Endocrine Exam

What is the most sensitive method of imaging the pituitary gland?

MRI with contrast -but CT scans can be used *also use CT to evaluate: adrenal glands, ovaries, & pancreas* -*ultrasound*: thyroid, parathyroid, ovaries, testes

What hormone is responsible for stimulating ovulation & progesterone secretion in the ovaries & testosterone secretion in the testes?

LH (luteinizing hormone)

Which hormone promotes pigmentaiton?

MSH (targeting melanocytes)

Is hypervolemia & edema seen with Addison's or cushing's?

cushing's (hypernatremia)

What is the most common cause of pituitary infarction, which results in decreased hormone secretion?

PP hemorrhage = *Sheehan's syndrome* -hypotension from hemorrhage causes ischemia & necrosis of gland -usually after delivery but can occur up to several years later

What works together to maintain normal calcium levels in the blood & in extracellular fluid?

PTH (bone to blood) & calcitonin (blood to bone) (high serum calcium = increased calcitonin & decreased PTH low serum calcium = decreased calcitonin & increased PTH)

Which patient likely has *deficient* adrenal hormone levels? a) A patient who craves salt b) A patient hyperglycemia c) A patient with diabetes insipidus d) A patient with a "buffalo hump" & truncal obesity

a (salt craving indicates hypofunction - all other choices occur w/ hyperfunction/cushing's)

You are preparing a care plan for a patient with Cushing disease. Which nursing diagnoses would you be sure to include? SATA a) disturbed body image b) risk for injury RT potential for bruising c) risk for hypertension d) imbalanced nutrition: less than body requirements e) risk for infection

a, b, c, e

Which of the following are systemic complications of peripheral intravenous therapy? SATA a) fluid overload b) air embolism c) phlebitis d) septicemia e) extravasation f) infiltration

a, b, d

You are caring for a pt newly diagnosed with Addison's disease. Which classess of adrenal corticosteroids do you anticipate will be reduced in this client? SATA a) mineralcorticoids b) androgens c) adrenocorticotrophic hormone d) glucocorticoids e) aldosterone

a, b, d

Your male patient comes in and reports having secretions from his breasts. You know that you should assess which endocrine gland hormones?

anterior pituitary hormones (prolactin secreted here)

What is important for a post-op hypophysectomy patient to avoid?

anything that increased ICP - straining, sneezing, coughing, blowing nose, bending at waist, tying shoes, etc. *take antitussives, stool softeners, wear sandals, etc*

If preservative is needed for a urine collection, when should it be added to the collection container?

at the *beginning* of the collection & make sure to keep it from splashing onto skin b/c it's caustic

In a patient with SIADH, urine volume _________ and urine osmolarity __________ while plasma volume __________ and plasma osmolarity __________.

urine volume decreases, urine osmolarity increases (increased urine concentration) plasma volume increases, plasma osmolarity decreases

What fluids are commonly used for diagnosing endocrine disorders?

urine, blood, saliva

What is the best indicator of fluid retention/overload?

weight gain -weigh daily -each 1 lb = 500 mL

What is exogenous hyperthyroidism?

hyperthyroidism caused by excessive use of thyroid replacement hormones

What is toxic multinodular goiter?

hyperthyroidism caused by multiple thyroid nodules (may be enlarged thyroid tissues or thyroid adenomas) -usually have had goiter for years -milder than Grave's disease -usually occurs after age 50 & affects women 4x more than men

What type of IV solution can treat SIADH when serum sodium levels are very low?

hypertonic saline (3% NS) -give cautiously b/c it could add to existing fluid overload & cause heart failure

If an enlarged thyroid gland is palpated, what is the purpose in auscultating it?

hypertrophy of thyroid gland increases vascular flow, which may result in *bruits*

Hypoparathyroidism has what effect on calcium levels?

hypocalcemia

How should a patient be positioned after a hypophysectomy?

semi-fowlers/HOB elevated

DI is associated most commonly with which electrolyte imbalance?

sodium (increased serum sodium levels with DI b/c excess water loss)

Explain the purpose of stimulation & suppression tests.

stimulation test --> done if you suspect *hypofunction* (if it doesn't increase, we know it's hypoactive) suppression test --> done if you suspect *hyperfunction* (if doesn't decrease, we know it's hyperactive)

What factors *impair* the conversion of T4 to T3?

stress, starvation, dyes, some drugs *cold temps increase the conversion*

True or False: If acute adrenal insufficiency is suspected, treatment is started *without* stimulation testing

true

True or False: Preventing injury is important in patients with hyperparathyroidism b/c of their increased risk for fractures

true

True or False: SIADH results in dilutional hyponatremia but also increased urine sodium loss leading to greater hyponatremia due to inhibited renin & aldosterone

true

True or False: The most common cause of Cushing's disease is a pituitary adenoma & women are more likely than men to develop the disease

true

True or False: The most common cause of death among patients with myxedema coma is respiratory failure

true

True or False: Thyroid hormones should be taken on an empty stomach

true

True or False: Treatment/management of SIADH & Cushing's is similar, monitoring & preventing fluid overload

true *pt w/ fluid overload is at risk for skin breakdown - assess skin pressure areas daily for redness or open areas* -change positions q 2 hrs

The ____________ _____________ gland regulates growth, metabolism, and sexual development.

anterior pituitary (adenohyphophysis)

What hormone is responsible for stimulating estrogen secretion & follicle maturation in the ovaries and stimulating spermatogenesis in the testes?

FSH (follicle-stimulating hormone)

Which hormone *promotes growth* through lipolysis, protein anabolism, and insulin antagonism?

GH (targets bone & soft tissue)

What type of drugs are used to manage SIADH when sodium levels are not an issue but *heart failure is present*?

diuretics -demeclocycline (antiobiotic) for mild SIADH

What is used for reducing serum calcium levels in patients who have a milder form of hyperparathyroidism?

diuretics & hydration therapy (*furosemide* - increases excretion of calcium --> used together w/ IV saline) *monitor cardiac function & I's/O's Q 2 HR* -report sudden drops in serum calcium levels (numbness/tingling)

What is *cinacalcet* (Sensipar) used for?

drug therapy for hyperparathyroidism (30 mg PO BID to 90 mg PO TID) -binds to calcium-sensitive receptors on parathyroid tissue, reducing PTH production/release = decreased calcium levels

How should the patient first begin a urine collection?

empty his/her bladder & dispose of the first void (collection starts *after* this specimen*) -note time of discarded specimen *to end the collection, empty bladder at the end of time period and ADD it to collection*

How often should LOC/ orientation to time, place, & person be checked with a patient getting treated for SIADH?

every 2 hrs b/c disorientation/confusion might be present *reduce environmental noise & lighting to prevent overstimulation*

How often should the nurse monitor the patient's neurological status after a hypophysectomy?

every hour for first 24 hrs then every 4 hrs after *also observe pt for transient DI, CSF leakage, infection, & increased ICP*

What are the two manifestations that occur with Grave's disease, in addition to the typical S/S of hyperthyroidism?

exophthalmos - protrusion of eyes pretibial myxedema - dry waxy swelling of the front surfaces of the lower legs that resembles benign tumors or keloids

Hyperthyroidism is associated with what fat metabolism effect?

fat metabolism *increases* so weight loss occurs

What restrictions are involved with the nutrition therapy for a patient with hypercortisolism?

fluid and *sodium* restrictions -teach pt & family how to check food labels for sodium content & how to keep daily record of sodium ingested -offer fluid throughout 24 hrs -monitor urine specific gravity (below 1.005 = fluid overload)

What is the nutrition therapy for hypoparathyroidism?

foods *high in calcium* but *low in phosphorus* -avoid milk, yogurt, cheese *stress that therapy for hypocalcemia is lifelong*

Explain the suppression test that is used to diagnose hyperpituitarism.

giving 100 g or oral glucose or 0.5g/kg should suppress release of GH (high blood glucose levels suppress release of GH) so if GH levels don't fall below 5ng/mL = hyperfunction

Hyperpituitarism (excess ACTH) can lead to what problem with adrenal gland function?

hyperfunction - *cushings*

Is the patient with hyperthyroidism hyperglycemic or hypoglycemic?

hyperglycemic

What risk is increased in woman receiving estrogen therapy?

hypertension or thrombosis (especially in smokers)

*Hypermetabolism* and *increased* SNS activity occur with what endocrine disorder?

hyperthyroidism *increases heart rate and stroke volume* which increases CO, systolic BP, and blood flow

*Negative nitrogen balance* is seen with what endocrine disorder?

hyperthyroidism *protein breakdown exceeds protein build up*, causing a net loss

Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract, meaning they are chronically *hypocalcemic*; this puts them at risk for what endocrine disorder?

hypocalcemia triggers overstimulation of the parathyroid glands = *hyperparathyroidism*

What electrolyte imbalance is a cause of hypoparathyroidism & causes impairment of PTH secretion and may interfere with effects of PTH on bones, kidneys, and calcium regulation?

hypomagnesemia

What is the most common treatment for hyperpituitarism?

hypophysectomy (successful surgery decreases hormone levels, relieves headaches, and could reverse changes in sexual function) -usually endoscopic transnasal approach instead of transsphenoidal (*under general anesthesia*) (craniotomy may be required if these approaches fail) -usually a muscle graft from the thigh is taken to support the area & prevent CSF leakage after gland is removed

If a female patient reports amenorrhea, dyspareunia (painful intercourse), infertility, or decreased libido, what endocrine disorder is likely the cause?

hypopituitarism (decreased gonadotropins) *check for dry skin, breast atrophy, and a decrease/absence of axillary & pubic hair* *gonadotropin deficiency can also be caused by PRL excess from hyperpituitarism

Headaches, *diplopia* and limited eye movement are common with what endocrine disorder?

hypopituitarism (neuro signs often manifest first in vision changes)

If a patient with hyperthyroidism has an increase in their temperature, what should you do first?

report & immediately assess cardiac status (check for dysrhythmias if cardiac monitor on)

What is the role of calcitonin?

lower serum calcium & phosphorus levels by *reducing bone resorption (breakdown)* -low serum calcium levels suppress release of calcitonin -high serum calcium levels increase calcitonin secretion *opposite actions of the PTH*

What is the first step in diagnosing a patient with DI?

measure 24 hr fluid intake & output w/out restrictions b/c DI is considered if *UOP is > 4 L in 24 hrs and is > than the intake* (*amount of UOP in 24 hrs varies from 4-30 L/day, it is DILUTE with a LOW specific gravity - less than 1.005, and LOW osmolarity* - [50-200])

*Nuchal rigidity* is a sign of what common post-transsphenoidal hypophysectomy complication?

meningitis (infection - commonly accompanied by *fever* and *tachycardia*) *make sure to take VS (esp. temp)

A client with hypothyroidism who develops another illness is at risk for what?

myxedema coma (maintaining an airway is a priority)

What are the two easiest parameters for the patient to check for hormone replacement therapy effectiveness for thyroid conditions?

need for sleep & bowel elimination -more sleep & constipation = need higher dose -less sleep & diarrhea = lower dose needed

What diagnostic assessment is a relatively safe & quick way to determine whether surgical intervention is needed for thyroid problems?

needle biospy

How is hormone activity/synthesis controlled?

negative feedback mechanism (hormone causes the opposite action of what initially caused the hormone secretion) ex. blood glucose levels high = insulin secretion --> insulin then decreases blood glucose levels (then hormone secretion is stopped when homeostasis returns)

If you run a TSH stimulation test on a pt w/ suspected hypothyroidism, what is the expected response?

no response (hypofunctioning)

If you notice a client develops *stridor* after a total thyroidectomy, what action should you take?

notify HCP & prepare for intubation (stridor = emergency situation - client's airway is obstructed [usually edema] & client is in resp. distress)

What is used for patients that don't respond to cinacalcet that inhibits bone resorption and interferes with calcium absorption?

oral phosphates *IV phosphates only used when serum calcium needs to be lowered rapidly

Which hormone stimulates uterine contraction & the ejection of breast milk?

oxytocin (targets uterus and mammary glands) (posterior pituitary)

What is the most common cause of *hyperpituitarism*?

pituitary adenoma (benign tumor of one or more tissues within the anterior pituitary) *PRL-secreting tumorrs are most common* = excessive PRL which inhibits secretion of gonadotropins (resulting in galactorrhea, amenorrhea, and infertility)

If medication stimulates beta 1 receptors, what do you expect about the affect it has on the heart?

positive chronotropic & inotropic (increased HR & contractility = increased CO) *concern if effect is the opposite = medicine isn't working

DI & SIADH are problems associated with what endocrine gland?

posterior pituitary gland (neurohypophysis) deficiency = DI excess = SIADH

What is the most common drug used for treatment of adrenal gland hypofunction?

prednisone (condition is treated by replacement therapy) *typically 2 in the am & 1 in the pm to mimic normal release of cortisol*

*Vitiligo* (patchy areas of pigment loss) is seen with what endocrine disorder?

primary adrenal insufficiency (addison's)

What is the function of the hypothalamus?

produce *regulatory* hormones

Which hormone stimulates breast milk production?

prolactin (PRL) (anterior pituitary)

What are common manifestations of *hypothyroidism*?

(think *decreased metabolism/BMR* ---> -*cold intolerance/decreased body temp*) *GI:* -*weight gain* -*constipation* *CARDIO/PULM*: -*hypotension* -dysrhythmias -*bradycardia* -pleural effusion -*hypoventilation*/dyspnea *SKIN*: -thick, brittle nails -dry, coarse, brittle hair -decreased hair growth (loss of eyebrow hair) -poor wound healing -pale, dry, scaly skin *NEUROMUSC:* -paresthesia of extremities -slowing intellectual functions (slow/slurred speech, impaired memory, inattentiveness) -decreased DTRs -*lethargy/weakness* (compare activity now to a year ago, pt. often reports increase in time spent sleeping) *REPRO:* -changes in menses (amenorrhea/prolonged) -anovulation -*decreased libido* *OTHER:* -apathy or depression -*goiter* -*thick tongue* -edema (face & extremities) -decreased UOP -iron deficiency anemia -hoarseness

During long-term corticosteroid therapy, the nurse should monitor the patient's laboratory results for which of the following adverse effects? SATA a) increased sodium levels b) increased serum potassium levels c) hypoglycemia d) hyperglycemia e) decreased serum potassium levels f) decreased sodium levels

(think cushing's - water/sodium retention) a, d, e

What are the *key features* (S/S) associated with diabetes insipidus?

(think dehydration/FVD) -hypotension -tachycardia -weak distal pulses -hemoconcentration -*increased UOP* -*dilute/low specific gravity* -poor skin turgor -*dry MM* -decreased cognition -ataxia -*increased thirst* -irritability

If your client has an aldosterone deficiency, what can you expect about his UOP?

*increased UOP* (b/c aldosterone retains Na+ & water, so if deficient, the client would have hyponatremia and hyperkalemia = less water retained) *aldosterone insufficiency = hyperkalemia, hyponatremia, & acidosis* = adrenal insufficiency (Addison's)

What is important to assess in a client who is 2 day post-subtotal thyroidectomy and reports *numbness & tingling* around the mouth?

*Chvostek's & Troussaeu's sign (numbness/tingling around mouth or in toes/fingers = *hypocalcemia* which could result in tetany or seizsures)

What clinical manifestations can be expected with a patient who has anterior pituitary *hyperfunction* (in regards to *GH*)?

*acromegaly* -protrusion of lower jaw -thickened lips -coarse facial features -enlarged head, hands, & feet -kyphosis -barrel shaped chest -enlarged heart, lungs, liver -hyperglycemia

What is the initial treatment for hyperthyroidism & how does it work?

*antithyroid drugs* (thionamides - *methimazole*) -block thyroid hormone production by preventing iodide binding in the thyroid gland (response is delayed b/c pt may have large amounts of stored thyroid hormones that continue to be released) *methimazole can cause birth defects & should not be used during pregnancy, especially in 1st trimester* - also, *avoid crowds/ill people* b/c increases risk for infection & *always monitor for S/S of hypothyroidism* - indicates need for lower dose (weight gain, slow HR, cold intolerance)

What clinical manifestations can be expected with a patient who has anterior pituitary *hyperfunction* (in regards to *ACTH*)?

*cushing's (pituitary)* -elevated plasma cortisol -weight gain/truncal obesity -"moon face" -extremity muscle wasting -decreased bone density -hypertension -hyperglycemia -striae & acne

What might you expect about the function of the adrenal gland of a patient whose family has reported changes in their mental/emotional status, saying that the pt. has had many mood swings, is often irritable and depressed, and has complained of trouble sleeping?

*hyperfunction* - hypercortisolism - Cushing's (excess hormones stimulate CNS, heightening responses to stimuli & cause emotional instability. *often pts report that they do not feel like themselves*)

What is the difference between *pituitary Cushing's disease*, *adrenal Cushing's disease*, and *Cushing's syndrome*?

*pituitary Cushing's*= problem w/ PITUITARY - excess ACTH secretion causes hyperplasia of adrenal glands = excess adrenal hormone secretion *adrenal cushing's*= problem w/ adrenal cortex, usually benign tumor (adrenal adenoma) - usually only in *one* adrenal gland *cushing's syndrome*= excess cortisol due to DRUG THERAPY for another health problem

ACTH levels are *elevated* with which type of Cushing's disease?

*pituitary* cushing's (ACTH levels are low w/ adrenal cushing's or cushing's syndrome)

What are the potential causes of DI?

*primary:* defect in hypothalamus or POSTERIOR pituitary which = *lack of ADH* (or inability of kidneys to respond to ADH) *secondary:* tumors at/near hypothalamus or pituitary gland, head trauma, infectious processes, brain surgery, or metastatic tumors (drug-related DI = lithium carbonate or demeclocycline which inhibit kidney's response to ADH)

What are the functions of glucocorticoid hormones (*cortisol*)?

-*body's response to stress* -*carb, protein, & fat metabolism* -*emotional stability* -*immune function/anti-inflammatory effects* -*sodium/water balance* -*degrade collagen & connective tissue* -*increase the number of mature neutrophils released from bone marrow* -prevent hypoglycemia by increasing liver gluconeogenesis and inhibiting peripheral glucose use -maintain excitability & responsiveness of cardiac muscle -increase lipolysis, releasing glycerol & free fatty acids

What are the functions of *thyroid hormones*?

-*control metabolic rate of all cells* -*exert effects on heart rate & contractility* -*increase RBC production* -*act as insulin antagonists* (hypothyroid = increased BG) -promote sufficient pituitary secretion of GH & gonadotropins -regulate protein, carb, & fat metabolism -affect respiratory rate & drive -increase bone formation & decrease bone resorption of calcium

What complications can occur after thyroid surgery?

-*hemorrhage* (first 24 hrs, inspect dressing for blood, may be seen as resp. distress - *moderate serosanguineous drainage is normal*) -*resp distress* (can result from swelling, tetany, or laryngeal nerve damage resulting in spasms - *stridor* = acute resp obstruction ---> keep emergency trache equipment nearby) -*parathyroid gland injury* = *hypocalcemia & tetany* (could occur if gland is accidentally removed or damaged blood supply = decreased PTH levels --> *ask pt hourly about tingling around mouth or toes/fingers*, assess for muscle twitching, have *calcium gluconate or IV calcium chloride* available) -*laryngeal nerve damage* = hoarseness & weak voice - assess voice q *2 hr*, temporary -*thyroid storm/crisis* = monitor BP & temp closely

What *metabolic* manifestations are seen with hyperthyroidism?

-*increased* basal metabolic rate -*heat intolerance* -low grade fever -fatigue

What are the potential causes of hyperparathyroidism?

-*parathyroid tumor or cancer* (most common cause = benign tumor in one gland) -congenital hyperplasia -neck trauma or radiation -vitamin D deficiency -CKD with hypocalcemia -parathyroid hormone secreting -carcinomas of the lung, kidney, or GI tract *primary hyperparathyroidism results when one or more parathyroid glands do not respond to normal feedback of serum calcium levels*

What are the diagnostic tests involved with hypoparathyroidism?

-EEG -blood tests -CT scans -serum calcium, phosphorus, magnesium -vitamin D -urine cyclic adenosine monophosphate (cAMP)

What is the emergency care associated with a patient experiencing a thyroid storm?

-Maintain airway and ventilation -Give oral antithyroids as prescribed -Administer sodium iodide solution -Give propranolol slowly over three min - hook up to a cardiac monitor and central venous pressure catheter -give glucocorticoids -Monitor for cardiac dysrhythmias -Monitor VS *q 30 min* -Provide comfort measures (*cooling blanket or icepacks to reduce fever*) -Give antipyretics -Correct dehydration with *NS*

What are the three hormones associated with the *thyroid gland*?

-T3 & T4 (produced by follicular cells & increase metabolism, which increases O2 use & heat production) *T3 is the most active* -Calcitonin (produced by parafollicular cells which helps regulate calcium levels)

What are the *anterior pituitary* hormones?

-TSH -ACTH -LH -FSH -PRL -GH (*mainly targeting repro system*)

What does the increased androgen production involved with hyperfunction of the adrenal gland lead to?

-acne -hirsutism -clitoral hypertrophy in women -oligomenorrhea

What factors lead to myxedema coma?

-acute illness -surgery -chemotherapy -d/c thyroid replacement therapy -sedatives or opioids

What stimulates the secretion of aldosterone?

-angio II (RAAS) OR -high serum potassium levels (so aldosterone stimulates kidneys to excrete K+)

What is the post-op care associated with an adrenalectomy?

-assess pt q *15min* for shock (hypotension, rapid/weak pulse, decreased UOP) -monitor VS -monitor central venous pressure & pulmonary wedge pressure -monitor I's/O's -daily weights -monitor serum electrolyte levels -begin hormone replacement therapy immediately after (if unilateral, only needed for 2 years after)

What are the *neurological* manifestations of hyperthyroidism?

-blurred/double vision -eye fatigue -increased tears -injected (red) conjunctiva -photophobia -exopthalmos (graves disease only) -eyelid retraction or lag -hyperactive deep tendon relfexes -tremors -insomnia

What are the S/S of fluid overload that should be monitored *q 2 hr* in a patient being treated for SIADH?

-bounding pulse -JVD -crackles -increasing peripheral edema -reduced UOP *pulmonary edema can occur very quickly and lead to death*

What are the common drugs used to treat hyperpituitarism?

-bromocriptine mesylate -cabergoline *these drugs stimulate dopamine receptors & inhibit release of GH & PRL*

How does the *low metabolic rate*, associated with hypothyroidism, affect the tissues & organs of the body?

-cellular energy decreases, GAGs build up -GAG build up increases mucus & water, forming cellular edema & changes organ texture -mucinous edema = *myxedema* - changes patient's appearance -nonpitting edema forms everywhere - eyes, hands, feet, b/w shoulder blades -tongue thickens, voice husky due to edema in the larynx *all general physiologic function is decreased*

What problems often occur with myxedema coma?

-coma -resp. failure -hypotension -hyponatremia -hypothermia -hypoglycemia -----> MC can lead to shock, organ damage, and death - assess pt w/ hypothyroidism *AT LEAST Q 8HR* for changes that indicate increasing severity, *especially changes in mental status* and report these immediately to HCP

Although a hypophysectomy can be used to treat hypercortisolism, if it involves the adrenal gland function an *adrenalectomy* is used. Describe the pre-op care with this procedure.

-correct F/E imbalances before -cardiac monitoring may be needed -hyperglycemia controlled before -prevent infection w/ handwashing & aseptic technique -raise top siderails to decrease fall risk & instruct pt to ask for help if needed -*high cal, high protein diet* prescribed before -glucocorticoid preparations given before & during to prevent adrenal crisis -discuss need for long-term drug therapy

How might you be able to infer that vasopressin therapy is effective in treating a patient with DI?

-decreased UOP -increased specific gravity -increased urine osmolality

With Cushing's disease, there is an increase in the *breakdown of tissue protein*. This excessive breakdown leads to what?

-decreased muscle mass -decreased muscle strength -thin skin -fragile capillaries (petechiae & bruising increases) -bone density loss

What are the manifestations of hyperthyroidism seen in the *skin*?

-diaphoresis -fine, soft, silky body hair -*smooth, warm, moist skin* -thinning of scalp hair

What are ways to manage the eye/vision problems associated with hyperthyroidism?

-elevate HOB at night -artificial tears -dark glasses if sensitive to light -tape eyes shut for sleep *ichemia and blindness can occur if pressure behind eyes continues*

What clinical manifestations can be expected with a patient who has anterior pituitary *hyperfunction* (in regards to *TSH*)?

-elevated TSH & thyroid hormone levels -weight loss -tachycardia/dysrhythmias -heat intolerance -increased GI motility -fine tremors

What are the manifestations of a thyroid storm?

-excessive thyroid hormone release = dramatic increase of metabolic rate -*fever, tachycardia, hypertension* -abdominal pain/NV/diarrhea -anxious -tremors -restless/confusion & may have seizures/coma as it progresses *even w/ treatment, thyroid storm may lead to death

What are the common eye problems associated with hyperthyroidism?

-exophthalmos -*eyelid lag (retraction)*- upper eyelid fails to descend when the patient gazes slowly downward -*globe lag (eyeball)* - upper eyelids pull back faster than they eyeball when the patient gazes upward *pt's may have dry eyes & ulcers could develop* (tape eyes shut when sleeping & use artificial tears)

Explain the *pre-op* care involved with a hypophysectomy.

-explain need to breathe through mouth for 2-3 days post-op due to nasal packing & mustache dressing -instruct not to brush teeth, blow nose, or bend forward post-op -avoid anything increasing ICP (can delay healing)

What are the common S/S of Addison's disease (adrenal gland hypofunction)?

-fatigue -muscle/joint weakness/pain -weight *loss* (anorexia) -*salt craving* -vitiligo -hyperpigmentation -anemia -*hypotension* -hyponatremia -*hyperkalemia* -hypercalcemia -hypovolemia

What is the pre-op care associated with a thyroidectomy?

-first pt treated with *thionamide drug therapy* to have near-normal thyroid function (*euthyroid*) -iodine preparations also used to reduce size & vascularity (*reduces risk for hemorrhage & thyroid storm during surgery*) -correct hypertension, dysrhythmias, and tachycardia before surgery -*high protein, high carb diet* for days/weeks before surgery -explain the surgery -inform that a drain/dressing may be in place post-op -answer any questions

What VS changes occur in a patient with SIADH?

-full, bounding pulses -hypothermia

What are the 3 main glands that have reduced function with aging?

-gonads -thyroid -pancreas *encourage older adults to get screened regularly* (fasting BG, random BG, calcium level test, thyroid function test)

What is the onset of a *thyroid storm* (life-threatening event that occurs with uncontrolled hyperthyroidism) characterized by?

-high fever -severe hypertension *so monitor BP & temp closely & report even a change in 1 degree immediately* -most common w/ Grave's disease

What clinical manifestations can be expected with a patient who has anterior pituitary *hyperfunction* (in regards to *PRL*)?

-hypogonadism (loss of secondary sex characteristics) -galactorrhea -increased body fat -increased serum PRL levels *also, LH & FSH levels increase in men but stay normal in women*

What side effects can radiation therapy for hyperpituitarism have?

-hypopituitarism -optic nerve damage -eye/vision problems

Explain how secretion of T3 & T4 is controlled by the hypothalamic-pituitary-thyroid gland axis negative feedback mechanism.

-hypothalamus secretes TRH -TRH triggers ant. pituitary to secrete TSH -TSH stimulates thyroid gland to make & release T3 & T4 *if thyroid hormone levels are HIGH, TRH & TSH are inhibited, if they are LOW, TRH & TSH are increased*

Regarding the patient's *psychosocial assessment*, what questions are important to ask when dealing with a patient diagnosed with hyperthyroidism?

-if pt cries or laughs without cause -if pt has difficulty concentrating -if pt has difficulty sleeping -if pt has had mood swings (usually family reports this) *some pts describe activity as "full speed ahead" or "completely stopped" (2 ends of the spectrum)

What are the expected outcomes/goals of Synthroid therapy for hypothyroidism?

-increase her activity tolerance over 2 to 3 months -achieve bowel pattern that was typical before onset of illness -maintain body temp of 98.6° F (37° C) -gradually decrease body weight -improve mental function -improve skin color/lessen dryness

What effect does hyperparathyroidism have on calcium & phosphorus levels?

-increased kidney reabsorption of calcium = *hypercalcemia* -increased kidney excretion of phosphorus = *hypophosphatemia*

What are the manifestations associated with hyperparathyroidism?

-increased risk for fractures -weight loss -arthritis -psychological stress -waxy pallor of skin -bone deformities of extremities & back -*kidney stones* & deposits of calcium in soft tissue -bone lesions -bone cysts -*osteoporosis* -fatigue/lethargy *GI:* -anorexia, NV, epigastric pain, constipation, weight loss -PUD *NEURO:* -if >12 serum level, psychosis w/ mental confusion and can lead to coma/death if untreated

How might the psychosocial assessment findings be for a patient with suspected Addison's?

-lethargic -depressed -confused -may even psychotic *assess orientation* -families may report mood swings & forgetfulness

When serum sodium levels fall below 115 in a patient with SIADH, what S/S are present & should be assessed?

-lethargy -headaches -hostility -disorientation/ LOC changes -decreased responsiveness -seizures/coma *assess DTRs, which are usually decreased, observe for muscle twitching before worsening to seizure* *PROVIDING SAFE ENVIRONMENT IS CRITICAL NURSING CARE*

If your patient has permanent DI, what teaching regarding management & treatment should be included?

-lifelong drug therapy required -polydipsia & polyuria indicate need for another dose -drugs could cause fluid overload -instruct pt to weight themselves daily to monitor any weight gain (same scale, same time, same amount of clothes) -report weight gain of 2.2 lbs (1 kg) or more -report s/s of water toxicity (persistent headache, acute confusion) *overcorrection of DI = SIADH*

What are the *early*/first manifestations of SIADH?

-loss of appetite -nausea -vomiting *dependent edema not usually present*

What is involved in the emergency care for a patient during myxedema coma?

-maintain patent airway -IV fluids with NS or hypertonic NS -admin synthroid, glucose IV, corticosteroids as prescribed -take temp & BP *q hr* -monitor for mental status -cover w/ warm blankets -turn q2h -institute aspiration precautions

What is the post-op care involved with a patient who just had a thyroidectomy surgery?

-monitor for complications (VS *q 15 min until stable then q 30 min*) -support head/neck with pillows -semi-fowlers position (avoid positions that cause neck extension) -assist pt to deep breathe *q 30 min to 1 hr* -stress importance of *supporting neck while coughing* (place both hands behind neck to reduce strain on incision)

Explain the post-op care for a patient who had a hypophysectomy.

-monitor neuro status q hr first 24 hrs then q 4 hrs -document any changes in vision, mental status, LOC, or strength of extremities -observe for transient DI, CSF leakage, infection, or increased ICP -teach pt to report any post-nasal drip or increased swallowing -elevate HOB -assess nasal drainage (quantity, quality, & presence of glucose) -teach pt to avoid coughing but to perform deep-breathing exercises hourly to prevent pulm. issues -instruct pt to rinse mouth frequently & to apply lubricating jelly to lips -assess for headache, fever, and nuchal rigidity -teach about hormone replacement (thyroid & glucocorticoids & vasopressin) -monitor fluid balance (*24 hr I/O*) -observe urine for color, odor, cloudiness, etc. to assess renal fx -suggest high fiber foods & plenty of liquids or use stool softeners -inform that decreased sense of smell is expected for about 3-4 months -report any signs of hyperpituitarism immediately

What are the priorities of nursing care for a patient with hyperthyroidism?

-monitoring for complications (apical pulse, BP, temp *q 4 hrs*) -reducing stimulation (helps prevent manifestations & risk for cardiac complications - *encourage rest*) -promoting comfort -teaching pt/fam about therapeutic drugs & procedures

What are the *cardiopulmonary* manifestations of hyperthyroidism?

-palpitations -chest pain -*increased systolic blood pressure* (usually diastolic is decreased, causing a widened pulse pressure) -*tachycardia* -*dysrhythmias* -rapid, shallow respirations

What are common causes/risk factors for hypopituitarism?

-pituitary tumors -*PP hemorrhage* -anorexia -hypotension -shock -head trauma -brain tumors/infection -radiation to head/brain -AIDS

Your patient has just undergone a hypophysectomy procedure. What post-op findings could indicate CSF leakage?

-postnasal drip -increased swallowing -presence of glucose in nasal drainage -light yellow "halo" around clear drainage -persistent severe headaches = CSF leaked into sinus area

What nutritional deficiencies could be a cause of endocrine disorders?

-protein -iodide-containing foods (salt-water fish/seafood & table salt)

What is a myxedema coma?

-rare but serious complication caused by untreated/poorly treated hypothyroidism -decreased metabolism causes heart muscle to become flabby & chamber size to increase = *decreased CO & decreased perfusion to brain/vital organs* -worsens already slowed cellular metabolism = *organ system failure*

What lab tests are run to detect hyperparathyroidism?

-serum PTH -calcium -phosphorus -urine cyclic adenosine monophosphate (cAMP) *x-rays can show kidney stones/calcium deposits/bone lesions other tests = arteriography, CT, venous sampling of thyroid, ultrasonography

How might you approach palpating a thyroid gland?

-stand behind pt -have pt swallow sips of water -pt should be sitting & should lower chin -to palpate right lobe, turn pt head to right & gently displace trachea to the right w/ left fingers (opposite for left) -place fingers b/w trachea & neck muscles *always palpate thyroid gently b/c if not it could cause thyroid storm if suspected hyperthyroidism*

What are the potential causes of hypoparathyroidism?

-surgical or radiation induced thyroid ablation -parathyroidectomy -congenital dysgenesis -idiopathic autoimmune -hypoparathyroidism -hypomagnesemia

What is the purpose of using iodine preparations for *short-term* therapy before surgery for a patient with hyperthyroidism?

-they decrease blood flow through the thyroid gland, which reduces production/release of thyroid hormones -improvement usually occurs within 2 weeks *can cause hypothyroidism* - monitored closely for the need to adjust regimen

What are the common causes of hypothyroidism?

-thyroid surgery -RAI treatment -endemic goiter (areas where soil/water have little natural iodide) -autoimmune thyroid destruction -congenital poor thyroid development -cancer (thyroid or metastatic) -drugs (*lithium & propylthiouracil*) -pituitary or hypothalamic tumors (secondary cause) (*overtreating hyperthyroidism*)

What are the manifestations associated with hypoparathyroidism?

-tingling and numbness- mild -muscle tetany, cramps, spasms of hands and feet, seizures- more severe -positive chvosteks sign and trousseaus sign

What is the drug therapy involved with treating SIADH when hyponatremia is present?

-tolvaptan (PO - BBW= rapid increase of sodium levels) -conivaptan (IV) *vasopressin antagonists that promote water excretion w/out causing sodium loss* ---> administer only in hospital setting so serum sodium levels can be monitored

What are the potential triggers of a thyroid storm?

-trauma -infection -diabetic ketoacidosis -pregnancy -vigorous palpation of thyroid gland -exposure to iodine -RAI therapy -thyroid surgery

What are the *posterior pituitary* hormones?

-vasopression (ADH) -oxytocin

What are the *GI* manifestations of hyperthyroidism?

-weight *loss* -*increased appetite* -increased stools

What changes are most common with hypercortisolism?

-weight gain & increased appetite -osteoporosis -easy bruising -frequent infections -menstrual changes -GI ulcers *ask patients about these changes*

What teaching points should be included with a patient diagnosed with hypothyroidism?

-well balanced diet following prescribed caloric intake to promote weight loss -avoid salty foods to prevent fluid retention, heart failure, & myxedema -moderate exercise (start walking 10-15 min/day then increase 1-2 min per week until 20-30 min/day) -drink plenty of fluids -plenty of rest periods until dosage is established -regular sleep patterns (7-8 hrs/night) -unscented lotion & good hygiene to prevent skin breakdown -layer clothing to prevent heat loss -high fiber & lots of fluids to prevent constipation -teach pt how to check pulse accurately

What are 4 priority nursing diagnoses associated with a patient diagnosed with Cushing's?

1. fluid overload 2. risk for injury RT thin skin, poor wound healing, & bone density loss 3. risk for infection 4. risk for acute adrenal insufficiency (w/ overtreatment)

How long should the patient wait to brush their teeth after a hypophysectomy?

2 weeks (encourage pt to use dental floss & oral mouth rinse until dr. gives permission to brush)

What is acute hypomagnesemia treated with?

50% magnesium sulfate IV

What do the thyroid hormones help regulate? (SATA) a) BP b) clotting c) calcium levels d) metabolism e) blood thinning

A, C, D (Hyper & Hypothyroidism both cause BP changes. Hyper= high & Hypo= low. The thyroid hormones function to "control metabolic rate of all cells". Parafollicular cells produce *calcitonin which helps to regulate serum calcium levels*)

What regulates the release of glucocorticoids (cortisol)?

ACTH & CRH (these hormones are affected by levels of free cortisol, sleep-wake cycle, & stress)

Deficiencies of what 2 anterior pituitary hormones are the most life-threatening?

ACTH & TSH (b/c they cause a decrease in the secretion of vital hormones from adrenal/thyroid glands)

Explain how the ACTH stimulation test is done to diagnose adrenal insufficiency.

ACTH 0.25 - 1 mg is given IV then plasma cortisol levels are obtained in 30min/1 hr intervals *primary*= cortisol response is *absent or decreased* *secondary*= cortisol response is *increased*

Which hormones are *produced* by the hypothalamus but *stored* in the posterior pituitary until they're released when needed?

ADH & oxytocin

What results from decrease in production of the hormone itself, failure of the liver to produce somatomedins, or failure of tissues to respond to somatomedins?

GH deficiency -in kids: short stature & slowed growth -in adults: increased rate of bone destruction = *osteoporosis* & increased risk for fractures *can be caused by HYPOPITUITARISM*

What is the autoimmune disorder resulting from Hashimoto's thyroiditis (HT)?

Grave's disease (toxic diffuse goiter) -most often diagnosed in women between ages 20-40

Which drug therapy (for hyperthyroidism) involves the thyroid gland picking up the drug & the cells that produce hormones are destroyed by the local radiation?

RAI - not used in pregnancy (can damage fetal thyroid gland) -complete symptom relief 6-8 weeks after therapy due to stored hormones -*outpatient basis* (radiation precautions are needed to prevent exposure to other people) - typically gone within a month *can cause hypothyroidism & result in the need of life-long hormone replacement*

What should be included in the patient teaching regarding bromocriptine to treat hyperpituitarism?

SE= -orthostatic hypotension (change position slowly) -gastric irritation -nausea/HA -abdominal cramping/constipation *take w/ meal or snack to reduce SE *stop immediately if get pregnant -seek medical care immediately if *chest pain, dizziness, watery nasal discharge occurs* b/c of serious SE including *cardiac dysrhythmias, coronary artery spams, & CSF leakage*

What hormone targets thyroid tissue and stimulates the formation of bone?

TSH (parathyroid hormone stimulates *bone resorption* =increase of calcium from bone and into blood, increasing serum calcium)

A client with a suspected autoimmune disease has laboratory work ordered, including a cortisol level. The nurse recognizes that cortisol is responsible for which of the following? SATA a) increased breakdown of lipids to fatty acids b) blocks effects of histamine c) stimulates storage of excess glucose d) increases breakdown of proteins & amino acids e) stimulates conversion of triglycerides to glucose

a, b, d, e

What actions by the nurse are essential to the care of a patient with hyperthyroidism? SATA a) close the door to the pt room b) monitor BP & temp closely c) restrict the use of artificial tears d) limit visitors e) eliminate/postpone nonessential care f) increasing room temp to prevent discomfort caused by cold intolerance

a, b, d, e (want to use artificial tears & want to reduce room temp - *encourage UAP to ensure pt has fresh pitcher of ice water & change bed linen whenever damp from sweating)

Which statements indicates a pt understands your teaching regarding hypothyroidism and using Synthroid? SATA a) "It may take several weeks before I feel better." b) "The best time to take my medicine is with breakfast." c) "If my heart rate is over 100, I will hold my medication until it is back below 100." d) "I will be able to discontinue my medication after the symptoms are under control." e) "I will come in when you need me to so my blood levels can be checked to make sure the medicine is working.

a, b, e (if the pulse is >100, she needs to call the prescriber for further instructions. The medication is not abruptly discontinued; instead, she may need lab work and a dosage adjustment. After symptoms are under control, dosage adjustments can be made. Because of the nature of the disease, treatment for hypothyroidism is generally lifelong.)

A client is diagnosed with Graves' disease. For which S/S of Graves' disease should the nurse assess the client? SATA a) nervousness b) mild tremors c) constipation d) bradycardia e) rapid, bounding pulses f) heat intolerance

a, b, e, f

Two weeks after a partial thyroidectomy, a client is being seen for his post-op follow-up appt. The nurse is aware that the client is at increased risk for hypothyroidism. Which S/S would the nurse expect to find in a client with hypothyroidism? (SATA) a) cold intolerance b) fatigue c) increased energy d) heat intolerance e) hair loss f) dry skin

a, b, e, f

Which electrolytes should the nurse expect to be abnormal in the lab work of a client with possible PTH deficiency? a) calcium b) potassium c) phosphorus d) sodium e) glucose f) chloride

a, c (PTH maintains calcium & phosphate balance)

When treating a pt w/ DI, which signs indicate over correction of this disorder? (SATA) a) Bounding pulses b) Hypotension c) Distended neck veins d) Crackles in the lungs e) Dry, flakey leg skin

a, c, d (all signs of FVE which is the opposite of DI manifestations. Overcorrection of DI can lead to *SIADH*)

The nurse is preparing to admit a client with a diagnosis of SIADH. Which assessment data does the nurse anticipate finding? SATA a) concentrated urine b) polydipsia c) fluid retention d) hypochloremia e) dilutional hyponatremia

a, c, d, e

What are signs/symptoms of dilutional hyponatremia? SATA a) muscle weakness b) constipation c) headache d) elevated BP e) nausea f) weak, slow pulse

a, c, d, e

What are the effects of epinephrine? SATA a) increase heart rate & force of contraction b) constricts bronchioles c) stimulate vasoconstriction in skin & most viscera d) stimulates liver to convert glycogen to glucose e) decreases peristalsis

a, c, d, e

Which of the following findings should the nurse expect to note during the assessment of a client with diabetes insipidus? SATA a) extreme polyuria b) elevated systolic BP c) low urine specific gravity d) elevated serum potassium level e) excessive thirst f) bradycardia

a, c, e

Which manifestations are most often seen in general *hyperthyroidism*? (SATA) a) increased appetite b) cold intolerance c) constipation d) eyelid retraction e) insomnia f) palpitations g) tremors h) weight gain

a, d, e, f, g

Which manifestations are most often seen in general hyperthyroidism? a) increased appetite b) cold intolerance c) constipation d) eyelid retraction e) insomnia f) palpitations g) tremors h) weight gain

a, d, e, f, g

Eighteen hours after surgery, the UOP of a pt who underwent a partial hypophysectomy is markedly *increased*, & the specific gravity is 1.002. The nurse expects to note which corresponding findings when reviewing results of lab tests? (SATA) a) Serum sodium 148 mEq/L b) Serum potassium 3.4 mEq/L c) Serum osmolality 263 mOsm/L d) Blood urea nitrogen 7 mg/dL e) Hematocrit 51%

a, e (suspect transient DI - increased serum sodium & increased hemoconcentration due to dehydration & increased UOP)

If a man has hypopituitarism & *prostate cancer*, what kind of therapy is avoided?

androgen therapy SE of therapy: -gynecomastia -acne -baldness -prostate enlargement

How is the adrenal medulla involved in the body's response to stress?

activation of the SNS releases catecholamines (epinephrine/ NE) from the adrenal medulla - results in the "fight or flight" response --> increased HR & RR and increased physical & emotional awareness

What is the life -threatening event that occurs in response to a stressful event when the need for cortisol & aldosterone is greater than the available supply?

addisonian crisis or acute adrenal insufficiency

What is the difference between hyperstimulation of the adrenal cortex & of the adrenal medulla?

adrenal cortex hyperstim = hypercortisolism (cushings), hyperaldosteronism, excessive androgen production adrenal medulla hyperstim by a tumor= *pheochromocytoma* = excessive catecholamine production

Decreased glomerular filtration & gastric acid production lead to reduced urea nitrogen excretion, causing anorexia & weight loss -- this is common with what endocrine disorder?

adrenal gland insufficiency *along with* -hypoglycemia -reduced aldosterone secretion = *hyperkalemia, hyponatremia, & hypovolemia* and *acidosis*

Fungal skin infections, slow wound healing, bruising, and petechiae are often seen in patients with what endocrine disorder?

adrenal hyperfunction (cushings)

Striae on the breasts or abdomen are often seen with what endocrine disorder?

adrenocortical excess (cushings)

Truncal obesity & a "buffalo hump" may indicate what endocrine disorder?

adrenocortical excess (cushings)

What is produced by the adrenal cortex that helps regulate fluid balance in the body?

aldosterone (along with RAAS - promotes sodium and water reabsorption and potassium excretion)

A client is being evaluated for primary *hypothyroidism*, and has had blood drawn to determine TSH & T4 levels. The RN concludes that which test results would support this diagnosis? a) Elevated TSH and elevated T4 levels b) Elevated TSH and decreased T4 level c) Decreased TSH and elevated T4 level d) Decreased TSH and decreased T4 level

b

Which urine properties indicate to the nurse that the client with SIADH is responding to interventions? a) UOP increased, specific gravity increased b) UOP increased, specific gravity decreased c) UOP decreased, specific gravity increased d) UOP decreased, specific gravity decreased

b

A client recently diagnosed with SIADH is receiving continuous enteral nutrition. Considering the impact of the disorder on fluid balance, what action should the RN take when working with the enteral feeding tube? a) Discard the 50 mL residual and replace it with 50 mL water b) Flush the tube with 50 mL of NS c) Count the flush but not the feeding in planning the fluid limitation d) Flush the tube with 50 mL of water to maintain patency

b (SIADH = *fluid restriction* --> essential because fluid intake further dilutes plasma sodium levels. *Dilute tube feedings with saline rather than water*, and use saline to irrigate GI tubes, Mix drugs given by GI tube with saline)

What medication is typically used to treat Diabetes Insipidus? a) atenolol b) desmopressin acetate c) diazapam d) methotrexate

b (desmopressin acetate - DDAVP) - synthetic ADH to reabsorb water

A client has a tumor of the posterior pituitary gland. A nurse planning his care should include which of the following interventions? SATA a) encourage intake of coffee & tea b) weight client daily c) measure urine specific gravity d) monitor intake & output e) restrict fluids

b, c, d (hypopituitarism = ADH deficiency)

A pt is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of lupus erythematosus. Which effects of this drug therapy would be present to support the nursing diagnosis of disturbed body image? SATA a) pallor b) weight gain c) alopecia d) facial erythema e) weight loss

b, d (*cushings*)

Which hormones would be affected by a hypofunctioning anterior pituitary? SATA a) calcitonin b) thyroid-stimulating hormone c) vasopressin d) follicle-stimulating hormone e) growth hormone

b, d, e

Which precaution or action is most important for the nurse to teach the client who is to collect a 24 hr specimen for endocrine testing? a) eat normal diet during collection period b) wear gloves when you void to prevent contamination of specimen c) urinate at end of 24 hr and add that sample to collection container d) avoid walking, running, dancing, or any vigorous activity during the collection period

c

Why are blood glucose levels increased in a patient with hypercortisolism?

b/c liver releases glucose & the insulin receptors are less sensitive, so blood glucose doesn't move easily into the tissues & is out in the serum *also muscle mass loss reduces glucose uptake*

How does a goiter develop in a patient with hypothyrodism if the levels of TH are very low?

b/c low levels of TH causes the hypothalamus & anterior pituitary gland to make TSH in an attempt to trigger hormone release from the thyroid gland -TSH binds to thyroid cells, causing thyroid to enlarge

What type of drugs are used as *supportive* therapy for a patient with hyperthyroidism? (they relieve manifestations but do not affect the hormone production)

beta-adrenergic blockers (*propranolol*) -relives diaphoresis, anxiety, tachycardia, palpitations

What lab test is done to diagnose Grave's disease?

blood test for TSH antibodies

What labs are run when testing for hyperthyroidism or hypothyroidism?

blood values of T3, T4, & TSH *hyper:* T3 & T4 are *increased*, TSH is *low* w/ Grave's but *high* w/ secondary or tertiary hyperthyroidism *hypo:* T3 & T4 are *decreased*, TSH is *high* w/ primary hypothyroidism but *low& w/ secondary or tertiary*

For which assessment finding in a client with severe hyperthyroidism does the nurse notify the rapid response team? a) An increase in premature ventricular heart ctx from 4/min to 5/min b) An increase/widening of pulse pressure from 40 mm Hg to 46 mm Hg c) An increase in temperature from 99.5°F to 101.3°F d) An increase of 20 mL of UOP/hr

c

For which client does the nurse question prescription for androgen replacement therapy? a) 35 yo man who had vasectomy b) 48 yo man who takes prednisone for severe asthma c) 62 yo man with h/o prostate cancer d) 70 yo man who has hypertension & type 2 DM

c

A client is being discharged after having a thyroidectomy. Which of the following discharge instructions would be appropriate for this client? SATA a) avoid all OTC medications b) report S/S of hypoglycemia c) take thyroid replacement meds as ordered d) carry injectable dexamethosone at all times e) watch for changes in body functioning, such as lethargy, restlessness, cold intolerance, and dry skin & report these to HCP

c, e

What are 2 factors that cause the hypothalamus to secrete TRH?

cold & stress (which then stimulates the ant. pituitary to secrete TSH)

When taking a blood pressure of a client receiving treatment for hyper parathyroidism, the nurse observes the clients hands to undergo flexion contractions. What is the nurses interpretation of this observation? a) Hyperphosphatemia b) Hypo phosphatemia c) Hypercalcemia d) hypocalcemia

d

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a resp problem? a) decreased sodium and glucose b) decreased sodium and increased glucose c) increased sodium, decreased glucose d) increased sodium and glucose

d (cushing's)

The client is 6 hours post thyroidectomy. The UAP reports that the client is upset because there is blood on his gown. Place the nursing actions in priority order. a) Ask the UAP to change the gown b) Reinforce the dressing c) Call the surgeon d) Assess the breath sounds and respiratory effort

d, b, c, a

What are good sources of calcium that should be included in dietary instruction for the patient who needs to follow a high-calcium diet? SATA a) potatoes b) whole grin breads & cereals c) chicken d) milk, cheese, yogurt e) sardines & salmon f) beef & pork

d, e

What is a huge concern about a patient with DI?

dehydration & excessive thirst due to excessive water loss

What is the most common reason that a patient with hypothyroidism sought medical attention in the first place?

depression

Explain the suppression test used to diagnose Cushing's disease.

dexamethasone takes place overnight or over 3-day period -set doses are given -24 hr urine collection follows drug admin -if cortisol levels suppressed, no Cushing's, if no change or if increase = cushing's

Besides impaired gas exchange, what is another priority nursing diagnosis for a patient with hypothyroidism & what are the interventions involved?

hypotension RT altered HR/rhythm as a result of decreased myocardial metabolism -goals: maintain HR above 60/min, maintain BP WNL, no dysrhythmias or peripheral edema or JVD -monitor VS -observe for signs of shock (hypotension, decreased UOP, change in mental status) -instruct pt to report episodes of chest pain or discomfort immediately -lifelong thyroid replacement -assess for chest pain/dyspnea during initiation of therapy

What endocrine gland controls all other endocrine glands by producing *releasing* or *inhibiting* hormones?

hypothalamus (main center - if not functioning correctly, it affects everything else)

A patient comes in with decreased cardiac & respiratory function, decreased BP, and low body temp. He complains of feeling depressed and lethargic, with impaired memory. Upon inspection you notice that the pt has periorbital edema, thick tongue, and coarse features. What might you expect the patient to have?

hypothyroidism

Levothyroxine sodium (Synthroid) is commonly prescribed for what endocrine disorder?

hypothyroidism -start at *low dose* and increase over period of weeks (too high or increasing too fast can cause severe hypertension, heart failure, and MI) --> final dosage is determined by blood levels of TSH & pt physical responses -take hormone replacement drugs exactly as prescribed & don't change dose or brand w/out contacting prescriber

What is the most common form of hypoparathyroidism that is caused by the removal of all parathyroid tissue during total thyroidectomy or by surgical removal of the parathyroid glands?

iatrogenic hypoparathyroidism

Why might a patient with *Cushing's* be at an *increased risk for infection*?

immune changes caused by excess cortisol levels result in immunosuppression (*pt may not have expected S/S of an infection*) (excess cortisol reducing # of lymphocytes, inhibits macrophage activity, reduces antibody synthesis, and inhibits production of cytokines & inflammatory chemicals) *make sure to wash hands before entering clients room*

What is the priority nursing diagnosis for a patient with hypothyroidism & what are the interventions associated with it?

impaired gas exchange RT decreased energy, obesity, muscle weakness, & fatigue -goals: maintain O2 sat of at least *90%*, absence of cyanosis, maintain cognitive orientation -monitor RR & depth, measure O2 sat -apply O2 if hypoxemia -auscultate lungs for decreased breath sounds -avoid sedating patient w/ hypothyroidism or use lower dose (makes gas exchange worse)

In patients with *primary adrenal insufficiency*, plasma ACTH levels & MSH levels are _______________?

increased (in secondary, skin pigmentation *is not changed*)

What effect does hyperparathyroidism (excessive PTH) have on bones?

increased bone resorption (bone loss of calcium, so PTH takes excessive amt of calcium FROM bone & puts in the blood) by *decreasing osteoblastic* activity & *increasing osteoclastic* activity -reduces bone density -calcium is deposited into soft tissues

What effect does hyperthyroidism have in both men and women?

increased libido

How does dietary intake affect thyroid hormones?

intake of *protein & iodine* is needed to produce them (salt, fish, meat, etc.) (*iodine is absorbed from intestinal tract as iodide which is needed to combine w/ amino acid tyrosine to form T4 & T3*)

What is the preferred management for Grave's disease?

surgery to remove all or parts of the thyroid gland (*total thyroidectomy or subtotal thyroidectomy*) -also used if goiters cause tracheal/esophageal compression or when hyperthyroidism doesn't respond to drug therapy -total thyroidectomy requires the pt to take life-long thyroid hormone replacement

What is the target tissue & action associated with *ACTH*?

target: adrenal cortex action: stimulate synthesis & release of corticosteroids and andrenocortical growth

What is the target tissue & action associated with vasopression (ADH)?

target: kidneys action: promotes water reabsorption

What is the target tissue & action associated with *TSH*?

target: thyroid action: stimulate synthesis & release of thyroid hormone

If a man with hypopituitarism requires testosterone therapy replacement, therapy is continued until when?

therapy begins with high-dose testosterone & is continued until *virilization* occurs (presence of secondary sex characteristics - increased penis size, libido, muscle mass, bone size, & bone strength) -the dose may then be *decreased* but therapy is *life-long*

Manifestations of hyperthyroidism are called ______________, regardless of the origin of the thyroid hormones

thyrotoxicosis

True or False: Adults that are treated with human GH injections receive them at night to mimic normal GH release

true

True or False: Goiters can be present with both hyper & hypothyroidism

true

True or False: Hyperkalemia can cause dysrhythmias with an irregular HR & can lead to cardiac arrest

true

True or False: Hypothyroidism occurs most often in women 30-60 yo & affects women 7-10x more than men

true

True or False: Glucocorticoid drugs (steroid therapy) must be withdrawn gradually to allow for increasing pituitary production of ACTH and activation of adrenal cells to produce cortisol

true (cessation could result in addison's)

True or False: After a parathyroidectomy, a hypocalcemic crisis can occur during the period of time it takes for remaining glands to return to normal function

true (check serum calcium levels until calcium is stable) -monitor for S/S of *hypocalcemia* (tingling/twitching in extremities/face) & check for *Chvostek's & Trousseau's*)

True or False: The patient most at risk for *acute* adrenal insufficiency is one who has Cushing's syndrome as a result of glucocorticoid therapy

true (completely dependent on exogenous drug- don't stop taking suddenly, must be weaned off)

True or False: The parental form of desmopressin is *10x* stronger than the oral and intranasal forms, so dosage must be reduced

true (each metered spray delivers 10 mcg) -during severe dehydration, ADH may be given IV or IM intranasal spray could cause: ulceration of MM, allergy, chest tightness, lung inhalation

True or False: Overtreating/overcorrecting conditions associated w/ endocrine disorders can lead to the opposite condition

true (ex. overtreating hyperthyroid can lead to hypothyroid, overtreating DI can lead to SIADH, etc.)

True or False: Cushing's disease increases the risk for pathological bone fracture

true (excess cortisol = increased bone demineralization) *use lift sheet to change client's position

True or False: A temperature elevation of 1 degree above baseline is significant for an immunosuppressed pt & indicates infection until proven otherwise

true (monitor VS at least q 4 hrs)

True or False: ACTH levels are *high* w/ primary adrenal insufficiency but *low* w/ secondary adrenal insufficiency

true (primary = adrenal gland issue, so pituitary is still producing ACTH)

True or False: A decrease in ADH is a normal age-related endocrine change

true - can lead to dehydration so ensure plenty of fluid intake with the older adult population (*q 2 hr*)

True or False: A decrease in estrogen (common in older adults) increases the risk for decreased bone density & fractures

true - risk for injury (encourage weight bearing exercises)

True or False: Even after adrenalectomy procedure & corrected cortisol levels, risks associated with hypercortisolism still manifest for months to years

true - teach pts how to prevent skin injuries (assess pressure areas, turn q 2 hrs, pad bony prominences, *soft toothbrush*, electric razor, lotion) -teach pts safety issues & dietary needs to prevent fractures (high calorie, increase calcium & vitamin D, avoid alcohol & caffeine) -teach pt to take antacids on regular schedule instead of prn