T4 - Blueprint (Josh) Flashcards
DI:
If DI is caused by Lithium, what drug do we give?
Amiloride (potassium sparing diuretic)
What are the disorders of the Posterior Pituitary?
Diabetes Insipidus
SIADH
Which part of the Adrenal Gland is the Sympathetic Nerve Ganglion?
Medulla
***fight of flight
Ductal Ectasia:
What is it caused by?
dilation and thickening of collecting ducts in subareolar area
Addisonian Crisis:
What are the CV manifestations of Hyperkalemia we should watch for?
slow HR
Heart Block
Peaked T waves
Fibrillation
Asystole
— regulates Phosphorous and Calcium balance.
Parathyroid Glands
***via the Kidneys, Bones and GI tract
Hyperaldosteronism:
Increased Aldosterone triggers kidneys to — sodium and — potassium and hydrogen.
retain
excrete
Pap Smear:
Start at age —.
Recommended how often?
21
recommended q 3 yrs for ages 21-29 and 1 5 yrs for ages 30-65 if they are cotested with HPV or q 3yrs if NOT cotested
Which lab is good for testing hormone levels?
Stimulation - Suppression Tests
- ** draw blood
- ** give med to stimulate or suppress
- ** draw blood again to check
Hyperpituitarism:
What is Postop care for a TPH (Transsphenoidal Hypophysectomy)?
Monitor Neurologic Response (vision, etc) q hr for first 24 then q 4 hrs
Monitor UOP (especially output greater than input)
Encourage deep-breathing exercises
Elevate HOB
Dental Floss and Mouth Rinse instead of Tootbrushing
Assess for CSF Leak
Assess for Meningitis
Avoid activities that increase ICP
Teach how to give Hormone Replacement meds
Lymphedema:
What are signs and symptoms they need to report?
Heaviness
Aching
Fatigue
Numbness, Tingling, Swelling of affected arm and chest
When does Cortisol levels peak?
in the AM and reach lowest 12 hrs later
Endocrine Changes with Aging:
Low Estrogen levels lead to VAGINAL DRYNESS.
What are nursing considerations?
Increased risk for cystitis so drink 2 L per day
Urinate immediately after sex
Use lubricant to reduce sexual discomfort
Hysterosalpingography:
When is this test best done?
first half of menstrual cycle
***should NOT be attempted for at least 6 wks after an abortion, delivery, or D and C
Cortisol affects…
- Body’s response to —
- CHO, Fat, and Protein —
- — stability
- — function
- — and — balance
stress
metabolism
Emotional
Immune
Na+ and H2O
DI:
What are the management goals?
Fluid Replacement
- Free Water
- Hypotonic Fluids
Sodium Restriction
Prevent Water Loss
Correct underlying issue if it’s Nephrogenic
Endocrine Changes with Aging:
Decreased ADH leads to — and means what?
more dilute urine
Clietn is at greater risk for dehydration
***offer fluids q 2 hrs if not restricted
HPV Test:
Can be taken at same time as the — — but it cannot replace it.
Pap Smear
- **age 30-65
- ** q 5 yrs
Endocrine Changes with Aging:
Low Estrogen levels lead to decreased bone density.
What are nursing considerations?
engage in regular weight bearing exercise
handle client with care to prevent pathologic fractrures
With a Hysterosalpingography, what should we do first?
confirm the date of last period
ask about shellfish allergies
educate that they might have some pelvic pain
Lymphedema will take — measures to treat.
life-long
Breast Cancer:
What is the common chemo regimen?
CAF
- Cytoxan
- Adriamycin
- Fluorouracil (5-FU)
***report cardiotoxic effects such as fatigue, SOB, chronic cough, and edema
RAI Therapy educatoin?
Use toilet not used by others
Sit to urinate
Flush 3 x’s after use
Men should use condome catheters instead of absorbant pads if they are incontinent
Use a laxative on 2nd and 3rd days to help you excrete the contaminated stools faster
Wash clothes seperately and run machine on fully cylce empty before washing other clothes
Avoid close contact with pregnant, infants, and young children during first week after therapy (remain 3 ft from them and limit to 1 hr day)
Radioactive Saliva so take precautions
Addisonian Crisis:
How do you manage the elevated K+?
Insulin (20-50 U) with Dextrose (20-50 mg) in NS to shift K+ back into cells
Kayexalate
Furosemide or HCTZ (avoid spironolactone)
Potassium restriction
Monitor I and O and Telemetry
Thyroid Storm:
What glucocorticoids do we give?
Hydrocortisone (100-500 mg IV) or…
Prednisone (4-60 mg IV) or…
Dexamethasone (2 mg IV q 6 hrs)
Parathyroid Glands:
How do they use the kidneys to regulate Calcium and Phosphorous?
Cause kidneys too…
- Activate Vit D
- Increase reabsorption of Ca and Mag
- Increase Phos, Bicarb, and Na+ excretion
SIADH:
How often for neuro checks?
q 4 hrs if no change in LOC
q hr if change in LOC
DI Labs:
Urine Osmolarity —
Urine Specific Gr —
Serum Osmolarity —
Serum Sodium —
less than 300
1.001 - 1.005
greater than 295
greater than 145
BPH:
What should we assess for with (-osin) meds?
orthostatic hypotension
***dose at bedtime to prevent falls
Cushing’s:
What will they look like?
Moon Face
Buffalo Hump
Truncal Obesity
Weight Gain
Toxic Shock Syndrome is typically caused by —
tampons
Laparascopy:
What should we teach
Observe for signs of infection or hematoma at incision site
Change bandage as needed
Avoid strenuous activity for about a week
Addisonian Crisis:
What should we do to manage the Hypoglycemia?
IV glucose
Glucagon
Maintain IV access
Monitor BG hourly
Hyperpituitarism:
What are some activities that increase ICP that should be avoided after TPH surgery?
Coughing too soon
Blowing nose - Sneezing
Bending at waist
Straining to poop
Using a straw to drink
– and – are catecholamines and secreted by — —
Epi
NE
Adrenal Medulla
What hormones are secreted by the Adrenal CORTEX?
Adrenal MEDULLA?
Cortex:
- Cortisol (Glucocorticoids)
- Aldosterone (Mineralcorticoids)
- Androgens (Test. Estro. Pregest.)
Medulla: (Fight of Flight)
- Epi
- NE
Hyperparathyroidism:
What are we trying to do?
decrease serum calcium and increase serum phosphorous
Thyroid Storm:
Emergent Care
Maintain Patent Airway
Oral Antithyroid Meds
Sodium Iodine Solution ( 2 G IV)
Propranolol (1-3 mg) slowly over 3 mins
Glucorticoids
Continous Telemetry
VS q 30 mins
Cooling blankets of Ice Packs
Antipyretics (non-salicylate)
NS for rehydration
Fibrocystic Breast Condition:
Teaching
Mild Analgesics
Reduce salt intake prior to menses
Apply ice or heat to reduce pain
Wear supportive bra (even to bed)
Hypopituitarism:
What is the intervention necessary for this?
Lifelong replacement of deficient hormones
SIADH:
What are the Vasopressin Receptor Antagonists that can be used to treat?
ConiVAPTIN
TolVAPTAN
Parathyroid Glands:
How do they use the BONES to regulate Calcium and Phosphorous?
Cause Bones too…
- Increase release of Ca and Phos into ECF
- Decrease bone formation
- Increase Bone breakdown
TSS:
What should we teach regarding tampon use
wash hands
instert delicately
change q 3-6 hrs
use pads at night instead
don’t use if you’ve had TSS before
BPH:
How long will it take meds to work?
What are adverse effects?
6 mths
orthostatic hypotension
decreased libido
ED
Cushings is a result of — of the — —
hyperfunction
Adrenal Gland
Breast Cancer:
Which type of work can increase risk?
Night shift work due to melatonin and light exposure)
Ductal Ectasia:
What is a nursing action to remember?
send the discharge for lab assessment
Cushings:
What are the Immune complications?
Increased risk for infection
Increased masking of signs of infection and inflammation
Decreased inflammatory response
SIADH:
When replacing Sodium, how should it be given?
slowly
around 35 mL per hr and increasing around 0.5 mEq per L every hr
Hypothyroidism:
What med and what do we teach?
Levothyroxone:
Take exactly as prescribed
Don’t change brands
SIADH Labs:
Urine Osmolarity —
Serum Osmolarity —
Serum Sodium —
Urine Sodium —
Urine Sp. Gravity —
Urine Aldosterone —
GFR —
elevated (greater than 300)
decreased (less than 295)
less than 115
greater than 30
1.030 or more
decreased
increased
Endocrine Changes with Aging:
Low Estrogen levels lead to THIN and DRY SKIN.
What are nursing considerations?
avoid pulling client
use minimal tape on skin
change position q 2 hrs
use skin moisturizers
Fibrocystic Breast Condition:
What is treatment?
Oral Contraceptives
Reduction in dietary fat and caffeine
Diuretics
Thyroid Storm:
What is it?
life-threatening event that occurs in patients with unontrollable hyperthyroidism (most often with Grave’s Disease)
SIADH:
What are complication sof SIADH we need to watch for?
Osmotic Demyelinatoin
Pulmonary Edema
Seizures (neurogenic changes from too little sodium)
What is the ADH Test and what does it Diagnose?
demonstrates that kidneys can concentrate urine in the presence of exogenous ADH
dx: Diabetes Insipidus
Endocrine Changes with Aging:
Decreased Glucose Tolerance will cause mean what to the older client?
Gain weight (try to keep within 10 lbs of ideal)
Slow wound healing
Frequent yeast infections
Polydipsia and Polyuria
Aldosterone is secreted by —
It’s action is to retain — and excrete —
Adrenal Cortex
Na+
K+
Hypopituitarism:
What are some of the adverse effects of Androgen (Gonadotropin) replacement?
HTN (women on Estrogen)
Thrombosis (women on Estrogen)
***DVT
Gynecomastia (Men)
Acne
Baldness
Prostate Enlargement (Men) ***avoided in men with Prostate Cancer
Hyperparathyroidism:
Medication Management
Furosemide to excrete Calcium
NS to hydrate
Calcitonin to decrease release of skeletal calcium
Cinacalet to reduce PTH production and release
Addisonian Crisis:
What are our treatment goals?
Treat Low Sodium
Hormone Replacement
Hyperkalemia Managemt
Hypoglycemia Management
Hyperparathyroidism:
Calcium is —
Phosphorous is —
elevated (greater than 10.2)
decreased (less than 3.0)
Cushings:
What are CV complications?
HTN
Dependent Edema
Bruising
Petechiae
Myxedema Coma is a complication of —
How do you treat?
hypothyroidism
Treatment:
- Patent Airway
- Repalce fluids with NS or Hypertonic Saline
- Levothyroxine IV
- Glucose IV
- Corticosteroids IV
- VS q hr
- Warm Blankets
- Aspiration Precautions
- Turn q 2 hrs
- Monitor for changes in LOC (Seizure or Coma)
When are women most likely to have Fibrocystic Breast Condition?
Late teens and 20s (usually subsides after menopause)
**mostly in premenopausal women between 20-50 yo
Cortisol is secreted by —
How does it prevent Hypoglycemia?
Adrenal Cortex
By increasing liver gluconeogenesis and inhibiting peripheral glucose use
When should we recommend a Mammogram?
begin at age 40
Radioactive Iodine Therapy (RAI) is used for —
Hyperthyroidism
Cushings:
What are MSK complications?
Muscle atrophy of extremeties
Osteoporosis
- pathologic fractures
- decreased height due to vertebral collapse
- asceptic necrosis of femural head
- slow or poor wound healing of bone fractures
DI:
What is the patho of DI?
excretion of large volume of dilute urine because the kidney tubules do not reabsorb water, leading to polyuria, dehydration, and disturbed fluid and electrolyte balances
— is a complication from mastectomy where an accumulation of protein fluid in subq tissue
Lymphedema
Addison’s is a result of — of —- —-
Hypofunction
Adrenal Gland
Ductal Ectasia will have a — discharge from —
greenish-brown
nipple
Endocrine Changes with Aging:
Decreased Estrogen leads to…
Decreased bone density
Thinner, drier, skin
Dry perineal tissue (increased risk for cystitis)
Hyperaldosteronism is caused by — of the — —
Hyperfunction
Adrenal Gland
Cushings:
What are the SKIN complications?
Thinning sking
Striae
Increased Pigmentation
An Addisonian Crisis is when the need for — and — is greater than the supply.
Cortisol
Aldosterone
***usually in response to stressful event
Endocrine Changes with Aging:
Decreased Metabolism will cause older client to be less tolerant of — weather.
cold
DI:
How does HCTZ work to treat DI since it’s a diuretic?
causes a mild dehydration in kidney (diuresis at proximal tubules) leaving less fluid excretion at distal tubules (part most affected by DI)
therefore, there is less fluid to be lost by the most affected part of kidney
also causes excretion of sodium which helps with the hypernatremia
Thyroidectomy:
What will hemorrhage look like?
either bleeding or swelling that causes compression of airway and respiratory distress (stridor)
Post op care for Mastectomy.
VS (no BP, IV or blood draw in affected side)
HOB 30 degrees with affected arm on pillow (keeping affected arm elevated promotes lymphatic return)
Pain control
Drains monitored (ensure no kinking)
Monitor incision
Gradually increase activity
Stimulation - Suppression Testing:
Stimulation testing is used for a client suspected of having hormone —
Suppression testing is used for a client suspected of having hormone —
Hyposecretion (low levels)
*** failure of hormone level to rise indicates hypofunction
Hypersecretion (high levels)
***failure of hormone production to slow indicates hyperfunction
Parathyroid Glands:
How do they use the GI TRACT to regulate Calcium and Phosphorous?
enhance absorption of Ca and Phos from gut via activated Vit D
Addisonian Crisis:
How do you Replace Hormones?
Hydrocortisone (100-300 mg) or Dexamethasone (4-12 mg) followed by continous infusion of Hydrocortisone over 8 hrs
Hydrocortisone 50 mg IM q 12 hrs
H2 Blocker for Peptic Ulcer prevention
Addisonian Crisis:
How do you treat Low Na+?
rapid infusion of NS or D5W
DI: ADH Test
In Central DI, the UOP will — and Urine Osmolarity will —-
In Nephrogenic, the UOP will — and Urine Osmolarity will —
decrease ***It’s working
increase (more concentrated)
***it’s working
not change ***not working
not change ***not working
SIADH:
What should we check q 2 hrs?
Serum Sodium
Serum Omsolarity
DI:
What meds are given for ADH replacement?
Desmopressin
Vasopressin
- **weight themselves daily to identify weight gain
- **use same scale at same time
Serum — levels control ALDOSTERONE secretion.
K+
***aldosterone causes kidneys to reabsorb Na+ to bring plasma volume and osmolarity back to normal
Hypopituitarism:
What are the clinical manifestations of low Growth Hormone?
Decreased Bone Density
Pathologic Fractures
Decreased Muscle Strength
Increased Serum Cholesterol
Thyroid Storm:
Key Manifestations
fever
tachycardia
systolic HTN
may have anxiety and tremors
decreased LOC and increased restlessness if continues
***can lead to death even with treatment
DI:
DI is considered if urine output is more than — during 24 hrs
4 L
Thyroid Storm:
What antithyroid meds do we give?
Methimazole (up to 60 mg per day)
Propylthiouracil (300 -900 mg per day)
SIADH:
What are the management goals?
Decrease fluid intake
Correct Na+ imbalance
SIADH:
What meds can we give?
Furosemide
Phenytoin (inhibits release of ADH)
Demeclocycline (decrease renal tubule response to ADH)
Vasopressin Receptor Antagonists
Addisons:
What is diagnostic?
ACTH Stimulation Test
— regulates glucocorticoid (cortisol) release.
ACTH
***anterior pituitary hormone
Hyperaldosteronism:
What will assessment look like?
Low Potassium
HTN
HA
Fatigue
Muscle Weakness
Nocturia
