Test 4 (Mod 4) Flashcards
One of the most common medical disorders in the United States
Hypothyroidism
Results from insufficient circulating thyroid hormone
Hypothyroidism
Related to destruction of thyroid tissue or defective hormone synthesis
Primary Hypothyroidism
Related to pituitary disease with ↓ TSH secretion or hypothalamic dysfunction
Secondary Hypothyroidism
Iodine deficiency is the most common cause of this worldwide
Hypothyroidism
Amiodarone and lithium can produce
Hypothyroidism
caused by thyroid hormone deficiencies during fetal or neonatal life
Cretinism
↓ cardiac output ↓ cardiac contractility Anemia Cobalamin, iron, folate deficiencies ↑ serum cholesterol and triglycerides
These are all cardiovascular system signs of _______
Hypothyroidism
Low exercise tolerance
Shortness of breath on exertion
These are both respiratory system signs of ______
Hypothyroidism
Fatigued and lethargic
Personality and mood changes
Impaired memory, slowed speech, decreased initiative, and somnolence
These are all neurologic system signs of _________
Hypothyroidism
↓ motility
Achlorhydria
Constipation
These are all gastrointestinal system signs of ________
Hypothyroidism
Cold intolerance Hair loss Dry/coarse skin Brittle nails Hoarseness Muscle weakness and swelling Weight gain Menorrhagia These are all clinical manifestations of \_\_\_\_\_\_\_\_\_
Hypothyroidism
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues
Causes puffiness, periorbital edema, masklike effect
Myxedema (seen with severe long-standing hypothyroidism)
Complications of this can lead to:
Mental sluggishness
Drowsiness
Lethargy progressing gradually or suddenly to impairment of consciousness or coma
Myxedema
This medication must be taken regularly, and need to monitor for angina and cardiac dysrhythmias
Levothyroxine (Synthroid)
Physical exam in someone with this may reveal: Bradycardia Distended abdomen Dry, thick, cold skin Thick, brittle nails Paresthesias Muscular aches and pains
Hypothyroidism
excessive thyroid hormone secretion from the thyroid gland, where normal feedback control over thyroid hormone secretion fails
• Hyperthyroidism
hypermetabolism and increased sympathetic nervous system activity are caused by
Excessive thyroid hormones
The most common cause of hyperthyroidism
Graves’ disease (toxic diffuse goiter)
usually have thyrotoxicosis, a goiter or enlargement of the thyroid gland, exophthalmos or abnormal protrusion of the eyes, and pretibial myxedema or dry, waxy swelling of the front surfaces of the lower legs.
Graves’ disease
an autoimmune disorder in which antibodies are made and attach to the thyroid stimulating hormone receptor sites on the thyroid.
Graves’ disease
• A hallmark of _________ is heat intolerance with diaphoresis even when environmental temperatures are comfortable for others.
hyperthyroidism
• Cardiac problems of _________include increased systolic blood pressure, tachycardia, dysrhythmias, and atrial fibrillation, which may be apparent on electrocardiography.
hyperthyroidism
evaluates the position, size, and functioning of the thyroid gland.
Thyroid scan
can determine size and the composition of any masses or nodules
Ultrasonography
• Priorities for nursing care of _________ focus on monitoring for complications, reducing stimulation, promoting comfort, and teaching about therapeutic drugs and procedures.
Hyperthyoridism
• Drug therapy with antithyroid drugs is the initial treatment of
Hyperthyoridism
occurs when the disease is untreated or poorly controlled or is triggered by stressors such as trauma, infection, diabetic ketoacidosis, and pregnancy.
• Thyroid storm or thyroid crisis
• This is an extreme state of hyperthyroidism in which manifestations are more severe and life threatening and is most common in patients who have Graves’ disease.
Thyroid Storm
• The patient at risk for _______ should remain in a cool, dark, and quiet environment
thyroid storm
the result of decreased metabolism from low levels of thyroid hormones.
Hypothyroidism
• Decreased metabolism causes the heart muscle to become flabby and dilated, resulting in decreased cardiac output and perfusion to the brain and other vital organs, with __________
Myxedema
an inflammation of the thyroid gland
Thyroiditis
The most common type of thyroiditis
Chronic thyroiditis or Hashimoto’s disease
an autoimmune disorder that is usually triggered by a bacterial or viral infection.
Hashimoto’s disease
papillary, follicular, medullary, and anaplastic, are the four distinct types of
Thyroid Cancer
Initial manifestation is a single, painless lump or nodule
Thyroid Cancer
Treatment of choice for papillary, follicular, and medullary carcinomas
Surgery
is a life-threatening event in which the need for cortisol and aldosterone is greater than the available supply.
• Acute adrenal insufficiency, or Addisonian crisis
• Anorexia, nausea, vomiting, diarrhea, abdominal pain, and weight loss occur with ________
Adrenal insufficiency, Addison’s disease
• Laboratory findings include low serum cortisol, low fasting blood glucose, low sodium, elevated potassium, and increased serum blood urea nitrogen levels.
Adrenal insufficiency, Addison’s disease
• Instruct the patient with ________ to wear a medical alert bracelet and to carry simple carbohydrates with them at all times.
adrenal insufficiency
disease causes problems with exaggerated actions of glucocorticoids which affect metabolism and all body systems to some degree.
Cushing’s disease
• The most common cause of _______ is a pituitary adenoma.
Cushing’s disease
physical changes in a pt with ______, include fat pads on the neck, back, and shoulders; enlarged trunk with thin arms and legs; and a round face.
Hypercortisolism
Can result in emotional lability and mood swings, and pt’s often say that they don’t feel like themselves anymore
Hypercortisolism
Regulate metabolism and ↑ blood glucose
Critical to physiologic stress response
Glucocorticoids
These regulate Sodium balance, and Potassium balance
Mineralocorticoids
contributes to
Growth and development in both genders
Sexual activity in adult women
Androgen
Caused by excess of corticosteroids, particularly glucocorticoids
Cushing Syndrome
Iatrogenic administration of exogenous corticosteroids is the most common cause of
Cushing Syndrome
Cushing disease and primary adrenal tumors are more common in women aged
20 tp 40
Weight gain most common feature of _______, to include:
Trunk (centripetal obesity)
Face (“moon face”)
Cervical area
Transient weight gain from sodium and water retention
Cushing Syndrome
Catabolic effects of cortisol
Leads to weakness, especially in extremities
Protein loss in bones leads to osteoporosis, bone and back pain.
Protein wasting
Inflammatory reaction in the glomerulous
Glomerulonephritis
Strep is the main cause of this renal disease
Glomerulonephritis
BUN and Creatinine ____ with glomerulonephritis
Increase
Sediment, protein, and blood, will be found in urine with
Glomerulonephritis
BP is ______ with glomerulonephritis
Increased
Urine output ________ with glomerulonephritis
Decreases
Urine specific gravity ________ with glomerulonephritis
Increases
With glomerulonephritis, client will go into fluid volume _____
Excess
Tx for glomerulonephritis
Get rid of strep Balance activity with rest I+O and daily weights Monitor BP Fluid replacement Dialysis
How to determine fluid replacement
24 hour fluid loss + 500cc
Dietary needs for glomerulonephritis include a _____ in protein, a ________ in sodium, and a _______ in carbs
Decrease
Decrease
Increase
Diuresis for glomerulonephritis usually begins ___ to ____ weeks after onset
1 to 3
Malaise, H/A, anorexia, N/V, decreased output, weight gain
Signs and symptoms of RENAL FAILURE
an inflammatory response in the glomerulous, which result in big holes that allow protein to leak out into the urine
Nephrotic Syndrome
Protein in the urine
Proteinuria
Low albumin in the blood
Hypoalbuminemic
Low albumin leads to a loss of fluid in the _______ space, into the ________
Vascular
Tissue
Aldosterone causes retention of
Sodium and water
Total body edema
Anasarca
Can be caused by bacteria or viral infections, NSAIDs, Cancer and genetic predisposition, systemic disease like lupus or diabetes, or strep
Nephrotic Syndrome
Proteinuria, Hypoalbuminemia, Edema (anasarca), Hyperlipidemia
Signs and symptoms of Nephrotic Syndrome
Ace inhibitors are used in nephrotic syndrome to
block aldosterone secretion
Prednisone is used in nephrotic syndrome to
reduce inflammation. It shrinks holes so protein (albumin) cant get out.
Prednisone can lead to
Immunosuppression
Lipid lowering drugs are used in nephrotic syndrome to
lower lipid levels
We need to ______ Na to treat nephrotic syndrome
decrease
We need to ______ protein to treat nephrotic syndrome
INCREASE
Anticoagulation therapy may be used for up to six months to treat
nephrotic syndrome
Limit protein with all kidney problems except __________
Nephrotic Syndrome
This requires bilateral failure
Renal failure
Blood cant get to the kidneys
Pre-renal failure
Causes of pre-renal failure
Hypotension
Decreased HR (arrhythmia)
Hypovolemic
Any form of shock
20 minutes of poor perfusion can lead to
kidney necrosis
Shock _____ kidneys
KILLS
Damage has occurred inside the kidney
Intra-renal failure
Causes of Intra-renal failure
Glomerulonephritis
Nephrotic Syndrome
Dyes used in tests such as cardiac cath or CT scan
Drugs (Aminoglycosides, Mycins)- causes nephrotoxicity
Malignant HTN (uncontrolled HTN)
DM (causes severe vascular damage)
Urine cant get out of the kidneys
Post-renal failure
Causes of post-renal failure
Enlarged prostate Kidney stone Tumors Ureteral obstruction Edematous stoma (Ileal conduit)
Creatinine and BUN will be _______ with renal failure
Increased
Specific gravity will initially be _____ with renal failure
High
Because there is not enough erythropoietin, _______ will occur with renal failure
Anemia
Stimulates RBC production
Erythropoietin
Retention of fluid in renal failure will lead to S&S of _____ and _______
HTN and HF
Anorexia, N/V, occur in renal failure due to
retaining toxins
Potassium will be _____ in renal failure
High- will have hyperkalemia
Metabolic _______ will occur with renal failure
Acidosis
Phosphorous will be ________ with renal failure
High
High phosphorous in renal failure will lead to a ______ in serum calcium
Decrease
A decrease in serum calcium in renal failure will lead to
calcium being pulled from bones
First phase of acute kidney failure
Oliguric phase
Urine output _____ in oliguric phase of kidney failure
decreases
UO of 100 to 400 ml / 24 hours is typical in the _____ phase of acute kidney failure
Oliguric
Client will be in fluid volume _______ excess during the oliguric phase of kidney failure
Excess
Potassium will ______ during the oliguric phase of kidney failure
Increase
Second phase of Acute Kidney Failure
Diuretic phase
This phase of acute kidney failure will have a sudden onset
Diuretic phase
UO will_______ during the diuretic phase of kidney failure
Increase
Client will be in fluid volume ________ during the diuretic phase of kidney failure
Deficit (SHOCK)
During the diuretic phase of acute kidney failure, it is possible for the client to lose up to __________ liters of fluid per day
10
Potassium will _________ during the diuretic phase of acute kidney failure
Decrease
It may take up to ____ months to recover completely from acute kidney failure
12
In ________, the machine is the glomerulus (filter).
Hemodialysis
Is done 3-4 times per week; the client must watch what they eat and drink between treatments
Hemodialysis
To prevent blood clots, the client is given an _________ during dialysis
Anticoagulant
Heparin lasts _____ to _______ hours in the body
4 to 6
With hemodialysis, blood is being removed, cleansed, and then retuned at a rate of ______ to ________ mL/min.
300-800
In forearm with an anastomosis between an artery and a vein
AVF (arteriovenous fistula)
A synthetic graft to join the vessels in dialysis use
AVG (arteriovenous graft)
Assess hemodialysis access by
Palpating for a thrill, and auscultating for a bruit
Uses the peritoneal membrane as a filter
peritoneal dialysis
Dialysate is warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter
Peritoneal dialysis
How much dialysate is used in peritoneal dialysis
200-2500 mL
This is what the time that the dialysate remains in the peritoneal cavity is called
Dwell time
The bag is lowered and the fluid, along with the toxins, are drained. This is referred to as the _____ in peritoneal dialysis
Exchange
We warm the dialysate to promote
vasodilation, and more blood flow
What should peritoneal dialysis drainage look like?
Clear, straw-colored.
Cloudy peritoneal dialysis drainage means
Infection
If fluid doesn’t come out during peritoneal dialysis, you should ________
turn the client side to side
This type of peritoneal dialysis is done 4 times a day, 7 days a week, and can cause pressure on the back, and is not recommended for someone with a colostomy due to a high risk of infection
CAPD (Continuous Ambulatory Peritoneal Dialysis)
