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med surg 49-51 > medsurg > Flashcards

medsurg Flashcards

1
Q

___ ___ secretes hormones directly into the blood stream. Plays a vital role in regulating homeostatic processes of
-metabolism, growth, fluid, electrolyte balance, reproductive processes, sleep and wake cycles

A

endocrine glands

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2
Q

___ ___ is connected by stalk to the hypothalamus. it has three lobes and is called the “master gland” bc it regulates function of other endocrine glands.

A

pituitary gland

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3
Q

___ is located between the cerebrum and brain stem
it influences the pituitary gland, creates a pathway for neurohormones
-stimulate, inhibit pituitary gland secretions
-hormone regulation- feedback loop controls hormone levels. Most hormones secreted in response to neg feedback.
-Most endocrine disorders: overproduction or underproduction of specific hormones

A

Hypothalamus

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4
Q

Pituitary hormones

Anterior lobe secretes:

A

TSH, ACTH, LH, GH

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5
Q

Pituitary hormones:

Posterior lobe secretes

A

oxytocin, ADH

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6
Q

___ ___ is small bean shaped bodies embedded in lateral lobes of thyroid (usually four)

A

parathyroid glands

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7
Q

The parathyroid gland secretes what?

A

parathormone. Parathormone maintains consistence of CA levels in blood and body fluids. It also helps maintain normal excitability of nerves and muscles.

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8
Q

__ __ is in the upper part of the chest above or near the heart. It is large during childhood then usually shrinks by adult hood bc the production of T lymphocytes decrease with age. Functional disorders are rare

A

thymus gland

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9
Q

The thymus gland secretes what two hormones

A

thymosin and thymopoietin.

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10
Q

___ ___ is attached to the thalamus. Function of melatonin is to help regulate mood and sleep-wake cycles

A

pineal gland

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11
Q

__ ___ Is located above the kidneys. each is divided into two parts: adrenal cortex and adrenal medulla.

A

adrenal glands.

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12
Q

the adrenal cortex secretes _____

A

corticosteroids. SWEET- glucocorticoids (cortisol) helps suppress inflammation, support metabolism, and help body withstand stress.
SALTY- mineralcorticoids (aldosterone)-regulates level of electrolyte and h2o in body.
-SEXY- gonadocorticoids (androgens) convert to estrogen and testosterone

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13
Q

the adrenal medulla secretes

A

epinephrine (adrenaline) and norepinephrine-functions for fight or flight.

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14
Q

The ___ is below the stomach with head of gland close to the duodenum. Both and endocrine and exocrine gland. Exocrine portion secretes digestive enzymes and endocrine is islets of Langerhans: Beta cells (insulin) and alpha cells (glucagon)

A

Pancreas

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15
Q

the gonads are the ____ and ___-

A

ovaries and testes.: importance of sex glands.

-secretion of testosterone, estrogen, and progesterone.

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16
Q

Atria of the heart releases the hormone

A

atrial natriuretic peptide.

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17
Q

kidneys release

A

renin; erythropoietin.

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18
Q

A metabolic disorder of the pancreas: CHO, fat, protein, metabolism, chronic disorder. Most common endocrine disorder in US. Seventh cause of death in US, 23.6 million in US have this. Incidence increased among African americans, latinos, native americans, Asian americans.

A

Diabetes mellitus

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19
Q

___ ____ is abdominal obesity. HTN, elevated LDL, tryglycerides, blood glucose levels and low HDL

A

Metabolic syndrome

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20
Q

Risk factors for metabolic syndrome

A

Heredity, obesity, life style, stress, pregnancy and oral contraceptives, viruses, autoimmune, medications.

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21
Q

__ is produced by beta cells in islet of Langerhans

A

Insulin.

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22
Q

Pre diabetes can lead to

  • type 2 diabetes
  • heart disease
  • stroke
A

know

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23
Q

Impaired fasting glucose (IFG) is __ to ___

A

100-125 mg/dL

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24
Q

Impaired glucose tolerance (IGT) __ to ___

A

140-199 mg/dL

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25
Q

____ can be associated with other disorder.
Pancreatitis, adrenocortical hormones, diuretics.
-management with insulin

A

hyperglycemia.

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26
Q

what is the issue with someone with juvenile Dm?

  • lipolysis, ketones, ketoacidosis.
  • autoimmune disorder
A

no insulin production

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27
Q

with type 2 dm what is the three issues

A

insulin resistant, insufficient insulin, inherited.

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28
Q

Type 2 dm

  • obesity-trigger
  • glycosuria
  • impaired renal threshold
  • ketonemia
  • kussmals respirations
A

know

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29
Q

S/S of type 2 DM

A
  • polyuria
  • polydipsia
  • polyphagia
  • weight loss
  • dehydration
  • blurred vision
  • thirst
  • infs-
  • skin, urinary tract, vaginal.
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30
Q

diagnostic finding of type 2 dm

A

urinary tests, blood tests, glucometer, hgb a1c test

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31
Q

Medical management of DM

A
  • diet and weight loss: major component of tx
    -exercise: improves need for insulin, improves circulation
    -insulin: types of insulin: human; beef and pork.
    dosage U100; type. Onset peak, duration.
    IV Subq, lipoatrophy, lipohypertrophy.
    -insulin pen. Jet injector, insulin pump
32
Q

Medical management of DM

A

Oral antidiabetic agents- type 2

  • pancreas transplantation
  • islet cell transplantation
33
Q

___ ____ is brittle diabetes, noncompliance with treatment; injection.
-acidotic state; coma.

A

diabetic ketoacidosis

34
Q

S/S of diabetic ketoacidosis.

A
  • weakness
  • thirst
  • anorexia
  • vomiting
  • drowsiness
  • abdominal pain
  • kussmauls respirations
  • low bP
35
Q

Diagnostic finding of diabetic ketoacidosis

A

blood glucose, urine test, lab test, blood ph

36
Q

Medical management of diabetic ketoacidosis

A

main goals

  • reduce elevated blood glucose
  • correct fluid and electrolyte imbalances
  • clear the urine and blood of ketones
  • IV insulin
  • Isotonic fluid
  • potassium replacements
37
Q

___ ___ ___ ___ results from serious illness, blood glucose is over 500 and the ph is in the normal range.

A

hyperosmolar hyperglycemic nonketotic syndrome

38
Q

During Hyperosmolar Hyperglycemic Nonketotic syndrome S/S

A

-Hypotension, mental changes
-extreme thirst, dehydration, tachycardia
-fever, neurologic signs, physical examination.
Diagnostic findings: blood glucose, serum potassium, sodium.

39
Q

Medical management of hyperosmolar hyperglycemic nonketotic syndrome

A
  • insulin administration

- correction of fluid and electrolyte imbalances.

40
Q

___ is a blood glucose less than 70 mg/dL
Contributing factors is diet, exercise, alcohol.
S/S drowsiness, nausea, hunger, malaise, excessive perspiration; confusion, coordination difficulty, personality or behavior changes.

A

Hypoglycemia

41
Q

Diagnostic findings of hypoglycemia

A

blood glucose levels, glucometer test

42
Q

Medical management of hypoglycemia.

A

Administration of 15g of simple carb as soon as possible. Recheck bp sugar in 15 min.

  • Glucagon,
  • IV admin of 50% glucose
  • complex carbs
43
Q

____ ___ is poor glucose control, decreased blood circulation to nerve tissue.

A 
Peripheral neuropathy
-motor neuropathy
-sensory neuropathy
-autonomic neuropathy
Assessment finding: pain, swollen feet
44
Q

S/S of Peripheral neuropathy

A

-disturbing sensations
-digestive, urinary, and sexual dysfunction
-dizziness
-smaller skeletal muscles
Diagnostic findings: neurologic exam, screening test, electromyography.

45
Q

Medical Management of peripheral neuropathy

A

Diet, exercise, pain relief measures.

-drug therapy, antibiotic therapy, drugs to reverse diabetic neuropathies.

46
Q

Diabetic Neuropathy:
-glomerular deterioration; five stages.
-swollen feet, hands, gradually increasing bp, tiredness, weakness, urinalysis.
Dx findings: serum creatinine test, renal creatinine clearance test.

A

Medical Management: drug therapy, dietary protein reduction, smoking cessation

47
Q

__ ___ vascular changes in the retina can lead to blindness

A

diabetic Retinopathy

48
Q

Assessments and findings of Diabetic Retinopathy:

A

Diminished visual acuity

ophthalmic examination; fluorescein angiography.

49
Q

Medical Management of Diabetic Retinopathy

A

Laser photocoagulation, vitretomy, ACE inhibitor

50
Q

Nursing management of Diabetic Retinopathy

A

Encourage therapeutic regimen for tight glucose control.

  • client education
  • complications of diabetes
  • regular ophthalmic exams
  • medication
51
Q

Vascular disturbances:
thickening of the arterial walls, coronary artery disease, hyperlipidemia.
-cool extremities, leg cramps, gangrene, skin ulcers, MI.
Dx testing: Lab test, angiography, doppler ultrasonic flow studies.
Medical and surgical management: lipid lowering measures, vasodilators, platelet aggression reduction drugs, amputation, insulin, antidiabetic drugs

A

know

52
Q

Diabetes sick day rules;

A 
take meds a/o
check bs q 3-4 hr 
follow med plan if hyperglycemia/hypoglycemia
n/v diarrhea then notify MD
fluids q 1/2 hr to 1 hr
53
Q

_____ is the oversecretion of GH due to hyperplasia

A

acromegaly.

54
Q

some products of Acromegaly is

  • giantism- oversecretion of GH before puberty.
  • dwarfism- insufficient GH during childhood
  • acromegaly-oversecretion of GH during adulthood
A

S/S
-coarse features, huge lower jaw, thick lips, thickened tongue, bulging forehead, bulbous nose, large hands and feet, enlarged organs, muscle weakness.

55
Q

___ is the over secretion of GH before puberty

A

giantism

56
Q

___ is the insufficient GH during childhood

A

dwarfism

57
Q

__ is the over secretion of GH during adult hood

A

acromegaly

58
Q

DX of acromegaly (hyperpituitarism)

A

GH level, glucose tolerance test.

59
Q

TX of acromegaly (hyperpituitarism)

A

surgery-hypophysectomy, hormone therapy, drug therapy.
Nursing care:
-psychological support, pacing activities, pain relief, self care, post op care.

60
Q

Post op care for acromegaly

A

monitor for inc ICP

  • avoid coughing, sneezing, bending over, drinking from straw- to prevent dislodging of graft/seal between cranium and nose.
  • monitor nasal drainage if packing.
61
Q

___ ___ is rare, the anterior pituitary hormone activity stops.
S/S is hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, premature aging, cachexia.

A

Simmonds disease (panhypopituitarism)

62
Q

tx of Simmonds disease

A

substitute hormones
Nursing care:
-client teaching
-adherence, medication schedule, monitor blood hormone level

63
Q

___ ___ is a disorder of the posterior lobe of the pituitary.

A

Diabetes insipidus
Types:
-neurogenic
-nephrogenic

64
Q

Causes of diabetes insipidus

A

Head trauma, congenital, lithium, pituitary removal.

65
Q

___ is a hormone that increase h20 absorption in kidney tubules which increases fluid volume.
-releases in response of thirst and fluid loss, raising bp by signaling peripheral arteries to constrict

A

ADH

  • also called Vasopressin
  • If we do not have enough ADH our tubules do not respond to it and we secrete large amts of h20
66
Q

S/S of ADH

A

polyuria, polydipsia- can have urine output 20 L/24 hrs

  • weight loss, weakness, dehydration
  • decreased specific gravity.
  • DX: fluid deprivation test- urine specific gravity.
  • TX: Neurogenic- Vasopressin- Lypressin/DDAVP nasally.
  • Nephrogenic -fluids, thiazide diuretics, dec protein and NA in diet.
67
Q

Nursing care for ADH imbalances:

A

free fluids, monitor iv infusions, monitor I&O

weights, monitor electrolyte levels, teach compliance with meds and diet.

68
Q

____ Is renal absorption of h2O instead of secretion. (opposite of diabetes insipidus)
Causes: brain/cns tumors, CVA, head trauma, tricyclic antidepressants, oral hypoglycemic.
S/S: increased fluid volume. (h2O retention) hyponatremia, h/a, muscle cramps, n/v, muscle twitching change in LOC
Dx: based on s/s- serum NA is decreased and urine NA is increased

A

SIADH

69
Q

TX for SIADH is

A

tx underlying cause.-fluid restriction and NA replacement.
-furosemide
-Osmitrol/mannitol
-3% hypertonic saline.
Nursing care: monitor VS, I&O, S/s fluid overload, med education

70
Q 
Thyroid disorders:
TSH regulates the thyroid hormone 
T4 & T3
Calcitonin
often difficult to tx and dx
A

know

71
Q

____ is hypersecretion of thyroid hormones.

Causes: Idiopathic, neoplasm, inflammation, thyroid sup, emotional distress.

A 
Hyperthyroidism
S/S:
-restlessness
-agitated
-hand tremors
-heat intolerance
-diarrhea
-increased appetite
-weight loss
-visual changes
-exophthalmos, neck swelling (goiter)
72
Q

Dx for hyperthyroidism: T3 and T4 is elevated

  • TSH decreased
  • thyroid scan
  • US
A

TX: antithyroid drugs- PTU/Tapazole

  • potassium iodine- SSKI
  • thyroidectomy
  • radiation
  • I:131
73
Q

Nursing care for hyperthyroidism:

A

Monitor VS, weight, sleep, promote rest, and avoid over stimulation

  • may need 4,500-5,000 cal/day to maintain weight
  • post op thyroidectomy-keep rescue equipment readily available.
74
Q

Thyrotoxic crisis:
-triggering factors: T3 and T4 oversecretion, epinephrine release.
S/S high temp, rapid pulse, dyspnea, cardiac dysrhythmias, vomiting, delirium, extreme restlessness.
DX: hyperthyroidism, history, lab tests
TX: immediate tx, antithyroid drugs, IV TX

A

know

75
Q

Nursing care for thyrotoxic crisis

A 
O2 
monitor VS 
antipyretics/cooling blanket
beta blockers
IV fluids
corticosteroids
76
Q

____ inadequate thyroid hormone secretion: myxedema.

A

Hypothyroidism:
S/S:
-slow metabolic rate (cold), lethargy, weight gain, dry skin, menstrual disorders.
-enlarged heart, atherosclerosis, anemia, mask like unemotional face, swelling of lips, tongue, eyelids, constipation, speech slow and low pitched.

77
Q

Dx for hypothyroidism.

A

TSH levels are increased.

  • TX: thyroid replacement-levothyroxine.
  • effects may start to be noticed in 48 hr
  • Nursing care: high fiber diet, low calorie diet, stool softeners, thyroid supplement

med surg 49-51 (1 decks)

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