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87 Cards in this Set
- Front
- Back
What does the hypothalmus do?
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secretes stimulating and inhibiting hormones
controls the pituitary operates on the principle of negative feedback |
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Where do 18% of all brain tumors arise from?
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pituitary gland
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What are some signs and symptoms of a pituitary tumor?
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h/a, loss of peripheral vision, unstable temperature, neurological manifestations, emotional changes, hydrocephalus
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What are the 3 most common hormones related to pituitary tumors?
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growth, prolactin, ACTH
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What might a person with excessive growth hormone have?
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acromegaly
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What are some diagnostic tests used to diagnose a pituitary tumor?
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CT/MRI
visual fields (remember a s/s is loss of peripheral vision) hormone levels (growth, prolactin, cortisol) |
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What does the anterior pituitary gland control?
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growth, metabolic activity and sexual development through hormones
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What is some treatment options for your pt. with a pituitary tumor?
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radiation, drug therapy (bromocriptine), surgery
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What type of surgery would be an option for your pt. with a pituitary tumor?
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transphenoidal hypophysectomy
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Your pt. has just had a transphenoidal hypophysectomy, what would be your greatest concern for this pt. postoperatively?
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hormone replacement. esp. cortisol immediately post op. but also ADH and thyroid (TSH)
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What is considered excessive urine output?
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more than 200 ml/hr
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How would you help your post op pituitary tumor pt. to prevent increased ICP?
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Head of bed elevated 30 degrees, have them change positions slowly, discourage coughing, bending or straining
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What happens if the ADH hormone is disturbed?
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it effects the pts Na balance and the pt will void frequenty and could result in dehydration
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What condition can result due to excess of the growth hormone?
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gigantism: before puberty
acromegaly: after puberty |
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How would you treat a pt. with acromegaly?
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surgically, with radiation and with medication
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What causes acromegaly?
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a tumor in adults between 30-50
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What can cause hyperprolactinemia?
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tumors and drugs(BCP, aldomet, opiates, phenothiazines)
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What are s/s of hyperprolactinemia?
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galactorrhea, decreased libido, erectile dysfunction, menstrual irregularity, decreased visual fields
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What does bromocriptine do?
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med that inhibits prolactin secretion
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What is diabetes insipidus?
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deficiency of ADH (anti-diuretic hormone)
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Explain what happens when you have a deficiency of ADH
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the kidney are unable to concentrate urine, water is not reabsorbed by the kidneys. Pt has continuous excretion of large volumes of dilute urine, only water is excreted, not electrolytes.
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What can result due to a deficiency of ADH?
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hypovolemia, hypernatremia
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What are some things that can cause the body to have a deficit of ADH?
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cranial surgery, head trauma, brain tumors, infection of the CNS, drugs/alcohol, renal disease, can be idiopathic
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What are some s/s your pt. might experience if they have a deficiency of ADH?
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polyuria, thirst, signs of dehydration, nocturia, polydipsia, weight loss, incr. serum NA, neuro changes, cardiac, hypotension, tachycardia
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If your pt. had diabetes insipidus, what would their BP and pulse be like and why?
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decr. BP and incr. pulse due to dehydration
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What test is given to diagnose diabetes insipidus?
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water deprivation test (ADH is given SubQ and the urine is checked for concentration)
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What types of treatment is there for your pt. with diabetes insipidus?
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ADH replacement (dose must be titrated to symptoms)
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What are some nursing implications for your pt. with diabetes insipidus?
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fluids, strict I/O, weight checked daily, assess for s/s of dehydration and hypernatremia
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What type of education would you give to your pt. with diabetes insipidus?
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that they need to report incr. thirst, weight gain, nasal symptoms, edema, and they need to wear a medic alert bracelet
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What is SIADH
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syndrome of inappropriate ADH
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Explain SIADH
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ADH secretion occurs without regard to serum osmolality. This results in an incr. of ADH so the kidneys reabsorb water resulting in hypervolemia and hyponatremia
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What are s/s of SIADH?
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decr. LOC, irritability, anxiety, N/V, anorexia, oliguria, weight gain, seizures, coma, death
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How do you diagnose SIADH?
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check for a decr. serum sodium (hyponatremia) and a decr. serum osmolality
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What is your treatment for ACUTE SIADH?
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hypertonic saline (3%)
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What is your treatment for CHRONIC SIADH?
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fluid restriction, high sodium diet, demeclocycline, lasix
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What is your goal in treating your SIADH pt.?
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to return the NA level to normal slowly
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What are your nursing concerns for your pt. with SIADH?
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VS, weight, I/O, fluid restiction, neuro status, monitor labs (serum Na will be checked freq.)
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What is hypothyroidism?
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an insufficiency of the thyroid hormone
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What is severe hypothyroidism called?
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myexedema
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What are s/s of hypothyroidism?
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intolerant to cold, low temp, dry skin, thin hair, weight gain, decr. appetite, constipation, incr. interstitial fluid, incr. cholesterol, anemia, bradycardia, enlarged heart, hypotension, apathy, slow speech, lethargy, parasthesia
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What diagnostic test would your do to diagnose hypothyroidism?
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Check for elevated TSH, a decr. T3 and T4, presence of thyroid antibodies, CBC(anemia), high cholesterol, high TG
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What is happening when a pt. has hypothyroidism?
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everything slows down
Ex: ability to break down fats slows down resulting in weight gain |
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What medication might you put your pt on if they have hypothyroidism?
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levothyroxine (synthroid)
*best absorbed if taken on an empty stomach, iron definitely interferes with absorption, slow process of feeling better, long 1/2 life |
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What is your pt at risk for if their hypothyroidism isnt corrected slowly?
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fluid overload
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What are some complications of hypothyroidism?
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myexedema coma, hypothermia, hypotension, bradycardia, coma
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What are some nursing concerns you might have for your hypothyroidism pt?
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activity intolerance, nutrition, weight loss, impaired drug metabolism, temp instability, safety, elimination, respiratory depression, goiter, cardiac output
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What education might you give to your hypothyroid pt.?
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that improvement of symptoms is a slow progression and that they need to be aware of the signs of hyperthyroidism
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What is hyperthyroidism?
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chronic excess of thyroid hormone, f>M, autoimmune, inherited tendency
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What are s/s of hyperthyroidism?
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goiter (maybe), incr. body temp, intolerant to heat, incr. appetite, weight loss, weakness, diarrhea, decr.TG, tachycardia, incr. BP, CHF, A-fib, DOE, CP, nervous, restless, insomnia, tremors, osteoporosis, exophthalmos, altered reproductive function
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What diagnostic findings should you look for if you suspect your pt. has hyperthyroidism?
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decr. TSH, elevated T3 and T4, thyroid antibodies
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What test would you use to help diagnose hyperthyroidism?
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ultrasound, thyroid scan
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What is the treatment of choice for hyperthyroidism?
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radioactive iodine therapy - concentrates in the glands and decr. functioning, effects in 3 weeks but may take approx. 6 months to get to normal
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What can happen if your hyperthyroid pt is radiated too much during therapy?
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they can become hypothyroid
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When would we consider removing the thyroid?
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only if cancerous, sometimes if goiter or if it is effecting the pts airway
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What are the medications for hyperthyroidism?
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thioamides(suppresses thyroid function
Lugol's solution(decr. vascularity of the gland) Beta Blockers (decr. symptoms) |
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When would you NOT give your hyperthyroidism pt a beta blocker?
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when they are asthmatic, have COPD, or are diabetic
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Why would you want your pts. euthyroid state to be restored before going to surgery?
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to prevent thyroid storm (all hormones in gland are released in excess during surgery)
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What are some complications of thyroid surgery?
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damage to laryngeal nerve, hypoparathyroidism
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What would be some signs of a calcium deficiency in your post op thyroid pt.? how would you treat it?
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tingling around outh, toes, fingers, low serum Ca
treated with calcium gluconate |
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What type of diet would you place your post op thyroid pt. on?
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high protein, high calorie
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What is hypoparathyroidism?
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decr. parathyroid hormone (low calcium level)
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What can happen as a result of hypoparathyroidism?
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since it is a low calcium level your pt. could experience tetny, laryngospasms, seizures, EKG changes
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How would you diagnose hypoparathyroidism?
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check for a decr. serum calcium level and a serum PTH level
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How is hypoparathyroidism treated?
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IV calcium gluconate, PO therapy
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What is hyperparathyroidism usually caused by?
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a tumor
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What can happen as a result of hyperparathyroidism?
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since it is a high calcium level your pt could experience hypercalcemia, osteoporosis, kidney stones, PUD
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What is the treatment for hyperparathyroidism?
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surgery, clacitonin, phosphates, loop diuretics, hydration
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What is Addisons disease?
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hyposecretion of cortisol and aldosterone
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what does aldosterone regulate?
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Na/H2O balance
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what does cortisol regulate?
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blood glucose levels
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What can your pt. experience if they have a cortisol deficiency?
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incr. ACTH(adrenocorticotropic hormone) and melanocytes, addisonian tan, hypoglycemia
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Addison's disease is a deficiency in......
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cortisol and aldosterone
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Cortisol deficiency can cause?
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addisonian tan, hypogylcemia
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Aldosterone deficiency(mineralcorticoids) can cause?
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kidney being unable to retain Na and excrete K, water goes with sodium, dehydration, hyponatremia, hyperkalemia
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Waht are s/s of addisons disease?
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hyoptension, tachycardia, decreased CO, dehydration, cardiac arrythmias, N/V, Hiarrhea, anorexia, weakness, fatique, emotional instability, hypoglycemia, pigmentation changes (addisons tan)
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How would you diagnose addisons disease?
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low cortisol levels, high ACTH, ACTH stimulation test, check for presence of auto-antibodies against 21-hydroxylase
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What is the treatment for addisons disease?
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a lifetime treatment of replacement. - hydrocortisone, incr. sodium intake or florinef(if prev. doesn't work)
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What is addisonian crisis?
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triggered by stress
life threatening hypotension, hyponatremia, hyperkalemia, dehydration |
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How is addisonian crisis treated?
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IV steroid replacement, nl saline, glucose, electrolytes
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What causes an addisonian tan?
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increased melanocytes
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What is cushings disease and what causes it?
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long term excessive levels of cortisol
caused by a tumor (ACTH secreting or adrenal) |
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What systems does cushing disease effect?
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CV, immune, MS, skin, endocrine, renal, hematology, psychological status
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what are some s/s of cushings disease?
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hypertension, edema, weight gain, dysrhythmias, DVT, infection, acne, etc
*remember: it effects multi systems |
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How do you diagnose cushings disease?
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increased cortisol, decreased ACTH, dexamethasone suppression test, 24 hour urine
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What are some nursing concerns with cushings disease?
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fluid excess (VS, I/O, weights), electrolyte imbalance, diabetic care, vutrition (high protein, low sodium, high K, high Calcium), tissue perfusion (DVT), infection, skin care, activity intolerance
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What is pheochromocytoma?
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tumor of the adrenal medulla with secretes epi/norepi
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What are the s/s of pheopchromocytoma and how is it treated?
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severe hypertension not responsive to meds
Treated by removing the tumor and controlling BP |