Exam 2 Flashcards
1
Q
Role of hypothalamus
A
Release and stimulate hormones
No direct effect on the body
2
Q
Releasing hormones
A
Adrenocortiocotropic hormone
Thyroid stimulating hormone
3
Q
What releases parathormone (parathyroid hormone)
A
Parathyroid gland
4
Q
What does parathormone do
A
Pulls calcium out of bones to increase serum calcium
Decreases phosphorus levels
5
Q
What is the effect of hyperfunction of parathyroid
A
Hypercalcemia
6
Q
What is the effect of hypofunction of the parathyroid
A
Hypocalcemia
7
Q
Hyperparathyroidism
A
Increase in serum calcium
Bones turn to swiss cheese
8
Q
Hyperparathyroidism risk factors
A
2-4x more in women, 60-70 yrs old
9
Q
Hyperparathyroidism s/sx
A
Apathy, fatigue, muscle weakness
Loss of appetite
Constipation
Hypertension, cardiac dysrhythmias
10
Q
Hyperparathyroidism complications
A
Osteoporosis
Skeletal pain and pathologic fractures
Kidney stones
11
Q
How to dx hyperparathyroidism
A
Elevated calcium and increase parathormone levels
Pathologic bone changes on x-ray
12
Q
Treatment for hyperparathyroidism
A
Laparoscopic removal of parathyroid gland
- For asymptomatic pts under 50, unlikely to follow up, calcium over 11, high urine calcium, or low bone density
13
Q
Medications for hyperparathyroid
A
Calcitonin and corticosteroids
- Reduces serum calcium and increases calcium deposit in bones
14
Q
Education/management of hyperparathyroidism
A
Hydration - 2+L/day
Encourage mobility (bone density)
Maintain dietary intake of calcium
Stool softeners
15
Q
What to monitor post-op parathyroidectomy
A
Monitor Chvostek and Trousseau’s sign
- Looking for rebound hypocalcemia
16
Q
Serious complication of hyperparathyroid
A
Hypercalcemic crisis
17
Q
Hypercalcemic crisis s/sx
A
Neurologic, cardiovascular, and kidney symptoms
- Can be life threatening
18
Q
Hypercalcemia crisis or hyperparathyroid tx
A
Rapid rehydration with large volumes of IV isotonic saline fluids
Calcitonin + corticosteroids to reduce serum calcium by increasing calcium deposition in bone
19
Q
Causes for hypoparathyroid
A
Abnormal parathyroid development
Destruction of parathyroid gland (surgical or autoimmune)
Vit D deficiency
20
Q
Hypoparathyroid s/sx
A
Tetany, numbness, tingling in extremities, stiffness of hands and feet
Bronchospasm, laryngeal spasm, carpopedal spasm
Anxiety, irritability, depression, delirium
ECG changes
21
Q
Tx goal for hypoparathyroid
A
Increase serum calcium to 9-10 mg/dL
22
Q
Tx for hypoparathyroid
A
Calcium gluconate IV - acute episodes
Pentobarbital - decreases neuromuscular irritability and tetany
Vitamin D
23
Q
Hypoparathyroidism nursing education/considerations
A
Maintain cardiac monitoring
Monitor respiratory status
Quiet environment, soft lights
High calcium, low phosphorus diet
24
Q
What hormones do the thyroid gland secrete
A
T3 and T4
25
What does T3 and T4 do
Regulates metabolism
Controls cell growth
Regulates basal metabolic rate, oxygen consumption, and glucose consumption
26
What stimulates hormones release from the thyroid
Pituitary gland releases thyroid stimulating hormone
27
What does TSH (thyroid stimulating hormone) do
Releases T3
Synthesis of T4 in liver
28
What do thyroid hormones require to be made
Iodine is needed for synthesis
29
Purpose of T3
Regulates metabolism
30
Purpose of T4
Steady state metabolism
Organ function, BMR, cholesterol, thermoregulation
31
**Goiter**
Enlarged thyroid
Caused by low iodine
32
**What can a goiter lead to**
Hypo or hyperthyroidism
33
**Dx tests for thyroid**
Primary screening of TSH
Serum T3/T4
Thyroid antibodies
Iodine uptake test
Thyroid biopsy
Thyroid scan
34
**What leads to thyroid hyposecretion**
Elevated TSH + decreased T3/T4
35
**What leads to thyroid hypersecretion**
Decreased TSH + increased T3/T4
36
Thyroiditis
Inflammation of thyroid gland
37
What is the effect of thyroiditis on thyroid hormones
Increased TSH and decreased T3/T4
Decreased function of thyroid gland
38
Is hypo or hyperthyroidism more common
95% of cases are d/t primary thyroid dysfunction
39
Cretinism
Congenital hypothyroid
40
Hasimotos Thyroiditis
Immune system (autoimmune) attacks thyroid
Leads to hypothyroidism
41
Most common population for Hashimotos Thyroiditis
Women 40-70
42
**Hypothyroid s/sx**
Extreme fatigue
Hair loss, brittle nails, dry skin
Numbness of fingers
Weight gain
Personality changes
43
**What V/S changes can happen with severe hypothyroidism**
Decreased pulse
Temperature changes
44
Myxedema coma s/sx
Depression, lethargy, somnolence, coma, hypoventilation, CO2 retention, hypoglycemia, bradycardia, hypothermia
45
**Hypothyroidism tx**
Synthroid - replaces thyroid hormones (long term)
46
**Synthroid AE**
Cardiac side effects
47
**What medication is used for hypothyroidism crisis**
IV T3/T4
48
**What to monitor after synthroid administration (nursing consideration)**
Monitor for angina and dysrhythmias
49
**Common nursing dx for hypothyroidism**
Activity intolerance - decreased metabolic activity
Impaired memory - reorient
Constipation - mobility, fluids, stool softeners
50
**How long do patients have to take hypothyroidism medications**
Lifelong (education)
51
Nursing considerations for myxedema coma
Maintain stable body temperature
Monitor gastric motility
Skin integrity
Reduced metabolism = hypoventilation
- Pulmonary toilet
52
**Causes of hyperthyroidism**
Graves disease (75% of cases)
Pituitary tumor - increases TSH
Too much thyroid hormone replacement
Hashimoto's Thyroiditis
53
Thyrotoxicosis
Hypermetabolism d/t thyroid stimulation
54
**S/sx of hyperthyroidism**
Increase metabolic activity
- Tachycardia, HTN, tachypnea, hyperthermia, palpitations, bounding pulses
- Diarrhea, weight loss with increased appetite
- Irritability and mood swings, nervousness, twitching, insomnia
- Amenorrhea
- Thinned hair and skin with flushed appearance
55
**Exopthalmos**
Protruding eyes
Common in Grave's disease or hyperthyroidism
56
**Hyperthyroidism manifestations**
Goiter - do not palpate
Pulse/thrill over thyroid
Decreased TSH, increased T4
Elevated iodine
57
**Hyperthyroidism tx**
Antithyroids - block hormone synthesis (Propylthiouracil [PTU] and methemazole)
Radioactive iodine - through straw
Beta blockers for tachycardia
Bedrest for acute hyperthyroid episodes
58
**Radioactive iodine therapy**
Tx of choice for nonpregnant pts
Removes sections of thyroid to decrease function
Takes up to 3 months for full effect
59
**Hyperthyroidism surgical tx**
Throidectomy
Requires long term thyroid hormone replacement
60
**Hyperthyroidism nursing management**
Increase calories
Extra fluids
Daily weight and calorie count
Ineffective coping - hypermetabolism puts pts on edge
- Low stress environment, dim lights, soft noises
Ice packs, cool room (hyperthermia r/t hypermetabolism)
Monitor for dysrhythmias d/t hypermetabolism - beta blockers, stress free environment, avoid stimulants/caffeine
61
**Hyperthyroidism patient education**
Avoid stimulants
High carb, high calorie, high protein diet
Cool room and loose clothes
Eye care - drops, lubricants, steroid drops
Long term hormone replacement after thyroidectomy
62
Thyroid storm
Acute episode of excessive thyroid production
Increase metabolism leads to diarrhea, weight loss, altered mental status
63
Thyroid storm dx
Fever >38.5
Tachy >130
64
Thyroid storm tx
IV glucose
Humidified O2
Iodine infusion
Beta blockers - for tachycardia and hypertension
65
What is the main concern for thyroid storm
Increased BP and tachycardia can lead to heart damage
66
Thyroid cancer
Malignancies on thyroid lead to increased secretion of thyroid hormones
67
Thyroid cancer common population
75% of cases are women, ⅔ are under age of 55
68
Thyroid cancer dx
Signs of hyperthyroidism
Hard, fixed, palpable lesions on thyroid
Biopsy confirms diagnosis
69
**Thyroid cancer tx**
Thyroidectomy and neck dissection
Radiation if possible
70
**Thyroidectomy indications**
Pregnancy
Pts with goiter
Thyroid med allergy
71
**What procedure is done alongside thyroidectomy**
Neck dissection - removal of lymph nodes from neck
72
**Pre-op thyroidectomy nursing considerations**
Reduce stress/anxiety to avoid thyroid storm
Decrease caffeine, stimulants
High carb, high protein diet
Vitamin supplements
73
**Post op thyroidectomy nursing considerations**
Monitor airway
Monitor for hemorrhage
Monitor voice changes
Supplement thyroid hormone
Monitor for hypocalcemia
74
**What is normal for thyroid hormone levels post thryoidectomy**
A surge of thyroid hormone can temporarily occur
75
**Complications of thyroidectomy**
Hemorrhage and hematoma
Edema in airway
Changes in calcium metabolism d/t manipulation of parathyroid
76
DM is the leading cause of
Adult blindness
End-stage renal disease
Lower limb amputations (nontraumatic)
77
DM is a major contributing factor of
Heart disease
Stroke
HTN
High cholesterol
78
What factors may cause DM
Genetic
Autoimmune
Environmental
Virus
79
Where is insulin produced
Beta cells in islet of Langerhans
80
Daily amount of insulin secreted by adult
40-50 U
81
Insulin function
Promote glucose transport from bloodstream across cell membrane to the cytoplasm of the cell
82
Where is excess glucose stored
Liver and muscle cells store glucose as glycogen
83
What does increased insulin do
Inhibits gluconeogenesis
Enhances fat deposition
Increases protein synthesis
84
What does decreased insulin do
Release glucose from liver
Release protein from muscle
Release fat from adipose tissue
85
What hormones are couterregulatory (opposite effect) to insulin
Glucagon
Epinephrine
Growth hormone
Cortisol
86
T2DM risk factors
Overweight/obese
Advanced age
Family hx
87
T2DM pathophysiology
Pancreas produces some endogenous insulin, but not enough produced
Body does not use insulin efficiently
88
T1DM pathophysiology
Absence of endogenous insulin d/t body developing antibodies against insulin and/or pancreatic beta cells
89
Metabolic syndrome
Increases the risk for T2DM
- Increased glucose levels
- Abdominal obesity
- High BP
- High level of triglycerides
- Decreased levels of HDLs
3 of 5 components = metabolic syndrome
90
Normal impaired glucose tolerance range for prediabetes
140-199 mg/dL
91
Normal fasting glucose for prediabetes
100-125 mg/dL
92
When does gestational diabetes resolve
6 wks postpartum
93
Gestational diabetes risks
Increased risk for C section and perinatal/neonatal complications
94
When is gestational diabetes dx during pregnancy
24-28 wks
95
What does gestational diabetes put you at risk for later in life
63% change of getting T2DM within 16 years
96
Other types of DM
Injury/destructino of beta cell function in pancreas
Medical conditions/drugs
- Resolves when underlying condition is treated
97
Symptoms of T1DM
Polyuria
Polydipsia
Polyphagia
Weight loss
Weakness
Fatigue
Ketoacidosis
98
Symptoms of T2DM
Nonspecific symptoms:
Fatigue
Recurrent infection
Recurrent vaginal yeast or candida infection
Prolonged wound healing
Visual problems
99
Rapid acting insulin
lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)
100
Short acting insulins
Regular (Humulin R, Novolin R)
101
Intermediate acting
NPH (Humulin N, Novolin N)
102
Long acting
glargine (Lantus)
detemir (Levemir)
1-2x/day
Do not mix with other insulin
103
Inhaled insulin
Afrezza
104
When to use bolus of insulin
Rapid acting or short acting before meals
105
When to give basal dose of insulin
Intermediate or long-acting insulin 1-2x/day
106
Insulin storage
Extreme temps make insulin less effective
Can be left at room temp for 4 wks
Refrigerate extra unopened insulin
Avoid direct sunlight
107
Why is insulin given SQ
IM injection can cause hypoglycemia
108
Why can insulin not be given PO
Inactivated by gastric fluid
109
Regular insulin route
Can be given IV
110
How often to change insulin pump
Every 2-3 days
111
How often to check BG throughout day with insulin pump
4-8x/day
112
Nursing considerations for insulin pumps
Infection risk at insertion site
Risk for DKA
Costs
Being attached to a device
113
AE of insulin
Hypoglycemia
Allergic reactions
Lipodystrophy - loss of fatty tissue, atrophy
Hypertropy of SQ tissue - overuse of site
114
Somogyi effect
High dose of insulin causes glucose to drop at night
Counterregulatory hormones cause rebound hyperglycemia
115
Dawn phenomenon
Morning hyperglycemia
May be due to release of counterregulatory hormones in predawn hours (growth hormone and cortisol)
116
Afrezza
Rapid acting inhaled insulin
Used in combo with long-acting insulin
117
AE of Afrezza
Hypoglycemia
Cough
Throat pain
Irritation
118
Contraindications for Afrezza
Tx of DKA
Smokers
Asthma/COPD - risk of bronchospasm
119
Metformin uses
Most effective 1st line tx for T2DM
Used for prevention of T2DM
120
Metformin (glucophage) routes
Immediate release
Extended release
Liquid
121
Metformin (glucophage) MOA
Reduces glucose production by liver
- Enhances insulin sensitivity
- Improves glucose transport
- May cause weight loss
122
Metformin (glucophage) alerts
Withhold for surgery/radiologic procedure
123
Metformin (glucophage) contraindications
Renal, liver, cardiac disease; lactic acidosis
Iodine based contrast medium can cause AKI
Excessive alcohol intake
124
Metformin (glucophage) nursing considerations/education
Take with good to minimize GI side effects
125
Sulfonylureas MOA
Increases insulin production from pancreas
126
Sulfonylureas SE
Hypoglycemia
127
Sulfonylureas examples
Glipizide (Glucotrol)
Glyburide (Glynase)
Glimepiride (Amaryl)
128
Meglitinides MOA
Increases insulin production from pancreas
129
What is the benefit of Meglitinides having a rapid onset
Decreases risk of hypoglycemia
130
Meglitinide pt education
Take 30 minutes to just before each meal to mimic normal response to eating
Do not take if skip a meal
131
Meglitinide examples
Repaglinide (Prandin)
Nateglinide (Starlix)
132
α-Glucosidase Inhibitors MOA
“Starch blockers”
Slow down absorption of carbohydrate in small intestine
133
α-Glucosidase Inhibitors patient education
Take with first bite of each meal
134
α-Glucosidase Inhibitors nursing consideration/education
Check 2 hour postprandial glucose to determine effectiveness
135
α-Glucosidase Inhibitors examples
Acarbose (Precose)
Miglitol (Glyset)
136
Thiazolidinediones MOA
Improve insulin sensitivity, transport, and utilization at target tissues
137
Thiazolidinediones examples
Pioglitazone (Actos)
Rosiglitazone (Avandia)
138
Thiazolidinediones uses
Most effective in those with insulin resistance
Rarely used because of adverse effects
139
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors MOA
Block reabsorption of glucose by kidney
Increase urinary glucose excretion
140
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors examples
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
141
What lifestyle modification can improve insulin sensitivity in T2DM
Wt loss of 5-7%
142
How to monitor effectiveness of therapy for T2DM
Blood glucose levels
A1C
Lipids
BP
143
Effect of alcohol on insulin/DM
Inhibits gluconeogenesis by liver
- Severe hypoglycemia
- Eat carbs when drinking
144
Recommended alcohol intake for DM
1 drink/day for women
2 drink/day for men
145
Risk during exercise (DM)
Hypoglycemia
146
When to delay activity for T1DM
If glucose is below 250 and ketones present in urine
147
When to self-test blood glucose
Before meals
Two hours after first bite
When hypoglycemia is suspected
Every 4 hours during illness
Before and after exercise
148
How often should diabetics check BG during illness
Every 4 hours
149
When and how often should diabetics check for ketones during illness
If glucose is over 240 check ketones every 3-4 hours
150
When should diabetic call HCP
If two consecutive BG are over 400 or if they have mod-high urine ketone levels
151
What is the risk for T1DM during illness
DKA d/t increased BG levels
152
What is the risk for all diabetic pts during illness
Risk of infection
Reduced healing
153
Nursing consideration for unconscious diabetic pt
Frequently monitor BG
Monitor for hypoglycemia: sweating, tachycardia, tremors
154
What condition may require pancreatic transplant
T1DM with ESRD and kidney transplant
155
Criteria for pancreas transplant
If no renal failure:
- Hx of acute/severe metabolic complications
- Incapacitating clinical/emotional problems with exogenous insulin
- Failure of insulin management
156
Islet cell transplantation
Donor islet cells infused into portal vein to liver
157
Effect of stress on glucose
Increases glucose secondary to counterregulatory hormones
158
Hypoglycemia Manifestations
Blood glucose < 70 mg/dL
Cold, clammy skin
Numbness fingers, toes, mouth
Tachycardia
Emotional changes
Headache
Nervousness, tremors
Faintness, dizziness
Unsteady gait, slurred speech
Hunger
Vision changes
Seizures, coma
159
Hypoglycemia causes
Alcohol intake without food
Too little food
Too much diabetes meds
Too much exercise without food
Diabetes med or food at wrong time
Loss of weight without med adjustment
Use of -adrenergic blockers interfering with symptoms
160
Hypoglycemia at home tx
Eat or drink 15 g of rapid-acting carbohydrates
Wait 15 minutes, check glucose
If less than 70 mg/dL, eat or drink another 15 grams of carbohydrates
If stable and meal more than 1 hour away or involved inn activity; give carbohydrate and protein
161
When hypoglycemic pt should call HCP/EMS
If glucose remains low after 2-3 times
162
Tx for acute care or unresponsive hypoglycemic pt
IV D50
IM glucagon
163
Hyperglycemia Manifestations
Elevated blood glucose
Increased urination
Increased appetite followed by lack of appetite
Weakness, fatigue
Blurred vision
Headache
Glycosuria
Nausea and vomiting
Abdominal cramps
Progression to DKA or HHS
Mood swings
164
Hyperglycemia causes
Illness, infection
Corticosteroids
Too much food
Too little or no diabetes meds
Inactivity
Emotional or physical stress
Poor absorption of insulin
165
Diabetic Ketoacidosis (DKA) cause
Profound deficiency of insulin
166
Most likely population for DKA
T1DM
167
DKA Precipitating factors
Illness
Infection
Inadequate insulin dosage
Undiagnosed type 1 diabetes
Lack of education, understanding, or resources
Neglect
168
DKA pathophysiology
Body burns fat as fuel
By-product of fat metabolism—acidic ketones alter pH (metabolic acidosis)
Ketones excreted in urine along with electrolytes
Impairs protein synthesis, causes protein degradation resulting in nitrogen loss from tissues
169
DKA complications
Hypovolemia followed by shock may cause renal failure, causing retention of ketones and glucose and further acidosis
Dehydration, electrolyte imbalance, and acidosis causes coma and if not treated, death
170
DKA manifestations
Dehydration
- Poor skin turgor
- Dry mucous membranes
- Tachycardia
- Orthostatic hypotension
171
DKA early signs
Lethargy and weakness
172
DKA manifestations as it progresses
Skin dry and loose; eyes soft and sunken
Abdominal pain, anorexia, nausea/vomiting
Kussmaul respirations
Sweet, fruity breath odor (acetone)
Blood glucose level of greater than or equal to 250 mg/dL
Blood pH lower than 7.30
Serum bicarbonate level less than 16 mEq/L
Moderate to high ketone levels in urine or serum
173
DKA tx
Replace potassium before starting insulin (insulin drives K into cells = hypokalemia)
IV regular insulin to correct hyperglycemia and ketosis
174
Long term complications of diabetes
Stroke
Retinopathy, cataracts, glaucoma, blindness
HTN
Dermopathy
CAD
Gastroparesis
Atherosclerosis
Islet cell loss
Nephropathy
Erectile dysfunction
Neurogenic bladder
Peripheral neuropathy
Peripheral vascular atherosclerosis
Gangrene
Infections
175
Angiopathy
Chronic complication of DM
Damage to blood vessels secondary to chronic hyperglycemia
Leading cause of diabetes-related death
176
Two categories of angiopathy
Macrovascular
Microvascular
177
Annual exams for diabetics
Retinopathy
Nephropathy
Neuropathy (comprehensive foot exam)
Cardiovascular risk factor assessment
178
As needed or every visit to HCP exams for diabetics
Foot and lower extremity exam
Exercise stress testing
179
Daily exam for diabetic pts
Self foot exam
180
Leading cause of end-stage renal disease in U.S.
Nephropathy d/t diabetes
- 20% to 40% of people with diabetes have it
181
Nephropathy risk factors
Hypertension
Genetics
Smoking
Chronic hyperglycemia
182
Monitoring for nephropathy
Annual screening for albuminuria and albumin-to-creatinine ratio
183
Drugs for albuminuria from nephropathy
ACE inhibitors
or
Angiotensin II receptor antagonists
184
When to screen T2 diabetic for neuropathy
At time of diagnosis
185
When to screen T1 diabetic for neuropathy
5 years after diagnosis
186
Distal symmetric polyneuropathy
Most common form
Both hands or feet are affected
187
Paresthesias
tingling, burning, itching
“walking on pillows" or numb feet
188
Sensory Neuropathy
Manage BG
Drugs:
Topical creams
TCA's
SSRI's and NRI's
Antiseizure meds
pregabalin (Lyrica)
189
Autonomic neuropathy complications
Bowel incontinence
Urinary retention - neurogenic bladder
Gastroparesis - N/V, anorexia, GERD
CV - postural hypotension, resting tachycardia, painless MI
ED, decreased libido, vaginal infections
190
Urinary retention/neurogenic bladder d/t diabetes tx
Credé’s maneuver - manual pressure to abd
Cholinergic agonists
Self-catheterization
191
Thrombocytopenia common nursing dx
Risk for bleeding
192
Causes of thrombocytopenia
Blood disorders - dyscrasias
Chemotherapy
193
Manifestations at different platelet levels
Symptoms present when under 50,000
Under 20,000 = spontaneous bleed
Under 5,000 = CNS/GI bleed
194
Thrombocytopenia nursing interventions
Platelet transfusion
Reduce blood loss - needles, gums, invasive procedures
Fall precautions
195
Thrombocytopenia complications
Hemorrhagic stroke
Shock
GI Bleed
Joint bleeds
196
Hemophila patho
Deficiency in a coagulation factor
197
Von Willebrand patho
Disorder of coagulation proteins
198
Hemophila & Von Willebrand assessment findings
Prolonged bleeds after:
Dental procedures
Minor trauma
Nosebleed
GI ulcers
SubQ hematomas
199
How to dx Hemophila & Von Willebrand
Deficient clotting factors on coagulation studies
200
Causes of Hemophila & Von Willebrand
Genetic link
201
Hemophila & Von Willebrand tx
Prevent bleeding
Genetic counseling
DDAVP - Desmopressin
Antifibrolynics
202
Hemophila & Von Willebrand pt education
Bleeds monitored for 72 hours
Notify surgeon before procedures
Prophylactic coagulation factor replacement
Immobilize bleeding joints
203
Disseminated Intravascular Coagulation patho
Not a disease but a sign of an underlying disorder
Increase in clotting combined with an increase in bleeding
204
Disseminated Intravascular Coagulation causes
Sepsis
Trauma
Shock
Cancer
Abruptio placentae
Toxins
Allergic reactions
205
Disseminated Intravascular Coagulation assessment findings
Bruising, hemoptysis, tachycardia & hypotension, bloody stools, hematuria
206
Manifestations of clotting - DIC
Tissue necrosis
Diminished pulses
Pulmonary embolism
Abdominal pain, diminished bowel sounds
207
DIC nursing interventions
Continuous cardiac monitor
Two large bore IV
Continuous O2 and BP monitoring
Platelet transfusion - for severe blleds
Cryoprecipitate or FFP
Heparin
208
Myeloid cells become
Granulocytes: Neutrophils, Eosinophils, Basophils
RBC
Platelets
209
Lymphoid cells become
Agranulocytes:
Lymphocytes - T cells, B cells, and Monocytes
Natural killer cell
210
**Leukemia patho**
Abnormal growth of WBC's
Normal during infections, abnormal if no infection is present
211
**What does leukemia cause**
Leukocytosis
212
Lymphoma
Neoplasms of lymphoid tissue, usually derived from B lymphocyte
213
**Multiple myeloma**
Malignancy of plasma cell
214
**Leukemia cause**
Many causes
Disease traced back to one type of stem cell
215
**Types of leukemias**
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
216
**Acute leukemia is more common for**
Children and young adults
- More fatal
217
**Chronic leukemia is more common for**
25-60
218
**Dx for leukemia**
CT scan - shows enlarged lymph nodes
PET scan - metabolic activity
219
Abnormal WBC symptoms
**Frequent, severe infections**
Leukocytes under 15,000
Enlarged liver and spleen
220
Symptoms of reduced RBC and/or platelets
Weakness, pallor, weight loss
Fatigue, lethargy, hypoxia
Bruising and hemorrhage
221
General s/sx of WBC imbalance in later stages
CNS changes
Renal failure
222
**Leukemia dx**
Bone marrow biopsy
Blood smears
CBC diff showing leukocytosis
223
**Acute Lymphocytic Leukemia complication**
Severe neurological symptoms
224
**Chronic Myelogeous Leukemia**
Occurs in stages:
Chronic stage can be controlled with meds
Blastic phase - acute drop in all cell counts
225
Cause of Chronic Myelogeous Leukemia
Philadelphia chromosome
226
**Chronic Lymphocytic Leukemia s/sx**
Can be asymptomatic
Lymph nodes enlarged
Chronic fatigue
Liver/spleen enlargement
B symptoms: fevers, drenching sweats (especially at night), and unintentional weight loss
227
**Leukocyte tx options**
Chemotherapy
Total body radiation
Stem cell transplant
Palliative
228
**Induction therapy**
Hard core chemo that destroys all abnormal leukemia cells
Similar to stem cell transplant
- Focus on neutropenia, thrombocytopenia and anemia
229
What to expect after induction chemotherapy
Intensification
Consolidation
Maintenance low doses to maintain leukemia-free cells
230
**Cause of stomatitis and oral irritation**
Gingival hyperplasia and chemo
- Frequent oral care
- Monitor for bleeding
231
When to implement neutropenic precautions
ANC (absolute neutrophil count) under 1,000
232
Neutropenic precautions
"Reverse isolation" keep pt from outside
No raw meats, fresh fruit, plants, vegetables
Avoid crowds
Handwashing
Minimize invasive devices - foleys
Avoid vaccinations and recently vaccinated people
Oral hygiene, avoid dental procedures
233
Cause of fatigue and activity intolerance in neutropenic precaution
Anemia, chronic infections, and chemotherapy
- Iron supplements
234
Pharmacological tx for chemotherapy/neutropenia
Filgrastim - for decreased ANC
Erythropoietin - for decreased RBC
Prophylactic antibiotics and antifungal
235
Most common type of lymphoma
Non-Hodgkin's
236
**Hodgkin's lymphoma**
Rare malignancy, high cure rate
Reed-Sternberg cells: abnormal cells found in lymph nodes (B-cell origin)
237
**Cause of Hodgkin's lymphoma**
Virus
238
**Hodgkin's lymphoma manifestations**
**Painless lymph node enlargement**
Pruritus
**B symptoms**: fever, night sweats, weight loss
Pain on ETOH ingestion
239
**Nursing management and tx of Hodgkin's lymphoma**
ABVD regimen of chemo
Radiation therapy for localized lymph node disease
Secondary malignancies common
Address fertility issues
240
Non-Hodgkin's lymphoma patho
Lymphoid tissues become infiltrated with malignant cells
Spread is unpredictable and localized disease is rare
Can originate outside of lymph nodes
241
Non-Hodgkin’s common population
Increases with age
Average age is 66 years old
242
Non-Hodgkin’s s/sx
Symptoms may depend on where lymph node masses spread
- Hepatomegaly
- Splenomegaly
- Renal failure
243
Non-Hodgkin’s dx
Bone marrow biopsy
Lumbar puncture
Organ biopsy
244
Non-Hodgkin tumor responses to tx
More aggressive tumors are more likely to respond to tx
T cells lymphomas are more difficult to tx
245
Non-Hodgkin’s tx
Manage symptoms
- Pain, bleeding, infection
- Monitor for bowel perforations
- Care for radiation sites
246
**Multiple Myeloma patho**
Plasma cells destroy the bone marrow
These create monoclonal B-cells that cannot fight infection
Cytokines engage in abnormal bone destruction
247
**Multiple Myeloma s/sx**
Bone pain in pelvis, spine and ribs
Osteoporosis and fractures related to bone destruction
- Hypercalcemia
Hyperviscosity syndrome
248
**Multiple Myeloma dx**
M proteins in blood
Bence-Jones proteins in urine
Decreased bone density on imaging
249
**Multiple Myeloma tx**
Corticosteroids, chemo, immune therapy and targeted therapy
250
**Multiple Myeloma nursing interventions**
Treatment for bone density:
- Ambulation and weight bearing exercise
- Monitoring for complications of hypercalcemia
- Hydration to improve renal function
Target UOP
Pain management: Peripheral neuropathy
High dose chemotherapy followed by HSCT
251
Essential thrombocytopenia patho
AKA primary thrombocythermia
Stem cell disorder within the bone marrow
252
Essential thrombocytopenia cause
Unknown
253
Essential thrombocytopenia population
Affects women more than men
Median age 65 to 70 years old
254
Essential thrombocytopenia symptoms
Vascular occlusion
Headaches
Enlarged spleen
Hemorrhage
255
Essential thrombocytopenia nursing consideration
Risk for developing thrombosis or hemorrhage
256
Primary Myelofibrosis patho
Chronic myeloproliferative disorder within the stem cell
257
Primary Myelofibrosis population
Disease of older adults 65 to 70 years; survival rate 2 to 10 years
258
Primary Myelofibrosis symptoms
Enlarged spleen
Fatigue
Pruritus
Bone pain
Weight loss
Infection
Bleeding
Cachexia
Pancytopenia common
259
Primary Myelofibrosis tx
Decrease symptoms and splenomegaly
Improve blood count
Splenectomy for significant problems
260
Types of genes (r/t cancer)
Protooncognes: Normal cell genes, important regulators in cell process, promotes growth
Tumor suppressor genes: Prevent tumor formation
261
Onco-genes
Mutants of protoncognes that create malignant cells
262
How are these genes changed during cancer
Onco-genes are turned ON
Tumor suppressor genes are turned OFF
263
CAUTION warning signs of cancer
**C**hange in bowel and bladder habits
**A** sore that does not heal
**U**nusual bleeding or discharge
**T**hickening or lump in tissue
**I**ndigestion or difficulty swallowing
**O**bvious change in wart or mole
**N**agging cough or hoarseness
264
Breast cancer screening guidelines
Begin screening when you choose
Yearly mammograms by age 45
Every other year mammograms at 55
265
Colon cancer screening guidelines
Over 50
African American - greater risk
Family hx
266
Prostate cancer dx
PSA - Prostate specific antigen
Protein produced by the prostate gland
Increased = prostate cancer/condition
Prostate biopsy
267
Types of biopsy
Fine needle
Surgical
Endoscopic
268
TNM classification
Tumor size
Lymph node status
Metastasis
269
Radiation uses
Isolated tumors
Reduction in tumor size
Instill radiation in body cavities
270
Types of radiation
Electromagnetic
Particulate
High energy x-ray
271
Different uses for low and high energy beams (radiation)
Low energy beams for external or superficial tumors
High energy beam for internal tumors
272
**External radiation pt teaching**
Irritation at radiation 1-24 hours after treatment
- Frequent skin assessment
Unscented, mild soaps
- No lotion/deodorant
Avoid sunlight, temperature extremes
Avoid rough washcloths and tape
273
**Brachytherapy**
Radiation "seeds" are implanted at the cancer site
Sealed sources of radiation placed near the tumor
274
Unsealed radiation
Type of internal radiation
Ingested or instilled in body cavity
275
ALARA
As low as reasonably achievable
- Reduce radiation
276
**Radiation nursing considerations/safety**
Stay in room for no longer than 30 mins
Door closed
Visitors 6 ft
Private room
Disposable trays
Keep linen in room
Radiation warning sign
Avoid pregnant nurses
Dosimeters can be worn with lead apron
277
Implanted brachytherapy seed nursing consideration
Bedrest while implant in place
Ensure location of implant
Body fluids are not radioactive
278
**Methods of chemo administration**
Intra-arterial
Intraperitoneal
Intrathecal - bypasses blood brain barrier
Intravesical bladder chemo
279
**Chemo side effects**
Hair, skin and nails
GI mucosa
Bone marrow cells: RBC, WBC, Platelets
- D/t destruction of all rapidly growing cells
Anaphylaxis, extravasation
Organ toxicity
280
**Stomatitis nursing interventions**
Frequent oral care
Soft bristled toothbrush
Baking soda + saline after meals
Avoid acidic or spicy food
Avoid extremes in temperature
281
**Chemo nutrition considerations**
Small, frequent meals - high protein, high calorie
Cachexia: muscle wasting
Monitor wt and nutrition labs - albumin, prealbumin
Monitor I&O's for dehydration
282
**Chemo skin potential reactions**
Erythema: redness of affected area
Wet desquamation: Exposure of underlying dermis
Hand-foot syndrome: redness/swelling
Extravasation: Many chemos are irritants or vesicants
283
**Nursing considerations/interventions for extravasation (during chemo)**
Use central lines for chemo
Extravasation kit at bedside - warm/cold compress, antidote meds
Stop infusion and notify HCP for pain, redness, swelling
284
SE of chemo/radiation
- Bone marrow suppression
Neutropenia
Thrombocytopenia
Anemia
285
Priority intervention for chemo/radiation
Infection
286
All blood cell types can be transfused except for
WBC
287
What level indicates neutropenia
ANC (absolute neutrophil count) under 1500mm3
Certain infection when ANC under 100mm3
288
What lab shows need for neutropenia isolation
WBC under 1000
289
Neutropenia tx
Depends on cause:
Remove offending meds
Tx bone marrow cancer
Hospital admission with cultures and CXR for suspected infection
290
Platelet labs levels and what they indicate
Below 150,000 = thrombocytopenia
Below 50,000 = increased risk of bleeding
Below 20,000 = spontaneous bleed
291
When is the typical onset of anemia after chemo
3-4 months after chemo is started
292
**Anemia tx**
erythropoetin (EPO) to stimulate RBC growth
RBC transfusion - last resort
293
Fatigue tx (chemo)
Treat anemia
Correct electrolyte imbalances
Cluster care
Establish a sleep/wake cycle
Maintain light daily activity as tolerated
294
Late effects of chemotherapy
- months or years after
In liver, kidneys, bone, heart muscle
Cataracts
Cardiac toxicity
Osteoporosis
Secondary malignancies
295
**Immunotherapy for cancer (prototypes)**
Interleuken-2 (IL2)
Rifuximab
296
Types of immunotherapy
Cytokines
Vaccines
Monoclonal antibodies (drugs ending in –mab)
297
**Immunotherapy SE's**
Flu-like symptoms
- Tylenol or IV Demerol
298
Infusion related symptoms
Fever
Chills
Urticaria
Muscosal congestion
N/D
299
**What is the tx for cancer that fails to respond to chemo**
Hematopoietic stem cell transplant or
Bone marrow transplant
300
Myelosuppression
Performed on transplant recipients
Eliminates existing stem cells - similar effect as chemo
301
Graft-vs-Host Disease
Major cause of morbidity and mortality in the allogeneic transplant population
Donor lymphocytes initiate immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment
302
Preventions of graft-vs-host disease
Immunosuppressant drugs - such as cyclosporine
303
Acute vs chronic graft-vs-host disease
Acute: within 100 days
Chronic: after 100 days
304
**Superior vena cava syndrome**
Obstruction of superior vena cava. Common causes are lung cancer, non-Hodgkin lymphoma
305
**Hypoproliferative anemia**
Abnormal RBC's are produced then destroyed
306
**Hemolytic anemia**
Destruction of RBC's
RBC's appear normal
Increase in byproducts of RBC breakdown - bilirubin
Increase in immature RBC's
307
**Iron deficiency anemia patho**
Inadequate dietary iron
Inadequate iron absorption
Blood loss
RBC destruction
308
**Iron deficiency anemia specific assessment**
Pallor
Inflammation of the tongue
Inflammation of the lips
Burning of tongue
Paresthesias
309
**Iron deficiency anemia dx**
Hgb, Hct, RBC below normal
Serum iron
Serum ferritin
RBC smears
Stool exam
310
**Iron deficiency anemia causes**
History of GI bleeds, heavy menses, peptic ulcers iron loss
311
**What foods are good/bad for anemia**
ETOH - blocks iron absorption
Red meat, leafy greens - good sources of iron
312
**Iron deficiency anemia tx**
Iron supplementation
Iron pill + calcium + stool softener
IM or IV iron
313
**Thalassemia patho**
Abnormal hemoglobin production causes decreased O2 delivery
Abnormal cells are destroyed in spleen
314
Thalassemia specific assessment
Pallor, deficits in growth and development
Jaundice
Bone marrow hyperplasia
315
Thalassemia dx
Small, pale RBCs
Hgb < 10 = transfusion
Bone marrow biopsy
316
Thalassemia cause
Genetic link – Mediterranean, north African, southeast Asian
317
Thalassemia tx
Frequent blood transfusion
Chelation therapy for iron overload
Monitor for DVT, s/s heart failure
Splenectomy
318
**Megaloblastic Anemia patho**
Lack of B vitamins leads to abnormally large RBCs that are destroyed in circulation
319
**Megaloblastic Anemia specific patho**
Sore, red, beefy tongue
Nausea and vomiting, abd pain
Paresthesias
Neuro changes
Pernicious = potentially fatal
320
**Megaloblastic Anemia dx**
Large RBCs on smear
Folate levels
Anti-IF antibodies
321
**Megaloblastic Anemia causes**
Dietary intake of folate
Scandinavian or African American
Family history
GI s/s and food diary
322
**Megaloblastic Anemia tx**
Pernicious anemia: IM B12 injections 2x week
B vitamin supplementation for inadequate dietary intake
323
Chronic anemia patho
Chronic infection, inflammation, disease leads to decreased RBC production
324
Chronic anemia specific assessment
Presence of 1 or more chronic diseases
325
Chronic anemia dx
Decreased RBC production with no other distinct cause of anemia
Iron levels normal
IF present
B vitamin levels normal (same as aplastic anemia)
326
Chronic anemia causes
1-2 month history of disease
Kidney disease
327
Chronic anemia tx
Correct underlying disorder
328
Anemia d/t renal disease patho
Decreased erythropoietin production
EPO stimulates RBC production
329
**Aplastic Anemia patho**
Bone marrow disorder causes decreased production of all cells
330
**Aplastic Anemia specific assessment**
Presence of 1 or more chronic diseases
331
**Aplastic Anemia causes**
Frequent bleeding
Frequent infection
Underlying disorders
332
**Aplastic Anemia dx**
Decreased RBC production with no other distinct cause of anemia
Iron levels normal
IF present
B vitamin levels normal (same as chronic anemia)
333
**Aplastic Anemia tx**
Correct underlying disorder
Bone marrow transplant
334
Anemia d/t acute blood loss patho
Trauma, surgery, esophageal varices causes acute anemia
335
Anemia d/t acute blood loss specific assessment
Sudden blood loss of 30% of Hgb can cause s/s of shock
336
Anemia d/t acute blood loss causes
Recent bleed
337
Anemia d/t acute blood loss tx
PIV x2 and resuscitation fluids
Blood transfusion
Correct underlying bleed
Albumin or Dextran
Platelet or plasma transfusion
Continuous cardiac monitor and frequent VS
338
Anemia d/t chronic blood loss patho
Slow GI bleed, menstrual bleeding, similar to iron deficient
Meds, ETOH
339
Anemia d/t chronic blood loss specific assessment
Gradual blood loss of up to 50% blood volume may only cause mild s/s
340
Anemia d/t chronic blood loss dx
S/s specific diagnostic tests
341
Anemia d/t chronic blood loss tx
Identify and treat cause of bleed
May lead to iron deficient anemia
342
Where does RBC breakdown happen
Spleen and liver
343
What does an excess of RBC's cause
Hepatomegaly
Splenomegaly
344
**Sickle Cell Disease cause**
Genetic - primarily affects African descent
Abnormal genes make RBCs that “sickle” when O2 concentrations get low
345
**Sickle cell crisis**
Severe clots and reduced circulations leads to tissue death
346
**Things that affect sickled cells**
**Infection**
High altitude
Heavy exercise
Stress
Surgery
Dehydration
347
**Sickle cell disease s/sx**
Chest pain, tachycardia
Pulmonary embolism, tachypnea - supplement with O2
Enlarged liver, gallstones
Damaged kidney - increased BUN/creat, decreased UOP
Grey skin, jaundice
348
**Sickle cell disease dx**
(+) Hgb-S
Sickled cells on smear
Chronic anemia
Bone and joint deformities
349
**Primary concern for sickle cell disease**
Respiratory failure
350
**Hospital interventions during acute sickle cell disease episodes**
IV abx
Continuous O2 - lung assessments
Rest
Anticoagulants
IV fluids - hydration
Monitor renal labs
Folic acid supplements
351
**Sickle cell disease complications**
Avascular necrosis – death of femoral head
Venous stasis ulcers
Iron overload
Changes in vision
Priapism
352
**Sickle cell disease tx**
Stem cell transplant
Hydroxyurea promotes normal Hgb growth
353
Acquired Hemolytic Anemia patho
Destruction of RBC from outside factors
354
Acquired Hemolytic Anemia tx
Immunosuppression
Folate replacement
Remove cause if possible
355
Acquired Hemolytic Anemia dx
Elevated bilirubin and decreased RBC
356
Acquired Hemolytic Anemia specific assessment
Jaundice
357
Acquired Hemolytic Anemia causes
Dialysis
Radiation
Poisoning
Heart valves - ask about hx
Antibodies
358
Hemachromatosis patho
Iron overload
Can be secondary to blood transfusion
*likely don't need to know this condition, skip over
359
Hemachromatosis specific assessment
Fatigue, joint pain, weight loss, cirrhosis
Bronze skin
360
Hemachromatosis dx
Iron levels > 6g and up to 50g
361
Hemachromatosis causes
Genetic link
History of anemic disorders with transfusion
362
Hemachromatosis tx
Therapeutic phlebotomy
Chelating agents
363
**Polycythemia patho**
Excess RBC production leads to sludgy blood
Secondary – excess RBC production d/t chronic hypoxia
364
**Polycythemia specific assessment**
Headache, dizziness, tinntus, vision changes
Itching and flushing
Chest pain and heart failure
DVT formation
365
**Polycythemia dx**
Elevated RBC and Hgb
Microcytosis
Low EPO levels
366
**Polycythemia tx**
Phlebotomy to target Hct < 45-42
Hydration
367
**Polycythemia causes**
Genetic link
History of anemic disorders with transfusion
368
Where are blood cells formed
Bone marrow
369
Where does the breakdown of RBC's occur
Spleen and liver
370
Where are immune cells formed
Lymph system
371
RBC's are also called
Erythrocytes
372
What controls RBC production
Erythropoietin
Released by kidneys
373
**Normal hct**
35-50%
374
**Normal hgb**
11-17
375
**Normal RBC**
4.5-5.7
376
Normal MCV
80-100
Mean corpuscular volume
- Size of RBC
377
Types of lymphocytes
B cells
T cells
Natural killer (NK)
378
Normal neutrophil count
4,500 - 7,000
Low = risk of infection
379
Normal platelet count
150,000 - 400,000
380
Normal aPTT
25-35 sec
381
**Normal PT**
11-16 sec
382
**Normal INR**
Below 1.1
2-3 in anticoagulated pts (warfarin)
383
**What level of Hgb diagnosis each severity of anemia**
Mild anemia = Hgb 10-11
Moderate anemia = Hgb 7-10
Severe anemia = Hbg under 7 (transfusion)
384
What does adrenal medulla release
Catecholamines - dopamine, norepinephrine, and epinephrine (adrenaline)
Sympathetic NS stimulation
385
What does the adrenal cortex release
Steroid hormones - Glucocorticoids, mineralocorticoids, progestins, androgens, and estrogens
386
What do glucocorticoids/corticosteroids do
Inhibit inflammation
Controls metabolism and stress response
387
What does too little glucocorticoids/corticosteroids do
Causes an inability to respond to stress
388
What does too much glucocorticoids/corticosteroids do
Suppress the immune response
389
What do mineralcorticoids do
AKA aldosterone
Regulates Na, K, and water
390
What does too much mineralcorticoids do
Increased Na, increased BV, decreased K
391
What does too little mineralcorticoids do
Decreased Na, decreased BV, increased K
392
Pheochromocytoma
Benign tumor in the adrenal medulla
393
Pheochromocytoma s/sx
5H:
Hypertension
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia
394
Pheochromocytoma dx
Elevated urine and plasma catelcholamines
- Measured with 24 hr urine collection
Clonidine suppression test
395
Pheochromocytoma nursing interventions
Bed rest
Raise HOB
396
Pheochromocytoma med tx and what to monitor for after administering
Alpha and beta blockers
- Monitor for orthostasis, nasal drainage, fatigue
397
Pheochromocytoma surgical tx
Removal of adrenal glands
398
Adrenalectomy nursing considerations
Pre-op: Hydration to control HTN
Calcium channel blockers to supplement Beta-blockers
10-14 days of BP control before adrenalectomy
399
What is the endocrine process that stimulates the adrenal glands
Hypothalamus secretes corticotropin-releasing hormone (CRH)
CRH stimualtes the pituitary gland to release adrenocorticotropic hormone (ACTH)
ACTH stimulates adrenal glands to release hormones
400
**Addison’s Disease**
Decrease in glucocorticoid production - inability to generate stress response
Decrease in aldosterone - dehydration
401
**Addison’s Disease s/sx**
Low glucocorticoids
- Decreased BG
- Fatigue, muscle weakness, depression
- Frequent infections
Low mineralcorticoids
- Decreased Na, dehydration
- Orthostatic hypotension
- Weak pulses
- Weight loss
Bronze mucous membranes
402
**Addison’s Disease dx**
ACTH stimulation test
→ACTH given IV, then blood is drawn to see if cortisol levels increase
-Decreased Na, increased K
-Increased BUN
403
**Addison’s Disease tx**
Lifelong hormone therapy
-Hydrocortisone is drug of choice
- "stress dosing"
Avoid high-stress activities
404
**Addison’s Disease risk factors**
Adrenal tumor, hemorrhage, tuberculosis
Long term corticosteroid use
Critically ill
Adrenal/renal hemorrhage
(anything that damages the adrenal gland)
405
**Secondary Addison’s Disease cause**
Damage to the pituitary gland causes decreased ACTH
406
**Addison’s Disease diet**
High sodium
Low potassium
Increase fluids
407
**Adrenal Crisis patho**
An acute drop in hormone production
408
**Adrenal Crisis causes**
Stressor during Addison’s disease
-Critical illness
409
**Adrenal Crisis s/sx**
Severe fatigue and weakness
Decrease in BP leading to shock
Hypoglycemia
410
**Adrenal Crisis tx**
IV dextrose and hydrocortisone replacement
411
**Adrenal Crisis nursing interventions**
V/S
Strict I/O's
Daily wt
Prevent stress
412
**Adrenal Gland Removal postop meds**
Continuous corticosteroid replacement with solumedrol or prednisone
- Avoids rebound Addison's disease
413
**Cushing’s Disease patho**
Excessive steroid hormone activity
-Increase in gluco- and mineral-corticoids
414
**Cushing’s Disease causes**
Adrenal hyperplasia
Excessive steroid administration
Pituitary tumor
415
**Cushing’s Disease s/sx**
Central obesity, "buffalo hump", thin extremities
Fragile, thin skin, ecchymosis, striae
Weakness, personality/mood changes
Osteoporosis, muscle wasting, HTN
Moon-face, acne, infection, slow healing
Virilization in women, loss of libido
Increased Na, decreased K
416
**Cushing’s Disease dx**
Serum and urine cortisols, dexamethasone (decadron) suppression test
-Decadron test given overnight to measure cortisol release
-Urine cortisol is 24 h collection
417
**Cushing’s Disease tx**
Pituitary removal or adrenalectomy
418
**Cushing’s Disease nursing interventions**
Monitor VS, daily weight, blood glucose
Close monitoring for early signs and symptoms of infection
Emotional support for body changes
419
**Cushing's post-op tx**
Supplemental steroid hormones
Monitor for rebound Addisonian crisis - extreme hypovolemia leading to shock
420
Organs that pituitary gland stimulates
Adrenal glands
Thyroid gland
Ovaries/Testes
Bone and soft tissues
421
Anterior pituitary hormones
**Adrenocorticotrophic hormone (ACTH)**
**Thyroid-stimulating hormone (TSH)**
Luteinising hormone (LH)
Follicle-stimulating hormone (FSH)
Prolactin (PRL)
**Growth hormone (GH)**
Melanocyte-stimulating hormone (MSH)
422
Posterior pituitary hormones
**Vasopressin - antidiuretic hormone (ADH)**
Oxytocin
423
Panhypopituitarism
Decrease in all hormones of the pituitary gland, including all releasing and stimulating hormones
424
What is the difference between anterior and posterior pituitary gland disorders
Anterior: Chronic, long term management
Posterior: Acute, hospitalization
425
Acromegaly
Oversecretion of GH from anterior pituitary
426
Dwarfism
Decrease in GH
427
**Diabetes insipidus dx**
Plasm and urine specific gravities
Fluid deprivation test: water held for 8-12 hours
- DI will have large urine volumes
428
**Diabetes insipidus tx**
Correct fluid imbalance
Long term: DDVAP - synthetic ADH, nasal spray
429
SIADH (Syndrome of inappropriate ADH)
Unable to dilute urine
Concentrated urine, diluted blood, third spacing
430
SIADH causes
Medications
Head injury
Brain surgery
Tumor
431
SIADH s/sx
Fluid retention, hyponatremia, concentrated urine
Weight gain, severe edema, pulmonary edema
432
Severe hyponatremia
Under 120
Neuro symptoms - seizures
N/V, cramps, muscle twitching
433
Pituitary tumor dx
CT
MRI
Serum hormone levels
434
**Pituitary tumor tx**
(Transsphenoidal) Hypophysectomy: removal of tumor through nasal passage
Hormone replacement
435
**(Transsphenoidal) Hypophysectomy nursing considerations**
Used for either hypo or hyper pituitarism
Removal of gland always leads to panhypopituitarism
- Lifelong hormone replacement
