Med Surg Test 4 Flashcards
eosinophilic
pituitary tumor; early in life = gigantism; later in life = large hands, feet, nose and chin
basophilic
pituitary tumor; Cushing Syndrome - masculinization in females, amenorrhea, HTN and obesity
hyposphysectomy
removal of pituitary gland; menses ceases; infertility
anterior pituitary hormones (and amount)
ACTH (9-52); TSH (0.4-4); GH (male - 1-9 and female 1-16)
hyper anterior pituitary syndromes
Cushing’s syndrome, gigantism and acromegaly
hypo anterior pituitary syndromes
dwarfism
posterior pituitary hormones (and amount)
ADH (1-5) aka vasopressin
hypo posterior syndromes
diabetes insipidus
hyper posterior syndromes
SIADH
diabetes insipidus S/S
excessive thirst (polydipsia) and large volume of dilute urine (>250 mL/hour) with specific gravity 1.001-1.005
diabetes insipidus medications
desmopression, chloropropamine and thiazide diuretics
other diabetes insidious medical treatments
replace ADH and fluid replacement (2L/day of cold water)
desmopression dosage
IN 2x/day
SIADH
“dilutional hyponatremia”; retained water is excreted in kidneys
SIADH treatment
furosemide (Lasix)
thyroid hormones (and amount)
T3 (80-200); T4 (5.4-11.5) and calcitonin (<10)
iodine is contained in thyroid hormones
TSH
from the anterior pituitary; control the release of the thyroid hormones
thyroid controls what
cellular metabolic activity
calcitonin
secreted in response to high plasma calcium level and increase calcium deposits in bone
single best test for thyroid function
TSH; screen every adult >35 yo and test every 5 years
radioactive iodine uptake
see how many nodules picks up iodine
medications that may alter thyroid test results
amiodarone, aspirin, cimetidine, diazepam, furosemide, heparin, lithium, phenytoin (anticonvulsants) and propranolol
cretinism
condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid
characteristics of cretinism
adult stature without treatment ranges from 3.3-5.2 feet; also have thickened skin, enlarged tongue or protruding abdomen
main cause of hypothyroidism
autoimmune thyroiditis (Hashimoto’s disease)
other causes of hypothyroidism
atrophy of thyroid gland with aging; therapy for hyperthyroidism (radioactive iodine and thyroidectomy); medications (lithium, antithyroid); radiation to head and neck in treatment for cancer; infiltrative disease of the thyroid; iodine deficiency and iodine excess
early symptoms of hypothyroidism
hair (course), skin and nail changes; fatigue; numbness and tingling of fingers; menstrual disturbances; subnormal temp and pulse; weight gain; subdued mention response; slow speech; tongue, hands and feet may enlarge; personality and cognitive changes; cardiac and respiratory complications
complications of hypothyroidism
myxedema; may progress to stupor, coma and death
medications for hypothyroidism
synthetic levothyroxine replacement therapy
guidelines for giving levothyroxine
give on an empty stomach; don’t give with iron or anti-acids
most common cause of hyperthyroidism
Grave’s disease
hyperthyroidism
a form of thyrotoxicosis; resulting from excessive output of thyroid hormones by the thyroid
S/S of hyperthyroidism
nervousness, rapid pulse, heat intolerance, tremors, skin flushed, warm/soft/most ski, exophthalmos (bulging eyes), increased appetite, weight loss, elevated systolic BP and cardiac dysrhythmias, goiter
treatment for hyperthroidism
radioactive 131I therapy; single dose to eliminate the hyperthyroid state; destroys thyroid cells and inevitably causes hypothyroidism
surgery- subtotal thyroidectomy (removal of 5/6 of the gland)
medications for hyperthyroidism
propylthiouracil (PTU) and methimazole; sodium and potassium iodine solutions; dexamethasone; beta-blockers (propranolol)
thyroid storm
also known as thyrotoxic crisis or thyrotoxicosis; severe form of hyperthyroidism (usually abrupt)
characteristics of thyroid storm
high fever (>101.3); extreme tachycardia (>130); exaggerated symptoms of hyperthyroidism (weight loss, diarrhea and abdominal pain; edema, chest pain, dyspnea and palpitation)
diagnostic test for thyroid tumors
“hot or cold”
hot - low risk
warm - low to moderate risk
cold - moderate risk
thryroidectomy
treatment of choice for thyroid cancer; modified or radical neck dissection (with possible radioactive iodine)
thryroidectomy pre-op
meet metabolic needs, avoidance of caffeinated beverages and other stimulants, explain test and procedure and the importance of supporting head and neck after surgery
thryroidectomy post-op
monitor respirations (potential airway impairment); monitor for bleeding and hematoma formation; sit in semi-fowler’s position with support of head and neck with pillows; assess voice and discourage talking; potential hypocalcemia related to injury or removal of parathyroid glands
parathyroid glands
4 glands on the posterior thyroid gland that releases parathormone
parathormone
regulates calcium and phosphorus balance
increased parathormone …
elevates blood calcium by increasing calcium absorption from the kidney, intestine and bone; and lowers phosphorus levels
manifestations of hyperparathyroidism
elevated serum calcium, bone decalcifcation, renal calculi, apathy, fatigue, muscle weakness, nausea and vomiting, constipation, hypertension, cardiac dysrhythmias, psychological manifestations (all from too much calcium)
treatment for hyperparathyroidism
parathyroidectomy, hydration therapy, encourage mobility and reduce calcium excretion
medications for hyperparathyroidism
calcitonin, biphosphate; cytoxic agents (mithramycin)
hypoparathyroidism cause
parathyormone deficiency caused by surgery (thyroidectomy, parathyroidectomy and radial neck dissection)
hypoparathyroidism result
hypocalcemia and hyperphosphatemia
S/S of hypoparathyroidism
tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, laryngeal spasm, cardopedal spasm, anxiety, irritability, depression, delirium and ECG changes; positive Chvostek and Trousseau’s sign
management of hypoparathyroidism
calcium gluconate IV; increase calcium levels to 9-10 mg/dL; pentobarbital to decrease neuromuscular irritability; diet high in calcium and low in phosphorus; vitamin D (helps absorption); quiet environment
