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Endo.Sys
NP2 Prof. King; Test 6
| Question | Answer |
|---|---|
| Trousseau's sign refers to | carpal spasms induced by inflating a blood pressure cuff on the arm |
| How do u check for trousseau's sign? | inflate bp cuff above systolic pressure and watch for carpal spasms, which shld occur within 3 minutes if hypocalcemia is present |
| Chevostek's sign is | contraction of facial muscles in response to a tap over the facial nerve in front of the ear, represents hypocalcemia |
| Which endocrine gland is the master gland | pituitary gland |
| How common is hypothyroidism | one of the most common medical disorders in the US |
| Hypothyroidism results from | insufficient circulating thyroid hormones T3 and T4 |
| Cause of hypothyroidism can be primary, secondary, or transient meaning | primary is related to destruction of thyroid tissue or defective hormone sythesis; secondary comes from a type of alteration of a cell such as pituitary disease; transient due to thyroiditis or discontinuance of thyroid hormone therapy |
| Most common cause of hypothyroidism in third world countries is | iodine defiency |
| Most common cause of hypothyroidism in US is | atrophy of the gland |
| Atrophy is caused by | end result of Hashimoto's thyroiditis, Grave's disease, and a consequence of tx for hyperthyroidism, (thyroidectomy, radioactive iodine therapy) |
| Hypothyroidism occasionally develops as a result of | excessive goitrogens |
| Cretinism is | a congentital condition that is caused by thyroid hormone deficiences during fetal or non-fetal life |
| Thyroid hormones T3 and T4 regulate | metabolic rate, caloric requirements, COH and lipid metabolism, O2 consumption, growth and development, brain function, nervous system |
| Hypothyroidism causes an accumulation of | mucopolysacchrides in the dermis and other tissues |
| Neurologic symptoms of hypothyroidism include (13) | apathy, lethargy, fatique, forgetfulness, slowed mental status, slow and slurred speech, hoarseness, anxiety, depression, paresthsias, polyneuropathy, stupor, coma |
| Cardiovascular symptoms of hypothyroidism include (4) | Increased capillary fragility, decreased rate and force of contraction, cardiac hypertrophy, distant heart sounds |
| Respiratory symptoms of hypothyroidsim (2) | dyspnea on excertion (DOE), decreased breathing capacity |
| GI symptoms of hypothyroidism (5) | decreased appetite, N&V, weight gain, distended abdomen, enlarged and scaly tongue, achlorhydria (absence or decrease in HCL acid) |
| Integumentary symptoms of hypothyroidism (6) | dry, thick, in-elastic, cold skin; thick, brittle nails; dry, sparse, course hair; pallor; puffy face |
| Reproductive symptoms of hypothyroidism (3) | prolonged menstrual periods or menorrahgia/amenorrhea, decreased libido, infertility |
| Hematologic symptoms of hypothyroidism | anemia- decreased erythropoietin, bone marrow activity |
| Musculoskeletol symptoms of hypothyroidism (5) | fatigue, weakness, muscular achs and pains, slow movements, arthralgia (painful joints) |
| Hypothyroidism increases susceptibility to | infection |
| Hypothyroidism causes a sensitivity to what medications | narcotics, barbiturates, anesthesia |
| Hypothyroidism may cause a (hint: physical feature) | goiter |
| Hypothyroidism causes an intolerance to what temperture | cold |
| Myxedema coma is a | gradual or sudden, impairment of conciousness or coma caused by hypothyroidism |
| Myxedema coma can be triggered by | infection, drugs, cold, or trauma |
| Myxedema is characterized by (3) | subnormal temperture, hyptension, and hyptoventilation |
| What is given to a patient with myxedema | iv thyroid hormone replacement |
| Serum TSH is high when the defect is in the... (gland) | thyroid |
| Serum TSH is low when the defect is in the... (gland) | pituitary or hypothalmus |
| An increase in TSH after TRH injection suggests | hypothalamic dysfunction |
| No change in TSH after a TRH injection suggest | anterior pituitary hypothalmus |
| Levothyroxin sodium medication replaces what hormone | T4 |
| Liothyronine sodium medication replaces what hormone | T3 |
| Liotrix (medication) is a synthetic form of what hormones | T3, T4 |
| When giving hypothyroidism medications to a pt. when should you administer the meds (time of day) | 1 hr befor morning meal or 2 hrs after meal |
| What information should you obtain from a pt with suspected hypothyroidism that is subjective | family hx of CHF, thyroid disorders. changes in bp, cardiac sxs, dyspnea, fatigue, weakness, aches and pain. lethargy, forgetfulness, hoarseness, paresthesias, anxiety or depression, idoine intakes, decreased appetite, n/v, weight gain, |
| What should you observe in a patient with hypothyroidism | distant heart sounds, distended abd, enlarged scaly tongue, dry, thick, elastic, cold skin. poor turgor of skin, puffy face, pallor, slow movements, slow/slurred speech, decreased hearing, labs |
| Hyperthyroidism is | a sustained increase in synthesis and release of thyroid hormones by thyroid gland |
| Causes of hyperthyroidism are _________, _____ ______, _______ ______ _______, _______ _______, _______ ________ and the most common cause is _______ _______. | gthyroiditis, nodular goiter, exogenoius idoine excess, pituitary tumors, thyroid cancer, graves disease < most common |
| Graves disease is | an autoimmune disease of unknown etiology (antibodies develop to TSH)that causes diffuse thyroid enlargement and excessive thyroid hormone secretion, may progress to destruction of thyroid tissue and hypothyroidism |
| hyperthyroidism and thyrotoxicosis = | thyroid storm |
| Percipitating factors for graves disease include | insufficent iodine supply, infections, and stressful life events interacting with genetic factors |
| Toxic nodular goiters are | thyroid hormone secreting nodules idependent of TSH, begin as follicular adenomas, small autonomous nodules do not secrete enough to cause clinical thyrotoxicosis, but large (>3) nodules may |
| Effects of Hyperthyroidism | Increased metabolism, increased hormones increase tissue sensitivity to stimulation by sympathetic nervous system by increasing number of beta-adrenergic receptors |
| Hyperthyroidism effects the thyroid by causing | a goiter, bruits |
| Hyperthyroidism effects the eyes by causing | exophthalmos which is an impaired drainage from orbit, increasing fat and edema in retro-orbital tissues, eyeballs forced outward and protrude, corneal surfaces become dry and irritated |
| Cardiovascular symptoms of hyperthyroidism | systolic hypertension, arrhythmias, cardiac hypertrophy, atrial fibrilation |
| GI symptoms of hyperthyroidism | increased appetite and thirst, weight loss, diarrhea, splenomegaly, hepatomegaly |
| Integumentary symptoms of hyperthyroidism | warm, smooth, moist skin, thin brittle nails, hair loss, clubbing of fingers, diaphoresis, vitiligo (white patches on skin) |
| Musculoskeletal symptoms of hyperthyroidism | fatigue, muscle weakness, proximal muscle wasting, dependent edema, osteoporosis |
| Nervous symptoms of hyperthyroidism | fine tremors, insomnia, lability of mood, delirium, hyperreflxia of tendon reflexes, inablility to concentrate |
| Reproductive symptoms of hyperthyroidism | menstrual irregularities, amenorrhea, decreased libido, impotence, gynecomastia in men (boobs), decreased fertility |
| Hyperthyroidism can cause an intolerance to what temperture | heat |
| Hyperthyroidism can cause thyrotoxic crisis aka | thyroid storm |
| Thyrotoxic crisis or thyroid storm is an | acute, rare condition where all manifestations are heightened, life-threatening emergency |
| presumed cause of thyrotoxic crisis or thyroid storm is | stressors |
| Mainfestations of thyrotoxic crisis (thyroid storm) are | increased hr and temp, restlessness, agiation, seizures, abdominal pain, coma |
| Acute interventions for Myxedema coma include (4) | mechanical respiratory support and cardiac monitoring PRN, IV thyroid hormone replacement therapy and other medications, Monitor core temperture for hypothermia, Assess vitals, weight, I&O's, and visible edema |
| Hypothyroidism medications potentiate | anticoaglants, digitalis, and increased insulin need |
| Hypothyroidism medications may cause a coronary insufficiency with s/s of | chest pain, tachycardia, SOB |
| Pt. with DM and hyptothyroidis should test _______ _______ _________ at least daily as return to ethyroid state requently increased insulin requirement | capillary blood glucose |
| Hyperthyroidism can cause an intolerance to what temperture | heat |
| Hyperthyroidism can cause an increased sensitivity to what type of drugs | stimulant |
| Treatment and therapy for thyrotoxic crisis include | reduce thyroid hormone levels and clinical manifestations, fever reduction, fluid replacements, and management of stressors |
| Diagnostic studies for hypethyroidism include | laboratory findings for TSH and TSH thyroxine (t4), Radioactive iodine (RAI) uptake is indicated to differenate Graves disease from other forms of thyroiditis |
| Goals for hypethyroidism treatment include | stop adverse affects, stop over secretion of hormones |
| The three treatment options for hyperthyroidism include | Antithyroid medications, radioactive iodine therapy (RAI), subtotal thyroidectomy |
| propythiouracil (PTU) and methimazole (Tapazole) are | antithyroid drugs that inhibit synthesis of thyroid hormones, may have spontaneous remission |
| How long does it take for antithyroid drugs to show improvement | 1-2 weeks |
| Does antithyroid medications cure hyperthyroidism | NO |
| Whats the most common use of antithyroid medications | to shrink the thyroid before surgery, making it safer |
| Iodine is used in hyperthyroidism for what reasons | preparation for thyroidectomy or treatment of crisis, usually used with other antithyroid medications |
| Idoine works to reduce symptoms of hyperthyroidsim by | rapidly inhibit synthesis of T3 and T4 and block their release into circulation (large dose's) and decreases vascularity of thyroid gland |
| Iodine's maxiaml effects are seen within | 1-2 weeks |
| Two types of B-adrenergic blockers include | proprandol and tenormin |
| B-adrenergic blockers are used for | symptomatic relief of thyrotoxicosis resulting from B-Adrenergic receptor stimulation |
| Proprandol a B-adrenergic blocker should be administered with... | other antithyroid agents |
| Tenormin a B-adrenergic blocker is perferred when clt has what type of diseases | heart disease and asthma |
| Radioactive Iodine Thearapy (RAI) has a high incidence of post-treatment | hypothyroidism |
| After radioactive iodine-therapy the pt will be on what medications life-long | thyroid hormone replacement medications |
| Radioactive Iodine therapy (RAI) effects the thyroid gland by | damaging and destroying the thyroid tissue |
| How long does it take for Radioactive iodine therapy to take affect | 2-3 months |
| During and for first three months of radioactive iodine therapy the pt is treated with what other drugs | antithyroid drugs adn inderal |
| Subtotal thyroidectomy is used for treatment of hyperthyroidism but is ___% effective but if too much is removed _________ will not occur resulting in _________ | 90%, regeneration, hypothyroidism |
| Surgical therapy is used for hyperthyroidism when | unresponisve to drug therapy, large goiters causing tracheal compression and possible malignancy |
| A pt with hyperthyroidism nutriton requirements include | 4-5,000 calories/day for hunger and prevention of tissue breakdown, protien allowance of 1-2 g/kg ideal body weight, avoid caffeine, highly seasoned foods and high-fiber foods |
| Subjective data you should gather from a pt with hyperthyroidism includes | pre-existing goiter, recent infection or trauma, immigration from iodine-deficeient area, medications, family hx, weight loss, nausea, diarrhea, dyspnea on exertion, muscle weakness, insomnia, heat intolerance |
| what s/s should you watch for when a pt has hyperthyroidism | agitation, hyperthermia, enlarged or nodular thyroid gland, eyelid retraction, diaphoretic skin, brittle nails, amenorrhea, delirium, edema, tachypnea, tachycarida, hepatosplenomegaly, hyperreflexia, fine tremors, muscle wasting, coma, |
| Nursing implementation for acute throtoxicosis include | ensure adequate o2 and iv fluids, administer medications, monitor cardiac arrhythmias, light bed coverings (diaphoretic), encourage exercise, restrict visitors, apply artifical tears to relieve eye discomfort, elevate HOB, and salt restriction for edema |
| Nursing implementation for thyroid surgery | assess for signs of iodine toxicity, teach deep cough and deep breathes, have suction equipment and tracheostomy tray available in room, calcium salts available for tetany |
| Signs of tetany include | tingling in toes, hands and around mouth |
| Glucocorticoids regulate the bodys use of | carbohydrates, protein, and fat; also affect the level of glucose in the blood |
| Mineralocorticoids control balance of | sodium and water in the body, which maintains the amt of blood in the heart and circulatory system, and regulate bp |
| Sex hormones in the adrenal cortex produce small amts of | androgens in both men and women |
| Etiology of cushings syndrome | Cause: excess corticosteroids, particularly gluccorticoids most common cause is exogenous corticosteroids |
| Clinical manifestations of cushing syndrome include | weight gain (trunk,face,cervical area, sodium/water retention), hyperglycemia, protien wasting mood disturbances, insomnia, irrationality, psychosis, mineralocorticoid-hypertension, adrenal androgen-acne, virilization in women, feminization in men |
| Diagnostic studies for cushing syndrome include | 24-hr urine for freee cortisol, low-dose dexamethasone suppression test, lab results, CT & MRI |
| Dexamthasone suppression test measures the response of adrenal glands to ACTH. Dexamethasone is given and levels of cortisol are measured, cortisol levels should | decrease. false postives can occur with depression, stress, or alcoholism |
| If a pt has cushing syndrome what labatory findings would you see | hypokalemis and alkalosis in ectopic ACTH (effect of cortisol on renal tubule) elevated plasma cortisol levels Plasma ACTH may be low, normal, or elevated depending on problem |
| What do low or undetectable ACTH levels in cushing syndrome pt indicate | adrenal or exogenous etiology |
| Treatment options for cushing syndrome include | surgery, radiation, drug therapy |
| Surgery/radiation therapy is consider for treatment of cushing syndrome if | pituitary adenoma, adrenalectomy for adrenal tumors or hyperplasia, Ectopic ACTH-secreting tumors managed by treating neoplasm |
| Drug therapy is considered for treatment of cushing syndrome if | surgery is contraindicated, inhibit adrenal function |
| Mitotane (Lysodren) is used for _________ __________ | cushing syndrome bc it suppresses cortisol production, alters peripheral metabolism of cortisol, decreases plasma and urine corticosteriod levels |
| Metyrapone, ketoconazole, and aminoglutethimide inhibit... | cortisol synthesis |
| Side effects of hormone replacements such as mitotane, metrapone, ketoconazole and aminoglutethimide include... | weight gain, & immunosuppression |
| If cushing syndrome is developed during the use of corticosteriods what is the intervention.... | gradually discontinue, reduce dose, convert to alternate-day regimen (not with endocrine replacement therapy) |
| s/s of cushing syndrome include (13) | truncal obesity, buffalo hump, moon facies, hirsutism (excessive body hair), thinning of hair, thin and fragile skin, acne, petechiae, purpura, hyperpigmentation, striae (strips on belly), hypertension, muscle wasting |
| Nursing implementation for cushing syndrome include | assess for hormone and drug toxicity effects on complicationg conditions (SE of tx; CVD, DM, infection, fractures),provide emotional support |
| Pre-op care for cushing syndrome includes | control of hypertension and hyperglycemia, hypokalemia corrected with supplements, provide written instructions |
| s/s of hypocortisolism post-surgery for cushing syndrome include | vomiting, increased weakness, dehydration, and hypotension |
| Etiology of addison's disease | an adrenocortical insufficiency from a primary cause, all there classes of adrenal corticosteriods are reduced. |
| Addison's disease is most commonly caused from | autoimmune response that destroys adrenal cortex tissue |
| Diagnostic studies for addison's disease includes | cortisol levels, labs, ECG, CT & MRI |
| In a patient with addison's disease what would you expect to see for their cortisol levels | subnormal levels or levels fail to rise over basal levels with ACTH stimulation |
| In a patient with addison's disease what abnormal lab results would you expect to see | hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, increased BUN, low cortisol urine levels |
| In a patient with addison's disease what would you expect to see for the ECG results | peaked T waves with hyperkalemia |
| Treatment for addison's crisis includes | shock management adn high-dose hydrocortisone replacement, large volumes of NS and D5 to reverse hypotension and electrolyte imbalances |
| Addisons disease can be caused from | autoimmune response (most common), TB (rare), infarction (necrosis), fungal infections, AID's, metastatic cancer, Iatrogenic addison's,adrenal hemorrhage |
| Addison's disease most often occurs in ___-___ y/o | 30-60 y/o adults |
| Addison's disease is not evident until ___% of adrenal cortex is destroyed | 90% |
| Clinical manifestations of addisons disease includes | progressive weakness, fatigue, weight loss, anorexia, skin hyperpigmentation, hypotension, hyponatremia,hyperkalemia, n/v, diarrhea |
| Secondary adrenocorticol hypofunction s/s is | common with addisons besides s/s lack hyperpigmentation |
| Addison's crisis is a life-threatening crisis caused by | insufficient or sudden, sharp decrease adrenocorticol hormones |
| Addison's crisis is triggered by | stress, sudden withdrawls of corticosteriod replacement therapy, post adrenal surgery, pituitary destruction |
| Treatment for addison disease includes | hydorcortisone-most common replacement therapy; has glucocorticoid, mineralcorticoid properties |
| For addison's disease glucocorticoid dosage must be _______ during times of stress to prevent addisonian crisis. (increased or decreased) | increased |
| when giving a pt steriods you must give with a full glass of | water; no juice |
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stilsl
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