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NRSE-3540 Adult Care 1 > Module 2 Blueprint > Flashcards

Module 2 Blueprint Flashcards

1
Q

The adrenal gland is made up of what two structures

A

adrenal cortex and adrenal medulla

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2
Q

The adrenal cortex secretes

A

corticosteroids (cortisol) and alderosterone (mineralocorticoid)

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3
Q

How does aldosterone work?

A

promotes sodium and water reabsorption and potassium excretion

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4
Q

Aldosterone is regulated by the?

A

RAAS system and adrenocorticotropic hormone (ACTH)

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5
Q

How does the RAAS system work

A

renin is produced in kidneys from sodium or blood loss. renin coverts angiotensinogen into angiotensin 1, then angiotensin 2. Angiotensin II triggers the release of aldosterone. Aldosterone promotes reabsorption in the kidneys to raise plasma level

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6
Q

How does serum potassium level control aldosterone secretion

A

aldosterone is released when serum potassium is above normal. Aldosterone then enhances kidney excretion of potassium, correcting fluid and electrolyte imbalances

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7
Q

What does cortisol affect

A

stress responses, metabolism, helps catecholamine function, maintenance of heart cell excitability

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8
Q

Describe the release of cortisol (negative feedback loop)

A

low blood cortisol levels –> secretion of CRH by hypothalamus –> causes pituitary to release ACTH –> ACTH releases cortisol from adrenal cortex

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9
Q

The adrenal medulla secretes

A

catecholamines

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10
Q

What are catecholamines

A

epinephrine and norepinephrine

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11
Q

Activation of the sympathetic nervous stem produces this response

A

stress response (release of catecholamines causing fight or flight)

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12
Q

What are the gonads

A

male and female reproductive glands

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13
Q

What are the male gonads

A

testes

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14
Q

What are the female gonads

A

ovaries

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15
Q

Function of the gonads is dormant until

A

puberty

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16
Q

How do the gonads become activated

A

gonadotropic hormones released by the anterior pituitary cause external genitalia and glands to mature

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17
Q

The testes produce what hormone

A

testosteroen

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18
Q

The ovaries produce what hormone

A

estrogen and progesterone

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19
Q

What is the hypothalamic hypophyseal portal system?

A

hormones produced in the hypothalamus travel directly to the anterior pituitary

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20
Q

the function of the hypothalamus is to produce _______ hormones

A

regulatory

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21
Q

The pituitary gland is known as the?

A

master gland

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22
Q

What two hormones are produced in the hypothalamus, but stored in the posterior pituitary?

A

ADH and oxytocin

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23
Q

Hormones of the posterior pituitary

A

oxytocin and vasopressin (ADH)

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24
Q

Hormones of the anterior pituitary

A

ACTH, FSH, GH, LH, MSH (melanocyte stimulating hormone), PRL (prolactin), TSH

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25
Q

target tissues for ACTH

A

adrenal cortex (stimulates release of corticosteroids)

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26
Q

target tissues for FSH

A

ovary , testes (secretes estrogen and stimulates spermatogenesis)

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27
Q

target tissues for GH

A

bone and soft tissues (promotes growth)

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28
Q

target tissues for LH

A

ovary, testes (stimulates progesterone secretion and ovulation, stimulates testosterone secretion)

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29
Q

target tissues for MSH

A

melanocytes

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30
Q

target tissues for PRL

A

mammary glands (breast development and milk production)

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31
Q

Target tissues for TSH

A

thyroid

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32
Q

ADH controls?

A

fluid and electrolyte balance

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33
Q

What three hormones does the pancreas secrete

A

glucagon, insulin, somatostatin

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34
Q

What does glucagon do?

A

hormone that increases blood sugar levels as a part of glucose regulation

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35
Q

What does insulin do

A

lowers glucose by moving glucose into the cells

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36
Q

What does somatostatin do

A

inhibits the release of glucagon and insulin

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37
Q

What does the parathyroid gland secrete

A

parathyroid hormone (PTH)

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38
Q

PTH regulates calcium and phosphorus metabolism by acting on?

A

bones, kidneys, and GI tract

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39
Q

PTH and how it works in the bone

A

promotes resorption (release of calcium from the bone)

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40
Q

PTH and how it works in the kidneys q

A

allows calcium to be reabsorbed back into the tubules

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41
Q

PTH and how it works in the intestines

A

in the kidneys, PTH activates vitamin D which increases absorption of calcium and vitamin d in the intestines

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42
Q

PTH secretion ____ when calcium is high

A

decreases

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43
Q

PTH secretion ____ when calcium is low

A

increases

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44
Q

The thyroid gland secretes what hormones

A

T4 and T3

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45
Q

Control of metabolism (protein, fat, carbohydrate) occurs through which hormones

A

T3 and T4

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46
Q

Explain the hypothalamic-pituitary-thyroid gland axis negative feedback loop

A

hypothalamus secretes thyrotropin-releasing hormone (TRH). TRH triggers anterior pituitary to secrete thyroid stimulating hormone (TSH). TSH stimulates thyroid glands to release thyroid hormones

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47
Q

If t3 and t4 are high, TSH is

A

low

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48
Q

If T3 and T4 are low, TSH is

A

high

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49
Q

Dietary intake to produce thyroid hormones includes

A

iodine and protein

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50
Q

Calcitonin, released by the thyroid gland, does what

A

lowers serum calcium levels by reducing bone resorption

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51
Q

If calcium levels are high, calcitonin is

A

increased

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52
Q

If calcium levels are low, calcitonin is

A

decreased

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53
Q

Common sources of iodine

A

table salt, eggs, saltwater fish, seaweed, shellfish, cheese, milk, yogurt

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54
Q

Explain the feedback loop of insulin secretion

A

blood glucose levels high - insulin secreted - insulin moves glucose into cells - blood glucose levels lower

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55
Q

What is hypopituitarism

A

deficiency of one or more of the pituitary hormones

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56
Q

most common cause of hypopituitarism

A

pituitary tumor (tumor suppresses gland)

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57
Q

What is selective hypopituitarism

A

one pituitary hormone is deficient

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58
Q

What is panhypopituitarism

A

two or more pituitary hormones decreased

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59
Q

How does shock or severe hypotension cause hypopituitarism

A

reaction of blood flow to pituitary gland causes hypoxia, infarction, and reduced hormones

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60
Q

head trauma, brain surgery, brain infection, radiation, and AIDS can all be causes of

A

hypopituitarism

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61
Q

Symptoms of hypopituitarism caused by ACTH

A

low cortisol, hypoglycemia, anorexia, hyponatremia, lethargy, hypotension, headache, decreased axillary or pubic hair

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62
Q

Symptoms of hypopituitarism caused by FSH and LH

A

males: decreased body and facial hair, decreased bone density and muscle mass, decreased libido, impotence
Females: amenorrhea, breast atrophy, decreased axillary and pubic hair, low estrogen, loss of bone density, decreased libido

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63
Q

Symptoms of hypopituitarism caused by GH (adults)

A

decreased bone density, decreased muscle strength, pathologic fractures

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64
Q

Symptoms of hypopituitarism caused by GH in children

A

short stature

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65
Q

Symptoms of hypopituitarism caused by TSH

A

cold intolerance, weight gain, slow cognition, alopecia, decreased libido

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66
Q

Symptoms of hypopituitarism caused by vasopressin (ADH)

A

dehydration, increased urine, increased thirst, hypotension

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67
Q

What kind of therapy is required for patients that have hypopituitarism

A

life-long hormone replacement therapy (HRT)

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68
Q

What is dyspareunia, a symptom reported by women with hypopituitarism

A

painful intercourse

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69
Q

Neurologic symptoms of hypopituitarism, frequently caused by tumor growth include

A

changes in vision, headaches, diplopia (double vision), limited eye movement

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70
Q

Laboratory findings for hypopituitarism

A

decreased levels in blood, abnormal assessment findings

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71
Q

Decreased TSH, which causes hypopituitarism, is treated with?

A

levothyroxine

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72
Q

Decreased GH, which causes hypopituitarism, is treated with?

A

somatotropin

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73
Q

Men who have gonadotropin deficiency, caused by hypopituitarism is treated with?

A

testosterone

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74
Q

Women who have gonadotropin deficiency, which causes hypopituitarism, is treated with?

A

estrogen and progesterone

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75
Q

Can men with prostate cancer receive androgen therapy

A

NO

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76
Q

Women taking androgen therapy with estrogen are at increased risk of ?

A

hypertension, thrombosis (especially with nicotine use)

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77
Q

Safety considerations for clients with decreased GH:

A

decreased bone density can increase risk of fractures –> increased risk for falls

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78
Q

hyperpituitarism is most commonly caused by

A

adenoma

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79
Q

As an adenoma grows larger in the pituitary, those with hyperpituitarism can experience/

A

vision changes, headaches, increased ICP

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80
Q

Acromegaly occurs from overgrowth of what hormone?

A

GH

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81
Q

The onset of acromegaly is usually

A

gradual (easily missed until late stages)

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82
Q

Symptoms of acromegaly

A

enlarged face, hands, feet, coarse facial features, increased head size, protruding jaw, joint pain, vision changes, voice changes, thick lips, sleep apnea

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83
Q

During acromegaly, we can see hypertrophy of the soft tissue such as the

A

tongue, skin, and visceral organs

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84
Q

Complications from acromegaly can occur when these organs become enlarged

A

heart, liver, lungs

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85
Q

Symptoms of acromegaly in children result in

A

gigantism

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86
Q

Why can those with acromegaly experience voice changes

A

hypertrophy of vocal cords

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87
Q

With acromegaly, will blood glucose be high or low

A

high

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88
Q

Cushings disease, a type of hyperpituitarism, occurs from overgrowth of what hormone

A

ACTH

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89
Q

Excess ACTH stimulates the adrenal cortex, so we have excessive production of what hormones

A

corticosteroids, mineralosteroids, androgens (this leads to bushings)

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90
Q

Symptoms of Cushing’s syndrome (a type of hyperpituitarism)

A

elevated cortisol, moon face, buffalo hump, purple striae, truncal obesity, weight gain, hypertension, hyperglycemia

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91
Q

Hypersecretion of PRL, a type of hyperpituitarism, has symptoms such as

A

sexual dysfunction, menstrual changes , decreased libido, painful intercourse

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92
Q

What is a growth hormone suppression test used for

A

acromegaly

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93
Q

Describe the growth hormone suppression test

A

oral glucose is given. if GH levels do not fall below 5ng/mL we have a positive test.

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94
Q

X-rays may be used to assess hyperpituitarism because it can see

A

bone

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95
Q

CT/MRI may be used to assess hyperpituitarism because it can see

A

pituitary gland itself

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96
Q

What medications can be used to treat acromegaly

A

dopamine agonists, somatostatin analogs, growth hormone receptor blockers

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97
Q

What do dopamine agonists do?

A

inhibit growth hormone

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98
Q

What are the dopamine agonists?

A

bromocriptine mesylate, cabergoline

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99
Q

Adverse reactions of dopamine agonists

A

CP, dizziness, watery nasal drainage (CSF leak)

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100
Q

How does somatostatin analogs work

A

inhibit growth hormone

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101
Q

What are the somatostatin analogs?

A

ocreotide , lanreotide

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102
Q

What is the growth hormone receptor blocker

A

pegvisomant

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103
Q

Client education for dopamine agonists

A

notify provider immediately if CP, dizziness, or water nasal drainage occurs

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104
Q

Surgical management of hyperpituitarism includes

A

hypophysectomy (removal of tumor)

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105
Q

Pre-surgical education for hypophysectomy

A

-nasal packing may be present 2-3 days
-do not cough, brush teeth, sneeze, blow nose, or bend over after surgery

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106
Q

What can coughing, sneezing, blowing nose, or bending over cause after hypophysectomy

A

increased cranial pressure, increased risk of CSF leak

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107
Q

Operative procedure during hypophysectomy

A

transphenoidal approach or transnasal approach. General anesthesia. Nasal packing with transphenoidal and mustache dressing.

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108
Q

Post operative interventions for hypophysectomy

A

neurochecks q h first 24 h –> then q 4
-mental status, altered LOC, pupillary response
monitor I & O
teach to report increased swallowing
teach to report post nasal drip
encourage deep breathing q h
monitor infection/meningitis
good oral care (mw and floss)
decreased smell 3-4 months

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109
Q

Presence of glucose in nasal drainage may indicate

A

CSF

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110
Q

presence of yellow halo sign in nasal drainage will indicate

A

CSF

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111
Q

Increased swallowing my indicate

A

CSF

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112
Q

S/S of meningitis we should monitor for after hypophysectomy

A

headache, fever, muscle rigidity

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113
Q

Straining while having a bowel movement, after hypophysectomy, can increase risk for

A

ICP

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114
Q

How long should our patients avoid brushing teeth after hypophysectomy ?

A

2 weeks

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115
Q

Treatment for CSF leak

A

bedrest (unless surgery is indicated)

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116
Q

What medications are used to treat cushings syndrome

A

ketoconazole , mitotane

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117
Q

Client education for ketoconazole

A

relief is temporary (findings will return after medication stops), take with food, can cause nausea vomiting fatigue

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118
Q

Risk factors for acromegaly

A

adult, pituitary tumors

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119
Q

Risk factors for cushings

A

females ages 20-40

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120
Q

laboratory tests used for Cushing’s syndrome

A

blood cortisol levels (elevated), ACTH (elevated), salivary cortisol (elevated), glucose and sodium levels (elevated), potassium and calcium levels (decreased) WBC levels (decreased)

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121
Q

Nursing care for Cushing’s syndrome

A

monitor I&O, monitor signs of hypervolemia, maintain safety due to pathological fractures, monitor for infections

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122
Q

Cushings syndrome can cause suppression of?

A

immune system and inflammatory response

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123
Q

Cushings syndrome can cause osteoporosis, so it is important to monitor our patients for

A

osteoporosis and their safety (due to fall risk)

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124
Q

Because of the suppressed immune system, people with Cushings syndrome are at risk of

A

frequent infections, delayed wound healing

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125
Q

Causes of hyperthyroidism include

A

Graves’ disease, thyroiditis, toxic nodular goiter, exogenous hyperthyroidism, adenoma

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126
Q

What functions does the thyroid control in the adult

A

metabolism, tissue use of fats proteins and carbs, increased RBC, RR rate and drive

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127
Q

When TH is high TSH is

A

low

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128
Q

When TH is low TSH is

A

high

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129
Q

How does hyperthyroidism cause hypertension

A

increase cardiac output –> increase blood flow –> increase BP

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130
Q

What does primary hyperthyroidism mean

A

caused by the thyroid itself secreting too many hormones

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131
Q

Secondary hyperthyroidism is caused by

A

hypothalamus or pituitary gland secreting too much TSH

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132
Q

What is Grave’s disease

A

autoimmune disorder in which autoantibodies attack the thyroid causing increase in hormone production

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133
Q

What specific changes occurs with Grave’s disease

A

exopthalamus (abnormal protruding of eyes) and pretibial myxedema

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134
Q

What is pretibial myxedema

A

dry, waxy swelling of the lower legs

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135
Q

symptoms of hyperthyroidism

A

irritability, weakness, heat intolerance, weight loss, diaphoresis, increased appetite, diarrhea, thin silky hair, goiter (common with graves), bruit over thyroid gland, tachycardia, dyspnea, amenorrhea, increased systolic BP, bulging eyes

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136
Q

Changes in vision can occur with hyperthyroidism. What will these changes look like

A

blurry vision, double vision, eye fatigue, eyelid lag

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137
Q

Which lab value is the greatest indicator of graves disease

A

thyrotropin receptor antibodies

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138
Q

What should the nurse monitor for patients with hyperthyroidism

A

apical pulse, blood pressure, and temperature every four hour

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139
Q

Why is it vital to monitor and report temperature

A

can indicate patient is moving into thyroid storm (even one degree difference is bad)

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140
Q

We should instruct patients with hyperthyroidism to report symptoms such as

A

palpitations, dyspnea, vertigo, chest pain

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141
Q

Reducing stimulation is good for our clients with hyperthyroidism because it

A

promotes rest and reduces cardiac problems

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142
Q

what are ways we can reduce stimulation in our clients

A

rest, dim lights, limit, time in room, limit visitors, close door, turn off monitors

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143
Q

What are ways we can increase comfort for our clients with hyperthyroidism/ graves disease

A

ice water, cold showers, turning down thermostat

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144
Q

What drugs are used to treat hyperthyroidism

A

pheoinomides (methimazole, propylthiouracil) , radioactive iodine

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145
Q

How does methimazole and propylthiouracil work

A

inhibits TH by preventing iodine from binding to thyroid gland

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146
Q

Nursing implications for hyperthyroid drugs

A

-teach patients to avoid crowds/other risks of infeciton
-monitor weight and HR (hypothyroidism)
-methimazole should not be used during pregnancy
-propylthiouracil can cause liver toxicity
-monitor CBC

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147
Q

What drugs can be used for supportive care with hyperthyroidism

A

beta blockers (to reduce HR, palpitations)

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148
Q

Describe Lugol’s solution, a treatment for hyperthyroidism

A

short term treatment before surgery
-reduces blood flow to thyroid which reduces hormone production

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149
Q

Why do patients with hyperthyroidism require ultrasound

A

determines thyroid size and assesses any masses or nodules q

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150
Q

Why would a patient with hyperthyroidism require EKG

A

see dysrhythmias, palpitations, fibrillations

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151
Q

What is radioactive iodine therapy

A

-treatment for hyperthyroidism
-thyroid picks up the RAI and some of the cells producing TH are destroyed by radiation

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152
Q

How long can radioactive iodine therapy take to be fully effective

A

6-8 weeks

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153
Q

Education for patient receiving radioactive iodine therapy

A

sit to urinate, flush 2-3 times with lid closed, avoid pregnant women children and infants for at least a week , stay away 6 feet, do not share toothbrushes utensils etc

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154
Q

What is thyroid crisis

A

acute attack with severe hyperthyroid symptoms

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155
Q

Thyroid storm is usually triggered by

A

stress (like pregnancy, infection, DKA, trauma)

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156
Q

Why is it not best practice to palpate a goiter

A

can cause thyroid storm Q

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157
Q

Key symptoms of thyroid storm include

A

pyrexia, tachycardia, delirium, seizures, coma

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158
Q

Nursing implications for patient during a thyroid storm

A

-maintain patent airway
-iv fluids NS
-BB
-monitor for dysrhythmias
-monitor vital signs every 15-30 minutes

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159
Q

Even after a thyroidectomy, it is a safety priority to monitor temperature because

A

thyroid crisis can still occur

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160
Q

What is a subtotal thyroidectomy

A

removal of part of the thyroid , may not require supplemental therapy afterwards

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161
Q

What is a total thyroidectomy

A

complete removal of the thyroid, will require supplemental replacement

162
Q

Prior to thyroidectomy, the client will need to follow what kind of diet

A

high carb and high protein

163
Q

Presurgical nursing actions for thyroidectomy

A

-premedicate (propylthiouracil and methamazole 4 to 6 weeks before)
-premedicate (iodine 10-14 days before)
-notify the provider immediately if client does not follow med regimen

164
Q

Pre-op education for client receiving thyroidectomy

A

support the neck when performing deep breathing, expect to have a neck incision covered with a dressing, hoarseness can occur, notify nurse of tingling of mouth or extremities occur

165
Q

Postprecedure nursing actions for thyroidectomy

A

-semi-fowlers position with pillows
-monitor vs q 15 min till stable then q 30
- ask client to speak upon waking from anesthesia and q 2 hours after
-avoid neck extension
-deep breathing exercises q 30 min-1hr
-pain management

166
Q

Client education for thyroidectomy

A

-support while coughing or changing positions
-do not manipulate surgical drain
-symptoms of hypothyroidism
-report incisional drainage, redness, or swelling (infection)
-s/s of thyroid storm

167
Q

Complications of thyroidectomy

A

hemorrhage, thyroid storm, respiratory distress, hypocalcemia

168
Q

Nursing actions for hemorrhaging after thyroidectomy

A

-inspect surgical incision especially at back of neck
-monitor for voice changes (blood can compress the trachea)

169
Q

Why do we assess client’s ability to speak after thyroidectomy

A

can damage the laryngeal nerves

170
Q

How can respiratory distress occur after thyroidectomy

A

swelling in neck will suppress trachea and cause poor gas exchange/ trouble swallowing

171
Q

What assessment finding will alert the nurse our patient may be experiencing an obstruction following a thyroidectomy

A

stridor

172
Q

What equipment should be kept at the bedside following a thyroidectomy

A

tracheostomy equipment

173
Q

If a patient experiences tracheal collapse following thyroidectomy, will oxygen and sitting up help?

A

No, call rapid response

174
Q

How could thyroidectomy cause hypocalcemia

A

if parathyroid gland is removed

175
Q

What symptoms will our patient experience with hypocalcemia

A

tingling around mouth, extremities, toes, trousseau and Chvostek signs

176
Q

What is hypothyroidism

A

decreased amounts of thyroid hormone

177
Q

What is myxedema, a symptom of hypothyroidism

A

buildup of proteins and sugars in the cell that forms cellular edema

178
Q

Myxedema can cause non pitting edema to occur in what areas

A

pretibial areas, top of the feet, hands, elbows, feet

179
Q

What is myxedema coma

A

rare but serious complication of poor hypothyroidism with reduced cardiopulmonary and neurologic functioning

180
Q

What is the pathophysiology of myxedema coma

A

decreased metabolism cause heart muscle to be flabby and chambers to increase. Cardiac output decreases perfusion, and gas exchange does not occur. The brain and other vital organs will go into organ failure

181
Q

Primary cause of hypothyroidism

A

decreased thyroid tissue, decreased synthesis of TH

182
Q

Secondary cause of hypothyroidism

A

hypothalamus or pituitary gland not producing TSH

183
Q

Risks for hypothyrodiism

A

females 30-60 years old, use of certain medications (lithium and amiodarone) inadequate intake of iodine, radiation therapy to the neck and back

184
Q

Symptoms of hypothyroidism

A

intolerance to cold, receding hairline, decreased activity tolerance, bradycardia, weight gain, confusion, poor wound healing, impaired memory, thick tongue, anorexia, constipation, dry skin, edema around eyes, face puffiness, body temp is hypothermic

185
Q

What is Hashimoto thyroiditis

A

autoimmune disorder where antibodies attack thyroid and leads to hypothyroidism

186
Q

Patients with hypothyroidism may experience symptoms to muscles such as

A

weakness, tingling, paresthesia

187
Q

Cardiac and respiratory function are decreased in hypothyroidism, which can lead to

A

reduced gas exchange

188
Q

How to improve gas exchange in patients with hypothyroidism

A

monitor oxygen saturation and auscultate breath sounds

189
Q

How to improve cardiac output in patients with hypothyroidism

A

monitor BP (diastolic may be increased) , heart rate, and rhythm

190
Q

What oral drug is given for hypothyroidism

A

levothyroxine

191
Q

Why should we monitor chest pain for clients that have chronic hypothyroidism

A

it can lead to cardiovascular disease

192
Q

Why should we take caution when using sedatives in patients with hypothyroidism

A

decreased metabolism can increase times of effects for these medications and cause respiratory distress

193
Q

Why should we apply anti-embolism stockings to our patients with hypothyroidism

A

decreased cardiac output and edema can increase risk of DVT

194
Q

Patient education for levothyroxine

A

take on empty stomach 30-60 minutes before breakfast, monitor for symptoms of hyperthyroidism

195
Q

Nursing implications for clients with hypothyroidism

A

monitor respoiratory status, monitor cardiovascular changes, provide extra blankets, administer stool softeners, gradually increase client’s a activity level

196
Q

What can increase the risk for myxedema coma

A

stress such as illness, surgery, use of sedatives/ opioids

197
Q

Manifestations of myxedema coma

A

respiratory failure, hypotension, hypothermia, bradycardia, dysrhythmias, hyponatremia, hypoglycemia, coma

198
Q

Treatment for myxedema coma

A

IV levothyroxine, IV fluids such as 0.9% sodium chloride

199
Q

Nursing actions for myxedema coma

A

maintain airway patency, EKG monitoring, monitor mental status, initiate aspiration precautions

200
Q

What is thyroiditis

A

group of conditions that cause inflammation of the thyroid gland

201
Q

What is infectious thyroiditis

A

bacterial invasion of the thyroid gland

202
Q

Symptoms of infectious thyroiditis

A

sudden pain, tenderness on one side of neck, malaise, fever

203
Q

Subacute or granulomatous thyroiditis results from

A

infection of the thyroid gland after a cold or upper respiratory infection

204
Q

Symptoms of subacute or granulomatous thyroiditis

A

neck pain, hard and enlarged thyroid on palpation

205
Q

What is radiation thyroiditis

A

occurs 5-10 days after treatment with radio iodine

206
Q

Palpation/trauma induced thyroiditis

A

occurs during physical examination, biopsy, neck surgery, trauma

207
Q

Chronic autoimmune thyroiditis (hashimotos disease)

A

autoimmune

208
Q

Symptoms of hashimotos thyroiditis

A

dysphagia and painless enlargement of the gland

209
Q

What are the four main types of thyroid cancer

A

papillary, follicular, medullary, anaplastic

210
Q

What is the initial sign of thyroid cancer

A

single painless lump or nodule

211
Q

What is the most common type of thyroid cancer

A

papillary carcinoma

212
Q

Cure for papillary carcinoma

A

partial or total thyroidectomy, if confined to the thyroid gland

213
Q

papillary carcinoma occurs most often in

A

women around 50 years of age

214
Q

Follicular carcinosi occurs most often in

A

adults between ages of 40 to 60 and in countries where iodine is not found easily in the diet

215
Q

Follicular carcinoma can easily spread because it

A

invades the blood vessels

216
Q

What is the result of follicular carcinoma after it spread

A

dyspnea and dysphagia

217
Q

What thyroid cancer is commonly found in children and young adults

A

medullary carcinoma caused by endocrine neoplasia type 2

218
Q

Anaplasatic carcinoma is a rapidly growing tumor that invades nearby tissues. Symptoms include

A

SOB, hoarseness, dysphagia

219
Q

For most types of thyroid cancer, what is the treatment regiment of choice

A

Surgery (total or partial thyroidectomy) , followed by RAI (radioactive iodine) to help destroy remaining tissue

220
Q

What treatment is used for anaplastic carcinoma

A

external beam radiation / chemotherapy and surgery (RAI is not used)

221
Q

After treatment for thyroid cancer, the patient will most likely develop what condition

A

hypothyroidism

222
Q

How do excessive PTH levels increase bone resorption (breaking down)

A

decreases osteblastic activity and increasing osteoclast activity

223
Q

Primary hyperparathyroidism is caused by

A

parathyroid glands secreting too much hormone

224
Q

Causes of secondary hyperparathyroidism include

A

vitamin D deficiency and and CKD

225
Q

Symptoms of hyperparathyroidism

A

kidney stones, bone fractures, gI upset, (anorexia, weight loss, constipation, vomiting) , fatigue, lethargy, confusion

226
Q

Laboratory values for someone with hyperparathyroidism

A

PTH increased , Calcium increased, Phosphorus decreased, magnesium increased

227
Q

How can x-rays help with the treatment of hyperparathyroidism

A

show kidney stones, calcium deposits, and bone lesions

228
Q

What does chronic hyperparathyroidism cause in our patients

A

loss of bone density

229
Q

What is the drug therapy used for hyperparathyroidism

A

cinacalcet (calcimimetic)

230
Q

What is required for our patients taking a calcimemetic for hyperparathyroidism

A

routine monitoring of calcium levels

231
Q

what is the preferred treament for hyperparathyroidism q

A

surgery

232
Q

Patient teaching for hyperparathyroidism

A

have regular exercise, adequate hydration, avoid lithium therapy, avoid prolonged bedrest, eat moderate amount of calcium and vitamin D

233
Q

Patients with hyperparathyroidism are at risk of?

A

fractures

234
Q

Parathyroidectomy pre and post surgical education

A

same as thyroidectomy

235
Q

Is a parathyroidectomy curative?

A

Yes ; calcium levels should return to normal

236
Q

Hypoparathyroidism occurs most often because of

A

postsurgical complication of thyroid or parathyroid glands

237
Q

Symptoms of hypoparathyroidism

A

numbness and tingling around lips, mouth, hands and feet. (mild) Chvostek and Trousseau signs, contractions, tetany (severe)

238
Q

Laboratory values of hypoparathyroidism

A

decreased PTH, decreased calcium, increased phosphorus, decreased magnesium

239
Q

Treatment for severe and acute hypocalcemia

A

IV calcium gluconate

240
Q

Treament for mild hypocalcemia

A

Oral vitamin D, calcitriol, calcium carbonate

241
Q

Why is medication dosage so important with hypoparathyroidism

A

we need calcium level high enough there are no symptoms, but low enough it will not cause kidney stones

242
Q

Patient teaching for hyperparathyroidism treatment

A

lifelong, wear medical alert bracelet

243
Q

What foods should we teach our patient why hypoparathyroidism to eat in moderation

A

milk, yogurt, cheese, ice cream

244
Q

Dietary recommendations for hyperthyroidism

A

avoid excessive iodine and tyrosine intake

245
Q

Dietary recommendations for hypothyroidism

A

increase iodine and tyrosine intake (seafood, dairy, strawberries, cranberries, pineapple)

246
Q

Dietary recommendations for hyperparathyroidism

A

avoid foods high in calcium and vitamin D

247
Q

dietary recommendations for hypoparathyroidism

A

increase calcium intake (avoid high phosphorus foods) with leafy greens and vegatbles. Dairy products in moderation

248
Q

Dietary recommendations for hypopituitarism

A

foods rich in minerals, iron, and iodine (whole grains, legumes, seafood, dairy, eggs, leafy greens)

249
Q

Which type of diabetes is autoimmune

A

type 1

250
Q

Why does diabetes type 1 occur

A

triggered by viral infection. this attacks the beta cells to where they no longer secrete insulin

251
Q

What is the age of onset for type 1 diabetes

A

< 30 years

252
Q

What are the symptoms of type 1 diabetes

A

abrupt onset, polyuria, polydipsia, polyphasic, weight loss

253
Q

What type of diabetes has beta cell dysfunction and insulin resistance

A

type 2 diabetes

254
Q

Is type 2 diabetes an autoimmune disorder?

A

no

255
Q

What is the age of onset for type 2 diabetes

A

any age

256
Q

What are the symptoms of type 2 diabetes

A

frequently none; thirst, fatigue, blurred vision, vascular or neural complications

257
Q

60-80 percent of adults with type 2 diabetes will have this condition

A

metabolic syndrome

258
Q

Risk factors for type 2 diabetes

A

family hx, African American, Hispanic, Pacific Islander, native American, high birth weight babies, gestational diabetes, PCOS

259
Q

What body shape will those with metabolic syndrome

A

apple in men and pear in women

260
Q

To qualify as metabolic syndrome, our patient must have _____ or more of the criteria

A

3

261
Q

What four things are evaluated in metabolic syndrome

A

abdominal obesity, hyperglycemia, hypertension, hyperlipidemia

262
Q

What is considered abdominal obesity (in metabolic syndrome)

A

waist circumference 40 inches in males and 35 in females

263
Q

What is considered hyperglycemia in metabolic syndrome

A

fasting glucose > 100

264
Q

What is considered hypertension in metabolic syndrome

A

systolic > 140 and diastolic > 90

265
Q

What is considered hyperlipidemia in metabolic syndrome

A

triglycerides 150 or more

266
Q

Those with metabolic syndrome have an increased risk of

A

CVD, stroke, heart attack

267
Q

Neurologic symptoms of metabolic syndrome

A

fatigue and inability to focus

268
Q

Integumentary symptoms of metabolic syndrome

A

browning of folds of skin around neck, armpits, etc

269
Q

Sexual dysfunction symptoms found with metabolic syndrome

A

PCOS (females) and erectile dysfunction (males)

270
Q

What is hemoglobin (A1C)

A

average glucose over the last 120 days (3 months)

271
Q

What is the normal range for hemoglobin A1c

A

4-5.7 %

272
Q

What is pre diabetes range for hemoglobin a1c

A

5.7-6.4%

273
Q

What is the diabetes range for hemoglobin a1c

A

> 6.5%

274
Q

What is a fasting glucose

A

level of glucose in the blood after someone has been fasting

275
Q

Normal range for fasting glucose

A

74-100mg/dL

276
Q

Prediabetes range for fasting glucose

A

100-125mg/dL

277
Q

Diabetes range for fasting glucose

A

> 126 mg/dL

278
Q

What is a glucose tolerance test mostly used to diagnose (what type of diabetes0

A

gestational

279
Q

How to give glucose tolerance test

A

give glucose in cup and monitor blood sugar 2h after

280
Q

Normal range for glucose tolerance test

A

< 140 mg/dL

281
Q

Prediabetes range for glucose tolerance test

A

140-199mg/dL

282
Q

Diabetes range for glucose tolerance test

A

> 200 mg/dL

283
Q

Can type 1 diabetes be prevented?

A

no

284
Q

For type 2 diabetes, what treatment strategies do we try first?

A

nutrition and exercise

285
Q

Are nutrition plans individualized for management for diabetes or are they the same

A

individualized

286
Q

For nutrition plans, diabetics should work with

A

registered dietitians

287
Q

clients with diabetes should focus on Whole Foods and limit

A

empty calories (like soda and candy)

288
Q

What kind of fats should clients with diabetes consume

A

avocado, nuts, olives, omega 3 fish

289
Q

What kind of fats should a client with diabetes avoid

A

trans and saturated fats

290
Q

How much fiber should clients with diabetes consume in a day

A

25 g

291
Q

Patient teaching for increasing fiber

A

increase slowly to limit gi irritation, increase fiber and fluids

292
Q

In a 24 hour period, how many alcoholic beverages can clients with diabetes consume?

A

1 (female) 2 (males)

293
Q

1 beer is equivalent to __ oz

A

12

294
Q

1 glass of wine is equivalent to ____ oz

A

5

295
Q

What important teaching should we include for diabetic clients

A

how to read food labels, avoid sugary drinks

296
Q

How can exercise improve diabetes

A

improves carb metabolism and increases insulin sensitivity

297
Q

What should an exercise schedule look like for a diabetic

A

150 mins total a week , resistance training as well as cardio, ideally do not miss more than 2 days

298
Q

Can our client exercise if ketones are present in the urine

A

no

299
Q

If it has been over 1 hour since the patient has eaten, they may need this before exercise

A

snack

300
Q

What must the glucose levels be in order to perform exercise

A

100-250

301
Q

What patient teaching should we include regarding exercise and insulin

A

check glucose more frequently after exercise (first 24 h) and they may need decreased insulin doses

302
Q

What kind of adjustments may need to be made for diabetic exercise

A

based on complications such as retinopathy and neuropathy

303
Q

What adjustments may need to occur with exercise and retinopathy? why?

A

exercise should not include jarring/jumping ; risk of hemorrhage or retina detachment

304
Q

Diabetic neuropathy and exercise

A

be mindful of activities that can cause falls

305
Q

How often should people with diabetes inspect their feet?

A

daily

306
Q

Should people with diabetes soak their feet?

A

No

307
Q

What should people with diabetes wash their feet with

A

mild soap and warm water

308
Q

Can people with diabetes use OTC remedies to remove calluses or corns

A

no

309
Q

What kind of shoes should people with diabetes a void

A

open - toe and open-heel

310
Q

What time should people with diabetes buy shoes? and why

A

in the evening to leave room for swelling

311
Q

What is the target goal for blood sugar for diabetic patient that’s sick or hospitalized

A

140-180

312
Q

When someone with diabetes is sick, how often should they monitor blood sugar

A

q 2-4 hours

313
Q

What could diabetic clients eat while they’re sick

A

6-8 small meals with carbs (pudding, jello, soups)

314
Q

If a diabetic client is sick and can’t eat, what should they drink

A

fluids with carbohydrates (sugary drinks like gatorade)

315
Q

How many oz of fluid should a diabetic drink in an hour if they are sick

A

8-12 oz of sugar free non caffeinated liquid

316
Q

If a diabetic client is sick and their blood sugar continues to rise, when should they notify their provider

A

consistent n/v, ketones in urine for 24+, hypoglycemia symptoms, BG 250+ after two doses/treatment, unable to tolerate liquids, illness lasts 2+ days, high fever 101.5

317
Q

How often should diabetics check their urine for ketones while sick?

A

q 2-4 hours

318
Q

When should diabetics monitor blood glucose

A

ACHS / PRN (before meals, at bedtime, as needed)

319
Q

Step by step of taking blood glucose

A
  1. clean with alcohol 2. let dry 3. stick with glucometer 3. wipe away first drop 4. obtain glucose
320
Q

patient education for blood glucose monitoring

A

how to take, when to take, pump education

321
Q

What angle is an insulin injection given

A

90 unless very thin

322
Q

what sites can be used for insulin administration

A

belly, bat wings, thigh, butt

323
Q

Should insulin injection sites be rotated?

A

yes (do but different places in the same site)

324
Q

What color is an insulin syringe

A

orange

325
Q

what is u500

A

very concentrated and dangerous form of regular insulin (used for insulin resistance)

326
Q

What color is u500 syringe

A

green

327
Q

Can u500 be given IV

A

NO

328
Q

How often does a cannula (part of insulin pump) have to be changed

A

2-3 days

329
Q

What is the name of short insulin

A

regular

330
Q

What is the onset of short acting insulin

A

0.5-1h

331
Q

What is the peak of short acting insulin

A

1-5 h

332
Q

What is the duration of short acting insulin

A

6-10 h

333
Q

What insulins can be given IV

A

regular

334
Q

What type of insulin is intermediate

A

NPH

335
Q

What is the onset of intermediate insulin

A

1-2 h

336
Q

What is the peak of intermediate insulin

A

4-14

337
Q

What is the duration of intermediate insulin

A

14-24

338
Q

What are the long acting insulins

A

glargine , determir

339
Q

What is the onset of long acting insulin

A

1-4 h

340
Q

What is the peak of long acting insulin

A

no peak

341
Q

What is the duration of long acting insulin

A

12-24 h

342
Q

To avoid hypoglycemia, it is important that patients eat their meals

A

before onset begins

343
Q

client is prescribed regular insulin before meals. If they got their dose at 0715, what time should they receive their breakfast

A

0745

344
Q

What is basal insulin dose

A

secreted throughout the days ; long-acting insulins

345
Q

What is bolus insulin dose?

A

given with meals to mimic normal insulin production ; rapid and regular insulins

346
Q

What must blood sugar be to classify as hypoglycemia

A

< 70

347
Q

What can hypoglycemia be caused by

A

giving too much insulin, missed meal/not enough food, being NPO, gastroparesis, alcohol, kidney failure

348
Q

If someone is NPO, how should the nurse manage their insulin doses

A

administer basal dose, hold bolus

349
Q

Why do we still administer basal dose when someone is NPO

A

if you hold both, hyperglycemia will be much harder to manage the next day

350
Q

Symptoms of hypoglycemia

A

weak, blurred vision, sweating, cool/clammy skin, tachycardia, tremors, palpitations, hunger, anxiety, decreased LOC

351
Q

Treatment for hypoglycemia

A

BG < 70 = 15 CHO
BG < 50 = 30 CHO

352
Q

What are examples of 15g carb snacks

A

glucose tab or gel (premeasured)
a half cup of fruit juice or regular soft drink (120 mL)
5 hard candies
4 cubes of sugar or 4 tsp of sugar
1 TBS (15mL) of honey

353
Q

15 g carb snacks from ATI quiz

A

1 slice bead, 1/3 cup sugar free yogurt, 1 cup milk, 1/2 regular ice cream

354
Q

If patient is unable to eat/ is passed out from hypoglycemia and does not have venous access, what do we administer

A

IM glucagon

355
Q

If patient is unconscious from hypoglycemia/ unable to swallow and has IV access, what do we administer

A

IV dextrose

356
Q

After we give glucagon IM, why is it important to roll patient onto their side

A

they will probably puke, get suction and turn on aspiration precautions

357
Q

If glucose does not raise after 2 doses (15 minutes apart) , we should now

A

contact the provider

358
Q

Symptoms of hyperglycemia

A

3 P’s, warm/ dry skin, Fruity breath if Kussmaul’s is present, stuporous/obtunded/coma

359
Q

Treatment for hyperglycemia

A

insulin or oral diabetic meds

360
Q

Nursing implications for hyperglycemia

A

encourage oral fluid intake of sugar free fluids, test urine for ketones

361
Q

What blood sugar is considered to be hyperglycemic

A

> 180

362
Q

What is DKA

A

serious complication of type 1 diabetes with uncontrolled hyperglycemia, metabolic acidosis, and presence of ketones

363
Q

What is starvation metabolism

A

occurs in DKA when insulin can no longer keep up with the amount of sugar in blood ; results in ketones that the body can use for energy

364
Q

The presence of ketones in DKA causes what?

A

metabolic acidosis

365
Q

What two symptoms can identify metabolic acidosis

A

fruity breath ; Kussmauls respirations (increased breathing rate and depth)

366
Q

S/S of diabetic ketoacidosis

A

3 p’s, Kussmaul resp, fruity breath, nausea/vomiting, abd. pain, dehydration, neurosymptoms

367
Q

Blood glucose levels of DKA

A

> 300

368
Q

Treatment for DKA

A

monitor VS q 15 min till stable, then q 4
s/s of dehydration with fluids
regular insulin continuous IV infusion
BS checks q 15 min

369
Q

What are s/s of dehydration

A

AMS, dry mm, decreased BP, increased HR, being very thirsty

370
Q

What is HHS

A

severe hyperglycemia present in type 2 diabetes

371
Q

Symptoms of HHS

A

dehydration, neuro symptoms

372
Q

Blood glucose levels of HHS

A

> 600

373
Q

in both HHS and DKA, BUN and creatinine will be elevated because of

A

dehydration

374
Q

DKA and HHS are more likely to occur during

A

times of stres s

375
Q

PH level of DKA

A

< 7.35

376
Q

PH level of HHS

A

> 7.4

377
Q

HCO3 of DKA

A

< 15

378
Q

HCO3 of HHS

A

> 20

379
Q

treatment for HHS

A

same as DKA

380
Q

What are the oral anti diabetic medications

A

metformin and sulfonylurea

381
Q

What should we monitor while patient is on metformin

A

monitor GI effects, monitor lactic acidosis, kidney function

382
Q

Metformin should be stopped _____ before contrast

A

24-48

383
Q

When can metformin be taken after contrast dye

A

after confirmation of normal kidney function (can cause kidney failure)

384
Q

Patient education while taking metformin

A

avoid alcohol, take vitamin B and folic acid, maintain hydration, gi effects (gas, NV, abd pain)

385
Q

Why should metformin and sulfonylurea be taken with food s

A

avoid adverse effect of hypoglycemia

386
Q

Why should we avoid alcohol on sulfonylurea

A

disulfiram like reaction

387
Q

s/s of lactic acidosis

A

myalgia, sluggishness, somnolence, hyperventilation

388
Q

Can diabetic patients use heating pads?

A

no because they may not be able to feel it

389
Q

What is diabetic retinopathy

A

when blood vessels in eye change

390
Q

Prevention of diabetic retinopathy

A

monitoring BG levels closely, proper diet and exercise

391
Q

patient education for diabetic retinopathy

A

get yearly eye exam, hypoglycemia can cause temporary blurred vision, exercise should not include straining or lifting weight

392
Q

Nursing implications for retinopathy

A

education, monitoring BG, if eyesight is bad be mindful of falls

393
Q

What is diabetic neuropathy

A

nerve damage –> slow progressing (can also effect urinary tract, minimizes effects hypoglycemia, and heart function)

394
Q

Prevention strategies of diabetic neuropathy

A

maintaining glucose level control, proper diet and exercise

395
Q

Patient education for diabetic neuropathy

A

conduct annual exams by podiatrist, report numbness and tingling/joint problems/ difficulties with urinary tract elimination, typical HA symptoms may not be present, reduced awareness for hypoglycemia requires more frequent monitoring

396
Q

Nursing actions for neuropathy

A

monitor activity tolerance and other cardiac indicators, administer meds to promote gastric motility, check for urinary retention, provide foot care

397
Q

What is diabetic nephropathy

A

damage to kidneys from prolonged dehydration and elevated BG

398
Q

Client education for diabetic nephorpathy

A

conduct yearly UA, BUN, creatinine, and micro albumin level
avoid soda, alcohol, acetaminophen and NSAIDS (high amounts)
consume 2-3 L day of fluid with artificial sweetener and water
report decrease in output to provider

399
Q

Nursing actions for diabetic nephropathy

A

monitor hydration and kidney function
(I&O, creatinine level (1.005-1.030) Bun (10-20)
report and hourly output less than 30 mL / h
monitor blood pressure

400
Q
A

NRSE-3540 Adult Care 1 (5 decks)

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