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Test 4 possible ?s
Breast, CA, endocrine, GI
| Question | Answer |
|---|---|
| hypothyroidism is a primary dz with the destruction ofthe _______. | thyroid |
| s/s of hypothyroid | increased wt, decreased metabolism, impaired memory etc...slow |
| dx studies for hypo/hyperthyroid? | T3 & T4 and free T3, serum TSH (high) |
| what should u monitor w/hypothyroid? | cardiac fx |
| how is synthroid given? | titrated up slowly |
| what do u promote w/hypothyroid? | low cal diet, wt loss, pt MUST exercise |
| phosphate and Ca have what type of relationship? | inverse |
| hyperparathyroid causes what? | increased bone resorption- osteoperosis |
| hyperparathyroid serious complication | kidney stone d/t increased (impaired renal fx) |
| hypoparathyroid s/s | tetany, decreased ca, positive trousseau and positive chvostec's (remember ch for cheek) |
| vitamin D is the same as what? | calcitonin |
| what are nursing interventions for hypercalcemia? | monitor for dysrhythmias, monitor magnesium, increase fluids and give diuretics |
| nursing intervention for hypocalcemia? | give meds and have them breath into a paper bag (rebreathing CO2 lowers Ph) |
| what should you have ready when parathyroid is removed? | ca+ may be low, check for tetany, positive and have IV Ca+ readily availabletrouseau's and chostec's |
| hypothyroid: how do u infuse Ca+ | slowly |
| what's a major vitamin D food? | sardines |
| coricosteroid = increased what in the body? | sugar |
| decreased PTH= what? | increased calcitonin= decreased bone resorption= increased serum Ca+ |
| cushing's syndome is d/t what? | roo much ACTH |
| cushing's syndrome s/s | TRUNKAL OBESITY, increased wt, ms wasting, hypoglycemia, POOR WOUND HEALING, moon face, buffalo hump, red cheeks, ACNE, osteoperosis- think SANTA CLAUSE |
| dx for cushing's | 24 hour urine for corticosteroids |
| dexamethasone test to differenciate what? | Cushings; if it's in the pituitary (will not lower), adrenal gland (will lower) |
| you do not stop taking corticosteroids- why? | addison's crisis- taper slowly |
| what do u monitor for Cushing's? | blood sugar, B/P, increased wt and infx |
| if problem for Cushing's is in the pituitary, what type of procedure is done? | hypophysectomy (through upper lip) |
| if problem for cushing's is in adrenal gland, what procedure is done? | adrenalectomy |
| post op care for hypophysectomy? | mouth care- soft toothbrush |
| excess coricosteroids causes what? | hirstuism, menstual d/o, infection (immunosuppresant right?), injury (osteoperosis), red striae (strech marks), hyperglygemia (wound healing) |
| nursing dx for excess corticosteroids? | decreased self esteem (stretch marks), impaired skin integrity |
| excess of corticosteroids nursing interventions | EMOTIONAL SUPPORT, d/t appearance, monitor s/s of hormone complications (v/s, daily wt, b/s, infx, abdominal pain, thromboembolitic, bone pain, decreased ROM, lower backn pain) |
| what is hypophysectomy? | removal of the pituitary gland |
| pre-op for adrenalectomy | sequential leg compression & exercise, monitor & info on IV for fluid/lyte balance, admin corticosteroids, NGT suctioning, CDB w/splinting) |
| pt teaching w/adrenalectomy | lifetime on corticosteroids |
| diet for pt w/adrenalectomy | high protein (for wound healing) |
| post-op for adrenalectomy (cushing's) | IV corticosteroids for 24h then PO, monitor B/P. fluid/lytes, AM urine for cortisol, monitor for infx, aeseptic care for dressing change, s/s of steroid imbalance |
| s/s of steroid imbalance | increased weakness, dehydration, hypotension |
| home care for post-op cushing's | MEDIC ALERT BRACELET, avoid extreme temperatures, infx & stress (meds according to stress- more stress more corticosteroids) |
| addison's dz caused by what? | autoimmune failure of adrenal glends |
| iatrogenic cause of addison's includes? | adrenal hemmorhage, chemo, or bilateral adrenalectomy SURGERY, meds |
| s/s of addison's dz | (VIDEO) weakness, tachycardia, HYPOTENSION, anorexia, skin color change (bronzing d/t ACTH), n/v/d, abdominal cramping, increased K+ |
| addison's crisis can be caused by what? | stopping corticosteroids cold turkey), stress or surgery |
| what does a person going through addison's crisis need | IV corticosteroids,(cannot just bulk w/fluids & vasopressin)--> then Na+, NS & 5% dextrose till B/P is normal |
| dx studies for addison's: ACTH stimulation test, cortisol does what? | fails to rise |
| lab findings w/addison's dz: | EKG (peaked T-wave d/t hyperkalemia), hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, increased BUN, low free cholesterol in urine |
| nursing management for Addison's | HYDROCORTISONE ADMINISTRATION #1, DAILY WTS, STIMULATION PRECAUTION/CALM ENVIRONMENT, no infx, total help w/ADLs, asses v/s and fluids Q30 min-4 hours |
| when do you give mineralcorticosteroids? | one in the morning on an empty stomach d/t the circadian rhythm |
| home care for addison's DZ | CARRY PREDNISONE PEN IN EMERGENCY KIT, MEDIC BRACELET, increased stress= increased dose (fever, flu, tooth extraction)- doses are doubled or tripled, teach to watch s/s |
| signs of addison's crisis | vomitting/diarrhea- call HCP for lyte replacement |
| therapeutic action of corticosteroids | supression of inflamation & immune response (neutropenia), inhibition of cell production, vasopressive actionb, maintain B/P, carb & protein metabolism (inc glucose resistance) |
| what do you need to supplement w/corticosteroids? | Ca+, vitamin D, biphosphonates, exercise |
| what other disorder are corticosteroids used for? | COPD (decreases inflammation) |
| corticosteroids are started prior to bilateral adreal surgery because... | surgery stress |
| pt teaching for corticosteroids | DECREASE FAT AND CARBS, take naps, exercise for bones, AVOID CAFFEINE, take B/P and report if > 120 |
| tx for hyperaldosterone | unilateral adrenalectomy |
| hallmark for hyperaldosterone | HTN and hypokalemic alkalosis(hypernatremia) |
| symptoms of hypokalemia | ms weakness, arrythmias, glucose intolerance, tetany, metabolic alkalosis, myalgia, constipation |
| nursing interventions for hyperaldosteronism | low Na+ diet, B/P frequently, oral K+ supplements, SPIRONALACTONE (K+ sparing), CCBs |
| dx for hyperaldosteronism | serum K+, EKG (arrhythmias) |
| what is pheochromcytoma? | a catecholamine secreting tumor of the adrenal medulla (may lead to DM, cardiomyopathy & death if untx) |
| Pheochromocytoma: classic HTN triad; | severe pounding HA, tachycardia, profuse sweating |
| what's the only cure for pheochromocytoma? | remove tumor (laparoscopic)- curative for HTN |
| Dx study for pheochromocytoma | 24-hr urine collection for catecholamine metabolites (fractionated metanephrines) |
| nursing management for pheochromocytoma | monitor B/P, look for classic triad, check B/S |
| post op for pheochromocytoma | same as adrenalectomy but with B/P included |
| s/s hypokalemia | 3.5-5 is norm; dysrhythmias, muscular weakness, myalgia, and muscle cramps and constipation |
| s/s of hyperkalemia | Irregular heartbeat, Fatigue, Weakness, Tingling, numbness, Paralysis, Difficulty breathing •Nausea and vomiting |
| s/s of hyponatremia | 135-145 is norm; N/V, HA, Confusion,Fatigue, Appetite loss, Restlessness and irritability, Muscle weakness, spasms or cramps Seizures Decreased consciousness or coma |
| s/s of hypernatremia | weakness, irritability, edema, seizures and coma |
| magnesium level- and inverse level with what? | 1.3-2.1; calcium |
| growth hormone mobilizes what? | glucose and free fatty acids |
| overproduction of GH caused by what?? | benign pituitary tumor |
| gigantism vs acromegaly | gigantism; onset before closure of epiphysis (tall- kids) & acromegaly; overgrowth of the bones and soft tissues (thick-adults) |
| sleep apnea can occur beecause of what r/t GH? | enlargement of the tonge |
| with GH excess, tx can arrest what and reverse what? | arrest bone growth and reverse tissue hypertrophy |
| what's a sign of GH excess? | hat is too big |
| leg cramps in Addison's is d/t what? | hyponatremia |
| discoloration in addison's is d/t what? | decreased aldosterone |
| test orf GH | OGGT |
| what surgical therapy is done for excess GH | hypophysectomy |
| what hormones are needed post hypophysectomy? | thyroid hormone, glucocorticoids, and ADH |
| pre op for hypophysectomy | pt teaching on MOUTH CARE, breathing, ambulation, pain, avoiding straining, and HRT |
| post op for hypophysectomy | HOB @ 30 degrees, mouth care q4h, NO TOOTH BRUSHING FOR 10 days, CLEAR NASAL DRAINAGE TESTED FOR GLUCOSE, analgestcs, anbx, IV fluids |
| possible complication of hypophysectomy | DI d/t loss of ADH |
| what does the posterior pituitary secrete? | ADH and oxytocin |
| most common cause of hypopituitarism (pituitary not working well) | tumor |
| hypophysectomy increases the risk for what? | infx, meningitis (that's why no brusging teeth 10 days) |
| What is SIADH? | opposite of DI, innappropriate secretion of ADH |
| SIADH characterized by what? | SWELLING IN THE BRAIN, fluid retention, hypoosmolality, dilutional hyponatremia |
| lyte imbalance w/SIADH can increase risk for what? | seizures |
| s/s of SIADH | INCREASED WT W/OUT EDEMA, DILUTIONAL HYPONATREMIA, CEREBRAL EDEMA W/LOW OSMOLOALITY |
| what is monitored w/SIADH? | I/O, daily wt, decreased BUN & CREATININE (and urine is concentrated- don't get why) |
| Care for acute SIADH | fluid restriction (1qt/day) & 3% sodium LOW AND SLOW, OFFER ICE CHIPS OR CHEWING GUM to decrease thirst |
| other nursing interventions for SIADH | observe LOC, food high in K+, HOB <10 degrees (enhance flow to heart, reduces ADH release), sz prec, side rails up & pad for sz, reduce lighting, oral care |
| hallmark for DI | polydypsia, polyuria |
| primary characteristic for DI | excreting >5-20L urine a day, HYPERNATREMIA D/T PURE WATER LOSS, INSOMNIA R/T FREQUENT URINATION |
| nursing management for DI: | replace fluids, have @ bedside & IV |
| what is the most abundant thyroid hormone? | T4 |
| what do you if a pt is going throu thyrotoxic storm? | call code |
| ESR marker for inflammation should be at what #? | <20 |
| what do you monitor for hyperthyroid? | temperature |
| most common form of hyperthyroid? | Graves dz- autoimmune |
| what's TSH level like for hyperthyroid? | low |
| what's a precipitating factor for hyperthyroid? | stress, infx, insufficient iodine |
| what do u make sure of @ NIGHT in the pt w/hyperthyroid? | they can shut their eyes or TAPE it |
| how does a pt w/hyperthyroid behave in regards to food? | eating & thirsty all the time |
| manifestations of hyperthyroid | sensitive to N/E, epinephrine (inc heart rate, B/P, palpitations), EXOPTHALMOUS |
| what is necessary to check in hyperthyroid pts?N/E | heart/cardio |
| what med is given to a hyperthyroid pt for s/s? | inderal (BB) |
| what system is affected by hyperthyroid? | every system |
| nursing interventions to help w/exopthalmos? | GIVE ARTIFICIAL TEARS, DEC SODIUM, DARK GLASSES, INTRAOCCULAR EXERCISES, KEEP HOB UP TO DECREASE PRESSURE |
| hyperthyroid and drug tx | NOT CURATIVE |
| hyperthyroid and iodine | TREATMENT OF CHOICE=radioactive- give PREGO TEST (do not walk into room if u want to become prego) |
| hyperthyroid and surgical therapy | last resort- try everything else 1st |
| postoperative complication of thyroidectomy | laryngeal stridor (harsh sounds)tx w/IV Ca+ first, then move on to tracheotomy |
| what kind of diet for hyperthyroid? | high calorie, avoid caffeine/high fiber foods/spicy foods |
| what is done post surgery for hyperthyroid? | eat 1/2 the calories, monitor for Trousseau's (B/P cuff) or chovstec's(cheek) to see if parathyroid is effected |
| nurse is most concerned with the pt post thyroidectomy when... | harsh, vibratory sounds when they breath (give Ca+ glutamate, then trache) |
| what is normal post op from a thyroidectomy? | sore throat, hold head when moving head |
| pts w/hyperthyroid are _________ d/t metabolism, pts w/hypothyroid are _______ d/t metabolism | hot; cold |
| What shouldn't u give w/levothyroxine? | iron- wait 2 hours or else it forms an insoluble compound in the GI |
| what does levothyroxine effect (med)? | anticoagulant/coumadin |
| what do you do do if hypothyroid pt is tachycardic? | hold dose & call HCP |
| benign vs malignant tumor | has controlled boundaries vs malignant |
| what is CA? | a DNA mutation--> forms a clone & IGNORES GROWTH REGULATING SIGNALS |
| CA cells can produce how many cells @ the time of mitosis? | more than 2--> ignore CONTACT INHIBITION |
| What is the stem cell theory? | loss of control d/t mutation of stem cells--> SURVIVING MUTATED CELLS CAN BECOME MALIGNANT |
| what is hyperplasia? example? | most often w/rapid body growth (young)- benign-increase in the # of cells in a tissue--> BPH and women who breastfeed |
| what is metaplasia? | conversion of one type of cell into another type- reversible- precancerous. ie; BARRETT'S ESOPHAGUS |
| what is dysplasia? | cell type that differs in size, shape, arrangement from cells of the same type tissue- 1st stage- ie; abnormal pap smear- can be cures |
| what is neoplasia? | uncontrolled cell growth that follows no physiological demand (can be benign) |
| what is anaplasia? | reversion of cells to immature or less differenciated form (difficult to tx)- late stage CA; lack normal characteristics and differ in shape and organization w/respect to their cells of origin (usually MALIGNANT) |
| what kinds of foods have carcinogen's? | smoked foods, bacon, basil |
| 2 types of genes affected by mutation? | 1)protooncogenes (promote normal cell growth) 2)tumor suppressor genes (suppress growth) |
| what does poorly differenciated mean? | bad- close to mother cell |
| degree of _____________ malignant potentialdetermines | anaplasia |
| characteristics of benign tumor | encapsulated, normally differentiated, absent metastasis, rare reoccurence, slightly vascular, similar to parent cell |
| characteristics of malignant cells | rarely encapsulated, poorly differenciated, capable of metastasis, possible reoccurance, marked vascularity, infiltrative & expansive, cells become more unlike parent cells |
| describe stage 1 initiation | irreversible, happens to everyone, mutation in the cell's genetic structure, SMOKING |
| describe stage 2 promotion | reversible, bad habits are promoters, OBESITY, #1 SMOKING |
| stage 3 progression | evidence of s/s, increased growth rate of tumor, invasive and spread to a distant site |
| In order to block the estrogen receptor, some women get ___________. | hysterectomies (prophylactic) |
| __________ receptors are easier to tx. | estrogen |
| benign vs malignant | benign is moveable, painless, changes size and have controlled boundaries (delineated) |
| Another pt teaching post masectomy. | exercise arm everyday |
| what's important to know rearding family hx and breast CA | it has to do w/1st degree maternal relative |
| what is the relationship between obesity and breast CA? | obese store more estrogen which increases risk |
| there's a correlation between breast CA and __________ CA. | ovarian |
| lumpectomy removes what? | only the bad area(<4cm)+ margin of normal tissue + radiation- but changes in breast sensitivity |
| masectomy removes what? | everything including the lymph nodes (the modified version conserves the pectoris ms) |
| what's another big risk factor for breast CA? | HRT- ESTROGEN |
| what does lymphedema feel like? | pressure and pain, no pitting edema |
| metastasis occurs widely and early with what? | inflammatory breast CA- more malignant, aggressive but most rare. Orange peel, red, warm |
| manifestations of breast CA | hard, irregularly shaped, nonmobile, nontender |
| initiation stage | irreversible & become tumors when they can self replicate |
| promotion stage is ___________ and it is a ______ period r/t _________ | reversible, latent, age |
| in the progression stage, the tumor is capable of ________ and forms____________ | angiogenesis, vascular supply |
| sarcomas originate from__________ | embryonal mesoderm (ct, ms, bone & fat) |
| carcinomas originate from______________. | embryonal ectoderm (skin/glands)and endoderm (mucousal membrane of respiratory tract, GI & GU tracts) |
| what kind of diet promotes CA growth? | high fat |
| lymphomas and leukemias originate from | hematopoitic system |
| histologic analysis evaluated | appearance and degree of differentiation- grades 1-4 |
| what are grades 1-4 | 1) well differentiated (good) 2) moderately differentiated 3) poorly differentiated 4)cells are primitive (anaplasia) UNDIFFERENTIATED- origin difficult to determine |
| what does caution stand for? | change in bowel/bladder habits, a sore that doen't heal, unusual bleeding/discharge, thickening or a lump, indigestion/difficulty swallowing, obvious changes in a wart/mole, nagging cough |
| yearly fecal occult test and prostate exam starts at what age? | 50 |
| what is debulking surgery | to decrease tumor burden. cannot remove the whole thing for some reason but helps radiation/chemo if done b/f hand |
| dx: which tumor marker is indicative of metastasis | CEA- only biopsy is really diagnostic, but this hints on whether it's sprean |
| what do you check w/vesicant drugs? | check for extravasation, check IV lines & d/c if bad |
| selecting drugs w/different MOA does what? | decreases s/e |
| Arm w/a PICC line must not be used for what? | drawing blood or b/p |
| chemo drugs work better when CA does what? | proliferates rapidly (ie; hair loss) |
| what do u do for the s/e of chemo? | give antiemetic 1 hr beforehand and watch for infx, etc (causes pancytopenia) |
| what do u infuse slowly? | IV Ca+ |
| hypophysectomy- you avoid what afterwards? | coughing |
| adrenalectmy- you need what afterwards? | hormones |
| which has a shorter half life- prednisone or dexamethasone? | prednisone |
| iatrogenic corticosteroids is d/t what drug? | prednisone |
| pre-op for adrenalectomy includes | info on eg compression device, info on IV for f/e imbalance, admin corticosteroids (stress of surgery), NGT sux, CBD w/splinting |
| adrenalectomy post op | IV steroids before PO for 24 hrs, monitor B/P, F/E, AM urine levels for cortisol, infx, aeseptic for dressing change |
| home care post adrenalectomy | medic bracelet, avoid exposure to extreme temp, infx, stress, increase cortisol when stressed |
| addison' dz caused by | failure of adrenal glands |
| addison's iatrogenic causes | chemo, hemmorhage, bilateral adrenalectomy surgery |
| s/s of addison's | hypotension (requires glucocorticoids to reverse), wt loss, hyperpigmentation, dehydration, salt craving, n/v, pain, tachycardia, unresponsive to vasopressin, lyte replacement |
| addisonian crisis is triggered by what? | stresss, withdrawal from corticosteroid hormone |
| with Addison's, if given an ACTH test, cortisol will... | fail to rise |
| adrenalectomy is dangerous b/c what? | hemmorhage |
| why are urine cortisol levels monitored? | effectiveness of surgery |
| what do u hand out to a pt w/addisonian to take home? | handout which explain drugs causing inc need for corticosteroids (dilantin, rifampin, antacids) |
| why are steroids given b/f surgery? | to dec stress |
| what is the hallmark of hyperaldosteronism? | HTN and hypokalemiic alkalosis |
| hypernatremia causes what 2 symptoms? | HA & HTN |
| hypokalemia causes what? | ms weakness, tetany, metabolic alkalosis, arrythmias, tiredness & glucose intolerance |
| what do you check with pheochromocytoma? | glucose (may lead to DM) |
| classic triad for pheochromocytoma: | HTN: HA, sweating, tachycardia |
| what do you monitor for pheochromocytoma? | B/P |
| specific gravity | 1.002- 1.030 (higher if concentrated- SIADH-,lower if dilute- DI) |
| SIADH- spinal tap is done to remove excess... | CSF |
| nursing mngmt for SIADH-- KNOW ALL! | I&O & specific gravity- high (1.002-1.030), wt. LOC, sz, n/v, ms camping, BP, heart & lung sounds, FLUID RESTRICTION, GIVE CANDY, food high K+, HOB <10, side rails up, oral care, reduce stimulation |
| what 2 things do you infuse low and slow? | hypertonic saline solution forSIADH, and Ca+ for hypoparathyroid |
| is serum osmolality high or low for SIADH? | low (normal is 285-295) |
| central or neurogenic DI caused by? | damage to pituitary or hypothalamus |
| what test do u use to test central or neurogemnic DI/ | water deprivation test |
| what is the water deprivation test? | to test pituitary fx, water is withheld- if no changes in volume excreted, desmopressin is given (ADH) |
| what is nephrogenic DI caused by? | kidneys not responding to ADH (or drugs like Lithium) |
| can u usew lithium for SIADH? | yes |
| what is DDVP? | ADH analog given to DI pt |
| do you give the pt thyroid hormones immediately after thyroid surgery? | no, u give the thyroid a chance to regenerate on it's own |
| post thyroid surgery- the pt can eat what? | seafood 1-2x a week |
| what do u check before giving synthroid? | check O2 to make sure heart is okay |
| what do u check when infusing CA? | patency |
| normal range for Ca+ | 8.4-10 |
| normal range for phosphate | 2-4 |
| serum osmolality | 285-295 (low w/SIADH & high w/DI) |
| specific gravity range | 1.002-1.030 (high if concentrated; SIADH, & low for DI) |
| urine osmolality range | 50-100 (high in SIADH and low in DI) |
| mg range | 1.3-2.1 |
| phosphate range | |
| PTH range |
Created by:
arsho453
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