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Semester 3 Unit 3-Endocrine > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

(72 cards)

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1
Q

What is acromegaly? What are the clinical manifestations?

A

Overproduction of GH, most often caused by a pituitary adenoma.
Will present as:
Overgrowth of bones/soft tissue of face, hands and feet.
Muscle/joint pain
Tongue enlargement
Deep voice
Vision changes
Headaches (very common)
Skin changes to thick, leathery, oily

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2
Q

Treatment for acromegaly

A

Surgery (hypophysectomy)
Drug therapy (Sandostatin)
Radiation
–The damage caused by this will not reverse–

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3
Q

Pituitary adenomas will manifest how?

A

Headaches
Vision changes
Nausea/vomiting
–These are all signs of increased intracranial pressure–
Also, the location of the adenoma will determine the hormone imbalance. This may manifest with breast, growth hormone, sex hormone, thyroid, fluid balance abnormalities.

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4
Q

What does GH naturally antagonize?

A

Insulin
When GH increases insulin decreases which makes glucose levels increase.

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5
Q

How do we care for a patient after a hypophysectomy (pituitary removal)?
—remember this will be a done through nose or mouth—

A

Watch for hematoma at site of pituitary-this will present at vision changes, eye movements, pupil changes.
Watch for CSF leaks from drain. Monitor for headache which may indicate CSF leak.
HOB >30%
No straining, bending, coughing etc.
No brushing teeth for 10 days
Watch for diabetes insipidus

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6
Q

What hormones are secreted by posterior pituitary?

A

ADH
Oxytocin

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7
Q

What are the two problems associated with imbalance of ADH?

A

SIADH-too much
Diabetes insipidus-too little

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8
Q

What are the hallmark signs of SIADH?

A

Fluid retention
Diluted serum and concentrated urine
Hyponatremia and hypochloremia

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9
Q

What is the most common cause of SIADH?

A

Cancer, especially lung cancer
–This is because the cancer cells start to produce their own ADH leading to an overproduction–This is called an ectopic release of ADH–

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10
Q

What population is most at risk of developing SIADH?

A

Geriatric

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11
Q

Nursing care of SIADH

A

Daily weights
I/O’s
VS
Heart and lung sounds
Watch for signs of hyponatremia like: headache, changes to LOC, decreased neuro function, muscle twitching, abdominal cramps, vomiting.
Fluid restriction
Keep HOB <10 degrees
Watch for skin breakdown

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12
Q

What is the only treatment in mild cases of SIADH?

A

Fluid restriction only—
to allow the sodium levels of body to balance slowly.

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13
Q

What meds are used to treat more severe SIADH?

A

Lasix (but this drops sodium levels)
Demeclocycline (blocks effect of ADH)
Conivaptan and tolvaptan (block ADH)
IV hypertonic NS 3%
–Rebalance must be done slowly–

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14
Q

What are hallmark signs of diabetes insipidus?

A

Polyuria
Polydipsia

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15
Q

What labs will be abnormal in DI?

A

Hypernatremia
Dilute urine with low specific gravity
—Remember this is water loss WITHOUT solute loss—

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16
Q

What are clinical manifestations of DI?

A

Drinking»Peeing very dilute urine
Exhaustion from nocturia
Weakness from hypernatremia
Dehydration s/sx
Neuro changes

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17
Q

What are the 3 types of DI?

A

Central (neuro) DI (problem in pituitary, most common)
Nephrogenic DI (problem in kidney as target tissue of ADH)
Primary DI (thirst center or psych disorder)

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18
Q

What replacement fluids are given in DI?

A

Hypotonic solutions (remember they are hypernatremic so need hypotonic solution)
NS 0.45%
D5W

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19
Q

What is first line drug for CENTRAL DI? Other drugs given?

A

1.DDAVP (ADH hormone replacement)
2.—-Pressin drugs (desmo and vaso)

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20
Q

What is treatment for NEPHROGENIC DI?

A

Hormone DDAVP doesn’t work
Low sodium diet
Thiazide diuretics help kidneys slow down.

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21
Q

What is a goiter? Caused by?

A

An enlarged thyroid
Can be caused by hypo or hyper thyroid issues.

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22
Q

What are goitrogens?

A

Goiter causing food/drugs

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23
Q

What is thyroiditis?

A

Inflammation of thyroid.
Can be caused by bacteria, virus, goiter, autoimmune.
S/Sx=pain, fever, chills, sweats, fatigue

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24
Q

What labs will be abnormal is Hashimoto’s thyroiditis?

A

Low T4, T3 with high TSH
Antithyroid antibodies-called TPO-Ab
(Thyroid peroxidase antibodies)

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25
Who are at risk for thyroid imbalances?
Women 20-40 yo White Family Hx Hx of autoimmune disorders
26
What is Graves disease?
Most common cause of hyperthyroidism The opposite of Hashimoto's Antibodies to TSH receptors results in low TSH and high T3, T4 Autoimmune
27
Clinical manifestations of hyperthyroidism.
Think sympathetic NS stimulation of heart, lungs, nerves, mood But also stimulates GI system and metabolism Increased metabolism>increased appetite but with weight LOSS
28
Clinical manifestations of hypothyroidism.
Slows down GI, metabolism, mood, heart, mind Increased cholesterol and triglycerides
29
What is exophthalmos?
Protruding eyes Classic finding in Graves disease
30
What is thyrotoxicosis?
Thyroid storm Big dump of T3, T4 in system Emergency Can be caused by stress, surgery, infection of someone who already has hyperthyroidism S/sx are: High fever, tachycardia, agitation, delirium, seizures, nausea, vomiting, diarrhea, abdominal pain
31
What is preferred treatment of hyperthyroidism?
Radioactive Iodine Therapy (RAI) Destroys thyroid tissue Given orally or IV Not suitable in pregnancy Causes patient to be radioactive so home precautions necessary to limit exposure to family Usually results in HYPOthyroidism
32
What are 3 main types of drugs to treat hyperthyroidism?
Antithryoid drugs Iodine (blocks T3, T4 and shrinks thyroid) Beta adrenergic blockers
33
What are the two antithyroid drugs used?
propyl-thio-uracil methi-ma-zole --Never abruptly stop--
34
What are some beta adrenergic blockers used to treat hyperthyroidism?
These block the effects of the sympathetic NS Pro-pran-olol A-ten-olol
35
What type of diet will a patient with hyperthyroidism need?
High calorie
36
Post op care of patient after thyroidectomy.
Semi Fowlers Monitor for signs of tracheal compression or hematoma on neck Monitor airway and have suction Assess voice Watch for signs of hypocalcemia and keep IV calcium gluconate available Monitor thyroid levels Keep head/neck protected and supported
37
Nursing care of patient with thyrotoxicosis.
ICU IV Fluid replacement from GI losses Calm, cool environment Build trust Artificial tears Sit upright (if increased ocular pressure) Dark glasses Eye muscle ROM exercises
38
What is the difference between primary and secondary hypothyroidism?
Primary=problem with thyroid Secondary=problem with pituitary or hypothalamus
39
What is cretinism?
Hypothyroidism that develops in infancy. Child will have physical and mental defects Newborns are routinely screened
40
What is myxedema?
Long standing hypothyroidism has led to facial swelling, deformity. Mask like look --Can lead to serious problem and CV collapse, will get IV T3 and T4 replacement
41
What is biggest caution while increasing T3 and T4 levels in hypothyroidism?
Cardiac assessment Monitor heart rate and dysrhythmias
42
What abnormal labs will be present in hyperparathyroidism?
Hypercalcemia Hypophosphatemia
43
What are clinical manifestations of hyperparathyroid?
Hypercalcemia s/sx: Constipation and decreased appetite Muscle weakness and decreased DTR Kidney stones and renal failure Brain fog and emotional lability Osteoporosis and occult fractures Dysrhythmias
44
What test is performed for bone density?
DEXA scan
45
Important when giving IV calcium.
Highly irritating to vein Give slowly Monitory EKG and hypotension
46
Tetany is a sign of ...
Hypocalcemia Can start as tingling of mouth and hands Treatment is IV calcium
47
What is the first sign of hyponatremia? (according to NCLEX)
Headache
48
What is Graves' disease?
Autoimmune Thyroid enlargement Excess T3, T4 Most common cause of hyperthyroidism
49
What is acropachy?
Sign of Graves disease. Swelling of hands and clubbing of fingers
50
What are two types of iodine meds and how do they work?
Potassium iodine (SSKI) Lugol's solution --Usually given to shrink and decrease vascularity of thyroid before surgery-- Blocks T3, T4 and shrinks thyroid
51
Most common type of endocrine cancer.
Thyroid
52
S/Sx of thyroid cancer.
Fullness of neck Dysphagia Hoarseness Painless Enlarged thyroid Normal T3, T4
53
What is MEN stand for?
Multiple Endocrine Neoplasm --Inherited, benign (but can become malignant) growths on multiple endocrine glands. Affects hormone balance of several types
54
What is main hormone of salt control?
Aldosterone
55
What are clinical manifestations of Cushings?
Weight gain through trunk Moon face with redness Hirsutism (Her-si-tism) Buffalo hump Weak thin extremities with edema Increased BP Hyperglycemia Thin, easily bruised skin Poor wound healing Purple red striae
56
Who are most at risk of developing Cushings?
Patients on long term corticosteroids --Must taper these down slowly--
57
Nursing goals in Cushings.
Relief of symptoms Prevent or treat any complicating conditions (hyperglycemia, hypernatremia, infection, CVD) Emotional support
58
Treatment for Cushings.
Find the cause Options include: Removing any pituitary or adrenal tumors Adrenalectomy Meds like ketoconazole (Nizoral) and mitotane (these meds suppress cortisol production, but they are highly toxic)
59
What hormones are hypo in Addison's disease?
Too little: Cortisol Aldosterone Androgens
60
What is primary cause of Addison's?
Autoimmune
61
S/Sx of Addison's.
Hypoglycemia Hyponatremia, dehydration>> hypovolemia>>Low BP Muscle weakness, anorexia, weight loss Bronzing --this is a slow progression--
62
What brings on an Addisonian crisis?
Emotional Stress Physical stress Surgery In an already hypoadrenal patient
63
What does an Addisonian crisis look like?
Signs of hypovolemic shock: Acute hypotension High fever Cyanosis Headache Nausea/diarrhea Confusion, restlessness
64
Treatment for Addisons.
Hydrocortisone Fludrocortisone DHEA IV fluid replacement
65
Nursing care for Addisons.
Watch for: Signs of shock Monitor BP closely Monitor I/O's carefully Protect from infection Protect from stressors
66
What is Conn syndrome?
Hyperaldosteronism Results in too much salt and too low potassium Results in high BP and hypokalemic alkalosis
67
What is pheochromocytoma?
Rare Tumor in adrenal medulla Makes too much epi and norepinephrine Severe HTN, headache, tachycardia, chest pain --Don't palpate the abdomen--
68
Side effects of corticosteroid therapy.
Delayed wound healing and increased risk for infection Suppressed inflammatory response Pathologic fx, muscle weakness and atrophy Hard on stomach>>Peptic ulcer Hyperglycemia, hypernatremia Hypokalemia, hypocalcemia Hypertension Mood/behavior changes
69
Number one thing to teach patients about corticosteroids?
Never stop abruptly
70
What are signs of Conn syndrome?
Hypertension Headache Hypokalemia --We should suspect this in patients with these 3 signs who are NOT on diuretics--
71
Treatment for Conn syndrome.
Adrenalectomy Spironolactone (K+ sparing) Antihypertensives Sodium restrictions
72
What is classic triad of symptoms in patients with pheochromocytoma?
Severe pounding headache Tachycardia Profuse sweating ---This will occur in young to mid age adults--

Semester 3 Unit 3-Endocrine (3 decks)

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