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Complex DMR > Endocrine/Thyroid, DM, adrenal dysfunction > Flashcards

Endocrine/Thyroid, DM, adrenal dysfunction Flashcards

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1
Q

Normal process of Thyroid hormone release

A 
1. Hypothalamus
releases
thyrotropin releasing hormone
(TRH) to anterior
pituitary
2.Anterior pituitary
releases thyroid stimulating
hormone (TSH) to
thyroid gland
3.Thyroid secretes
thyroid hormones
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2
Q

T3

A

Increases metabolic rate

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3
Q

T4

A

Increases cellular response to catecholamines

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4
Q

Thyrocalcitonin

A

Decreases breakdown of bone and
decreases reabsorption of calcium in the intestines and
kidneys (↓Ca++)

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5
Q

Causes of hypothyroidism

A 
• Disorders of hypothalamus or
anterior pituitary
• Autoimmune disease
– Hashimoto’s thyroiditis
• Hyperthyroidism treatment
– Thyroidectomy, radioactive iodine
therapy
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6
Q

Causes of hyperthyroidism

A

• Autoimmune disease

̶ Graves’ disease

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7
Q

Clinical manifestations Hypothyroidism (mental status?, weight, GI, appetite, sensitivities, HR, skin)

A

-Sluggish mental & physical activity
- Weight gain
- Decreased GI motility
- Decreased appetite
- Cold sensitivity
- Bradycardia
- Coarse, dry (not fragile) skin
- Goiter
- Decreased fertility/menstrual
irregularities

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8
Q

Clinical manifestations Hyperthyroidism (mental status?, weight, GI, appetite, sensitivities, HR, skin)

A 
-Tachycardia, hypertension
• Nervousness, excitability
• Increased gastric activity
• Increased appetite
• Weight loss
• Heat intolerance
• Insomnia
• Decreased fertility/menstrual
irregularities
• Exophthalmos/goiter
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9
Q

Hypothyroid management Diagnosis labs

A
  • Elevated TSH

* Decreased T3, T4

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10
Q

Treatment of hypothyroid

A

• Thyroid hormone replacement (levothyroxine)

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11
Q

Levothyroxine safety/drug metabolism

A

Safety – Drug metabolism
• Decreased metabolism of sedatives, hypnotics or narcotics
• Decrease dose or frequency

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12
Q

Hypothyroid nursing actions/interventions

A
  • Administer medication in AM
  • Be mindful of drug metabolism (i.e. narcotics and sedatives)
  • Warming blankets
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13
Q

Complication of hypothyroidism:

Myxedema Coma

A

• Profound decrease in cellular metabolism
– Hypoventilation → Hypoxia and CO2 retention
– Fluid and electrolyte imbalance
– Hypothermia
– Decreased cardiac function → Bradycardia and hypotension
– Hypoglycemia
– Hyponatremia

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14
Q

Myxedema Coma treatment

A

• Treatment – Replace thyroid hormone, supportive care

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15
Q

Hyperthyroid Diagnosis

A

• Decreased TSH, Increased T3, T4

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16
Q

Hyperthyroid treatment

A

Treatment
• Symptom management (fluid replacement, beta blockers)
• Medical
– Propylthiouracil (PTU), methimazole (Tapazole), lithium carbonate (Lithonate)
• Radioactive iodine
• Surgical
– Total or subtotal thyroidectomy

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17
Q

Thyroidectomy Preoperative considerations

A

Antithyroid medications and/or beta blockers
• Potassium iodide
• Vitamin D and calcium

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18
Q

Thyroidectomy postoperative care

A
  • Pain control
  • Thyroid hormone supplementation
  • Calcium management
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19
Q

What is a complication of thyroidectomy and why does this happen

A

Hypocalcemia – Complication of thyroidectomy
• Parathyroid damage during surgery
– Surgical damage, devascularization
• Appears within 48 hours, resolves within a few months

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20
Q

What is done to treat preThyroidectomy complication

A

Calcium given pre-procedure
► Calcium levels checked routinely post procedure and Ca
replaced
• May need exogenous calcitrol for Ca absorption if PTH levels are also
low
► S/s hypocalcemia

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21
Q

Hyperthyroid Assessment

A 
Vital signs
• Intake and output
• Eyes and vision
• Thyroid hormone levels
• Seizures
• Daily weight
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22
Q

Thyroid storm symptoms

A

Tachycardia, fever, systolic hypertension, abdominal pain, tremors,
changes in level of consciousness

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23
Q

Treatment of thyroid storm

A

Treatment
• Supportive care – i.e. Airway, pulse rate and blood pressure
management
• Fluid resuscitation
• Glucocorticoids
• Anti-thyroid meds once the pt’s symptoms stabilize

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24
Q

What is Diabetes insipidus

Study These Flashcards
A

Decreased secretion of antidiuretic hormone (ADH) from

posterior pituitary r/t hypothalamus damage

25
Diabetes insipidus causes
30% idiopathic (usually autoimmune) • 25% brain tumor • 20% intracranial surgery • 16% head trauma
26
What happens in the body to lead to DI
``` 1. Decrease in ADH production 2. Collecting ducts in kidney less permeable to water 3. Excretion of large volumes of very dilute urine ```
27
Clinical symptoms of Diabetes insipidus
``` R/t extreme water loss • Polyuria, polydipsia, nocturia • Hemoconcentration – Elevated Na+ and hematocrit • Hypotension and tachycardia ```
28
Diagnosis of DI
Serum osmolality > urine osmolality • Concentrated blood, dilute urine H&H, BMP MRI (determine cause)
29
What meds are given for management of DI
``` Hypotonic fluid (D5) • Glucose control ``` Gentle correction of hypernatremia Desmopressin DDAVP • Synthetic ADH • Subcutaneous, intranasal, PO
30
Nursing interventions for DI
Maintain IV access • Administer IVF and medications • Provide mouth care
31
What are the adrenal glands important for?
``` Glucocorticoids (cortisol) Mineralocorticoids: Aldosterone Other hormones/NT Sex hormones: Androgens and estrogens Epi/Norepi ```
32
What is cortisol used for?
Carb, fat and protein metabolism; Suppression of immune response, control of stress response
33
What regulates mineral corticoids
RAAS system
34
Adrenal insufficiency (types)
Primary: destruction of adrenal gland can be due to autoimmune disorder or infection Secondary: Decreased secretion of ACTH from anterior pit Tertiary: dysfunction of hypothalamus
35
Adrenal hyperfunction
Cushings syndrome
36
S/s of adrenal insufficiency r/t cortisol | What is it associated with and when do they present
``` Addisons disease Present 90% is non functional Dec Cortisone/aldosterone C-Hypoglycemia C-weakness C-weight loss C-fatigue C-mental health s/s (dep) ```
37
S/s adrenal Hyper function r/t cortisol
``` Cushings C-Hyperglycemia C-Abnormal fat distribution C-High protein metabolism=dec muscle mass C-Increase susceptibility to infection (suppressed immune response) C-Thin, friable skin C-Mental health s/s Virilization in F ```
38
S/s of adrenal insufficiency r/t aldosterone.
A-Dehydration A-Hypotension A-Hyperkalemia
39
S/s of adrenal insufficiency not r/t cor or aldosterone.
Hyperpigmentation | Decreased pubic hair
40
S/s adrenal Hyper function r/t Aldosterone
A-Fluid retention HTN A-Sodium retention A-Hypokalemia
41
S/s of adrenal hyperfunction not r/t cor or aldosterone.
Virilization in F
42
Adrenal insufficiency, what is the greatest cause and what goes wrong
Addisons disease, nonspecific autoimmune destruction of adrenal gland. or abrupt discontinuation of corticosteroids
43
Diagnosis of adrenal insufficiency
Cortisol levels -Drawn first thing in the AM (body produces more cortisol to help us wake up) Less than 3mcg/dL=adrenal insufficiency CT or MRI of adrenal gland Shrinking of adrenal gland = autoimmune destruction Enlarged gland= infectious process (inflammation)
44
Management of Adrenal insufficiency
Replace coritsol (hydrocortisone/dexamethasone) IV fluids Treat hyperkalemia
45
Assessments of Adrenal insufficiency (vitals)
Hypotension & tachycardia risk due to dehydration
46
Assessments of Adrenal insufficiency I&O
Fluid recussestation
47
lab Assessments of Adrenal insufficiency
Na, K, Glucose, Hct, cortisol
48
Nursing intervention of adrenal insufficiency
``` IV access, admin meds safety precautions (postural hypotension) ```
49
Adrenal crisis clinical manifestation
Hypotension unresponsive to fluid resuscitation or vasoactives (septic likely to present with this)
50
Treatment of Adrenal crisis
200-300 mg hydrocortisone IVP daily in divided doses | Taper once serum lactate has normalized
51
Hypercortisolism
excessive secretion of glucorticoids
52
Hyperaldosteronism
Excessive secretion of aldosterone
53
Causes of adrenal hyperfunction
70% caused by anterior pituitary tumor 15% causes by tumor of adrenal cortex 15% caused by ectopic tumors
54
Adrenal hyperfunction diagnosis
Lab values: Cortisol levels, electrolytes, glucose, dexamethasone suppression test (Dexamethasone before bed, cortisol level drawn in AM, if high =Cushings)
55
Hyperaldosteronism medical management
Potassium sparing diuretic (spironolactone) | secretes NA+ and water while preserving K+
56
Hypercortisolism medical management
Ketoconazole, pasireotide Decreases cortisol secretion Surgery Radiation
57
Adrenal hyperfunction what should nurse assess for
Vitals: HTN Weight fat muscle distribution I&O Skin, wound healing (thin frible skin)
58
Adrenal hyperfunction what labs should nurse assess
Glucose potassium sodium
59
Adrenal hyperfunction what should nurse
Med mngment HOB elevated Meticulous skin care (extra thin) Turn/reposition

Complex DMR (12 decks)

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