Module 7 (test Specific Hints) Flashcards
Hypothalamus
Interrelationship with pituitary by releasing substances to stimulate or inhibit hormones of the pituitary gland
*fear, anger, pleasure
Pituitary
Regulated by hypothalamus
-secretes ‘tropic’ (t3 t4 hormones)
-growth hormones + oxytocin
-secretes ADH
Parathyroid
behind thyroid nodules
2 pairs (4 total, sometimes 6)
regulates calcium
~triggered when calcium is low or high~
Pineal gland
SLEEP!!
-secretes melatonin
* circadian rhythm
*reproductive system (night shift nurse)
Thyroid
Pituitary stimulates the thyroid to produce T3 and T4 + calcitonin - when CA+ is high in blood (calcitonin job: keep calcium in bone & not blood)
*needs iodine to function
Adrenals
Above kidneys and have 2 parts: medulla and cortex
Medulla: secretes catecholamines
Cortex: secretes:
-glucocorticoids (most abundant in body) anti inflammatory
-mineralocorticoids. Aldosterone promotes renal absorption which in turn regulates sodium and potassium
-Androgens /sex hormones
Pancreas
A gland that is Responsible for insulin and glucagon regulation
A cells: make/secrete glucagon
B cells: make/ secrete insulin
Delta cells: secretes somatostatin (glucose regulation)
F cells: secrete pancreatic polypeptide (glucagon storage)
SIADH (soaked inside)
Overproduction of ADH ~soaked inside~ diluted osmolality!
Decreased sodium, increased GFR
S/S:
-low urine output, sticky/dark
-increased body weight
-THIRST
-dyspnea
-fatigue
-hyponatremia (cerebral edema and seizure precautions
SIADH :NURSING MANAGEMENT
-I&O
-DAILY WEIGHTS
-oral care
-fluid restriction (800-1000 ml/day)
- HOB no more than 10 degrees (enhances venous return to heart and increases left atrial response. Decreases release of ADH by another organ telling it to stop releasing)
- hypertonic fluids (only is severe)
-lasix/diuretic
-vasopressor antagonist (conivapton-vaprisol) (Tolvaptin- samsca) blocks action of ADH releasing
DI (diabetes insipidus)
DRY INSIDE DX: water deprivation test (DDAVP)
-under-production of ADH OR decreased renal response to ADH
-excessive fluid loss increased urine output
-concentrated osmolality. Increased sodium, decreased GFR
-polyuria, polydipsia
-tired, weak
- hypotension
-tachycardia
-HYPER-natremia
-S/S: dehydration, lethargy, fatigue, confusion
DI TYPES
Central: Neutrogenic -head injury
Nephrogenic: poor renal response
Primary: excess water intake
DI: NURSING MANAGEMENT
-F&E balance
-I&O
-Daily weights
-vital signs
-Glucose monitoring
-LOC (hypernatremia)
*limit salty food/ sodium intake
MEDS:
-Hypotonic solutions or D5W
-DDVAP (diagnosis)
-chlorpropamide & carbamazepine (Tegretol) increases thirst
-thiazides (decreases urine production)
- NSAIDs (antidiuretic effect)
Graves Disease s/s
*exophthalmus (bulging eyes)
-weight loss / nervousness (1st signs)
-sweating, jittery, fatigue, palpitations, confusion
-acropachy (finger swelling/painful)
-Pretibial myexedma (red, thick skin on shin front and back)
Cushing’s S/S (SATA)
SATA TEST QUESTION common in women
-weight gain (most common)
-moon face
-buffalo hump
-hyperglycemia (steroids increase blood sugar)
- muscle wasting
-osteoporosis, back pain
-purple/red striae (stretch marks), acne
-menstrual disorders
- hirsutism (excessive hair growth) gynecomastia (man boobs)
-impotence (erectile dysfunction)
Post thyroidectomy care
1 monitor airway
- assess for bleeding (check behind neck/pillow)
-monitor calcium levels (may become low d/t removal of parathyroid)
-gentle neck ROM exercises
-support head when turning in bed
-sore/hoarse voice common for 3-4 days, if persisting call Dr
-call Dr is SOB occurs
Myexedema Coma
MEDICAL EMERGENCY
-hypothermia(subnormal temperature)
-hypotension
-hypoventilation
-hyponatremia
-hypoglycemia
-lactic acidosis (heart is not perfusing)
-can be gradual or sudden
-stress, drugs or trauma induced
-infection/exposure to extreme cold
Tx:
-IV thyroid replacement
-support vital functions (fluids, vasoressors, and keep Pt warm)
Thyroid storm
Thyrotoxicosis is a thyroid storm Complication of removal of the thyroid
S/S:
-severe tachycardia
-Heart failure
-Shock
-Hyperthermia
-Delirium
-agitation
-Seizures
-Abdominal pain
-Vomiting
-Diarrhea
-Coma
Iodine rich foods
-Spinach
-lentils
-figs
-quinoa
-almonds
-soy beans
-oats
-potatoes
-kidney beans
-pumpkin seeds
-chard greens
Addisonian crisis
-adrenocortical insufficiency
Either insufficient adrenocortical hormones OR a sudden sharp decrease
Triggered by :
-stress from psych, infection, surgery
-Sudden withdrawal of corticosteroid therapy
-Adrenal surgery
-sudden pituitary gland destruction
Addisonian Crisis S/S
-Hypotension (could lead to shock)
-Tachycardia
-Dehydration
-Hyponatremia
-Hyperkalemia
-Hypoglycemia
-Fever, weakness, confusion
GI: vomiting, diarrhea, pain in abdomen/low back and legs
Tx:
- vasopressors
-fluid replacement
won’t work if Pt is experiencing circulatory collapse
Radioactive Iodine Therapy
Tx precautions
-private toilet (flush 2-3x after use)
-separate laundry and do it daily
-do not prepare foods or others that require prolonged handling with bare hands
-Avoid being close to pregnant or children for 7 days after therapy
Adrenalectomy (Cushing’s) post-op care
Monitor BP, RR, HR, I&O, F&E
Giving corticosteroids
Collect urine samples at the same time each morning for cortisol measurement
Acute adrenal Insufficiency s/s:
Vomiting
Weak
Dehydrated
Hypotension
Joint pain
Pruitis
Peeling skin
Emotional (change dosage)
Info on Levothyroxine/Synthroid
Drug of choice to Tx hypothyroidism
MOA: thyroid hormone replacement T3 & T4
-Lifelong therapy drug
-given in low dosages then increased to see how Pt tolerates therapy (can take up to 4-8 weeks to take effect)
-monitor for heart problems
-it could increase HR/BP
-Report chest pain, weight loss, nervousness, tremors, insomnia
-Take as prescribed and don’t D/C abruptly
Tamoxifen
Estrogen Receptor Antagonist (blocker)
It’s a hormone therapy for Breast Cxr & help prevent if hereditary, etc. some people may take it without being diagnosed.
Adverse Effects: hot flashes, mood swings, vaginal discharge, dryness and other effects associated with decreased estrogen (think menopause)
Increase the risk for: blood clots, cataracts, stroke and endo cancer.
EYE PROBLEMS
Vag bleeding
Monitor for DVT, pulmonary embolism, stroke, SOB, leg cramps & weakness.
