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Health Care Participant Nursing: N1220 > Endocrine System (Exam One) > Flashcards

Endocrine System (Exam One) Flashcards

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1
Q

How does the Negative Feedback System/Mechanism work?

HINT: Thermostat

A
  • This mechanism reverses changes that occurred
  • Body condition moves away from normal range (homeostasis), specific hormone is stimulated to bring body back to homeostasis, need is met and conditions normalized, hormone stimulation is stopped
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2
Q

How does the Positive Feedback System/Mechanism work?

HINT: Childbirth

A

-This mechanism amplifies or reinforces changes that have occurred

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3
Q

What regulatory hormones does the hypothalamus produce? What organ do these hormones act on?

A
  • Releasing hormones and Inhibiting hormones

- These hormones act on the Anterior Pituitary Gland and tell it to release or inhibit the release of hormones

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4
Q

What two hormones are synthesized in the hypothalamus?

A
  • Antidiuretic hormone (ADH)

- Oxytocin

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5
Q

What gland stores and releases Antidiuretic hormone and Oxytocin?

A

Posterior Pituitary Gland

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6
Q

The Anterior Pituitary Gland is regulated by which gland?

A

Hypothalamus

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7
Q

What are tropic hormones?

A

Hormones that send messages to other glands and tell those glands to release their specific hormones

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8
Q

What hormones are classified as tropic hormones?

A
  • Thyroid Stimulating Hormone (TSH)
  • Adrenocorticotropic Hormone (ACTH)
  • Follice Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)
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9
Q

What hormones come from the Anterior Pituitary Gland?

A
  • Thyroid Stimulating Hormone
  • Adrenocorticotropic Hormone
  • Follice Stimulating Hormone
  • Luteinizing Hormone
  • Growth Hormone
  • Prolactin
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10
Q

How does Thyroid Stimulating Hormone (TSH) work?

A
  • Stimulates the thyroid to release thyroid hormones (T3 and T4)
  • Acts on the thyroid gland
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11
Q

How does Adrenocorticotropic Hormone (ACTH) work?

A
  • Stimulates the adrenal cortex to release glucocorticoids (cortisol)
  • Acts on the adrenal gland
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12
Q

If there is a malfunction of the Anterior Pituitary Gland, what will happen with secretion of its hormones?

A

There will either be too little or too much of various hormones released

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13
Q

The Posterior Pituitary Gland is an extension of what?

A

Extension of the hypothalamus

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14
Q

Does the Posterior Pituitary Gland synthesize its hormones?

A
  • No

- It only stores and releases hormones (Antidiuretic Hormone and Oxytocin)

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15
Q

When would increased levels of Adrenocorticotropic Hormone be present in the body?

A
  • During periods of stress, trauma, infection, illness, etc.
  • Levels of Adrenocorticotropic Hormone (ACTH) would be increased because this hormone is stimulating the Adrenal Cortex to release glucocorticoids (cortisol)
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16
Q

How does Antidiuretic Hormone (ADH) (also known as Vasopressin) work?

A
  • It regulates fluid volume within the body

- When released, it tells the kidneys to reabsorb water, thus conserving water within the body

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17
Q

Which endocrine gland can possibly be palpated? When should you avoid palpating this gland?

A
  • Thyroid Gland

- Avoid palpitation in patient with uncontrolled hyperthyroidism, due to excess secretion of hormone

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18
Q

What hormone stimulates the thyroid to release T3 and T4?

A

Thyroid Stimulating Hormone (TSH)

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19
Q

What three hormones come from the thyroid?

A
  • Triiodothyronine (T3)
  • Thyroxine (T4)
  • Calcitonin
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20
Q

What do T3 and T4 do within the body?

A
  • Regulate cellular respiration of glucose and fatty acids
  • Control metabolism throughout entire body and all bodily processes
  • Growth and development
  • Brain function
  • Essential for life
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21
Q

In order for T3 and T4 to be synthesized by the thyroid, what must be in the diet?

A
  • Protein

- Iodine

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22
Q

What does calcitonin do within the body?

HINT: Calcitonin = “tone down”

A
  • Inhibits reabsorption of calcium
  • Lowers serum calcium levels
  • Retains calcium and phosphate within the bones
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23
Q

When is calcitonin stimulated?

A
  • When serum calcium levels are too high (hypercalcemia)

- It will take excess calcium and store it in the bones and teeth

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24
Q

What hormone is produced by the Parathyroid Gland?

A

Parathyroid Hormone (PTH)

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25
Q

What does Parathyroid Hormone (PTH) do?

HINT: Antagonist to calcitonin

A
  • Raises serum calcium levels:
  • Pulls calcium from bones
  • Encourages small intestine to absorb more calcium
  • Encourages the kidneys to reabsorb more calcium and eliminate phosphate
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26
Q

When is Parathyroid Hormone (PTH) secreted?

A

During hypocalcemia

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27
Q

The Adrenal Medulla releases what hormones?

HINT: MEN

A

Epinephrine and Norepinephrine

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28
Q

What effect do Epinephrine and Norepinephrine have on the body?

A
  • Act on alpha one, beta one and beta two receptors
  • Increase the heart rate, increase the force of cardiac contraction, bronchodilation, vasoconstriction of peripheral arteries, vasodilates skeletal muscle arterioles, tells the liver to convert glycogen to glucose for energy
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29
Q

When are Epinephrine and Norepinephrine released?

A

Released during stressful times (flight or fight) to manage stress response and keep body safe

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30
Q

The Adrenal Cortex releases what hormones?

HINT: Sex, Sugar, Salt or Make Good Sweets

A

It releases corticosteroids, which include:

  • Glucocorticoids (Cortisol)
  • Mineralocorticoids (Aldosterone)
  • Gonadocorticoids (Androgens)
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31
Q

Thyrotrophin-releasing hormone (TRH) stimulates the release of what hormone?

A

Thyroid Stimulating Hormone (TSH)

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32
Q

Cortricotropin-releasing hormone (CRH) stimulates the release of what hormone?

A

Adrenocorticotropic Hormone (ACTH)

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33
Q

What hormones are essential for life?

A

Thyroid Hormones (T3 and T4)

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34
Q

What signs are used to assess for hypocalcemia?

A

Chvostek sign and Trousseau sign

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35
Q

What hormones released by the Adrenal Cortex are essential for life?

A
  • Mineralocorticoids (Aldosterone)

- Glucocorticoids (Cortisol)

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36
Q

What tropic hormone is released to promote the release of Cortisol from the Adrenal Cortex?

A

Adrenocorticotropic Hormone (ACTH)

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37
Q

What is the target organ of Mineralocorticoids (Aldosterone)?

A

Kidneys

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38
Q

What is the target organ of Glucocorticoids (Cortisol)?

A

Many systemic body tissues

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39
Q

What does Glucocorticoids (Cortisol) do for the body?

A

Provides energy sources to the body during stress (because it tells the liver to convert glycogen to glucose)

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40
Q

What organ is both an endocrine and exocrine gland?

A

Pancreas

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41
Q

What hormones does the Pancreas synthesize and release?

A
  • Insulin

- Glucagon

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42
Q

What specific cells secrete insulin?

A

Beta cells

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43
Q

What specific cells secrete glucagon?

A

Alpha cells

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44
Q

What specific cells secrete somatostatin?

A

Delta cells

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45
Q

Where do beta and alpha cells live within the Pancreas?

A

Islet of Langerhans

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46
Q

What two endocrine disorders can occur if Antidiuretic Hormone isn’t regulated properly?

A
  • Diabetes Insipidus (DI)

- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

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47
Q

What is Diabetes Insipidus (DI)? What happens during this issue?

HINT: Dry Inside (DI)

A
  • Hyposecretion of Antidiuertic Hormone (ADH) (too little)
  • Dehydrated
  • Excessive water secretion
  • Blood is concentrated, sodium levels high
  • High blood osmolality
  • Increased urine output
  • Low urine osmolality, low urine specific gravity, dilute urine
  • Low urine specific gravity < 1.005
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48
Q

What is a priority** nursing concern with Diabetes Insipidus? What is a priority** nursing intervention?

A
  • Concern: Dehydration!**
  • Intervention: Promote fluids!**
  • Weight loss
  • Decreased BP
  • Increased HR
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49
Q

What is Syndrome of Inappropriate Antidiuretic Hormone? What happens during this issue?

HINT: Soaked Inside (SI) or Syndrome of Increased Antidiuretic Hormone

A
  • Hypersecretion of Antidiuertic Hormone (ADH) (too much)
  • Fluid overloaded
  • Excessive water retention
  • Blood is diluted, sodium levels low
  • Low blood osmolality
  • Decreased urine output
  • High urine osmolality, high specific gravity, highly concentrated urine
  • High urine specific gravity >1.030
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50
Q

What is a priority** nursing concern with Syndrome of Inappropriate Antidiuretic Hormone? What is a priority nursing intervention?

A
  • Concern: Fluid overload!**
  • Intervention: Restrict fluids, monitor respiratory system for breathing complications (pulmonary edema)!**
  • Hypoosmolality
  • Hyponatremia
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51
Q

What are common laboratory tests for the thyroid glands?

A
  • Thyroid-stimulating hormone (TSH)

- T3 and T4

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52
Q

What are common laboratory tests for the parathyroid gland?

A
  • Parathyroid hormone (PTH)
  • Calcium
  • Phosphorus
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53
Q

What are common laboratory tests for the pituitary gland?

A
  • Growth hormone (GH)
  • Antidiuretic hormone (ADH)
  • Urine specific gravity
  • Adrenocorticotropic hormone (ACTH)
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54
Q

What are common laboratory tests for the adrenal glands?

A
  • Cortisol

- 24-hour urine for VMA

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55
Q

What do simulation tests help determine?

A

Adrenal gland function

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56
Q

What does a thyroid scan test for? What must you assess before initiating the scan? What patient eduction should you provide?

A
  • Presence of nodules or tumors
  • Shellfish allergy
  • Small amounts of radioactive material is used, no risk, no special precautions necessary
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57
Q

Hot spots on a thyroid scan are considered to be what?

HINT: Not Hot

A

Nodules that are NOT malignant

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58
Q

Cold spots on a thyroid scan are considered to be what?

A
  • Nodules or tumors that are malignant

- Biopsy is usually necessary

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59
Q

The anterior pituitary gland is also known as what?

A

The master gland

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60
Q

How does Follicle-Stimulating Hormone (FSH) work?

A
  • Control of reproductive function
  • Acts on ovaries and testis
  • Stimulates secretion of estrogen
  • Development of eggs in women
  • Development of sperm in men
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61
Q

How does Luteinizing Hormone (LH) work?

A
  • Control of reproductive function
  • Acts on ovaries and testis
  • Stimulates ovulation in women
  • Stimulates secretion of sex hormones in men and women
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62
Q

How does Growth Hormone (GH) work?

A
  • Promotes growth (indirectly)

- Acts on liver and adipose tissue

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63
Q

How does Prolactin work?

A
  • Stimulates breast development necessary for lactation

- Acts on mammary glands

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64
Q

How does Oxytocin work?

A
  • Stimulates ejection of milk into mammary ducts
  • Stimulates uterine contractions
  • Acts on ovaries and testis
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65
Q

What are the three causes of endocrine disorders?

A
  • Overproduction of hormones
  • Underproduction of hormones
  • Side effects of certain drugs
66
Q

What is a primary endocrine disorder?

A

Something is wrong with the actual gland

67
Q

What is a secondary endocrine disorder?

A
  • Problems outside of the gland

- Something is wrong with a different gland or organ

68
Q

A deficit of growth hormone causes what disorder?

A

-Short stature

69
Q

An overproduction of growth hormone causes what disorder?

A
  • Gigantism

- Acromegaly

70
Q

What causes a deficiency in growth hormone (GH)?

A
  • Pituitary tumor
  • Heredity
  • Psychosocial (severe neglect or emotional stress)
  • Malnutrition (most common)
  • Unknown
71
Q

What are the signs and symptoms of growth hormone (GH) deficiency in children?

A
  • Stunted growth
  • Slowed sexual maturation
  • Possible mental retardation
  • Other symptoms depend on other pituitary hormones involved
72
Q

What are the signs and symptoms of growth hormone (GH) deficiency in adults?

A
  • Fatigue, weakness
  • Excess body fat
  • Hypercholesterolemia
  • Decreased muscle and bone mass
  • Sexual dysfunction
  • Risk for cardiovascular disease
  • Risk of cerebrovascular disease
  • Overall decreased quality of life
73
Q

What is the most reliable diagnostic test for determining growth hormone (GH) level?

A

-Growth Hormone stimulation test

74
Q

What are the therapeutic interventions for growth hormone deficiency?

A
  • Administer synthetic growth hormone (GH)

- Surgery

75
Q

What is the difference between acromegaly and gigantism?

A
  • Acromegaly occurs in middle-ages adults

- Gigantism occurs in children

76
Q

What does acromegaly cause? Is the onset of symptoms rapid or slow?

A
  • Overgrowth of soft tissues and certain bones (think width, not length)
  • Develops slowly over time
77
Q

What are the signs and symptoms of acromegaly?

A
  • Abnormally large growth of hands, feet, nose, jaw, or brow
  • Tongue and lips becomes thicker
  • Skin changes
  • Hoarse voice
  • Sleep apnea
  • Arthritis
  • Enlargement of internal organs
  • Diabetes
  • Weight gain (overweight)
  • Galactorrhea (in women only)
  • Impotence (in men only)
78
Q

What should be included in the diagnosis of acromegaly?

A
  • Thorough history and physical exam
  • Growth hormone levels
  • CT or MRI
79
Q

What are the treatment options for acromegaly?

A
  • Treat cause
  • Surgery (hypophysectomy)
  • Radiation
  • Drug therapy
80
Q

Can overgrowth of bones and soft tissues be reversed with treatment or are they permanent?

A
  • Bone overgrowth is permanent

- Soft tissues can be reversed

81
Q

What is a transsphenoidal hypophysectomy?

A
  • Removing the pituitary gland or tumor through the sinuses

- Does not affect or harm brain tissue

82
Q

What type of education should be provided to a patient before undergoing a transsphemoidal hypophysectomy?

A
  • Prepare patient for location of surgery and what to expect after surgery
  • Nasal packing in place for 2-3 days
  • Will have to mouth breath
83
Q

What type of education should be provided to a patient after undergoing a transsphemoidal hypophysectomy?

A
  • Head of bed elevated to 30-degree angle
  • Monitor neurological status
  • Avoid coughing, sneezing, bending, or straining with a bowel movement
  • Monitor clear leakage from nose
  • Nasal packing, mouth breathing
  • Avoid brushing teeth
  • Observe patient for excess urine output (Transient Diabetes Insipidus)
  • Hormone therapy, advise lifelong
84
Q

Do you need an order to remove the nasal packing on a hypophysectomy?

A

Yes

85
Q

Acromegaly, gigantism, and growth hormone deficiency are all what type of gland disorder?

A

Anterior Pituitary Gland Disorders

86
Q

Posterior pituitary gland disorders will result in the overproduction or underproduction of what hormone?

A

Antidiuretic Hormone (ADH)

87
Q

What environment within the body will cause Antidiuretic Hormone (ADH) to be released?

A

When blood volume (pressure) within the body/vascular system is low
i.e. the patient is dehydrated

88
Q

When will the release of Antidiuretic Hormone (ADH) be inhibited?

A

When blood volume (pressure) within the body/vascular system is at an appropriate level or high

89
Q

What is the role of Antidiuretic Hormone (ADH) when it is released?

A

To conserve fluids through the kidneys

90
Q

What is the normal specific gravity of urine?

A

1.005 to 1.030

91
Q

If specific gravity is low (less than 1.005), what does that tell us?

A
  • The urine is very dilute

- There is more fluid in the urine than waste/particles

92
Q

If specific gravity is high (greater than 1.030), what does that tell us?

A
  • The urine is very concentrated

- There is more waste/particles than fluid

93
Q

Low urine osmolality and low specific gravity does what to the urine?

A

Causes diluted urine

94
Q

High urine osmolality and high specific gravity does what to the urine?

A

Causes concentrated urine

95
Q

What can cause Diabetes Insipidus (DI)?

A
  • Pituitary tumor
  • Head trauma
  • Surgery
  • Drugs
96
Q

What are the signs and symptoms of Diabetes Insipidus (DI)?

A
  • Polyuria
  • Polydipsia (excessive thirst)
  • Nocturia
  • Elevated serum osmolality
  • Dilute urine
  • Dehydration
  • Hypovolemic shock
  • Decreased LOC
  • Death
97
Q

What diagnostic tests do you use to determine and monitor Diabetes Insipidus (DI)?

A
  • Urine specific gravity
  • Plasma osmolality
  • Urine osmolality
  • CT or MRI
  • Fluid deprivation test
  • Glucose test
98
Q

What is a fluid deprivation test?

A

Restrict fluids for approximately 6 hours and monitor patient urine for continued signs and symptoms of Diabetes Insipidus

99
Q

List nursing management for Diabetes Insipidus (DI).

A
  • Manage hydration
  • Free access to fluids!
  • Monitor vital signs and LOC
  • Measure urine output
  • Monitor urine specific gravity
  • Control with drug therapy
  • Teach patient about long term management
100
Q

What drug can be given to control Diabetes Insipidus (DI)?

A
  • Synthetic Vasopressin (synthetic antidiuretic hormone)

- Lifelong therapy

101
Q

What does a synthetic vasopressin do? What should you educate the patient about in regards to this drug?

A
  • Decrease urine output
  • Concentrate the urine
  • Increase in urine specific gravity
  • Educate on fluid retention, becoming fluid overloaded
102
Q

What is the most common cause of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A

Hormone-secreting tumor (i.e. lung cancer)

103
Q

What population is most at risk for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A

Older adults

104
Q

Should you restrict salt in a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? Why or why not?

A
  • No

- They are at a higher risk for hyponatremia

105
Q

What are the signs and symptoms of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A
  • Weight gain without edema
  • Dilutional hyponatremia (<135)
  • Low serum osmolality
  • Decreased urine output
  • Muscle cramps and weakness
  • High blood pressure
  • Headache
  • Brain swelling, seizures, death
106
Q

What diagnostic tests do you use to determine and monitor Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A
  • Serum osmolality
  • Urine osmolality
  • Serum sodium
  • ADH levels
  • CT scan or MRI
107
Q

List nursing management for Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

A
  • Treatment directed at underlying cause
  • Physical assessment (i.e. crackles, JVD, bounding pulses)
  • Mental status changes
  • Fluid overload
  • Restricting fluids
  • Daily weights
  • Safety (i.e. seizure precautions)
  • Assess skin integrity
  • Frequent oral care
  • Drug therapy (i.e. furosemide AKA Lasix)
  • Teach patient self management (i.e. do not restrict salt)
108
Q

What sign/symptom does Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) have in common?

A

Patient will present with excessive thirst

109
Q

What is a Goiter?

A

Enlarged thyroid gland

110
Q

What is the priority nursing concern with a Goiter? What is the primary nursing intervention?

HINT: ABC’s

A
  • Concern: Compromised airway (priority)
  • Presence of stridor is an emergency
  • Interfere with swallowing
  • Intervention: Protect the airway (priority)
111
Q

What are the causes of a Goiter? Which is the most common?

A
  • Lack of iodine (most common)
  • Overproduction/underproduction of thyroid hormone
  • Nodules in the gland
  • Thyroid-inhibiting medications
  • Thyroiditis
112
Q

What are the signs and symptoms of a Goiter?

A
  • Swelling of thyroid gland
  • Feeling of fullness in the neck
  • Interfere with swallowing or breathing
113
Q

What are the treatment options for a Goiter?

A
  • Prevent enlargement and protect airway
  • Medications
  • Surgery
114
Q

What is Thyroiditis? What causes it?

A
  • Inflammation of the thyroid gland

- Caused by infection (viral or bacterial) or Hashimoto’s

115
Q

What is the treatment for infectious thyroiditis?

A
  • Drainage

- NSAID’s, corticosteroids, antibiotics

116
Q

What nursing interventions would you provide for a patient with infectious thyroiditis?

A
  • Steroid education

- Assess breathing/swallowing

117
Q

What is Hashimoto’s thyroiditis? What causes it?

A
  • Autoimmune disorder
  • Thyroid tissue is destroyed by antibiotics, causing hypothyroidism
  • T3 and T4 levels will be decreased, TSH level will be increased
118
Q

What is the treatment for Hashimoto’s thyroiditis?

A

-Hormone replacement therapy for T3 and T4

119
Q

What nursing care would you provide for a patient with Hashimoto’s thyroiditis?

A
  • Educate on signs and symptoms of autoimmune diseases

- Educate on hormone replacement therapy

120
Q

Patients with Hashimoto’s thyroiditis are at an increased risk for what?

A

Other autoimmune diseases (Addison’s disease)

121
Q

What is the basic definition of hypothyroidism? What is the most common cause of hypothyroidism?

A
  • Too little thyroid hormone (T3 and T4)
  • Metabolic rate slowed
  • Most common cause is iodine deficiency
122
Q

What is the basic definition of hyperthyroidism?

A
  • Too much thyroid hormone (T3 and T4)
  • Metabolic rate sped up
  • Enhances activity of epinephrine and norepinephrine
123
Q

Describe primary hypothyroidism

A
  • Thyroid gland isn’t functioning appropriately
  • Thyroid gland is unable to synthesize and release T3 and T4 into circulation
  • Anterior Pituitary Gland is releasing additional Thyroid Stimulating Hormone (TSH) in attempts to stimulate the thyroid gland.
  • T3 and T4 are low, TSH is high (opposite directions)
124
Q

Describe secondary hypothyroidism

A
  • Anterior Pituitary Gland is not working. It is not synthesizing and releasing Thyroid Stimulating Hormone (TSH)
  • Thyroid gland isn’t being stimulated, so it cannot release T3 and T4 into circulation
  • TSH is low thus causing T3 and T4 to be low (same direction)
125
Q

Describe primary hyperthyroidism

A
  • Thyroid gland isn’t functioning appropriately
  • Thyroid gland is over synthesizing and releasing T3 and T4 into circulation
  • Anterior Pituitary Gland is not releasing additional Thyroid Stimulating Hormone (TSH) in attempts to slow the thyroid gland down

(T3 and T4 are high, TSH is low)

126
Q

Describe secondary hyperthyroidism

A
  • Anterior Pituitary Gland is not working. It is over synthesizing and releasing Thyroid -Stimulating Hormone (TSH)
  • Thyroid gland is being over stimulated, so it is releasing additional T3 and T4 into circulation

(TSH is high thus causing T3 and T4 to be high)

127
Q

What are some reasons hypothyroidism may occur?

A
  • Thyroid gland malfunction
  • Anterior Pituitary Gland malfunction (TSH secretion insufficient)
  • Hashimotos Thyroiditis
  • Insufficient iodine in the diet
  • Thyroid gland removed
128
Q

List signs and symptoms of hypothyroidism

A
  • Fatigue/Lethargy
  • Mental Dullness
  • Bradycardia
  • Hypoventilation
  • Cold intolerance
  • Consitpation
  • Weight gain
  • Dry skin and hair
  • Heart failure
  • Hyperlipidemia
  • Myxedema (Coma)
129
Q

What are some reasons hyperthyroidism may occur? What is the most common cause of hyperthyroidism?

A
  • Graves Disease (most common)
  • Goiter
  • Thyroiditis
  • Thyroid tumor
  • Pituitary tumor
  • Patients with hypothyroidism who are overmedicated
130
Q

List signs and symptoms of hyperthyroidism

A
  • Hypermetabolic state
  • Heat intolerance
  • Tachycardia
  • Palpitations
  • Hypertension
  • Chest Pain
  • Increased Appetite
  • Weight Loss
  • Frequent stools
  • Fatigued, Irritable
  • Mood swings
  • Nervousness
  • Tremulous
  • Goiter
  • Exopthalmos (with Graves)
  • May mimic cardiac conditions (in older adults)
131
Q

What medication is given to treat hypothyroidism?

A

Levothyroxine (Synthroid)

132
Q

How does Levothyroxine (Synthroid) work in the body?

A

Levothyroxine (Synthroid) is an exogenous hormone
Levothyroxine (Synthroid) is a synthetic preparation of thyroxine (T4)
When in the body, it converts into T3

133
Q

Why is Levothyroxine (Synthroid) given?

A
  • To treat hypothyroidism

- It is the drug of choice for thyroid hormone replacement

134
Q

What education regarding signs ang symptoms does the nurse need to provide when a patient begins Levothyroxine (Synthroid)?

A
  • Watch out for s/s of hyperthyroidism
  • S/S include: tachycardia, angina (chest pain), palpitations, tremors, nervousness, hyperthermia, heat intolerance, sweating
  • Notify provider ASAP if these s/s occur
135
Q

What is the drug class of Levothyroxine (Synthroid)?

A

Thyroid Hormone Replacement

136
Q

What nursing interventions should you implement with hypothyroidism?

A
  • Educate on hormone replacement therapy (i.e. cannot stop taking abruptly, lifelong therapy)
  • Educate on signs and symptoms of hyperthyroidism
  • Diabetic patients should check blood glucose regularly
137
Q

What causes myxedema?

A

Long-standing (advanced) hypothyroidism

138
Q

What are the signs and symptoms of myxedema?

A
  • Facial puffiness
  • Facial and preorbital edema
  • Edema of hands and feet
139
Q

Hypothyroidism can progress to what life threatening condition?

A

Myxedema Coma

140
Q

What is the cause of a myxedema coma?

A
  • Long-standing undiagnosed hypothyroidism
  • Infection
  • Medications
  • Exposure to cold
  • Trauma
141
Q

What are the signs and symptoms of a myxedema coma?

HINT: Think hypothyroidism s/sx to a severe state

A
  • Mental sluggishness
  • Drowsiness
  • Lethargy
  • Hypoventilation
  • Subnormal temperatures
  • Hypotension
  • Cardiovascular collapse
142
Q

What nursing management would you want to provide for a patient in a myxedema coma?

A
  • Maintain airway!
  • Monitor HR and BP
  • Cardiac monitor
  • IV fluids
  • Warm patient slowly with warming blankets/bair hugger
  • IV Levothyroxine
  • For discharge, provide psychosocial support (i.e. small reminders for self-care)
143
Q

What is the primary nursing concern with hyperthyroidism? What are the therapeutic interventions for hyperthyroidism?

A
  • Concern: Attempt to slow down thyroid

- Interventions: Antithyroid medication, radioactive iodine therapy, thyroidectomy

144
Q

What is the main problem with antithyroid medications?

A

They take multiple months to begin working

145
Q

What is radioactive iodine therapy (RAI)? What are some considerations to take regarding care?

A
  • Attaches to iodine and destroys thyroid tissue
  • Limit time spent with patient
  • Pregnant caregivers should avoid taking care of these patients
  • Flush toilet twice after disposal of urine or feces
146
Q

When would a thyroidectomy be necessary? What education should be provided to the patient?

A
  • Patient unresponsive to other treatments
  • Present goiter causing tracheal compression
  • Patient has thyroid cancer

-Will cause hypothyroidism, must be placed on lifelong Levothyroxine

147
Q

What medications are given to treat hyperthyroidism?

A
  • Methimazole (Tapazole)

- Propylthiouracil (PTU)

148
Q

Which medication for hyperthyroidism is the first line treatment? What does it do?

A
  • Methimazole

- Prevents T3 and T4 from being made

149
Q

What education regarding signs and symptoms does the nurse need to provide when a patient begins Methimazole (Tapazole)?

A
  • Can take 3 to 12 weeks to take effect because it does not destroy existing buildup of thyroid hormone
  • Can put patient into hypothyroid state (teach patient signs/symptoms of hypothyroidism)
150
Q

What is the drug class for Methimazole (Tapazole)?

A

Thionaminde

151
Q

What nursing care should you provide for a patient with hyperthyroidism?

A
  • Assess airway and ability to swallow (Goiter)
  • Administer beta blocker (Cardiac Complications)
  • Provide quite environment (Restlessness)
  • Relieve dry eyes and discomfort (Exophthalmos)
  • Increase carbs, proteins, fats, caloric intake (Weight loss)
152
Q

What nursing care should you provide for a patient who has undergone a thyroidectomy?

A
  • Assess neck swelling/airway (stridor)
  • Signs/symptoms of hypothyroidism
  • Monitor vital signs
  • Assess for hypoparathyroid complications
  • Monitor calcium levels
  • Numbness or tingling around mouth
  • Educate on hormone replacement therapy (HRT)
153
Q

What is a thyrotoxic crisis/thyroid storm? What causes it?

A
  • Acute, rare condition which increases hyperthyroid conditions
  • Life-threatening, EMERGENCY!
  • Caused by stress, thyroid surgery, or withdrawal of anti-thyroid medications
154
Q

What are the signs and symptoms of a thyroid storm?

A
  • Tachycardia
  • Extreme hypertension
  • Heart failure
  • Shock
  • Hyperthermia
  • Seizures
  • Nausea/Vomiting/Diarrhea
  • Apprehension/Restlessness
  • Delirium
  • Coma
155
Q

What is the primary nursing concern with a thyroid storm? What are the therapeutic interventions for thyroid storm?

A
  • Concern: Manage signs and symptoms

- Interventions: Beta blockers, cooling blanket, fluid replacement, elevate HOB, apply O2, give anti-thyroid medication

156
Q

What is hyperparathyroidism? What causes hyperparathyroidism?

A
  • Increased secretion of parathyroid hormone
  • Caused by hyperplasia of parathyroid gland, benign tumor on gland, hereditary
  • Patients with kidney disease are at an increased risk for hyperparathyroidism because they cannot absorb Vitamin D or Calcium which results in hypocalcemia
157
Q

What are the signs and symptoms of hyperparathyroidism?

HINT: Think hypercalcemia

A
  • Asymptomatic
  • Osteoporosis (i.e. fractures)
  • Kidney stones
  • Muscle weakness, lethargy
  • Loss of appetite, N/V, constipation
  • Peptic ulcers
  • Emotional disorders
  • Coma
  • Cardia arrhythmias
  • Cardiac arrest
158
Q

What are patients at risk for with hyperparathyroidism?

A
  • Injury!

- Want to prevent falls

159
Q

What is the treatment for hyperparathyroidism?

A
  • Remove it! (Parathyroidectomy)
  • Medication to lower calcium
  • Weight-being exercise
  • High fluid intake
  • Moderate calcium diet
160
Q

What is the main concern for a patient who has had a parathyroidectomy? What is the treatment for these patients?

A
  • Laryngospasms (can cause stridor, blocks the airway)
  • Seizures (due to drop in calcium levels)
  • Administer IV calcium
161
Q

A sudden decrease in serum calcium levels can cause what?

A
  • Tetany!
  • Tingling of lips/hands/tongue, stiffness in extremities
  • Laryngospasms (compromises airway)
162
Q

What are the long term goals of patients with hypoparathyroidism?

A
  • Maintain normal calcium levels
  • Prevent complications
  • Long term drug therapy
  • DO NOT ADMINISTER PTH
  • Oral calcium supplements, vitamin D supplements, high calcium foods
  • Follow up care
  • Report any tingling

Health Care Participant Nursing: N1220 (5 decks)

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