New Gen NCLEX review - Endocrine

Addison's - Treatment

Addison's - Treatment - Corticosteroids: end in -sone or -solone - Both Glucocorticoid and Mineralocorticoid needed - Mineralocorticoid: fludrocortisone - STRESS! Increase in dose needed....surgery, strenuous exercise, sickness/sepsis - Don't stop taking abruptly - This will NOT cure the patient - Will indefinitely take the medication - Steroid precautions - RAPID weight gain (one pound per day) - Fever>100.4 F - sign of infection since steroids suppress immune system - Increase glucose - Increased WBC - Increased risk of fracture - Increased risk for cataracts - Do not stop taking abruptly

Hyperthyroid Question Immediately following a thyroidectomy, the nurse asks the client to say 'hello.' The client moves the lips, but is not able to speak the word. What should the nurse do next? A. Give the client a sip of water. B. Have the client take a deep breath and cough. C. Notify the surgeon. D. Check client's pupillary response.

C. Notify the surgeon.

Parathyroid gland

Parathyroid Gland - Parathyroid Hormone (PTH) - Puts The Calcium High - Secretes PTH to bring calcium up - Calcium - Calcium levels: 8.5-10 - When calcium is LOW, PTH is secreted to increase it to normal levels

hyperthyroidism - thyroidectomy - what is it? - concerns for post surgery - post surgery monitoring

- Thyroidectomy - Removal of the thyroid - Post surgery: concerned about Thyroid Storm! - Monitor for: agitation, restlessness and confusion! - Post Surgery Monitoring: - Airway - Laryngeal stridor --priority--> Endotracheal Tube/Tracheostomy Kit at bedside -Breathing - Hoarseness/weak voice/noising breathing needs to be monitored --Priority--> Endotracheal Tube/Tracheostomy Kit at bedside - Circulation - monitoring for bleeding - around pillow and insertion site To PREVENT bleeding -neutral/midline head position -HOB 30-45 degrees -No flexing or extending neck Calcium Levels - hypocalcemia -First sign/symptoms: numbness and tingling around mouth and fingers

Hypothyroidisim - what conditions can cause hypothyroidism - s/s - diet - priorities

- Hypothyroidism = Low Energy & Slow Metabolism - Hashimoto's Disease - autoimmune disease - Low iodine in the diet - Pituitary Tumor - Thyroidectomy - removal of thyroid gland s/s - Low heart rate, BP, and RR - Weight Gain - Constipation - low digestion - Alopecia - hair loss - Low mentation - forgetful - Low mood - Low libido - Dry and slow (delayed turgor) skin - cold - DO NOT USE ELECTRIC BLANKETS...can harm the patient if not closely monitored - Irregular periods Diet: low calories, low fats, and cholesterol, activity, frequent rest periods Priority: monitor for extremely low respiratory rate - Myxedema coma - Nurse to have endotracheal intubation kit at patient bedside - Most likely occurs: abruptly stopping levothyroxine OR post thyroidectomy

Hyperthyroidism: potassium iodine (SSKI) - pharm and therapeutic classification - mechanism of action

- generic (Brand) - Potassium iodide (SSKI) - Pharmacologic: iodine-containing agents - Therapeutic: antithyroid agent - Use in adjunct with other antithyroid drugs in preparation for thyroidectomy -MOA - rapidly inhibits the release and synthesis of thyroid hormones - decrease the vascularity of the thyroid gland by shrinking the size of the gland - Pt. ed - stain the teeth... drink through a straw and dilute with a beverage - keep 1 hour apart from other antithyroid medication

Hypothyroidism - levothyroxine - pharmacologic classification - patient education - pregnancy safe?

- generic (Brand) - levothyroxine (Synthroid) - Pharmacologic: thyroid preparations -Synthetic form of T4 - Patient education: - Do NOT switch brands/pharmacy locations - Do NOT stop taking medication abruptly - Pregnancy safe - Life-long drug: 3-4 weeks for patient to get relief...not a cure

Hyperthyroidism medications: propylthiouracil & methimazole - which is safe for pregnancy? - pharm and therapeutic class

- generic (Brand) - propylthiouracil (PTU)....Pregnancy safe P=P - methimazole (Tapazole)....NOT Pregnancy safe - Pharmacologic: thioamides Inhibits the synthesis of thyroid hormones - Therapeutic: antithyroid agent

Hyperthyroidism - graves disease - s/s - priority - early s/s - diet

-Hyperthyroidism = High Energy & High Metabolism - Graves Disease - Exophthalmos (Grape Eyes) - Use eye patch/tape down eyelids - Goiter ('Golf Ball lump' in Neck) - High BP - Tachycardia - Heart Palpitations - Weight Loss (high energy) - Heat Intolerance - High Temp, Hot and Sweaty - Diarrhea - Priority: Monitor for thyroid storm - Early signs and symptoms: agitation, confusion and restlessness - Diet: - Frequent meals: 6-8 per day - High calories: 400-500 per day - High protein and carbs - Avoid: caffeine

Addisonian crisis - treatment & priority medication - priority goal

Addisonian Crisis - PRIORITY MEDICATION: IVP Glucocorticoid - IV Fluids - IV Dextrose - PRIORITY GOAL: INCREASE BLOOD PRESSURE!!!!!

A client admitted to your hospital unit has been diagnosed with SIADH. Which findings would be expected? Select all that apply. A. Low blood pressure B. Low serum osmolality C High urine specific gravity D High sodium level E Increased thirst

B. Low serum osmolality C High urine specific gravity

Hypothyroid Question The nurse is instructing the client with hypothyroidism who takes levothyroxine 100mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medications is effective if the client will take: A. the levothyroxine with breakfast and the other medications after breakfast. B. the levothyroxine before breakfast and the other medications 4 hours later. C. all medications together 1 hour after eating breakfast D. all medications before going to bed.

B. the levothyroxine before breakfast and the other medications 4 hours later.

Hyperparathyroid Question Which finding would you not expect to find someone with hyperparathyroidism? A. Constipation B. Renal Caliculi C. Fractures D. Headaches

D. Headaches

Hyperthyroidism - Reactive Iodine - how does it work? - pt. education before & after

Radioactive iodine (I-131) - Oral route - Accumulates in thyroid gland - Destroys thyroid tissue cells - Permanent, long-term solution Patient Education BEFORE: - NPO 2-4 hours before and 1-2 hours after med - Negative pregnancy test Remove neck jewelry and dentures - Hold additional antithyroid meds 5-7 days before administering - NO ANESTHESIA NECESSARY Patient Education AFTER: - Avoid prolonged, close contact with other people for several days. - Use private toilet facilities and flush twice after each use. - Separate laundry baskets for clothes, separate utensils

describe the difference between Syndrome of Inappropriate Antidiuretic Hormone (SIADH) & Diabetes Insipidus (DI)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) vs. Diabetes Insipidus (DI) DI: excessive diuresis....body is dry Low BP - because of the diuresis High Serum Osmolality Hypernatremia Low urine Specific gravity - dilute urine Patient VERY thirsty Treatment: intranasal vasopressin (synthetic form of ADH) Can cause Hyponatremia > Seizures > Death!!!! Headaches --> Priority!!!!! When administering intranasal vasopressin SIADH: stop urinating....body retains water Increased BP Low Serum Osmolality Hyponatremia > Seizures > Death!!!!! Headaches --> Priority!!!!! High Urine Specific gravity Treatment: fluid restriction, Isotonic OR Hypertonic IV Fluids (3% NS) & diuretics Daily weight Causes of both DI and SIADH: trauma to the brain SIADH ONLY: small cell lung cancer

Cushing's - Diagnosis

Cushing's - Diagnosis - Dexamethasone suppression test (DST) - Blood Test - Dexamethasone po pill at 2300 - Cortisol level - blood drawn at 0800 - Elevated cortisol = potential Cushing Syndrome

Hyperparathyroidism - complications -treatment

Hyperparathyroidism - Fractures - Renal Caliculi (Stones) - Constipation - Treatment: surgery...remove the parathyroid gland ... parathyroidectomy - BEWARE of hypocalcemia then occuring - Increase in PTH --> increase in calcium in blood - Bones are low of calcium--> higher risk of fractures --> going into kidneys and causing kidney stones

Hypersecretion of steroids - Cushing's

Hypersecretion of steroids - Cushing's - High Blood Pressure (SBP >140) - High Glucose: Hyperglycemia - High Sodium: Hypernatremia - Moon Face - Truncal Obesity - Fat Pad "Buffalo hump" - Hirsutism: lots of hair - Purple Striae: stretch marks - Rosy Cheeks: red face - Slow wound healing - TREATMENT: adrenalectomy *life-long corticosteroids*

The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? A. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." B. My need for glucocorticoids will stabilize, and I will be able to take a predetermined dose once a day." C. Glucocorticoids are cumulative, so I will take a dose every third day." D. I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."

A. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage."

You are recovering a client that underwent an adrenalectomy for Cushing's Syndrome. Which of the following will be included in the patient's discharge teaching? A. Glucocorticoid replacement therapy B. Avoiding avocadoes and pears C. Declomycin therapy D. Signs of Grave's Disease

A. Glucocorticoid replacement therapy

hypocalcemia: trousseaus vs. Chvostek

Trousseaus Sign - not the FIRST sign of hypocalcemia - Inflate blood pressure cuff on arm to a pressure greater than the patient's systolic blood pressure - Hold pressure for 3 minutes - Positive: hand draws in as thumb and wrist flex with fingers extending. Chvostek Sign - not the first sign of hypocalcemia - Tapping the cheek in front of the ear - Triggers stimulus of the Facial CN 7.