Endocrine
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| Laryngospasms | constriction of the airway causing dyspnea with long, crowing respirations as the air tries to get past the constriction. cyanosis may be present and the patient may be in danger of asphyxia and cardiac dysrhythmia. In response to hypocalcemia.
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| trousseau's sign- | Inflate BP cuff on the upper arm, above the systolic reading, and hold, wait 3 mins and observe client for carpo-pedal spasm ( spasm of hand flexing inward)
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| Chvostek's sign | Patient's mouth twitches and jaw tightens when facial nerve is tapped.
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| laryngospasms, trousseau's and chvostek's...... | are signs common in patients with HYPOparathyroidism. Common for checking hypocalcemia
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| Parathyroid glands | are located on the posterior surface of the thyroid gland. release increases reabsorption of calcium and magnesium from kidney tubules and increases elimination of phosphorus by kidneys.
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| what is the function of the parathyroid glands? | to secrete parathyroid hormone, increase concentration of calcium, and regulate the amount of phosphorus in the blood.
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| What is the function of the thyroid gland? | -regulates metabolism, growth and development, and activities of the nervous system
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| Where is the Thyroid Gland located? | -Just below the larynx on either side of the trachea
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| Etiology-HYPERthyroidism (Graves’ disease) | overproduction of the thyroid hormones, resulting in exaggerated metabolic processes. Cause is unknown.
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| Clinical manifestations- HYPERthyroidism (Graves’ disease) | vary from mild to severe, anterior neck enlargement, exophthalmos (bulging eyes)
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| Subjective Assessment- HYPERthyroidism (Graves’ disease) | Decreased ability to concentrate, presence of memory loss, Dysphagia or hoarse voice, Weight loss even with increased appetite, Complaint of nervousness, jittery, excitable, Insomnia, Emotionally labile, may overreact to stress
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| Objective assessment- HYPERthyroidism (Graves’ disease) | Tachycardia, hypertension, edema of anterior portion of neck, Exophthalmos, elevated body temp, intolerance to heat, skin is warm and flushed with profuse diaphoresis, Tremors of hands, cessation of menses, weight loss.
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| Diagnosis- HYPERthyroidism (Graves’ disease) | Increased serum T3 and T4 levels, Radioactive Iodine uptake test (RAIU) , thyroid scan
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| Med management- HYPERthyroidism (Graves’ disease) | Administer drugs blocking production of thyroid hormones (propylthiouracil, or methimazole), Ablation therapy
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| Surgical management- HYPERthyroidism (Graves’ disease) | Subtotal thyroidectomy: 5/6th of thyroid removed; risk of excessive bleeding; hypothyroidism, vocal cord paralysis.
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| Nursing interventions- HYPERthyroidism (Graves’ disease) | Hyperthermia: Assess body temp every 4 hrs. Keep room cool. Keep skin dry and clean. Encourage food and fluids to replace electrolytes. Altered nutrition: high calorie diet plus vitamins. Snacks between meals. Avoid caffeine. Assess weight daily.
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| Etiology- HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | decreased hormone secretion of thyroid gland; primarily effects women 30-60 years old. Failure of anterior pituitary to secrete adequate TSH for proper stimulation. Side effects of surgical tx of HYPERthyroidism
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| Clinical manifestations- HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | mild to severe depending of deficiency; hypothermia/intolerance to cold; weight gain; development of atherosclerosis/ CAD
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| Subjective Assessment-HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | impaired memory, slow thought processes. Depression or paranoia. Lethargy, forgetfulness and irrability. Anorexia and constipation. Decreased libido and reproductive difficulty. Menstrual irregularities. Speech and hearing impairment.
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| Objective assessment- HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | bradycardia, hypotension and bradypnea. Facial features become enlarged and edematous. Voice low and hoarse. Exercise intolerance. Weakness, clumsiness and ataxia. Ileus.
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| Diagnosis- HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | Physical exam and history. Lab test ( TSH, T3, T4 levels) to identify if hypo secretion is from anterior pituitary or thyroid.
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| Med management-HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | replacement therapy (cytomel, proloid, armhour). Side effects include palpitations, tachycardia, nervousness, headache, insomnia, vomiting, diarrhea, weight loss, sweating and heart intolerance.
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| Nursing interventions- HYPOthyroidism (severe in adults= myxedema; congenital= cretinism) | Meds given in the morning. Initially low dose, increased gradually. Establish maintenance dose. Symptomatic relief.
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| Etiology- Goiter | develops when thyroid gland enlarges. Low circulating T3 levels signal the pituitary gland. Attributed to inadequate dietary intake of iodine.
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| Subjective Assessment- Goiter | emotional response to enlargement, dysphagia, hoarseness, dyspnea
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| Objective assessment- Goiter | Increase goiter size, voice changes, adequacy of food and fluid intake.
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| Diagnosis- Goiter | History and physical
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| Med management- Goiter | Thyroidectomy surgery can be done to improve respiration and swallowing, or cosmetic effect. Most of gland is removed. Medical treatment consists of oral administration of oral potassium iodine and food high in iodine.
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| Nursing interventions- Goiter | prevent post-op complications such as thyroid storm, bleeding, and tetany. Dietary and med regimen education. Encourage patient to express feelings about treatment plan.
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| What dietary information is important for the patient to know when he/she has a goiter? | -The importance of taking in adequate dietary intake of iodine.
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| Etiology- Thyroid cancer | Rare malignancy. More frequent in female Caucasians. Cancer grows slowly, usually contained and does not spread beyond adjacent lymph nodes. Types: papillary, anaplasticand follicular.
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| Clinical manifestations- Thyroid cancer | presence of a firm, fixed, small, rounded painless nodule that is palpable on examination. In rare instances, symptoms of hyperthyroidism are seen.
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| Subjective Assessment-Thyroid cancer | Patient coping and support system. Importance of medical follow up.
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| Objective assessment-Thyroid cancer | progression of tumor are post operatively . Response to therapy and skin involvement in neck and torso after radiation.
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| Diagnosis-Thyroid cancer | thyroid scan shows a “cold” nodule for papillary thyroid cancer. Benign adenomas and follicular cancers are seen as “hot” nodules. To confirm diagnosis, thyroid needle biopsy may be done.
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| Med management- Thyroid cancer | Radiation, chemo, radioactive iodine treatment.
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| Surgical management- Thyroid cancer | Total thyroidectomy with lifelong thyroid replacement therapy. Radical neck dissection with metastasis.
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| Nursing interventions- Thyroid cancer | Monitor patients level of anxiety. Try to decrease stressors. Help identify successful coping methods.
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| What is the risk involved in needle biopsy? | Possibility of “seeding” adjacent tissue with cancer cells causing metastasis.
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| What possible complications are associated with total thyroidectomy? | Thyroid storm, tetany, excess bleeding.
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| What is the location and function of the adrenal glands? | Lie atop the kidneys; help regulate chemical balance, regulate metabolism, and supplement other glands.
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| Name the three types of steroids released by the adrenal glands. | Mineralcorticoids(aldosterone)
Glucocorticoids (Cortisol)
Sex hormones
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| Glucocorticoids- | (Cortisol)- Glucose metabolism, Energy in times of stress, Anti-inflammatory properties
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| Sex hormones- | Androgensmale hormones. Estrogens female hormones.
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| Mineral corticoids(aldosterone)- | Water and electrolyte balance, Indirectly manage blood pressure
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| Etiology/pathophysiology- Cushing’s syndrome (adrenal hyperfunction) | More common in women. Hyperplasia of adrenal tissue. Tumor of the adrenal cortex. Excess secretion of the adrenal hormones, and increased adrenocortical hormones.
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| Clinical manifestations-Cushing’s syndrome (adrenal hyperfunction) | Hyperglycemia, hypernatremia, hypokalemia, Plasma cortisol elevated, Plasma ACTH may be increased or decreased
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| Subjective assessment-Cushing’s syndrome (adrenal hyperfunction) | Irritable, Mental changes, Emotional instability, Depression, Loss of libido, Severe backache, Appetite change
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| Objective assessment- Cushing’s syndrome (adrenal hyperfunction) | Ecchymoses and petechiae, Skin-thin and fragile, Weight gain, Hypertension, Muscle wasting, Moon face, Buffalo hump, Prolonged wound healing, Increased susceptibility to infection, Osteoporosis/ kyphosis, Women- Hirsutism and menstrual irregularities
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| Diagnosis- Cushing’s syndrome (adrenal hyperfunction) | Adrenal angiography, 24-hr urine, Abdominal CT, Ultrasound
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| Medical management- Cushing’s syndrome (adrenal hyperfunction) | Treat causative factor, Adrenalectomy, Pituitary tumors-irradiated or removed surgically. Mitotane (Lysodern)
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| Nursing interventions- Cushing’s syndrome (adrenal hyperfunction) | Strict I&O, Examine extremities, Inspect skin daily, Use of heel/elbow, protectors & eggcrate mattress, Monitor blood glucose level. Encourage patient to maintain normal ADL’s. Monitor for signs/symptoms of depression or suicidal thoughts.
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| Etiology/pathophysiology-Addison’s Disease (adrenal hypofunction) | Inadequate secretion of glucocorticoids (cortisol) & mineralcorticoids (aldosterone). Deficiencies in aldosterone and cortisol. Electrolyte and fluid imbalance.
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| Clinical manifestations-Addison’s Disease (adrenal hypofunction) | glucocorticoid and mineralocorticoid deficiency. Impotence and decreased libido in males, amenorrhea in females. Myalgias and flaccid muscle paralysis may occur due to hyperkalemia Dizziness with orthostasis due to hypotension.
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| Subjective assessment- Addison’s Disease (adrenal hypofunction) | Nausea, anorexia and salt craving. Postural hypotension. Vertigo, weakness, and syncope. Severe headache, disorientation, abdominal pain. Anxious and apprehensive.
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| Objective Assessment- Addison’s Disease (adrenal hypofunction) | Skin hyperpigmentation. Weight loss. Hypoglycemia. Abnormal temperature. Hyponatremia and hyperkalemia
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| Diagnosis- Addison’s Disease (adrenal hypofunction) | Hyponatremia, hypoglycemia, hyperkalemia. 24-hr urine. Cortisol & aldosterone are low
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| Medical management- Addison’s Disease (adrenal hypofunction) | Prompt restoration of fluid and electrolyte balance. Replacement of deficient adrenal hormones. Diet high in sodium and low in potassium.
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| Nursing interventions-Addison’s Disease (adrenal hypofunction) | Assess circulatory status. Monitor vital signs. Screen visitors. Observe for signs and symptoms of hypoglycemia.
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| Deficiencies in aldosterone and cortisol will produce what type of metabolic disturbances? | -Deficiencies in aldosterone and cortisol produce disturbances of the metabolism of carbohydrates, fats, proteins, as well as sodium, potassium, and water
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| Define Addisonian crisis- | An acute, emergency, life-threatening state of profound adrenal cortical insufficiency that occurs when the adrenal glands suddenly fail
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| Nursing care of a patient in Addisonian crisis- | Only responds to vasopressin
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| What are the signs/symptoms of Addisonian Crisis? | - Symptoms may include anorexia, nausea and vomiting, diarrhea, abdominal pain, headache, hypotension, restlessness, and fever.
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| What are the signs/symptoms of pheochromocytoma? | -Presence of severe headache, palpitations, anxiety.Severe hypertension. Tremors, nervousness, dizzy and dyspnea. Nausea and intolerance to heat. Paresthesias. Tachycardia, tremors, diaphoresis, and dilated pupils. Hyperglycemia. Glycosuria
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| What is the most common symptom of pheochromocytoma? | -Severe hypertension
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| The nurse is administering lispro insulin, and should keep in mind that this insulin is: | A rapid-acting insulin ->Lispro insulin is a rapid-acting insulin.
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| A 48-year-old is diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The purpose of the metformin, in this situation, is to: | -Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.
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| When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, which are: | -Irritability and confusion are early signs of hypoglycemia.
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| The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? | -If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill.
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| The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5 1/2 NS). What effect may saline solution have on calcium chloride? | - Calcium for IV use should be mixed with D5W, not a saline solution. Sodium encourages calcium loss.
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| Which vitamin promotes calcium absorption from the GI tract? | - Vitamin D.The pH affects the amount of circulating free ionized calcium.When pH is decreased (acidic), there is more free calcium because it has been released from protein-binding sites.With an increased pH (alkalosis) more calcium is bound to protein.
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| Thyroid Agents | -Replacement or substitution in diminished or absent thyroid function.
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| Antithyroid Agents | - Palliative treatment of hyperthyroidism. Adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
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| What is Propylthioruracil (PTU) is used for? | -Propylthiouracil (PTU) is used for hyperthyroidism.
Propylthiouracil (PTU) is used to reduce the synthesis of new thyroid hormones.
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| What are the two cardinal features of a patient with diabetes insipidus? | hypernatremia and dilute urine
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| What regulates thyroid hormone release? | Thyroid stimulating hormone (TSH)
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| Why is Propanolol used in the treatment of thyroid storm? | Propanolol alleviates the peripheral effects of thyroid hormones on the cardiovascular system.
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| In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), which of the following interventions would be appropriate? | insulin IV via infusion pump
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| Question 7: Which of the following is a feature of Cushing syndrome? | Increased susceptibility to infection
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| What are the five signs and symptoms of diabetes insipidus? | Polydipsia (increased thirst), high output of dilute (hyposmotic) urine (polyuria), hypernatremia, hypovolemia (dehydration), hypotension
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| : name the rapid/short acting insulins? | Lispro (Humalog), Aspart (NovoLog), Gluisine (Apidra), Humulin R
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| You are caring for a patient who has undergone a thyroidectomy. Which of the following signs or symptoms should be reported immediately to the RN/MD for further evaluation? | numbness in fingers, HR of 160, noticeable arm twitching when you took pt’s BP.
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| When a nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs, what information should the nurse obtain from the client? | plan of injection rotation
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| A characteristic of hyperparathyroidism is increased serum __________ levels | Calcium
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| A chemical messenger, which travels throughout the bloodstream to its target organ, is known as a(n): | Hormone
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| What type of insulin is NPH (Humulin N/Novolin N) classified as? | Intermediate acting
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| A patient taking rosiglitazone (Avandia) tells the nurse, "There's my inulin pill." Which information will the nurse provide to the patient regarding the mechanism of action of rosiglitazone? | It decreases insulin resistance
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| : When monitoring a patient who is taking corticosteroids, the nurse observes for which adverse effects (select all that apply)? | fragile skin, increased glucose levels, nervousness
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| What condition results from all treatments for hyperthyroidism? | hypothyroidism
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| Which information should be included in the nurse's teaching of patients taking thyroid medications? | Nervousness, irritability, and insomnia may be a result of a dosage that is too high; keeping a log or journal of individual responses and a graph of pulse rate, weight, and mood would be helpful; the medication should be taken at the same time every day
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| When is the appropriate time to administer a patient's AC dose of insulin who is receiving Humulin R | 30 mins before meal
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| ______ may produce hypoglycemia and mask signs and symptoms of hypoglycemia. | beta blockers
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| A patient who is beginning therapy with levothyroxine (Synthroid) asks the nurse when the medication will start working. What is the nurse's best answer? | within a few weeks
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| Select the following true statement(s) about diabetes mellitus, type 2. | The main problem in this disease seems to be abnormal resistance to insulin action
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| : You are caring for a patient with Addison's disease. Which of the following signs would you expect? | postural hypotension
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| Insulin is secreted by ___________ from the _________. | beta cells, Islets of Langerhans
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| Which of the following medications works primarily by stimulating the beta cells of the pancreas to release insulin? | Glipizide (Glucotrol)
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| What occurs in the syndrome of inappropriate antidiuretic hormone (SIADH) secretion? | Answer: there is excessive reabsorption of water from renal tubules secondary to high levels of circulating ADH
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| The physiological effects of metformin (Glucophage) on the body include: | decreases glucose production by the liver, decreases intestinal absorption of glucose, improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue
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| The disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH) is called? |
diabetes insipidus
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| What are some signs and symptoms of Graves’ disease? | increased sweating, intolerance to heat, weight loss, varying degrees of diarrhea
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| What are the symptoms of inappropriate antidiuretic hormone secretion? | hyponatremia and hyperosmotic plasma
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| : Which of the following are characteristics of a type I diabetic? | Caused by an insulin deficiency, and insulin dependent
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| : Which of the following drugs can be used in the treatment of hyperthyroidism? | Potassium iodide, Levothyroxine (Synthroid), Propylthioruracil (PTU)
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| : While monitoring a patient who is receiving insulin therapy, the nurse observes for which signs of hypoglycemia? | Irritability, sweating, and confusion
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| The four components for treatment for the syndrome of inappropriate antidiuretic hormone section are remove the underlying cause, antagonize the effects of ADH on the renal tubule, administer hyperosmotic saline with or without diuretics, and? | restrict water intake
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| What is the cause of diabetes insipidus? | Failure to release antidiuretic hormone (ADH) from the posterior pituitary
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| The parathyroid gland regulates what two electrolytes? | Calcium and phosphate
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| What is the only insulin that can be used intravenously? | Regular
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| the anatomy and physiology of the pituitary gland- THE MASTER GLAND! | Controls/communicates the functions over the other endocrine glands by the negative feedback system. Secretes hormones that activate other endocrine glands in response to low circulating levels of that hormone or decreased function of the endocrine gland.
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| acromegaly-etiology/ pathophysiology | An overproduction of somatotropin (growth hormone or GH) in the adult. Can be caused by: Idiopathic hyperplasia of the anterior pituitary gland; Tumor growth
Growth changes are irreversible.
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| acromegaly-clinical manifestations | Large cranium/lower jaw. Bulging forehead/bulbous nose/thick lips. Enlarged tongue/coarsening of facial feats. Partial blindness/severe headache Hepato/Cardio/Splenomegaly. Stiff/painful joints.Males= impotent.Females=deepened voice/facial hair.
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| acromegaly- assessment | Subjective:Headaches, visual disturbances, Muscle weakness,Decreased ability to ADL’s, Sexual problems
Objective:Bone and joint,Gait changes, Inability to perform activities, Dyspnea, tachycardia, weak pulse and hypotension = early heart failure
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| acromegaly-diagnosis | Based on the patient’s history/clinical manifestations.
Computed Tomography (CT Scan) and cranial radiographic evaluation.
Laboratory test- confirms elevated serum Growth Hormone (GH) levels.
Oral glucose challenge test is definitive
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| acromegaly-pharmacology | Bromocriptine mesylate-Parlodel- inhibits release of GH. side effects: headache, nausea, nasal congestion and abdominal cramps.
Octreotide (Sandostatin)which inhibit GH, for patients who are not candidates for surgery or radiation therapy.
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| acromegaly-medical management | Transphenoidal hypophysectomy- removal of tumor tissues through the nose.
Irradiation procedures using proton bean therapy have been used to destroy GH- secreting tumors.
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| acromegaly-nursing management | Teach/assess understanding of treatment regimen,
complications,
exercises that can be done at home to help prevent muscle atrophy and loss of movement,
spacing activities to prevent fatigue.
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| gigantism-etiology/ pathophysiology | Over secretion of (GH) as a result of hyperplasia of anterior pituitary.Defect in the hypothalamus
directs the anterior pituitary to release excess amounts of GH. may be caused by certain genetic disorders of by disturbance in sex hormone production.
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| gigantism-clinical manifestations | In childhood before closure of the epiphyses:
Overgrowth of the long bones=great height
Increased muscle/visceral development
Weight increase, body proportions are usually normal.
Despite their size these pts are usually weak.
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| gigantism- assessment | Subjective:
Understanding of disease process
Emotional state
Objective:
Height measurement
Muscle strength determination
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| gigantism-diagnosis | The GH suppression test ( AKA glucose-loading test)
Reveals elevated baseline GH levels.
Criterion standard: The “inability to suppress serum GH level
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| gigantism-medical management | Surgical removal of tumor tissue.
Irradiation of the anterior pituitary gland.
Replacement of pituitary hormones as indicated.
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| gigantism-prognosis | Increased life expectancy than before but Still shorter than average individual
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| gigantism-nursing management | Provide emotional support.
Teach/assess understanding of condition.
understanding importance of regular follow-up with and endocrinologist.
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| dwarfism-etiology/ pathophysiology | Deficiency in growth hormone.
Most cases are idiopathic but small number caused by autosomal-recessive trait
In some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and gonadotropins
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| dwarfism-clinical manifestations | -Shorter than their peers
-Well proportioned/well nourished; look younger than chronological age
-Underdeveloped jaws=problems with dentition as the permanent teeth erupt
-Sexual development=normal but delayed
-Normal intelligence & normal offspring
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| dwarfism- assessment | Subjective:Patient understanding,Emotional state,Family history of dwarfism, Onset of growth retardation, complain of headache, visual disturbances, or behavior changes.
Objective: Regular measurement of height and weight, Compare with siblings
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| dwarfism-diagnosis | Radiographic evaluation, Decreased plasma levels of growth hormone
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| dwarfism-medical management | Medication regimen
-GH injection
-Other hormonal replacements
Surgical removal of tumors
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| dwarfism-prognosis | -Lead fairly normal lives
-Produce normal children
Complications:
-Musculoskeletal
-Cardiovascular
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| dwarfism-nursing management | Early identification
Emotional support
Patient teaching
-Wearing of age-appropriate clothing
-Engage in activities
-Emphasize strengths and abilities
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| diabetes insipidus-etiology/ pathophysiology | Deficiency in ADH; Transient or permanent metabolic disorder.
Primary- malfunction of the posterior pituitary
Secondary-head injury, intracranial tumor,
intracranial aneurysm, or infarct,Infections,
encephalitis or meningitis.
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| diabetes insipidus-clinical manifestations | Marked polyuria & Intense polydipsia.
Dilute urine, looking much like water, with a low specific gravity.
Urinary output may exceed 3 to 4 L in a 24hrs.
Urine output exceeds 200mL an hour for over 2 hrs.
experience dehydration/hypernatremia.
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| diabetes insipidus-assessment | Subjective:Understanding of condition,Severity of thirst,
Nocturia,
Weakness, tiredness and lethargy,Avoidance of social situation
Objective:Poor skin turgor,Urine color and specific gravity,Strict I & O, Weight loss, Constipation
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| diabetes insipidus-diagnosis | -Based on clinical manifestations
Urine specific gravity < 1.003
Serum sodium level > 145 mEq/L)
Serum osmolality >300 mOsm/hg (280-300)
Water deprivation test
Radiographic evaluation
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| diabetes insipidus-medical management | Vasopressin/ desmopressin
-Increases water resorption
-IV, IM, SQ, Nasal, oral
Eliminate caffeine
-coffee, tea, and other R/T diuretic effect
Monitor fluid and electrolyte balance
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| diabetes insipidus-prognosis | Depends on etiology
Will require medication for life
May still lead a relatively normal life
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| diabetes insipidus-nursing management | Closely monitor vital signs: BP lying, standing
Instruct patient to wear medical alert jewelry
Teach/assess understanding of disease process and medical regiment/ importance of continuity of medications
Ensure patient remains under medical supervision
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| Syndrome of Inappropriate Antidiuretic Hormone- etiology/ pathophysiology | -Pituitary releases too much ADH
-Kidneys reabsorb more water
-Urine output decreases
-Circulating volume expands
Risk factors:Medications,Malignancies,Nonmalignant pulmonary disease,Nervous system disorders,Miscellaneous
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| Syndrome of Inappropriate Antidiuretic Hormone- clinical manifestations | -Hyponatremia
-Hemodilution
-Fluid overload without peripheral edema
-Water retention that progresses to water intoxication
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| Syndrome of Inappropriate Antidiuretic Hormone- assessment | subjective: vage complaints; weakness, muscle cramps, anorexia, nausea, headache
Objective: hyponatremia (triggers diarrhea), change in LOC, weight gain, PO intake, minimal peripheral edema, dyspnea/ crackles.
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| Syndrome of Inappropriate Antidiuretic Hormone- diagnosis | -Hyponatremia (Sodium < 134 mEq/L)
-BUN/Creatinine is low to normal
-Urine specific gravity > 1.032
-urine sodium will be elevated
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| Syndrome of Inappropriate Antidiuretic Hormone-medical management | Fluid restriction= 800-1000ml/day
Electrolyte management= hypertonic saline infusion
Eliminate cause- surgical resection, radiation, chemo, or discontinue causative meds.
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| Syndrome of Inappropriate Antidiuretic Hormone- pharmacology | Demeclocycline (Declomycin)- tetracycline derivative- 300 mg PO 4/day may be ordered; Lithium Carbonate.
-Both of these drugs interfere with the antidiuretic action of ADH and cause polyuria.
-Diuretics- if the serum sodium is at least 125 mEq/L.
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| Syndrome of Inappropriate Antidiuretic Hormone-nursing management | monitor fluid/electrolyte status, neuro checks Q3-4H, strict I&Os, daily weight, asucultate sounds for crackles
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| Anterior pituitary- adenohypophysis | TSH,ACTH,LH,FSH,GH, Prolactin
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| posterior pituitary- neuropophysis | Oxytocin- Uterus smooth muscles and Mammary glands. vasopressin (Anti-diuretic Hormone)- Kidney tubules.
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| Explain stimulation of the pituitary gland, that is, negative feedback loop? | Hormones are released in response to low circulating hormones or decreased organ function.
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| What is the definition of Hormones? | Hormones are chemical messengers which travel to target organs to achieve balance.
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| What takes place when hormones reach the target organ? | A metabolic change takes place.
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| Are the physical manifestations of acromegaly reversible? | nope
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| When collecting information from the patient with acromegaly, what subjective data should be gathered? | Neurological (headaches, visual disturbances)
Muscle weakness
Sexual problems (male impotency, female – masculinization).
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| What tests can be anticipated in diagnosing acromegaly? | Oral glucose challenge test.
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| Identify two characteristics of patients with dwarfism? | Child is great deal shorter than peers
Well proportioned, but smaller
Sexual development is usually normal but delayed
May produce normal offspring
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| What is considered a definitive diagnosis? | Decreased plasma levels of growth hormone.
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| What patient teaching is important prior to the lab tests? | Patient must remain NPO after midnight.
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| List three clinical manifestations of Diabetes Insipidus? | Polyuria
Urine specific gravity <1.005
Hypernatremia
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| When there is an electrolyte imbalance what is the serum osmolality? | Greater > 300 mOsm / kg.
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| What is the purpose of the Water deprivation test? | To determine how well the Pituitary is producing ADH.
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| Name three symptoms of water intoxication: | changes in LOC, nausea, decreased UOP, weight gain
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| SIADH is potentially dangerous, but treatable. What happens if treatment is withheld? | Coma and death can occur
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| What assessment data will a patient with laryngospasms present with? | dyspnea with long, crowing respirations Cyanosis.
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| What cardiac complications can occur with a patient with laryngospasms? | cardiac dysrhythmias.
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| Hyperparathyroidism- bones lose calcium to blood | overactive parathyroid gland, causing hypercalcemia
-Occurs in adults 30-70 yrs old
-twice as likely in women
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| hypoparathyroidism- low blood calcium | decrease in PTH resulting in low blood calcium.
-rare.
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| hyPERparathyroidism- S/S | skeletal pain, muscle weakness
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| HYPOparathyroidism- S/S | Uncontrollable muscle spasms
Tetany
Laryngeal spasm
Stridor
Cyanosis
Numbness and tingling of the lips and fingers
Anxious, irritable or depressed
Positive Chvostek's or Trousseau’s sign
Decrease cardiac output (low calcium)
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| hyPERparathyroidism- Diagnostic tests | -Calcium blood levels (high)
-X-ray for bone decalcification
-PTH blood levels are increase
-Alkaline & phosphate levels increased
-Phosphorus blood levels (low)
-Possible Kidney stones
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| HYPOparathyroidism- Diagnostic tests | -Calcium blood levels (low)
-Increase urine calcium
-Increase blood phosphorus
-Decrease urine phosphorus
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| hyPERparathyroidism- TREATMENTS | -Remove {adenoma} tumor with surgery
-Autotransplantation of parathyroid tissue to forearm or sternocleidomastoid muscle (neck)
-calcium replacement for life if removed
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| HYPOparathyroidism-TREATMENTS | -Give iv calcium- monitor for hypercalcemia, N/V,abd pain, bradycardia
-VitaminD for bone resorption- chronic hypocalcemia
-Bone resorption- osteoclasts break down bone & release the minerals, results transfer of calcium from bone fluid to the blood
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| hyPERparathyroidism- nursing interventions | -Monitor for hypocalcemia after surgery - tetany, cardiac dysrhythmias, carpopedal spasms.
-tetany - administer calcium gluconate IV
Furosemide= diuretic of choice: thiazides cause renal excretion of calcium. Monitor for fatigue, personality changes
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| HYPOparathyroidism- nursing interventions | -Monitor calcium and phosphorus (low)
-Maintain fluid balance
-Use calcium supplements
-Dihydrotachysterol & calcitriol are the preferred meds.
-High calcium diet – dairy, dark green vegs, soybeans, tofu, canned fish w/bones
-Good prognosis
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| Identify lab abnormalities in hypoparathyroid and hyperparathyroid disorders. | Hypoparathyroid- Hypocalcemia and hyperphosphatemia
Hyperparathyroid- Hypercalcemia and hypophosphatemia
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| What are the four common causes of hyperparathyroidism? | 1) Hypertrophied gland tissue and tumors (adenoma).
2) Chronic renal failure.
3) Pyelonephritis/glomerulonephritis.
4) Carcinoma is rare with rapid progress and a poor prognosis
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| What is the drug of choice? | Lasix is the drug of choice.
-Diuretic to manage fluid retention and decreased urine output as a result of parathyroid surgery.
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