Exam 4 - General Endocrine Flashcards
(31 cards)
Why does gigantism-giantism occur only in children?
- Occurs before epiphyses close
- Pituitary disorder –> excess secretion of GH
- Benign tumor (IGF-1 in liver)
- Increased growth of bone and tissue
What causes acromegaly?
- Excessive GH secretion after closure of epiphyses of long bones
- Often result of benign slow-growing tumor (pituitary adenoma)
Graves disease—would you expect the TSH level to be high or low? Physical assessment findings.
- (Hyperthyroidism)
- TSH high
- ** Exophthalmos (bulging of eyes)
- Fatiguability, hypertension, shortness of breath, tachycardia, nervousness, diaphoresis, increased sensitivity to heat
Signs of thyroid storm/crisis
- Elevated temperature
- Tachycardia, arrhythmias
- Agitation, tremors, anxiety, restlessness
- Delirium
- Confusion and seizures as condition progresses
Clinical manifestations of hypothyroidism (common & less common ones). Be able to select the
correct combination of S/S
- Intolerance to cold
- Weight gain
- Myxedema (facial swelling)
- Constipation & abdominal distention
- Tongue enlarged, voice hoarse/husky
- Carpal tunnel & other entrapment syndromes common
- Weakness, lethargy
- Dry, coarse skin and hair
<p>
| Dangerous complication influencing the parathyroid glands after thyroidectomy</p>
<p>
- Check calcium levels and assess for tetany (will happen if calcium is low) because parathyroid may have been damaged or accidentally removed - Permanent hypothyroidism due to damage to parathyroid gland, blood supply, post-surgical swelling or fibrosis</p>
Be able to match Cushing disease with its clinical manifestations in a multiple choice question
- Buffalo hump
- Moon face
- Truncal obesity, thin extremities
- Thin skin, purple striae
- Muscle weakness, osteoporosis
- Hyperglycemia, glucose intolerance
What are the general s/s of diabetes insipidus?
- Excessive thirst and large amounts of diluted urine most characteristic
- Hypernatremia due to water deficit
- Low urine specific gravity
- Dehyration, dry mucous membranes
Neurogenic diabetes insipidus—be able to recognize the clinical manifestations
- Deficiency in ADH secretion related to head trauma, brain surgery, genetics, tumors
- Less ADH than nephrogenic DI
Syndrome of inappropriate antidiuretic hormone (SIADH)–effects on solutes & water (retention
or loss?)
- Excessive ADH –> increased water retention
- Solutes low because they are heavily diluted (e.g. hyponatremia)
What is the very basic pathophysiology of pheochromocytoma?
- Adrenal medulla secretes catecholamines (norepinephrine & epinephrine)
- Pheochromocytoma is a tumor of chromaffin tissue resulting in excessive production and release of catecholamines
What causes adrenocortical insufficiency/Addisonian crisis?
- Failure for Addison’s patient to take medication or increased emotional stress without appropriate hormone replacement
- Exposure to minor illness
- Inadequate levels of glucocorticoids & mineral corticoids in circulation
- May occur with acute withdrawal of corticosteroids
- Cause: destruction of the adrenal gland through idiopathic or autoimmune mechanisms, tuberculosis, trauma or hemorrhage, fungal disease, or neoplasia
Which medication will the nurse have available for emergency treatment of tetany in the client who has had a thyroidectomy?
- Calcium chloride
- Potassium chloride
- Magnesium sulfate
- Propylthiouracil (PTU)
- Calcium chloride
Calcium chloride or calcium gluconate should be available to treat tetany caused by accidental removal of the parathyroid glands during surgery. The parathyroid glands regulate calcium metabolism. Potassium chloride replaces the electrolyte potassium. Magnesium sulfate is used in the treatment of preeclampsia (pregnancy induced hypertension). Propylthiouracil is an antithyroid medication used to block production of thyroid hormone.
When caring for a client in a thyroid crisis, the nurse would question an order for:
- IV fluids
- Propanolol (Inderal)
- Propylthiouracil (PTU)
- A hyperthermia blanket
- A hyperthermia blanket
Fever (hyperthermia) is a symptom of thyroid storm. The correct treatment would be a hypothermia blanket to cool the client. All other choices (IV fluids, Inderal, and PTU) are appropriate interventions for this diagnosis.
What is the nurse’s priority concern for a client admitted to the hospital with a diagnosis of diabetes insipidus?
- Sleep disturbance caused by nocturia
- Decreased physical mobility due to muscular cramping
- Fluid volume excess caused by water retention
- Skin breakdown caused by generalized edema
- Sleep disturbance caused by nocturia
Diabetes insipidus (DI) is associated with a decrease (or deficiency) in the secretion of antidiuretic hormone (ADH). Lack of ADH leads to increased urinary output (as much as 5 to 20 L/day). Clients with DI become very fatigued from nocturia. Fluid volume deficit can occur due to the excess urine output. There is no edema or muscle cramping.
A nurse assessing a client with syndrome of inappropriate antidiuretic hormone (SIADH) would expect to find which laboratory values?
- Serum sodium = 150 mEq/L and low urine osmolality
- Serum potassium = 5 mEq/L and low serium osmolality
- Serum sodium = 120 mEq/L and low serum osmolality
- Serum potassium = 3 mEq/L and high serum osmolality
- Serum sodium = 120 mEq/L and low serum osmolality
SIADH occurs when excessive antidiuretic hormone (ADH) is released, even when the plasma (serum) osmolality is normal. The excess ADH increases the permeability of the renal tubules, causing reaborption of water into the circulation. As a result of extracellular fluid expansion, serum osmolality decreases. Also, sodium levels decline (as a result of being diluted), leading to hyponatremia.
The nurse is performing an assessment on a client who has been receiving long-term steroid therapy. What would the nurse expect to find during the assessment?
- Jaundice
- Flank pain
- Bulging eyes
- Central obesity
- Central obesity
Cushing’s syndrome develops because an excess of cortisol, in this case from prolonged exogenous steroid administration. This syndrome may be characterized by truncal (central) obesity, hypertension, weakness, hirsutism, abdominal striae, edema, and hypokalemia. Flank pain is associated with kidney problems. Bulging eyes are found in hyperthyroidism. Jaundice is associated with liver and gallbladder problems.
A client has been receiving inhalation desmopressin (DDAVP) therapy for hypothalamic diabetes insipidus. What will the nurse evaluate to determine the therapeutic response to this medication?
- Urine specific gravity
- Blood glucose
- Vital signs
- Oxygen saturation levels
- Urine specific gravity
Demopressin (DDAVP) alleviates polyuria by acting as antidiuretic hormone (ADH). In the case of diabetes insipidus, urine specific gravity should return to a normal level of 1.010 to 1.030. There is no effect on blood glucose or oxygen saturation levels. One adverse effect (not considered therapeutic for demopressin) is the possibility of a change in vital signs related to peripheral vascular resistance (vasoconstriction). Another reason the vital signs may be affected is water intoxication, which is also a side effect of demopressin.
The nurse is caring for a client who has exophthalmos associated with thyroid disease. What is the cause of exophthalmos?
- Impaired vision, which causes the client to squint in order to focus
- Fluid in the retro-orbital tissues that increases pressure behind the eyes
- Increased intraocular pressure from an increase in circulating thyroid hormone
- Decrease in extraocular eye movements, which results in the “thyroid stare”
- Fluid in the retro-orbital tissues that increases pressure behind the eyes
Impaired venous drainage from the orbit of the eye causes fluid and fat accumulation in the areas behind (retro-orbital) the eyeballs, which forces the eyes forward and out of their sockets. It is the increased pressure in the area that causes the eyeballs to be forced outward and protrude. There is no decrease the extraocular eye movements. The upper lids are usually retracted and elevated, giving a “thyroid stare” appearance. Vision is not impaired, and it is possible that the exophthalmos could lead to increased intraocular pressure.
The nurse is caring for a client postoperative thyroidectomy. What would be an important nursing intervention?
- Have the client speak every 5 to 10 minutes if hoarseness is present.
- Provide a low-calcium diet to prevent hypercalcemia.
- Check the dressing at the back of the neck for bleeding.
- Apply a soft cervical collar to restrict neck movement.
- Check the dressing at the back of the neck for bleeding.
If bleeding occurs, the blood will drain posteriorly or behind the client’s neck. Serum levels of calcium are important to monitor because of possible damage to the parathyroids during surgery. Oral intake of calcium is not immediately significant. The client is often hoarse; it is important to monitor for increasing hoarseness that would be indicative of edema but not every 5 to 10 minutes. A cervical collar is not indicated.
A nurse knows the clinical manifestations of a client with Addison’s disease include which of the following? Select all that apply.
- Nausea
- Hypothermia
- Hypertension
- Hyperpigmentation
- Hypotension
- Hypernatremia
1, 4, 5 (Nausea, hyperpigmentation, hypotension)
Addison’s disease is due to a hypofunctioning of the adrenal cortex. The clinical manifestations have a very slow onset, and skin hyperpigmentation (melanosis) is a classic sign. This bronze coloring of the skin is seen primarily in those areas exposed to the sun, pressure points, joints, and in skin creases (especially on the palms, knuckles, and elbows). Fatigue, nausea, weight loss, hypotension, hyponatremia, and hyperkalemia are other findings associated with the condition.
A client admitted with a pheochromocytoma returns from the operating room after adrenalectomy. The nurse should carefully assess this client for:
- Hypoglycemia
- Hypokalemia
- Changes in blood pressure
- Increased sodium and water retention
- Changes in blood pressure
Pheochromocytoma is a tumor in the adrenal medulla that produces excess catecholamines (epinephrine and norepinephrine). An excess of these catecholamines can cause severe hypertension. Surgery (an adrenalectomy) alleviates the elevated blood pressure most of the time. In 10% to 30% of clients, hypertension remains and must be monitored and treated. Electrolytes imbalances and blood sugar are not typically affected.
A client is brought in to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician’s prescriptions?
- Endotracheal intubation
- 100 units of NPH insulin
- Intravenous infusion of normal saline
- Intravenous infusion of sodium bicarbonate
- Intravenous infusion of normal saline
571
After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder?
- Fatigue
- Diarrhea
- Polydipsia
- Weight gain
- Polydipsia
582
