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;
377 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
A pt. is suspected of having Pheochromocytoma (tumors of the adrenal medulla), what test might be performed?
|
Urinary levels of free catecholamines (norepinephrine, epinephrine, and dopamine) may be measured
|
|
|
|
What is the pituitary gland commonly referred to as?
|
The master gland because it secretes hormones that control the secretion of hormones by other endocrine glands
|
|
|
|
What controlls the pituitary?
|
The hypothalamus
|
|
|
|
What is the growth hormone GH also reffered to?
|
Somatotropin
|
|
|
|
Stress, exercise, and low blood glucose levels increase the secretion of what hormone?
|
Growth Hormone
|
|
|
|
What is the half life of growth hormone activity in the blood?
|
20-30 minutes
|
|
|
|
What happens when Growth Hormone reaches the liver
|
It is inactivated
|
|
|
|
What is ADH also known as?
|
Vasopressin
|
|
|
|
What secretes vasopressin?
|
The posterior lobe of the pituitary gland
|
|
|
|
What stimulates secretion of Vasopressin, (ADH)?
|
It is stimulated by an increase in the osmolality of the blood or by a decrease in blood pressure.
|
|
|
|
Total destruction o fth epituitary gland by trauma, tumor, or vascular lesion removes all stimuli that are normally recieved by the thyroid, the gonads, and the adrenal glands, what occurs as a result of the destruction?
|
Extreme wt. loss, emaciation, atrophy of all endocrine glands and organs, hair loss, impotence, amenorrhea, hypometabolism, hypoglycemia, coma and death
|
|
|
|
What two hormones are most commonly involved in oversecretion (hypersecretion) in the Anterior pituitary?
|
ACTH or growth hormone
|
|
|
|
What diseases are the result of oversecretion?
|
Cushing's syndrome or Acromegaly
|
|
|
|
What is acromegaly?
|
Thre result of excessive secretion of somatotropin
|
|
|
|
What is Cushing's syndrome?
|
The result of excess of free circulating cortisol from the adrenal cortex.
|
|
|
|
What are signs and symptoms of Acromegaly?
|
Progressive enlargement of peripheral body parts, commonly the face, head, hands, and feet.
|
|
|
|
What are the signs and symptoms of Cushing's syndrome?
|
Truncal obesity, moon face, acne, abdominal striae, and hypertension
|
|
|
|
What symptoms are seen in adults with Acromegaly?
|
Bone and soft tissue deformities and enlargement of the viscera without an increase in height.
|
|
|
|
What symptoms are seen in children with Acromegaly?
|
gigantism, with a person reaching 7 or 8 feet tall
|
|
|
|
What occurs when there is insufficient secretion of growth hormone during childhood?
|
Results in limited growth and dwarfism
|
|
|
|
Define panhypopituitarism
|
undersecretion / hyposecretion involving all of the anterior pituitary hormones
|
|
|
|
What occurs in panhypopituitarism?
|
The thyroid gland, adrenal cortex, and gonads atrophy (shrink)
|
|
|
|
What is Sheehan's syndrome?
|
Postpartum pituitary necrosis
|
|
|
|
Who is more likely to have Sheehan's syndrome?
|
Women with severe blood loss, hypovelemia, hypotension at the time of delivery.
|
|
|
|
What is the most common disorder related to the posterior lob of the pituitary?
|
Diabetes insipidus
|
|
|
|
What is diabetes insipidus?
|
A condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin.
|
|
|
|
Eosinophilic tumors that develop early in life result in what?
|
gigantism
|
|
|
|
What are symptoms of eosinophilic tumors?
|
7 feet tall and large in all proportions, yet so weak and lethargic that he or she can hardly stand
|
|
|
|
What occurs in adults with Eosinophilic tumors?
|
Excessive skeletal growth only in the feet, hands, superciliary ridge, molar eminences, nose, chin. Enlargement involves all tissues and organs of the body. Many suffer from severe headaches, visual distrubances, decalcification of the skeleton, muscular weakness, endocrine disturbances, loss of color discrimination, diplopia (double vision), or blindness
|
|
|
|
What are features of Basophilic tumors?
|
Give rise to Cushing's syndrome with features largely attributable to hyperadrenalism, including masculinization and amenorrhea, truncal obesity, hypertension, osteoporosis, and polycythemia
|
|
|
|
What are the most common tumors of the pituitary gland?
|
Chromophobic tumors
|
|
|
|
What are characteristics of Chromophobic tumors?
|
These tumors usually produce no hormones, those affected are often obese and somnolent, fine, scanty hair; dry, soft skin; pasty complexion; small bones, headaches, loss of libido, visual defects, polyuria, polyphagia, lowering of basal metabolic rate, and subnormal body temperature
|
|
|
|
How are pituitary tumors usually treated?
|
Surgical removal through a transsphenoidal approach, steroatactic radiation therapy, radiation therapy
|
|
|
|
What meds are used to treat pituitary tumors?
|
bromocreptine (dopomine agonist) and octreotide (Sandostatin, synthetic analogue of growth hormone, may shrink tumor)
|
|
|
|
What is the treatment of choice for patients with Cushing's syndrome resulting from excessive production of ACTH by a tumor of the pituitary gland?
|
Hypophysectomy
|
|
|
|
What is hypophysectomy?
|
The removal of the pituitary gland
|
|
|
|
What should you teach your female pt. undergoing total or near total ablation of the pituitary gland?
|
Menstruation ceases and infertility will occur
|
|
|
|
What must a pt. take for replacement after have the pituitary gland removed?
|
Corticosteroids and thyroid hormone
|
|
|
|
What are the clinical manifestations of Diabetes Insipidus?
|
Waterlike urine
Excessive thirst Specific gravity of 1.001 to 1.005 Pt. usually drinks 2-20 L daily |
|
|
|
What happens to a pt. with diabetes insipidus who attempts to restrict fluid intake?
|
They will develop hypernatremia and severe dehydration
|
|
|
|
What is Desmopressin (DDAVP), and how is it administered?
|
Used to treat Diabetes Insipidus. Synthetic vasopressin without vascular effects of ADH. Give intranasally. One or two sprays daily
|
|
|
|
If administration of desmopressin nasally is contraindicated, what can be done?
|
IM administration of ADH, vasopressin tannate in oil
|
|
|
|
What should you teach the pt. who is recieving vasopressin tannate in oil?
|
Given every 24-96 hours, vial should be warmed or shaken vigorously before given. Given in the evening so maximum results are obtained during sleep, abdominal cramps are a side effect
|
|
|
|
If diabetes insipidus is renal in origin, what should be given?
(Nephrogenic form of diabetes insipidus) |
Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors (ibuprofen, indomethacin, and aspirin)
|
|
|
|
Why should a pt. with coronary artery disease be cautious of vasopressin administration?
|
Because it causes vasoconstriction
|
|
|
|
What is the result of excessive ADH secretion from the pituitary gland although low serum osmolality?
|
Syndrome of inappropriate antidiuretic hormone (SIADH) secretion
|
|
|
|
What are signs and symptoms of SIADH?
|
Pts are unalbe to excrete a dilute urine, develop dilutional hyponatremia
|
|
|
|
What is the origin of SIADH?
|
Often not of endocrine origin, can be caused by certain medications, surgery, bronchogenic carcinoma
|
|
|
|
What medications can cause SIADH?
|
Vincristine, phenothiazines, tryicyclic antidepressants, thiazide diuretics, niccotine
|
|
|
|
What can be done to manage SIADH?
|
Eliminate underlying cause, restrict fluid intake, Furosemide (Lasix) - if hyponatremia is present
|
|
|
|
How does restricting fluid intake work in SIADH?
|
Retained water is excreted slowly through the kidneys, the extracellular fluid volume contracts and the serum sodium concentration gradually increases to normal
|
|
|
|
What three main hormones are responsible for normal thyroid function?
|
thyroid hormone, calcitonin, and iodine
|
|
|
|
What does the 3 and 4 after the T stand for?
|
T4 contains 4 iodine atoms
T3 contains 3 iodine atomes |
|
|
|
How are thyroid hormones formed?
|
Ioidide ions are converted to iodine molecules, which react with tyrosine (an amino acid) and form the hormones
|
|
|
|
What hormone controlls the secretion of T3 and T4?
|
TSH aka thyrotropin from the anterior pituitary gland
|
|
|
|
What determines the release of TSH?
|
The level of thyroid hormone in the blood
|
|
|
|
If the thyroid hormone concentration in blood decreases, what occurs?
|
The release of TSH increases, which causes an increase of T3 and T4 (negative feedback)
|
|
|
|
What does euthyroid refer to?
|
State of normal thyroid hormone production
|
|
|
|
What would a decrease in temperature do to TRH?
|
May lead to an increased secretion of TRH (thyrotropin releasing hormone)
|
|
|
|
An increase in TRH leads to what?
|
result in elevated secretion of thyroid hormones
|
|
|
|
What is different in T3 and T4?
|
T 4 is weak, T3 is 5x stronger than T4.
|
|
|
|
What do T3 and T4 do?
|
Accelerate metabolic processes by increasing the level of specific enzymes that contribute to oxygen consumption and altering the responsiveness of tissues to other hormones
|
|
|
|
How does calcitonin work?
|
It is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone
|
|
|
|
What is cretinism?
|
Stuned body growth and mental development appearing during the first year of life as a result of congenital hypothyroidism
|
|
|
|
In Adults with hypothyroidism, what symptoms do they exhibit?
|
Lethargy, slow mentation, generalized slowing of body functions
|
|
|
|
In order to inspect or swelling or asymmetry of the thyroid, what should you instruct the patient to do?
|
Instruct the pt. to extend the neck slightly and swallow. Thyroid tissue normally rises with swallowing.
|
|
|
|
When the isthmus is palpable, what should it feel like?
|
Firm and of a rubber band consistency
|
|
|
|
On palpation, if an enlarged thyroid gland is noted, what should be done?
|
Auscultate both lobes using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This abnormal finding indicates increased blood flow through the thyroid gland and necessitates referral to a physician
|
|
|
|
What findings during an assessment of the Thyroid indicate a referral to a physician?
|
Tenderness, enlargement, and nodularity
|
|
|
|
What test are most commonly used for detection of thyroid dysfunction?
|
Serum immunoassay for TSH and free T4.
|
|
|
|
What is the normal value for serum TSH?
|
0.4-6.15
|
|
|
|
TSH levels greater than 6.15 indicate what?
|
Primary hypothyroidism
|
|
|
|
TSH levels lower than 0.4 indicate what?
|
Hyperthyroidism
|
|
|
|
When should all adults begin testing of TSH levels?
|
35 years of age, and every 5 years after
|
|
|
|
What does T4 test do?
|
Confirms an abnormal TSH result, also a direct measurement of free unbound thyroxine, the only metabolically active fraction of T4
|
|
|
|
What is goiter?
|
Enlargement of the thyroid gland; usually caused by an iodine deficient diet
|
|
|
|
What is the normale free T4?
|
0.9-1.7
|
|
|
|
What is the more reliable test of Free T4?
|
Dialysis method, because it is not affected by variations in proein binding and is the procedure of choice
|
|
|
|
When measuring T4 and T3 which more accurately indicates hyperthyroidism?
|
T3
|
|
|
|
What does hyperthyroidism do for T3 or T4 levels?
|
Hyperthyroidism causes a greater increase in t3 than T4.
|
|
|
|
What is the normal range of T3?
|
1.15-3.10
|
|
|
|
When assessing the thyroid, you find a single nodule. It could possibly be autonomously functioning adenoma, what you the special features be?
|
Opposite lobe would not be palpable
|
|
|
|
What are special features of adenoma or adenomatous nodule?
|
Rubbery, firm; tenderness suggests recent hemorrhage or infarction
|
|
|
|
You suspect a single nodule you have found to be cancerous, what findings would support this diagnosis?
|
The nodule would be hard, may also have lymph node enlargement, or vocal cord palsy
|
|
|
|
You suspect multinodular goiter, what are the characteristics?
|
Firm lobes or irregular surface may be misinterpreted as multiple nodules
|
|
|
|
What would be the features of Graves Disease ?
|
Bruit or thrill; pyramidal lobe
|
|
|
|
You suspect diffuse goiter, however, as you continue to assess the pt. you determine the pt. has Hashimoto's thyroiditis, what findings suggest Hashimoto's thyroiditis?
|
Irregular surface; pyramidal lobe; rubbery or firm; occasionally mild tenderness; fibrous variant may be hard
|
|
|
|
You find a diffuse goiter, after continuing the assessment you conclude it to be thyroid lymphoma, what are the characteristics of thyroid lymphoma?
|
Rapidly growing goiter, particularly in setting of preexisting Hashimoto's thyroiditis
|
|
|
|
You find a diffuse goiter, however after completing the assessment you conclude it is a mulinodular goiter, what findings suggest this diagnosis?
|
Nodules may be hidden within gland and may become apparent with thyroid hormone suppression
|
|
|
|
You note tenderness when palpating the thyroid, what would make you think it is associated with subacute thyroiditis?
|
Unilateral or bilateral tenderness often severe
|
|
|
|
What would be the characteristics of a hemorrhagic or infarcted adenoma?
|
Discrete nodule with tenderness
|
|
|
|
A cancerous nodule has what characteristics?
|
irregular, firm thyroid nodule with chronic tenderness
|
|
|
|
You are reading a T3 resin uptake test, the T3 uptake is greater than 35%, you know that this indicates what?
|
Hyperthyroidism
|
|
|
|
You are reading a T3 resin uptake test, it states at the bottom that "The number of available sites is high." What would you suspect the T3 uptake level to be, what does this indicate?
|
The level would be less than 25%, which indicates hypothyroidism
|
|
|
|
What can affect the test results of T3 uptake?
|
Use of estrogens, androgens, salicylates, phenytoin, anticoagulants, or corticosteroids
|
|
|
|
How is the radioactive iodine uptake test performed?
|
The pt. is given a tracer dose of iodine 123, count is made over the thyroid gland with a scintillation counter
|
|
|
|
A pt. exhibited 90% uptake of the iodine 123, what would this indicate?
|
hyperthyroidism
|
|
|
|
What is the initial test for evaluation of thyroid masses?
|
Fine- needle aspiration biopsy
|
|
|
|
A negative finding of biopsy indicates what kind of mass?
|
benign
|
|
|
|
A positive biopsy test incicates what kind of mass?
|
malignant
|
|
|
|
A indeterminate biopsy test incidates what kind of mass?
|
suspicious
|
|
|
|
An adequate biopsy test indicates what kind of mass?
|
nondiagnostic
|
|
|
|
What medications contain iodine?
|
estrogens, sulfas, corticosteroids, propranolol, cimetidine, 5- gluorouracil, phenytoin, heparin, chloral hydrate, x ray contrast agents, opioids, androgens, salicylates, lithium, amiodarone, clofibrate, furosemide, diazepam, danazol, dopamine antagonists, propylthiouracil, cough syrup, chemotherapeutic agents, antibiotics
|
|
|
|
What is the most common cause of hypothyroidism in adults?
|
Hashimoto's disease
|
|
|
|
How does Hashimoto's disease work?
|
The immune system attacks the thyroid gland
|
|
|
|
What does primary or thyroidal hypothyroidism refer to?
|
Dysfunction of the thyroid gland itself
|
|
|
|
What does central hypothyroidism refer to?
|
Thyroid dysfunction is the result of failure of the pituitary gland, the hypothalamus or both
|
|
|
|
If the cause of hypothyroidism is due entirely to the pituitary gland, what may it be called?
|
Secondary hypothyroidism
|
|
|
|
If the cause of hypothyroidism is due to a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation by TRH, what may it be referred to as?
|
hypothalamic or tertiary hypothyroidism
|
|
|
|
What is myxedema?
|
Severe form of hypothyroidism characterized by an accumulation of mucopolysacchariedes in subcutaneous and other interstitial tissues, a mask like expression, puffy eyelids, hair loss in the eyebrows, thick lips, and a broad tongue.
|
|
|
|
Who is at more risk for developing hypothyroidism?
|
Affects women five times more frequently, between ages of 30-60 years old
|
|
|
|
What are the sympotoms of Hypothyroidism?
|
Extreme fatigue, hair loss, brittle nails, dry skin, numbness and tingling of fingers, husky voice, hoarsness, menstrual disturbences, menorrhagia, amenorrhea, loss of libido
|
|
|
|
What are the symptoms of severe hypothyroidism?
|
subnormal temperature and pulse rate, gain wt. without increase in food, thick skin, hair thins and falls out, face becomes expressionless and masklike, being cold even in warm environment, irritable, emotional responses subdued, mental process become dulled, appear apathetic, speech is low, tongue enlarges, hand and feet increase in size, constipation, deafness
|
|
|
|
What occurs to pts who have advanced hypothyroidism?
|
personality changes like dementia, sleep apnea, pleural effusion, pericardial effusion, respiratory muscle weakness, elevated cholesterol level, atherosclerosis, poor left ventricular function, hypothermic, sensitive to meds.
|
|
|
|
Pt. with unrecognized hypothyroidism who under go surgery are at increased risk for what?
|
Intraoperative hypotension, postoperative heart failure, altered mental status
|
|
|
|
What would a pt. look like if they have myxedema, the most severe stage of hypothyroidism?
|
Hypothermic and unconscious, respiratory drive is depresseed , resulting in alveolar hypoventilation, progressive carbon dioxide retention, , narcosis, comacardiovascular collagpse, shock
|
|
|
|
What should the nurse be aware of when administering analgesics, sedatives , and or anesthetic agents to a pt. with hypothyroidism?
|
The effects are prolonged, and also decressed liver and renal function
|
|
|
|
What is the primary objective of management for hypothyroidism?
|
To restore a normal metabolic state by replacing the missing hormone
|
|
|
|
What is the preferred medication of choice for treating hypothyroidism?
|
Synthetic levothyroxine, (also supresses non toxic goiters)
|
|
|
|
What is the dosage based on?
|
The dosage of replacement therapy is based on TSH concentration
|
|
|
|
What should be suspected in a pt. with hypothyroidism for a long period of time?
|
Elevated serum cholesterol, atheroxclerosis, coronary artery disease
|
|
|
|
If angina is detected in a patient, what is the nurses first action?
|
Must report finding and treat at once to avoid a fatal myocardial infarction, thyroid hormone administration must be discontinues immediately
|
|
|
|
What causes angina or dysrhythmias to occur when thyroid replacement is initiated?
|
Thyroid hormones enhance the cardiovascular effects of catecholamines
|
|
|
|
What are some side effects of thyroid hormones?
|
May increase blood glucose levels, may increase the effects of digitalis glycosides, anticoagulant agents, and indomethacin, bone loss, osteoporosis
|
|
|
|
What medication may increase the effects of thyroid hormones?
|
Phenytoin (Dilantin)
|
|
|
|
If hypnotic or sedative agents are needed, what should be done to the dose, if given to a pt. with hypothyroidism?
|
The dose should be one half or one third of that ordinarily prescribed in pts of similar age and wt. with normal thyroid function. (Must monitor the pt. closely for impending narcosis (stuporlike condition) or respiratory failure
|
|
|
|
What treatment should be done with a pt. who has severe hypothyroidism / myxedema?
|
arterial blood gases, pulse ox, fluids are given IV, Concentrated glucose, levothyroxine is given IV until consciousness is restored
|
|
|
|
Your pt. with hypothyroidism is complaining of being cold, what should you not do to warm up the pt.? Why?
|
Application of external heat, heating pads, is avoided, because it increases oxygen requirements and may leadt to vascular collapse and causes peripheral vasodilation
|
|
|
|
Screening of TSH levels is recommended women of what age, with what symptoms?
|
Women older than 50, who have one or more symptoms of hypothyroidism
|
|
|
|
If an elderly pts metabolic rate is increased to quickly, what occurs?
|
They may become Confused and agitated
|
|
|
|
What is the most common type of hyperthyroidism?
|
Grave's disease
|
|
|
|
What causes Graves' disease?
|
Excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
|
|
|
|
Who is at higher risk of developing Graves' disease?
|
Women, usually between the second and fourth decades
|
|
|
|
The symptoms experienced by pts. with hyperthyroidism are often refered to as what?
|
Thyrotoxicosis
|
|
|
|
What are symptoms of hyperthyroidism?
|
Nervousness, emotionally hyperexcitable, irritable, apprehensive, cannot sit quietly, suffer from palpitations, rapid pulse, sweat, stay hot, skin is usually flushed, salmon colored skin that is warm , soft and moist. Exophthalmos, bulging eyes, fine tremor of the hands, increased appetite, wt. loss, abnormal muscular weakness, amenorrhea, pulse rate between 90-160, systolic BP elevated, atrial fibrillation, cardiac decompensation (Heart failure), osteoporosis, tachycardia, dysrhythmias, myocardial hypertrophy
|
|
|
|
Elderly pts. who present with hyperthyroidism exhibit skin changes opposite of those normally found in pts. with hyperthyroidism, what would the skin appear to be?
|
dry skin and diffuse pruritus
|
|
|
|
What are characteristics of a hyperthyroid?
|
Thyroid gland enlarged
Soft, may pulsate, thrill can be palpated Bruit is heard |
|
|
|
What are lab findings of hyperthyroidism?
|
Decreased TSH levels
Increased free T4 Increase in radioactive iodine uptake |
|
|
|
What is the most common treatment of Graves' disease?
|
Radioactive iodine (The remission rate achieved with a single dose is 80%)
|
|
|
|
How does irradiation by administration of the radioisotope iodine 131 effect the thyroid?
|
It has destructive effecs on the thyroid gland, it destroys overactive thyroid cells without jeopardizing other radiosensitive tissues
|
|
|
|
How do antithyroid medications work?
|
They interfere with the synthesis of thyroid hormones and other agents that control manifestations of hyperthyroidism
|
|
|
|
What happens to the symptoms of hyperthyroidism once the iodine 131 is given?
|
Initially it causes an acute release of thyroid hormone from the thyroid gland and results in an increase of symptoms
|
|
|
|
What should the nurse monitor for after the iodine has been given?
|
Thyroid storm, hypothyroidism
|
|
|
|
How long after treatment of iodine 131 does it usually take for symptoms of hyperthyroidism to subside?
|
3-4 weeks
|
|
|
|
What other disease is iodine 131 used to treat?
|
Diffuse toxic goiter
|
|
|
|
Who would treatment via iodine 131 be contraindicated in/
|
during pregnancy, breast feeding, women who want to get pregnant within 6 months
|
|
|
|
What is the most commonly used antithyroid medication?
|
PTU, propylthiouracil or methimazole (Tapazole)
|
|
|
|
In what instances should the pt. be instructed to stop taking the medication?
|
Any sign of infection, especially pharyngitis and fever, or mouth ulcers
|
|
|
|
If your pt. has hyperthyroidism, and is pregnant, what medication would you anticipate the dr. to order?
|
PTU
|
|
|
|
What is the most common thyroid hormone used to "put the thyroid at rest?"
|
Levothyroxine sodium , (Synnthroid),
|
|
|
|
What medications may be given to prepare the patient with hyperthyroidism for surgery?
|
Potassium iodide, Lugol's solution, saturated solution of potassium iodide
|
|
|
|
How are solutions of iodine and iodide compounds administered?
|
In milk or fruit juice through a straw to prevent staining of the teeth
|
|
|
|
Your pt. is recieving iodine therapy, what should you instruct the pt. to avoid that may have iodine in them?
|
Cough medications, expectorants, bronchodilators, salt substitutes
|
|
|
|
What type of medications are important in controlling the sympathetic nervous system effects of hyperthyroidism?
|
Beta-adrenergic blocking agents, (Propranolol) used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance
|
|
|
|
Your pt. with hyperthyroidism is taking propranolol, you understand that it is being used to control what symptoms?
|
Tachycardia, nervousness, tremor, anxiety, and heat intolerance
|
|
|
|
How long will your pt. continue to take propranolol?
|
Until the free T 4 is within normal range and the TSH level approaches normal
|
|
|
|
If a pt. is going to have thyroid surgery, when does it take place?
|
4-6 weeks, after the thyroid function has returned to normal
|
|
|
|
What is a subtotal thyroidectomy?
|
surgical removal of 5 sixths of the thyroid tissue, results in a prolonged remission with exophthalmic goiter
|
|
|
|
What are canditates for subtotal thyroidectomy?
|
Pts with obstructive symptoms, for pregnant women in the second trimester, and for pts. with a need for rapid normalization of thyroid function
|
|
|
|
What is given before subtotal thyroidectomy surgery?
|
PTU is given until signs of hyperthyroidism have disappeared
|
|
|
|
What medications are stopped before surgery?
|
Aspirin because it increases the risk of postoperative bleeding
|
|
|
|
What should you monitor pts for who are receiving iodine medication?
|
Iodine toxicity iodism
|
|
|
|
What are symptoms of iodism?
|
Swelling of the buccal mucosa, excessive salivation, coryza, and skin eruptions
|
|
|
|
What should be done if iodism develops?
|
It requires immediate withdrawal of the med
|
|
|
|
Is hypothyroidism or hyperthyroidism more common in the elderly?
|
Hypothyroidism is more common in the elderly
|
|
|
|
What are some signs and symptoms of thyrotoxicosis in the elderly?
|
anorexia, and wt. loss, absence of ocular signs, or isolated atrial fibrillation
|
|
|
|
When is measurment of TSH levels indicated in the elderly?
|
When pts. have unexplained physical or mental deterioration
|
|
|
|
What is the recommended treatment of thyrotoxicosis in the elderly?
|
the use of radioactive iodine
|
|
|
|
What would contraindicate the use of radioactive iodine in this instance?
|
If the pt. has an enlarged thyroid gland pressing on the airway
|
|
|
|
What must be done before the elderly pt. can recieve radioactive iodine
|
Thyrotoxicosis must be controlled by antithyroid meds before because the radiation therapy may precipietate thyroid storm by increaseing the release of hormone from the thyroid gland
|
|
|
|
What is the most common cause of thyrotoxicosis in the elderly?
|
Toxic nodular goitar
|
|
|
|
What should pts. with hyperthyroidism avoid to prevent diarrhea?
|
They should avoid highly seasoned foods and stimulants such as coffee, tea, cola, and alcohol
|
|
|
|
What does PTU stand for?
|
methimazole
|
|
|
|
What is thyroiditis?
|
Inflammation of the thyroid gland
|
|
|
|
What causes acute thyroiditis?
|
Bacteria, fungi, mycobacteria, or parasites, staphylococcus aureus
|
|
|
|
What are the symptoms of acute thyroiditis?
|
anterior neck pain and swelling, fever, dysphagia, dysphonia, pharyngitis or pharyngeal pain
|
|
|
|
Upon examination of the thyroid of a pt. with acute thyroiditis, what would expect?
|
warmth, erythema, tenderness
|
|
|
|
What are two types of subacute thyroiditis?
|
subacute granulomatous thyroiditis (de Quervain's thyroiditis) or painless thyroiditis (silent thyroiditis or subacute lymphocytic thyroiditis)
|
|
|
|
Who and what age group are more commonly affected by subacute granulomatous thyroiditis?
|
Women between 40 and 50
|
|
|
|
What are the symptoms of subacute granulomatous thyroiditis?
|
painful swelling in the anterior neck that lasts 1 -2 months, respiratoy infection, thyroid enlarges symmetricallly , painful, reddened and warm, difficulty swallowing, irritability , nervousness, insomnia, wt. loss, chills and fever
|
|
|
|
How is subacute granulomatous thyroiditis treated?
|
NSAIDS, (not aspirin), propranolol,
|
|
|
|
Why sould aspirin not be used if hyperthyroidism is present?
|
Aspirin displaces thyroid hormone from its binding sites and increases the amount of circulating hormone
|
|
|
|
What other medications inparticular will not work to treat subacute granulomatous thyroiditis?
|
Tntithyroid agents which block the synthesis of T3 and T4 will not work
|
|
|
|
When does subacute lymphocytic thyroiditis usually occur?
|
During the postpartum period
|
|
|
|
What are symptoms of painless thyroiditis?
|
symptoms of hyperthyroidism or hypothyroidism are possible
|
|
|
|
What is chronic thyroiditis referred to?
|
Hashimoto's disease
|
|
|
|
Whom and what age group are more likely to develop hashimoto's disease?
|
women 30-50
|
|
|
|
How is hashimoto's disease diagnosed?
|
based on the histologic appearance of the inflammed thyroid gland
|
|
|
|
What are the symtpoms of Hashimoto's disease?
|
no pain, no pressure, or fever. Thyroid activity usually is normal or low rather than increased.
|
|
|
|
How is hashimoto's disease treated?
|
Thyroid hormone therapy to reduce thyroid activity and the production of thyroglobulin (if hypothyroid symptoms are present)
|
|
|
|
What is the objective of treatment of Hashimoto's disease?
|
to reduce the size of the thyroid gland and prevent hypothyroidism
|
|
|
|
At what point is a tumor referred to as a goiter?
|
If it causes a visible swelling in the neck
|
|
|
|
What is the most common type of goiter?
|
Simple or colloid goiter
|
|
|
|
What is colloid goiter caused by?
|
Iodine deficiency, or by an intake of large quantities of iodine or lithium
|
|
|
|
What does simple goiter represent?
|
A compensatory hypertorphy of the thyroid gland caused by stimulation by the pituitary gland
|
|
|
|
What are the symptoms of simple goiter?
|
Usually no symptoms except for sweling in the neck which may result in tracheal compression when excessive
|
|
|
|
How are simple goiters treated?
|
Usually reced after iodine imbalance corrected
|
|
|
|
An iodine intake less than 40 fg/day causes what?
|
They thyroid gland to hypertrophy
|
|
|
|
To prevent simple or endemic goiter, what should salt be iodized to?
|
A concentration of 1 part in 100,000
|
|
|
|
Iodine deficient goiter is aka
|
Endemic goiter or simple goiter
|
|
|
|
What increases a persons risk of developing thyroid carcinoma?
|
External radiation of the head, neck, or chest in infancy and childhood
|
|
|
|
Upon assessment of pt. A's thyroid, you note lesions that are single, hard, and fixed on palpation and associated with cervical lymphadenopathy, what do you suspect?
|
Malignancy
|
|
|
|
How is thyroid cancer diagnosed?
|
Fine needle biopsy, followed by a large bore needle if the FNB results are inconclusive or if the pt. has a rapidly growing tumor
|
|
|
|
What is the most common type of thyroid cancer?
|
Papillary adenocarcinoma
|
|
|
|
What are the characteristics of papillary adenocarcinoma?
|
Least aggressive, asymptomatic nodule in a normal gland, starts in childhood or early adult life, remains localized, metastasizes along the lymphatics if untreated , more aggressive in the elderly
|
|
|
|
What are characteristics of follicular adenocarcinoma?
|
It appears after 40 yrs of age, encapsulated, feels elastic or rubbery on palpation, spreads through the bloodstream to bone, liver, and lung, prognosis is not as favorable as for papillary adenocarcinoma
|
|
|
|
What are characteristics of Medullary thyroid cancer?
|
Appears after 50 yrs of age, occurs as part of multiple endocrine neoplasia (MEN), hormone producing tumor causing endocrine dysfunction symptoms, metastasizes by lymphatics and bloodstream, moderate survival rateq
|
|
|
|
What are characteristics of Anaplastic thyroid cancer?
|
50% occur in pts older than 60, hard , irregular mass that gorws quickly and spreads y direct invasion to adjacent tissues, may be painful and tender, survival for pts. is usually less than 6 mo
|
|
|
|
What are characteristics of thyroid lymphoma?
|
Appears after age 40, may have history of goiter, hoarseness, dyspnea, pain, and pressure, good prognosis
|
|
|
|
If an individual has been exposed to radioactivity, what should be given to the pt. to inhibit the radioactive iodide and promote rapid excretion thus decreasing the risk of developing cancer?
|
Give Potassium iodide (KI)
|
|
|
|
What is the treatment of choice for treating thyroid carcinoma?
|
Total or near total thyroidectomy
|
|
|
|
If the parathyroid tissue is accidently removed during surgery, what are some complications that may occur post op?
|
hypocalcemia and tetany
|
|
|
|
What is done after surgery to eradicate residual thyroid tissue if the tumor is radiosensitive?
|
Radioactive iodine is given
|
|
|
|
Why is thyroid hormone given after surgery?
|
To lower the levels of TSH to a euthyroid state
|
|
|
|
If the remaining thyroid tissue is inadequate to produce sufficient thyroid hormone what is required?
|
Thyroxine for life
|
|
|
|
What are side effects of external administration of radiation therapy?
|
mucositis, dryness of the mouth, dysphagia, redness of the skin, anorexia, fatigue
|
|
|
|
Post op what should you instruct the pt. to take to prevent hypothyroidism?
|
exogenous thyroid hormone
|
|
|
|
When are total body scans performed after surgery?
|
2-4 mo
|
|
|
|
What should the pt. be instructed to do before having the body scan?
|
Stop thyroid hormones for about 6 weeks before the test
|
|
|
|
What should the pt. avoid during this time?
|
Iodine containing foods and contrast agents
|
|
|
|
When should the pt. schedule a repeat scan?
|
In one year after the surgery
|
|
|
|
When is the final scan obtained?
|
In 3-5 years if measurements are stable
|
|
|
|
What lab values are monitored to determine whether the thyroid hormone supplementation is adequate?
|
Free T4, TSH, Calcium
|
|
|
|
What kind of diet should the pt. follow preop?
|
A diet high in carbohydrates and proteins, high caloric intake
|
|
|
|
What supplementary vitamins may be presicribed?
|
Thiamine and ascorbic acid
|
|
|
|
What foods should the pt. avoid?
|
tea, coffee, cola, stimulants
|
|
|
|
How should the pt. support the neck after surgery?
|
raise the elbows and place the hands behind the neck to provide support and reduced the strain and tension on the neck muscles and the surgical incision
|
|
|
|
Your pt. who has just had a thyroidectomy complains of a sensation of pressure and fullness at the incision site, what should you do, what do you suspect?
|
It may indicate subcutaneous hemorrhage and hematoma formation , report to physician
|
|
|
|
What is kept by the pts. bed at all times post op?
|
A tracheostomy set, and the surgeon is summoned at the first indication of respiratoy distress
|
|
|
|
What position should the pat. be placed in post op?
|
Semi fowlers, with the head elevated and supported by pillows
|
|
|
|
When can the pt. have fluids by mouth?
|
Usually as soon as nausea subsides
|
|
|
|
Your pt. who is post op a thyroidectomy complains of difficulty swallowing, what should you do?
|
Inform the pt. this is normal, give cold fluids and ice
|
|
|
|
Your pt. who is post op thyroidectomy has visitors in the room, the family is asking the pt. lots of questions, what should you do?
|
Advise the family that the pt. should talk as little as possible to reduce edema to the vocal cords
|
|
|
|
When are sutures and skin clamps usually removed?
|
the second day
|
|
|
|
Your pt. who has had a thyroidectomy is asking when he may get to go home, what is your response?
|
You may be dischrged today or tomorrow as long as there are no complications
|
|
|
|
What indication would make the nurse suspect damage to the laryngeal nerve?
|
Voice changes
|
|
|
|
How is tetany treated?
|
IV calcium gluconate
|
|
|
|
What is the function of parathyroid hormone?
|
it regulates calcium and phosphorus metabolism
|
|
|
|
Increased secretion of parathormone results in what?
|
An increased calcium absorption from the kedney, intestine, and bones, which raises the blood calcium level
|
|
|
|
Increased serum calcium results in ______________ parathormone?
|
decreased
|
|
|
|
What disorder of the parathyroid gland is characterized by bone decalcification and the development of renal calculi containing calcium?
|
Hyperparathyroidism
|
|
|
|
Who is more at risk of developing hyperparathyroidism?
|
Women between 60-70
|
|
|
|
What are signs and symptoms of hyperparathyroidism?
|
apathy, fatigue, muscle weakness, nausea, vomiting , constipation, hypertension, cardiac dysrhythmias, irritability, neurosis, psychoses, kidney stones, increased urinary excretion of calcium and phosphorus, renal damage, parenchyma, renal calculi, obstrucion, pyelonephritis, renal failure
|
|
|
|
What are characteristics of bones of a pt. with hyperparathyroidism?
|
demineralization of bones, skeletal pain, tenderness, pain on wt. bearing, pathologic fractures, deformities, shortening of body stature, bone loss
|
|
|
|
How is primary hyperparathyroidism diagnosed?
|
persistent elevation of serum calcium levels and elevated parathormone, radioimmunoassays
|
|
|
|
How can primary hyperparathyroidism be distinguished from malignancy?
|
Using a double antibody parathyroid hormone test
|
|
|
|
What is the recommeded treatment of primary hyperparathyroidism?
|
Surgical removal of abnormal parathyroid tissue (parathyroidectomy)
|
|
|
|
How much fluid is recommended for pts. with hyperparathyroidism?
|
2000 mL
|
|
|
|
Why should the pt. with parahyperthyroidism be encouraged to drink this much fluid?
|
To prevent calculur formation
|
|
|
|
How can the pt. reduce thier urinary PH?
|
Drinking cranberry juice
|
|
|
|
If the pt. expeiences abdominal pain and hematuria what should they do?
|
Call the dr.
|
|
|
|
Oral phosphates lower the serum calcium level, however long term use is avoided because?
|
it increases the risk of ectopic calcium phosphate deposition in soft tissues
|
|
|
|
Hypercalcemic crisis occurs when calcium levels reach/
|
15 or greater
|
|
|
|
How is hypercalcemic crisis treated?
|
Iv fluids, diuretic agents, phosphate therapy to correct hypophosphatemia and decrease serum calcium levels, mithramycin, calcitonin and dialysis
|
|
|
|
What is the most common cause of Hypoparathyroidism?
|
inadequate secretion of parathormone after interruption of the blood supply or surgical removal of parathyroid gland tissue during thyroidectomy, parathyroidectomy, or radical neck dissection
|
|
|
|
A deficciency of parathormone results in increased blood phosphate (hyperphosphatemia) and _____________ calcium?
|
decreassed (hypocalcemia)
|
|
|
|
What is the chief symptom of hypoparathyroidism?
|
tetany
|
|
|
|
What are some symptoms of hypoparathyroidism?
|
tetany, numbness, tingling, cramps in extremities, stiffness in hands and feet, bronchospasm, laryngeal spasm, carpopedal spasm (flexion of the elbows and wrists and extension of the carpophalangeal joints and dorsiflexion of the feet), dysphagia, photophobia, cardiac dysrhythmias, seizures, anxiety, irritability, depression, delirium
|
|
|
|
how is hypoparathyroidism diagnosed?
|
Positive trousseau's sign or positive chvosteks sign (suggest latent tetany), serum calcium levels of 5-6, serum phosphate levels are increased, xrays of bone show increased density, calcification is detected on xrays of subcutaneous or paraspinal basal ganglia of the brain
|
|
|
|
At what calcium level does tetany develop?
|
5-6
|
|
|
|
What is a positive trousseaus sign?
|
when carpopedal spasm is induced by occluding the blood flow to the arm for 3 min with a blood pressure cuff
|
|
|
|
What is a positive chvosteks sign?
|
Its positive when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth nose and eye
|
|
|
|
What is the goal of treatment fo hypoparathyroidism?
|
To increase the serum calcium level to 9-10 and to eliminate the symptoms
|
|
|
|
If hypocalcemia and tetany occur after a thyroidectomy, how is it treated?
|
IV calcium gluconate, if this is not effective pentobarbital
|
|
|
|
If acute hypoparathyroidism and tetany occur how is it treated?
|
parenteral parathormon
(high allergic reactions) |
|
|
|
What kind of environment should they be in?
|
free of noise, drafts, bright lights, or sudden movement
|
|
|
|
If the pt. has chronic hypoparathyroidism, what is the treatment?
|
a diet high in calcium and low in phosphorus, oral tablets of calcium salts, calcium gluconate, aluminum hyrooxide, Gelusil, Amphojel to bind phosphate and promote its excretion through the GI tract, vitamin D supplements
|
|
|
|
What forms of calcium shoudl the pt. avoid? Why?
|
Milk, milk product, egg yolk because they contian high levels of phosphorus, Spinach because it contains oxalate which would form insoluble calcium substances
|
|
|
|
What is function of epinephrine (adrenaline)?
|
secretion of epinepharine causes decreased blood flow to tissues that are not needed in emergancy situations such as the GI tract, and increased blod flow to tissues that are important for effective fight or flight such as cardiac and skeletal muscle
|
|
|
|
WHat three steroids are produced by the adrenal cortex?
|
glucocorticoids (hydrocortisone), mineralocorticoids (aldosterone), androgens (male sex hormones)
|
|
|
|
Without the adrenal cortex what would happen?
|
Severe stress would cause peripheral circulatory failiur, cirulatory shock, and prostration
|
|
|
|
Increased hydrocortisone secretion results in ?
|
increased blood glucose levels
|
|
|
|
What stimulates the secretion of glucocorticoids?
|
the release of ACTH
|
|
|
|
What are glucocorticoids in the form of corticosteriods given to do?
|
Inhibit the inflammatory response to tissue injury and to suppress allergic manifestations
|
|
|
|
If corticosteroids are given and discontinued suddenly what results?
|
adrenal insufficiency results because of the inabliity of the atrophied cortex to respond adequately
|
|
|
|
What is the primary function of mineralocorticoids (aldosterone)?
|
regulation of sodium balance
|
|
|
|
If andiotensin II has caused the blood pressure to be elevated, how would aldosterone couteract this effect?
|
Increased aldosterone levels promote sodium reabsorption by the kidney and the GI tract, which restores blood pressure to normal
|
|
|
|
What is adrenogenital syndrome?
|
When androgens are secreted in excess, masculinization results
|
|
|
|
What is pheochromocytoma?
|
A tumor that is usually benign and originates from the chromaffin cells of the adrenal medulla
|
|
|
|
Although uncommon, what effect does pheochromocytoma have on the BP?
|
It can exert hypertension on the pt. usually cured by surgery
|
|
|
|
What are symptoms of pheochromocytoma?
|
anxiety, tremulous, weak, headache, vertigo, blurring of vision, tinnitus, air hunger, dyspnea, polyuria, nausea, vomiting, diarrhea, abdominal pain, feeling of impending doom, tachycardia, palpitations, high blood pressure, cardiac dysrhythmias, dissecting aneurysm, stroke, renal failure, postural hypotension, light headedness, flushing, hyperglycemia, diaphoresis
|
|
|
|
your pt. exhibis signs of sympathetic nervous system overactivity and has elevated blood pressure, what do you suspect?
|
Pheochromocytoma
|
|
|
|
What are the 5 H's associated with pheochromocytoma?
|
hypertension
headache hyperhidrosis (excess sweating) Hypermetabolism Hyperglycemia |
|
|
|
What test is the most direct and conclusive for overactivity of the adrenal medulla?
|
Measurements of urine and plasma levels of catecholamines and metanephrine (MN)
|
|
|
|
How can free catecholamines MN and VMA be determined?
|
24 hour urine specimen
|
|
|
|
What should you instruct the pt. to avoid while doing the 24 hour urine specimen?
|
Avoid coffee, tea, bananas, chocolate, vanilla, aspirin
|
|
|
|
How is the total plasma catecholamine (epinephrine and norepinephrine) concentration measured?
|
With the pt. supine and at rest for 30 min, with a butterlfly needle or scalp vein needle or venous catheter inserted 30 min before the blood specimen is obtained
|
|
|
|
What are the normal values for epinephrine?
|
100
|
|
|
|
What is the normal value for norepinephrine?
|
less than 100-550
|
|
|
|
A value of epinephrine greater than 400 or norepinephrine values greater than 2000 indicate what?
|
pheochromocytoma
|
|
|
|
If the plasma and urine tests of catecholamines are inconclusive, what may be done?
|
a clonidine suppression test
|
|
|
|
If the pt. has pheochromocytoma, how the clonidine test result?
|
it will not suppress the release of catecholamines
|
|
|
|
How is pheochromocytoma treated during an acute attack?
|
bed rest , with the head of the bed elevated to promote an orthostatic decrease in BP
|
|
|
|
What can be given to lower the pts. bp?
|
•Medication to lower blood pressure (Nipride), or regitine, procardia, Inderal
|
|
|
|
What are surgical options for the pt. with phenochromocytoma?
|
•adrenalectomy if pt has adrenal hypertrophy
•transsphenoidal hyposectomy if pt has a pituitary tumor |
|
|
|
How do you prepare the pt. for adrenalectomy?
|
Control BP and blood volumes, over 4-7 days, Procardia (fast and effective capsules can be chewed), Cardene, well hydrated
|
|
|
|
What corticosteroids may be given before and after adrenalectomy? (required)
|
Solu medro, prednisone
|
|
|
|
What should you teach the pt. about BP?
|
Teach the pt. and family to monitor BP and notify the Dr. if there are changes in BP
|
|
|
|
What is Addisons disease?
|
adrenocortical insufficiency
|
|
|
|
What can cause addisons disease?
|
autoimmune or iodiopathic atrophy of the adrenal galnd, surgical removal of the adrenal glands, infectio by TN and histoplasmosis, therapeutic use of corticosteroids (most common cause)
|
|
|
|
What are the signs and symptoms of Addisons disease?
|
muscle weakness, anorexia, fatigue, emaciation, dark pigmentation of th emucous membranes and skin on the knuckles, knees, elbows, hypotension, low blood glucose, low serum sodium , high serum potassium levels, depression, emotional lability, apathy, confusion, chronic dehydration, addisonian crisis
|
|
|
|
What are symptoms of addisons crisis?
|
cyanosis, pallor, apprehension, rapid, weak pulse, rapid respirations, low bp, headache, nausea, abdominal pain, diarrhea, confusion, restlessness, even slight over exertion exposure to cold, acute infection, or a decrease in salt intake may lead to circulatory collapse shock or death
|
|
|
|
How is Addisons disease diagnosed?
|
hypoglycemia, hyponatremia, hyperkalemia, elevated WBC,low serum and urine levels of adrenalcoritical hormone, ACTH stimulation test, decreased serum cortisol levels
|
|
|
|
How is the ACTH stimulation test done?
|
•ACTH Stimulation Test
baseline serumcortisol drawn ACTH given IM/IV serum cortisol drawn at 30 min. and 60 min. - ACTH should stimulate increased cortisol level- little response suggests adrenocortical insufficiency (problem=adrenal cortex) |
|
|
|
How are cortisol levels measured?
|
Decreased serum cortisol levels
- levels drawn at highest point - 8AM - try to minimize stress (causes increased levels) |
|
|
|
In what position should the pt. be place?
|
recumbent position with the legs elevated
|
|
|
|
How is Addisons disease treated?
|
•Administer Solu-Cortef IV
Give vasopressor amines to raise Bp •Switch to po corticosteroids (prednisone) and mineralocorticoids (Florinef) ASAP |
|
|
|
Upon assessing a pt. with addisons disease, the pt c/o increased thirst and a decrease in systolic pressure of 20 mm what should the nurse suspect?
|
fluid depletion
|
|
|
|
What should you teach the pt. with addisons disease about salt intake?
|
to increase salt intake during times of illness , very hot weather, and other stressful situations
|
|
|
|
What signs could the family watch for to notify the dr that the dose of hormoen is to high?
|
wt. gain or edema
|
|
|
|
What signs could the family watch for to notify the dr. that the dose of hormone is to low?
|
wt. loss , postural hypotension
|
|
|
|
What is cushings syndrome?
|
excessive adrenocortical activity
|
|
|
|
What should a pt. with addisons disease and their family keep with them at all times?
|
• Teach pt and family to always keep IM Decadron available and how to administer
|
|
|
|
What can cause cushings syndrome?
|
too much production of ACTH or corticosteriod use
|
|
|
|
What are the symptoms of cushings syndrome?
|
•Central-type obesity = fatty “buffalo hump” in the neck and supraclavicular areas, a heavy trunk and thin extremities
•Thin, fragile skin that bruises easily •Weakness •Sleep disturbances •Muscle wasting •Osteoporosis •Kyphosis, backache and compression fractures •Sodium and water retention = hypertension and heart failure •“Moon-face” and acne •Slow healing and susceptibility to infection •Hyperglycemia •Weight gain •Masculine traits in women = facial hair, breasts atrophy, menses cease, voice deepens •Mood and mental changes •Psychosis •Distress and depression |
|
|
|
How is cushings syndrome diagnosed?
|
•Increased blood glucose
•Increased serum Na •Decreased serum K •Dexamethaxone Suppression •Urine Free Cortisol Levels •Serum ACTH •US/ CT Scan / MRI of brain and adrenal glands |
|
|
|
How is the Dexamethaxone Suppression Test done?
|
most often used, Administer dexamethasone 1 mg po at 11PM, (should decrease ACTH by negative feedback)
- Serum cortisol level drawn at 8 AM the next morning, (should have decreased cortisol from decreased ACTH levels) - Increased cortisol levels suggests Cushings Syndrome that is caused by hyperactivity of the adrenal glands |
|
|
|
How is the urine free cortisol level measured?
|
24-hour urine collection
have patient avoid stress/exercise/sodium- note drugs patient is taking/can effect results (diuretics) - Increased urine cortisol level highly indicative of Cushing’s |
|
|
|
How is cushings syndrome treated?
|
steriod use, (must use low dose qod), adrenalectomy if adrenal hyperplasia is the problem, hypophysectomy if anterior pituitary tumor is the problem
|
|
|
|
When is the best time of day to take coritcosteroids?
|
7 am to 8 am
|
|
|
|
What can the pt. do to decrese moon face?
|
low calorie, low sodium diet
|
|
|
|
After having transsphenoidal surgery, what should you teach the pt. to avoid?
|
vigourous coughing, blowing the nose, sucking through a straw, or sneezing, bending over or straining
|
|
|
|
Post op the transsphenoidal surgery, you ask the pt "how many fingers am I holding up?" the pt. says I can't tell, what should you suspect?
|
expanding hematoma
|
|
|
|
When is the nasal packing removed and the nares cleaned?
|
The nasal packing is removed in 3-4 days, then the area around the nares can be cleaned with the prescribed solution to remove crusted blood and moisten the mucous membranes
|
|
|
|
How long is the head of the bed elevated for the pt., including while at home?
|
2 weeks after surgery
|
|
|
|
What are SE pts. should be aware of when taking levothyroxine (synthroid)?
|
This medication may cause nervousness, fast or irregular heart beat, heat intolerance, excessive wt. loss, and diarrhea
|
|
|
|
Your pt. has hyperthyroidism, and asthma, what medication would best fit this pt.?
|
Metoprolol (Lopressor), because it is cardioselective and will not have effects on the respiratory tract
|
|
|
|
heat intolerance, exopthalmos, palpitations, wt. loss, excess persipiration, insomnia, increased blood pressure are all symptoms of what?
|
hyperthyroidism
|
|
|
|
dry skin, constipation, st. gain, cold intolerance , lowblood pressure, bradycardia are all symptoms of what?
|
hypothyroidism
|
|
|
|
Why does radiation for a brain tumor place the pt. at risk for diabetes insipidus?
|
Any injury can directly or indirectly damage the pituitary gland , placing the pt. at risk for reduced ADH secretion and diabetes insipidus
|
|
|
|
What do symptoms of diabetes insipidus and diabetes mellitus have in common?
|
polyuria, polydipsia
|
|
|
|
Your pt. with diabetes insipidus is complaining of weakness and confusion, you suspect she has fluid depletion, would her specific gravity be low or high?
|
The specific gravity should be low because she is excreting too much water
|
|
|
|
Would you also suspect that her serum osmolality would be high or low?
|
Her serum osmolality should be high because she is losing water and is becoming dehydrated
|
|
|
|
Replacement therapy for diabetes insipidus includes administration of aqueous vasopressin (Pitressin), how should the nurse evaluate the effectiveness of the medication and fluid therapy?
|
Stable vital signs, intake and output balance, electrolytes within normal limits, moist mucous membranes, good skin turgor, no report of thirst
|
|
|
|
The pt. with diabetes insipidus begins treatment with desmopressin acetate (DDAVP), what signs of overdose should she be instructed to observe for?
|
She should watch for signs of fluid overload, such as increaseing wt. and concentrated urine
|
|
|
|
Your pt. has SIADH, what would be an appropriate nursing diagnosis?
|
Because the pt. has too much ADH, he will be retaining water, a nursing diagnosis is fluid volume excess
|
|
|
|
Why is the pt. with SIADH at risk for seizures?
|
The pt. will retain water, which will reduce serum osmolality, , which can cause cerebral edema, increased intracranial pressure, and seziures
|
|
|
|
What would you expect the pt. with SIADH urine to look like?
|
very concentrated because they are not excreting much water
|
|
|
|
Once treatment has begun, what should the urine look like?
|
more dilute
|
|
|
|
Two days after treatment, the pt. is vomiting, disoriented to time and place, and reporting a severe headache, what should the nurse do?
|
immediately notify the pts dr, the pt. is exhibiting clinical manifestations of severe hyponatremia and is at high risk for seizures and coma
|
|
|
|
The dr. orders IV 3% normal saline and infuse 100 ml over 1 hr. What are some possible consequences of too rapid an infusion?
|
It can induce severe volume overload and pulmonary edema
|
|
|
|
What is the basic cause of Cushings disease?
|
an adrenal gland is hyperfunctioning
|
|
|
|
What hormone is produced in excess in Cushings disease?
|
Cortisol
|
|
|
|
What are some complications of Cushings disease?
|
perforated viscera/ ulceration, infection, adreanl crisis with abrupt withdrawl
|
|
|
|
Will a pt. with cushings disease have hyperglycemia or hypoglycemia?
|
Hyperglycemia
|
|
|
|
Will a pt. with Cushings disease gain or lose wt.?
|
gain wt
|
|
|
|
Why is it important to monitor a pt. with cushings disease for infection?
|
Because he has a decreased immune response and decreased inflammatory response
|
|
|
|
The Dr has ordered a chest x ray and CT of the thorax, on the pt. with cushings disease, why?
|
There can be tumors in the lungs that secrete ACTH
|
|
|
|
Your pt. with Cushings disease c/o abdominal pain, is this a serious sign , why or why not?
|
It is serious, because it can be a sign of a visceral perforation
|
|
|
|
The Dr ahs ordered the pts BP be checked q4h , why?
|
Because Cushings can cause hypertension
|
|
|
|
The nurse observes the nuring diagnosis for a pt. with Cushings disease as "risk for injury: fractures" on the pts. nursing car plan. why is the pt at risk for fractures?
|
Excessive cortisol destroys bone proteins and alters calcium metabolism, which predisposes the person to back pain, compression fractures of the vertebrae, and rib fractures
|
|
|
|
What are two causes of Addisons disease?
|
autoimmune dysfunction and TB
|
|
|
|
Why is it important to ensure that the env. for the pt. with addisons disease is safe?
|
dehydration and electrolyte abnormalities make th pt. weak and confused
|
|
|
|
Would the pt. with addisons disease be hyperglycemic or hypoglycemic?
|
Hypoglycemic
|
|
|
|
How should you monitor the pt. with addisons disease for dehydration?
|
check orthostatic vital signs
|
|
|
|
Why should the nurse question the order of "Administration of insulin to treat acute hypokalemia? for treatment of a pt. with Adrenal crisis"
|
Adrenal crises are characterized by hyperkalemia, hypovolemia, hypoglycemia, and cortisol deficits, insulin proomtes the movement of potassium into cells which can tem. reduce life threatening hyperkalemia
|
|
|
|
Your pt. has pheochromocytoma, why would Elavil be contraindicated in this pt?
|
Amitriptyline inhibits the reuptake of catecholamines, this would result in sustained levels of epinephrine and sympathetic stimulation
|
|
|
|
What can cause a catecholamine surge?
|
general anesthesia, morphine, narcan, haldol, licorice, red wine, coffee
|
|
|
|
The pts blood glucose is 49, and is lethargic but arousable what should the nurse do?
|
give 15 carbohydrates, recheck blood glucose in 15 min, i fbelow 70 give 15 more carbs, recheck in 15 min, if above 70 gie 7 g of protein
|
|
|
|
A med record reads, lispro insulin 10 unites SC 0800. What is an importatn consideration?
|
This is a rapid acting insulin, wait until the breakfast tray arrives
|
|
|
|
How should you draw up regular insulin and lantus insulin?
|
In one syringe draw up 6 u of regualr insulin, in a separate insulin syringe draw up 12 units of lantus insuin, and give two separate injections.
|
|
|
|
What ype of acid base imbalance is likely in a pt. with DKA? How would the nurse recognize compensation for this acid base disorder?
|
Metabolic acidosis. Rapid, deep respirations (Kussmaul's respirations) will show compensation for the acidosis
|
|
|
|
What are S&S of hypoglycemia?
|
Tachycardia, pallor, tremors, changes in mental status
|
|
|
|
What type of EV fluids are used in treating DKA initially and as blood glucose levels decrease?
|
Initially 0.9% normal saline. Insulin is given, then add dextrose to prevent hypoglycemia
|
|
|
|
Why is it important to monitor a pts. serum potassium levels throughout DKA?
|
DKA produces an intracellular to extracellular shift in potassium. Acidosis causes serum potassium to rise. As insulin is given , glucose and potassium will move back into the cells, which hypokalemia may develop
|
|
|
|
Clinical manifestation associated with a diagnosis of type 1 diabetes mellitus includes all of the following except>
|
A. hypoglycemia
B. Hyponatremia C. Ketonuria D. Polyphagia |
A. Hypoglycemia
|
|
|
The lowest fasting plasma glucose level suggsetive of a diagnosis of diabetes is:
|
A. 90
B. 115 C. 126 D. 180 |
C. 126
|
|
|
The most sensitive test for diabetes mellitus is the :
|
A. Fasting plasma glucose
B. two hour post load glucose C. urine glucose |
A. fasting plasma glucose
|
|
|
Which is an intermediate acting insulin?
|
A. NHP
B. Iletin II C. Humalog D. Humulin U |
A. NHP
|
|
|
The nurse knows that an intermediate acting insulin should reach its peak in :
|
A: 1-2 hours
B. 3-4 hours C. 4-12 hours |
4-12 hours
|
|
|
A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
|
A blurred vision
B. diaphoresis |
B. diaphoresis
|
|
|
The major electrolyte of concern in the treatment of deabetic ketoacidosis is >
|
A. calcium
B. potassium |
B. potassium
|
|
|
During surgery, glucose levels will rise, because there is an increased secretion of:
|
A. cortisol
B. epinephrine C. glucagon D. all of the above |
D.
|
|
|
What percent of fthe diabetic meal plan is carbohydrates?
|
A. 50-60
B. 30-40 |
A 50-60
|
|
|
What percent of the diabetic meal plan is fat?
|
A. 20-30
B. 30-40 |
20-30
|
|
|
What are examples of rapid acting insulin?
|
A. Humalog and Novolog
|
A
|
|
|
What are symptoms of HHNS
|
Hypotension, dehydration, tachycardia, seizures
|
|
