EXAM 3 - endocrine Flashcards
The nurse provides care for a conscious client with severe ketoacidosis. The nurse anticipates which treatment modality?
insulin
The nurse provides care for a client with Addison disease. The nurse assesses for which of the following conditions most importantly?
dysrhythmias
A client is evaluated in the outpatient clinic for hypothyroidism. The nurse expects the client to exhibit which symptom?
fatigue
A client is recovering from a subtotal thyroidectomy. The nurse identifies which symptom indicating damage to the parathyroid gland?
HYPOCALCEMIA:
numbness in fingers
face twitch (pos chovstek)
arm twitch (pos trosseaus)
stridor
The nurse counsels a client about preparation for a subtotal thyroidectomy. The client was prescribed an iodine solution to take prior to the surgery, and asks the nurse why this is necessary?
prevents post op hemorrhage
The nurse understands that glucocorticoids provide a source of energy during a stressful situation. Which statement best describes the action of glucocorticoids?
converts fat to glucose
A client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) reports nausea, vomiting, headache, and confusion. Which nursing intervention is an essential part of care
seizure precautions
A client has laboratory tests regarding thyroid function. Which test results indicate to the nurse the client an underactive thyroid gland?
3
high TSH
low BMR
high cholesterol
hormones produced by anterior pituitary
TSH and GH
thyroid produces what hormone
t3 / t4
posterior pituitary produces what hormone
ADH
is Na and K high or low in SIADH
low Na and high K
is Na and K high or low in DI
high NA and low K
is Na and K high or low in cushings
high Na, low K+
is Na and K high or low in addisons
low Na, high K
is Na and K high or low in DKA
low K , low Na
is Na and K high or low in HHS**
low K
tx for hyponatremia
push NaCl slowly
tx for hypernatremia
hypotonic saline
what is SIADH
increased ADH
9 ss of SIADH
hyponatremia
urinary retention
serum HYPOosmolality
fluid retention
tachycardia
anorexia
n/v
lethargy
polydypsia
positioning in bed for SIADH
flat HOB
4 interventions for chronic SIADH
fluid restriction
restrict K and increase Na
monitor F and E
ice chips for thirst
MOA of conivaptan
vasopressin - causes urination by increasing ADH
what to monitor for with vasopressin
liver function tests
what can diuretics cause
hypokalemia
what is DI
too little ADH
7 SS OF DI
high osmolality
high urine output (polyuria >2L)
low urine SG
HYPER natremia
fatigue
weakeness
polydypsia
nutrition for DI
lower Na in diet
desmopressin function
ADH supplement
indomethacin MOA
increases renal response to ADH
hyopituitary lab values 2
low TSH
low ACTH
tx meds for hypopituitary
LIFELONG hormone replacemnt
lab value for acromegaly
INC GH
octreotide use
lowers GH in acromegaly
hypophysectomy is
removal of pituitary
position in bed for hypophysectomy
30 deg
what are pts at risk for post hypophysectomy
SIADH and DI
what is most important action post hypophysectomy
assess for CSF
teaching post hypophysectomy
no straining, bending, lifting, coughing
lab values for hypothyroid and hyperthryoid
hypo: high TSH and low T3/4
hyper: low TSH and high T3/T4
7 ss of hypothyroid
decrease sweat
cold intolerance
weight gain
constipation
LOW HR (bradycardia)
puffy face
high cholesterol
4 ss of hyperthyroid
diaphoresis
weight loss
diarrhea
HIGH HR (tachycardia)
3 shared ss of hypo and hyperthyroid
fatigue
hair loss
insomnia
MOA of levothyroxine
inrease T4
2 nursing actions for levothyroxine
monitor for DYRHYTHMIAS and chest pain
4 teaching for levothyrox
lifelong taking
empty stomach
increase fiber
dont switch brands
what are pts who have exothalamos at risk for
corneal lesions so tape over eyes
popythyuracil MOA
decrease thryoid hormone synthesis
methimazole MOA
decrease thryoid hormone synthesis
main teaching for antithyroid meds
dont abruptly stop
MOA of metoprolol in hyperthryoid
relieves symptoms of hyper, but not synthesis
when are beta blockers used in hyperthryoid
during thyroid storm
iodine MOA
dec T3/4 synthesis
if pt has bucchal swelling, salivating, n/v what is happening and what to do
too much iodine, discontinue it
teaching for someone doing RAI
use separate laundry, food, etc
6 nutrition inc or dec for hyperthryoid
dec fiber
dec caffeine
dec iodine (like fish)
inc cal
inc carb
inc protein
what does thyroiectomy accomplish
dec T3/T4
most important complication of thyroidectomy
LOW CA because parathyroid may have been remvoed
4 main nursing actions for thyroidectomy
trach tray
O2
suction
maintain airway
4 teaching for thyroidectomy post op
lifelong meds
regular exercise
AVOID EXTREMES IN TEMP etc
WATCH FOR SS OF HYPOTHYROID
9 ss of cushings
HIGH BP (HTN)
edema
purple striae
increased infection risk
buffalo hump
trunchal obesity
thin arms and legs
moon face
HYPERNATREMIA
what VS for addisonian crisis
LOW BP and HIGH HR
2 labs for addisons
low cortisol and low aldosterone
5 ss of addisons
bronze skin
N/v
exhaustion
cramps
salt cravings
how to dx cushings
dexamethasone test - if cortisol is increased then its pos for cushings
how to dx addisons 2
ACTH stimulation - if cortisol doesnt rise, then pos for addisons
CRH stim - if no cortisol then pos for addisons
most important teaching for cushings
body image
most important teaching for cushings and addisons
avoid extreme temps
IF SOMEONE IS HYPOKALEMIA WHAT IS PRIORITY OVER EVERYTHING ALWAYS
cardiac monitoring
what is most important to monitor after adrenalectomy
F and E
corticosteroid MOA
convert fat to glucose
8 SE of corticosteroids
inc glucose
low BP
lowK
high Na
low CA
delayed healing
infection prone
dec protein
important corticosteroid teaching when someone is stressed
inc dose when stressed
8 SS of hyperglycemia and what are 2 disorders with hyperglycemia
glyocuria
diarrhea
cramps
polyuria
weakness
fatigue
blurry vision
mood swings
n/v
DKA and HHS
what is number one cause of low K
DKA
16 ss of DKA
kusmall resp
ketosis
acidosis
dehydration
dry membranes
tachycardia
increase urine
lethargy
weakness
sweet breath
low bicarb
high CO2
ketones in urine
hot dry skin
inc thirst
acidic PH of blood
difference between HHS and DKA
HHS has no ketones in urine, no acidosis, no sweet breath, no KUSMALL
tx for DKA
INSULIN
9 ss of hypoglycemia
shakiness
pallor
hunger
confusion
change in mental
visual disturb
diaphoresis
palpitations
nervousness
3 causes of hypoglycemia
alc without food
increased exercise
beta blockers
if BG is below 70 what to do
give carb and juice and recheck in 15
what to do if BG is low but above 70
investigate further
if pt is unresponsive with low BG what to do
give dextrose and glucagon
how to dx diabetes
H1ac (2-3 mo fasting)
or 8 hour fast and <99 is normal and 100-125 is prediabetes
what is angiography
complication of diabetes - damage to blood vessels
teaching for retinopathy
routine eye exams
sensory vs autonomic neuropathy
sensory is loss of LE sensation and autonomic is systemic symptoms like gastroparesis
capsacin use
sensory neuropathy
amitriptyline use
inc pain signals to brain
diabetic demopathy
red brown oval patches
acanthsis nigricans
velvety skin
necrobiosis diabeticorum
red yellow lesions
what does glyburide do
stimulates insulin production
if Q comes up with boxes and assessment datanew nclex what to choose
give fluids
+ sugar
OPD of short acting insulin
30
2-5
OPD of intermediate acting insulin
1-2
4-12
4 nutriton teaching for diabetes
low fat
low carb
high fiber
limit alcohol
exercise teaching for diabetics
dont exercise if BG > 300
exercise 1 hr after meal
monitor before during after exercise
teaching for someone with insulin pump
need backup insulin
teaching after pancreas transplant
need lifelong immunosupression
if pt calls and has n/v diarrhea is suck what to do
monitor BG every 2-4 hours
