N300 Q#1 Endocrine

Question 1

Hormones are carried by the blood to other sites in the body where their actions are exerted. Some hormones (e.g., ___ and ___ hormones) are not water soluble. Therefore these types of hormones are bound to plasma proteins for ____ in the blood. Hormones are____when bound to plasma proteins, they can be released when appropriate and ____ exert their action at the target tissue. Water-soluble hormones (e.g.,___ and ____) circulate freely in the blood and are not dependent on proteins for transport.

Answer 1

steroid and thyroid
transport
 inactive 
immediately
protein hormones, catecholamines (EPI and NE)

Question 2

When ___ travels through the blood, it is a hormone and affects target tissues. When it travels across synaptic junctions, it acts as a ___

Answer 2

EPI, neurotransmitter

Question 3

What are the 2 types of hormone receptors?

1. Those that are ___ the cell (Ex?)
2. Those that are in the ___ ____ Ex?
3. The location of the receptor sites affects the mechanism of ____ for the hormone.

Answer 3

1. within (steroid and thyroid)
2. cell membrane (protein-type)
3. action

Question 4

Name the 4 feedback mechanisms for hormone regulation.

Answer 4

1. Simple feedback
2. Negative feedback
3. Positive feedback
4. complex feedback

Question 5

Provide an example of simple feedback.

Answer 5

Blood levels of a particular substance

Question 6

With negative feedback, a ___ responds by increasing or decreasing ___ of a hormone.

Answer 6

gland
secretion
For example, when blood calcium is low, PTH is secreted to raise calcium levels.

Question 7

With positive feedback, the target organ is ___ beyond normal

Answer 7

increased.

For example, oxytocin is triggered by breast feeding; also enhances uterine contractions

Question 8

____ feedback usually involves several glands. An example, with low T3 and T4, the ___ releases TRH which triggers the anterior pituitary to release more TSH.

Answer 8

Complex

hypothalamus

Question 9

With circadian rhythms, ___ rise in the morning and decline toward evening. ___ hormones peak during sleep.

Answer 9

steroids

growth

Question 10

The ___ produces hormones and works closely with the pituitary. It secretes many releasing and inhibiting hormones that act on the pituitary

Answer 10

hypothalamus

Question 11

The hypothalamus contains ____, which receive input from the brainstem and limbic system. These neurons influence the limbic system, brainstem, and spinal cord. This creates a circuit to facilitate the coordination of the endocrine system, autonomic nervous system (ANS), and expression of complex behavioral responses, such as anger and feelings of fear and pleasure.

Answer 11

neurons

Question 12

The Anterior pituitary secretes ___hormones. These are hormones that control the secretion of hormones by other glands. TSH stimulates the_____ to secrete thyroid hormones. ACTH stimulates the adrenal cortex to secrete ____. FSH stimulates secretion of ___and the development of ova in the female and sperm development in the male. LH stimulates ____ in the female and secretion of sex hormones in both the male and female.

Answer 12

tropic
 thyroid gland 
corticosteroids
estrogen 
ovulation

Question 13

The ___ is the master gland located under the hypothalamus and has an ___ and posterior part.

Answer 13

pituitary

anterior

Question 14

The anterior pituitary releases ___ hormone which affects growth and development of skeletal muscles and long bones. Also has a role in protein, fat and ___ metabolism.

Answer 14

Growth

carbohydrate

Question 15

The anterior pituitary secretes ____ which is responsible for breast development and lactation.

Answer 15

prolactin

Question 16

The posterior pituitary is composed of nerve tissue that is an extension of the ___.
It releases ___ and oxytocin which are hormones produced in the _____ but travel down nerve tracts to the pituitary and are stored until released.

Answer 16

hypothalamus
ADH
hypothalamus

Question 17

True or False: ADH causes retention of sodium and water.

Answer 17

False, water only.

Question 18

ADH is regulated by fluid ___ and ____ concentration. ADH stimulates the ___ tubules to ___ water creating ____ urine.

Answer 18

volume, plasma
renal
reabsorb
concentrated

Question 19

Oxytocin simulates the production of ___ by mammary ducts and contraction of ___ muscle. It is released by ___ of touch receptors in the nipples of lactating women.

Answer 19

milk
smooth
stimulation

Question 20

_____ disorders cause an ___ of growth hormone. ____ occurs with excessive GH before closure of the epiphyses. ____ occurs with excessive GH after closure of the epiphyses.

Answer 20

Pituitary (anterior)
excess
Gigantism
Acromegaly

Question 21

___ pituitary disorders can cause overproduction of ___. called “SIADH”. This causes fluid ___, dilutional ____ and concentrated urine. A deficiency of ADH causes diabetes insipidus where urine output is ____ and urine is ____. This a life threatening ____ causing _____.

Answer 21

Posterior
ADH
retention
hyponatremia
increased
dilute
dehydration
hypernatremia

Question 22

The thyroid glad produces stores and releases __ and ___. These hormones are responsible for body ___, increased ___ and require ___ for activity. Also stimulated by ___.

Answer 22

T3 and T4
metabolism, BP, iodine
TSH

Question 23

Hyperthyroidism causes:

1. diarrhea or constipation
2. fatigue or energy
3. Tachycardia or bradycardia
4. weight gain or loss

Answer 23

1. diarrhea
2. fatigue
3. tachycardia
4. weight loss

Question 24

Hypothyroidism causes:

1. diarrhea or constipation
2. fatigue or energy
3. tachycardia or bradycardia
4. weight gain or loss

Answer 24

1. constipation
2. fatigue
3. bradycardia
4. weight gain

Question 25

The thyroid gland produces calcitonin in response to ____ levels of calcium. This ___ resorption of bone, ____ calcium in the bone and increases renal ___ of calcium. This is a ___ feedback mechanism.

Answer 25

``` high inhibits (reduces bone breakdown) increases excretion simple ```

Question 26

The parathyroid is embedded behind the ___ and secretes ___. PTH ____ blood calcium levels. A complication of a thyroidectomy?

Answer 26

thyroid PTH increases lose parathyroid

Question 27

PTH ___ bone resorption and promotes ___ of calcium and ___ of phosphorus. Also activates Vitamin ___ which enhances intestinal ___ of calcium.

Answer 27

``` increases reabsorption excretion D absorption ```

Question 28

The adrenal glands are ____ vascular and consist of the medulla and ___. The medulla releases ____ which have an effect on all body systems. __ is an example.

Answer 28

highly cortex catecholamines Epinephrine

Question 29

The adrenal cortex releases what 3 steroid hormones? provide an example.

Answer 29

Glucocorticoids (cortisol) mineralcorticoids (aldosterone) Androgens

Question 30

Glucocorticoids effect ____ metabolism, have anti-____ action, ___ response and are released using ___ feedback (CRH hypothalamus and ACTH pituitary)

Answer 30

glucose inflammatory negative

Question 31

1. An example of a mineralcorticoid is ____. Mineralcorticoids are released in response to ___ volume and altered ___ levels. 2. Aldosterone has what two primary functions? 3. This has come influence from ___ since the adrenal cortex is involved.

Answer 31

``` 1. Aldosterone fluid potassium 2. Retain sodium and water and excrete potassium 3. ACTH ```

Question 32

____ syndrome is an excess of corticosteroids, effects are related to excess ____ and retention of sodium and water. This is a result of an adrenal ___ disorder

Answer 32

Cushings glucocorticoids cortex

Question 33

____ disease results from a deficiency of corticosteroids (Adrenal Cortex disorder). Which steroids are reduced?

Answer 33

Addison's | All 3: glucocorticoid, Aldosterone and androgen

Question 34

____ results from excess epinephrine and blood sugar due to a tumor on the adrenal medulla. This causes severe ____ and the patient is at a high risk for stroke and heart attack.

Answer 34

Pheochromocytoma | hypertension

Question 35

The pancreas has alpha cells that release ____ and beta cells that release ___.

Answer 35

alpha: glucagon beta: insulin

Question 36

What kinds of questions would be helpful to ask a patient having a suspected endocrine disorder?

Answer 36

``` Hydration Hair growth mood changes energy level weight gain cardiac palpatios ```

Question 37

What should be focused on in the Physical Exam for a suspected endocrine disorder?

Answer 37

``` Thyroid enlargement Weight edema Urine input and output Labs skin turgor ```

Question 38

Goiter is caused by a___ disorder. It is a hypertrophy and ___ of the thyroid. It is caused by excessive ___ stimulation from inadequate thyroid hormones. Goiter can also be caused by ___ or foods or drugs that suppress gland function.

Answer 38

thyroid enlargement TSH goitrogens

Question 39

What is the priority nursing diagnosis for a patient with goiter?

Answer 39

Airway

Question 40

___: palpable deformity that is benign or malignant. A major sign of thyroid cancer is a hard ___ nodule on an enlarged gland. U/s, CT and MRI can be performed but the true test to determine if a nodule is cancerous is ____ via aspiration.

Answer 40

Nodules painless biopsy

Question 41

____: inflammation of the thyroid, caused by ___, bacterial, ___ or autoimmune. Can lead to hypothyroidism (_____). usually thyroid levels are ____ but can become depressed. ___ is low then elevated.

Answer 41

``` Thyroiditis viral fungal Hashimoto's elevated TSH ```

Question 42

_____: thyrotoxicosis s/s result from ____ T4, T3 or both. More common in ___ ages 20-__. Most common form is ____ disease which is an autoimmune disorder.

Answer 42

``` Hyperthyroidism excessive women 40 Graves ```

Question 43

Manifestation of Hyperthyroidism include: 1. diaphoresis or dry skin 2. Tachycardia or bradycardia 3. sunken eyes or exophthalmos 4. increased or decreased T4, TSH

Answer 43

1. diaphoresis from increased metabolic rate 2. tachycardia (high HR and BP) 3. exophthalmos (from high pressure behind eyes) 4. increased T4 and decreased TSH

Question 44

Thyrotoxic crisis or ____ ___ is life ___. manifestations include: 1. bradycardia or sever tachycardia 2. Heart failure or shock 3. hypothermia or fever 4. restlessness or somnolence 5. seizures, delirium or coma 6. NVD or constipation

Answer 44

Thyroid storm, threatening 1. sever tachycardia 2. Both HF and shock 3. fever 4. restlessness 5. ALL 6. NVD

Question 45

How is thyroid storm treated?

Answer 45

reduce circulating hormones: RIT, antithyroid drugs manifestations: Beta adrenergic blockers, sedatives, tylenol, oxygen decreased effects of metabolic rate: insulin

Question 46

Nutritional Therapy for hyperthyroidism includes food that are high in ___, protein and carbs, ___, anti-____ meds and daily weights, ___/__.

Answer 46

calories vitamins diarrheal input/output

Question 47

CAre related to manifestations of hyperthyroidism includes?

Answer 47

relaxation techniques, eye care, post-op care related to thyroidectomy

Question 48

Post-op thyroidectomy care includes: 1. ___: keep a tracheostomy tray at bedside. 2. Assess for ___. 3. Position: ____ 4. monitor ___ and ___ imbalance 5. Diet: ___ as soon as tolerated.

Answer 48

1. Airway (swelling obstruction) 2. bleeding (back of neck) 3. semi fowlers 4. vital signs and calcium 5. fluids

Question 49

____ is hypothyroidism. Presents with ___, puffiness. Is life ___; observe for signs of hypoglycemia and ____.

Answer 49

Myxedema, edema threatening hyponatremia

Question 50

True or false: cardiac issue is main concern for hyperthyroidism or hypothyroidism?

Answer 50

BOTH

Question 51

treatment for hypothyroidism includes mechanical ____, IV ____ supplements, ____ fluids, IV ____ and monitoring for ____.

Answer 51

``` ventilation thyroid isotonic glucose heart failure ```

Question 52

Nutritional Therapy for hypothyroidism includes foods: 1. low in ___ 2. High in ____ (bc/ of slow GI tract and constipation) 3. fluids but if in ___ decrease fluids

Answer 52

1. calories 2. fiber 3. HF

Question 53

Hypothyroidism requires nutritional therapy, patient ____ and thyroid hormone ____.

Answer 53

teaching, replacement

Question 54

With hypothyroidism, with the TSH level be elevated or decreased?

Answer 54

elevated

Question 55

_____: caused by overproduction of PTH by the parathyroid gland. Characterized by bone ____ and the development of renal ___ containing calcium. With high calcium levels, concern should always be with ____ and kidney stones.

Answer 55

Hyperparathyroidism decalcification stones bone fractures

Question 56

Hyperparathyroidism manifests with ____ or asymptomatic. Diagnose using ___ levels, serum calcium and ____ levels, dexa scan, U/s and ECG. Manifestations include cardiac ____, lethargy and ___.

Answer 56

``` hypercalcemia PTH phosphorus arrhythmias constipation ```

Question 57

Nursing care for hyperparathyroidism includes treatment for ____: fluids, limit ___ and meds. ___ are important to flush out stones, decrease broccoli and ___. Give ___.

Answer 57

``` hypercalcemia calcium Fluids Dairy Phosphorus ```

Question 58

Nursing management of Hyperparathyroidism includes: 1. safety due to ____ 2. ____ as tolerated 3. PT 4. fluids 5. report s/s of ___ pain. 6. strategies to relieve ____

Answer 58

1. weakness 2. ambulate 5. back 6. constipation

Question 59

Hypoparathyroidism is due to inadequate ___. This is most commonly due to ____ with thyroid surgery.

Answer 59

PTH | removal of parathyroid

Question 60

Hypoparathyroidism manifests with low ___. Treat acute ___, maintain normal serum ____ levels, provide calcium and Vitamin ___ supplements. Diarrhea or constipation?

Answer 60

``` serum calcium levels tetany calcium D diarrhea ```

Question 61

Two signs for hypocalcemia (caused by hypoparathyroidism, low PTH and low calcium levels) are positive ____ and ____ sign (both indicate tetany).

Answer 61

Chvosteks sign: contraction of facial muscle with light tap on face by ear. Trousseus sign: carpal spasm with inflated BP cuff over systolic for a few minutes.

Question 62

nutrition for hypoparathyroidism should include a diet high in ___ and low in ____ (limit meats, poultry and cereals).

Answer 62

calcium | phosphorus