Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Med surge 2 Final > Adrenal Cortex > Flashcards

Adrenal Cortex Flashcards

(123 cards)

Start Studying
1
Q

What hormones are produced by the adrenal cortex?

A

Glucocorticoids (e.g., cortisol, hydrocortisone)

Mineralocorticoids (e.g., aldosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the functions of glucocorticoids (cortisol, hydrocortisone)

A

Decrease inflammation

Regulate glucose metabolism

Increase blood glucose during stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is another name for adrenal cortex insufficiency?

A

Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the patho of Addison’s disease (adrenal cortex insufficiency)

A

The adrenal cortex doesn’t produce enough steroids (glucocorticoids and mineralocorticoids).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What hormone does the hypothalamus release to begin the steroid production process

A

CRH (Corticotropin-Releasing Hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What hormone does the pituitary gland release in response to CRH?

A

ACTH (Adrenocorticotropic Hormone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does ACTH stimulate the adrenal cortex to produce?
What does ACTH stimulate the adrenal cortex to produce?

A

Glucocorticoids and mineralocorticoids, especially cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the problem with the negative feedback loop in Addison’s disease?

A

The loop is broken — the signal to produce hormones stays “off,” so cortisol and aldosterone aren’t made.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S/S of Addison’s disease (adrenal cortex insufficiency) “ADDDSS”

A

A: added potassium and bronzed hyperpigmentation

D: decreased BP (deadly)

D: decreased weight r/t lack of mineralocorticoids which means lack of fluid and weight loss

D: decreased hair, energy, sugar
Alopecia, Hypoglycemia, Hypotension, Fatigue

D: Decreased BP (deadly)
S: decrease sodium (hyponatremia)

S: Salt Craving

Other Symptoms:
GI: Gastroenteritis, Abdominal Pain
Weak brittle bones
Emotional Lability: Depression/Mood changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the function of mineralocorticoids (aldosterone)?

A

Maintain fluid and electrolyte balance

Regulate blood pressure

Retain sodium

Excrete potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can happen if a patient suddenly stops taking exogenous steroids if they have been on it for 2 weeks+

A

They are at risk for Addisonian crisis due to a sudden drop in cortisol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes addisions

A

A: autoimmune
D: diseases (Infection, TB, HIV)
D: damage to the adrenal glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnostic testing for Addison’s disease (adrenal cortex insufficiency)

A

1) MRI/CT: To see the size and structure of the adrenal glands

2) ACTH stimulation test: test to see how well the adrenal glands respond to ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ACTH stimulation test procedure

A
  1. Draw cortisol levels
  2. Give cosyntropin (Synthetic ACTH)
  3. Redraw cortisol levels
    Its best to draw cortisol levels in the morning because that is when the most cortisol is produced r/t the circadian rhythm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ACTH stimulation test results

A

In normal patients: Cortisol levels will increase because the adrenal glands are responding

In Addison’s patients: Will stay low because the adrenal glands are not responding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Addison’s disease (adrenal cortex insufficiency) treatment

A

A: Add steroids in times of stress

D: diet high in sodium, protein and carbs

D: don’t think meds are going to cure you, lifelong hormone therapy (specifically hydrocortisone because it has gluccosteriod and mineralsteriod effects)

D: don’t stop abruptly (will go into shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two main complications of Addison’s disease (adrenal cortex insufficiency)

A
  1. Circulatory/Hypovolemic Shock
  2. Addisons crisis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

S/S To circulatory shock in Addison’s disease (adrenal cortex insufficiency)

A
  1. Hypovolemia
  2. Hyperkalemia
  3. Hyponatremia
  4. Hypotension
  5. Hypoglycemic

Remember in the compensatory stage the HR/RR will be increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Addison’s Crisis
what is it and what are the symptoms

A

Life threatening emergency due low cortisol and adrenal insufficiency

S/S:
Hypoglycemia
Hyperkalemia
Hyponatremia
Confusion
Rapid Pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for Addison’s Crisis

A

IV Steroid (- Sone)

Rapidly replaces the hormone , increase glucose and stabilize BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patient EDU for Addison’s disease (adrenal cortex insufficiency)

A
  1. Increase sodium in hot weather r/t sweating
  2. Steroids:
    Mask infection
    Increase blood glucose rapidly ( monitor in diabetics)
    Delay wound healing
    Taper
  3. Wear medical bracelet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why should you monitor BUN and hematocrit with
Addison’s disease (adrenal cortex insufficiency)

A

dehydration causes hemoconcentration which increases the BUN and hematocrit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adrenal Cortex Hyperfunction:
Cushing’s disease patho

A

To many steroids being
leading to an overproduction of ACTH, normally cortisol levels are only high in the morning and decreased in the evening but with adrenal hyperfunction (cushings) that pattern is destroyed and the cortisol levels are always high from the overproduction of ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Adrenal Cortex Hyperfunction:
Cushing’s disease
S/S :CushD”

A

C:ushion: Moon face, Buffalo Hump, “Truncal Obesity

U:nsual Hair: Hirturisum (R/t increased androgen hormone)

S:kin: Delayed wound healing, Abdominal Striae (stretch marks), Tearable skin

H:igh: BP, Sugar, Salt, Weight, Tumor
↪HPTN, Hyperglycemia, Hypernatremia, Fluid overload(edema), Hypersecreting adrenal tumor

D:ecreased: Potassium and Bones
↪ Osteoporosis, Hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What does increased glucocorticoids lead to in Cushing’s?
Impaired glucose metabolism, abnormal fat distribution, and decreased muscle mass.
26
What does a hypersecreting adrenal tumor cause in terms of electrolytes?
A: Increased reabsorption of sodium and water, and increased potassium excretion — leading to arrhythmias and hypertension.
27
What does increased corticosteroids do to the immune system?
It decreases the inflammatory and immune response by destroying lymphocytes, increasing infection risk.
28
Why is a 24-hour urine test done for Cushing’s?
To check for constant high cortisol levels. In Cushing’s, cortisol is high all day, not just in the morning.
29
What electrolytes are checked in Cushing’s diagnosis?
Potassium and sodium.
30
What is the Dexamethasone Suppression Test?
A test to see how well the adrenal glands respond to synthetic steroid synthetic steroid is given at night; cortisol is rechecked in the morning.
31
What do Dexamethasone test results show in Cushing’s vs. normal?
Cushing’s: Cortisol stays high (feedback loop doesn’t work). Normal: Cortisol drops (feedback loop works).
32
What meds are used to treat Cushing’s?
Aminoglutethimide: Pasireotide:
33
Aminoglutethimide:
Stops the conversion of cholesterol to steroids which lowers the cortisol level
34
Parositide:
Somatostatin analog that stop release of ACTH from the pituitary gland
35
What are the main diagnostic tests for Cushing’s syndrome?
24-hour urine test for cortisol Serum electrolyte test (especially sodium and potassium) Dexamethasone suppression test to check cortisol regulation
36
What are the surgical interventions for Cushing’s syndrome?
Adrenalectomy and transsphenoidal hypophysectomy.
37
What is an adrenalectomy and what are the risks?
Removal of the adrenal glands. Patient will need lifelong hormone replacement and is at risk for rebound adrenal insufficiency.
38
What is a transsphenoidal hypophysectomy and what should be monitored after surgery?
Minimally invasive removal of a pituitary tumor. Monitor for increased ICP, vision changes, CSF leak (clear nasal drainage—test for glucose), DI, hormone and electrolyte changes. Keep HOB elevated.
39
What are the complications of Cushing’s syndrome?
Severe hypertension and severe hypokalemia
40
What does severe hypertension lead to in Cushing’s syndrome?
Heart, vascular, vision, and renal damage
41
What can severe hypokalemia lead to in Cushing’s syndrome?
Lethal dysrhythmias
42
What is pheochromocytoma?
A tumor on the adrenal glands that releases excessive catecholamines (epinephrine/norepinephrine), causing risk for hypertensive crisis.
43
Is pheochromocytoma usually unilateral or bilateral?
Usually unilateral
44
What are the 5 H’s of pheochromocytoma symptoms?
Headache, Hyperhidrosis, Hypermetabolism, Hypertension Hyperglycemia.
45
What are other symptoms of pheochromocytoma?
Widened pulse pressure, vasoconstriction, and high stroke volume.
46
What diagnostic tests are used for pheochromocytoma?
24-hour urine test (for cortisol) blood test: to look for excess catecholamines CT/MRI (for tumor size/structure).
47
What medications are used for pheochromocytoma?
1. Beta blockers/ nipride: for heart rate 2. calcium channel blockers/smooth muscle relaxers, 3. glucocorticoids before surgery. to reduce risk for adrenal crisis
48
What is the main surgical treatment for pheochromocytoma?
Adrenalectomy.
49
What is important to prepare for after adrenalectomy in pheochromocytoma?
Treating the opposite of symptoms (e.g., hypotension, hypoglycemia
50
What nursing interventions are important for pheochromocytoma patients?
Provide a quiet environment and continuous cardiac monitoring
51
What hormones are decreased in hypothyroidism?
TSH, T3, and T4.
52
What is the role of the anterior pituitary gland in thyroid hormone production?
It releases TSH, which stimulates the thyroid to produce T3 and T4. And realease calcitonin
53
What does calcitonin do?
It stores calcium in the bones and lowers calcium levels in the blood.
54
What is a major risk factor for hypothyroidism?
Hashimoto’s disease, an autoimmune disorder that causes the thyroid gland to attack itself.
55
What is the hallmark symptom of hypothyroidism?
Slow metabolism.
56
Name three common symptoms related to cold and energy in hypothyroidism.
Cold intolerance, severe fatigue, and anemia.
57
What happens to the thyroid gland in hypothyroidism?
It can enlarge forming a goiter due to fibrous tissue replacing functional tissue.
58
List four common physical symptoms of hypothyroidism.
Fluid retention/edema, weight gain, constipation
59
Nails and skin in hypothyriodism
Dry brittle skin and nails: because they don’t sweat
60
menstrual symptoms seen in hypothyroidism?
Heavy and irregular periods
61
What are two muscle-related symptoms in hypothyroidism?
Muscle spasms and weakness.
62
What cardiovascular issues can hypothyroidism cause?
CAD, atherosclerosis, and lipid dysfunction.
63
What is a distinctive eyebrow feature in hypothyroidism?
Thin lateral eyebrows.
64
What diagnostic tests are used for hypothyroidism?
Test T3 and T4 hormone levels and TSH levels.
65
What are the lab results for primary hypothyroidism?
↑ TSH, ↓ T3/T4 — problem with the thyroid gland itself.
66
What are the lab results for secondary hypothyroidism?
↓ T3/T4 and ↓ TSH — problem with the anterior pituitary gland
67
What causes myxedema
untreated hypothyroidism
68
myxedema s/s
Confusion/AMS: at risk to be in a comatose state Hypothermia Multiple organ failure Periorbital and lower extremity edema Cardiac issues and trouble breathing: Low cardiac output and contractility
69
What is myxedema coma and what causes it?
Life-threatening emergency caused by severe untreated hypothyroidism; suddenly stopping levothyroxine thyroidectomy
70
What are the key symptoms of myxedema coma?
1. Hypoxia & CO₂ retention, 2.hypotension/bradycardia 3. hypoglycemia 4. hypothermia 5. Fluid/Electrolyte imbalance: hyponatremia 6. facial puffiness
71
What is the priority intervention for a patient in myxedema coma?
Keep emergency trach equipment at the bedside due to risk of hypoventilation.
72
Q: Why should you use caution when giving narcotics to patients with myxedema coma?
These patients have slow metabolism and are highly sensitive to sedatives and narcotics.
73
What is Levothyroxine (Synthroid) used for and how long is it taken?
It's a thyroid hormone replacement for hypothyroidism; taken for life.
74
How long does it take for Levothyroxine to start relieving symptoms?
It has a slow onset—takes 3 to 4 weeks for symptom relief.
75
When and how should Levothyroxine be taken?
Take every morning, same time, on an empty stomach 30–60 minutes before breakfast.
76
Why should Levothyroxine be taken in the morning
To mimic the body's natural circadian rhythm.
77
What should you report to the HCP while taking Levothyroxine?
Increased irritability or agitation—could be a sign of thyroid storm and need for dose adjustment.
78
What is the goal of Levothyroxine therapy and how is dosing managed?
Goal is to normalize metabolism; dose is based on TSH levels and adjusted as needed.
79
Can Levothyroxine be stopped abruptly?
No, it must be titrated slowly and never stopped suddenly.
80
What should you do if a patient is on tube feed but has a prescription for Levothyroxine?
Stop the tube feeding 1 hour before giving Levothyroxine.
81
Who should use Levothyroxine with caution?
Diabetics: It can increase blood glucose. Cardiac patients: It increases heart rate and contractility, raising the risk for MI and angina.
82
What hormone levels in hyperthyroidism?
: ↑ T3, ↑ T4, ↓ TSH
83
What is Graves’ disease and how does it relate to hyperthyroidism?
Graves’ disease is an autoimmune disorder where thyroid-stimulating immunoglobulins overstimulate the thyroid, increasing T3/T4 and enlarging the gland.
84
What are the types of hyperthyroidism and their causes?
Primary: Thyroid overproduces T3/T4 Secondary: Pituitary overproduces TSH Tertiary: Hypothalamus overproduces TRH
85
What is the hallmark sign of hyperthyroidism?
High metabolism
86
What are common eye-related symptoms of hyperthyroidism?
Exophthalmos (bulging eyes), vision changes, need for eye patches or lubricants to prevent dryness
87
What are the cardiac symptoms of hyperthyroidism?
Elevated heart sounds, tachycardia, palpitations, dysrhythmias
88
What are metabolic and temperature-related symptoms of hyperthyroidism?
Heat intolerance, always hot, sweating
89
How does hyperthyroidism affect appetite and the GI system?
Increased appetite and diarrhea
90
What are the menstrual symptoms of hyperthyroidism?
Amenorrhea or light periods
91
How does hyperthyroidism affect weight and hair? and why for weight
Weight loss: the body is in a hyper metabolic state and using all of its protein stores which decreases muscle mass and hair loss
92
Does hyperthyriodism have a thyroid bruit if yes what causes it?
Yes and Increased blood flow through the thyroid
93
What causes the goiter in hyperthyroidism and how does it compare to hypothyroidism?
Goiter is due to hyperplasia and is usually larger than in hypothyroidism
94
What diagnostic tests are used for hyperthyroidism?
1.Blood test for T3, T4, and TSH - (T3/T4 will be high, TSH low in primary hyperthyroidism) - Thyroid scan to assess goiter - Antibody test for Graves' disease (TSHR antibodies)
95
What medications are used to treat hyperthyroidism?
1. Antithyroid meds: - PTU (Prophylthiouracil) - Methimazole - Lithium 2. Beta blockers: To reduce heart rate 3. SSKI (Sodium Iodine) 4. Radioactive Iodine (RAIU): Shrink or destroy thyroid cells by stopping blood flow
96
What is the goal of hyperthyroidism treatment?
Normalize metabolism Lower heart rate Decrease body temperature
97
What are important considerations when caring for a patient with hyperthyroidism?
Provide a quiet environment (patient is overstimulated) Encourage increased fluid intake
98
When is a thyroidectomy needed?
If the patient doesn't respond to medications for hyperthyroidism.
99
What long-term medication is required after a thyroidectomy and why?
Levothyroxine (Synthroid), because the patient can no longer produce T3/T4 hormones.
100
What are key post-op considerations after a thyroidectomy?
Swelling is normal Provide humidified oxygen Parathyroid tissue can get damaged; Monitor for voice/swallowing problems (possible larynx or parathyroid damage)
101
Things we monitor for with thyroidectomy
1. Airway 2. Hemorrhage 3. Tetany 4. Hypocalcemia
102
What is the #1 priority after a thyroidectomy?
Airway. - Keep emergency trach and suction equipment at bedside. - Position patient in semi-Fowler's to reduce aspiration risk.
103
What signs suggest laryngeal nerve damage after thyroidectomy?
Noisy breathing Laryngeal stridor Voice changes or hoarseness Assess voice every 1–2 hours
104
When is bleeding most likely after a thyroidectomy and what should you monitor?
Bleeding is most common 24–48 hours post-op Monitor surgical site for signs of hemorrhage
105
What is tetany and what causes it after thyroidectomy?
Tetany is uncontrollable muscle spasms Caused by hypocalcemia (calcium < 8.6)
106
What are signs of hypocalcemia to monitor for after thyroidectomy?
Muscle cramps/spasms Numbness and tingling Positive Trousseau’s or Chvostek’s sign
107
What is thyroid storm?
A life-threatening medical emergency caused by severe untreated hyperthyroidism.
108
What are signs and symptoms of thyroid storm?
Hyperthermia (105–106°F) Tachycardia (180–200 BPM) Confusion or altered mental status Seizures and coma (due to fever, hypernatremia, hypermetabolic state)
109
What is the priority treatment for thyroid storm?
Lower body temperature and control heart rate
110
Treatment for thyroid storm
Give beta blockers and antipyretics Use IV fluids and cooling blankets Administer antithyroid meds and RAIU
111
What is the function of PTH (Parathyroid Hormone)?
PTH raises calcium levels by pulling calcium from bones, increasing absorption from the gut, and storing calcium in the kidneys.
112
Function of calcium 3 B's
Bones: Stores calcium to keep them strong Blood: Supports blood clotting Beat: Helps the heart muscle contract effectively
113
How does the kidney help increase serum calcium?
PTH Signals kidney to reabsorb calcium instead of excreting it in urine.
114
How does the intestine contribute to calcium levels?
It absorbs calcium from food with the help of activated vitamin D (calcitriol).
115
How does the bone help raise serum calcium?
The body pulls calcium from bones when levels in the blood are low
116
What are the key lab findings in hyperparathyroidism?
Calcium ↑ Parathyroid Hormone (PTH) ↓ Phosphorus
117
What is the cause of high calcium levels in hyperparathyroidism?
Excess PTH pulls calcium from the bones, kidneys, and intestines into the blood, raising serum calcium.
118
S/S for hyperparathyroidism
1) Stones ( Renal Calculi): Kidney is overload with trying to filter out calcium 2) Bones: To much calcium is being pulled from the bones - Generalized weakness and atrophy - At risk for pathological fractures - Decreased deep tendon reflexes 3) Moans ( constipation) Overload of calcium causes rock hard bowel movements - Abdominal pain 4) dysrhythmias/anorexia/ polyuria
119
Treatment for hyperparathyroidism
1. Furosemide (Lasix): - To flush out excess calcium the kidneys 2. Calcitonin: Decreases serum calcium 3. Increase fluid and fiber intake - 3000 ml per day to flush out renal calculi -Increase fiber and fluids for constipation - Strain urine for renal calculi
120
What are the key lab findings in hypoparathyroidism?
↓ PTH & Calcium ↑ Phosphorus
121
What causes low calcium levels in hypoparathyroidism?
Low PTH leads to: ↓ Calcium absorption in intestines ↓ Calcium reabsorption in kidneys ↓ Calcium release from bones → Resulting in hypocalcemia
122
S/S
1. Trousseau sign: hand spasms/contract with blood pressure cuff 2. Chvostek sign: Face tremors 3. Severe muscle cramps /spasms 4. Tetany 5. Muscle tingling in face, mouth, hands and feet 6. Laryngeal spasm/compromised airway - Have emergency trach and suction equipment at bedside 7. Diarrhea
123
Treatment:
1. Calcitriol: increases serum calcium 2. Increase calcium intake (dairy/milk) , decrease phosphorus 3. Vitamin D/ Calcium / Mag supplement

Med surge 2 Final (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions