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NCLEX: Med Surg > Endocrine System > Flashcards

Endocrine System Flashcards

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1
Q

What are four key hormones produced by the hypothalamus?

A

Corticotropin releasing hormone, thyroid releasing hormone, growth releasing hormone, gonadotropin releasing hormone

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2
Q

Hormones released from the anterior pituitary gland

A

TSH, prolactin, FSH, luteinizing hormone, ACTH, growth hormone

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3
Q

Hormones released from the posterior pituitary gland

A

ADH, oxytocin

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4
Q

The thyroid gland produces

A

T3 (triiodothyronine), T4 (thyroxine), calcitonin

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5
Q

Effects of epinephrine and norepinephrine on body

A

Vasoconstriction, increased HR and BP, bronchodilation, pupil dilation, increased blood flow to muscles, increased blood glucose levels

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6
Q

Epinephrine has more effect on the _________ as opposed to norepinephrine that has more of an effect on

A

Heart; blood vessels

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7
Q

Normal T3 range

A

70-204

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8
Q

Normal T4 range

A

4-12

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9
Q

Normal TSH range

A

0.5-5

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10
Q

Normal fasting blood glucose should be less than

A

100

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11
Q

A 2 hour oral glucose tolerance test should be less than

A

140

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12
Q

HgbA1C should be less than

A

6%

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13
Q

A deficiency in one or more of the pituitary gland hormones that are released

A

Hypopituitarism

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14
Q

S/S of hypopituitarism

A

Delayed growth, amenorrhea, impotence (males), hypothyroidism, fatigue, weakness, weight loss, hypoglycemia, hyponatremia, orthostatic hypotension

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15
Q

Diagnoses of hypopituitarism

A

ACTH stimulation test

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16
Q

Hypopituitarism treatment

A

Hormone replacement depending on deficiency: corticosteroids, thyroid, growth, sex

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17
Q

Oversecretion of pituitary gland hormones

A

Hyperpituitarism

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18
Q

S/S of hyperpituitarism

A

Increased ICP (headache, N/V), acromegaly, arthralgia (joint pain), S/S of Cushing’s disease, sexual dysfunction

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19
Q

Hyperpituitarism treatment

A

Surgical: hypophysectomy (removal of part or all of pituitary gland)
Meds: dopamine agonist (inhibits GH or prolactin secretion), somatostatin for acromegaly

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20
Q

Hypophysectomy nursing care

A

monitor for S/S of CSF leak (halo sign around drainage, headache, sweet taste of drainage, drainage positive for glucose)

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21
Q

Hypophysectomy patient education

A

Avoid activities that can increase ICP: coughing, sneezing, blowing nose, bending at waist, straining during bowel movements; transphenoidal (nasal) route: decreased sense of smell is expected for first month following procedure; oral route: do not brush teeth for two weeks. Flossing and rinsing mouth with water is okay; life-long hormone replacement is needed

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22
Q

S/S of growth hormone deficiency

A

Short stature, reduced muscle mass, increased fat, delayed puberty

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23
Q

Growth hormone deficiency treatment

A

Growth hormone replacement (Somatropin IM)

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24
Q

Somatropin nursing consideration

A

Stop treatment once X-Ray shows epiphyseal closure (x-rays needed throughout therapy)

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25
Q

S/S of growth hormone excess

A

Depends on onset of disorder…
Prior to epiphyseal closure: gigantism - excessive height, arthritis
After epiphyseal closure: acromegaly - enlarged hands and feet, protruding jaw, kyphosis, arthritis, enlarged larynx (causes a deep and hollow voice)

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26
Q

Growth hormone excess treatment

A

Hypophysectomy

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27
Q

Under which circumstances would the body release ADH?

A

In response to low blood volume, low blood pressure, hypernatremia, increased blood osmolarity

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28
Q

S/S of diabetes insipidus (DI)

A

Large amounts of dilute urine, polydipsia, dehydration, hypotension, anorexia

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29
Q

Labs associated with DI

A

Urine Specific Gravity <1.005 (dilute urine), Urine Osmolarity <200, Serum osmolarity >300, hypernatremia (Note: decreased sodium level in urine but INCREASED sodium level in blood because body is getting rid of a lot of fluid so blood will be concentrated)

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30
Q

Medication for treatment of DI

A

Vasopressin, desmopressin

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31
Q

Nursing care for patients with DI

A

Monitor I&Os, urine specific gravity, and daily weight

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32
Q

Excess release of ADH from posterior pituitary gland, causing kidneys to reabsorb water

A

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

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33
Q

S/S of SIADH

A

Very small amount of very concentrated urine, fluid volume excess (tachycardia, HTN, crackles, JVD, weight gain, headache, weakness, muscle cramping), hyponatremia (confusion)

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34
Q

Labs associated with SIADH

A

Urine specific gravity >1.03 (concentrated), urine osmolarity elevated, serum osmolarity decreased <270, hyponatremia (NOTE: blood will be dilute due to extra fluid volume)

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35
Q

SIADH treatment

A

Diuretics, vasopressin antagonist, HYPERTONIC saline

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36
Q

SIADH nursing care

A

Monitor I&Os, weight daily, restrict fluids and replace Na as ordered, monitor for fluid volume excess and pulmonary edema, continually monitor neurologic status and implement seizure precautions (d/t hyponatremia)

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37
Q

Insufficient secretion of hormones (aldosterone, cortisol, androgens) from the adrenal cortex

A

Adrenocortical insufficiency

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38
Q

What is one of the key causes of PRIMARY adrenocortical insufficiency?

A

Addison’s Disease (autoimmune disorder)

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39
Q

Examples of SECONDARY causes of adrenocortical insufficiency

A

Abrupt discontinuation of corticosteroid therapy, issue with pituitary gland or hypothalamus

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40
Q

S/S of adrenocortical insufficiency

A

Weakness, fatigue, weight loss, hypotension, dehydration, hypoglycemia, bronzed skin appearance

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41
Q

Labs associated with adrenocortical insufficiency

A

Elevated: potassium, calcium, BUN
Decreased: cortisol, sodium, glucose

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42
Q

Adrenocortical insufficiency treatment

A

Hydrocortisone, Kayexalate and insulin (for hyperkalemia) (NOTE: if giving insulin, you will also need to administer glucose because hypoglycemia is a side effect of insulin and patients with adrenocortical insufficiency are also hypoglycemia d/t inadequate cortisol)

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43
Q

Adrenocortical insufficiency patient education

A

Additional doses of corticosteroids may be needed during times of illness or stress

44
Q

Life-threatening disorder caused by adrenal insufficiency

A

Addisonian Crisis

45
Q

Causes of Addisonian Crisis

A

Infection, stress, trauma, abrupt d/c of corticosteroids

46
Q

S/S of Addisonian Crisis

A

Weakness, fatigue, SEVERE hypotension that can cause shock, dysrhythmias

47
Q

Addisonian Crisis treatment

A

IV glucocorticoids and fluids with dextrose, identify and treat underlying cause

48
Q

Addisonian Crisis nursing care

A

Monitor vitals, I&Os, weight, S/S of shock (decreased LOC, decreased UOP), monitor dysrhythmias, provide patient with bed rest and quiet environment

49
Q

Overproduction of cortisol by the adrenal cortex

A

Cushing’s Disease

50
Q

S/S of Cushing’s Disease

A

Buffalo hump, moon face, truncal obesity, weight gain, fluid retention, peptic ulcer disease, diabetes, bone loss, weakness, emotional instability, increased risk for infection

51
Q

Labs associated with Cushing’s Disease

A

Elevated: glucose, sodium, cortisol (in saliva)
Decreased: potassium, calcium

52
Q

Treatment for Cushing’s Disease

A

Hypophysectomy, adrenalectomy, ketoconazole (inhibits cortisol synthesis)

53
Q

Cushing’s Disease nursing care

A

Restrict fluid and sodium, encourage increased intake of potassium, calcium, and protein, monitor for fluid volume overload and pulmonary edema, protect patient from skin breakdown, protect patient from bone fractures, protect patient from GI bleeding (DO NOT give meds like NSAIDs or aspirin!), prevent infection

54
Q

Tumor on the adrenal gland which causes excess secretion of catecholamines norepinephrine and epinephrine from the adrenal medulla

A

Pheochomocytoma

55
Q

S/S of pheochromocytoma

A

Tachycardia, hypertension, headache, diaphoresis, SOB

56
Q

Pheochromocytoma treatment

A

Surgical removal of tumor, adrenalectomy, antihypertensives prior to surgery

57
Q

Pheochromocytoma nursing consideration

A

DO NOT palpate abdomen (triggers sudden release of catecholamines which can result in severe hypertension)

58
Q

Adenoma or hyperplasia in adrenal gland causing excess amounts of aldosterone to be secreted

A

Hyperaldosteronism

59
Q

S/S of hyperaldosteronism

A

Hypertension, hypernatremia, hypokalemia (d/t aldosterone reabsorbing sodium and water and excreting potassium, headache, weakness

60
Q

Hyperaldosteronism treatment

A

Adrenalectomy, spironolactone

61
Q

Hyperaldosteronism nursing care

A

Monitor BP, I&Os, potassium levels, encourage patient to consume low sodium and high potassium diet

62
Q

An autoimmune disorder that is the primary cause of hypothyroidism and causes antibodies to attack and destroy the thyroid tissue

A

Hashimoto’s disease

63
Q

S/S of hypothyroidism

A

Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle nails, depression

64
Q

Labs associated with hypothyroidism

A

Primary: elevated TSH, decreased T3, T4
Secondary or Tertiary: decreased TSH, T3, and T4

65
Q

Hypothyroidism treatment

A

Levothyroxine or Liothyroxine (give BEFORE meals with full glass of water)

66
Q

Hypothyroidism nursing care

A

Encourage frequent rest periods, encourage low-calorie high-fiber diet, increase room temperature

67
Q

Severe, life-threatening hypothyroidism d/t untreated hypothyroidism, abrupt d/c of thyroid meds, or infection/illness

A

Myxedema coma

68
Q

S/S of myxedema coma

A

Hypoxia, decreased CO, decreased LOC, bradycardia, hypotension, hypothermia

69
Q

Myxedema coma nursing care

A

Maintain patent airway, assist with intubation or mechanical ventilation, monitor cardiac rhythm and administer large doses of thyroid meds, warm the patient

70
Q

Autoimmune disease that is the most common cause of primary hyperthyroidism

A

Grave’s Disease

71
Q

S/S of hyperthyroidism

A

Tachycardia, hypertension, heat intolerance, exophthalmos, weight loss, insomnia, diarrhea, warm sweaty skin

72
Q

Labs associated with hyperthyroidism

A

Primary: low TSH, elevated T3 and T4
Secondary or Tertiary: elevated TSH, T3, and T4

73
Q

Hyperthyroidism treatment

A

Thyroidectomy, PTU, iodine solutions, BB

74
Q

Hyperthyroidism nursing care

A

Increase calorie and protein intake, monitor I&Os, weight, and vitals, tape eyelids closed from sleep and provide eye lubricant

75
Q

Life-threatening condition characterized by excessively high levels of thyroid hormone brought on by infection, stress, DKA, or thyroidectomy

A

Thyrotoxicosis or thyroid storm

76
Q

S/S of thyrotoxicosis

A

Severe hypertension, chest pain, dysrhythmias, dyspnea, delirium, fever, N/V

77
Q

Thyrotoxicosis treatment

A

BBs, Antithyroid medications, antipyretics

78
Q

Thyrotoxicosis nursing care

A

Maintain patent airway, monitor for dysrhythmias

79
Q

Thyroidectomy post-op nursing care

A

Semi-fowler’s position, support head and neck with sandbags or pillows to keep in neutral midline position, monitor for bleeding (dressing and behind neck), monitor for parathyroid damage (numbness and tingling around mouth, muscle twitching, positive Chvostek sign, positive trousseau sign)

80
Q

Thyroidectomy patient education

A

Avoid extreme neck extension or flexion, thyroid replacement will need to be taken for rest of life

81
Q

Decreased or insufficient secretion of PTH causing decreased calcium levels

A

Hypoparathyroidism

82
Q

S/S of hypoparathyroidism

A

S/S of hypocalcemia: muscle cramps, numbness, tingling, positive chvostek and trousseau sign, tetany, seizures, dysrhythmias

83
Q

Labs associated with hypoparathyroidism

A

Decreased: PTH, calcium (<9)
Elevated: phosphorous
** calcium and phosphorus have an inverse relationship

84
Q

Hypoparathyroidism treatment

A

Calcium gluconate, calcium and vitamin D supplements, phosphate binders

85
Q

Hypoparathyroidism nursing care

A

Implement seizure precautions, provide patient with high calcium low phosphorus diet, provide patient with phosphorus binders with meals

86
Q

Hypersecretion of PTH from the parathyroid glands

A

Hyperparathyroidism

87
Q

Labs associated with hyperparathyroidism

A

Elevated: PTH, calcium
Decreased: phosphorus

88
Q

S/S of hyperparathyroidism

A

S/S of Hypercalcemia: fatigue, muscle weakness, bone pain and deformities, N/V, weight loss, constipation, hypertension, kidney stones, dysrhythmias

89
Q

Hyperparathyroidism treatment

A

Furosemide (Lasix), calcitonin, phosphates to elevate levels, parathyroidectomy

90
Q

Hyperparathyroidism nursing care

A

Implement safety precautions (risk for falls and fractures), low-calcium high-phosphorus diet, increased fluid intake (prevent constipation and kidney stones)

91
Q

Risk factors for Type II diabetes

A

Obesity, inactivity, hypertension, hyperlipidemia, smoking, genetics, race (African American, Hispanic, American Indian)

92
Q

S/S of hyperglycemia

A

Polydipsia, polyphagia, polyuria, warm and dry skin (warm and dry, sugar is high!), dehydration, weak pulses, decreased skin turgor, fruity breath, kussmaul respirations (increased rate and depth), N/V, weakness, lethargy

93
Q

Diagnosis of Diabetes

A

2 or more of the following labs on separate days:
Casual blood glucose >200
Fasting blood glucose >126
Glucose >200 with oral glucose tolerance test
HgbA1c > 6.5%

94
Q

A patient with diabetes should aim to keep their Hgb A1c below ___%

A

7

95
Q

Diabetic foot care

A

Inspect feet DAILY using mirror, check shoes for object before putting feet in, apply moisturizer to feet but NOT between toes, wear cotton socks, wear close-toed shoes, shoes should be properly fitted, cut toenails straight across (NO rounding), do NOT use heating pads on feet

96
Q

Diabetes illness care

A

Monitor blood glucose levels frequently, DO NOT skip insulin, monitor urine for ketones, prevent dehydration (drink 3L water/day), notify provider if: sick for more than 1 day, temp >38.6 C, glucose over 250, urine positive for ketones

97
Q

Hypoglycemia is defined as a blood glucose level under

A

70 mg/dL

98
Q

S/S of hypoglycemia

A

Hunger, irritability, confusion, diaphoresis, headache, shakiness, blurred vision, pale cool skin (cold and clammy, eat some candy!), decreased LOC that could progress into coma

99
Q

Nursing care for the conscious hypoglycemic patient

A

Give them 15 g of a readily absorbed carbohydrate (half cup of juice or soda, or 8 ounces of milk), recheck blood glucose in 15 minutes, once blood glucose is over 70 provide the patient with a snack that contains both a protein and a carbohydrate

100
Q

Nursing care for the unconscious hypoglycemic patient

A

IM or subcutaneous glucagon, when patient regain consciousness and can safely swallow provide them with a snack

101
Q

Life-threatening complication of diabetes that causes increased blood glucose And ketones in the blood and urine

A

Diabetic ketoacidosis (DKA) — rapid onset, more common and type I diabetics

102
Q

DKA risk factors

A

Infection/illness, stress, untreated or undiagnosed type one diabetes

103
Q

Labs associated with DKA

A

Blood glucose >300, ketones in urine and blood, metabolic acidosis, hyperkalemia

104
Q

Labs associated with HHS

A

Blood glucose >600, NO ketones in urine or blood, NO metabolic acidosis

105
Q

Complication of diabetes characterized by severe hyperglycemia and dehydration with a gradual onset and that is more common in type two diabetics

A

Hyperglycemic hyperosmolar state (HHS)

106
Q

HHS risk factors

A

Older age, inadequate, fluid intake, decreased kidney function, infection, stress

107
Q

Complications of diabetes

A

Cardiovascular disease, which can lead to MI and stroke, diabetic neuropathy, nephropathy, retinopathy, gastroparesis, which can impair digestion, tooth decay, gum disease, sexual dysfunction

NCLEX: Med Surg (10 decks)

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