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Med Surg Test 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What hormones are secreted by the thyroid gland?

A

Follicular cells secrete T3 & T4

Parafollicular cells secrete thyrocalcitonin

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2
Q

What are the functions of thyrocalcitonin?

A

maintain calcium deposits in bone
decreases intestinal absorption of CA++
decreases Ca++ & PO4- reabsorption in kidneys

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3
Q

How are levels of thyroid hormone regulated?

A

negative feedback loop

levels of T3 and T4 in blood are monitored by pituitary gland and hypothalamus (they release TSH and TRH respectively)

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4
Q

3 examples of hyperthyroidism

A

Grave’s Disease
Nodular Thyroid Disease
Toxic Nodular Goiter

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5
Q

What is most common cause of hyperthyroidism?

A

Grave’s Disease

75% of cases

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6
Q

What cause Grave’s disease

A

autoimmune

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7
Q

What is nodular thyroid disease?

A

multiple/singular autonomously functioning nodules, can be benign of malignant, usually develop in 6th or 7th decade of life

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8
Q

What is toxic nodular goiter?

A

usually benign; caused by over-medication of exogenous hormone

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9
Q

Why should the thyroid gland not be over palpated?

A

thyroid gland is highly vascular and palpation can increase the release of thyroid hormone

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10
Q

What are clinical signs of hyperthyroidism?

A 
fatigue
goiter, hypertrophy of thyroid gland
tremors
irritability
heat intolerance; flushed moist skin
increased appetite
oily hair and skin
diarrhea
increased heart rate and palpitations
exopthalmos (eyes bulge)--impaired venous drainage-edema; deposition of excess tissue pushes eyes forward
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11
Q

diagnosing hyperthyroidism

A

Decreased TSH levels
Increase in free T4 levels
Radioactive Iodine Uptake Test

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12
Q

What must you consider when treating a geriatric hyperthyroid patient?

A

other medications may need to be adjusted due to increased metabolism
you must watch medications when treating thyroid conditions due to changes in metabolism

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13
Q

Pharmacotherapy for Hyperthyroidism

A

PTU (propylthiouracil)
Tapazole (methimazole)
take 4-8 weeks

Large doses of iodine for 1-2 weeks–decrease vascularity and size of gland

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14
Q

Irradiation–RAI (radioactive iodine)

A

treatment for hyperthyroidism
effect not evident for 2-3 months
hypothyroidism is common complication

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15
Q

Nursing care for hyperthyroidism

A

monitor cardiac function (beta-blockers to calm heart)
low fiber diet with increased caloric intake
protect eyes and keep them moist (may need to tape them at night)
cool, quiet environment

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16
Q

Nursing interventions for surgery for hyperthyroidism

A

Pre-treat with anti-thyroid medications–get patient to euthyroid state
Post-operative–observe for thyrotoxic crisis (cutting into thyroid can send a rush of thyroid hormone into circulation due to the thyroid’s high vascularity)
respiratory management–trachea is there
observe for signs and symptoms of hypocalcemia (parathyroid may have been taken too)
head alignment
bleeding at site (check behind neck)
damage to laryngeal nerve % parathyroid gland
avoid goitrogens–thyroid inhibiting substances (drugs and foods–gluten, soy, cruciferous vegetables)

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17
Q

causes of thyrotoxic crisis

A

precipitated by stress (infection, trauma, surgery) in partially controlled or untreated patients

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18
Q

signs and symptoms of thyrotoxic crisis

A

temperature of 102-106
heart rate > 130
nausea, vomiting, diarrhea
delirium–coma

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19
Q

treatment of thyrotoxic crisis

A

anti-thyroid hormone
manage by lowering temperature and supporting high metabolic demand
do not give aspirin

20
Q

Why should a patient in thyrotoxic crisis not be given aspirin?

A

aspiring displaces thyroid hormone from protein binding sites (watch combination drugs)

21
Q

hypothyroidism

A

slowly progressing autoimmune disease
it can be treatment related or from goitrogens (thyroid inhibitors–drugs and foods that contain thyroid inhibiting substances)

22
Q

primary hypothyroidism

A

hypothyroidism related to thyroid dysfunction

23
Q

secondary hypothyroidism

A

hypothyroidism related to pituitary or hypothalamic dysfunction

24
Q

myxedema coma

A

severe hypothyroidism

accumulation of hydrophilic mucopolysaccharides in the dermis; atherosclerosis (no angina due to decreased metabolic demand)

25
Q

diagnosis of hypothyroidism

A

Increased TSH (problem with thyroid)
Decreased TSH problem in anterior pituitary or hypothalamus
decrease T4

mush find origin of problem–inject TRH; if there is increased TSH, the problem is in the hypothalamus; if there is no change, the problem is with the anterior pituitary

assess serum ferritin levels–iron is required to make thyroid hormone

26
Q

clinical manifestations of hypothyroidism

A

varies–look at the individual–could range from no symptoms to systemic manifestations
onset is insidious–month to years
severity of symptoms depends on degree of deficient

Long term hypothyroidism effects can include neurologic, cardiovascular (atherosclerosis), GI, reproductive and hematologic (anemia)

fatigue, lethargy, impaired memory
expressionless face; apathy
slow speech; husky voice
dry hair and skin; alopecia (hair loss), brittle nails
intolerance to cold
achlorhydria (low HCl in stomach); constipation
edema, weight gain
decreased libido
enlargement of hands and feet
menstrual disturbances
27
Q

clinical manifestations of myxedema coma

A

lethargic
confusion progressing to unresponsiveness
decreased temperature, blood pressure and respirations

28
Q

causes of myxedema coma

A

cold, trauma, infection, drugs, stress

29
Q

management of hypothyroidism

A 
life-time drug replacement therapy
Synthroid (T4 only; must be able to convert to T3)
Liotrix T3 & T4 at 1:4 ratio
Liothyrinine T3
Armour thyroid
30
Q

nursing concerns for hypothyroidism

A 
altered health maintenance
knowledge deficit regarding medications
activity intolerance
altered body temperature
alterations in bowel elimination: constipation
31
Q

acute thyroiditis

A

bacterial infection causing extreme pain, enlarged thyroid, dysphagia

32
Q

acute thyroiditis treatment

A

antibiotics, surgical drain
may give aspirin if there are no signs of hyperthyroidism
NSAIDS and steroids if no response to other drugs within 50 hours

33
Q

sub-acute thyroiditis

A

thyroiditis that is usually preceded by viral infection

symptoms include fever, malaise, and firm and painful thyroid gland

34
Q

sub-acute thyroiditis treatment

A

can only treat the symptoms

35
Q

silent painless thyroiditis

A

form of lymphocytic thyroiditis with variable onset that occurs post-partum and resolves in 3-12 months

may progress to Hashimoto’s

36
Q

Hashimoto’s thyroiditis (chronic)

A

autoimmune condition where thyroid gland is replaced with lymphocytes and fibrous tissue

gradual enlargement of gland and decrease in T3 and T4

there is a feeling of pressure, fever, but no pain AB present

if left untreated may progress to hypothyroidism

37
Q

control of parathyroid glands

A

responds to serum Ca++ levels; a decrease in Ca++ and Magnesium triggers an increase in PTH release; an increase in active Vitamin D causes decrease in PTH

38
Q

function of parathyroid hormone

A

increase of CA++ absorption from kidneys, intestine and bone

increase bone resorption–breaking down bone
stimulates renal conversion of vitamin D to active form
stimulates renal absorption of Ca++ and decrease absorption of phosphorus

39
Q

hyperparathyroidism

A

over-secretion of PTH–hypercalcemia

40
Q

primary hyperparathyroidism

A

tumor in gland; benign adenoma

41
Q

secondary hyperparathyroidism

A

response to hypocalcemia–Vitamin D deficiency, chronic renal failure, malabsorption, hyperphosphatemia

42
Q

tertiary hyperparathyroidism

A

autonomous secretion of PTH–hyperplasia (increase in number of cells) of gland with loss of negative feedback from circulating Ca++ levels

43
Q

diagnoses of hyperparathyroidism

A

increase in PTH
Serum Ca++ levels > 10 mg; phosphorus < 3 mg
Increased urinary Ca++
Increased uric acid
Increased creatinine
Increase amylase (if pancreastitis)
increased alkaline phosphatase (if bone disease)

44
Q

clinical manifestations of hyperparathyroidism

A 
reflective of hypercalcemia and hypophosphatemia
weakness
loss of appetite
constipation
increased need for sleep
emotional disorders; shortened attention span
osteoporosis; fractures
kidney stones
45
Q

medical management of hyperparathyroidism

A

for mild symptoms–increase fluids and give phosphate

for tumors–partial or complete gland removal–auto-transplantation of parathyroid tissue into forearm or sternocleidomastoid muscle

pharmacology
anti-hypercalcemic agent–Pilcamycid which prevents RNA synthesis in osteoclasts
calcium-mimetic agents–Sensipar which increase sensitivity of Ca++ receptors on parathyroid glands

46
Q

nursing management of hyperparathyroidism

A

increase mobility to increase bone density
observe for signs and symptoms of tetany post-op due to low levels of calcium
observe for tingling around mouth and hands
observe for Chvostek’s & Trousseau’s Signs
have IV Calcium gluconate available
teach signs and symptoms of hypocalcemia verses hypercalcemia
may need to take Ca++ supplements for life in auto-transplantation fails or is not done

Med Surg Test 3 (3 decks)

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