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140 Cards in this Set
- Front
- Back
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What is acromegaly
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Over production of somatotropin (Gh) after the onset of puberty.
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When does acromegaly usually begin
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In the third or fourth decade of life
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What are the two causeses of acromegaly
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Idiopathic hyperplasia(increase number of cells)of anterior love of pituitary gland and tumor growth
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What happens to froth changes that occur with acromegaly
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They are irreversible even with adequate medical surgical intervention
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How is acromegaly characterized?
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By blushing forehead bulbous enlarged cranial lower jaw teeth separation bulging forehead nose thick lips enlarged tongue coursing facial features
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What happen to the tongue feet hands and finger tips of a person with acromegaly
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Grow larger fingertips develop tufted or club appearance
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What enlargements can Acromegaly lead to?
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Heart liver spleen muscle weakness develops
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What happens to make pt with acromegaly females?
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Become impotent females dev deepened voice increased facial hair amenorrhea
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What should be closely assessed in a pt with acromegaly
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Pt ability to maintain normal body function and quality of life
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If a tumor is present in Acromegaly what can it cause
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Pressure to the optic nerve may cause partial or complete blindness
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What are the first signs of acromegaly
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Visual disturbance serve headaches are common
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In acromegaly what changes in vital signs may be clue to onset of hf
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Dyspnea tachycardia weak pulse hypotension
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What is the pt at risk for after surgical removal of pituitary tumor
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Diabetes insipidus
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What are some sec complications to enlarge heart
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Hypertension hf cardiomyopathy
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What is the diagnosis of acromegaly based on
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Medical history the defensive test is growth hormone suppression test acromegaly levels donot fall
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What should be restricted before growth hormone suppression test in acromegaly
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Restrict pt oral intake for 10-12 hr
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What does medical treatments include for acromegaly
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Dopamine agonist such as dositex somatostostatin inhibit Gh sandostatin especially in pt not cand for surgery analogs and surgery
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What should a pt with acromegaly diet consist of
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Soft chewable foods
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What does gigantism result from
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Oversecetion of GH before the onset of puberty as a result of hyperplasia of the anterior pituitary
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What can the hyper plastic tissue develop in with gigantism
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Tumor
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What can be another possible cause of gigantism?
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Defect in he hypothalamus that directs the anterior pituitary to release excessive amounts of GH
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When does the overproduction of gigantism happeb
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Before the epiphyses close there is a overgrowth in long bone which cause info vial to grow abnormally tall and have increased muscle and visceral development
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What happens to the weight and the body in gigantism
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Weight increases body promotions are normal pt are weak
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What will other kinds of gigantism be cause by
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Gentic disorders or disturbance in sex hormones production
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What is the assessment of gigantism aimed at what test are used
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Early detection growth hormone suppression test
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What are the levels in a pt with giantism
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Baseline levels of Gh are high blood levels of growth hormone are also elevated for the diagnosis of gigantism
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What is the medical management of children with gigantism
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Surgical removal of tumor tissue or irradiation of anterior pituitary gland
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What would be related complications after the removal of anterior pituitary
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Hypertension hf osteoporosis thickens bones delayed sexual development
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Nursing interventions for gigantism
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Early detection height recorded at each visit decoration of two or more percentile levels from median should be reported girls usually experience more emotional problems than boys
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Why is early detection in gigantism essential
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Proper medical management can hinder the height of a child will reach visit pediatric endocrinologist
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What are the prognosis of a child with gigantism
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Better than before still less than that of the average info vial bec of cardiovascular and joint disorders
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What is hypo pituitary dwarfism caused by
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Growth hormone deficiency
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Most cases of dwarfism are
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Idiopathic small number can be autosomal recursive
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What do pt lack with dwarfism
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ACTH,tsh,and gonadotropin
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What are the clinical main festoons in dwarfism
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Short stature well proportioned well nourished but seem younger than age.
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When should you follow up about dwarfism what will they have problems with
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If child height is below third percentile dentition as the permanent teeth erupt since jaws are under developed sexual development delayed
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Are people with dwarfism able to reproduce
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Yes average height unless there is an accompanying deficiency in gonadotropin
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What would reveal previously successful coping Ayrshires in dwarfism
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Family history if dwarfism
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What happens with the weight if a child with dwarfism
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Normal birth weight compare current height and weight with standard growth charts compare with siblings
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What diagnostic test are used for a pt with dwarfism
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Radio graphic evaluation of the wrist to determine any difference between pt bone she and his chronolical age which might indicate a growth problem MRI ct scan to rule out pituitary tumor
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Defentive diagnosis is based on what in dwarfism what should you do
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A dec plasma levels of Gh restrict the pt oral intake after midnight for this test
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What is the medical management of a pt with dwarfism
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Replacement of Gh by injection if Tumor is the cause surgery is indicated nurses should be aware of expenses of this hormone
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What is diabetes insipidus
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Metabolic disorder of the pituitary occurs when the posterior pi does not produce sufficient adh or action of adh is diminished May be transit or permanent
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What does an decrease in adh cause
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Increased urinary output results in dehydration and increase plasma osmolality in lace in electrolytes and fluid components of plasma
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What sec can cause diebtic insipidus
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Head injury intracranial tumor intracranial abet drum infraction pituitary gland damaged during surgery infections such as encephalitis or meningitis
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What are the character ticks of diabetic insipidus
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Polyuria polydipsia(excessive thirst) loo urine dilate and look like water
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What is the normal range of urine specific gravity
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1.0003-1.030
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What is the normal urinary output
What is the urinary output of a person with diabetes insipdus |
1.5l/24
Exceeding 5-20 L/24 |
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What does this pt crave
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Fluids may drink 4-20L a day still become serve rely dehydrated and have increased levels of sodium in the blood due to excess urinary output
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What happen when unconious in pt with diabetic I
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Still produce qualified of urine after surgery or head trauma
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If diabetic I isn't prevented what can it cause
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Hypovolemic shock
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What are the manifestations of hypolvelic shock what does this follow
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Loc changes tachycardia tachyons hypotension
Trauma and blood loss |
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What wil the pt with Diabetic I be
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Weak tired lethargic
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What should be assessed in these pt
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Skin turgor color and gravity of urine vs
If skin is dry turgor poor and body weight is lost constipation may occur Determine nocturnal weigh pt before breakfast |
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Which test are used in diabetic I
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Urine gravity will drop below 1.003 and sodium will increase to more than 145 serum osmoliaty test will be greater than 300
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What is a key thing to remember about the fluid deprivation test for Diabetic I
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How the pituitary is producing AdH to rule out with hold fluids for 12 hr orthotic vs measured beg and ending weights are obtained
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When does Syndrome of Iapproaite Antidiyrtic hormone happen
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When the pituitary gland release to much ADH the kidneys tea sorb water decreasing urinary output expanding body fluid volume
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What will the pt with SIADH experience
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Hypoatremia he modulation fluid overload peripheral edema
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Whee is ADH stored
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In the posterior pituitary gland help regulates the body water blance
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What happens to water in SIADH
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It is reabsorbed decrease urinary output increase blood volume
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Who does SISDH occur more often in
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Older adults
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What are the clinical manifestations of S I ADH
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Hyponatremia and water retention progress is to water intoxication
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When does the signs and symptoms of SIADH occur
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When Serum sodium level as fall below 125 s/s include nausea vomiting tremors seizures stupor coma pathological reflexes
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What is the earliest symptom of SIADH
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Hyponatrimea report cramping anorexia nausea headaches watch if fluid intake exceed urinary output
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What kind of edema is noted in a pt with SIADH.
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Vascular weight gain is not always noted
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What are the later signs of SIADH
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Neuro become lethargic with personality changed has seizures deep tendon reflexes finish or disappear
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How are diagnosis of SIADH made
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Serum less than 280) normal 285-295 Hyponatrimea sodium less than 134 urine gravity greater than 1.032
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What would be he medical management for a pt with SIADH
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Fluid restriction 800-1000 per day with serve Hyponatrimea fluids must be restricted to 500 ml fluid intake should equal output d
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Medical management for SIADH
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Hypertonic saline solution 3-5% on I've slow rate to avoid rapid rise in sodium pill water out of brain cells may prescribe LASIx I'v only of serum sodium level is at least 125
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Closely mt what in pt with SiADH
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Intake output
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Nursing goals for a pt with SIADH
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Fluid restriction electrolyte replacement
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What is Hyperthyrodism also called
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Graves' disease exophthalmic goiter, thyrotoxicosis
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What is hyperthyroidism(Graves' disease )
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Increase activity overproduction of t4 and T4 leads to exaggerated metabolic process
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Who does Hyperthyrodism graves d occur in
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Women 20-40 autoimmune disorder with unknown etiology
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What are the clinical main festoons of Graves' disease Hyperthyrodism
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Visible edema of anterior portion of the neck enarlent of thyroid May cause exophthalmos enlargement of eyeballs peri orbital edema
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What can Exophthalmos cause
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Exposed corneas become dry develop corneal ulcer loss of vision
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What is the objective data of hyperthyroidism Graves' disease
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Vs changes increased Bp tachycardia hair becomes fine and brittle diarrhea bruit over thyroid skin warm flushed female pt stop menstration profuse diaphoresis tremors to hands hyperactivity clumsiness
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What symtoms do a pt with Hyperthyrodism Graves' disease have
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Weight loss. Nervousness, insomia shortness of breath
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What subjective data is noted in graves hypothyroidism
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Inability to concern gate memory loss dysphasia may become hoarse feel nervous jittery experience insomia heart palioations
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What is the thyroid controlled by
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The hypothalamus
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How is hyperthyroidism confirmed
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Decrease in TSH level
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What is medical management if Hyperthyrodism who is this dangerous to
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Ablation therapy using radioactive iodine is the gold standard.pregnant women
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Continue medical management
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Drugs that block the production of thyroid hormones such as PTU or Trapazole 6-8 weeks notice
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What are the nursing interventions for hyperthyroidism
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Diet therapy food high in protein increased b vitamins minerals carbs calcium bec of loss in bone density avoid osteoporosis between meal snaks food should be soft and easily swallowed coffee tea colas should be avoided
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What is some proper tube teaching for a pt with graves pre operative
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Stable environment to prevent hyper stimulation how to support head place both hands behind head and maintain anatomical position while rest of body is moved voice rest for 48 hrvouce checks every 2-4 hr slight hoarseness expected
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Post op graves
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Pt in semi fowlers avoid hyper extending head have suction or trach trach tray Ava for emergency use cool must humdifer special attention paid to rate depth of rr
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Internal bleeding s/s post op graves
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Restless apprehension increased pulse rate decreased blood pressure fullness in neck cyanosis notify surgeon
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Post op diet graves
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Clear cool liquids professing to soft food as tolerated followed by regular diet ASAP to regain lost weight
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Thyroidectomy
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Removal of the thyroid mt airway mt caropedal spasms chvostecks sign and Trousseus signi mr thyroid storm
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Normal serum Calicut level low serum causes edema of operative site symtoms
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9.0-10.5 numbness and tingling of fingers and toes and around mouth
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What are caropedal spasms
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Muscle spasms in wrist and feet increased pulse respiration and blood pressure anxiety and agitation
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What is the Chvostecks sign?
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Abnormal spasms of the facial muscles elicited by light taps in facial nerve for a person who is hypocalcemic
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What is Trousseues sign
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Late tetany spans induced by inflating a cuff to upper arm to pressure exceeding systolic Bp for 3 min pos in hypocalcemic
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What us the emergency treatment of tetany
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I'v calcium glauconite always Ava post op
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What happens if thyroid crisis occur
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Within first 12 hr post op all s/s nausea commuting severe tachycardia hypertension hyperthermia exceed 106 may dev hf
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What are the three goals in thyroid storm management
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Induce normal thyroid state, prevent cariodvascular collapse prevent excessive hyperthermia admins trot I'v sodium PTU and oxygen
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What diet should the pt practice until weight is stable
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High calorie high protein high carb
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What is hypothyroidism
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Most often in women 30-60 thyroid fails to secrete sufficient hormones slowing all body's metabolic process
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Causes of hypothyroidism
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Autoimmune response radiation therapy pituitary disorders iodine deficiency may result in treatment of hyperthyroidism
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What is serve hypothyroidism called in adukts
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My edema edema of the hands face feet periorbutal tissues
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What is congenital hypothyroidism called
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Cretinism infants are scanned
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Clinical manifestations of hypothyroidism
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Metabolic process slow decrease production of heat intolerance to cold weight gain consort artery disease decrease cardiac output decrease exercise tolerance and dyspnea on exertion
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What are early signs of hypothyroidism
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Weight gain difficulty concentrating constipation and fluid weight gain
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What are late signs if hypothyroidism
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Mood swings infertility acute fatigue syndrome depression
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Objective data of hypothyroidism
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Hair thins and may fall out skin become thick and dry facial features enlarge mask like voice low hoarse bradycardia dec Bp and rr dec in ability to preform activities weakness clumsiness ataxia
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What is a frequent complaint in women with hypothyroidism
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Menorah his excessive mental flow ovulation subsequent infertility may occur
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Diagnostic test for pt with hypothyroidism
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Tsh t4 t3 ft4
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How is hypothyroidism treated
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Hormone replacement using desiccated animal thyroid given in morning to enhance metabolizatiom of nutrients take on empty stomach hormone level my 6-8 weeks
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Nursing interventions for hypothyroidism
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Keep room at least 70-74degrees21-23 c be certain pr does not become chilled during bathing keep records of bowel elimination bec constipation is server stol sof bulk laxatives orderd provide high protein low calorie high fiber
Encourage increase fluid intake |
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What should be avoided in a pt with hypothyroidism
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Concentrated carbs sweets prevent assess weigh gain
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What to watch for hypothyroidism
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Chest pain dyspnea changes in rate rhytm of heart caution pt not to stop taking thyroid hormone without consulting physician must be taken for life take on consitrnt schedule morning empty stomach
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What is a simple goiter
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Develop when the thyroid gland enlarged in response to low idioms levels in blood
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Clinical manifestations simple goiter
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Physical appearance
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Symptoms of simple goiter
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Dysphasia hoarseness dyspnea
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Objective data for dimple goiter
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Size, voice changes adequacy of food and fluid
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Diagnostic testing for simple goiter
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Thyroid scan ultrasound of thyroid gland T3 T4 TSH levels
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Medical management for simple goiter
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Replacing iodine surgery to improve breathing or swilling anti hyperthyroid agent used to shrink the thyroid before surgery
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Once Thyroidectomy Is performed with simple goiter what's the treatment
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Oral administration of potassium iodine foods high in iodine seafood seaweed dairy grains iodized salt eggs
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Cancer of the thyroid
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Rare malignancy affects 25-1000 percent if people
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Risk factors of cancer of thyroid
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Diets low in iodine women in 49-50 radiation exposure
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How is cancer of thyroid characterized
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Firm fixed small rounded painless masses or nodule that is felt over thyroid gland grows slowly
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She is cancer if the thyroid diagnosed
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When thyroid scan shows cold nodule
Ultra sound ct cans |
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What us the treatment of thyroid cancer
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Total thryriodectomy life long hormone replacement
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What is hyperparathyroidism
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Over activity of the parathyroid glands increase production of other May result from chronic renal failure pyelonephritis or glouerulonephritis
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Who does hyperparathyroidism occur in
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Adults between 30-70 twice often on women risk factors are postmenpausal prolonged serve calcium vitamin d deficiency lithium use radiation to neck
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Clinical manifestations include
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Hypercalcemia cause skeletal pain fatigue weakness drowsiness pathological fractures dysthymias
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Diagnostic test for hyperparathyroidism
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Radiography lab values pt should not recurve nothing by mouth for 8-12 hr before test
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Medical treatment fir hyperparthyrodism
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Surgical restoring maintains fluid electrolyte balance mt IO due to diuretics
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Hypoparathyroidism
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Occurs when PtH is decreased resulting in decreased levels of serum calcium auto immune or family offing
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Medical management for hypo parathyroid
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Aimed at replacing calcium IV vitamin D given orally
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What should pt be raugt
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Sat goods high in Calicum
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Cushing syndrome) adrenal hypercinction )
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Caused by increase corticosteroids especially glucocorticoids
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Clinical main federations of cushings
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Moon face buffalo hump weight gain adipose tissue in the trunk face cervical spine area arms and legs become thin as result of muscle wasting
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What is usually present in Cushing syndrome
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Hypo kalmia has protein in the tribe hyperglycemia
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What will women have in result of cushings what us adrenal
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Hirsutism excessive hair deepening voice
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What us adrenal hypo function
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Addisions disease most commonly caused by autoimmune response Tb cause Addison's world wide occurs in adults 60 yr of age.
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What should pt be assessed for
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Weakness vertigo syncope postural hypotension craving for salt
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Medical management for Addisions disease
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Replacement of fluid electrolyte balance hydrocortisone
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Nursing interventions for Addison's disease
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Aimed at improving circulatory status maiming accurate I &to and daily weights ✔️ skin turgor offer fluids pay attention to temp Bp education need to increase In periods of physical emotional stress
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Haha
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Hana
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