w4 notes

Question 1

ADH patho:

Patho
1. When there is an ___crease in plasma osmolality or ___crease in blood volume
2. ADH is released from _________ (AND thirst is increased)
3. ______ is excreted within the body (AND the body’s thirst mechanism prompts them to consume fluids)
4. the kidneys _______ the fluid so the water is retained within the body
- retaining pure water = ___crease in plasma volume and ___crease in plasma osmolality
5. the blood volume ___creases, and when normal blood _________ is achieved = ADH release is stopped (AND thirst mechanism stops)

(this is another example of ________ feedback cycle)

Answer 1

Patho
1. When there is an increase in plasma osmolality (concentrated blood) or decrease in blood volume (concentrated blood)
2. ADH is released from posterior pituitary (AND thirst is increased)
3. water is excreted within the body (AND the body’s thirst mechanism prompts them to consume fluids)
4. the kidneys reabsorb the fluid so the water is retained within the body
- retaining pure water = increase in plasma volume and decrease in plasma osmolality (blood concentration)
5. the blood volume increases, when normal blood osmolality is achieved = ADH release is stopped (AND thirst mechanism stops)
(this is another example of negative feedback cycle)

Question 2

hyperthyroidism = overactive thyroid

TSH =
T4 =
T3 =

Caused by
- ______________ – most common, autoimmune
- toxic multi-_________ goiter

Answer 2

hyperthyroidism
overactive thyroid

TSH low
T4 low
T3 high

Caused by
- grave’s disease – most common, autoimmune
- toxic multi-nodular goiter

Question 3

Teaching DM pt: what to do when sick
- notify provider when you are _____
- monitor BS more frequently
- keep taking meds
- prevent dehydration
- meet __________ needs – food, Gatorade, Pedialyte
- rest
- call provider when:
- ______ in urine
- BS >250
- Fever >101.5 and not _______
- Feeling confused, ______ breathing
- Persistent n/v/d
- Cant tolerate liquids
- Illness lasting longer than ___ days

Answer 3

Teaching DM pt: what to do when sick
- notify provider when you are sick
- monitor BS more frequently
- keep taking meds
- prevent dehydration
- meet carbohydrate needs – food, Gatorade, Pedialyte
- rest
- call provider when:
- ketones in urine
- BS >250
- Fever >101.5 and not responding to Tylenol
- Feeling confused, rapid breathing
- Persistent n/v/d
- Cant tolerate liquids
- Illness lasting longer than 2 days

Question 4

Adrenal (cortex):
- responds to _______
- regulates ____
- adrenal gland sits on _______
- Adrenal ________ – 3 S’s
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- Adrenal ________
- Epinephrine
- Norepinephrine

Answer 4

Adrenal (cortex) Disorders
- responds to stress
- regulates Na
- adrenal gland sits on kidney
- Adrenal cortex (covers) – 3 S’s
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- Adrenal medulla (middle)
- Epinephrine
- Norepinephrine

Question 5

Major regulator of water supply in body
(2)

Answer 5

• ADH
• thirst mechanism

Question 6

Pituitary studies: _________ test
- used to differentiate the cause/the why behind diabetes insipidus
- Neurogenic – head trauma
- Nephrogenic – kidney issue
- Psychogenic – psychological issue
how does it work?
- stimulates ______ by administering ______
- monitor urine output, specific gravity, and serum osmolality every 1-2 hours during test (reaction to ADH)

Answer 6

Pituitary studies: water deprivation test
- used to differentiate the cause/the why behind diabetes insipidus
- Neurogenic – head trauma
- Nephrogenic – kidney issue
- Psychogenic – psychological issue
- stimulates ADH by administering ADH/vasopressin
- monitor urine output, specific gravity, and serum osmolality every 1-2 hours during test (reaction to ADH)

Question 7

Hyp____glycemia
- sweating
- blurry vision
- dizzy
- anxiety
- hunger
- irritability
- shakiness
- tachycardia
-h/a
- weakness, fatigue

Hyp___glycemia
s/s – weak, fatigue, blurry vision, h/a, n/v/d

Answer 7

hypo BS < 70

hyper

Question 8

cushings syndrome/disease treatment:
- depends on cause
- If ________ tumor = adrenalectomy
- If ectopic ACTH-secreting tumor = removal of _______
- Drug therapy to suppress ______
- If prolonged ________ = gradual d/c of drugs, reduction of dose, conversion of alternate-day regimen

teaching diet – ___creased protein and potassium, ___creased calories and sodium

Answer 8

cushings syndrome/disease treatment:
- depends on cause
- If adrenal tumor = adrenalectomy
- If ectopic ACTH-secreting tumor = removal of tumor
- Drug therapy to suppress cortisol
- If prolonged steroids = gradual d/c of drugs, reduction of dose, conversion of alternate-day regimen

teaching diet – increased protein and potassium, decreased calories and sodium

Question 9

addisons Treatment
- hormone replacement therapy
- Hydrocortisone (daily) – exogenous ________
- 2/3 dose AM/PM?
- 1/3 dose AM/PM?
- Fludrocortisone (daily) – exogenous ________
- Salt additives for heat/humidity
- ___creased doses when stress
- Frequent vs
- stress free environment – low noise, light, temp

Answer 9

Treatment
- hormone replacement therapy
- Hydrocortisone (daily) – exogenous cortisol
- 2/3 dose AM – naturally higher cortisol in body upon wakening
- 1/3 dose PM
- Fludrocortisone (daily) – exogenous aldosterone
- Salt additives for heat/humidity
- Increased doses when stress
- Frequent vs
- stress free environment – low noise, light, temp

Question 10

Cushing’s disease/syndrome = too much 3 S’s/cortisol
- Glucocorticoids - _______ (steroids)
- Mineralocorticoids – _________ (salt)
- Sex steroids – testosterone (sex)

(syndrome = collection of _____)

Common cause
- PO systemic __________

Answer 10

Cushing’s disease/syndrome
too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)

(syndrome = collection of s/s)

Common cause
- PO systemic steroids long term

Question 11

DI
s/s
- 3 P’s?
- high or low urine specific gravity?
- high or low urine osmolality?
- high or low serum osmolality?
- hyp___natremia
- fatigue from nocturia
- weakness from Na imbalance

Answer 11

s/s
- Polydipsia (r/t high serum osmolality)
- polyuria – 5-20 L/day
- (not polyphagia)
- Urine low specific gravity (not concentrated, diluted urine)
- low urine osmolality (not concentrated urine b/c it is very diluted with fluid that the kidneys are excreting)
- high serum osmolality (concentrated blood b/c there is no water in the body, the kidneys are excreting everything)
- hypernatremia (pure water loss in kidney, sodium is concentrated)
- fatigue from nocturia
- weakness from Na imbalance

Question 12

Hypoglycemia Treatment
- check BS
- rule of 15
- conscious and able to swallow:
- 15g simple carbs – ______ or ______, avoid ______
- unconscious/unable to swallow:
- IM ______
- IV ______
- check BS again in 15 mins
- if > 70 = eat regular meal
- if < 70 = repeat rule of 15 until > 70

Answer 12

Hypoglycemia Treatment
- check BS
- rule of 15
- conscious and able to swallow:
- 15g simple carbs – 4 oz juice or regular soda, avoid sugars w/ fat like candy bar b/c delayed absorption
- unconscious/unable to swallow:
- IM glucagon
- IV D50
- check BS again in 15 mins
- if > 70 = eat regular meal
- if < 70 = repeat rule of 15 until > 70

Question 13

Insulin deficit and F/E balance
1. increased serum glucose levels
2. __creased plasma oncotic pressure
3. fluid shifts ______ cells and _______ intravascular (to fix the pressure/concentration issue)
4. cells swell or shrink ?

Answer 13

Insulin deficit and F/E balance
1. increased serum glucose levels
2. increased plasma oncotic pressure (r/t balance/concentration of blood sugar in blood vessels)
3. fluid shifts out of cells and into intravascular (to fix the pressure/concentration issue)
4. intracellular dehydration, cells are dehydrated and shrink

Question 14

TSH low
T4 low
T3 high

TSH high
T4 low
T3 low

Answer 14

hyper

hypo

Question 15

hypothyroidism = underactive thyroid

TSH ____
T4 _____
T3 _____

Caused by
(1)

Answer 15

hypothyroidism
underactive thyroid

TSH high
T4 low
T3 low

Caused by
- Hashimoto’s thyroiditis

Question 16

T___ s/s
- younger people – most common
- abrupt
- not common in DM cases
- no endogenous insulin production – must have insulin replacement
- 3 p’s = excessive thirst (polydipsia), excessive hunger (polyphagia), excessive urination (polyuria)
- Weight loss
- fatigue
- weakness
- recurrent infections
- prolonged wound healing
- pruritis
- vision changes
- paresthesia
- CV symptoms

T___ s/s
- adults with risk factors
- can be undx for years b/c s/s not as evident
- insulin resistant – PO/SQ meds, maybe insulin replacement
- fatigue
- increased thirst and urination
- recurrent infections and slow wound healing
- vision changes
- pruritus (itching)
- symptoms of neuropathy like paresthesias or weakness
- overweight w/ unexpected weight loss

Answer 16

T1 s/s
- younger people – most common
- abrupt
- not common in DM cases
- no endogenous insulin production – must have insulin replacement
- 3 p’s = excessive thirst (polydipsia), excessive hunger (polyphagia), excessive urination (polyuria)
- Weight loss
- fatigue
- weakness
- recurrent infections
- prolonged wound healing
- pruritis
- vision changes
- paresthesia
- CV symptoms

T2 s/s
- adults with risk factors
- can be undx for years b/c s/s not as evident
- insulin resistant – PO/SQ meds, maybe insulin replacement
- fatigue
- increased thirst and urination
- recurrent infections and slow wound healing
- vision changes
- pruritus (itching)
- symptoms of neuropathy like paresthesias or weakness
- overweight w/ unexpected weight loss

Question 17

Pharmacotherapy for SIADH or DI?
- Desmopressin/DDAVP

Answer 17

DI
Desmopressin/DDAVP is a synthetic form of vasopressin/ADH for replacement (DI has a lack of ADH)

Question 18

Goiter = ________

can be caused by
- hyperthyroid (toxic)
- hypothyroid
- thyroiditis
- benign thyroid nodules
- malignancy
- _______ deficiency

1. iodine is necessary for synthesis of _______
2. only the thyroid gland can uptake _______
3. most iodine needs are met through _____
4. (4)
5. iodine deficiency is an issue in ______, and not an issue in _____

Toxic goiter – goiter with hyp___thyroidism

________ goiter – goiter with normal thyroid levels, d/t autoimmune problems

Answer 18

Goiter
Enlarged thyroid gland

can be caused by
- hyperthyroid (toxic)
- hypothyroid
- thyroiditis
- benign thyroid nodules
- malignancy
- iodine deficiency

1. iodine is necessary for synthesis of thyroid hormones,
2. only the thyroid gland can uptake iodine,
3. most iodine is consumed through diet
4. (yogurt, milk, eggs, and iodinized salt),
5. issue in some parts of the world, not an issue in US

Toxic goiter – goiter with hyperthyroidism

Non-toxic goiter – goiter with normal thyroid levels, d/t autoimmune problems

Question 19

Pancreatic disorders
diabetes mellitus

T___
- autoimmune
- immune system attacks and destroys insulin producing beta cells in the pancreas
- without beta cells body can’t make insulin = hyperglycemia

T____
- body’s cells wear out and become resistant to the effects of insulin = hyperglycemia

Answer 19

T1
T2

Question 20

1. A hypertonic solution/medium has a _______ osmolality/concentration of solutes compared to normal body fluids or cells.
2. A hypotonic solution/medium has a ________ osmolality/concentration of solutes compared to normal body fluids or cells.
3. When a hypertonic solution is administered IV, it causes water to move ______ the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
4. When a hypotonic solution is administered IV, it causes water to move ______ the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
5. Hypertonic solutions are useful in treating conditions like hyp___natremia
6. Hypotonic solutions are useful in treating conditions like hyp___natremia

Answer 20

A hypertonic solution/medium has a higher osmolality/concentration of solutes compared to normal body fluids or cells.

A hypotonic solution/medium has a lower osmolality/concentration of solutes compared to normal body fluids or cells.

3. When a hypertonic solution is administered IV, it causes water to move out of the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
4. When a hypotonic solution is administered IV, it causes water to move into the cells by osmosis to equalize the osmolality between the intracellular and extracellular compartments.
5. Hypertonic solutions are useful in treating conditions like hyponatremia
6. Hypotonic solutions are useful in treating conditions like hypernatremia

Question 21

ADH
Regulator of __________
- loss of pure water r/t ADH will not effect _________
Increase in ADH = ___crease in water retention
___crease in blood volume
___crease in BP

Answer 21

Regulator of pure water supply
- loss of pure water r/t ADH will not effect POTASSIUM
(will not cause hypokalemia)
Increase in ADH = Increase in water retention
Increase in blood volume
Increase in BP

Question 22

hyperthyroidism s/s:
- ___creased HR
- 4 heart things?
- __creased RR
- breathing?
- ___creased appetite and thirst
- weight _____
- __creased peristalsis
- diarrhea or constipation?
- memory lapses, short attention span
- warm/cold?, dry/moist?, smooth skin
- hair amount?
- ________ erythema
- hair texture?
- diaphoresis
- hyper or depigmentation of skin
- goiter?
- bruit over ________
- _________ - abnormal protrusion/bulging of the eyeballs from the eye sockets

Answer 22

metabolism is turned up
- increased HR, murmurs, dysrhythmias, palpitations, angina
- increased RR,
- DOE
- increased appetite and thirst
- weight loss
- increased peristalsis,
- diarrhea
- memory lapses, short attention span
- warm, moist, smooth skin
- hair loss
- palmar erythema (red palm)
- fine silky hair
- diaphoresis
- vitiligo (autoimmune, depigmentation of skin)
- goiter
- bruit over thyroid gland – d/t increased vascularity
- exophthalmos - abnormal protrusion/bulging of the eyeballs from the eye sockets

Question 23

ADH disorders:
________ = too much ADH (holding onto water)
_______ = not enough ADH (losing water like crazy)

Adrenal cortex disorders:
__________ = not enough 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
__________ = too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)

Adrenal medulla disorders:
___________ = too much epinephrine and norepinephrine

Thyroid disorders:
_________(_______) = overactive thyroid
__________(______) = underactive thyroid

Pancreatic disorders:
___________ = hyperglycemia due to the body’s inability to produce or effectively use the hormone insulin

Answer 23

ADH disorders:
- SIADH (syndrome of inappropriate ADH) = too much ADH (holding onto water)
- diabetes insipidus) = not enough ADH (losing water like crazy)

Adrenal cortex disorders:
- addisons disease = not enough 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)
- cushing disease/syndrome = too much 3 S’s/cortisol
- Glucocorticoids - Cortisol (steroids)
- Mineralocorticoids – aldosterone (salt)
- Sex steroids – testosterone (sex)

Adrenal medulla disorders:
- pheochromocytoma = too much epinephrine and norepinephrine

Thyroid disorders:
- hyperthyroidism (grave’s disease) = overactive thyroid
- hypothyroidism (Hashimoto’s thyroiditis) = underactive thyroid

Pancreatic disorders:
- diabetes mellitus = hyperglycemia due to the body’s inability to produce or effectively use the hormone insulin

Question 24

Negative feedback cycle and the thyroid gland:

hyperthyroidism = T3/T4 will be ______ and TSH will be _______

Answer 24

Negative feedback cycle and the thyroid gland:
- hyperthyroidism = T3/T4 will be high and TSH will be low

Question 25

hyperthyroidism treatment: surgical therapy endoscopic vs subtotal? 1. _________ thyroidectomy - Removal of a _________ of the thyroid gland - If too much is taken = __________ - Indications – not responsive to ________ therapy, very large ______, possibility of _________ 2. __________ thyroidectomy – less invasive, used for __________ Post op interventions: - Assess for s/s _________ - Assess for ______ compression - would these signs be concerning? Irregular breathing, neck swelling, frequent swallowing, choking, blood on dressing, sensations of fullness at incision site - Place in _________ with head on pillow - Avoid flexion or any tension on ________ - Monitor vs - parathyroid close to thyroid - Monitor serum ________ levels, tetany, “AMB?”, tingling in toes/fingers/mouth, muscular twitching, apprehension, trousseaus sign and chvosteks sign

Answer 25

1. Subtotal thyroidectomy - Removal of a large portion of the thyroid gland - If too much is taken = hypothyroidism - Indications – not responsive to anti-thyroid therapy, very large goiter, possibility of malignancy 2. Endoscopic thyroidectomy – less invasive, used for small nodules Post op interventions: - Assess for s/s hemorrhage (thyroid very vascular) - Assess for tracheal compression (thyroid close to airway) - Irregular breathing, neck swelling, frequent swallowing, choking, blood on dressing, sensations of fullness at incision site - Place in semi fowlers with head on pillow - Avoid flexion or any tension on suture lines - Monitor vs - parathyroid close to thyroid - Monitor serum calcium levels, tetany, “AMB?”, tingling in toes/fingers/mouth, muscular twitching, apprehension, trousseaus sign and chvosteks sign

Question 26

hyperthyroid Treatment: drug therapy 1. anti-thyroid meds = _________ - improvements in 1-2 weeks, good results 4-8 weeks 2. _______ therapy = SSKI and Lugol’s solution - used to prep pt for __________ - when given in _____, _______ doses - inhibits synthesis of T3 and T4, lowers the vascularity of the thyroid gland, makes surgery easier and safer 3. beta blockers - used for s/s relief of ________ 4. radioactive iodine therapy – 1st line for non-pregnant adults - route? - require hospitalization? - The radioiodine is rapidly incorporated into the thyroid and its beta emissions result in extensive local tissue damage - ________ is radio active for a period of time - Delayed response – _______ of thyroid function over a period of 6-18 weeks - Anti-thyroid drugs and ______ given together to help s/s management - Radioactivity is gone within______ days - Radioactivity precautions – minimize ________ for 2-3 days, __________ toilet, separately _______ clothes

Answer 26

Treatment - drug therapy - anti-thyroid meds = methimazole - improvements in 1-2 weeks, good results 4-8 weeks - idodine therapy = SSKI and Lugol’s solution - used to prep pt for thyroidectomy - when given in rapid large doses - inhibits synthesis of T3 and T4, lowers the vascularity of the thyroid gland, makes surgery easier and safer - beta blockers - used for s/s relief of thyrotoxicosis - radioactive iodine therapy – 1st line for non-pregnant adults - PO solution/capsule - Doesn’t require hospitalization - The radioiodine is rapidly incorporated into the thyroid and its beta emissions result in extensive local tissue damage - Excretions are radio active for a period of time - Delayed response – ablation of thyroid function over a period of 6-18 weeks - Anti-thyroid drugs and beta blockers given together to help s/s management - Radioactivity is gone within a few days - Radioactivity precautions – minimize direct contact for 2-3 days, double flush toilet, separately launder clothes and towels

Question 27

ADH disorders: which one are you holding onto water? which one are you losing water like crazy?

Answer 27

ADH disorders: - SIADH (syndrome of inappropriate ADH) = too much ADH (holding onto water) - diabetes insipidus) = not enough ADH (losing water like crazy)

Question 28

SIADH Patho 1. ___creased ADH 2. ___creased water reabsorption in kidneys 3. ___creased intravascular fluid volume 4. dilutional hyp___natremia and ___creased serum osmolality

Answer 28

Patho 1. increased ADH 2. increased water reabsorption in kidneys 3. increased intravascular fluid volume 4. dilutional hyponatremia and decreased serum osmolality

Question 29

- parathyroid gland (buried in the _______ gland) Parathyroid regulates (2) If the parathyroid is removed = hyp___calcemia = check for what?

Answer 29

- parathyroid gland (buried in the thyroid gland) Parathyroid regulates - calcium - phosphorus If the parathyroid is removed = hypocalcemia = treuseaus and chovsteks signs

Question 30

Negative feedback cycle Example: 1. stress occurs 2. triggers release of ______ from hypothalamus 3. reaches target organ: _______ gland 4. releases _______ 5. reaches target organ: __________ 6. releases ________ 7. blood sugar _______ and body prepares for fight or flight in response to stress

Answer 30

Negative feedback cycle Example: 1. stress occurs 2. triggers release of CRF from hypothalamus 3. reaches target organ: pituitary gland 4. releases ACTH 5. reaches adrenal cortex 6. releases cortisol 7. blood sugar rises and body prepares for fight or flight in response to stress

Question 31

Adrenal cortex dx tests: cortisol - evaluates status of adrenal cortex function - serum cortisol is affected by - __________ – higher in ______ - ________– higher when _______ - urine cortisol – 24 hour urine, excreted from urinary tract

Answer 31

Adrenal cortex dx tests: cortisol - evaluates status of adrenal cortex function - serum cortisol is affected by - Diurnal variation/circadian rhythm – higher in AM (body preparing for day) - Stress – higher when stressed - urine cortisol – 24 hour urine, excreted from urinary tract

Question 32

cushing syndrome/disease s/s r/t high cortisol: 1. ____creased glucose availability = glucose intolerance, hyperglycemia 2. impacts vascular system = hyp___tension, capillary _______ leads to ________ 3. _______ breakdown = muscle wasting, muscle weakness, thinning of skin, osteoporosis, bone pain 4. fat breakdown = redistribution of fat to _______, _______, and _______ 5. suppression of _______ and _________ responses = impaired wound healing, impaired immune response, risk for infection 6. _____ excitability = mood swings, insomnia

Answer 32

cushing syndrome/disease s/s r/t high cortisol: 1- increased glucose availability = glucose intolerance, hyperglycemia 2- impacts vascular system = hypertension (fluid retention), capillary friability/fragile/rupture leads to bruising/ecchymosis 3- protein breakdown = muscle wasting, muscle weakness, thinning of skin, osteoporosis, bone pain 4- fat breakdown = redistribution of fat to abdomen, shoulders, and face 5- suppression of immune and inflammatory responses = impaired wound healing, impaired immune response, risk for infection 6- CNS excitability = mood swings, insomnia

Question 33

hypothryoid treatment: 1 - thyroid hormone replacement = ________ 2- monitor thyroid hormone levels and adjust dosage prn - T3 and T4 ______ - TSH _______ = when defect is in thyroid - TSH______ = when defect is in pituitary or hypothalamus - presence of antibodies indicates its ______ 3 - nutrition to promote weight _____

Answer 33

- thyroid hormone replacement = levothyroxine - monitor thyroid hormone levels and adjust dosage prn - T3 and T4 low - TSH high = when defect is in thyroid - TSH low = when defect is in pituitary or hypothalamus - presence of antibodies indicates its autoimmune - nutrition to promote weight loss

Question 34

thyroid is regulated by _______ (which comes from anterior pituitary) thyroid secretes: (3) 1. most abundant 2. together with PTH regulates calcium balance 3. most potent

Answer 34

thyroid is regulated by TSH (which comes from anterior pituitary) thyroid secretes: - thyroxine (T4) - triiodothyronine (T3) - calcitonin 1. T4 2. calcitonin 3. T3

Question 35

Thyroid labs and dx studies - blood studies: TSH (secreted from anterior pituitary, target organ is thyroid) - blood studies: T3 and T4 1. Most sensitive test used for evaluation of thyroid dysfunction? 2. - Used for evaluation of thyroid function and monitoring thyroid therapy?

Answer 35

TSH T3 and T4

Question 36

hyperthyroid vs hypothyroid treatment: 1. levothyroxine 2. idodine therapy = SSKI and Lugol’s solution 3. nutrition to promote weight loss 4. methimazole 5. beta blockers 6. radioactive iodine therapy 7. Subtotal thyroidectomy 8. Endoscopic thyroidectomy

Answer 36

1. hypo (replacement) 2. hyper 3. hypo 4. hyper (anti-thyroid meds ) 5. hyper used for s/s relief of thyrotoxicosis 6. hyper – 1st line for non-pregnant adults 7. hyper 8. hyper

Question 37

addisons disease: Early s/s - hunger? - weight gain or loss? - strength? - malaise - apathy - hyp___kalemia - skin hyp___pigmentation s/s r/t hypoaldosterone: (Think _______ and ______ problems) - hyp___tension - diminished vascular tone - reduced CO - inadequate circulating blood volume - _____ craving - Low serum Na levels - Dehydration s/s r/t hypocortisolism: (think lack of stress hormones = no ______) - hyp___glycemia - weakness and fatigue - unsuppressed ACTH production = hyp___pigmentation

Answer 37

Early s/s - anorexia - weight loss - weakness!! – r/t fluid and electrolyte imbalance - malaise, apathy - hyperkalemia (low aldosterone, low Na, high K+) - skin hyperpigmentation Hypoaldosterone s/s (Think Na and water retention problems) - hypotension - diminished vascular tone - reduced CO - inadequate circulating blood volume - salt craving - Low serum Na levels - Dehydration Hypocortisolism s/s (think lack of stress hormones = no energy) - hypoglycemia - weakness and fatigue - unsuppressed ACTH production = hyperpigmentation

Question 38

Addisons disease = not enough 3 S’s/cortisol 1. Glucocorticoids - Cortisol (_________one) 2. __________coids – aldosterone 3. Sex steroids – testosterone 4. primary stress hormone? 5. male hormone? 6. steroid hormone, causes Na and water retention, and increased BP?

Answer 38

1. Glucocorticoids - Cortisol (hydrocortisone) 2. Mineralocorticoids – aldosterone 3. Sex steroids – testosterone 4. primary stress hormone? Glucocorticoids - Cortisol (hydrocortisone) 5. male hormone? testosterone 6. steroid hormone, causes Na and water retention, and increased BP? Mineralocorticoids – aldosterone

Question 39

ADH disorders: - SIADH (syndrome of inappropriate ADH) = - DI (diabetes insipidus) = Adrenal cortex disorders: - addisons disease = - cushing disease/syndrome = Adrenal medulla disorders: - pheochromocytoma = Thyroid disorders: - hyperthyroidism (grave’s disease) = - hypothyroidism (Hashimoto’s thyroiditis) = Pancreatic disorders: - diabetes mellitus =

Answer 39

ADH disorders: - SIADH (syndrome of inappropriate ADH) = too much ADH (holding onto water) - diabetes insipidus) = not enough ADH (losing water like crazy) Adrenal cortex disorders: - addisons disease = not enough 3 S’s/cortisol - Glucocorticoids - Cortisol (steroids) - Mineralocorticoids – aldosterone (salt) - Sex steroids – testosterone (sex) - cushing disease/syndrome = too much 3 S’s/cortisol - Glucocorticoids - Cortisol (steroids) - Mineralocorticoids – aldosterone (salt) - Sex steroids – testosterone (sex) Adrenal medulla disorders: - pheochromocytoma = too much epinephrine and norepinephrine Thyroid disorders: - hyperthyroidism (grave’s disease) = overactive thyroid - hypothyroidism (Hashimoto’s thyroiditis) = underactive thyroid Pancreatic disorders: - diabetes mellitus = hyperglycemia due to the body's inability to produce or effectively use the hormone insulin

Question 40

addisons disease s/s - r/t low levels of _______ and ________ - depends on rate of onset and severity of symptoms - Slow/rapid? degenerative destruction = subtle onset of s/s - Slow/rapid? onset = severe, life threatening s/s

Answer 40

s/s - r/t low levels of cortisol and aldosterone - depends on rate of onset and severity of symptoms - Slow degenerative destruction = subtle onset of s/s - Rapid onset = severe, life threatening s/s

Question 41

Hormones that affect blood sugar - __crease = insulin - __crease = glucagon -__crease = epinephrine -__crease = glucocorticoids -__crease = growth hormone

Answer 41

Hormones that affect blood sugar - decrease = insulin - increase = glucagon - increase = epinephrine - increase = glucocorticoids - increase = growth hormone

Question 42

Adrenal cortex dx tests: Aldosterone (regulator of sodium) - used to assess for hyperaldosteronism - maintain assigned position for 2 hours - levels vary depending on ________ - high aldosterone = _____ NA retention, _____ water retention, ______ blood volume

Answer 42

Adrenal cortex dx tests: Aldosterone (regulator of sodium) - used to assess for hyperaldosteronism - maintain assigned position for 2 hours - levels vary depending on position - high aldosterone = high NA retention, high water retention, high blood volume

Question 43

s/s of ____________ - thin body hair - upper body/truncal obesity - moon face – round face - buffalo hump – neck of neck - hirsutism – hair growth in unexpected places - skin – fragile and thin - bruising – petechiae and ecchymosis - poor healing - striae – purple stretch marks on abdomen, thighs, butt, arms, breasts - mental depression or euphoria, lability (mood swings), irritability - glucose intolerance - HTN – 2ndary to cortisol’s salt retaining activity and increased blood volume - hypokalemia – high cortisol stimulates mineralcorticoid/aldosterone = increased Na and decreased K+ - bone demineralization – spontaneous fractures possible

Answer 43

cushings

Question 44

ACTH dx tests: ACTH tests (secreted by anterior pituitary, target organ is adrenal cortex) - evaluates how adrenal cortex function and how the body responds to ACTH - serum ACTH 1. ACTH stimulation/suppression test – synthetic ACTH given 2. ACTH stimulation/suppression test – dexamethasone given

Answer 44

- ACTH stimulation test – synthetic ACTH given - ACTH suppression test – dexamethasone given

Question 45

Cushings syndrome/disease s/s: - _____ body hair - ________ obesity (where?) - ______ face - _________– back of neck - _________ – hair growth in unexpected places - skin – _______ and ________ - bruising – _________ and _________ - _____ healing - ________ – purple stretch marks on abdomen, thighs, butt, arms, breasts - mental depression or ________, _______ility (mood swings), _______ility - glucose _________ - BP? - hyp___kalemia - bone ____________

Answer 45

s/s - thin body hair - upper body/truncal obesity - moon face – round face - buffalo hump – neck of neck - hirsutism – hair growth in unexpected places - skin – fragile and thin - bruising – petechiae and ecchymosis - poor healing - striae – purple stretch marks on abdomen, thighs, butt, arms, breasts - mental depression or euphoria, lability (mood swings), irritability - glucose intolerance - HTN – 2ndary to cortisol’s salt retaining activity and increased blood volume - hypokalemia – high cortisol stimulates mineralcorticoid/aldosterone = increased Na and decreased K+ - bone demineralization – spontaneous fractures possible

Question 46

Addisons disease: Drug therapy teaching hormone/3 S's replacement - critical - closely follow rx dosing schedule - never _______ stop therapy - replacement therapy is ______ long - when body is stressed = 3x3 rule = 3x _____ dose for 3 _____ - always have an emergency supply of meds - wear medic alert bracelet - carry emergency kit – hydrocortisone 100mg IM, syringes, instructions

Answer 46

- critical - closely follow rx dosing schedule - never abruptly stop therapy - replacement therapy is life long - when body is stressed = 3x3 rule = 3x normal dose for 3 days - always have an emergency supply of meds - wear medic alert bracelet - carry emergency kit – hydrocortisone 100mg IM, syringes, instructions

Question 47

addisons disease = hyp__kalemia (___ aldosterone, ___ Na, ___ K+) cushings = hyp__kalemia (___ aldosterone, ___ Na, ___ K+)

Answer 47

addisons disease = hyperkalemia (low aldosterone, low Na, high K+) think jfK = think hyperK+ cushings = hypokalemia (high aldosterone, high Na, low K+)

Question 48

Myxedema vs myxedema coma 1. Myxedema - changes seen in the skin and tissues, with prolonged hyp___thyroidism - swelling is hard/soft? and pitting/non-pitting? - permanent or can be reversed with thyroid hormones? 2. myxedema coma - sever hyp__thyroidism, with very ____ thyroid hormone levels - medical emergency - give IV thyroid hormones and steroids - AMS, may be unresponsive - caused by – HF, stroke, infections, not taking prescribed thyroid meds, - hypothyroidism complication

Answer 48

Myxedema – - changes seen in the skin and tissues, with prolonged hypothyroidism - swelling is hard and non-pitting - can be reversed with thyroid hormones myxedema coma – - sever hypothyroidism, with very low thyroid hormone levels - medical emergency - give IV thyroid hormones and steroids - AMS, may be unresponsive - caused by – HF, stroke, infections, not taking prescribed thyroid meds, - hypothyroidism complication

Question 49

Caused by - Hashimoto’s thyroiditis Caused by - grave’s disease – most common, autoimmune - toxic multi-nodular goiter

Answer 49

hypo hyper

Question 50

patho T1 DM 1. genetics, environment factors 2. autoantigens form on insulin producing ____ cells and circulate in the blood stream and lymphatics 3. activation of cellular immunity (macrophages and T cytotoxic cells) and humoral immunity (autoantibodies) toward beta cells 4. destruction of beta cells with decreased insulin secretion Patho T2 DM 1. insulin ________ on cells lose their glucose sensitivity 2. glucose can’t leave blood stream and go into cell

Answer 50

patho T1 DM 1. genetics, environment factors 2. autoantigens form on insulin producing beta cells and circulate in the blood stream and lymphatics 3. activation of cellular immunity (macrophages and T cytotoxic cells) and humoral immunity (autoantibodies) toward beta cells 4. destruction of beta cells with decreased insulin secretion Patho T2 DM 1. insulin receptors on cells lose their glucose sensitivity 2. glucose can’t leave blood stream and go into cell

Question 51

hypothyroidism s/s: - weight ? - depression - fatigue - slow mentation - slow speech - somnolence - low exercise tolerance - DOE - anemia - diarrhea or constipation? - warm skin or cold intolerance? - hair? - moist or dry skin? - goiter? - difficulty swallowing - myxedema

Answer 51

(think metabolism turned down) - weight gain - depression - fatigue - slow mentation - slow speech - somnolence - low exercise tolerance - DOW - anemia - constipation - cold intolerance - hair loss - dry skin - goiter - difficulty swallowing - myxedema

Question 52

hypothyroidism: Myxedema vs myxedema coma 1. __________ – - changes seen in the skin and tissues, with prolonged hypothyroidism - swelling is hard and non-pitting - can be reversed with thyroid hormones 2. ___________ – - sever hypothyroidism, with very low thyroid hormone levels - medical emergency - give IV thyroid hormones and steroids - AMS, may be unresponsive - caused by – HF, stroke, infections, not taking prescribed thyroid meds, - hypothyroidism complication

Answer 52

Myxedema myxedema coma

Question 53

________ studies: water deprivation test Adrenal studies: ________, _______, ACTH Adrenal _________ dx tests: cortisol Adrenal cortex dx tests: Aldosterone (regulator of _________) ACTH dx tests: ACTH tests ________ labs and dx studies: TSH, T3, T4, thyroid scan, ultrasound and radioactive iodine uptake ________ blood studies: fasting blood glucose, casual blood glucose, A1C, OGTT Pancreas _______ studies: ketones

Answer 53

Pituitary studies: water deprivation test (b/c this is an ADH test and ADH comes from posterior pituitary gland) Adrenal studies: cortisol, aldosterone, ACTH Adrenal cortex dx tests: cortisol Adrenal cortex dx tests: Aldosterone (regulator of sodium) ACTH dx tests: ACTH tests Thyroid labs and dx studies: TSH, T3, T4, thyroid scan, ultrasound and radioactive iodine uptake Pancreas: blood studies: fasting blood glucose, casual blood glucose, A1C, OGTT Pancreas: urine studies: ketones

Question 54

does ADH impact potassium? does aldosterone impact potassium?

Answer 54

No yes

Question 55

Desmopressin/DDAVP: - synthetic form of vasopressin/____ - very _____ doses - route – nasal spray, PO, IV, SQ - hormone therapy and fluid = cornerstone of treatment for ne____ogenic DI

Answer 55

Desmopressin/DDAVP: - synthetic form of vasopressin/ADH - very small doses - route – nasal spray, PO, IV, SQ - hormone therapy and fluid = cornerstone of treatment for neurogenic DI

Question 56

SIADH Care - restore normal fluid volume and osmolality/concentration of blood - mild s/s and mild hyponatremia (<125) = - 1000 ml/day fluid ________ - severe s/s and/or severe hyponatremia (<120) = - give ________ IV, admin rate? - 500 ml/day fluid ________ - drug therapy only in acute or chronic? - Diuretics - Demeclocycline (blocks ADH effects)

Answer 56

Care - restore normal fluid volume and osmolality/concentration of blood - mild s/s and mild hyponatremia (<125) = - 1000 ml/day fluid restriction - severe s/s and/or severe hyponatremia (<120) = - give 3-5% NS IV, admin SLOWLY, over hours to days - 500 ml/day fluid restriction - drug therapy only in chronic - Diuretics - Demeclocycline (blocks ADH effects)

Question 57

SIADH s/s - depends on hyponatremia severity (<____) and rate of onset - muscle ________ -breathing? - fatigue? - neurologic – (3) - GI – (2) taste, eating

Answer 57

s/s - depends on hyponatremia severity (<100) and rate of onset - muscle cramping -dyspnea - fatigue - neurologic – dulled senses, confusion, lethargy - GI – impaired taste, anorexia

Question 58

Nursing care: pre-diabetic patient T/F 1- high risk of developing T1 2- may be no s/s, but damage is occuring 3- teach lifestyle modifications 4- encourage blood glucose and A1C monitoring 5- teach monitor for s/s of T2 DM Nursing care: DM - ______ meds started at low dose and increased gradually based on A1C and fasting glucose levels - hold _______ before procedures - ___crease insulin when patients are sick – steroids, stress will cause the glucose to ____ - b_____ – scheduled time, long acting - b_____ - correction SSI, short/rapid acting

Answer 58

1 F - T2 2 - T 3 - T 4 T 5 T Nursing care: DM - oral meds started at low dose and increased gradually based on A1C and fasting glucose levels - hold metformin before procedures - increase insulin when patients are sick – steroids, stress will cause the glucose to rise - basal – scheduled time, long acting - bolus - correction SSI, short/rapid acting

Question 59

addisons disease Complications: Addisonian crisis s/s - Sudden _______ _______ in lower back, abdomen, legs - Severe ______ and ________ - hydration? - BP? - LOC? treatment 1. IV ________sone, s______, and d________ 2. When the pt can take fluids and meds PO = ___________sone dose is decreased until a maintenance dose is achieved 3. If ________one is low = maintenance therapy includes fludrocortisone acetate if untreated can be ______

Answer 59

- s/s - Sudden penetrating pain in lower back, abdomen, legs - Severe vomiting and diarrhea - Dehydration - Low BP - Loss of consciousness - treatment - IV hydrocortisone, saline, and dextrose - When the pt can take fluids and meds PO = hydrocortisone dose is decreased until a maintenance dose is achieved - If aldosterone is low = maintenance therapy includes fludrocortisone acetate - if untreated can be fatal

Question 60

Adrenal (medulla) disorders: pheochromocytoma = ________ epinephrine and norepinephrine dx - elevated 24 hour urine and plasma - often missed initially bc very rarely is _____ caused by pheochromocytoma s/s monitor for intractable (can’t be controlled) _____ and P – H – E –

Answer 60

Adrenal (medulla) disorders pheochromocytoma = too much epinephrine and norepinephrine dx - elevated 24 hour urine and plasma - often missed initially bc very rarely is HTN caused by pheochromocytoma s/s monitor for intractable (can’t be controlled) HTN and P – palpitations!! H – h/a!! E – episodic sweating (diaphoresis)!!

Question 61

DI = Not enough ADH - __________ = head trauma (ADH issue) - Usually more/less abrupt onset - more/less severe s/s - Self-limitng - ___________ = (kidney issue) there is enough ADH but kidney doesn’t respond to ADH - more/less abrupt onset - more/less severe s/s Most common cause of drug induced nephrogenic DI (1)

Answer 61

Diabetes insipidus (DI) Not enough ADH - neurogenic = head trauma (ADH issue) - Usually more abrupt onset - Most severe s/s - Self-limitng - nephrogenic = (kidney issue) there is enough ADH but kidney doesn’t respond to ADH - Less abrupt onset - Less severe s/s Most common cause of drug induced nephrogenic DI - lithium

Question 62

Thyroid labs and dx studies: - thyroid ultrasound - thyroid scan - Used to evaluate ________ in the thyroid - Radioactive isotope given PO or IV - Scanner passes over thyroid - ______ modules = warm spot (uptake isotope) - ______ tumors = cold spot (did not uptake) - reaction to iodine is rare, minimally used, encourage fluids after to flush kidneys - radioactive iodine uptake - evaluates___________ in the thyroid - provides direct measure of thyroid activity - Radioactive isotope given PO or IV - Uptake is measured at several intervals- 2-4 hours, 24 hours - Values expressed in % 1. which one gives more info?

Answer 62

- thyroid ultrasound - thyroid scan - Used to evaluate nodules in the thyroid - Radioactive isotope given PO or IV - Scanner passes over thyroid - benign modules = warm spot (uptake isotope) - malignant tumors = cold spot (did not uptake) - reaction to iodine is rare, minimally used, encourage fluids after to flush kidneys - radioactive iodine uptake - evaluates function of nodules in the thyroid, gives more info than just a thyroid scan - provides direct measure of thyroid activity - Radioactive isotope given PO or IV - Uptake is measured at several intervals- 2-4 hours, 24 hours - Values expressed in % 1. radioactive iodine uptake

Question 63

Hyperglycemia 1. caused by illness, infection, self management, stress 2. s/s – weak, fatigue, blurry vision, h/a, n/v/d 3. treatment – check urine ketones, insulin, drink fluids, education 4. complications - _________ – damage to retina r/t chronic hyperglycemia - ________– damage to small blood vessels in the kidneys r/t chronic hyperglycemia - ________– nerve damage due to metabolic imbalances r/t chronic hyperglycemia

Answer 63

Hyperglycemia - caused by illness, infection, self management, stress - s/s – weak, fatigue, blurry vision, h/a, n/v/d - treatment – check urine ketones, insulin, drink fluids, education - complications - Retinopathy – damage to retina r/t chronic hyperglycemia - Nephropathy – damage to small blood vessels in the kidneys r/t chronic hyperglycemia - Neuropathy – nerve damage due to metabolic imbalances r/t chronic hyperglycemia

Question 64

DI patho 1. ___creased ADH 2. __creased water reabsorption in kidneys 3. __creased intravascular fluid volume 4. __creased serum osmolality and excessive, very diluted _______

Answer 64

DI Patho 1. decreased ADH 2. decreased water reabsorption in kidneys 3. decreased intravascular fluid volume 4. increased serum osmolality (hypernatremia) and excessive (very diluted) urine output

Question 65

________ - lispro, aspart, glulisine ________ - regular _________ - NPH ________ - glargine, detemir, degludec

Answer 65

Rapid Short Intermediate Long

Question 66

DM diet - _____ fiber, _____ fat, _____ cholesterol 1- carbs – grains, fruit, legumes, milk ? 2- carbs - pasta, bread ? 3- fats – whats good? 4- ______ – beans veg, oats, whole grain 5- ______ – meats, egg, fish, nuts, beans 6- alcohol – ?

Answer 66

1 good 2 - limit simple carbs like pasta, bread 3 fish 4 fiber 5 protein 6 limit intake

Question 67

addisons disease Complications: _________ - Acute adrenal ________ - medical emergency causes – sudden insufficiency of serum __________ - Sudden ____ of gland - Sudden ___crease in stress in chronic condition - Sudden _______ of corticosteroid drug therapy

Answer 67

addisons disease Complications: Addisonian crisis - Acute adrenal insufficiency - medical emergency causes – sudden insufficiency of serum corticosteroids - Sudden loss of gland - Sudden increase in stress in chronic condition - Sudden cessation of corticosteroid drug therapy

Question 68

hyperthyroidism complications: thyroid storm/acute thyrotoxicosis/thyrotoxic crisis T/F 1- acute and severe 2- rare 3- death is common 4- caused by stressors – infection, trauma, surgery - in pt with hyperthyroidism 5- pts having thyroidectomy are not at any higher risks 6- s/s same as hypothyroidism, more severe

Answer 68

1 T 2 T 3 F - death is rare when treatment is early 4 T 5 F - pts having thyroidectomy are at risk – d/t manipulation of the hyperactive thyroid 6 F - s/s same as hypERthyroidism, more severe

Question 69

hypo vs hyper thyroidism or both 1 - weight gain 2 - increased HR 3 murmurs, 4- depression 5- fatigue 6 angina 7- slow mentation 8 dysrhythmias 9 palpitations 10 - slow speech 11- somnolence 12- low exercise tolerance 13 increased RR 14- DOE 15- anemia 16 - increased appetite and thirst 17- constipation 18 - weight loss 19 - increased peristalsis, diarrhea 20- cold intolerance 21- hair loss 22- dry skin 23 - memory lapses, short attention span 24 - warm, moist, smooth skin 25- goiter 26 - palmar erythema (red palm) 27- difficulty swallowing 28 - fine silky hair 29 - diaphoresis 30- myxedema 31 - vitiligo (autoimmune, depigmentation of skin) 32 - bruit over thyroid gland – d/t increased vascularity 33 - exophthalmos - abnormal protrusion/bulging of the eyeballs from the eye sockets

Answer 69

1 hypo 2 hyper 3 hyper 4 hypo 5 hypo 6 hyper 7 hypo 8 hyper 9 hyper 10 hypo 11 hypo 12 hypo 13 hyper 14 both 15 hypo 16 hyper 17 hypo 18 hyper 19 hyper 20 hypo 21both 22 hypo 23 hyper 24 hyper 25 both 26 hyper 27 hypo 28 hyper 29 hyper 30 hypo 31 hyper 32 hyper 33 hyper

Question 70

Sodium = 80% of body’s osmolality - if pt is hypernatremic = cells _______ - if pt is hyponatremic = cells _______ (with both, patient is ________)

Answer 70

Sodium = 80% of body’s osmolality - hypernatremic cells shrink - hyponatremic cells swell (with both, patient is confused)

Question 71

Thyroid disorders: Think thyroid, think ________ Thyroid secretes TSH = thyroid stimulating hormone T4 (thyroxine) T3 (tri-iodothyronine) 1. active hormone, activates and energizes all cells of the body? 2. shut off valve? 3. inactive hormone?

Answer 71

1. T3 2. TSH 3. T4

Question 72

_______ = Too much ADH causes: - excess water ________ - _____ serum sodium levels (dilutional or true?) - cells _______ as fluid shifts into intracellular spaces Most common cause (1)

Answer 72

SIADH = Too much ADH - causes excess water reabsorption - and dilutional low serum sodium levels - cells swell as fluid shifts into intracellular spaces Most common cause - ectopic hormone production from lung cancer cells (paraneoplastic disorder) HOLDING ONTO WATER

Question 73

- Oxytocin - secreted by _______ target organ - _________ - ADH/antidiuretic hormone - secreted by ________ target organ - _______ - TSH - secreted by ________ target organ - ________ - ACTH - secreted by _______ target organ - _________

Answer 73

- Oxytocin - secreted by Posterior pituitary gland (master gland) target organ - (uterus, mammary) - ADH/antidiuretic hormone - secreted by Posterior pituitary gland (master gland) target organ - (kidneys) - TSH - secreted by Anterior pituitary gland (master gland) target organ - (thyroid) - ACTH - secreted by Anterior pituitary gland (master gland) target organ - (adrenal cortex)

Question 74

___________ studies: cortisol, aldosterone, ACTH - urine cortisol – 24 hour urine - ACTH stimulation and suppression - CT/MRI

Answer 74

Adrenal studies: cortisol, aldosterone, ACTH - urine cortisol – 24 hour urine - ACTH stimulation and suppression - CT/MRI

Question 75

Integumentary assessment: shows maybe uncontrolled/undiagnosed DM - _____________ – reddish/brown spots usually on shins - _____________– brown/black thickening of skin, often seen in skin folds ______________ – red patches around blood vessels acanthosis nigricans Diabetic dermopathy necrobiosis lipoidica diabeticorum

Answer 75

- Diabetic dermopathy – reddish/brown spots usually on shins - acanthosis nigricans – brown/black thickening of skin, often seen in skin folds - necrobiosis lipoidica diabeticorum – red patches around blood vessels