Endocrine Flashcards
(318 cards)
1
Q
Patients experiencing acute adrenal insufficiency are most commonly those who are currently receiving or having recently been withdrawn from what kind of therapy?
A
Corticosteroid
2
Q
Thyroid storm has an abrupt onset and is best categorized as a state of unregulated what?
A
Hypermetabolism
3
Q
Neurogenic diabetes insipidus results from an insufficiency of which hormone?
A
Antidiuretic
4
Q
Myxedema coma can occur in pateitns who have an extremely low metabolic state associated with what?
A
Hypothyroidism
5
Q
Extreme hyperthyroidism with serious signs and symptoms
A
Thyroid storm
6
Q
Syndrome on inappropriate ADH is associated with low levels of what?
A
Serum sodium
7
Q
Controls and regulates the metabolic process
A
Hormones
8
Q
Destruction of the adrenal gland itself
A
Addison’s disease
9
Q
Which disease results in myxedema
A
Hypothyroidism
10
Q
In what patients is hyperglycemic hyperosmolar syndome most commonly seen?
A
Newly diagnosed type 2 DM
11
Q
Results from alterations in insulin secretion, insulin action, or both
A
Diabetes Mellitus
12
Q
What is the most frequent form of hyperthyroidism?
A
Graves’ disease
13
Q
What is the preferred energy source for the brain?
A
Glucose
14
Q
Glucocorticoid and mineralocorticoid deficiency
A
Acute adrenal crisis
15
Q
Hypersecretion of ADH
A
SIADH
16
Q
Hypersecretion of cortisol
A
Cushing’s syndrome
17
Q
Hypersecretion of insulin
A
Hypoglycemia
18
Q
Hypersecretion of T3 and T4
A
Thyroid Storm
19
Q
Hyposecretion of ADH
A
Diabetes Insipidus
20
Q
Hyposecretion of insulin
A
Type 1 DM
21
Q
Hyposecretion of T3 and T4
A
Myxedema Coma
22
Q
What would not be a laboratory finding in a patient with SIADH?
A
Low urine sodium
23
Q
Indicators for primary hyperthyroidism would include what lab values?
A
Low to normal TSH with elevated T3 and T4
24
Q
What is cortisol released in response to?
A
Anterior pituitary release of ACTH
25
What often causes the hypothyroid state in secondary hypothyroidism?
Pituitary gland dysfunction
26
Which test can be performed to assess for the presence of adrenal insufficiency?
Cortisol stimulation test
27
What would the assessment findings for a pateint who is in a myxedema coma include?
Lethargy, edema, swollen tongue, and abdominal distension
28
What is the hallmark sign of SIADH?
Dilutional Hyponatremia
29
What is a potential cause of ectopic ADH secretion, causing SIADH?
Small cell carcinoma of the lung
30
What do the pituitary glands regulate?
The endocrine system
31
What does the hypothalamus regulate?
Body temperature
32
What do the gonads regulate?
The sex hormones
33
What do the adrenal glands regulate?
Steroids
34
What does the thyroid regulate?
Metabolism
35
What does the parathyroid regulate?
Serum calcium and phosphorus levels
36
What does the pancreas regulate?
Insulin
37
What steroids does the adrenal cortex make?
Mineralocorticoids and corticosteroids
38
Name a mineralocorticoid
Aldosterone
39
Name a corticosteroid
Cortisol
40
What steroid does the adrenal medulla make?
Catecholamines
41
Name the catecholamines
Epinephrine and Norepinepherine
42
What is the important history to gather when assessing the endocrine system?
Energy levels, elimination pattern, sexual and reproductive functions, and physical appearance
43
Which endocrine disease would cause a prominent forehead or jaw?
Acromegaly
44
Which endocrine disease would cause a round or puffy face?
Cushing's
45
Which endocrine disorder would cause a dull or flat expression?
Hypothyroidism
46
Which endocrine disorder would cause striae?
Cushing's
47
Which endocrine disorder would cause hirsutism?
Cushing's
48
What laboratory testings would have to be done with an assessment of the endocrine system?
Stimulation/suppression tests, assays, and urine tests
49
What would cause primary pituitary dysfunction?
There would be a problem with the pituitary itself
50
What would cause secondary pituitary dysfunction?
A hypothalamic disorder
51
Deficiency of one or more anterior pituitary hormones
Hypopituitarism
52
Partial or total failure of all anterior pituitary hormones
Panhypopituitarism
53
What are the causes of primary pituitary dysfunction?
Hypophysectomy, non-secreting pituitary tumor, radiation, infarction, metastatic disease, and trauma
54
Why does a non-secreting pituitary tumor cause primary pituitary dysfunction?
The pressure of the tumor destroys the pituitary gland
55
Why does an infarction cause primary pituitary dysfunction?
It causes hypertrophy of the pituitary gland
56
Which metastatic disease is likely to cuase primary pituitary dysfunction?
Small cell carcinoma of the lung
57
What kind of trama causes primary pituitary dysfunction?
Closed head injury that puts pressure on the pituitary
58
What are the causes of secondary hypopituitarism?
Infection, trauma, tumors, congenital defects, and infiltrative processes
59
What infection generally causes secondary hypopituitarism?
Meningitis
60
What type of infiltrative processes generally causes secondary hypopituitarism?
Scaroidosis
61
What disorders are associated with hypopituitarism?
Sterility, loss of libido and secondary sex characteristics, ammenhorhea, decrease of spermatogenesis, and testicular atrophy
62
What is the second most common cause of hypopituitarism?
Growth hormone deficiency
63
What do you have to screen for before giving replacement growth hormone?
Cancer
64
What are the interventions for patients with hypopituitarism?
Improve body image
65
Why are females with hypopituitarism given estrogen and progesterone?
To replace lost LH and FSH
66
When can females with hypopituitarism not be given estrogen or progesterone?
Before puberty and the closure of the epiphyseal plates
67
What do females on estrogen and progesterone replacement need to ovulate?
Clomid
68
What are the side effects of estrogen and progesterone replacement therapy?
Blood clots and hypertension
69
What does testosterone given to males with hypopituitarism treat?
Gynocomastia, baldness, chest hair, high pitched voice, low muscle mass, poor libido and small peens
70
When should growth hormone be given?
Prior to the closal of the epiphyseal plates
71
What is a side effect of somatropin?
Bone pain
72
Over secretion of one or more pituitary hormones
Hyperpituitarism
73
What is the cause of primary hyperpituitarism?
Benign adenoma
74
Disease caused by the over secretion of growth hormone in children
Giantism
75
Disease caused by the over secretion of growth hormone in adults
Acromegaly
76
What disease is caused by excess ACTH?
Cushing's
77
What drug treats hyperpituitarism?
Parlodel
78
How does parlodel work?
Suppresses the secretion of prolactin
79
What are the risks of radiation of the pituitary gland?
Hypopituitarism and optic nerve damage
80
What are the symptoms of hyperpituitarism?
Hyperpolactinemia
81
Removal of the pituitary gland or microadenoma?
Hypophysectomy
82
What are the nursing interventions for a patient who is post op with a transsphenoidal hypophysectomy?
No toothbrushing, dental flossing, or mouthwash for 1-2 weeks; avoid nasotracheal suctioning; no blowing nose, sneezing or coughing; avoid straining bowel movements; check for a CSF leak; and monitor for signs and symptoms of meningitis
83
What is the hallmark characteristic of acromegaly?
Large facial features
84
What is the purpose of the posterior pituitary?
Promotes water reabsorption
85
What is the pathophysiology of SIADH?
Excess ADH causes the reabsorption of water from the renal tubules, causing dilutional hyponatremia
86
What are the treatments for hyperpituitarism?
Drugs, radiation, or surgical management
87
Which condition causes an increase in milk production, gynecomastia, and altered sexual function
Hyperpolactinemia
88
What can cause SIADH?
Oat cell cancer metastasis, thymomas, non-malignant pulmonary problems, CNS disorders, and various drugs
89
Which disorders of the CNS causes SIADH?
CVA or infection
90
Which drugs cause SIADH?
Anesthesia, narcotics, or tricyclic antidepressants
91
Which disorder can produce ectopic ADH?
Non-malignant pulmonary problems
92
What are the clinical manifestations of SIADH?
Water retention, GI disturbances, edema, increased heart rate, hypothermia, increased urine Na levels, increased urine specific gravity, low serum Na, low plasma osmolarity, changes in LOC, seizures, coma, and sluggish deep tendon reflexes
93
Tumors behind the breast bone that make cells identical to ADH
Thymomas
94
What are the nursing interventions for patients with SIADH?
Restrict fluid intake to 500-600 mL/day, administer diuretic, maintain strict I/Os, take daily weights, and monitor for LOC changes
95
What is the pathophysiology for diabetes insipidus?
Decreased ADH causes decreased water reabsorption in the renal tubules, resulting in hypernatremia and excessive urine output
96
What can cause diabetes insipidus?
Generally head trauma, but also surgery or destruction of the proximal pituitary
97
How much can patients with diabetes insipidus void daily?
Up to 3 liters
98
What would the sodium levels of a patient with diabetes insipidus be?
Greater than 145 mEq/L
99
What are the clinical symptoms of diabetes insipidus?
Extreme thirst and dehydration, hypovolemia, tachycardia, poor skin turgor, low PA pressures, and low urine specific gravity
100
What is the treatment of diabetes insipidus?
Vasopressin or Desmopressin, maintain adequate hydration, monitor strict I/Os, administer IV and oral fluids, teach for life long med administration, and have the patient wear a medic alert band
101
What is vasopressin?
A potent vasoconstrictor
102
What is desmopressin?
A nasal spray that does not have the potency of vasopressin but has a longer lasting anti-diuretic effect
103
What kind of IV and fluids should a patient with diabetes insipidus be given?
Normal saline through two large bore IVs
104
What do patients newly diagnosed with diabetes insipidus need to be taught?
To always have their meds with them and always wear a med alert bracelet
105
What would the serum osmolality of a patient with diabetes insipidus be?
Greater than 295
106
What would the urine osmolarity of a patient with diabetes insipidus be?
Less than 100
107
What would the urine specific gravity of a patient with diabetes insipidus be?
Less than 1.005
108
What would the serum osmolarity of a patient with SIADH be?
Less than 280
109
What are the symptoms of Cushing's syndrome?
Moon face, buffalo hump, decreased ability to fight infection and heal, weight gain, and increased glucose levels
110
Which steriods regulate the metabolism and increase blood sugar in response to physiologic stress?
Glucocoritcoids
111
Which steroids balance sodium and potassium?
Mineralocoritcoids
112
What does androgen contribute to?
Growth and development in both genders and sexual activity in women
113
What do androgens increase the instance of?
Myocardial infarctions
114
What is the leading endogenous cause of Cushing's syndrome?
ACTH-secreting pituitary tumors
115
What are the clinical manifestations of Cushing's syndrome?
Hyperglycemia, protein wasting, loss of collagen, mood disturbances, insomnia, irrationality, psychosis, hypertension, and acne
116
What causes Cushing's syndrome?
Excess corticosteroids, particularly glucocorticoids
117
Who is Cushing's disease most common in?
Women 20-40 years old
118
Why do patients with Cushing's exhibit muscle wasting?
Cortisol has catabolic effects
119
Why do patients with Cushing's exhibit hypertension?
Mineralocorticoids cause fluid retention, causing hypertension
120
What do the excess adrenal androgens seen in patients with Cushing's syndrome cause?
Pronounced acne, virilization in women, and feminization in men
121
Why is hyperglycemia a clinical manifestation of Cushing's syndrome?
Glucose intolerance is associated with cortisol-induced insulin resistance and there is increased gluconeogenesis by the liver
122
How is Cushing's syndrome diagnosed?
24-Hour urine collection looking for free cortisol or a CT and MRI of the the pituitary and adrenal glands
123
What levels of free cortisol in urine indicate Cushing's syndrome?
50-100 mcg/day
124
What indicates ACTH-dependent Cushing's disease?
High or normal ACTH levels
125
What is the primary goal in treating Cushing's syndrome?
Normalize hormone secretion
126
What imbalances are seen in patients with ectopic ACTH syndrome and adrenal carcinoma?
Hypokalemia and alkalosis
127
What is the treatment for Cushing's caused by a pituitary adenoma?
Surgical removal of tumor and/or radiation and drug therapy
128
What conditions can lead to false positives in the diagnostic tests for Cushing's syndrome?
Depression, stress, and alcoholism
129
What indicates an adrenal or exogenous etiology of Cushing's disease?
Low or undetectable ACTH levels
130
What is the treatment for Cushing's caused by an adrenal tumor or hyperplasia?
Adrenalectomy and drug therapy
131
What is the treatment for Cushing's caused by ectopic ACTH-secreting tumors?
Treatment of the primary neoplasm and drug therapy
132
Suppresses cortisol production, alters peripheral metabolism of cortisol, and decreases plasma and urine corticosteroid levels
Mitotane (Lysodren)
133
Which drugs inhibit cortisol synthesis?
Metyrapone, ketoconazole, and aminoglutethimide
134
What are the side effects of drug therapy for Cushing's syndrome?
Anorexia, nausea and vomiting, GI bleeding, depression, vertigo, skin rashes, and diplopia
135
What should you do if Cushing's develops during use of corticosteroids?
Gradually discontinue therapy
136
What happens if you stop corticosteroid therapy too suddenly?
Life-threatening adrenal insufficiency
137
What nursing diagnoses should be implemented for a patient with Cushing's syndrome?
Risk for infection, imbalanced nutrition related to decreased appetite, disturbed self-esteem related to altered body image, and impaired skin integrity
138
What are the goals for patients with Cushing's syndrome?
Experience relief of symptoms, have no serious complications, maintain positive self-image, and actively participate in the therapeutic plan
139
What nursing interventions should be implemented for patients with Cushing's syndrome?
Health promotion, acute intervention, patient monitoring, emotional support, preoperative care, postoperative care and home care
140
What is diplopia?
Double vision
141
What should the nurse monitor for a patient with Cushing's syndrome?
Vital signs, daily weights, glucose, infection, signs and symptoms of abnormal thromboembolic phenomena
142
What needs to be controlled tightly pre-op for patients with Cushing's syndrome?
Hypertension, hyperglycemia, and hyperkalemia
143
What preoperative care needs to be performed on a patient with Cushing's syndrome?
Nasogastric tube, urinary catheter, IV therapy, central venous pressure monitoring, and leg compression devices
144
Why is the risk of hemorrhage increased post-op for patients with Cushing's?
High vascularity of the adrenal glands
145
Why are the blood pressure, fluid balance, and electrolyte levels of a post-op patient with Cushing's unstable?
Manipulation of the glandular tissues may release hormones into circulation
146
What should be reported to the doctor about post-op patients with Cushing's?
Blood pressure, respirations, heart rate, skin, circulation, and infection
147
What should be closely monitored post-op for patients with Cushing's?
Fluid intake and output, circulatory instability, and urine levels of cortisol
148
What is the critical period for circulatory instability post-op for patients with Cushing's?
24-48 hours
149
What are the indications of hypocortisolism post-op for patients with Cushing's?
Vomiting, increased weakness, dehydration, and profound hypotension
150
What are the side effects of surgery for patients with Cushing's syndrome?
Painful joints, pruritus, peeling skin, and severe emotional disturbances
151
How long should the post-op patient with Cushing's be on bed rest?
Until the blood pressure is stabilized
152
What should post-op patients with Cushing's be taught to avoid?
Stress, extremes of temperature, and infections
153
What indicates that surgery for patients with Cushing's has been successful?
They have no signs or symptoms of infection, attain weight appropriate for height, increase acceptance of appearance and maintain intact skin
154
What is Addison's disease caused by?
Adrenocortical insufficiency
155
Which classes of adrenal corticosteroids are decreased in Addison's disease?
Glucocorticoids, mineralocorticoids, and androgens
156
What are the possible causes of Addison's disease?
Autoimmune disease, TB, infarction, fungal infection, AIDS, or metastatic cancer
157
Who does Addison's disease most often affect?
Women younger than 60
158
When does Addison's disease become evident?
When 90% of the adrenal cortex is destroyed
159
What are the primary features of Addison's disease?
Progressive weakness, fatigue, weight loss, anorexia, and skin hyperpigmentation
160
Why does Addison's manifest the symptoms it does?
Low androgens
161
Where is hyperpigmentation generally manifest in patients with Addison's?
Areas exposed to the sun, at pressure points, over joints, in skin and especially palmar creases
162
What are the clinical manifestations for patients with Addison's?
Orthostatic hypotension, hyponatremia, hyperkalemia, nausea and vomiting, and diarrhea
163
How can primary Addison's be distinguished from secondary Addison's?
Secondary lacks hyperpigmentation
164
What triggers a life-threatening Addisonian crisis?
Sudden, sharp decrease in adrenocortical hormones caused by stress from infection, surgery, trauma, hemorrhage, psychological distress or sudden withdrawal of corticosteroid replacement therapy
165
What are the manifestations of glucocorticosteroid and mineralocorticoid deficiencies in patients with Addison's?
Hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion
166
What can the hypotension associated with Addison's lead to?
Shock and circulatory collapse
167
Which diagnostic study indicates Addison's disease?
Cortisol levels fail to rise over basal levels with ACTH stimulation
168
What abnormal laboratory findings would a patient with Addison's exhibit?
Hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, increased BUN and low urine cortisol levels
169
What would the ECG of a patients with Addison's exhibit?
Low voltage, vertical QRS axis, and peaked T waves
170
What is most commonly used as replacement therapy for patients with Addison's disease?
Hydrocortisone
171
What is the most important teaching for patients with Addison's disease?
Glucocorticoid dosage must be increased during times of stress to prevent an Addisonian crisis
172
What is the treatment for patients in Addisonian crisis?
Administer large volumes of NSS and 5% dextrose
173
What are the nursing interventions for patients with Addison's?
Frequent assessment, monitoring vitals, daily weights, diligently administer corticosteroid therapy, protect against infection, assist with daily hygiene, and protect from extreme light, noise, and temperature
174
How often do the vitals of patients with Addison's need to be taken?
Every 30 minutes to 4 hours for the first 24 hours
175
What is the priority nursing intervention for people with Addison's?
Administer corticosteroid therapy diligently
176
Why do patients with Addison's disease need to avoid extreme light, noise, and temperature?
They don't have the physiological ability to cope with stress
177
Why do patients with Addison's need to have their vitals monitored so closely?
To check for signs of fluid and electrolyte imbalance
178
Why do mineralocorticoids need to be given in the morning?
To reflect the normal circadian rhythm and decrease the side effects like GI irritaion
179
What indicates a need for corticosteroid dose adjustment?
Fever, influenza, tooth extraction, and physical exertion
180
What symptoms indicate an Addisonian crisis?
Vomiting and diarrhea
181
What is the discharge teaching for a patient with Addison's disease?
Teach for signs and symptoms of corticosteroid deficiency and excess, always wear a medical alert bracelet, teach when to increase glucocorticoids, instruct how to take BP, carry emergency kit, teach how to give IM injections
182
What are the expected side effects of corticosteroid therapy?
Altered anti-inflammatory action, altered immunosuppression, inability to maintain normal BP, and altered carbohydrate and protein metabolism
183
What is the pathophysiology of hyperadolsteronism?
Excessive aldosterone secretion, causing sodium retention, hypokalemia, and extra hydrogen ion excretion
184
What is the hallmark of hyperaldosteronism?
Hypertension with hypokalemic alkalosis
185
What causes primary hyperaldosteronism?
Adrenocorticoid adenoma
186
What causes secondary hyperaldosteronism?
Renal artery stenosis, renin-secreting tumors, and chronic kidney disease
187
What does elevated aldosterone do to electrolytes?
Sodium retention and elimination of potassium, leading to hypernatremia, hypertension, and headache, and hypokalemia causing muscle weakness, fatigue, and cardiac dysrhythmias
188
What laboratory levels of a patient with hyperaldosteronism would be off?
Increased plasma aldosterone levels, increased sodium levels, decreased potassium levels, and decreased renin activity
189
What is the preferred treatment of primary hyperaldosteronism?
Surgical removal of the adenoma
190
What do patients with hyperaldosteronism need pre-surgery?
Low sodium diet, potassium sparing diuretic, antihypertensive agents, normal blood pressure and fluid electrolyte balance
191
What is pheochromocytoma caused by?
A tumor of the adrenal medulla producing catecholamines
192
Who is most susceptible to pheochromocytomas?
Young to middle aged women
193
What is the hallmark of pheochromocytoma?
Severe hypertension
194
How is pheochromocytoma generally diagnosed?
Blood pressure screenings
195
What can untreated pheochromocytoma lead to?
Diabetes mellitus, cardiomyopathy, and death
196
What are the clinical manifestations of pheochromocytoma?
Severe, episodic hypertension, severe, pounding headache, tachycardia with palpitations, profuse sweating, and abdominal or chest pain
197
What is the best diagnostic test for pheochromocytoma?
Measurement of urinary fractionated metanephrines and catecholamines in a 24 hour collection
198
How is a pheochromocytoma treated?
Surgical removal of the tumor, calcium channel blockers, sympathetic drugs and beta blockers
199
What do calcium channel blockers do for patients with pheochromocytoma?
Controls blood pressure
200
What do sympathetic blocking agents do for patients with pheochromocytoma?
Lower blood pressure and decrease the symptoms of catecholamine excess
201
What do beta blockers do for patients with pheochromocytoma?
Decrease dysrhythmias
202
What are the nursing interventions for patients with pheochromocytoma?
Monitor blood pressure and glucose closely and make the patient as comfortable as possible
203
Why do patients with pheochromocytoma need a lot of nourishment?
They are in a hyper metabolic state
204
Over activity of one or more the the parathyroid glands
Hyperparathyroidism
205
What are the classifications hyperparathyroidism?
Primary, secondary or tertiary
206
Who is hyperparathyroidism most common in?
Females older than 60
207
What is the pathophysiology of primary hyperparathyroidism?
Severity of hypercalcemia reflects the quantity of hyperfunctioning parathyroid tissue
208
Where does the excess serum calcium come from in patients with hyperparathyroidism?
Intestines, kidneys, and bones
209
What problems result from hyperparathyroidism?
Kidney stones, bone demineralization, myopathy, and hypercalcemia
210
What does hypercalcemia cause?
Hypergastinemia, abdominal pain peptic ulcer disease, pancreastitis and constipation
211
What causes primary hyperparathyroidism?
Adenoma or hyperplasia of the parathyroid gland
212
What causes secondary hyperparathyroidism?
The parathyroid glands are hyper plastic because of another organ's dysfunction
213
Which patients are at risk for secondary hyperparathyroidism?
Patients with renal failure, Paget's disease, multiple myeloma, or carcinoma with bony metastasis
214
What is the pathophysiology of secondary hyperparathyroidism?
Chronic renal failure hyperphosphatemia caused by a decrease in GFR
215
What are the clinical manifestations of hyperparathyroidism?
Back pain, joint pain, pathological fractures, polyuria, polydipsia, hypertension, thirst, nausea, anorexia, constipation, listlessness, depression, paranoia, and hypercalcemia
216
What would the labs of a patient with hyperparathyroidism be?
Serum calcium elevated, serum phosphate levels decreased, urine calcium and phosphate levels are high, and alkaline phosphatase is high
217
How is hyperparathyroidism treated?
Lower calcium levels, administer NSS, administer loop diuretics, administer anti-reabsorption agents, phosphates, calcitonin,and glucocorticosteriods
218
What should the diet of a patient with hyperparathyroidism be?
Low calcium and vitamin D
219
What are the nursing diagnoses for patients with hyperparathyroidism?
Risk for injury and altered nutrition
220
What is the surgical treatment for hyperparathyroidism?
Parathyroidectomy
221
What are the possible complications of parathyroidectomies?
Hypocalcemia and respiratory distress
222
What should parathyroidectomy patients be loaded with post-op?
Calcium
223
Hyposecretion of the parathyroid glands produce the reverse syndrome of hyperparathyroidism
Hypoparathyroidism
224
What are the clinical manifestations of hypoparathyroidism caused by?
Low serum calcium levels, elevated pH and alkalosis
225
What are the signs of acute hypoparathyroidism?
Tetany, Chvostek's sign, and Trousseasu's sign
226
What are the symptoms of chronic hypoparathyroidism?
Lethargy, thin, patchy hair, brittle nails, dry, scaly skin, personality changes, calcifications in eyes and basal ganglia and eventual cardiac problems
227
What findings diagnose hypoparathyroidism?
Chvostek's sign, trousseaus's signs, hyperactive deep tendon reflexes, circumoral paresthesia, numbness and tingling of the fingers, low calcium, low PTH, high phosphorous, decreased urine calcium, and opthalmic exam
228
What would a opthalmic exam of a patient with hypoparathyroidism reveal?
Cataracts
229
How should hypoparathyroidism be treated?
Administer calcium gluconate, vitamin D, PTH hormone, and treat seizures and laryngeal spasms
230
What should always be in the room of a patient with hypoparathyroidism?
Trach tray
231
Touching the facial nerve causes it to twitch
Chvostek's sign
232
One of the most common medical disorders in the US affecting 10% of women and 3% of men over 65 years old, resulting from insufficient circulating thyroid hormone
Hypothyroidism
233
Hypothyroidism related to the destruction of thyroid tissue or defective hormone synthesis
Primary hypothyroidism
234
What is the most common cause of hypothyroidism?
Iodine deficiency, then atrophy of the gland
235
What is atrophy of the typhoid gland the end result of?
Hashimoto's thyroiditis and Graves' disease
236
What drugs can produce hypothyroidism?
Amiodarone and lithium
237
Hypothyroidism related to pituitary disease with lowered TSH secretion or hypothalamic dysfunction
Secondary hypothyroidism
238
Blood pressure cuffs makes arm pronate
Trousseau's sign
239
Caused by thyroid hormone deficiencies during fetal or neonatal life
Cretinism
240
What do the clinical manifestations of hypothyroidism depend on?
Severity, duration, and age of onset
241
What are the cardiovascular symptoms associated with hypothyroidism?
Decreased cardiac output, decreased cardiac contractility, anemia, cobalamin, iron, and folate deficiencies, and increased serum cholesterol and trigylcerides
242
What are the respiratory symptoms associates with hypothyroidism?
Low exercise tolerance and shortness of breath on exertion
243
What are the neurological symptoms associated with hypothyroidism?
Fatigued and lethargic, personality and mood changes, impaired memory, slowed speech, decreased initiative and somnolence
244
What are the GI symptoms associated with hypothyroidism?
Decreased motility, achlorhydria common, and constipation
245
What are the integumentary symptoms associated with hypothyroidism?
Cold intolerance, hair loss, dry/coarse skin, brittle nails, hoarseness, muscle weakness and swelling, and weight gain
246
What are the reproductive symptoms associated with hypothyroidism?
Menorrhagia
247
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues causing puffiness, periorbital edema and a mask like effect
Myxedema
248
What are the compilations of myxedema?
Mental sluggishness, drowsiness, and lethargy
249
What are the characteristics of myxedema?
Subnormal temperature, hypotension, and hypoventilation
250
What precipitates a myxedema coma?
Infection, drugs, cold, or a trauma
251
How is a myxedema coma treated?
IV thyroid hormone replacement
252
What would the diagnostics labs of a patient with hypothyroidism show?
Elevated serum TSH, elevated free T4, lowered serum T3, lowered serum T4, and increased cholesterol, triglycerides and anemia
253
What should the diet of a patient with hypothyroidism be?
Low calorie
254
What drug to patients take to treat hypothyroidism?
Synthroid
255
What has to be monitored when a patient is on synthroid?
Angina and cardiac dysrhythmias
256
What are the nursing diagnoses for patients with hypothyroidism?
Imbalanced nutrition, activity intolerance, and disturbed thought process
257
What acute nursing care does a patient with myxedema coma require?
Mechanical respiratory support, cardiac monitoring, aspiration precautions, IV thyroid hormone replacement, and monitoring of core temperature
258
What discharge teaching is needed for a patient with hypothyroidism?
Prevent skin breakdown, emphasize the need for a warm environment, avoid sedatives, minimize constipation
259
What are the signs of a synthroid overdose?
Orthopnea, dyspnea, rapid pulse, palpitations, nervousness, and insomnia
260
How often should patients with diabetes and hypothyroidism check their blood glucose?
At least daily
261
What leads to thyroid cancer?
Hormones in food, lack of sun, and pollution
262
A sustained increase in the synthesis and release of thyroid hormones by the thyroid gland
Hyperthyroidism
263
Who is hyperthyroidism most common in?
Women 20-40 years old
264
What most commonly causes hyperthyroidism?
Graves' disease, and then thyroiditis, toxic nodular goiter, exogenous iodine excess, pituitary tumors, and thyroid cancer
265
Physiological effects/clinical syndrome of hyper metabolism resulting from increased circulating levels of T3 and T4
Thyrotoxicosis
266
Autoimmune disease of unknown etiology caused by diffused thyroid enlargement and excessive thyroid hormone secretion
Graves' disease
267
What percentage of hyperthyroidism results from Graves' disease?
75%
268
What does Graves' disease lead to?
Thyrotoxicosis
269
Thyroid hormone-secreting nodules independent of TSH
Toxic nodular goiters
270
What are the hallmark clinical manifestations of thyroid hormone excess?
Increased metabolism, increased tissue sensitivity to stimulation by sympathetic nervous system, ophthalmopathy, and intolerance to heat
271
What are the cardiovascular symptoms of hyperthyroidism?
Bruit over the thyroid gland, systolic hypertension, increased cardiac output, dysrhythmias, cardiac hypertrophy, and atrial fibrillation
272
What are the GI symptoms of hyperthyroidism?
Increased appetite, increased thirst, weight loss, diarrhea, splenomegaly, and hepatomegaly
273
What are the integumentary symptoms of hyperthyroidism?
Warm, smooth, moist skin, thin, brittle nails, hair loss, clubbing of fingers, diaphoresis, vitiligo
274
Protrusion of the eyeballs from the orbits
Exophthalmos
275
What causes exophthalmos?
Increased fat and edema in retroorbital tissues and impaired drainage from the orbit
276
What are the musculoskeletal symptoms of hyperthyroidism?
Fatigue, muscle weakness, proximal muscle wasting, dependent edema, and osteoporosis
277
What are the neurological symptoms of hyperthyroidism?
Fine tremors, insomnia, delirium, hyperreflexia of tendon reflexes, and inability to concentrate
278
What are the reproductive symptoms of hyperthyroidism?
Menstrual irregularities, amenorrhea, decreased libido, impotence, gynecomastia, and decreased fertility
279
Acute, rare, and life threatening condition in which all manifestations of hyperthyroidism are heightened
Thyrotoxic crisis
280
What is the cause of thyrotoxic crisis?
Additional stressors
281
What are the clinical manifestations of a thyrotoxic crisis
Tachycardia, heart failure, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain, nausea, vomiting, diarrhea, delirium, and coma
282
What is the treatment of thyrotoxic crisis?
Decrease thyroid hormone levels and treat symptoms
283
How is hyperthyroidism generally diagnosed?
Radioactive iodine uptake levels
284
Which laboratory studies are done to diagnose hyperthyroidism?
TSH, Free T4, and total T3 and T4
285
What are the primary treatment options for hyperthyroidism?
Antithyroid medications, radioactive iodine therapy, and subtotal thyroidectomy
286
What types of drug therapy are patients with hyperthyroidism on?
Antithyroid drugs, iodine, and beta adrenergic blockers
287
Why are patients with hyperthyroidism given beta adrenergic blockers?
To decrease the arrhythmias, tachycardia, and hypertension
288
How long do patients have to be on antithyroid hormones to have good results
4-8 weeks
289
What are the antithyroid medications?
Propylthiouracil (PTU) and methimazole (tapazole)
290
How does propylthiouracil work?
Blocks the conversion of T4 to T3
291
Used with other antithyroid drugs in preparation for thyroidectomy or treatment of a crisis
Iodine
292
How does iodine work to lower thyroid levels?
Decreases the vascularity of the thyroid gland
293
What are the types of iodine drugs?
Saturated solution of potassium iodine, and Lugol's solution
294
When does the maximal effect of iodine occur?
1-2 weeks
295
Symptomatic relief of thyrotoxicosis resulting from beta adrenergic receptor stimulation
Beta adrenergic blockers
296
What are the beta adrenergic blockers?
Propranolol
297
What is the treatment of choice for non pregnant adults with hyperthyroidism?
Radioactive iodine therapy
298
How long does radioactive iodine therapy take to work?
2-3 months
299
What is the drug used to treat hypopituitarism?
Somatropin
300
What is the drug used to treat hyperpituitarism?
Parlodel
301
Why is it okay for radioactive iodine therapy to cause hypothyroidism?
Because it is easy to control and replace them
302
When is surgical therapy indicated for hyperthyroidism?
When the condition is unresponsive to drug therapy or there is tracheal compression or if there is a possible malignancy
303
What is the preferred surgical procedure to treat hyperthyroidism?
Subtotal thyroidectomy
304
How much of the thyroid has to be removed for a subtotal thyroidectomy to be effective?
90%
305
What needs to be achieved before a subtotal thyroidectomy can take place?
A euthyroid state
306
What are the post op complications of a subtotal thyroidectomy?
Hypothyroidism, hyperparathyroidism, damage of the parathyroid glands, hemorrhage, injury to laryngeal nerve, thyrotoxic crisis, and infection
307
What should the diet of a hyperthyroid patient be like?
High calorie, avoidance of caffeine, highly seasoned foods, and high-fiber foods, and a protein allowance of 1-2 g/kg
308
What are the nursing diagnoses or patients with hyperthyroidism?
Activity intolerance, risk for injury, imbalanced nutrition, anxiety, and insomnia
309
What are the goals for patients with hyperthyroidism?
Relief of symptoms, maintain nutritional balance, and control therapeutic pain
310
Where does treatment for hyper and hypothyroidism generally take place?
Outpatient settings
311
What should the environment of a patient with thyrotoxicosis be?
Calm, quiet, and cool room with light bed coverings
312
What should the nurse do for a patient with thyrotoxicosis?
Administer medications to block thyroid hormone production, administer IV fluids, ensure adequate oxygenation, monitor for cardiac dysrhythmias and decompensation, assist with exercise, apply artificial tears, elevate head of bed, restrict salt, and dark glasses
313
What pre-op teaching should be done for patients with hyperthyroidism?
Coughing, deep breathing, and leg exercises, range of motion for neck
314
How often should patients post-op subtotal thyroidectomy be checked for hemorrhage and tracheal compression?
Every 2 hours for 24 hours
315
What are the signs and symptoms of tracheal compression post-op subtotal thyroidectomy?
Irregular breathing, neck sweeping, frequent swallowing, and choking
316
What position should patients post-op subtotal thyroidectomy be in?
Semi-fowlers with head supported
317
When is hoarseness acceptable post-op subtotal thyroidectomy?
3-4 days
318
What are the side effects of radioactive iodine therapy?
Dryness and irritation of the mouth
