Exam 3: Endocrine Function Alterations Flashcards

Question

Hyposecretion of the Posterior Pituitary Gland causes

Answer 1

Diabetes Insepidus

Answer 2

Pituitary Gland

Answer 3

Hypophysectomy

Answer 4

Diabetes Insipidus (DI)

Answer 5

To produce and release several different hormones like FSH, LH, prolactin, ACTH, TSH, GH

Answer 6

Cushing Syndrome Gigantism Acromegaly

Answer 7

Dwarfism Panhypopituitarism

Answer 8

Syndrome of inappropriate antidiuretic hormone Posterior Pituitary Gland - Hyperexcretion Excessive amount of serum ADH, resulting in water intoxication and hyponatremia

Answer 9

Malignant tumors on the POSTERIOR Pituitary Gland Hypersecretion of ADH by the hypothalamus Ventilation (increased intrathoracic pressure) Trauma Pain Stress

Answer 10

Fluid volume excess Thirst Neurologic changes r/t swelling of brain cells Seizures NO edema (it's between the cellular and extracellular spaces) Increased BP Crackles Distended jugular veins I > O Weight gain

Answer 11

High URINE osmolality Low SERUM osmolality decreased H&H, BUN, Na Levels (Hyponatremia)

Answer 12

FLUID OVERLOAD Alteration in thought process insufficient nutrients fatigue

Answer 13

Information about the disease process Medications are lifelong Oral intake plan (fluid and sodium) Daily weight

Answer 14

Restrict oral fluids including ice chips to 800 mL/day Monitor intake/output Monitor serum sodium, and urine osmolality, and specific gravity Weigh daily Assess changes on LOC, cognition Meds: Declomycin, Vasopressin, Diuretics

Answer 15

Results from excessive water loss caused by hyposecretion of ADH or kidney's inability to respond to ADH --> polyuria --> severe dehydration

Answer 16

Assess for hx of head injury, brain surgery, infection, or tumor Medication list Assess LOC VS (hypotension) Skin turgor I&O Weight (loss) Polydipsia Polyuria Bowel sounds (constipation) (from dehydration)

Answer 17

Low urine osmolality Positive water deprivation test Hypernatremia (increased sodium)

Answer 18

Dehydration (most common) Reduced cardiac output potential for interrupted skin integrity possible constipation

Answer 19

Information about disease process Medic Alert bracelet Keep I&O log Weight skin care normal bowel elimination

Answer 20

monitor I&O hourly weight daily - report weight loss!!! monitor urine labs!!! encourage fluid intake greater than urine output !!! skin protection PRN meds: Supplemental ADH, replacement IV fluids

Answer 21

UO greater than 200 m/hr for 2 consecutive hours or one hour with over 500 mL

Answer 22

T3 T4 Calcitonin

Answer 23

TSH from the anterior pituitary gland

Answer 24

the thyroid

Answer 25

cellular metabolic activity

Answer 26

in response to high plasma calcium levels and it increase calcium deposit in bones

Answer 27

butterfly shaped in the neck

Answer 28

Hypothalamic - pituitary - thyroid axis Hypothalamus --(TRH)--> stimulate pituitary gland to release TSH --> Stimulates thyroid to release T3/4-->high levels of T3/4 feedback loops to inhibit TRH production and release (negative feedback)

Answer 29

excessive secretion of thyroid hormone from the thyroid gland, leading to increased basal metabolic rates rates higher in women than men hyperthyroidism

Answer 30

clinical manifestation's vary depending on amount and time: assess health hx, VS, neck (goiter), eyes (exophthalmos), resp effort increase, energy level, irritability, weight pattern, sleep pattern potential thyroid storm/crisis

Answer 31

Life threatening extreme hyperthyroidism from long term stress or manipulation of the gland s/s include elevated temp (fever above 101.3), extreme tachycardia (above 100), and other exaggerated hyperthyroid s/s and neuro changes

Answer 32

acetaminophen (ASA would displace thyroid hormone from proteins and make things worse) hypothermia mattress ice packs cool environment IV fluids beta blocker, propanolol/inderal antithyroid medications/PTU

Answer 33

elevated T3, T4, free T4 Decreased TSH positive RAI uptake scan and thyroid scan

Answer 34

possible reduced CO disturbances in vision threat to airway insufficient nutrients

Answer 35

related to lifelong antithyroid medications: ablative radioactive I-131, or partial/total thyroidectomy meds: antithyroid meds for life (potassium iodide, Tapazole, and/or PTU)

Answer 36

Medication usage and LIFELONG usage Daily weight environment temp cool and stress free activity-rest balance

Answer 37

Eye protection and potential altered visual field regular eye exam report any changes in vision or appearance eye protection moisten eyes elevate HOB eye patch at night

Answer 38

high carbohydrate and protein diet including snacks (burns fast)

Answer 39

Ablative radioactive I-131 OR Thyroidectomy (partial or total)

Answer 40

thyroid gland absorbs I-131 which destroys some thyroid cells over a period of 6-8 weeks

Answer 41

someone pregnant

Answer 42

RADIATION PRECAUTIONS

Answer 43

Drink with a straw use a private toilet no handling others food avoid contact with persons (no children) use disposable utensils and plates

Answer 44

once thyroid hormone levels out it may indicate a thyroidectomy, but the hyperthyroidism needs treatment before surgery options

Answer 45

Deep breathing cough instruct to hold hands behind neck during cough, sitting and turning (supports neck and gland region) teach to expect hoarseness instruct on wound care pre and post op

Answer 46

provide comfort/pain monitor for hemorrhage promote patent airway prevent tetany (hypocalcemia) maintain patent IV avoid/minimize talking: Assess for laryngeal nerve damage prevent infection monitor for hypothyroidism

Answer 47

removal of parathyroid gland can cause low calcium

Answer 48

insufficient amount of thyroid hormone (TH) being secreted by the thyroid gland, causing decreased BMR, decreased hear production, and effects on all body systems

Answer 49

depends on condition severity: health hx, LOC, VS, resp., activity tolerance, and comfort Goiter again, myexedema crisis, everythging slows down

Answer 50

Life threatening crisis of hypothyroidism precipitated by trauma, infection, etc non pitting edema in connective tissue occurs with neuro changes high mortality if untreated

Answer 51

Decreased T4 NORMAL T3 Increased TSH

Answer 52

via medication to replace T4

Answer 53

reduced CO excess nutrients constipation impaired skin integrity sexual dysfunction body image

Answer 54

information about the disease and medications work medicalert bracelets medication lifelong - same time 1 hour prior to a meal hold med if HR >100 weight changes

Answer 55

medication environmental comfort activity-rest periods bowel elimination

Answer 56

thyroid hormone replacement (levothyroxine/Synthroid, triiodothyronine/Cytomel); raise BMR

Answer 57

at the same time daily 1 hour before a meal

Answer 58

behind the thyroid gland can be embedded in thyroid tissue

Answer 59

increased parathyroid hormone (PTH) secretion form parathyroid glands located in the neck PTH increases Calcium

Answer 60

older adults and women most at risk

Answer 61

health hx VS ECG elimination nutrition activity exercise LOC may be asymptomatic, or polyuria, renal calculi, etc

Answer 62

Elevated serum levels of total calcium increased PTH decreased phosphate possible bone changes

Answer 63

increase fluids avoid thiazide diuretics weight bearing activity avoid vitamin A and D and calcium supplements

Answer 64

decrease serum Ca with IV NS diuretics and phosphate replacement surgery to remove PT glands

Answer 65

because they can raise calcium levels even more

Answer 66

pain reduce mobility potential for injury elimination issues

Answer 67

disease process medication s/s of hypocalcemia

Answer 68

promote safety and comfort strain all urine to detect stones increase fluids activity - rest periods promote nutrition pre-post op care prevent tetany caused by surgery postop (chvostek and tousseau signs) meds: analgesia, diuretics, IV NS to excrete calcium, phosphate, calcitonin

Answer 69

general muscle hypertonia with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements

Answer 70

a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye

Answer 71

carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a BP cuff

Answer 72

low PTH levels causing hypocalcemia, usually caused by damage or surgical removal of the thyroid

Answer 73

health hx VS ECG Elimination nutrition activity exercise LOC GI symptoms!! signs fo hypocalcemia (anxiety, HA, tremor, spasm, tetany, seizure)

Answer 74

decreased serum PTH, total calcium, free calcium, increased serum phosphate

Answer 75

Supplemental Calcium and Vitamin D (possible via calcium gluconate IV and/or pentobarbital to decrease neuromuscular irritability)

Answer 76

potential for injury anxiety knowledge deficit

Answer 77

disease process medicalert bracelet VITAMIN C and VITAMIN D EVERYDAY Diet HIGH IN CALCIUM AND VITAMIN D

Answer 78

promote safety/comfort: neuromuscular activity-rest periods/quiet environment promote nutrition meds: calcium supplement oral or IV, vitamin D oral

Answer 79

beans greens tomatoes cheese milk

Answer 80

2 glands on the upper portion of the kidneys Has a medulla and cortex effects stress response, lyte and fluid volume, and glucose metabolism

Answer 81

center of the adrenal gland releasing catecholamines fxns as part of the autonomic NS

Answer 82

outside of the adrenal gland releasing steroid hormones

Answer 83

EP and NEP (90% of secretion is EP for fight or flight)

Answer 84

glucocorticoids (important influence on glc metabolism) mineralocorticoids (lyte metabolism) androgens (sex hormones)

Answer 85

Tumors (benign often) from the Adrenal medulla (Catechol.) Rare neuroendocrine tumor Causes release of high amounts of EP and NEP (Catecholamines) If undetected and untreated can be fatal 90% of tumors are in the medulla with 10% in extra adrenal chromatin tissue elswhere

Answer 86

any age but peaks at 40-50 y/o Effects men and women equally

Answer 87

Headache Diaphoresis Palpitations *HDP* TRIAD -------

Answer 88

Anxiety Lightheaded when getting up attacks or symnptoms may be paroxysmal 5 H's HA HTN Hyperhidrosis (sweating) Hypermetabolism (fever) Hyperglycemia TIAs tremor Flushing postural hypotension Cafe Au Lait Spots

Answer 89

pigmented birthmarks that are benign not causing pheochromocytoma ailment themselves but may indicate disorders esp if multiple spots are present

Answer 90

24 hour urine catecholamine and metabolite catch (most conclusive test) plasma metanephrine testing

Answer 91

Abdominal CT Initially MRI Follow up EKG - Tachyarrhythmias GENETIC TESTING per endocrine society guidelines lifelong follow up biochemical testing annually

Answer 92

Meds: 1st Alpha Adrenergic Blocking agents to prevent CV complication and then 2nd Beta Adrenergic Blocking Agents Monitor BP and bed rest until stable with the HOB elevated High sodium diet to prevent post op hypotension Surgical removal of the adrenal gland if the source Personalized management *all occurs 7-14 days pre-surgery*

Answer 93

either a singular or dual adrenalectomy

Answer 94

corticosteroid replacement needed

Answer 95

(Catecholamine Withdrawal) Hypotension support (diet with enough salt and water) hypoglycemia support monitor for ectopic sites until stable: EKG, arterial pressures, fluid/lyte balance, blood glc levels maintain IV access

Answer 96

need regular follow up care, chance for reoccurrence general diet self monitoring BP regular monitoring labs and urines medications - corticosteroids if both adrenal glands removed with regular compliance

Answer 97

sudden withdrawal from large catecholamine amounts

Answer 98

ADRENOCOTICAL INSUFFICIENCY Adrenal suppression by exogenous steroid use Adrenal glands damaged and cannot make sufficient cortical steroids

Answer 99

muscle weakness, myalgia anorexia, weight loss, low blood sugar NVD Fainting and salt craving GI symptoms fatigue, irritable, depressed dark pigmentation of skin and mucosa - knuckles, knees, elbows, mucous membranes, hair loss (in women esp) AND vitiligo --- occurs months/years before the disease low blood Glc low serum sodium high serum K apathy, emotional lability, confusion dehydration, hypotension potential Addisonian crisis

Answer 100

adrenocortical hormone levels, ACTH levels, ACTH stimulation test

Answer 101

corticosteroid use

Answer 102

Primary - Adrenal Gland Secondary - Pituitary Iatrogenic - Result of Therapeutic Use of Corticosteroids

Answer 103

partial or complete destruction of adrenal cells - 80-90% from autoimmune destruction from autoimmune adrenalitis can also be due to infection of Tb or AIDS

Answer 104

Pituitary Gland issue inadequate secretion of ACTH resulting in a deficiency of cortisol, aldosterone

Answer 105

result of therapeutic use of corticosteroids suppressed adrenal gland release of glucocorticoids after only 2-4 weeks of steroid use chronic steroid administration suppresses the HPS axis and eventually causes adrenal atrophy

Answer 106

insidious onset - symptoms develop slow, often over several month

Answer 107

may present in ER in circulatory shock they compensate until they crash and it is precipitated by stress (infection, environmental temp)

Answer 108

8 am serum cortisol test for hypocortisolism Rapid ACTH stimulation test (cortrosyn, cosyntropin, or synacthen) (complex interpretation) "short corticotrophin test" imaging: CT of abdomen (adrenal) or MRI scan (pituitary)

Answer 109

Increased plasma ACTH and a serum cortisol lower than normal This means decreased blood glc, decreased serum Na, hyperkalemia, increased WBC

Answer 110

hormone replacement therapy to correct steroid levels (cortisol, corticosteroid injections, double or triple in stress) monitor due to infection risk increase life long supervision serial labs of lytes, plasma renin, fasting blood glucose level monitor long term complications

Answer 111

osteoporosis gastric ulcers depression glaucoma cataracts

Answer 112

noting illness and stressors participating problems!!! fluid and lyte status, VS, orthostatic BP Note s/s of insufficiency like weight loss, muscle weakness, fatigue Medication monitor for s/s of Addisonian crisis

Answer 113

a drop in SBP 20 mmHg or more - could lead to stress and crisis

Answer 114

1. Replacement Corticosteroids - lifelong, regular, sick day emergency kit 2. Diet - hyponatremia and hypovolemia could occur 3. Times to replace sodium and increase fluids 4. Assess tolerance of position changes with BP check in lying, sitting and standing 5. Sensible activity limitations, lifestyle changes (avoid strenuous activity and hot humid weather) 6. Temp increase in corticosteroids when stressed 7. Sick Day Rules

Answer 115

heavy exercise hot weather GI symptoms including NVD

Answer 116

consume adequate fluid, sodium, potassium need HIGH PROTEIN and HIGH CARB DIET excessive weight gain or edema indicates cortisol replacement too high - see provider

Answer 117

surgery infection illness life events hot weather

Answer 118

1. Double dose routine oral glucocorticoid with fever and illness - bed rest - and double oral glucocorticoid when taking antibiotics for infection or before small outpatient procedures like dental work 2. Inject Gluco. IM/IV incase of severe illness trauma, fasting for procedure, persistent vomiting, or during surgery - safety box available with 100 mg of hydrocortisone IV/IM followed by 200 mg hydrocortisone through cont IV infusion every 6 hours

Answer 119

Disturbed body image Self care deficit related to weakness, fatigue, muscle wasting, altered sleep patterns Risk for injury related to weakness risk for fluid volume deficit activity intolerance and fatigue risk for infection knowledge deficit

Answer 120

monitor for s/s of fluid volume deficit encourage fluids and foods select foods high in sodium administer hormone replacement as prescribed

Answer 121

avoid stress and activity until stable perform all activities for patient when in crisis - transferring, ADLs, etc maintain a quiet, nonstress environment measures to reduce anxiety

Answer 122

if having elective surgery hold exercise until 7-10 days later, monitor for infection, have foods high in Na esp during GI disturbances and hot weather carry emergency care kit of cortisone IM injection instruct how to give self IM injection need increased treatment before procedures medical regime compliance lifelong medic alert bracelet, medical information card

Answer 123

Life threatening adrenal insufficiency emergency critically low corticosteroid levels that can cause shock, hypotension, rapid weak pulse, rapid respiration rate, pallor, and weakness - CRISIS

Answer 124

Stress - trauma, infection, recent surgery, cold exposure (cannot release cortisol for stress!) Decreased NA intake Dehydration not taking prescribed steroid replacement adrenalectomy removal pituitary (tumor) (ACTH secondary)

Answer 125

Mental Status Changes (Confusion, agitation, lethargy) Muscle Weakness HA, Abdominal Pain, Nausea, Weakness Postural hypotension or Shock Hyperthemia (as high as 105 F) Labs: Hyponatremia, Hyperkalemia, Hypoglycemia

Answer 126

Prevent irreversible shock

Answer 127

Support Search for precipitating illness Salt Sugar Steroids (IV Corticosteroids)

Answer 128

Vasopressin Hydrocortisone Antibiotics IV fluids shock tx: recumbent, D5 and NS, cortisol, VS monitor, legs elevated, correct hyperkalemia, fix volume deficit and hypotension, treat precipitating factor

Answer 129

Adrenal Gland Disorder Excessive adrenocortical activity or corticosteroid medications opp of Addison's Disease

Answer 130

Hyperglycemia Central type obesity with buffalo hump heavy trunk and thin extremities fragile thin skin ecchymosis striae wakness lassitude sleep disturbances osteoporosis muscle wasting HTN MOON FACE acne infection slow healing virilization in women, loss of libido mood changes increased serum sodium decreased serum potassium

Answer 131

Dexamethasone Suppression Test

Answer 132

ACTH Dependent - Pituitary Tumor or Ectopic ACTH Production ACTH Independent - Medications, hyperfunction, ectopic cortisol production

Answer 133

pituitary adenomas (micro ones)

Answer 134

1. Pituitary adenoma - hypersecretion of ACTH. No normal cortisol feedback and continue to stimulate cortisol production and release 2. Ectopic ACTH -tumors producing it elsewhere in the body like lung, pancreas, thymus

Answer 135

1. Iatrogenic - cortisol meds as anti inflammatory 2. Primary adrenal gland hyper function - hyperplasia or tumor 3. Ectopic cortisol production -tumor elsewhere making cortisol

Answer 136

women 20-40 (5x more likely than men)

Answer 137

androgen excess leading to masculine traits and recession of female traits excess hair (Hirtuism), breast atrophy, menses cease, voice deepens

Answer 138

1. Serum Cortisol 2. urinary Cortisol 3. Low dose dexamethasone or Decadron suppression test 2/3 of these need to be abnormal for diagnosis

Answer 139

CBC - WBC >11,000/mm^3 Metabolic Panel - Hyperglycemia (cortisol) and Hypokalemia (aldosterone - Kidneys excrete K+) Abdominal CT scat, MRI Brain scan on pituitary, Chest and Abdominal CT scan Lab tests for relevant hormone levels

Answer 140

Surgery to remove a tumor targeted tumor radiation after removal of pituitary tumors lifelong cortisol replacement after pituitary removal routine monitoring for reoccurrence taper corticosteroid use

Answer 141

activity level and ability to carry out self care skin assessment changes in physical appearance and patient responses to these changes emotional status medications mental function Hx of level of activity, ability for ADLs skin for breakdown and such patient responses to changes, depression, awareness of environment

Answer 142

risk fo injury risk for infection self care deficit impaired skin integrity disturbed body image disturbed thought processes

Answer 143

accident proof environment, concern falls and fractures ambulation assistive devices diet: high protein, calcium, vitamin D, low sodium, watch calorie intake

Answer 144

(Increased susceptibility to injury or infection secondary to immunosuppression caused by excessive cortisol) avoid those who are ill infection and inflammation are marked monitor for changes that may indicate infection offer age appropriate vaccinations particularly influenza, herpes zoster and pneumococcal vaccinations due to increased risk of infection

Answer 145

encourage rest and consistent sleep patterns moderate activity relaxing, quiet environment for rest and sleep

Answer 146

meticulous skin care avoid adhesive tape frequent position change frequent assessment bony prominences monitor for DVT

Answer 147

weight gain and edema modified by low carb, low sodium diet high protein diet may decrease other bothersome symptoms

Answer 148

explain disease to patient and family members coping methods to deal with mood swings, irritability, depression report psychotic behavior - potential encourage patient and family to verbalize feelings and concerns

Answer 149

Addisonian Crisis or shock can occur from sudden corticosteroid withdrawal Monitor blood glc, HTN, hyperglycemia, weight gain Teach self monitoring BP, BG, Weight medic alert bracelet (for dentists) keep adequate supply of corticosteroid medication (avoid running out) goal forming patient and family education

Answer 150

decreased risk of injury decreased risk of infection increased ability to carry out self care activities improved skin integrity improved body image improved mental function absence of complications

Answer 151

suppresses inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection big for adrenal insufficiencies and inflammation

Answer 152

Timing of doses Need to take as prescribed, tapering required to discontinue or reduce therapy Potential SE and measures to reduce SE

Answer 153

Cardiovascular, HTN, Fluid retention, hypokalemia, embolism,. atherosclerosis immune effects, increased infection risk, masked infection signs ophthalmologic changes, glaucoma, corneal lesions muscle issues - wasting, poor healing, osteoporosis Metabolic effects - increased insulin resistance, steroid withdrawal Appearance changes *They are important because we need to be able to educate and do collaborative intervention against these things*