Endocrine thyroid and parathyroid 1/22-26

1kg=___L of fluid

1

parathyroidectomy age cutoff

50yoa

Normal calcium levels

8.5-10.5 mg/dL

(Adrenocortical insufficiency/Addisonian crisis) is a form of Addison's disease that is also known as acute adrenal insufficiency and is a medical emergency

Addisonian crisis

(Adrenocortical insufficiency/Addisonian crisis) is a form of Addison's disease that is caused by damage or dysfunction of the adrenal cortex, which then leads to low levels of aldosterone and cortisol.

Adrenocortical insufficiency

___________________________ is also known as a provocation Test. The patient is given an infusion of ACTH and then we measure cortisol levels at 30 minutes and 1 hour intervals.

Adrenocorticotropin hormone stimulation test

Which complication would the nurse monitor in a client with hyperparathyroidism? -A. Tetany -B. Seizures -C. Bone pain -D. Graves disease

C

The nurse is admitting a client diagnosed with untreated hypothyroidism. What manifestations can the nurse expect to find during the initial assessment? Select all that apply. A. Cold intolerance B. Tachycardia C. Hypotension D. Weight gain E. Mental sluggishness

CDE

A patient who had all parathyroid glands removed would need this supplement for life

Calcium

Tetany results from inadequate _____________

Calcium

What two electrolytes are regulated by the parathyroid?

Calcium and phosphate

Calcimimetics such as __________________ can help the body detect calcium so that it doesn't supply extra

Cinacalcet

The adrenal (medulla/cortex) hormones are the salt sugar and sex hormones and include the following: ~ Mineralocorticoids: Aldosterone increases sodium absorption and causes potassium excretion in the kidneys ~ Glucocorticoids: Cortisol affects glucose, protein, and fat metabolism. Impacts the body's response to stress. Impacts the body's immune function. ~ Sex hormones: Androgens and estrogens, which influence sex characteristics, fertility, and maintenance of overall health.

Cortex

Adrenal crisis can be a life threatening complication of _______________ if hormones like corticosteroids are not replaced when the body can't produce its own

Cushings

___________________ and ___________________ are conditions of too much of the adrenal cortex hormones cortisol, aldosterone, and androgen/estrogen as a result of endogenous or exogenous causes

Cushings disease/Cushings syndrome

Vitamin ____ helps absorption of calcium

D

The medication desmopressin will tell the kidneys to hold on to water and decrease urine output and is used in the treatment of (SIADH/DI)

DI

Blood osmolality will be (increased/decreased) in SIADH because it is very diluted

Decreased

Cholestyramine can cause (increased/decreased) absorption of levothyroxine and should be avoided within 2hrs of each other

Decreased

Ferrous sulfate can cause (increased/decreased) absorption of levothyroxine and should be avoided within 4hrs of each other

Decreased

Levothyroxine can cause (increased/decreased) efficacy of digitalis

Decreased

Diabetes insipidus (Dry Inside)is a condition of ADH (excess/deficiency) wherein the kidneys will not collect and concentrate urine, causing dilute urine with high output

Deficiency

Dose of steroids (dexamethasone) is administered, and then the body's response is measured based on cortisol excretion over the next 24 hours. Can measure cortisol levels in blood and urine. •24 hour urine will show low cortisol secretion if the person does not have Cushing's •If the secretion is not suppressed by the steroid dose and the cortisol levels are the same despite taking the dexamethasone, it indicates Cushing's. This test is called _____________________________

Dexamethasone suppression test

Cushings (disease/syndrome) is an endogenous condition of increased cortisol due to an issue within the adrenal/endocrine system. It commonly results from conditions such as adrenal hyperplasia, adrenocortical carcinoma, pituitary carcinoma, lung/GI tract/pancreas carcinomas. These things can produce ACTH

Disease

The lab test Plasma adrenocorticotropin hormone (ACTH) tests for cushing's disease or syndrome. Levels for this test will be (elevated/decreased) if the issue is within the pituitary gland and (elevated/decreased) if the issue is within the adrenal cortex or caused by medication

Elevated pituitary ; decreased adrenal/med

The provocation test determines whether or not an individual has Addison's disease (t/f)

False, determines the type (primary = plasma cortisol levels stay the same, secondary = plasma cortisol levels ⬆️)

Patients can recover from DI (t/f)

False, lifelong issue, will need meds as scheduled to avoid complications

Dietary modifications for treatment of hypothyroidism include a low protein diet (t/f)

False, low calorie diet

The nurse correctly educates the patient taking a loop diuretic such as torsemide that the medication can cause nausea, vomiting, and decreased appetite as normal and expected side effects (t/f)

False, these are symptoms of hyponatremia and should be reported to provider asap

Hypoparathyroidism can cause osteoporosis (t/f)

False; hypERparathyroid

CVP (central venous pressure) shows __________________

Fluid status

Medications that can cause SIADH

Fluoroquinolones, chemo, TCA's, SSRI's, opioids

A 24 hour urine collection is a test for elevated levels of _________________ that would indicate cushings

Free cortisol

What is an ADL consideration regarding use of vasopressor receptor antagonists (drugs that block the activity of ADH) such as Conivaptan and tolvaptan that are used for SIADH?

Frequent oral care

TSH will be (high/low) in a patient with hypothyroidism

High

A person in addisons crisis will have severe (hypo/hyper)tension

HypO

A benign tumor (adenoma) in the parathyroid gland is the most common primary cause of (hyper/hypo)parathyroidism

Hyper

Graves' disease is a condition of (hyper/hypo)thyroidism and manifests with accelerated physical and mental functions

Hyper

Hyperparathyroidism will show (hyper/hypo)calcemia

Hyper

Vitamin D deficiency, malabsorption, kidney disease, and hyperphosphatemia are the most common secondary causes of (hyper/hypo)parathyroidism

Hyper

(Hypo/hyper)natremia should be watched out for with SIADH

Hypo

Oral anticoagulants can cause (increased/decreased) absorption of levothyroxine

Increased

The water deprivation test used for DI will show an (increased/decreased) urine specific gravity and osmolality to confirm the diagnosis

Increased

What precautions are used with a patient who is getting a RAU test?

Isolation because of the radioactive iodine

For cushings patients, ______________ is an antifungal med that will lower production of cortex hormones if given in high doses. It can be a supplement to radiation or surgery. Liver function should be monitored with this med.

Ketoconazole

T3 and T4 will be (high/low) in a patient with hypothyroidism

Low

Levothyroxine is safe for use for a breastfeeding person (t/f)

Maybe, does enter breast milk in small amounts

The adrenal (medulla/cortex) hormones are the fight or flight hormones and include the following: ~ Catecholamines: Epinephrine and norepinephrine boost organ function in response to stress and support mental health.

Medulla

What time of day should levothyroxine be given?

Morning, can cause insomnia

SIADH is a condition of too (much/little) ADH

Much

Mental sluggishness, drowsiness, lethargy, bradycardia, hypothermia, hypoventilation associated with hypothyroidism that progresses following infection, use of CNS depressants, or exposure to cold is known as

Myxedema coma

(Primary/secondary/nephrogenic) DI can be a result of lithium or demeclocycline use or kidney damage, or can be inherited

Nephrogenic

(Primary/secondary/nephrogenic) DI: ADH is produced and released adequately, but the renal tubules do not respond to the ADH

Nephrogenic

ADH (antidiuretic hormone) is secreted from the _______________ and balances the amount of water in blood

Posterior pituitary

(Primary/secondary) risk factors for Addison's disease are the following: Idiopathic autoimmune dysfunction **majority of cases** •Tuberculosis •Histoplasmosis •Adrenalectomy •Cancer with metastasis •Radiation therapy

Primary

(Primary/secondary/nephrogenic) DI: Defects in the hypothalamus or pituitary gland cause low production of ADH or impaired release.

Primary

(Primary/secondary) risk factors for Addison's disease are the following: ~ Steroid withdrawal ~ Hypophysectomy ~ Pituitary neoplasm ~ High dose radiation of entire brain or the pituitary gland

Secondary

(Primary/secondary/nephrogenic) DI: Infection or tumor near the hypothalamus or pituitary gland, head trauma, or brain surgery lead to the low production or release of ADH.

Secondary

A _______________ restricted diet would be therapeutic for a patient with cushings

Sodium

Vasopressor receptor antagonists (drugs that block the activity of ADH) such as Conivaptan and tolvaptan can only be used in the inpatient setting and help to remove fluid while conserving __________________

Sodium

ACTH (adrenocorticotropic hormone)

Stimulates adrenal cortex to release glucocorticoids (cortisol)

Cortisol (glucocorticoid)

Stress response; increase blood glucose, decrease immune response; metabolism

Cushings (disease/syndrome) is an exogenous condition of increased cortisol due to an issue outside the adrenal/endocrine system. It typically results from use of glucocorticoids for conditions such as organ transplant, chemo, asthma, allergies, autoimmune diseases, or chronic fibrosis.

Syndrome

For Cushing's (disease/syndrome)- taper off steroids and manage the symptoms

Syndrome

Severe fluid overload would cause (tachy/brady)cardia, reduced urinary output, and (bounding/thready) pulses

Tachy; bounding

Cushings disease symptoms include fatigue, joint pain, irritability, depression, and weakness. Clinical manifestations include (tachy/brady)cardia, (hyper/hypo)tension from sodium and water retention, weight gain, scant menses, dependent edema, and changes in _____________________

Tachy; hyper; fat distribution (moon face, truncal obesity, Buffalo hump)

To assess for Chvostek sign which indicates hypocalcemia, you would

Tap in front of the ear which would cause facial spasm

(Primary/secondary/tertiary) hyperthyroidism is seen in a patient who had a kidney transplant and long period of dialysis

Tertiary

______________ diuretics change the Na concentration in the kidneys and are useful in the treatment of DI

Thiazide

Main life-threatening complication of Graves' disease

Thyroid storm

DI is associated with polyuria of abrupt onset 4-30L per day and polydipsia with consumption of 2-20L of fluids per day (t/f)

True

Hyperparathyroidism can cause osteoporosis (t/f)

True

Levothyroxine can be given IV for myxedema coma (t/f)

True

Mild tetany typically manifests as tension in hands (t/f)

True

SIADH causes hyponatremia because the blood volume is so large that there is not enough sodium to balance it out (t/f)

True

Surgical treatment is most helpful for primary and secondary hyperparathyroidism (t/f)

True

Patients looking for sources of calcium but also have hyperphosphatemia should avoid milk and yogurt (t/f)

True, contains phosphate

Higher doses of desmopressin can cause _______________ so should be used cautiously in those with CAD

Vasoconstriction

Fludrocortisone is a mineralocorticoid medication that can be used for ______________ insufficiency replacement related to Addison's disease

adrenal

Biphosphonates such as _____________ help enhance bone density in patients with hyperparathyroidism

alendronate

200-300mL of (hyper/hypo)tonic saline is used to increase blood sodium level in patients with hyponatremia secondary to SIADH

hypER

Prostaglandin inhibitors such as indomethacin and ibuprofen, thiazide diuretics, and a mild sodium restriction would be used to treat _________________ DI

nephrogenic

Teriparatide (Forteo) is supplemental ________________________

parathyroid hormone

RAU test uses ___________________ to measure thyroid absorption

radioactive iodine

SIADH

syndrome of inappropriate antidiuretic hormone

The water deprivation test used for DI involves inducing dehydration by withholding fluids and then giving a subcutaneous injection of _____________(ADH) or ____________________.

vasopressin ; desmopressin

A person with Addison's disease will have (⬆️/⬇️) potassium, calcium, and WBCs

⬆️

Cushings blood sodium and glucose levels will be (⬆️/⬇️)

⬆️

A person with Addison's disease will have (⬆️/⬇️) sodium and glucose, and can actually be encouraged to increase sodium intake

⬇️

Cushings lymphocytes, blood potassium and calcium levels will be (⬆️/⬇️)

⬇️