Cha Endocrine

Myxedema coma

extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure

Which intervention would be included in the plan of care for a client diagnosed with hyperthyroidism? 1 Monitor for hypoglycemia. 2 Protect visitors and staff from radiation exposure. 3 Provide foods to increase appetite. 4 Arrange for sufficient rest periods.

4 Arrange for sufficient rest periods.

Adrenal gland hypofunction

Adrenocortical steroids may decrease as a result of inadequate secretion of ACTH Dysfunction of the hypothalamic-pituitary control mechanism Direct dysfunction of adrenal tissue

diagnostics of cushings

Increased cortisol, sodium, glucose, BP Decreased potassium, calcium, lymphocytes Dexamethazone suppression test: nonsuppression of cortisol=cushings -Fasting blood glucose levels -serum electrolyte levels 24-hr urine collection Images of pituitary treatment of glands

Labs for thyroid function

T3 and T4 -triiodothyronine and thyroxine TSH -Depends on the level of thyroid hormone TSH receptor antibodies Thyroid scan-RAU

Hyperthyroid Medications

Thionamides, iodine preparations, beta-adrenergic blockers Propylthiouracil (PTU) Methimazole (Tapazole) SSKI Propranolol

Secondary causes of diabetes Insipidus

Trauma, tumors, central nervous system infection, aneurysm, medications

adrenal cortex

outer section of each adrenal gland; secretes cortisol, aldosterone, and sex hormones

Treatment of Cushing's Syndrome

surgery, radiation, or chemotherapy Monitor weight ,I&O,Encourage turn cough & deep breathing

Medication treatment for Thyroid problems

* hormone replacement life long * signs and symptoms of hypo and hyper thyroidism *interact with many medications : warfarin, digoxin, estrogens, cholestyramine *taken on an empty stomach

Thyroid functions

-General body metabolism -Carbohydrate, protein, lipid metabolism -thermal regulation -cardiovascular function -growth and maturation -lactation and reproduction.

Hyperthyroidism assessment

1. Personality changes such as irritability, agitation and mood swings 2. Nervousness and fine tremors of hands 3.Heat intolerance 4. Weight loss 5. Smooth soft skin and hair 6. Palpations, cardiac dysrhythmias such as tachycardia or afib 7.Diarrhea 8. Protruding eyeballs (exophthalmos) 9. Sweating 10. Hypertention 11. Goiter *thyrotoxicosis *excessive thyroid hormone secretion *Hypermetabolism and increased SNS *Causes: graves disease, multiple thyroid nodules, excessive use of thyroid replacement hormones

thyrotoxicosis

condition caused by excessive thyroid hormones

Thyroid storm

increased temp, pulse and HTN- severe

euthyroid

normal thyroid function

A client is scheduled for a computed tomography (CT) of the brain with contrast. The nurse reviews the client's medical record before the start of the procedure. The nurse would report which significant finding to the primary healthcare provider before the test is performed? 1 The client takes metformin daily. 2 The client consumed a meal 1 hour before the scheduled test. 3 The client reports an allergy to gadolinium. 4 The client was not prescribed intravenous (IV) sedation

1 The client takes metformin daily.

Which dietary instruction would be beneficial to a client who has undergone a hypophysectomy and has difficulty passing stools? 1 "Drink plenty of water." 2 "Eat foods rich in protein." 3 "Drink a glass of milk daily."

1. "Drink plenty of water."

Which nursing intervention is appropriate to include in the plan of care for a client with diabetic ketoacidosis (DKA)? 1 Intravenous administration of regular insulin 2 Administer insulin glargine subcutaneously at hour of sleep 3 Maintain nothing prescribed orally (NPO) status

1. Intravenous administration of regular insulin

Hypothyroidism assessment

1. Lethargy 2. Weakness, muscle aches paresthesias 3. Intolerance to cold 4. Weight gain 5. Dry skin and hair and loss of body hair 6. Bradycardia 7. Constipation 8. Generalized puffiness and edema around eyes and face (myxedema) 9. Forgetfulness and loss of memory 10. menstrual disturbances 11. goiter may or may not be present 12. Cardiac enlargement, tendency to develop heart failure -Health history -low levels of thyroid hormone and decreased metabolism -signs and symptoms may develop slowly -Due to : Hashimoto thyroiditis, thyroid surgery, RAI, diet, and aging.

Which statement made by a diabetic client shows that dietary teaching by the nurse was effective? 1 "My diet should be rigidly controlled to avoid emergencies." 2 "My diet can be planned around a wide variety of commonly used foods." 3 "My diet is based on nutritional requirements that are the same for all people." 4 "My diet must not include eating any combination dishes and processed foods."

2 "My diet can be planned around a wide variety of commonly used foods."

Which type of medication-induced hormonal imbalance is likely to be observed in a client undergoing treatment with demeclocycline? 1 Acromegaly 2 Diabetes mellitus 3 Diabetes insipidus 4 Cushing syndrome

3 Diabetes insipidus

The nurse is caring for a client who presents with dilute urine even when fluid intake is low. The nurse suspects that the dilute urine is caused by a decrease in which physiological activity? 1 Glucose tolerance 2 General metabolism 3 Ovarian production of estrogen 4 Antidiuretic hormone production

4 Antidiuretic hormone production

Which clinical findings support the diagnosis of diabetic ketoacidosis (DKA) 1. nervousness and tachycardia 2. erythema toxicum rash and puritus 3. diaphoresis and altered mental state 4. deep respirations and fruity odor to the breath.

4. Deep respirations and fruity odor to the breath.

Addison crisis

A medical emergency that is rough on by sudden withdrawal of steroids or a stressful event; causes vascular collapse, hypoglycemia, parenteral hydrocortisone is essential to reversing the crisis; aldosterone replacement with fludrocortisones

Which assessment findings would indicate the need for atenolol in a client diagnosed with hyperthyroidism? Select all that apply. One, some, or all responses may be correct. 1 Tachycardia 2 Atrial fibrillation 3 Distant heart sounds 4 Systolic hypertension 5 Decreased cardiac output

Correct1 Tachycardia Correct2 Atrial fibrillation Correct4 Systolic hypertension

After a teaching session, the nurse evaluates the client's understanding of hypoparathyroidism. Which statement made by the client indicates the need for further education? 1 "I should eat an orange a day." 2 "I should include yogurt in my diet." 3 "I should perform mild exercises daily." 4 "I should sit outside in the sun."

Correct2 "I should include yogurt in my diet."

Which clinical manifestation is seen in a male client as a result of deficiency of gonadotropin? 1 Decreased fertility 2 Increased muscle mass 3 Increased bone density

Decreased fertility

RAI (radioactive iodine therapy)

Drug: Iodine-131 Actions: Selectively destroys hyperactive thyroid tissue Uses: Treat hyperthyroidism for select individuals *common and serious adverse effects *tenderness in the thyroid gland, hyperthyroidism; hypothyroidism *Lithium carbonate

Steroid the adrenal cortex secretes

Glucocorticoids (cortisol, corticosterone) Mineralocorticoids (aldosterone) Sex steroids (androgens, estrogens and progestins)

Adrenal Gland Hyperfunction

Hypersecretion by adrenal cortex results in cushings disease, hypercortisolism, or excessive androgen production Assessment -Clinical manifestations- Skin changes, cardiac changes, musculoskeletal changes, glucose metabolism, immune system changes -psychosocial assessment

Diabetes Insipidus Interventions

Maintain adequate hydration and monitoring for dehydration Medication: Desmopressin PO,SL and Intranasally Severe dehydration- IV, IM Patient Education

Thyroid treatments

Medication or Surgery *total or subtotal thyroidectomy **Post op monitoring** - Stridor, suture line pressure, tetany

Endocrine system is a

Negative feed back system -self regulating system -temp regulation -blood sugar control -every action has an opposite reaction

Hypothyroidism in children

a common endocrine disorder in which your child's thyroid gland does not produce enough thyroid hormone. A child with an underactive thyroid may experience fatigue, weight gain, constipation, decreased growth, and a host of other issues. *congenital and acquired *intellectual impairment, slow growth.

diabetes insipdus

a condition often caused by pituitary dysfunction that is associated with production of large volumes of dilute urine and in which patients experience extreme thirst -Posterior pituitary disorder, hyposecretion of ADH -Excretion of large amounts of water, dilute urine - Polyuria, dehydration and F/E imbalance Neurogenic Nephrogenic Drug related

Addison's disease

a condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone -Bronze (or dark) skin pigmentation (primary) -Muscle weakness, joint pain -N/V/D- weight loss -Constipation -Salt Craving -Hypoglycemia -Hyponatremia -Anemia -S/sx dehydration -Cardiac dysrhytmias

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol -caused by excessive circulating free cortisol -may be caused by excessive or prolonged steroid use -Condition: reversible once steroids are discontinued -abrupt withdrawl of steroids: may precipitate acute adrenal insufficiency.

Myxedema coma

extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure *Life threatening complications *loss of brain function as a result of severe, long standing low levels of thyroid hormone in the blood (hypothyroidism)

Which clinical feature is indicative of hypercortisolism? 1 Loss of weight 2 Thickening of skin 3 Enhanced density of bones 4 Increased pigmentation

4 Increased pigmentation

Cushing's symptoms

-Moon face -Buffalo hump -Central obesity -Purple striae -DM -Sexual dysfunction or Amenorrhea -HTN -Oteoporosis -Acne -Impaired wound healing

Pediatric differences in the endocrine system

-The endocrine system is less developed at birth than any other body system -Hormonal control of many body functions is lacking until 12−18 months of age -Infants may manifest imbalances in concentration of fluids, electrolytes, amino acids, glucose, and trace substances

The nurse is educating a client on postoperative care after a transsphenoidal hypophysectomy. Which action made by the client is incorrect? 1 Performing deep-breathing exercises 2 Bending at the knees to pick up objects 3 Coughing to clear pulmonary secretions 4 Taking stool softeners to prevent straining

3. Coughing to clear pulmonary secretions