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136 Cards in this Set
- Front
- Back
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Which anterior pituitary cells are most likely to have tumors?
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Those that produce growth hormone, prolactin, and ACTH
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Most common cause of hyperpituitarism:
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Pituitary adenoma
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Define pituitary adenoma:
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A benign tumor of one or more tissues within the anterior pituitary
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Symptoms of a pituitary adenoma pressing on brain tissue:
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Visual changes, headache, and increased intracranial pressure
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Most common type of pituitary adenoma:
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Prolactin (PRL)-secreting tumors
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Overproduction of GH results in:
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Gigantism or acromegaly
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GH blocks the action of which hormone?
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Insulin
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Excess ACTH leads to the development of:
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Cushing's disease
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Assessment for pituitary disorders:
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Changes in hat/glove/ring/shoe size, backache/arthralgias (GH), headaches/changes in vision
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Manifestations of hypersecretion of prolactin:
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Sexual dysfunction, menstrual changes, impotence, decreased libido
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Initial manifestations of GH hypersecretion:
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Changes in facial features
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Manifestations of prolactin hyperproduction:
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Hypogonadism
Galactorrhea Increased body fat Decreased libido Sexual dysfunction Impotence |
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Manifestations of ACTH hyperproduction (Cushing's disease):
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Elevated plasma cortisol levels
Weight gain Truncal obesity “Moon face” Extremity muscle wasting Loss of bone density Hypertension Hyperglycemia Purple striae Acne Thin, easily damaged skin Hyperpigmentation |
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Manifestations of TSH hyperproduction:
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Elevated plasma TSH levels
Elevated plasma thyroid hormone levels Weight loss Tachycardia and dysrhythmias Heat intolerance Increased GI motility Fine tremors |
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Major nursing diagnoses for anterior pituitary disorders:
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Disturbed Body Image
Sexual Dysfunction related to disease Acute Pain and Chronic Pain related to compression of tissues by tumor Anxiety Disturbed Sensory Perception (Visual) |
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Most common drugs used to treat anterior pituitary hyperfunction:
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Dopamine agonists, including bromocriptine mesylate, cabergoline, and pergolide
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Common side effects of bromocriptine:
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Orthostatic hypotension
Headaches Gastric irritation Nausea Abdominal cramps Constipation |
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Serious/rare side effects of bromocriptine:
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Cardiac dysrhythmias
Coronary artery spasm CSF fluid leakage |
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Pre-surgery teaching for transsphenoidal hypophysectomy:
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Nasal packing 2-3 days postop
"Mustache" dressing under nose Body changes, organ enlargement, visual changes not reversible Avoid increasing ICP post-op |
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Post-op care for the s/p transsphenoidal hypophysectomy patient:
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Neurologic checks!!!
Diabetes insipidus CSF leakage signs (postnasal drip) Infection Increased ICP signs |
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Ways to tell if nasal drainage is CSF:
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Glucose present
Light yellow color at edge of clear drainage ("halo sign") Persistant, severe headaches |
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What should we teach patients to avoid early after hypophysectomy surgery to keep the incision intact?
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COUGHING/sneezing/bending
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What signs of infection are important to monitor for after a transsphenoidal hypophysectomy?
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Meningitis signs: headache, fever, nuchal rigidity
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What hormones need to be replaced lifelong if the entire pituitary gland is removed?
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Thyroid
Glucocorticoid (Possibly) Gonadal |
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How long after a transsphenoidal hypophysectomy does the pt need to avoid increasing ICP?
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2 months
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Oral care after transsphenoidal hypophysectomy:
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No brushing for 2 weeks
Mouthwash q4-6hr Floss daily |
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Hormone produced by the posterior pituitary:
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ADH/vasopressin
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ADH deficiency leads to:
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Diabetes insipidus
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ADH excess leads to:
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SIADH
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Manifestations of diabetes insipidus:
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Polyuria
Polydipsia Dehydration |
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Types of diabetes insipidus:
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Nephrogenic (tubules do not react to ADH)
Primary (defect in hypothalamus/pituitary) Secondary (tumor/trauma/infection/surgery) Drug-related (lithum, Declomycin) |
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Characteristics of urine in a pt with diabetes insipidus:
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Low specific gravity
Low osmolarity |
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Urine output per 24hr with diabetes insipidus:
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4-30L
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Pharmaceutical treatment of diabetes insipidus:
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Chlorpropamide (increases ADH action)
Vasopressin replacement therapy |
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Nursing management of diabetes insipidus:
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Accurate I&Os
Checking urine SG Urge pts to drink fluids in amount equal to urine output OR make sure IV is replacing fluids appropriately |
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Important patient teaching for diabetes insipidus:
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Daily weight monitoring
Recognizing other signs of water toxicity (headache, confusion) |
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Changes in electrolyte levels as a result of SIADH:
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Hyponatremia
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Early manifestations of SIADH:
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Water retention
GI disturbances (N/V, anorexia) |
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Is edema a manifestation of SIADH?
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No
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VS changes seen in SIADH:
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Tachycardia
Hypothermia |
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CNS manifestations of SIADH:
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Lethargy
Headaches Hostility Disorientation Change in LOC (all the way to coma) |
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Changes in plasma and urine osmolarity in SIADH:
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Urine: volume down, osmolarity up
Plasma: volume up, osmolarity down |
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Medical interventions for SIADH:
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Restrict fluid intake
Promote excretion of water Replace sodium Interfere with ADH action |
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With a patient with SIADH, what should be used for mixing tube feeds, GI tube irrigation, etc?
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Saline, not normal water
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Problematic side effect of demeclocycline:
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Oral candidiasis
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Nursing assessment for SIADH:
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Fluid status
Neurological status |
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Three general causes for adrenal hypofunction:
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Inadequate ACTH
Dysfunctional of the hypothalamic-pituitary control mechanism Direct dysfunction of the adrenal gland |
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Impaired secretion of cortisol causes:
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Decreased gluconeogenesis
Hypoglycemia |
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Reduced aldosterone secretion causes:
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Imbalances in potassium, sodium, and water:
Hyperkalemia Hyponatremia Hypovalemia |
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Define Addisonian crisis:
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A life-threatening event in which the need for cortisol and aldosterone is greater than the available supply
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Most common cause of secondary adrenal insufficiency:
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Long-term glucocorticoid therapy
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Lab results seen in primary adrenal insufficiency:
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Elevated plasma ACTH and MSH
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Definitive test for adrenal insufficiency:
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ACTH stimulation test
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Nursing interventions for adrenal insufficiency:
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Promote fluid balance
Monitor for fluid deficit Prevent hypoglycemia |
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Hypersecretion by the adrenal cortex results in:
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Cushing's disease/syndrome and/or
Hyperaldosteronism and/or Excessive androgen production |
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Tumor of the adrenal cortex resulting in excessive production of catecholamines:
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Pheochromocytoma
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Define Cushing's disease:
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Exaggerated actions of glucocorticoids, arising from excessive secretion
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Define Cushing's syndrome:
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Excess glucocorticoids as a result of drug therapy for another health problem
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Laboratory findings that accompany hypercortisolism/Cushing's:
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Increased blood glucose
Decreased lymphocyte count Increased sodium Decreased calcium Decreased potassium |
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Priority nursing diagnoses for Cushing's:
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Excess fluid volume
Risk for injury Risk for infection |
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What pt is most at risk for acute adrenal insufficiency?
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The one who has Cushing's as a result of glucocorticoid drug therapy
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Differentiate hyperthyroidism and thyrotoxicosis:
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Hyperthyroidism: excessive thyroid hormone secretion from the thyroid gland
Thyrotoxicosis: the manifestations of hyperthyroidism, regardless of the origin of hormones |
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Two very generalized manifestations of hyperthyroidism:
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Hypermetabolism
Increased SNS activity |
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How does hyperthyroidism affect the cardiovascular system?
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Palpitations
Chest pain Increased SBP Widened pulse pressure Tachycardia Dysrhythmias |
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How does hyperthyroidism affect the integumentary system?
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Diaphoresis
Warm, moist skin Thinning of scalp hair |
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How does hyperthyroidism affect the pulmonary system?
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Shortness of breath
Rapid, shallow respiration |
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How does hyperthyroidism affect the gastrointestinal system?
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Weight loss
Increased appetite Increased stools Hypoproteinemia |
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How does hyperthyroidism affect the musculoskeletal system?
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Muscle weakness
Muscle wasting |
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How does hyperthyroidism affect the neurological system?
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Blurred/double vision
Eye fatigue Increased tears Photophobia Hyperactive tendon reflexes Tremors Insomnia |
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How does hyperthyroidism affect metabolic systems?
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Increased metabolic rate
Heat intolerance Low-grade fever Fatigue |
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How does hyperthyroidism affect the psychological/emotional systems?
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Decreased attention span
Restlessness Irritability Emotional lability Manic behavior |
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Define goiter:
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Swelling in the neck from hypertrophy/hyperplasia of the thyroid gland
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Define exophthalmos:
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Protrusion of the eyes (seen in Graves' disease)
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Most common cause of hyperthyroidism:
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Graves' disease
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Is a goiter a defining sign of hyperthyroidism?
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No
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Define Graves' disease:
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Autoimmune disorder in which antibodies attack to the TSH receptor sites
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Another name for T3 hormone:
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Triiodothyronine
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Another name for T4 hormone:
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Thyroxine
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Which VS is most critical to monitor in a hyperthyroid patient?
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Temperature
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What does an increase in temperature in a hyperthyroid potentially indicate?
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Thyroid storm
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Manifestations of thyroid storm:
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Fever
Tachycardia Systolic hypertension |
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Potential complications of thyroidectomy:
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Hemorrhage
Respiratory distress (can be hemorrhage-related) Hypocalcemia (parathyroid-related) Tetany (parathyroid-related) Laryngeal nerve damage |
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Production of alpha & beta cells of the pancreas:
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Alpha: glucagon
Beta: insulin, amylin |
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What is the relationship between glucagon and insulin?
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They counterregulate each other
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Function of glucacon:
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Causes release of glucose from cell storage sites when blood glucose levels are low
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Function of insulin:
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Allows body cells to store/use energy
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Cause of Type 1 diabetes:
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Beta cell destruction
Autoimmune process, possibly virus-triggered |
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Cause of Type 2 diabetes:
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Insulin resistance
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Classic symptoms of diabetes:
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Polyuria
Polydipsia Polyphagia |
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The dehydration that occurs with diabetes leads to (5 H's):
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Hemoconcentration
Hypovolemia Hyperviscosity Hypoperfusion Hypoxia |
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How does blood pH change with an absence of insulin?
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Acidotic
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What breathing pattern is associated with diabetic acidosis?
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Kussmaul respiration
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Define Kussmaul respiration:
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Increased rate and depth
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What characteristic can be noted in the breath of someone with diabetic acidosis?
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Fruity/acetone breath
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What electrolyte gets out of whack with a lack of insulin?
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Potassium
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Three glucose-related emergencies that can occur in diabetics:
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Diabetic ketoacidosis (DKA)
Hyperglycemic-hyperosmolar state (HHS) Hypoglycemia |
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Macrovascular complications of diabetes:
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Coronary heart disease
Cerebrovascular disease Peripheral vascular disease |
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Microvascular complications of diabetes:
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Nephropathy
Neuropathy Retinopathy |
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What's the earliest clinical sign of diabetic nephropathy?
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Microalbuminuria
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How can Type 2 diabetes be prevented or delayed?
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Weight loss, increased physical activity
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Questions to ask a pt to assess for diabetes:
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Ask about fatigue, polyuria, polydipsia
Ask about major/minor infections (esp. yeast infections in women) Ask if wounds take longer to heal Ask about vision and sense of touch |
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What's the ideal range for hemoglobin A1c?
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4-6%
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What level of hemoglobin A1c indicates poor diabetic control?
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> 8%
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What's another name for hemoglobin A1c testing?
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Glycosylated hemoglobin assay
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What are ketone bodies a byproduct of?
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Fat metabolism
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Which diabetic patients can benefit from sulfonylurea agents?
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Those with some remaining beta-cell function
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How do sulfonylurea agents work?
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Stimulate insulin secretion from beta cells & increase sensitivity at cell receptor sites
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Side effects of sulfonylurea agents:
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Weight gain
Hypoglycemia |
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How do meglitinide analogues work?
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Same as sulfonylurea agents - stimulate insulin secretion
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How does Metformin work?
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Decreases liver glucose production and improves insulin receptor sensitivity
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Why is Metformin the drug of choice for Type 2 diabetes?
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No weight gain/hypoglycemia
Low cost Few adverse effects |
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Side effects of metformin:
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Abdominal discomfort/diarrhea
Lactic acidosis in renal patients |
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How do alpha-glucosidase inhibitors work?
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Delay absorption of carbohydrates
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Side effects of alpha-glucosidase inhibitors:
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Flatulence, diarrhea, abdominal discomfort
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How do TZDs work?
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Improve insulin sensitivity, reduce liver glucose production
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Side effects of TZDs:
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Increase in adipose tissue
Fluid retention |
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What type of insulin is used for basal coverage?
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NPH or long-acting insulin
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Types of rapid-acting insulin:
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Insulin aspart (NovoLog)
Insulin glulisine (Apidra) Human lispro (Humalog)** |
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Types of short-acting insulin:
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Regular insulin (anything w/ an "R" at the end, i.e. Humulin R)
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Types of intermediate-acting insulin:
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NPH (anything w/ an "N" at the end)
Insulin detemir |
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Type of long-acting insulin:
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Insulin glargine (Lantus)
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Where is insulin absorption fastest subcutaneously?
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The abdomen
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When insulins are mixed, which should be drawn into the syringe first?
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The SHORT-ACTING one
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Which insulins should NOT be mixed?
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Insulin glargine (Lantus)
Insulin detemir |
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What type of insulin is used with an insulin pump?
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Rapid-acting
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How should insulin be stored?
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Insulin not in use should be refrigerated, away from sunlight
Insulin in use can be kept at room temp for 28 days |
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When mixing insulins, which bottle should you inject air into first?
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The intermediate-acting insulin (NPH) bottle
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Sx of hypoglycemia:
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Weakness/fatigue
Confusion Behavior changes Seizures LOS Shaking/tremors Pounding heart Nervousness/anxiety Sweating Hunger Tingling |
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Management of hypoglycemia:
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Carbohydrate replacement
Glucagon drug therapy |
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What is the most common initial trigger for DKA?
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Infection
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DKA vs. HHS: onset
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DKA is sudden
HHS is gradual |
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DKA vs. HHS: precipitating factors
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Both precipitated by infection and other stressors
DKA: inadequate insulin HHS: poor fluid intake |
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DKA vs. HHS: manifestations
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DKA: Kussmaul respiration, "fruity" breath, nausea and abdominal pain
HHS: Altered CNS function Both: dehydration, electrolyte loss, lethargy, coma |
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Management of hyperglycemia:
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Assess fluid status
Keep patient hydrated Insulin to lower blood glucose Potassium replacement Acidosis management |
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Management of HHS:
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Fluid therapy!
IV insulin/potassium |
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When is IV insulin administered in a patient with HHS?
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AFTER rehydration
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