Exam 5 - Endo Flashcards
what is pheochromcytoma
tumor of medulla (center) of adrenal glands
can be a single tumor or multiple
what occurs with pheochromcytoma
excessive production of catecholomines (epi, norepi)
are men or women more likely to have pheochromcytoma
equally common in men and women
pheochromcytoma age
can occur at any age, rarely after 60
textbook says peak is 40-60 years
are pheochromcytoma tumors malignant or benign
90% are benign
risk factors for pheochromyctoma
family hx
tumors in other glands
hormonal disorders
genetic disease
s/sx of pheochromyctoma is directly related to which type of bodily response
fight or flight
s/sx of pheochromyctoma
hyperglyemic
HTN (rapid onset, abrupt cessation)
HA ** (#1 s/sx)
N/V
abdominal, CP
tachycardia
agitation
emotional instability
diaphoresis
increased metabolic rate
acute attacks r/t pheochromyctoma
profuse diaphoresis
dilated pupils
cold extremities
severe HTN (can lead to stroke, sudden blindness)
c/o black floaters
normal range for urinary catecholamines
14g/100 mL of urine
normal vanillylmandelic acid (VMA)
< 7 mg over 24 hours
how will does alpha blockers help with pheochromcytoma
relax muscles
keep small blood vessels open
alpha blocker SE
orthostasis
nasal stuffiness
increased fatigue
retrograde ejaculation
how do beta blockers help with pheochromcytoma
heart beast more slowly, less forceful
stops norepi
pheochromcytoma complications
HTN
MI
HF
stroke
kidney failure
cognitive decline
dementia
visual impairment
pheochromcytoma treatment if medication therapy is not effective
adrenalectomy
should you palpate the abdomen is a person has or suspected to have pheochromcytoma
no bc it can cause a release in additional catecholamines
5 H’s of pheochromcytoma
HTN
HA
hypermetabolism
hyperglycemia
hyperhidrosis
what type of drinks should be avoided prior to adrenalectomy
caffeine
coffee, tea, cola, energy drinks
adrenalectomy requires what for life
cortical replacement therapy
diabetes insipidus (DI) is a disorder of what gland
posterior pituitary gland
what is there a deficiency of with DI
ADH (vasopressin)
DI results in the inability to conserve what
water
will have a large amount of UOP
what are the 4 types of DI
neurogenic
nephrogenic
dipsogenic
gestagenic
neurogenic vs. nephrogenic DI
neuro: deficiency of ADH
nephro: insensitivity of the kidneys to the effect of ADH
what occurs with dipsogenic DI
form of primary polydipsia
abnormal thirst, excessive intake of liquids
causes of DI
head injury **
family hx
idopathic
neurosurgery
damage to hypothalamic areas
DI causes extreme ___ and ___
polydipsia
polyuria
DI causes a risk for ___ if there is an impaired thirst mechanism
dehydration
how does ethanol and phenytoin cause DI
inhibits ADH secretion
how does lithium and demecyocycline cause DI
inhibits ADH action in the kidneys
DI plasma osmolality will be > ___
> 295
DI urine osmolality will be < ___
< 500
will DI cause hypo or hypernatremia
HYPERnatremia
what is a normal specific gravity
1.01-1.025
DI urine specific gravity
1.001-1.005
what needs to be monitored HOURLY with a fluid deprivation test
VS
UOP
urine specific gravity
what leads to a positive DI dx with a fluid deprivation test
specific gravity remains low
continued large UOP
continued rise in serum osmolality
continued decline in urine osmolality
continued rise in serum sodium
DDAVP is a synthetic form of ___
desmopressin
how is DDAVP administered
SQ
intranasally
SE of DDAVP
chest tightness
nasal ulcerations
allergy
medications for mild/moderate ADH deficit
Tegretol PO
Atromid PO
how does tegretol and atromid work
augment action of existing ADH
how to know DI meds are effective
UOP will decrease
osmolarity will increase
what occurs with syndrome of inappropriate ADH (SIADH)
sustained secretion of ADH (water intoxication)
too much ADH is released = water retention
SIADH urine osmolarity will be > __
> 11
SIADH urine sodium concentration will be > __
> 20
causes of SIADH
PNA
TB asthma
small cell lung cancer
CHF
Positive-pressure ventilation
excessive exogenous vasopressin
meds that can cause SIADH
morphine
barbituates
vincristine
general anesthetics
thiazides
NSAIDs
MAOIs
oxytocin
haldol
ASA
tylenol
beta adrenergic agonists
malignancies r/t SIADH
bronchiogenic
pancreatic
duodenal
lymphoid tissue
prostate
thymus
colon
brain
nonmalignant causes of SIADH
hypothyroid
TB
lung abscesses
PNA
COPD
status astmaticus
SLE
SIADH s/sx will be r/t ____
HYPOnatremia s/sx
irritable
lethargic
impaired memory
SIADH daily UOP will be <
< 500 cc/24 hours
with SIADH there will be weight gain with or without edema
without edema
precautions needed if Na is < 119
seizure precautions
what to do if low Na is a new finding
report to HCP
SIADH fluid restriction
800-1000 mL
how does declomycin work for SIADH
blocks action of ADH but can cause nephrotoxic DI
SIADH intervention if pt is on a fluid restriction and c/o of thirst
suck on hard candies
what type of IVF can be administered with SIADH
3% NS
hypErtonic: Enters vessels from the cells
how can phenytoin help with SIADH
inhibits ADH release
with SIADH, HOB should not be > __ degrees
10 degrees
acute inflammation of demyelinating disorder of peripheral nervous system; acute onset of ascending motor paralysis
GBS
GBS occurs how long after infectious onset
1-3 weeks
viruses r/t GBS
epstein barre
cytomegalovirus (CMV)
shingles
chickenpox
textbook: epstein barre, campylobacter jejuni, mycoplasma pneumoniae, HiB, Zika virus
GBS recovery is usually ___
spontaneous
will the body be inflamed with GBS
no, only nerves
GBS onset is ___ but recovery is ___
ascending; descending
does GBS affect cognitive function or LOC
No
stage 1: acute stage GBS
severe, rapid weakness
loss of muscle strength
quadriplegia
respiratory failure
decrease deep tendon reflex
paresthesia
numbness
pain
stage 2: stablizing/plateau stage GBS
2-3 weeks after onset
marks end of condition
autonomic function returns
stage 3: recovery stage GBS
several months to years
marked by improvement of s/sx
muscle strength, function return in descending order
is GBS muscle weakness symmetrical or asymmetrical
symmetrical
what can be the first s/sx of a compromised airway
drooling
what test can be done to confirm GBS dx
electromyogram (EMG)
these 2 forms of treatment are most effective for GBS if performed within the first 2 weeks of symptom onset
plasmapheresis (plasma exchange)
IVIG
GBS primary focus is on ___
ventilation
be ready for intubation PRN
lyme disease is caused by spirochete borrelia burgdorferi which is transmitted primary by ___
ticks
may be carried by mice, deer, dogs, and cats
lyme disease outbreaks are commonly seen when
summer months
lyme disease incubation period
30 days
what is erythema mirgrans
flat or slightly raised (bullseye shaped) red lesion that expands over several days
systemic s/sx of lyme disease
fatigue
malaise
fever
chills
myalgia
lyme disease can cross the BBB and lead to ___
meningitis
dx: LP
precautions: droplet
what test is used to dx lyme disease within the first 2-4 weeks of initial skin lesion
ELISA or Western blot
abx for lyme disease
doxycycline
tetracycline
amoxicillin
erythromycin
how to remove a tick
tweezers
use a straight, upward pull
what to use to disinfect skin after removing a tick
soap + water
rubbing alcohol
H2O2
lyme disease prevention education
use insect repellents that contains DEET on clothing and exposed skin
what is scleroderma
overproduction of collagen
autoimmune disoder
systemic scleroderma is aka ___ ___ ___ ___
hardening of the skin
is scleroderma more common in men or women
women
onset 25-50 y/o
CREST r/t scleroderma
Calcinosis
Raynauds phenomenon
Esophageal dysfunction
Sclerodactyly
Telangiectasias
**must have 4/5 for dx
prognosis for localized scleroderma is ___
good because it is just on the skin, organs are not affected
which med group is used for raynauds
CCB
scleroderma room temp should be ___
constant; keep warm
how long should a pt with scleroderma sit up after meals
1-2 hours
scleroderma education re: foods + drinks
small frequent meals
avoid spicy foods
avoid caffeine, alcohol
what is sjogrens syndrome
autoimmune disorder that causes inflammation and dysfunction of the exocrine glands throughout the body
sjogrens syndrome is often associated with other ___ diseases
rheumatic
RA
SLE
scleroderma
hashimotos
thyroiditis
does sjogrens syndrome commonly occur in women or men
women
most common s/sx of sjogrens syndrome
xerophthalmia (dry eyes)
xerostomia (dry mouth)
can also cause dryness in the nose, bronchi, vagina, and skin
sjogrens will cause the paratoid gland to become ___
enlarged
how is sjogren’s dx
H&P
lacrimal or salivary gland tissue bx
sjorgen’s treatment is ___
supportive
