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endocrine test 5
level 3
| Question | Answer |
|---|---|
| Chemical substances produced in the body that control and regulate the activity of certain target cells or organs | Hormones |
| Some hormones are released directly into the circulation, whereas others mya act locally on cells where they are released and never enter the bloodstream | Paracrine action |
| 3 common charecteristics of hormones. | 1. secrete in small amounts at predicatble rates, 2. regulated by feedback mechanims and 3. binding to specfic target cell receptors |
| Horomones help regulate the? | Nervous system |
| the adrenal medualla secretes? | Catecholamines |
| Results in the gland increasing or decreasing the release of a hormone | Negative feedback |
| increased levels causes further increase | Positive feedback |
| Two important groups of hormone from the hypothalmus are | releasing hormones and inhibiting hormones |
| The pituitary is connectede to the hypothalmus by> | the unfundibular (hypophyseal) stalk |
| Sectered by the anterior pituitary, these are hormones that control the secretion of hormones by other glands. | Tropic hormones |
| Adtenocorticotropic (ACTH) Stimulates the adrenal cortex to secrete ? | Corticosteroids |
| Follicle stimulating hormone stimulates secretion of? | Estrogen and the development of ova in women and sperm in men. |
| Stimulare ovulation in women and secretion of sex hormones in both men and women | Lutenizing hormone |
| Affectes the growth and development of all body tissues? | Growth hormone |
| Where is TSH, ACTH, FSH and LH secretred? | Anterior pituitary |
| Where is growth hormone secreted? | Anterior pituitary |
| Hormones secreted by the posterior pituitary are? | ADH but it is actually produced by hypothalmus |
| ADH does what? | Stimulares reabsorption of water in the renal tubules |
| ADH is a potent? | Vasoconstrictor |
| located in the anterior porton of the neck in front of the trachea? | Thyroid gland |
| Hormones produced and secreted by the thyroid gland? | T4 (thyrozine and T3( triiodothyronine) |
| Iodine is neccasery for the synthesis of? | T3 and T4 |
| Affect metabolic rate, caloric requirement, oxygen consumption, carbohyrate and lipid metabilism, growth and development, brain function and other nervous system activities | T3 and T4 |
| What happens when thyroid hormones are low? | Hypothalmus releases thyroropin releasing hormone (TRH), whihx in turn causes the aneterior pituitary to secrete TSH |
| The parathyroid gland secretes parathyroid hormone and its major role is to? | regulare blood levels of calcium |
| Stimulates the transfer of calcium from the bone into the blood and inhibirs bone formation, resulting in increased? | serum calcium |
| High levels of vitamin D inhibit? | PTH |
| The adrenal medulla secretes? | Catecholamines epinephrnine, norepinephrine and dopamine |
| Essential part of the bodys fight or flight response to stress | Catecholamines |
| The adrenal cortex secretes? | Steroids, glucocorticoids, mineralocorticoids and adrogens |
| Main glucocorticoid? | Cortisol |
| One major function of cortisol is regulation of blood glucose levels this is done by? | Stimulation of hepatic glucose fromation |
| Cortisol inhibits protein sythesis and stumulates the mobilization of? | fatty acids |
| Decreases the inflamatory reponse by stabilizing the membranes of cellular lysosomes and preventing increased capillary permeability | Cortisol |
| A mineralcorticoid? | Aldosterorne |
| Aldosterone does what? | Maintains extracellular fluid volume. It acts on the renal tubule to preomote renal reabsorption of sdodium and excretion of potassium |
| Angrogens are? | Sex hormones, they eventually are converted to estrogen and testosterone. |
| Decreased hormone production and secretion, altered hormone metabolism and biologic activity, decreased responsiveness of target tissues to hormones and altertions in circadian ruthrms | effects of aging |
| Why is it hard to diagnose elderly problems with endocrine. | it is assumeed that they are normal aspects of aging |
| Fatigue, weakness, mentrual problems and weight changes are? | Usual non specfic complaints that a person with endocrine dysfunction presents with |
| In endocrine assesment in women it is important to ask about> | Obsteric history and number of births |
| Ask the client to compare their health now and from a year ago | Endocrine assesmnet |
| Weight loss with increased appetite may indicate? | Hyperthyroidism. |
| Weight gain may indicate? | Hypothyroidism or hypocortisolism |
| Truncal obesity, purple abdominal stiae and thin extremities occur in patients with | hypercortisolism |
| Increased SNS activity including nervousness, palpitations, sweating and trmors may indicate? | thyroid dysfunction or tumor on medulla |
| Heat intolerance may indicate? | Hyperthyroidism |
| Col intolerance may indicate? | Hypothyroidism |
| Where particulary focus assement on skin? | Face, neck hands or body creases |
| Hair loss may indicate | Hypopituiriarism, hypothyodism, hyperthyroidism, hypoparathyroidism or increased androgen |
| Decreased skin pigmentation> | hypopituitarism, hypothyroidism, and hypoparathyroidism |
| Increased body hair may indicate? | Hypercortisolism |
| Increased skin pigmentatiin particulary in sun exposed areas may indicate | hypocortisolism |
| Skin that is coarse or lethary | Hypothyroidism or excess growth hormone |
| fine, silky hair | Hyperthyroidism |
| frequent defecation may indicate? | Hyperthyroidism |
| Consitpation is seen in? | Hypothyroidism, hypoparathyroisims and hypopituitarism |
| Headaches may indicate? | Abnormal pituiraty growth |
| At the begining of the endocrine exam do what? | Take a full set of vitals |
| Large and protruding eyes are associated with? | Hyperthyroidism |
| Palpation of this may trigger a release of? | Thyroid hormones so be careful |
| In a normal person the thyroid? | is not palabale |
| If the thyroid is palapable what is a normal funding? | Smooth with firm consitency but it is not tender |
| puple blue striae across the abdomen | Cushings disease |
| The most sensitive and accurate lab test for thyroid function is measurement of | Thyroid stimulating hormone TSH |
| Diagnositic tests for parathyroid Gland are? | PTH. serum calcium and serum phosphate levels |
| Two ways to measure adrenal cortex function? | Serum as well as urine |
| a change in menses and libido as well as thirst and urinary patterns may indicate a? | Endocrine dysfuntion |
| Modifiable risk factors for endocrine disorders | Medications (ex, corticosteroids increase glucose levels), stress, diet and obesity |
| growth hormon deficiency? | Hypopituitarism |
| Usuual cause of hypopituirarism is? | A pituitary tumor |
| Highest incidence of pituitary adenomas? | African americans |
| In addition to growth hormone the pituitary also secretes? | Adrenocototropic hormone ACTH, thyroid stimulating hormone and ADH |
| ACTH deficiencu can lead to? | Acute adrenal insufficneny and shock |
| Hypovolemic shock due to pituitary dysfunction is often due to? | Sodium and water depletion |
| Headaches, visual changes, loss of smell, nausea and vommiting and sezures | Hypopituitarism |
| Lab tests for hypopituirarism? | Direct measurement of pituitary hormone like TSH or an indirect determination or target organ hormones like T3 and T4 |
| Treatment for hypopituitarism? | Surgery or radiation and then lifelong hormone therapy |
| used for long term therapy in adults with growth hormone deficency | Somatotropin |
| How should patients respond to growth hormone substition> | increased lean body mass, feeling of well bwing |
| When is GH substion given? | Sub q perfreably in the evening |
| The dosing of GH substion is? | Adjusted according to IGF-1 levels |
| The loss of all anterior pituitary hormones, leaving only posterior function intact | Panhypopituitarism |
| Retarded somatic growth | Deficency in growth hormone (hypopituitarism) |
| congential hypopituitarism is often the result of? | Birth trauma |
| Growth failure (seen in hypopituitarism) is defined as? | An absolute height of less than -2 standard deviation for age or a linear growth veloviey less than -1 SD for agr. |
| When growth failure occurs without the presence of hypothyroidism, systemic disease or malnutirion then an abdomality of the? | GH insulin like-growth factor axis (IGF-I) should be considered |
| Otherwise healthy children who have ancesroes with adult height in the lower percentiles | Familial short stature |
| Individuals (usually boys) with delaued linear growth, generally begining as a toddler and skeletal and sexual maturation thaat is behind that of age mates | Constituational growth delay (typically will never reach adult height) |
| Giving growth hromone to children is | not usually indicated as it is controversial |
| Growth of a child with hypopituitarism? | Grow normally during the first year and then (2ncd year) follow a slowed growth curve that is below the third precentile. |
| Skeletal porportions and weight in a child with hypopituitarism/growth hormone dieficency is> | Normal but appear normal than chronologic age. |
| Dentition is delayed and the teeth may be overcrowded and malpostioned because of the underdeveloped jaw | Hypopituitarism/Growth hormone deficiecy |
| Sexual developemnt in hypopituitarism (growth hormone deficency) | delayed but otherwise normal |
| In hypopituitarism growth may extend into the ? | third or fourth decade of life, but if left unteated permeanet height is diminished |
| In most cases of short stature the cause is ? | Consitutional growth delay |
| This is important in evaluating growth | A skeletal survery in children younger than 3 and and examination of hand and wrist to exam bone age |
| Definitve diagnoses of hypopituitarism? | Absent or subnormal reserves of pituitary Growth hotmone. |
| As growth hormone levels are variable, this is usually required for diagnoses? | GH stimulation testing. |
| When do GH stimulation testing. | IGF-1 indicates abnormality and poor rowth |
| treatment of GH deficiency? | Surgery/radiation of tumor, and biosythetic GH admistered on a daily basis |
| Growth velocity increases in the first year and then declines in subsequent years | Using growth hormone therapy, but final height is still less than normal |
| When Stop growth hormone replacement? | Growth rates of less tan an inch per year and a bone age of more than 14 years in girsl and more than 16 years in boys |
| In growth hormone stimulation test how often is blood levels taken? | every 30 minutes for 3 hours |
| When is growth hormone best given? | At bedtime |
| Even when hormone replacement with GH is succesfull kids still attain their eventual adult height at? | a SLOWER RATE |
| Cheif complaint in hypopituitarism? | Small stautre |
| Nutrition in hypopituitarism? | Appears well nourished |
| In hypopituitarism bone age is often? | retarded but near height age |
| Primary teeth and hypopituitarism | Appear at expected age |
| Permanent teeth and hypopituitarism | Delayed |
| Treatment of GH is often? | Expensive |
| With GH replacement children will attain? | Their adult height but at a slower rate |
| Early diagnoses and hypopituiatrism | Is important |
| 4 things GH does? | Stimulates cell growth, reproduction and regeneration, increases protein production, increases fat mobilization, and increases carbohydrate use |
| Since growth hormone increases protein production what might you see in some one with protein defficency? | Decreased lean body mass |
| Acromegaly is charecterized by? | overproduction of growth hormone |
| Why does acromegaly usually occur? | Benign pituitary tumor (adenoma) |
| The Excessive secretion of growth hormone results in an overgrowth of soft tissues and bones in the hands, feet and face. | Acromegaly |
| Bones of arms and legs in acromegaly? | They do not grow longer because it develops after epiphuseal closure |
| In acromegaly, enlargment of the hands and feet may result in? | Joint pain that can range from mild to crippling |
| In acromegaly thickening and enlargment often occurs in the? | bony and soft tissues on the face, feet and head |
| Speech/ mouth in acromegaly? | Enlarged tongue, voice deepens (hypertrophy of vocal cords) sleep apnea (increased pharyngeal soft tissues |
| The skin in acromegaly is? | Thick, lethary and oily |
| menstrual distubances, neuropathy and muscle weakness is often seen in? | Acromegaly |
| Due to pressure on the optic nerve from a pituitary adenoma in acromgealy this may occur? | Visual changes/headaches |
| Glucose levels in acromegaly? | High may see S/S of diabetes |
| In acromegaly (too much growth hormone) GH mobilizes stored fat for energy, it increases free fatty acid levels in the blood and predisposes the patient to? | Atherosclerosis |
| Life expectancy in acromegaly? | Reduced by 5-10 years. |
| Even when patients are cured or acromegaly is well controlled, manifestations such as ? | Joint pain and deformities often remain |
| How diagnoses acromegaly? | Evalue plasma insulin-like growth factos (IGF-1 levels) and GH response to OGTT) |
| As GH levels rise so do the? | IGF-1 levels |
| Because GH secretion is normally inhibited by glucose measurement of glucose nonsupresability shows? | Acromegaly |
| Normally GH concentrations will _______ during an OGTT? | FALL, if stays same or rises think acromegaly/GH excess |
| Because a pituitary ademoa may cause acromegaly this is done because a tumor may cause pressure on the optic chasm or optic nerves | A complete opthalmic examination |
| With treatment for acromegaly, bone growth can be stopped and tissue hypertrophy reveresed, But what two things may persisist? | Sleep apnea and diabetic and cardiac complications |
| 3 treatment options for acromegaly? | Surgery, Radiation and drugs |
| The treatment of choice as it offers the best chance of cure in Hyperpituitarism (GH excess) | Hypophysectomy |
| Most surgeries to correct hyperpituitarism is done by what apporach> | Transsphenodial |
| In total removal of the pituitary all pituitary hormones are lost so what hormones are replaced? | Essenital hormones produced by the target organs not the stimulating hormones the pituiarty secretes |
| When would somone with acromegaly need radiation or drug use? | Patients with large tumors or GH levels greater than 45 |
| When using radiation to correct hyperpituitarism it can cause? | Hypopituitarism |
| When use drugs in acromegaly? | Patients who have bad response to surgery/radiation |
| Primary drug used for acromegaly is? | Sandostatin a somastostatin analog |
| Interventions needed for Sandostatin a somastatin analog? | Given 3 times a week, GH levels monitored every 2 weeks |
| Patient presents complining about increase in hat, glover and show size think? | Acromegaly |
| Physical changes in acromegaly occur? | Slowly |
| The sella turnica is entered thorugh the floor of the nose and sphenoid sinuses in a> | Transphednoidal hyposyectomy. |
| To decrease headaches and avoid pressure after a transphenoidal hypophysectomy (removal of pituitary) it is important to? | Elevate the clients head to a 30 degree angle |
| After a transphenoidal hypophysectomy it is imortant to do mouth care every 4 hours to keep surgery sit clean but what should be avoided? | Tooth brusing for 10 days post-op |
| after a transphedioial hypophysectomy to avoid CSF leakage instruct the patient to avoid? | Vigorous coughing, sneezing, or straining at stool |
| What if you see clear nasal drainage after a transphenoidal hypophysectomy? | Notify surgeron and have it checked for glucose |
| A glucose level greater than ________ indicates CSF leakage from an open connection in the brain a complication of a transphenoidal hypophsectomy and increaeases risk of? | 30 mg of glucose and menigitis |
| Complaints of persistent and severe generalized or supraorbital headache may indicate? | CSF leakage into sinus |
| A CSF leak usually resolves within? | 72 hours by elevating the head, may need surgery |
| In stereototic radiosurgery for hyperpituitarism this is impotant? | Pin care |
| When you remove the pituitary you hvae to monitor for this ____________ as ADH is stored in the posteror lobe of the pituiaty | Diabetes insipidus because of loss of ADH also monitor for cerebral edema |
| If hypophysectomy is done or pituitary is damaged hormone therapy will be neccessary what should be replaced? | ADH, cortisol and thyroid hormon as needed, may become infertile |
| Excess Gh before closure of the epiphyseal shafts results in? | Overgrowth of the long bones untill the individual reaches 8ft or more (gigantism) |
| In gigatism (excess GH) vertical growth is accomponid by ? | Rapid and increased development of muscle and viscera |
| Weight in gigagtims? | Increased but proportional to height |
| In giaganstims proportional enlargement of head circumfrence may also occur and resuls in? | Delyayed closure of fontannels |
| If oversecretion of GH occurs after epiphyseal closure growth is in what direction? | Transverse |
| Overgrowth of the head, lips, nose, tongue, jaw and aranasal and mastoid sinuses, seperation and maloclusion of the teeth in the enlarged jaw, | Acromegaly |
| Disproportion of the face to the cerebral division of the skull, increased facial hair, | Acromegaly |
| Thickened and depply creased skin | Acromegaly |
| Diagnoses of pituitary hyper function in children is done by? | H/o Excess growth during childhood and evidence of increased levels of growth hormone |
| Dependining on the extent of surgery for pituitary hyperfunction hormone replacement may include? | Thyroid, cortisone and sex hormoes |
| In Pituitary hyperfunction why is early identification so important? | While medical managment can not reduce growth already attained it can stop further ggrowth |
| Headache is often a sign of a? | Pituitary tumor |
| Overgrowth of long bones? | GH excess, gigantism |
| If there is a lesion causing hyperpituitarism, other than a hyposhyectomy what is another surgery? | cryosurgery |
| What does T3 and T4 due? | Regulate energy metabolism and growth and development |
| Thyroxine | T4 |
| Triiodothyrone | t3 |
| An enlarged thyroid gland | Goiter |
| In a person with a goiter the thyroid cells are stimulated to grow, which may result in an? | Hyperthyroid or hypothyroid |
| Most common cause of goiter? | Lack of iodine |
| In the U.S. goiters are not cause by lack of iodine, so what causes them? | HYPO/HYPER THYROID, or nodules |
| Food or drugs that contain thyorid inhibiting substances that can thus cause goiter are called? | Goitrogens |
| A diffuse enlargement of the thyroid gland that does not result from malignancy or inflmatory process. | A nontoxic goiter |
| Thyroid levels in a nontoxic goiter are? | normal |
| thyroid hormone secreting nodules that function independent of TSH stimulation | Nodular goiters (Usually bening follicular adenomas) |
| If nodules are associated with hyperthyroidism they are termned? | Toxic nodular goiters |
| Toxic nodular goiters are usually seen in? | Graves disease |
| Goiters normally appare ar what age? | over 40 |
| Tests for a person with a goiter? | TSH, and T4 levels to see if the goiter is associated with normal thyroid function, hyperthyroidism or hypothyroidism |
| Measured in people with goiters to assess for thyroidits (inflamation of the thyroid) | TPO antibody |
| Hyperactivity of the thyroid gland with sustained increase in sythesis and release of thyorid hormones | Hyperthyroidism |
| Hyperthyroidism occurs more in women than in men and what age? | 20-40 |
| The most common form of hyperthyroidism is? | Graves disease |
| Toxic nodular goiter, thyroditis, excess iodine intake, pituitary tumors and thyroid c word | Other causes of hyperthroidism |
| Referes to the physiologic effects or clininical syndrome of hypermetabolism that results from excess circulating levels of T4, T3 or both | Throtoxiciosis |
| An autoimmune disease of unkown etiology charecterized by diffuse thyroid enlargement and excessive thyroid secretion | Graves disease |
| Inssufficent iodine, infection, stress and cig smoking may be | Precipitating factors of graves disease |
| In graves disease the patient develops antibodies to the? | TSH receptor (when they attach they cause increase of T3/T4. |
| prognosis of graves? | Exacerbations and remissions, may get so bad that it damages thyroid causing hypothyroidism |
| Keeping the function of the thyroid hormone in mind What does excess thyroid hormone due? | Increases metabolism and tissue sensitivity to stimulation by the sympathetic nervous system |
| In graves palpation of the thyroid gland may reveal a? | Goiter |
| In graves disease (hyperthyroidism) Auscultation of the thyroid gland may reveal____________ a reflection of increased blood supply | Bruits |
| A protrusion of the eyeballs from the orbits that is usually bilateral. | Exophthalmus cardinal sign of graves |
| Results from increased fat deposits and fluid (edema) in the orbital tissues and ocular muscles. | Exophthalmus |
| In exopthalmus, the increased pressure forces the eyeballs outward, the uper lids are usally retracted and elevated with the sclera? | visible above the iris |
| In exophalmus, when the eyelids do not close completely the exoposed eyelids become? | Dry and irrirated |
| Serioud consequaeces of expophtalmos? | corneal ulcers and eventual loss of vision, diplopia |
| Weight loss and increased nervousness | hyperthyroidism |
| Acropathy (clubbing of digits) may occur in advanced diseases of? | Hyperthyroidism |
| Palpations, tremors, weight loss | Hyperthyroidism |
| In older patients hypperthyoidism may be confused with? | Dementia |
| AKA thyroid storm, Is an acute, severe and rare condition that occurs when exessive amounts of thyroid hormones are released into the circulation, it is a life threatneing EMERGENCY | Thyrotoxicosis |
| Is thought to result from STRESSORS (infection, trauma, surgery) in a patient with preexisting hyperthyroidism | Thyrotoxicosis |
| Patients particullary prone to thyroroxicosis? | those having a thyroidectimy, cuz manipulation of a hyperactive thyroid gland results in an increase in hormones released |
| In thyotoxicosis all symptoms of hyperthyroidism are prominent and severe. manifestations include? | Tachycardia, heart failure, shock, hyperthermia, vommiting, seizures and coma |
| Lab findings to confirm dx of hyperthyroidism? | Decreased TSH and elevated free thyroxine (free t4 levels) |
| in hyperthyroidism T3 and T4 may be assesed but they are not definitive | Total T3 and T4 |
| A test used to differentiate Graves disease from other forms of thyoiditis | RAIU |
| In the RAIU test the patient with graves shows a diffuse uptake of? | 35-95% whereas thyodits is less than 2%, nodular goiter=high uptake as well |
| 3 treatments of hyperthyroidism? | Antithyoid meds, radioactive iodine, and surgical intervention |
| Drugs used in the treatment of hyperthyroidism? | Antithyorid drugs, iodine and B-adrenergic blockers (note thest drugs are not curable just used in thyrotoxic state) |
| First line antithyroid drug is? | Pylthiouracil (PTU) and meyhinmazole (tapazole) |
| PTU drug inhibits the synthesis of? | Thyroid hormones |
| generally used for patients in first trimester of pregnancy | PTU |
| First line drug in thyrotoxicosis as it blocks the peripheral conversion of T4 to T3 | PTU |
| When are good results seen in antithyorid drugs? | 4-8 weeks so continue use. |
| If you stop antithyoid drugs like PTU abruptly what can happen? | Return of hyperthyroidism |
| The administration of ___________ in large doses rapidly inhibits synthesis of T3 and T4 and blocks the release of these hormones into circulation. It also decreases the vascularity of the thyroid gland making surgery safer and easier | Iodine |
| The maximal effect of iodine in treatment of hyperthyroidism is seen in? | 1-2 weeks |
| Used for the symtpomatic releied of thyrotoxicosis | B-adrenergic blockers |
| These drugs block the effects of the SNS stimulation therby decreasing tachycardia, nervousness, irritability and trmors | B-adrenergic blockers |
| Drugs like propranolol is often usually administered with other? | Antithyodid drug |
| Treatment of choice for hyperthyroidism for most non-pregnant adults | Radioactive Iodine therapy (RAI) |
| damages or destroys thyroid tissue , thus limmiting thyroid hormone secretion | RAI |
| When is maximum effect of Radioactive iodine therapy seen? | up to 3 months, thus antithyroid drug before it takes effect. |
| Although Radioactive iodine theraphy (RAI) is effective in hyperthyroidims this can occur? | Hypothyroidism and the need of hormone replacement for life. |
| Teaching for RAI in treatment of hyperthyroidims? | thyroditis or parodtis may occur. you need to 1. use privat toilets, flush twice 2. speratly wash all clothes, ben linens and towels daily. 3. dont prepare foods for others with bare hands 4.avoid being by pregnant people for 7 days after therapy |
| This is indicated for clients who have 1. a large goiter causing tracheal compression, 2. been unresponsive to antithyroid therapy or 3. have thryoid c word | Thyroidecomy |
| Offers most rapid reduction in t3 and t4 levels | Thyroidectomy |
| A minimally invasive procedure that several small incisions are made and a scope is inserted Instuments are passed through the scope to remove thyroid tissues or nodules | Endocopic thyroidectomy |
| Metabolism in hyperthyroidism is? | VERY high |
| Diet consderations for hyperthyroidism? | A high cal diet (4,000-5,000), six full meals a day and snacks high in protein, carbs, minerals and vitamins |
| Protein content for hyperthyroidims should be? | 1-2 g/kg of ideal body weight |
| Avoid what in hyperthyroidism and why? | Avoid highly seasoned, and high fiber foods as they stimulate already hyperactive GI tract, AVOID caffeine to decrease restlessness and sleep disturbances cause by hyperthyroidism |
| in acute thyrotoxicosis monitor? heart wise? | For dsyrythmias |
| Why give IV fluids in acute thyrotoxicoxis? | Cuz of vommiting and diarhea |
| Due to increased metabolism and increased sensitivity to SNS what is seen in regrads to sleep? | Sleep disturbacnes (hyperthyroidism) |
| While its hard in hyperthyroidism cuz they are restless and irritable it is important to? | Provide a calm enviornment |
| Exercise in hyperthyroidism? | Large muscles to allow the release of nevous tension and restlessness |
| Nursing interventions (in exathalmos seen in hyperthyroidism/graves to relive eye discofort and prevent corneal ulceration due what? | apply artificial tears to soothe and mosten conjunctival membranes, salt restrisction to decrease edema, elevate the head to promote drainage/have them sit upright |
| In exopthlmos these reduce glare and prevent irritation from smoke, air currents, dust and dirt | Dark glassess |
| If in exopthalmos the eyes cannot be closed the nurse should? | Lightly tape then shut |
| In exopthalmos to maintain flexibility, teach the patient to | Exercuse the intraocular musculses several times a day |
| Before thyroid surgery what is given before hand to get a euthyroid state? | Antithyroid drugs, iodine and b blockers |
| Reduces vascularization of the thyroid gland reducing the risk of hemmorage pre-surgery | Iodine |
| How is iodine taken? | Mixed with water or juice sipped with a straw and administered after meals |
| Swelling od the buccal mucosea, excessive salvation, nausea and vommiting and skin reactions? | Iodine toxicity, DC and call dr. |
| Before thryoidectomy surgery teach the patient to support the head | manually while turning in bed to minimize stress on suture line. but do do ROM |
| Talking after a thyroidectomy is? | Difficult for a short time. |
| Postop complications of thyroidectomy? | Hypothyroidism, damage to or inadvertnly removal of parathyroid glands causing hypoparathyroidims and hypocalcemia, injury to larygeal nerve, thyrotoxicosis and infection. |
| Reccurent laryngeal damage is a postop complication of thyroidectomy and if both cords are paralyzed waht occurs? | Spastic airway obstruction requiring an immediate tracheostomy, so keep one at beside postopertavily |
| a harsh, vibratory sound may occur during inspiration and expiration as a result of edema of the larngyeal nerve post op thyroidecotmy | Laryngeal stridor |
| Besides edema larygeal stidor may also be related to? | Tetany if parathyroid gland is injured in the thyroidectomy |
| How treat tetany? | Iv calcium salts (calcium gluconate) |
| How often asses the patient post-op thyroidectomy? | Every 2 hours |
| irregular breathing, neck swlling, frequent wallowing, sensations of fullness and the incision site , choking and blood | May indicate hemorage or tracheal compression potop thyroidectomy |
| What postion place patient post- thyroidectomy? | Semi-fowlers and support head wiht pillow |
| Postop thyroidectomy monitor vital signs and? | Calcium levles |
| Tingling in toes, figers around the mouth, muscular twitching and aprehenstion | Tetany |
| Post op thyroidectomy often eats soft diet? | the day after sugery |
| Some hoarness post thyroid ectomy should be? | Expected for 3-5 days |
| While right after a thyroidectomy there may be hypothyroidism it? | Usually goes a way as the thyroid begins to hypertrophy |
| The administration of thyroid hormone postop thyroidectomy is? | Avoided because it inhibits pituitary production of TSH and lowers chance of normal funciton |
| Diet after thyroidectomy? | To prevent weight gain, reduce cals that was required before surgery, adequate iodine is needed to promote thyroid function so eat seafood once or twice a week |
| Teach the paitient post-op thyroidectomy to avoid? | Hot temps |
| How often follow up post-op thyroidectomy? | Biweekly for a month and then semianually to assess for thyroid function |
| common in children associated with an enlarged thyroid gland and exopthalmos | Graves disease |
| Peak of graves in kids? | 12-14 |
| Autoimmune response to TSH receptors | Graves fisease |
| s/s of hyperthyroidism/graves develops? | gradually 6-12 months |
| Exessive motion, irritability, hyperactivity, short attention span, tremors, insomnia, and emotional lability | Clinical features of hyperthyroidism |
| Wide eyed staring, increased blinking, lack of convergence and absence of wrinkling of the forehead when looking upward | Exopthalmos (protruding eyelids) |
| Exopthalmus may cause? | blurred vision and loss of visual acuity |
| prior irradiaitation to the head and neck and exposure to a goitrigen think? | hyperthyroidism |
| DX levels of hyperthyroidism? | increased T4 and T3, TSH is supressed |
| 3 treatments of hyperthyroidism? | antithyroid drugs (methimaxole) subtotal thyroidectomy and ablation with radioiodine |
| Antithyroid drugs may induce a? | remission but relapse is common |
| increased weight loss, pulse, pulse pressure and BP | Hyperthyroidism |
| If you notice sings of hyperthyrodisim the activity of children? | Is restricted to class work only till thyroid levels are normal |
| acute onset of severe irritability and restlesness, vommiting, diarhea, hyperthermia, hypertension, severe tachycardia and prostrastion, may be rapid progression to delerium, coma and even death | Thrtotoxicosis |
| Treatment for throtoxicosis? | Antithyoid meds and B-adrenergic blockers, required for 2-3 weeks |
| weight loss despite a great appetite, | Hyperthyroidism |
| sleplessness and difficulty with fine motor skills like writing. | Hyperthyroidism |
| academic difficulities due to short attention span and inability to sit still, unexplained fatigue | Hyperthyroidism |
| A regular routine is beneficial in providing frequent rest periods, minimiing stress of coping with unexpected demands and meeting the childrens needs promptly is important in? | Hyperthryoidism |
| Heat intolerance is seen in? | Hyperthyroidism |
| Skin rashes, arthalgias, vasculitis, liver dysfunction and agranulocytosis is ? | S/E of antithyoid meds |
| Most common idictions of hypothyroidsm that can occur from overdoese of antithyroid drugs? | Lethargy and somolence |
| If a child taking methimazole (antithytoid med) develops sore throat and fever do what and why? | Dr. immediatly as it shows leukopenia |
| Excess iodine intake may cause? | Hyperthyroidism |
| Pituitary tumor may cause? | Hyperthryoidism |
| Diarhea or constipation in hyperthyroidism? | Diarhea |
| Warm moist skin, hair loss, fine silky hair | Hyperthyroidism |
| Mestruation irregularity in hyperthyroidism? | Amenorrhea |
| bp in hyperthryoidism? | increased |
| AFIB is often seen in? | HYPERTHRYOIDISM |
| Why are total t3 and t4 measurements not as useful in dx hyperthyroidism | measures both free and bound to protein hormone level |
| Radioactive iodine uptake test in graves disease | Increased uptake |
| malignancy can be checked through observing? | hot/cold areas |
| Treatment of choice in hyperthyroidism? | Radioactive iodine therapy |
| inhibits synthesis of thyroid hormones but are not curative | Antithyroid hormones, PTU and tapazole |
| inhibits sythesis of t3 and t4 bu and blocks release | iodine used in hyperthyroidism |
| Surgical therapy for hyperthyroidism? | Subtotal thyroidectomy |
| Diet for hyperthyroidism? | High cal, high protein, frequent meals restrict caffein |
| What must be at the bedside after a thyroidectomy? | Tracheostomy, oxygen and suction |
| Keep calcium gluconate avalible even after a? | Thyroidectomy |
| severe tachycardia, heart failure, shock, hyperthermia, res;essness, irritability, seizures, abdominal pain, vommiting, diarrhea, delerium and coma | Thyrotoxicosis |
| Digital clubbing and swelling of fungers? | Hyperthryoidism |
| treatment for thyrocytococosis? | Oxygen therapy, monitor for dysrtyhmias, fever reduction, and flud replacement |
| Deficiency of thyroid hormone that causes a general slowing of the metabolism | Hypothyroidism |
| Metabolism in hypothyroidism is? | SLOW |
| Caused by destruction of thyroid tissue or defective hormone synthesis | Primary hypothyroidism |
| Caused by pituitary disease with decreased TSH secretion or hypothalmic dysfunction with decreased thyrotropin releasing hormone secretion | Seconday Hypothyroidism |
| Most common cause of hypothyroidism? | Lack of iodine |
| In the united states the most common cause of primary hypothyroidism is? | Atrohy of the thyroid gland as the end result of hashimotos thyroditis or Graves disease |
| Both Hasimotos and graves disease ? | Destory the thyroid gland |
| RAI therapy may result in? | Hypothyroidism. |
| Drugs like lithium and amiodarone may cause? | Hypothyroidism |
| Hypothyroidism that develops in infancy is called? | Creatinism |
| Are all infants screened for decreased thyroid function at birth? | Yes |
| Systemic effects charecterized by slowing of body processes | Hypothyroidism |
| If hypothyroidism is not caused by ablation, antithyoid drugs or thyroidectomy onset of symprtoms may ocur? | over months to yeats |
| Fatigued and lethargic, personaloty and mental changes, | Hypothyroidism |
| Impaired memory, slowed speech, decreased initative and somnolece DEPRESSED | Hypothyroidism |
| Weight gain is seen in? | Hypothyroidism |
| The heart and hypothyroidism? | Decreased cardiac contractility and decreased cardiac output, thus SOB, low exercise tolerance, cardiovascular problems |
| In hypothyroidism oxygen demand is ? | reduced cuz metabolic rate is lower |
| Blood in hypothyroidism? | erthropoetin is normal or low and anemia is common., other hematologic problems are r/t cobalmin, iron and folate deficies, MAY BRUISE EASY |
| Increased serum cholesterol and triglyceride levels and the accumulation of mucopolysaccbrides in the intima of small blood vessels can result in coronary atherosclerosis this is seen in? | Hypothyroidism |
| This alters the physical appearance of the skin and subcuntaneous tissues with puffness, facial and periorbital edema and a masklike affect | Myxedema seen in long standing hypothyroidism |
| Occurs due to the accumulation of hydrophillic mucoplusaccharides in the dermis and other tissues | Myxedema in hypothyroidism |
| Fatigue, cold and dry skin, hoarsness, hair loss constipation, and cold intolerance | Hypothyroidism |
| Constipation or diarhea in hypothyroidism? | Constipation |
| The mental sluggishness, drowsiness and letharfy of hypothyroidism may progress gradually or suddenly to a notable impairment of consciousess or coma called? | Myexedma Coma it is a medical emergenvy |
| Can be precipitated by infection, drugs (especially opiods, tranquilizers and barbituates) exposure to cold and trauma | Myedema coma |
| Charecterized by subnormal temperature, hypotension and hypoventilation, cardiovasculat collapse can result from hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis | Myexdema coma (hypothyroidism) |
| To survive a myxedema coma what must be done? | Vital function and IV thyroid replacement |
| best tests to dx. hypothyroidism | TSH and free T4 |
| In hypothyroidism serum TSH is ________ when the defect is in the thyroid? | high |
| In hypothyroidism TSH is _________ when it is in the pituirary or the hypothalmus | Low |
| Elevated cholesterol, and triglycerides, anemia and increased creatine kinase | Hypothyroidism |
| Restoration of a euthyroid state as safely and as rapidly as possible with hormone therapy | Hypothyroidism |
| Diet in hypothyroidism? | Low cal to promote weight loss |
| Drug of choice to treat hypothyroidism | Levothyroxine (synthroid) |
| Important consideration when just staring a thyroid replacement drug like levothroxine? | Doses start out low to avoid increases in resting HR and BP. be especially careful in those with heart problems as the usual dose may increase myocardial ocygen demand. |
| When starting/adjusting doses of thyroif relacement hormone like levothyroxine the increased oxygen demand may cause? | Angine and cardiac dysrythmias (remeber the heart is not use to a normal thyroid) |
| When taking levothyroxine (synthroid) monitor HR and report pulse greater than? | 100, report any chest pain, weight loss, insomnia, nervousness, tremors |
| In patients without s/e of levothyroxine/synthroid the dose is increased at 4-6 week intervals, how long might it take to see the full effect of hormone therapy? | up to 8 weeks |
| How long will a person with hypothyroidism need replacement drugs | Lifelong |
| increased dryness and thickening of the skin? | Hypothyroidism |
| Cold intolerance, consitpation and depression | Hypothyroidism |
| All high risk population including women over 50 should be screened for? | hypothyroidism |
| Most individuals with hypothyroidism are treated on an? | outpatient bassis unless myexdema coma! |
| Why do we give thyroid meds IV in a mxyedema coma? | Cuz paralytic ileus may be present in mxyedema coma |
| Besides monioting for hypothermia during a myoexdema coma it is important to monitor what in regards to skin? | Breakdown use a pressure matress |
| When should energy level and mental alertness occur if being treated with thyroid replacement? | within 2-14 days |
| Since there metabolism is low. it is important to do what in regards to instructions with hypothyroid patients? | Repeat them |
| Teach the patient taking levothyroxine (synthoid) hyperthyroid symptoms as well as manifestations of overdose including? | orpthopnea, dypnea, rapid pulse, palpitations, chest pain, nervousness or insomnia |
| When take thyroid hromone? | In the morning with food |
| Monitor for skin breakdown in hypothyroidism and due what in regards to soap? | use sparingly and apply lotion to skin |
| While the hypothyroid patient should increase fiber and stool softers they should avoid _______ as it can cause vagal stimulation and thus cardiac problems? | enemas |
| diabetic and treatment of hypothyroidism? | monitor glucose more frequently as insulin requirments usually go up in euthyroid state |
| thyroid drugs potentiate the effect of? | anticoagulants |
| Thyroid drugs decrease the effects of? | digitalis |
| Most adults with hypothyroidsm through proper treatment return to a? | normal state. |
| it may be either congential or acquired and represents a deficiecy of secretion of TH? | Juvenile hypothyroidism |
| a congential hypoplastic thyroid gland may provide sufficent amounts of TH during the first year or two but be? | inadequate when raoud body growth increases demands on the gland |
| Radiotherpy for diseases can lead to? | hypothyroidism |
| Infectious processes may cause? | Hypothyroidism |
| Low levels of circulation TH's and raised levels of TSH at birth | Primary congential hypothyroidism |
| if left untreated congential hypothyroidism causes? | Decreased mental capacitiyes |
| Decelarated growth from chronic deprivation of TH or Thryomegaly | Juvinel hypothyroidism |
| Impaired growth and development are ____________ when juvenile hypothyroidism is acquired at a later age | Less severe |
| because brain growth is complete by __________ intelectual disability and neurologic sequale are not associated with juvenil hypothyoidism | 2-3 years of age |
| Dry skin, puffiness around the eyes, sparse harir | Myxedmedatous skin changes of juvinele hypothyroidism |
| While therapy is the same in infants (congential hypothyroidism) as it is in juvenile hypothyroidism what is imporatant? | early identification to prevent decreased mental capacity |
| Syntrhoid/leveothyoxine is admistered to kids over a period of ______ to avoid symptoms of hyperthyroidism? | 4-8 weeks |
| Children treated early with hypothyroidism continue to have _______ delays in reacding comprehension and arithmitic but cath up quickly | mild |
| adolescents treated for hypothyroidism mya demostration problems with visuospatial processing and? | memory/attention |
| Growth cessation or retardiation in a child whose growth has previously been normal should allert the nurse to? | Hypothyroidism |
| What age kids take responsibility for health? | 9 |
| most common cause of hypothyroidism? | iodine defficiency |
| Transient hypothyroidism is r/t | thryoditis or d/c of thyroid hormone therapy |
| radioacvtive iodine can cause? | hypothyrodism |
| prominent tongue, | Hypothyroidism |
| Coarse, sparse hair | Hypothyroidism |
| Periorbital edema? | Hypothyroidism |
| Dx of juvenile hypothyroidism? | infant metabolic screening and TSH levels |
| Sleepiness, mental decline and skin changes | Juvenile hypothyroidism |
| Treatment of juvenile hypothyroidism? | TH replacement |
| TRH stimulation test may be done to dx? | Hypothyroidism |
| in hypothryoidism serum thyroid antiboidies may point to? | Hasimototos thyroditis |
| ECG shows sinus bradycarida? | Hypothyroidism |
| The RAI uptake test is ________ blank in hypothyroidism? | decreased |
| based on thyroid levels during admin of levothyroxine (sythroid) | amount of drug may need to be adjusted. |
| Helps regulaate serum calcium and phospahte leels by timulating bone resorption of calcium, renal tubular reabsorption of calcium and activatio of vitamin D | Parathyroid hormone PTH |
| Oversecretion of PTH is ascoiated with? | increased serum calcium levels |
| Due to an increased secretion of PTH leading to disorders of caclium phoshate and bone metabolism, | Primary hyperparathyroidism |
| The most common cause of primary hyperparthyroidism is? | A benign tumor (ademoa) in the parathyroid gland |
| Who may be at risk for developing a parathyroid ademoa and thus hyperparathyroidism? | Those who undergone neck and head radiation |
| Long term _______ therapy has been associated with primary hyperparathyroidism | Lithium |
| Appears to be a compensatory response to conditions that induce or cause hypocalcemia, the main stimulus of PTH secretion | Secondary hyperparathyroidism |
| Main stimulus of PTH secretion? | hypocalcemia |
| Vitamin deficencies, malabsorption, chronic kindey disease and hyperphosphatemia may all cause hypocalemia and thus? | Hyperparathyroidism |
| Occurs when there is hyperplasia of the parathyroid glands and a loss of negative feedback from circulating calcium levels. | Tertiary hyperparathytoidism |
| High secretion of PTH even with normal calcium levels? | Tertiary hyperparathyroidism |
| Seen in those who have a kidney transplant after long periods of dialusis | Tertiary hyperparathyroidism |
| Escessive levels of circulating PTH usually lead to? | Hypercacemia and hypophosphatemia |
| Decreased bone desity due to the efect of PTH on bone resprotopm and bone formatiom activity? | Hyperparathyroidism |
| Since in hyperparathyroidism there is escessive amounts of calcium, the kindey can not reasorb it and thus there is increased calcium in the urine making this common? | Calculi formation |
| The manifestations of hyperparathyroidism is based on? | Hypercalcemia |
| Muslce wekness, loss of appetire, fatigue, emotional disorders, Shortned attention span | Hyperparthyroid |
| Consitpation or diarhea in hyperparthyroidism? | constipation |
| Osteoporosis, fractures and kidey stones (nepjrolithais) | Hyperparathyroidism |
| muscle weakness particullary in the proximal muscles of the lower extremiries | Hyperparthyroidsm |
| Serious complications of hyperparthyroidism? | Renal failure, pancreatis, cardiac changes and long bone, rib and verterbral fractures |
| PTH levels are elevated in clients with? | hyperparathyroidism |
| Serum calcium levels in hyperparthyroidism? | usually exceed 10 mg/dl |
| Phosphate level in hyperparthyroidism? | inverser relationshio with calcium so less than 3 |
| increase in serum chloride, uric acid, creatinine and amylase (if pancreatisi) and increase in alkaline phosphate (if bone disease) | Hyperparathyroidism |
| Bone loss on a DEXA scan usually meens? | Hypercalcemia and thus hyperparthyroidism |
| Primary treatment for primary/seconday hyperparathyroidism? | Surgery-partial or complete removal of parathyroid glands involves endoscopy and is outpatient |
| Criteria for surgery of hyperparathyroidism? | serum calcium 11 or higher, hypercalcuria, decreased bone mineral denisty and overt symptoms OR under 50 |
| Patietns who have multiple parathyroid glands rmoved may? | have paratyroid tissue placed in the skin |
| This is done to measrure PTH, calcium, phosphorous, ALkaline phosphate, creatine, and BUN (renal) ad urniery calculi | Anuall check up for Parathyroid hormone. |
| Teaching for hyperparthyroidism non surgical approach | Contiued ambulation and avoidance of imobility, high fluid and moderate calcium intake |
| In hyperparthyroidism, several drugs lower calcium levels but they do not treat the underlying prblem give a examples? | Biophospahtes |
| Why would you give IV biophospahtes like pamidronate (adredia)? | It can rapidly lower calcium when it is extremely elevated ilevels |
| Phosphorous levels are low in hyperparthyrodism and are usually? | Suplemented UNLESS risk for urinary calculi formation |
| Phosphates should be used only if the patient ? | Has a normal renal function and low serum phosphare levels |
| This may be given to increase the urianry exretion of calcium? | Loop diurtetic |
| Increase the sensitivity of the calcium receptior on the parathyroid gland, resulting in decreseased PTH secretion and cacloum blood levels. | Calcimimetic agents given for hyperparthyroidism |
| Postop complications of parathyroidectomy? | Hemorrahge and F/E disturbanes, tetany (due to sudden low calcium levels) |
| A condition of neuromuscular excitability due to low calcium levels? | Tetany |
| In post-op parathyroidectomy- mild tetant charecterized by unpleaseant tingling of the hands and around the mouth? | may be present but should decrease over time |
| If tetany becomes severe demostrated by (muscular spams or laryngospasms) | IV calcium may be given |
| Should always be readily avalible for clients after parathyroidectomy | Iv calcium gluconate in case of severe tetany |
| Why encourage mobility postop hyperpatrthayroidism? | To promote bone calcification |
| Check for two signs after post op parathyroidectomy? | Chevostek and trouseas |
| Because immobility can agravate bone loss in hyperaparthyroidims is it important to? | stay active |
| chronic renal disease, renal osteodystophy, and congential anomalies of the urinary tract ? | Secondary hyperparathyroidism |
| Hypercalcemia | Hyperparathyroidism |
| Increase calcium in serum, decreased phophate in serum? | Hyperparathyroidism |
| The treatment of primary hyperraarthyroidsim (according to wong) is? | Surgical removal of the tumor of hyperplastic tissue |
| ONLY in cases of chronic renal failure when there is absolotuley NO WAY to fix hyperparathyroidsim treatment is aimed at? usualu seconday hyperparthyroidism | Raising serum calcium levels to stop PTH stimulation |
| Secondary hypoarhtyroidism is ususally a consequence of? | chronic renal failure |
| Because urinary symptoms are the earliest indication of hyperparathyodism assement of body sumptoms for evidence of high calcium levels is indicated when? | Polyuria and polydypsia coexist |
| Change in behavior INACTIVITY, Unxplaained GI symptoms and cardiac irregularities | Hyperparathyroidism |
| Muscle weakness, loss of appetite, vague abdominal pain, constipation, fatigue, emotional disorders and shortened attention span | Hyperarathyoridims |
| Dysrtrhymias and hypertensiton common in? | Hyperparathyroidism |
| Complications of hyperparathyroidism? | Pancreatitis, renal failure, cardiac changes and fractures |
| Treatment goals for hypoparathyroidism? | Treat acute complications like tetany and maintain normal calcium levels |
| Uncommon | Hyperparathyodism |
| Most common cause of hypoparathyroidism? | Iatrogenic |
| Acidenal removal of the parathyroid glands or damage to the vascular supply of the glands during surgery (thyroidectomy) | Iatrogenic causes of hypoparathyroidism |
| Results from the absecne, fatty replacement or atrophy of the glands and is a rare disease that usually occurs early in lige and may be associated with othr endocrine diorders | Ideopathyic hypoparathyroidism |
| Severe hypomgnesme may lead to supression of? | PTH secretion |
| Tumors and heavy metal posioning can result in? | Hypoparathyroidism |
| Tingling of the lips and stifness in the extremities | Tetant caused by sudden decreases in calcium |
| Painful tonic spasms of smooth and skeletal muscles can cause dysphagia and laryngospasms which ompromoise breathung | Hypocalcemia in hypoparathyroidims |
| Levels in hypoparathyrodism | decreased serum calcium, decreased PTH and increased serum phosphate |
| Emergency treatment of tetany after surgery requires? | IV calcium |
| How fast give iv calcium gluconate? | slowly |
| high serum calcium levels can cause | hypotension |
| Why do ECG monitoring during calcium administration? | Cuz excess levels of calcium can cause hypotension, cardiac dysrthymias and cardiac arrest |
| It is important to do what before administering calcium gluconate? | Check IV patency |
| Breathing into a paper bag will help temporarily relive? | manifestations of hypocalcemia |
| Long term drug and nutritional therapy is needed in hypoparathyroidism what drugs? | NOT PTH, oral calcium supplements in dived doses, may need to correct hypomagnesium, Vitamin D is Given to help enhance intestinal calcium absorption |
| Nutritional therapy for hypoparathyoidism/hypocalcemia? | A high calcium meal such as dark greens, soybeans and tofu, avoid foods containing oxalic acid like spinach and rhubarb as they inhibit absorption of calcium |
| May be caused by a specific defect in the synthesis or cellular processing of PTH or by aplasia or hypoplasia of the gland | Congentital hypoparathyroidism |
| Hypopartharyoidism can occur secondary to other causes like? | Infection/autominue disorders |
| A mother has a kid she herself has hyperparathyroidism what will baby possible have? | Hypoparathyroidism |
| Occurs when there is a genetic defect in the cellular receprots to PTH this results in normal PTH levels, calcium and phophate are not affected by admin of PTH? | Pseudohypoparathyroidism |
| Muscle cramps, progressing to numbness and stiffness | Hypoparathyroidism |
| Laryngeal spams, chevostek or trousea may be present | Hypoparathyroidism |
| Bone density in hypoparthyrodism? | Usually normal |
| Long term management of hypoparathyroidism usually consists od? | Long term vitamin D and oral calcium supplements |
| Unexplained convulsions, Diarhea, vommiting, cramping | Hypoparathyroidism |
| stidor, hoarsness and feeling of tightness in the throat indicates? | Larygeal spasm |
| hypocalcemia and hyperphosphatemia | Hypoparathyroidism |
| treatment for hypoparathyroidism is? | Lifelong |
| Results from chronic exposure to excess corticosteroids particulatly glucorticoids | Cushing syndrome |
| The most common cause of cushing syndrome? | Iatrogenic administration of corticosteroids |
| An ACTH sereting pituitary adenoma can cause? | Cushing syndrome |
| Weight gain results from accumulation of adipose tissue in the trunk, face and cervical spine | Cushing syndtome |
| This is associated with cortisol induced insulin resistance and increased glucogensis by the liver, this is seen in CUSHING SYNDROME | Hyperglycemia |
| Muscle wasting causes weakness especially in the extremities | Cushing syndrome |
| Loss of bone matrix leads to ostoporaosis, the loss of collagen makes the skin weaker and thinner and more easily bruised | Cushing syndrome |
| Delay in would healing, irritability, anxiety, euphoria | Cushing syndrome |
| In cushing's the mineralcorticoid excess may cause? | Hypertensions secondary to fluid retention |
| The adrgogen escess seen in cushings may cause? | Severe acne |
| Menstrual disorders, hirtuism in women and gyneocomastia and impotence in men | Cushings |
| Cenripetal (truncal) obesity or generalized obesity | Cushings |
| Moon face (fullness in face with facial plethora | Cushings |
| Purpilish red striae (depresses below skin surface on abdomen, breast or but | Cushings |
| Hirituism in women? | Cushings |
| BP in cushings? | Hypertenson |
| Unexplained hypokalemia? | Think cushings |
| Plasma cortisol levels may be elevated with loss of diurnal variation | Plasma cortisol (primary glucorticoid) |
| When cushings is suspected what test is doen? | A 24 hour urine collection for free corisol |
| High or normal ACTH levels indicate? | Cushings |
| Low levels of ACTH but high corticosteroids indicates? | adrenal or medication etology |
| hypokalmea and alcklosis are seen in? | Ectopic ACTH sundrome and adrenal carcinoma |
| Treatment for cushings if it is a tumor? | Surgical removal of pituitary by transphendoinal aproach |
| Indicated for cushings caused by adrenal tumors or hyperplasia | Adrenalectomy |
| When surgery has failed, drug therapy is used to supress the syhtesis and secretion of cortisol from the adrenal gland an example is? | Cytraden |
| To avoid adrenal insufficency when taking drugs to supress adrenals you may need this | Hydorcortisone/predisone |
| Patients recieving long term corticosteroids are at risk for? | Cushings syndrome |
| Asees and monitor glucose and possible infection in? | Cushings |
| Becuase in cushings there is excess crtisol this may be absent? | S/S of inflmation like fever and redness |
| Monitor for pulmonary emboli in? | Cushigns syndrome |
| Treatmetn in cushings prognosis? | Pyshical changes and much of the emotional lability will resolve when hormone levels return to normal |
| 3 main concerns in pre-op for cushings? | Hypertension, hyperglycemia and hypokalameia |
| The protein depletion in cushings disease is correccted by? | High protein diet. |
| Because adrenal glands are vascular the risk for hemorrhage is? | Inceeased |
| After surgery fro cushings wheter removing pituitary or adrenals, this is given IV during surgery and for several days after to ensure adequate response to the stress of the procedure? | Corticodteroids |
| If during surgery for cushings large amounts of endogenous hormones are released through manipulation this may occur? | Hypertension |
| High levels of corticosteroids do what? | Delay woud healing and increase chance of infection |
| Critical period fro circulatory instability postop adrenelectomy or pituirary removal? and 2 things to do? | 24-48 hours (check urine levels in morning for cortisol to determin effectivness of program and keep IV open in case need corticosteroids. |
| If corticosteroid dosafe is tapered too rapidly after surgery what can occu? | Acute adrenal insfuccinecy |
| Vommiting, increased weakness, dehydration and hypotension, painful joints, and peeling of skin indiacte? | Hypocortisolism. |
| After surgery to correct cushings it is important to? | Wear medic alert, avoid exposure to exterme temps, infections and emotional disturbances (no longer have ability to react to stressors) |
| Teach patients to adjust there cortisosteroid levels in accordance with their? | Stress levels |
| Is treatment life long after surgery to correct cushings? | Usually |
| Excessive or prolonged steroid therapy that produces cushings but abrupt withdrawl of the exogenous steroids can not be abruptly withdrawl as it may cause | Acute adrenal insufficency |
| Gradual withdraawl of exogenous corticosteroids is necessary to allow thanterior pituirary and oppurtunity to secretete? | Increasing amounts of ACTH to stimulate the adrenals to produce cortisol |
| Hyperglycemia, susceptibility to infaction, hypertension and hypokalemia may be seen in | Cushings syndrome |
| The physical signs of cushings usually is apparent? | Early |
| Children with short stature may be responding to increased cortisol levels resulting in? | Cushings syndrome |
| Cotisol inhibits the action of? | GH |
| in dx for cushings cortisol should be measured? | at midnight and in the morning |
| Bones in cushings? | Osteoporosis |
| In the dexemethasone supression test- administration of an exogenous supply of cortisone normally supresses ACTH production but in cushings syndrome cortisol levels remain? | Elevated |
| Two surgerys for cushings? | Adrenelectomy or removal of pituirary tumor |
| When steroids are the cause of cushings this may be altered by giving it at wha titme? | In the morning |
| Post -op complications of adrenalectomy? | Hypotension and hyperprexia (shock) taking away cortisol |
| Anorexia, N/V and joint pain are common in? | Cushings |
| pituitary, tumor, adrenal tumors, and ectopic (like lungs) ACTH production tumors | Possible cause of cushings |
| Buffalo hump | Cushings |
| BP in cushigns | Hypertension |
| unexplained hypokalemia? | Cushings |
| Edema in lower extremeties, Hirtuism in women, and bone fractures | Cushings |
| Menstrual disorders in cushing? | Yes |
| Emotion in cushings? | Disturbed |
| Plasma ACTH levels in cushing ? | Low, normal or elvated depending on cause |
| diet in cushings? | High protein diet |
| after removal of pituitary or adrenals? stress? | Is almost impossible to deal with? |
| acid base in cushings? | Alkalosis |
| Primary cause of adrenacorticortical insuffudiency | Adisons |
| In addisons disease what is reduced? | All three clases of adrenal corticosteroids (glucorticoids, mineralocorticoids and adrognes). |
| In secondary adrenalcoritocal insufficency, (lack of pituiatary ACTH secretion) what is deficent? | Corticosteroids and androgens are deficent but mineralcortiocoids rarely are. |
| May be caused by pituitary disease or supression of the hypothalmic pituitary axis, cuz of the adminstration of exogenous corticosteroids? | ACTH deficiency |
| Most common cause of addisons disease? | Autoimmune |
| Tuberculosis often causes? | Addisons |
| Infarction, fungal infections, AIDS and metastic cancers can cause? | Addisons |
| May be due to adrenal hemmorhage often related to anticoagulant therapy, chemo, ketocanzole therapy fro aids or bilateral adrenalectomy | Iatrogenic causes of addisons disease |
| Onset of addisons? | Manifestations do not tend to become evident untill 90% of adrenal cortex is destroyed so manifestions is insidious |
| Progressive weakness, fatigue, weight loss, and anorexia are primary features? | Addisons disease |
| Bronze colored skin hyperpigentation seen primary in sun edxposed areas of the body, pressure points, CREASES, especially palmar creases | Addisons disease |
| Orthostatic hypotentsion, hyponatermia, SALT CRAVING, N/V and diarhea | Addisons disease |
| Potassim levels in addisons? | Hyperkalemia |
| Mood in addisons? | Irritability and depression |
| If the pituitary is at fault as in secondary causes of adisons what will you see? | decreased ACTH so NO skin prigmentation |
| Complication in addisons? | Acute adrenal insufficinecy (addisonian crises) life threatning emegency |
| What is adisinonian crises is triggered by? | Stress (infection/surgery), Sudden withdrawl of coticosteroids, adrenal surgery or sudden pituitary gland destruction |
| In this Hypotension may lead to shock, circulatoy collapse, hyperkalemia, tachycardia, fever, weakness, and hyponatremia | Addisonian crises |
| How dx adisson? | Depressed serum and urinary cortisol levels |
| ACTH levels in primary adrenal insuffinciny? | increased and decreased in secondary |
| Cortisol levels fail to rise with an ACTH stimulation | Primary adrenal insufficency |
| Aldosterone levels in Adisons? | Low |
| Peaked T waves as in hyperkalemia may be seen in? | Addisons |
| BUN in addisons? | elvated |
| Blood sugar in addisons | Hypoglycemia |
| Main treatment for adrenocorticol insufficeincy | Hormone therapy, (Hyrdocortisone is best as it has glucortocoid and mineralcorticoid) |
| This is given in adrenocrticol insufficnecy with a mineraclicticoid replacement is done with? | Fludrocortisone, |
| Salt needed in adrenalcorticol insuffinceny? | Needs to be increased cuz aldosterone is decreased |
| Adisons is a life threatning emergecny, how is it treated? | High dose cortisone, Fluids to reverse hypotension and electorylytes |
| Changes in BP, weight gain , and weakness in addisons beging treated with corticosteroids could indicate? | Cushings |
| Stress in addisons? | They do not have the coriocosteroids to deal with it so they need to be protected from noise, light and enviormental temperatures to decrease stress |
| How long on hormones in addisons? | Life long |
| When give glucorticoid supplemnts in treatment of addisons? | 2/3 in morning and 1/3 in afternoon |
| When in adrenalcortiocal insufficency give mineralcorticoid? | Mornign |
| A patient with addisons is undergoing tooth extrasion, rigourous activity on a hot day, Vomits and nauseas and has influenza? | Call dr. as may need to increase cortisol dosage |
| It is important to wear what in addisons? | Med alert bracelet |
| What should the patient with addisons always carry? | IM hydrocortisone 100 mg |
| Prolonged difficult labor, infction like menigococemia (which can result in hemorrahge and necrosis) congenital adrenogenital hyperplasia of the salt loosing type | Adrenocortical insufficiency |
| Increased irritability, headahce, diffuse abdominal pain, weakness, N/V and diarrhea | Adrenocortical insufficincy |
| Extreme hyperprexia, tachypnea, cyanosis, seizures | In newborns adrenal crises. |
| Hemorrahge into the adrenal gland may result in? | Adrenocorticol insufficency |
| WONG- diagnoses is usually based on clinical presentations, especially when a fulmitatinf sepsis is accomponaed by hemorrhagic menifestations and signs of circulatory collpase despite antibiotics? main intervention | Acute adrenocorticol insufficency immedialy institute cuz there is no real harm in cortisol administration. |
| Treatment involves replacement of body fluids to combat dehydration and hypovolvemia administration of glucose to correct hypoglycemia and antibiotics in the prescence of infection and replacement of cortisol usualy IV hydrocortisone is given | Acute adrneocortocol insufficinecy |
| In acute adrenocorticolal insufficincy due to abrup onset and potentially fatal results vital signs are taken every? | 15 minutes and monitor for hyperprexia and shock like state, seizure precautions |
| Once acute phast of adrenocortical insuffincency is over administer fluid? | gradually |
| When oral potassium is given mix it with? | juice |
| definitive dz for chronic adrenocorticol insufficency? | Fasting cortisol and urine corticosteroid are low and plasma ACTH are elvated with ACTH stimulation |
| Treatment involves replacement of what in adrenal insufficney | Glucortiocid (cortisol) and mineralcortiods (aldosterone) |
| in adrenalcortocil insuffecy? unecessary administration of cortisone will? | not harm the child but may be life saving |
| primary cause of adrenocortical insuffincency? | Addisons disase |
| Seconday cause of adrenocortical insufficency? | Lack of pituitary ACTH secretions |
| In Addisons all 3 adrenal corticosteroids are reduced they are? | glucorticoid, mineralcorticoid and androgensA |
| adrenal tissue is destroyed by antibodies against patients own adrenal cortex? | Adissons disease |
| Decreased sodium, glucose and hyperkalemia in? | Adrenocortiocal insufficency |
| hyperkalemia and peaked T waves seen in? | Addisons disease/Adrenocortocal insufficency |
| The daily mineralocrtiod Florinef is given in the? | Morning |
| salt additives for increased heat or humidity | Adrenal cortocol insuffincency |
| Hypotension, tachycardia, dehydration , hyponatremia, hyperkalemia, hypoglycemia, fever, weakness and confusion severe diarrhea vommiting and pain, shock and circulatory collapse | Acute adrenal insufficency (Adinsonian crises) |
| Treatment of adisoninan crises? | Shock managment and high dose hydrocortisone replacement, large columes of NS and 5% dextrose |
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rebo14