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Medsurg Exam 2 Endocrine
Terms in this set (75)
CM of Cushings
Moon face, buffalo hump, hirtuism, skin discoloration, skin easily bruised, hypertension, hyperglycemia, abdominal purple striae, trunk obesity with small arms
Diagnostic Tests for Cushings
Serum cortisol, ACTH
24 hour Urine for free cortisol
*50-100 mcg a day indicates cushings
Drug for Cushings
Mitotane- supresses cortisol. Decreases plasma and urine corticosteroid levels
SE: double vision (diplopia), anorexia, n/v, GI bleed, depression, vertigo, skin rashes
-Gradual tapering avoids life threatening adrenal insufficiency
Nursing Management of Cushings
-Monitor I & O
Signs of infection
Urinary and serum Glucose
Nursing considerations for Cushings
Diet high in protein and ow calorie
Secondary complications of Cushings
Alterered mental status
Is cushings too little or too much cortisol?
Too much cortisol (excessive glucocorticoids and mineralcorticoids)--> adrenal cortex hyper function
Cushings- hyper or hypoglycemia?
hyperglycemia and low potassium
Addison's Disease H's
Hyponatremia, Hyperglycemia, HYPERkalemia, hyperpigmentation (of skin), hydrocortisone (treatment)
-Adrenal cortex hypofunction, autoimmue (cancer, TB, hemorrhaging, trauma)
A key sign of Addisons that has to do w/ BP
Diagnostic Tests for Addisons
Fasting blood sugar
Electrolytes, BUN, Creatinine
Glucorticoids for Addisons (Hydrocortisone)
-Dosage must be adjusted during times of stress
-Given in divided doses
-Dose adjustment with: fever, flu, tooth extraction, physical exertion
-doses are double for minor stressors and tripled for major stressors
Corticosteroids: -take in morning with good
-don't stop abruptly
-long term use can lead to complications and s/e therefore it is only used for severe cases with risk of death of loss of function
4 expected effects of corticosteroids
-Maintence of normal BP
-Carb and protein metabloism
-anti inflammatory action
2 signs of Addisonian crisis and what do you do
-Vomiting and diarrhea
-Notify health care provider since electrolyte replacement may be necessary
also: sudden back pain, stomach, or legs, syncope, shock, super low BP
Teaching for Addisons
-Notify physician if stress/ illness occurs
-eat diet high in protein fat and consume salt
-wear medic alert bracelet
What are the two adrenal gland disorders?
Addisons- hypo function of adrenal
Cushings-hyperfunciton of adrenal
1. hashimotos (most common)
2. pituitary tumor
3. Iodine deficiency (seafood- fish, eggs, dairy)
severe stunted physical growth resulting from untreated congenital hypothyroidism
Main thing to monitor for with hypothyroidism
-happens if they abruptly stop meds or removal of thyroid gland
-monitor vitals, keep patient warm, avoid sedatives
Meds for hypothyroidism
-Don't abruptly stop taking meds
-Take one hour before breakfast in morning
-take 4 hours separate from GI meds
-Monitor signs and symptoms of toxicity
-most common: Levothyroxine (Synthroid)
Diagnostic Tests for Hypothyroidism
-TFTS: t3, t4, tsh
Radioactive iodine uptake test
T3 resin uptake test
-Therapeutic in 4 weeks PO/IV
Adverse effects: thyroidtoxicosis- s/s hyperthyroidsim
Implications: drug interactions, monitor TSH (target 1-3)
Teaching for hypothyrodism
-encourage high fiber diet (constipation)
-provide emotional support (body changes)
-importance of lifelong meds
-avoid sedatives or narcotics
-teach s/s of over and under medication
Role of thyroid gland
Metabolism, regulation of body temp, growth and development
What is the complication of hyperthyroidism?
Thyroid storm: result of untreated Graves disease in setting of stress/illness
-tachycardia, arrythmias, hyperthermia, heart failure, N,V,D, agitation---> delirium
-fatal within 24 hrs if untreated
TFTs, T3 resin uptake, TSH thyroid scan, ultrasonography, electrocardiography
radioactive iodine increased uptake
Causes of hyperthyroidism
-Graves disease: bulging eyes, myxedema ( waxy orange on legs and feet)
-Toxic nodular goiter
-thyroiditis (inflammation of thyroid gland)
-too much iodine
Antithyroids-Thionamides (Hyperthyroidism meds)
-Propylthiouracil (PTU) and Methimazole (Tapazole)
-3-12 weeks for therapeutic effect
adverse effects: argunlocytosis: monitor WBC
Strong Iodine Solution for Hyperthyroidism
-suppresses TH production pre-op
-PO with fruit juice use straw (stains teeth)
Beta Blocker for Hyperthyroidism
suppress symptoms of graves
-PO or IV
SE: avoid in heart failure, asthma
goal: partially destroy thyroid tissue for clinical remission
therapeutic 2-3 ms
adverse effects: hypothyroidism
nursing management hyperthyroidism
-heart monitoring and support
-fluid and electrolyte replacement
-quiet room, rest
-high calorie diet-4000 calories a day-low fiber caffeine free
Thyroidectomy for hyper
prudent monitoring of airway and respiratory status
semifowlers position with sandbags on each side of head and neck to avoid flexion
-monitor for s/s of tetany
**mandatory to have emergency equipment because client can suddenly develop an airway obstruction due to the edema of the glottic, nerve damage, or tracheal compression due to bleeding
**amples of calcium gluconate should be on hand if tenting develops
Hyperparathyroidism 3 stages
Primary: develops when the normal regulation between serum CA levels and PTh secretion is interrupted
Secondary: result of renal failure, cancer with bone metastasis, Pagets disease
Tertiary: uncontrollable production of PTH
Increased calcium, urine CA and phosphate
Decreased serum phosphorus
diffiuse demineralization of bones on X-ray
Diagnostics: serum PTH, calcium, phosphorus
Urine: pH, calcium, ultrasound
Meds for hyperpara
calcitonin, mithracin, glucorticoids- increase bone reabsorption of calcium
encourage hydration and low calcium low vitamin d diet
Parathyroidectomy for Hypaparthyroidism
-monitor fluid and electrolytes
-monitor for tetany
Hypoparathyroidism hallmark features
decreased serum levels
increased serum phosphorus
convulsions, seizures, grimacing, dysrythmias, chvosteks sign, trousseau's signs, muscle cramps, muscle spasms are symptoms of what?
symptoms of hypoparathyroidism
Meds for hypoparathyroidism
-achieve normal serum calcium
vitamin D Pth replacement
-have calcium gluconate available
-tracheostomy tray at bedside
-rebreathing techniques for tetany
-high calcium low phosphorus diet
-one of the primary communicating and coordinating systems of the body
-reproduction, growth and development, regulation of energy
What is hypopituitarism?
-decreased secretion of one or more of the eight hormones of the pituitary gland
Treatment: hormone replacement and tumor resection
What usually causes hypopituitarism?
Water retention, GI disturbances, weight gain, hyponatremia, neurologic- mental status changes are symptoms of what pituitary disease?
Syndrome of Inappropiate Antidiuretic Hormone (SIADH)
Medical treatment for SIADH
restore fluid and electrolyte balance
-sodium chloride infusion
Declomycin is used to treat what
SIADH- block effect of ADH on renal tubules-enhanced H20 excretion
Diabetes insipidus is a deficiency of what?
3 outcomes of diabetes insipidus
-large volumes of dilute urine=dehydration
-increased serum osmolarity=hypernatremia
CM of diabetes insipidus
polyuria, polydispia, nocturia, dehydration, low specific gravity
increased sodium >145
ADH level, serum osmolarity, urine osmolarity, water deprivation test, MRI are all diagnostic tests for what?
Management of Diabetes Insipidus
-treat underlying cause
-hypotonic saline of D5W
ADH Replacement drugs
Desmopressin (DDAVP) = long term
daily weights, lab monitoring
Diabinese, Tegretpl (Central DI)
Thiazide diuretics, incodin (nephrogenic di)
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? (Select all that apply.)
Strict intake and output
• Neurologic function
• Urine and blood chemistry
A client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. He's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which nursing diagnosis is most appropriate for this client?
Deficient fluid volume related to inability to conserve water
-patient is showing signs of diabetes insipidus
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply.
Urine specific gravity of 1.001
• Serum osmolality of 310 mOsm/kg
• Serum sodium level of 149 mEq/L
A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.
• Decrease in serum thyroid-stimulating hormone (TSH)
• Increased T3
• Increased T4
• Increase in radioactive iodine uptake
Which condition may contribute to hyperparathyroidism?
chronic renal failure
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?
A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly.
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome?
-Admin 2-3 L of IV fluid RAPIDLY
Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement
A hypophysectomy is the treatment of choice for which endocrine disorder?
What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination?
• "Buffalo hump"
• Thin extremities
• "Moon face"
• Truncal obesity
• Purple striae
When caring for a client who's being treated for hyperthyroidism, the nurse should:
balance the clients periods of activity and rest
-they get hot a lot
Nursing care for a client in addisonian crisis should include which intervention?
place client in a private room
The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection
Which of the following is a clinical manifestation of hypothyroidism?
pulse rate below 90 beats
Bradycardia, a heart rate below 90 bpm, is associated with hypothyroidism because metabolism is subnormal and the tissues require little oxygen
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is:
-tingling and numbness of fingers
-vague sign frequently ignored
A client with adrenal insufficiency is brought into the ED where you practice nursing. The client is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include which of the following?
Observe for hyponatremia and hyperkalemia.
A nurse is providing postoperative care to a client recovering from a hypophysectomy. Which of the following would be included in the care plan? Select all that apply.
• Assess for neurologic changes.
• Closely monitor nasal packing and postnasal drainage.
A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and fluid volume deficit,
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus?
Below-normal urine osmolality level, above-normal serum osmolality level
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings would indicate that the client has developed fluid overload?
dyspnea, HTN ,
pulmonary congestion, confusion
When teaching a patient diagnosed with hypothyroidism regarding medical intervention, which of the following is important to communicate?
Thyroid hormones may increase the pharmacologic effect of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.
Which nursing diagnosis is most appropriate for a client with Addison's disease?
Risk for infection
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
An irregular apical pulse
Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician.
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