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Nsg 213 Endocrine
| Question | Answer |
|---|---|
| What 7 hormones are produced in the anterior pituitary? | GH, TSH, ACTH, FSH, LH, Prolactin, and MSH |
| What 2 hormones are produced in the posterior pituitary? | ADH and Oxytocin |
| What is hypopituitarism? | Growth hormone deficiency |
| Etiology of hypopituitarism | trauma, tumors, vascular abnormalities, surgery, anorexia, most often idiopathic |
| Clinical manifestations of hypopituitarism | short stature with normal skeletal proportions, normal growth 1st year of life, growth drops below established percentile 2nd year of life, subsequet growth measuremnt below 5th percentile, appear well nourished, inactive |
| What can occur with hypopituitarism if it is not caught in time? | dental abnormalities, late eruption of permanent teeth, delayed sexual development, dwarfism or growth delay |
| How is hypopituitarism managed? | biosynthetic GH injections, replacement of other hormones if needed |
| Prognosis of hypopituitarism | successful tx in 80% of children, early diagnosis can reach normal adult heights, just later |
| What is hyperpituitarism? | growth hormone excess |
| Etiology of hyperpituitarism | most often pituitary adenoma(benign tumor), abnormal stimulation of the hypothalamus |
| Manifestations of hyperpituitarism | Gigantism- before closur of epiphyseal plates, overgrowth of long bones, can be 8ft or more Acromegaly- after closure of epiphyseal plates, overgrowth of facial features, increased facial hair,thick, deeply creased skin |
| Management of hyperpituitarism | surgical removal of tumor, may need radiation or hormone therapy |
| Prognosis of hyperpituitarism | tumor removal halts abnormal growth |
| Diagnostics of Growth hormone abnormalities | family hx, growth pattern and health hx, birth weight, nutritional state, MRI of brain, serum level of GH, levels of other hormones, X-ray |
| What is SIADH and what are the manifestations? | Syndrome of inappropriate ADH, increased secretion of ADH- vasopressin- kidney saves water. Water intoxication r/t increased circulatory volume w/out edema- decreased Na levels- irratibility, decreased urine output, anorexia, N/V, cramps, stupor/ seizures |
| Management of SIADH | fluid restrictions, assess for fluid overload, monitor i and o, seizure precautions, tetracyclines block action of vasopressin,ADH antagonizing drugs "vaptans" |
| What is Diabetes Insipidus? Manifestations? | Deficiency of ADH, vasopressin = persistent diuresis polyuria and polydipsia, older children spend their time drinking and voiding, enuresis often 1st sign. Infants irritability is relieved by water- dehydration, hyperthermia, electrolyte imbalances |
| What 7 hormones are produced in the anterior pituitary? | GH, TSH, ACTH, FSH, LH, Prolactin, and MSH |
| What 2 hormones are produced in the posterior pituitary? | ADH and Oxytocin |
| What is hypopituitarism? | Growth hormone deficiency |
| Etiology of hypopituitarism | trauma, tumors, vascular abnormalities, surgery, anorexia, most often idiopathic |
| Clinical manifestations of hypopituitarism | short stature with normal skeletal proportions, normal growth 1st year of life, growth drops below established percentile 2nd year of life, subsequet growth measuremnt below 5th percentile, appear well nourished, inactive |
| What can occur with hypopituitarism if it is not caught in time? | dental abnormalities, late eruption of permanent teeth, delayed sexual development, dwarfism or growth delay |
| How is hypopituitarism managed? | biosynthetic GH injections, replacement of other hormones if needed |
| Prognosis of hypopituitarism | successful tx in 80% of children, early diagnosis can reach normal adult heights, just later |
| What is hyperpituitarism? | growth hormone excess |
| Etiology of hyperpituitarism | most often pituitary adenoma(benign tumor), abnormal stimulation of the hypothalamus |
| Manifestations of hyperpituitarism | Gigantism- before closur of epiphyseal plates, overgrowth of long bones, can be 8ft or more Acromegaly- after closure of epiphyseal plates, overgrowth of facial features, increased facial hair,thick, deeply creased skin |
| Management of hyperpituitarism | surgical removal of tumor, may need radiation or hormone therapy |
| Prognosis of hyperpituitarism | tumor removal halts abnormal growth |
| Diagnostics of Growth hormone abnormalities | family hx, growth pattern and health hx, birth weight, nutritional state, MRI of brain, serum level of GH, levels of other hormones, X-ray |
| What is SIADH and what are the manifestations? | Syndrome of inappropriate ADH, increased secretion of ADH- vasopressin- kidney saves water. Water intoxication r/t increased circulatory volume w/out edema- decreased Na levels- irratibility, decreased urine output, anorexia, N/V, cramps, stupor/ seizures |
| Management of SIADH | fluid restrictions, assess for fluid overload, monitor i and o, seizure precautions, tetracyclines block action of vasopressin,ADH antagonizing drugs "vaptans" |
| What is Diabetes Insipidus? Manifestations? | Deficiency of ADH, vasopressin = persistent diuresis polyuria and polydipsia, older children spend their time drinking and voiding, enuresis often 1st sign. Infants irritability is relieved by water- dehydration, hyperthermia, electrolyte imbalances |
| What is the difference between diabetes mellitus and diabetes insipidus? | if urine tests negative for sugar and ketones, it is diabetes insipidus |
| How is diabetes insipidus managed? | lifelong tx of DDAVP(desmopressin acetate- hormone replacement for vasopressor- overdose of DDAVP leads to SIADH. Wear medic alert bracelet, drinking water and restrooms accessable at school |
| What is juvenile hypothyroidism? 2 types? | deficiency in circulating T3 and T4, thyroid stores depelete during childhood = slowed growth 2 types- acquired (thyroidectomy, irradiation for hodgkin's disease) congenital (dx in infancy = mental retardation, goiter, underdevelopment of thyroid gland) |
| Manifestations of juvenile hypothyroidism in children | decelerated growth, constipation, sleepiness, dry skin, sparse hair, low on forehead, periorbital edema |
| Manifestations of jevenile hypothyroidism in infants | puffy face, swollen tongue, hoarse cry, cold extremeties, mottled skin, low muscle tone, poor feeding, large fontanel, prolonged jaundice, described as "good baby". Risk of mental retardation if not caught by 3 mos- metabolic assay required at birth |
| Tx for thyroid hypfunction | levothyroxine |
| An autoimmune disease that leads to destruction of thyroid gland (low TH=increased TSH- increase size of gland) | Hashimoto disease (thyroiditis) More common in caucasian girls after the age of 6, peak in adolecsence |
| Manifestations of Hashimoto disease | inflammation, hyperplasia of thyroid- often palpable, tracheal compression, goiter- may resolve spontaneously within 1-2 years. Oral TH decreases size of goiter. No surgery indicated. |
| disease caused by thyrotropin receptor antibodies IgG these mimic TSH and stimulate thyroid to produce TH- most common cause of hyperthyroidism in children- peak incidence 12-14 y/o | Graves disease |
| How is does graves disease cause transient fetal hyperthyroidsm? | mother has graves- transfer of maternal IgG across placenta causes transient fetal hyperthyroidism |
| Manifestations of Graves disease | emotional liability, restlessness, fatigue, decrased school perfomance, voracious appetite with weight loss, fine hair, goiter, exophtalmus |
| Tx and Nsg management of a pt with Graves disease | PTU or methimazole, subtotal thyroidectomy, ablation with radioiodine, Nsg: quite environment, rest periods, dietary requirements ot meet metabolic needs, limit activity, teach meds and SE such as rash ,fever, enlarged lymph nodes, decreased taste, edema |
| Uncommon in chidren- fever 106, tachycardia, profuse diaphoresis, extreme vasodilation, decreased BP, hyperreflexia, delirium, NVD | thyroid storm or crisis |
| Types of hypoparathyroidism | Autoimmune- familial, autosomal recessive, low PTH, low Ca Psuedo- failure of parathyroid hormone to work properly- Ca and Phos can be normal, no end organ response hereditary |
| type of hereditary hypoparathyrodism | Albright's hereditary Osteodystrophy- round face, flat nasal bridge, short fingers/toes, bony swelling, bowing of bones |
| What is primary and secondary hyperparathyroidism usually caused by? | primary- adenoma of thyroid gland secondary- renal disease, renal osteodystrophy |
| What causes an increased PTH? | decreasd calcium |
| symptoms of high levels of Ca | weakness, atrophy, parasthesias, bradycardia, renal calculi, constipation |
| Group of inherited disorders, leack of enzyme activity that leads to decreased production of cortisol and aldosterone and the overproduction of androgen- decreased sodium, chloride, and incresed potassium | congenital adrenal hyperplasia |
| symptoms of girls with congenital adrenal hyperplasia | enlarged clitoris, fused labia, closed vaginal orfice,if untreated will lead to no breast development, failure to menstruate, deep voice, early appearance of pubic,armpit hair, excessive hair growth and facial hair, infertility- small statute by adulthood |
| Girls with congenital adrenal hyperplasia, do they have normal internal female reproducive organs, or are they affected too? | they usually are normal |
| When do signs of congenital adrenal hyperplasia appear for boys? | No problems at birth, may enter puberty as young as 2-3 years old with deep voice, early appearance of pubic, armpit hair, enlarged penis, small testes, well-developed muscles |
| How is height affected with boys and girls with congenital adrenal hyperplasia? | they will both be tall as children but significantly shorter than normal as adults |
| Management of congenital adrenal hyperplasia | sex assignment- karotype-bar body, US to visualize internal organs cortisol- increased need when stressed adosterone replacement- increased dietary salt RISK of wrong sex assignment |
| What is a pheochromoacytoma? | a tumor of the adrenal glands that cause high epinephrine and norepinephrine release |
| treatment for pheochromacytoma | adrenalectomy, glucocorticoid and mineralocordicoid replacement life long- DO NOT PALPATE MASS, may lead to increased catecholemine release |
| What is Type 1 diabetes? | destruction of beta cells, absoulute insulin deficiency, typically onset in childhood or early adolescence |
| Honeymoon phase? | pancreas kicks in causing falsehood of cure- type 1 |
| What is Type 2 diabetes? | Insulin resistance- sufficient insulin production but no response to insulin, rare in childhood |
| Polyphasia, polydipsia, polyuria, weight loss, enuresis, nocturia, irritability, short attention span, fatigue, dry skin, blurred vision, recurrent uti's and yeast infections in girls. what is it? | Diabetes mellitus type 1 |
| Signs of diabetes in infants and toddlers | yeasty diaper rash, not improving, lethargy, dehydration |
| tx for type 1 diabetes | subcut insulin, insulin pump(need to monitor carbs per meal for proper bolus of insulin for meals, encourage exercise and activity, extra snacks before activity and during, check bs before, during, and after new strenuous exercise |
| Inherited autosomal recessive trait- exocrine gland dysfunction that effects epithelial lined organs, lungs are most prone, abnormal mucous secretion | Cystic fibrosis |
| What can occur with the bronchi in cystic fibrosis? | chronic bronchial pneumonia, obstructive emphysema |
| What can occur with the GI tract in cystic fibrosis? | large, bulky stools, intestinal obstruction in newborns, rectal prolapse, deficiency of fat soluble vitamins, anemia |
| What can occur with the pancreas in cystic fibrosis? | secretions block duct, enzymes can't reach duodenum, steatorrhea and azotorrhea, CF related diabetes, pancreatic fibrosis |
| What can occur with the liver in cystic fibrosis? | bilary fibrosis, portal hypertension (dilated blood vessels) |
| Why is it so important for a CF patient to have a high calorie, high fat diet | Nutrition and lung health are closely linked, need extra calories to compensate for malabsorption of nutrients, extra calories needed to meet greater energy needs of breathing |
| Hallmark sign of CF in a newborn | meconium ileus- abdominal distention, failure to pass stool, dehydration |
| What can be seen in a pulmonary assessment of a patient with CF? | wheezes, cough, barrel shaped chest in late disease, clubbing of fingers |
| Diagnosics for CF | sweat chloride test, cxr, pulmonary function test, stool fat and enzymes |
| collaborative management for CF | prevent and treat respiratory infections, chest PT bid, bronchodilators before CPT, pancreatic enzymes with meals, thorough resp and gi assessments |
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