Pathobreeze Flashcards
(105 cards)
0
Q
Mortality Incident Rates facts about patients with Cushing’s Disease:
- High risk for infection - Why?
- High risk for suicide - Why?
- High risk for cardiovascular complications - Why?
A
- High risk for infection - R/T increased blood sugar
Especially seen in COPD / Rheumatoid Arthritis patients who receive Aldosterone medication for comorbidities > increases cortisol - High risk for suicide - R/T changes body image and depression
- High risk for cardiovascular complications - This patient will retain fluid which will eventually elevate BP which can cause Heart Failure. This patient will also have hypokalemia which has adverse effects on the heart. Which can cause death.
Hyperfunction of Adrenal Gland
-This is Cushing’s Disease
1
Q
Adrenergic stimulation causes increased vitals / SNS stimulation.
Increased oxygen consumption b/c increased respirations
Increased metabolic demand increases demand on heart and lungs
These are the clinical manifestations of what endocrine disorder?
A
Grave’s Disease
2
Q
What is the treatment for a hypercalcemic crisis?
A
- Hydration 3-4 L per day
- Diuretics Administered
- Calcitonin
3
Q
Neoplasia R/T cancer
Hyperplasia - englarged gland
Autoimmune disorders - body attacks itself
These are causes of what endocrine disorder?
A
Hyperfunction
4
Q
Calcium and phosphorus have an __________ relationship.
A
Inverse
Can create disorders.
5
Q
What is the most common way to develop hypoparathyroidism?
A
post-thyroidectomy
Study Tip: parathyroid glands are discarded and saving the glands and implanting elsewhere could spread the cancer.
6
Q
What secretes T3 and T4?
A
Thyroid gland
7
Q
What does calcitonin do in the body?
A
Deposits calcium from the blood stream back into the bone
Study tip: calci-bone-in. This is also a medication.
8
Q
Decreased T3
decreased T4
How is this patient’s thyroid functioning?
A
Hypofunction of thyroid
-this is Myxededma
9
Q
What is required to make thyroid hormone?
A
Iodine
10
Q
Decrease temperature decrease pulse decreased respiratory rate decrease blood pressure increased weight Increased fluid retention how is this patient's thyroid functioning?
A
Hypofunction of thyroid
-This is myxedema
All vital signs decreased this can kill the patient
11
Q
What secretes TSH?
A
Anterior Pituitary gland
This level lets you know where the problem is caused.
12
Q
Increased temperature increased pulse increased respiratory rate increased blood pressure decreased weight how is this patient's thyroid functioning?
A
Hyper function of thyroid
-This is Graves’ disease
13
Q
What are diagnostic tests for Hyperparathyroidism or Graves’ disease?
A
Bone X-Ray - Monitor Bone Density ^ Ca+
MRI - Monitor size and location of gland
Bone Scan - Monitor Bone Density ^ Ca+
14
Q
Thyroidectomy the Dr must be sure to NOT cut the parathyroid glands or you will have to deal with calcium issues after surgery > Cut it out can be re-implanted somewhere else. If that can’t occur because of cancer then what happens to the patient?
This is the treatment for what type of thyroid gland function?
A
Patient will become parathyroid hypofunctioning > calcium deficiency and will need medication replacement.
Hyperfunctioning Thyroid
-This is Graves’ disease
15
Q
Too much medication given to a hypo functioning thyroid patient will cause _________.
A
Hyperfunction of thyroid
-This is Graves’ disease
16
Q
What is the treatment for a myxedema with the hypofuctioning thyroid?
A
Give a TSH medication and put in a warm environment
17
Q
If the patient has a Low T3 T4 and High TSH that means what is the cause of the problem? What is the treatment?
A
Primary Hypothyroidism. Hypothyroidism is a primary cause it means the thyroid it is secreting TSH and doing it’s job. This means negative feedback is working.
Place in a warm environment because of cold temp.
Administer TSH medication.
18
Q
Thyroid Storm
How is this patient’s thyroid functioning?
A
Hyperfuction of thyroid
-This is Graves’ disease
19
Q
What is another name for severe or long standing hypothyroidism?
A
Hypofunction of thyroid
-This is Myxedema
20
Q
Energizer bunny
How is his patients thyroid functioning?
A
Hyperfunction of thyroid
-This is Graves’ disease
21
Q
What is cretinism?
A
Hypothyroidism. A congenital condition see in infants that is caused by a lack of thyroid hormones during the fetal period due to depression of metabolic activity, characterized by arrested physical and mental development, myxedema, dystrophy of the bones and soft tissues, and lowered basal metabolism. Results in dwarfism and mental retardation.
22
Q
If the patient has a High T3 High T4 and Low TSH that means what is the cause of the problem?
A
Primary hyperthyroidism caused by the Thyroid gland because negative feedback is working. The hypothalamus knows there is an excess of t3 and t4 in the blood stream. This patient would have a thyroidectomy.
23
Q
What is the treatment of cretinism?
A
The treatment consists of administration of synthetic thyroid hormones.
24
What are the nursing interventions during a myxedema coma?
Maintain Patent Airway
Monitor vitals because they can die from no vital signs.
Administer thyroid hormone
Put the patient in a warm environment
25
What is the hereditary cause of cretinism?
This is a genetic mutation that comes from the mother being iodine deficient and it causes the child's pituitary to under develop.
26
Name the 5 most common hyperthyroid disorders?
1. Thyrotoxicosis - Excessive Thyroid Hormone in the blood
2. Grave's Disease - hypertension causes exophthalmus. Enlarged thyroid gland looks like a butterfly.
3. Diffuse Toxic Goiter - tire around the neck. This patient can hyperthyroidism, hypothyroidism, or euthyroidism with this disorder. This is caused by an iodine deficiency or an increased metabolism such as in pregnancy.
If you give the patient iodine it can go away.
4. Thyroid Storm - Excessive Thyroid Hormone in the blood. FATAL.
5. Cancer - neoplasm. Secretes Thyroid Stimulating Hormone which stimulates the parathyroid.
27
Slow, tired, cold, swollen with edema, weight gain, things don't move, this disorder can be confused with the aging process. These patients often go misdiagnosed.
These are the clinical manifestations of what thyroid related endocrine disorder?
Hypofunction of thyroid
-This is Myxedema
Study tip: Give supplemental thyroid to increase quality of life.
28
Autoimmune disorder. The thyroid gland is stimulated by antibodies the body created against itself causes the body to secrete high levels of t3 and t4.
What endocrine disorder related to they thyroid gland is this?
Hyper function of thyroid
| - This is Grave's Disease
29
Administer medications that block synthesis of Thyroid Hormone
Provide Symptomatic/Supportive Care
Protect the heart with beta blockers and calcium channel blockers to prevent the patient from going into heart failure.
This is the treatment for what thyroid related endocrine disorder?
Thyroid Storm
30
If the patient has a High T3 High T4 and High TSH that means what is the cause of the problem?
Secondary hyperthyroidism caused by the Pituitary gland feedback mechanism being broken causing it to over secrete too much TSH and causes the body to keep producing T3 and T4. Or the Hypothalamus is not aware that there is too much T3 and T4 and is still stimulating the anterior pituitary (Neuro) to release TSH. This patient will need a Thyroidectomy when you figure out what is the cause.
31
What are 3 causes of hyperparathyroidism?
1. Hypersecretion of PTH (Parathyroid Hormone) by the Anterior Pituitary Gland
2. Adenoma- Tumor of gland
3. Hyperplasia of parathyroid gland (enlarged)
32
Increased Parathyroid hormone
Increased Calcium levels
Decreased Phosphorus Level
How is this patient's parathyroid functioning?
Hyperfunction of ParaThyroid hormone
| - Cushing's Disease
34
When ________ is released:
1. Calcium absorption is increased in the intestines
2. Removal of calcium as needed from the bones and the teeth.
When it reaches a satisfactory level it will stop secreting PTH.
3. If the calcium level gets too high the thyroid will intervene and secrete calcitonin to decrease the elevated calcium level in the blood by putting the calcium back into the bone.
Parathyroid Hormone
35
If your patient is constipated how is their thyroid functioning?
Hypofunction of the thyroid
| -this is myxedema
36
Huge amounts of thyroid hormone being released into the patients blood stream.
Dangerous worsening of thyrotoxic state.
Death in 48 hours if untreated.
Thyroid Storm
37
Myxedema
| how is his patients thyroid functioning?
Hypofunction of Thyroid
| -This is Myxedema
38
What is the treatment for a hypofunctioning parathyroid?
Give a drug - Calcium
39
Where is the parathyroid gland located?
Located in the thyroid gland.
40
What are the 3 signs and symptoms of hypocalcemia?
+ Chvostek's Sign - assesses for tetany / Tap Cheek = Tetany
+ Trousseau's Sign - assesses for tetany / BP Cuff = Carpal-Pedal spasms
Decreased cardiac function and contractility can lead to Heart Failure
41
Decreased parathyroid hormone
Decreased Calcium levels
Increased Phosphorus Level
How is this patient's parathyroid functioning?
Hypofunction of ParaThyroid
| - Addisons Disease
42
A hyperactive thyroid gland uses a lot of _______.
Iodine
43
What is the treatment for a hyperfunctioning parathyroid?
1. Increase fluids 3-4L a day to decrease the formation of calcium stones.
2. Administer diuretics to decrease calcium levels
3. Surgery- Cut It Out (difficult to locate) will need calcium replacement for life after surgery.
44
What part of the body regulates itself based on the amount of calcium in the blood?
Parathyroid gland
45
Graves Diseases
| How is this patient's thyroid functioning?
Hyperfunction of the thyroid
| - This is Graves' disease
46
What are the 3 signs and symptoms of hypercalcemia?
1. Kidney Stones R/T excess Ca+ creating rocks in the blood.
2. The urine precipitates and the stone clogs the kidneys causing acute renal failure.
3. Increased cardiac function and contractility.
47
What secretes calcitonin?
Thyroid gland
48
A renal failure patient does not excrete ___________ and cannot absorb ___________. This can cause them to go into hypoparathyroidism. These are commonly seen together in patients. Can cause increased risk of fracture because of decreased calcium.
phosphorus
| calcium
49
When the calcium level in the blood is too low the parathyroid a secrete what hormone?
Parathyroid Hormone
50
Increased calcium causes _______ musculoskeletal and cardiac contractility.
Increased
51
Increased T3
increased T4
how is this patient thyroid functioning?
Hyper function of the thyroid
-This is Graves Disease.
52
_________ in the blood does not dissolve it precipitates and makes rocks that floats in the blood stream and clogs the kidneys causing acute renal failure or kidney stones.
Calcium
53
If this disorder is caused by a malfunctioning Pituitary gland the nurse will give medication to suppress the gland
If this disorder is caused by a malfunctioning Adrenal gland the nurse will give medication to suppress the gland
This is the treatment for what type of adrenal gland disorder?
Hyperfunction of Adrenal Gland
| -This is Cushing's Disease
54
autoimmune destruction why?
neoplasm why?
infection in gland
These are causes of what endocrine disorder?
R/T body destroying islet of langerhans cells > this cell creates insulin: diabetics
R/T cancer
Hypofunction of thyroid gland
Myexedema
55
What are 2 causes of hypoparathyroidism?
1. Abnormal decrease in PTH (parathyroid hormone) secretion.
| 2. Thyroidectomy affecting the parathyroid tissue (COMMON)
56
Increased Nerve muscle excitability
+ Chvostek's Sign (2cm anterior to the earlobe)
+ Trousseau's Sign (bf cuff causes carpopedal spasm)
Convulsions
Laryngeal spasms
These are the clinical manifestations of what parathyroid related endocrine disorder?
Hypoparathyroidism
| -This is Addison's disease
56
What is the treatment for hypoparathyroidism or Addison's disease?
Calcium IV
Calcium Supplement
Vitamin D Supplement > activate Ca+ in the intestines
57
Slow
Tired
Cold
how is his patients thyroid functioning?
Hypofunction of Thyroid
| -This is Myxedema
57
If the patient has a Low T3 T4 and Low TSH that means what is the cause of the problem?
Hypothyroidism is caused by a secondary cause by the pituitary gland because it is not secreting TSH or by the Hypothalamus not stimulating the anterior pituitary (Neuro)
Hypofunction of Thyroid
-This is Myxedema
58
If your patient has diarrhea how is their thyroid functioning?
Hyperfunction of Thyroid
| - Graves Disease
59
What regulates the amount of T3 and T4 in the blood?
The hypothalamus using a negative feedback system.
These are thyroid hormones.
60
Excessive Osteoclastic Activity: Increased Bone Resorption (breaks down bone to release calcium in the bone)
Pathological Fractures: decreased bone density because of resorption
These are the clinical manifestations of what parathyroid gland disorder?
Hyperparathyroidism
| - This is Cushing's Disease
61
Exogenous hormone administration Ex. Prednisone=Cortisol
Altered target tissue responses - unexpected
These are causes of what adrenal gland disorder?
Hyperfunction of adrenal gland
| - This is Cushing's Disease
62
Where are the adrenal glands located?
Above the kidneys
63
What three hormones are secreted from the adrenal gland?
Cortisol
Aldosterone
Androgens
64
What stimulates the adrenal gland and the anterior pituitary gland?
The hypothalamus
Study Tip: The parathyroid gland stimulates itself. The thyroid gland is stimulated by the anterior pituitary gland.
65
The hypothalamus stimulates the ________ to secrete ACTH which stimulates the ________ to secrete cortisol, aldosterone, and androgens.
anterior pituitary gland
| adrenal glands
66
What does cortisol do in the body?
Increased blood sugar
| decreased immune system
68
Nourishment moisture / Give patient a lot of food. Because of increased calories
cool dark room
S/sx: Exophthalmos
This is the treatment for what type of thyroid gland function?
Hyperfunctioning Thyroid
| - Graves Disease
69
What does aldosterone do in the body?
Retains sodium
Retains water
Excretes potassium in the urine
71
_________ is a catabolic steroid it breaks everything down for energy.
Cortisol
71
1. Monitor blood sugar and what does the nurse do?
2. Wean off Prednisone if possible. Why?
3. Adrenalectomy. Why?
This is the treatment for what type of adrenal gland function?
1. Provide insulin coverage in Diabetic patient
2. If the Cushing's is caused by the Prednisone medication and you remove the medication and the patient can go back to normal. Use the least amount of medication possible when treating these patients this causes less signs and symptoms.
3. Adrenal Tumor
Hyperfunctioning Adrenal Gland
- This is Cushing's Disease
72
Cortisol + ___________ = Prednisone
Glucocorticoid
Study Tip: Acts like any drug ending in "one"
Ex. If given in a pill.
74
Monitor the heart because it's rate increases so rapidly that it doesn't have time to fill which affects cardiac output and perfusion. Give Cardizem or Inderal as ordered > why?
This is the treatment for what type of thyroid gland function?
lowers hr does not cure hyperthyroid has a long half life. This disorder can lead to HF.
Hyperfunctioning Thyroid
- Graves Disease
75
What do androgens do in the body?
Sex hormones
Ex. Testosterone anabolic steroid / builds
76
1. Administer drugs to suppress gland > What drugs?
2. Monitor for signs and symptoms of infection
3. Administer Diuretics > What type would you administer and why?
This is the treatment for what type of adrenal gland function?
1. SSKIs and Lugols (Iodine)
2. Ex. UTI's, cancers, and low WBCS. Unable to mount an immune response.
3. Aldactone (aldosterone antagonist) b/c it blocks effects of aldosterone use care with potassium wasting diuretics because the disease process already wastes potassium.
Hyperfunctioning Adrenal gland
-This is Cushing's Disease
76
Irradiate with strong Radioactive Iodine I 131 I medication given to patient with hyper functioning thyroid will absorb the medication which will kill all or part of the gland.
This is the treatment for what type of thyroid gland function?
Hyperfunctioning Thyroid
| - Graves Disease
77
Aldosterone + ________ = Aldosterone = Florinef
Mineralcorticoid
Ex. Prednisone and Florinef are usually combined in a med.
77
ischemic damage why?
profound hypotension why?
alterations in hormonal synthesis why?
These are causes of what endocrine disorder?
R/T disruption in blood flow
R/T disruption in blood flow which effects all organs - shock
R/T atrophy of gland or decreased secretion
Hypofunction of Thyroid
-This is Myxedema
78
Decreased Cortisol
Decreased Aldosterone
How is this patient's adrenal gland functioning?
Decreased cortisol decreases blood sugar.
Decreased aldosterone decreases blood pressure / releasing water and increases potassium level / retaining K+
Hypofunction of Adrenal Gland
-This is Addison's Disease
80
In response to stress the hypothalamus causes the anterior pituitary gland to secrete _______ which stimulates the adrenal cortex to secrete cortisol, androgens, and prednisone and when the correct levels are reached the hypothalamus will stop stimulating the anterior pituitary gland. This shuts off the negative feedback mechanism.
ACTH
81
Prednisone
Florinef
This is the treatment for what type of adrenal gland disfunction?
Hypofunction of the Adrenal Gland
| - This is Addison's Disease
82
These signs and symptoms occur during which adrenal gland disorder?
1. Increased risk for infection - Why?
2. Moon face - Why?
3. Buffalo hump - Why?
4. Obese abdomen - Why?
5. Thin Extremities - Why?
6. Osteoposorosis - Common complication?
1. Suppressed immune system R/T the fact that Prednisone elevates blood sugar. Cortisol depresses immune system so even if there is an infection but WBC count will be in the normal range because of the immunosuppression. Bacteria love to eat sugar.
2. The patient develops a round face R/T redistributed fat molecules.
3. This is caused by the mobilization of molecules to create energy and this redistributes fat.
4. A patient can develop striae due to rapid increase in fat transport during mobilization.
5. A patient will have muscle wasting which gives them the skinny appearance. The patient will also have see through, thin skin R/T
6. Stress Fractures
Hyperfunction of the adrenal gland
- This is Cushing's Disease
83
Increased Cortisol
Increased Aldosterone
How is this patient's adrenal gland functioning?
Increased cortisol increases blood sugar.
Increased aldosterone increases blood pressure and decreases potassium.
Hyperfunction of Adrenal Gland
-This is Cushing's Disease
83
```
Administration of Salt Tablets
Monitor blood sugar
Monitor blood pressure
Monitor K+ level
This is the treatment for what type of adrenal gland function?
```
Give salt to help the patient retain water and increase blood pressure.
Hypofunction of the adrenal gland
- This is Addison's Disease
84
_______ prevents the patient from getting sick.
Cortisol suppresses the immune system
85
What hormones are anabolic?
Growth hormone
Anabolic steroids
Testosterone
Ex. Builds muscles up
86
A person with Addison's disease needs to take extra Cortisol medication if they know they are taking an exam because if they don't what three dangerous symptoms will occur?
Increased blood sugar
Increased blood pressure
Increased K+ level
87
Adrenal glands stimulates what three S's?
Sugar Increase - cortisol - breaks down bone and muscle to increases blood sugar.
Salt Retention - aldosterone - decreases serum osmolality and increases blood pressure R/T increased salt and water
Sex Hormones - androgens - increased testosterone - anabolic steroid
88
Addison's patients are more _________ than Cushing's patients.
critical to treat
90
___________ patients will have all of the visual assessment characteristics of Cushing's Disease (primary cause) but they won't have the disease they have the manifestations because they have been given oral Prednisone that they are being given to treat another co-existing conditions such as COPD, rheumatoid arthritis, organ transplantation, or cortisol toxicity.
Cushing's Syndrome (secondary causes)
91
ACTH stimulation test
Increased ACTH level - Why?
This diagnostic test is used to diagnose what adrenal gland disorder?
If no response the patient has the disease. This tests ACTH stimulates the patients adrenal gland or not. Response means the adrenal gland is working.
Indicates the problem has a primary glandular cause.
If ACTH was low the problem would be with the pituitary gland.
The ACTH is high because it is secreting a lot to raise the cortisol and aldosterone levels but the adrenal gland is not responding so it continues to secrete ACTH
Hypofunction of the Adrenal Gland
- This is Addison's Disease
92
If the patient has true Cushing's Disease and has a adrenal tumor and they remove the tumor and the adrenal glands with an Adrenectomy this causes Addison's disease in that same patient because of decreased cortisol and aldosterone and loss of the adrenal medulla hormones which are epinephrine and norepinephrine which can cause blood pressure control issues. What is the nursing priority with this patient?
Nurse MUST monitor BP.
93
ASK ARBOGAST? Complications of Prednisone include what three things? On ppt ask Tina
Agnosia
GI bleeding
DVT
93
Decreased serum cortisol level
Decreased urine cortisol level
This diagnostic test is used to diagnose what adrenal gland disorder?
Hypofunction of the Adrenal Gland
| - This is Addison's Disease
95
If the patient has decreased cortisol, decreased aldosterone
| elevated ACTH that means what is the cause of the problem?
Primary Adrenal insufficiency means the problem is caused by the Adrenal gland itself.
Hypofunction of the Adrenal Gland
- This is Addison's Disease
95
```
Hyperkalemia
Hyponatremia
Low Blood Sugar
Low Blood Pressure
This diagnostic test is used to diagnose what adrenal gland disorder?
```
Hypofunction of the Adrenal Gland
| - This is Addison's Disease
96
Administer Glucocorticoid and Mineralcorticoid replacement - Why?
Increased salt intake - Administer salt tablets. Why?
This is the treatment for what type of adrenal gland disfunction?
Glucocorticoid: Cortisol increase BS
Mineralcorticoid: Aldosterone increase BP to maintain Normal K+ level
Given to increase blood pressure by causing the patient to retain water. Increase the amount of salt given if the patient is sweating.
Hypofunction of the Adrenal Gland
- This is Addison's Disease
97
What is the difference between Cushing's Syndrome and Cushing's Disease? What are the two causes of Cushing's Disease?
1. Cushing's Syndrome - Chronic Hypercortisolism without Pituitary Involvement
Causes:
1a. Meds > Prednisone > Increases Cortisol
1b. Tumor > Secretes Adrenocorical hormones > Increases Aldosterone
2. Cushing's Disease - Pituitary or Adrenal Gland Dependent
99
ASK ARBOGAST? Decreased aldosterone level
Decreased 17-ketosteroids level -why?
This diagnostic test is used to diagnose what adrenal gland disorder?
This is by product of cortisol metabolism ?
Hypofunction of the Adrenal Gland
- This is Addison's Disease
100
Check serum cortisol level
Check urine cortisol level
Dexamethasone suppression test - Why?
This diagnostic test is used to diagnose what adrenal gland disorder?
During this test the nurse will give the patient a high load of cortisol. In a healthy patient the pituitary is supposed to stop secreting ACTH and and the adrenal gland should stop secreting cortisol in response to the high level.
In a patient with Cushing's the feedback mechanism is broken so you get the additive effect of the Dexamethasone so the cortisol level goes very high because the body continues making ACTH and making Cortisol regardless of the already high level.
Hyperfunction of Adrenal Gland
-This is Cushing's Disease
101
ASK ARBOGAST? Hormone Replacement Therapy why?
Administer Synthroid medication Why? start slow when giving Synthroid because it's hard on the heart or cause
Monitor the patients heart and for signs of hyperthyroidism
This is the treatment for what type of thyroid gland disfunction?
Hypothyroidism
| -this is Myxedema
102
How to tell by looking at the labs if the patients Cushing's syndrome is Pituitary or Adrenal Gland Dependent?
Elevated Cortisol
Elevated Aldosterone
High ACTH
>Pituitary Dependent Hypercortisolism
Elevated Cortisol
Elevated Aldosterone
Low ACTH
>Adrenal Dependent Hypercortisolism
103
Ectopic cancer - Why?
Medication - Why?
This is the treatment for what type of adrenal gland disorder?
- radiation, surgery, and medication that suppresses the gland
- decrease the dosage as needed
Hyperfunction of Adrenal Gland
-This is Cushing's Disease
104
Insulin Resistance: increased insulin secretion because high calcium levels increase the body's resistance to insulin
These are the clinical manifestations of what parathyroid gland disorder?
Hyperparathyroidism
| - This is Cushing's Disease
