Med sure 2 quiz # 6 pituitary, adrenal, thyroid and parathyroid

Question 1

Blood studies for endocrine disorders

T3 and T4

Answer 1

• test purpose- serum T3 (triidothyronine) and T4 (thyroxine)dectect abnormal levels of thyroid hormones.
• Elevated T3 indicates possible graves, toxic adenoma, or toxic nodular goiter.
• elevated T4 = hyperthyroididm or too much hormone replacement.
• decreased T3 or T4 is hypothyroidism.
• PT prep- nothing really maybe some meds need to be held.
• after- pressure on site for a few minutes.

Question 2

Age related changes to the endocrine system

Answer 2

• Diminished response ADH, older person less able to conspensatew for inadequate fluid intake ir excess fluid loss, at risk for dehydration.
  *

Question 3

Gigantism

Answer 3

• occurs in early childhood and puberty when long bones are still growing.
• excessive growth occurs in the epiphysis or diaphysis before it epiphyseal (growth plate) closes from excess GH.
• growth is ususally proportional
• may grow 8 feet and over 300 lbs
• multiple health problems and early adulthood death

Question 4

Acromegaly

Answer 4

• rare but more common than gigantism
• most also have pitiutary macroadenomasd that secrete excess GH.
• appears in 40’s/50’s both men/women equally.
• GH production occurs after epiphyseal closure
• closed epiphyseal= thicker and wider bones
• also affects the cardio, GI, nervous and genitourinary system.

Question 5

hyperpituitarism

Answer 5

• Diagnosis- physical assessment, radiographic studies and labs.
• skull x rays may show large sella turcica and > bone density.
• Enhanced computer tomography (CT) and MRI may locate intra and extracellular lesions or tumor formation.
• angiography= vascular abnormalities, aneurysms and anteriovenous malformations.
• Labs- GH or prolactin produced in excess
• anterior pitiuatary hormones levels measured
• LH and FSH elevation ok in postmeoposal women
• elevate GH and insulin growth factor 1 (IGF-1) suggest acronemaly.
• GH suppression test is most definite
• nomaly GH falls in response to glucose but not in ppl with acromegaly
• dexamethasone suppression to R/O adrenal function issues.

Question 6

focused assessment for acromegaly and gigantism

Answer 6

• Energy levels
• HT and WT
• vitals
• face/skull contours
• visual acuity
• speech
• voice quality
• abdominal distention
• if sx, what are the expectations of pt and knowledge.

Question 7

hypopituitarism

Answer 7

• S/S: depends on stage of life adn hormones involved
• dwarfism: very short, (as low as 36in), porportional.
• delayd or absent sexual maturation
• > frequency of mental retardation
• accelerated pattern of aging= shorter life span by 20 yrs
• panhypopituitarism- simmonds cachexia syndrome present= muscle/organ wasting, disruption of digestion and metabolism., < muscle /organ size due to low GH
• An absence of ACTH affects the persons ability to cope effectively with stress. This affects a persons ability to metabolize glucose and hypoglycemia may result.
• TSH depleted the thyroid is not stimulated to produce thyroid hormone resulting in hypothyroidism.
• People with hypothyroidism don’t have normal metabolism or thermogenesis or heat production they are unable to maintain a normal basil metabolic rate or body temperature.
• In lack of melanocyte stimulating hormone MSH exist, decreased pigmentation of the skin occurs. Resulting in power. With the absence of gonadotrophins, gonads may be atrophy. Both men and women lose libido, decreased body hair, and sexual dysfunction may occur, and woman amenorrhea.
• General symptoms are fatigue, weakness, malaise, cold intolerance, and lethargic. If this is function is caused by a tumor the patient may have headaches, vision disturbances, seizures, and loss of sense of smell.

Question 8

Diabetes Insipidus

Answer 8

• Characterized by excessive output of dilute urine.
• Caused by a number of factors, it’s classified as nephrogenic, neurogenic (central or hypothalmic), or dipsogenic (primary polydipsia).

Question 9

Nephrogenic DI

Question 10

Neurogenic DI

Answer 10

• defect in production or secretion of ADH

Question 11

Dipsogenic DI

Answer 11

• disorder of thirst stimulation
• when PT ingest water, serum osmolality decreases, which cause vasopressin secretion
• other factors:
• habitual excessive H2O intake
• psychiatric conditions

Question 12

DI focused assessment

Answer 12

• complete Hx of symptoms, medical Hx, and drug Hx by RN
• LVN can monitor for thirst, change in urine appearance or volume, dizziness, weakness, fainting and palpitations.
• monitor hydration, skin turgor, mucous membranes, pulse rate and quality, BP, mental status, I and O, daily wt, urine specific gravity.

Question 13

Innapropriate ADH syndrome

Answer 13

• S/S: reflects dilutional hyponatremia and water retention
• weakness
• muscle cramps/twitching
• anorexia
• nausea
• diarrhea
• irritability
• headache
• wt gain w/o edema

Question 14

Adrenal Hypofunction-addisons

Answer 14

• primary or secondary
• primary-results from destructive disease process affecting adrenal gland causing deficiencies in cortisol and aldosterone-from idiopathic atrophy autoimmue process
• other primary reasons from- tuberculosis, hemorrhage r/t anticoagulants, fungal infecvtions, AIDS, metastatic cance, gram neg sepsis, adrenalectomy, adrenal toxin, abrupt withdrawl od exogenous steroids.
• secondary reasons- insufficiency of the hypthalamus or pituitary= androgen and cortisol production. pituitary tumors, postpartum necrosis of pituitary, hypophysectomy, radiation, pituitary/intracranial lkesions,m high dose long term glucocorticoids tx.

Question 15

Addisons pathophysiology

Answer 15

• insufficiensy of adrenocortical steroids causes defects associated with mineralcorticosteroids and glucocorticosteroids.
• impaired secretions of cortisol results in decreased gluconeogenesis and decreased liver and muscle glycogen.
• causes:
• hypoglycemia
• slows glomerular FR, and gastric acid productions
• all this shit causes:
• decreased urea nitro excretiomn
• irritability
• anorexia
• wt loss
• nausea
• vomiting
• diarrhea

Question 16

Other manifestations of adrenal insufficiency

Answer 16

• Weakness, lethargic, unexplained abdominal pain, and malaise.
• Skin hyperpigmentation, particularly in sun exposed areas, pressure points, joints and creases of the body, is another possible sign.
• When levels are lowered there’s a decrease or loss of body, axillary, and pubic hair.
• And prepubescent people facial, pubic, and axillary hair may fail to grow entirely.

Question 17

Acute adrenal crisis/addisonian crisis

Answer 17

• Life-threatening emergency
• Sudden decrease in adrenal hormones
• Precipitating factors are adrenal surgery, pituitary destruction, abrupt withdrawal of steroid therapy, and stress.
• Examples of stressors include infection, illness, trauma, and emotional or psychiatric disturbances.
• Signs and symptoms hypotension, tachycardia, dehydration, confusion, hyponatremia, hypokalemia, hypercalcemia, and hypoglycemia.
• If not treated fluid and electrolyte in balance is lead to circuit Tory collapse, cardiac dysrhythmias, cardiac arrest, coma, and death.

Question 18

Addison disease medical treatment

Answer 18

• Hormone replacement with glucocorticoid and mineralcorticoids.
• Glucocorticoids peek in the early morning and our lowest level afternoon.
• If patient has an acute illness, additional glucocorticoid or needed to prevent a life-threatening condition.
• Addisonian crisis is treated with IV fluids, hydrocortisone, electrolytes, and dextrose to restore normal BP.

Question 19

Adrenal hypersecretion

Answer 19

• patho- clinical manifestations of Cushing’s syndrome affects most body systems and I related to access levels of circulating cortical steroids. In some instances such as symptoms of mineral corticoid an adjunct in exes me up here; however, symptoms of glucocorticosteroid excess usually predominate.
• Hyperadrenalism produces changes in the personal appearance including obesity, facial redness,hirtuism, menstrual disorders, hypertension a verying degrees, muscle wasting of extremities.
• Additional findings are delayed wound healing, insomnia, irrational behavior, mood disturbances, irritability, anxiety.
• Hallmark findings; truncal obesity, protein wasting, facial fullness, purple stray an admin breath by text or thighs, osteoporosis, hypokalemia.

Question 20

Hyperthyroidism

Answer 20

• Also known as thyrotoxicosis
• ABNORMALLY INCREASED SYNTHESIS AND SECRETION OF THYROID HORMONES.
• Most common type is Graves’ disease and multi nodular goiter.
• Graves’ disease is autoimmune disorder triggered by genetic and or environmental factors.
• Antibodies activate TSH receptors which intern stimulate thyroid enlargement and hormone secretion.
• Graves is more often diagnosed in women.
• Has periods of remission and exaggeration.
• Eventually may develop into hypothyroidism.
• Multinodular goiter occurs most and women in their sixth and seventh decade. Caused by thyroid nodules that secrete excess thyroid hormone without TSH stimulation. There may be multiple hyperfunvtioning small nodules or a single module called toxic adenoma.
• Nodules may be benign or malignant.
• Symptoms are usually less severe with multi nodular goiter than with Graves’ disease.

Question 21

Signs and symptoms of hyperthyroidism

Answer 21

• Weight loss
• nervousness
• restlessness irritability
• sleep disturbances
• emotional liability
• personality changes
• hair loss
• fatigue.
• Poor tolerance of heat and excessive perspiration \
• changes in the menstrual and bowel patterns
• warm moist velvety skin
• fine tremors of hands
• swelling of neck
• exophthalmos

Question 22

Dermopathy

Answer 22

• Some patients with Graves’ disease develop skin changes that are manifested as itching and thickening on the anterior aspect of the shins. Occlusive wraps with topical glucocorticoids may limit the progression of dermopathy he but there is no definite cure.

Question 23

Severe thyrotoxicosis

Answer 23

• Referred to as thyrotoxic crisis or thyroid storm.
• Medical emergency requiring intensive monitoring and treatment.
• Excessive stimulation by elevated thyroid hormones produced dangerous tachycardia and hypothermia.
• Risk of heart failure exists.
• The patient is restless and agitated and may lapse into a coma.

Question 24

Medical diagnosis of hyperthyroidism

Answer 24

• Lab findings consistent with Graves’ disease are decreased TSH and elevated serum T4.
• TSH can be so low that it cannot be detected in the blood.
• Measurement of thyroid stimulating and antibodies and results of an RAA uptake test are useful and specifically diagnosing Graves’ disease
  *

Question 25

Treatment of hyperthyroidism

Answer 25

• Drug therapy- anti-thyroid drugs and better adrenergic blockers. Thionamides and iodides are anti-thyroid drugs.
• Drugs could be used for long-term treatment but are often used for temporary to lower the level of hormones before surgery or radiation the process reduces the risk of bleeding and lowers the dangers of releasing large amount of thyroid hormones into the blood stream during surgery.
• thionamides- propylthiouracil (PTU) and mathematical (tapazole) are currently in use. It can take up to eight weeks for a fax to be noticeable drug may be given for months or years.
• Rare but serious effects or hepatitis and agranulocytosis
• iodides inhibit the synthesis of thyroid hormones. Most often used after a course of PTU to the press Harmons accretion before thyroidectomy. May also be used to treat thyrotoxicosis. SSKI saturated solution of potassium iodide can be given to people who have been exposed to radiation to prevent damage to the thyroid gland.
• Most common iodides arm lugols solution which is 5% iodine and 10% SSA & SSKI. Relief within 24 hours but several weeks for Max effects affects does not last as long therefore not generally use as a sole treatment for hyper thyroidism.
• idodine solutions can cause discoloration of the teeth and gastric upset. Effects or minimize of the iodine is diluted with milk, fruit juice, or other beverage and sit through a straw. Signs of iodine toxicity include swelling and irritation of the mucous membranes and increased salavation.
• Radiation therapy
• Surgery
• In addition, better adrenergic blockers such as propranolol (inderal) may be given to relieve some of the cardiovascular symptoms associated with hyperthyroidism.

Question 26

Thyroid surgery preop care

Answer 26

• Ask the patient what they know about the surgery and what to expect before and after the procedure.
• Identify and address learning needs.
• Notify the patient that there will be a surgical dressing in front of the neck.
• Of the incision will depend the size of the incision will depend on the surgical approach use.
• Demonstrate how to avoid straining the neck incision by supporting the head one rising.
• To evaluate the effectiveness of the teaching ask the patient to repeat the information presented. Ask patient to demonstrate activity such as deep breathing and supporting the head during position changes.

Question 27

Postop care

Answer 27

• Usually discharged home in one or two days
• Serious complications are airway obstruction, recurrent laryngeal nerve damage, hemorrhage, and tetany. A sign of hypocalcemia associated with damage to the parathyroid.
• Another complication is thyrotoxic crisis usually prevented by preop anti-thyroid drugs.
• Important to monitor and document respiratory status, level of consciousness, wound drainage or bleeding, voice quality, comfort, and neuromuscular irritability muscle twitching spasms.

Question 28

Nursing interventions

Answer 28

• Potential for airway obstruction;
• turning and deep breathing or recommended to prevent respiratory complications.
• Patient may not be able to cough due to stress to the suture line.
• Monitor and document the rate and ease of respiration. Respiratory distress can result from compression of the trachea or from a spasm of the larynx because of nerve damage or hypercalcemia.
• Suction equipment, laryngoscope, and endotracheal tube, oxygen and an emergency tracheotomy tray must be available in the room.
• Elevate the head of the bed to decrease edema.
• Use pillows to prop and support the head to avoid stress on the suture line.
• edema bleeding cause pressure on the trachea.
• Signs and symptoms of poor oxygenation because of airway obstruction or blood loss include restlessness, increasing pulse and respiratory rates, dyspnea
• Vocal cord paralysis me occure may cause spasms that close the airway called laryngospasms. Signs of laryngeal nerve damage or hoarseness and in ability to speak.
• Muscle contractions begin as twiches around the mouth at eyes. The face, fingers, and toes begin to tingle. Painful cramps . The most serious signs of hypocalcemia spasm of the larynx. tetany treated with calcium salts given IV or orally.

Question 29

decreased cardiac output

Answer 29

• Frequently inspect the dressing to detect bleeding and take vital signs. Blood make flow under the dressing to the back of the neck check behind the patient’s neck and upper back to detect this.

Question 30

Thyroid crisis

Answer 30

• Can develop with large amount of thyroid hormone enter the bloodstream during surgery or when patient with severe hypothyroidism develop a severe illness or infection.
• Complication is rare because surgery is typically delayed until serum hormone levels are reduced.
• Approximately 12 hours after surgery the patient and thyroid crisis show signs of severe hyper thyroidism:
• Tachycardia, cardiac dysrhythmias, vomiting, fever, confusion.
• Must be treated properly or patient with time as a result of heart failure.
• Treatment consist of anti-thyroid drugs IV sodium iodide, corticosteroids, better adrenergic blockers, antipyretics, IV fluids, 02, and hypo thermia blanket or other measures to reduce body temperature.

Question 31

Signs and symptoms of hypothyroidism

Answer 31

• onsetit is gradual the metabolic rate slows causing weight gain even with the crease food intake. Authority, forgetfulness, and irritability. Frequent headaches, constipation, menstrual disorders, numbness and tingling in the arms and legs, intolerance to cold.
• Slow pulse and dyspnea may be present
• Swelling of the lips and eyelids, try thick skin, bruising, then coarse hair, and hoarseness.
• Non-pitting Adema and facial edema may be present. The patient may seem slow, depressed, or apathetic. Taylor may be present because of anemia. Symptoms may be more subtle and older patients or maybe mask by signs and symptoms of other acute or chronic disorders.

Question 32

Medical treatment of hypothyroidism

Answer 32

• Hormone replacement therapy level thyroxine Synthroid replacement for older patients or those with heart disease is usually started with the slow dose and gradually increased

Question 33

Nursing assessment of parathyroid function

Answer 33

• Physical examination; heart rate and rhythm, BP, respiratory effort, muscle strength, muscle twitching, and hair and skin texture. chvostek sign and trosseau sign may be elicited to detect hypocalcemia.

Question 34

Signs and symptoms of hyper parathyroidism

Answer 34

• Weakness, lethargic, depression, anorexia, constipation. Mental and personality changes, cardiac dysrhythmias, weight loss, and urinary calculi.

Question 35

Drug therapy for hyperparathyroidism

Answer 35

• Hi fluid intake to dilute the urine. Calcium intake may be restricted. Sodium and plus phosphorus replacements may be ordered. Infusion of normal Celine is often prescribed. Several drugs can be used to treat hypercalcemia. Calcitonin. This phosphonate’s. Estrogen. Inhibit the release of calcium from bones. Cena calls that suppresses PTH secretion. Oral phosphates inherit the absorption of calcium from the digestive tract. For also made maybe given to promote the excretion of calcium in the urine. If hypercalcemia is caused by vitamin D intoxication, glucocorticoids are highly effective.

Question 36

Pheochromocytoma

Answer 36

• Is a tumor, usually benign, of the adrenal medulla that causes the creation of excess of catecholamines. (epinephrine, norepinephrine)
• Patient with pheochromocytoma exhibit episodes of severe hypertension, hyper metabolism, and hyperglycemia.
• The classic clinical findings are hypertension with a diastolic pressure of 115 or higher, severe pounding headache, and diaphoresis.
• Other symptoms include flank pain, elevated heart rate, palpitations, anxiety, pallor, dilated pupils, orthostatic hypotension, and blurred vision.
• Episodes may be triggered by emotional distress, exercise, manipulation of the tumor, postural changes, and major trauma including surgery.
• Condition is treated by surgical removal of the tumor, usually the laparoscopy.
• Treatment before surgery includes adrenergic antagonist to stabilize the patient’s fluid status.
• The nurse monitor is cardiovascular status and prepares the patient for surgery.
• Postop care is the same as patient having adrenalectomy. However special problems in the patient include a greater risk for fluctuations in blood pressure and hypoglycemia.
• Non-surgical patients are treated with Netty Rosen which reduces catecholamine production.