Adult Nursing Test 8

Two forms of pharmacotherapy are available for treating hyperthyroidism and controlling excessive thyroid activity

1- the use of irradiation by administration of the radioisotope 131I for destructive effects on the thyroid gland 2- antithyroid medications that interfere with the synthesis of thyroid hormones and other agents that control manifestations of hyperthyroidism

Pancreatic enzyme secretion is normally

1500 to 3000 mL/day

The nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function?

30 mg/dL Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function. (lower than 30)

Acute pancreatitis

80% result from cholelithiasis or sustained alcohol abuse Two main types: interstitial edematous pancreatitis and necrotizing pancreatitis Interstitial pancreatitis affects the majority of patients and is characterized by lack of pancreatic or peripancreatic parenchymal necrosis with diffuse enlargement of the gland due to inflammatory edema; inflammation and edema confined to pancreas; minimal organ dysfunction; return to normal usually within 6 months Necrotizing pancreatitis- there is presence of tissue necrosis in either the pancreatic parenchyma or the tissue surrounding the gland; if parenchyma is involved this is marker for more severe disease; this disease is characterized by widespread and complete enzymatic digestion of the gland; systemic complications from this disease include organ failure, pulmonary insufficiency, hypoxia, shock, kidney disease, GI bleeding; also characterized as having severe acute pancreatitis

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Imbalanced nutrition: Less than body requirements related to biliary inflammation b) Anxiety related to unknown outcome of hospitalization c) Deficient knowledge related to prevention of disease recurrence d) Acute pain related to biliary spasms

Acute pain related to biliary spasms

A client with a history or alcohol abuse comes to the ER and complains of abdominal pain. Lab studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

Administering morphine IV as ordered

Which of the following hormones controls secretion of adrenal androgens?

Adrenocorticotropic hormone (ACTH) The secretion of T3 and T4 by the thyroid is controlled by TSH. Parathormone regulates calcium and phosphorus metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

Gallstone formation increases with

Age as a result of increased hepatic secretion of cholesterol and decreased bile acid synthesis With malabsorption of bile salts in patients with GI disease or T-tube fistula Those who have undergone ileal resection or bypass Diabetics

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?

Assisting the client to turn, cough, and deep breathe every 2 hours.

Causes of hypothyroidism

Autoimmune disease (Hashimoto thyroiditis, post-Graves disease) Atrophy of thyroid gland with aging Therapy for hperthyroidism- radioactive iodine or thyroidectomy Medications- Lithium, Iodine compounds, Antithyroid medications Radiation to head and neck in treatment for head and neck cancers/lymphoma Infiltrative diseases of the thyroid- amyloidosis, scleroderma, lymphoma Iodine deficiency and iodine excess

Acute cholecystitis pain meds

Avoid morphine due to concern that it could cause spasm of sphnicter of Oddi Use merperidine (Demerol) instead

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have?

Bile stained vomiting N/V are common in acute pancreatitis. The emesis is usually gastric in origin, but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur

Cholelithiasis

Calculi in the gallbladder Rare in children and young adults; more prevalent with increased age Affects approximately 50% of women by the age of 70

Before cholecystectomy

Chest x-ray, electrocardiogram, liver function test, imaging of gallbladder Vitamin K given if prothrombin level is low Nutritional supplements if needed to aid wound healing and prevent liver damage Educate about deep breathing and coughing and early ambulation to prevent pneumonia and atelectasis Laparoscopic cholecystectomy is the standard of therapy for symptomatic gallstones; with this procedure the patient no experience paralytic ileus that occurs with open abdominal surgery and has less postop abdominal pain The most severe complication with this surgery is bile duct injury; bile leak can be managed with stent placement; bile peritonitis may lead to serious illness or death

______ is used successfully in the diagnosis of acute cholesystitis or blockage of a bile duct

Cholescintigraphy Uses IV radioactive agent taken up through the biliary tract Often used when ultrasound is not conclusive

Conditions caused by dysfunction of the anterior pituitary include

Cushing's syndrome- over secretion of ACTH Acromegaly- over secretion of GH Dwarfism- under secretion of GH

Cholelithiasis risk factors

Cystic fibrosis, Diabetes, Frequent change in weight, Ileal resection or disease, Low dose estrogen therapy, Obesity, Rapid weight loss, Treatment with high dose estrogen (seen in prostate cancer), Women- especially those who have had multiple pregnancies or who are of Native American or US southwestern Hispanic ethnicity

Medication given for diabetes insipidus is a synthetic vasopressin administration called ______.

DDAVP

_______ glands include the pituitary, thyroid, parathyroid, adrenals, islet cells, ovaries and testes.

Endocrine

Clinical Manifestations of hypothyroidism

Extreme fatigue, hair loss, brittle nails, dry skin, numbness and tingling of fingers, husky voice, hoarseness, menstrual disturbances, menorrhagia, amenorrhea, loss of libido Severe hypothyroidism results in subnormal body temp and pulse rate; skin becomes thickened; hair thins and falls out; face becomes expressionless and masklike; report being cold even in warm environments At first may be irritable with fatigue, but over time emotional responses are subdued; mental processes become dulled, patient appears apathetic, speech is slow, tongue enlarges, hands/feet increase in size, deafness may occur; frequent constipation Advanced hypothyroidism may produce personality changes and cognitive changes characteristic of dementia; inadequate ventilation and sleep apnea; pleural effusion, pericardial effusion, respiratory muscle weakness; hypothrermic and abnormally sensitive to sedative, opioid, and anesthetic agents Severe hypothyroidism is associated with elevated serum cholesterol, atherosclerosis, CAD, and poor left ventricular function Affects women 5-8 times more than men and occurs most often between 40 - 70 years old; prevalence increases with age Patients with unrecognized hypothyroidism are at increased risk for intraoperative hypotension, post-op heart failure and altered mental status Myxedema coma is the decompensated state of severe hypothyroidism

The anterior pituitary hormones include ______, ______, ______, and _______. These hormones release hormones from other endocrine glands. Another anterior pituitary hormone is GH, which increases protein synthesis, increases fatty acid breakdown in adipose tissue, and increases blood glucose levels.

FSH LH ACTH TSH

Thyroid storm- thyrotoxic crisis, thyrotoxicosis

Form of severe hyperthyroidism, usually of abrupt onset If untreated, it is almost always fatal Manifested by cardiac dysrhythmias, fever, and neurologic impairment

Hyperthyroidism

Form of thyrotoxicosis resulting from excess thyroid hormone Most common causes are Grave's disease, toxic multinodular goiter, and toxic adenoma Graves disease most common cause of hyperthyroidism and affects women 8 times more than men

A nurse is caring for a client with mild acute pancreatitis. Which health care provider prescriptions will the nurse question as it related to evidence based practices in the treatment of acute pancreatitis? Select all that apply.

Full liquid diet as tolerated Nasogastric tube to intermittent suction for removal of gastric secretions Initiate parenteral feedings first and advance to enteral feedings as tolerated. The nurse should question any order for clear liquid diet because oral intake should be held to inhibit pancreatic enzyme secretion. However, enteral feedings should be initiated as soon as possible, as the client tolerates them. The placement of an NG tube to wall suction is recommended for N/V and abdominal distention only; routine use of an NG tube for removal of gastric secretions in order to limit pancreatic enzymes is not recommended. Enteral feedings should be tried first before parenteral feedings.

__________ is the most common disorder of the biliary system

Gallbladder disease with stones

The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level?

Glucagon

A nurse cares for a client with a disorder of the endocrine function of the pancreas. Which hormone or enzymes may be impacted by this disorder? Select all that apply.

Glucagon, somatostatin, insulin Lipase and amylase are enzymes released by the exocrine function of the pancreas and are not directly impacted by endocrine function.

The use of radioactive iodine is the most common form of treatment for ______ in North America. Beta blocking agents (propranolol, atenolol, metoprolol, are used as adjunctive therapy for symptomatic relief, particularly in transient thyroiditis. The three treatments (radioactive iodine therapy, antithyroid medications, and surgery) all have the same complications- relapse or recurrent hyperthyroidism and permanent hypothyroidism

Graves

Thyroid storm clinical manifestations

High fever >38.5C or >101.3F Extreme tachycardia >130 bpm Exaggerated symptoms of hyperthyroidism with disturbances of a major system- GI (weight loss, diarrhea, abdominal pain) or cardiac (edema, chest pain, dyspnea, palpitations) Altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma Usually precipitated by stress, such as injury, infection, thyroid and nonthyroid surgery, tooth extraction, insulin reaction, diabetic ketoacidosis, pregnancy, digitalis intoxication, abrupt withdrawal of antithyroid medications, extreme emotional stress, vigorous palpitation of the thyroid

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?

I may stop taking this medication when I feel better

Management of thyroid storm

Immediate objectives are to reduce body temperature and heart rate and prevent vascular collapse -Hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, acetaminophen- do not use aspirin (salicylates) because they displace thyroid hormone form binding proteins and worsen the hypermetabolism -Humidified oxygen is given to improve tissue oxygenation and meet high metabolic demands; ABG and pulse ox used to monitor respiratory status -IV fluids containing dextrose are given to replace liver glycogen stores -PTU or methimazole is given to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone -Hydrocortisone is prescribed to treat shock or adrenal insufficiency -Iodine is given to decrease output of T4 from the thyroid gland -For cardiac problems such as atrial fibrillation, dysrhythmias and heart failure, sympatholytic agents may be given. Propranolol combined with digitalis has been effective in reducing severe cardiac symptoms

Cholecystitis

Inflammation of the gallbladder Causes pain, tenderness, rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder Associated with N/V, inflammation Empyema- pus can fill gallbladder Calculous cholecystitis- stone obstructs outflow of bile and leads to compromised vascular supply Secondary infection of bile occurs in 50% of cases Bacterial contamination is not believed to stimulate the actual onset of acute cholecystitis Acalculous cholecystitis- acute gallbladder inflammation without gallstones which can occur after surgery, trauma or burns Speculated that acalculous cholecystitis is caused by alterations in fluids and electrolytes and altered blood flow in visceral circulation; bile stasis and increased bile viscosity are also through to play a role

Pancreatitis

Inflammation of the pancreas Acute- can be medical emergency with high risk of life threatening complications and mortality Chronic- often goes undetected because findings are not always present in the early stages By the time symptoms appear in chronic pancreatitis, approximately 90% of normal acinar cell function (exocrine function) has been lost Pancreatitis is often described as auto-digestion of the pancreas

_____ occurs in some patients with gallbladder disease usually with obstruction of the common bile duct. This is frequently accompanied by pruritis.

Jaundice

Gerontologic considerations of pancreas

Little change in size Increase in fibrous material and fatty deposition in those over 70 Localized arteriosclerotic changes Decreased rate of pancreatic enzyme secretion (amylase, trypsin, lipase) Decreased bicarb output Impairment of normal fat absorption due to delayed gastric emptying and pancreatic insufficiency Decreased calcium absorption

Insulin via beta cells in pancreas

Lowers blood glucose Promotes fat storage in adipose tissue and synthesis of protein in body tissues Level of glucose in the blood is normally regulated by insulin secretion from the pancreas

A nurse is providing dietary instruction to a client with a history of pancreatitis. Which instruction is correct?

Maintain a high-carb, low-fat diet

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system?

Maintain the client in a semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion

Gallstone manifestations

May be silent with no pain and only mild GI symptoms The patient with gallbladder disease resulting form gallstones may develop two types of symptoms: those due to disease of gallbladder itself and those due to obstruction of the bile passages by a gallstone Epigastric distress, fullness, abdominal distention, and vague pain in RUQ may occur Distress may follow meal rich in fried or fatty food

A client with acute pancreatitis has been started on TPN. Which action should the nurse perform after administration of the TPN?

Measure blood glucose concentration every 4-6 hr

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis?

Pain with abdominal distention and hypotension Also, fatty diarrhea, tachycardia

A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction?

Parathyroid gland

Two major types of gallstones

Pigement and Cholesterol Risk of developing pigment stones increased with cirrhosis, hemolysis, and infections of the biliary tract Pigment stones must be removed surgically Cholesterol saturated bile predisposes to formation of gallstones and acts as an irritant that produces inflammatory changes in the mucosa of gallbladder

________ gland is known as the master gland.

Pituitary

Manifestations of hyperthyroidism / Graves

Presenting symptom is often nervousness emotional hyperexcitability, irritable, apprehensive can not sit quietly palpitations and rapid pulse at rest and on exertion tolerate heat poorly; excess perspiration skin is flushed continuously with characteristic salmon color in Caucasians skin is likely warm, soft, moist; but patients may report dry skin and diffuse pruritis fine tremor of the hands exophthalmos increased appetite and dietary intake weight loss fatigue and weakness amenorrhea changes in bowel function Atrial fibrillation occurs in 15% of older patients with new onset hyperthyroidism Cardiac effects include: tachycardia, dysrhythmias, increased pulse pressure, palpitations Myocardial hypertrophy and heart failure may occur if the hyperthyroidism is severe and untreated

Myxedema coma

Rare life threatening condition; decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious May be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesics; may also occur if missed doses of thyroid replacement medication Most often among older women in the winter months and appears to be precipitated by cold Initially the patient shows signs of depression, diminished cognitive status, lethargy, and somnolence; increasing lethargy may progress to stupor; respiratory rate is depressed resulting in alveolar hypoventilation, progressive carbon dioxide retention, narcosis and come Patients can also exhibit hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, hypothermia, cardiovascular collapse and shock; all require aggressive and intensive supportive and hemodynamic therapy if the patient is to survive Mortality rate high at 30-40% Patients at greatest risk are older adults, those with cardiac complications, reduced consciousness, persistent hypothermia, and sepsis

The goal in medical management of diabetes insipidus is

Replace ADH Maintain adequate fluid status Correct underlying problem

_______ and ______ are hormones from the GI tract that aid in digestion of food substances by controlling the secretions of the pancreas

Secretin and CCK

Diagnostic evaluation for endocrine disorders includes

Serum tests to detect hormone levels, the presence of antibodies, and to monitor the effects of hormones on other substances Urine tests may be done to detect the amount of hormone secreted by kidneys

Hypothyroidism

Suboptimal levels of thyroid hormone Can range from mild to myxedema Most common cause in adults is autoimmune thyroiditis (Hashimoto disease) in which the immune system attacks the thyroid gland Commonly occurs in patients with previous hyperthyroidism that has been treated with radioiodine or anti-thyroid medications or had thyroidectomy Increased incidence of thyroid cancer in men who have undergone radiation therapy for head and neck cancer More than 95% of patients have primary or thyroidal hypothyroidism- dysfunction of thyroid gland itself Central hypothyroidism- cause of thyroid dysfunction is failure of pituitary gland, hypothalamus or both Pituitary or secondary hypothyroidism- caused by pituitary disorder Hypothalamic or tertiary hypothyroidism- caused by disorder of hypothalamus resulting in inadequate secretion of TSH due to decreased stimulus of TRH Neonatal hypothyroidism- thyroid deficiency present at birth Myxedema- accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues; term is used to describe extreme symptoms of severe hypothyroidism

Hypothyroid medications and treatments

Synthetic levothyroxine (synthroid or levothroid) is commonly prescribed for treating hypothyroidism and suppressing nontoxic goiters If the disease progresses to myxedema coma, IV admin of T4 and T3 are recommended Administration of glucocorticoids (hydrocortisone) given in high doses every 8-12 hours until coexisting adrenal insufficiency is ruled out

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient?

The patient has developed peritonitis.

A nurse is teaching a client about hormones within the endocrine system. Which hormones would be included as the hypothalamic hormones? Select all that apply.

Thyroid releasing hormone Corticotropin releasing hormone Gonadotropin releasing hormone Corticotropin releasing hormone causes the anterior pituitary to secrete adrenocorticotropic hormone. Thyrotropin releasing hormone stimulates the release of thyroid stimulating hormone from the anterior pituitary. Gonadotropin releasing hormone triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone and follicle stimulating hormone

Posterior pituitary hormones include ______ and ______.

Vasopressin (ADH) Oxytocin

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?

Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency.

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis?

Weight loss Weight loss is most common due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) black, tarry stools. b) circumoral pallor. c) light amber urine. d) yellow sclerae.

Yellow sclerae

For a client with hyperthyroidism, treatment is likely to include

a thyroid hormone antagonist

The chief symptom of cholecystitis is

abdominal pain or biliary colic typically the pain is so severe that the client is restless and changes positions frequently to find relief

If the gallstone continues to obstruct the duct

abscess, necrosis, and perforation with generalized peritonitis may occur

Pancreatic enzymes include

amylase- digest carbs trypsin- digest proteins lipase- digest fats

GH is secreted by the _____. It is also known as somatotropin. This hormone _______ protein synthesis, fatty acid breakdown in adipose tissue, and blood glucose levels.

anterior pituitary increases

A client who is 24 hours post-op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?

apply a heating pad to your shoulder for 15 minutes hourly as needed

Cholelithiasis may cause

biliary colic jaundice very dark urine gray or clay colored stools deficiency of vitamins A, D, E, K

Ultrasound is the diagnostic procedure of choice to detect calculi in the gallbladder or a dilated common bile duct

can be used in patients with liver dysfunction and jaundice does not expose patients to ionizing radiation most accurate if the patient fasts overnight so the gallbladder is distended

During the physical assessment of a patient with an endocrine gland disorder you need to note ______, ______, ______, _____.

changes in vital signs changes in physical appearance weight gain development of secondary sex characteristics

A patient with a gallstone in the common bile duct is said to have

choledocholithiasis

A client with calculi in the gallbladder is said to have

cholelithiasis

2-3 times more women than men develop _______ and gallbladder disease; affected women are usually over 40, multiparous, and obese.

cholesterol stones

Which is a clinical manifestation of cholelithiasis?

clay colored stools The client with gallstones has clay colored stools and excruciating RUQ pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are gray like putty or clay colored. The client develops a fever and may have a palpable abdominal mass

A nurse is performing a physical examination on a client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland?

cold intolerance The thyroid releases hormones that regulate the body's metabolic rate. A client with a malfunctioning thyroid gland may experience weight gain, constipation, cold intolerance, and slowing of body functions.

Biliary colic is caused by

contraction of the gallbladder which can not release bile due to obstruction by stones; when distended, the fundus of the gallbladder comes in contact with the abdominal wall in the region of the 9th and 10th costal cartilages producing marked tenderness in the RUQ on deep inspiration and prevents full inspiratory excursion

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Choose all that apply.

dark urine jaundice clay colored stools pruritis Obstructed bile flow produces jaundice, clay colored stools, and dark urine. Malabsorption of nutrients and fat soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritis may be noted, along with anorexia, weight loss, and malasie. If these s/s are present, cancer of the head of the pacreas is suspected

Patients with SIADH can develop _______ because the patient is hemodiluted.

delusional hyponatremia

Lithotripsy

disintegration of gallstones by shock waves

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Inability for the liver to reabsorb serum glucose b) Ingestion of foods high in sugar c) Dysfunction of the pancreatic islet cells d) Renal failure

dysfunction of the pancreatic islet cells This is treated with diet, insulin, or oral anti-diabetic agents

Any patient who has had hypothyroidism for a long period usually has associated

elevated serum cholesterol, atherosclerosis, and CAD Angina or dysrhythmia can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines and increase oxygen demand If angina or dysrhythmia occurs, stop thyroid medication immediately; when resumed at a later time, start at a lower dose and the patient will need to be monitored very closely

The pituitary gland influences the secretion of hormones from other __________.

endocrine glands

When assessing a health history of patient with an endocrine gland disorder you need to note ________________________________, as well as, documenting the severity of s/s, length of time experiencing s/s, how the s/s have affected the patient's ADLs, affects of s/s on self-perception, and any family history of endocrine gland disorders.

energy level heat/cold tolerance/intolerance sleep disturbances mood disturbances memory and concentration problems complaints of sexual dysfunction

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is caused by ________. This can occur even though the patient has a low serum osmolarity. This excessive secretion leads to ______.

excessive ADH secretion intervascular fluid retention

Diabetes insipidus and vasopressin deficiency causes

excessive thirst with excessive dilute urine low specific gravity due to dilute urine

Somatostatin via delta cells in pancreas

exerts a hypoglycemic effect by interfering with release of growth hormone from the pituitary and glucagon from the pancreas, both of which tend to raise blood glucose levels

The pancreas has both ____ and ____ functions.

exocrine and endocrine

Which condition in a client with pancreatitis makes it necessary for the nurse to check the fluid intake and output, check hourly urine output, and monitor electrolyte levels?

frequent vomiting, leading to loss of fluid volume Fluid and electrolyte disturbances are common complications because of N/V, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction

Small incision cholecystectomy

gallbladder is removed through a small abdominal incision short length hospital stay is the major advantage procedure is controversial because it limits exposure to all involved biliary structures

Surgical intervention for disease of the biliary tract is the most common operative procedure performed in the older adult

gerontologic considerations include cholesterol saturation of bile increases with age because of increased hepatic secretion of cholesterol and decreased bile acid synthesis incidence of gallstones increases with age, but the older patient may not exhibit the typical symptoms of fever, pain, chills, jaundice; symptoms in the older adult may be accompanied or preceded by signs of septic shock- oliguria, hypotension, changes in mental status, tachycardia, tachypnea

With cholelithiasis, excretion of the bile pigments by the kidneys

gives urine a very dark color and the feces, no longer colored with bile pigments, are grayish like putty or clay colored

Hypopituitarism can be from ______ or ______.

gland dysfunction dysfunction of hypothalamus

Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenesis?

glucagon

Hormones that raise blood glucose levels

glucagon, epinephrine, adrenocorticosteroids, growth hormone, thyroid hormone

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress?

glucocorticoids

Percutaneous cholecystostomy

has been used in the treatment and diagnosis of acute cholecystitis in patients who are poor risks for any surgical procedure or general anesthesia; including patients with sepsis, or with severe cardiac, renal, pulmonary, or liver failure Needle is inserted to remove bile and decompress biliary tract Almost immediate relief of pain and resolution of s/s of sepsis and cholecystitis have been reported with this procedure Antibiotics given before, during, after

The endocrine system involves release of _______ to regulate body functions. These are produced in various locations throughout the body.

hormones

With diabetes insipidus, excessive urine production can not be controlled with fluid restriction, doing so could lead to _____ and _____.

hypernatremia dehydration

An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder?

hyperparathyroidism

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?

hyperthyroidism

A client with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of?

hyponatremia and hyperkalemia

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called?

hypophysectomy The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma.

The ______ controls the release of pituitary hormones from both the anterior and posterior pituitary lobes.

hypothalamus

Posterior pituitary hormones are made in the ______ and stored in the ______.

hypothalamus posterior pituitary

After laparoscopic cholecystectomy,

immediate diet is low fat liquids added as tolerated- cooked fruit, rice, tapioca, lean meat, mashed potatoes, non gas forming vegetables, bread, coffee, tea should avoid- eggs, cream, pork, fried food, cheese, rich dressings, gas forming veggies, alcohol Remind patient that fatty foods may induce an episode of cholecystitis

If the flow of bile is impeded blood levels of bilirubin _____.

increase

GH _______ blood glucose.

increases

The anterior and posterior lobes of the pituitary are ______.

independent

Endocrine glands work on negative feedback. This means that hormone production is ______ when hormone concentration ______. This prevents ______ of a hormone.

inhibited increases accumulation

The endocrine pancreas is responsible for

insulin via beta cells glucagon via alpha cells somatostatin via delta cells

For gallstones, cholelithiasis, _________ is the standard management

laparoscopic cholecystectomy Dissolution therapies are used for those patients who may not be candidates for the procedure due to safety concerns regarding anesthesia

After surgery for gallbladder disease the patient is placed in

low Fowler position and a soft diet is started after bowel sounds return

SIADH can be caused by

lung cancer pneumonia pneumothorax certain medications- Vincristine, phenothiazides, tricyclide antidepressants, thiazide diuretics

A client is undergoing diagnostics for an alteration in thyroid function. What phsyiologic function is affected by altered thyroid function?

metabolic rate The thyroid concentrates iodine from food and uses ut to synthesize T3 and T4, which regulate metabolic rate

A client is receiving long term treatment with high dose corticosteroids. Which of the following would the nurse expect the client to exhibit?

moon face

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?

myxedemic coma severe hypothyroidism is called myxedema and if untreated can progress to myxedemic coma, a life threatening event. Thyroid storm is an acute, life threatening form of hyperthyroidism. Addison's disease refers to primary adrenal gland insufficiency. Acromegaly refers to oversecretion of growth hormone by the pituitary gland during adulthood.

Endocrine glands regulate organ function in conjunction with the

nervous system.

SIADH is often _______ in origin.

non-endocrine

Gallstone formation is more frequent in people who use _____, _____, or _____ as these meds are known to increase biliary cholesterol saturation.

oral contraceptives, estrogen, or clofibrate

Cardiac effects of hyperthyroidism include

palpitations may also include sinus tachycardia, increased pulse pressure, and elevated systolic blood pressure

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis.

The nurse is caring for a client with acute pancreatitis who is admitted to the ICU to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis?

pancreatitis can elevate the diaphragm and alter the breathing pattern

Surgical cholecystostomy

performed when the patient's condition precludes more extensive surgery or when an acute inflammatory reaction is severe gallbladder is opened and stones and bile are removed, drain tube placed patient may return for laparscopic cholecystectomy surgical cholecystostomy has a high mortality rate because of the underlying infectious disease process

Endoscopic retrograde cholangiopancreatography ERCP

permits direct visualization of structures that previously could be seen only during laparotomy Examines the hepatobiliary system using flexible fiberoptic endoscope inserted through the esophagus to the descending duodenum Begin in left semiprone position, multiple position changes needed Fluoroscopy and multiple x-rays are used during ERCP to detect presence and location of ductal stones NPO before procedure Moderate sedation used Use glucagon or anticholinergic agents to make cannulation easier by decreasing duodenal peristalsis Watch for respiratory/CNS depression, hypotension, oversedation, vomiting, return of gag reflex and coughing reflex

Client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce PTH. PTH maintains the balance between calcium and

phophorus

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

position the client on the side with the knees flexed to promote comfort by decreasing pressure on the abdominal muscles

Oxytocin is a ______ pituitary hormone. This hormone facilitates ______ and ______.

posterior lactation uterine contraction

Vasopressin (AHD) is a ______ pituitary hormone. This hormone controls ______. It is stimulated by ______ or ______.

posterior water excretion by the kidneys increased blood osmolarity or decreased BP

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?

pressure on the optic nerve

Glucagon via alpha cells in pancreas

raises blood glucose

A client is admitted to the health care facility with abdominal pain, low grade fever, abdominal distention, and weight loss. The physician diagnosis acute pancreatitis. What is the primary goal of nursing care for this client?

relieving abdominal pain

Treatment of SIADH includes ________ and ________.

removing cause limiting fluids

The nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase BP and blood volume?

renin

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Withhold oral feedings for the client. b) Instruct the client to avoid coughing. c) Monitor pulse oximetry every hour. d) Reposition the client every 2 hours.

reposition the client every 2 hours

Choledochostomy

reserved for the patient with acute cholecystitis who may be too ill to undergo a surgical procedure small incision through common duct to remove stones, then a tube is inserted to allow bile to drain laparoscopic cholecystectomy is scheduled for future date after inflammation has resolved

The hormone _____ is the major stimulus for increased bicarb secretion from the pancreas, and the major stimulus for digestive enzyme secretion is the hormone _____.

secretin CCK

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?

serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. These concentrations are elevated within 24 hours of the onset of symptoms. Amylase usually returns to normal within 48-72 hours, but lipase may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

Clinical manifestations of pancreatitis

severe abdominal pain abdominal pain and tenderness and back pain pain often in midepigastrium pain is acute onset, 24-48 hr after heavy meal or alcohol consumption abdominal distention poorly defined, palpable abdominal mass decreased peristalsis vomiting that fails to relieve pain or nausea abdominal guarding rigid or boardlike abdomen may occur indicating peritonitis ecchymosis in the flank or umbilicus may indicate severe pancreatitis N/V fever, jaundice, mental confusion, agitation hypotension is typical and reflects hypovolemia and shock tachycardia, cyanosis, cold, clammy skin acute kidney injury is common respiratory distress and hypoxia diffuse pumlonary infiltrates dyspnea, tachypnea, abnormal blood gas values myocardial depression, hypocalcemia, hyperglycemia, disseminated intervascular coagulation

Mortality rate of patients with acute pancreatitis is 2-10% because of

shock, anoxia, hypotension, or fluid and electrolyte imbalance. This mortality rate may also be related to the 10-30% of patients with severe acute disease characterized by pancreatic and peripancreatic necrosis.

Secretion of GH is increased by _______, _______, and _______.

stress exercise low blood glucose

There are four categories of hormones classified by their _____. They are ________, ________, ________, and ________.

structure amines / amino acids peptides, polypeptides, proteins, glycoproteins steroids fatty acid derivatives

Endocrine glands release hormones into

the bloodstream

The major exocrine function of the pancreas is

to facilitate digestion through secretion of enzymes into the proximal duodenum

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?

to reduce gastric and pancreatic secretions

Self digestion of the pancreas by its own proteolytic enzymes, mainly _____, cause acute pancreatitis

trypsin Gallstones obstruct flow of pancreatic juice or cause reflux of bile into the pancreatic duct activating enzymes within the pancreas. Normally, these enzymes would remain inactive until reaching the lumen of the duodenum. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage. Less common causes of pancreatitis- bacterial or viral infection, complication of mumps

Dissolution therapy

use of medication to break up or dissolve gallstones

The _____ nerve also influences exocrine pancreatic secretion

vagus

Diabetes insipidus is caused by a deficiency of _______.

vasopressin (ADH)