Exam 2: Endocrine Problems Flashcards
What should be monitored postoperatively for in hypophysectomy (surgical removal of the pituitary gland)
Leaks in the mustache dressing for clear drainage (clear could be cerebrospinal fluid)
What test could be done to tell if the fluid in a mustache dressing is cerebrospinal fluid?
Glucose test
During an assessment of a patient with acromegaly, what should the nurse expect the patient to report?
Undesirable physical changes (facial features)
A patient with acromegaly is treated with transsphenoidal hypophysectomy. What should the nurse do postoperatively?
Ensure that any clear nasal drainage is tested for glucose
Describe SIADH (syndrome of inappropriate antidiuretic hormone)
ADH increases the permeability of the distal renal tubules and collecting ducts leading to water reabsorption causing FLUID RETENTION
In SIADH, urine output is?
Urine output is low, serum sodium levels are low
What should a nurse expect to see in a patient with SIADH (2)
- decreased urine output
- increased body weight
What is the serum concentration of sodium in a patient with hyponatremia? S/S? (5)
- less than 120 mEq/L
- lethargy, confusion, seizures, muscle weakness, coma
During the care of the patient with SIADH, what should the nurse do?
Monitor neurologic status every 2 hrs because the patient can go into a seizure or coma as sodium levels become lower/diluted
What medications are given to promote diuresis and increase urine output to lessen fluid retention in SIADH? (2)
Demeclocycline and Lasix
What is a less invasive intervention for patients with SIADH? (3)
- restrict fluid intake
- diuretic admin
- maintain HOB at 10 degrees to enhance venous return to the heart and increase atrial filling
In diabetes insipidus, urine output is?
very HIGH, causing serum sodium to be more concentrated due to fluid loss
Diabetes insipidus is caused by?
Deficiency in the production of ADH
What medication/orders should be given to a patient with diabetes insipidus to reverse the process? (2)
- synthetic ADH (vasopressin)
- fluid administration
What is the etiology of hyperthyroidism or Grave’s disease?
An autoimmune disease precipitated by the development of thyroid-stimulating antibodies that cause the growth and overproduction of the thyroid gland
What are s/s of hyperthyroidism or Grave’s disease? (5)
- large goiter
- exophthalmos (bulging eyes)
- increased HR
- weight loss
- excessive thirst
What is the worst onset complication of hyperthyroidism? What are the s/s? (5)
- Thyroid storm/thyrotoxicosis
- HF, shock, hyperthermia, coma, death
The patient is diagnosed with syndrome of inappropriate antidiuretic hormone. What manifestation should the nurse expect to find?
Decreased urinary output
What electrolyte should be monitored following a thyroidectomy? (removal of the thyroid and parathyroid glands)
Serum calcium levels
What are the signs and symptoms of hypocalcemia? (3)
- tingling
- Trousseau’s sign (carpal spasms)
- Chvostek’s sign (twitching of the facial nerve)
What position should the HOB be for a patient who had a thyroidectomy?
In semi- or high-Fowler’s position to prevent aspiration
What should be monitored for a patient following a thyroidectomy?
Respiratory status, patient may have harsh breathing or have vibration upon assessment including potential bleeding
What are the signs and symptoms of hypothyroidism? (6)
- lethargy
- fatigue
- impaired memory
- weight gain
- decreased cardiac contractility = low HR
- swelling appearance of the skin
Diagnostic testing in the patient with Grave’s disease will reveal?
Decreased thyroid-stimulating hormones levels
A patient is admitted to the hospital with thyrotoxicosis. On physical assessment with the patient, what should the nurse expect to find?
Elevated temperature and signs of heart failure
What drug would be involved in the treatment for hypothyroidism?
A Synthroid (levothyroxine): should be given in the morning time before breakfast at the same time every day
Nursing management for hypothyroidism? (2)
- Educate the patient on the amount of medication to be taken, if they take too much they can develop hyperthyroidism
- Observe for s/s of hypothyroidism (weight gain, decreased HR)
What is the cause of Cushing’s disease? What gland is being affected?
- adrenal cortex
- overabundance of corticosteroids (glucocorticoids and mineralocorticoids)
Signs and symptoms of Cushing’s disease? (5)
- truncal obesity
- fluid retention
- rounded face (moon face)
- fat deposits on the back, neck, shoulders
- buffalo hump
Nursing management of pituitary removal?
Steroid treatment
Addison’s disease affects which gland? What is the cause?
- adrenal cortex
- autoimmune disease-causing an underabundance of corticosteroids
Signs and symptoms of Addison’s disease? (5)
- bronze-colored skin
- ABD pain
- diarrhea
- salt craving
- joint pain
What is a complication of Addison’s disease? S/S? (3)
- Adrenal crisis: sudden drop in all hormones
- tachycardia, fever, hypovolemic shock if steroids are stopped suddenly
Patients with Addison’s disease must have lifelong treatment of?
Corticosteroids
If a patient is losing weight while on corticosteroid therapy, what should be done?
Dosing must be increased (medication is no longer effective if the patient is losing weight)
A patient with Addison’s disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. What collaborative care should the nurse expect?
IV administration of hydrocortisone
What can develop from the long-term use of corticosteroids? (3)
- osteoporosis
- hypertension (too many mineralocorticoids)
- hyperglycemia
Long-term administration of corticosteroids can lead to what disease of the endocrine? Too little can lead to?
- Too much: Cushing’s disease
- Too little: Addison’s disease
Common s/s of SIADH? (2)
- low serum sodium level
- muscle weakness
What is a potential side effect of taking steroids?
Hyperglycemia (high doses of steroids while require monitoring of blood sugar)
