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68WM6 Phs 2 Test 13
68WM6 Phase 2 test 13 Endocrine System
| Question | Answer |
|---|---|
| what hormones do the thyroid pump out? | T3 & T4 Requires good IODINE intake |
| what does the Thyroid do? | regulates growth, metabolism, development, and activity of the nervous system |
| hyperthyroidism a.k.a. | Grave's Disease |
| exophthalmos | bulgling eyes |
| what are some subjective things you will look for r/t hyperthyroidism? | memory loss, dysphagia/hoarse voice, weight loss, jittery, insomnia, may overreact to stress |
| objective things to look for r/t hyperthyroidism | tachycardia, HTN, edema of anterior neck, exophthalmos, hyperthermia, warm skin, hand tremors, cessation of menses, |
| how would hyperthyroidism be diagnosed? | increased T3 & T4, radioactive iodine uptake test(RAIU), thyroid scan |
| what are two drugs that can be given to block the production of t3 and t4? | Propylthiouracil - Propyl-Thoracil, PTU Methimazole – Tapazole |
| what does ablation therapy? | destroy Hypertrophied tissue |
| what are side effects for ablation therapy? | Abdominal pain, n/v, diarrhea, sore throat, neck pain and edema, chronic hypothyroidism |
| side effects for medication therapy r/t hyperthyroidism | rash / pruritis, N/V, abd pain, loss of taste |
| what are some things you would teach your pt pre-opt r/t hyperthyroidism | Teach deep breathing techniques, need for voice rest, possible complications, keep environment calm/cool, instruct how to support head when turning in bed and rising |
| post-op teaching r/t hyperthyroidism | semi-fowler's position, avoid hyperextension of head, cool mist humidification, VS q4 hrs, assess swallow reflexes prior to liquids |
| what would you assess for post op r/t hyperthyroidism | bleeding, tachycardia, hypotension, apprehension, restlessness |
| what are s/s of tetany | Numbness or tingling Carpopedal spasm Tachycardia, tachypnea, hypertension Laryngeal spasm Positive Chvostek’s Sign Positive Trousseau’s Sign |
| what is tx for tetany | IV calcium gluconate |
| a thyroid strom appears usually within ___ hrs of surgery | 12 |
| s/s of thyroid storm | Exaggerated hyperthyroidism Severe hypertension, tachycardia Hyperthermia up to 106F Cardiac dysrhythmias, heart failure |
| what are tx's for thyroid storm? | IV fluids Sodium iodide and Corticosteroids Antipyretics and oxygen as needed |
| what is the severe form of hypothyroidism; congenital name | myxedema; cretinism |
| Failure of anterior pituitary to secrete adequate TSH for proper stimulation | hypothyroidism |
| Clinical Manifestations of hypothyroidism | Mild to severe depending on deficiency Hypothermia/intolerance to cold Weight gain Development of atherosclerosis /CAD |
| what subjective things would you look for r/t hypothyroidism | Impaired memory, slow thought processes Depression or paranoia Lethargy, forgetfulness, and irritability Anorexia and constipation Decreased libido and reproductive difficulty Menstrual irregularities Speech and hearing impairments |
| Objective Assessment r/t hypothyroidism | Bradycardia, hypotension and bradypnea Facial features become enlarged, edematous Voice low and hoarse Exercise intolerance Weakness, clumsiness, and ataxia Ileus |
| what are some options for replacement therapy r/t hypothyroidism? | Desiccated animal thyroid (Armhour Thyroid) Thyroglobulin (Proloid) Levothyroxine sodium (Levothroid /Synthroid) Liothyronine sodium (Cytomel) |
| what are some side effects r/t medical management r/t hypothyroidism | Palpitations, tachycardia, and nervousness Headache and insomnia Vomiting, diarrhea, and weight loss Sweating and heart intolerance |
| what are some nursing considerations r/t hypothyroidism | Medication usually given in the morning Initially low dose Increased gradually Side effects Establish maintenance dose |
| where is the pancreas located? | Right Upper Quadrant |
| Systemic metabolic disorder that involves improper metabolism of carbohydrates, fats and proteins | Diabetes Mellitus (DM) |
| Decreased or absolute lack of insulin production by the beta cells of the “islets of Langerhans | Type I DM |
| Decreased activity of the insulin that is secreted Target cells in the body resist action of insulin | Type II DM |
| Three P's to DM | Polyuria(mucho urine), Polydipsia(mucho thirst), Polyphagia(mucho hungry) |
| things r/t DM that make you go "hmmmmmm" | random blood glucose over 200, glycosuria, ketonuria |
| symptoms of DM | Hunger Thirst Nausea Nocturia Weakness,Fatigue Blurred vision Appearance of halos around lights Headache |
| what are some causes of Type II DM? | Decrease tissue responsiveness to insulin Caused by receptor defects Insulin resistance Decrease secretion of insulin from beta cells Abnormal hepatic regulation |
| Type II DM is Found primarily in adults > ____ years old | 30 |
| causes of Type I DM | Progressive destruction of beta cell function: Autoimmune process Viral Genetic predisposition Chemical agents |
| Mobilization of protein and fat stores Muscle wasting and weight loss Thin clients, and hyperglycemia are all s/s of Type ____ DM | Type I |
| Subjective data for Type I DM | Headache Hunger Nausea, vomiting Nocturia, dehydration, hypovolemia Blurred vision, halo around lights |
| objective data for Type II DM | May have Type I s/s, Slow wound healing Pruritus Boils or other skin infections Vaginal infections,Skin on lower extremities may appear thin and shiny Legs and feet may feel cold to touch Decreased sensation to pain and temp in feet and hands |
| SMBG | self monitoring blood glucose |
| describe Fasting blood glucose | after 8 hour fast normal blood sugar is 60-120, >126 is abnormal |
| OGTT | Oral Glucose Tolerance Test |
| Describe an OGTT | fast for 8 hrs, blood and urine collected for baseline, client ingests oral glucose solution, blood is drawn @ 30min, 1hr, 2hr, 3hr-urine collected @ same time, |
| how will a non-diabetic respond to a OGTT? | Blood glucose levels return to normal in 2 – 3 hours Urine is negative for glucose |
| how will a +diabetic respond to a OGTT? | Blood glucose levels return to normal slowly Urine is positive for glucose |
| PPBS | Postprandial blood sugar |
| Describe a PPBS | Fasting client is given a measured amount of carbohydrate solution orally, Blood drawn 2 hours after completion of oral intake Blood glucose > 160 mg/dl indicates DM |
| Test shows effectiveness of diabetic therapy for the preceding 8 – 12 weeks; Measures the amount of glucose bound to hemoglobin within the RBC | Glycosylation - HgbA1c |
| what is the normal HgbA1c? | 4-6%. Critical value is below 7, >8= avg blood glucose level apprx 200 |
| what are the goals in managing DM? | Achievement of optimal serum lipid levels Intake of adequate calories for client’s condition |
| Long term complications of DM | Renal disease Neuropathy Hypertension Cardiovascular disease |
| Some complex carbohydrates | rice, potatoes and bread |
| Insulin dependent clients are usually given ___ _____ and ______ snacks. | mid afternoon ; bedtime |
| What are 2 goals for diabetic clients? | Helping achieve normal blood glucose level < 126 mg/dl. Prevention and treatment of acute complications |
| insulin may be injected how? | Subcutaneously |
| short acting Insulin | regular, Humulin R or novulin insulin - ONLY Insulin that can be given IV |
| intermediate acting Insulin | NHP, Humulin N, Lente |
| long acting insulin | Ultralente, Humulin U |
| numbers for short acting insulin: | Onset: 30 – 60 min Peak: 3 – 6 hours Duration: 6 –8 hours |
| numbers for intermediate acting insulin | Onset: 60 –90 minutes Peak: 8 – 12 hours Duration: 24 hours |
| numbers for long acting insulin | Onset: 4 – 8 hours Peak: 16 – 19 hours Duration: 36 hours (book - 24 hrs) |
| other insulin | insulin Lispro(insulin pumps), Lantus-long acting, |
| r/t external infusion pump, how long is the cannula good for? | 72 hrs; External, battery operated computerized Worn on belt |
| signs of hypoglycemia | faintness, sudden weakness, diaphoresis, irritability, hunger, palpations, trembling, drowsiness |
| _______ insulin is used at lunch and bedtime to cover meal/snack | Regular |
| always draw up _____ insulin first | regular |
| Tolbutamide (Orinase), Chlorpropanamide (Diabinese), Glipizide (Glucotrol), Glyburide (Micronase) | oral hypoglycemics - Sulfonylureas |
| Oral Hypoglycemics - Non-sulfonylureas | Glucophage (Metformin) - Acts by inhibiting hepatic glucose production and increases sensitivity of peripheral tissue to insulin |
| what does Glucophage (Metformin) do in the body? | Acts by inhibiting hepatic glucose production and increases sensitivity of peripheral tissue to insulin |
| what does Precose (Acarbose) do in the body? | Acts by delaying the digestion of ingested carbohydrates Results in smaller rise of blood glucose after a meal |
| would a pancreas transplant be a surgical option for type I or type II DM? | Type I |
| a hormone secreted in response to decreased levels of glucose in the blood (secreted by the alpha cells | glucagon |
| a hormone secreted in response to the increased levels of glucose in the blood (secreted by beta cells). | Insulin |
| Promotes the conversion of amino acids to proteins in muscle, stimulates triglyceride formation, and inhibits the release of free fatty acids | Insulin |
| what insulin would you expect to give before breakfast? | combination of short-acting(Regular) and intermediate-acting (NPH) |
| which insulin would you expect to give before dinner? | short-acting(Regular) |
| which insulin would you expect to give before bedtime? | intermediate-acting (NPH) |
| Lispro is a _____ acting Insulin | rapid |
| what do oral hypoglycemics do within the body? | lower blood glucose by stimulating endogenous insulin secretion by beta cells of the pancreas and by increasing sensitivity to insulin at the intracellular receptor sites |
| what do Alpha-Glucosidase Inhibitors do within your body? | delays digestion of ingested carbohydrates, thus lowering blood glucose, especially after meals |
| Oral Hypoglycemics Category includes what drugs? | Alpha-Glucosidase Inhibitors. Biguanide. Meglitinides. Sulfonylureas. 1st Generation: rarely used. 2nd Generation. Thiazolidinediones |
| what are some contraindications for oral hypoglycemics? | Type 1 DM, severe kidney, liver, thyroid and other endocrine dysfunction. Avoid use in pregnancy or lactation |
| would elderly pts need the same amount of insulin or a reduced dose? | reduced dose |
| The purpose of the metformin | Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; improves insulin receptor sensitivity in the liver |
| ______ and _____ do not cause hypoglycemia when taken alone but may increase the hypoglycemic effect of other hypoglycemic agents. | Miglitol and Pioglitazone |
| Hypoglycemia may be treated by ingestion of _____ _____. | oral glucose |
| what are s/s of insulin and oral hypoglycemic toxicity and overdose? | Overdose is manifested by symptoms of hypoglycemia |
| Slide Scale Insulin may be required for patient exposed to: | Stress. Fever. Trauma. Infection. Surgery |
| what does the thyroid secrete and what is important for this to happen? | T3 / T4 ; iodine |
| what controls the thyroid? | controlled by the release of thyroid-stimulating hormone (TSH) from the pituitary gland. |
| what are the functions of the thyroid? | Growth and development. Metabolism. Activity of the nervous system |
| released by the thyroid gland. Decreases blood calcium levels by by causing calcium to be stored in the bones. | calcitonin |
| what are some contraindications for thyroid agents? | Hypersensitivity. Recent MI. Thyrotoxicosis. Known alcohol intolerance (liothyronine injection only). Hypersensitivity to beef (thyrar product). |
| what are some precautions for thyroid medications? | Cardiovascular disease (initiate therapy with lower doses). Severe renal insufficiency. Uncorrected adrenocortical disorders. Swallowing difficulty (levothyroxine tablets |
| r/r Geriatric pts, would you expect a typical adult dose or a reduced dose r/t thyroid meds? | markedly REDUCED |
| side effects r/t thyroid meds | HYPOtension, TACHYcardia, D/V, choking, gagging, hair loss, weight loss, heat intolerance |
| if heart rate is > than ____ we HOLD T3 | 100 |
| what are two antithyroid meds? | methimazole (Tapazole). propylthiouracil (PTU). |
| what are some side effects of antithyroid meds | CNS: drowsiness, headache, vertigo. GI: diarrhea, drug-induced hepatitis, loss of taste, nausea, parotitis, vomiting. Derm: rash, skin discoloration, urticaria. Hemat: agranulocytosis, anemia, leukopenia, thrombocytopenia |
| Propylthioruracil (PTU) is used for: | hyperthyroidism |
| Treatment of thyrotoxic crisis, and a supplement during long-term parenteral nutrition | iodine containing agents |
| what are the therapeutic effects of iodine agents | Control of hyperthyroidism. Decreased bleeding during thyroid surgery. Replacement/supplementation of iodine. Decreased incidence of thyroid cancer following radiation emergencies |
| give examples of iodine agents | potassium iodide (Pima, SSKI, Thyro-Block, Thyrosafe). sodium iodide (Iodopen). strong iodine solution (Lugol's solution). |
| Radioactive iodine isotopes will | The thyroid gland absorbs high concentrations of radioactive iodine, which destroys the hyperactive thyroid tissue with essentially no damage to other tissues in the body |
| antithyroid agents will cause what type of Lab differences | WBC and differential counts periodically throughout therapy, May cause increased AST, ALT, LDH, alkaline phosphatase, serum bilirubin and prothrombin time |
| r/t meals, when would you teach your pt to take antithyroid meds? | administer at same time in relation to meals every day. |
| if a dose of antithyroid meds are missed, when would you take the missed dose? | If a dose is missed, take as soon as remembered. Take both doses together if almost time for next dose |
| what s/s would you teach your pt to report r/t antithyroid meds? | sore throat, fever, chills, headache, malaise, weakness, yellowing of eyes or skin, unusual bleeding or bruising, rash, or symptoms of hyperthyroidism or hypothyroidism promptly |
| when you evaluate the effectivness of antithyroid meds, what are you looking for? | decrease symptoms of hyperthyroidism, return of thyroid to normal state, prepare pt for thyroidectomy or radiation therapy, prevent/tx for iodine deficiency. |
| Which nursing diagnosis may appear on a hyperthyroid patient’s care plan? | disturbed sleep pattern |
| The primary treatment for hypothyroidism is: | Levothyroxine (Synthroid) |
| what are some tx for hyperthyroidism? | Radioactive iodine, Propylthiouracil, Methimazole |
| what is used to prevent/tx hypocalcemia | electrolyte replacements |
| contraindications for electrolyte replacement | Hypercalcemia. Renal calculi. Ventricular fibrillation |
| side effects of electrolyte replacements | CNS: syncope (IV only), tingling. CV: cardiac arrest (IV only), arrhythmias, bradycardia. GI: constipation, nausea, vomiting. GU: calculi, hypercalciuria. Local: phlebitis (IV only). |
| what foods may decrease the absorption of calcium supplements? | cereals, spinach, or rhubarb |
| what are signs of hypercalcemia | Assess patient for nausea, vomiting, anorexia, thirst, severe constipation, paralytic ileus, and bradycardia |
| how do you diagnose hyperthyroidism? | serum t3 & t4 levels, Radioactive iodine uptake test (RAIU) Thyroid scan |
| what is the medical management for hyperthyroidism? | Administer drugs that block the production of thyroid hormones Propylthiouracil - Propyl-Thoracil, PTU Methimazole – Tapazole, Ablation Therapy Radioactive Iodine |
| what are some side effects from ablation therapy r/t hyperthyroidism | Abdominal pain, n/v, diarrhea, sore throat, neck pain and edema, Rash or pruritis N/V, abdominal pain Loss of taste |
| what is the surgical management for hyperthyroidism? | subtotal thyroidectomy |
| what are two nursing diagnoses r/t hyperthyroidism? | Hyperthermia, risk for, related to increased metabolism, Nutrition altered, less than body requirements related to increased metabolism |
| r/t hypothyroidism, what are some examples of symptomatic relief? | Keep room warm (68o - 74o F) Avoid hypothermia Encourage high-fiber, low-calorie diet Do not stop medication without consulting physician Emphasize need for regular medical checkups |
| what are two nursing diagnoses r/t hypothyroidism? | Cardiac output, decreased, related to decreased metabolism, Constipation related to decreased peristaltic action |
| how do you diagnose hyperthyroidism? | serum t3 & t4 levels, Radioactive iodine uptake test (RAIU) Thyroid scan |
| what is the medical management for hyperthyroidism? | Administer drugs that block the production of thyroid hormones Propylthiouracil - Propyl-Thoracil, PTU Methimazole – Tapazole, Ablation Therapy Radioactive Iodine |
| what are some side effects from ablation therapy r/t hyperthyroidism | Abdominal pain, n/v, diarrhea, sore throat, neck pain and edema, Rash or pruritis N/V, abdominal pain Loss of taste |
| what is the surgical management for hyperthyroidism? | subtotal thyroidectomy |
| who would you expect to have thyroid cancer? | caucasians and females |
| what are the three types of thyroid cancer | Papillary Follicular Anaplastic |
| Clinical Manifestations of thyroid cancer | Presence of a firm, fixed, painless nodule, palpable on examination |
| what are the diagnostic tests for thyroid cancer? | Thyroid scan "Cold" scan "Hot" scan Thyroid Function Tests (TFT) Needle biopsy |
| What possible complications are associated with total thyroidectomy? | Thyroid storm, tetany, excess bleeding |
| what function does your liver play r/t DM and normal metabolism? | Changes glycerol and fatty acids into glucose Changes glucose into triglycerides as needed Stores glucose in the form of glycogen |
| ONLY organs that can use free serum glucose without insulin | brain & kidney |
| Body attempts to rid itself of the excess glucose by excreting it in to the urine, this causes | glycosuria |
| To excrete the increased glucose, the kidneys require extra water for dilution, this causes | polyuria |
| Because the kidneys require extra water, the client develops excessive thirst, this causes | polydipsia |
| Client is often unable to drink enough fluids to compensate for volume loss, this causes | dehydration |
| Despite excessive glucose in blood stream, it can not be used by body without insulin, this causes | polyphagia |
| In spite of over eating, metabolism remains faulty, resulting in | weight loss |
| Carbohydrates can not be used properly Body’s fat and protein sources are broken down for energy, resulting in | ketoacidosis |
| what are 4 causes of IDDM | Autoimmune process Viral Genetic predisposition Chemical agents |
| Regular...whatever, this is everything but 'regular'...it's faster than the avg Joe | Regular insulin - fast acting |
| Not Puckin Happenin....not right now type of insulin | NPH - intermediate acting insulin |
| 36 hrs is nothing compared to 30 days of Lent. hey we have something in common.... | Ultralente - long acting insulin |
| Primary mineralcorticoid | Aldosterone |
| Mineralcorticoids | Involved in water and electrolyte balance, and indirectly manage blood pressure |
| what does Aldosterone do? | Causes retention of sodium; with sodium comes water to increase circulating blood volume Causes wasting of potassium and hydrogen |
| Primary glucocorticoid | cortisol |
| what does cortisol do? | Involved in glucose metabolism Provides extra energy in times of stress Also exhibits anti-inflammatory properties |
| Adrenal medulla releases two hormones during stress "Fight or Flight“...what are they? | Epinephrine Norepinephrine |
| Name the three types of steroids released by the adrenal glands | Mineralcorticoids Glucocorticoids Sex hormones |
| cushing's disease | mass release of hormones from adrenal glands |
| Rare condition in which the plasma levels of adrenocortical hormones are increased Body's protective feedback mechanism fails, with resultant excess secretion of the adrenal hormones: glucocorticoids, mineralcorticoids, and sex hormones | Cushing's Disease |
| Depression very common with possibility of suicide, mental changes, irritability, emotional instability, severe back ache, loss of libido, increase in appetite | Cushing's Disease |
| objective data r/t Cushings Disease | Presence of ecchymoses and petechiae Skin becomes thin and fragile Weight gain, edema and abdominal enlargement, with development of striae, buffalo hump, MOON FACE, HTN |
| More s/s of Cushings Disease | prolonged wound healing, Osteoporosis/kyphosis from abnormal calcium absorption, Women may experience hirsutism and menstrual irregularities |
| what are some diagnostic tests r/t cushings disease | Diagnosis usually based on clinical appearance and lab results Hyperglycemia, hypernatremia, hypokalemia Plasma cortisol elevated Plasma ACTH may be increased or decreased, depending on location of a tumor |
| More tests to diagnose Cushings Disease | Adrenal angiography (to identify tumors) 24-hr urine test for 17 - ketosteroids and 17-hydroxysteroids shows increased presence Abdominal CT, ultrasound to identify tumors |
| what is some medical tx for Cushings Disease | Treatment is directed toward the causative factor Adrenalectomy for adrenal tumor Pituitary tumors may be irradiated or removed surgically (Transphenoidal hypophysectomy |
| cytotoxic agent that is toxic to adrenal glands | Mitotane (Lysodern) |
| side effects for Mitotane (Lysodern) | depression, vertigo, hypertension, orthostatic hypotension, hepatotoxicity, GI upset, pruritis, maculopapular rash |
| what kind of diet would you expect for a pt in Cushings Disease | Lowered in sodium, reduce calories and carbohydrates. Foods high in potassium |
| Nursing interventions for a pt w/ Cushings Disease | strict I&O, watch for edema in extremities, watch for bony prominences, for open lesions, ulcers, & ecchymosis, use heel/elbow protectors & eggcrate mattress, monitor blood glucose |
| what are two nursing diagnoses r/t Cushings Disease | Knowledge deficit, related to therapeutic regimen, Activity intolerance, related to weakness and immobility, Excess fluid volume, related to sodium and water retention |
| an acute, emergency, life-threatening state of profound adrenal cortical insufficiency that occurs when the adrenal glands suddenly fail | Addisonian Crisis |
| Continually assess for signs of developing adrenal (Addisonian) crisis such as | Sudden, severe drop in B/P (hypotension) Anorexia, nausea and vomiting Extremely high temperature Diarrhea, abdominal pain Profound weakness Headache, restlessness or fever |
| adrenal crisis is an emergency: death may occur from | hypotension and vasomotor collapse |
| what kind of tx would you expect r/t Addisonian crisis? | Corticosteroids via an intravenous solution of normal saline and glucose Antibiotics are administered due to extremely low resistance to infection |
| Chromaffin cell tumor, usually found in the adrenal medulla, that causes excessive secretion of epinephrine and norepinephrine | Pheochromocytoma |
| The principle manifestation of pheochromocytoma is ___ | HTN; as high as 300/175 |
| subjective assessment r/t phenochromocytoma | Presence of severe headache, palpitations, anxiety Severe hypertension Tremors, nervousness, dizzy and dyspnea Nausea and intolerance to heat Paresthesias (an abnormal sensation, such as burning, prickling, tickling, or tingling) |
| objective assessment r/t phenochromocytoma | Severe hypertension- resulting in potential CVA, kidney damage, retinopathy, cardiac damage may result in heart failure Tachycardia, tremors, diaphoresis, and dilated pupils Hyperglycemia, glycosuria |
| if you were going to teach your pt about an Andrenalectomy, what would you tell them? | Surgically approached by means of an abdominal or flank incision under and following the position of the 12th rib |
| Post-op care after an Andrenalectomy would include | Observe for hemorrhage, atelectasis, and pneumothorax |
| Monitor VS carefully for signs of adrenal insufficiency would include | Hypotension Nausea, vomiting Hypoglycemia Muscle weakness |
| what type of diet would be ordered after an Andrenalectomy | Diet - free from stimulants, such as coffee, tea and soft drinks containing caffeine |
| what is the function of the pituitary gland? | Controls functions over the other endocrine glands through the negative feedback syste Secretes hormones that activates other indocrine glands |
| the anterior pituitary releases which hormones? | FSH, LH, MSH, Prolactin, GH, TSH, ACTH |
| the posterior pituitary releases which hormones? | vasopressin, oxytocin, ADH |
| overproduction of the Growth Hormone | Acromegaly |
| what are some s/s of acromegaly? | big head and lower jaw, bulging forehead, thick lips, enlarged tongue, large hands and feet |
| objective findings r/t acromegaly | Bone enlargement and joint involvement Gait changes and inability to perform activities Dyspnea, tachycardia, weak pulse and hypotension – signs of early heart failure |
| what is a medical tx / drug that can be used for acromegaly? | Bromocriptine mesylate (Parlodel) Antipartkinsonian drug that inhibits the release of GH, Somatostatin analogues (which inhibit GH), Octrotide (sandostatin) |
| Transphenoidal hypophysectomy | removal of tumor tissues through the nose |
| what are some causes for Diabetes Insipidus | malfunction of posterior pituitary, head injury, infections |
| s/s of DI | polyuria, polydipsia, pt craves ice or water, hypernatremia, severe dehydration |
| what are some objective sign for DI? | poor skin turgor, urine color, I&O, weight loss, constipation |
| List three clinical manifestations of Diabetes insipidus? | Polyuria, Urine specific gravity <1.005, Hypernatremia |
| Kidneys to conserve water by decreasing the amount of urine produced. Also constricts the arterioles, which results in increased blood pressure. Referred to as vasopressin | ADH |
| what are some actions of Vasopressin? | Alters the permeability of the renal collecting ducts, allowing reabsorption of water. Directly stimulates musculature of GI tract, nonadrenergic peripheral vasoconstrictor |
| what are some precautions of vasopressin? | Comatose patients. Seizures. Migraine headaches. Asthma Heart failure. Cardiovascular disease |
| vasopressin side effects | "pounding" sensation in head, MI, angina, chest pain, allergic reactions, fever, water intoxication, |
| vasopressin nursing implications | Monitor BP, HR, and ECG periodically throughout therapy and continuously throughout cardiopulmonary resuscitation |
| constriction of the airway causing dyspnea with long, crowing respirations as the air tries to get past the constriction | Laryngospasms |
| too much calcium causes: | Kidney stones Depressed neural function Calcium deposits in soft tissues |
| too little calcium causes: | Muscle tetany Osteoporosis Retarded growth in children |
| function of parathyroid | Increases the concentration of calcium and regulates the amount of phosphorus in the blood |
| subjective signs of hypoparathyroidism | Complaint of dysphagia Complaint of numbness and tingling Anxiety, irritability, depression Headaches, nausea Kidney stone formation due to increased renal excretion |
| objective signs of hypoparathyroidism | Positive Chvostek's sign Positive Trousseau's sign Laryngeal spasm/stridor Decreased cardiac output Spasms of the extremities, N/V, convulsions, cardiac dysrhythmias |
| r/t diagnosing hypoparathyroidism, which way would calcium and phosphate present? | hypocalcemia, hyperphosphatemia |
| what are medical management steps for a pt with hypoparathyroidism | Intravenous calcium gluconate or calcium chloride Vitamin D Bronchodilators may be ordered Endotracheal intubation and mechanical ventilation may be necessary A diet high in calcium and low in phosphorus is usually recommended |
| what items should you keep at bedside r/t a pt w/ hypoparathyroidism? | emergency tracheostomy tray, airways, mechanical ventilation, and endotracheal intubation equipment |
| what are some things you will want to teach your pt r/t hypoparathyroidism? | understanding of medication and diet, s/s of hypocalcemia |
| loss of Ca+ from bones, Increased urinary excretion of phosphorus Bones become demineralized as calcium leaves and enters the bloodstream is related to | HYPERparathyroidism |
| what type of diet would you teach your pt r/t hypothyroidism? | high-fiber, low calorie |
| what are two nursing diagnoses r/t hypothyroidism? | Cardiac output, decreased, related to decreased metabolism, Constipation related to decreased peristaltic action |
| what is the etiology of a goiter? | thyroid gland enlarges, low T3 signals pituitary gland, inadequate intake of iodine |
| what are two types of medical mngt r/t a goiter? | oral potassium iodine, iodine rich foods |
| what are three post-op complications r/t a goiter? | thyroid storm, bleeding, tetany |
| what are two nursing diagnoses r/t a goiter? | Noncompliance, risk for, related to therapeutic regimen, Body image, disturbed, risk for, related altered physical appearance |
| what are examples of medical management r/t hyperparathyroidism? | removal of hypertrophied gland tissue, observe for s/s of hypoparathyroidism, post-op is similar to thyroidectomy |
| What is the name of the hormone secreted by the parathyroid gland | PARATHORMONE |
| OVER PRODUCTION OF PARATHORMONE RESULTS IN INCREASED LEVELS OF WHAT ELECTROLYTE IN THE BLOOD? | calcium |
| WHAT ARE POSSIBLE COMPLICATIONS OF HYPERCALCEMIA | PATHOLOGIC FRACTURE CARDIAC ARRHYTHMIAS RENAL DISEASE NAUSEA/VOMITING |
| WHAT IS THE MOST COMMON CAUSE OF HYPOPARATHYROIDISM | trauma |
| WHAT IS THE MEDICAL CARE FOR A PATIENT WITH HYPOPARATHYROIDISM | CALCIUM GLUCONATE ET BRONCHODILATORS VIT D HIGH CA, LOW PO4 DIET |
| what part of the body provides the fastest, lease variable absorption r/t insulin? | abdomen |
| how would you teach your DM pt to care for their feet? | poor circulation=decreased feeling=likelihood of infection. thoroughly wash w/soap and water daily, dry fee and look for blisters, cracks, and foreign objects. CHECK BETWEEN TOES |
| what are some other examples of pt teaching r/t foot care r/t DM? | foot soaks and powders not recommended, clean socks daily, avoid tight garters, cut toenails straight across, no hot water or heating pads on feet-will burn you |
| what kind of shoes would you teach/recommend for a DM pt? | sturdy, proper fitting, wide toe box, PUT SHOES ON! NO BARE FEET! |
| a DM pt is prone to circulatory disturbances. Where? | arteriosclerosis, lower extremities, kidneys, eyes, and heart |
| Decreased blood supply to the skin and peripheral nerves result in | Decreased ability to fight infection Delayed wound healing Cramping |
| Any abnormal condition characterized by inflammation and degeneration of the peripheral nerves | neuropathy |
| what is most affected by neuropathy? | Legs |
| Microvascular changes affect retinal capillaries, may cause cataracts and retinal detachment | Diabetic retinopathy |
| _________ and _______ imbalances occur due to the elevated blood glucose | hypovolemia and electrolyte |
| when ketones accumulate in the blood, pH ____ | decreases |
| what are Kussmaul's respirations | Client begins to hyperventilate in an effort to blow off CO2 to counteract the fall in pH |
| early s/s of ketoacidosis | Weakness Drowsiness Vomiting Thirst Abdominal pain Dehydration Hot, dry skin Flushed cheeks Dry mouth |
| early s/s of ketoacidosis | Kussmaul’s breathing Sweetish odor on breath Acetone Hypotension Rapid weak pulse Restlessness Stupor, coma, Death |
| T/F: when treating ketoacidosis, make an effort to correct the hyponatremia imbalance by introducing high levels of NS fluids | False. cerebral edema may occur with sudden influx of fluids |
| blood glucose below less than 60 | hypoglycemia |
| initial symptoms of HYPOglycemia | Faintness Sudden weakness Diaphoresis Irritability Hunger Palpitations Trembling Drowsiness Pallor Headache Nausea/vomiting Personality changes |
| intermediate s/s of HYPOglycemia | Dizziness Confusion Loss of speech Unable to control body movements Diplopia, blurred vision |
| late s/s of HYPOglycemia | Convulsions Unconscious Brain damage Death |
| T/F: r/t hypoglycemia, restore normal blood sugar as soon as possible | True. administer rapid acting simple carbohydrate |
| Addison's Disease = arenal ___ | HYPOfunction |
| what are some of the things that can cause Addison's Disease? | Adrenalectomy Pituitary hypofunction Longstanding steroid therapy Idiopathic adrenal atrophy Cancer of the adrenal cortex Tuberculosis Autoimmune response |
| what two hormones are the cause of Addison's disease | decreased cortisol and aldosterone |
| s/s of Addison's disease | nausea, anorexia and craving for salt, hypotension, Vertigo, weakness, and syncope, Severe headache, disorientation, abdominal pain, |
| Changes in the color of the mucous membranes and skin, with darkly pigmented areas, weight loss, N/V | objective data r/t Addison's Disease |
| what is a test that could be ordered to diagnose Addison's Disease | 24 hr urine, fasting plasma, |
| what type of diet would you expect r/t Addison's Disease | Diet high in sodium and low in potassium |
| what nursing intervention would make most sense r/t Addison't Disease | especially monitor BP and Temp, daily weights, I&O's, |
| what are some nursing diagnoses r/t Addison't Disease? | Infection, risk for, related to altered metabolic processes, Tissue perfusion, ineffective peripheral, related to volume depletion secondary to electrolyte imbalance |
| T/F: medical or surgical tx for pituitary d/o can reverse the physical changes and the pt will never develope other complications. | False. The physical changes are irreversible and pt is prone to developing complications |
| defects of the hypothalamus which directs the anterior pituitary to release excess amounts of GH | Gigantism |
| happens in childhood before the closure of the epiphyses; overgrowth of the long bones that result in the attainment of great height | gigantism |
| pt will appear well proportioned and well nourished but appear younger than their chronological age | dwarfism |
| what are two characteristics of a pt with dwarfism? | child is a great deal shorter than peers, well proportioned, but smaller. sexual development is usually normal but delayed, may produce normal offspring |
| what medication could be expected to tx acromegaly? | dopamine agonists |
| This is not a complete set of the information. The drug section is not competely covered | good luck |
Created by:
jrstrader
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