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232 Cards in this Set
- Front
- Back
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What is the Endocrine System also called?
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The Neuro-endocrine Regulation System.
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What does the Endocrine systme work with to regulate function?
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The endocrine system works with the nervous system to regulate function.
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What does TSH stand for?
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Thyroid Stimulating Hormone
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What does ACTH stand for?
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AdrenoCorticoTropic Hormone
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What does FSH stand for?
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Folicle Stimulating Hormone
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What does LH stand for?
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Leutinizing Hormone
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What does GH stand for?
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Growth Hormone
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What does MSH stand for?
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Melenasites stimulating hormone (has to do with skin color)
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Endocrine tissue secretes what to act on specific tissue?
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Hormones
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What are the three classes of Hormones?
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1. Steroids
2. Peptides 3. Amino Acid Derivatives |
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How fast is the response time of Steroids?
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Minutes to Hours
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How fast is the response time of Peptides?
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Rapid (Insulin)
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How fast is the response time of Amino Acid Derivatives?
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Immediate (Thyroid Hormones)
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What does ADH stand for and what does it affect?
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Anti-Diuretic Hormone and it affects Fluid Electrolyte balance.
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What do Mineral Corticoids correspond with?
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Salt
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What do Glucocorticoids correspond with?
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Sugar
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What system do Epinephrine and Norepinephrine of the Adrenal Medulla correspond with?
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The Fight or Flight system.
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What type of hormone does the Thyroid Gland secrete?
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Amino Acid Derivatives
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What are the hormones that the Thyroid Gland secretes?
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T3 (tri-iodothronine), T4 (thyroxine), and Thyrocalcitonin.
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What are the Islet Cells of the Pancreas?
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Insulin and Glucagon
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What hormone does the Parathyroid Gland secrete?
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Para Thyroid Hormone (PTH)
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This hormone is important in calcium balance. It pulls calcium from the bone when the serum calcium is low?
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Para Thyroid Hormone (PTH)
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It is butterfly shape, is in front of the Trachea and below the larynx?
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Thyroid Gland
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How many lobes does the Thyroid Gland have?
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2 lobes
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Has 5X's the blood flow of the liver?
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Thyroid Gland
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What does the Thyroid Gland's high blood flow reflect?
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The high blood flow reflect the high metabolic activity in the thyroid gland.
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What are the 3 disorders of the Thyroid Gland?
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Goiter
Hypothyroidism Hyperthyroidism |
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An enlargement of the Thyroid Gland?
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Goiter
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Under functioning Thyroid Gland?
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Hypothyroidism
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Over functioning Thyroid Gland?
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Hyperthyroidism
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What are the 3 lab tests for Thyroid disorders?
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TSH
T3 T4 |
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What hormone increases if the Thyroid is not functioning?
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Thyroid Stimulating Hormone (TSH)
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This lab test is done to differentiate hypothyroidism?
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TSH lab
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What are the three levels of hypothyroidism as pertaining to labs?
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Primary
Secondary and Tertiary |
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If the TSH lab reveals Primary, it means what is not functioning?
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The Thyroid Gland
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If the TSH lab reveals secondary, it means what is not working like it should?
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The Ptuitary Gland
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If the TSH lab reveals tertiary, it means what is not working like it should?
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The Hypothalamus
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Lab test used to diagnose level of Thyroid function (Hypo or Hyperthyroidism)?
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T3 lab
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Lab test used to diagnose level of Thyroid function (Hypo or Hyperthyroidism) and replacement therapy?
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T4 lab
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Lab test used to check for autoimmune disorders of the Thyroid Gland?
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Thyroid stimulating antibodies.
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What Diagnostic test is used to determine the metabolic activity of the Thyroid Gland?
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Radioactive Iodine Uptake (RAIU)
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What Diagnostic test is where the pt has to be NPO for 6-8hrs prior to the test. They are given a radioactive iodine and the Thryoid gland is scanned or a 24hr urine is collected to reveal if Hypo or Hyperthyroid?
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Radioactive iodine uptake (RAIU)
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What Diagnotic test is where the size, shape, and function of the thyroid are found?
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Thyroid Scan
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What Diagnostic test is where tissue is extracted and looked at by the lab?
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Fine Needle Aspiration
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What is the main reason for Goiters Worldwide?
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Lack of iodine in the diet
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What is the main reason for Goiters in the U.S.?
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Over/under production of thyroid hormones.
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Visible Swelling
Tight feeling in the throat Coughing Hoarseness Difficulty swallowing Difficulty breathing are signs and symptoms of? |
Goiter
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What is done if the Goiter is not causing problems?
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Just observe
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Observation
Medications Surgery (removal) Radioactive Iodine (kills) are what for Goiter? |
Treatments
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Suboptimal levels of thyroid hormone
Occurs more often in women (5:1) Incidence increases after age 60 Check every 5 years beginning at 35 Myxedema? |
Hypothyroidism
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What is severe hypothyroidism called?
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Myxedema
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Accumulation of many areas of pitting edema throughout the body?
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Myxedema
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Congenital defects (cretinism)
Inflammation of the thyroid gland Anti-thyroid drugs Surgery or treatment with radioactive agents Chronic inflammatory (auoimmune) disease, like Hashimoto's? |
Primary Hypothyroidism
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Hashimoto's is an?
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Autoimmune disorder
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Insufficient stimulation of thyroid gland?
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Secondary Hypothyroidism
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Decreased T3
Decreased T4 Decreased TSH |
Abnormal hormone levels in Secondary hypothyroidism.
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Hypothalmus doesn't produce TRH so the pituitary doesn't secrete TSH so the thyroid deosn't secrete thyroid hormones?
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Tertiary (Central) Hypothyroidism
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Primary Hypothyroidism accounts for what percentage of cases?
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95%
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Metabolic rate is slowed
Irritable and extreme fatigue Emotional responses are subdued Mental processes are "dull" Speech is slow Tongue, hands and feet enlarge Hair loss, brittle nails, and dry skin? |
Clinical Manifestations of Hypothyroidism
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Weight gain - without increased dietary intake
Constipation Intolerance to cold Mentrual irregularities? |
Clinical Manifestations of Hypothyroidism
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Personality changes
Cognitive changes? |
Advanced Hypothyroidism
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If the Thyroid Gland enlarges to produce T4, what may develop?
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Goiter
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Abnormally sensitive to sedatives and narcotics?
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Yet another clinical manifestation of Hypothyroidism.
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Why is it difficult to diagnose hypothyroidism in the elderly?
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Vague symptoms and "Is it hypothyroidism or is it aging?"
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When T4 is given in the elderly what do you monitor for?
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Ischemia, Heart Disease, and angina.
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What is given to the elderly carefully for hypothyroidism?
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T4
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Major Complication in Hypothyroidism
Rare (today) Can result in death if not caught and treated? |
Myxedema Coma
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Certain medications
Exposure to cold Illness Infection These are causes of? |
Myxedema Coma
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Usually affects pt's over 60
Seizures my be first sign Other S/S are: Severe Bradycardia, Significantly delayed DTR, Hypothermia with 91-95 degree temperature, may have non-pitting edema, enlarged tongue, and decreased LOC? |
Myxedema Coma
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Tests will show decreased T4 and increased TSH in what?
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Myxedema Coma
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Below normal temperature
Decreased breathing Low blood pressure Low blood sugar Unresponsiveness? |
S/S of Myxedema Coma
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Intravenous thyroid replacement
Steroids Supportive therapy (fluid replacement, oxygen, ventilator) |
Treatment of Myxedema Coma
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How do you correct TH deficiency?
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With TH replacement.
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Levothyroxine (synthroid) is used in?
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TH replacement.
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Can pt's with goiters also receive TH replacement?
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Yes
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How long does it take to reverse the manifestations related to TH deficiency?
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Usually 2-3 weeks.
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In TH replacement, how do you prevent cardiac complications from happening?
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Start with small doses of TH and give in the morning so as not to keep the pt up all night.
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Imbalanced Nutrition: More than body requirements
Activity intolerance Constipation are Nursing Interventions related to? |
Hypothyroidism
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In what setting is hypothyroidism usually dealt with?
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Outpatient
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How would one correct Imbalanced Nutrition: More than body requirements?
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A low calorie diet until weight stabilizes.
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How would one correct Activity Intolerance?
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Plan rest periods and then gradually increase activity.
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How would one correct Constipation?
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Give high fiber diet, 6-8 glasses of water a day and/or use a stool softener.
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Hair loss, apathy, lethargy, dry skin (coarse and scaly), muscle aches & weakness, constipation, intolerance to cold, receding hairline, facial & eyelid edema, dull-blank expression, extreme fatigue, thick tongue-slow speech, anorexia, brittle nails & hair, menstrual disturbances, gains weight without eating as much?
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S/S hypothyroidism
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Subnormal temp, bradycardia, weight gain, decreased LOC, thickened skin, cardiac complications?
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Sever S/S hypothyroidism
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Excessive output of the thyroid hormones
Predominantly affects women (5-10:1) Incidence increases after age 60 Check every 5 years beginning at 35? |
Hyperthyroidism
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Over function of the entire gland
Thyroid nodules Thyroiditis Graves disease? |
Hyperthyroidism
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Can be growth of tissue or fluid filled cyst that on the thyroid that can lead to hyperthyroidism?
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Thyroid nodules
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Inflammation of the thyroid?
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Thyroiditis
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Autoimmune disease of hyperthyroidism?
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Graves disease
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Metabolism is speeded up
Nervousness, can't sit still Hyperexcitable, irritable, and apprehensive Palpitations, increased pulse rate Continuously flushed and perspires Heat intolerant, skin warm, soft and moist, hand tremors, increased appetite with weight loss, amenorrhea (women), exophthalmos, goiter? |
Clinical manifestations of hyperthyroidism.
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Pitting edema behind eyes pushing the eyes forward?
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Exophthalmus
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Tachy, atrial fib, HF in elderly, treated with Beta blockers?
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Heart Disease
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Used to treat Heart Disease that won't block production of hormones but helps with S/S?
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Beta Blockers
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Counterpart to Myxedema
Hyperthyroidism up to 105 degrees restlessness, aggitation, abdominal pain, N/V, severe tachycardia, shock, heart failure, coma? |
Thyroid Storm (thyrotoxicosis)
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Thyrotoxicosis
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Thyroid Storm
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Exophthalmus
Heart Disease Thyroid Storm (thyrotoxicosis)? |
Complications of Graves' disease
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Propylithiouracil (Propacil, PTU)
Methimazole (Tapazole)? |
Anti-thyroid medications
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Anti-thyroid medication
Radioactive Iodine Therapy Surgery? |
Medical management of Hyperthyroidism
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What is the "Gold Standard" for medical management of Hyperthyroidism?
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Ablation
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Imbalance nutrition: less than body requirements
Activity intolerance Risk for injury Hyperthermia Impaired social interaction? |
Nursing Interventions for Hyperthyroidism
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How would one correct Imbalance nutrition: less than body requirements?
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A high calorie diet, let them eat as much as they can.
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How would one correct Activity Intolerance?
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Promote rest
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How would one correct Risk for Injury in relevant to Hyperthyroisism?
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Take precautions to keep the eyes protected, the person should wear eye protection, use eye drops (because they don't blink as much), pull their eyelids down and tpe them down at night.
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How would one treat Hyperthermia?
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Keep a cool environment.
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Intolerance to heat, fine-straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, increased systolic BP, breast enlargment, weight loss, muscle wasting, localized edema, mentrual changes (amenorrhea), increased diarrhea, tremors, finger clubbing?
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S/S Hyperthyroidism
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This has been performed since the 1880's?
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Thyroidectomies
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Before a thyroidectomy, what must an pt be free of?
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Complications that put them at risk post operatively.
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Check dressing for bleeding and pooling behind neck, maintain airway due to injury, keep a trach set by bedside at all times, check voice for changes, decrease hoarseness by decreasing talking, monitor incision, keep emergency equipment available?
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Nursing care for Thyroidectomy
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Hoarsness leads to increased parathyroid hormone which leads to?
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Hypocalcemia
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Excessive thyroid hormone?
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Thyroid Storm
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What is the only gland in the endocrine system that stores hormones?
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Thyroid Gland
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Hemorrhage
Infection Thyroid Storm Tetany Respiratory obstruction Laryngeal edema Vocal cord injury? |
Complications of Thyroidectomy
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Why is Tetany a complication of Thyroidectomy?
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Tetany is a complication of a thyroidectomy because of possible hypocalcemia.
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Why is Respiratory obstruction a complication of a thyroidectomy?
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Respiratory obstruction is a complication of a thyroidectomy because Laryngeal edema can cause it.
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Minimize talking and note quality of voice to prevent?
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Vocal cord injury, a complication of a thyroidectomy.
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Neck exercises (just turn head not body)
Medications (synthroid) Follow up care (check hormones periodically) Wound care? |
The parts of discharge teaching for a thyroidectomy.
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Paired endocrine organs on the superior pole of kidney?
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Adrenal Gland
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Secretes mineralocorticoids, glucocorticoids, and Androgen?
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Adrenal Gland
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Aldosterone and Corticosterone are?
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Mineralocorticoids
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Cortisol and Corticosterone are?
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Glucocorticoids
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What excretes Epinephrine and Norepinepherine?
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The adrenal medulla
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Sugar hormones?
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Glucocorticoids
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Salt hormones?
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Mineralcorticoids
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Sex hormones?
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Androgens
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Aldosterone
Cortisol ACTH ACTH Stimulation Dexamethasone Suppression? |
Lab Diagnostic Tests for the Adrenal Function
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This lab diagnostic test for adrenal function is done as serum or 24hr urine?
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Aldosterone test
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This lab diagnostic test for adrenal function draws 2 separate times which may be specific times like 8AM & 4PM?
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Cortisol Test
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This lab diagnostic test for adrenal function test the anterior pituitary gland function?
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ACTH Test
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This lab diagnostic test for adrenal function is adminstered in synthetic form of ACTH IV and blood is drawn at specific intervals to measure adrenal gland response to ACTH?
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ACTH stimulation test
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In this lab diagnostic test for adrenal function, the drug is given (the drug name is in the name of the test) at bedtime and the cortisol level is checked, then cortisol levels are checked again in the morning?
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Dexamethasone Suppression
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Primary adrenal insufficiency due to destruction of the adrenal cortex?
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Addison's Disease
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Accounts for 75% of primary adrenal insufficiency?
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Autoimmune destruction of the adrenal cortex.
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TB, infections, fungal infections, vascular problems, hypothyroidism of adrenal glands?
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Problems that can lead to autoimmune destruction of the adrenal cortex.
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Secondary adrenal insufficiency due to suppressed function of hypothalmic pituitary process?
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Addison's Disease
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Can be caused by excessive use of glucocorticoids and also surgical removal?
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Secondary Adrenal Insufficiency in Addison's Disease
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Lack of or decreased ACTH is related to?
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Secondary adrenal insufficiency in Addison's Disease.
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History of other endocrine disorders
Taking glucocorticoids for more than 3 weeks with sudden cessation Taking clucocorticoids more than once every other day Adrenalectomy TB? |
Risk factors for Addison's Disease
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Fatigue, muscle weakness, anorexia, nausea, frequent hypoglycemic reactions, hypotension, broze pigmentation of the skin, decreased capacity to deal with stress, decreased body hair?
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Clinical manifestations of Addison's
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This disorder will be chronic after acute episode?
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Addison's Disease
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Abrupt decrease in blood cortisol levels leads to?
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Acute Addison's Disease
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Chronic Addison's Disease leads to?
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Slow development of adrenal insufficiency
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What are the treatment of symptoms of Addison's Disease based on?
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If it is acute or chronic.
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Administer hydrocortisone at lowest effective dose?
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Chronic Addison's Disease
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In Addison's Disease, in times of stress, pt should receive what proportional to their stress level?
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Hydrocortisone
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You monitor sodium, potassium, calcium, glucose, and fluid status when treating?
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The symptoms of Addison's Disease
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Fluid balance
Activity Intolerance Knowledge deficit? |
Nursing Interventions in Addison's Disease
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When dealing with the Fluid Balance Nursing Intervention, what do you monitor?
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I/O's and Electrolytes
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When dealing with the Activity Intolerance Nursing Intervention, what do you provide?
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Stress free environment.
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When dealing with Knowledge Deficit Nursing Interventions, what do you teach them?
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Teach them about replacing their cortisol in periods of stress, use of cortisol pen, and complications.
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Stress without appropriate hormone replacement due to pregnancy, surgery, infection, or dehydration?
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Addisonian Crisis
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Drop in blood cortisol because of stress?
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Accute Addisonian Crisis
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Sudden pain in back, abdomen, lower legs, N/V
Change in mental status Volume depletion (hypovolemic shock) Hypotension Loss of Consciousness Shock? |
Manifestations of Addisonian Crisis
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Salt, sugar, steroids, support, and search out cause?
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Five "S" method of treatment.
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Correct fluid and electrolyte balance
Correct hypoglycemia Use the five "S" method? |
Medical Manangement of Addisonian Crisis
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No body hair, bronze pigmentation of skin, GI disturbances, weakness, hypoglycemia, postural hypotension, weight loss?
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Addison's Disease S/S
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Profound fatigue, dehydration, vascular collapse, renal shut down, decreased serum NA, increased serum K?
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Adrenal Crisis (Addison's Disease)
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Hypercortisolism?
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Cushing's Syndrome
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Excessive adrenocortical activity, relatively rare, mainly women, 20-50 years, can mimic other diseases?
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Cushing's Syndrome
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The etiology of Cushing's Syndrome that account for most cases of Cushing's, secondary to using steroids in high doses?
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Iatrogenic hypercortisolism
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30% of cases of Cushing's?
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Cortisol secreting adrenal tumors
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Adrenal gland producing too much ACTH?
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Adrenal hyperplasia
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Muscle weakness, fatigue, truncal obesity, "Moon Face", "Buffalo hump" (fatty deposit), menstrual irregularities, masculinization in females, Petechiae, Osteoporosis, mood alterations, psychoses, GI bleed, poor wound healing leading to immunosuppressed (secondary to cortisol)?
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Clinical Manifestations of Cushing's Syndrome
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When a pt does not take their cortisol?
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Addisonian Crisis
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Radiation Therapy,
Pharmacological (Adrenal blocking agents and ACTH reducing agents) Surgery (removal of enlarged adrenal gland)? |
Medical Management of Cushing's Syndrome
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What medical management is used for Cushing's Syndrome if the problem is a cortisol producing tumor?
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Radiation Therapy
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In Cushing's Syndrome, what medical management is used it it is a metastatic tumor?
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Radiation therapy used as paliative care.
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What drugs inhibit cortisol production?
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Myocane or Lysotrine (Adrenal blocking agents)
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Periactin is a what?
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ACTH reducing agent
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Risk for Injury
Risk for Infecition Self Care Deficit Impaired Skin Integrity Disturbed Body Image Disturbed Thought Process |
Nursing Interventions for Cushing's Syndrome
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Cushing's Syndrome Nursing Intervention, Risk for injury to prevent?
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Falls
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Cushing's Syndrome Nursing Intervention, Self care deficit due to?
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Issues with cognition
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Cushing's Syndrome Nursing Intervention, Impaired skin integrity due to?
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Petechiae (slow healing wounds)
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Cushing's Syndrome Nursing Intervention, Distubed body image due to?
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Moon Face and or Buffalo Hump.
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Cushing's Syndrome Nursing Intervention, Disturbed Thought Process due to?
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Mood Swings
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One or both Adrenal glands removed?
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Adrenalectomy
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Addisonian Crisis, will need replacement therapy?
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Adrenalectomy
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The pt only needs basic post-operative care because their are less complications if the Adrenalectomy is performed?
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Lathroscopically
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Personality changes, Moon Face, increased susceptibility to infection, gynecomastia (males), fat deposits on back, osteoporosis, hyperglycemia, CNS irritability, NA and fluid retention, thin extremities, GI distress (increased acid), Amenorrhea Hirsutim (Females), Thin skin, purple striae, bruises and petechiae?
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S/S Cushing's Syndrome
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Second most commonly diagnosed cancer in males (skin), 2004: 190,000 diagnosed with the disease and 29,000 died from the disease, Second leading cause of death?
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Prostate Cancer
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Clinically aggressive prostate cancer affects about how many American men?
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1 in 6
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It has an unknown etiology but there are two types of tumors diagnosed in the clinical setting?
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Prostate Cancer
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This form of prostate cancer occurs in about 30% in their 50's and about 60-70% in their 80's?
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Latent prostate cancer
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Early stage means cancer cells only found in prostate so it is?
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Latent
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About how many years for the tumor to be big enough to be found or the pt to show symptoms?
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10-30 years
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Familial Hx: about 10% are thought to be inherited, 90% are classified as sporadic, risks increase with age, approx. 75% of men diagnosed will be over 65, clinically aggressive in younger men?
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Risk factors for Prostate Cancer
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African-American men at greater risk, Asian-American men have lower risk when residing in Asia?
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Prostate Cancer
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A diet high in saturated animal fats increases risk, green and yellow vegetables decrease risk of?
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Prostate Cancer
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Is essential to growth and development of the prostate?
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Testosterone
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Absence of BPH and prostate CA caused by?
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Absence of functioning testes.
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Fertilizers, working in textiles, urban areas?
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Environmental and occupational risk factors related to Prostate Cancer
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95% are adenocarcinoma, usually located in the outer lobe of the prostate, remaining are classified as nonepithelial, staging per TNM (tumor node metastises method)?
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Pathophysiology of Prostate
Cancer |
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If T1 and T2 remain within the prostate it is a?
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localized prostate cancer
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If T3 and T4 have spread beyond the prostate it is the?
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Advanced stage of prostate cancer
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10 possible grades based on how well differentiated tumor cells appear on microscopic exam?
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Gleason Grading System (Prostate Cancer)
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In the Gleason Grading System, what does a score of 5-7 mean?
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40% Metastasis
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In the Gleason Grading System, what does a score of 8-10 mean?
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75% Metastasis
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What does DRE stand for (an assessment for Prostate Cancer)?
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Digital Rectal Exam
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What does PSA stand for (an assessment for Prostate Cancer), increased if prostate is enlarged, cancerous,etc., but is not definitive?
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Prostate Specific Antigen
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This assessment is a probulous ultrasound of the prostate?
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Transrectal ultrasound and biopsy
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Most times, what is the predominant site for prostate cancer?
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Bones
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This assessment for Prostate Cancer includes chest x-rays, CT or MRI's of pelvis and/or abdomen as well as bone scan?
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Radiological testing for metastasis in Prostate Cancer.
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Watchful Waiting and Radiation Therapy are?
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Medical Managements for Localized Prostate Cancer
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Hormone deprivation and chemotherapy are?
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Medical Managements for Advanced Prostate Cancer
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If Watchful Waiting Prostate Cancer, a pt over 70 with life expectancy less than ten years or pt under 70 with life expectancy less than 5 years, what assessments will they receive every 6 months?
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Digital Rectal Exam (DRE)
& Prostate Specific Antigen (PSA) |
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Which hormone deprivation drug is chemical castration?
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Degarelix
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Which Hormone deprivation drug is controversial but blocks adronergic effects at the tumor?
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Estrogen
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What is the surgical removal of testes called that causes a decrease in testosterone level?
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Orchiectomy
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What is the luteinizing hormone releasing hormone agonist or gonadotropin releasing hormone receptor inhibitor used in advanced prostate cancer?
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Degarelix
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What is the surgical removal of the Prostate?
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Radical Prostatectomy
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Retropubic
Superpubic Perineal and Laparoscopic are? |
Types of Radical Prostatectomy
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This Radical Prostatectomy occurs between the rectum and the scrotum?
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Perineal Radical Prostatectomy
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This Radical Prostatectomy is robotically assisted?
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Laparoscopic Radical Prostatectomy
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Absence of large incision
Decreased operative time Potentially faster recovery are the? |
Advantages of Laparoscopic Radical Prostatectomy
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Greater risk for positive margins
and Risk for rectal damage (rare) are the? |
Disadvantages of Radical Prostatectomy
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Bleeding
Infection Urinary Incontinence Rectal injury with fecal incontinence (rare) ED Nerve Damage are? |
Complications of Radical Prostatectomy
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Why would infection occur in a Radical Prostatectomy?
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Infection may occur due to location of incision.
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When is the possibility of urinary incontinence (a complication of radical prostatectomy) greatest?
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After removal of a catheter.
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If Nerve Damage occurs as a complication of radical prostatectomy, what may the pt experience?
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ED
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When is Cryosurgical Ablation used in Prostate Cancer?
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In localized cancer or other conditions.
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Transrectal ultrasoud with cryoprobe (to destroy tissue) is used in?
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Cryosurgical Ablation
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Urinary Incontinence
and ED are? |
Complications of Cryosurgical Ablation
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Removal of both testes
irreversable and can have psychological affects? |
Bilateral Orchiectomy
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Prevent injury
Provide support and Suggest resources are? |
Nursing Interventions in Prostate Cancer
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This nursing intervention is important if prostate gland removed from patient?
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Provide Support Nursing Intervention
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In Bladder Irrigation, what will run into foley and wash out to help prevent clots?
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Normal Saline
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In Nursing Interventions for Prostate Cancer, to Prevent Injury you monitor the urine output because you do not want?
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Ketchup (though clots are to be expected)
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Urine may be clear when pt is lying down but bloody when they?
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get up.
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Check the color of urine, not in the foley bag, but in the what?
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tubing connected to the foley bag.
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What condition can happen because of positioning of pt in surgery?
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DVT
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How do you prevent DVT?
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Leg exercises
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Why do you want the pt to avoid constipation after a radical prostatectomy?
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Because if the "bear down", they can rupture their capillaries.
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Pain management in a pt after radical prostatectomy can be needed if the pt has?
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Spasms from the foley (because it is not natural) or foley discomfort.
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