Med Surge - Test 3 P. 17-21

Front 1

Disorders of the Parathyroid Gland

Hyperparathyroidism results when?

Back 1

when 1 or more parathyroid glands do not respond to the normal feedback of serum calcium.

Front 2

Disorders of the Parathyroid Gland

hyperparathyroidism
-what is the most common cause?



what are some other causes?

Back 2

The most common cause is a benign tumor in one parathyroid gland.



Other reasons are caused by
hyperplasia,
neck trauma,
radiation,
vitamin D deficiency,
chronic renal failure.

Front 3

Hyperparathyroidism

-increased levels of parathyroid hormone (PTH), act directly on the kidney, causing what?

Back 3

increased kidney reabsorption of calcium and increased phosphate excretion. These processes cause hypercalcemia (excessive calcium), and hypophosphatemia (inadequate phosphate) in the pt with hyperparathyroidism






These processes cause: hypercalcemia and hypophosphatemia

Front 4

Hyperparathyroidism


in bone, excessive PTH levels increase what?

Back 4

bone resoprtion (bone loss of calcium) by decreasing bone production activity and increasing bone destruction activity. This process releases calcium and phosphate into the blood and reduces bone density.

Front 5

Hyperparathyroidism


Serum levels:
-Calcium:
-Phosphate:

Back 5

These processes cause: hypercalcemia and hypophosphatemia

Front 6

Hyperparathyroidism – Assessment

-skeletal system effects

Back 6

-Fatique & muscle weakness due to a rise in serum calcium


-Skeletal pain & tenderness


-Bone deformities with pathologic fractures

Front 7

Hyperparathyroidism – Assessment

-Anorexia, nausea, vomiting, epigastric pain, weight loss and constipation are common when _____ levels are high

Back 7

calcium

Front 8

Hyperparathyroidism – Assessment


BP? fast or slow?

Back 8

hypertension

Front 9

Hyperparathyroidism – Assessment

-High levels of PTH cause what with the amount of calcium in the kidney?

Back 9

renal calculi (kidney stones) and deposits of calcium in the soft tissue of the kidney.

Front 10

Hyperparathyroidism – Assessment


what causes elevated serum gastrin???? which can lead to what?

Back 10

-hypercalcemia causes elevated serum gastrin, which can lead to peptic ulcer disease

Front 11

Hyperparathyroidism – Interventions

MONITOR what? 3

Back 11

VS,

cardiac rhythm (look for changes in the T waves and QT interval),

I & O (every 2-4 hrs)

Front 12

Hyperparathyroidism – Interventions

monitor calcium & phosphorous levels. Immediately report any sudden drops in calcium levels which may cause what feeling?

Back 12

tingling and numbness in the muscles

Front 13

Hyperparathyroidism – Interventions

Move patient slowly & carefully , why?

Back 13

because the patient often has significant bone density loss and is at risk for pathologic fractures (use a lift sheet to reposition the patient)

Front 14

Hyperparathyroidism – Interventions

encourage what?



administer what PRN?

Back 14

Encourage fluids






-Administer phosphates prn to interfere with calcium absorption (inhibit bone resorption and interfere with calcium absorption)

Front 15

Hyperparathyroidism – Interventions

what is most often used for reducing serum calcium levels in patients who are not candidates for surgery

Back 15

diuretic and hydration therapies, such as:


Lasix, a diuretic that increases kidney excretion of calcium, is often used together with IV NS to promote renal Ca excretion

Front 16

Interventions for hyperparathyroidism

Administer Calcitonin, which does what?

Back 16

decrease skeletal calcium release & increases kidney excretion of calcium

Front 17

Interventions for hyperparathyroidism

Calcitonin is not effective when used alone, why?

what is given along with it?

Back 17

because of its short duration of action.




Its action is enhanced if it is given along with glucocorticoids)

Front 18

Interventions for hyperparathyroidism

-Administer Phosphates which inhibit what? 2

Back 18

bone resorption & interfere with calcium reabsorption

Front 19

Interventions for hyperparathyroidism

Calcium Chelators, do what?

Back 19

-lower calcium levels by binding (chelating) calcium which reduces levels of free calcium.

Front 20

Mithramycin, a cytotoxic agent, is used for what???




what is it??


2 side effects?

Back 20

hyperparathyroidism



the most effective and potent calcium chelator used to lower serum calcium levels. SE: thrombocytopenia (decreased circulating platelets and increased tendency to bleed) and kidney and liver toxicity can result

Front 21

Parathyroidectomy is used in managing what????



before surgery, the patient is stablized (what is decreased or near normal)

Back 21

hyperparathyroidism
(it's the removal of 1 or more of the parathyroid glands)

calcium levels

Front 22

Parathyroidectomy / Hyperparathyroidism

monitor for what?

Back 22

Monitor for hypocalcemic crisis

check serum calcium levels immediately after surgery and every 4 hrs thereafter until calcium levels stabilize.


manifestations of hypocalcemia include what:




numbness and tingling and twitching in the extremities and the face (check for Trousseau’s and Chvostek’s sign which may signal tetany

Front 23

Parathyroidectomy / Hyperparathyroidism



what position do you put them in?

Back 23

semi-fowler’s





-30 degrees or higher to keep fluids draining down and not accumulate

Front 24

Assess for S/S of hypocalcemia , which include:

Back 24

–anxiety,

confusion,

irritability,

paresthesia of toes, fingers, face, especially around the mouth,

twitching,

muscle cramps,

tremors,


laryngeal spasms

Front 25

Assess for S/S of hypocalcemia

-Prepare for possible _________________

Back 25

parathyroidectomy

Front 26

Assess for S/S of hypocalcemia


Elicit Chvostek’s sign, which is what

Back 26

tap the face just below and in front of the ear (over the facial nerve) with a finger to trigger facial twitching of 1 side of the mouth, nose, and cheek. if the facial muscles contract toward the ear, the test is positive for hypocalcemia

Front 27

Assess for S/S of hypocalcemia


Elicit Trousseau’s sign

Back 27

place a BP cuff on the patient’s arm and inflate it above its systolic pressure. In a positive test, the patient will exhibit a spasm in palmar flexion (ventral contraction of the thumb and digits)

Front 28

Hypoparathyroidism

caused by what (3)

Back 28

surgical or radiation-induced thyroid ablation,

parathyroidectomy,

hypomagnesemia

Front 29

Hypoparathyroidism

Problems are directly related to a lack of what hormone?? or to decreased effectiveness of what on target tissue.




Regardless of the problem, the result is the same: which is?

Back 29

of parathyroid hormone (PTH) secretion


PTH














hypocalcemia

Front 30

Hypoparathyroidism

Hypomagnesaemia (decreased serum magnesium levels) may also cause hypoparathyroidism. Hypomagnesaemia is seen in -4

Back 30

alcoholics and in patient’s with malabsorption syndromes, chronic kidney disease, and malnutrition.

















It causes impairment of PTH secretion and may interfere with the effects of PTH on the bones, the kidneys, and calcium regulation

Front 31

Hypoparathyroidism

can be caused by 4 things:

Back 31

-Caused by hyposecretion of the parathyroid gland


-Can occur after thyroidectomy because of “accidental” removal of parathyroid glands


-Hypomagnesemia can also cause this!



-radiation therapy (treatments can cause hypoparathyroidism)

Front 32

Hypoparathyroidism

hypomagnesium and PTH
what happens?

Back 32

Hypomagnesium causes impairment of PTH secretion & interferes with PTH effects on bones and kidneys.

Front 33

Hypoparathyroidism - Assessment

Serum levels:
Calcium
Phosphate

Back 33

Hypocalcemia

hyperphosphatemia


(when less PTH is synthesized, less phosphorous is excreted from the kidneys;

Front 34

Hypoparathyroidism - Assessment

s/s include

Back 34

Anorexia


Chvostek’s or Trousseau’s sign conjunctivitis


decreased mental status,

cramps



muscle weakness



paresthesia (mild tingling and numbness)



tetany

hypotension


irritability



hyperreflexia


excessive or inappropriate muscle contractions that cause finger, hand, and elbow flexion

Front 35

Hypoparathyroidism – Interventions

medical management focuses on what 3 things

Back 35

corrective hypocalcemia, vitamin d deficiency, and hypomagnesemia

Front 36

Hypoparathyroidism – Interventions


administer what through an IV to treat severe hypoglycemia?

Back 36

Administer IV Calcium Gluconate prn to treat severe hypocalcemia.



Acute vitamin D deficiency is treated with calcitriol (Rocaltrol) PO daily.

Front 37

Hypoparathyroidism – Interventions

what kind of diet

Back 37

a high calcium, low phosphate diet (no milk, yogurt, or processed cheeses)

Front 38

Hypoparathyroidism – Interventions


-phosphate binders do what

Back 38

lowers serum phosphate levels by binding to phosphorus present in food


allows calcium to bind to phosphate and rise calcium???

Front 39

Pituitary gland rests where?

Back 39

-in the sella turcica, a depression in the sphenoid bone at the base of the brain.

Front 40

Pituitary gland

-this pea size gland has 2 regions:

Posterior lobe - secretes what 2 hormones

Back 40

The posterior pituitary lobe stores and releases: oxytocin and vasopressin (antidiuretic hormone), which are produced in the hypothalamus. They are stored in the posterior pituitary and are released into the blood when needed.

Front 41

Pituitary gland



Anterior lobe -secretes what 6 "tropic" hormones

Back 41

which are hormones that stimulate other endocrine glands

1. Growth hormone (GH), or somatotropin

2.Thyroid-stimulating hormone (TSH), or thyrotropin


3.Corticotropin


4Follicle-stimulating hormone (FSH)

5.Luteinizing hormone (LH)


6) Prolactin

Front 42

Anterior pituitary hormone

Thyroid stimulating hormone –TSH:


Target tissue:
Actions:

Back 42

Thyroid stimulating hormone –TSH:
Target tissue: Thyroid
Actions: Stimulates synthesis and release of T3 and T4

Front 43

Anterior pituitary hormone

Adrenocorticotropin hormone- ACTH:


Target tissue:
Actions:

Back 43

Target tissue: Adrenal cortex
Actions: stimulates synthesis and release of corticosteroids

Front 44

Anterior pituitary hormone


Luteinizing hormone –LH

Target tissue:
Actions:

Back 44

Luteinizing hormone –LH
Target tissue: ovary and testis
Actions: stimulates ovulation and progesterone secretion. Stimulates testosterone secretion.

Front 45

Anterior pituitary hormone


Follicle-stimulating hormone – FSH


Target tissue:
Action:

Back 45

Follicle-stimulating hormone – FSH
Target tissue: ovary and testis
Action: stimulates spermatogenesis,

Front 46

Anterior pituitary hormone

Prolactin –PRL:
Target tissue:
Actions:

Back 46

Prolactin –PRL:
Target tissue: mammary glands
Actions: stimulates breast milk production

Front 47

Anterior pituitary hormone

Growth hormone – GH:

Target tissue:
Action:

Back 47

Growth hormone – GH:
Target tissue: bone and soft tissue
Action: promotes growth through lipolysis, protein anabolism, and insulin antagonism

Front 48

Posterior pituitary hormone


Vasopressin (antidiuretic hormone –ADH:

Target tissue:
Actions:

Back 48

Vasopressin (antidiuretic hormone –ADH:
Target tissue: kidney
Actions: promotes water reabsorption

Front 49

Posterior pituitary hormone

Oxytocin
Target tissue:
Action:

Back 49

Oxytocin
Target tissue: uterus and mammary glands
Action: stimulates uterine contractions and ejection of breast milk

Front 50

4 Disorders of the Pituitary Gland:

Back 50

-Hypo-pituitarism
-Hyper-pituitarism too much
-Diabetes Insipidus
-SAIDH

Front 51

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

Back 51

-

(working against dieresis-urination- pulling fluid out of the body. So this is working against pulling fluid out of the human body. The body retains the fluid.

Front 52

-hormones secreted from the anterior pituitary gland regulate what 4 changes:

Back 52

growth,
metabolism,
pigment changes,
sexual development

Front 53

the posterior pituitary problems result in (2)

Back 53

fluid and electrolyte imbalance

Front 54

Causes of Hypopituitarism (6)

Back 54

-Pituitary Tumor

-Partial or Total surgical hypophysectomy (removal of the pituitary gland)

-Radiation

-Infarction – a piece of gland has been killed off. Reduce blood flow and tissue dies.

-Cancer

-Trauma

Front 55

-A person with _____________________has a deficiency of 1 or more anterior pituitary hormones, resulting in metabolic problems and sexual dysfunction.

Back 55

Hypopituitarism

Front 56

Hypopituitarism

Hyposecretion of what 3 hormones:

Back 56

growth hormone,

LH, & FSH (aka: gonadotropins)

Front 57

Hypopituitarism

Assessment:

Back 57

Retarded physical growth (shorter)

- Premature aging, hair loss


- Low intellectual development


- Poor development of secondary sex characteristics; impotence, amenorrhea, infertility –won’t have breast development, no hair distribution that you would see normally during puberty, testes may not descend

Front 58

Hormone Deficiency


Adrenocorticotrophic (ACTH) hormone


Acute:

Back 58

Fatigue, weakness, dizziness, nausea, vomiting, circulatory failure. Similar to Addison’s disease, except lack of hyperpigmentation, absence of hyperkalaemia

Front 59

Hormone Deficiency


Adrenocorticotrophic (ACTH) hormone
-Chronic:

Back 59

Tiredness, pallor, anorexia, nausea, weight loss, myalgia, hypoglycaemia

Front 60

Hormone Deficiency

Gonadotrophins (LH and FSH)

Men

Back 60

delayed puberty

Impaired fertility, impotence, reduced libido, decreased muscle mass and strength, decreased bone mass, decreased erythropoiesis and hair growth, fine wrinkles, testicular hypotrophy

Front 61

Hormone Deficiency

Gonadotrophins (LH and FSH)

Women

Back 61

delayed puberty


Amenorrhoea, oligomenorrhoea, infertility, loss of libido, dyspareunia, fine wrinkles, breast atrophy, osteoporosis, premature atherosclerosis

Front 62

Hormone Deficiency

Thyroid-stimulating hormone

children:

Back 62

Growth retardation

Front 63

Hormone Deficiency

Thyroid-stimulating hormone


adults:

Back 63

Fatigue, cold intolerance, constipation, weight gain, dry skin, slow relaxing reflexes