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103 Cards in this Set
- Front
- Back
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What does the hypothalamus secrete?
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CRH: corticotropin-releasing hormone
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What does CRH stimulate the anterior pituitary to secrete?
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TSH
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What does TSH increase?
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production of the thyroid hormones
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What is the most common cause of hyperthyroid?
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Grave's disease (autoimmune disease that destroys the thyroid gland)
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What are the s/s of hyperthyroidism?
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sweating, increased temp, weight loss, goiter, increased HR, nervousness, restlessness
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What is the rx and gold standard for hyperthyroidism?
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radioactive iodine (ablation therapy)
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What can radioactive iodine cause?
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hypothyroidism--> will need lifetime hormone replacement therapy
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What are some antithyroid medications?
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PTU (propylthiouracil), Methimazole--> block production of TH
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What type of diet should a person receive with hyperthyroidism?
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six meals/day
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What is needed at the bedside after a patient undergoes a thyroidectomy?
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suction and trach set
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What are some calcium deficiency s/s?
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Chevostek's (facial twitch) and Trousseau's (BP cuff and carpal spasm)
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What should low CA levels be treated with?
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calcium gluconate
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This is often prescribed preop to reduce vascularity of the thyroid gland?
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saturated solution of potassium iodide (SSKI)
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With hypothyroidism T4 are _____ and TSH is ______.
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decreased, increased
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What is the most common cause of hypothyroidism?
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Hashimoto's disease
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What are the s/s of hypothyroidism?
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intolerance to cold, depression, hair loss, mild weight gain, constipation, dry skin
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What are the s/s of myxedema coma?
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seizures, increased BP,
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This medication used for hypothyroidism replaces TH
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Levothyroxine sodium
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What is important to remember while taking Levothroid?
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do not switch brands, take at same time each day, take 1 hour prior to eating
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With hyperparathyroidism what leaves the bones?
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Calcium and phosphate--> calcium increases in the blood
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Because calcium increases in soft tissues with hyperparathyroidism, what forms?
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renal calculi
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What are the s/s of hyperparathyroidism?
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renal calculi, osteoporosis, fatigue, lethargy, depression, constipation
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What are the s/s of hypoparathyroidism?
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CA deficiencies--> Chevostek's and Trousseau's, tetany
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What is the rx for hypoparathyroidism?
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Calcium gluconate and vitamin D
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What is the most common cause of Cushing's syndrome?
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medical treatment with steroids
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What are the s/s of Cushing's syndrome?
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muscle wasting, osteoporosis, hypernatremia, hypokalemia, abnormal fat distribution, peptic ulcers, increased risk for infections
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What are the labs affected with hypoparathyroidism?
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increased cortisol, increased blood glucose, increased sodium and decreased potassium
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What is a transsphenoidal hypophysectomy?
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incision made between the upper lip and gums, under nasal cartilage
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What is the purpose of a transsphenoidal hypohysectomy?
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prevent CSF leakage
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What is post-op care for transsphenoidal hypophysectomy?
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lifelong administration of cortisol, I/O, SG, watch for DI (hyposecretion), monitor for CSF via nasal drip, avoid increasing ICP
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How do you prevent increased ICP?
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do not bend over, no coughing, deep breathing, no straining,
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What must be in place postop transsphenoidal hypophysectomy?
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nasal packing for at least 24 hours--> do not remove
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What is Addison's disease?
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adrenal insufficiency (hyposecretion); autoimmune destruction of the adrenals
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What are s/s of Addison's disease?
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hyperpigmentation, hyponatremia, hyperkalemia, hypotension, anorexia
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Which labs are altered with Addison's disease?
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decreased cortisol, blood glucose, sodium levels, increased potassium
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This may occur with sudden cessation of glucocortical therapy?
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addisonian crisis (acute adrenal insufficiency)
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Treatment for Addisonian crisis involves replacement of fluids and glucocorticoids, which should increase _____.
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blood pressure
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What is the treatment for Addison's disease?
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lifelong steroid replacement, diuretics and potassium restrictions, watch for hypoglycemia
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What should you teach patients receiving steroid therapy?
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wounds may not display s/s of infection: decreased wound healing; report unusual stress to physician for increase in doses, do not stop abruptly
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What are the primary problems of the posterior pituitary?
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Diabetes Insipidus and Syndrome of Inappropriate ADH
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What is the pathophysiology of post. pit. problems?
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DI-> decreased ADH (vasopressin)--> dehydration
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What is the most common cause of DI?
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transsphenoidal hypophysectomy
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What are the s/s of DI?
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hypotension, tachycardia, increased H&H, increased UO, dry mucous membranes, irritability, decreased cognition, increased thirst and dehydration
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What is the rx for DI?
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synthetic vasopressin (causes water retention)
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What is the cause of SIADH?
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increased production of ADH
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What does hypervolemia lead to?
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inhibition of the renin-angiotensis system
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Inhibition of the renin-angiotenis system causes and increased excretion of ____.
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sodium
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What are the s/s of DI?
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same as fluid overload, hyponatremia (CNS dysfunction), GI disturbances, N/V, lethargy, HA, changes in LOC
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What is the rx for DI?
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fluid restriction, I and O, DW, diuretics,
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What is the most important lab value to monitor with SIADH?
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sodium
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If T3 and T4 are decreased, what is always elevated?
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TSH
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What is the icon of hyperthyroidism?
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sweating
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With hyperthyroidism, what is the hair like?
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fine, thin
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What is the hair like with hypothyroidism?
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brittle, dry (hair loss)
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What is a common dysrhythmia in hyperthyroidism?
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a-fib
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In hyperthyroidism, what is muscle weakness caused by?
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high calcium levels (stimulation of parathyroid)
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What is the gold standard rx for hyperthyroidism?
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RAI--> produces fastest results, given orally, limits secretion of TH by destroying thyroid tissue
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What should the patient do following RAI rx?
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drink plenty of water--> flush iodine out of body
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What should a patient with hyperthyroidism avoid to relieve symptoms?
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caffeine, cola--> anything that will stimulate thyroid
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What is an important thing to remember with myxedema coma?
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airway, intubation, decreased temperature and HR
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What does the parathyroid respond to?
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serum calcium
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Why is muscle weakness present with hyperparathyroidism?
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calcium calms
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What are nursing implications for Fosamax administration?
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give alone early in the morning; keep the patient upright to prevent heartburn
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Which lab value is altered with hyperparathyroidism?
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ionized calcium
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Is muscle weakness a s/s of hypoparathyroidism?
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no, because calcium calms
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What is Cushing's disease associated with?
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pituitary tumor
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What is Cushing's syndrome caused from?
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medical treatment with steroids
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Why is osteoporosis associated with Cushing's?
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steroids cause bone resorption (calcium is not absorbed in the bones)
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What is resorption?
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being pulled out of the bones
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What are the manifestations of abnormal fat distribution?
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moon face, buffalo hump, truncal obesity
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What is hirsutism?
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facial hair
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What is there an increased risk for with Cushing's disease?
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infections--> steroids mask s/s of infection
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What are the labs to monitor with Cushing's disease?
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glucose, cortisol, decreased potassium, increased sodium
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What is the number one treatment for Cushing's disease?
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hypophysectomy
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What can glucocorticoid excess cause?
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mood swings
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What is the major complication with transphenoidal hypophysectomy?
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Diabetes insipidus
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Adrenal insufficiency is _____ destruction of the adrenals.
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autoimmune
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What is the treatment for Addison's disease?
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lifelong steroid replacement
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What should be restricted in a patient with Addison's?
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potassium
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A patient with Addison's has __ __ deficit.
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fluid volume
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What are the labs with Addison's?
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high potassium, low sodium, low cortisol, low blood glucose
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What may occur with a sudden cessation of glucocorticoid therapy?
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Addisonian crisis
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What is the icon of Addisonian crisis?
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hypotension
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A patient with DI will appear to be _____.
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dehydrated
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With SIADH, there is an _____ ADH and ____ Na.
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increased, decreased
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With DI, SG is _____.
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increased
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Adrenal insufficiency is _____ destruction of the adrenals.
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autoimmune
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What is the treatment for Addison's disease?
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lifelong steroid replacement
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What should be restricted in a patient with Addison's?
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potassium
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A patient with Addison's has __ __ deficit.
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fluid volume
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What are the labs with Addison's?
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high potassium, low sodium, low cortisol, low blood glucose
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What may occur with a sudden cessation of glucocorticoid therapy?
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Addisonian crisis
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What is the icon of Addisonian crisis?
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hypotension
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A patient with DI will appear to be _____.
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dehydrated
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With SIADH, there is an _____ ADH and ____ Na.
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increased, decreased
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With DI, SG is _____.
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decreased
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With dehydration, what is the SG?
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high, because of the dilutional effect
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What are s/s of low sodium?
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irritability, coma, confusion, lethargy
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If a patient has a low ADH, what is the appropriate medication to administer?
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Vasopressin
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What is a priority outcome for the client with DI?
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maintains normal fluid balance and electrolytes
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What are some common clinical manifestations of DI?
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extreme polyuria and thirst
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What is the Rx for SIADH?
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fluid restriction, daily weight
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What should be given very cautiously for SIADH Rx?
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hypertonic solution
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