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M/S 2 > Exam 4 - Endo > Flashcards

Exam 4 - Endo Flashcards

1
Q

where is the pituitary gland located

A

base of the brain

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2
Q

the pituitary gland is aka

A

the master gland

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3
Q

primary vs. secondary pituitary adenoma

A

primary: localized
secondary: metastasized

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4
Q

functional vs. nonfunctional pituitary adenoma

A

function: creating too little or too much hormone

nonfunctional: not secreting hormones but still causing issues

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5
Q

pituitary adenomas are usually ___ and ___ growing

A

benign; slow

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6
Q

anterior pituitary gland secretes these 6 hormones

A

GH
ACTH
LH
FSH
prolactin
TSH

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7
Q

posterior pituitary gland secretes these 2 hormones

A

ADH
Oxytocin

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8
Q

only definitive way to know whether someone has cancer

A

biopsy

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9
Q

stimulation test

A

med is given to stimulate the secretion of a hormone

gland should capable of secreting the hormone

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10
Q

suppression test

A

excess hormone is administered

the gland should be able to suppress the extra hormone

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11
Q

3 types of treatment for pituitary adenoma

A

meds: shrink growth, reduce hormone production (may not be effective)
transsphenoidal/hypophysectomy
radiation

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12
Q

least invasive pituitary adenoma treatment

A

transsphenoidal/hypophysectomy

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13
Q

what is a transsphenoidal/hypophysectomy

A

cut into the back of the nose, tool removes the growth

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14
Q

stereotactic is still ____

A

radiation; it is a high 1 time dose of radiation

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15
Q

acromegaly is caused by an overproduction of which hormone?

A

GH

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16
Q

too much GH in children is called ___

A

gigantism

excess GH beings before the end of puberty (when growth plates close)
too much GH before plates close cause children to grow tall

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17
Q

in which ages is acromegaly commonly seen

A

4th-5th decade

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18
Q

what changes occurs in acromegaly

A

skeletal thickening, enlargement, and decalcification

overgrowth of soft tissue and bones (hands, feet, nose, chin)

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19
Q

s/sx of acromegaly

A

muscle weakness
joint pain
deep voice
HA
visual disturbances
shortened life expectancy
change in menstrual cycle
galactorrhea (50% of women)
DM 2
HTN

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20
Q

acromegaly risk factor

A

genetics

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21
Q

appropriate nursing dx for acromegaly

A

risk for fractures r/t bone decalcification

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22
Q

acromegaly goals

A

meds to suppress or block GH
meds for joint pain
prepare for radiation or hypophysectomy
emotional support

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23
Q

how to Dx acromegaly

A

GH suppression test
IGF-1
OGTT (oral glucose tolerance test)
MRI, CT, XR
eye exam (eval optic nerve)

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24
Q

what is administered for a GH suppression test

A

glucose

glucose is supposed to suppress GH

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25
Q

how often are labs drawn for GH suppression test

A

10 minutes
1 hour
2 hour

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26
Q

what is needed prior to GH suppression test

A

baseline glucose level

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27
Q

can a pt eat before GH suppression test

A

No

28
Q

hypophysectomy postop education

A

no straining
no heavy lifting
do not bend at the waist
do not blow nose, cough, or sneeze
do not brush teeth

x2 weeks

29
Q

hypophysectomy postop nursing interventions

A

neuro checks
monitor packing (bleeding, CSF: glucose test, yellow ring)
no less than semi-fowlers
encourage deep breathing with mouth open (no coughing)
med education (will be on rest of their life)
monitor for meningitis (fever, photosensitivity, petechia, nuchal rigidity)

30
Q

2 adrenal gland disorders

A

Addison
Cushing

31
Q

3 adrenal cortex hormones

A

mineralocorticoid (aldosterone)
glucocorticoid (cortisol)
androgens (testosterone)

32
Q

2 adrenal medulla hormones

A

epi
norepi

33
Q

Addison vs. Cushing

A

A: deficient secretion
C: over secretion

34
Q

ACTH regulates which 2 hormones

A

glucocorticoids (cortisol)
androgens (testosterone)

35
Q

___ is regulated by the amount of K+ is in the body

A

mineralocorticoid (aldosterone)

36
Q

glucocorticoids is a part of which feedback loop

A

Negative

37
Q

Primary vs. secondary Addison

A

P: autoimmune; unknown cause

S: surgery removal, illness, meds

38
Q

does Addison effect some or all 3 hormones

A

all 3 are affected

39
Q

Addison s/sx

A

weakness, fatigue
liable mood
weight loss
anorexia
hyperpigmentation (d/t increase ACTH)
orthostatic hypotension (d/t low fluid volume)
hyponatremia
hyperkalemia
salt craving
dehydration
hypoglycemia
N/V/D
depression
decrease sex drive
decrease menses
hair loss
hair is fine, thin

40
Q

life threatening emergency caused by insufficient ACTH hormones or sudden, sharp decrease in hormones

A

Addisonian crisis/Acute Adrenal Insufficiency

41
Q

Addisonian crisis/Acute Adrenal Insufficient is triggered by

A

stress
sudden WD from corticosteroid therapy
—review meds on admission!
s/p adrenal surgery
sudden pituitary gland destruction

42
Q

SALT LOSS re: addisonian crisis s/sx

A

S low Na
A anorexia
L lethargy
T decrease tendon reflex
L limp muscles
O orthostatic hypotension
S eventually seizures
S stomach cramps

43
Q

Addisonian crisis replacement therapy

A

Bolus NS with Dextrose
hydrocortisone (glucocorticoid + mineralocorticoid properties)
salt
treat underlying cause
Florinef (mineralocorticoid)

44
Q

Addisonian crisis nursing interventions

A

monitor VS
electrolyte imbalance
daily weight
corticosteroid administration
protection, monitor for infection
avoid extreme temps and stressors

45
Q

how to Dx Addisons

A

assess s/sx
serum cortisol (low)
serum ACTH (high)
serum glucose
serum Na, K+
leukocytosis
CT, MRI
stimulation test

46
Q

when should serum cortisol and ACTH lab be drawn for Addisons dx

A

early morning

47
Q

stimulation test for Addisons

A

ACTH infused, glucocorticoid (cortisol) measured (should not go up)

48
Q

when are labs drawn for stimulation test re: Addisons

A

q30 minutes x2

glucocorticoid (cortisol) measured, should not go up

49
Q

Addison’s diet

A

low K+
high Na

50
Q

Addison’s medications

A

Florinef (monitor for HTN; fluid volume excess)
Prednisone (monitor BGL)
Hydrocortisone (take with food to prevent GI distress)

51
Q

Addison’s home care/education

A

lifelong treatment
med alert bracelet
emergency prefilled hydrocortisone or dexamethasone on hand
stress management
avoid infection
mineralocorticoids in AM
glucocorticoids: 2/3 in AM; 1/3 in PM
when to call HCP
–HTN, weight gain, fluid overload, low BGL, increased fatgiue

52
Q

Cushing disease vs. Cushing syndrome

A

Disease: tumor

Syndrome: d/t long term corticosteroid use

53
Q

s/sx of Cushings

A

weight gain (most common)
buffalo hump
central obesity
purple striae
moon faced
hyperglycemia
muscle wasting
osteoporosis
fragile skin
hirsutism
virilization
infections
ecchymosis
HTN
depression
acne

54
Q

Cushing diagnostic labs

A

CBC
CMP
-BGL: elevated
-K+, Ca: low

55
Q

Salivary free cortisol level for diagnosis of Cushing is drawn when

A

late evening

56
Q

Dexamethasone suppression test for Cushing is administered in the ___ and labs are drawn in the ___

A

evening; morning

57
Q

Cushings diet

A

high protein
high potassium
low calorie/carb
low Na
calcium + D

58
Q

medications for Cushing suppression

A

ketoconazole (Nixoral)
aminogluethimide (Cytadren)

59
Q

ketoconazole considerations

A

anti-fungal
large doses supress adrenal cortex activity
may cause liver failure

60
Q

cytraden considerations

A

temporarily suppresses adrenal cortex activity
start in hospital
usually no more than 3 months
S/E: N/V

61
Q

bisphosphonates are given to Cushing pts to prevent ___

A

osteoporosis

S/E: HA

62
Q

Cushing pre op care

A

control BGL, HTN, K+
high protein diet

63
Q

Cushing postop care

A

high dose Solu-Cortef (hydrocortisone)
monitor VS, wound, bleeding, infection

64
Q

Cushing postop critical period

A

24-48 hours

must report changes in VS or UOP

65
Q

Cushing daily weight changes to be reported

A

2# in 24 hours
3# in 1 week

66
Q

postop cushing diet

A

high calorie
high salt

**opposite of preop

67
Q

corticosteroid therapy effects on the body

A

anti-inflammatory
immunosuppression
maintain normal BP
carb + protein metabolism

M/S 2 (10 decks)

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