Unit 5 and 6 Flashcards
(293 cards)
1
Q
What kind of hormones will the patient who had a hypophysectomy need?
A
Cortisol
Thyroid
Gonadal
2
Q
Sick Day Rules:
What changes are made to how insulin and antidiabetic agents is administered?
A
No changes! Take everything as prescribed.
3
Q
True/False: It is important to look for subtle changes in the patient with SIADH such as muscle twitches before the progresses to seizures or a coma.
A
True.
4
Q
What are the key manifestations of DI?
A
Increase in urination and excessive thirst.
5
Q
What happens to serum magnesium in hyperparathyroidism?
A
It increases
6
Q
What are the manifestations of hypoparathyroidism caused by?
A
Hypocalcemia
7
Q
Where is muscle mass decreased in patients with Cushing’s?
A
All over but especially in the arms and legs.
8
Q
Normal Magnesium
A
1.5-2.5
9
Q
Normal phosphorus
A
2-4.5
10
Q
For the patient with HHS, what is assessed hourly?
A
When they are exhibiting signs and symptoms of cerebral edema like abrupt changes in mental status, abnormal neurologic signs and coma.
11
Q
What can cause myxedema coma?
A
Acute illness
Surgery
Chemotherapy
Stopping thyroid replacement therapy
12
Q
Why is it important to NOT palpate the abdomen of a patient with pheochromocytoma?
A
Because palpating could stimulate a sudden relase of catecholamines and trigger severe hypertension.
13
Q
A rare, serious complication of untreated or poorly treated hypothyroidism is known as?
A
Myxedema coma
14
Q
What type of fluid is used initially for the patient with DKA?
A
Hypotonic fluids like 0.45% normal saline.
15
Q
What type of diabetes is associated with DKA?
A
Type I
16
Q
What happens to serum calcium in hyperparathyroidism?
A
It increases
17
Q
What is the best way to determine the degree of fluid restriction?
A
By measuring intake, output and daily weights.
18
Q
What are the nursing interventions of prednisone?
A
Instruct the patient to report illnesses because the dose may need to be changed while the patient is sick.
19
Q
What are the psychological/ emotional manifestations of hypothyroidism?
A
Apathy
Depression
Paranoia
20
Q
What can trigger a thyroid storm?
A
Trauma
Infection
DKA
Pregnancy
21
Q
What is the first outcome of fluid therapy for the patient with DKA?
A
Restore volume and maintain perfusion to the brain, heart and kidneys.
22
Q
Normal glucose
A
70-110
23
Q
What occurs in hyperparathyroidism that makes preventing injury important?
A
Because this patient has significant bone density loss and is at risk for pathologic fractures.
24
Q
What are the other manifestations of hyperthyroidism?
A
Goiter
Wide-eyes or startled appearance
Enlarged spleen
Muscle weakness and wasting
25
What are the cardiopulmonary manifestations of hyperthyroidism?
```
Palpitations
Chest pain
Increased systolic blood pressure
Tachycardia
Dysrhythmias
Rapid, shallow respirations
```
26
Acidic pH
Less than 7.35
27
Acidic HCO3
Less than 22
28
What are the nursing interventions associated with fludrocortisone?
Monitor the patient's blood pressure and instruct the patient to report any weight gain or edema.
29
What are the neurologic manifestations associated with diabetes insipidus?
Decreased cognition
Ataxia
Increased thirst
Irritability
30
What type of fluid is used when blood glucose levels reach 250?
Dextrose 5 % in 0.45% saline.
31
Normal pH
7.35-7.45
32
Expected Potassium levels for the patient with Addison's will be...
Increased
33
Why is Tolvaptan and Conivapta only administered in a hospital setting?
So that sodium levels can be monitored very closely for the development of hypernatremia.
34
What are the skin manifestations associated with adrenal insufficiency?
Vitiligo (patches of skin with lost pigmentation)
| Hyperpigmentation
35
What is the difference between Cushing's disease and Cushing's syndrome?
Disease is when the cause is from a problem in the actual adrenal cortex (usually a benign tumor).
Syndrome is when the problem results from drug therapy.
36
When taking a medical history on a patient who is suspected of having SIADH, what conditions should be asked about?
```
Recent had trauma
Cerebrovascular disease
Tuberculosis or other pulmonary disease
Cancer
All past and present drug use
```
37
Safety precautions for the patient receiving an unsealed radioactive isotope:
What is a woman is incontinent of urine?
Have them line their clothing with layers of facial tissue instead of gel-filled briefs. The tissue should then be flushed down the toilet that is used exclusively by the patient.
38
Sick Day Rules:
| When does urine need to be tested for ketones?
When blood glucose level is greater than 240.
39
Sick Day Rules:
| How can the patient treat symptoms from their illness?
As directed by the health care provider.
40
Emergency care of the patient during thyroid storm:
| Other than the oral antithyroid drugs, what else is administered to the patient?
Sodium iodine solution
41
A problem in which vasopressin (ADH) is secreted even when plasma osmolarity is low or normal is known as?
SIADH.
42
Safety precautions for the patient receiving an unsealed radioactive isotope:
Why use a laxative on the second and third day after receiving radioactive iodine?
Because it will help you excrete the contaminated stool faster and reduce the exposure time of your organs to radiation.
43
Cortisol replacement therapy:
| How and when should medication be taken?
Medication should be taken in divided doses, the first being in the morning and then the second between 4 and 6 PM.
44
What can high levels of PTH cause?
Kidney stones
| Deposits of calcium in the soft tissue of the kidney
45
What are the neuromuscular manifestations of hypothyroidism?
```
Slow or slurred speech
Impaired memory
Inattentiveness
Lethargy
Confusion
Hearing loss
Paresthesia
Decreased DTR
Muscle aches and pains
```
46
A rare endocrine disorder in which parathyroid function is decreased is known as?
Hypoparathyroidism
47
What are the two easiest parameters the patient with hypothyroidism can check in order to monitor the effectiveness of drug therapy?
The need for sleep and and bowel elimination.
48
How should a patient who had a hypophysectomy pick something up off of the floor?
Bend at the knees and then lower the body to pick up fallen objects.
49
Safety precautions for the patient receiving an unsealed radioactive isotope:
Because radioactivity will be in the saliva, what should be avoided and incorporated?
```
Avoided:
Sharing toothbrushes
Sharing toothpaste
Fruits with a core
Meat on the bone
Incorporated:
Disposable tissues
Disposable utensils, plates and cups
```
50
Describe hirsutism and which disease is it seen with?
Increased body hair growth and its commonly seen in patient's with Cushing's.
51
What is known as a hyperosmolar state caused by hyperglycemia?
HHS
52
Normal serum osmolarity
285-295
53
Normal T4
5-12
54
What are the complications that can occur following thyroid surgery?
Hemorrhage
Respiratory distress
Parathyroid gland injury (causing hypocalcemia)
Tetany (hyper excitability of nerves and muscles)
Damage to layngeal nerves
Thyroid storm
55
Safety precautions for the patient receiving an unsealed radioactive isotope:
What happens if urine is spilled on the toilet seat or floor?
Wipe it up with paper tissues or towels, bag them in a sealable plastic bag and then take them to the hospital's radiation department.
56
What acid base disturbance is associated with DKA?
Metabolic acidosis
57
What drugs are used to treat a hospitalized patient with SIADH?
Vasopressin antagonists like Tolvaptan and Conivapta.
58
What happens to serum parathyroid hormone in hypoparathyroidism?
It decreases
59
What is the key feature of DKA?
Elevation of blood ketone concentration.
60
What type of problems occur when serum calcium levels are high?
GI problems like anorexia, nausea, vomiting, epigastric pain, constipation and weight loss.
61
What are the key manifestations associated with thyroid storm?
Tachycardia
Fever (of even one degree)
Systolic hypertension
62
Expected Bicarb levels for the patient with Cushing's will be...
Decreased
63
What are the musculoskeletal manifestations of Cushing's?
```
Muscle atrophy (mainly in the extremeties)
Osteoporosis
```
64
What are the psychosocial/emotional manifestations of hyperthyroidism?
Decreased attention span
Restlessness and irritability
Emotional lability
Manic behavior
65
What type of diet does the patient with hypothyroidism need to stick to?
A diet high in fiber and not fluids.
66
What happens to serum magnesium in hypoparathyroidism?
It decreases
67
Safety precautions for the patient receiving an unsealed radioactive isotope:
What type of clothing should this patient wear?
Machine washable clothing only and wash them separately from any other clothes in the household.
68
Expected glucose levels for the patient with Addison's will be...
Normal to decreased
69
What are the causes of hyperparathyroidism?
```
Parathyroid tumor or cancer
Congenital hyperplasia
Neck trauma or radiation
Vit D deficiency
Chronic kidney disease with hypocalcemia
Parathyroid hormone--secreting carcinomas of the lung, kidney, or GI tract
```
70
What are the classic manifestations of DKA?
```
Polyuria
Polydipsia
Polyphagia
Vomiting
Abdominal pain
Dehydration
Weakness
Confusion
Shock
Coma
Fruity breath
Kussmaul respirations
```
71
True/False: A patient suspected of having DI can be deprived of fluids for up to 6 hours.
False; no patient suspected of having DI should be deprived of fluids for more than 4 hours.
72
A life threatening event that occurs in patients with uncontrolled hyperthyroidism is known as?
Thyroid storm
73
Why is it important for a patient with DI to have adequate fluids?
Because urine output is not reduced and continued urine output without adequate fluid intake will lead to severe dehydration.
74
How is serum calcium levels reduced in patients with a mild form of hyperparathyroidism?
With diuretic and hydration therapies.
75
What must be assessed first in the patient with DKA?
```
Airway
LOC
Hydration status
Electrolytes
Blood glucose level
```
76
Normal specific gravity
1.005-1.030
77
Whata re the GI manifestations associated with adrenal insufficiency?
```
Anorexia
Fatigue
Abdominal pain
Constipation and diarrhea
Weight loss
Salt craving
```
78
What type of blankets are given to the patient during myxedema coma?
Warm blankets.
79
Emergency care of the patient during thyroid storm:
| True/False: Non-salicylate antipyretics can be given as prescribed.
True.
80
True/False: A patient with Cushing's as a higher risk of infection and the patient may not have the expected manifestations when an infection is present.
True
81
What is the most common medication used to treat hypothyroidism?
Levothyroxine
82
What are the GI manifestations of hypothyroidism?
Anorexia
Weight gain
Constipation
Abdominal distention
83
How often is the patient's who just had a hypophysectomy neurological status monitored?
Once an hour for the first 24 hours and then once every four hours.
84
Who is mostly affected by by hypothyroidism?
Women between 30 and 60 years old.
85
What are the reproductive changes for men manifestations of hypothyroidism?
Decreased libido
| Impotence
86
What foods are avoided in the patient with hypoparathyroidism?
Milk, yogurt, and processed cheese.
87
What type of environment is best for the patient with SIADH?
A quiet and dim environment.
88
What are the cardiovascular manifestations of Cushing's?
Hypertension
Frequent dependent edema
Bruising
Petechiae
89
Cortisol replacement therapy:
| What should the patient do if they have persistent diarrhea or vomiting?
Call their health care provider or go to the nearest ER... they may need an injection to take place of the usual oral medication.
90
Normal CO2
35-45
91
What causes diabetic ketoacidosis?
Combination of insulin deficiency and an increase in hormone release that leads to increased liver and kidney glucose production and decreased glucose use in peripheral tissues.
92
When is IV insulin administered for the patient with HHS?
When adequate fluids have been replaced.
93
What is the most common reason a person with hypothyroidism seeks medical attention?
Depression
94
How often do you check the temperature of a patient during myxedema coma?
Hourly
95
What are the expected lab values that are associated with adrenal insufficiency?
```
Low serum cortisol
Low fasting blood glucose
Low sodium
Elevated potassium
Increased BUN
```
96
How does a nurse promote comfort for the patient with hyperthyroidism?
Reduce room temperature
Have fresh picture of ice water
Change bed linens when it becomes damp from diaphoresis
Suggest a cool shower or sponge bath a few times throughout the day
Use artificial tears for the patient with exophthlamos.
97
What are the cardiovascular manifestations of adrenal insufficiency?
```
Anemia
Hypotension
Hyponatremia
Hyperkalemia
Hypercalcemia
```
98
What needs to be asked about when assessing a patient with hypoparathyroidism?
Head or neck surgery or radiation
| Car crash or strangualtion
99
When is Grave's disease usually diagnosed?
In women older than 50.
100
Other than episodes of hypertension, what other manifestations with patients with pheochromocytoma complain of?
Heat intolerance
Weight loss
Tremors
101
What happens to serum calcium in hypoparathyroidism?
It decreases
102
Normal RBC
4.2-6.1 million
103
What is the nursing management for hypoparathyroidism?
Teaching about the drug regimen and interventions to reduce anxiety.
Teach the patient to eat foods high in calcium but low in phosphorus.
Teach the therapy will be lifelong.
104
Normal TSH
0.5-5
105
For the patient with Cushing's disease, what does high levels of corticosteroids do to the body?
Kills lymphocytes and shrinks organs that contain lumphocytes such as the spleen and the lymph nodes.
106
True/False: The patient with adrenal insufficiency should be weighed once per shift.
False, the patient only needs to be weighed daily and the intake and output needs to be documented.
107
What are common side effects of desmopresssin nasal spray?
Ulceration of the mucous membranes
Allergy
Sense of chest tightness
Lung inhalation
108
What is the result of diabetes insipidus?
The excretion of large volumes of dilute urine because the distal kidney tubules and collecting ducts do not reabsorb water. (This is what leads to polyuria, dehydration and disturbed fluid and electrolyte balance).
109
What are the causes of hypoparathyroidism?
```
Surgical or radiation-induced thyroid ablation
Parathyroidectomy
Congenital dysgenesis
Autoimmune hypoparathyroidism
Hypomagnesemia
```
110
What is the most common drug used to treat hypofunction of the adrenal gland?
Prednisone.
111
What are the reproductive changes for women manifestations of hypothyroidism?
Amenorrhea
Prolonged menses
Anovulation
Decreased libido
112
When do you call rapid response team for a patient following a thyroid surgery?
When stridor, dyspnea or any other obstruction appears.
113
What are the 3 nursing interventions associated with Propylthiouracil (PTU)?
1. Avoid crowds and people who are ill.
2. Report darkening of the urine, a yellow appearance to the skin or whites of the eyes. (Drug is hepatotoxic)
3. Check for weight gain, slow heart rate and cold intolerance.
114
Emergency care of the patient during thyroid storm:
| What nursing interventions can be done to reduce a fever?
Cooling blanket and ice packs
115
What does water retention cause in urine volume and urine osmolarity for patients with SIADH?
Urine volume to decreaseand urine osmolarity increases.
116
Emergency care of the patient during thyroid storm:
| Which medication is given slowly over 3 minutes?
Propranolol; and the patient should be hooked up to cardiac monitor.
117
What are the medical interventions for the patient with SIADH?
Restrict fluid intake
Promote excretion of water
Replace lost sodium
Interfering with the action of ADH
118
What are the metabolic manifestations of hyperthyroidism?
Increased BMR
Heat intolerance
Low grade fever
Fatigue
119
Why is sedating a patient with hypothyroidism avoided?
Because it can make gas exchange worse.
120
What are the kidney/ urinary manifestations of diabetes insipidus?
Increased urine output
| Dilute, low specific gravity
121
Safety precautions for the patient receiving an unsealed radioactive isotope:
Who should avoid contact with a patient who took radioactive iodine one week ago?
Pregnant women
Infants
Young children
122
Describe the intermittent episodes that are associated with pheochromocytoma.
```
Severe hypertension accompanied with:
Severe headache
Palpitations
Profuse diaphoresis
Flushing
Apprehension or a sense of impending doom
```
123
What could happen if interventions are not promptly initiated for the patient having an Addisonian Crisis?
Sodium levels will fall and potassium levels will rise quickly and severe hypotension will result from blood volume depletion that was caused by the loss of aldosterone.
124
What causes fluid and electrolyte disturbances in SIADH?
ADH is continuously released even when plasma is hypo-osmolar. This means that water is retained resulting in diluted hyponatremia and fluid overload.
125
What does the normal thyroid gland have an uptake of?
5%-35% of the given dose at 24 hours.
126
A water loss problem caused by either an ADH deficiency or an inability of the kidneys to respond to ADH.
Diabetes insipidus
127
Surgical removal of the pituitary gland and tumor is known as?
Hypophysectomy
128
Cortisol replacement therapy:
| When is it appropriate to increase your dose?
When you are under increased physical stress or severe emotional stress.
129
When is DI considered?
When the urine output is more than 4 L during the 24 hours testing period and the output is greater than the volume ingested.
130
How should the patient who just had a hypophysectomy perform mouth care?
With floss and oral mouth rinse instead of brushing their teeth.
131
Normal T3
70-220
132
What is a great way to prevent HHS?
Stay hydrated. HHS will not occur in patients that are not dehydrated.
133
Emergency care of the patient during thyroid storm:
| What glucocorticoids can be given?
```
Hydrocortisone
OR
Prednisone
OR
Dexamethasone
```
134
What is the most common diagnostic test is used for pheochromocytoma?
Blood and a 24 hour urine collection
135
What is a mustache dressing?
Its a drip pad that is placed under the nose after a hypophysectomy.
136
What are the reproductive manifestations of hyperthyroidism?
Amenorrhea
| Increased libido
137
Safety precautions for the patient receiving an unsealed radioactive isotope:
Why does a male need to sit to urinate?
To avoid splashing the seat, wall and floor.
138
What are the 6 complications that often occur with myxedema coma?
```
Coma
Respiratory failure
Hypotension
Hyponatremia
Hypothermia
Hypoglycemia
```
139
How does the nurse promote a quiet environment for the patient with hyperthyroidism?
Encourage the patient to rest
Close the door to their room
Limit visitors
Eliminating or postponing nonessential care or treatments
140
Normal Sodium
135-145
141
True/False: The patient with DKA will have distended neck vein and a bounding pulse.
False, the patient in DKA will exhibit symptoms of fluid volume deficit.
142
What drugs cause a decreased synthesis of thyroid hormone?
Lithium
Propylthiouracil
Sodium or potassium perchlorate
Aminoglutethimide
143
Describe how a thyroid scan works.
Radioactive iodine is given by mouth and the uptake of iodine by the thyroid gland is measured.
144
What type of medications can induce a hypertensive crisis in patients with pheochromocytoma?
```
Tricyclic antidepressants
Droperidol
Glucagon
Metoclopramide
Phenothiazines
Naloxone
```
145
What are the GI manifestations of hyperthyroidism?
Weight loss
Increased appetite
Increased stools
146
What is the most common disturbed electrolyte imbalance?
Sodium and its usually increased.
147
Why is a patient with Cushing's on fall precautions?
Because muscle weakness puts them at risk for falling.
148
Safety precautions for the patient receiving an unsealed radioactive isotope:
How many times should a patient flush the toilet?
At least 3 times.
149
Expected Calcium levels for the patient with Addison's will be...
Increased
150
What does pheochromocytoma produce, store and release?
Epinephrine and norepinephrine.
151
Why should a patient avoid coughing early after hypophysectomy?
Because coughing increases pressure in the incision area and may lead to a CSF leak.
152
Normal Albumin
3.5-5
153
What does water loss in diabetes insipidus produce?
Changes in blood and urine.
154
What is the most common treatment for hyperpituitarism?
Hypophysectomy
155
What type of fluids need to be given to the patient during myxedema coma?
Normal or hypertonic saline
156
Normal HCO3
22-28
157
What happens to serum phosphorus in hyperparathyroidism?
It decreases
158
When and why does a patient with pheochromocytoma start an adrenergic blocking agent?
7-10 days before surgery because of of the increased risk for severe hypertension during surgery.
159
What is the main treatment for patients with pheochromocytoma?
Surgery
160
What is oligomeorrhea and which disease is it seen with?
scant or infrequent menses and its is commonly seen in patients with Cushing's.
161
How often should the patient deep breath after a thyroid surgery?
Every 30-60 minutes.
162
What should the patient be taught to avoid after a hypophysectomy?
Bending forward
Blowing their nose
Brushing their teeth
Coughing and sneezing
163
How quickly should insulin lower serum glucose?
About 50-75 mg/dL/hr.
164
What is the most preferred drug to manage or control manifestations of diabetes insipidus?
Desmopressin acetate (DDAVP). It is a synthetic vasopressin given PO or intranasally in a metered spray.
165
What are the skin manifestations associated with diabetes insipidus?
Poor turgor
| Dry mucous membranes
166
Why does a patient with hypertyroidism get fatigued?
Because of the hyperactivity that causes the inability to sleep well.
167
What is monitored every two hours during hydration therapy for the patient with hyperparathyroidism?
Cardiac function
| Intake and output
168
Cortisol replacement therapy:
| What is important to teach to the patient about daily weights?
Be sure to keep record of your daily weights to show your health care provider.
169
How is hyperthyroidism diagnosed?
Measurement of T3, T4 and TSH as well as a thyroid scan.
170
How is vitamin D deficiency treated?
With oral calcitrol.
171
What is the first priority when taking care of a patient during myxedema coma?
Maintain a patent airway.
172
What are the cardiovascular manifestations of hypothyroidism?
```
Bradycardia
Dysrhythmias
Enlarged heart
Decreased activity tolerance
Hypotension
```
173
When does a patient with diabetes need to consult their physician?
When blood glucose exceeds 250
Ketonuria lasts for more than 24 hours
Can not take food or liquids
has an illness that lasts more than 1 or 2 days.
174
Acidic CO2
Less than 35
175
What is the most serious complication after surgery for pheochromocytoma?
Hypertension.
176
When is saline used for a patient with SIADH?
To dilute any tube feedings
To irrigate GI tubes
To mix drugs that need to be given by GI tube.
177
What organ is highly affected by HHS?
The kidneys -- they will continue to deteriorate.
178
What are the skin manifestations of hyperthyroidism?
Diaphoresis
Fine, soft silky body hair
Smooth, warm moist skin
Thinning of scalp hair
179
What type of solution is used to treat SIADH when sodium levels are very low?
Hypertonic saline like 3% NaCl
180
What needs to be taught to the patient with pheochromocytoma before discharge?
Do not smoke
Do not drink caffeinated beverages
Do not change positions quickly
Eat a diet rich in calories, vitamins and minerals.
181
What are the nursing interventions for a patient with diabetes insipidus?
Accurately measuring fluid intake and output.
Checking urine specific gravity.
Recording patient's weight daily.
182
What fluid and electrolyte disturbances are often seen in patients with Cushing's?
Hypernatremia and hypervolemia which lead to elevated blood pressure and pulses that are full and bounding.
183
Expected sodium levels for the patient with Addison's will be...
Decreased
184
Safety precautions for the patient receiving an unsealed radioactive isotope:
What are important reminders to friends and family that are visiting their loved one who took radioactive iodine?
Stay at least three feet away from them and do not visit for longer than one hour each day.
185
Safety precautions for the patient receiving an unsealed radioactive isotope:
What if a man is incontinent of urine?
Have them wear a condom cath instead of gel-filled briefs.
186
Why is it important to reduce stimulation in the patient with hyperthyroidism?
Because it helps prevent increasing the manifestations of hyperthyroidism and the risk for cardiac complications.
187
True/False: They only way to prevent death from thyroid storm is to treat it.
False, even with treatment, thyroid storm can still lead to death.
188
What needs to be taught to the patient and their family about their thyroid medication?
It needs to be taken on an empty stomach, 30 minutes before any other medication or supplement.
They also need to take the medication as prescribed and not alter the dose or schedule without speaking with the health care provider.
Also teach them to not change brands.
189
What can happen if a patient with SIADH has fluid overload that is worsening?
They can get pulmonary edema and heart failure.
190
What are two common drugs used for patients with hyperthyroidism?
Propylthiouracil (PTU)
| Methimazole
191
What are the cardiovascular manifestations of diabetes insipidus?
Hypotension
Tachycardia
Weak peripheral pulses
Hemoconcentration
192
True/False: IV glucose is given to the patient during myxedema coma.
True.
193
How does calcitonin work?
It decreases the release of skeletal calcium and increases the kidney excretion of calcium.
194
Expected bicarb levels for the patient with Addison's will be...
Increased
195
Basic HCO3
Greater than 28
196
Sick Day Rules:
| What does the patient need to do in order to prevent dehydration?
Drink 8-12 ounces of sugar free liquid that they are awake.
| If blood sugars are below target range, drink beverages with sugar.
197
How is adrenal insufficiency diagnosed?
With an ACTH stimulation (provocation) test.
198
Describe the physical changes in a patient with Cushing's.
They will have the buffalo hump, round face, enlarged trunk with thin arms and legs.
199
Expected Glucose levels for the patient with Cushing's will be...
Normal to increased
200
For the patient with Cushing's disease, what happend when the fat redistribruted?
It produces truncal obesity , buffalo hump and moon face.
201
Emergency care of the patient during thyroid storm:
| What is the number one priority?
Maintain a patent airway and adequate ventilation.
202
Which form of desmopressin is 10 times stronger than the other?
The parenteral form.
203
What is the big differences between HHS and DKA?
HHS does not have ketones present and HHS has blood glucose levels that are much higher than DKA
204
What electrolyte imbalances are associated with DKA?
Hyperkalemia
205
Why is fluid restriction essential to the patient with SIADH?
Because fluid intake can further dilute plasma sodium levels.
206
What are the nursing interventions for a patient with adrenal insufficiency?
Promote fluid balance
Monitor for fluid deficit
Prevent poor glucose regulation with hypoglycemia.
207
What does reduced aldosterone secretion cause?
Disturbances of fluid and electrolytes, especially potassium, sodium and water.
208
Safety precautions for the patient receiving an unsealed radioactive isotope:
How long does the patient need to use an unshared toilet?
For two weeks after receiving the radioactive iodine.
209
For the patient with long term DI, what does polyuria and polydipsia indicate?
The need for another dose of medication.
210
What does a nurse need to ask about when screening a patient for hyperparathyroidism?
```
Bone fractures
Recent weight loss
Arthritis
Psychological stress
Radiation to the head or neck
```
211
What are the skin manifestations of Cushing's?
Thinning skin
| Striae and increased pigmentation
212
What does decreased cortisol levels cause?
Poor glucose regulation with hypoglycemia.
213
What manifestations of hyperthyroidism are specific to Grave's disease?
Exophthalmos and pretibial myxedema.
214
True/ False: If a patient has a goiter, they will have hyperthyroidism.
False. Not all patients with a goiter have hyperthyroidism.
215
What are the nursing interventions for the patient with SIADH?
Monitor the patient's response to therapy
Prevent further complications
Teach patient and family about fluid restrictions and drug therapy
Prevent injury
216
What indicates loss of calcium in the teeth?
Bands or pits may encircle the crowns of the teeth.
217
How do vasopressin antagonists work?
They promose water excretion without causing sodium loss.
218
How often do you turn the patient during myxedema coma?
Every 2 hours.
219
What type of precautions is the patient put on during myxedema coma?
Aspiration precautions.
220
What does excessive epinephrine and norepinephrine stimulate?
Adrenergic blockers which causes adverse effects that mimick the action of the sympathetic division of the autonomic nervous system.
221
How do you keep the mouth moist for a patient with SIADH?
Offer frequent oral rinsing and reminding the patient to not swallow the rinse.
222
Normal platelet
150-400 million
223
Expected BUN level for the patient with Addison's will be...
Increased
224
Expected BUN level for the patient with Cushing's will be...
Normal
225
Normal Calcium
9-10.5
226
In some cases, what can fluid intake be limited to?
500-1000 mL/ 24 hours
227
What are the metabolic manifestations of hypothyroidism?
Decreased BMR
Decreased body temperature
Cold intolerance
228
A catecholamine-producing tumor that arises in the adrenal medulla is known as?
Pheochromocytoma
229
What are the labratory findings that accompany hypercortisolism?
```
High blood glucose
Decreased lymphocyte count
Increased sodium level
Decreased serum calcium level
Elevated blood, saliva and urine cortisol levels.
```
230
Emergency care of the patient during thyroid storm:
| What solution is used to correct dehydration?
Normal saline
231
What fluid and electrolyte imbalances are associated with adrenal gland hypofunction?
Hyperkalemia
Hyponatremia
Hypovolemia
232
What is Grave's disease?
an autoimmune disorder resulting from Hashimotos thyroiditis.
233
Safety precautions for the patient receiving an unsealed radioactive isotope:
What needs to happen to the washing machine after you wash your clothes?
Empty it and run a full cycle on empty.
234
What can happen if the dose of levothyroxine is not adequate?
If its too low, they patient will still have have manifestations of hypothyroidism. If the dose it too high, they patient will show signs and symptoms hyperthyroidism.
235
For the patient with diabetes insipidus, how much fluid should you encourage them to drink?
The amount of fluid that is equal to urine output.
236
For the patient with Cushing's disease, what does the presence of excess glucocorticoids affect?
Metabolism and all body systems
237
Normal WBC
5-10 million
238
Why is it important to assess cardiac function of a patient with adrenal insufficiency?
Because hyperkalemia can cause dysrhythmias, irregular heart rate and result in cardiac arrest.
239
Expected Potassium levels for the patient with Cushing's will be...
Decreased
240
What is the first step in diagnosing diabetes insipidus?
Measure a 24 hour fluid intake and output without any restrictions.
241
What causes elevated serum gastrin levels and what can that lead to?
Hypercalcemia and it can lead to peptic ulcer disease.
242
How will the specific gravity and osmolarity be of the urine from a patient with DI?
Specific gravity will be low and the osmolarity will be low as well.
243
Expected calcium levels for the patient with Cushing's will be...
Decreased
244
After a hypophysectomy, why does a patient have to breathe through their mouth?
Because nasal packing is present for 2-3 days.
245
After a patient has thyroid surgery, how should they be positioned?
In semi-fowlers position and use pillows to support the head and neck.
246
How is cortisol and aldosterone deficiencies corrected?
With hormone replacement therapy.
247
Expected cortisol levels for the patient with Cushing's will be...
Increased
248
Normal Potassium
3.5-5
249
What are the 3 nursing interventions associated with Methimazole?
1. Notify health care provider if you become pregnant.
2. Avoid crowds and people who are ill.
3. Check for weight gain, slow heart rate and cold intolerance.
250
What electrolytes are maintained by the parathyroid gland?
Calcium and phosphate.
251
What are the immune system manifestations of Cushing's?
Increase risk for infection
Decreased immune function
Decreased inflammatory response
Manifestations of infection/inflammation may be marked
252
What type of insulin is used to treat patients in DKA?
Regular -- which is the only insulin that can go through IV.
253
What is striae and which disease is is commonly seen in?
They are stretch marks are occur on the abdomen, thighs and upper arms because of the destructive effect of cortisol on collagen in patients with Cushing's.
254
What are the other manifestations of hypothyroidism?
```
Periorbital edema
Facial puffiness
Nonpitting edema of the hands and feet
Hoarseness
Goiter
Thick tongue
Increased sensitivity to opioids and tranquilizers
Weakness and fatigue
Decreased urine output
Easy bruising
Vitamin deficiencies
Iron deficiency anemia
```
255
What are the neurologic manifestations of hyperthyroidism?
```
Blurred or double vision
Eye fatigue
Increased tears
Injected (red) conjuctiva
Photophobia
Exothohthalmos
Eyelid retraction, eyelid lag
Globe lag
Hyperactive DTR
Tremors
Insomnia
```
256
What are the nursing interventions associated with cortisone?
Instruct the patient to take the drug with a meal or snack because GI irritation can occur.
257
Basic pH
Greater than 7.45
258
What is one of the earliest problems in the patient with Grave's disease?
Visual changes.
259
Why are fasting blood glucose levels high in the patient with Cushing's?
Becuase the liver releases glucose and the insulin receptors are less sensitive so blood glucose does not move as easily into the tissues.
260
What happens to plasma volume, plasma osmolarity, urine sodium levels and urine specific gravity in patients with SIADH?
Plasma volume increases.
Plasma osmolarity decreases.
Urine sodium levels rise
Specific gravity is elevated to reflect increased urine concentration.
261
A life threatening even in which the need for cortisol and aldosterone is greater than the available supply is known as?
Addisonian Crisis
262
Why does a patient need to report any post nasal drip or increased swallowing after a hypophysectomy?
Because it could indicate leakage of CSF.
263
When is Grave's disease most often diagnosed?
In women between 20 and 40 years of age.
264
What thyroid related issue can lead to shock, organ damage, and death?
Myxedema coma
265
Emergency care of the patient during thyroid storm:
| What type of blanket can be given to promote comfort?
A cooling blanket.
266
Expected cortisol levels for the patient with Addison's will be...
Decreased
267
Besides the key manifestations, what are the other manifestations associated with thyroid storm?
```
Abdominal pain
Nausea
Vomiting
Diarrhea
Anxious
Tremors
Restlessness
Confused
Psychotic
Seizures
Coma
```
268
What happens to serum parathyroid hormone in hyperparathyroidism?
It increases
269
What is the appropriate way for a patient taking corticosteroids for more than a week to stop in order to avoid Cushing's?
To avoid abrupt discontinuation and to gradually taper down under supervision of the health care provider.
270
What can happen to the patient with SIADH whose sodium level is less than 120 mEq/L?
Neurological changes can occur and the risk for seizures increase as a result of osmotic fluid shifts into brain tissue.
271
What is the result of insufficient adrenocorticoid steroids?
The loss of aldosterone and cortisol.
272
What manifestations are associated with SIADH specifically related to hyponatremia?
```
Lethargy
Headache
Hostility
Disorientation
Change in LOC
Decreased responsiveness
Seizures
Coma
Decreased deep tendon reflexes
```
273
How often does the nurse monitor the amount of fluid infused for the with patient with diabetes insipidus?
Hourly. The patency of the access catheter is also checked.
274
How is acute or severe hypocalcemia treated?
IV calcium is given as a 10% solution of calcium chloride or calcium gluconate over 10-15 minutes.
275
What are the neuromuscular manifestations associated with adrenal insufficiency?
Muscle weakness
Fatigue
Joint/muscle pain
276
What drugs are used to treat hyperparathyroidism?
Cinacalcet
| Calcitonin
277
Cortisol replacement therapy:
| How is a hydrocortisone injection given?
IM-- so it is important to teach the patient how to self administer.
278
Emergency care of the patient during thyroid storm:
| How often do you monitor vital signs
Every 30 minutes.
279
The excess secretion of cortisol from the adrenal cortex is known as?
Cushing's disease.
280
Expected sodium levels for the patient with Cushing's will be...
Increased
281
How do you treat severe hyperkalemia?
Give IV insulin with glucose.
282
How is the patient with pheochromocytoma blood pressure stabilized?
With adrenergic blocking agents like phenoxybenzamine.
283
What are the nursing interventions associated with hydrocortisone?
Instruct the patient to report the following symptoms:
Rapid weight gain
Round face
Fluid retention
Because these symptoms indicate Cushing's syndrome and the dose needs to be corrected
284
What types of food should be avoided in the patient with pheochromocytoma?
Foods that are high in tyramine like aged cheese or red wine.
285
What can occur to the patient with diabetes insipidus who has a poor thirst mechanism or if they are unable to obtain water?
Dehydration becomes severe and can lead to death.
286
What are the skin manifestations of hypothyroidism?
Cool, pale or yellowish, dry, course, scaly skin
Thick, brittle nails
Dry, course brittle hair
Decreased hair growth with loss of eyebrow hair
287
What causes adrenal gland hypofunction?
Inadequate secretion of ACTH
Dysfunction of the hypothalamic-pituitary control mechanism
Direct dysfunction of adrenal gland tissue
288
Sick Day Rules:
| How often should blood glucose levels be checked?
Every four hours.
289
What are the nonsurgical treatments of hypoparathyroidism?
Correcting hypocalcemia, vitamin d deficiency, and hypomagnesemia.
290
When does a patient with diabetes insipidus need to call 911 or go to the emergency room?
When they gain 2.2 kg (or 1 lb) or show other signs of water toxicity like persistent headache or acute confusion.
291
What are the pulmonary manifestations of hypothyroidism?
Hypoventilation
Pleural effusion
Dyspnea
292
What happens to serum phosphorus in hypoparathyroidism?
It increases
293
Basic CO2
Greater than 45
