Endocrine: Med Surge

Front 1

Hypopituitarism: most life threatening

Back 1

ACTH and TSH deficiencies

Front 2

hypopituitarism creates problems with

Back 2

1. 2 sex characteristics (LH, FSH)
2. retarded growth (GH)
3. hypothyroidism (TSH)
4. adrenal hypofunction (ACTH)
5. Diabetes Insipidus (ADH)

Front 3

Causes of hypopituitarism:

Back 3

1. tumor
2. malnutrition
3. severe hypotension or shock
4. Brain: trauma, surgery, tumor, infection
5. Postpartum hemorrhage: most common

Front 4

clinical manifestations of hypopituitarism

Back 4

1. vision chg- peripheral
2. temporal headache
3. chg in secondary sex characteristics

Front 5

Nx concern for gonadotropin deficiency

Back 5

decreased bone density

Front 6

Nx concern for GH deficiency

Back 6

bone destruction
muscle strenght

Front 7

Nx concern for TSH deficiency

Back 7

slowed cognition, lethargy

Front 8

Nx concern for ACTH deficiency

Back 8

hypoglycemia, hyponatremia, postural hypotension

Front 9

What is pt displaying w/ gonadotropin deficiency

Back 9

1. secondary sec characteristics
2. testicular/ovarian failure
3. sterility/infertility
4. amenorrhea
5. decreased libido

Front 10

What is pt displaying w/ GH deficiency

Back 10

decreased muscle strength
increased cholesterol

Front 11

What is pt displaying w/ TSH deficiency

Back 11

wt gain
slow cognition
intolerance to cold

Front 12

What is pt displaying w/ ACTH deficiency

Back 12

diabetes insipidus: polyuria, polydypsia
hypotension
dehydration

Front 13

testosterone replacement
1. avoid w/
2. SE:

Back 13

1. avoid in men w/prostate cancer
2. SE: gynecomastia, acne, baldness, prostate enlargement

Front 14

caution re: women on estrogen

Back 14

thrombosis risk- holeman sign
stroke and HTN risk: monitor w/serial BP

Front 15

causes of excess- hyperpituitarism

Back 15

adenoma
PRL secreting tumor

Front 16

most common symptoms w/ hyperpituitarism

Back 16

visual chg, headache, increased intracranial pressure

Front 17

clinical manifestations of prolactin over production

Back 17

( visual chg, headache, increased intracranial pressure)
galactorrhea, increased body fat,
amenorrhea
decreased libido
inpotence/can't get pregnant

Front 18

clinical manifestations of acromeglay, GH overproduction

Back 18

visual chg, headache, increased intracranial pressure
increase shoe or hat size after age 25

Front 19

clinical manifestations of ACTH overproduction

Back 19

visual chg, headache, increased intracranial pressure
Cushings symptoms: moon face, truncal obesity

Front 20

questions to ask during assessment of hyperpituitarism

Back 20

1. visual chg, headache, increased intracranial pressure
2. shoe or hat size chg
3. sexual issues

Front 21

Drugs to inhibit release of growth hormone

Back 21

octreotide
bromocriptine- cardiac dysrhythmia

Front 22

Major SE bromocriptine:

Back 22

orthostatic hypotension gastric irritation, N, headache, abd cramp, constipation

Stop med if become pregnant

Front 23

name of surgery to remove pituitary

Back 23

transsphenoidal

Front 24

CAUTION ACTIVITIES THAT ↑ ICP FOR

Back 24

2 MONTHS DUE TO REPAIR OF BONE

Front 25

Instructions for after surgery: transsphenoidal

Back 25

1.Don’t brush teeth, cough, sneeze, blow nose= ↑ cranial pressure X 2 WKS
2.HEAD OF BED UP
3.AVOID BENDING OVER= ↑ INNER CRANIAL PRESSURE

Front 26

Observe after transsphenoidal surgery observe for

Back 26

1. LOC FOR MENTATION AND SENSATION
2. DIABETES INSIPIDUS
3. CSF LEAKAGE- ↑ postnasal drip, swallowing; TEST FOR GLUCOSE
4. Severe headache
5. INFECTION: meningitis: headache, fever, nuchal rigidity
6. ↑ CRANIAL PRESSURE
7. Ask about headache/visual disturbances

Front 27

diabetes insipidus is caused by

Back 27

lack of ADH

Front 28

normal urine output

Back 28

1500 ml/day

Front 29

Dx DI:

Back 29

urine output greater than 4L/24hr
specific gravity less than 1.005

Front 30

1. cardio symptoms of DI

2. monitor

Back 30

1. hypotension, decreased pulse pressure, tachycardia, weak peripheral pulse, hemoconcentration ↑ hemoglobin, ↑ hematocrit, ↑ BUN
2. sitting and standing, apical pulse (for 1 full minute)- rate and quality, hemoglobin, hematocrit, BUN, listen for heart mumur(-K+off)

Front 31

neuro symptoms of DI

2. monitor

Back 31

1. thirst, irritable, ↓ cognition, hyperthermia (fever due to inability to regulate temp), lethargy to coma, ataxia
2. Monitor: I& O, temp, LOC

Front 32

kidney symptoms of DI

2. monitor

Back 32

1. copious amts of dilute, low specific gravity, hypo-osmolar

2. Monitor: specific gravity, look at BUN for kidney function, look at I&O

Front 33

skin symptoms of DI

Back 33

dry mucous membrane, poor turgor

Front 34

1. drugs used for DI
2. watch for signs of

Back 34

1.desmopressin\vasopressin/chlorpropamide

2. water toxicity

Front 35

s/sx water toxicity

value for anurea

Back 35

lethargy, headache, confusion, wt. gain, anurea, siezures

<100/24hrs

Front 36

Nx intervensions for desmopressin (synthetic ADH)

Back 36

1. warn pt not to drink more than 3L/day (pulmonary edema)
2. daily weights (>2lb/day notify health provider- excessive water retention)
3. monitor for headaches, confusion- water toxicity
4. inhaled form: blow nose first, sit upright, hold breath while spraying

Front 37

SE chlorpropamide

Back 37

hypoglycemia

Front 38

What is SIADH-

Back 38

ADH continues to be released, water retained, excess Na+ not retained = dilutional hyponatremia

Front 39

deep tendon reflex, decreased w/

Back 39

SIADH

Front 40

SIADH: manifestations
nuero, GI, vital, I&O

Back 40

*Neuro- due to hyponatremia and fluid shifts: lethargy, headache, hostility, disorientation, LOC chg, se sizure precaution when there is osmotic shift in brain-
*GI: loss appeitite, N/V
*Vital Signs: full bounding pulse, hypothermia
*I&O: ↓ urine volume , ↑ urine osmolarity, ↑ urine Na+, ↑ specific gravity

Front 41

Interventions for SIADH

Back 41

1.Restrict fluid intake (500-600 ml/24hrs)
2.Use saline in tube feeding, irrigate GI tube, mix GI tube meds w/saline - to replace Na+
3.Daily weights

Front 42

S/sx fluid retention is getting worse w/ SIADH

Back 42

1. bounding pulse
2. neck vein distention
3. crackles in lungs
4. decrease urine output
5.peripheral edema

Front 43

drug for SIADH- promotes water excretion

black box warning

Back 43

Tolvaptan- caution: rapid Na retention

Front 44

Addison

Back 44

acute adrenal insufficiency
loss of aldosterone and cortisol

Front 45

In Addison's, the decreased cortisol results in

decreased aldosterone

Back 45

Cortisol- hypoglycemia

Aldosterone- hyperkalemia (dysrythmia-cardiac arrest)
hypovolemia, hyponatremia

Front 46

What contributes to a person entering into Addison's

Back 46

stress
removal of glucocorticoid therapy

Front 47

Addison's treatment focuses on 3H's

Back 47

hormone replacement
hyperkalemia management
hypoglycemia management

Front 48

1.how is the hyperkalemia of addison's managed

2. what do you monitor

Back 48

1.insulin helps promote uptake of K into cells
loop or thiazide diuretic

2. labs: Na/K, heart rate/rhythm, ECG

Front 49

symptoms of hypoglycemia

Back 49

SHAKING, SWEATING, DIZZY, ANXIOUS, WEAK, HEADACHE, IRRITABLE, TACHYCARDIA

Front 50

In addison's crisis how often do you monitor blood sugar?

Back 50

every 30 min

Front 51

what is the most definitive assessment for addision

what must you have in room before performing

Back 51

ACTH stimulation

need monitoring equipment, crash cart, antidote

Front 52

what are the key features for addison
1. neuro
2. GI
3. skin
4. cardio

Back 52

1. neuro: muscle weakness, fatigue
2. GI: salt craving, wt loss, anorexia, N/V, bowel chg
3. skin: hyperpigmentation, vitiligo
4. anemia, hypotesnion, hyponatremia, hyperkalemia, hypercalcemia

Front 53

What is the focus of intervention w/ Addison

Back 53

fluid balance
hypoglycemia

Front 54

what do we monitor w/ Addison?

Back 54

daily wt, I&O
postural hypotension, dysrhythmia (ECG, pulse)
Labs: Na, K, Ca, glucose, BUN, cortisol, bicarb

Front 55

Medication for Addision

When are they given?

Back 55

Cortisone
hydrocortisone
fludrocotrisone

Given 2/3 in morning, 1/3 in evening

Front 56

NI for cortisone (addison's)

Back 56

instruct pt to take w/snack to minimize GI discomfort

Front 57

s/sx drug toxicity for hydrocotrisone (Addison's)

Back 57

wt gain, round face, fluid retention

Front 58

what to monitor w/ fludrocortisone? aldosterone replacement

Back 58

BP, wt, Na/H2o retention, edema

Front 59

Cushings 1. define
2. symptoms
fat, skin, CV, musco/skel, immune

Back 59

hypercortisolism
2. moon face, hump, truncal obesity
skin: thin, petechae, pigmentation, striea
CV: hypertension, increase risk thrombus, fragile capillary
muscle atrophy, osteoporosis
Immune: decreased

Front 60

labs for Cushings

Back 60

cortisol levels: urine, saliva, blood
Na/K, Ca
glucose

Front 61

what suppression test is used to dx Cushings

Back 61

dexamethasone

Front 62

Cushing pt and fluid status

S/SX

Back 62

Cushing's pts. are in fluid overload

Signs of fluid overload: bounding pulse, neck vein distention, lung crackles, peripheral edema, decreased urine output, low specific gravity <1.005

Front 63

Used to decrease cortisol production. What are we going to monitor?

Back 63

Glucose, CBC- rbc TAKING BEATING , Na, K+, Ca+

I&O

Front 64

nutritional considerations for Cushings

Back 64

limit salt and H2O
take daily wt to monitor fluid overload

Front 65

After surgery for Cushings pt, what need to monitor?

Back 65

epi stimulation from adrenal gland

Front 66

Hyperaldosteronism

Back 66

over production of aldosterone

too much water retention, neuro and fluid problem
Na retention, K excretion

Front 67

3 P's of hyperaldosteronism

Back 67

polyuria, polydipsia, paresthesis (numb, tingling feeling)

Front 68

s/sx of hyperaldosterosism

Back 68

a. HA, HTN, Headache, fatigue, muscle weakness, plus 3 P's Polydipsia, polyuria, paresthesis
i. Take serial BP

Front 69

Drug: for hyperadlosteronism
a. Watch for

Back 69

spironolactone- K wasting diuretic- takes up to 48 hrs to take effect

1. hyperkalemia
2. Hyponatremia: dry mouth, thirst, lethargy, drowsiness

Front 70

SE of Spironolactone (K wasting diuretic, used for hyperaldosteronism)

Back 70

hyperkalemia, hyponatremia
endocrine effect
gynecomastia, diarrhea, drowsiness, headache, rash, urticaria, confusion, erectile dysfunction, hirsutism, amenorrhea

Front 71

pheochromocytoma

Back 71

catecholamine producing adrenal medulla tumor
Excess Epi/NE produced

Front 72

hallmark symptom of pheochromcytoma

Back 72

HTN: hallmark of disease

Front 73

Pheochromcytoma Dx:

Back 73

Dx: 24hr urine on ice w/sponge to preserve urine from turning to ammonia

Front 74

Pheochromcytoma assess:

Back 74

BP, HA, palpitations, diaphoresis, flushing, apprehension, Pain