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NUR150 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What are the 6 hormones of the anterior pituitary?

A

TSH- thyroid stimulating hormone- stimulates the thyroid gland

ACTH- adrenocorticotropic hormone- stimulates the adrenal gland

LH- luteinizing hormone- stimulates ovulation in women and testosterone in me

FSH- follicle stimulating hormone- stimulates growth of ovarian follicles and estrogen secretion in women, and stimulates sperm production in men

Prolactin- stimulates breast milk production

GH- growth hormone- stimulates protein synthesis and muscle and bone growth

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2
Q

What are the two hormones of the posterior pituitary?

A

ADH- antidiuretic hormone (vasopressin)- produced in the hypothalamus and stored in the PP

Oxytocin- stimulates contraction of the uterus

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3
Q

What is the cause of primary neurogenic diabetes insipidus?

A

a lack of ADH production (hypothalamus) or release (pituitary) caused by defects in the glands

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4
Q

What is the cause of secondary neurogenic diabetes insipidus?

A

a lack of ADH production or release caused by an infection, trauma, brain surgery, or tumors near the glands

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5
Q

What is the cause of nephrogenic diabetes insipidus?

A

the renal tubules do not react appropriately to ADH (causes such as genetics, kidney damage, or lithium)

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6
Q

What labs would we look at to diagnose diabetes insipidus?

A

Urine testing: specific gravity, osmolarity, pH, sodium, potassium will all be DECREASED

Blood testing: osmolarity, sodium, potassium will all be INCREASED

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7
Q

What is a water deprivation test?

A
  • water gets withheld
  • vasopressin is given
  • if urine becomes more concentrated after vasopressin it is neurogenic DI
  • if urine concentration does not change following the vasopressin then it is nephrogenic DI (or psychogenic)
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8
Q

What medications would we give for neurogenic DI?

A

Desmopressin (synthetic ADH)
*lifelong
Vasopressin may also be given but its is short acting and must be given parenterally, causes vasoconstriction

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9
Q

What medications would we give for nephrogenic DI?

A

Prostaglandin inhibitors

Thiazide Diuretics

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10
Q

What is the cause of SIADH?

A

OVER-secreted ADH due to malignant tumors of the hypothalamus, positive pressure ventilation, head injury, meningitis, stroke, tuberculosis, chemotherapy, TCAs, SSRIs, opioids, and some abx

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11
Q

What mental status manifestations should we watch for in SIADH?

A

SIADH causes water retention and sodium excretion so hyponatremia occurs. Watch for:

  • confusion/hostility
  • lethargy
  • Cheynes-Stokes respirations
  • seizures
  • coma
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12
Q

What labs will we check for when we suspect SIADH?

A

Urine testing: sodium and osmolarity will be increased

Blood testing: sodium and osmolarity will be decreased

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13
Q

What medications should we give for SIADH?

A

Demeclocycline- unlabeled use to correct fluid and electrolyte imbalances in mild SIADH

Tolvaptan/Conivaptan- promote water excretion and sodium retention *rapid effects

Furosemide- increases urination (use with caution due to potential for sodium loss)

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14
Q

What are the three hormones the thyroid produces?

A

thyroxine (T4) and triiodothyronine (T3) - regulated by the ant pituitary (TSH), and plays a role in regulating body metabolism and energy production

calcitonin- inhibits calcium loss from bone, and reduces overall blood calcium levels

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15
Q

What are the causes of hyperthyroidism?

A
  • Graves disease is #1 cause- autoimmune antibodies result in hypersecretion of thyroid hormones
  • thyroiditis
  • toxic adenoma
  • toxic nodular goiter
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16
Q

What are the manifestations of hyperthyroidism?

A
  • nervous, irritable, hyperactivity, labile
  • weak, easy to fatigue, activity intolerance
  • heat intolerance
  • weight loss
  • insomnia
  • diarrhea
  • menstrual irregularities
  • libido increases followed by decrease
  • warm, sweaty, flushed skin (velvet)
  • fine, soft, silky texture to hair
  • tremor, hyperreflexia
  • exopthalmos (Graves only)
  • photophobia
  • excessive tearing of the eyes
  • pretibial myexedema- waxy swelling that resembles benign tumors (Graves only)
  • bruit over the thyroid gland
  • increased systolic BP
  • tachycardia, dysrhythmias
  • dyspnea
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17
Q

What labs can we take to determine hyperthyroidism?

A

Blood TSH- will be decreased in Graves but increased in all other kinds
Free T4 and T3- elevated

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18
Q

What is a thyroid scan? How does it detect hyperthyroidism?

A
  • the pt takes a radioactive isotope orally

- if uptake is HIGH then its hyperthyroidism

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19
Q

What medications can we give for the hyperthyroid patient?

A

Methimazole and Propylthiouracil inhibit production of thyroid hormone by blocking iodine

  • adverse effects: agranulocytosis (monitor CBC for reduced leukocytes and neutrophils, report a fever and sore throat) aplastic anemia, hepatotoxicity
  • should be taken with meals
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20
Q

What does radioactive iodine therapy do?

A

the radioactive iodine is taken up by the thyroid and destroys some of the hormone producing cells
**if being given for thyroid cancer its a larger dose so dont use the same toilet as others for 2 weeks, flush 3x, keep distance from pregnant ppl or infants

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21
Q

What is preoperative care for a patient undergoing thyroid surgery?

A
  • the patient gets 4-6 weeks of thionamides
  • the client should receive iodine for 10-14 days prior to surgery to shrink the gland
  • teach that hoarseness and sore throat may occur after surgery due to intubation
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22
Q

What is postoperative care for a patient who had a thyroidectomy?

A
  • semi-fowlers with head and neck supported
  • deep breathing exercises every 30-60 min
  • provide suction as needed
  • check dressing for bleeding
  • keep tracheostomy supplies nearby, monitor for respiratory distress
  • check for laryngeal nerve damage by asking the client to speak after waking up and every 2 hrs after
  • monitor for signs of hypocalcemia bc parathyroid can get damaged during surgery
23
Q

What are the complications of thyroidectomy?

A

Hemorrhage

Thyroid Storm- high mortality rate as a sudden surge of thyroid hormone hits the blood stream (hyperthermia, hypertension, delerium, vomiting, abdominal pain, tachydysrhythmias, chest pain, dyspnea. Give tylenol NOT aspirin for the fever, give thionamides, sodium iodide, beta blockers, IV fluids, and O2

Airway Obstruction

Hypocalcemia

Nerve Damage

24
Q

What is the cause of primary hypothyroidism?

A

the thyroid gland is dysfunctional due to autoiummune thyroiditis, loss of the thyroid gland, use of medications that decrease production of T4 and T3
*it is the most common form of hypothyroidism

25
Q

What is the cause of secondary hypothyroidism?

A

the anterior pituitary fails to stimulate the thyroid (TSH), or the target tissue fails to respond to thyroid hormones (pituitary tumors)

26
Q

What is the cause of tertiary hypothyroidism?

A

the hypothalamus fails to produce TSH

27
Q

What are the risk factors for hypothyroidism? (4)

A
  • females 30-60
  • lithium, amiodarone
  • inadequate intake of iodine
  • radiation therapy to the head and neck
28
Q

What are the manifestations of hypothyroidism?

A
  • irritability, depression, apathy, fatigue, lethargy, slow thought process and speech
  • intolerance to cold
  • constipation
  • weight gain
  • pallor
  • thick, brittle fingernails
  • bradycardia, hypotension, dysrhythmias
  • hypoventilation, pleural effusion
  • hair loss, dry flaky skin, thickened skin, swelling of the face, and tongue
  • decreased taste and smell acuity
  • hoarse raspy speech
  • decreased libido
29
Q

What labs can we look at to diagnose hypothyroidism?

A

T3 and T4: decreased
TSH: increased with primary hypothyroidism, decreased or within range for secondary
Cholesterol: increased

30
Q

What will a thyroid scan show in a patient with hypothyroidism?

A

LOW uptake of radioactive iodine

31
Q

What medications can we give to the patient with hypothyroidism?

A

Thyroid hormone replacement!
Levothyroxine:
-increases the effects of warfarin and can increase the insulin and digoxin requirements
-slow and low is key to prevent cardiac complications (blood TSH will get monitored)
take on an empty stomach (30-60 min before meals)
-lifelong treatment

32
Q

What is a myxedema coma? s/sx? nursing care?

A
  • *life-threatening**
  • occurs when hypothyroidism is untreated

s/sx: respiratory failure, hypotension, hypothermia, bradycardia, dysrhythmia, hyponatremia, hypoglycemia, coma

nursing care: maintain airway, monitor ECG, monitor ABGs, monitor mental status, cover with warm blankets, replace fluids with NS, admin levothyroxine IV bolus, treat hypoglycemia

33
Q

What is Cushing’s syndrome? What are (2) causes of it?

A

-OVERsecretion of adrenal hormones

Caused by:
long-term glucocorticoid use
1- tumor of the pituitary (releases ACTH)
2- hyperplasia of the adrenal cortex

34
Q

What are the (3) hormones of the adrenal cortex?

A

Mineralcorticoids: aldosterone
Glucocorticoids: cortisol
Sex Hormones: androgens and estrogen

35
Q

What are the (2) functions of aldosterone?

A
  • increases sodium absorption

- causes potassium excretion

36
Q

What are the (3) functions of cortisol?

A
  • glucose, protein, and fat metabolism
  • body’s response to stress
  • immune function
37
Q

What are the s/sx of Cushing’s?

A
  • weakness, fatigue, irritability, depression, labile emotions
  • moon face, buffalo hump, truncal obesity
  • thin, fragile skin
  • tachycardia, hypertension
  • fractures, infections
  • hirsutism, acne, red cheeks
  • hyperglycemia
  • thinning/balding hair
38
Q

What are the labs to look at in Cushing’s?

A

Blood cortisol: elevated
Salivary cortisol: elevated
24-hour urine: shows elevated cortisol

Plasma ACTH: elevated when caused by hypersecretion of ACTH by the A.Pituitary; decreased in disorders of the adrenal cortex

Blood potassium: decreased
Blood calcium: decreased
Blood glucose: elevated
Blood sodium: elevated
Lymphocytes: decreased
39
Q

What medication can be used for Cushing’s?

A

Ketoconazole

  • it is an antifungal agent that inhibits adrenal corticosteroid synthesis in high dosages
  • side effects: N&V (take w/food), fatigue, dizziness, skin changes
40
Q

What is Addison’s disease?

A

-UNDERsecretion of adrenal hormones

Caused by:
-damage or dysfunction of the adrenal cortex

41
Q

What is Addisonian crisis?

A

life-threatening

Risk Factors: sepsis, trauma, stress, adrenal hemorrhage, steroid withdrawal

Nursing Care: rapid 0.9%NaCl infusion, admin hydrocortisone as IV bolus or IM, admin insulin and dextrose, admin calcium, polystyrene sulfonate, sodium bicarbonate, loop/thiazide diuretics

42
Q

What are the s/sx of Addison’s?

A
  • weight loss
  • craving salt
  • hyperpigmentation
  • weakness/fatigue
  • N&V
  • abdominal pain, constipation or diarrhea
  • orthostatic hypotension
  • hyponatremia
  • hypoglycemi6a
  • hyperkalemia
  • hypercalcemia
43
Q

What are the labs to look at in Addisons?

A

Electrolytes- increased K, Ca, and WBC; decreased Na
BUN and Creatinine- increased
Glucose- normal or decreased
Salivary and Blood Cortisol- decreased

44
Q

What medications can we give for Addison’s?

A

Replacement!
Hydrocortisone, prednisone, cortisone
-admin w/ food
-may need increased dose during illness/stress
-avoid discontinuing abruptly (could cause Addisonian crisis)

45
Q

What is a normal RBC count?

A

males: 4.7-6.1
females: 4.2-5.4

46
Q

What is a normal hemoglobin?

A

males: 14-18
females: 12-16

47
Q

What is a normal hematocrit?

A

male: 42-52
female: 37-47

48
Q

What is MCV? What is a normal lab value?

A

Mean Corpuscular Volume (size of the RBC)

normal: 80-100
* a low result is microcytic and a high result is macrocytic

49
Q

What is MCH? What is a normal lab value?

A

Mean Corpuscular Hemoglobin (amount of Hgb per RBC)

normal: 27-31
* hypochronic is too little hemoglobin

50
Q

What is MCHC? What is a normal lab value?

A

Mean Corpuscular Hgb Concentration (amount of Hgb compared to the size of the cell)
normal: 32-36

51
Q

What is the normal range for platelets?

A

150,000-350,000

52
Q

What are the (4) causes of anemia?

A

Blood loss- GI bleed, hemorrhage, menorrhagia, radiation exposure

Decreased RBC production- cancer

Increased RBC destruction- sickle cell, transfusion reactions, autoimmune, heart valve

Nutritional Deficiencies- iron deficiency, B12 deficiency, folic acid deficiency

53
Q

What are the manifestations of anemia?

A

1 PALLOR

  • weakness/fatigue
  • decreased activity tolerance
  • SOB
  • orthostatic hypotension
  • tachycardia (murmurs, gallops, palpitations)

NUR150 (8 decks)

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