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Complex DMR > Endocrine/Thyroid, DM, adrenal dysfunction > Flashcards

Endocrine/Thyroid, DM, adrenal dysfunction Flashcards

1
Q

Normal process of Thyroid hormone release

A 
1. Hypothalamus
releases
thyrotropin releasing hormone
(TRH) to anterior
pituitary
2.Anterior pituitary
releases thyroid stimulating
hormone (TSH) to
thyroid gland
3.Thyroid secretes
thyroid hormones
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2
Q

T3

A

Increases metabolic rate

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3
Q

T4

A

Increases cellular response to catecholamines

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4
Q

Thyrocalcitonin

A

Decreases breakdown of bone and
decreases reabsorption of calcium in the intestines and
kidneys (↓Ca++)

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5
Q

Causes of hypothyroidism

A 
• Disorders of hypothalamus or
anterior pituitary
• Autoimmune disease
– Hashimoto’s thyroiditis
• Hyperthyroidism treatment
– Thyroidectomy, radioactive iodine
therapy
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6
Q

Causes of hyperthyroidism

A

• Autoimmune disease

̶ Graves’ disease

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7
Q

Clinical manifestations Hypothyroidism (mental status?, weight, GI, appetite, sensitivities, HR, skin)

A

-Sluggish mental & physical activity
- Weight gain
- Decreased GI motility
- Decreased appetite
- Cold sensitivity
- Bradycardia
- Coarse, dry (not fragile) skin
- Goiter
- Decreased fertility/menstrual
irregularities

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8
Q

Clinical manifestations Hyperthyroidism (mental status?, weight, GI, appetite, sensitivities, HR, skin)

A 
-Tachycardia, hypertension
• Nervousness, excitability
• Increased gastric activity
• Increased appetite
• Weight loss
• Heat intolerance
• Insomnia
• Decreased fertility/menstrual
irregularities
• Exophthalmos/goiter
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9
Q

Hypothyroid management Diagnosis labs

A
  • Elevated TSH

* Decreased T3, T4

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10
Q

Treatment of hypothyroid

A

• Thyroid hormone replacement (levothyroxine)

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11
Q

Levothyroxine safety/drug metabolism

A

Safety – Drug metabolism
• Decreased metabolism of sedatives, hypnotics or narcotics
• Decrease dose or frequency

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12
Q

Hypothyroid nursing actions/interventions

A
  • Administer medication in AM
  • Be mindful of drug metabolism (i.e. narcotics and sedatives)
  • Warming blankets
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13
Q

Complication of hypothyroidism:

Myxedema Coma

A

• Profound decrease in cellular metabolism
– Hypoventilation → Hypoxia and CO2 retention
– Fluid and electrolyte imbalance
– Hypothermia
– Decreased cardiac function → Bradycardia and hypotension
– Hypoglycemia
– Hyponatremia

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14
Q

Myxedema Coma treatment

A

• Treatment – Replace thyroid hormone, supportive care

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15
Q

Hyperthyroid Diagnosis

A

• Decreased TSH, Increased T3, T4

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16
Q

Hyperthyroid treatment

A

Treatment
• Symptom management (fluid replacement, beta blockers)
• Medical
– Propylthiouracil (PTU), methimazole (Tapazole), lithium carbonate (Lithonate)
• Radioactive iodine
• Surgical
– Total or subtotal thyroidectomy

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17
Q

Thyroidectomy Preoperative considerations

A

Antithyroid medications and/or beta blockers
• Potassium iodide
• Vitamin D and calcium

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18
Q

Thyroidectomy postoperative care

A
  • Pain control
  • Thyroid hormone supplementation
  • Calcium management
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19
Q

What is a complication of thyroidectomy and why does this happen

A

Hypocalcemia – Complication of thyroidectomy
• Parathyroid damage during surgery
– Surgical damage, devascularization
• Appears within 48 hours, resolves within a few months

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20
Q

What is done to treat preThyroidectomy complication

A

Calcium given pre-procedure
► Calcium levels checked routinely post procedure and Ca
replaced
• May need exogenous calcitrol for Ca absorption if PTH levels are also
low
► S/s hypocalcemia

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21
Q

Hyperthyroid Assessment

A 
Vital signs
• Intake and output
• Eyes and vision
• Thyroid hormone levels
• Seizures
• Daily weight
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22
Q

Thyroid storm symptoms

A

Tachycardia, fever, systolic hypertension, abdominal pain, tremors,
changes in level of consciousness

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23
Q

Treatment of thyroid storm

A

Treatment
• Supportive care – i.e. Airway, pulse rate and blood pressure
management
• Fluid resuscitation
• Glucocorticoids
• Anti-thyroid meds once the pt’s symptoms stabilize

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24
Q

What is Diabetes insipidus

A

Decreased secretion of antidiuretic hormone (ADH) from

posterior pituitary r/t hypothalamus damage

25
Q

Diabetes insipidus causes

A

30% idiopathic (usually autoimmune)
• 25% brain tumor
• 20% intracranial surgery
• 16% head trauma

26
Q

What happens in the body to lead to DI

A 
1. Decrease in ADH
production
2. Collecting ducts in
kidney less
permeable to
water
3. Excretion of large
volumes of very
dilute urine
27
Q

Clinical symptoms of Diabetes insipidus

A 
R/t extreme water loss
• Polyuria, polydipsia, nocturia
• Hemoconcentration
– Elevated Na+ and hematocrit
• Hypotension and tachycardia
28
Q

Diagnosis of DI

A

Serum osmolality > urine osmolality
• Concentrated blood, dilute urine
H&H, BMP
MRI (determine cause)

29
Q

What meds are given for management of DI

A 
Hypotonic fluid (D5)
• Glucose control

Gentle correction of hypernatremia

Desmopressin DDAVP
• Synthetic ADH
• Subcutaneous, intranasal, PO

30
Q

Nursing interventions for DI

A

Maintain IV access
• Administer IVF and medications
• Provide mouth care

31
Q

What are the adrenal glands important for?

A 
Glucocorticoids (cortisol)
Mineralocorticoids: Aldosterone
Other hormones/NT
Sex hormones: Androgens and estrogens 
Epi/Norepi
32
Q

What is cortisol used for?

A

Carb, fat and protein metabolism; Suppression of immune response, control of stress response

33
Q

What regulates mineral corticoids

A

RAAS system

34
Q

Adrenal insufficiency (types)

A

Primary: destruction of adrenal gland can be due to autoimmune disorder or infection
Secondary: Decreased secretion of ACTH from anterior pit
Tertiary: dysfunction of hypothalamus

35
Q

Adrenal hyperfunction

A

Cushings syndrome

36
Q

S/s of adrenal insufficiency r/t cortisol

What is it associated with and when do they present

A 
Addisons disease
Present 90% is non functional 
Dec Cortisone/aldosterone 
C-Hypoglycemia
C-weakness
C-weight loss 
C-fatigue
C-mental health s/s (dep)
37
Q

S/s adrenal Hyper function r/t cortisol

A 
Cushings 
C-Hyperglycemia
C-Abnormal fat distribution
C-High protein metabolism=dec muscle mass
C-Increase susceptibility to infection (suppressed immune response)
C-Thin, friable skin
C-Mental health s/s 
Virilization in F
38
Q

S/s of adrenal insufficiency r/t aldosterone.

A

A-Dehydration
A-Hypotension
A-Hyperkalemia

39
Q

S/s of adrenal insufficiency not r/t cor or aldosterone.

A

Hyperpigmentation

Decreased pubic hair

40
Q

S/s adrenal Hyper function r/t Aldosterone

A

A-Fluid retention HTN
A-Sodium retention
A-Hypokalemia

41
Q

S/s of adrenal hyperfunction not r/t cor or aldosterone.

A

Virilization in F

42
Q

Adrenal insufficiency, what is the greatest cause and what goes wrong

A

Addisons disease, nonspecific autoimmune destruction of adrenal gland.
or abrupt discontinuation of corticosteroids

43
Q

Diagnosis of adrenal insufficiency

A

Cortisol levels -Drawn first thing in the AM (body produces more cortisol to help us wake up)
Less than 3mcg/dL=adrenal insufficiency
CT or MRI of adrenal gland
Shrinking of adrenal gland = autoimmune destruction
Enlarged gland= infectious process (inflammation)

44
Q

Management of Adrenal insufficiency

A

Replace coritsol (hydrocortisone/dexamethasone)
IV fluids
Treat hyperkalemia

45
Q

Assessments of Adrenal insufficiency (vitals)

A

Hypotension & tachycardia risk due to dehydration

46
Q

Assessments of Adrenal insufficiency I&O

A

Fluid recussestation

47
Q

lab Assessments of Adrenal insufficiency

A

Na, K, Glucose, Hct, cortisol

48
Q

Nursing intervention of adrenal insufficiency

A 
IV access, admin meds
safety precautions (postural hypotension)
49
Q

Adrenal crisis clinical manifestation

A

Hypotension unresponsive to fluid resuscitation or vasoactives (septic likely to present with this)

50
Q

Treatment of Adrenal crisis

A

200-300 mg hydrocortisone IVP daily in divided doses

Taper once serum lactate has normalized

51
Q

Hypercortisolism

A

excessive secretion of glucorticoids

52
Q

Hyperaldosteronism

A

Excessive secretion of aldosterone

53
Q

Causes of adrenal hyperfunction

A

70% caused by anterior pituitary tumor
15% causes by tumor of adrenal cortex
15% caused by ectopic tumors

54
Q

Adrenal hyperfunction diagnosis

A

Lab values: Cortisol levels, electrolytes, glucose, dexamethasone suppression test (Dexamethasone before bed, cortisol level drawn in AM, if high =Cushings)

55
Q

Hyperaldosteronism medical management

A

Potassium sparing diuretic (spironolactone)

secretes NA+ and water while preserving K+

56
Q

Hypercortisolism medical management

A

Ketoconazole, pasireotide
Decreases cortisol secretion
Surgery
Radiation

57
Q

Adrenal hyperfunction what should nurse assess for

A

Vitals: HTN
Weight fat muscle distribution
I&O
Skin, wound healing (thin frible skin)

58
Q

Adrenal hyperfunction what labs should nurse assess

A

Glucose potassium sodium

59
Q

Adrenal hyperfunction what should nurse

A

Med mngment
HOB elevated
Meticulous skin care (extra thin)
Turn/reposition

Complex DMR (12 decks)

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