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Med Surg II > Exam 5: Chapter 42 - Endocrine > Flashcards

Exam 5: Chapter 42 - Endocrine Flashcards

1
Q

Pituitary Gland and Hormones Secreted

A

Posterior pituitary —> Antidiuretic hormone (ADH, vasopressin) —-> Kidney

Anterior Pituitary —> ACTH —-> Adrenal Cortex —-> Adrenocorticosteroids

Anterior Pituitary —> TSH —> Thyroid gland —> Thyroid hormones

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2
Q

Anterior Pituitary Hormones

A

FSH, LH, prolactin, ACTH, TSH, GH- somatotropin

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3
Q

Effects of anterior pituitary hormones being in excess (hyper)

A

Cushing syndrome (ACTH)
Gigantism (GH)
Acromegaly (GH)

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4
Q

Effects of anterior pituitary hormones being insufficient (hypo)

A

dwarfism (GH)

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5
Q

Condition caused by hyposecretion of all of the anterior pituitary hormones

A

Panhypopituitarism

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6
Q

The cause of panhypopituitarism:

A

loss of the stimulating hormones leading to shrinking of the target organs.

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7
Q

Posterior Pituitary Hormones

A

ADH or Vasopressin

Oxytocin

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8
Q

Effects of posterior pituitary hormones being in excess (hyper)

A

SIADH

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9
Q

Effects of posterior pituitary hormones being insufficient (hypo)

A

Diabetes insipidus - most common condition r/t decrease in vasopressin

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10
Q

Pituitary tumors

A
  • 95% are benign
  • Primary or 2ndary: functional/nonfunctional - don’t secrete hormones
  • Surgery: hypophysectomy: removal of the pituitary gland
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11
Q 
Diabetes Insipidus (DI)
Causes:
A
  • decreased amounts of ADH
  • CAUSE:
  • *head trauma, brain tumor, surgical interventions r/t pituitary gland, infections (meningitis, encephalitis, TB), tumors
  • *Nephrogenic: failure of the renal tubules to respond to ADH
  • *Drug-induced: Lithium, Declomycin
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12
Q

Clinical manifestations of DI

A

Increased amounts of dilute urine

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13
Q

Management/treatment of DI

A
  • Replace ADH, fluids, and correct underlying pathology
  • Desmopressin (DDAVP) is synthetic vasopressin
  • Diabinese/thiazide - potentiate the action of vasopressin - used in mild disease
  • Nephrogenic: Thiazide diuretics, ibuprofen, aspirin (prostaglandin inhibitors), Na restriction
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14
Q

The nurse is caring for a patient with DI. What nursing intervention should be implemented?

A

-Assess skin turgor every 2 to 4 hours.

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15
Q

The cause of SIADH

A
  • Head injury, craniotomy, CNS infections, lung cancer

- Medications: Oncovin (chemo drug), Phenothiazines, TCA’s thiazide diuretics, nicotine.

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16
Q

Clinical manifestations of SIADH

A
  • fluid retention
    Test results:
    urine = increased sodium, increased osmolarity
    Blood = decreased sodium, decreased osmolarity (radioimmunoassay = increased adh)
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17
Q

Management/treatment of SIADH

A
  • Diuretics - Lasix

- Fluid restriction

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18
Q

Nursing management r/t SIADH

A
  • monitor I&O
  • daily weight
  • urine and blood work
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19
Q

A patient with a pituitary tumor has developed SIADH. What interventions would the nurse implement?

A

-Assess neuro status and weight daily

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20
Q

Thyroid hormones

A

T3, T4, Calcitonin

-Iodine is contained in thyroid hormone; T3 = 3 atoms and T4 = 4 atoms

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21
Q

What is needed by the thyroid gland to make the thyroid hormones?

A

Iodine

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22
Q

_____ from the _____ ______ controls the release of thyroid hormone.

A

TSH

Anterior Pituitary

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23
Q

The thyroid controls

A

Cellular metabolic activity

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24
Q

Between T3 and T4, which is more rapid-acting?

A

T3 is more potent and rapid-acting than T4.

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25
Q

Calcitonin

A

-is secreted in response to high plasma calcium level and increases calcium deposit in the bone

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26
Q

Hypothalamic - Pituitary - Thyroid Axis: the mechanism for which the body makes thyroid hormones

A

TRH: Thyroid releasing hormone, from the hypothalamus, stimulates the pituitary gland to release TSH.
TSH stimulates the thyroid to produce T3 & T4 which will then inhibit further TSH secretion & thyroid hormone production
**Thyroid hormone levels in the blood determine the release of TSH
**When the thyroid concentration decreases, the release of TSH increases

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27
Q

Thyroid diagnostic tests

A
  • TSH: this is the BEST test. It’s highly sensitive
  • Serum free T4: unbound thyroxine. Measures for changes in T4 secretion during tx for hyperthyroidism
  • T3/T4: total levels
  • T3 resin uptake: tells the mount of thyroid hormone bound to TBG (thyroxine-binding globulin) and available binding sites
  • Thyroid antibodies: autoimmune causes
  • Radioactive iodine uptake: measures the rate of iodine uptake by the thyroid gland.
  • Fine-needle biopsy: malignancies
  • Thyroid scan, radioscan, or scintiscan: cold and hot spots
  • Serum thyroglobulin: checks for recurrence of thyroid carcinoma
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28
Q

Partial list of Medications that may alter Thyroid Test Results (Chart 42-2)

A

Estrogens, sulfonylureas, corticosteroids, iodine, propranolol, Cimetidine, 5-Fluorouracil, Phenytoin, Heparin, Chloral hydrate, X-ray contrast agents, Opioids, Androgens, Salicylates, Lithium, Amiodarone, Clofibrate, Furosemide, Diazepam, Danazol, Dopamine antagonists, Propylthiouracil

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29
Q

Hypothyroidism: Causes

A
  • Hashimoto’s Disease (autoimmune thyroiditis) - most common; Autoimmune, women 30-50 years old
  • Atrophy of the thyroid gland: women over 50, women.
  • Decreased iodine
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30
Q

Therapy/management for hypothyroidism

A
  • primary objective is to restore a normal metabolic state by replacing the missing hormone.
  • Meds: Synthroid or Levothroid (levothyroxine); meds are dosed based on the patient’s TSH concentration
  • Support of cardiac function and respiratory function
  • Prevention of complications
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31
Q

Hashimoto’s disease

A
  • most common cause of hypothyroidism
  • affects women 5x more frequently than men
  • early symptoms may be nonspecific
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32
Q

Causes of hypothyroidism (Chart 42-3)

A
  • Autoimmune disease
  • Atrophy of the gland
  • Therapy for hyperthyroidism
  • Medications
  • Radiation to head and neck for treatment of head and neck cancers, lymphoma
  • Infiltrative diseases of the thyroid
  • Iodine deficiency or excess
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33
Q

Complications of hypothyroidism

A
  • Myxedema….may progress to stupor, coma and death
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34
Q

Hypothyroidism Signs and Symptoms (picture slide)

A

Hair loss, apathy, lethargy, dry skin (coarse & scaly), muscle aches & weakness, constipation, intolerance to cold, receding hairline, facial & eyelid edema, dull-blank expression, extreme fatigue, thick tongue/slow speech, anorexia, brittle nails & hair, menstrual disturbances
LATE S/S: subnormal temperature, bradycardia, weight gain, decreased LOC, thickened skin, cardiac complications

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35
Q

Hypothyroidism therapy

A
  • Levothyroxine
  • required lifelong
  • take on schedule (am 1 hr before food or 2 hrs after)
  • First start: monitor for angina (ACS) O2 needs of the heart exceed the blood supply b/c of atherosclerosis r/t longstanding hypothyroidism
  • Start with lowest dose: adults 75-125 mcg or 1.6 mcg/kg/day **Elderly: dose 75% less
  • Has long half life; change in dosage does not cause change in TSH for about 6-5 drug half lives or 6-8 weeks
  • Teach effect of too much/little drug
  • Teach about drug interactions (caffeine, calcium)
36
Q

The patient diagnosed with hypothyroidism is prescribed Synthroid. What assessment data indicates the medication has been effective?

A

Temperature is WNL

37
Q

Myxedema Coma

A
  • A complication of hypothyroidism
  • Rare but serious
  • Precipitated by: acute illness, surgery; rapid withdrawal of thyroid medication; hypothermia; sedatives and narcotics
38
Q

Manifestations of a myxedema coma

A
  • decreased respirations —> increased CO2
  • hypotension
  • bradycardia
  • hypothermia
  • confusion
  • coma
  • *S/S go in a decreasing direction
39
Q

Implementations (nursing) R/T myxedema coma

A
  • Airway
  • Blood pressure / HR
  • IV fluids / IV glucose
  • EKG monitoring
  • ABGs
  • Keep warm
  • Levothyroxine sodium (Synthroid) IV
  • Corticosteroids
  • Monitor mental status
  • Monitor F&E level
40
Q

Hyperthyroidism….causes

A
  • 2nd most prevalent endocrine disorder
  • Grave’s disease (most common cause)
  • Thyrotoxicosis: excessive output of thyroid hormone (thyroid storm)
  • Affects women eight times more than men
41
Q

Grave’s Disease

A

Autoimmune, circulating immunoglobulins stimulate the thyroid gland to produce too much thyroid hormone.

42
Q

Assessment findings for hyperthyroidism

A
  • enlarged thyroid gland
    • thrill and bruit
  • diagnosis based on s/s
  • decrease in TSH
  • increased free T4 & increased radioactive uptake
43
Q

Clinical Manifestations / Signs & Symptoms of Hyperthyroidism

A
  • Nervousness
  • Rapid pulse
  • Heat intolerance
  • Tremors
  • Skin flushed, warm, soft and moist
  • Exophthalmos
  • Increased appetite with weight loss
  • Elevated systolic BP
  • Cardiac dysrhythmias
44
Q

S/S of hyperthyroidism (picture from power point)

A 
Finger clubbing
tremors
diarrhea
menstrual changes (amenorrhea)
intolerance to heat
fine, straight hair
bulging eyes
facial flushing
enlarged thyroid
tachycardia
increased systolic bp
breast enlargement
weight loss
muscle wasting
localized edema
45
Q

Medical management of hyperthyroidism

A
  • The objective is to stop the synthesis or stop the hormone release
  • Radioactive I therapy: most common tx; destroys the thyroid gland cells
  • Surgery; subtotal thyroidectomy
  • Disease or treatment may result in hypothyroidism
  • Medications
46
Q

Medications used to treat hyperthyroidism (table 42-3)

A

Prophylthiouracil (PTU) - blocks synthesis of hormones (conversion of T3 to T4); monitor cardiac parameters, observe for hypothyroidism, PO only, Watch for rash, N/V, agranulocytosis, lupus syndrome
Methimazole - blocks synthesis of thyroid hormone; more toxic than PTU, watch for rash and other symptoms as for PTU
Sodium iodide - suppresses release of thyroid hormones; given 1 hour after PTU or methimazole, watch for edema, hemorrhage, GI upset
Potassium iodide - suppresses release of thyroid hormones; discontinue for rash, watch for signs of toxic iodinism
Saturated solution of potassium iodide (SSKI) - suppresses release of thyroid hormone; mix with juice or milk, give by straw to prevent staining of teeth
Dexamthasone - suppresses release of thyroid hormone; monitor input and output, monitor glucose, may cause HTN, N/V, anorexia, infection
Beta-blocker (eg, propranolol) - Beta-adrenergic blocking agent; monitor cardiac status, hold for bradycardia or decreased cardiac output, use with caution in patients with heart failure, tachycardia

47
Q

Name the medications that block the synthesis of thyroid hormone?

A

Prophylthiouracil (PTU)

Methimazole

48
Q

Thyroid storm

A
  • an acute and life-threatening condition
  • usually an abrupt onset
  • untreated, it’s almost always fatal
  • uncommon today because methods of diagnosis and treatment have improved
49
Q

Predisposing factors for a thyroid storm

A
  • thyroid surgery
  • infections
  • stress
  • injury
  • tooth extraction
  • insulin reaction
  • DKA
  • pregnancy
  • digitalis intoxication
  • abrupt withdrawal of antithyroid medications
  • extreme emotional stress
  • vigorous palpation of the thyroid
50
Q

Signs and symptoms of a thyroid storm

A
  • fever (over 101.3)
  • tachycardia (more than 130 bpm)
  • systolic HTN
  • angina
  • N/V/D, abdominal pain
  • agitation and restlessness
  • delirium
51
Q

Implementations for thyroid storm

A
  • Airway, O2, ventilation
  • VS
  • IV fluids: need fluids with dextrose to replace liver glycogen stores
  • EKG monitoring
  • Beta blockers: reduce cardiac s/s
  • Anti-thyroid medications: stop formation of thyroid hormone
  • Sodium iodide solution
  • Monitor glucose: give insulin as needed
  • Administer nonsalicylate antipyretics (Tylenol) b/c they displace thyroid hormones from binding proteins and worsen the hypermetabolism
  • Cooling blanket: b/c of the high fevers
52
Q

Thyroidectomy

A
  • Removal of the thyroid gland
  • Done for persistent hyperthyroidism or tumor; total or subtotal
  • Euthyroid prior to surgery - anti-thyroid meds given prior to surgery until s/s of hyperthyroidism have gone away
  • Treatment of choice for thyroid cancer
  • Modified or radical neck dissection, possible radioactive iodine to minimize metastasis
  • Preoperative goals: reduction of stress and anxiety to avoid precipitation of thyroid storm
  • Preoperative education: dietary guidance to meet patient metabolic needs, avoidance of caffeinated beverages and other stimulants, explanation of tests and procedures, and head and neck support used after surgery
53
Q

Postoperative care for a thyroidectomy

A
  • monitor respirations; potential airway impairment
  • monitor for potential bleeding and hematoma formation; check posterior dressing, sensation of fullness/pressure at site
  • assess pain and provide pain relief measures
  • semi-fowler’s position, support head and neck
  • assess voice, discourage talking b/c causes swelling on vocal cords
  • potential HYPOCALCEMIA r/t injury or removal of parathyroid glands
  • analgesia
  • assess for thyroid storm
  • monitor for signs of hypocalcemia and tetany; IV calcium available
54
Q

Parathyroid glands

A
  • Four glands on the posterior thyroid gland
  • Parathormone (parathyroid hormone) regulates calcium and phosphorus balance or metabolism.
  • Increased parathyroid hormone elevates blood calcium by increasing calcium absorption from the kidney, intestine, and bone.
  • Parathyroid hormone lowers phosphorus level
  • Serum calcium levels regulate the output of PTH-increased calcium levels decrease PTH secretion.
55
Q

Hyperparathyroidism

A
  • PRIMARY: Hypercalcemia through the increased secretion of PTH; most common cause is benign tumor adenoma in the parathyroid gland
  • SECONDARY: compensatory response to conditions that cause hypocalcemia, which is the main stimulus for PTH secretion; Vit D deficiencies, CRF, renal rickets r/t renal disease, hyperphosphatemia, malabsorption
  • Overall, increased amounts of circulating PTH is going to lead to hypercalcemia & hypophosphatemia
56
Q

Clinical Manifestations of Hyperparathyroidism

A
  • Elevated serum calcium
  • Bone decalcification
  • renal calculi
  • Apathy
  • Fatigue
  • Muscle weakness
  • N/V
  • constipation
  • HTN
  • cardiac dysrhythmias
  • psychological manifestations
57
Q

Treatment/management of hyperparathyroidism

A
  • Parathyroidectomy: recommended tx for primary: partial or complete removal of the parathyroid gland
  • Hydration therapy: 2000 mL / day or more; risk for renal stones, avoid thiazide diuretics b/c they decrease the renal excretion of calcium
  • Encourage mobility: bones give up less calcium with activity; bedrest increases calcium excretion from the bone, activity promotes bone calcification
  • Diet and medications: avoid diet with restricted or too much calcium, adapt a meal plan to patient lifestyle, make efforts to improve appetite, constipation is an issue post-op; implement interventions
58
Q

Post-operative hyperparathyroidism complications

A
  • Tetany: neuromuscular hyperexcitability - concern after a parathyroidectomy; associated with sudden decrease in calcium levels; usually present early in the post-operative period but can develop over several days
  • Hemorrhage and F&E disturbances
59
Q

Hypoparathyroidism

A
  • Inadequate circulating PTH
  • Parathormone deficiency can be caused by surgery - thyroidectomy, parathyroidectomy, or radical neck dissection
  • Results in hypocalcemia and hyperphosphatemia
60
Q

Signs and symptoms of hypoparathyroidism

A
  • Tetany
  • Numbness & tingling in extremities
  • Stiffness of hands and feet
  • Bronchospasms
  • Laryngeal spasm
  • Carpopedal spasm
  • Anxiety
  • Irritability
  • Depression
  • Delirium
  • ECG changes
  • Positive Chvostek’s (face) & Trousseau’s sign (hand)
61
Q

Management of hypoparathyroidism

A
  • Increase serum calcium level to 9 to 10 mg/dL
  • Tx with oral calcium supplements, Mg, Vit D- calcitriol
  • Calcium gluconate IV
  • Sedatives such as pentobarbital to decrease neuromuscular irritability
  • Parathormone may be administered; potential allergic reactions
  • Quiet environment; no bright lights or sudden movement
  • Dieth high in calcium (dark green veggies, soybeans, tofu) and low in phosphorus
  • Avoid milk, milk products and egg yolk b/c they contain high levels of phosphorus
  • Avoid foods that contain oxalic acid (spinach and rhubarb) b/c they inhibit absorption & form insoluble calcium substances
  • Instruct patient on long term drug and nutritional therapy
62
Q

Adrenal Glands

A
  • Adrenal medulla: functions as part of the autonomic nervous system; secretes catecholamines- epinephrine and norepinephrine
  • Adrenal cortex: Glucocorticoids, primarily cortisol; regulate metabolism, increase blood glucose levels and play a role in physiologic stress response; Mineralocorticoids, primarily aldosterone; regulates sodium and potassium balance; Androgens, sex hormones; contribute to growth and development in both genders.
63
Q

Adrenal glands (mnemonic)

A
  • S: sugar/stress; glucocorticoids
  • S: salt; mineralocorticoids
  • S: sex; sex hormones
64
Q

Adrenocortical Insufficiency

A

-Addison’s disease: hypofunction of adrenal cortex

65
Q

Causes of Addison’s disease

A
  • Autoimmune - adrenal tissue is destroyed by autoantibodies
  • TB
  • Surgical removal of both adrenal glands
  • Adrenal suppression by exogenous steroid use for tx of other chronic conditions (asthma, arthritis) - abrupt stopping of steroids
  • Decreased ACTH: comes from the pituitary gland - stimulates adrenal cortex to produce its hormones - inadequate ACTH can lead to insufficient production of hormones from the adrenal cortex
66
Q

Signs and Symptoms of Addison’s disease

A
  • bronze pigmentation of the skin
  • changes in distribution of body hair
  • GI disturbances
  • weakness
  • weight loss
  • hypoglycemia
  • postural hypotension
67
Q

S/S of an adrenal crisis

A
  • profound fatigue
  • dehydration
  • vascular collapse (decreased bp)
  • Renal shut down
  • Decreased serum Na
  • Increased Potassium
  • apathy
  • confusion
  • emotional lability
  • anorexia
68
Q

Diagnostic tests for adrenocortical insufficiency

A
  • Adrenocortical hormone levels
  • ACTH levels
  • ACTH stimulation test
69
Q

Complications of adrenocortical insufficiency

A
  • Addisonian crisis: life threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones
  • Triggers: stress; infection, surgery, psychological; sudden withdrawal of corticosteroid hormone therapy; adrenal surgery
70
Q

Assessment of a patient with adrenal insufficiency

A
  • not any illness or stressors
  • F&E status
  • VS & orthostatic blood pressures
  • Note S/S r/t adrenocortical insufficiency: weight changes, muscle weakness, fatigue
  • Medications
  • Monitor for s/s of addisonian crisis
71
Q

Nursing Diagnosis r/t adrenal insufficiency

A
  • Disturbed body image
  • self-care deficit r/t weakness, fatigue, muscle wasting, altered sleep patterns
  • Risk for injury related to weakness
  • Risk for fluid volume deficit
  • Activity intolerance and fatigue
  • Risk for infection
  • Knowledge deficit
72
Q

Nursing Interventions for the care of the patient with adrenal insufficiency

A
  • Risk for fluid deficit: monitor for s/s of fluid volume deficit; encourage fluids and foods; select foods high in sodium; administer hormone replacement as prescribed
  • Activity intolerance: avoid stress and activity until stable, perform all activities for patient when in crisis; maintain a quiet, nonstressful environment; meausres to reduce anxiety
  • Patient education
73
Q

Cushing’s Syndrome

A
  • condition that results from chronic exposure to excess corticosteroids; increased cortisol
  • Endogenous Causes: adrenal hyperplasia, adrenal tumor, pituitary tumor, lung cancer
  • Exogenous causes: secondary - most common cause, use of corticosteroid medications (prednisone)
  • Excessive adrenocortical activity
74
Q

Manifestations of Cushing’s syndrome

A
  • Hyperglycemia; central-type obesity with “buffalo hump”; heavy trunk and thin extremities; fragile, thin skin; ecchymosis; striae; weakness; lassitude; sleep disturbances; osteoporosis; muscle wasting; HRN; “moon-face”; acne; infection; slow healing; virilization in women; loss of libido; mood changes; increased serum sodium; decreased serum potassium
75
Q

Diagnosing Cushing’s syndrome

A
  • Cortisol levels
  • 24 hour urine cortisol
  • ACTH levels
  • Dexamethasone suppression test: oral dexamethasone given in evening/bedtime - plasma cortisol levels obtained around 0800 the next day; if your cortisol level remain high you have Cushing’s; taking dexamethasone should reduce ACTH level and lead to a decreased cortisol level
76
Q

Nursing assessment of a patient with Cushing’s

A
  • activity level and ability to carry out self-care
  • skin assessment
  • changes in physical appearance and patient responses to these changes
  • mental function
  • emotional status
  • medications
77
Q

Pheochromocytoma

A
  • Benign tumor of the adrenal medulla
  • increased catecholamines
  • affects men and women equally
  • 40 - 50 years old
  • family tendency
  • Diagnostics: cortisol levels, 24 hour urine for catecholamines, serum catecholamines, MRI/CT
78
Q

Cushing’s syndrome…..5 H’s

A 
HTN
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia
79
Q

Management of Cushing’s syndrome

A
  • Episodic: manage HTN, tachycardia, anxiety; bedrest; head of bed elevated to promote orthostatic decrease in bp
  • Surgical: removal of tumor; adrenalectomy; laparoscopic/open
  • Medications: control HTN (antihypertensives)
  • Other: quiet environment, VS, EKG, F&E, glucose monitoring, corticosteroids pre and post-op
80
Q

Corticosteroid therapy

A
  • suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection
  • Patient education: timing of doses, need to take as prescribed, tapering required to discontinue or reduce therapy, potential side effects and measures to reduce side effects
81
Q

Chart 42-5: Home Care Checklist for the Patient with Hypothyroidism (Myxedema)

A
  • state effects of hypothyroidism on the body
  • state precipitating factor and interventions for complications
  • explain the purpose, dose, route, schedule, side effects, and precautions of prescribed medication
  • state the compliance with medical regimen is lifelong
  • State the need to avoid extreme cold temps until stable
  • state importance of regular f/u w/ dr
  • identify dietary strategies to promote weight reduction and prevent constipation (high fiber, low calorie, adequate fluids)
  • state potential for menstrual irregularities and potential for pregnancy for women
  • state the importance of avoiding infection
  • identify changes in personality as r/t hypothyroidism
  • identify areas of activity limitations and impact on lifestyle
82
Q

Chart 42-4: Plan of nursing care of the patient with hypothyroidism

A
  • *Activity intolerance r/t fatigue and depressed cognitive funtion
  • Promote independence in self-care activities; space activities to promote rest and exercise as tolerated; provide stimulation through conversation and nonstressful activities
  • *Risk for imbalanced body temperature
  • provide extra layer of clothing/blankets
  • avoid and discourage use of heating source
  • monitor temp
  • protect from exposure to cold drafts
  • *Constipation r/t depressed GI function
  • Encourage fluids w/in fluid restriction limits
  • Provide high fiber foods, high water content foods
  • Monitor bowel function
  • Encourage increased mobility
  • Use laxatives & enemas sparingly
83
Q

Table 42-2: Summary of findings on physical examination of the thyroid gland

A
  • single nodule: autonomously functioning adenoma, adenoma or adenomatous nodule, cancer
  • multiple nodules: multinodular goiter, Hashimoto’s thyroiditis
  • diffuse goiter: Graves’ disease, Hashimoto’s thyroiditis, thyroid lymphoma, multinodular goiter
  • tenderness: subacute thyroiditis, hemorrhagic or infarcted adenoma, Hashimoto’s thyroiditis, cancer
84
Q

Chart 42-11: Home Care Checklist for the patient with adrenal insufficiency (Addison’s disease)

A
  • state need to avoid strenuous activity in hot, humid weather
  • state need for increased fluid intake and salt with excessive perspiration
  • state need for high-carbohydrate, high-protein diet with adequate sodium intake
  • identify needed activity limitations and impact on lifestyle
  • recognize the need for dosage adjustment during times of stress
  • state need to notify health care providers about disease before treatment of procedure
85
Q

Chart 42-12: Clinical Manifestations of Cushing’s Syndrome

A
  • Ophthalmic: cataracts, glaucoma
  • Cardiovascular: HTN, HF
  • Endocrine/Metabolic: truncal obesity, moon face, buffalo hump, Na retention, hypokalemia, metabolic alkalosis, hyperglycemia, menstrual irregularities, impotence, negative nitrogen balance, altered calcium metabolism, adrenal suppression
  • Immune function: decreased inflammatory responses, impaired wound healing, increased susceptibility to infections
  • Skeletal: osteoporosis, spontaneous fx, aseptic necrosis of femur, vertebral compression fx
  • GI: peptic ulcer, pancreatitis
  • Muscular: myopathy, muscle weakness
  • Dermatologic: thinning of skin, petechial, ecchymoses, striae, acne
  • Psychiatric: mood alterations, psychoses
86
Q

Commonly used corticosteroid preparations

A
  • *meds al end in -one
  • hydrocortisone
  • cortisone
  • dexamethasone
  • prednisone
  • prednisolone
  • methylprednisolone
  • triamcinolone
  • beclomethasone
  • betamethasone
87
Q

Side effects of corticosteroid therapy

A
  • Cardiovascular effects: HTN, thrombophlebitis, thromboembolism, accelerated atherosclerosis
  • Immunologic effects: increased risk of infection and masking of signs of infection
  • Ophthalmologic changes: glaucoma, corneal lesions
  • Musculoskeletal effects: muscle wasting, poor wound healing, osteoporosis w/ vertebral compression fractures, pathologic fx of long bones, aseptic necrosis of head of the femur
  • Metabolic effects: alterations in glucose metabolism, steroid withdrawal syndrome
  • Changes in appearance: moon face, weight gain, acne

Med Surg II (4 decks)

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