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Snapsu ahII exam IV endocrine, part 2
Terms in this set (62)
What results from insufficient circulating thyroid hormone as a result of a variety of abnormalities?
What two actions can cause primary hypothyroidism?
destruction of thyroid tissue or defective hormone synthesis.
What two actions can cause secondary hypothyroidism?
Pituitary disease with decreased TSH secretion or hypothalamic dysfunction with decreased thyrotropin-releasing hormone secretion.
What is the most common cause of hypothyroidism worldwide? Why is this cause not a large cause for the U.S. and what is the primary cause?
Iodine deficiency. The U.S. has iodized salt. The most common cause for the U.S. is atrophy of the gland.
Which of these signs and symptoms are NOT associated with hypothyroidism? Fatigue, weight loss, dry rough skin, cold intolerance, diarrhea, depression, increased libido, and myxedema.
Weight loss - they have difficulty losing weight and experience weight gain. Diarrhea - they experience constipation. Increased libido - they experience decreased libido.
What are some common features of myxedema in a pt with hypothyroidism?
Dull, puffy skin; coarse, sparse hair; periorbital edema; and prominent tongue.
What is defined as the progression of hypothyroidism that leads to hypothermia, hypotension, and hypoventilation?
Myxedema coma, which is a life-threatening emergency.
Myxedema coma can be precipitated by what?
Infection, drugs (esp. opioids,tranquilizers, and barbiturates), exposure to cold, and trauma.
What is the treatment for a pt with myxedema coma?
Vital functions must be supported and IV thyroid hormone therapy must be administered.
What are the most common and reliable lab tests for thyroid function?
TSH and free T4
Serum TSH is ______ (high/low) when the defect is in the thyroid? The TSH is ______ when it is in the pituitary or hypothalamus?
What is the overall goal for treatment in a patient with hypothyroidism?
Restoration of a euthroid state as safely and rapidly as possible with hormone replacement and a low calorie diet to promote weight loss.
What is the drug of choice to treat hypothyroidism? And what interventions should be performed before administering?
Levothyroxine (synthroid); Check apical pulse and report a rate greater then 100, monitor pts with cardiovascular disease and symptoms of hyperthyroidism.
T/F: it is good to change to different preparations from time to time?
F: It is not a good thing to change manufactures or preparations.
What is know as a condition associated with inadequate circulating parathyroid hormone (PTH)?
What is the most common cause of hypoparathyroidism?
Accidental removal of the glands or damage to the blood supply during neck surgery.
Hypoparathyroidism is characterized by _______ resulting from a lack of PTH to maintian serum calcium levels?
What are some signs and symptoms of hypocalcemia?
Tingling lips, fingers, and toes; muscle tension, spasms, and stiffness; laryngospasms and airway obstruction; anxiety.
What are some emergency treatment measures of tetany?
Give IV calcium gluconate. Monitor ECG for dysrhythmias, rebreathing may parially alleviate acute neuromuscular symptoms. Long term diet therapy to include oral calcium. Vitamin D therapy.
What are the 3 main classifications of adrenal cortex steroid hormones?
Glucocorticoid, mineralocorticoid, and androgen.
What is the primary glucocorticoid and what does it do?
Cortisol; it regulates metabolism, increase blood glucose levels, and is critical in the physiologic stress response.
What is the primary mineralocorticoid and what does it do?
Aldosterone; it regulates sodium and potassium balance.
What do androgens do?
Contribute to growth and development in both genders and to sexual activity in adult women.
What is characterized as a spectrum of clinical abnormailites caused by an excess of corticosteroids, particularly glucocorticoids?
What are some causes of cushing syndrome?
Corticosteroid therapy (Prednisone), ACTH-secreting pituitary tumor and lung/pancreatic cancer (ACTH dependent) and benign and malignant adrenal tumors (ACTH independent).
What signs and symptoms of cushings syndrome are NOT correct? Adipose tissue in trunk, face and c-spine (moon face and buffalo hump); hypoglycemia; muscle wasting in extremities; osteoporosis (fx), tough, thick skin; delayed wound healing, bruising?
Hypoglycemia - these pts have hyperglycemia. Tough, thick skin - these patients have thin, weak skin.
What signs and symptoms of cushings syndrome are NOT correct? Irritability, anxiety, and psychosis, pale striae on abdomen, breast and buttocks, hirsuitism, hypotension, hyperkalemia?
Pale striae on abdomen, breast, and buttocks - the striae is purple. Hypotension - pts have hypertension. Hyperkalemia - pts have hypokalemia.
When cushings syndrome is suspected, a 24 hour urine collection for free cortisol is done. Levels beyond _____ to _____ mcg in 24 hours indicates cushing syndrome?
80 - 120 mcg.
If the 24 hour urine test is boarderline, a low-dose _________ suppression test is done?
What factors can cause a false-positive result and an increase the corisol levels?
Depression, stress, alcohol, and medications such as Dilantin and rifampin.
What is the goal for patients with cushing syndrome?
To normalize hormone secretion and treat the underlying cause.
Surgery to remove tumors is one of the main treatments of cushing syndrome, what are the risks?
Hemorrhage, release of large amounts of hormones into the circulation, increased risk for infection.
What are some nursing interventions that should be performed in pts with cushing syndrome that have a tumor removed?
Critical period for circulatory instability is 24-48 hrs after surgery, monitor vs, daily weights, i/o, glucose levels, monitor for s/sx of infection, safety, provide emotional support, and s/sx of abnormal thromboembolic phenomena (chest pain, dyspnea, and tachypnea).
What is administered intravenously during surgery and for several days afterward to ensure adequate responses to the stress of the procedure?
High doses of corticosteroids (hydrocortisone), which also increases the susceptibility to infection and delays wound healing.
What signs of acute adrenal insufficiency (hypocorisolism) are NOT correct? Vomiting, increased weakness, dehydration, hypertension, painful joints, moist, intact skin, and emotional stability?
Hypertension - these pts have hypotension. Moist, intact skin - these pts have pruritis and peeling skin. Emotional stability - these pts have emotional instability.
What discharge teaching should be performed in pts with cushing syndrome?
Pt should wear medical alert bracelet, avoid trauma and stress which can precipitate acute adrenal insufficiency, and report weakness, fever, fainting, nausea and vomiting.
In what automimmune disease are all three classes of adrenal corticosteriods (glucocorticoids, mineralocorticoids, and androgens) reduced?
Adrenocortical insufficiency (hypofunction of the adrenal cortex) may be from a primary cause such as ______ ______ or a secondary cause such as a lack of ______ ______ secretion?
Addison's disease; pituitary ACTH
In secondary andrenocortical insufficiency, ______ and _______ are deficient but ________ rarely are? (corticosteroids, glucocorticoids, androgens).
Corticosteroids and androgens; mineralocorticoids.
What are causes of Addison's disease?
TB, infarcion of the adrenal glands, fungal infection, AIDS, cancer, bilateral adrenalectomy, and medications (anticoagulants, chemotherapy, AIDS medications).
Manifestations do not tend to become evident until ___% of the adrenal cortex is destroyed.
90%, therefore the disease is often advanced before it is diagnosed.
What signs and symptoms of addison's disease are NOT correct? Weakness, fatigue, weight loss, anorexia, skin hyperpigmentation, orthostatic hypotension, hyponatremia, hyperkalemia, N/V/D, and irritability?
None, they are all correct :)
What is defined as a life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease of these hormones?
What can trigger an addisonian crisis?
1. Stress from infection, surgery, trauma, or psychologic. 2. sudden withdrawl of corticosteroid hormone replacement therapy. 3. after adrenal surgery 4. following sudden pituitary gland destruction.
What signs and symptoms are NOT associated with addisonian crisis? Hypertension, tachycardia, dehydration, hypernatremia, hyperkalemia, hyperglycemia, chills, weakness, confusion, vomiting, diarrhea, abdominal, arm, and back pain.
Hypertension - these pts are hypotensive (shock), Hypernatremia - these pts are hyponatremic (lose sodium), Hyperglycemia - these pts are hypoglycemic. Chills - these pts have fever. Abdominal/arm/back pain - these patients do have abdominal and back pain, but they have leg pain, not arm pain.
The diagnosis of Addison's disease is made when cortisol levels are _______ or ____ to rise over basal levels with an ACTH-stimulation test?
Subnormal or fail
The failure of cortisol levels to rise in response to ACTH stimulation indicates _______ adrenal disease? (primary/secondary)
A positive response to ACTH stimulation indicates a functioning adrenal gland and points to a probable diagnosis of _____ disease?
What are some other diagnostic findings?
Hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, increased BUN, low urine cortisol, low voltage, peaked T waves****, CT/MRI
What medication therapy is most commonly used to treat adrenocortical insufficiency?
Hydrocortisone, which has both glucocorticoid and mineralcoricoid properties.
T/F: pts with adrenocortical insufficiency should increase dosage of glucocorticoids during times of stress (illness, surgery)?
What is the treatment for addisonian crisis?
Shock management and high-dose hydrocortisone replacement. Large volumes of 0.9% saline solution and 5% dextrose are administered to reverse hypotension and electrolyte imbalances until BP returns to normal.
What are the nursing interventions for pts with addison's disease?
Monitor VS, signs of fluid and electrolyte imbalance every 30 min to 4 hours for the first 24 hours. Monitor I/O, daily weight, protect from infection, provide calm/cool environment, assist with hygiene.
T/F: it is o.k. to administer corticosteroids within an hour of scheduled time?
F: diligent corticosteroid administration must be maintained.
What is defined as a rare condition characterized by a tumor of the adrenal medulla that produces excessive catecholamines?
What 2 catecholamines are produced by phenochromocytoma?
Epinephrine and norepinephrine
What are the signs and symptoms of phenochromocytoma?
Episodic nature (minutes to hours), HTN, anxiety, pounding headache, tachycardia, and chest pain.
What precipitating causes increase the catacholamine surge?
Anesthesia, opiates/opiate antagonist, tricyclic antidepressents, contrast media, tyramine containing foods (beer, cheese, wine, smoked meat), increases in abdominal pressure (bending over or deep palpation).
How is phenochromocytoma diagnosed?
Elevated urine catecholamine metabolites, clonidine suppression test (will not respond), response to alpha blockers (will respond), CT and MRI
What is the treatment of phenochromocytoma?
Adrenalectomy, if bilateral the pt will need life-long steroid replacement therapy.
When providing life-long steroid replacement therapy, is the acual hormone or the stimulating hormone replaced?
HTN in pts with phenochromocytoma should be controlled with what medications first?
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