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;
71 Cards in this Set
- Front
- Back
|
Function of the Adrenal Gland
|
Secrete mineralocorticoids with control the body’s fluid and electrolyte balance. Aldosterone promotes sodium & water reabsorption & potassium excretion in the kidney tubules. Gluccorticoids (cortisol) affect carbohydrate, fat and protein metabolism, the body’s response to stress, emotional stability and immune function.
|
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Pathophysiology |
Inadequate secretion of ACTH by hypothalamus & pituitary
|
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Causes |
Primary-Autoimmune disease, TB, metastatic cancer, AIDs, hemorrhage, Gr- sepsis, adrenalectomy, abdominal radiation, fungal lesions, drugs (mitotane) & toxins
Secondary- pituitary tumors, hypophysectomy, high doses of radiation |
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Clinical Manifestations |
Muscle weakness, fatigue, joint/muscle pain, anorexia, N/V, constipation/diarrhea, wt loss, salt craving, vitiligo – white patches where they lose pigmentation on skin, ↑ skin pigmentation, anemia, ↓BP, ↓Na, ↑K+, ↑Ca++
|
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Laboratory and Diagnostics |
↓ cortisol, ↓fasting BG, ↓Na , ↑K+, ↑Ca++, ↑BUN,
Primary- ↑ACTH, ↑ESR CT, MRI,skull X-ray if problem is pituitary |
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Interventions |
Goal- fluid balance, prevent hypoglycemia
Cortisone replacement (give 2/3 dose in AM, 1/3 dose PM) Hydrocortisone or prednisone Fludrocortisones (Florinef)-causes Na reabsorption & K+ excretion ↑Na+ intake Emergency Mgmt- rapid infusion NS or D5NS, 100-300 mg Solucortef, hydrocortisone drip over 8 hrs, hydrocortisone 50 mg IM, histamine blocker IV, ↑K+ give insulin +D50W (shifts K+ into cells), Lasix, hypoglycemia give d50W & monitor BG hourly. |
|
|
Adrenal Gland
Addison’s Disease (Adrenal Insufficiency) Nursing Intervention |
Daily weight, accurate I&O, monitor for dysrhythmias, orthostatic hypotension
|
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Pathophysiology |
Excessive secretion of cortisol with affects metabolism, ↑ body fat, kills lymphocytes & shrinks organs containing lymphocytes (spleen, liver, lymph nodes)
|
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Causes |
Endogenous secretion- bilateral adrenal hyperplasia, pituitary adenoma, malignant CA of lungs, GI tract, pancreas, Adrenal cancer
Exogenous-use of mineral corticoids for disease (asthma, autoimmune disorders, organ transplant, cancer chemo, allergic reaction, chronic fibrosis) |
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Clinical Manifestations |
Moon face, buffalo hump, truncal obesity, HTN, dependent edema, ↑RF bleeding, muscle atrophy, osteoporosis, thin skin, striae, ↑ skin pigmentation, ↑RF infection, ↓ immune function & inflammatory response
|
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Causes |
Endogenous secretion- bilateral adrenal hyperplasia, pituitary adenoma, malignant CA of lungs, GI tract, pancreas, Adrenal cancer
Exogenous-use of mineral corticoids for disease (asthma, autoimmune disorders, organ transplant, cancer chemo, allergic reaction, chronic fibrosis) |
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Clinical Manifestations |
Moon face, buffalo hump, truncal obesity, HTN, dependent edema, ↑RF bleeding, muscle atrophy, osteoporosis, thin skin, striae, ↑ skin pigmentation, ↑RF infection, ↓ immune function & inflammatory response
|
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Laboratory & Diagnostic |
↑ cortisol, ↑BG, ↑Na, ↓lymphocytes, ↓Ca+, ↓K+
Dexamethasone suppression testing |
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Interventions |
Goal- ↓cortisol level, removal of tumor, restore body appearance to normal or acceptable.
Aminoglutethimide (Elipten, Cytadren) and metyrapone (Metopirone) use different pathways to decrease cortisol production. For increased ACTH production, cyproheptadine (Periactin) may be used because it interferes with ACTH production. Mitotane (Lysodren) is an adrenal cytotoxic agent used for inoperable adrenal tumors causing hypercortisolism. |
|
|
Adrenal Gland
Cushing’s Disease (Hypercortisolism) Nursing Intervention |
Monitor for ↓ weight and ↑U/O, monitor electrolyte balance
|
|
|
Adrenal Gland
Pheochromocytoma |
tumor of adrenal medulla (benign (90%)or malignant)-tumor produces, stores & releases epinephrine & norepinephrine → intermittent HTN, severe HA, profuse diaphoresis, flushing, apprehension & sense of doom. Do not palpate abdomen→catacholamine release & severe HTN.
Diagnostic – 24 hr. urine for VMA. Intervention-surgical removal, stabilize BP prior to surgery. If inoperable treat with alpha-adrenergic & beta-adrenergic blocking agents. |
|
|
Anterior Pituitary Gland
Functions |
controls growth, metabolic activity, and sexual development through the actions of these hormones:
•Growth hormone (GH; somatotropin) •Luteinizing hormone (LH) •Thyrotropin (thyroid-stimulating hormone [TSH]) •Follicle-stimulating hormone (FSH) •Corticotropin (adrenocorticotropic hormone [ACTH]) •Prolactin (PRL) •Melanocyte-stimulating hormone (MSH) |
|
|
Anterior Pituitary Gland
Hypopituitarism Clinical Manifestations |
↓ gonadotropins- ↓ libido, fertility, impotence, (female) amenorrhea, dyspareunia
↓ growth hormone- osteoporosis, ↑RF fractures, ↓muscle strength, ↑ cholesterol levels ↓ TSH- ↓T3, T4, cold intolerance, alopecia, hirsutism, slowed cognition, lethargy ↓ ACTH- ↓cortisol, lethargy, anorexia, postural hypotension, H/A, ↓ BG & Na ↓ ADH → diabetes insipidus |
|
|
Anterior Pituitary Gland
Hypopituitarism Laboratory & Diagnostic |
↓ levels depending on hormone deficiency
|
|
|
Anterior Pituitary Gland
Hypopituitarism Interventions |
GH- (male)testosterone, (female) estrogen & progesterone replacement. Fertility- hCG injections
|
|
|
Anterior Pituitary Gland
Hypopituitarism Surgical Intervention |
NONE
|
|
|
Anterior Pituitary Gland
Hypopituitarism Home Care |
Hormone Replacement
|
|
|
Anterior Pituitary Gland
Hyperpituitarism Causes |
Oversecretion of GH, PRL, & ACTH from tumor or tissue overgrowth
|
|
|
Anterior Pituitary Gland
Hyperpituitarism Clinical Manifestations |
Pituitary adenoma-benign tumor in anterior pituitary.
↑PRL →galactorrhea, amenorrhea, infertility, ↓libido, impotence, dyspareunia ↑GH→ gigantism (before puberty) or acromegaly (after closure of growth plates). Arthralgia, H/A, vision changes. Acromegaly- ↑size of lips, nose, prominent brow ridge, ↑head, hand & foot size. ↑ACTH- cushings disease, moon face, weight gain, ↑BG ↑TSH→hyperthyroidism |
|
|
Anterior Pituitary Gland
Hyperpituitarism Laboratory & Diagnostic |
↑ levels depending on hormone involved
↑ LH & FSH (normal in post menopausal women) CT & MRI show soft tissue lesions Angiography – R/O aneurysm or vascular malformation |
|
|
Anterior Pituitary Gland
Hyperpituitarism Interventions |
Nonsurgical-
bromocriptine mesylate (Parlodel)SE- orthostatic hypotension, cabergoline (Dostinex), and pergolide (Permax)- stimulate dopamine receptors in brain → inhibits hormone release (GH, PRL), ↓tumor size. Radiation- not useful in immediate mgmt of hyperpituitarism. SE-hypopituitarism, optic nerve damage, vision problems |
|
|
Anterior Pituitary Gland
Hyperpituitarism Surgical Intervention |
Transsphenoidal hypophysectomy-MIS, gland removed, muscle graft from thigh placed to prevent CSF leakage, nasal packing & mustache dressing (Monitor for presence of glucose or yellow halo)
Avoid coughing early postop. Monitor for signs of meningitis indicating infection |
|
|
Anterior Pituitary Gland
Hyperpituitarism Home Care |
Post op -Avoid bending over → ↑ICP, high fiber diet, push fluids, gentle tooth brushing until incision healed, may have numbness or ↓ sense of smell up to 3 months. Lifetime hormone replacement (ADH, thyroid, cortisol, gonadal hormones)
|
|
|
Parathyroid Gland function
|
maintains calcium & phosphorus balance
|
|
|
Parathyroid Gland
Hyperparathyroidism Pathophysiology |
↑ parathyroid hormone (PTH) act directly on the kidney, causing ↑ kidney reabsorption of calcium &↑ phosphate excretion.
In bone, ↑ PTH levels ↑ bone resorption (bone loss of calcium) by ↓osteoblastic (bone production). ↑PTH → renal calculi & deposits of calcium in the soft tissue of the kidney. Bone lesions are due to ↑rate of bone destruction →pathologic fractures, bone cysts, & osteoporosis. |
|
|
Parathyroid Gland
Hyperparathyroidism Causes |
Parathyroid adenoma , Parathyroid carcinoma , Congenital hyperplasia , Neck trauma or radiation , Vitamin D deficiency, Chronic kidney disease with hypocalcemia , Parathyroid hormone–secreting carcinomas of the lung, kidney, or GI tract
|
|
|
Parathyroid Gland
Hyperparathyroidism Clinical Manifestations |
anorexia, nausea, vomiting, epigastric pain, constipation, weight loss. Fatigue and lethargy as the serum calcium ↑. Serum Ca++ > 12 mg/dL- may have psychosis with mental confusion→coma & death if untreated.
|
|
|
Parathyroid Gland
Hyperparathyroidism Laboratory & Diagnostic |
↑Serum PTH, ↑calcium, and↓ phosphate
|
|
|
Parathyroid Gland
Hyperparathyroidism Interventions |
Diuretic and hydration therapies are used most often for reducing serum calcium levels in patients who are not candidates for surgery.
furosemide (Lasix) with IV saline in large volumes → renal calcium excretion. Oral phosphates inhibit bone resorption and interfere with calcium absorption. Calcium chelators (Mithramycin) ↓ calcium levels by binding (chelating) calcium Parathyroidectomy- calcium levels are decreased to near normal prior to surgery. If mithramycin used check bleeding and clotting times & CBC to determine bone marrow function. Tumor on one side but the other side normal- remove the glands containing tumor, leave remaining glands on the opposite side. If all four glands are diseased- all removed. |
|
|
Parathyroid Gland
Hyperparathyroidism Post Op Managemet |
Closely observe for respiratory distress, which may occur from compression of the trachea by hemorrhage or swelling of neck tissues. Maintain suction, oxygen, and tracheostomy equipment at bedside. If severe swelling occurs, the surgeon may need to remove clips from the incision to preserve the airway. Monitor vital signs, check the neck dressing for abnormal amounts of drainage or bleeding (1 -5 mL is normal)
|
|
|
Parathyroid Gland
Hypoparathyroidism Pathophysiology |
lack of parathyroid hormone (PTH) secretion or to decreased effectiveness of PTH on target tissue
|
|
|
Parathyroid Gland
Hypoparathyroidism Causes |
Surgical or radiation-induced thyroid ablation, Parathyroidectomy , Congenital dysgenesis , Idiopathic (autoimmune) hypoparathyroidism , Hypomagnesemia
|
|
|
Parathyroid Gland
Hypoparathyroidism Clinical Manifestations |
Excessive or inappropriate muscle contractions that cause finger, hand, and elbow flexion. +Chvostek's sign &Trousseau's sign
|
|
|
Parathyroid Gland
Hypoparathyroidism Laboratory & Diagnostic |
↓Serum PTH, ↓Serum calcium, ↑phosphate, ↓magnesium
|
|
|
Parathyroid Gland
Hypoparathyroidism Interventions |
Correct hypocalcemia, vitamin D deficiency, & hypomagnesemia.
Severe hypocalcemia give IV calcium chloride or calcium gluconate over 10 to 15 minutes. Acute vitamin D deficiency give calcitriol (Rocaltrol), 0.5 to 2 mg daily. Acute hypomagnesemia give 50% mag sulfate in 2-mL doses (up to 4 g daily) either IM or IV. Long-term - calcium, 0.5 to 2 g daily, in divided doses. Long-term - vitamin D 50,000 to 400,000 units daily. Teach to eat foods ↑calcium but ↓phosphorus. Avoid milk, yogurt, & processed cheeses - ↑ phosphorus content. Therapy for hypocalcemia is lifelong. Wear a medical alert bracelet. |
|
|
Posterior Pituitary
Function |
Vasopressin (ADH – controls fluid balance) & oxytocin (induces contractions for labor) are produced in the hypothalamus & sent through the nerve tracts that connect the hypothalamus with the posterior pituitary. Hormones are stored in the nerve endings of posterior pituitary and released into blood when needed.
|
|
|
Posterior Pituitary
Diabetes Insipidus |
ADH deficiency results in the excretion of large volumes of dilute urine (4-30 liters/day).
|
|
|
Posterior Pituitary
Diabetes Insipidus Causes |
Neprogenic- inherited-renal tubules don’t respond
Primary- defect in the hypothalamus or pituitary gland resulting in a lack of ADH production or release Drug induced- Lithium carbonate, demeclocycline (interfere with kidney’s response to ADH |
|
|
Posterior Pituitary
Diabetes Insipidus Clinical Manifestations |
Increase in the frequency of urination and excessive thirst. Signs of dehydration. U/O 4 liters > intake.
|
|
|
Posterior Pituitary
Diabetes Insipidus Laboratory & Diagnostic |
↓ urine specific gravity, ↑ H&H, ↑BUN
|
|
|
Posterior Pituitary
Diabetes Insipidus Interventions |
chlorpropamide (Diabinese)-↑action of existing & stimulates production of ADH in hypothalamus
Desmopressin acetate (DDAVP) is a synthetic form of vasopressin given orally or intranasally in a metered spray- mild 1-2 doses/24, severe 2-3 doses/24 hr. |
|
|
Posterior Pituitary
Diabetes Insipidus Nursing Intervention |
Monitor I/O, daily weights, monitor for dehydration, push PO fluids
|
|
|
Posterior Pituitary
Diabetes Insipidus Home Care Patient teaching |
Permanent DI requires lifelong desmopressin or vasopressin therapy. Teach that polyuria and polydipsia are signals for the need for another dose.
|
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate antidiuretic hormone) |
vasopressin (antidiuretic hormone [ADH]) is secreted even when plasma osmolarity is low or normal. A decrease in plasma osmolarity normally inhibits ADH production and secretion.
|
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Causes |
Cancer and cancer treatment, recent head trauma, stroke, TB, pneumonia, lung abscess, chronic lung disease, pneumothorax, SLE
Drugs- chemotherapeutic agents, general anesthesia, tricyclic antidepressants, opioids |
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Clinical Manifestations |
Water is retained, → dilutional hyponatremia. Anorexia, N/V, weight gain, lethargy, headaches, hostility, disorientation, and a change in level of consciousness, ↓ DTRs, ↑HR, hypothermia
|
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Laboratory & Diagnostic |
Serum Na < 115 mEq/L. dilutional ↓H&H
|
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Interventions |
Fluid restriction - as low as 500 to 600 mL/24 hr. Dilute tube feedings with saline rather than plain water, and use saline to irrigate GI tubes. Mix drugs to be given by GI tube with saline.
Diuretics Hypertonic saline (3% NaCl)- given slowly, monitor for worsening fluid overload Demeclocycline (Declomycin)-monitor for Candida. |
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Nursing Interventions |
Monitor the patient's response to therapy to prevent the fluid overload from SIADH from becoming worse, leading to pulmonary edema and heart failure. Monitor for seizures, confusion. Safety with hyponatremia
|
|
|
Posterior Pituitary
SIADH (Syndrome of inappropriate Home Care Patient teaching |
Oral care for thrush-, eat yogurt, daily weight
|
|
|
Thyroid Gland
Function |
control metabolism. Calcitonin (secreted by thyroid) lowers serum calcium & phosphorous levels by reducing bone reabsorption.
|
|
|
Thyroid Gland
Hyperthyroidism Pathophysiology |
↑ secretion of thyroid hormone called thyrotoxicosis
|
|
|
Thyroid Gland
Hyperthyroidism Causes |
Graves’ disease (autoimmune disorder), toxic multinodular goiter, excessive thyroid replacement
|
|
|
Thyroid Gland
Hyperthyroidism Clinical Manifestations |
↑ metabolism- diaphoresis, thin hair, smooth warm skin, SOB with exertion, ↑resp rate, palpitations, CP, ↑sys BP, ↑HR, dysrhythmias, wt. loss, ↑appetite, ↑BM, hypoproteinemia, muscle weakness & wasting, blurred vision, ↑tears, photophobia, ↑DTRs, insomnia, heat intolerance, low-grade fever, fatigue, restless, irritable, emotional liability, manic behavior, amenorrhea, ↑libido, goiter, exophtalmos, enlarged spleen
|
|
|
Thyroid Gland
Hyperthyroidism Laboratory & Diagnostic |
↑ T3, ↑T4, ↓TSH (graves disease), ↑TSH (secondary hyperthyroidism ↓WBC, Thyroid scan evaluates the position, size, and functioning of the thyroid gland, Ultrasonography can determine its size and the general composition of any masses or nodules.
|
|
|
Thyroid Gland
Hyperthyroidism Interventions |
Drug therapy-propylthiouracil (PTU) [preferred drug] and methimazole (Tapazole)-block thyroid hormone production by preventing iodide binding in the thyroid gland. Iodine preps may be used prior to surgery to ↓ bld flow to thyroid→↓hormone release.
Lithium – inhibit hormone release. Beta-blocker to ↓HR, palpitations, anxiety & diaphoresis Radioactive iodine (RAI) therapy –given in oral form, The thyroid gland picks up the RAI, and some of the cells that produce thyroid hormone are destroyed by the local radiation. Contraindicated with pregnancy- damage fetal thyroid gland. Because the thyroid gland stores thyroid hormones to some degree, the patient may not have complete symptom relief until 6 to 8 weeks after RAI therapy. Additional drug therapy for hyperthyroidism is still needed during the first few weeks after RAI treatment. No radiation precautions needed. |
|
|
Thyroid Gland
Hyperthyroidism Surgical Intervention |
Total or subtotal thyroidectomy-drug therapy 1st to have euthyroid function prior to surgery. HTN, dysrhythmias, ↑HR must be controlled during surgery
|
|
|
Thyroid Gland
Hyperthyroidism Nursing Interventions |
Postop Mgmnt-VS q 15-30 min, maintain semi fowlers position, maintain head & neck alignment, humidified air, monitor for signs of ↓Ca++ (parathyroid injury)- tetany around mouth. Monitor for hemorrhage-inspect behind neck. Monitor respiratory status-stridor indicates laryngeal swelling, O2. Keep trach tray at bedside.
|
|
|
Thyroid Storm
|
life threatening event occurs with Graves’ disease. Patient has sudden ↑ in metabolic rate → fever, tachycardia & HTN.
|
|
|
Thyroid Gland
Hypothyroidism Pathophysiology |
Under secretion of thyroid hormone
|
|
|
Thyroid Gland
Hypothyroidism Causes |
Hypothalamus & pituitary don’t secrete TSH, overtreatment of hyperthyroidism, Autoimmune thyroid destruction, thyroid cancer, Drugs-Lithium
|
|
|
Thyroid Gland
Hypothyroidism Clinical Manifestations |
↓ metabolism- cool, dry, scaly skin, brittle nails & hair, poor wound healing, dyspnea, poor ventilation, ↓HR, ↓BP, dysrhythmias, enlarged heart, ↓activity intolerance, ↓temp, cold intolerance, slow intellectual functioning, lethargy, ↓DTRs, apathy, depression, anorexia, wt. gain, constipation, amenorrhea, ↓libido, impotence, fluid retention & edema, goiter, nutritional anemias, ↓U/O, thick tongue, hoarseness
Provide safe environment with cognitive disturbance. Monitor for manifestations of ↓ cardiac output |
|
|
Thyroid Gland
Hypothyroidism Laboratory & Diagnostic |
↑TSH, ↓T3,↓T4,
|
|
|
Thyroid Gland
Hypothyroidism Interventions |
levothyroxine sodium (Synthroid, T4, Eltroxin- started with low doses and gradually increased over a period of weeks. Lifelong treatment
|
|
|
Thyroid Gland
Hypothyroidism Myxedema coma |
Brought on by acute illness, surgery, chemotherapy, sudden d/c of hormone therapy, sedatives & opioid use
Lead to coma, resp failure, ↓BP, ↓Na+, ↓BG, hypothermia. If left untreated lead to death |
|
|
Thyroid Gland
Hypothyroidism Nursing Interventions |
Assess for chest pain & dyspnea during initial treatment. Wear medic alert bracelet. Teach S&S of hypo & hyperthyroidism, adequate diet to prevent constipation-fiber supplements can interfere with absorption of thyroid hormone. Take drug on empty stomach. May need to ↑ dose if patient has insomnia or constipation.
|
