Exam 2 Flashcards
A nurse is caring for a client following a transsphenoidal hypophysectomy. The nurse notices a large area of clear drainage seeping from the nasal packing, what should the nurse do?
check the drainage for glucose (this would indicate a CSF leakage)
A client reports experiencing a tingling sensation in the hands, soles of feet, and around the lips 1 day after a subtotal thyroidectomy. What should the nurse assess the patient for?
Chvostek’s sign (assess for hypocalcemia, a potential complication of subtotal thyroidectomy)
How can we assess for Chvostek’s sign?
tap face just below and in front of ear; positive sign would be twitching of facial muscles causes by neuromuscular excitability due to hypocalcemia
Which thyroid abnormality may cause frequent mood changes?
hyperthyroidism (they often can’t sit still)
How would a client appear during a myxedema coma (severe hypothyroidism)?
non-pitting edema everywhere, especially eyes, hands, and feet
+ bradycardia, constipation, and cold intolerance
What will TSH do in a client that has primary hypothyroidism?
it will be elevated
what s/s would be expected in a patient that developed thyrotoxicosis following taking too much levothyroxine?
heat intolerance, sweating, and hyperthermia
what are key manifestations of thyroid storm?
fever, tachycardia, and systolic hypertension
others: abdominal pain, n/v/d, anxiety, restlessness, tremors, confusion, dysrhythmias, and seizures
What are the lab findings in primary hyperparathyroidism?
increased magnesium, calcium, and PTH
- decreased phosphorus
What manifestations may be expected for a client with acromegaly?
loss of color discrimination( visual changes), coarse facial features, enlarged distal extremities, and hepatomegaly
why may a client with hypoparathyroidism experience numbness and tingling in hands and feet?
due to hypocalcemia caused by insufficient PTH
Why should a client’s voice be checked every 2 hrs following a thyroidectomy?
to monitor for hoarseness, a sign of laryngeal nerve damage
How often should a client deep breathe following a thyroidectomy to prevent atelectasis?
30 min - 1 hr
Which gland is responsible for the production of ADH (regulates fluid volume) and oxytocin (stimulates uterine contractions)?
hypothalamus
How may shock cause hypopituitarism?
- 4 steps
- hypotension causes decreased perfusion to pituitary gland
- lack of blood flow causes hypoxia
- infarction may occur
- result is reduction of hormone secretion
What assessment findings may be present in an individual experiencing decreased growth hormone secretion due to a pituitary tumor (hypopituitarism)?
- children - shorter stature
- adults - decrease bone density/muscle strength and increases risk for fractures
What symptoms may be seen with insufficient ACTH secretion (hypopituitarism)?
low cortisol, causing anorexia, decrease body hair, headache, hypoglycemia, hyponatremia, and postural hypotension
Following head trauma a patient has been experiencing cold intolerance, lethargy, weight gain, and slow cognition, what should the nurse suspect this patient is experiencing?
hypopituitarism resulting in insufficient thyroid (TSH) hormone
Which medication may be prescribed to a patient with decreased growth hormone r/t hypopituitarism?
somatropin
If a patient develops an adenoma (benign tumor) on the anterior pituitary gland that produces growth hormone, what condition are they at risk for developing?
acromegaly
Why my a patient with acromegaly experience visual/mental alterations?
(vision changes, headaches, neurologic dysfunction, increased ICP)
if it is caused by a pituitary adenoma, the growth can compress the surrounding brain tissue, including the centers for vision.
What type of surgical intervention is indicated for hyperpituitarism (ex. acromegaly)?
hypophysectomy (trans-nasally or transsphenoidal)
What type of DM is caused by no insulin production by the beta cells of the pancreatic islet cells of Langerhans?
Type 1
What type of DM is characterized by insulin resistance?
Type 2 DM
What are some complications of diabetes mellitus?
Blindness (from retinopathy) , impaired blood vessels (from prolonged hyperglycemia) causes delayed wound healing and increases risk of infection, neuropathy which can result in gangrene, osteomyelitis, and amputation. Diabetic Ketoacidosis can result from prolonged hyperglycemia and no insulin.
What are the manifestations of hypoparathyroidism?
hypocalcemia (Chvosteks and Trosseaus), patchy hair loss, fatigue, abdominal cramping, and memory loss
What are the manifestations of hyperparathyroidism?
hypercalcemia, kidney stones, osteoporosis (pathologic fractures), polyuria, constipation, bone pain, and vomiting
What are the manifestations of Cushings Syndrome?
obesity (especially in trunk), “moon face,” “buffalo hump,” thin arms and legs, purple striae, weak muscles, acne, psychosis
What are the manifestations of hypothyroidism?
sluggishness, weight gain, depression, constipation, facial edema, hypotension, goiter
What happens to T3, T4 and TSH in hypothyroidism?
increased TSH (thyroid stimulating hormone), and decrease T3 and T4
What are the manifestations of hyperthyroidism?
everything speeds up (weight loss, thyroid storm, goiter, diarrhea, hypertension, exophthalmos, tremor)
What is thyroid storm?
complication of hyperthyroidism characterized by high temp, hypertension, and arrythmia caused by heart working too fast; can lead to heart attack
What happens to TSH, T3 and T4 during hyperthyroidism?
decreased TSH and increased T3 & T4
Which autoimmune condition is characterized by deficient adrenal cortex hormones?
(anterior pituitary gland doesn’t produce enough ACTH/adrenocorticotropic hormone, causing insufficient production of corticosteroids by adrenal cortex)
Addison’s Disease
What is acromegaly and what causes it?
increased GH (growth hormone) in adults; can be caused by pituitary tumor (adenoma)
What is metabolic syndrome and what does it increase the risk for?
large waist, hyperglycemia, high b.p., hypercholesterolemia; type 2 diabetes
Which hormone is produced by the alpha cells of the pancreas to prevent hypoglycemia?
glucagon
Which condition is characterized by a compensatory mechanism of rapid and deep breathing to correct metabolic acidosis?
DKA
What type of diabetes is described?
- Insulin deficiency
- Age of diagnosis usually <30 years old
- S/S: polyuria, polydipsia,
polyphagia
- Can be triggered by viral
infection
Type 1 DM
With which type of diabetes may patients have no symptoms, but they may have thirst,
fatigue, blurred vision,
vascular/neuro changes, characterized by adult onset, and the body is insulin resistant?
type 2 DM
A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which intervention should the nurse include?
observe the dressing drainage for the presence of glucose
What is expected lab finding in Graves disease?
decreased TSH
which finding should the nurse include in the client teaching about manifestations of hyperthyroidism?
heat intolerance, palpitations, weight loss
If a client were to receive propranolol to aid the treatment of Graves disease, what teaching should the nurse include?
take your pulse before each dose
What equipment should the nurse ensure that is available near a patient who is post-op following a thyroidectomy?
suction equipment, humidified oxygen, and tracheostomy tray
What patient teaching should the nurse provide about methimazole to a patient with Grave’s?
- monitor CBC
- monitor T3
- take the medication at the same time everyday
What findings are indicative of a patient experiencing a thyroid crisis following a thyroidectomy?
- dyspnea
- abdominal pain
- mental confusion
what lab finding is expected for a client with secondary hypothyroidism?
decreased T3 and T4
decreased TSH
What findings are expected in a client who has hypothyroidism?
menorrhagia, dry skin, hoarseness
what teaching should be provided for a patient receiving levothyroxine?
- medication should not be discontinued without provider instruction
- follow-up TSH should be obtained
- take on empty stomach
- weight loss is expected
What may indicate a decrease need of levothyroxine?
hand tremors, tachycardia
what does Cushings put clients at an increased risk for developing?
infection
gastric ulcer
bone fractures
what actions should the nurse perform for a client who has myxedema coma?
- observe cardiac monitor for dysrhythmia
-observe for uti (this may have caused myxedema)
-give 0.9 % IV - levothyroxine IV bolus
What would be a priority assessment finding during shift change for a client who has Cushing’s disease?
weight gain (fluid retention - pulmonary edema, HTN, and heart failure)
What are expected lab findings for Cushings disease?
hypernatremia, hypokalemia, hypocalcemia, elevated fasting glucose
Why should clients eat a high fiber diet following a hypophysectomy?
prevent straining from constipation because this may increase ICP
What is a normal value A1C?
4-5.7%
What is indicated by an A1C value between 5.7 and 6.4%?
prediabetic
What A1C value meets the criteria for a patient to be diabetic?
> or = 6.5 %
What range of fasting glucose falls WDL?
74-100 mg/dL
What fasting glucose range is considered prediabetic?
100-125 mg/dL
what is indicated by a fasting BG of > 126?
diagnosis of diabetes
what is an expected range for a glucose tolerance test for an individual who does not have diabetes?
< 140
140-199 is the reference range for which diagnosis in a glucose tolerance test?
prediabetes
What is the expected value that a diabetic would have during a glucose tolerance test?
> or = 200
lispro, aspart, and glulisine are all rapid acting insulins. How soon after the administration of these insulins should patients eat?
within 10 mins
How soon after the administration of regular insulin should an individual eat a meal?
within 30 mins
When is the peak for intermediate insulin (NPH)?
6-14 hrs
What type of insulins do not have a peak?
long acting (detemir and glargine)
What are the criteria for metabolic syndrome?
- abdominal obesity, hyperglycemia (fasting glucose), HTN, and hyperlipidemia
What is considered abdominal obesity?
males > 40 in
female > 35 in
what fasting BG meets the criteria for metabolic syndrome?
> 100
What is the criteria for HTN in metabolic syndrome?
systolic > 140 or diastolic >90
What does a triglyceride level of 165 indicate in the criteria for metabolic syndrome?
this is considered hyperlipidemia (>150 meets metabolic syndrome criteria)
Where is the goal to maintain a hospitalized diabetics BG?
140-180
What hormones are secreted by the anterior pituitary gland?
TSH, ACTH, LH, FSH, prolactin, and GH
What gland secretes ADH and oxytocin?
posterior pituitary gland
Which portion of the adrenal gland is responsible for the secretion of cortisol and aldosterone?
cortex
What is secreted by the medulla of the adrenal gland?
catecholamines (epinephrine and norepinephrine)
what are examples of 15 g carbohydrate snacks?
- 1 cup milk
- 1 slice of bread
- 1/3 cup sugar free yogurt
- 1/2 cup regular ice cream
What are some practical tips for reducing the risk of complications of DM?
- reduce cholesterol and saturated fat intake
- increase physical activity and daily exercise
- smoking cessation
- optimal BP (prevent kidney damage)
what is expected if a patient is found in bed with sweating, tachycardia, tremors, palpitations, hunger and anxiety?
hypoglycemia
What interventions are expected for a type 1 diabetic pt with hyperglycemia, hyperkalemia, fruity breath, very high BG, and is hypotensive?
- urinalysis (ketones)
- ABG (metabolic acidosis)
- potassium every 2 hr
- 0.9 NS (hypotension)
- capillary BG every hr
What should the nurse say to a client who asks “why did i develop type 2 DM?”
“your body has insulin resistance and decreased insulin secretion”
What is the goal HGB A1C for a client who already has a diagnosis of DM?
< or = 6.5 %
What happens to the muscles in hypoparathyroidism?
excessive contractions
Bromocriptine mesylate, cabergoline, somatostatin, and pegvisomant are medication used to treat which condition?
increased growth hormone (acromegaly) caused by hyperpituitarism
Which endocrine disorder causes acromegaly and Cushing’s?
hyperpituitarism
- cushings - increase ACTH
- acromegaly - increased GH
Why does CKD cause hyperparathyroidism?
- kidney dysfunction causes decrease calcium absorption
- parathyroid gland tries to compensate for hypocalcemia by increasing PTH secretion
- this is hyperparathyroidism
How does vitamin D deficiency cause hyperparathyroidism?
- lack of vitamin D causes decreased calcium absorption
- parathyroid gland attempts to compensate by releasing PTH
- this leads to hyperparathyroidism
what is important for administration of glucagon?
lay on left side (vomiting) and have suction available (prevent aspiration)
