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NRSG 110: Med Surg 2 > [Exam 3] Chapter 52: Assessment and Management of Patients with Endocrine Disorders ( Page 1502-1524, 1527-1532, 1534-1540, 1541-1543 ) > Flashcards

[Exam 3] Chapter 52: Assessment and Management of Patients with Endocrine Disorders ( Page 1502-1524, 1527-1532, 1534-1540, 1541-1543 ) Flashcards

1
Q

What does the endocrine system affect?

A

Most cells, organs, and body functions

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2
Q

Endocrine system is closely linked with what?

A

Neurologic and immune systems

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3
Q

Endocrine System: What kind of feedback mechanism is this?

A

Negative

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4
Q

Endocrine System: Amines and Amino Acids produce what?

A

Epinephrine, norepinehprine and thyroid hormones

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5
Q

Endocrine System: Peptides (Protein), Polypeptides do what? and Produce what?

A

Act on cell surface

Follicle Stimulating Hormone (FSH), Growth Horomone (GH), Thyrotropin Releasing Hormone (TRH)

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6
Q

Endocrine System: Steroid hormones do what?

A

Act inside the cell, and these include corticosteroids

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7
Q

Endocrine System: Fatty Acid Derivatives produce what?

A

Eicsanoid and Retinoids

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8
Q

What is a Paracrine action?

A

When a hormone acts locally in the area where they are released.

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9
Q

What is a Autocrine Action?

A

When hormones act on actual cells from which they were released

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10
Q

What are some major hormone secreting glands?

A

Hypothalamus (Controls Pituitary), Pituitary (Mastery Gland, Anteroir responsible for Thyroid), Thyroid, Parathyroid (Responsible for Calcium Levels), Adrenals, and Islets of Langerhans (In Pancreas)

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11
Q

Endocrine System: What major hormone secreting glands will we not talk about?

A

Testes, Ovaries, Pineal, and Thymus.

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12
Q

What will as assess when performing an assessment of the endocrine?

A

Change in energy level? Tolerance to heat/cold. Weight loss/gain. Thirst and frequency of urination. Fat and fluid distribution. Memory/Concentration/Mood.

Vision changes, joint pain.

VS. Palpate Thyroid.

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13
Q

Endocrine System: What visual changes may be observed with an endocrine dysfunction?

A

Facial hair in women, “moon face”, “buffalo hump”, exophthalmos (abonormal protrusion of one or both eyeballs), vision changes, edema, obesity of trunk, and increased size of feet and hands.

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14
Q

Endocrine System, and Labs/Diagnostics: What tests should be done?

A

Serum levels of hormones

Presence of autoantibodies

Blood Glucose

Urine Test to measure hormone metabolites

Stimulation and Suppression Tests

CT, MRI, Ultrasound

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15
Q

Endocrine System, and Labs/Diagnostics: Serum levels of hormones evaluated because

A

It may provide information to determine the presence of hypofunction or hyperfunction of the endocrine system and the site of dysfunction

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16
Q

Endocrine System, and Labs/Diagnostics: What are autoantibodies?

A

A lot of the diseases studied are autoimmune diseases.

This means that the body is attacking its own body or hormone.

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17
Q

Endocrine System, and Labs/Diagnostics: Blood Glucose is useful because

A

theyre many endocrine disorders that involve glucose

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18
Q

Endocrine System, and Labs/Diagnostics: Urine Tests are used to measure what?

A

Hormone metabolites, which is the end products of hormones excreted by the kidneys

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19
Q

Endocrine System, and Labs/Diagnostics: Why are stimulation tests performred?

A

To confirm hypofunction of an endocrine organ. Determines how endocrine gland responds to administration of stimulating hormones that are normally produced or released by the hypothalamus or pituitary gland

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20
Q

Endocrine System, and Labs/Diagnostics: In a stimulation test, if the specific endocrine gland responds to the stimulation, this means that the specific disorder may be where?

A

In the hypothalamus or pituitary

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21
Q

Endocrine System, and Labs/Diagnostics: What are Suppression tests used for?

A

To detect hyperfunction of an endocrine organ. They determine if organ is not responding to the negative feedback mechanisms that normally control secretion of hormones from the hypothalamus or pituitary gland

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22
Q

Endocrine System, and Labs/Diagnostics: CT/MRI shows what?

A

Blood flow through an organ as well as structural components

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23
Q

Endocrine System, and Labs/Diagnostics: Ultrasound shows what?

A

Tells you the function of an organ

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24
Q

Endocrine System, and Labs/Diagnostics: Stimulation Example: Pt given TSH and if T3/T4 leveles rise, this means that the problem lies where?

A

Posterior Pituitary. Thyroid was able to produce T3/T4 with no problem. Problem was not enough TSH was being produced to make T3/T4

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25
Q

What does Exogenous mean?

A

Hormone given from outside the body

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26
Q

What deos Endogenous mean?

A

Body produces the hormone itself.

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27
Q

What is the Pituitary Gland also known as?

A

Hypophysis, or master gland

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28
Q

Where is the Pituitary Gland located?

A

Located on the inferior aspect of the brain

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29
Q

Why is the Pituitary Gland considered the master gland?

A

Because it releases hormones that affect the rest of the glands of the body

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30
Q

What does the Anterior Pituitary release?

A

FSH, LH, Prolactin, GH, ACTH, and TSH

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31
Q

Anterior Pituitary Gland: What does ACTH or Adrenocorticotropic Hormone stimulate?

A

Production and release of cortisol from the cortex of the adrenal gland

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32
Q

Anterior Pituitary Gland: What does TSH stimulate?

A

Causes the thyroid gland to make triodothyronine (T3) and Thyroxine (T4)

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33
Q

Posterior Pituitary Gland: What does this release?

A

Vasopressin or Anti-Diuretic Hormone (ADH)

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34
Q

Posterior Pituitary Gland: What does Vasopressin or ADH do?

A

Controls the secretion of water by the kidneys , secretion is stimulated by high serum osmolality or low blood pressure. If osmolaity increased after eating something salty, it ADH will increase amount of water you hold onto.

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35
Q

What can hyper production of the Anterior Pituitary cause?

A

Cushing Syndrome

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36
Q

What can hypo production of the Anterior Pituitary cause?

A

Addisons Disease

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37
Q

What can hypo production of the Posterior Pituitary cause?

A

Diabetes Insipidus (DI)

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38
Q

What can hyper production of the Posterior Pituitary cause?

A

Syndrome of Inappropriate Diuretic Hormone (SIADH)

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39
Q

What is released by the posterior pituitary gland?

A

ADH/Vasopressin

Oxytocin

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40
Q

Anterior Pituitary: ACTH stimulates what?

A

Adrenal Cortex to produce -> (Cortisol)

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41
Q

Anterior Pituitary: If not enough Cortisol produced, what does patient have?

A

Addisons Disease

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42
Q

Anterior Pituitary: If too much Cortisol produced, what does patient have?

A

Cushings Disease

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43
Q

Anterior Pituitary: TSH stimulates what?

A

Thyroid to produce T3, T4, Storing Iodine, Calcium Levels

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44
Q

Anterior Pituitary: Too much T3/T4 results in

A

Graves Disease

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45
Q

Anterior Pituitary: Too little T3/T4 results in

A

Hashimoto Disease

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46
Q

Posterior Pituitary: ADH controls what?

A

The secretion of water

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47
Q

Posterior Pituitary: Increase in ADH =

A

Increase in holding water

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48
Q

Posterior Pituitary: Too little ADH released results in

A

Diabetes Insipidus (DI)

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49
Q

Posterior Pituitary: Too much ADH released results in

A

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

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50
Q

Posterior Pituitary - ADH/Vasopressin: Too much SIADH causes you to retain what?

A

Fluids

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51
Q

Posterior Pituitary - ADH/Vasopressin: Patient holding onto extra fluid with SIADH has what electrolyte imbalance?

A

Hyponatremia (Dilutional). This dilutes all of our salt out.

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52
Q

Posterior Pituitary - ADH/Vasopressin: Treatment for SIADH?

A

Fluid restriction and lasix.

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53
Q

Posterior Pituitary - ADH/Vasopressin: Too little ADH released results in?

A

Diabetes Insipidus

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54
Q

Posterior Pituitary - ADH/Vasopressin: What is Diabetes Insipidus?

A

When abnormally large volumes of dilute urine are excreted as a result of deficient production of ADH, also has low specific gravity

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55
Q

Posterior Pituitary - ADH/Vasopressin: How does the patient feel thirst wise with Diabees Insipidus?

A

Extremely Thirsty, because they are dehydrated

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56
Q

Posterior Pituitary - ADH/Vasopressin: What Electrolyte dysfunction does Diabetes Insipidus corrleate to?

A

Hypernatremia. Water has been lost but the salt got to stay.

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57
Q

Posterior Pituitary - ADH/Vasopressin: Treatment for Diabetes insipidus?

A

Desmopressin, an exogenous ADH

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58
Q

Thyroid: What are the hormones here?

A

T3, T4, and Calcitonin

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59
Q

Thyroid: What is stored, specifically in the thyroid?

A

Iodine

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60
Q

TSH from the anterior pituitary controls the release of?

A

Thyroid hormone

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61
Q

Thyroid: What are the Thyroid hormones responsible for?

A

Controls cellular metabolic activity

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62
Q

Thyroid: Increase in thyroid hormones results in what?

A

Increase in metabolic activity

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63
Q

Thyroid: Is T3 or T4 faster?

A

T3 is more potent and rapid-acting than T4

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64
Q

Thyroid: When is Calcitonin secreted?

A

If Calcium level in blood is high, Calcitonin will lower the blood plasma calcium levels and increases calcium deposit into the bone

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65
Q

Thyroid: What are the Thyroid Diagnostic Tests that can be conducted?

A

TSH, Seerum Free T4 , T3/T4.

T4 Resin Uptake

Thyroid Antibodies

Radioactive Iodine Uptake

Fine Needle Biopsy

Thyroid Scan, Radioscan, or Scintiscan

Serum Thyroglobulin

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66
Q

Thyroid and Serum-Free T4 Test: What does this test?

A

Direct measure of free thyroxine, the only metabolically active fraction of T4. Ranges from 0.9-1.4

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67
Q

Thyroid and T4 Resin Uptake Test: What does this test?

A

Indirect measure of unsaturated TBH (which binds to T4). Purpose is to determien amount of thyroid hormone bound to TBG and number of available binding sites

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68
Q

Thyroid and Thyroid Antibodies Test: What does this test?

A

Some Hypo and Hyper Thyroid diseases can be autoimmune diseases and can show whether the antibodies are attacking the thyroid or the hormone itself.

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69
Q

Thyroid and Radioactive Iodine Uptake Test: What does this test?

A

Iodine made radioactive. Measures the rate of iodine uptake by the thyroid gland. Patient given tracer dose of iodine and a count is made over thyoid gland which detects and counts from the breakdown of iodine in the thyroid. Causes damage to thyroid tissue.

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70
Q

Thyroid and Fine-Needle Biopsy Test: What is this?

A

To help determine if person has Graves, Hashimoto, or Thyroid Cancer. Is a biopsy

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71
Q

Thyroid and Thyroid Scan, Radio Scan, or Scintiscan Test: How is this performed?

A

Iodine 123/131 injected and scintillation detector moves camera back and forth across area to be studied. Determines size and shape of thyroid

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72
Q

Thyroid and Serum Thyroglobulin Test: What is this?

A

This is only released by the Thyroid. Thus they will do a blood draw and it can determine if thyroid tissue is growing, even once thyroid is removed

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73
Q

Hypothyroidism causes what disease?

A

Hashimoto

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74
Q

What is Hashimoto disease?

A

Autoimmune disease in which the body produces antibodies against the thyroid. Causes thyroid cell death and becomes unable to produce sufficient T3/T4, which causes metabolism to slow

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75
Q

Thyroid and Hashimoto: How long for symptoms to show up?

A

Slow onset, occuring over months to years

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76
Q

Thyroid and Hashimoto: Occurs most often to who?

A

Middle age and older women

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77
Q

Thyroid and Hashimoto: Signs anad Symptoms?

A

Thinning Hair

Intolerance to Cold (Metabolism generates heat)

Brittle Nails and Dry Skin

Numbness/Tingling of Fingers

Low PR and Body Temp

Constipation

Fatigue (Everything slows down)

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78
Q

Thyroid and Hashimoto: This can also be what type of disease?

A

Autoimmune, meaning it may be attacking its own body

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79
Q

Thyroid and Hashimoto: Risk Factors For getting this?

A

Middle/Older Women

Autoimmune Disease

Genetic Predisposiiton

Radiation Exposure

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80
Q

Thyroid and Hashimoto: What complications can this leadt to?

A

Bradycardia can lead to cardiac complications

Myxedema Coma

High Cholestrol

Arthroclerosis (Monitor HR because decrease in metabolism of fats and lipids can lead to this)

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81
Q

Thyroid and Hashimoto: What are some nursing diagnosis for this?

A

Decreased CO

RF Impaired Integrity

Fatigue

Constipation

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82
Q

Thyroid and Hashimoto: Those with Decreased CO should do what?

A

Keep environment warm to reduce shivering so metabolic demand is lowered to decrease demands on heart

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83
Q

Thyroid and Hashimoto: What does a low TH cause to the body?

A

Decrease in HR and Stroke Volume, ,Athrosclerosis, or fluid in pericardial sac from edema

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84
Q

Thyroid and Hashimoto: How to reduce risk of Constipation?

A

Low calorie fluids or water, high fiber diet. And Activity wtih rest periods (Careful of demands on heart)

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85
Q

Thyroid and Hashimoto: What to do with RF Impaired Skin Integrity?

A

Alcohol free soaps and lotions and to make sure you use warm water instead of hot

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86
Q

Thyroid and Hashimoto: What are the goals fro someone with this?

A

Prevent complications , Maintain CO, and Prevent Injury

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87
Q

Thyroid and Hashimoto: What should you monitor for medication wise?

A

Increased effects of anticoagulants and digoxin

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88
Q

Medical Management of Hypothyroidism: What should you do for this?

A

Start Synthetic Levothyroxine Replacement Therapy.

Take 1 hour prior or 2 hours after eating. Required for life and needs adjustments

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89
Q

Medical Management of Hypothyroidism: What happens if you pairi Levothyroxine Replacemenet Therapy with Hyponotic, Sedative Agents, or Nacrotics?

A

Its metabolism is lower and can knock out respiratory system. You should reduce this dose.

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90
Q

Medical Management of Hypothyroidism: What should you monitor for if someone is on Levothyroxine Replacement Therapy and is on an anticoagulant?

A

Monitor for bruising, bleeding gums, and blood in the urine

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91
Q

Medical Management of Hypothyroidism: TH Drugs can potentiate the effects of what drugs?

A

Anticoagulants and Digoxin

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92
Q

Medical Management of Hypothyroidism: What is Myxedema Coma?

A

Metabolism is so low that they are not able to maintain body processes. Monitor for HR being low and LOC.

93
Q

Hyperthyroidism - Graves Disease: What is this?

A

Autoimmune disease in which the body produces an antibody called thyroid stimulating immuglobin, which has the same effect on the thyroid as TSH and therefore causes the thyroid to produce too much T3 and T3 causing metabolism to increase

94
Q

Hyperthyroidism - Graves Disease: What are some signs of this?

A

Nervousness, rapid pulse, heat intolerance, tremors, skin flushed, warm soft and moist skin, exophthalmos (Bulging eyes), increased appetite , weight loss, elevated systolic bp, and cardiac dysrhythmias

95
Q

Hyperthyroidism - Graves Disease: What are some complications of this?

A

Excessive output of thyroid hormone (Thyroid storm): Metabolism is so fast that it affects CO, HR is fast, and burn through a lot of glucose become hypoglycemic increasing body temperature.

Life threatening condition

Dysrhythmias, fever, neurologic impairment

96
Q

Hyperthyroidism - Graves Disease: Risk Factors for this?

A

Genetic Predisposition, Other Autoimmune Disease, and Smoking

97
Q

Medical Management of Hyperthyroidism: How to control a Thyroid Storm?

A

Beta blocker is used in order to lower the heart rate

98
Q

Medical Management of Hyperthyroidism: Why would Dexamethasone be given?

A

Inhibits release of T3 and T4

99
Q

Medical Management of Hyperthyroidism: Why is Radioactive 131 Iodine Therapy done?

A

Goal is to eliminate the hyperthyroid state with the administration of sufficient radiation in a single dose, destroying the thyroid tissue.

100
Q

Medical Management of Hyperthyroidism: Why would surgery be done?

A

Subtotal Thyroidectomy, to remove the tyroid

101
Q

Medical Management of Hyperthyroidism: Why is proplthiouracil and MEthianmazole used?

A

Block conversion of T4 to T3

102
Q

Medical Management of Hyperthyroidism: Why is Sodium or Potassium Iodine solutions used?

A

Inhibit the release of T3 and T4.

103
Q

Medical Management of Hyperthyroidism: CAlcium should be watched because

A

Parathyroid glands could be damanged when removed thyroid. Cause a disruption in calcium

104
Q

Medical Management of Hyperthyroidism: What position should the patient be in after surgery?

A

Semi Fowlers with the neck in a netural position

105
Q

Medical Management of Hyperthyroidism: What environment would you place someone with this in?

A

Low stimulus environment, so the heart does not work too much

106
Q

Medical Management of Hyperthyroidism: What are some interventions to help someone out?

A

Protect eyes and provide drops for moisture

Reduce activity

Keep cool environment

High calorie, low salt diet

107
Q

Medical Management of Hyperthyroidism: What are some nursing diagnosis of this?

A

Decreased CO, RF Impaired Integrity, Fatigue

RF Impaired Nutrition, Hyperthermia, Diarrhea

108
Q

Patient Education about thyroid disorders?

A

Medications, Diet, Pace activity to reduce stress of heart

109
Q

Parathyroid Glands: Where are these located?

A

Four glands on the posterior thyroid gland

110
Q

Parathyroid Glands: These glands produc symptoms of what electrolyte imablance?

A

Hypocalcemia and Hypercalcemia

111
Q

Parathyroid Glands: What does Parathormone regulate?

A

Calcium and Phosphorus balance

112
Q

Parathyroid Glands: Increased parahormones does what?

A

Elevates blood calcium by increasing calcium absorption from the kidney intestine, and bone

113
Q

Parathyroid Glands: What does Parathormmone lower?

A

Phosphorus level

114
Q

Parathyroid Glands: An increase in calcium levels causes what to happen to phosphorus?

115
Q

Hyperparathyroidism: What is this?

A

High levels of parathormone are released causing kidneys and intestine to absorb too much calcium and also causes bone to release too much calcium resulting in high blodo serum calcium

116
Q

Hyperparathyroidism: What puts someone at risk for this?

A

Benign tumor of the gland

Post Menopause

Prolonged calcium or Vit. D deficiency

Neck Radiation

Lithium

117
Q

Hyperparathyroidism: What can happen to the body with this?

A

Elevated serum calcium, bone decalcification, renal calculi, apathy, fatigue, muscle weakness, N/V, Constipation, Hypertension, Cardiac Dysrhythmias and Psychological Manifestations

118
Q

Hyperparathyroidism: What hpapens to the bones here?

A

They become brittle

119
Q

Hyperparathyroidism: What can develop with excess calcium?

A

Kidney stones, therefore 2000 ml or more is encouraged to prevent this

120
Q

Hyperparathyroidism: What are some interventions that can be done?

A

Hydration, encourage mobility, restrict dietary calcium/ OTC calcium, and avoid thiazide diuretics

121
Q

Hyperparathyroidism: What can be done once interventions have been done?

A

Parathyroidectomy or Medications to inhibit bone resorption.

122
Q

Hyperparathyroidism: What medications can be given ?

A

Alendronate (Fosamax)

Zoledronate (Zometa)

123
Q

Hyperparathyroidism: What complications can develop from havin g this?

A

Osteoporosis

Kidney Stones

Hypertension

Dysrhythmias

124
Q

Hypoparathyroidism: What is this?

A

Low levels of parathormone are released and this causes the kidneys and intestine to not absorb enough calcium

125
Q

Hypoparathyroidism: What is this caused by?

A

Abnormal parathyroid development, destruction of parathyroid glands and vitamin d deficiency

126
Q

Hypoparathyroidism: What does this result in electrolye wise?

A

Hypocalcemia and Hyperphosphatemia

127
Q

Hypoparathyroidism: Risk factors for getting this?

A

Neck Surgery

128
Q

Hypoparathyroidism: What are some complications from having this?

A

Bronchospasm and Dysrhythmias

129
Q

Hypoparathyroidism: Signs of having this?

A

Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes

130
Q

Hypoparathyroidism: Results in what positive signs?

A

Positive Chvosteks and Trousseaus Signs, because hypocalcium and the gates are wide open

131
Q

Lab Tests to Test Parathyroid LEvels?

A

Bone Mineral Density Test, Serum Ca Levevl, Phosphorus Levels, Vitamin D levels

Ultrasound, CT, Urinalysis

132
Q

Goals for someone with Parathyroid disorder?

A

Maintain electrolyte balance

No Complications

Remain free of injury

PT will have Ca level of 9-10

133
Q

Hypoparathyroidism: What are some interventions you could do to help with this?

A

Quiet envionment

No drafts, no bright lights

No sudden movements

High Ca and low Phosphorus diet

134
Q

Hypoparathyroidism: What are some medications that can be given?

A

Calcium Gluconate IV

Pentobarbital

Parathormone may be administed

135
Q

Hypoparathyroidism: Why would Calcium Gluconate be given?

A

Given first when hypocalcemia and tetany occur

136
Q

Hypoparathyroidism: Why is Pentobarbital given?

A

Given 2nd to decrease reaction to the stimuli and decreasing neuromuscular irritability

137
Q

Hypoparathyroidism: What to watch for if giving Parathormone?

A

Potential allergic reactions

138
Q

Hypoparathyroidism: What are some foods you would not give?

A

Milk, and egg yolks, because they are high in both calcium and phosphorus.

139
Q

Hypoparathyroidism: Why is Vitamin D prescribed?

A

To help maintain Calcium levels

140
Q

Nursing Diagnosis for Parathyroid Disorders?

A

Electrolyte Imbalance

RF Confusion

RF Decreased CO

RF Injury

Constipation

Imbalanced Nutrition

141
Q

Parathyroid Disorders: What patient education should be given about OTC medications?

A

Should be avoided if they have Ca

142
Q

Parathyroid Disorders: What is some patient teaching for Fosamax in Hyperpara?

A

Sit up right for 30 mins after taking meds, drink full glass of water with meds and it can stay in system for weeks to months

143
Q

What is the Adrenal Cortex/Medulla considered to be in terms of essentially?

A

Adrenal Medulla - Not Essential

Adrenal Cortex - Essential

144
Q

Why is the Adrenal Medulla not essential?

A

Because the hormones its responsible for can be produced by other parts of the body.

145
Q

What is the Adrenal Medulla responsible for?

A

Catecholamines hormones: Epinephrine and Norepinephrine

146
Q

Adrenal Medulla functions as part as

A

the autonomic nervous sytem

147
Q

What does the Adrenal Cortex produce?

A

Glucocorticoids, Mineralocorticoids, Androgens, and Aldosterone

148
Q

Adrenal Cortex is stimulated by what? To produce what?

A

ACTH from the Anterior Pituitary to produce cortisol and aldosterone

149
Q

What is hte Adrenal Cortex often called?

A

Stress hormone because it is released in higher amounts during stress to help body prepared for fight or flight response

150
Q

What is an example of the adrenal cortex and a patient having stress? What happens to the body?

A

Increased cortisol and aldosterone released to cause an increase in glucose, increase metabolism and retain water to prepare for fight or flight

151
Q

What does Cortisol do to the body?

A

Regulates blood glucose levels, regulates metabolism, reduces inflammation and assists in memory formation

152
Q

What doees Aldosterone have effect on?

A

Salt and Water balance to help control blood pressure

153
Q

What does increased levels of Aldosterone do to the body?

A

Increased levels cause the kidneys to retain sodium and excrete potassium

154
Q

What happens in Addisons Disease?

A

Adrenal Cortex does not produce enough cortisol or aldodsterone.

155
Q

What can Addisons disease be due to?

A

Abrupt withdraw of exogenous steroids or autoimmune. This causes a loss of water, which leads to hypotension and low glucose level which leads to weakness.

156
Q

Low Aldosterone levels in Addisons Disease can lead to

A

Hyponatremia and Hyperkalemia, which causes N/V, Dysrhythmias

157
Q

Simple cause of Addisons Disease?

A

Low Cortisol Level

158
Q

Addisons DiseasE: (Simple) often caused by what? #1 Cause

A

Sudden cessation of exogenous steroid use due to adrenal suppression while on steroids

159
Q

Addisons DiseasE: Risk factors for developing this?

A

Abrupt withdraw of steroids, Trauma, Autoimmune

160
Q

Addisons DiseasE: How to prevent this?

A

Taper off steroids

161
Q

Addisons DiseasE: Labs and Diagnositcs for this?

A

ACTH and Cortisol Levels

ACTH Stimulation Test

162
Q

Addisons DiseasE: What is the ACTH Stimulation Test?

A

ACTH is given and then blood drawn to see if cortisol levels increase.

If it rises, we know its not a problem with Adrenal Cortex. If no rise, we know it is a Adrenal Cortex Problem.

163
Q

Addisons DiseasE: ACTH Stimulation Test, What is the problem if cortisol levels increase during this test?

A

Pituitary is the problem

164
Q

Addisons DiseasE: How will ACTH / cortisol leveles look in someone with Addisons?

A

Will have high ACTH level and a low-normal cortisol range

165
Q

Addisons DiseasE: Complications that can occur when someone has this disease?

A

Addisonian Crisis

Hypotension

Cardiac Dysrhythmias

166
Q

Addisons Disease: How can Addisonian Crisis occur?

A

From trauma or abrupt withdrawal fo steroids

167
Q

Addisons Disease: What does Addisonian Crisis cause?

A

Acute systemic illness followed by chronic manifestations of Addiosns

168
Q

Addisons Disease: Manifestations of Addisonian Crisis?

A

Develop rapidly, severe N/V, high fever, abdomen and low back pain, diarrhea, hypotension, circulatory collapse -> shock, coma

169
Q

Addisons Disease: Tx for Addisonian Crisis?

A

IV Fluid and IV GLucocorticoid to prevent circulatory collapse

170
Q

Addisons Disease: What is a distinguishing visual characteristic of soemone with this?

A

Orange skin color

171
Q

Addisons Disease: How will someone in Addisonian Crisis appear?

A

Can become very pale because of circulatory collapse

172
Q

Addisons Disease: What are some signs and symptoms of this?

A

Muscle weakness and fatigue (Lack of steroids)

Anorexia with GI Symptoms

Dark Pigmentation of Skin/Mucosa (or orange. More orange= less controlled disease is)

Hypotension (circulatory collapse)

Low blood glucose (can become hyglycemic very quickly), serum sodium, and high potassium.

Apathy, emotional lability, confusion

173
Q

Addisons Disease: What can illness or stress do to Addisons disease?

A

May precipitate problems and cause Addisionian Crisis

174
Q

Addisons Disease: What should you Assess?

A

Fluid and Electrolyte

VS and Orthostatic BP

S&S RT Adrenocortical Insufficiency: Weight changes, muscle weaknes, fatigue,

Medications

S&S of Addisonian Crisis

175
Q

Addisons Disease: What are some Nursing diagnosis?

A

Disturbed Body Image

Self-Care Deficit RT Weakness

RF Injury RT Weakness

RF Fluid Volume Deficit

Activity Intolerance and Fatigue

RF Infection

Knowledge Deficit

176
Q

Addisons Disease: Interventions with Deficient Fluid Volume?

A

I&O and VS, Assess for Dehydration

VS for Cardiovascular Status, Orthostatic Hypotension

Daily Wt

Increase fluid and Na PO intake

177
Q

Addisons Disease: Interventions with RF Ineffective Therapeutic Management?

A

Lifetime medications with emergency cortisol,

Increase fluid

High Na, Low K diet

178
Q

Addisons Disease: Interventions for Activity Intolerance?

A

Avoid stress and activity untils table

Perform all activites for pt when in crisis

Maintain a quiet, nonstressful environment

measures to reduce anxiety

179
Q

What is Cushing Syndrome?

A

The adrenal cortex produces too much cortisol and aldosterone.

180
Q

Cushing Syndrome: What does the elevated cortisol levels cause?

A

Increase in blood glucose, decreases in immune system

181
Q

Cushing Syndrome: What does the high aldosterone cause?

A

Causes the body to retain fluid, retain sodium and excrete potassium

182
Q

Cushing Syndrome: Simple definition.. what causes this?

A

Excessive adrenocortical activity or corticosteroid medications (Excess ACTH and Cortisol levels)

183
Q

Cushing Syndrome: Risk Factors for getting this?

A

Type 2 Diabetes

Poorly controlled blood glucose

HYpertension

Prolonged steroid use

184
Q

Cushing Syndrome: How to prevent Cushing Syndrome?

A

Control blood glucose

Control BP

Use Steroids Sparingly

185
Q

Cushing Syndrome: What complications can arise from this?

A

Osteoporosis, Hypertension, Type 2 Diabetes, Infections

186
Q

Cushing Syndrome: Blood glucose level here?

A

Hyperglycemia

187
Q

Cushing Syndrome: Signs and Symptoms of this?

A

Central-type obesity with “buffalo hump” heavy trunk and thin extremities

Fragile, Thin Skin.

Ecchymosis, Striae (Stretch marks), Weakness, Sleep Disturbance, OSteoporossis, Muscle Wasting, Hypertension (Bc holding onto extra fluid)

“Moon-face”.

Acne, Infection, Slow Healing, Loss of Libido, Mood Changes

188
Q

Cushing Syndrome: Electrolye Levels here for K and Na?

A

Increased serum sodium, and decreased serum potassium

189
Q

Cushing Syndrome: What is a Dexamethasone Suppression Test?

A

1 mg of Dexamethasone is given po at 11 pm and plasma cortisool level is drawn at 8am next morning. This should cause patient to push back. If it doesnt, its a pituitary problem.

190
Q

Cushing Syndrome: What tests can be performed for this?

A

ACTH & CortisolLevels

Dexamethasone Suppression Test

191
Q

Cushing Syndrome Assessment: What is assessed?

A

Activity level, Skin Assessment

Changes in Physical Appearance.

Mental function and emotional status. Meds. Daily wt, edema, jugular vein distention

192
Q

Cushing Syndrome Assessment: What electrolytes observed here?

A

Hypernatremia, Hypokalemia

193
Q

Cushing Syndrome Assessment: What specific nursing diagnosis would apply here?

A

Impaired Skin Integrity

RF FVE

194
Q

Cushing Syndrome Assessment: What are some goals?

A

Decrease RF Injury/Infection

Improved skin integrity, body image, and mental functions

195
Q

Cushing Syndrome Interventions: What do you do diet wise?

A

High protein, Vit D, Calcum, Potassium Diet

Low Sodium Diet

196
Q

Cushing Syndrome Interventions: Decrease risk of injury by establishing what type of environment?

A

Protective

197
Q

Cushing Syndrome Interventions: What should we do with infections?

A

Decrease them by avoiding exposure to them. Corticosteroids may mask signs of infection

198
Q

Cushing Syndrome Interventions: What should we do with skin care and family?

A

Provide meticulous skin care and frequent skin assessment

Explain the causes of emotional instablility to the patient and family

199
Q

Cushing Syndrome Interventions: What should you do with fluids?

A

Restrict them, because you are already holding onto fluids

200
Q

Cushing Syndrome Interventions: What medically and medication wise can be done?

A

Radiation - If Adrenal tumor is cause

Surgery - Removal of adrenal gland

Meds

201
Q

Cushing Syndrome Interventions: What meds can be used?

A

Lysodren (Blocks adrenal hormone production, can also tx adrenal tumors)

Ketocanozole (Treats fungal infections)

Cytadren (Antisteroid med)

202
Q

Cushing Syndrome Interventions: Is there a cure for this?

A

There is no cure

203
Q

Cushing Syndrome Interventions: What is an Adrenalectomy?

A

Removal of the adrenal gland

204
Q

Cushing Syndrome Interventions: Preop Adrenalectomy care includes what about a diet consultation?

A

High protein, Vitamin D

If hypokalemia, need high K foods

205
Q

Cushing Syndrome Interventions: Postoperative care after Adrenalectomy?

A

Periodic turning, couhghing, deep breathing, vital signs . Monitor I/O

206
Q

What is the Parathyroid stimulated by?

A

Low serum calcium which causes a release in parathyroid hormone, which causes the kidneys and intestine to absorb more calcium.

207
Q

Posterior Pituitary, SIADH: What is this?

A

Release of too much ADH causes kidneys to hold on to too much water. This causes hypervolemia and resulting hyponatremia

208
Q

Posterior Pituitary, SIADH: Risk Factors of getting this?

A

Brain and lung cancer

Brain injury

Lung disorders

Alcohol withdraw

opiates and chemo

Genetic predisposition

209
Q

Posterior Pituitary, SIADH: What complicaations can occur here?

A

Cerebral edema

Pulmonary Edema

Hyponatremia

210
Q

Posterior Pituitary, SIADH: Lab and Diagnostic Tests that cna be performed?

A

Low serum sodium

High urine Sodium

211
Q

Posterior Pituitary, SIADH: How to prevent SIADH?

A

Treat/remove risk factors

212
Q

Posterior Pituitary, SIADH: Diagnoses for this?

A

RF Electrolyte imbalance, fluid imbalance, injury

213
Q

Posterior Pituitary, SIADH: What should be assessed?

A

Edema, S&S of hyponatremia, VS

214
Q

Posterior Pituitary, SIADH: Goals for this?

A

Maintaining fluid balance

Maintain Electrolyte balance

Will not experience complications

215
Q

Posterior Pituitary, SIADH: Medical management for this?

A

Dimethylchlorotetracycline

216
Q

Posterior Pituitary, SIADH: Interventions for this?

A

Water restriction and Hypertonic solution IV with LAsix.

217
Q

Posterior Pituitary, SIADH: Patient education?

A

Diet /Fluid Restriction

218
Q

Posterior Pituitary, Diabetes Insipidus: What happens here?

A

Not enough ADH so kidneys release too much water. Causes hypovolemia and resulting hypernatremia

219
Q

Posterior Pituitary, Diabetes Insipidus: Risk factors for this?

A

Genetic Predisposition

Pregnancy

HEad Injury

220
Q

Posterior Pituitary, Diabetes Insipidus: Complications for this?

A

Dehydration, Kidney Damage, Brain Damage,Hypotension

221
Q

Posterior Pituitary, Diabetes Insipidus: Lab/Diagnostic Tests ?

A

Low urine specific gravity and high serum sodium

222
Q

Posterior Pituitary, Diabetes Insipidus: How to prevent this?

A

Treat/remove factors

223
Q

Posterior Pituitary, Diabetes Insipidus: Diagnosis for this?

A

RF electrolyte imabalnce, fluid imbalance, and injury

224
Q

Posterior Pituitary, Diabetes Insipidus: What assessments would be done?

A

VS, S&S of Hypernatremia, Polydypsia, Polyuria, Dilute Urien, Dry Skin and COnstipation

225
Q

Posterior Pituitary, Diabetes Insipidus: Interventions for this?

A

Increase fluid intake and low salt diet

226
Q

Posterior Pituitary, Diabetes Insipidus: Medical management for this?

A

Desmopressin

227
Q

Posterior Pituitary, Diabetes Insipidus: Education for patietn

A

Diet

Increase fluid intake

228
Q

What are corticosteroids used for?

A

Suppressing inflammation adn autoimmune reactions, controlling allergic reactiosn adn reducing rejection process in transplanation

NRSG 110: Med Surg 2 (29 decks)

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