Week Seven Modules Flashcards
the anterior pituitary hormone produces which hormones?
the posterior pituitary hormone produces what hormone?
adreno-corticoid hormone (ACTH) and thyroid stimulating hormone (TSH)
vasopressin/ anti-diuretic hormone
what is the job of both the pituitary and adrenal glands?
secrete hormones for cellular regulation of the entire body as well as fluid and electrolyte balance
what is the main function of the anterior pituitary?
what is the main function of the posterior pituitary?
regulates growth, metabolism, and sexual development
secretes vasopressin which helps to maintain fluid and electrolyte imbalance
what is the main function of the adrenal gland hormones?
provide life sustaining assistance
issues with the anterior pituitary can cause what kinds of diseases?
if the patient is experiencing cushing’s disease this means there is _____ levels of cortisol
if the patient is experiencing addison’s disease this means there is ____ levels of cortisol
addison’s disease and cushing’s disease
high
low
what is the etiology of cushing’s disease?
cushing’s disease means that there is anterior pituitary _____
how are adenomas classified?
most common cause is a pituitary adenoma (tumor)
hyperfunction
classified by the hormone that is secreted
what are some common s/s we’d expect to see with cushing’s disease?
elevated plasma cortisol levels, weight gain, truncal obesity, “moon face”, and loss of bone density
what are some nursing interventions for cushing’s disease?
first, you’ll want to do an assessment of the complicating conditions such as CV, DM, and infections
monitor VS, daily weight, and glucose
emotional support –> due to appearance changes such as truncal obesity
when it comes to providing emotional support for your patient, you’ll want to remember
patients may feel ____ or _____
remain _____ to the patient’s condition
offer _____ and unconditional acceptance
unattractive; unwanted
sensitive
respect
what are some expected diagnostic tests for a patient who has been diagnosed with cushing’s disease?
chem 7 (especially Na+, K+, and glucose); 24 urine tests, serum cortisol level, and dexamethasone suppression test
what are the normal ranges for serum cortisol?
what are the normal ranges for the dexamethasone suppression test?
at 8 am: normal ranges are from 5 - 23 mcg/dL
at 4pm: normal ranges are from 3 - 13 mcg/dL
low dose: >50%
high dose: same as above
how can we surgically manage cushing’s disease due to anterior pituitary hyperfunction?
before any of these surgical procedures occur what might the patient’s pre-op teaching consist of?
hypophysectomy; trasnphenoidal approach or transnasal approach; if tumor cannot be reached, then craniotomy
teach the patient about mustache dressing (dri pad placed under the nose), do not cough, brush teeth (oral rinse is okay), bend over, or blow your nose
what does post-op care look like for a patient who has cushing’s disease?
assess VS, assess congestion and mental status, assess the OR site and observe for drainage, teach drug plan, and teach the patient to report any s/s of hyperpituitarism
addison’s disease = _______
what is the etiology of addison’s disease?
adrenocortical insufficiency
all 3 classes of adrenal corticosteriods are reduced and these patients also have low cortisol levels
addison’s disease may cause things like _____ or lack of pituitary ACTH _____
up to 80% of addison’s disease cases are due to an _______ response
ACTH deficiency; secretion
autoimmune
what is the function of ACTH?
what are some functions of androgens?
regulate the levels of cortisol which is released by the adrenal glands
in women, androgen plays a key role in the hormonal cascade that starts puberty;
regulates the function of bone, liver, kidneys, and muscle
name some functions of cortisol
controls blood sugar levels, regulates metabolism, reduces inflammation, assists with memory, and has a controlling effect on the salt/water balance
what are some signs and symptoms of addison’s disease?
has a slow onset, symptoms are not evident until 90% of the adrenal cortex is destroyed, anorexia, nausea, progressive weakness, bronze colored skin, and salt craving
what are some nursing interventions for addison’s disease?
life long hormone therapy (glucocorticoids & mineralcorticoids); monitor the patient while correcting fluid and electrolyte imbalances; take VS and blood sugar; and guard the patient against infection
another nursing intervention we want to be agile about is making sure we obtain _____ and monitor _____
daily weights; intake/output
what does the patient teaching plan look like for an individual who has been diagnosed with addison’s disease?
educate the patient about the need for lifelong replacement therapy, lifelong medical supervision, prevention of infection, prevent falls, and wear a medication alert ID bracelet
another important teaching tip we might want to mention to a patient with addison’s disease would be what?
always carry an emergency medical kit that contains 100 mg IM (intramuscular) hydrocortisone, syringes, and instructions for use
what are some abnormal lab findings we would expect to see in a patient with addison’s disease?
hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, and anemia
what is an ACTH stimulation test?
a test where base line cortisol and ACTH levels are drawn, patient is given an IV injection of synthetic ACTH, and then cortisol and ACTH levels are rechecked
with an ACTH stimulation test, the normal expected response would cause a ___ in cortisol levels
however, people with addison’s disease will have ____ to ___ increase in their cortisol levels
rise
little; no
what are some of the main functions of the thyroid?
thyroid stimulating hormone stimulates the thyroid gland to produce T4 and T3
the thyroid takes iodine found in many foods and converts it into T4 and T3
these hormones help regulate the body’s metabolic rate, heart function, digestive function, and mood maintenance
what are two examples of thyroid disorders?
goiter and hyperthyroidism
what is goiter?
what can cause goiter?
goiter is an enlargement of the thyroid gland with/without s/s of thyroid dysfunction
increased levels of TSH can stimulate thyroid enlargement and cause goiter formation
thyroid hormone levels should be monitored in patients who take what medications?
lithium, phenytoin, and rifampin
if the individual has ____ iodine levels then they are also at risk for developing goiter
low iodine can cause goiter because iodine is a necessary component in the synthesis of ______
low iodine levels tend to be a problem for people living in _______
low
thyroid hormones
developing countries
what causes hyperthyroidism?
what is the etiology behind hyperthyroidism?
what does the diagnosis for hyperthyroidism look like?
excessive secretion of T3 and T4
most common etiology is Grave’s disease (50 - 60% of cases), autoimmune disorders, and autoantibodies that work against the thyroid
high levels of T3 and T4 with low levels of TSH
what is the next most common cause of hyperthyroidism?
subacute thyroiditis which usually occurs following episodes of extreme stress or infection
what are risk factors for grave’s disease?
does grave’s disease have a familial component?
being between the ages of 40 - 60 years old; women often are diagnosed more than men
yes, about 15% of patients have a relative with grave’s disease
what are s/s of grave’s disease/hyperthyroidism?
all metabolic activities are accelerated; energy expenditure increases with a rise in heat production; effects of hyperthyroidism can be seen in all body systems
patients with grave’s disease will also have _____ sensitivity to the SNS neurotransmitters which puts them at risk for things like ____ or ____
another symptom to be on the lookout for is ___ which is what?
enhanced; a-fib; heart failure
exopthalmos which is a wide-eyed stare that is often present
what are some signs and symptoms of grave’s disease that we can observe?
anxiety, tremor, tachycardia, weight loss, and decreased fertility
what are some treatment options for graves’ disease?
ablation of the hyperactive thyroid gland, medications like methimazole, PTU, and radioactive iodine; or surgery where the gland itself is removed
after a patient goes under ablation therapy, the thyroid gland is rendered as “____”, and replacement thyroid hormone (___) is needed for life
inactive; levothyroxine
what are some medication interventions for graves’ disease?
with methimazole, we want to remind women to report pregnancy b/c the drug can cause birth defects and should not be used while the woman is pregnant
with PTU, we need to teach the patients to report darkening of the urine or yellowing of the skin/eye whites
another patient teaching tip we might offer to a graves’ disease patient would be …..
teach patients to avoid crowds and people who are ill because the drugs they are prescribed reduce the immune response, which increases the risk for infection
what are some nursing interventions for graves’ disease?
monitor patient for complications (check VS every 4 hours and look out for increase in temp and BP b/c this could be a sign of “thyroid storm”)
reduce stimulation - encourage the patient to rest in a quiet environment
promote comfort - lower room temperature, suggest a cool shower
teach the patient and family about therapeutic drugs and procedures
if the patient has graves’ disease, the serum T3 levels will be ____, the serum T4 will be _____, and the TSH levels will be ____
increased; increased; low
what are the normal ranges for serum T3?
what are the normal ranges for serum T4?
what are the normal levels for TSH?
70 - 205 ng/dL
4 - 12 mcg/dL
2 - 10 micro/mL
hypothyroidism is the same as _______
hashimoto’s thyroiditis
what causes hypothyroidism to occur?
occurs when T3 and T4 levels are low and the TSH remains high
what is primary hypothyroidism?
what can cause primary hypothyroidism?
what is secondary hypothyroidism?
happens when the thyroid itself does not secrete t3 and t4 - about 90% of patients
autoimmune thyroid destruction, endemic iodine deficiency, cancer, and drugs
the pituitary is not secreting enough TSH, so there are low levels of T3 and T4
thyroid disease is much more common in ____ than ____
it has been found that _____ have a higher incidence than African Americans or Asian Americans
women; men
caucasians
hashimoto’s thyroiditis is an _____
hashimoto’s thyroiditis is the most _____ of hypothyroidism
what are some risk factors for hashimoto’s thyroiditis?
autoimmune disease
common cause
greater than 50 years old; pregnancy; radiation to the neck; female; family history
taking medications like ______, _____, _____, and lithium can increase your risk of hashimoto’s thyroiditis
radioactive iodine; amiodarone; interleukin
what are some s/s of hypothyroidism?
hyper carotenemia (causing yellow/orange tint to the skin); puffy face; hoarse voice; brittle nails; high cholesterol and high triglycerides
what is the treatment program for hypothyroidism?
replacement hormone therapy
patient will be prescribed levothyroxine that needs to be taken on an empty stomach 30 min to 1 hour before breakfast
what are some nursing interventions for hypothyroidism?
monitor VS, improve ventilation and oxygenation, prevent hypotension, and observe and chart the presence of lethargy, drowsiness, and poor attention
syndrome of inappropriate antidiuretic hormone occurs when there is _____ ADH
too much
with SIADH, water is _____ causing a dilutional effect on Na+ leading to _______
SIADH occurs when there is a problem in which ______ is secreted, even when plasma osmolarity is ___
retained; dilutional hyponatremia
vasopressin; low; normal
what some other causes of SIADH?
recent head trauma, cerebrovascular disease, tuberculosis/pulmonary disease, cancer, and medications
what are some s/s of SIADH?
hyponatremia, hypothermia, loss of appetite, bounding pulse, lethargy and headaches
what are some nursing interventions for SIADH?
restrict fluid intake (500 - 1000 ml in 24 hours)
promote excretion of water
monitor responses to therapy by doing things like taking daily weight
prevent complications
teach and educate the patient about fluid restrictions
remember:
with SIADH, weight gain of ____ or more per day is cause for concern
1 kg = ____ of fluid
1kg
1 L
what are some other nursing interventions to keep in mind when providing care for a patient diagnosed with SIADH?
monitor the patient for increased fluid overload, provider a safe environment (in case of neuro changes/seizures), assess for muscle twitching, place seizure pads on bed, assess neuro status frequently (once every 24 hours)
what does drug therapy look like for diseases like SIADH?
vasopressin receptor antagonists like “vaptans” are given to the patient
these are used to treat SIADH when hyponatremia is present in hospitalized patients
promote water excretion without causing Na+ loss
what are some other medications that might be prescribed to patients with SIADH?
diuretics - to be used on a limited basic when Na+ levels are near normal but heart failure is present
hypertonic saline (3%) - which is used for treating SIADH patients with low sodium levels
diabetes insipidus occurs when there is _____ ADH in the posterior pituitary
too little
what is the etiology of diabetes insipidus?
with diabetes insipidus, water is ____, due to ADH ___, or the inability of the ____ to ____ to ADH
it is a disorder of the posterior pituitary
lost; deficiency; kidneys; respond
what happens as a result of diabetes insipidus?
diabetes insipidus can lead to things like ____, ____ and disturbed ______
excretion of large volumes of dilute urine
polyuria, dehydration, fluid & electrolyte imbalance
with diabetes insipidus, dehydration ____ serum sodium levels and plasma osmolarity which leads to feelings of ____
thirst aids in maintaining ______
increases; thirst
hydration
what causes PRIMARY diabetes insipidus?
what causes SECONDARY diabetes insipidus?
what causes DRUG RELATED diabetes insipidus?
caused by a defect in the hypothalamus or pituitary
caused by tumors, head trauma, and infections
caused by demeclocycline or lithium which are known to interfere with kidneys response to ADH
what are some s/s of diabetes insipidus?
most symptoms are related to dehydration
key symptoms are increase in urination and excessive thirst
individuals who have had a recent surgery, head trauma, or lithium use are also at risk for developing DI
what are some CARDIOVASCULAR s/s of diabetes insipidus that we might see in a patient?
hypotension, tachycardia, and weak peripheral pulses
what are some KIDNEY/URINARY s/s of diabetes insipidus that we might see in a patient?
increased urine output, dilute urine with low specific gravity (less than 1.005)
what are some treatment options for diabetes insipidus?
if the patient has been prescribed DDVAP as a nasal spray what education should they receive?
drug therapy such as desmopressin acetate (DDAVP) either given sublingually or as a nasal spray
teach the patient that each metered dose delivers 10 mcg and they may only need one or two doses in 24 hours
what are some nursing interventions for diabetes insipidus?
strict i&os; measure specific gravity; measure patient’s daily weight; encourage the patient to drink fluids; teach the patient that polyuria and polydipsia are signals that the body needs another dose of DDVAP
with diabetes insipidus patients, we must teach them the importance of ______ daily adn to identify any signs of weight gain
weighing themselves daily
if there is a weight gain of more than _____, along with persistent ____ or _____, we must instruct the patient to go to the ___ or call 911 immediately
1kg; nausea/vomiting; confusion; ER
what is acute kidney injury?
injury to the kidney that can range from slight deterioration in kidney function to severe impairment
what are some characteristics of acute kidney injury?
rapid loss in kidney function; a rise in serum creatinine; or reduction in urine output
ACUTE KIDNEY INJURY
- potentially ______
- affects patients with other conditions like ____, ____, and _____
- AKI often follows severe, prolonged _____, and _____
reversible
HF, MI, and infections
hypotension; hypovolemia
what is the etiology of (PRE-RENAL) acute kidney injury (AKI)?
pre-renal factors that reduce systemic circulation causing reduction in renal blood flow
then
the decreased blood flow leads to decreased glomerular perfusion and filtration of kidneys
what causes pre-renal oliguria?
with pre-renal etiology factors is there damage to the kidney?
is pre-renal kidney injury reversible?
caused by decreased circulating blood volume
no, no damage
reversible with dehydration
what is the etiology of (INTRA-RENAL) acute kidney injury (AKI)?
caused by direct damage to the kidney tissue resulting in impaired nephron function
intra-renal acute kidney injury causes _____ of structures by crystallizing which causes damage to the ____
does intra-renal acute kidney injury affect the kidneys?
obstruction; tubules
yes
what is the most common cause of intra-renal acute kidney injury?
acute tubular necrosis
what 3 things cause acute tubular necrosis?
is acute tubular necrosis reversible?
due to ischemia, nephrotoxins (90% of the time), or sepsis
yes, it is potentially reversible if the basement membrane has not been destroyed
what is ischemia?
what are nephrotoxins?
causes disruption in the basement membrane and destruction of the tubular epithelium
causes necrosis of the tubular epithelial cells which can plug the tubules
what causes post-renal acute kidney injury?
caused by the mechanical obstruction in the outflow of urine
b/c outflow of urine is blocked it can lead to impaired kidney function
what are some examples of post-renal acute kidney injuries?
what are some examples of intra-renal acute kidney injuries?
benign prostatic hyperplasia, prostate cancer, and kidney stones
prolonged ischemia and nephrotoxins
post-renal acute kidney injuries account for less than ___% of acute kidney injury patients
what are the three phases of acute kidney injury?
what can happen if the patient does not recover from AKI?
10%
oliguric, diuretic, and recovery
chronic kidney disease may develop
the most common initial sign of acute kidney injury is _____
what happens during the oliguric phase?
during the oliguric phase, damaged tubules cannot conserve _____
in the oliguric phase, _____ increases because the kidneys are unable to excrete 80-90% of the body’s potassium
oliguria
kidneys cannot excrete acid products so metabolic acidosis occurs
sodium
potassium
during the oliguria phase, hyper_____ and hypo____ can occur
during the oliguria phase, the patient will complain of feelings of _____ and ____
hyperkalemia; hyponatremia
fatigue and malaise
if your patient suffers from high potassium levels what are some things you could do?
give kayexalate
hemodialysis
D50 push, followed by 10 units of regular insulin through IV
dietary restrictions - low K+ foods
what are some examples of neurologic disorders in the oliguric phase?
because nitrogenous waste products are accumulating in the brain issues like fatigue, difficulty concentrating, and seizure can occur
what are some hematologic disorders that can occur with the oliguric phase?
what is the most common cause of death in acute kidney injury?
what are some examples of waste products that are produced due to the oliguric phase of acute kidney injury?
leukocytosis is often present
infection
the kidneys excrete urea which is the end product of protein metabolism; resulting in high levels of BUN and Creatinine
during the oliguric phase of acute kidney injury, it’s important that the patient receives ______
on average, how much fluids will the patient receive per day as part of their fluid replacement treatment?
why is the initial base of 600 mL given?
fluid replacement
600 mLs + the amount of the previous day’s urine output
it’s given to replace the insensible fluid loss which consists of things like sweating, respirations,and water in the stool
what is the average water loss through diffusion that passes through the skin?
approximately 300 mLs + the other 300 mLs that is lost through respirations = which equals 600 mLs
when does the diuretic phase of acute kidney injury occur?
during the diuretic phase, you want to monitor the patient for _____ and ______
during the diuretic phase, the kidneys have recovered from their ability to _____ but not to ____ the urine
with the diuretic phase of acute kidney injury we want to monitor ____ levels and ____ levels because of the large losses of fluids/electrolytes
when the urine output increases, but the nephrons are not fully functional
hypotension; hypovolemia
excrete waste; concentrate
sodium; potassium
what happens during the recovery phase of acute kidney injury?
the bun/creatinine levels decrease
kidney function may take up to 12 months to stabilize
some patients don’t always recover and progress to end stage renal disease
what are some possible nursing interventions for acute kidney injury?
daily weights; vitals signs; strict i & o’s; examining the urine (color, clarity, and volume); and checking electrolytes
according to the CDC, CHRONIC KIDNEY INJURY is more common in ____ (15%) than ____ (12%)
women; men
what are some prevention tips for chronic kidney disease?
what are some treatment options for chronic kidney disease?
keep blood sugar WDL, keep blood pressure WDL, and having healthy body weight
test patients for creatinine, test patient’s urine for protein
what are some risk factors for chronic kidney disease?
diabetes and HTN are the major causes of CKD in adults
other risk factors include: heart disease, obesity, and family history
what are some other health problems that chronic kidney disease can cause?
increases the risk of heart disease and stroke
as the chronic kidney disease worses, there is higher incidence of anemia, low calcium, and high potassium
chronic kidney disease is much more ____ than acute kidney injury
prevalence of chronic kidney injury is attributed to ____ rates of ____, ___, and diabetes
since the kidneys are highly adaptive, kidney disease is not detected until there is a considerable amount of _______
common
increasing; obesity; HTN
loss of neurons
CKD is often _____ about ____% of patients are not aware that they have CKD
asymptomatic; 70%
if the patient has stage 1 chronic kidney disease, their glomerular filtration rate is either greater than/equal to _____
if the patient has stage 2 chronic kidney disease, their glomerular filtration rate is between ____ and ____
if the patient has stage 3A chronic kidney disease, their glomerular filtration rate is between ___ and ____
> =90
60 - 89
45 - 59
what is the action plan for stage 1 chronic kidney disease?
what is the action plan for stage 2 chronic kidney disease?
what is the action plan for stage 3a chronic kidney disease?
diagnosis and treatment, CVD risk reduction
estimate the progression
evaluate and treat complications
what is glomerular filtration rate?
how much blood is filtered through the glomeruli each minute
what are clinical manifestations of chronic kidney disease?
all body systems are affected
s/s are retained urea, creatinine, and hormones
_____: a syndrome where the kidney function decreases
uremia
when does the symptom of uremia tend to occur?
when the GFR is less than or equal to 15 mLs/min
what are some neuro s/s of chronic kidney disease?
______ should help improve CNS s/s
lethargy, decreased concentration, fatigue, and peripheral neuropathy
dialysis
what are some neuro/psych s/s of chronic kidney disease?
personality and behavioral changes; emotional lability; and depression
the most common cause of death in chronic kidney disease is ______
issues like HTN are worsened by the ____ retention
chronic kidney disease patients are susceptible to _____ due to _____
cardiovascular disease
sodium
dysrhythmias; hyperkalemia
what is a pulmonary s/s of chronic kidney disease?
how does the body compensate for metabolic acidosis?
metabolic acidosis
kussmaul breathing which removes CO2 and
what are some GI symptoms of chronic kidney disease?
what can chronic kidney disease due to the hematologic system?
stomatitis and ulcers; anorexia; weight loss; and malnutrition
can cause anemia, bleeding, and infection
why does anemia happen with CKD?
why does bleeding happen with CKD?
why does infection happen in CKD?
it happens due to decreased production of erythropoietin by the kidneys
due to a defect in platelet function caused by impaired release of platelet factor III
happens b/c the cellular and humoral responses are suppressed
what does chronic kidney disease due to the musculoskeletal system?
causes mineral and bone disorder due to low vitamin D levels which result in decreased serum calcium levels
when calcium levels are decreased, it stimulates bone demineralization
chronic kidney disease patients have ___ levels of calcium and ___ levels of phosporus
low; high
chronic kidney disease can cause what kinds of s/s to the integumentary system?
when does uremic frost occur?
pruritus (itching) and uremic frost which is a rare condition where urea crystallizes on the skin
occurs when the BUN levels are greater than 200
when it comes to nutritional therapy for chronic kidney disease what are the 5 treatment goals?
maintain optimal nutrition; prevent protein catabolism; minimize uremic toxicity; slow down the progression of renal failure; and position the initiation of dialysis
NUTRITIONAL THERAPY FOR CKD:
if the patient is predialysis, you’ll want to avoid feeding the patient ____ protein diets
if the patient is ON dialysis, then the patient should be allowed to have ____ intake of protein
high
increased
typically, renal patients are placed on the ____ diet
DASH
NUTRITIONAL THERAPY FOR CKD:
when it comes to sodium restrictions, you’ll want to limit the CKD patient to __ - ___ grams per day
you’ll want to teach the patient to ___ consumption of ____ processed ___, ___, and ____
1 - 3 grams;
reduce; canned foods; meats; soups; cottage cheese
what are some potassium containing foods we want our CKD patients to avoid?
potatoes, bananas, cantaloupe, raisins, broccoli, coffee, and chocolate
NUTRITIONAL THERAPY FOR CKD:
when it comes to calcium restrictions, you’ll want to limit the CKD patient to about ___ to ___ grams per day
when it comes to phosphorus restrictions, you’ll want to limit the CKD patient to consume less than ____ mg/day
what are some foods that are high in phosphorus
1 - 1.5
10
milk, beer, chocolate, american cheese, dried beans, and bran cereals
what are some nursing interventions for chronic kidney disease patients?
teach patients about their medications and use “teach back”; monitor urine output & daily weight; assess for s/s of high potassium; monitor BUN/Creatinine levels
for end stage renal disease, what is the criteria that needs to be met in order for dialysis to occur?
serum creatinine that is 6 mg/dL; general uremic symptoms (n/v, anorexia, itching); pericarditis; mental dysfunction
the principles of ____, osmosis, and ____ across a semipermeable membrane are involved in both ____ and ____
diffusion; ultrafiltration; hemodialysis; peritoneal dialysis
HEMODIALYSIS:
requires access either through a ___ or ___
hemodialysis runs last about __ to ___ hours
it pulls about __ to __ L of fluid from the patient
patients are often very ___ afterwards
what is the purpose of hemodialysis?
what medications are typically held from the patient before a hemodialysis procedure?
fistula; mahurkar/hickman
2 - 4
1 - 4
tired
correct fluid and electrolyte imbalances
drugs like antibiotics and HTN medications
what are some complications of hemodialysis?
infection of the access site; hypotension; cramps; N/V; and blood loss
PERITONEAL DIALYSIS:
what are the three individual phases?
these three phases are called an ___
inflow (fill) stage; dwell (equilibration) stage; drain stage
exchange
what happens in the inflow stage?
how longs does the dwelling stage last?
how long does the drain stage last?
when the draining stage occurs, the dialysate should be ____ b/c cloudy dialysate indicates an ____
2L of fluids are infused over 10 minutes
usually between 4-6 hours
15 - 30 minutes
clear; infection
