Exam 3 - review session
interfering with prostaglandins (make inflammation happen and protect the gut) so it will make the gut have risk with bleeding, gastritis and it will hurt the kidneys
glucocorticoids
suppresses inflammation, interfering with the body's ability to show you are in trouble no fever or inflammation or pain signs
glucocorticoids
stimulates growth. controlled by PITUITARY
growth hormone
1) to much cortisol is? 2) to little cortisol is?
1) Cushings 2) addisions disease
1) stimulate GH 2) suppress GH
1) somatotropin 2) somatoSTATIN
Should not be moving around a lot Hypocortisol They would need a private room because they cannot handle any outside stimuli They will be hot Avoid stress
Addisonal crisis
How do you test for adrenal insufficiency
ACTH stimulation test
fluid build up because low protein levels so nothing stops fluid from leaking into tissues, fluid balance is a big problem
ascites
stimulate the patient and give huge dose of cortisol and see if the body response
dexamethasone test?= if the plasma levels don't go up and stay up then you would give them steriods
Long term steriod use, hirtuism, secondary problem, increased cortisol levels.
Cushing
made from cholesterol
gallstones
Go into anerobic metablism* and it will make the body make acid Not enough O2 because of low fluid state Pt will come in barely conscious, terrible color, pressure will be low, sugar high, potassium high, acid base balance will be all acidic, metabolic
DKA
Sugar is out of control, the higher the sugar in the body have the three polys, body is peeing a lot so you are losing fluid and retaining potassium, and the more you pee out the more you are in shock, life threatening condition
DKA
Take it close to a meal because steriods cause gastric ulcers
GC (steroids)
Pt with addisons disease and take Corticoid steriod replacements what are the common side effects (5)
Hypokalemia Muscle weakness Mood changes Hypocalcemia Immune system gone so risk for infection
Catch that when doing BP on patient As you are blowing up the cuff you will see spasm which means low calcium and it is dangerous
Truso's sign
what is abdomen preferred for insulin?
absorption and a little bit faster
Metformin - warn the patient that it causes hypoglycemia and you never give it with
ace inhibitors
to much GH, increased bone growth = wider bones
acromegaly
stimulates production of cortisol
adrenal corticoid tropic hormone (ACTH)
Sx - acid reflux, feel burning pain related to MI pain?, cell differentiates endoscopy to discover if you have this stay away from anything that can cause inflammation to esophagus such as citrus, alcohol, hot drinks
barret's esophagus
What can you give for hypoglycemia if milk is not available
bread, soda
cannot have gluten if you are allergic to gluten and the body is trying to digest it the bowel becomes inflamed, bloody stools and diarrhea
celiacs disease
ACTH secrete
cortisol
increases glucose and BP
cortisol? ACTH?
34 y/o females dx of hypothyrodism, what do you think signs and sx are (4)
decrease energy and fatigue weight gain 10lbs constipation menorrhegia - bad periods
The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:
decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. #
vasopressin = holds onto fluids
desmopressin
liver is supposed to be detoxifying and it isn't in liver disease so the pt NH4 levels of sky high and this is
hepatic encephalopathy
communicate between organ and tissues to make thing happen like growth, menopause and just overall trigger actions
hormones
Fruity breathe, dehydration, sweating, sluggish, slurred speech
hyperglycemia
heat intolerance
hyperthyroidism
How is hyperparathyrodism related to hypercalcemia = parathyroid hormone (PTH)
hypoPT = hypocalcemia so bones lose Ca so the bones become brittle, risk of fractures hyperPT = hypercalcemia
Irritable, tetany, not tired, restless
hypocalcemia
Tachycardia, BP down, fainting juice, milk, orange juice, candy
hypoglycemia
Renal system takes longer so stuff goes through BBB
infants
Pregnant patient there metabolism will be
slower
inside the cell that the hormones are targeting they are waiting to be stimulated and they have receptors for whatever hormones you are going to need
target cell
are stimulated by receptors
target cells
ADH equals?
vasopressin
1) inflammation, bloody stools, diarrhea 2) diarrhea 3) painful, loose, often, unpredictable, stress makes it worse, tends to show up in younger people, diarrhea, constipation
1) ulcerative colitis 2) IBS 3) Crohn's
1) block H+ ion and that interferes with gastric production 2) stops the acid from being made 3) anything you coat the stomach to decrease the acid exposure makes it so other medications cannot be absorbed so what do you do help this?1
1) H2 blockers 2) PPI 3) 2 hours before giving meds that coat the stomach or 4 hours after the coating meds
1) TSH levels HIGH = 2) TSH levels LOW =
1) hypothyroidism = body is making so much because the thyroid is low 2) hyperthyroidism
1) what is a chemical obstruction 2) what is a mechanical obstruction
1) ileus = from anesthesia, bowel not recovering as much as it should, vomiting, no visible signs in x-ray 2) tumor, need surgery to take it out
GI bleeding that is active will appear _____ ulcer bleeding/chronic eating away of lining is ____
1) red 2) melena
common reason is = alcoholism and gallstones labs = look for an increase in amylase and lipase Sx = bad appetite, anorexia leads to poor nutrition state and you could draw albumin levels at risk for diabetes*
pancreatitis
Hurt parathyroid = less calcium
parathyroid problem
pretty much in charge of everything
pituitary gland
problem with the actual organ
primary
The client with cirrhosis who has ascites receives 100 mL of 25% serum albumin I.V. Which finding would best indicate that the albumin is having its desired effect?
reduces ascites?
back flow of chyme because LES isn't working cannot lay down give H2 blockers and PPI, Pepto bismal
GERD
infection causes it can have inflammation treat with Quad treatment - antibiotics, H2 blockers, PPI, stomach lining protectant (pepto bismal)
H. Pylori
thyroid levels* are high, GRAVES DISEASE Sx = bludging eyes, weight loss, increase appetite, heat intolerance, achy, muscle weakness, tired all the time, aches and pains, loss of appetite and confusion, thristy all the time
HYPERthyroidism
An adult client with type 2 diabetes is taking metformin 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says:
If I know I will be having alcohol, I must not take metformin; I could develop lactic acidosis."
work inside the cell - cAMP, Calcium instigated by the first messenger and does what first messenger tell them to do
second messanger
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
Myxedema coma
What do you do for an intestinal obstruction
NG tubes are put in because we are trying to keep the gut from sending acid from bowel but the down side is acid base problems and dehydration*
Used in hypothyrodism - same thing as methal drug because it is trying to decrease thyroid levels
PTU
problem is with the signals so problems with the pituitary
secondary
Pt treated for hyperthyrodism would them need (2)
SEE = Restless, sweating, losing weight NEED= Periods of activty and rest
assessment labs for cushing's disease
Sodium levels, potassium, glucose, WBC count because it is bad for your immune system WBC are the only thing you can count on to see if there is an infection when you are on GC(steriods)****
Priority when caring for a patient that just had adrenal and thyroid surgery
Tachycaridic, hypotension, vascular collapse, shock, heart will be twitchy
A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply.
skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection
hypotension, dehydration, vomiting, diarrhea, sudden back pain, nothing left to give, body can no longer use the renin system
adrenal crisis
purpose = release cortisol when we need more energy the levels of cortisol will go up when it is healthy, levels subside the cortisol levels will decrease
adrenal gland
chronic problem, take steroids regularly for this*, adrenals are NOT WORKING and giving you cortisol when you need it so you will not be: tired, weak, no appetite, weight loss, hypotension, hypoglycemia, bad mood, headaches, sweating, menstrual irregulars, NVD
adrenal insufficiency
don't have supply of cortisol anymore so it is a depressed environment = everything negative
adrenal insufficiency
what basically says ok because you changed into II im going to increase my production and this will make the antidurietic hormone to increase which causes fluid retention
aldosterone
Which finding in the client who has returned from having a subtotal thyroidectomy would require a nurse to take immediate action?
facial muscle twitching
how do you treat adrenal crisis
give corticoid steroid and Five S's = sugar, salt, steroid (long acting), search, support
treatment for DKA
give volume first then give regular insulin in the IV
don't like to use them long term because it can cause peptic ulcers*, retain salt and water*, lose potassium*, kidney failure*, HTN
glucocorticoids
given a lot for organ transplants, serious allergies increase in stress
glucocorticoids
Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply.
hair loss, dry skin cold intolerance
What causes it: lack of iodine, inflammation of thyroid, had to remove the thyroid because it had cancer, some medications, HASHEMOTO DISEASE = attack itself, immune system attack thyroid
hypothyroidism
cold intolerance, loss of hair, dry skin, over weight, they are in a depressive state, GOITER, you really cannot tell it is a problem unless you look for it
hypothyroidism
lose all the effects of body to retain Na and H2O, increase in potassium so the heart will not work properly, losing aldosterone
issues with losing cortisol
Hyperventilation and deep Happens with DKA
kussmaul respirations
hormones go right in to the cell and invade - steroids
lipid soluble
ascites is a major problem because you cannot breathe as deeply or out as deeply, BP will decrease Common sign = jaundice
liver disease
weak muscles - care about the heart
low potassium
what does the anterior pituitary hormone prolactin do?
mammory glands and pregnancy
Has to deal with thyroid. It will help you get rid of it if you have to much thyroid level
methymazole??
acetylcholine, ACH
neurotransmitters
Need enough albumin or you have to decrease dose because they do not have enough protein
older patients
it helps get the body ready for pregnancy, it is in the POSTERIOR PITUITARY
oxytocin
The nurse might expect to see which of these manifestations in the client who is hypocalcemic? Select all that apply.
tetany, prolonged QT interval, irritability
deal with metabolism measure it with stimulation and suppression test when you draw TSH test pay attention to T4 T4 is more specific for the thyroid problem - best indicator
thyroid
First 12 hours fever up, pressure up, heart rate up - if you don't stop it they are going to have a stroke
thyroid crisis
when do you go into adrenal crisis
trauma, shock, sepsis, something major happens
helps the body hold onto water
vasopressin
it equals antiduretic hormone
vasopressin
on top of the cell - TSH, vitamins and catecholamines
water soluble hormones
when is it a bad idea to give Miralax or other GI motility drugs
when there is an obstruction in the small bowel because it can cause the bowel to rupture
add more freq glucose checks, add more insulin and can cause hyperglycemia
when you give GC to a diabetic patient
When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication?
with meals or with an antacid
Subtotal thyroid ectomy, the problem is
worry about to little Ca because they are twitchy (facial muscles) twitchy = hypocalcemia
Metformin and drinking
you cannot drink because pt will get lactic acidosis