1
Q
Which hormones are produced by the Anterior Pituitary Gland?
A
- FSH (Follicle Stimulating Hormone)
- LH (Luteinizing Hormone)
- ACTH (AdrenoCorticoTropic Hormone)
- TSH (Thyroid Stimulating Hormone)
- GH (Growth Hormone)
2
Q
Which hormones are produced by the Posterior Pituitary Gland?
A
- ADH (Antidiuretic Hormone)
- Oxytocin
3
Q
What are the causes of Diabetes Insipidus?
A
NOT enough ADH in the body
Injury to the hypothalamus or posterior pituitary gland
- Trauma to head
- Surgery
- Infection
- Inflammation
- Brain tumors
- Cerebral vascular disease
- Idiopathic
4
Q
What are clinical manifestatons of Diabetes Insipidus?
A
- Lack of concentration, memory, or focus
- Dry eyes, mouth
- Extreme thirst
- Tachycardia
- Hypotension
- Muscle cramps
- Large amounts of urine
- Weight loss
- Lightheadedness/headaches
- DILUTE urine - Specific gravity: 1.001 - 1.0025
- Decreased urine osmolality
- HYPERnatremia
- Increased Serum Osmolality
- Increased Hct
4
Q
What is the management for Diabetes Insipidus?
A
- Monitor Neuro Status
- Replace fluids
- Monitor hourly urine output
- Give vasopressin or desmopressin
- Monitor vitals
- Pt. education for meds, medical bracelet, dangers, prevention and complications
5
Q
What are the diagnostic tests for Diabetes Insipidus?
A
Fluid deprivation test for 8-12 hours or until 3%-5% body weight loss
- Frequent weights
- Plasma and urine osmolality test at start and end of test
- If tachycardic and excessive weight loss, or hypotension = STOP the test!
- Na+ levels rise
ADH plasma level test
Trial desmopressin therapy
Tumor assessment
6
Q
What are the causes of SIADH?
A
Negative feedback loop has gone awry - body is making TOO much ADH
- Usually a NON-endocrine origin
- Broncho-genic carcinoma (lung cancer)
- Severe pneumonia, pneumothorax
- Trauma to the head
- Brain surgery, tumor, or infection
7
Q
What is the management for SIADH?
A
- Eliminate underlying cause
- Restrict fluid intake
- Diuretic drugs (furosemide)
- Hypertonic solution if hyponatremic
- Monitor serum sodium
- Strict I&Os
- Daily weights
- Urine/Blood Chems
- Neuro assessments
- Pt. education
- Seizure precautions
8
Q
What are the clinical manifestations of SIADH?
A
- Weight gain
- NO peripheral edema
- Anorexia
- Nausea/vomiting
- LOW serum sodium (hyponatremia signs)
- Concentrated urine (Inc. osmolality, inc. urine specific gravity)
- Decreased urine output
- Inc. urine sodium
- Anemia
9
Q
Which of the Thyroid hormones is more potent and rapid acting?
A
T3
10
Q
Which hormones does the thyroid secrete?
A
- T3
- T4
- Calcitonin (secreted in response to HIGH plasma calcium - increases calcium deposit in bone)
11
Q
What are the thyroid diagnostic tests?
A
- Lab tests: T3, T4, TSH, Serum free T4, thyroid antibodies
- T3 Resin uptake
- Radioactive iodine uptake
- Fine needle biopsy
- Thyroid scan, radioscan, or scintiscan
- Serum thyroglobulin
12
Q
Which medications can alter a thyroid diagnostic test?
A
- Amiodarone
- Aspirin
- Cimetidine
- Diazepam
- Estrogens
- Furosemide
- Glucocorticoids
- Heparin
- Lithium
- Phenytoin
- Other anticonvulsants
- Propranolol
13
Q
What are the causes of HYPOthyroidism?
A
- 95% = Hashimoto’s Disease (autoimmune)
- Atrophy of the thyroid gland (with aging)
- Infiltrative diseases of the thyroid (amyloidosis, lymphoma, scleroderma)
- Iodine deficiency, iodine excess, and iodine compounds
- Radioactive iodine
- Therapy for hyperthyroidism
- Thyroidectomy
- Radiation to the head and neck for other cancers
14
Q
What are the clinical manifestations of hypothyroidism?
A
SLOWED DOWN
- Dec. T4
- Inc. TSH
- Hair thinning/loss
- Bradycardia
- Weight gain
- Cold intolerance
- Constipation
- Lethargy
- Loss of lateral eyebrows
- Muscle weakness
- Peripheral edema
15
Q
What is the treatment for hypothyroidism?
A
- Levothyroxine
- Pt. education: take on an empty stomach, 1 hr. before breakfast; report signs of hyperthyroidism
- Supportive care for symptoms
16
Q
What are the causes of hyperthyroidism?
A
- Grave’s disease: autoimmune disorder - most common cause
- Toxic multinodular goiter
- Toxic adenoma
17
Q
What are the treatments for Hyperthyroidism?
A
- Radioactive therapy
- Propylthiouracil (PTU)
- Methimazole
- Sodium or potassium iodine solutions
- Dexamethasone
- Beta-blockers
- Surgery - thyroidectomy
18
Q
Which antithyroid medication blocks the synthesis of Thyroid hormones (conversion of T3 - T4)?
A
PTU
19
Q
What are the clinical manifestations of hyperthyroidism?
A
SPED UP
- Sweating
- Tachycardia
- Weight loss
- Heat intolerance
- Muscle wasting
- Increased T4
- Decreased TSH
20
Q
What is the treatment of choice for thyroid cancer?
A
Thyroidectomy
21
Q
What is the preop goal for thyroidectomy?
A
- Reduction of stress and anxiety
- Avoid a thyroid storm
22
Q
What is the preop education for a thryoidectomy?
A
- Dietary guidance to meet patient’s metabolic needs
- Avoid caffeinated beverages and other stimulants
- Explanation of tests and procedures
- Head and neck support used after surgery
23
Q
What does parathormone (Parathyroid hormone) regulate?
A
Calcium
- Tells kidneys, intestines, and bone to increase absorption back into the blood
- Lowers phosphorus level (inc. excretion)
24
What are the **clinical manifestations** of **HYPERparathyroidism**?
* May have NO symptoms
* Apathy
* Fatigue
* Muscle weakness
* Constipation
* N/V
* Hypertension
* Cardiac dysrhythmias
25
What is the **treatment** for **HYPERparathyroidism**?
* Surgical removal of the affected gland
* Hydration therapy *(2,000 mL)*
* Increase mobility
* Do not restrict calcium
26
What is the **treatment** for a **hypercalcemic crisis**?
* Rapid rehydration with large volumes of IV isotonic saline fluids
* Combination of calcitonin and corticosteroids
27
What are the **causes** of **hypoparathyroidism**?
* Abnormal parathyroid development
* Destruction of parathyroid glands *(surgical removal or autoimmune)*
* Vitamin D Deficiency
28
What are the **clinical manifestations** of **hypoparathyroidism**?
* Tetany
* Positive Chvostek and Trousseau's signs
* Numbness
* Parasthesias
* Stiffness of hands and feet
* Bronchospasm
* Laryngeal spasm
* Anxiety
* Irritability
* Depression
* Delirium
* ECG changes
29
What is the **management** for **hypoparathyroidism**?
* Increase calcium to 9-10 mg/dL
* Calcium gluconate IV
* Pentobarbital to decrease neuromuscular irritability
* Quiet environment - no drafts, bright lights, or sudden movement
* Diet high in calcium and vitamin D
* Diet low in phosphorus
30
What are the **causes** of **Adrenal Insufficiency**?
* **Addison's disease** (primary): dysfunction of hypothalamus-pituitary gland-adrenal gland feedback loop = not enough production of steroids.
* Autoimmune 70-90% of the time
* Adrenal suppression by exogenous steroid use
* Adrenalectomy
31
What are the **clinical manifestations** of an **Addisonian Crisis**?
**LIFE THREATENING**
* Severe hypotension
* Cyanosis
* Fever
* N/V
* Shock
* Pallor
* Headache
* Abdominal pain/diarrhea
* Confusion/restlessness
* Renal failure
* HYPERkalemia and HYPOnatremia - due to low levels of aldosterone
* Metabolic acidosis
* Dehydration
32
What are the **diagnostic tests** for **Adrenal insufficiency**?
* early morning serum cortisol and ACTH hormone levels
* ACTH Stimulation test
33
What is the **management** of **Adrenal Insufficiency/ Addisonian Crisis**?
THINK SHOCK!
* IV Fluid administration
* Increased sodium intake
* Corticosteroid/IV Hydrocortisone/Fludrocortisone
* Vasopressors
* Bed position - recumbent, elevated legs
* ABX if infection is present
* Daily weights
* Monitor I&Os
* Discharge teaching: how to take steroids, s/s monitoring, diet
34
What must happen for an **adrenal insufficient patient undergoing stress**?
**e.g. illness, surgery, 3rd trimester pregnancy**
Must have supplemental corticosteroid med therapy
35
What are the **causes** of **Cushing's Syndrome**?
* Excessive adrenocortical activity or corticosteroid medications
* Hyperplasia of adrenal cortex = excessive glucocorticoid production
36
What are the **diagnostic tests** for **Cushing's Syndrome**?
**2 out of the 3 must be abnormal for a definitive dx**
* Serum cortisol
* Urinary cortisol
* Low-dose-dexamethasone suppression test
37
What are the **clinical manifestations** of **Cushing's Syndrome**?
* Immunosuppression
* Hyperglycemia
* Moon Face
* Mood alteration
* Fluid retention
* Sodium retention
* Potassium excretion
* Oily skin/acne
* Hypertension
* Sleep disturbances
* Heavy trunk, thin extremities
* Muscle wasting
* Loss of libido
38
What is the **treatment** of **Cushing's Syndrome**?
* Adrenalectomy
* Avoid infection
* Promote skin integrity
* Improve body image
* Maintain adequate cardiac output
* Patient education
39
**True or False**
Oversecretion of adrenocorticotropic hormone or the growth hormone results in Grave's Disease.
**FALSE**
40
**Which medication blocks synthesis of thyroid hormone?**
**a.** Dexamethasone
**b.** Methimazole
**c.** Potassium iodide
**d.** Sodium iodide
**b. Methimazole**
Methimazole blocks synthesis of thyroid hormone. Dexamethasone, potassium iodide, and sodium iodide suppress release of thyroid hormone.
41
**TRUE or FALSE**
A patient in acute hypercalcemic crisis requires close monitoring for life-threatening complications and prompt treatment to reduce serum calcium levels.
**TRUE**
A patient in acute hypercalcemic crisis requires close monitoring for life threatening complications and prompt treatment to reduce serum calcium levels. Rapid rehydration with large volumes of IV isotonic fluids to maintain urine output of 100-150 mL/hr is combined with administration of calcitonin. Nurse must monitor closely for fluid overload.
NRS 202 Exam #1
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