Endocrine
Primary cause of DI
*** Lack of ADH Head Injury Infection Surgery/Trauma Tumor/Strokes Lithium What will my patient look like! Inability to concentrate urine Urine S.G. will be low.....1.005 or lower Urine Osmolality will be low (<100) Serum Osmolality will be high (> 295) Fatigue Postural Hypotension -> vascular collapse Tachycardia Shock from fluid loss
ACROMEGALY/GIGANTISM: TOO MUCH GROWTH HORMONE
- hight BP - sleep apnoea -kyphosis -big feet - progressive heart failure -mood swings
Hypothyroidism vs hyperthyroidism
-Hypothyroidism: under activity (overweight patient) Low T3 T4 HYPO----LOW and SLOW -HASHIMOTO -IODINE DEFICIENCY -OR- SURGICAL REMOVAL BODY needs IODINE to make thyroid hormone High T3 and T4 Hyperthyroidism: over activity (very thin) TSH opposite of T3 and T4 HIGH- FAST (High and Hot) High energy Graves Disease (Gains-high) Goiter=Golf ball Too much IODINE= Too much thyroid hormone Too much levothyroxine
A CLIENT IS ADMITTED TO AN EMERGENCY ROOM, AND A DIAGNOSIS OF MYXEDEMA COMA IS MADE. WHICH ACTION WOULD THE NURSE PREPARE TO CARRY OUT INITIALLY? 1. Warm the client 2. Maintain a patent airway 3. Administer thyroid hormone 4. Administer fluid replacement
2
A nurse in a clinic is reviewing the lab values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following lab values?1. Serum T3 2. Thyroid stimulating hormone (TSH) 3. Free T4 4. Serum T4
2
A NURSE IS PERFORMING AN ASSESSMENT ON A CLIENT FOLLOWING A THYROIDECTOMY AND NOTES THAT THE CLIENT HAS HOARSENESS AND COMPLAINS OF A SORE THROAT. WHICH NURSING ACTION IS APPROPRIATE? 1. Check for signs of bleeding 2. Administer calcium gluconate 3. Notify the physician immediately 4. Reassure the client that this is normal
4
A nurse at the beginning of the shift is assessing a client who has Cushing's disease. Which of the following is a priority assessment?A. Weight gain B. Fatigue C. Fragile skin D. Joint pain
A
A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech
A
A nurse is caring for a client who has a primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output
A
A nurse is reviewing the laboratory findings of the client has suspected hyperthyroidism. An elevation of which of the following supports this diagnosis?A. Triiodothyroxine B. Plasma-free metanephrine C. Urine Cortisol D. Urine osmolality
A
If prednisone is suddenly discontinued what complication is the pt at risk for? a. hypovolemia b. hypernatremia c. hypothermia d. hyperglycemia
A
The nurse correlates which clinical manifestations to the pathophysiology of decreased ACTH production from the anterior pituitary gland? a. hypotension b. polyuria c. diarrhea d. pruritus
A
The nurse correlates which lab value as an indication that desmopressin is effective in the treatment of DI? a. sodium of 140 b. serum osmolarity of 305 c. urine specific gravity of 1.004 d. hematocrit of 48%
A
A nurse in an intensive care unit is admitting a client who has myxedema coma. Which of the following should the nurse anticipate in caring for this client? A. Observe cardiac monitor for dysrhythmias B. Observe for evidence of urinary tract infection C. Initiate IV fluids using 0.9% sodium chloride D. Administer a levothyroxine IV bolus E. Provide warmth using a heating pad
A, B, C, D
A nurse is reviewing serum laboratory results for a client who has Addison's disease. Which of the following findings are typical for a client who has his condition? A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. BUN 28 mg/dL E. Glucose 148 mg/dL
A, B, C, D
A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings are expected for this client? A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL D. Lymphocyte count 35% E. Fasting glucose 145 mg/dL
A, B, C, E
A nurse in a providers office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole (Tapazole). Which of the following should the nurse include in the plan of care? A. Monitor CBC B. Monitor triiodothyronine C. Inform the client to increase consumption of shellfish D. Advise the client to take the medication at the same time every day E. Inform the client that an adverse effects of this medication is iodine toxicity
A, B, D
The nurse is planning care for a client who has Cushing's disease. In planning care, the nurse should recognize that the clients with Cushing's disease are increased risk for which of the following? A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia
A, B, D
The nurse is preparing to receive a client from the PACU who is post operative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply. A. Suction equipment B. Humidified O2 C. Flashlight D. Tracheostomy tray E. Chest tube tray
A, B, D
A nurse is caring for a client who has SIADH. Which of the following findings should the nurse expect? A. Decreased serum sodium B. Urine specific gravity of 1.001 C. Serum osmolarity 230 MOSM/liter D. Polyuria E. increased thirst
A, C
The nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse anticipate? A. Low sodium B. High serum potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity
A, C, D, E
Which hormones are released from the posterior pituitary gland?
ADH (antidiuretic hormone) and Oxytocin
POSTERIOR PITUITARY......HORMONE IS ADH!
ADH....ANTI DIURETIC HORMONE....so what is that? ADH THINK WATER..... (against diuresis) Too much ADH is too many messages to the kidneys...so the kidneys hold on to WATER Post Pit releases too much ADH! So there is too much WATER! Leading to SIADH (Syndrome of Antidiuretic Hormone)!!!!!
A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of morning fasting blood glucose results. Which of the following is an appropriate response by the nurse? A. HB A1C measures how well insulin is regulating your blood glucose between meals. B. HB A1 C indicates how well you have regulated your blood glucose over the past 120 days. C. A test of HB A1C is the first test to determine if an individual has diabetes. D. A test of HB A1C determines if the dosage of insulin needs to be adjusted.
B
A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected for a client with this condition? A. Elevated serum T4 B. Decreased serum T3 C. Elevated serum thyroid stimulating hormone D. Decreased serum cholesterol
B
A nurse in a providers office is reviewing the health record of a client who is being evaluated for Graves' disease. Which of the following is an expected laboratory finding for this client?A. Decreased thyrotropin receptor antibodies B. Decreased thyroid stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine
B
A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs
B
A nurse is caring for a client who has DI. Which of the following urinalysis laboratory findings should the nurse anticipate? A. Absence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of RBCs
B
A nurse is providing instructions to client who has Graves' disease and has a new prescription for propanolol (Inderal). Which of the following information should the nurse include? A. An adverse affects of this medication is jaundice. B. Take your pulse before each dose. C. The purpose of this medication is to decrease production of thyroid hormones. D. You should stop taking the medication if you have a sore throat.
B
The nurse questions which order in the patient who has undergone transsphenoidal hypophysectomy for a pituitary tumor? a. offer clear fluids b. oxygen 2 L via nasal cannula c. maintain head of bed at 45-60 d. apply lip balm
B
Pt at greatest risk of adrenal insufficiency? a. 19 yo male b. 35 yo female c. 45 yo male d. 80 yo female
B -hypoglycemia is a manifestation of adrenal insufficiency
A nurse is caring for a client who has Addison's disease and is taking hydrocortisone (Cortef). Which of the following medication instructions is appropriate for the nurse to include? A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any symptoms of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low sodium diet.
B, C, D
The nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat hypothyroidism. Which of the following should the nurse include in the teaching? A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow up serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.
B, C, D
A nurse is admitting a client who has acute adrenal insufficiency to the intensive care unit. Which of the following prescriptions should the nurse anticipate? A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate (Solu-Cortef) D. Sodium polyestyrene sulfonate (Kayexalate) E. Furosemide (Lasix)
B, C, D, E
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings are expected with this condition? A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness
B, C, E
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following findings should the nurse include? Select all that apply. A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
B, D, E
The nurse correlates which findings with age-related changes of the endocrine system in a 55-year-old female? a. breast enlargement b. decreased libido c. increased sweating d. vaginal dryness e. insomnia
B, D, E
A nurse is caring for a client who is 6 hr postoperative following a transsphenoidal hypophysectomy. The nurse should test the clients nasal drainage for the presence of which of the following? a. RBCs b. Ketones c. Glucose d. Streptococci
C
A nurse is planning to teach a client who is being evaluated for Addison's disease about the ACTH stimulation test. The nurse should base her instructions to the client on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.
C
The nurse correlates an increase in the secretion of which hormone with the release of thyrotropin-releasing hormone? a. triiodothyronine (T3) b. thyroxine c. thyroid stimulating hormone (TSH) d. thyrocalcitonin
C
The nurse is providing discharge instructions to a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? A. Brush teeth after every meal or snack. B. Avoid bending at the knees. C. Eat a high-fiber diet. D. Notify the provider of increased swallowing. E. Notify the provider if he has diminished sense of smell.
C, D
A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings are indicative of a thyroid crisis? Select all that apply. A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion
C, D, E
TOO LITTLE GROWTH HORMONE: DWARFISM
Cause due to: low GH Features: plumpness immature face small genitalia Proportionate short stature Delayed skeletal and dental development Decreased circulating levels of GH
THYROID GLAND DISORDERS HYPERTHYROIDISM
Causes... Excess TSH Autoimmune (Graves' Disease) Thyroiditis Tumor Too much thyroid replacement GRAPE eyes-=exophthalamos (remember G in high)
A nurse is caring for a client who is one day post operative following a sub total thyroidectomy. The client reports a tingling sensation in the hands the soles of the feet and around the lips. For which of the following findings should the nurse assess the client?
Chvostek's sign
THYROID GLAND DISORDERS....HYPOTHYROIDISM
Clinical Manifestations Bradycardia Constipation Puffiness around eyes & face Loss of memory Reproductive issues Elevated serum lipids Varying degrees of S/S May have large number of S/S Lethargy Weakness & muscle aches Diminished reflexes Cold Intolerance Weight gain Dry skin & hair Depression/Withdrawal
A nurse is assessing an adolescent who has an exacerbation of Graves Dx. Which of the following findings should the nurse expect?A. Wt gain B. Bradycardia C. Lethargy D. Heat intolerance
D
A nurse is caring for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low-Fowler's position. B. Encourage deep breathing and coughing. C. Encourage the client to brush his teeth when awake and alert. D. Observe dressing drainage for the presence of glucose.
D
A nurse is providing teaching to a client who has a new diagnosis of DI. Which of the following statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C. "I should expect to gain weight during this illness." D. "I might experience confusion or balance problems."
D
To better locate the isthmus of the thyroid gland in preparation for palpation, the nurse asks the patient to perform which action? a. say ah b. touch your chin to your chest c. look at the ceiling d. swallow a sip of water
D
A nurse is assessing a client who has grave's disease. the nurse should expect which of the following lab results?
Decreased TSH level
Hypoparathyroidism
Decreased secretion of parathyroid hormone (PTH) Etiology: s/p thyroidectomy s/p parathyroid surgery s/p radiation therapy of neck Idiopathic hypoparathyroidism is rare Results: Serum calcium ↓ -->>>> s/s tetany Serum phosphate ↑
A patient is undergoing a stimulation test to assess adrenal function. After administration of cortisol, which laboratory result indicates normal function?
Decreased serum potassium
Post-op thyroidectomy
Educate: Importance of taking anti-thyroids DB'ing Safety: Use of hands to splint neck when Coughing Sitting Turning Getting up/back to bed
Education for hypothyroidism
Educate: Thyroid replacement (Synthroid) S/S of both hypo- and hyperthyroidism Report: weight gain or loss of 5 lbs activity intolerance CP SOB, fatigue, dizziness Intol. to heat/cold sleep pattern disturbances Low calorie, low cholesterol, low sat. fat diet Medic Alert bracelet
Hyperthyroidism: radioactive iodine therapy educations for pt
Education: For first week after treatment: Mildly radioactive Avoid close contact with children Avoid sleeping with another Avoid body fluid contact with others Double flush toilet Thorough handwashing Labs needed S/S hypothyroidism
Hyperthyroidism diagnostics
Free T4, T3 and T4 Increased and TSH is low Increased metabolic rate Common Cause is Grave's disease Toxic diffuse goiter
A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?
Frequent mood changes
Hyperparathyroidism assessment
Hypercalcemia Hypophosphatemia Fatigue and muscle weakness Skeletal pain Bone deformities - - pathological fxs. GI symptoms HTN Cardiac Dysrhythmias Renal Stones CNS symptoms
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?
Hyperpigmentation -Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormones cortisol, and in some cases the hormone aldosterone. The disease is characterized by weight loss muscle weakness fatigue low blood pressure and hyperpigmentation (darkening) of the skin in both exposed and not expose parts of the body
Hyperparathyroidism
Hypersecretion of PTH Occurs in older adults More frequent in women Usual cause is adenoma Calcium reabsorption ↑'s .... If dietary intake too low to meet PTH demands ---demineralization of bone occurs Excretion of phosphorus by kidneys ↑'s
Hyperthyroidism: graves disease
Hyperthyroidism (overactive thyroid) Thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat.
Diagnostic tests: thyroid scan with radioactive iodine uptake (RAIU)
Identify nodules/growths Radioisotope of iodine or Technetium Levels not dangerous to themselves or others
A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. the nurse should recognize which of the following findings is a therapeutic response to this medication?
Increase in energy
A patient with DI is ordered to receive DDAVP. The nurse monitors for which therapeutic effect?
Increased urine specific gravity
Hypothyroidism interventions/ treatments
Interventions / Treatment Monitor VS Monitor for s/s hypocalcemia & tetany Safety: - Initiate Seizure Precautions - Tracheostomy set @ bedside - Oxygen & suction set up @ bedside Prepare for calcium gluconate or calcium chloride IV Supplemental calcium & vitamin D - Calcium salts given orally Parathormone injections Reduce stimuli Diet: high calcium, low phosphorus
WHAT DO YOU EXPECT WITH TOO MUCH WATER??
Is blood pressure low or high? High Is weight high or low? high Is your patient urinating a lot or not at all? Not at all Is urine specific gravity high or low? High Is urine concentrated or dilute? Hypo or hypernatremia? Hypo s/s of low Na is confusion so you give the 3% saline or mannitol bc it pushes water out of the cells (Remember the body is keeping too MUCH water) Weigh people, do BPs
Myxedema coma interventions
Knowing the S/S what is your priority? Maintenance of patent airway Safety: Institute Aspiration precautions What about for the hypotension? IV Fluids Administer Synthroid IV Administer glucose IV Administer corticosteroids Assess temp, monitor BP q1hour Keep patient warm, assess LOC
Thyroid gland
Location Functions: Metabolic Rate & Growth Affects metabolism of fats, CHO, protein Produces T4, T3 and Thyrocalcitonin
Parathyroid glands
Location Function: Control Ca+ and phosphorus metabolism Produce parathyroid hormone
Hypothyroidism diagnostics
Low Triiodothyronine (T3) Low Thyroxine (T4) High TSH in primary High Triglycerides & Cholesterol Calcitonin (ton of calcium in the bone).....so calcium in the blood is low...
Hypothyroidism
Low levels of T3 and T4 Hypothyroidism means that the thyroid gland can't make enough thyroid hormone! -LOW thyroid hormone in the blood. -Low T3 and Low T4 Causes: -Automimmune Disease -(Hashimoto's Thyroiditist) -Radiation treatment (Iodine deficiency) -Surgical Removal of Thyroid -Inadequate TSH -Drugs Treatment: Medication
Endocrine glands
Maintain & regulate vital functions Respond to stress & injury Inflammation & Immune Responses Growth & Dev. Energy Metabolism Reproduction F/E & A/B balance Endocrine glands have many hats to wear and many jobs to do!! So we need to make sure they are within the correct levels! START WITH THE HORMONE.... INSTEAD OF THE DISORDER..... all disease come in pairs
Thyroid storm interventions
Maintain patient airway / ventilation - Administer supplemental oxygen Initiate continuous cardiac monitoring Establish vascular access Administer (as ordered): - Antithyroids - Sodium Iodine - Propranolol (Inderal) Aggressively control hyperthermia Closely monitor VS, I&O
Treatment
Manage the symptoms OR Fix the underlying problem If the underlying problem is too much ADH from pituitary gland (SIADH)...treatment may be removal of the gland....but then you may have the opposite problem (DI)!!
Thyroidectomy post-op monitor....
Monitor / Prevent tetany Identify s/s hypocalcemia EARLY - Know the S/S of hypocalcemia - Chvostek's Sign - Trousseau's Sign Safety: Always have the following within immediate access- IV calcium gluconate or calcium chloride (calcium in the bone not in the blood)Priority intervention for Priority intervention for hypocalcemia after thyroidectomy!!
Hypothyroid interventions
Monitor VS Thyroid replacement Diet: Encourage fluids, roughage Warm environment Pace activities with rest Avoid sedatives & opioids Monitor for OD of thyroid medications
Hyperthyroidism interventions
Monitor for cardiac dysrhythmias & Tachycardia Sedatives & Antipyretics PRN Provide rest in a cool, quiet environment Well balanced, high calorie diet (hyper metabolism) frequent meals Daily weight, I&O's Avoid stimulants Protect eyes & Keep HOB elevated
Post-op for thyroidectomy
Monitor for hemorrhage First 24 hours is the most critical Monitor for maintenance of airway patency Assess for stridor Promote patent airway Keep HOB @ 30 degrees Safety: Always have the following within immediate access- - Oral & sterile suction equipment and supplies - Emergency tracheostomy tray & kit - Oxygen as needed Assess for hematoma and stridor
THYROID GLAND DISORDERS MYXEDEMA COMA
Myxedema coma is severe hypothyroidism Rare but serious Result of poorly or untreated hypothyroidism Persistently low thyroid production S/S ↓BP ↓ HR ↓ Temperature ↓ Na+ ↓ blood sugar Generalized edema Respiratory failure Coma
Hypoparathyroidism assessment
Neurological & Cardiovascular Musculoskeletal & GI Integumentary C/O photophobia, muscle cramps, tingling ↓ Serum Calcium & Parathormone + Trousseau's & + Chvostek's S/S of hypocalcemia Other S/S of tetany ↑ Serum phosphate Xrays - increased bone density
Clinical manifestations of hyperthyroidism
Range of S/S will vary Classic Symptoms: Weight Loss Nervousness Exophthalmos (protruding eyes) Increased appetite Palpitations Diaphoresis - Heat Intolerance
Thyroid storm
Rare, life-threatening complication Presenting Signs & Symptoms Extremely high temp. - Cardinal sign Severe tachycardia with heart failure & shock Systolic HTN Restlessness & agitation!!!! Abd. pain, N/V, Diarrhea Tremors Weakness & Confusion or disorientation -->Coma!!!! So this is severe hyperthyroidism vs myxedema is severe hypothyroidism
Thyroidectomy
Removal of thyroid gland Total Partial Thyroid lobectomy Persistent hyperthyroidism -not first line
A nurse is providing dietary teaching for a client who has Cushing's Disease. Which of the following recommendations should the nurse include in the teaching?
Restrict sodium intake -the nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no added salt" to table foods to a restriction of 2 grams per day
Hypoparathyroidism education
S/S to report Diet Administration of calcium supplements Administration of Vitamin D supplements Administration of phosphate binders Medic-Alert bracelet Other Important Interventions
Treatments
SIADH High blood pressure: Monitor ___BP_____, administer blood pressure meds and/or __3%_and mannitol________ as ordered Weight gain: Monitor __urine output_____ to measure fluid retention, fluid restrictions to help control symptoms Oliguria/anuria and High specific gravity of urine: Monitor ____specific gravity______ and concentration (color and amount, lab tests) Hyponatremia: monitor level of consciousness, encourage extra sodium intake in diet (Sometimes with hyponatremia we would also give a hypertonic or isotonic IV solution...but this is a perfect example of how you also have to use your common sense! SIADH patients are on fluid overload already, so additional IV solutions should be given with extreme caution.) DI Desmopressin (DDAVP) to treat missing ADH hormone Vital signs-monitor for low BP Urine output Weight loss Urine specific gravity (low) Hypernatremia (confusion)
Parathyroid controls calcium levels by secreting parathyroid hormone...
Secretes Parathyroid Hormone which controls Calcium levels Hypoparathyroidism: low parathyroid hormone causing low Calcium (tetany, high phosphorus) Hyperparathyroidism: high parathyroid hormone causing high calcium (low phosphorus) Relationship of calcium to phosphorus is inverse!
Thyroid system
So where are thyroid hormones produced and where do the signals come before they hit the thyroid?
A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take?
Teach the parents about cortisol replacement therapy -the nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies of a sudden cessation of the medications can cause acute adrenal crisis.
TOO LITTLE ADH.....DIABETES INSIPIDUS
Too few messages to the kidneys so the kidneys do not hold on to WATER! Low or high blood pressure? Polydypsia- thirst caused by not enough water in the body Polyuria- Kidneys are not holding onto water so urine output increases Low specific gravity-kidneys are not holding onto water so there is dilute urine as the kidneys get rid of the water Dehydration and hypernatremia
ANTERIOR PITUITARY - GROWTH HORMONE
Too much Growth Hormone: Acromegaly/GigantismToo little Growth Hormone: Dwarfism GH: spurs growth in children and adolescents. It also helps to regulate body composition, body fluids, muscle and bone growth, sugar and fat metabolism, and possibly heart function.
Hyperthyroidism: radioactive iodine therapy
Treatment of choice Administered orally Fewer complications Radioactive iodine given to patient Reduces vascularity & Size = ↓ T3 & T4 Safety Alert: Contraindicated in pregnancy and in those who are breastfeeding
A nurse is caring for a client who is 1-day post-operative following a thyroidectomy reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take?
Verify the most recent calcium level -the client who has had a thyroidectomy is at risk of hypocalcemia due to the possible disruption of the parathyroid gland during surgery. The parathyroid glands are the four small glands located inside the thyroid gland that are responsible for calcium regulation. If they are damaged during a thyroidectomy, there is a risk of hypocalcemia. low calcium levels can be manifested as numbness and tingling of the fingers and around the mouth, muscle spasms particularly of the hands and feet, and hyperactive reflexes. If a client develops any of these manifestations following a thyroidectomy, the nurse should check the clients latest calcium level. The expected reference range for calcium is 8. 5 to 10. 5 milligrams per deciliter. if the calcium level is low, the provider should be notified, and oral or intravenous calcium replacement should be administered.
A nurse is caring for a client who has Addison's disease in this at risk for addisonian crisis. Which of the following actions should the nurse take?
Weigh the client daily -Addison's disease is an endocrine disorder that causes weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation of the skin. Obtaining the client's daily weight will alert the nurse a dehydration is developing, which could indicate an impending crisis.
Cretinism (congenital hypothyroidism)
congenital lack of thyroid gland Appears normal at birth due to maternal hormones Mental retardation and impaired physical growth -child version of myxedema
Increased secretion of ADH results in which action?
decreased urine output
SIADH can cause .....
decreased urine output
A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. Which of the following medication should the nurse prepare to instruct the client?
levothyroxine-levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine T4. it is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on use of this medication.
A nurse is caring for a client who has cuhsing's syndrome. The nurse should recognize that which of the following are manifestations of cushing's syndrome? (select all that apply)
moon face, purple striations, buffalo hump, alpoceia
