Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
127 Cards in this Set
- Front
- Back
|
4 major classifications of hormones
|
1. Amines/Amino acids
2. Peptides, polypeptides, proteins, glycoproteins 3. steroids 4. fatty acid derivatives |
|
|
types of amino acid hormones
|
epinephrine, norepinephrine, thyroid hormones
|
|
|
types of peptide/protein hormones
|
thyrotropin, FSH, GH
|
|
|
types of steroid hormones
|
corticosteroids
|
|
|
hormones are excreted by the ______ and deactivated by the ________
|
kidney
liver |
|
|
calcium and phorphorus have a __________ relationship
|
inverse
|
|
|
OPQRST of hormone disorder
|
onset, provoke/palliate, quality, radiation, severity, time
|
|
|
hypothalamus is part of the _______
|
autonomic nervous system
|
|
|
hormones/glands of the hypothalamus
|
corticotropin, thyrotropin, growth hormone regulating hormone, gonadotropin, pituitary gland
|
|
|
proper name for anterior/posterior pituitary
|
Adenohypophysis
Neurohypophysis |
|
|
Anterior pituitary hormones
|
FSH, LH, ACTH (cortisol), GH, TSH, melanocyte stimulating hormone, Prolactin
|
|
|
common s/s of neonatal anterior pituitary defects
|
apnea, cyanosis, severe hypoglycemia, seizures, prolonged jaundice
|
|
|
hyperpituitarism is most commonly caused by a
|
hypersecretion of GH or cortisol
|
|
|
hyperpituitarism causes these disorders
|
gigantism, acromegaly, cushing's
|
|
|
Describe Gigantism
|
- > in GH in children
-unusual growth in height, organs and muscles -occurs before epiphyses (growth plate) of bone closes |
|
|
Gigantism. Assess for:
|
-Acromegaly later in life
-bone changes -soft tissue changes -tongue, skin, abdominal organ enlargement |
|
|
Acromegaly characteristics
|
- > GH in adults
-affects bone and soft tissue - minimal effect on height -Speech is hoarse -coarse facial features -enlarged tissue |
|
|
complications with acromegaly
|
HTN, HF, diaphoresis, DM, peripheral neuropathy, joint pain, blurrred vision, menstrual abnormalities
|
|
|
one main risk with gigantism/acromegaly
|
sleep apnea!!
|
|
|
Precocious puberty
|
> in GH
causes earlier or later puberty than normal more common in girls |
|
|
pituitary adenoma
|
tumos in pituitary gland, usually benign
|
|
|
s/s of pituitary adenoma
|
HA, visual disturbances, >GH - causing > fatty acids and insulin
|
|
|
which assessment is most important when assessing for pituitary adenoma?
|
neuro
|
|
|
RN Dx r/t hyperpituitarism
|
body image disturbance, deficient fluid volume, sleep disturbance, sensory perception alterance
|
|
|
goal of tx of hyperpituitarism
|
return GH level to normal
|
|
|
options for pituitary adenoma
|
Hypophysectomy - removal of part of pituitary gland (also an option for cushings)
Radiation Medication - parlodel, sandostatin |
|
|
Common side effect of radiation for hyperpituitarism
|
hypopituitarism
|
|
|
timeline of care for pt undergoing hypophysectomy
|
preop - nasal antibiotics, teach post op expectations: (mouth breathing, mouthcare), avoid sneezing, straining, HOB >30 degrees, no toothbrush, report H/A!!
postop- monitor for complications: -diabetes insipidus -excessive thirst -abnormal Na levels -CSF leak -hemorrhage -infection -adrenal/thyroid insufficiency -neurovisual disturbance monitor I/O |
|
|
most common post-hypophysectomy complication
|
diabetes insipidus - from decrease in ADH
|
|
|
if CSF leak, culture will be positive for
|
glucose
|
|
|
calcium and phorphorus have a __________ relationship
|
inverse
|
|
|
OPQRST of hormone disorder
|
onset, provoke/palliate, quality, radiation, severity, time
|
|
|
hypothalamus is part of the _______
|
autonomic nervous system
|
|
|
hormones/glands of the hypothalamus
|
corticotropin, thyrotropin, growth hormone regulating hormone, gonadotropin, pituitary gland
|
|
|
proper name for anterior/posterior pituitary
|
Adenohypophysis
Neurohypophysis |
|
|
when dealing with a HYPER- disorder, keep in mind that a side effect of Tx can always be
|
HYPO- that same thing
|
|
|
hypopituitarism (dwarfism) characteristics
|
growth retardation
infertility/impotence amenorrhea post partum pituitary necrosis weakness/fatigue H/A < resistance to infection extreme weightloss/ atrophy failure to grow fasting hypogylcemia hairloss dry skin apathetic |
|
|
causes of hypopituitarism
|
infection
tumor autoimmune vascular disease pituitary destruction |
|
|
RN management of hypopituitarism
|
GH therapy
monitor fluid retention replacement of ADH, cortisol, thyroid, sex hormones |
|
|
Diseases of posterior pituitary
|
SIADH and DI
|
|
|
SIADH and DI are r/t ____ imbalance
|
ADH
|
|
|
Describe SIADH
|
> release of ADH (or vasopressin)
this causes: fluid retention Na deficiency (dilutional) |
|
|
clinical s/s of SIADH
|
thirst
dyspnea AMS serum Na <120 weight gain W/O edema orthostatic hypotension dehydration <H&H N/V/D <UO <BUN/Cr lethargy/confusion H/A cerebral edema delayed deep tendon reflexes |
|
|
two important diagnostic findings with SIADH
|
serum Na < 134 mEq
Specific gravity > 1.30 |
|
|
Tx of SIADH
|
fluid restriction
strict I/O NS or hypertonic saline depending on severity |
|
|
meds given to treat SIADH
|
loop diuretic (< ADH effectiveness, used when Na <105)
declomycin (blocks action of ADH, dose ranges from 600-1200mg/day) |
|
|
never use _____ _________ when treating SIADH
|
thiazide diuretics
|
|
|
If you overtreat SIADH, the result is
|
diabetes insipidus
|
|
|
to see if declomycin is effective in SIADH Tx, test
|
specific gravity. if this decreases, it's working.
|
|
|
alternative to declomycin Tx
|
lithium - also inhibits ADH
|
|
|
3 Ds of DI
|
diabetes insipidus
decreased ADH diuresis |
|
|
what is DI
|
deficiency of posterior pituitary
deficiency in ADH excessive thirst dilute urine |
|
|
3 main causes of DI
|
Neurogenic
Nephrogenic Dispogenic |
|
|
Neurogenic causes of DI
|
head injury (most common)
tumors meningitis/encephalitis aneurysm sarcoidosis |
|
|
Nephrogenic causes of DI
|
pyelonephrosis
polycystic kidney sickle cell myeloma drugs: lithium, alcohol, dilantin |
|
|
severe findings of DI
|
voiding 5-20 l/day
urine osmolality <100 fatigue dehydration weightloss poor skin turgor/dry mucous membranes tachycardia hypotension shock AMS/coma |
|
|
lab findings associated with DI
|
serum osm >295
urine osm <500 hypernatremia S.G. 1.001-1.005 <ADH |
|
|
describe water deprivation test
|
baseline weight, urine/plasma osm
withhold fluids for 8-16 hours weigh hourly, ortho BPs every hour, urine vol and S.G. hourly, serum osm. hourly **should stimulate ADH |
|
|
Treatments for DI
|
hormone replacement therapy (ADH effects)
-Pitressin -Lysine vasopressin -Desmopressin -Diabinese Nephrogenic -diuretics (encourages h20 reabsorption) -salt restriction -indocin -replace fluids |
|
|
Thyroid produces these 3 hormones
|
thyroxine(t4), triiodothyronine(t3), thyrocalcitonin (tsh)
|
|
|
during potential iodine toxicity, administer
|
potassium iodide
|
|
|
disorders of hyperthyroidism
|
Grave's disease (75%)
toxic nodular goiter goiter thyroiditis |
|
|
foods potentiating goiters
|
soy beans, peanuts, turnips, seafoods, lithium and iodine also
|
|
|
exopthalmos
|
a protrusion of the eyeball from the orbit
|
|
|
care for exopthalmos
|
HOB up
exercise ocular muscles protect eyes |
|
|
meds for hyperthyroid
|
Propylthiouracil (PTU)
- Methimazole (Tapazole) - Saturated Solution of potassium iodine (SSKI) - Radioactive Iodine I-131: - most common |
|
|
radioactive iodine precaution
|
extended hospital stay
gown up!! as RN |
|
|
Concerns for thyroidectomy
|
we want thyroid tests WNL preop
weight, cardiac, nutrition WNL preop risk for : thyroid storm, hypocalcemia, hemorrhage |
|
|
goals immediately postop thyroidectomy
|
patent airway - have trach at bedside
assess swallowing, hoarseness semi-fowlers, pillow, no neck flexion may have tetany from knicking of parathyroid during surgery on d/c, order cbc, h/h, Ca and P |
|
|
Major complications with thyroidectomy
|
resp obstruction**
hemorrhage weakness hoarseness tetany** hypocalcemia** |
|
|
what is thyroid storm
|
life threatening s/s of hyperthyroidism
s/s include: cardiac dysrhythmias, fever, neuro impairment, severe tachycardia, HF, shock, hyperthermia, flushed, eye irritation, elevated t3/t4, reduced TSH, N/V/ab pain, coma |
|
|
drug of choice for thyroid storm
|
inderol
|
|
|
primary hypothyroidism
|
cretinism
iodine deficiency antithyroid drugs defective hormone synthesis |
|
|
secondary hypothyroidism
|
pituitary disease
|
|
|
tertiary hypothyroidism
|
hypothalmic disease
|
|
|
s/s of hypothyroidism
|
lethargy/depression
dry skin subnormal temp bradycardia hypertension |
|
|
diagnostic findings for hypothyroidism
|
<T3
<T4 >TSH |
|
|
hypothyroid prevention
|
1- iodized salt
2- birth screen 3- hormone replacement |
|
|
meds to tx hypothyroidism
|
thyrocine
prolid euthroid/thyrolar synthroid these are T3/T4 replacements |
|
|
worst effect of hypothyroidism
|
myxedema coma (life threatening hypothyroidism)
|
|
|
s/s of myxedema coma
|
non pitting edema
cool/dry skin large tongue loss of eyebrows/hair bradycardia goiter delayed deep tendon reflex shallow resp hypothermia hyponatremia/resp acidosis low t3, t4, increased TSH high cholesterol |
|
|
RN Dx for hypothyroidism
|
imbalanced nutrition
activity intolerance constipation risk for ineffective mgmt |
|
|
how to treat myxedema coma
|
tx s/s
thyrpoid replacement |
|
|
parathyroid hormone controls
|
calcium and phosphate metabolism
maintains inverse Ca/P relationship regulates release of Ca from bone if serum Ca too low activates vit D |
|
|
primary hyperparathyroidism
|
>PTH secretion
disorders of Ca, P, bone metabolism due to neoplasm or adenoma |
|
|
secondary hyperparathyroidism
|
compensatory response
causes hypocalcemia PTH stimulation vit D deficiency CRF, >P |
|
|
teriary hyperparathyroidism
|
hyperplasia of parathyroid gland, kidney transplant may be needed
|
|
|
s/s of hyperparathyroidism
|
80% mild or no symptoms
weakness, fatigue, no appetite, n/v/c, thirst, > urination |
|
|
hypoparathyroidism may be result of
|
accidental removal of parathyroid gland during surgery
infarction of gland or strangulation |
|
|
Diagnostic findings during hyperparathyroidism
|
>PTH
>serum Ca <P |
|
|
Diagnostic findings during hypoparathyroidism
|
<PTH
<Ca >P |
|
|
clinical manifestations of hyperparathyroidism
|
stones, risk of renal failure
osteoporosis, osteopenia high risk for fracture, pancreatitis |
|
|
med given for bone decalcification r/t hyperparathyroidism
|
Areddia
Zomota --- contraindicated in renal impairment |
|
|
clinical manifestations of hypoparathyroidism
|
tetany
+chvostek and trousseu sign (facial contraction/carpal spasm) parathesia cramps hydration calciura |
|
|
Tx for hyperparathyroidism
|
parathyroidectomy
push fluids moderate Ca intake PO4 supplement meds - mithracin, antihypercalcemic |
|
|
Tx for hypoparathyroidism
|
supplement Ca
supplement vit D cant give PTH prevent/treat convulsions Ca gluconate may be administered (risk or hypotension and cardiac arrest) ensure patent airway (risk due to laryngeal spasm) |
|
|
hypo and hyperparathyroidism put you at risk for
|
fracture
|
|
|
significance of 'stones, bones, moans and groans'
|
in hyperparathyroidism....
kidney stones bone decalcification pain emotional disorders |
|
|
RN Dx for hyperparathyroidism
|
risk for injury
altered urinary elimination imalanced nutrition constipation |
|
|
RN Dx for
hypoparathyroidism |
impaired skin integrity
activity intolerance disturbed thoughts ineffective mgmt |
|
|
sections of adrenal gland
|
adrenal cortex
adrenal medulla |
|
|
adrenal cortex produces
|
ACTH(cortisol)
glucocorticoids mineralcorticoids androgens aldosterone |
|
|
adrenal medulla produces
|
catecholamines
epinephrine norepinephrine dopamine |
|
|
another way to look at hormones that adrenal cortex produces
|
salt, sugar, sex
|
|
|
cushing's disease is caused by
|
too much cortisol due to pituitary tumor or administering too much cortisol
|
|
|
addison's disease is caused by
|
too little cortisol due to autoimmune dysfunction, too much aldosterone
|
|
|
hypoaldosterone is very rare except in
|
adrenal failure
|
|
|
clinical manifestations of hyperaldosteroneism
|
HTN, hypokalemia, hypernatremia, muscle weakness, fatigue, cardiac arrythmias, glucose intolerance, metabolic alkalosis, tetany
|
|
|
Tx for hyperaldosteroneism
|
decrease HTN
surgical removal of adrenal gland low sodium diet increase potassium meds - to <aldosterone prevention of kidney damage |
|
|
s/s of cushings disease
|
Persistent hyperglycemia,
Protein tissue wasting, Potassium depletion Sodium and water retention, Hypertension, lower extremity edema Increased susceptibility to infection Abnormal fat distribution Mental status changes Weight gain, truncal obesity Moon face, buffalo hump, supraclavicular fat pad Glucose intolerance Diabetes type symptoms Hypertension, edema of lower extremities, Hypokalemia Thin, fragile skin, purplish red striae (abdomen), florid cheeks (plethora), petechial hemorrhages, thinning hair Muscle wasting, osteoporosis, awkward gait, back pain, weakness Delayed wound healing Mood swings (depression, euphoria) GI changes (increase pepsin and HCL, peptic ulceration) Acne, menstrual changes, hirsutism (increased facial & body hair) Gynecomastia & impotence in men |
|
|
diagnostic findings for cushings disease
|
UA to test free cortisol level
MRI CT scan |
|
|
most general findings in cushings disease
|
elevated WBC
elevated glucose leukocytosis Lymphocytopenia Lower lymphocytes increased ESR sedement rate coagulapathies hypernatremia hypokalemia metabolic alkalosis |
|
|
Tx of cushings and goals
|
reduce steroid level
normalize hormone level poss hypophyectomy if pituitary problem is discovered adrenalectomy if adrenal prob |
|
|
adrenalectomy preop care
|
stabalize HTN, <K, >glucose
increase protein teaching! - steroid Tx before and after Sx |
|
|
adrenalectomy postop care
|
corticosteroid admin postop
monitor VS control HTN monitor incision hemorrhage I/O, F/E control hyperglycemia monitor for shock |
|
|
risk factors post adrenalectomy to teach about
|
avoid risks for infection, extreme temps, fatigue and stress
|
|
|
RN Dx for cushings
|
risk for injury
risk for infection impaired skin integrity imbalanced nutrition knowledge deficit disturbed self esteem |
|
|
primary adrenal insufficiency
|
aka addisons disease
all 3 adrenal corticosteroids are reduced: glucocorticoid, mineralcorticoid, androgens. |
|
|
secondary adrenal insufficiency
|
lack of pituitary ACTH secretion - so only glucocerticoids and androgens are deficient
|
|
|
adrenal insufficiency clinical manifestations
|
(postural) hypotension, hypovolemia, <Na, shock, confusion, hyperkalemia, n/v/anorexia, hyperpigmentation, <cortisol, hypoglycemia, <aldosterone, <androgen, sepsis
|
|
|
most dangerous Sx of adrenal insufficiency
|
hypotension (hypovolemic shock possible)
|
|
|
s/s of Addisonian crisis
|
profound weakness
severe ab/flank/leg pain hyperpyrexia followed by hypothermia hypotension renal failure cardiovascular collapse death |
|
|
Diagnostic findings in Addisons
|
<BP, <cortisol, <Na, <K, adrenal calcification or atrophy
|
|
|
Tx of Addisons
|
manage underlying cause
replace glucocorticoids hydrocortisone (IV) salt additives manage shock risks... need to increase BP monitor VS I/O F/E rapid fluid replacement! monitor cardiac r/t K fluctuations |
|
|
effects of corticosteroid therapy
|
antiinflammation
immunosuppression blood pressure maintenence glucose intolerance protein wasting delayed wound healing gastric ulceration |
|
|
pt teaching associated with corticosteroid therapy
|
adherence to prescribed cortisol dosage and schedule
Need increased cortisol doses in times of stress ( Minor surgery, flu, personal crisis) Better to overestimate than underestimate the dose Never abruptly stop cortisol replacement therapy Diet Avoid periods of fasting, Increase salt intake Emergency Kit- with hydrocortisone solution, Medic alert Tags Medication interactions: Dilantin, barbituarates, rifampin, antacids - need increased glucocorticoid dose |
|
|
Pheochromocytoma
|
tumor in adrenal gland secreting too much catecholamine - causes HTN, H/A, tachycardia, diaphoresis
|
