Endocrine

Question 1

What hormones does the thyroid glad produce?

Answer 1

T3
T4
Calcitonin

Question 2

Calcitonin action

Answer 2

Decreases serum Ca levels by taking Ca out of the blood and putting it into the bone

Question 3

What do you need in your diet to make hormones?

Answer 3

Iodine (completely different action than iodine drugs)

Question 4

What does the thyroid hormone give you?

Answer 4

Energy

Question 5

Another name for hyperthyroidism

Answer 5

Graves Dz

Question 6

Graves Dz

Answer 6

Too much energy

Question 7

S/S of graves dz

Answer 7

Weight LOSS
Exophthalmos (bulging eyes, irreversible)
Increased appetite, fast GI
Increased BP, HR
Enlarged thyroid
Nervous/irritable
Decreased attention span
Sweaty, HOT

Question 8

How to diagnose graves dz

Answer 8

Increased T4, thyroid scan

Question 9

What must the client do 1 week prior to thyroid scan?

Answer 9

Discontinue iodine containing meds

Question 10

Amiodarone

Answer 10

Anti arrhythmic

Contains high levels of iodine, affects thyroid function

Question 11

Tx for Graves dz

Answer 11

Anti-Thyroid drugs, iodine compounds, beta blockers, radioactive iodine, sx

Question 12

Anti thyroid meds

Answer 12

Propylthiouracil (PTU), methimazole

• Stop thyroid from making hormones
• Used prep to stun thyroid

Question 13

Iodine compounds

Answer 13

Potassium iodine

• Decrease size/vascularity of the gland
• All endocrine glands are VERY vascular
• Give in milk or juice, use straw (stains teeth)

Question 14

Beta blockers

Answer 14

Propranolol

• Decreases myocardial contractility
• Can decrease CO
• Decreases HR, BP
• Decreases anxiety
• Don’t let you release epi and norepi

Question 15

Who do you not gibe beta blockers to?

Answer 15

Asthmatics (can precipitate an attack) or diabetics (will hide symptoms of hypoglycemia)

Question 16

Radioactive iodine

Answer 16

• One dose
• Given PO liquid or tablet
• Not used in pregnancy
• Destroys thyroid cells leading to hypothyroid
• Follow radioactive precautions (stay away from babies and don’t kiss anyone for 24 hours)
• Watch for thyroid storm-rebound effect post radioactive iodine

Question 17

Post op thyroidectomy

Answer 17

• Partial or complete
• Support neck, place personal items close to them
• Elevate HOB
• Check for bleeding behind neck, under skin (pooling)
• Client needs calories before and after

Question 18

What could hoarseness after thyroidectomy mean?

Answer 18

Recurrent laryngeal nerve damage

Question 19

What could feelings of pressure mean after a thyroidectomy?

Answer 19

Vocal cord paralysis. Paralysis of both cords means airway obstruction and requires immediate trach

• Have trach ready at bedside
• Check for swelling, hypocalcemia (parathyroid removal)

Question 20

Another name for myxedema

Answer 20

Hypothyroid

Question 21

S/S of myxedema

Answer 21

• Weight GAIN, slow GI
• COLD
• Fatigue, no energy
• Amenorrhea
• Slow and slurred speech
• No expression
• Possibly totally immobile client
• Do not give them a heating pad, they can’t tell if it gets too hot

Question 22

Cretinism

Answer 22

When hypothyroid is present at birth, very dangerous and can lead to slowed mental and physical development if not detected

Question 23

Tx of myxedema

Answer 23

Levothyroxine, thyroglobulin, liothyronine

• Take these meds forever
• Makes their energy increase
• Increased BP/HR and CAD

Question 24

PTH

Answer 24

Pulls Ca from the bone and places it in the blood

Question 25

Partial parathyroidectomy

Answer 25

2 parathyroids are removed, PTH secretion decreases

Question 26

What do you monitor for after partial parathyroidectomy?

Answer 26

Rigid/tight muscles

Question 27

Tx of hyperPTH

Answer 27

Partial parathyroidectomy

Question 28

Tx of hypoPTH

Answer 28

IV Ca, phos binding drugs

Question 29

What do you need your adrenal glands for?

Answer 29

To handle Stress

Question 30

Two parts of the adrenal gland

Answer 30

Adrenal medulla | Adrenal cortex

Question 31

What does the adrenal medulla secrete?

Answer 31

Epi and Norepi

Question 32

Pheochromocytoma

Answer 32

Benign tumors that secrete epic and norepi in boluses

Question 33

S/S of pheochromocytoma

Answer 33

Increased BP/HR | Flushing/diaphoretic

Question 34

Dx of pheochromocytoma

Answer 34

VMA (vanillylmandelic acid) test: 24 hour urine specimen to look for increased levels of epic and norepi -Anything with vanilla will alter test, stay away for a week prior

Question 35

What are epi and norepi also called?

Answer 35

Catecholamines

Question 36

What to remember about 24 hour urine specimens

Answer 36

- Throw away first void | - Keep last void

Question 37

Tx of pheochromocytoma

Answer 37

Sx to remove tumors

Question 38

What does the adrenal cortex secrete?

Answer 38

Glucocorticoids, mineralocorticoids, sex hormones

Question 39

What do glucocorticoids do?

Answer 39

``` Change your mood (insomnia, depressed, psychotic, euphoric) Alter defense mechanisms, immunosuppressed Breakdown fats and proteins Inhibit insulin (monitor BG) ```

Question 40

Mineralocorticoids are what?

Answer 40

Aldosterone

Question 41

Aldosterone action

Answer 41

Retain Na and water, excrete K

Question 42

Cortisol

Answer 42

ACTH from pituitary stimulates cortisol to be made. They are steroids

Question 43

Not enough steroids, think what?

Answer 43

Shock, high K | No aldosterone

Question 44

Addison's Dz

Answer 44

Adrenocortical insufficiency, not enough steroids (glucocorticoids, mineralocorticoids, sex hormones)

Question 45

S/S of Addison's

Answer 45

Initially, s/s of hyperkalemia Then, anorexia/nausea, hyper pigmentation of skin and mucous membranes, white patchy areas of depigmented skin (vitiligo), decreased bowel sounds, GI upset, hypotension, decreased Na, increased K and hypoglycemia Losing weight, low BP, fluid volume deficit

Question 46

Tx of Addison's

Answer 46

Combat shock-Give Na in diet, processed juice/broth | I&O, daily weights, drugs

Question 47

Drugs for addison's

Answer 47

Fludrocortisone (aldosterone) | DAILY WEIGHTS-keep within 2-3 lbs of normal weight

Question 48

Addisonian Crisis

Answer 48

Severe hypotension and vascular collapse

Question 49

Cushing's Dz

Answer 49

Too many glucocorticoids, mineralocorticoids, sex hormones

Question 50

S/S of too many glucocorticoids

Answer 50

``` Growth arrest Thin extremities/skin (lipolysis) Risk of infection Hyperglycemia Psychosis then depression Moon faced (fat redistribution/fluid retention) Truncal obesity (fat redistribution, lipogenesis) Buffalo hump (fat redistribution) ```

Question 51

S/S of too many minerals

Answer 51

High BP CHF Weight gain Fluid volume excess

Question 52

S/S of too many sex hormones

Answer 52

Oily skin/acne Women with male traits Poor sex drive/libido

Question 53

If the client has too much mineralocorticoid, what will the serum K do?

Answer 53

Decrease

Question 54

If you did a 24 hour urine on a client with too much minerals, would the cortisol levels be high or low?

Answer 54

High

Question 55

Tx of cushing's

Answer 55

Adrenalectomy (unilateral or bilateral), if both are removed they'll need a lifetime replacement Quiet environment Diet before treatment-high K, protein, and Ca, low Na Avoid infection

Question 56

What might appear in the urine of cushing's dz pt?

Answer 56

Glucose and ketones

Question 57

What do steroids do to the serum Ca?

Answer 57

Decrease it by excreting it through the GI tract