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94 Cards in this Set
- Front
- Back
All hormones of the Anterior Pituitary are stimulated by what area of the brain?
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Stimulated by the hypothalamus
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What are those hormones called? |
GH- TSH- ACTH- Prolactin- FSH- LH |
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Define panhypopituitarianism: |
Panhypopituitarism is a condition of inadequate or absent production of the anterior pituitary hormones. It is frequently the result of other problems that affect the pituitary gland and either reduce or destroy its function or interfere with hypothalamic secretion of the varying pituitary-releasing hormones.
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In panhypopituitarianism what changes would you expect to see in hormones stimulated in the anterior pituitary? |
All hormone levels are decreased |
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Which two hormones are secreted in the body by a simple feedback loop and are not affected by the anterior pituitary? |
Parathyroid hormone & insulin |
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What are the effects of lack of estrogen on the female? |
Osteoporosis* mood swings* hot flashes* vaginal dryness*bladder problems* loss of femininity |
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What is ADH?
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Antidiuretic hormone
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where is it made |
Made in the hypothalamus
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and where is it stored? |
Stored in the posterior pituitary
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When ADH increases you would expect the reabsorption of free water from the renal tubules to____? |
Increase |
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What is another name for ADH? |
Vasopressin |
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What is SIADH?
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Syndrome of inappropriate ADH occurs when ADH is released in excess amounts |
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What are the signs & symptoms of Soggy Sid? |
*Fluid retention (in vascular space 1 not tissues) *Serum hypo-osmolality *Dilutional Hyponatremia (decreased Na due to water intoxication) *Hypochloremia *Concentrated urine (decreased urinary output) |
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What are the labs that diagnose SIADH? |
Decreased serum sodium *decreased serum osmolality* increased urine osmolality* *increased urine specific gravity
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What information would tell you that the patient is improving?(SIADH) |
Improvement – increased serum sodium* increased serum osmolality* decreased urine osmolality* decreased urine specific gravity* |
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What are the major nursing assessments?(SIADH) |
Low urinary output High specific gravity Sudden weight gain Serum sodium decline |
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What is the treatment ACUTE: SIADH? |
For serum Na >125- restrict fluids to 800-1000 ml/day For serum Na >120- give IV 3-5% saline & potassium supplements When Na is at least 125- give diuretic |
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What is the treatment? CHRONIC SIADH? |
Lithium Declomycin Lasix Potassium supplement |
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What are the 2 causes of death?(SIADH) |
Water intoxication Hyponatremia |
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What are the 2 major nursing diagnoses?(SIADH) |
*Altered urinary elimination *Fluid volume excess r/t excess ADH, AEB_________
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What is DI? Diabetes Insipidus:
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Occurs when ADH is deficient
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What is the treatment?(DI) |
Administer IV fluids/glucose Replace vasopressin with DDAVP |
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What are the signs & symptoms? (DI)
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Increased thirst* increased urination (5-20 L/day)* generalized weakness* poor sleeping
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What are the labs? (DI)
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Increased serum sodium* increased serum osmolality* decreased urine specific gravity* decreased urine osmolality*
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What are T3 & T4 in the thyroid gland?
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Thyroid hormones |
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What is the function of thyroid hormones? |
Oxygen consumption Metabolic rate |
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What is hyperthyroidism?
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Condition marked by an excessive increase in thyroid hormones |
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What are the signs & symptoms the nurse should assess for? |
It can affect many systems see individual systems below:
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Cardiovascular S/Sx of hyperthyroidism: |
*Tachycardia systolic hypertension *bounding/rapid pulse *murmurs/angina *arrhythmias/a fib *palpitations |
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Respiratory S/Sx of hyperthyroidism |
*Increased respiratory rate *dyspnea on mild exertion |
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GI S/Sx of hyperthyroidism: |
Increased appetite/thirst *weight loss |
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Integumentary S/Sx of hyperthyroidism |
*Warm/smooth/moist skin* thin/brittle nails*hair loss |
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Nervous S/Sx (hyperthyroidism): |
Nervousness* tremor* lability of mood* exhaustion* depression* apathy* lack of concentration |
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Reproductive S/Sx of hyperthyroidism: |
Menstrual irregularities *decreased libido *impotence & gynecomastia in males* decreased fertility |
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Other S/Sx hyperthyroidism:
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Heat intolerance* lid lag *exopthalamus *goiter *rapid speech
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Musculoskeletal S/Sx: of hyperthyroidism:
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Fatigue* muscle weakness* osteoporosis*
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What labs indicate a primary hyperthyroid problem?
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*Increased T3 and T4 *free T4 and T3 uptake *decreased TSH |
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What labs indicate a secondary hyperthyroid problem? |
Increased TSH |
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What are the 3 treatments for hyperthyroidism? |
*Antithyroid drugs PTU* Tapazole* Inderal* Tenormin* Iodine *Ablation therapy *Subtotal Thyroidectomy |
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What is a thyroid storm? |
Condition in which all hyperthyroid manifestations are heightened |
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What are the signs & symptoms of a thyroid storm? |
*Same as hyperthyroidism but much worse *Fever (up to 105) *tachycardia/CHF *systolic hypertension *abdominal pain* N&V* tremors*seizures *coma |
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What is the treatment of a thyroid storm? |
Radioactive iodine therapy using 131I Subtotal Thyroidectomy |
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What 3 items should be available in an emergency for thyroid storm? |
Trach kit* suction* IV calcium gluconate |
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Why should a patient never stop thyroid medications as ordered? |
May lead to thyroid storm |
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What are nursing interventions for hyperthyroidism? |
Elevate HOB- tape eyes shut at night- use eye drops- avoid caffeine- provide high calorie diet |
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What is hypothyroidism?
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Condition in which there is insufficient thyroid hormone |
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What are the signs & symptoms of hypothyroidism? |
*Lethargy *personality changes *impaired memory *cold intolerance *hair loss *dry/coarse skin *brittle nails *hoarseness *muscle weakness *constipation *weight gain *menorrhagia |
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What is the major problem seen in the elderly in treatment for hypothyroidism? |
Cardiac dysfunctions |
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What is myxedema crisis and what are the signs & symptoms? |
Severe long-standing hypothyroidism |
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Myxedema s/sx |
– coma *respiratory failure *hypotension *Hyponatremia *hypothermia *hypoglycemia
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Why should patients never stop medications for hypothyroidism when ordered? |
May cause myxedema coma |
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What are nursing interventions for hypothyroidism? |
Provide blankets *increase fluids *provide written handouts with instructions |
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What labs would you expect to see if primary hypothyroidism?
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*Decreased T3 and T4 *T3 uptake *increased TSH *cholesterol *TRH
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What is the treatment for hypothyroidism?
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Synthetic oral thyroxineSynthroid/Levothyroid
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What is PTH Parathyroid Hormone:
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Parathyroid Hormone:
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and what does it do in the body? |
Hormone released from the parathyroid glands which regulates blood calcium levels |
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Where is PTH located? and how is it secreted? |
Located in the parathyroid gland (behind thyroid) Secreted in response to low calcium levels |
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What is a normal calcium level in the blood? |
8.8-10 mg/dl |
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What are the causes of Primary
hyperparathyroidism? |
Benign neoplasms (single adenoma) |
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What are the causes of Secondary hyperparathyroidism? |
Compensatory states due to hypocalcemia |
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What is the treatment? |
*Relieve symptoms *Treat complications *Remove tumors surgically *Increase fluids to 3000-4000 ml/day *Hyperparathyroidism Drug Therapy *Mithracin (antihypercalcemic agent) *Estrogen *IV saline (severe cases – correct fluid volume deficit and promote calcium excretion) |
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What is the greatest complication when the parathyroids are removed in surgery?
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Tetany |
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What are the signs & symptoms of tetany? |
Tingling lips *fingertips *feet Painful spasms of smooth and skeletal muscles Laryngeal stridor Dysphagia Chvostek’s Sign Trousseau’s Sign Compromised respiratory function |
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What is the lifelong treatment for hypoparathyroidism when the parathyroids have been removed? |
Hormone replacement Vitamin D*calcium & phosphate supplements |
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What are the hormones of the adrenal cortex?
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Glucocorticoids (cortisol) Mineral corticoids (aldosterone) Androgens (sex hormones) |
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What are their functions? |
*Glucocorticoids – regulate metabolism *increase blood glucose levels & *physiological stress response *Mineral corticoids – regulate Na & K+ & water balance *Androgens – sexual activity in women contribute to growth & development |
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What are the hormones of the adrenal medulla? |
Norepinephrine Epinephrine |
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Another name for these adrenal hormones is …? |
Catecholamines |
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What is the function of Catecholamines? |
Aid the body in response to stress |
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What are the signs & symptoms of Cushing’s Syndrome?
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Acne *moon face *plethora (red cheeks) *buffalo hump *body & facial hair *pendulous abdomen (centripetal obesity)*ecchymosis *thin extremities *slow wound healing *edema in extremities* HTN |
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What are the labs that indicate this disorder? |
Plasma cortisol levels-increased Plasma ACTH level-decreased Sodium-increased Potassium-decreased Glucose-increased |
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What are the nursing diagnoses in this disorder? |
*Altered body image *Risk for injury r/t hyperglycemia and hypokalemia *Risk for Infection |
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What are the treatments? |
Surgical adrenalectomy (laparotomy – benign or open – malignant) Drug Therapy: Lysodren Nizaral Cytadren |
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What are the signs & symptoms of Addison’s Disease?
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*Hypotension *hyponatremia *hyperkalemia *nausea/vomiting *diarrhea *dehydration |
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The lack of what major hormone is the leading cause of death? |
Cortisol |
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What is the crisis associated with this disorder’s name? |
Addison’s Crisis *Acute Adrenal Insufficiency *Adrenal Crisis |
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What are the symptoms of acute adrenal insufficiency? |
Hypotension *tachycardia *dehydration *abdominal pain *hyponatremia *hyperkalemia *hypoglycemia *nausea/vomiting/diarrhea *weakness *confusion |
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What are the major nursing diagnoses for acute adrenal insufficiency? |
*Activity intolerance *altered nutrition: less than body requirements *decreased cardiac output |
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What are the major treatments for acute adrenal insufficiency? |
IV hydrocortisone Fluid & electrolyte replacement |
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What are some patient teaching points for Addison’s Disease? |
Avoid stress *be timely with doses *don’t abruptly stop medication *take medication with meals *know the signs & symptoms of adrenal crisis |
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Why are patients given IV hydrocortisone after bilateral adrenalectomy? |
To prevent the cortisol levels from bottoming out and causing adrenal insufficiency |
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Why is it not advised to stop steroids abruptly?
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Can lead to adrenal insufficiency and death |
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What are the nursing considerations for giving steroids? (time of day) |
Glucocorticoids – 2/3 given in morning and 1/3 given in afternoon Mineral corticoids – given once a day in the evening |
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What is pheochromocytoma?
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Neoplasms that produce excessive urinary catecholamines |
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What are the signs & symptoms? |
Severe episodic hypertension accompanied by severe pounding headache tachycardia & perfuse sweating |
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Why can it be so deadly if untreated? |
Cardiac complications & stress (r/t epi & norepi production) |
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What is acromegaly?
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Condition in adults caused by excesses of growth hormone |
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What are the signs & symptoms of excess growth hormone? |
Feet & hand enlargement *deformities in spine & mandible *speech difficulty *hoarseness *abdominal distention *hypertension *cardiomegaly *diaphoresis *chest/joint pain *peripheral neuropathy *menstrual disturbances |
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Transsphenoidal hypophysectomy?:
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is a commonly used surgical approach for pituitary region masses
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What complications can occur after Transphenoidal Hypophysectomy: surgery? |
CSF leak *increased ICP *meningitis *diabetes insipidus |
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What are areas for patient teaching post-op? |
*Avoid coughing *blowing nose *sneezing *or straining *Instruct to use dental floss & rinses (no brushing for 10 days post-op) *Avoid bending at waist |
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What are nursing interventions post-op? |
*Monitor nasal drip pad for type & amount of drainage *Monitor neurological status & fluid/electrolyte balance *HOB elevated 30 degrees at all times *Mild analgesia for headaches |
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What is Sheehan’s?
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Condition following postpartum hemorrhage that causes failure to lactate & amenorrhea |
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Why is it a dangerous disorder? |
May lead to panhypopituitarianism acute adrenal insufficiency & shock |