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92 Cards in this Set
- Front
- Back
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GIGANTISM is caused by .... and occurs in....before....
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Excess growth hormone from the anterior pituitary gland and occurs in children before the epiphysis is closed.
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What is acromegaly?
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Excess growth hormone from tumor on anterior pituitary causing growth after the epiphysis is closed.
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Acromegaly causes what physical changes?
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Enlarged hands and feet, tufted/club fingers, joint pain, jutting jaw, thick oily skin, cardiomegaly (enlarged heart)
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Growth Hormone Excess Treatment
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Hypophysectomy through transphenoidal approach (most common), stereotactic radiation therapy,
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Hypophysectomy includes what?
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Surgical removal of tumor go through nose or upper lip under the nose.
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What is a disorder of the posterior lobe of the pituitary gland that is characterized by a deficiency of ADH?
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Diabetes Insipidus
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Diabetes Insipidus may occur secondary to...
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head trauma, brain tumor, surgical ablation, or irradiation of the pituitary gland
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Diabetes insipidus may also occur with infections of the CNS or with tumors.. these are?
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meningitis, encephalitis, tuberculosis
metastatic disease, lymphoma of the breast or lung |
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What is the urine specific gravity of those who have diabetes insipidus?
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1.001 to 1.005
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Attempts to restrict fluids in a patient with diabetes insipidus would cause the patient to experience...
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extreme thirst, severe dehydration, and may develop hypernatremia (sodium retention)
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What is thyroidtoxicosis ?
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Too much serum T3 & T4
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What would you do to treat thyroidtoxicosis?
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ice packs, hypothermic blanket, cool environment, hydrocoritsone, tylenol.
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Why would you not give asprin to a person who is experiencing a thyrotoxic crisis?
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Asprin displaces thyroid hormone from binding proteins and worsen the hypermetabolism.
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What are the signs and symptoms of SIADH? (syndrome of inappropriate antidiuretic hormone) too much or too little ADH
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Fluid retention, serum osmolality decreased and urine osmolality is normal, dilutional hyponatremia, concentrated urine with normal or increased edema
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Lactated ringers is what type of solution?
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Isotonic solution
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What is one way to treat hyperthyroidism?
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Administer thyroid hormones so that you can put the thyroid to rest.
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S/S of Hyperthyroidism
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hyper-excitability irritable, apprehensive, palpitations, rapid pulse at rest, tolerate heat poorly, sweat easily, flushed skin, skin is warm,soft, and moist. Fine tremor of the hands.
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Manifestations of Hyperthyroidism
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Increased appetite, progressive weight loss, abnormal muscular fatigability and weakness (difficulty climbing stairs) amenorrhea, and changes in bowel function.
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What is the normal pulse rate for a patient with hyperthyroidism?
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90-160 bpm with systolic blood pressure elevated- not usually diastolic. Osteoporosis and fracture.
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What is most common in elderly patients with hyperthyroidism?
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Cardiac decompensation, in the form of heart failure.
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Bulging eyes related to Grave's disease is also referred to as...
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Exophthalmos which produces a startled facial expression
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Symptoms of hyperthyroidism may occur with..
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Excessive release of thyroid hormone
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Excessive release of thyroid hormone can be a result of...
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Inflammation after irradiation of the thyroid or destruction of thyroid tissue by tumor. Or excessive administration of thyroid hormone used to treat hypothyroidism.
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Assessment of hyperthyroidism
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Palpation, the gland is enlarged, soft and may pulsate and a bruit is heard of the thyroid arteries.
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Goiter can be caused by and excess of what hormone?
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TSH
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Treatment of goiter (enlarged thyroid) is...
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Surgical removal which may be total, lobe or isthmus removal. Radiation may also be used.
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What will a patient who has partial, total or isthmus removal of the thyroid need?
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Patient will need Synthroid replacement therapy
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Hashimoto's Thyroiditis
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Chronic condition where the thyroid tissue is replaced with lymphocytes and fibrous tissue.
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Hashimoto's thyroiditis is the most common form of
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Hypothyroidism and goiter which is silent and painless
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Usually takes how long to regulate synthroid (thyroid replacement therapy)
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6 Months
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Maintenance needed with hypothyroidism therapy
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Will need to draw serum levels and then regulate dosage of synthroid.
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Medical treatment of thyroiditis
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Monitor TSH, IV antibiotics (send serum culture before giving) surgical drainage for bacterial causes, surgical removal, NSAIDS for inflammation, Corticosteriods for acute phase, Beta blockers for hyperthyroid conditions
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Most common bacteria that causes thyroiditis?
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Staph
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Patients with thyroiditis or hyperthyroid conditions are given a beta blocker because...
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Elevated heart rate, They are used because the patient can be very tachycardic and these relax smooth muscle.
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Nursing considerations for a patient suffering from thyroiditis
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Vital Signs, Eduacation, Compliance with treatment regimen, risk of other autoimmune disorders such as addisions, post op care
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What is a common symptom of hyper and hypothyroid
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Eye Dryness
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A thyroid storm or thyrotoxic crisis can be caused by...
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Stressors such as infection, trauma in people with pre-existing hyperthyroidism
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What is the first line of defense against a patient who is suffering from a thyroid storm?
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Antithyroid medications
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Medical treatment of a patient who is suffering from a thyroid storm?
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reduce circulating thyroid hormone, treatment of respiratory depression, fever reduction, and fluid replacement
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Why would you give a patient suffering from a thyrotoxic crisis fluids containing dextrose?
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They will replace liver glycogen stores that have been decreased in the hyperthyroid patient.
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Nursing management for a patient experiencing a thyroid storm?
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Monitor all body systems, monitor for cardiac dysrythmias, adequate oxygenation, IV fluid replacement (monitor volumes), calm quiet environment, protect cornea from abrasions, education, care of surgical patient.
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A dose of ______ initially causes an acute release of thyroid hormone from the thyroid and may cause increased symptoms. (thyroid storm)
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Radioactive Iodine Therapy
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The goal of radioactive iodine therapy is to...
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destroy overactive thyroid cells
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Hydrocortisone or Solumedrol is prescribed for a patient undergoing thyroid storm because...
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to treat shock or adrenal insufficiency as well as to subside inflammatory process
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When should a patient take Synthroid or any thyroid hormone replacement?
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Take on an empty stomach for proper absorption, same time every day.
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Patient should be sure to let the doctor know immediately while taking antithyroid medications symptoms like...
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sign of infection, especially pharyngitis and fever or the occurrence of mouth ulcers
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A goiter of hypothyroidism is caused by a lack of what in the diet?
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Iodine
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A goiter which is an enlarged thyroid is caused by over production of TSH which is from which gland?
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Pituitary Gland
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What OTC medications can cause a false reading on a thyroid serum test?
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topical antiseptics, multivitamin prep, food supplements, cough syrups.
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What other medications would cause an elevated T3 and T4 count?
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estrogens, salicylates, amphetamines, chemo agents, antibiotics, coritcosterioids and mercurial diuretics.
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Patients with hyperthyroidism exhibit a high uptake of what?
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Iodine (Radioactive Iodine Uptake test)
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Reading results of a Radioactive Iodine uptake test and the patient exhibits a low uptake shows that the patient is experiencing...
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Hypothyroidism
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A patient who has had hypothyroidism for a long period is almost certain to have an elevated serum __________, ______, & __________
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Cholesterol, atherosclerosis, and coronary artery disease.
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Signs and Symptoms of hypothyroidism
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Fatigue/Lethargy, personality.mental changes, impaired memory,slowed speech,depression,sleep pattern disturbances, decreased cardiac output, anemia, constipation,cold intolerance,hair loss, dry course skin, hoarseness, weight gain
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One of the major things that needs to be watched and avoided when treating a patient with hypothyroidism is...
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Cardiac dysfunction
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The occurrence of angina in a patient with hypothyroidism is the signal that the...
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oxygen needs of the myocardium exceed its blood supply
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Thyroid hormones enhance the cardiovascular effects of what?
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catecholamines
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When a patient is taking thyroid hormone replacement you should watch the effects of what type of agents?
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Hypnotic and sedative agents, people with hypothyroidism have a low tolerance, they should be given one half or one third of what is typically prescribed for patients.
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Thyroid hormones may increase levels of what in the blood?
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Glucose
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In a case of myxedema coma what is usually given IV until consciousness is restored?
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Syntrhyroid (levothyroxine) then treatment continues with PO hormone therapy.
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because of an assocaiated adrenocoritcal insufficiency _____ therapy may be necessary.
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Corticosteroid
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Medical management of hypothyroidism?
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Synthroid, treat elevated cholesterol (statin drug), monitor for angina and oxygen levels, treat dysrythmias
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Why would you want to watch a patients oxygen level who is suffering from hypothyroidism?
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Lack of oxygen in the blood could cause angina because the myocardium is not getting the oxygen it needs to work.
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Nursing considerations of a patient with hypothyroidism
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Monitor oxygen levels, monitor for med interactions, modify activity, monitor physical and mental status, educate, self care support
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Signs and symptoms of myxedema coma
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hypothermia, hyperventilation, hypotension
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Medical treatment of patient with myxedema coma
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IV thyroid hormone, supportive therapies of synthroid, monitor cardiac status, monitor glucose, and do not overload with fluids.
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Nursing considerations for a patient experiencing myxedema coma
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support of euthyroid state, low calorie diet, synthroid (small dose and then increase if needed) Check for cardiac side effects, teaching of patient and family emotional support.
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During a thyroidectomy the doctor tries to avoid taking parathyroid tissue to reduce the risk of what?
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Postoperative hypocalcemia and tetany
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Hyperparathyroidism is most commonly caused by what?
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Benign tumors on the parathyroid gland
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Parathormone a protein hormone produced by parathyroid glands regulates what?
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Calcium and phosphorus metabolism
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Increased secretion of parathormone results in increased...
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calcium absorption from the kidney, intestine, and bones, which raises the blood calcium level.
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Negative feedback system of parathyroid?
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Elevation in serum calcium results in decreased parathormone production
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Excess parathormone levels will cause excess calcium which ultimately leads to what?
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Calcium phosphate precipitation in various organs of the body causing tissue calcification (kidney stones)
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Hyperparathyroidism is characterized by...
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bone decalcification, and the development of renal calculi
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What is Bone de-calcification?
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Calcium is pulled out of the bones and put into the blood stream
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Clinical manifestations of patients who have hyperparathyroidism
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No symptoms,Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias
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If high serum calcium levels are found what test needs to be done in order to rule out nonspecific finding?
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Double antibody parathyroid hormone test.
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The recommended treatment for a patient with hyperparathyroidism
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surgical removal of abnormal parathyroid tissue
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Surgery may be delayed for a patient with hyperparathyroidism if
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their serum calcium are only slightly elevated and they still have normal renal function. They do need to be monitored closely for worsening of hyper calcemia.
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Whats a good way to treat acute tetany?
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IV calcium push slowly
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After removal of the parathyroid glands what can happen almost immediately to the patient?
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Tetany
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Signs and Symptoms of Tetany
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unpleasant tingling of the hands, around the mouth, muscular spasms, laryngospasm,carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias, and seizures. Other symptoms include anxiety, irritability, depression, and even delirium.
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Most common cause of Hypoparathyroidism is?
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accidental removal of the glands or loss of blood supply to the gland during neck surgery
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Severe _______ can lead to PTH secretion.
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Hypermagnesmia.
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A patient is having a hypercalcemic crisis when the serum calcium levels are greater than _____
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15mg/dL
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Treatment of a hypercalcemic crisis
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Re-hydration with large volumes of IV fluids, diuretic agents to promote renal excretion of excess calcium, phosphate therapy.Dialysis may be used in emergency situations.
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Which hormone controls water balance by causing an uptake of sodium ions and followed by water re absorption in the kidney?
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Aldosterone
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What vitamin do you need to activate calcium and enhance intestinal absorption?
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Vitamin D
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For a patient with hypoparathyroidism (hypocalcemic) what diet is recommended and what should be avoided?
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A diet high in calcium and low in phosphorus.
Milk products and egg yolk are high in calcium but they are high in phosphorus therefore should be avoided. Spinach should be avoided because it contains oxalate with forms insoluble calcium substances. |
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Glucocorticoids interfere with glucose metabolism resulting in
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Hyperglycemia
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What is the hormone that regulates release of TSH?
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Thyroid releasing Hormone TRH
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Can you hear bruits and feel a thrill with Graves disease or thyroiditis?
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Grave's only
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