Exam #3: Study Guide Part 2 Flashcards
1
Q
Thyroid Gland
A
Gland responsible for secretion of hormones that regulate metabolism.
2
Q
What is the function of the thyroid gland?
A
- Works through negative feedback (TRH from hypothalamus -> TSH from anterior pituitary -> T3 & T4 immediately released)
- Communicates with parathyroid glands.
3
Q
What are the hormones that are secreted by the thyroid gland?
A
- Thyroxine (T4)
- Triiodothyronine (T3)
- Calcitonin
These hormone regulate metabolism.
4
Q
Parathyroid gland
A
Produces parathyroid hormone (PTH)
Most important factor in increasing serum calcium and decreasing serum phosphate
5
Q
What is the function of PTH?
A
- Decreased serum-ionized calcium stimulates PTH secretion acting directly on bone to release calcium.
- PTH also acts on kidney to increase calcium reabsorption and to decrease phosphate reabsorption.
6
Q
What hormones are released by the parathyroid gland?
A
PTH
*Not sure if there’s more
7
Q
What hormones are released by the anterior pituitary gland?
A
TSH ACTH LH FSH Prolactin Growth Hormone Melanocyte Stimulating Hormone
8
Q
Anterior Pituitary Gland
A
..
9
Q
Posterior Pituitary Gland
A
..
10
Q
What hormones are released by the posterior pituitary gland?
A
ADH
Oxytocin
11
Q
Adrenocorticotropic Hormone (ACTH)
A
Stimulates production and release of cortisol.
12
Q
What is the pathophysiology of diabetes insipidus?
A
Insufficiency of ADH activity.
Caused by:
1. Neurogenic (lesions, brain injury, aneurysm)
Hypothalamus doesn’t make enough ADH OR posterior pituitary doesn’t release ADH
2. Nephrogenic: kidney abnormalities affect the way ADH is processed.
3. Unknown (30%)
13
Q
What are the signs and symptoms of diabetes insipidus?
A
- Polydipsia
- Polyuria
- Dehydration (dry skin, dry mucous membranes, poor Skin turgor, fever, tachycardia, sunken appearance of eyes, unintentional weight loss)
- Electrolyte imbalance (fatigue, lethargy, headache, irritability, and muscle pains)
14
Q
How do you treat diabetes insipidus?
A
ADH replacement (Vasopressin) Fluid replacement
15
Q
What is the mechanism of action for Vasopressin (Pitressin)?
A
Causes renal collecting tubules to increase permeability to water.
Enhances water reabsorption.
16
Q
What are the adverse effects of Vasopressin (Pitressin)?
A
- Hypertension
- Can precipitate angina episodes and MI in clients with CAD.
- Excessive fluid retention can cause water intoxication.
17
Q
Hypothyroidism
A
Congenital:
Lack of thyroid gland
Cretinism (severely stunted physical and mental growth)
18
Q
How can hypothyroidism be acquired?
A
- hashimoto or autoimmune thyroiditis (most common)
- irradiation or removal of thyroid
- iodine deficiency
- Goitrogenic foods (Brussels sprouts, broccoli, cauliflower, cabbage..etc)
- Drugs such as lithium
19
Q
What are complications of hypothyroidism?
A
MYXEDEMA - occurs when the body’s level of thyroid hormones become severely low.
SYMPTOMS - below normal temperature, decreased breathing, BP and Blood Sugar, unresponsiveness
20
Q
How is hypothyroidism treated?
A
Levothyroxine (Synthroid)
21
Q
What is the mechanism of action for Levothyroxine (Synthroid)?
A
- Synthetic form of thyroxine (T4).
- MOA: Same as endogenous thyroid hormone.
- Leads to weight loss, improved tolerance to environmental temperature, increased activity and pulse rate.
22
Q
What are the adverse effects of Levothyroxine or Synthroid?
A
Symptoms of Hyperthyroidism:
- Palpitations
- Dysrhythmias
- Anxiety, insomnia, weight loss, heat intolerance
- Menstrual irregularities and osteoporosis in women (long term treatment)
23
Q
What are the drug interactions for Levothyroxine for Synthroid?
A
Questran Aluminum containing antacids (Maalox) Iron and calcium supplements Warfarin Dilantin Zoloft
24
Q
Hyperthyroidism
A
- An autoimmune disorder of unknown origin with a genetic component.
- A syndrome initiated by excessive production of thyroid hormones -> multiple system abnormalities.
- Graves’ disease is the most common type.
25
What is the pathophysiology of hyperthyroidism?
..
26
What are the signs and symptoms of hypothyroidism?
```
Cold intolerance
Unintentional weight gain
Depression
Dry, brittle hair
Fatigue
```
27
What are the signs and symptoms of hyperthyroidism?
```
Diarrhea
Flushing
Increased appetite
Muscle weakness
Fatigue
Palpitations
Irritability
Nervousness
Sleep disorders
Heat intolerance
Altered menstrual flow
```
28
What are the complications of hyperthyroidism?
- Cardiac insufficiency: tachycardia, a-fib, CHF
- Generalized muscle wasting
- Corneal ulcers
- Osteoporosis
- Impaired fertility
- Thyroid Storm (thyroxic Crisis)
29
What is the primary goal of treatment for hyperthyroidism?
Purpose is to control over-activity of thyroid gland.
30
How is hyperthyroidism treated?
1. Beta-blockers (Propranolol): treats symptoms of tachycardia, swearing, tremors and palpitations.
2. Administer antithyroid agents (propylthiouracil)
3. Radioactive Iodide
4. Surgery: Thyroidectomy
31
What is the mechanism of action for propylthiouracil (PTU)?
Interfere with synthesis of T3 and T4 in thyroid gland.
| Also prevents conversion of T4 to T3 in target tissues.
32
What are the adverse effects of propylthiouracil (PTU)?
Symptoms of hypothyroidism:
Rash and transient leukopenia (most frequent)
Small percentage experience agranulocytosis
33
How does radioactive iodine therapy treat hyperthyroidism?
Destroys active thyroid gland with ionizing radiation.
34
Cushing’s Disease vs Cushing’s Syndrome
Cushing’s Disease: excessive anterior pituitary secretion of ACTH -> too much cortisol
Cushing’s Syndrome: excessive level of cortisol, regardless of cause.
35
Addison’s Disease
Characterized by the hyposecretion of adrenal cortex hormones (glucocorticoids (cortisol) and mineralcorticoids (aldosterone)) from the adrenal gland, resulting in deficiency of the corticosteroid hormones.
36
Signs and Symptoms of Cushing’s Disease
- Truncal obesity*
- Moon face*
- Buffalo hump on the back*
- Easy bruising
- Purple Striae*
- HTN
- Edema
- Weakness
- Osteoporosis
- Hirsutism*
- Acne
- Mood/affect changes to psychosis
37
Signs and Symptoms of Addison’s Disease
- Begins with weakness and easy fatigability progressing to N/V/D
- Skin changes (hyperpigmentation and vitiligo)
- Hyponatremia, hyperkalmeia and salt cravings
- Hypotension (can progress to vascular collapse and shock)
38
What is the treatment for Cushing’s Disease/Syndrome?
- Surgical removal of tumor
- Radiation of tumor
- Tapering of the glucocorticoid therapy
39
What is the treatment for Addison’s Disease?
-Replace both cortisol and aldosterone
40
Glucocorticoids
Used as replacement therapy for clients with adrenocrotical insufficiency.
Dampen inflammatory and immune responses.
41
What is the mechanism of action of glucocorticoids?
..
42
What are the adverse effects of glucocorticoids?
..
43
Glucocorticoids include
Hydrocortisone
44
Hydrocortisone (Cortef)
Glucocorticoids used as a drug of choice in treating adrenocortical insufficiency.
45
What is the mechanism of action for hydrocortisone (Cortef)?
Acts as synthetic corticosteroid.
46
What are the adverse effects of hydrocortisone?
- Sodium and Fluid Retention.
- CNS effects: insomnia, anxiety, headache, vertigo, confusion and depression.
- HTN, tachycardia, PUD, Cushing’s Syndrome
47
What are adverse effects of long-term glucocorticoid therapy?
- Increased susceptibility to infection
- PUD increased risk when combined with NSAIDs
- Osteoporosis
- Behavioral changes: nervousness or moodiness; hallucinations or increased suicidal thoughts.
- Eye changes: cataracts and open-angle glaucoma
- Metabolic changes: raises serum glucose -> glucose intolerance or diabetes; hyperlipidemia and abnormal fat deposits; electrolyte changes (hypocalcemia, hypokalmeia, hypernatremia)
- Myopathy: muscle wasting -> weakness and fatigue
- Fluid Retention, weight gain, HTN, edema common
48
What is the role of PTH in calcium balance?
- Stimulates osteoclasts
- Accelerates bone resorption
- Causes breakdown of bone
- Consequently increases calcium in blood.
49
What is the role of calcitonin in calcium balance?
- Calcitonin stimulates bone deposition.
- This removes calcium from the blood.
- Works with PTH to control calcium homeostasis.
50
What is the role of Vitamin D in calcium balance?
Vitamin D is necessary for effective absorption of calcium
| More info on PP, not sure if need to know?
51
What are the concerns with low calcium levels?
Cause cell membranes to become hyper-excitable.
| Convulsions or muscle spasms.
52
What are the concerns with high calcium levels?
Decreases sodium permeability across cell membranes - a dangerous state.
53
What is the mechanism of action of Vitamin D supplements (i.e calcitriol)?
Acts as an active form of Vitamin D:
- promotes intestinal absorption of calcium.
- reduces bone resorption
- elevates serum levels of calcium
54
What are the adverse effects of Vitamin D supplements (Calcitriol)?
```
May cause symptom of hypercalcemia including:
Headache*
Lethargy*
Confusion*
Palpitations*
Dysrhythmias*
```
55
What are the nursing implications of Vitamin D supplements?
- Assess for symptoms of hypercalcemia (palpitations, dysrhythmias, blurred vision, photophobia, lethargy and confusion)
- Obtain a thorough history of current medications including intake of fat-soluble vitamins (ADEK)
- Monitor lab studies
56
What are the causes of osteomalacia?
- Bone requires adequate concentration of Ca and Phosphate.
- Vitamin D enhances the absorption of calcium from the intestines.
- Low serum Ca levels stimulate PTH
- PTH raises serum Ca levels but decreases phosphate levels.
- Without phosphate bone mineralization can’t occur.
57
What are the signs and symptoms of osteomalacia?
- Muscular and Skeletal Pain: Hip most common
- Muscle Weakness
- Hypocalcemia
- Fragility and fractures may occur
- Bowlegs and pigeon chest (in Rickets)
58
What is the pathophysiology of osteoporosis?
- Bone resorption and bone formation cycle is disrupted
| - Osteoclasts are disrupted
59
What are the signs and symptoms of osteoporosis?
- Pain and bone deformity (secondary to fracture)
| - Vertebral collapse - kyphosis (hunchback)
60
What are the risk factors for osteoporosis?
- Most common: onset of menopause
- High alcohol or caffeine consumption
- Anorexia Nervosa
- Tobacco use
- Physical inactivity
- Testosterone deficiency
- Hyperthyroidism
- Lack of Vitamin D or calcium
- Drugs that lower calcium in the blood (corticosteroids, anticonvulsants, immunosuppressants)
61
Osteomalacia
Characterized by softening of bones due to demineralization.
62
Osteoporosis
Related to bone deterioration (Bone resorption outpaces bone deposition):
- Lack of dietary calcium and Vitamin D
- Disrupted bone homeostasis
63
What is the treatment used to treat osteoporosis?
Bisophophonates
| Raloxifene (Selective Estrogen Receptor Modulators aka SERMs) - Second line drug
64
What is the mechanism of action of bisphosphonates (i.e alendronate or Fosamax)?
Becomes incorporated into skeletal tissue.
| Blocks bone reabsorption by inhibiting osteoclast activity.
65
What are the adverse effects of bisphosphonates (i.e alendronate or Fosamax)?
```
GI disturbances (abdominal pain, flatulence, dyspepsia, N/V/D)
*TAKE ON EMPTY STOMACH
```
66
What is the mechanism of action for SERMs (i.e raloxifene or Evista)?
- Decreases bone resorption.
- Increases bone density.
- Binds to estrogen receptors (may be estrogen agonists or antagonists - depends on drug or tissue involved)
67
What are the adverse effects of SERMs (i.e raloxifene or Evista)?
Most common:
- Hot flashes
- Migraine headache
- Leg cramps
- Weight gain
- Flu-like symptoms
68
Osteoarthritis
- Degenerative, age-onset disease
| - Affects the entire joint - characterized by wearing away of cartilage at articulate joint surfaces.
69
What is the pathophysiology of osteoarthritis?
- Failure of chondrocytes to maintain balance between degradation and synthesis of collagen.
- Biochemical, biomechanical, inflammatory and immunologic factors contribute to cartilage loss
70
What are the signs and symptoms of osteoarthritis?
Muscle spasms
Localized pain and stiffness
Joint and bone enlargement
71
What is the treatment for osteoarthritis?
Analgesics
NSAIDs (Ibuprofen)
Corticosteroid Injection
72
How do NSAIDs (Ibuprofen or Naproxen) treat osteoarthritis?
Goal of osteoarthritis treatment is to reduce pain and inflammation.
NSAIDs are analgesics and anti-inflammatory agent.
73
Rheumatoid Arthritis
- Systemic autoimmune damage to connective tissue, primarily in joints (synovial membrane)
- Autoantibodies (rheumatoid factors) activate inflammatory response in joints symmetrically
74
What is the pathophysiology of Rheumatoid Arthritis?
- An insult (infection, smoking, trauma) precipitates an autoimmune reaction.
- Anti-body activation results in endothelial activation (synovial hypertrophy, joint inflammation)
- Systemic disorder:
- abnormal B- and T-cell interactions
- overproduction of cytokines
75
What are the signs and symptoms of Rheumatoid Arthritis?
- Painful, tender and stiff joints (usually affects both sides equally): hands, wrist and feet joints are most common
- Stiffness usually lasts for about 1 hour after rising in morning (synovitis).
- Reduced ROM, difficulties with ADLs
76
What is used to treat Rheumatoid Arthritis?
- DMARD Therapy
- NSAIDs (naproxen or ibuprofen)
- Prednisone (if not responding to NSAIDs)
77
What is the mechanism of action of DMARDs (i.e hydroxychloroquine sulfate or Planequil)?
Relieves severe inflammation of arthritis and lupus.
| MOA is unknown.
78
What are the adverse effects of Disease Modifying Anti-Rheumatic Drugs (DMARDs)?
```
Anorexia
Aplastic Anemia
Agranulocytosis
Seizures
Retinopathy
Headache
Mood and mental changes
```
79
Gout
Characterized by buildup of uric acid in blood or joint cavities.
Triggered by diet (high purine), injury or other stress.
Attacks often occur at night.
80
What is the pathophysiology of gout?
Overproduction or underexcretion of uric acid.
| Leads to inflammation and pain in joints: Often in big toes, ankles, fingers, wrists, knees, elbows
81
What are the sings and symptoms of gout?
- Monoarticular arthritis
- Tophi (helix of ear, arm or leg)
- Renal Disease
- Renal Calculi
- Abrupt attacks (red swollen tissue; peripheral joint)
- Pain several hours to several weeks
82
How do you treat an acute exacerbation of gout?
Glucocorticoids(used for short-term relief; injected into joint)
NSAIDs (for pain and inflammation)
83
How is colchicine or colycrys treat gout?
- Terminates acute attacks of gout by reducing inflammation.
- Does so by inhibiting the synthesis of microtubules (subcellular structures responsible for helping WBCs infiltrate area)
84
What is anti-gout prophylaxis (i.e allopurinol or Zyloprim)?
- Prevents future attacks of gout.
- Indicated for hyperuricemia.
- Does so by inhibiting xanthine oxidase (which prevents uric acid production).
85
Osteomyelitis
Most often caused by an infection.
86
What is the pathophysiology of osteomyelitis?
- Similar to body tissue
- Invading pathogen revokes Inflammatory response
- Suppurative infection of bone with edema and vascular compromise
- Can occur as a result of:
- Bacteria transported through blood
- Spread of infection through contact
- Direct inoculation into intact bone (trauma or surgery)
87
What are the signs and symptoms of osteomyelitis?
- Varies
- Abrupt onset of inflammation (acute)
- Fever, chills, lethargy (in children)
- Lymphadenopathy
- Chronic - necrotic bone
88
What is used to treat osteomyelitis?
Antibiotics
Debridement
Surgical removal of exudates
Hyperbaric oxygen therapy
89
What class of drugs increases the risk for peptic ulcers?
..
90
What class of drugs increases the risk of decreased wound healing?
..
91
What class of drugs increases the risk of capillary fragility?
..
92
Adequate levels of calcium in the body are necessary to:
- Transmit nerve impulse
- Prevent muscle spasms
- Provide stability and movement
-Also important for blood coagulation and myocardial activity.
93
Calcium balance in th body is regulated by
The parathyroid hormone
94
What is the recommended daily allowance of calcium for adults?
800 to 1,200 mg/day
*Increased amounts are needed for pregnant women, growing children and menopausal women
95
What is the normal serum calcium range?
4.5 - 5.5 mEqL
| OR 8.5 - 10 mg/dL
96
What three organs does calcitonin and PTH target?
Bones
Kidneys
GI Tract
97
What is the mechanism of action for alendronate (bisophosphonate)?
Lowers serum alkaline phosphatase (enzyme associated with bone turnover)
98
What is the most frequent cause of osteomalacia?
Deficiency of vitamin D and calcium in the diet.
99
What is the etiology of osteoarthritis?
Etiology is poorly understood.
| Thought to be d/t excessive wear of weight-bearing joints (hip, knee and spine)
100
What can trigger gout?
Diet (high purine)
Injury
Other stress
101
Look at negative feedback of thyroid gland
MIGHT BE IMPORTANT
102
Primary Hypothyroidism
Direct dysfunction of the thyroid.
| Thyroid can’t produce amount of hormones the pituitary gland calls for.
103
Secondary Hypothyroidism
```
Defects in TSH production such as:
Head trauma
Brain infections
Brain neoplasm
Neurosurgery
Cranial irradiation
```
104
Early Symptoms of Hypothyroidism include
General Weakness
Muscle Cramps
Dry Skin
105
More severe symptoms of hypothyroidism include
```
Lethargy
Poor memory
Decreased appetite
Slurred speech
Bradycardia
Weight gain
Constipation
Decreased sense of taste and smell
Intolerance to cold environments
Facial edema (periorbital)
Goiter
```
106
Thyroid Storm (Thyrotoxic Crisis)
Life-threatening form of hyperthyroidism.
107
Symptom of Thyroid Storm
```
High fever
Cardiovascular effects (tachycardia, CHF, angina, MI)
CNS effects (agitation, restlessness, delirium, progressing to coma)
Hepatic dysfunction
Severe diarrhea (may lead to electrolyte imbalance and dehydration)
```
108
Cushing’s disease is caused by
A tumor or excess growth (hyperplasia) of the pituitary gland.
109
Cortisol
Normally released during stressful situations.
Controls the body’s use of carbs, fats and proteins.
Also reduces the immune system’s response to swelling (inflammation).
110
What is the role of calcium in maintaining homeostasis?
-Critical to proper function of the nervous, muscular and cardiovascular systems.
