ENDOCRINE/PREOP Flashcards
What are endocrine glands also known as?
Ductless glands
How do hormones reach their target tissues?
Through blood transport
What is the mechanism called that regulates hormone secretion based on the body’s needs?
Negative feedback
Fill in the blank: Insulin causes a decrease in blood glucose levels, which is the _______ of the initial condition that stimulated its secretion.
Opposite action
What health patterns are most affected by endocrine problems?
- Nutritional/metabolic
- Activity/exercise
- Elimination
- Sleep/rest
- Sexuality/reproductive
What dietary deficiencies should be assessed in patients with endocrine problems?
- Protein
- Iodide-containing foods
What changes should be noted in a patient’s physical appearance during assessment?
- Hair texture and distribution
- Facial contours and eye protrusion
- Voice quality
- Body proportions
- Secondary sexual characteristics
What is a key neurological symptom associated with hypopituitarism?
Change in vision
What is the most life-threatening deficiency in hypopituitarism?
- ACTH
- TSH
What are the common causes of hyperpituitarism?
Anterior pituitary tumors or tissue hyperplasia
What is acromegaly?
Growth hormone hypersecretion after puberty
What are common symptoms of diabetes insipidus (DI)?
- Polydipsia
- Polyuria
- Dehydration
True or False: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by vasopressin secretion even when plasma osmolarity is low.
True
What is the primary intervention for diabetes insipidus?
Lifelong vasopressin therapy
What does a high aldosterone level promote?
Sodium and water reabsorption and potassium excretion
What is a common assessment finding in SIADH?
- Headache
- Weakness
- swollen
- Muscle cramps
Fill in the blank: The major mineralocorticoid produced by the adrenal cortex is _______.
Aldosterone
What diagnostic assessments are important for evaluating endocrine disorders?
- Labs
- Imaging tests
- Stimulation/suppression tests
What should be monitored post-transsphenoidal pituitary surgery?
- Neurologic response
- Postnasal drip
- Hormone replacement
What might truncal obesity and buffalo hump indicate?
Adrenocortical excess
What is the result of ADH deficiency in diabetes insipidus?
Excretion of large amounts of diluted urine
What is the typical urine output in a patient with diabetes insipidus?
4-20 liters/day
What are some interventions for SIADH?
- Fluid restriction
- Monitoring intake and output
- Drug therapy with vasopressin antagonists
What physical changes are assessed in patients with potential endocrine disorders?
- Height
- Weight
- Fat distribution
- Muscle mass
What is the purpose of the water deprivation test in diagnosing diabetes insipidus?
To determine if urine osmolality increases with fluid deprivation
What are signs of dehydration in a patient with diabetes insipidus?
- Extreme thirst
- Weight loss
- Muscle weakness
- Dry mucous membranes
What neurological changes could indicate hyperpituitarism?
- Visual changes
- Headache
- Increased intracranial pressure
What factors should be considered during endocrine assessment?
- Age
- Gender
- Medication use
What is the primary function of aldosterone?
Controls extracellular fluid volume by promoting sodium and water reabsorption and potassium excretion
What regulates aldosterone production?
Renin-angiotensin system, serum potassium concentration, and adrenocorticotropic hormone (ACTH)
What are glucocorticoids produced by the adrenal cortex regulated by?
Anterior pituitary hormone ACTH and corticotropin-releasing hormone (CRH)
What is the main glucocorticoid and its effects?
Cortisol; affects carbohydrate, protein, and fat metabolism, the body’s response to stress, emotional stability, and immune function
What is Addison’s disease?
A condition characterized by diminished production of mineralocorticoids and glucocorticoids, resulting in decreased aldosterone and cortisol
What are common causes of primary adrenal insufficiency?
- Idiopathic autoimmune (majority of cases) * Tuberculosis * Metastatic cancer * AIDS * Hemorrhage * Gram-negative sepsis * Adrenalectomy * Abdominal radiation * Drugs or toxins
What triggers Addison’s crisis?
Rapid onset life-threatening event; need for cortisol and aldosterone exceeds available supply, often in response to stress
What are common symptoms of adrenal gland insufficiency?
- Anorexia * Nausea/Vomiting * Abdominal pain * Bowel changes * Weight loss * Salt craving * Hyperpigmentation * Muscle weakness
What interventions are important for adrenal gland insufficiency?
- Promote fluid balance * Prevent hypoglycemia * Monitor labs * Administer hydrocortisone and fludrocortisone
What is Cushing’s syndrome?
A condition caused by hypersecretion of adrenal cortex hormones leading to excessive cortisol or androgen production
What are common manifestations of Cushing’s syndrome?
- Central obesity * Fragile skin * Diabetes * Osteoporosis * Muscle wasting * Hypertension * Moon face * Increased susceptibility to infection
What is the treatment approach for Cushing’s syndrome?
- Excision or radiation of tumors * Tapering steroids * Dexamethasone suppression test for diagnosis
What is the role of thyroid hormones?
- Control metabolic rate * Promote growth hormone secretion * Regulate metabolism of proteins, carbohydrates, and fats * Affect heart rate and respiratory drive
What is hyperthyroidism?
Excessive secretion of thyroid hormones from the thyroid gland
What are common causes of hyperthyroidism?
- Graves’ disease * Toxic nodular goiter * Exogenous hyperthyroidism
What are symptoms of hyperthyroidism?
- Nervousness * Heat intolerance * Weight loss * Palpitations * Bulging eyes (exophthalmos) * Increased appetite
What is thyroid storm?
A life-threatening condition of extreme hyperthyroidism requiring immediate medical attention
What laboratory findings are indicative of hyperthyroidism?
- Low TSH * High T4 levels * Increased radioactive iodine uptake
What is hypothyroidism?
A condition characterized by insufficient production of thyroid hormones
What are common manifestations of severe hypothyroidism?
- Extreme fatigue * Hair loss * Weight gain * Cold intolerance * Myxedema coma
What is myxedema coma?
A rare and life-threatening condition caused by severe hypothyroidism, often triggered by stress or sedatives
What is the function of calcitonin?
Lowers serum calcium and phosphorus levels by reducing bone resorption
What is the normal range for TSH?
0.3-5.0 uU/mL
What is the most common treatment for Graves’ disease?
Radioactive iodine therapy
What dietary requirements are necessary for thyroid hormone production?
Adequate intake of protein and iodine
What is Myxedema Coma?
A rare and life-threatening condition caused by severe hypothyroidism, often occurring in elderly women during winter.
It can be triggered by undiagnosed hypothyroidism, sedatives, or opioid agents.
What are the early signs and symptoms of Myxedema Coma?
Depression, diminished cognitive status, lethargy, somnolence, and respiratory drive depression.
These symptoms can lead to coma, and the condition is considered an emergency.
What is the mortality rate of Myxedema Coma?
Very high.
What precautions should be taken when treating Myxedema Coma?
Administer oxygen and fluids cautiously, avoid heating pads.
Heating pads increase oxygen requirements and may lead to vascular collapse.
What is a goiter?
An enlarged thyroid gland, often associated with thyroid tumors.
What characterizes an Iodine Deficient Goiter?
High TSH levels with thyroid enlargement to compensate for low thyroid hormone levels.
Usually presents with no symptoms other than swelling.
What is a Nodular Goiter?
A thyroid enlargement with nodules, can be associated with thyroid cancer.
What is a common characteristic of Thyroid Cancer?
A hard, single, fixed nodule that usually produces hyperthyroidism initially.
What are the post-operative concerns after a Thyroidectomy?
Edema of the glottis, airway management, potential injury to parathyroid glands leading to calcium deficiency, and risk of laryngospasm.
Keep a trach set at bedside and advise the patient to minimize talking.
What is Hyperparathyroidism?
An increase in parathyroid hormone (PTH) levels leading to hypercalcemia and hypophosphatemia.
What are common assessment findings in Hyperparathyroidism?
Weight loss, bone fractures, osteoporosis, arthritis, psychological distress.
What is the management for Hyperparathyroidism?
Nonsurgical and surgical management, including diuretics and hydration with normal saline.
What defines Hypoparathyroidism?
Decreased function of the parathyroid gland, often due to removal of parathyroid tissue.
What are common causes of Hypoparathyroidism?
Iatrogenic causes, idiopathic causes, and hypomagnesemia from various conditions.
What interventions are needed for Hypoparathyroidism?
Correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia.
What symptoms might a patient with hypothyroidism exhibit?
Fatigue, muscle aches, bradycardia, non-pitting edema, and low blood pressure.
What laboratory results would indicate hypothyroidism?
Decreased T3 and T4 levels, increased TSH levels.
Which patient statement indicates a need for further teaching about hypothyroidism?
When I am feeling better in a few months, I will no longer need to take the Synthroid pills.
Which finding requires immediate attention in a patient with Grave’s disease?
Irregular heart rate and rhythm.
What is the priority nursing intervention for an older female patient with hyperparathyroidism?
Implement fall precautions.
What should be included in the postoperative plan of care after a total thyroidectomy?
Avoiding extending the patient’s neck.
What is the priority concept for perioperative patients?
Gas exchange, Pain
The interrelated concepts include Infection and Tissue integrity.
What is the role of nurses in the perioperative process?
Provide care before, during, and after surgery
What organization defines evidence-based guidelines for perioperative care?
AORN - Association of periOperative Registered Nurses
What are the National Patient Safety Goals related to surgical care?
SBAR, Surgical Care Improvement Plan (SCIP), Surgical Safety Checklist, TeamSTEPPS
When does the preoperative phase begin and end?
Begins when patient is scheduled for surgery; ends at time of transfer to surgical suite
What is a key focus during the preoperative phase?
Preparing for surgery and ensuring safety
What should be obtained during the physical assessment in the preoperative phase?
Baseline vital signs
What systems should be assessed during the preoperative phase?
- Cardiovascular
- Respiratory
- Kidney
- Neurologic
- Musculoskeletal
- Nutrition
- Skin
- Psychosocial
What are the priority collaborative problems for preoperative patients?
- Need for health teaching
- Anxiety due to fear
- Minimizing anxiety
What are methods to minimize anxiety in preoperative patients?
- Encourage communication
- Promote rest
- Use distraction
- Teach the caregiver
What is essential for informed consent in the preoperative phase?
Ensure informed consent is obtained
What dietary restrictions might need to be implemented in the preoperative phase?
Implement dietary restrictions as per guidelines
What should be documented before surgery?
- Allergies
- Height
- Weight
- Laboratory and diagnostic test results
What are expected outcomes of the preoperative phase?
- States understanding of informed consent
- Demonstrates preoperative exercises
- Verbalizes reduced anxiety
What should be assessed in the respiratory system postoperatively?
Patent airway and adequate gas exchange
What vital signs should be monitored in the cardiovascular system postoperative?
Report BP changes that are 25% higher or lower than baseline
What should be assessed in the neurologic system postoperatively?
Cerebral function and level of consciousness
What is important to assess regarding fluid, electrolyte, and acid-base balance?
Intake and output (I&O), hydration status
What should be reported regarding urine output in the renal/urinary system?
Report urine output of <30 mL/hr
What should be assessed in the gastrointestinal system postoperatively?
- Postoperative nausea/vomiting (PONV)
- Intestinal peristalsis
- Constipation
What indicates impaired wound healing postoperatively?
Dehiscence and evisceration
What is essential for pain assessment postoperatively?
Continuous assessment needed
What should be assessed in psychosocial evaluation postoperatively?
Signs of anxiety
What laboratory assessments are important preoperatively?
- Analysis of electrolytes
- CBC
- Urinalysis
- Kidney function tests
- ABG
What are the priority collaborative problems for patients in the immediate postoperative period?
- Potential for decreased gas exchange
- Potential for infection and delayed healing
- Acute pain
- Potential for decreased peristalsis
What should self-management education include postoperatively?
- Pain management
- Drug therapy
- Safety
- Prevention of infection
- Nutrition therapy
What health care resources might be available for postoperative patients?
- Home care nurse
- Meals on Wheels
- Support groups
What are expected outcomes for postoperative patients?
- Adequate lung expansion
- Appropriate wound healing
- Acceptable pain management
- Return of peristalsis
Which laboratory finding requires nursing intervention before surgery?
Serum potassium 2.5 mEq/L
What is the purpose of compression stockings and pneumatic compression devices?
They help to prevent blood clots
What nursing actions are appropriate for a client with GI bleeding showing signs of hypovolemia?
- Increase IV infusion rate
- Monitor vital signs frequently
- Administer supplemental oxygen
- Notify the Rapid Response Team
What is the definition of perfusion?
The process of delivering blood to the capillary beds in the body’s tissues.
What are the two commonly known values that make up a blood pressure reading?
Systolic (SYS) and diastolic (DIA) pressures.
What is the normal range for Mean Arterial Pressure (MAP)?
Between 70 and 100 mmHg.
What is the formula for calculating Mean Arterial Pressure (MAP)?
MAP = [(2x diastolic) + systolic] ÷ 3
What is the minimum MAP required to provide sufficient blood to the coronary arteries, kidneys, and brain?
At least 60 mmHg.
Name the four stages of shock.
- Initial Stage
- Compensatory Stage
- Progressive Stage
- Refractory Stage
What causes hypovolemic shock?
Too little blood volume, resulting in decreased Mean Arterial Pressure (MAP).
List three laboratory assessment signs of hypovolemic shock.
- Decreased pH
- Increased lactic acid
- Increased or decreased hemoglobin
What are the nonsurgical management strategies for hypovolemic shock?
- Oxygen therapy
- IV therapy
- Drug therapy
- Monitoring
What are early indicators of shock that should be taught to patients and family members?
- Increased thirst
- Decreased urine output
- Light-headedness
What is septic shock a subset of?
Sepsis.
What are the components of the systemic inflammatory response syndrome (SIRS)?
The clinical features include fever, tachycardia, tachypnea, and leukocytosis.
What does DIC stand for and what is it?
Disseminated intravascular coagulation; a serious disorder where blood clotting proteins become overactive.
What is the Modified Early Warning Score (MEWS) used for?
Early detection of patients at risk for deterioration.
What is the priority nursing intervention when a client with suspected sepsis has vital signs of BP 92/44, HR 134, and SpO2 90%?
Initiate intravenous fluid resuscitation.
What is the earliest clinical sign of hypovolemic shock?
Increased heart rate.
What assessment finding in a client in the refractory phase of shock requires immediate nursing intervention?
Bleeding, oozing from IV sites.
What is the primary intervention for a client with an abscessed tooth showing signs of sepsis?
Initiating IV fluids.
What is the significance of a moderate amount of purulent drainage at a surgical site?
It indicates a potential infection.
What should be done before administering antibiotics in cases of suspected sepsis?
Obtain blood cultures.
What does a decrease in urine output indicate in a patient with severe sepsis?
Possible acute kidney injury due to inadequate perfusion.
True or False: Changes in systolic blood pressure are always present in the initial stage of shock.
False.
Fill in the blank: The __________ phase of shock is characterized by severe hypotension and inadequate perfusion.
refractory
