Monitor fluid electrolyte imbalances
-Admin IV fluids with saline to restore fluid volume
-Observe for dehydration check for orthostatic VS
-I+O, daily weight
-IV hydrocortisone
-Vasopressors (hypotension)
-Check ECG for arrhythmia (Bradycardia, heart block, peaked T waves) from potassium
-Monitor and treat hyperkalemia (Kayexalate, Insulin and dextrose, calcium
-Sodium bicar: for acidosis and to move K into the cell
-Monitor and treat hypoglycemia
-Calm safe environment
-Recumbent with legs elevated

103
Q

Care of a pt with adrenal insufficiency: Risk for fluid volume deficit

A

-Monitor S+S of fluid volume deficit
-Encourage fluids and foods
-Select foods high in sodium
-Admin hormone replacement as prescribed, electrolyte replacement

104
Q

Care of a pt with adrenal insufficiency: Activity intolerance and fatigue

A

-Avoid stress and activity until stable
-Preform all activities for pt when in crisis
-Maintain a quiet non stressful environment
-Measures to reduce anxiety

105
Q

Care of a pt with adrenal insufficiency: Self care deficit

A

Weakness, fatigue, muscle wasting, altered sleep patterns

106
Q

Care of a pt with adrenal insufficiency: Risk for infection

A

Teach to avoid sick people, crowds, S+S infection, increase hydrocortisone use when sick

-Avoid stress avoid infection

107
Q

Adrenal insufficiency Discharge teaching

A

-Call 911 for Addison crisis, teach S+S
-Med adherence, do not stop hydrocortisone replacement, cannot stop on their own without doctor
-Avoid stress, strenuous activities in hot weather
-Avoid crowds, illness, and wash your hands
-Big dose of meds in morn smaller dose in afternoon
-Diet
-Increased meds when sick or stressed
-Need med alert bracelet with adrenal insufficiency
-Emergent IM steroid when in a crisis: need to teach injection

-Note and teach any illness or stressors that may cause a crisis

108
Q

Adrenal insufficiency diet

A

High protein, high carb, enough sodium

109
Q

People with adrenal insufficiency can stop taking meds without doctors permission

T/F?

A

False if they do this it can trigger an Addisonian crisis

110
Q

Cushing syndrome Causes

A

-Long term use of steroids
-Excessive secretion of cortisol from adrenal cortex secondary to hyperplasia
-Pituitary secreting excess ACTH
-Ectopic production of ACTH from certain types of cancer
-Cancer mgmt and auto immune too

111
Q

Cushing syndrome S+S: Physical observation

A

-Moon Face
-Buffalo hump (fat deposit on cervical spine area)
-Purple striae on abdomen breast upper arms (where fat is deposited)
-Truncal obesity, with skinny extremities
-Hirsutism
-Thining or balding hair (head)
-Acne thin skin, ecchymosis
-Menstrual irregularities

112
Q

Cushing syndrome S+S: Bone

A

-Aseptic necrosis of femur
-Osteoporosis (effect of long term steroid as well)
-Compression fracture of spine and spontaneous Fx

113
Q

Cushing syndrome S+S: Heart and vasculature

A

-HF
-Htn
-Decreased wound healing
-Decreased inflammatory response

114
Q

Cushing syndrome S+S: Electrolyte balance, fluid and glucose

A

-Fluid retention
-Sodium retention
-Hyperglycemia (impaired glucose tolerance)
-Altered calcium metabolism
-Hypokalemia
-Metabolic alkalosis

115
Q

Cushing syndrome S+S: Mental

A

Mood alterations/psychosis

116
Q

Cushing syndrome S+S: Muscle

A

Muscle weakness/ myopathy
Thin extremities

117
Q

Cushing syndrome S+S: GI

A

Peptic ulcer disease

118
Q

Cushing syndrome S+S: sexual

A

Impotence

119
Q

Cushing’s syndrome Labs: Increased

A

-Plasma cortisol levels (blood and urine)
-1 Mg dexamethasone supression test (shows a high cortisol level)
-ACTH levels salivary cortisol level (done at bed time and shows a high level of cortisol)
-24 urine (cortisol in urine)
-Glucose and Sodium are elevated

120
Q

Cushing’s syndrome Labs: Decreased

A

-Potassium
-Calcium
-Leukocytes(Immune system is supressed)

121
Q

mgmt of Cushing’s: Radiation or surgery

A

-Remove pituitary tumor, or adrenalectomy
-Mgmt of diabetes preop
-Post op symptoms of adrenal insufficiency within 12-24 hours after resection due to reduction in circulating hormone: need temp hydrocortisone
-Bilateral adrenalectomy: needs lifetime steroid replacement

122
Q

Mgmt of Cushing’s: long term steroid use

A

Wean slowly and allow adrenal gland to function again (can take months)

123
Q

mgmt of Cushing’s: adrenal enzyme inhibitors

A

-Inhibits cortisol production
-If syndrome is caused by ectopic ACTH secretion by a tumor which cannot be eradicated
-Metyrapone, Aminoglutethimide, Mitotane (adrenal cancer), Ketoconazole

124
Q

Nursing mgmt of cushing syndrome

A

-I+O, daily weight
-Treat hypovolemia, assess
-Monitor for hypertension and hypokalemia
-Monitor for addisonian crisis
-Maintain safety (skin, trauma, patho)
-Ensure physical activity as tolerated
-Meticulous skin care
-Infection control/hand-washing
-Monitor for GI bleed (peptic ulcers)
-Hyperglycemia mgmt (Can become diabetic easily)
-PSych support, body image

125
Q

Nursing mgmt of cushing post op, transsphenoidal

A

-HOB elevated
-Nasal packing
-Frequent mouth care
-Avoid increasing ICP, (Nose blowing/coughin)
-Monitor for CSF leak
-Monitor for adrenal insufficiency
-Fluid and electrolyte mgmt
-N+V diarrhea

126
Q

Nursing mgmt of cushings hydrocortisone post op

A

-Daily weight
-VS
-Monitor lytes and glucose
-Monitor for infection
-Stress dose/ emergency IM dose

127
Q

A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client’s care plan? Select all that apply.

A. Monitor gait, balance, and fatigue level with ambulation.
B. Monitor for fluid overload.
C. Monitor for signs and symptoms of diarrhea.
D. Encourage intake of dairy products, seafood, nuts, broccoli,
and spinach.

A

A. Monitor gait, balance, and fatigue level with ambulation.
B. Monitor for fluid overload.

Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute.
Possible effects include nausea, vomiting, and constipation.
Client would be on a calcium-restricted diet.

128
Q

Nursing care for a client in addisonian crisis should include which intervention?

A. Encouraging independence with activities of daily living (ADLs)
B. Allowing ambulation as tolerated
C. Offering extra blankets and raising the heat in the room to keep the client warm
D.Placing the client in a private room

A

D.Placing the client in a private room

The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.

NSG 470 (26 decks)

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