Endocrine System (Exam One) Flashcards
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
2
Q
How does the Positive Feedback System/Mechanism work?
HINT: Childbirth
A
-This mechanism amplifies or reinforces changes that have occurred
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
4
Q
What two hormones are synthesized in the hypothalamus?
A
- Antidiuretic hormone (ADH)
- Oxytocin
5
Q
What gland stores and releases Antidiuretic hormone and Oxytocin?
A
Posterior Pituitary Gland
6
Q
The Anterior Pituitary Gland is regulated by which gland?
A
Hypothalamus
7
Q
What are tropic hormones?
A
Hormones that send messages to other glands and tell those glands to release their specific hormones
8
Q
What hormones are classified as tropic hormones?
A
- Thyroid Stimulating Hormone (TSH)
- Adrenocorticotropic Hormone (ACTH)
- Follice Stimulating Hormone (FSH)
- Luteinizing Hormone (LH)
9
Q
What hormones come from the Anterior Pituitary Gland?
A
- Thyroid Stimulating Hormone
- Adrenocorticotropic Hormone
- Follice Stimulating Hormone
- Luteinizing Hormone
- Growth Hormone
- Prolactin
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
11
Q
How does Adrenocorticotropic Hormone (ACTH) work?
A
- Stimulates the adrenal cortex to release glucocorticoids (cortisol)
- Acts on the adrenal gland
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
13
Q
The Posterior Pituitary Gland is an extension of what?
A
Extension of the hypothalamus
14
Q
Does the Posterior Pituitary Gland synthesize its hormones?
A
- No
- It only stores and releases hormones (Antidiuretic Hormone and Oxytocin)
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)
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
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
18
Q
What hormone stimulates the thyroid to release T3 and T4?
A
Thyroid Stimulating Hormone (TSH)
19
Q
What three hormones come from the thyroid?
A
- Triiodothyronine (T3)
- Thyroxine (T4)
- Calcitonin
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
21
Q
In order for T3 and T4 to be synthesized by the thyroid, what must be in the diet?
A
- Protein
- Iodine
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
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
24
Q
What hormone is produced by the Parathyroid Gland?
A
Parathyroid Hormone (PTH)
25
What does Parathyroid Hormone (PTH) do?
HINT: Antagonist to calcitonin
- 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
26
When is Parathyroid Hormone (PTH) secreted?
During hypocalcemia
27
The Adrenal Medulla releases what hormones?
HINT: MEN
Epinephrine and Norepinephrine
28
What effect do Epinephrine and Norepinephrine have on the body?
- 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
29
When are Epinephrine and Norepinephrine released?
Released during stressful times (flight or fight) to manage stress response and keep body safe
30
The Adrenal Cortex releases what hormones?
HINT: Sex, Sugar, Salt or Make Good Sweets
It releases corticosteroids, which include:
- Glucocorticoids (Cortisol)
- Mineralocorticoids (Aldosterone)
- Gonadocorticoids (Androgens)
31
Thyrotrophin-releasing hormone (TRH) stimulates the release of what hormone?
Thyroid Stimulating Hormone (TSH)
32
Cortricotropin-releasing hormone (CRH) stimulates the release of what hormone?
Adrenocorticotropic Hormone (ACTH)
33
What hormones are essential for life?
Thyroid Hormones (T3 and T4)
34
What signs are used to assess for hypocalcemia?
Chvostek sign and Trousseau sign
35
What hormones released by the Adrenal Cortex are essential for life?
- Mineralocorticoids (Aldosterone)
| - Glucocorticoids (Cortisol)
36
What tropic hormone is released to promote the release of Cortisol from the Adrenal Cortex?
Adrenocorticotropic Hormone (ACTH)
37
What is the target organ of Mineralocorticoids (Aldosterone)?
Kidneys
38
What is the target organ of Glucocorticoids (Cortisol)?
Many systemic body tissues
39
What does Glucocorticoids (Cortisol) do for the body?
Provides energy sources to the body during stress (because it tells the liver to convert glycogen to glucose)
40
What organ is both an endocrine and exocrine gland?
Pancreas
41
What hormones does the Pancreas synthesize and release?
- Insulin
| - Glucagon
42
What specific cells secrete insulin?
Beta cells
43
What specific cells secrete glucagon?
Alpha cells
44
What specific cells secrete somatostatin?
Delta cells
45
Where do beta and alpha cells live within the Pancreas?
Islet of Langerhans
46
What two endocrine disorders can occur if Antidiuretic Hormone isn't regulated properly?
- Diabetes Insipidus (DI)
| - Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
47
What is Diabetes Insipidus (DI)? What happens during this issue?
HINT: Dry Inside (DI)
- 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
48
What is a priority** nursing concern with Diabetes Insipidus? What is a priority** nursing intervention?
- Concern: Dehydration!**
- Intervention: Promote fluids!**
- Weight loss
- Decreased BP
- Increased HR
49
What is Syndrome of Inappropriate Antidiuretic Hormone? What happens during this issue?
HINT: Soaked Inside (SI) or Syndrome of Increased Antidiuretic Hormone
- 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
50
What is a priority** nursing concern with Syndrome of Inappropriate Antidiuretic Hormone? What is a priority nursing intervention?
- Concern: Fluid overload!**
- Intervention: Restrict fluids, monitor respiratory system for breathing complications (pulmonary edema)!**
- Hypoosmolality
- Hyponatremia
51
What are common laboratory tests for the thyroid glands?
- Thyroid-stimulating hormone (TSH)
| - T3 and T4
52
What are common laboratory tests for the parathyroid gland?
- Parathyroid hormone (PTH)
- Calcium
- Phosphorus
53
What are common laboratory tests for the pituitary gland?
- Growth hormone (GH)
- Antidiuretic hormone (ADH)
- Urine specific gravity
- Adrenocorticotropic hormone (ACTH)
54
What are common laboratory tests for the adrenal glands?
- Cortisol
| - 24-hour urine for VMA
55
What do simulation tests help determine?
Adrenal gland function
56
What does a thyroid scan test for? What must you assess before initiating the scan? What patient eduction should you provide?
- Presence of nodules or tumors
- Shellfish allergy
- Small amounts of radioactive material is used, no risk, no special precautions necessary
57
Hot spots on a thyroid scan are considered to be what?
HINT: Not Hot
Nodules that are NOT malignant
58
Cold spots on a thyroid scan are considered to be what?
- Nodules or tumors that are malignant
| - Biopsy is usually necessary
59
The anterior pituitary gland is also known as what?
The master gland
60
How does Follicle-Stimulating Hormone (FSH) work?
- Control of reproductive function
- Acts on ovaries and testis
- Stimulates secretion of estrogen
- Development of eggs in women
- Development of sperm in men
61
How does Luteinizing Hormone (LH) work?
- Control of reproductive function
- Acts on ovaries and testis
- Stimulates ovulation in women
- Stimulates secretion of sex hormones in men and women
62
How does Growth Hormone (GH) work?
- Promotes growth (indirectly)
| - Acts on liver and adipose tissue
63
How does Prolactin work?
- Stimulates breast development necessary for lactation
| - Acts on mammary glands
64
How does Oxytocin work?
- Stimulates ejection of milk into mammary ducts
- Stimulates uterine contractions
- Acts on ovaries and testis
65
What are the three causes of endocrine disorders?
- Overproduction of hormones
- Underproduction of hormones
- Side effects of certain drugs
66
What is a primary endocrine disorder?
Something is wrong with the actual gland
67
What is a secondary endocrine disorder?
- Problems outside of the gland
| - Something is wrong with a different gland or organ
68
A deficit of growth hormone causes what disorder?
-Short stature
69
An overproduction of growth hormone causes what disorder?
- Gigantism
| - Acromegaly
70
What causes a deficiency in growth hormone (GH)?
- Pituitary tumor
- Heredity
- Psychosocial (severe neglect or emotional stress)
- Malnutrition (most common)
- Unknown
71
What are the signs and symptoms of growth hormone (GH) deficiency in children?
- Stunted growth
- Slowed sexual maturation
- Possible mental retardation
- Other symptoms depend on other pituitary hormones involved
72
What are the signs and symptoms of growth hormone (GH) deficiency in adults?
- 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
What is the most reliable diagnostic test for determining growth hormone (GH) level?
-Growth Hormone stimulation test
74
What are the therapeutic interventions for growth hormone deficiency?
- Administer synthetic growth hormone (GH)
| - Surgery
75
What is the difference between acromegaly and gigantism?
- Acromegaly occurs in middle-ages adults
| - Gigantism occurs in children
76
What does acromegaly cause? Is the onset of symptoms rapid or slow?
- Overgrowth of soft tissues and certain bones (think width, not length)
- Develops slowly over time
77
What are the signs and symptoms of acromegaly?
- 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
What should be included in the diagnosis of acromegaly?
- Thorough history and physical exam
- Growth hormone levels
- CT or MRI
79
What are the treatment options for acromegaly?
- Treat cause
- Surgery (hypophysectomy)
- Radiation
- Drug therapy
80
Can overgrowth of bones and soft tissues be reversed with treatment or are they permanent?
- Bone overgrowth is permanent
| - Soft tissues can be reversed
81
What is a transsphenoidal hypophysectomy?
- Removing the pituitary gland or tumor through the sinuses
| - Does not affect or harm brain tissue
82
What type of education should be provided to a patient before undergoing a transsphemoidal hypophysectomy?
- 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
What type of education should be provided to a patient after undergoing a transsphemoidal hypophysectomy?
- 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
Do you need an order to remove the nasal packing on a hypophysectomy?
Yes
85
Acromegaly, gigantism, and growth hormone deficiency are all what type of gland disorder?
Anterior Pituitary Gland Disorders
86
Posterior pituitary gland disorders will result in the overproduction or underproduction of what hormone?
Antidiuretic Hormone (ADH)
87
What environment within the body will cause Antidiuretic Hormone (ADH) to be released?
When blood volume (pressure) within the body/vascular system is low
i.e. the patient is dehydrated
88
When will the release of Antidiuretic Hormone (ADH) be inhibited?
When blood volume (pressure) within the body/vascular system is at an appropriate level or high
89
What is the role of Antidiuretic Hormone (ADH) when it is released?
To conserve fluids through the kidneys
90
What is the normal specific gravity of urine?
1.005 to 1.030
91
If specific gravity is low (less than 1.005), what does that tell us?
- The urine is very dilute
| - There is more fluid in the urine than waste/particles
92
If specific gravity is high (greater than 1.030), what does that tell us?
- The urine is very concentrated
| - There is more waste/particles than fluid
93
Low urine osmolality and low specific gravity does what to the urine?
Causes diluted urine
94
High urine osmolality and high specific gravity does what to the urine?
Causes concentrated urine
95
What can cause Diabetes Insipidus (DI)?
- Pituitary tumor
- Head trauma
- Surgery
- Drugs
96
What are the signs and symptoms of Diabetes Insipidus (DI)?
- Polyuria
- Polydipsia (excessive thirst)
- Nocturia
- Elevated serum osmolality
- Dilute urine
- Dehydration
- Hypovolemic shock
- Decreased LOC
- Death
97
What diagnostic tests do you use to determine and monitor Diabetes Insipidus (DI)?
- Urine specific gravity
- Plasma osmolality
- Urine osmolality
- CT or MRI
- Fluid deprivation test
- Glucose test
98
What is a fluid deprivation test?
Restrict fluids for approximately 6 hours and monitor patient urine for continued signs and symptoms of Diabetes Insipidus
99
List nursing management for Diabetes Insipidus (DI).
- 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
What drug can be given to control Diabetes Insipidus (DI)?
- Synthetic Vasopressin (synthetic antidiuretic hormone)
| - Lifelong therapy
101
What does a synthetic vasopressin do? What should you educate the patient about in regards to this drug?
- Decrease urine output
- Concentrate the urine
- Increase in urine specific gravity
- Educate on fluid retention, becoming fluid overloaded
102
What is the most common cause of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
Hormone-secreting tumor (i.e. lung cancer)
103
What population is most at risk for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
Older adults
104
Should you restrict salt in a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? Why or why not?
- No
| - They are at a higher risk for hyponatremia
105
What are the signs and symptoms of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
- 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
What diagnostic tests do you use to determine and monitor Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
- Serum osmolality
- Urine osmolality
- Serum sodium
- ADH levels
- CT scan or MRI
107
List nursing management for Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
- 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
What sign/symptom does Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) have in common?
Patient will present with excessive thirst
109
What is a Goiter?
Enlarged thyroid gland
110
What is the priority nursing concern with a Goiter? What is the primary nursing intervention?
HINT: ABC's
- Concern: Compromised airway (priority)
- Presence of stridor is an emergency
- Interfere with swallowing
- Intervention: Protect the airway (priority)
111
What are the causes of a Goiter? Which is the most common?
- Lack of iodine (most common)
- Overproduction/underproduction of thyroid hormone
- Nodules in the gland
- Thyroid-inhibiting medications
- Thyroiditis
112
What are the signs and symptoms of a Goiter?
- Swelling of thyroid gland
- Feeling of fullness in the neck
- Interfere with swallowing or breathing
113
What are the treatment options for a Goiter?
- Prevent enlargement and protect airway
- Medications
- Surgery
114
What is Thyroiditis? What causes it?
- Inflammation of the thyroid gland
| - Caused by infection (viral or bacterial) or Hashimoto's
115
What is the treatment for infectious thyroiditis?
- Drainage
| - NSAID's, corticosteroids, antibiotics
116
What nursing interventions would you provide for a patient with infectious thyroiditis?
- Steroid education
| - Assess breathing/swallowing
117
What is Hashimoto's thyroiditis? What causes it?
- Autoimmune disorder
- Thyroid tissue is destroyed by antibiotics, causing hypothyroidism
- T3 and T4 levels will be decreased, TSH level will be increased
118
What is the treatment for Hashimoto's thyroiditis?
-Hormone replacement therapy for T3 and T4
119
What nursing care would you provide for a patient with Hashimoto's thyroiditis?
- Educate on signs and symptoms of autoimmune diseases
| - Educate on hormone replacement therapy
120
Patients with Hashimoto's thyroiditis are at an increased risk for what?
Other autoimmune diseases (Addison's disease)
121
What is the basic definition of hypothyroidism? What is the most common cause of hypothyroidism?
- Too little thyroid hormone (T3 and T4)
- Metabolic rate slowed
- Most common cause is iodine deficiency
122
What is the basic definition of hyperthyroidism?
- Too much thyroid hormone (T3 and T4)
- Metabolic rate sped up
- Enhances activity of epinephrine and norepinephrine
123
Describe primary hypothyroidism
- 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
Describe secondary hypothyroidism
- 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
Describe primary hyperthyroidism
- 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
Describe secondary hyperthyroidism
- 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
What are some reasons hypothyroidism may occur?
- Thyroid gland malfunction
- Anterior Pituitary Gland malfunction (TSH secretion insufficient)
- Hashimotos Thyroiditis
- Insufficient iodine in the diet
- Thyroid gland removed
128
List signs and symptoms of hypothyroidism
- Fatigue/Lethargy
- Mental Dullness
- Bradycardia
- Hypoventilation
- Cold intolerance
- Consitpation
- Weight gain
- Dry skin and hair
- Heart failure
- Hyperlipidemia
- Myxedema (Coma)
129
What are some reasons hyperthyroidism may occur? What is the most common cause of hyperthyroidism?
- Graves Disease (most common)
- Goiter
- Thyroiditis
- Thyroid tumor
- Pituitary tumor
- Patients with hypothyroidism who are overmedicated
130
List signs and symptoms of hyperthyroidism
- 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
What medication is given to treat hypothyroidism?
Levothyroxine (Synthroid)
132
How does Levothyroxine (Synthroid) work in the body?
Levothyroxine (Synthroid) is an exogenous hormone
Levothyroxine (Synthroid) is a synthetic preparation of thyroxine (T4)
When in the body, it converts into T3
133
Why is Levothyroxine (Synthroid) given?
- To treat hypothyroidism
| - It is the drug of choice for thyroid hormone replacement
134
What education regarding signs ang symptoms does the nurse need to provide when a patient begins Levothyroxine (Synthroid)?
- 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
What is the drug class of Levothyroxine (Synthroid)?
Thyroid Hormone Replacement
136
What nursing interventions should you implement with hypothyroidism?
- 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
What causes myxedema?
Long-standing (advanced) hypothyroidism
138
What are the signs and symptoms of myxedema?
- Facial puffiness
- Facial and preorbital edema
- Edema of hands and feet
139
Hypothyroidism can progress to what life threatening condition?
Myxedema Coma
140
What is the cause of a myxedema coma?
- Long-standing undiagnosed hypothyroidism
- Infection
- Medications
- Exposure to cold
- Trauma
141
What are the signs and symptoms of a myxedema coma?
HINT: Think hypothyroidism s/sx to a severe state
- Mental sluggishness
- Drowsiness
- Lethargy
- Hypoventilation
- Subnormal temperatures
- Hypotension
- Cardiovascular collapse
142
What nursing management would you want to provide for a patient in a myxedema coma?
- 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
What is the primary nursing concern with hyperthyroidism? What are the therapeutic interventions for hyperthyroidism?
- Concern: Attempt to slow down thyroid
| - Interventions: Antithyroid medication, radioactive iodine therapy, thyroidectomy
144
What is the main problem with antithyroid medications?
They take multiple months to begin working
145
What is radioactive iodine therapy (RAI)? What are some considerations to take regarding care?
- 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
When would a thyroidectomy be necessary? What education should be provided to the patient?
- Patient unresponsive to other treatments
- Present goiter causing tracheal compression
- Patient has thyroid cancer
-Will cause hypothyroidism, must be placed on lifelong Levothyroxine
147
What medications are given to treat hyperthyroidism?
- Methimazole (Tapazole)
| - Propylthiouracil (PTU)
148
Which medication for hyperthyroidism is the first line treatment? What does it do?
- Methimazole
| - Prevents T3 and T4 from being made
149
What education regarding signs and symptoms does the nurse need to provide when a patient begins Methimazole (Tapazole)?
- 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
What is the drug class for Methimazole (Tapazole)?
Thionaminde
151
What nursing care should you provide for a patient with hyperthyroidism?
- 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
What nursing care should you provide for a patient who has undergone a thyroidectomy?
- 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
What is a thyrotoxic crisis/thyroid storm? What causes it?
- Acute, rare condition which increases hyperthyroid conditions
- Life-threatening, EMERGENCY!
- Caused by stress, thyroid surgery, or withdrawal of anti-thyroid medications
154
What are the signs and symptoms of a thyroid storm?
- Tachycardia
- Extreme hypertension
- Heart failure
- Shock
- Hyperthermia
- Seizures
- Nausea/Vomiting/Diarrhea
- Apprehension/Restlessness
- Delirium
- Coma
155
What is the primary nursing concern with a thyroid storm? What are the therapeutic interventions for thyroid storm?
- Concern: Manage signs and symptoms
| - Interventions: Beta blockers, cooling blanket, fluid replacement, elevate HOB, apply O2, give anti-thyroid medication
156
What is hyperparathyroidism? What causes hyperparathyroidism?
- 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
What are the signs and symptoms of hyperparathyroidism?
HINT: Think hypercalcemia
- 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
What are patients at risk for with hyperparathyroidism?
- Injury!
| - Want to prevent falls
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What is the treatment for hyperparathyroidism?
- Remove it! (Parathyroidectomy)
- Medication to lower calcium
- Weight-being exercise
- High fluid intake
- Moderate calcium diet
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What is the main concern for a patient who has had a parathyroidectomy? What is the treatment for these patients?
- Laryngospasms (can cause stridor, blocks the airway)
- Seizures (due to drop in calcium levels)
- Administer IV calcium
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A sudden decrease in serum calcium levels can cause what?
- Tetany!
- Tingling of lips/hands/tongue, stiffness in extremities
- Laryngospasms (compromises airway)
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What are the long term goals of patients with hypoparathyroidism?
- 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
