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Endocrine STCC
STCC class of 2011 nursing 402 endocrine study guide
| Question | Answer |
|---|---|
| A nurse assessing a patient with diabetes insipidus would expect to see which clinical manifestations associated with this condition? | Polyuria; Polydipsia; Sudden, drastic increase in urine output over several hours; Very dilute urine (low specific gravity); High serum osmolarity; Hypotension; Tachycardia; Hypernatremia |
| The nurse would expect which tests to be performed on a patient suspected of having diabetes insipidus? | Fluid deprivation test and/or Vasopressin stimulation test |
| A patient showing decreased, concentrated urine; low serum sodium (dilutional hyponatremia); and hypertension would be likely to have which endocrine disorder? | Syndrome of inappropriate antidiuretic hormone |
| A nurse caring for a patient with SIADH would understand that the main nursing intervention for this condition is what? | Fluid restriction |
| What dietary changes would be appropriate to implement for a patient with SIADH? | Restrict fluids as ordered and increase dietary intake of sodium. |
| The hypersecretion disorder of the posterior pituitary gland is: | SIADH |
| The hyposecretion disorder of the posterior pituitary gland is: | Diabetes insipidus |
| A patient suspected of having diabetes insipidus and undergoing a fluid deprivation test would be considered positive if they do what after the test? | Continue to excrete large amounts of urine. |
| The nurse caring for the patient with diabetes insipidus should notify the MD if the patients urine output is how much? | Greater than 100 ml/hour for 3 hours. |
| What condition is caused by the removal of the anterior pituitary and what special medication needs does a patient with this have? | Panpituitaryism. After the anterior pituitary is removed the patient will have to be on replacement hormones for the rest of his/her life. |
| All of the following are symptoms of diabetes insipidous except: -Low blood pressure -Bradycardia -Very dilute urine -High Serum Osmolarity | Bradycardia. A patient with DI will be tachycardic. |
| What is a removal of the anterior pituitary gland called and what is the most common surgery to perform the removal? | Hypophysectomy, it is usually removed through transphenoidal microsurgery, which involves removing the anterior pituitary through the nose |
| What hormones are secreted by the posterior pituitary? | ADH and oxytocin |
| What is the function of ADH? | Inhibits urine production/excretion. Holds fluid in the body. |
| In what situation may a patient be given ADH (vasopressin) as a medication? | In trauma situations where there is massive fluid/blood loss. |
| What hormones are secreted by the anterior pituitary? | FSH (follicle stimulating hormone) LH (leutenizing hormone) Melanocytes Prolactin ACTH TSH GH |
| What is the function of ACTH? | Stimulates the adrenal glands to secrete cortisol, aldosterone, and androgen |
| What is the function of TSH? | Stimulates the thyroid to secrete thyroid hormone |
| Cushings disease is cause by a an excess/deficiency of what hormone? | An excess of ACTH |
| Addisons disease is caused by an excess/deficiency of what hormone? | A deficiency of ACTH |
| What processes in the body is the Thymus gland responsible for and what is the major hormone it produces? | It is responsible for immune response; the development of "T" cells necessary for immune response. It produces thymopoietin. |
| What bodily function is the thyroid gland responsible for? | All metabolic activity including energy production, growth, and development |
| What are the major hormones of the thyroid gland? | T3, T4, and Calcitonin |
| What is the function of the hormone calcitonin? | It puts calcium back into the bone. |
| What hematologic state causes the thyroid to release calcitonin? | An increase of calcium levels in the blood stimulate the thyroid to release calcitonin to put the calcium into the bones. |
| Greys disease is caused by excess/deficiency of what hormones? | An excess of thyroid hormones |
| Myxedema is causedby an excess/deficiency of what hormones? | A deficiency of thyroid hormones |
| What body functions does the parathyroid regulate? | Calcium and phosphorous metabolism |
| What is the major hormone of the parathyroid and what does it do? | Parathormone, it pulls calcium out of bones if the circulating amount (serum) is too low |
| Hypersecretion of parathormone causes what to happen in the body? | Bone decalcification |
| Hyposecretion of parathormone causes what to happen in the body? | Tetany |
| What hormones are secreted by the adrenal cortex? | Cortisol, Aldosterone, and androgen |
| What is the function of the hormone cortisol? | It's a glucocorticoid. It makes sugar, preps the body to handle stress, increased glucose metabolism, supresses the inflammitory response |
| What is the function of Aldosterone? | Mineralocorticoid. Holds water and sodium, gets rid of potassium |
| What is the function of the adrenal medulla and what hormones does it produce? | Functions with the sympathetic nervous system to support/prolong sympathetic response. It produces the catecholamines: epinepherine and norepinepherine |
| What is a stimulation test performed for and what would indicate a positive result? | Performed to diagnose hypofunction. Failure of hormone level to rise would indicate this. |
| What is a supression test performed for and what would indicate a positive result? | Performed to diagnose hyperfunction. Failure of hormone level to drop or the hormone to quiet down indicates this. |
| What is a secondary endocrine disorder and what is an example of one? | A problem outside of the gland affected. An example is cushings disease where the adrenals are healthy, but there is a problem with oversecretion of ACTH in the pituitary. |
| What is a primary endocrine disorder? | The problem involves the gland itself. |
| Acromegaly is a disorder caused by the oversecretion of what hormone? | Somatotrophin (GH) |
| What age group does acromegaly afflict? | Adults (after the epiphyses closes) |
| What age group does gigantism afflict? | Children (before the epiphyses closes) |
| What is the difference between gigantism and acromegaly in regards to how they affect bone growth? | Acromegaly causes the bones to increase in width and thickness. Gigantism causes the bones to grow longer. |
| What is the treatment of choice for Acromegaly/gigantism? | Transphenoidal microsurgery to remove the anterior pituitary |
| What two conditions must be closely monitored for following transphenoidal microsurgery (or any brain surgery)? | Diabetes insipidus and SIADH |
| An enlarged pituitary tumor exerting pressure on other structures of the brain can cause what symptoms? | Visual disturbances and headaches |
| GH antagonizes insulin. In addition to causing hypoglycemia and symptoms of diabetes mellitus, what other condition does an excess of GH cause? | Cardiomegaly |
| What is the definitive test for Aromegaly? What indicates a positive result? | Oral glucose challenge test. Normally GH concentration falls during the test, however in acromegaly GH levels do not fall. |
| What test is performed to determine the extent of spread of a pituitary tumor into surrounding tissue? | MRI |
| What is the treatment goal for acromegaly/gigantism? | Return the patients GH levels to normal. |
| The treatment of choice for acromegaly is what? | Hypophysectomy |
| What drugs are used for drug therapy when treating acromegaly/gigantism? | Somostatin analogs, GH receptor analogs, dopamine agonists, parlodel to suppress GH secretions |
| SIADH usually develops in what type of patients? | Critically ill patients, as well as tumor patients, severe stress/trauma, cerebral hemorrhage, cranial surgery, CNS infection |
| When does SIADH tend to be chronic, as opposed to self limiting? | It is chronic in nature when associated with tumors or metabolic disease |
| What are some clinical manifestations specific to SIADH? | Increased weight, Increased BP, Decreased urine output, VERY concentrated urine, PROFOUND LOC changes (weak, confused, lethargic), NO EDEMA, serum hyponatremia (under 130, dilutional) |
| What is the immediate treatment goal for a patient with SIADH? | restore normal fluid volume and osmolality |
| What are the treatments for SIADH | Correct underlying cause, fluid restriction, maybe diuretics, supplements, increased sodium in diet, albumin, declomycin |
| What is the action of declomycin when given to a patient with SIADH? | Blocks the effect of ADH on the renal tubules, allows for more dilute urine, increases clearance in the tubules |
| What is the expected goal of fluid restriction in SIADH? | Should result in gradual, daily reductions in weight, higher serum sodium concentration, and symptomatic improvement |
| What is the nursing management for SIADH? | Monitor VS and i+o, increased Na in diet**, daily weights, fluid restriction, administer diuretics as ordered (check serum sodium) |
| What are the causes of Diabetes insipidus? | Either a deficiency in production/secretion of ADH (primary) or decreased renal response to ADH (secondary) |
| What drug is commonly a cause for nephrogenic diabetes insipidus? | Lithium |
| What are some clinical manifestations of diabetes insipidus? | Marked polyuria (5-20L/day), very dilute urine (specific gravity 1.000-1.005), polydipsia, Hypernatremia (serum) |
| How would a patient be prepped for a fluid deprivation test for diabetes insipidus, what would be a positive result? | The patient would ZERO fluids for 8 hours before the test. If the patient continues to excrete lots of urine and ADH doesn't increase, there is a problem, indicates DI |
| When is a vasopressin stimulation test, what does it determine, and is a positive result? | Performed after fluid deprivation test, determines nephrogenic DI v. neurogenic DI. ADH given to PT, considered nephrogenic if there is still no decrease in urine output. |
| What is the nursing management for DI? | Monitor VS/weights (notify MD for greater than 5% weight loss), DO NOT limit fluids, support thirst**, monitor LOC, monitor for hypovolemic shock |
| What life threatening condition would the nurse monitor for in a patient with diabetes insipidus? | Hypovolemic shock (hypotension, tachycardia) |
| When would the nurse notify the MD when assessing the urine output of a patient with diabetes insipidus? | when the UO is greater than 100ml/h for 3 hours (check trends) |
| Addisons disease is cause by hypofunction of what endocrine gland? | The adrenal cortex |
| What lab results would the nurse expect to see in a patient with addisons disease? | High serum potassium, low serum sodium levels, dehydration |
| A deficiency in what hormone that stimulates the adrenal gland is a secondary cause of addisons disease? | ACTH (problem with the anterior pituitary, likely a tumor) |
| When is the best time to obtain a blood sample from a patient when checking levels of cortisol? | Right after they wake up, cortisol levels are highest when waking. Taking this into account, consider patients sleep pattern, if they work night shift and sleep during the day (or have been kept up all night in the hospital), morning may not be best |
| What are some clinical manifestations of a patient with addisons disease? | Profound weakness, weight loss/anorexia (low BMR), hypovolemia, cramping/diarrhea, bronze color skin, low cortisol, hypotension**** |
| What lab results are used to confirm PRIMARY addisons disease? | high serum potassium and acth |
| What lab results are used to confirm SECONDARY addisons disease? | low serum levels of acth, glucose, Na, and cortisol |
| What is an ACTH stimilation test and what does it determine? | ACTH is given and cortisol levels are checked. Failure of cortisol levels to rise indicates primary addisons disease (function pituitary/bad adrenal) |
| What is the main thing the nurse is watching for when monitoring vital signs in an addisons disease patient? | Hypotension |
| What dietary consideration should be implemented for a patient with addisons disease? | Encourage fluid intake of at least 3000ml/day, unrestricted salt diet, high protein, high carb diet to promote glucose levels/protein synthesis |
| What teaching is important for a patient with addisons in regards to sodium replacement? | When performing exercise or activity, they should plan to increase their sodium/fluid intake |
| What would be a primary nursing diagnosis for a patient with addisons disease? | fluid volume deficit |
| What life threatening emergency is associated with addisons disease and what is it triggered by? | Addisons crisis, it is triggered by stress, loss of fluid/Na (hot weather), or sudden withdraw from corticosteroids |
| What is the treatment for addisons crisis? | RAPID fluid replacement, IV hydrocortisone, IV dextrose, increase Na/decrease K, quiet environment |
| An excess of what hormone (usually caused by a tumor) causes cushings disease? | ACTH, usually caused by a tumor of the anterior pituitary. Excess ACTH causes an excess production of adrenal cortex hormones (particularly cortisol) |
| What lab values r/t excess mineralcorticoids are seen in a patient with cushings disease? | High serum sodium, low serum potassium |
| What changes can occur in males/females with cushings disease? | Females: Menstrual disorders, excessive hair Males: gynecomastia (man boobs), impotence |
| What other clinical manifestations may be seen in a cushings patient (think s/s too much cortisol) | moon face, buffalo hump, weight gain in the trunk (with thin extremeties), acne, paperlike skin, hyperpigmentation, ecchymoses, abdominal striae, osteoperosis, hypertension, increased infections |
| What is the treatment goal for the patient with cushings disease? | return cortisol levels to normal |
| What adrenal supressant drugs may be used to treat a patient with cushings disease? | Mitotane |
| What cardiac complication does a nurse need to monitor for in a patient with cushings disease? | CHF because of too much retained sodium and H2O. |
| What are some nursing considerations for a patient with cushings disease? | Low sodium diet, strict i+o, prevent infection (high cortisol=immunosupressed), daily weights, vital signs, support for emotional body disturbances |
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omgmurse
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