Endocrine & Endocrine Flashcards
(413 cards)
1
Q
what is the function of the kidneys?
A
regulate the volume and composition of ECF
excrete waste products from the body
control BP
erythropoietin production
vitamin d activation
acid base regulation
2
Q
what are the cortex of the kidneys?
A
loop of henle
collecting tubes
3
Q
where is blood filtered in the kidneys?
A
glomeruli
4
Q
how is blood filtered in the glomeruli?
A
filtered by hydrostatic pressure
passess through the bowman’s capsule
glomerular filtrate passes down the tubule
5
Q
what is the normal GFR?
A
125 ml/min
6
Q
decreased kidney capillary, increases what to get through?
A
protein
7
Q
where is absorption mostly done?
A
GI
8
Q
ADH is needed for?
A
it is important for water balance
regulated by posterior pituitary gland
9
Q
what is Aldosterone needed for?
A
reabsorption of sodium and water
released from the adrenal cortex
10
Q
what is the kidneys major role?
A
water balance
electrolyte balance
acid-base balance
control bp
11
Q
what do ureters do?
A
carry urine from renal pelvis to the bladder
12
Q
true or false the ureteral lumens are narrow?
A
true
13
Q
what is the bladder?
A
reservoir for urine (600-1000ml)
the bladder is a muscle (detrusor)
14
Q
how long is the female and male urethra?
A
female: 1-2 inches (3-5 cm)
male- 8-10 in (20-25 cm)
15
Q
who is at most risk for UTI?
A
female
16
Q
what is the urethrovesical unit?
A
-formed by bladder, urethra, and pelvic floor muscles
17
Q
voluntary control of the urethrovesical unil is defined as continence, true or false?
A
true
18
Q
how is the urethrovesical unit stimulated?
A
impulses are sent to the brain to the sacral area to the spinal cord to control the tubule
19
Q
what is stress incontience?
A
something is pushing on it to where you can’t control
20
Q
what is the assessment (history collection)
A
gender/age
socioeconomic/occupation
dietary/personal habit
previous surgeries/hospitalization
family/personal health history
21
Q
what is anuria?
A
inability to urinate
22
Q
what is olguiria?
A
small amounts of urine
23
Q
what is polyuria?
A
too much urine
24
Q
what is the objective data assessment for genitourinary?
A
inspection
ausculation
palpation
percussion
25
what is normal BUN?
7-21
25
what is normal creatinine?
0.6-1.3
26
what are the blood diagnostics for kidney eval?
serum creatinine
blood urea/nitrogen
BUN/creatinine ration
estimated GFR
27
what does the BUN indicate?
renal function and hydration status
28
what are the urine diagnostic studies for kidney eval?
urinalysis
urine studies
creatinine clearance
29
how to preform a urinalysis?
first morning void
examine urine within 1 hour
30
what is a urine studies?
urine culture and sensitivity
looking for infection
31
what is a creatinine clearance? and how to perform it?
collect 24 hours specimen
discard the first urination
collect for 24 hour hours into a large container and place on ice
have pt urinate at end of 24 hours and add specimen to collection
32
with renal impairment serum creatinine goes up but the urinary clearance will go down?
true
33
what does the KUB radiographic diagnostic show?
exams of abd and pelvis
delineates size, shape, and position of kidneys, ureter, and bladder. can see radioplaque and foreign bodies
34
what does IVP ct scan show?
see urinary tract after IV contrast media is inserted. evaluates shape of kidney, ureters, bladder. Cysts, tumors, and ureteral obstruction distort normal appearance of these structures
35
why should patients with decreased renal function not have an IVP?
contrast media can be nephrotoxic
36
what should be seen before patient goes in for IVP?
BUN and creatinine
37
what does the ct scan show?
visualizes kub. can detect tumors, abscesses, and obstruction.
38
what are the renal surgical diagnostic studies?
renal biopsy
cystoscopy
renal arteriogram
39
how and what is a renal biopsy?
obtains tisse for examination to determine the type of disease
-usually done as a skin biopsy through needle insertion into lower lobe of kidney under CT or ultrasound guidance
40
what are the contraindications of a renal biopsy?
bleeding disorders
single kidney
uncontrolled hypertension
41
what is renal biopsy's #1 risk factor?
bleeding
42
what is done before a renal biopsy?
-type and crossmatch patient for blood
-ensure consent is signed
-assess coagulation status
-pt history and medication history
-review labs (CBC & H&H) (clotting factors)
43
what to do after renal biopsy?
apply pressure
keep pt positioned on affected side for 30-60min
bed rest for 24 hours
vs q5-10 min for the first hour
assess frequently for signs of bleeding or infection
44
what to do before a renal arteriogram (angiogram)?
-cathartic or enema may be used the night before
-before injection of the contrast material, assess for iodine sensitivity
-prior to contrast media injection, notify pt of possible transient warm feeling along the course of blood vessels
-look at the kidney function before procedure
45
what to do after the renal arteriogram (angiogram)
-place pressure dressing over femoral artery injection site
-observe site for bleeding and inflammation
-have pt maintain bed rest with affected leg straight
-take peripheral pulses in the involved leg every 30-60 min to detect occlusion of blood flow (from thrombus or emboli)
46
what is a UTI?
bacteria enters the sterile bladder causing inflammation
47
what is the common bacterial infection in a UTI?
escherichia coli (E. coli)
48
what can cause a CAUTI?
e.coli
prseudomonas species
49
what are the lower UTIs?
urethritis
cystitis
50
what is the upper uti?
pyelonephritis
51
what are the different type of UTIs
lower uti
upper uti
urosepsis
52
what are the risk factors of UTI?
immunosuppressed/immunocompromised
diabetes
Hx of kidney problems
have undergone multiple antibiotic courses
have traveled to developing countries
catheterization
cystoscopy examination
occupation/habitual delay
STI
53
what is urethritis?
inflammation in the urethra
54
what is cystitis?
inflammation of the bladder
55
what are signs and symptoms of urethritis?
pain/burning/dysuria
frequency
urgency
nocturia
males: clear mucous like discharge
females: lower abd discomfort
56
what are the signs and symptoms of cystitis?
bladder irritability
hesitancy
suprapubic pain
incontinence
nocturnal enuresis
pain/burning/dysuria
frequency
urgency
nocturia
57
what are the diagnostic studies for LOWER UTI?
-H&P
-UA (get before antibiotics)
+nitrates
+WBC
+Leukocyte esterase
-urine culture and sensitivity (determine the bacteria and susceptibility to antibiotic drug)
-imaging studies
58
what is pyelonephritis?
inflammation of renal parenchyma and collecting system
59
how does pyelonephritis occur?
usually begins with lower UTI
preexisting factor may present
vesicoureteral reflex
-retrograde movement or urine from lower to upper urinary tract
60
what are the causes of pyelonephritis?
dysfunction of lower UTI
obstruction from BPH
stricture
urinary stone
CAUTI
-recurring episodes lead to scarred, poorly functioning kidney and chronic pyelonephritis
61
what are the typically signs and symptoms of pyelonephritis
fever
chills
flank pain
62
what are other clinical manifestations of pyelonephritis?
fever/chills
N/V
fatigue/malaise
flank pain
may also have s/s of cystitis
63
what are the diagnostic studies of pyelonephritis?
H&P
UA
urine culture/sensitivity
imagine studies (US, CT scan, cystoscopy)
CBC
blood culture
percussion for flank pain
64
what is urosepsis?
UTI has spread systemically
life-threatening condition requiring emergent treatment
usually begins lower tract and ascends urethral route
65
what are frequent causes of urosepsis?
escherichia coli
proteus
klebisiella
enterobacteria
66
what are the clinical manifestations of urosepsis?
shiver, fever, or very cold
extreme pain or general discomfort
pain or discolored skin
sleepy difficult to rous confused
i feel like i might die
short of breath
N/V
malaise/fatigue
fever, hr increase
bp decrease
67
what are uti preventions/treatment
antibiotics
NSAIDS or antipyretic drugs
vit c
urinary analgesics
phenazopyridine (pyridium)
fluids
IV/PO
cranberry juice
68
what are the antibiotics for a UTI?
Nitrofurantoin, ampicillin, amoxicillin, cephlasporins, fluoroquinolones
69
what are the analgesic for a UTI?
Phenazopyridine/pyridium
70
what are the antifungals for UTI
amphotericin or fluconazole
71
what is nitrofirantoin (macrodantin)
antibiotic
given 3 or 4 times a day
long-lasting preparation (macrobid) is taken twice daily
72
what is Ampicillin, amoxicillin, cephalosporins?
antibiotic
treats uncomplicated UTI no stricture, normal bacteria
73
what are fluoroquinolones?
antibiotic
treat complicated UTI
ex. ciprofloxacin (Cipro)
active against broad spectrum bacteria
po or iv route
74
what are the adverse effects of Fluoroquinolones
tendon rupture
phototoxicity
N/V/D abd pain
dizziness, HA, restlessness, confusion
75
what are the antifungals?
amphotericine or fluconazole
76
what are antifungals?
UTIs secondary to fungi
harder on the veins, more toxic
not compatible with NS, have to hang with D10, no flushing with NS
77
what os glomerulonephritis?
inflammation of the glomeruli
destruction of glomeruli
78
when is glomerulonephritis commonly seen?
after strep infection or untreated strep infection
79
what are the risk factors of glomerulonephritis?
kidney infection
nephrotoxic drugs
immunocompromised system
systemic disease
80
what are the clinical manifestations of glomerulonephritis?
general body edema
decreased urine output
oliguria/hematuria/proteinuria
hypertension
increase BUN/creatinine
history of group A strep
evidence of immune-mediated response
81
what are the nurse management of glomerulonephritis?
-daily wt and i&o
-measure abd girth
-medications
antihypertensive
diuretics
corticosteroids
dietary
-low in sodium/low to moderate protein/fluid restriction
82
what are nephrotoxic drugs?
nsaids
antibiotics
contrast media
83
HADSTREP
hypertension
Asa titer(+) this is for strep
decreased gfr
swelling in face/eyes
tea colored urine
recent strep infection
elevated BUN and creatinine
proteinuria
84
what is renal calculi?
occurs in the kidneys, ureters, and bladder, with renal stones being the most prevelant
-calcification in the urinary system
-microscopic crystals in the urinary tract aggregate together causing a stone to occur
85
what are renal calculi clinical manifestation?
pain (pain meds)
n/v
urinalysis (blood in urine)
+rbc
uti like symptoms (blocking and developing UTI
86
What is the #1 symptom of renal calculi?
pain
87
what are the medication nursing management for renal calculi?
narcotics and nsaids
antimetic
alpha-adrenergic blockers
88
what are the lab nursing management for renal calculi?
increased BUN/creatinine
UA
cbc-infections, increased WBC
89
what are the teaching nursing management for renal calculi?
strain urine
symptoms of infection/obstruction
prevention
90
what nutrition should a patient with kidney stones take?
encourage hydration
lemons/limes/grapefruit
91
what should patients limit in nutrition with kidney stones?
caffeine/alcohol
calcium
sugar
oxalate (chocolate)
uric acid
92
what a bladder cancer?
tumor formation is attributed to genetic changes in target cells
93
what cancer is the 4th common in males and 8th in females?
bladder cancer
94
what is the most important risk factor of bladder cancer?
smoking
95
what are the clinical manifestations of bladder cancer?
painless hematuria
96
what is the nurse managements with patients who have bladder cancer?
vital signs
medication
chemo
immunotherapy
continuous bladder irrigation
i&o
superficial or low grade-bladder cancer
invasive bladder cancer
radial cystectomy
combined with neoadjuvant or adjuvant chemo
97
what is renal cancer?
renal cell carcinoma is most common
usually found in the cortex or pelvis of the kidney
98
what are the male ages of renal cancer?
50-70
99
what are the renal cancer manifestations?
initially asymptomatic
classic triad (flank mass, flank pain, hematuria)
wt loss
hypertension
fever
anemia
100
what are the diagnostic studies for renal cancer?
ivp
ultrasound
ct/mri
urine cytology
101
what are the treatments of renal cancer?
biological immunotherapy or cytokinesis
radical nephrectomy
102
what are the nurse managements for renal cancer?
pain management
iv hydration
103
what are the post op nursing management for renal cancer?
bleeding
incision
patency of tubes/catheters
i&o
104
what is incontinence?
involuntary or uncontrolled loss of urine in any amount
105
what is stress incontinence?
due to increase abd pressure under stress (weak pelvic floor muscles)
106
what is urge incontinence?
due to involuntary contraction of the bladder muscles
107
what is overflow incontinence?
due to blockage of the urethra
108
what is neurogenic incontinence?
due to disturbed function of the nervous system
109
what are the nursing managements for incontinence?
assessment
lab
110
what are the teachings for incontinence?
medication
kegal excercises
skin care
voiding diary
emotional support
111
why should patients with incontinence use anticholinergics?
reduces overactive bladder contractions; improve storage capacity of bladder
oxybutymin (ditropan)
112
why should patients with incontinence use alpha-adrenergic blocker?
reduce urethral resistance to urinary overflow
-doxazosin (cardura)
-tamsulosin (flomax)
113
why should patients with incontinence use tricyclic antidepressants?
reduce sensory urgency and burning pain
-amitriptyline (elvail)
114
when age is renal trauma seen in males?
less than 30
115
what can cause a renal trauma?
stabbing
gunshot wound
object piercing the abd wall
blunt force trauma
116
what is kidney failure?
inability of the kidney to excrete waste products and water from the bloodstream through filtration
117
what is the patho of AKI?
acute, rapid loss of renal function
oliguria may be present
uremia may be present
118
what are the AKI manifestations?
-rapid decrease in renal function
-increase in serum creatinine, BUN, K+
-decrease in urine output
-azotemiz
119
what is prerenal AKI?
due to decreased blood flow into the kidneys
120
what causes prerenal AKI?
absolute loss of fluid
relative loss of fluid
renal artery issue
(hemorrhage, vomiting, diarrhea, burns)
121
what is postrenal AKI?
obstruction from the outflow of the kidney
-1ureter obstructed, unilateral obstruction
-both ureters obstructed, bilateral obstruction
122
what can cause postrenal AKI?
-compression
intra-abd tumors
bph (benign prostatic hyperplasia)
-blockage
kidney stones
123
what is intrarenal AKI?
damage to the tubules, the glomerulus or the intersititium
124
what are the causes of AKI?
acute tubular necrosis
glomerulonephritis
acute interstitial nephritis
125
what is acute tubular necrosis?
most common cause of intrarenal AKI
126
what is glomerulonephritis (GN)
inflammation of the glomerulus
127
what is acute interstitial nephrtis?
damage to the kidney interstitium
128
what are the 4 phases of AKI?
initiating phase
oliguric phase
diuretic phase
recovery phase
129
what is the initiating phase of AKI?
renal blow flow decrease to a lever resulting in severe cellular depletion, that intern leads to acute cell injury and dysfunction
130
what is the oliguric phase of AKI?
<400ml/day occurs within 1-7days of kidney injury
-increase K+ and decrease Na+
-elevated BUN and creatinine
-fatigue and malaise
-metabolic acidosis
131
what is the diuretic phase of AKI?
gradual increase in urine output 1-3 L/day
-hypovolemia, dehydration
-hypotension
-BUN and creatinine levels begin to normalize
132
what is the recovery phase in AKI?
1-2 weeks can take up to years
-begins when GFR increases
-BUN and creatinine levels plateau, then decrease
133
what are the signs and symptoms of AKI?
-decrease urine output
-swelling of the legs, ankles, and feet
-sob
-fatigue
-loss of appetite
-n/v
-irregular heartbeat (arrythmias)
-chest pain or pressure
-easy or unusual bleeding
-confusion
134
what are the nursing management of AKI?
eliminate cause, prevent complications and assist recovery
-vital signs
-i&o, daily wt
-oxygenation
-manage fluid balance
-positioning
-skin care
-dialysis may be considered
135
what are your nurse managements of medications for AKI?
diuretics
avoid nephrotoxic agents
sodium polystyrene sulfonate-kayexalate
136
what are the nutrition nursing managements of AKI
high calorie
low sodium
low potassium
137
what are the drug therapies for AKI?
fluid challenges
loop diuretics (furosemide)
sodium polystryene (kayexalate)
calcium channel blockers
renal replacement therapy
diet therapy
138
what are the gerontological complications of AKI?
-GFR declines with age
-other organ impairment increases risk for AKI
-CVD or diabetes
-older kidney does not compensate as well for fluid volume, solute food, and cardiac output
-increase risk for dehydration
139
what is long term chronic kidney disease?
progressive, irreversible loss of kidney function
-most common cause are diabetes and hypertension
140
what are the leading causes of CKD?
diabetes
hypertension
141
what are the risk factors of CKD?
age >60
cardiovascular disease
diabetes
ethnicity (black, native americans)
exposure to nephrotoxic drugs
family hx of CKD
hypertension
142
how many stages of CKD are there?
5 stages
143
what is the 1 stage of CKD?
kidney may have normal function
-GFR of 90 or greater
-BUT there are structural changes that indicate renal damage
144
what is the stage 2 of CKD?
kidney damage with mild decrease in GFR
GFR of 60-89
145
what is stage 3 CKD?
stages 3a and 3b
moderate to poor kidney function
GFR 30-59
146
what is stage 4 of CKD?
moderate to poor kidney function
GFR 15-29
147
what is stage 5 of CKD?
end stage renal disease (ESRD)
GFR is 15 or less
renal replacement needed if there is buildup of toxins in the blood, and if the patient desires treatement
148
what are the clinical manifestation for CKD?
-devastating effect on every body system
-sodium and fluid balance alteration
-altered potassium excretion
-impaired metabolic waste elimination
- neuro symptoms
-altered calcium and phosphorus levels
-metabolic acidosis
-chronic anemia
149
what are the lab values of CKD?
-increase serum creatinine/BUN/potassium
-decrease creatinine clearnace
-decrease or increase serum sodium
-decrease serum calcium
-decrease CO2/hemoglobin and hematocrit
150
what are the nursing management of CKD?
-preserve existing kidney function
-reduce risk of cardiovascular disease
-prevent complications
-provide for patients comfort
-fluid management
-monitor V/S and lab values
-monitor i&o and daily wt
-skin care
-medication (diuretics, CCB, antihypertensives)
151
what is the nutritional therapy for CKD?
-monitor/restrict protein
-fluid restriction
-sodium/potassium restriction
-phosphate restriction
-citrus juice contrainticated
-designed to maintain good nutrition
-DASH
-monitor laboratory parameters
-protein intake
-should be carefully monitored
-normal for HD patients
-increased for PD patient
152
what are some foods that patients with CKD can eat?
fruits
vegetables
fat-free or low-fat milk
milk products
whole grain
fish
poultry
beans
seeds
nuts
153
what drug therapy can patients with CKD take with hyperkalemia?
-restrict high potassium foods and drugs
-IV glucose and insulin
-IV 10% calcium gluconate
-sodium polystyrene sulfonate
-dialysis may be needed
154
what antihypertensive drugs can patients with CKD take?
ace inhibitors
arb agents
155
what is mineral and bone disorder in CKD?
calcium and phosphorus levels out of balance
156
who does MBD affect more in CKD?
kidney failure receiving dialysis
157
what are some interventions with patients with MBD)
-phosphate not restricted until patient requires renal replacement therapy
-phosphate binders
-avoid aluminum preparations
-supplementing vit D
158
what is the drug therapy for MBD?
-phosphate binders
-calcium acetate (PhosLo)/Calcium carbonate (Caltrate)
-bind phosphate in bowel and then excreted
-sevelamer hydrochloride (renagel)
-lowers cholesterol and LDL levels
159
what are drug therapy medications for CKD?
erythropoiten (EPO)
iron supplements
160
what is erythropoietin?
-glycoprotein hormone
-used for anemia
epo stimulates the bone marrow to increase RBC
-in response to anemia or hypoxia, circulating levels of epo rise dramatically triggering an increase in erythrocyte synthesis
epoetin alfa (epogen, procrit/darbepoeitin, alfa (aranesp)
161
what other supplements should be taken with EPO?
iron
folic acid
vit b12
162
what does lasix do for CKD?
-acts in thick segement of the ascending loop of henele to block reabsorption of water
-can promote diuresis even when renal blood flow and GFR are low
-administered PO, IV, or IM
-oral admin: diu5resis begins within 60 min; persists for 8 hours
-IV admin: diuresis begins within 5 min; persists for 2 hours
-IV is used in critical situations
163
what are the drug therapy complications?
digoxin
diabetic agents
antibiotics
opioid medications
164
what is dialysis?
artificial process for removing waste and water from the body when kidney no longer function
165
who needs dialysis?
acid base problems
electrolyte problems
intoxications
overload of fluids
uremic symptoms
166
what is hemodialysis?
-obtaining a vascular access is one of the most difficult problems
167
what are the types of hemodialysis?
arteriovenous fistulas and grafts
168
created in forearm between artery and vein they connect directly
fistula
169
what are the hemodialysis complications?
hypotension
muscle cramps
loss of blood
hepatitis
systemic infection
dialysis dementia
disequilibrium syndrome
av fistula complications
170
what can be given when patient has hemodialysis and has hypotension?
administer albumin
171
what is CCRT?
for acutely ill with AKI or severe fluid overload
172
what is peritoneal dialysis?
-peritoneal membrane acts as the semipermeable membrane
-peritoneal access is obtained by inserting a catheter through the anterior abd wall
173
what is the catheter placement requirements for peritoneal dialysis?
-technique for catheter placement varies
-usually done via surgery
-prep for placement include emptying bladder and bowel
174
what are the different types of peritoneal dialysis?
-automated peritoneal dialysis
-continuous ambulatory peritoneal dialysis
-intermittent peritoneal dialysis
175
what are the 3 phases of PD?
inflow (fill)
dwell (equilibration)
drain (15-30 min depending on pt)
whole process is called exchange
176
what are the contraindications of PD?
history of mulitple abd surgeries
chronic or abd conditon
recurrent hernias
obesity
pre-existing back problems
severe chronic obstructive pulmonary diease
exit site infection
peritonitis
hernias
lower black problems
bleeding
177
what are PD complications?
atelectasis
pneumonia
bronchitis
protein loss
178
what are the nursing management for PD?
vital signs
daily wt
nutrition
lab values
179
what to look for in HD?
bruit/thrill, neuro assessment, post dialysis (fistula,hypotension)
180
what to look for in CCRT?
frequent v/s, fluid assessment (ICU, trauma, AKI, something fast)
181
what to look for in PD?
ABD girth, monitor for outflow (home, peritoneium, move back and fourth )infection
182
what are the different renal transplantation sources?
-cadaver donors with compatible blood type
-blood relatives
-emotionally related living donors
-altruistic living donors (friends)
-paired organ donation
183
renal transplantation is a cure, true or false?
false
184
what are the renal transplantation contradictions?
malignancies (advanced cancer)
refractory/untreated cardiac disease
chronic respiratory failure
extensive vascular disease
chronic infection
unresolved psychosocial disorders
185
what is the goal of immunosuppressive therapy for renal transplantation?
-adequately suppress the immune response to prevent rejection
-maintain sufficient immunity to prevent infection
186
what are the renal transplantation immunosuppressive therapies
corticosteroids (prednisone)
calcineurin inhibitors (cyclosporine)
cytoxic (antiproliferative drugs)
187
identical immune cells
monoclonal antibodies
188
several immune cells
polyclonal antibodies
189
1st choice to help organ rejection
mycophenolate (cellcept)l
190
lifelong medication
tacrolimus (prograf)
191
help to prevent rejection of the transplanted organ
monoclonal antibodies
polyclonal antibodies
myciphenolate (cellcept)
tacrolimus (prograf)
192
what is hyperacute antibody?
no cure
onset with 48 hours
malaise, high fever
graft tenderness
organ must be removed to decrease s/s
193
what is acute occur?
-first 6 months after transplant, 1 week to 2 years
-oliguria, anuria
increase temp
increase bp
flank tenderness
lethargy
increase BUN/creatinine
fluid retention
-reversible
increase immunosuppressive therapy
194
what is chronic process?
occurs over months or years
increase BUN/creatinine
imbalances in proteinuria electrolytes
-fatigue
irreversible
195
what are the renal transplantation nursing managements
prevent infection
watch for s/s of infection
-fever/chills
-tachypena
-tachycardia
-increase/decrease in WBCs indicating leukocytosis or leukopenia
196
what are the precautions patients with a renal transplantation should take?
avoid crowds
wash hands
good nutrition
vitamin c
197
what are the s/s of transplant rejection?
high fever
malaise
organ must be removed to help decrease these symptoms
198
what is benign prostatic hyperplasia (BPH)
-condition in which the prostate gland increases in size
-outflow of urine from the bladder to the urethra is disrupted
199
what is the percentage of problems with BPH in men on 40 years old?
25%
200
what is the percentage of problems in BPH with men of 70 years old?
75%
201
what are the risk factors of BPH?
age
obesity (epecially increased waist circumference)
lack of physical activity
high amount of dietary animal protein
alcohol consumption
ED
smoking
diabetes
202
what are the irritative clinical manifestations of BPH?
nocturia (often firs recognized symptom)
frequency
urgency
dysuria
bladder pain
incontinence
203
what are the obstructive clinical manifestations of BPH?
decreased urinary stream caliber and force
intermittency
hesitancy
dribbling
204
what are complications of BPH?
urinary retention
bladder distention
sudden pain and inability to urinate
post void residual (>100-200cc)
UTI
overflow incontience
hydronephrosis
AKI
decrease GFR
increased BUN/Creatinine
205
what are the diagnostic studies for BPH?
detailed H&P
digital rectal exam (DRE)
urinalysis/culture
prostate specific antigen (PSA)
206
what is digital rectal exam (DRE)
estimates prostate size, symmetry, and consistency
207
what is normal DRE in BPH?
symmetrical, large, smooth
208
what is prostate-specific antigen (PSA)
screens for prostate cancer
209
what age should men do DRE?
men past 50
210
what are the treatments for BPH?
catheter insertion if possible
pharmacological interventions
possible surgery
211
what are the interprofessional care goals for patients with BPH
restore bladder drainage
relieve the patients symptoms
prevent or treat the complication of BPH
212
what are the nursing managements for BPH?
active surveillance
bladder scan
dietary changes
avoid anticholinergics and decongestants
limit fluids at night
bladder re-training
annual follow ups
213
why should patients with BPH avoid anticholinergics and decongestants?
they can cause urinary retention (used for overactive bladder)
214
what are the dietary changes that patients with BPH should do?
decrease caffeine, alcohol, carbonated drinks, artificial sweeteners, spicy or acid foods
AVOID: processed sugar, processed foods
215
what does alpha-adrenergic blockers do to help patients with BPH?
relax smooth muscle that surrounds the urethra
-facilitates urinary flow through the urethra
symptoms improve days to weeks
216
what are the adverse effects of alpha adrenergic blockers
abnormal ejaculation
caution using when going for cataract surgery
217
how long does alpha-adrenergic blockers take to improve symptoms?
weeks
218
what are 5 alpha reductase inhibitors
shrink enlarged tissue
reduce the size of the prostate gland
219
how long does it take 5-alpha reductase inhibitors to help improve symptoms?
3-6 months
220
what are the adverse effects of 5-alpha reductase inhibitors?
increase risk of high-grade prostate tumor
ED/decrease libido
gynecomastia (breast enlargement)
221
what is finasteride (proscar), dutasteride (avodart), jalyn (finasteride plus tamsulosin)?
-blocks enzyme necessary for conversion of testosterone to DHT
-decrease size of prostate gland
-more effective for larger prostates with bothersome symptoms
222
what is the TURP?
transurethral resection of the prostate
223
what to assess for complications for TURP?
hemorrhage
bladder spasms
urinary incontinence
infection
224
what is continuous bladder irrigation (CBI)
remove blood clots
ensure drainage of urine
use aseptic technique
225
what are the post of care for TURP?
-stool softeners and high fiber diet to prevent straining
-treat bladder spasms-muscle relaxer
-catheter care
-teach kegel exercise
-observe for signs of infection v/s changes increase temp, resp, BP, HR
226
what the #1 complaint post op after TURP?
bladder spasms
227
whats the patho of prostate cancer
slow growing cancer
cause of 9% of cancer-related deaths of males
-most common cancer in men
228
what are the clinical manifestations for prostate cancer?
BPH symptoms
PSA elevated
DRE abnormal
dysuria/hematuria
pain
perineal
suprapubic
rectal
229
how to detect prostate cancer with DRE?
enlarged, asymmetrical, and lumpy
230
what are the diagnostic studies for prostate cancer?
PSA screening
DRE
Biopsy
231
what age should prostate cancer screening be done?
55-69 every 2 years
232
whats the nursing management treatment for prostate cancer?
-radiation
-brachytherapy
-cryotherapy and ablative hormone therapy
-chemotherapy
233
whats the surgical management for prostate cancer?
radical prostatectomy
234
what the post op care for prostatectomy?
indwelling catheter
surgical site drain
hospital stay for 1-3 days
235
what are the major complications of prostatectomy
ED
incontinence, urinary retention
hemorrhage
infection
wound drainage
wound dehiscence
DVT/PE
236
what is erectile dysfunction?
inability to achieve or maintain an erection sufficient for sexual intercourse
237
what are the erectile dysfunction common causes?
diabetes, vascular disease, side effects of medications, result of surgery, trauma, stress, depression, smoking, alchol
238
if having ED what medication should not be taken with 5(PDE-5) INHIBITORS?
nitrates (nitrogen)
239
what are contraindications when taking medications for ED?
Nitrates
alpha blockers
240
what causes testicular cancer?
-abnormal testical development
-exposure to certain chemicals
-HIV infection
-history of testicular cancer
-history of undescended testicles
-infertility
-tobacco use
-down syndrome
241
what is are the common ages of testicular cancer?
15-39
242
tumors on right side may spread to what side in testicular cancer?
right side of lymph nodes
243
tumors on the left side may spread to what side with testicular cancer?
back of the abdomen
244
what are the clinical manifestations of testicular cancer?
painless mass in scrotum
nontender and firm
dull ache or heavy sensation in lower abdomen, perineal area or scrotum
245
what are the diagnostic studies for testicular cancer?
palpation of scrotal content (firm and does not transilluminate
ultrasound
lab (tumor markers)
-AFP (a-fetoprotein)
-LDH (lactate dehydrogenase)
hCG (human chorionic gonadotropin)
246
what is treatment for testicular cancer?
surgery
chemo
radiation
247
what is orchiectomy?
surgical removal of affected testis, spermatic cord, and regional lymph nodes
248
what is seminomas?
radiation and or chemotherapy
-very sensitive to radiation therapy
249
what is nonseminomas?
not responsive to radiation
removal of lymph nodes
chemo
250
whats the patho of male breast cancer?
uncontrolled growth of abnormal cells in breast tissue
251
what are the risk factors of male breast cancer?
hyperestrogensim-high estrogen
family history of breast cancer
radiation exposure
252
what are the clinical manifestations of male breast cancer?
swelling/lump in breast area
dimpling of skin or nipple erythema
nipple discharge
nipper inversion
ultrasonography and MRI
253
what are the diagnostics for male breast cancer?
MRI
Ultrasound
lab studies
biopsy
254
what are the treatment nursing management for male breast cancer
surgery
chemo
hormone therapy
radiation therapy
255
what are the patient teaching for male breast cancer?
men who test positive for BRCA gene mutation should be aware of what breast look and feel
-report any changes to PCP
-self breast exams
-clinical breast exams starting at age 35
monitor for signs of infection
256
what is testicular trauma?
result from sport injuries, kick to groin, motor vehicle accidents, or falls and injury
257
what are the categories of injury for testicular cancer?
blunt trauma
penetrating trauma
degloving trauma
258
what are the functions of the endocrine system?
-maintain and regulate vital functions
-respond to stress and injury
-growth and development
-energy metabolism
-reproduction
-balance of fluid, electrolytes, acid-base
259
what are the risk factors for endocrine disorders?
age
heredity
trauma
environmental factors
consequence of other disorders or surgery
260
what is known as the master gland and is influenced my the hypothalamus?
master gland
pituitary
261
what is disorders are on the anterior pituitary?
hyperpituitarism (acromegaly)
hypopituitarism
262
what disorders are located on the posterior pituitary?
diabetes insipidus (DI)
syndrome of inappropriate antidiuretic hormone (SIADH)
263
what is hypopituitarism?
hormones most affected are growth hormone and gonadotropic hormone
264
what is hyperpituitarism (Acromgaly)
hypersecretion of growth hormone
primary cause of pituitary tumors
265
what is antiduretic hormone?
-made in the hypothalamus secreted in the posterior pituitary
266
what does the antidiuretic hormone do?
regulates the amount of water in the body
267
what does increased ADH lead to?
increased water retention and decrease serum Na+
268
what are the causes of SIADH
-hypothalamus or pituitary damage from trauma
-RECENT stroke or infection like meningitis
-malignant tumor secreting ADH
-lung, pancreas, or hodgkin lymphoma
269
is the serum osmolality with SIADH high or low?
low
270
is the urine specific gravity high or low with SIADH?
high
271
what is the normal specific urine gravity
1.030
272
what is the SIADH assessment?
fluid volume overload
wt gain without peripheral edema
change in LOC, seizure risk
concentrated amber urine
hypertension, tachycardia
273
what are additional complications with SIADH?
water intoxication
274
what are the signs and symptoms of water intoxication?
mild headache
confusion
anorexia
seizures
N/V
275
what are the labs with SIADH?
increase urine osmolality and specific gravity
decrease serum sodium and serum osmolality
276
what are interventions for SIADH?
-monitor: VS, CV and neuro status, daily wts
-strict i&o's, fluid restriction
-daily labs
-seizure precautions
-medications
277
what fluids should be used for SIADH?
3% NS in severe cases
278
what medications can be used for SIADH?
vasopressin antagonist (demeclocycline)
diuretics
sodium po or iv
279
what is do decreased ADH lead to?
DI
decreased water retention
increased serum Na+
280
what are the causes of Diabetes insipidus (DI)
-malfunction of posterior pituitary
-hypothalamus or pituitary damage due to stroke, trauma, or surgery
-nephrogenic- kidneys dont respond to ADH
281
what are the DI assessments?
polyuria
polydipsia
dehydration
hypotension
282
what are labs in DI?
decrease urine osmolality and specific gravity
increase serum sodium, serum osmolality
283
what are the diagnostic studies for DI?
fluid deprivation test
synthetic vasopressin trial
284
what is the fluid deprivation test?
-withhold water for 8 to 12 hours
-give patient DDAVP
-monitor if urine osmolality increases and urine volume decreases
285
what is synthetic vasopressin trial?
-distinguish nephrogenic DI from central DI
286
what are the DI interventions?
-identify and correct underlying cause
-daily wt, strict i&o's, V/S, CV, neur status
-fluid replacement oral or iv
-safety-fall precautions
-restrict foods that diurese
287
what foods diurese?
watermelon, grapes, caffeine
288
what is demopressin acetate (DDAVP)
synthetic vasopressin
decrease urine output therefore increase urine osmolality
289
what are the adverse effects of DDAVP?
flushing, water retention, water intoxication, nasal irritation, injection site irritation
290
what are the contraindications for DDAVP?
no concurrent use of loop diuretic or glucocorticoids, hold if creatinine clearance <50ml/min
291
what are the interventions of DDAVP?
monitor wt
I/O's
electrolytes
VS
signs of water intoxication
292
what is hypophysectomy?
done to remove pituitary tumors or the entire pituitary gland
293
what is transsphenoidal
through the nose and sphenoid sinus located in the back of the nuse
294
what is the post op care of hypophysectomy?
-elevate HOB 30º or more to decrease IOP and reduce headaches
-check dressing for drainage
(clear drainage should be checked for glucose)
-monitor I&O's, electrolyte, labs
-access patients vision and pupils
295
what are the hypophysectomy discharge teachings?
-avoid blowing nose, straining, coughing, sneezing, heavy lifting
-corticosteroid and thyroid replacement
-(sublabial approach- avoid brushing teeth for 10 days)
-AVOID ANYTHING THAT COULD INCREASE ICP
296
what do thyroid hormones regulate?
energy metabolism
growth and development
297
what does the hypothalamus secrete?
TRH (thyrotropin-releasing hormone)
298
what does the pituitary gland release?
TSH (thyroid stimulating hormone)
299
what does the thyroid secrete?
T3, T4, calcitonin
300
is the thyroid palpable?
no
301
what is the thyroid assessment?
-physical exam
-laboratory (serum TSH, free T4, serum T3, and T4)
-ultrasound
-radioactive iodine uptake test
302
what is the radioactive iodine uptake test?
diagnose hyperthyroidism
303
what is a goiter?
abnormal enlargement of thyroid gland
304
why can goiter occur?
hyperthyroidism
hypothyroidism
euthyroidism
305
what is the most common cause of goiter US?
chronic lymphocytic thyroiditis (Hashimoto)
306
what are the interventions for goiter?
measure the neck to have baseline of growth
-monitor for compromised airway
307
what is thyroiditis?
inflammation of thyroid gland
frequent cause of goiter
acute, subacute, chronic (hashimoto's)
308
what is acute thyroiditis?
due to bacterial or fungal infection
-abrupt onset with pain in thyroid area radiating to throat, ears, or jaw
s/s: fever, chills, sweat, fatigue
treat: antibiotics or antifungal
309
what is subacute thyroiditis?
due to viral infection
brupt onset with pain in thyroid area radiating to throat, ears, or jaw
s/s: fever, chills, sweat, fatigue
310
what is chronic lymphatic thyroiditis? (hashimoto's)
destruction of thyroid tissue by antibodies
311
do patients with chronic thyroiditis need thyroid replacement for life?
yes
312
what is hyperthyroidism?
elevated T3 and T4
low TSH
313
what causes hyperthyroidism?
-autoimmune reaction (grave's disease)
-excess dose of thyroid replacement
-thyroiditis
-too much iodine
314
what is they hyperthyroidism assessment?
increased metabolic rate
increased HR, BP, Temp
Wt loss
diarrhea
restless, insomnia, tremors
heat intolerance, diaphoresis
may have goiter, exophthalmos, dermopathy
315
what is exophthalmos?
protrusion of the eyeballs from the orbit
-result from fat deposit and fluid in the orbital tissue and ocular muscles
316
what is they hyperthyroid patient education?
-avoid spicy and high fiber foods to decrease diarrhea
-eat 4000-5000 calories/day
-good protein intake
-avoid caffeine or nicotine
-eye protection for exophthalmos
-ensure patient has adequate rest in quiet, cool environment
-lower simulation
317
what medication is for hyperparathyroidism?
propylthiouracil and methimazole
318
what does propylthiouracil and methimazole for?
-keep from making T3 and T4
-inhibit thyroid hormone synthesis
319
which medication is given to pregnant women with hyperthyroidism?
PTU (propylthiouracil)
320
what are the adverse effects of Propylthiouracil & Methimazole
hypothyroidism, agranulocytosis, N/V
321
what is agranulocytosis?
extremely low white blood cell count that causes a very high risk for infection
322
what are the patient teachings on taking Propylthiouracil & Methimazole?
-take medication with meals
-report signs of hypothyroidism
-importance of medication compliance
323
what are the patient teachings when taking Propylthiouracil & Methimazole?
-take medication with meals
-report signs of hypothyroidism
324
what is radioactive iodine?
destroys thyroid tissue
325
what are the adverse effects of radioactive iodine?
Hypothyroidism, Radiation Thyroiditis and Parotitis, dryness and irritation of mouth and throat
326
what is parotis?
swelling of parotid gland located between ear and jaw
327
what are the patient teachings with radioactive iodine?
-private toilet facilities, flush twice after each use
-sleep alone, avoid physical contact
-launder towels and linens and clothes seperatly
-do not prepare food for others with bare hands
-avoid being around pregnant women and young children for 7 days
328
what are the causes of acute thyrotoxicosis "thyroid storm"
severe infection/stress
manipulation of thyroid gland
329
what are the assessments for acute thyrotoxicosis "thyroid storm"
-elevated temp 106º
-tachycardia, systolic hypertension
-n/v/d, abd pain
-agitation, tremors, confusion, seizure
330
what are the medical management for acute thyrotoxicosis?
-stabilize CV function
-BETA BLOCKERS #1 INTERVENTION
-oxygen
-replace fluid and electrolytes
-anti-thyroid medication
-treat hyerthermia
-calm environment
331
what is thyroidectomy?
removal of thyroid gland
332
what is the preop intervention for a thyroidectomy?
-beta blockers, anti-thyroid meds, and iodine may be fiver to decrease risk of thyroid storm
-iodine also reduces risk for post-op hemorrhage
333
what are the post op care and education for thyroidectomy?
head and neck support
incision and airway
thyroid hormone
334
what are the signs and symptoms of hypocalcemia?
bronchospasms
numbness and tingling in face
postive chvesteks
trousseau's signs
335
what is hypothyroidism
low t3 and t4
elevated TSH
336
what are the causes of hypothyroidism
-antibody destruction of thyroid
-iodine deficiency
-hyperthyroidism treatement
337
what is they hypothyroid assessment
-decreased metabolic rate
-decreased hr
-wt gain
-constipation
-lethargy and fatigue
-cold intolerance, dry skin, and hair
-may have goiter
338
what are the hypothyroid management?
-thyroid hormone replacement
-nutrition therapy to promote wt loss
-patient education
339
what is the drug choice for hypothyroidism?
levothyroxine
340
what are the drug effects of levothyroxine?
nausea and decreased appetite
s/s: hyperthyroidism
341
what are the patient teaching for levothyroxine
medication will be lifelong
take med on empty stomach at the same time each morning
monitor for signs of hyperthyroidism
342
levothyroxine decreases the action of what?
insulin and oral hypoglycemics
343
what are the hypothyroidism patient education?
-exercise, low calorie and low-fat diet
-increase fiber in diet, stool softener
-avoid sedative and opioids if possible
-take thyroid hormone even while pregnant
-s/s: hypo/hyerpthyroidsim
344
what is myxedema coma?
severe hypothyroidism
345
what are the causes of myxedema coma?
-sudden withdrawal of thyroid medication
-acute illness, trauma, anesthesia, sedative/opiod use
-hypothermia
346
what are the assessments of myxedema coma?
hypotension, bradycardia
hypothermia
hypoventilation>respiratory failure
hypoglycema, hyponatremia
generalized edema
-puffy eyes, double chin, thick tongue, mask-like face from edema
347
what are myxedema managements?
respiratory and cardiovascular support
administer levothyroxine IV
administer IVF, glucose, corticosteroids
keep patient warm
monitor vs hourly
monitor LOC
348
what is the parathyroid gland?
-four pea sized endocrine glands
-located on the back of the thyroid gland
-parathyroid hormone regulates Ca+ balance in the body
349
what is primary hyperparathyroidism
increased PTH secretion, most commonly from benign tumor
350
what is secondary hyperparathyroidism
compensatory response to low Ca+
351
what is tertiary hyperparathyroidism
-enlargement of parathyroid gland
-PTH secreted regardless of Ca+ levels
352
what is the hyperparathyroid assessment
labs: increased Ca+ and PTH, decreased phosphate
CV: increased BP, dysrhythmias
MS: fractures (osteoporosis) muscle weakness
GI: abd pain, N/V, constipation
GU: kidney stones
CNS: decreased reflexes, poor coordination
depression, psychosis, irritability, confusion
353
what are some mild hyperthyroid managments?
increase fluid and weight bearing excersie
moderate Ca+ intake
354
what are the severe hyperparathyroid managements?
IVF, loop diuretics, Biophosphates, calcimimetics
surgery parathyroidectomy
355
what are bisphosphonates
aldendronate and risedronate
work by slowing the action of osteoclasts
monitor serum Ca+, phos, PTH and bone density
356
what are the patient education of bisphosphonates
swallow tablet whole, take 30 min prior to breakfast
do not lie down 30 min after taking
do not take with Ca+ supplements, antacids, caffeine or OJ
357
what is parathyroidectomy
-endoscopic radio-guided parathyroidectomy with autotransplantation
-autotransplantation done to continue PTH secretion
358
what are the post op instructions for parathyroidectomy
watch for respiratory distress
assess neck for dressing for hemorrhage, voice may be hoarse
do not flex neck, elevate HOB, avoid straining
359
what symptoms should you watch out for after parathyroidectomy
hypocalcemic crisis: tingling/twitching in extremities and face
positve trousseau's sign
chvostek's sign
360
what is hypoparathyroidism
deficienty of PTH leads to decrease Ca+
361
what are the causes of hypoparathyroidism
latrogenic
idiopathic
severe hypomagnesemia
362
what is latrogenic?
accidental removal during thyroidectomy
363
what is idiopathic
absence or atrophy of glands
364
what are the hypoparathyroid assessment
lab: decreased Ca+, and PTH, increased phosphorus
CV: decreased BP, dysrhythmias
Resp: bronchospasm, laryngealspasm, difficulty breathing
GI: abd cramps, dysphagia
CNS: tetany, seizures, hyperflexia, +Chvostek/Trousseau
Ms: weakness, painful muscle cramp/spasm
personality changes, irritability
365
what are the management of hypoparathyroid?
increase calcium level and treat acute complication
immediate treatment: IV calcium gluconate
long-term treatment:PO calcium supplements, vit D supplement
366
what are the hypoparathyroidism nursing interventions
patient needs to be on telemetry until Ca+ level normalize
seizure precautions
367
what are the hyperparathyroidism patient education?
-educate patient on long-term supplemental therapy
-educat patient on high calcium and high vit d foods
-avoid food containing oxalic acid:inhibit Ca+ absorption
-followup app for calcium monitoring
368
what are the oxalic foods?
spinach and rhubarb
369
why should patients with hypoparathyroidsm take vit d?
enhance intestinal calcium absorption
370
what disorders are in the cortex?
addison's disease
cushing's syndrome
371
what disorders are located in the medulla?
pheochromocytoma
372
what does the adrenal cortex hormones release?
-corticosteroids
-mineralocorticoids
-glucocorticoids
-androgens
373
what are mineralcorticoids?
regulate sodium and potassium balance, fluid balance
aldosterone
374
what are glucocorticoids?
regulate metabolism, increase glucose levels, physiologic stress response
cortisol
375
what do androgens do?
growth and development
376
what is cushing's syndrome
chronic exposure to excess corticosteroids, especially glucocorticoids
-corticosteroids used for conditions such as COPD, asthma, certain cancers
377
what is the cushing's assessment?
labs: increase glucose, cortisol Na+ decrease K+
general appearance: truncal obesity, rounding of face (moon face) fat on back of neck (buffalo hump)
CV: hypertension, fluid retention
GI: increased risk for peptic ulcer disease
MS: muscle wasting, osteoporosis
integument: thin and fragil skin straie, poor wound healing, acne, hirsutism
pysch: mood changes, euphoria
reproductive: development of male characteristics in women and vice versa
378
what are the cushing syndrome diagnostic studies
-confirmation of increased plasma cortisol levels
midnight or late-night salivary cortisol
low dose dexamethasone suppression test
24-hour urine cortisol
-plasma ACTH levels
low or undetectable with cushing syndrome
379
what is the latrogenic cushing syndrome management
-decrease corticosteroid dose
-change to every other day schedule
-taper off gradually
380
what medications can be used but is rarely used for cushing syndrome?
ketoconazole and mitotane
381
what are the nursing interventions for cushing syndrome?
-monitor vs, daily wt, and glucose level
-assess for infection
-emotional support
-pre/post op teaching for hypophysectomy and adrenalectomy
382
what patient education should be given for cushing syndrome?
-sodium restriction, high K+, Ca+, protein diet
-adrenalectomy will require lifelong glucocorticoid replacment
-medical altert bracelet
383
what is addison's disease?
-adrenocorical insufficiency
-hypofunctional of adrenal cortex
-decrease in glucocorticoids, mineralcorticoids, and androgens
384
what are the causes for addison's disease?
-sudden D/C of high dose steroids
-destruction of adrenal cortex
385
what are the addison's assessment
lab: decrease aldosterone, cortisol, Na+, glucose
increase in K+
general appearance: wt loss, emaciation
CV: hypotension, hypovolemia, tachycardia
GI: anorexia, N/V/D
integument: bronze hyper-pigmentation, vitiligo, alopecia
psych: depression, irritability, delusion
386
what does addison's disease not have enough of?
glucocorticoid-cortisol
mineralocorticoid-aldosterone
387
what are the diagnostic studies
ACTH stimulation test
corticotropin releasing hormone stimulation test
388
what are the managements for addison's disease?
lifelong hormone replacement therapy
glucocorticoids and mineralocortioids
women need androgen replacement
389
treatment that has both glucocorticoid and mineralocorticoid properties
hydrocortisone
390
only mineralocorticoid properties
fludrocortisone
391
how is hydrocortisone given?
given in divided doses 2/3 dose in the morning and 1/3 in the afternoon
392
what are the adverse effects of hydrocortisone?
hyperglycemia, osteoporosis, cushing syndrome, increase risk for infection
393
what are the patient teaching for hydrocortisone?
do not stop abruptly, do not take live virus vaccine, patient may need additional doses during periods of stress, medical alert ID, emergency kit
394
what are examples of stress dosing?
fever, flu, tooth extraction, rigorous physical activity
395
what are the adverse effects of fludrocortisone
Na+ and H2O retention, hypokalemia, osteoporosis
396
what are the patient teaching of fludrocortisone?
take medication with food or milk in the morning, eat high potassium diet, report signs of illness, do NOT stop abruptly, medical alert ID
397
what are the addison's disease management
-v/s, daily wt, i&o's, electrolytes, BG
monitor for s/s of cushing syndrome, addisonian crisis
protect pt from infection
-calm environment, no loud noise, bright light, temp extreme balance rest and activity
398
what medications can interact with corticosteroids?
oral hyperglycemics, cardiac glycosides, oral contraceptives, anticoagulants, NSAIDS
399
what is addisonian crisis?
life-threatening emergency requiring aggressive treatement
-caused by acute adrenal insufficiency
precipitated by:
stress
trauma
infection
surgery
abrupt withdrawal of exogenous corticosteroid use
400
what are the signs and symptoms of addisonian crisis?
severe headache
severe abdominal, leg, back pain
severe hypotension
low BG,
high K+
weakness
irritability and confusion
shock
401
what are the addisonian crisis management
IV glucocorticoid (hydrocortisone)
IVF
shock management
monitor neuro checks, vs
monitor lab, especially Na+, K+, and glucose
provide quiet, stress-free environment
402
what does the adrenal medulla hormone release?
catecholamines
-epinephrine
-norepinephrine
function as part of autonomic nervous system
403
what is pheochromocytoma?
hyperfunction of adrenal medulla
404
what are the causes of pheochromocytoma?
catecholamine producing tumor in adrenal medulla
increase epinephrine and norepinephrine
405
what are the pheochromocytoma assessment?
increase catecholamines (blood and urine)
severe hypertension
classic triad: severe pounding HA, tachycardia, profuse sweating
unexplained abd/chest pain
406
why should you not palpate patient with pheochromocytoma?
can cause sudden release of catecholamines and severe HTN
407
what are the pheochromocytoma complications?
hypertensive crisis: renal and retinal damage
acute MI
CVA
dysrhythmias
408
what are the diagnostic studies of Pheochromocytoma?
24 hour urine for VMA
Vanillylmandelic Acid
Biproduct of Epi and Norepi metabolism
Plasma-Catecholamine levels
CT/MRI to detect tumor
409
what are the management of Pheochromocytoma?
medication: alpha blocker then beta blocker
monitor: BP, electrolytes, EKG
manage: rest and activity, stress
surgery: adrenalectomy
educate: medication and diet
410
what is adrenalectomy?
surgical removal of one or both adrenal glands
typically done laparoscopically
411
what are the adrenalectomy postop
Bilateral Adrenalectomy- lifelong glucocorticoid and mineralocorticoid replacement
Unilateral Adrenalectomy- temporary glucocorticoid replacement, up to 2 years
Sudden decrease in catecholamine levels:
Cardiovascular collapse, hypotension, shock
Monitor vital signs
Risk for Acute Kidney Injury
Monitor I/O’s closely
Risk for hemorrhage
412
what are the adrenalectomy discharge teachings?
lifelong replacement therapy
teach: med adjucement and stress dosing
avoid: extreme temp, infection, and stress
medical alert bracelet
