Ams Test 4 Scc Endocrine System

Front 1

What does the hypothalmus do?

Back 1

secretes stimulating and inhibiting hormones
controls the pituitary
operates on the principle of negative feedback

Front 2

Where do 18% of all brain tumors arise from?

Back 2

pituitary gland

Front 3

What are some signs and symptoms of a pituitary tumor?

Back 3

h/a, loss of peripheral vision, unstable temperature, neurological manifestations, emotional changes, hydrocephalus

Front 4

What are the 3 most common hormones related to pituitary tumors?

Back 4

growth, prolactin, ACTH

Front 5

What might a person with excessive growth hormone have?

Back 5

acromegaly

Front 6

What are some diagnostic tests used to diagnose a pituitary tumor?

Back 6

CT/MRI
visual fields (remember a s/s is loss of peripheral vision)
hormone levels (growth, prolactin, cortisol)

Front 7

What does the anterior pituitary gland control?

Back 7

growth, metabolic activity and sexual development through hormones

Front 8

What is some treatment options for your pt. with a pituitary tumor?

Back 8

radiation, drug therapy (bromocriptine), surgery

Front 9

What type of surgery would be an option for your pt. with a pituitary tumor?

Back 9

transphenoidal hypophysectomy

Front 10

Your pt. has just had a transphenoidal hypophysectomy, what would be your greatest concern for this pt. postoperatively?

Back 10

hormone replacement. esp. cortisol immediately post op. but also ADH and thyroid (TSH)

Front 11

What is considered excessive urine output?

Back 11

more than 200 ml/hr

Front 12

How would you help your post op pituitary tumor pt. to prevent increased ICP?

Back 12

Head of bed elevated 30 degrees, have them change positions slowly, discourage coughing, bending or straining

Front 13

What happens if the ADH hormone is disturbed?

Back 13

it effects the pts Na balance and the pt will void frequenty and could result in dehydration

Front 14

What condition can result due to excess of the growth hormone?

Back 14

gigantism: before puberty

acromegaly: after puberty

Front 15

How would you treat a pt. with acromegaly?

Back 15

surgically, with radiation and with medication

Front 16

What causes acromegaly?

Back 16

a tumor in adults between 30-50

Front 17

What can cause hyperprolactinemia?

Back 17

tumors and drugs(BCP, aldomet, opiates, phenothiazines)

Front 18

What are s/s of hyperprolactinemia?

Back 18

galactorrhea, decreased libido, erectile dysfunction, menstrual irregularity, decreased visual fields

Front 19

What does bromocriptine do?

Back 19

med that inhibits prolactin secretion

Front 20

What is diabetes insipidus?

Back 20

deficiency of ADH (anti-diuretic hormone)

Front 21

Explain what happens when you have a deficiency of ADH

Back 21

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.

Front 22

What can result due to a deficiency of ADH?

Back 22

hypovolemia, hypernatremia

Front 23

What are some things that can cause the body to have a deficit of ADH?

Back 23

cranial surgery, head trauma, brain tumors, infection of the CNS, drugs/alcohol, renal disease, can be idiopathic

Front 24

What are some s/s your pt. might experience if they have a deficiency of ADH?

Back 24

polyuria, thirst, signs of dehydration, nocturia, polydipsia, weight loss, incr. serum NA, neuro changes, cardiac, hypotension, tachycardia

Front 25

If your pt. had diabetes insipidus, what would their BP and pulse be like and why?

Back 25

decr. BP and incr. pulse due to dehydration

Front 26

What test is given to diagnose diabetes insipidus?

Back 26

water deprivation test (ADH is given SubQ and the urine is checked for concentration)

Front 27

What types of treatment is there for your pt. with diabetes insipidus?

Back 27

ADH replacement (dose must be titrated to symptoms)

Front 28

What are some nursing implications for your pt. with diabetes insipidus?

Back 28

fluids, strict I/O, weight checked daily, assess for s/s of dehydration and hypernatremia

Front 29

What type of education would you give to your pt. with diabetes insipidus?

Back 29

that they need to report incr. thirst, weight gain, nasal symptoms, edema, and they need to wear a medic alert bracelet

Front 30

What is SIADH

Back 30

syndrome of inappropriate ADH

Front 31

Explain SIADH

Back 31

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

Front 32

What are s/s of SIADH?

Back 32

decr. LOC, irritability, anxiety, N/V, anorexia, oliguria, weight gain, seizures, coma, death

Front 33

How do you diagnose SIADH?

Back 33

check for a decr. serum sodium (hyponatremia) and a decr. serum osmolality

Front 34

What is your treatment for ACUTE SIADH?

Back 34

hypertonic saline (3%)

Front 35

What is your treatment for CHRONIC SIADH?

Back 35

fluid restriction, high sodium diet, demeclocycline, lasix

Front 36

What is your goal in treating your SIADH pt.?

Back 36

to return the NA level to normal slowly

Front 37

What are your nursing concerns for your pt. with SIADH?

Back 37

VS, weight, I/O, fluid restiction, neuro status, monitor labs (serum Na will be checked freq.)

Front 38

What is hypothyroidism?

Back 38

an insufficiency of the thyroid hormone

Front 39

What is severe hypothyroidism called?

Back 39

myexedema

Front 40

What are s/s of hypothyroidism?

Back 40

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

Front 41

What diagnostic test would your do to diagnose hypothyroidism?

Back 41

Check for elevated TSH, a decr. T3 and T4, presence of thyroid antibodies, CBC(anemia), high cholesterol, high TG

Front 42

What is happening when a pt. has hypothyroidism?

Back 42

everything slows down
Ex: ability to break down fats slows down resulting in weight gain

Front 43

What medication might you put your pt on if they have hypothyroidism?

Back 43

levothyroxine (synthroid)

*best absorbed if taken on an empty stomach, iron definitely interferes with absorption, slow process of feeling better, long 1/2 life

Front 44

What is your pt at risk for if their hypothyroidism isnt corrected slowly?

Back 44

fluid overload

Front 45

What are some complications of hypothyroidism?

Back 45

myexedema coma, hypothermia, hypotension, bradycardia, coma

Front 46

What are some nursing concerns you might have for your hypothyroidism pt?

Back 46

activity intolerance, nutrition, weight loss, impaired drug metabolism, temp instability, safety, elimination, respiratory depression, goiter, cardiac output

Front 47

What education might you give to your hypothyroid pt.?

Back 47

that improvement of symptoms is a slow progression and that they need to be aware of the signs of hyperthyroidism

Front 48

What is hyperthyroidism?

Back 48

chronic excess of thyroid hormone, f>M, autoimmune, inherited tendency

Front 49

What are s/s of hyperthyroidism?

Back 49

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

Front 50

What diagnostic findings should you look for if you suspect your pt. has hyperthyroidism?

Back 50

decr. TSH, elevated T3 and T4, thyroid antibodies

Front 51

What test would you use to help diagnose hyperthyroidism?

Back 51

ultrasound, thyroid scan

Front 52

What is the treatment of choice for hyperthyroidism?

Back 52

radioactive iodine therapy - concentrates in the glands and decr. functioning, effects in 3 weeks but may take approx. 6 months to get to normal

Front 53

What can happen if your hyperthyroid pt is radiated too much during therapy?

Back 53

they can become hypothyroid

Front 54

When would we consider removing the thyroid?

Back 54

only if cancerous, sometimes if goiter or if it is effecting the pts airway

Front 55

What are the medications for hyperthyroidism?

Back 55

thioamides(suppresses thyroid function
Lugol's solution(decr. vascularity of the gland)
Beta Blockers (decr. symptoms)

Front 56

When would you NOT give your hyperthyroidism pt a beta blocker?

Back 56

when they are asthmatic, have COPD, or are diabetic

Front 57

Why would you want your pts. euthyroid state to be restored before going to surgery?

Back 57

to prevent thyroid storm (all hormones in gland are released in excess during surgery)

Front 58

What are some complications of thyroid surgery?

Back 58

damage to laryngeal nerve, hypoparathyroidism

Front 59

What would be some signs of a calcium deficiency in your post op thyroid pt.? how would you treat it?

Back 59

tingling around outh, toes, fingers, low serum Ca

treated with calcium gluconate

Front 60

What type of diet would you place your post op thyroid pt. on?

Back 60

high protein, high calorie

Front 61

What is hypoparathyroidism?

Back 61

decr. parathyroid hormone (low calcium level)

Front 62

What can happen as a result of hypoparathyroidism?

Back 62

since it is a low calcium level your pt. could experience tetny, laryngospasms, seizures, EKG changes

Front 63

How would you diagnose hypoparathyroidism?

Back 63

check for a decr. serum calcium level and a serum PTH level

Front 64

How is hypoparathyroidism treated?

Back 64

IV calcium gluconate, PO therapy

Front 65

What is hyperparathyroidism usually caused by?

Back 65

a tumor

Front 66

What can happen as a result of hyperparathyroidism?

Back 66

since it is a high calcium level your pt could experience hypercalcemia, osteoporosis, kidney stones, PUD

Front 67

What is the treatment for hyperparathyroidism?

Back 67

surgery, clacitonin, phosphates, loop diuretics, hydration

Front 68

What is Addisons disease?

Back 68

hyposecretion of cortisol and aldosterone

Front 69

what does aldosterone regulate?

Back 69

Na/H2O balance

Front 70

what does cortisol regulate?

Back 70

blood glucose levels

Front 71

What can your pt. experience if they have a cortisol deficiency?

Back 71

incr. ACTH(adrenocorticotropic hormone) and melanocytes, addisonian tan, hypoglycemia

Front 72

Addison's disease is a deficiency in......

Back 72

cortisol and aldosterone

Front 73

Cortisol deficiency can cause?

Back 73

addisonian tan, hypogylcemia

Front 74

Aldosterone deficiency(mineralcorticoids) can cause?

Back 74

kidney being unable to retain Na and excrete K, water goes with sodium, dehydration, hyponatremia, hyperkalemia

Front 75

Waht are s/s of addisons disease?

Back 75

hyoptension, tachycardia, decreased CO, dehydration, cardiac arrythmias, N/V, Hiarrhea, anorexia, weakness, fatique, emotional instability, hypoglycemia, pigmentation changes (addisons tan)

Front 76

How would you diagnose addisons disease?

Back 76

low cortisol levels, high ACTH, ACTH stimulation test, check for presence of auto-antibodies against 21-hydroxylase

Front 77

What is the treatment for addisons disease?

Back 77

a lifetime treatment of replacement. - hydrocortisone, incr. sodium intake or florinef(if prev. doesn't work)

Front 78

What is addisonian crisis?

Back 78

triggered by stress
life threatening hypotension, hyponatremia, hyperkalemia, dehydration

Front 79

How is addisonian crisis treated?

Back 79

IV steroid replacement, nl saline, glucose, electrolytes

Front 80

What causes an addisonian tan?

Back 80

increased melanocytes

Front 81

What is cushings disease and what causes it?

Back 81

long term excessive levels of cortisol
caused by a tumor (ACTH secreting or adrenal)

Front 82

What systems does cushing disease effect?

Back 82

CV, immune, MS, skin, endocrine, renal, hematology, psychological status

Front 83

what are some s/s of cushings disease?

Back 83

hypertension, edema, weight gain, dysrhythmias, DVT, infection, acne, etc
*remember: it effects multi systems

Front 84

How do you diagnose cushings disease?

Back 84

increased cortisol, decreased ACTH, dexamethasone suppression test, 24 hour urine

Front 85

What are some nursing concerns with cushings disease?

Back 85

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

Front 86

What is pheochromocytoma?

Back 86

tumor of the adrenal medulla with secretes epi/norepi

Front 87

What are the s/s of pheopchromocytoma and how is it treated?

Back 87

severe hypertension not responsive to meds
Treated by removing the tumor and controlling BP