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M/S 2 > Exam 4 - Endo > Flashcards

Exam 4 - Endo Flashcards

(67 cards)

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1
Q

where is the pituitary gland located

A

base of the brain

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2
Q

the pituitary gland is aka

A

the master gland

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3
Q

primary vs. secondary pituitary adenoma

A

primary: localized
secondary: metastasized

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4
Q

functional vs. nonfunctional pituitary adenoma

A

function: creating too little or too much hormone

nonfunctional: not secreting hormones but still causing issues

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5
Q

pituitary adenomas are usually ___ and ___ growing

A

benign; slow

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6
Q

anterior pituitary gland secretes these 6 hormones

A

GH
ACTH
LH
FSH
prolactin
TSH

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7
Q

posterior pituitary gland secretes these 2 hormones

A

ADH
Oxytocin

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8
Q

only definitive way to know whether someone has cancer

A

biopsy

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9
Q

stimulation test

A

med is given to stimulate the secretion of a hormone

gland should capable of secreting the hormone

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10
Q

suppression test

A

excess hormone is administered

the gland should be able to suppress the extra hormone

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11
Q

3 types of treatment for pituitary adenoma

A

meds: shrink growth, reduce hormone production (may not be effective)
transsphenoidal/hypophysectomy
radiation

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12
Q

least invasive pituitary adenoma treatment

A

transsphenoidal/hypophysectomy

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13
Q

what is a transsphenoidal/hypophysectomy

A

cut into the back of the nose, tool removes the growth

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14
Q

stereotactic is still ____

A

radiation; it is a high 1 time dose of radiation

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15
Q

acromegaly is caused by an overproduction of which hormone?

A

GH

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16
Q

too much GH in children is called ___

A

gigantism

excess GH beings before the end of puberty (when growth plates close)
too much GH before plates close cause children to grow tall

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17
Q

in which ages is acromegaly commonly seen

A

4th-5th decade

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18
Q

what changes occurs in acromegaly

A

skeletal thickening, enlargement, and decalcification

overgrowth of soft tissue and bones (hands, feet, nose, chin)

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19
Q

s/sx of acromegaly

A

muscle weakness
joint pain
deep voice
HA
visual disturbances
shortened life expectancy
change in menstrual cycle
galactorrhea (50% of women)
DM 2
HTN

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20
Q

acromegaly risk factor

A

genetics

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21
Q

appropriate nursing dx for acromegaly

A

risk for fractures r/t bone decalcification

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22
Q

acromegaly goals

A

meds to suppress or block GH
meds for joint pain
prepare for radiation or hypophysectomy
emotional support

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23
Q

how to Dx acromegaly

A

GH suppression test
IGF-1
OGTT (oral glucose tolerance test)
MRI, CT, XR
eye exam (eval optic nerve)

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24
Q

what is administered for a GH suppression test

A

glucose

glucose is supposed to suppress GH

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25
how often are labs drawn for GH suppression test
10 minutes 1 hour 2 hour
26
what is needed prior to GH suppression test
baseline glucose level
27
can a pt eat before GH suppression test
No
28
hypophysectomy postop education
no straining no heavy lifting do not bend at the waist do not blow nose, cough, or sneeze do not brush teeth x2 weeks
29
hypophysectomy postop nursing interventions
neuro checks monitor packing (bleeding, CSF: glucose test, yellow ring) no less than semi-fowlers encourage deep breathing with mouth open (no coughing) med education (will be on rest of their life) monitor for meningitis (fever, photosensitivity, petechia, nuchal rigidity)
30
2 adrenal gland disorders
Addison Cushing
31
3 adrenal cortex hormones
mineralocorticoid (aldosterone) glucocorticoid (cortisol) androgens (testosterone)
32
2 adrenal medulla hormones
epi norepi
33
Addison vs. Cushing
A: deficient secretion C: over secretion
34
ACTH regulates which 2 hormones
glucocorticoids (cortisol) androgens (testosterone)
35
___ is regulated by the amount of K+ is in the body
mineralocorticoid (aldosterone)
36
glucocorticoids is a part of which feedback loop
Negative
37
Primary vs. secondary Addison
P: autoimmune; unknown cause S: surgery removal, illness, meds
38
does Addison effect some or all 3 hormones
all 3 are affected
39
Addison s/sx
weakness, fatigue liable mood weight loss anorexia hyperpigmentation (d/t increase ACTH) orthostatic hypotension (d/t low fluid volume) hyponatremia hyperkalemia salt craving dehydration hypoglycemia N/V/D depression decrease sex drive decrease menses hair loss hair is fine, thin
40
life threatening emergency caused by insufficient ACTH hormones or sudden, sharp decrease in hormones
Addisonian crisis/Acute Adrenal Insufficiency
41
Addisonian crisis/Acute Adrenal Insufficient is triggered by
stress sudden WD from corticosteroid therapy ---review meds on admission! s/p adrenal surgery sudden pituitary gland destruction
42
SALT LOSS re: addisonian crisis s/sx
S low Na A anorexia L lethargy T decrease tendon reflex L limp muscles O orthostatic hypotension S eventually seizures S stomach cramps
43
Addisonian crisis replacement therapy
Bolus NS with Dextrose hydrocortisone (glucocorticoid + mineralocorticoid properties) salt treat underlying cause Florinef (mineralocorticoid)
44
Addisonian crisis nursing interventions
monitor VS electrolyte imbalance daily weight corticosteroid administration protection, monitor for infection avoid extreme temps and stressors
45
how to Dx Addisons
assess s/sx serum cortisol (low) serum ACTH (high) serum glucose serum Na, K+ leukocytosis CT, MRI stimulation test
46
when should serum cortisol and ACTH lab be drawn for Addisons dx
early morning
47
stimulation test for Addisons
ACTH infused, glucocorticoid (cortisol) measured (should not go up)
48
when are labs drawn for stimulation test re: Addisons
q30 minutes x2 glucocorticoid (cortisol) measured, should not go up
49
Addison's diet
low K+ high Na
50
Addison's medications
Florinef (monitor for HTN; fluid volume excess) Prednisone (monitor BGL) Hydrocortisone (take with food to prevent GI distress)
51
Addison's home care/education
lifelong treatment med alert bracelet emergency prefilled hydrocortisone or dexamethasone on hand stress management avoid infection mineralocorticoids in AM glucocorticoids: 2/3 in AM; 1/3 in PM when to call HCP --HTN, weight gain, fluid overload, low BGL, increased fatgiue
52
Cushing disease vs. Cushing syndrome
Disease: tumor Syndrome: d/t long term corticosteroid use
53
s/sx of Cushings
weight gain (most common) buffalo hump central obesity purple striae moon faced hyperglycemia muscle wasting osteoporosis fragile skin hirsutism virilization infections ecchymosis HTN depression acne
54
Cushing diagnostic labs
CBC CMP -BGL: elevated -K+, Ca: low
55
Salivary free cortisol level for diagnosis of Cushing is drawn when
late evening
56
Dexamethasone suppression test for Cushing is administered in the ___ and labs are drawn in the ___
evening; morning
57
Cushings diet
high protein high potassium low calorie/carb low Na calcium + D
58
medications for Cushing suppression
ketoconazole (Nixoral) aminogluethimide (Cytadren)
59
ketoconazole considerations
anti-fungal large doses supress adrenal cortex activity may cause liver failure
60
cytraden considerations
temporarily suppresses adrenal cortex activity start in hospital usually no more than 3 months S/E: N/V
61
bisphosphonates are given to Cushing pts to prevent ___
osteoporosis S/E: HA
62
Cushing pre op care
control BGL, HTN, K+ high protein diet
63
Cushing postop care
high dose Solu-Cortef (hydrocortisone) monitor VS, wound, bleeding, infection
64
Cushing postop critical period
24-48 hours must report changes in VS or UOP
65
Cushing daily weight changes to be reported
2# in 24 hours 3# in 1 week
66
postop cushing diet
high calorie high salt **opposite of preop
67
corticosteroid therapy effects on the body
anti-inflammatory immunosuppression maintain normal BP carb + protein metabolism

M/S 2 (10 decks)

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