Quiz 5 Flashcards
What is acromegaly?
Excessive growth hormone
What are the clinical manifestations of acromegaly?
HE’S TALL
H - Hypertension & Height
E - Enlarged Organs (cardiac issues/fractures)
S - Sweating & oily skin
T - Too much pain in joints
A - Arthritis
L - Long hands & feet
L - Long protruding jaw
What is the surgical treatment for acromegaly? What are the post op considerations?
Transphenoidal Hypophysectomy
- surgical removal of pituitary gland
Post op: important to decrease ICP
- no coughing/bending over
- HOB 30 degrees
- stool softener
- assess nasal drainage (CSF leak)
What are the medications used for acromegaly? What do they do?
Octreotide (helps to slow GI bleeds)
Bromocriptine
Pergolide (long acting)
Stop the release of growth hormone
What are the nursing interventions for acromegaly?
Provide emotional support
Provide post op or radiation care
Teach medication f/u adherence
What is hyperthyroidism?
HIGH thyroid hormones (T3 and T4)
What are the risk factors of hyperthyroidism?
Graves’ disease (GAINS)
Thyroiditis (hashimotos)
Goiter
Excessive iodine intake
Pituitary tumor
Thyroid cancer
What are the clinical manifestations of hyperthyroidism?
HIGH & HOT
Grape eye (exophthalmos)
Goiter
High BP (HTN crisis 180/100+)
High HR (Tachycardia)
Heart palpitations
High temp (hot & sweaty)
Diarrhea
Bruit over thyroid
Pretibial myxedema
What therapeutic procedure is done for hyperthyroidism?
thyroidectomy
preop: administer SSKI and antithyroid meds
postop: semi flowers, resp status, hypocalcemia, note any hoarseness, hypothyroidism
What medications are given for hyperthyroidism?
propylthiouracil (PTU)
methimazole
potassium iodine (SSKI)
Lugol’s solution
atenolol
propranolol
What nursing interventions are done for hyperthyroidism?
encourage rest
monitor VS, dysrhythmias, I&O, weight
report increase in temp
eye protection for exophthalmos
high caloric-diet, avoid high fiber and stims
What is a complication of hyperthyroidism? What are the clinical manifestations?
thyroid storm/crisis (thyrotoxicosis)
manifestations:
high and hot
agitation/confusion
How is a thyroid storm managed?
antithyroid meds
acetaminophen
cool IV fluids to keep temp down
What is hypothyroidism?
LOW & SLOW
primary: thyroid gland dysfunction (postop trach placement)
secondary: anterior pituitary gland dysfunction (can’t produce TSH)
tertiary: hypothalamus dysfunction (can’t produce TRH)
What are the risk factors of hypothyroidism?
female 30-60
inadequate iodine intake
radiation therapy to head/neck
meds (lithium or amiodarone)
What are the clinical manifestations of hypothyroidism?
LOW & SLOW
low energy
low metabolism
constipation
low mood (depression)
dry skin
What medication is given for hypothyroidism?
LEVOthyroxine
Life long and long slow onset (3-4 weeks til relief)
Early morning or Empty stomach (NOT @ NIGHT)
Very active (high HR/BP) report agitations/confusion
Oh the baby is fine (pregnancy dafe)
do not stop abruptly
What drugs interact with levothyroxine?
increases effects of warfarin
increases insulin requirements
increases excretion of digoxin
decreases absorption w/ calcium, iron, and sucralfate
What are the nursing interventions for hypothyroidism?
safe warm environment
avoid sedatives
monitor weight
increase activity
What is a complication of hypothyroidism? How is it managed?
myxedema coma (non pitting edema)
very low and slow: breathing airway, low BP = death
hoarseness
tx: IV hormone therapy
What do the parathyroid glands do?
regulate serum calcium
What is hyperparathyroidism?
increased PTH (parathyroid hormone) = high calcium
hypercalcemia (over 10.5)
What are the risk factors of hyperparathyroidism?
parathyroid disease
renal disease
tumor (adenoma [not cancer]/ malignant [cancer])
What are the clinical manifestations of hyperparathyroidism?
weak bones
kidney stones (nephrolithiasis)
constipation
dysrhythmias
N/V
polyuria
What therapeutic procedure is done for hyperparathyroidism?
parathyroidectomy
preop: mithramycin to decrease Ca (SE: bleeding and increased clotting times)
postop: similar to thyroidectomy
What medications are given for hyperparathyroidism?
calcitonin
loop diuretic
bisphosphonate - alendronate
calcimimetic - cinacalcet
calcium chelator - mithramycin
What nursing interventions are done for hyperparathyroidism?
initiate fall precautions
weight bearing exercises
low-calcium, low-vitamin D diet
strain urine
hydrations
monitor for hypercalcemic crisis (hyperreflexia >15mg/dL tx: mithramycin)
What is hypoparathyroidism?
decreased PTH = low calcium (under 9)
What are the risk factors of hypoparathyroidism?
iatrogenic (due to medical tx)
idiopathic (no known cause)
hypomagnesemia
What are the clinical manifestations of hypoparathyroidism?
Trousseau’s sign: twerk w/ BP cuff
Chvostek’s sign: cheeky smile when stroking face
diarrhea
paresthesia
muscle cramps
tetany (hyperreflexia)
bradydysrhythmias
What medications are given for hypoparathyroidism?
acute: IV calcium chloride or gluconate
chronic: calcium carbonate, phosphate binder, vitamin D
What are the nursing interventions for hypoparathyroidism?
seizure precautions
assess s/s for neuromuscular irritability
monitor ECG
high calcium, low phosphorus diet
What is Cushing’s Syndrome?
high cortisol levels
cushion of steroids HIGH (big round hairy)
What are the risk factors of Cushing’s syndrome?
pituitary adenoma
adrenal hyperplasia
adrenal adenoma or carcinoma
malignancies (GI, lung cancer)
exogenous glucocorticoids
What are the clinical manifestations of Cushing’s syndrome?
BIG bp, infections, weight, hair, belly, brittle bones
CUSH
Cushion - truncal obesity, moon face, hump
Unusual hair growth - hairy suit
Skin - purple striae, butterfly mark
High - sugar, BP, weight
What therapeutic procedures are done for Cushing’s syndrome?
chemotherapy (mitotane)
hypophysectomy
adrenalectomy
What medications are used for Cushing’s syndrome?
ketoconazole (manages)
metyrapone (temporarily decreases cortisol)
antacid, H2RB, PPI to prevent GI bleed
What interventions are done for Cushing’s syndrome?
assess for hyperglycemia
taper steroids down
What is Addison’s disease?
adrenal insufficiency
What are the clinical manifestations of Addison’s disease?
AADDSS
Added tan (hyperpigmentations)
Added potassium (over 5.0)
Decreased weight
Decreased BP, hair, sugar, energy, hydration
Sodium loss (<135)
Salt craving
What medications are given for Addison’s disease?
hydrocortisone (main tx-increase dose during illness)
prednisone
fludrocortisone
vasopressors for hypotension crisis
antibiotics for infection
What nursing interventions are done for Addison’s disease?
ADDDI
Add steroids
Diet high in protein, carbs, sodium
Don’t abruptly stop
Don’t believe meds will cure
Indefinitely (life long)
What is a complication of Addison’s disease?
Addisonian crisis:
decreased BP, HR, sodium
increased RR, potassium
tx: IV fluid replacement and IV steroids
What is pheochromocytoma?
tumor on adrenal gland
What are the clinical manifestations of pheochromocytoma?
hypertension
hyperhidrosis
hyperglycemia
hypermetabolism
headache
What medications are given for pheochromocytoma?
phentolamine and propanolol (decreases BP)
sodium nitroprusside (@ risk for hemorrhagic stroke / decreases BP)
calcium channel blockers
What is the therapeutic procedure for pheochromocytoma?
surgical removal of tumor
What are the nursing interventions for pheochromocytoma?
monitor BP
provide a quiet environment and frequent rest
provide a high calorie nutritious diet
What does the liver do?
nutrient metabolism
hematologic function
detoxification and storage
bile production (bilirubin)
What does it mean if there in an increase in liver enzymes?
liver damage
What does it mean if there is an increase in bilirubin?
jaundice
What does it mean if there is an increase in PT?
liver disease
bleeding disorder
vitamin K deficiency
blood thinners
What does it mean if there is a decrease in albumin?
edema in abdomen (ascites)
liver disease
malabsorption
low protein
What is the most common method of transmission of HCV?
needle sharing
What is cirrhosis?
progressive liver disease characterized by extensive irreversible scarring
What are the risk factors of cirrhosis?
alcohol use (most common)
hepatitis
chemicals
biliary disease
R heart failure
What are the clinical manifestations of cirrhosis?
fatigue
pruritus
clay-colored stool
tea-colored urine
weight loss
emotional lability
What are the complications of cirrhosis?
peripheral edema (ankle and presacral edema)
ascites (abdominal distention with weight fain, everted umbilicus, abdominal striae)
portal hypertension (increased portal venous pressure, large collateral veins, esophageal and gastric varices)
splenomegaly
hepatic encephalopathy
Describe esophageal varices
varicose veins in esophagus
s/s of rupture: hematemesis - hypovolemic shock
tx for ruptured: stop bleeding w/blakemore tube (most common)
What should be in the room if an esophageal varice ruptures?
scissors
cuts all the part to get air out asap for pt to breath
What are the risk factors of hepatic encephalopathy?
cerebral depressants
GI bleed
constipation
metabolic alkalosis
uremia
infection
dehydration
hypokalemia
increased metabolism
paracentesis
What are the clinical manifestations of hepatic encephalopathy?
neurologic changs
asterixis (flapping hand tremor seen)
fector hepaticus (sweet must odor, can be smelled in breath and urine, results from accumulations of digestive products)
inappropriate behavior
sleep disturbances
What is hepatorenal syndrome?
azotemia (too much BUN in blood)
oliguria
intractable ascites
What are the therapeutic procedures for cirrhosis?
paracentesis to relieve ascites
transjugular intrahepatic portosystemic shunt
surgical bypass shunting procedure (portacaval shunt/distal splenorenal shunt)
EGD
liver bx
liver transplantation
What medications are used for cirrhosis?
1st - albumin IV
2nd - diuretics (furosemide)
neomycin and metronidazole (rifaximin - targets bacteria in blood stream to get rid of ammonia)
lactulose
supp. vitamins
PPIs or H2RBs (help precent GI bleed)
beta blockers
What are the nursing interventions for cirrhosis?
measure abdominal girth and weigh client daily
What are nursing interventions for esophageal and gastric varices?
prevent bleeding
- avoid alc, ASA, NSAIDs, irritating foods
- screen for bleeding
What are the nursing interventions for ascites? What medications are given?
restrict sodium
measure abdominal girth
weigh client daily
cleanse abdomen gently
meds: albumin, diuretics, tolvaptan
What medication reduce ammonia formation?
lactulose
rifaximin
What is the most common method of transmission of HBV?
healthcare related blood or fluid exposure w/o protection
What is acute liver failure?
fulminant hepatic failure
What are the clinical manifestations of acute liver failure?
jaundice
coagulation problems
encephalopathy
renal failure
hypoglycemia
metabolic acidosis
sepsis
multiorgan failure
What are the risk factors of liver cancer?
cirrhosis
hepatitis c
chronic alcoholism
What are the clinical manifestations of liver cancer?
early (absent or subtle)
- fatigue
- hepatosplenomegaly
- complications from portal hypertension
late
- fever, chills
- jaundice, anorexia, weight loss
- palpable mass, RUQ pain
What is the evaluation process for a liver transplantation?
assessment for comorbid conditions
physical assessment
lab tests and diagnostic tests
psychological evaluation
What are postoperative complications of liver transplantations?
graft rejection
infection (fever)
bleeding
renal failure
What are the types of graft rejection?
hyperacute rejection (rare): occurs within 24 hours after transplantation tx: removal of organ
acute rejection: occurs in first 6 months after transplantation tx: immunosuppressive therapy, but pt at higher risk of infection /neoplastic changes
chronic rejection: occurs sporadically over months or years tx: similar to acute rejection but long term success is poor
What is the clinical manifestations of graft rejection?
liver failure
What are the nursing interventions of liver transplantation?
prevent infection
assess neurologic status
assess for bleeding
monitor fluid and electrolyte levels
monitor urinary output
monitor for signs of rejection (increased BP/HR)
provide emotional support
