Week 10 Endocrine

The nurse is instructing the client who will undergo a suppression test. Which statement by the client indicates that teaching was effective?

" I am being tested to see whether my hormone glands are hyperactive"

The client with a endocrine disorder says "I can't, you know, satisfy my wife anymore" what is the nurses best response?

"Can you please tell me more?"

Meglitinide analogues

Prandin

Kussmaul respirations

Very deep and rapid respirations cause respiratory alkalosis in an attempt to correct metabolic acidosis by exhaling carbon dioxide.

Hyposecretion of growth hormone

Pituitary Dwarfism

Sheehan's syndrome

Pituitary enlarges during pregnancy, postpartum hemorrhage causes hypotension=>ischemia=>necrosis

Diabetes Insipidus Manifestation

Polyuria due to ADH deficiency, dehydration is the danger, can be nephrogenic (inherited), primary, secondary or drug-related (Lithium). Low urinary osmolarity <1.005

Urine ketone testing can indicate? normal values?

Possible ketoacidosis normal=none present

Polyphagia

excessive hunger and eating

Polydipsia

excessive thirst (as in cases of diabetes or kidney dysfunction)

Factors that inhibit TSH release do not include ________.

excessively high blood iodine concentrations

Regulating hormones from the hypothalamus ________.

first enter into the hypophyseal portal system

Hypoglycemia

from too much insulin or too little glucose

Aldosterone ________.

functions to increase sodium reabsorption

Alpha cells release? Beta cells release? Delta Cells release?

glucagon; raise glucose levels. pushes glucose from cells to plasma. insulin and amylin; lowers gluc levels. unlocks cells and pushes glucose OUT of plasma INTO cells Somatostatin; inhibs release of insulin and glucagon. inhibs release of gastrin, secretin, and GI peptides

Emotional, chemical, or physical stress increases the release of:

glucocorticoids

hypoxia

lack of oxygen

what route should short and rapid acting insulin be given?

iv only

What is the diagnosis of diabetes on these three tests? Fasting blood glucose Glucose Tolerance Test Hemoglobin A1C

over 126 on two occasions over 200 after a 75g challenge 6.5% or greater

Anterior Pituitary Hormone TSH Target Tissue & Actions:

thyroid; Stimulates synthesis and release of thyroid hormone

Why is urine albumin measured? what's normal reading?

to monitor for nephropathy. normal reading is none in urine.

The nurse is assessing the client for endocrine dysfunction. Which comment by the client indicates a need for further assessment?

"I don't have any patience with my kids, I lose my temper fast." *many endocrine problems can change a clients behavior, personality, & psychological responses.

The nurse is providing discharge to the client on spironolactone therapy. Which comment by the client indicates a need for further teaching?

"I should eat a banana everyday" *spironolactone increases potassium levels, so potassium supplements & foods rich in potassium should be avoided.

Hormone-Receptor Binding

"Lock and Key" hormone A fits and binds to receptor sites, causing a change in cell action. Hormone B does not fit or bind to receptor sites, no change in cell action results.

Instruct pt with hyperhtyroidism to report what immediately?

*Temp. increase if 1 degree or more & assess cardiac status & check for dysrhythmmias *Palpitations *Dyspnea *Vertigo *Chest pain

Hypothyroidism

*Thyroid fails to produce sufficient hormones due to: Cells damange & no longer function normally

Metabolism with hyperthyroidism

*Appetite is increased, food intake does not meet energy demands *Pt loses weight *Nutritional deficiency *Fat metabolism is increased and body fat is decreased *Hyperglycemia

How to diagnose hypothyroid

*Ask pt's to compare activity now with that of a year ago

Grave's Disease

*Auto-immune disease . ANtibodies are made and attach to TSH receptor sites on the thyroid gland

Thionamides (anti-thyroid med)

*Block thyroid hormone production by preventing iodide binding in thryoid gland *Watch for & teach S/S of hypothyroid

Manifestations of hypothyroidism

*Bradycardia *Dysrhythmias *Enlarged heart *Cold intolerance *Fatigue *Weight gain

Methimazole (Tapazole)

*Contraindicated in pregnancy *Teach to expect joint pain

Myxedema

*Edema is mucinous

Hyperthyroidism

*Excessive thyroid hormone *Grave's disease is the most frequent cause *Thyrotoxicosis

Thyroid storm

*Extreme state of hyperthyroidism in which all manifestations are more severe

Key manifestations of Thyroid Storm

*Fever *Tachycardia *Systolic HTN

Lithium

*Inhibits thyroid hormone release

What does myxedmea cause?

*Low energy *Fatigue (cell level not functioning) *Non-pitting edema forms, especially around eyes, hands, and feet. *Tongue thickens

Monitoring with hyperthyroidism

*Measure apical pulse, BP, temp @ least Q 4h *Increase in temp. can indicated thyroid storm

Thyrotoxicosis

*Palpitations, chest pain, increased systolic BP, widened pulse pressure, dysrhythmias, tachycardia *Rapid shallow resp, SOB *Weight loss, hypo-proteinema, increased stools *Heat intolerance, low-grade fever

What can happen if a pt is started on too high of a dose when treating hypothyroidism?

*Severe tachy *HTN *heart failure *MI

Four common causes of hypoglycemia

1. excess insulin 2. deficient intake or absorption of food 3. exercise 4. alcohol intake

Someone who has diabetes should aim for a Hemoglobin A1C test reading of?

7% or less

Self glucose check goals.

70-130 pre meal less than 180 post meal 100-140 @HS Check 3-5 times/day for Type 1 Type 2: at least ONCE/day

Leptin is secreted by ________.

Adipocytes

Hemoconcentration

A decrease in the fluid content of the blood (plasma), resulting in an increase concentration. This is determined by an increase in the hematocrit. Caused by a filtration of plasma into the body tissue and often created by dehydration

Which of the following is true about calcium homeostasis?

Parathyroid hormone is the single most important regulator of calcium levels in the blood

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem?

A weight loss of 15 lbs in the past 6 weeks without dieting.

In Type 1 DM, what hormone is absent?

Amylin

The risk factors for Graves' disease are increased in clients with which of the following? (Select all that apply.) A. Autoimmune disease C. Type 1 diabetes D. Pernicious anemia

ANS: A, C, D Rationale: The pattern of inheritances of Graves' disease appears to be familial clustering. However, a specific gene or gene mutation has been identified as a cause of Graves' disease. People with autoimmune disease appear to be at a higher risk.

Which of the following can cause hypopituitarism? (Select all that apply.) A. Benign tumors C. Anorexia nervosa D. Hypotension E. Shock

ANS: A, C, D, E Rationale: These four situations can cause hypopituitarism.

The client has chronic hypercortisolism. Which of the following changes in the white blood cell count is an early indicator of the presence of an infection in this client? (Select all that apply.) A. Decreased lymphocyte count D. Increased leukocyte count

ANS: A, D Rationale: Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse must check laboratory results to detect the presence of an infection.

Which of the following are common key features of hormones? (Select all that apply.) B. Continued hormone activity requires continued production and secretion. C. All hormones exert their influence at low blood concentration. E. Most hormones cause target tissue to increase or decrease their activity by changing gene activity.

ANS: B, C, E Rationale: The control of cellular function by any hormone depends on a series of reactions working through negative feedback control mechanisms.

Use the following diagram to fill in the correct name of the gland or organ that makes up the endocrine system.

ANS: Rationale: It is important for the nurse to understand the anatomic location of the gland or organ to identify appropriate nursing interventions. Therefore, any disease, injury, or other factor affecting the endocrine system could have a far-reaching impact on the client, which could influence his or her health status.

A client with iatrogenic Cushing's syndrome is a resident in a long term care facility. Which nursing action included in the clients care would be best to delegate to a nursing assistant?

Assist with personal hygiene and skin care.

When performing personal care on a 40-year-old white woman, the nurse observes that the client has very little pubic and axillary hair. What is the nurse's best action? A. Ask the client if she has less pubic hair now than 5 years ago.

ANS: A Although pubic hair thickness varies from person to person, loss of pubic hair is associated with gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for this client.

Which serum electrolyte values alert the nurse to the possibility of hyperaldosteronism? A. Serum sodium 150 mmol/L, serum potassium 2.5 mmol/L

ANS: A Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia and hypokalemia.

The client is receiving an antithyroid medication to treat hyperthyroidism. Which of the following should be included in client education regarding the initiation of this therapy? A. "Increased need for sleepy or not tolerating cold like you used to can occur when taking this medication. If it does, notify your physician."

ANS: A Antithyroid medication may result in hypothyroidism, which is manifested by sleepiness and intolerance to cold. The client must be closely monitored to determine the need for drug regimen changes. B is a side effect of the medication. C does not give the client specific parameters for "fast pulse." D uses medical terminology which the client may not understand.

Combination Agents

Glucovance

How should the nurse monitor for possible endocrine effects in the client receiving frequent doses of large amounts of morphine for severe pain? A.Measure intake and output.

ANS: A Opiates, particularly morphine, increase the release of vasopressin (antidiuretic hormone), decreasing urine output.

Which clinical manifestations alert the nurse to the possibility of anterior pituitary hyperfunction? A. Enlarged hands and feet, heat intolerance

ANS: A Pituitary hyperfunction can involve the oversecretion of one or more pituitary hormones. Enlarged hands and feet in an adult are indicators of growth hormone excess. Heat intolerance occurs as a result of increased secretion of thyroid-stimulating hormone (TSH), increasing the production and release of thyroid hormones, which increase basal metabolic rate and heat generation.

The client with hyperaldosteronism is being treated with spironolactone therapy. What precautions should the nurse teach this client? A. "Avoid salt substitutes."

ANS: A Spironolactone is a potassium-sparing diuretic and can lead to hyperkalemia. Salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy.

What change in cardiac function would the nurse expect to find in the client who is taking a drug that stimulates beta1 receptor sites in the heart? A. Increased pulse rate, pulse bounding

ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions.

Which action should the nurse teach the diabetic client as being most beneficial in delaying the onset of microvascular and macrovascular complications? A. Controlling hyperglycemia

ANS: A The Diabetes Control and Complications Trial, a prospective study involving 29 medical centers and more than 1400 people with type 1 diabetes, provides convincing evidence that hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications.

What is the priority nursing diagnosis for the client newly diagnosed with hyperthyroidism? A. Decreased cardiac output related to tachycardia

ANS: A The cardiac problems of hyperthyroidism include increased systolic blood pressure, a widened pulse pressure, tachycardia, and other dysrhythmias. The goals of nonsurgical management are to decrease the effect of thyroid hormone on cardiac function and to reduce thyroid hormone secretion.

The ovaries of a 55-year-old woman are producing only minimal amounts of estrogen. What effect should the nurse expect this decreased estrogen secretion to have on hypothalamic production of gonadotropin-releasing hormone (Gn-RH) and anterior pituitary production of follicle-stimulating hormone (FSH)? A. Increased Gn-RH, increased FSH

ANS: A The trigger for Gn-RH is decreased circulating levels of estrogen. As this woman's ovarian production of estrogen decreases, the circulating levels of estrogen also decrease, stimulating the hypothalamus to increase production and release of Gn-RH, which stimulates the anterior pituitary gland to increase production and release of FSH.

For what complications is the client with hypercortisolism at greater risk? A. Skin breakdown, infection, GI ulceration

ANS: A Under the influence of excessive amounts of cortisol, the skin becomes thinner, prone to striations, and has decreased cell division. Although the white blood cell count may be high, the activity of the leukocytes (especially lymphocytes) is decreased and the client is immunosuppressed. Cortisol increases the risk for GI ulceration in many ways, including stimulating increased secretion of hydrochloric acid and thinning the protective mucous layer in the stomach.

What is the priority nursing diagnosis for the client in thyroid crisis (storm)? A. Potential for Ineffective Breathing Pattern

ANS: A Thyroid crisis is a life-threatening emergency that has a 25% mortality rate, even with intervention. Maintaining a patent airway and providing adequate ventilation are the primary concerns for clients in thyroid crisis.

Which endocrine gland function is most important to assess in the 45-year-old woman who has bilateral patchy areas of skin depigmentation on her arms and face? A. Adrenal gland

ANS: A Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands.

The client with hyperthyroid symptoms is having hormone studies done to confirm the diagnosis. Which set of values indicates non-Graves' disease hyperthyroidism? A. Elevated T3, elevated T4, high TSH levels

ANS: A With hyperthyroidism, both the T3 and T4 blood levels are elevated, causing the hypermetabolism. In Graves' disease, the autoantibodies bind to the TSH receptor and activate it, causing an overproduction of thyroid hormones. The increased metabolic rate negatively feeds back and suppresses hypothalamic secretion of thyrotropic hormone, which in turn suppresses thyroid-stimulating hormone (TSH). When the TSH levels are elevated, causing an increased synthesis of thyroid hormones, the hyperthyroidism is not a result of Graves' disease.

The client scheduled to have a radioimmunoassay to determine blood hormone levels asks the nurse how long she will be radioactive. What is the nurse's best response? B. "The radioisotope is added to the blood sample after it is drawn from you, so you are never radioactive."

ANS: B The client is not exposed to radiation during a radioimmunoassay. The radioisotope is added to the client's specimen after it is obtained from the client.

Which safety measure should the nurse use for a client who has adrenocortical insufficiency? B. Assist the client to change positions slowly.

ANS: B Adrenocortical insufficiency causes severe orthostatic (postural) hypotension, greatly increasing the client's risk for falls.

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates an adequate understanding of actions to prevent complications from this treatment? B. "I will keep the cat food bowl on my counter so that I do not have to bend over."

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waist and should not bear down, cough, or lay flat.

What symptoms or problems should the nurse expect in a client who is receiving a treatment that has a side effect of increasing the synthesis and release of aldosterone? B. Hypertension, hypokalemia

ANS: B Aldosterone increases reabsorption of water and sodium, causing hypertension, and increases renal excretion of potassium, resulting in hypokalemia.

Parathyroid galnds

Calcium & phosphate balance

The client diabetic client asks the nurse why it is necessary to maintain blood glucose levels no lower than about 74 mg/dL. What is the nurse's best response? B. "The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel."

ANS: B Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system.

The risk for which endocrine problem increases with aging? B. Diabetes mellitus

ANS: B Beta cell function appears to decrease with aging. Lack of exercise and obesity, which are also more common among older adults, decreases the sensitivity of the insulin receptor to the presence of insulin, contributing to hyperglycemia.

The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." What is the nurse's best response? B. "You feel this way because of your high hormone levels. The doctor can order an antianxiety drug for you."

ANS: B Changes in blood cortisol levels can cause the client to show neurotic or psychotic behaviors. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. Drug therapy to reduce these feelings and behaviors may be appropriate.

Which client is at greatest risk for hyperparathyroidism? B. 45-year-old client receiving dialysis for end-stage renal disease

ANS: B Clients who have chronic renal failure do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, which triggers overstimulation of the parathyroid glands.

Which medication should the nurse be prepared to administer to a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion? B. Demeclocycline

ANS: B Demeclocycline, a tetracycline derivative, antagonizes antidiuretic hormone and corrects the water and sodium imbalance resulting from SIADH.

What is the priority nursing diagnosis in a 35-year-old man being treated for hyperpituitarism in which excessive amounts of prolactin are secreted? B. Disturbed Body Image related to gynecomastia

ANS: B Excessive amounts of prolactin can cause galactorrhea in men or women. In addition, the excessive blood levels of prolactin inhibit gonadotropin-releasing hormone, suppressing testosterone production. Low circulating levels of testosterone allow breast development in men (gynecomastia).

What is the priority nursing diagnosis in a 45-year-old man with Cushing's syndrome? B. Disturbed Body Image related to change in appearance

ANS: B Excessive amounts of prolactin can cause galactorrhea in men or women. In addition, the excessive blood levels of prolactin inhibit gonadotropin-releasing hormone, suppressing testosterone production. Low circulating levels of testosterone allow breast development in men (gynecomastia).

Which clinical manifestation alerts the nurse to the possibility of Graves' disease as the cause of hyperthyroidism? B. Exophthalmos

ANS: B Graves' disease causes edema in the extraocular muscles and increased retro-orbital fat that pushes the globe of the eye forward. This exophthalmos is not a feature of hyperthyroidism from any other cause.

What would be the effect on the client's hormone response to a naturally occurring hormone if the client were taking a drug that "blocked" that hormone's receptor site? B. The client's response would resemble decreased hormone activity.

ANS: B Hormones cause an activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the cell's activity. When the receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when there is a decreased level of the hormone.

What intervention should the nurse use to prevent injury in the client with hyperparathyroidism? B. Use a lift sheet to assist the client with position changes.

ANS: B Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. The use of a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury.

The client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which of the following client reports alerts the nurse to side effects of this therapy? B. Increased thirst and urination

ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus.

Which manifestation of Graves' disease is unaffected by medical treatment for the hyperthyroidism? B. Exophthalmos

ANS: B Medical or surgical therapy for hyperthyroidism does not reduce the exophthalmos, although these therapies will prevent progression of the associated eye changes.

Which of the following does not act as a second messenger in second-messenger systems of hormone action?

Calmodulin

A 35-year-old female client has been diagnosed with a deficiency of most anterior pituitary hormones. Which fact reported in her history should the nurse explore further with regard to her pituitary problem? B.The client experienced a postpartum hemorrhage 5 years ago.

ANS: B Postpartum hemorrhage is the most common cause of pituitary infarction. With this injury to the pituitary gland, secretion of more than one hormone is deficient. The condition may develop immediately postpartum or years after the delivery.

For which client with hyperthyroidism is radioactive iodine therapy contraindicated? B. 28-year-old woman who is pregnant

ANS: B Radioactive iodine therapy is contraindicated in pregnant women because 131I crosses the placenta and can adversely affect the fetal thyroid gland.

The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. What is the nurse's best answer? B. "When your beard thickens and your voice deepens, the dose is decreased but must continue forever."

ANS: B Testosterone therapy is initiated with high-dose testosterone derivatives and continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life.

What is the major hormone secreted by the adrenal medulla? B. Epinephrine

ANS: B The adrenal medulla secretes norepinephrine and epinephrine in proportions of 15% and 85%, respectively.

What dietary alterations should the nurse make for the client with Cushing's disease? B. Low carbohydrate, high calorie, low sodium

ANS: B The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to restrict sodium intake moderately.

Which of the following statements regarding thyroid disorders is true? B. The effects of thyroid dysfunction are found in all body tissues and organs.

ANS: B The presence of a goiter is associated with thyroid dysfunction; however, some types of hyperthyroidism cause a goiter and some types of hypothyroidism cause a goiter. Thyroid hormones affect virtually all metabolic processes in all body organs.

Which medication should the nurse be prepared to administer to a client with bradycardia as a result of hypothyroidism? B.Levothyroxine sodium

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism.

Aldosterone is the most potent mineralocorticoid produced in the adrenals but the least abundant

False

Calcitonin is a peptide hormone that has destructive effects on the skeletal system

False

Diabetes insipidus and diabetes mellitus are both caused by a genetic mutation involving the synthesis of insulin

False

Direct gene activation involves a second-messenger system

False

The client with hypothyroidism as a result of Hashimoto's thyroiditis asks the nurse how long she will have to take thyroid medication. What is the nurse's best response? C. "You will need thyroid replacement hormone therapy for the rest of your life because the thyroid gland function will not return."

ANS: C Hashimoto's thyroiditis results in a permanent loss of thyroid function.

Which safety measure should the nurse use for a client who has Cushing's disease? C. Use a lift sheet to change the client's position.

ANS: C Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fractures.

Follicle cells of the thyroid gland produce thyroglobulin, while follicle cells of the parathyroid produce calcitonin

False

The client has a deficiency of all the following pituitary hormones. Which one should be addressed first? C. Thyroid-stimulating hormone

ANS: C A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

The client is being admitted with acute adrenal insufficiency (addisonian crisis). What medication should the nurse be prepared to administer? C. Hydrocortisone sodium succinate

ANS: C Addisonian crisis results from insufficient secretion of glucocorticoids and mineralocorticoids. Intravenous infusion of hydrocortisone sodium succinate supplies the missing glucocorticoid.

Which clinical manifestation change indicates to the nurse that the therapy for the client with hyperaldosteronism is effective? C. The systolic blood pressure has decreased by 24 mm Hg.

ANS: C Aldosterone causes the kidneys to increase the reabsorption of sodium and water and to increase the excretion of potassium. Clients with hyperaldosteronism have hypertension and hypokalemia. A decrease in blood pressure is indicative of effective therapy.

The client just diagnosed with hyperpituitarism and acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment? C. "I hope I can go back to wearing size 8 shoes instead of size 12."

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible.

Which tissue(s) or organ(s) should be evaluated in a man who begins to have fluid secretion from the breast? C. Hypothalamus and anterior pituitary

ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The hypothalamus regulates secretion of prolactin through the activity of prolactin-inhibiting hormone. A problem in either the hypothalamus or the anterior pituitary gland can cause lactation in men or women.

Glucocorticoids are steroid hormones that usually enhance the immune responses when an individual is suffering from severe stress

False

The "mustache" dressing of a client postoperative from a transsphenoidal hypophysectomy is saturated with clear, yellow-tinged fluid. What is the nurse's best first action? C. Test the drainage for glucose.

ANS: C Clear, yellow-tinged drainage could be serous or could contain cerebrospinal fluid (CSF). CSF contains a relatively high concentration of glucose; serous drainage does not.

The client, a 45-year-old woman, has acromegaly as a result of a pituitary adenoma found and removed when she was 16 years old. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. What is the nurse's best action? C. Document the finding as the only action.

ANS: C Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver.

The client who is taking corticosteroids daily for severe asthma now has an elevated blood glucose level. He asks the nurse if he is now considered diabetic. What is the nurse's best response? C. "No, the blood glucose level is elevated because corticosteroids increase the synthesis of glucose."

ANS: C Corticosteroids cause a "pseudodiabetes" with increased blood glucose levels by stimulating liver synthesis of glucose and suppressing glucose use by cells. The ability of the pancreas to synthesize insulin is unaffected.

Which client responses demonstrate to the nurse that treatment for diabetes insipidus is effective? C. Urine output is decreased; specific gravity is increased.

ANS: C Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in a decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

Which statement regarding diabetes mellitus is true? C. Diabetes increases the risk for development of cardiovascular disease.

ANS: C Diabetes mellitus is a major risk factor for morbidity and mortality caused by coronary artery disease, cerebrovascular disease, and peripheral vascular disease.

While assessing the client who has had diabetes for 15 years, the nurse notes that the client has decreased tactile sensation in both feet. What is the nurse's best first action? C. Examine the client's feet for signs of injury.

ANS: C Diabetic neuropathy is common when the disease is long-standing. It cannot be reversed and the client is at great risk for injury in any area with decreased sensation, because he or she is less able to feel injurious events.

Growth hormone always exerts its influence by targeting other endocrine glands to produce hormones

False

Which hormone prevents hypoglycemia by promoting the conversion of glycogen to glucose (glycogenolysis) and the conversion of protein to glucose (gluconeogenesis)? C. Glucagon

ANS: C Glucagon increases or maintains blood glucose levels. Glucagon is stimulated by a decrease in blood glucose levels and an increase in blood amino acid levels. In the liver, the primary target organ of glucagon, glucagon causes glycogenolysis (the conversion of glycogen to glucose). In addition, glucagon enhances amino acid transport from muscle and promotes gluconeogenesis (the conversion of amino acids to glucose).

Peptide hormones enter the target cells and elicit a response by mediating neurotransmitter effects

False

What is the priority nursing diagnosis for the client with hypothyroidism? C. Disturbed Thought Processes

ANS: C Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. The client may be too lethargic, apathetic, or drowsy to recognize changes in his or her condition. Memory and attention span may be impaired. Paranoia and agitation also may be present. The client may have such disturbed thought processes that they are unable to care for themselves.

What safety measure should the nurse use for the adult client who has growth hormone deficiency? C. Use a lift sheet to reposition the client.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones.

Which clinical manifestation alerts the nurse to the possibility of an endocrine disorder? C. Increased sense of thirst and increased urine output

ANS: C Increased thirst and increased urine output are associated with at least two endocrine disorders, diabetes mellitus and diabetes insipidus.

The client who had a transsphenoidal hypophysectomy 2 days ago now has nuchal rigidity. What is the nurse's best first action? C. Take the client's temperature.

ANS: C Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection, and usually the client also will have a fever.

On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around the mouth. What is the nurse's best first action? C. Notify the physician.

ANS: C Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity.

Which drug(s) would the nurse expect to administer to a client to prevent gastrointestinal ulceration from hypercortisolism? C. Omeprazole (Prilosec)

ANS: C Omeprazole is a proton pump inhibitor that reduces the amount of hydrochloric acid present in the stomach and reduces the risk for cortisol-induced ulceration.

The client who has been taking high-dose corticosteroid therapy for a month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking the corticosteroids. What is the nurse's best response? C. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again."

ANS: C One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol.

Which statement made by the client indicates the need for clarification with regard to the instructions for collecting a 24-hour urine specimen for assessment of endocrine function? C. "I will begin the collection with the urine I excrete when I first get up in the morning and note the time."

ANS: C The 24-hour urine collection specimen is started when the client first arises and urinates. This first specimen is discarded but the time is noted. This first urine is discarded because there is no way to know how long it has been in the bladder. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection.

In collaboration with the dietician, what dietary modification should the nurse suggest for the client with hyperthyroidism? C. Increase calories, proteins, and carbohydrates.

ANS: C The client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance.

Which test results should the nurse check to ascertain how well the client is managing her diabetes mellitus overall? C. Glycosylated hemoglobin

ANS: C The glycosylated hemoglobin level reveals the average blood glucose level over a period of 2 to 3 months. Its primary use is in assessing overall control of the glucose level in diabetes mellitus.

The family of a client with SIADH asks the nurse if the water restriction is a punishment for the client's uncooperative behavior. What is the nurse's best response? C. "No, limiting fluid intake keeps the client's blood from becoming more dilute and causing other complications."

ANS: C The increased water reabsorption that occurs with SIADH causes a fluid overload and can dilute serum electrolyte concentrations, especially sodium, to dangerously low levels. Appropriate therapy aims to reduce the overhydration by limiting fluids and increasing urine output.

The client is taking exogenous cortisol, in the form of prednisone, daily for a temporary pulmonary inflammation. She tells the nurse that she is upset about her moon-shaped face and fat body. What is the nurse's best response? C. "When you come off the drug, your body fat will change back to normal over time."

ANS: C The moon face and truncal obesity side effects of prednisone therapy are caused by changes in fat distribution and are affected little, if at all, by diet or exercise. These effects do resolve when therapy is discontinued, but it could take months to years before the fat distribution returns to normal.

The endocrine gland that is probably malfunctioning if a person has a high metabolic rate is the parathyroid

False

What is the basic underlying pathology of diabetes mellitus? C. A failure to synthesize and/or utilize insulin

ANS: C The lack of insulin in diabetes, either from a lack of insulin secretion or from insulin receptor pathology, prevents insulin-sensitive cells from using glucose as an energy source.

The client scheduled to have a thyroid scan asks the nurse how long she will be radioactive after the scan. What is the nurse's best response? C. "The dose of radiation is so low and is excreted by the kidneys in just a few days, so you are not considered radioactive."

ANS: C The radioactive iodine used in thyroid scans is low intensity and has such a short half-life that the client is not considered to be a radiation hazard, and no radiation precautions are necessary.

How does a tropic hormone differ from other hormones? C. Tropic hormones stimulate other endocrine glands to secrete hormones.

ANS: C The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. Tropic hormones are involved in more complex negative feedback regulatory loops.

If a client has a low dietary intake of iodine (iodide), which hormone would be most profoundly affected and how would it be affected? C. Deficiency of thyroid hormones

ANS: C Thyroid production of thyroid hormones, thyroxine (T4) and triiodothyronine (T3), is dependent on adequate amounts of the amino acid tyrosine and of iodide.

The endocrine structure that develops from the nervous system is the anterior pituitary

False

The hormone that raises blood sugar levels is insulin

False

The only known effect of prolactin in humans is to produce impotence in males

False

Which client is at greatest risk for the development of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)? D. 68-year-old man with chronic emphysema

ANS: D SIADH is neither gender- nor age-related. Of the many disorders causing increased secretion of antidiuretic hormone (ADH) or ectopic synthesis of ADH, pulmonary disorders, including emphysema and other chronic lung diseases, are the most common.

The client with adrenocortical insufficiency has an irregular pulse. What is the nurse's best first action? D. Notify the physician.

ANS: D Adrenocortical insufficiency causes excessive reabsorption of potassium, leading to hyperkalemia. The hyperkalemia is considered to be a life-threatening emergency resulting in dysrhythmias and cardiac arrest.

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? D. "I am always tired, even when I get 10 or 12 hours of sleep."

ANS: D Clients with hypothyroidism usually feel tired or weak and often report an increase in time spent sleeping, sometimes up to 14 to 16 hours daily.

Which situation or condition is likely to result in an increased production of thyroid hormones? D. Cold environmental temperature

ANS: D Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid- stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increases the rate of metabolism to maintain body temperature near normal.

Which statement made by the client after a bilateral adrenalectomy indicates a need for further clarification regarding medications? D. "If I have nausea or vomiting, I will skip the medication until I am better."

ANS: D Cortisol replacement after bilateral adrenalectomy must continue daily for the rest of the client's life. Skipping doses could cause adrenal crisis and death. If the client cannot take the drugs orally, arrangements must be made for the client to receive the drug parenterally.

Which of the following clinical manifestations alerts the nurse to the possibility of side effects of desmopressin acetate (DDAVP) therapy, taken nonparenterally by a client with diabetes insipidus? D. Nasal ulceration

ANS: D DDAVP is administered as a metered-dose intranasal spray. It can cause irritation and breakdown of the nasal mucosa.

When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the client's hand has gone into flexion contractions. What is the nurse's interpretation of this observation? D. Hypocalcemia

ANS: D Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) occurring during blood pressure measurement are indicative of hypocalcemia.

Which clinical manifestation indicates to the nurse that treatment for the client with hypothyroidism is effective? D. The client has had a bowel movement every day for 1 week.

ANS: D Hypothyroidism decreases gastrointestinal motility significantly. One of the parameters that clients can use to determine if changes in the dose of thyroid replacement should be adjusted is the frequency of bowel movements. A bowel movement every day is a strong indication that the dose of thyroid replacement hormone is adequate.

The client scheduled for a partial thyroidectomy for hyperthyroidism asks the nurse why she is being given an iodine preparation before surgery. What is the nurse's best response? D. "To decrease the blood vessels in the thyroid and prevent excessive bleeding during surgery."

ANS: D Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery.

What would be the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone? D. Darkening of the skin

ANS: D Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) they produce.

Which assessment maneuver should the nurse avoid performing with a client suspected of having a pheochromocytoma? D. Palpating the abdomen

ANS: D Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and precipitate a hypertensive crisis.

The client thought to have a problem with the pituitary gland is given 25 units of regular insulin. A short time later, blood analysis reveals elevated levels of growth hormone and adrenocorticotropic hormone (ACTH). What is the nurse's interpretation of this finding? D. The client has a normal pituitary response to insulin.

ANS: D Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are called stimulation tests. For example, the presence of insulin in people with normal pituitary function causes an increased release of GH and ACTH. The stimulation test for either GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking the circulating levels of GH and ACTH.

Twelve hours after a total thyroidectomy, the client develops stridor on exhalation. What is the nurse's best first action? D. Call for emergency assistance.

ANS: D Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. In some settings, this may be a nursing action; in other settings, this is a physician function. Emergency intubation also may be necessary.

The stimulus for calcitonin release is usually excessive amounts of growth hormone synthesis

False

The thyroid gland is embedded in the parathyroid tissue

False

The client has been taking an oral cortisol preparation for 2 years to manage an autoimmune disease. What effects does the nurse expect this therapy to have on this client's circulating levels of ACTH and aldosterone? D. Decreased ACTH, decreased aldosterone

ANS: D Taking exogenous cortisol increases the blood levels of cortisol, causing the negative feedback loops to be inhibited. The elevated cortisol levels will suppress hypothalamic secretion of corticotropin-releasing hormone (CRH). Low levels of CRH suppress the anterior pituitary production of adrenocorticotropic hormone (ACTH). Elevated blood levels of cortisol cause increased sodium retention and water reabsorption, inhibiting aldosterone synthesis.

Excessive GH secretion

Gigantism if it occurs before closure of the growth plates (adolescence), acromegaly if afterwards.

Alpha-glucosidase inhibitors

Acarbose (Precose)

Which clinical manifestation indicates to the nurse that the client's adrenocortical insufficiency is of primary origin rather than secondary origin? D. Increased skin pigmentation

ANS: D With primary adrenocortical insufficiency, the adrenal gland is not able to produce sufficient amounts of adrenocortical hormones. The low circulating levels of these hormones stimulates the hypothalamus to release corticotropic-releasing hormone (CRH), which in turn causes the anterior pituitary to release large amounts of ACTH and melanocyte-stimulating hormone (MSH). The increased MSH causes increased skin pigmentation. Because secondary adrenocortical insufficiency does not stimulate higher endocrine centers, MSH levels are not increased, and there is no increase in skin pigmentation.

Metabolic Syndrome

Abdominal obesity Hyperglycemia HPTN Dyslipidemia

Hypersecretion of growth hormone

Acromegaly

Hyposecretion of the adrenal cortex

Addison's Disease

A client with SIADH is admitted with a serum sodium level of 105. Which request by the health care provider should the nurse address first?

Administer infusion of 150 mL of 3% NaCl over 3 hours.

A client presents to the ED with a history of adrenal insufficiency. The following lab values are obtained: Na 130 K 5.6 & glucose 72. Which of the following is the first request that the nurse should anticipate?

Administer insulin & dextrose in normal saline to shift potassium into cells

Which gland releases catecholamines?

Adrenal

The gland that controls the fight-or-flight reaction

Adrenal Medulla

The most important regulator of electrolyte concentrations in extracellular fluids is ________.

Aldosterone

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Liver

Alpha - increased gluconeogenesis and glycogenolysis

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Skin

Alpha - increased sweating

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Eyes

Alpha; Dilation of pupils

Select the correct statement about the structure or function of chemical messengers.

An amino acid derivative can be a hormone

The nurse should encourage fluids every 2 hours for an older adult client because of the decrease in which factor?

Antidiuretic hormone (ADH) production.

Health Teaching

Assessing learning needs Assessing physical, cognitive, and emotional limitations Explaining survival skills Counseling Psychosocial preparation Home care management Health care resources Pg 1518: NCLEX pointers 1514

Thiazolinedione antidiabetic agents

Avandia Actos

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment?

Avoids palpating the abdomen *the abdomen must not be palpated bc this action could cause a sudden release of catecholamines & severe hypertension in the client.

Exercise Therapy

Benefits of exercise Risks related to exercise Screening before starting exercise program Guidelines for exercise Exercise promotion

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Fat cells

Beta - increased lipolysis

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Heart

Beta 1 - Chronotropic action; Inotropic action

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Kidneys

Beta 2 - Increased renin release

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Bronchioles

Beta 2 - Relaxation; Dilation

Potential for Hypoglycemia

Blood glucose level < 70 mg/dL Diet therapy: carbohydrate replacement Drug therapy: glucagon, 50% dextrose, diazoxide, octreotide Prevention strategies for: Insulin excess Deficient food intake Exercise Alcohol Pg 1508: chart 67-11

Anterior Pituitary Hormone GH (growth hormone) Target Tissue & Actions:

Bone and soft tissue; Promotes growth through lipolysis, protein anabolism, and insulin antagonism

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Bladder

Both Alpha & Beta; Alpha - sphincter contractions; Beta 2 - Relaxation of detrusor muscle

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Blood vessels

Both Alpha and Beta 2; Alpha - Vasoconstriction; Beta 2 - Vasodilation

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: Pancreas

Both Alpha and Beta: Alpha - decreased glucagon and insulin release; Beta - increased glucagon and insulin release

Catecholamine Receptors and Effects of Adrenal Medullary Hormone Stimulation: GI tract

Both Alpha and Beta; Alpha - increased sphincter tone; Beta - Decreased motility

What ion is sometimes used as a second messenger of amino acid-base hormones?

Calcium

Glucocorticoids are produced by the adrenal cortex and are essential for life. The main glucocorticoid produced by the adrenal cortex is cortisol. Cortisol affects:

Carbohydrate, protein, and fat metabolism; The body's response to stress; Emotional stability; Immune function.; Cortisol also influences other important body processes. For example, it must be present for allowing catecholamine action and maintaining the normal excitability of the heart muscle cells.

Adrenal Medulla

Center of the adrenal glands Catecholamines - epinephrine and norepinephrine: secreted in small amounts at all times to maintain homeostasis. Severe stress triggers increased secretion of these hormones "Fight or Flight"

A client is hospitalized with possible disorder of the adrenal cortex. Which one of these nursing activities would be best for the charge nurse to delegate to an experienced nursing assistant?

Check blood glucose levels every 4 hours.

Interventions and foot care practices:

Cleanse and inspect the feet daily. Wear properly fitting shoes. Avoid walking barefoot. Trim toenails properly. Report nonhealing breaks in the skin.

These data are obtained by a RN who is assessing a client who had a trans-sphenoidal hypophysectomy yesterday. What information has the most immediate implications for the clients care?

Client report of a stuff neck and a headache.

The charge nurse is making client assignments for the med surg unit. Which client will be best to assign to an RN who has floated from pedi unit?

Client with Cushing's syndrome who has an elevated blood glucose and requires frequent administration of insulin.

The charge nurse on a med/surg unit is making client assignments for the shift. Which client will be most appropriate to assign to LVN?

Client with Cushing's syndrome who requires ortho static vital sign assessments.

Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use?

Client with SOB and chest tightness, nasal flaring, audible wheezing, & O2 sat of 85% for the second time this week.

After receiving change of shift report about the following four clients, which should the nurse address first?

Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL

Alternative Methods of Insulin Administration

Continuous subcutaneous infusion of insulin Implanted insulin pumps Injection devices

Thyroid Gland

Control of metabolism - T3 and T4 increase metabolism, which causes an increase in oxygen use and heat production in all tissues. T3 - triiodothyronine T4 - thyroxine

Thyroid Gland

Controls the balance of Calcium and phosphorus through the actions of calcitonin, also called thyrocalcitonin or TCT. Calcitonin lowers serum calcium and serum phosphorus levels by reducing bone resorption (it stops the bones from releasing calcium into the blood). Low serum calcium levels inhibit the release of calcitonin

Interventions for hypoparahtyroidism

Correcting hypocalcemia, vitamin D deficiency, & hypomagnesemia

Glucocorticoids

Corticosteroids - Cortisol is the main one produced by the adrenal cortex, it affects: Carbohydrate, protein and fat metabolism The body's response to stress Emotional Stability Immune function

Principal Hormones of the Endocrine Glands: Hypothalamus

Corticotropin-releasing hormone (CRH); Thyrotropin-releasing hormone (TRH); Gonadotropin-releasing hormone (GnRH); Growth hormone-releasing hormone (GHRH); Growth hormone-inhibiting hormone (somatostatin GHIH); Prolactin-inhibiting hormone (PIH); Melanocyte-inhibiting hormone (MIH)

Gluconeogenesis occurs in the liver due to the action of ________.

Cortisol

Mineralocorticoid is to aldosterone as glucocorticoid is to ________.

Cortisol

The client has suspected alterations in ADH function. Which diagnostic test does the nurse anticipate will be requested for this client?

Cranial computed tomography (CT) *ADH is a hormone of posterior pituitary. Brain access, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These could be seen on a CT scan of the Brain.

Hyposecretion of the thyroid in infants

Cretinism

Assessment

Current health problems including any changes in: Energy levels Elimination Sexual and reproductive functions Physical appearance

Hypersecretion of the adrenal cortex

Cushing's Disease

The nurse is teaching the client about how to monitor therapy effectiveness for SIADH. What will the nurse tell the client to look for?

Daily weight gain of less than 2 lbs.

Endocrine - aging

Decreased antidiuretic hormone (ADH) production - Urine is more dilute and may not concentrate when fluid intake is low. Causes greater risk for dehydration as a result of urine loss

Endocrine - aging

Decreased glucose tolerance - weight becomes greater than ideal along with: Elevated fasting blood glucose level Elevated random blood glucose level Slow wound healing Frequent yeast infections Polydipsia (excessive thirst) Polyuria (excessive urination)

Endocrine - aging

Decreased ovarian production of estrogen - Bone density decreases; Skin is thinner, drier and at greater risk for injury; Perineal and vaginal tissues become drier and the risk for cystitis(inflammation of the bladder) increases

A client has been admitted to the medical ICU with a dx of diabetes insipidus secondary to lithium overdose. Which medication is used to treat the DI?

Desmopressin (DDAVP)

Hyposecretion of the pancreas

Diabetes Mellitus

Sulfonylurea agents

Diabinese Tolinase Glucotrol Glyburide (Micronase) Amaryl

Interventions include:

Dietary interventions, blood glucose monitoring, exercise program, weight control.

Hyperpituitarism drugs

Drug therapy: bromocriptine mesylate (Parlodel), cabergoline (Dostinex) and pergolide (Permax) Side effects: orthostatic hypotension, gastric irritation, nausea, headache, abdominal cramps and constipation. Serious side effects: dysrhythmias, coronary artery spasms, CSF leakage Stop for pregnancy Samostatin analogues: ocreotide (Sandostatin) a GH blocker and Somavert.

DI interventions

Drugs: Desmopressin (DDAVP) - synthetic ADH, encourage oral intake of fluids, daily weights, teach: polyuria and polydipsia indicate need for another dose

Why is lithium limited?

Due to its side effects: *Diabetes Insipidus *Tremors *N &V ***Drink @ least 3-4 quarts of fluid daily!

Dawn phenomenon

Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.

Which of the following is not a category of endocrine gland stimulus?

Enzyme

When it becomes necessary to enlist the fight-or-flight response, a hormone that is released during the alarm phase of the general adaptation syndrome is ________.

Epinephrine

Which of the following is not a steroid-based hormone?

Epinephrine

Principal Hormones of the Endocrine Glands: Ovary

Estrogen, Progesterone

Physical Assessment

Examine for: Prominent forehead or jaw Round or puffy face Dull or flat expression Exophthalmos - protruding eyeballs, retracted upper lids Vitiligo - patchy areas of pigment loss Striae- reddish purple "stretch marks" Buffalo Hump Hirsutism - excessive growth of body hair especially on the face, chest and linea alba of the abdomen in women

A man has been told that he is not synthesizing enough follicle-stimulating hormone (FSH), and for this reason he may be unable to father a child. Choose the correct statement to explain this problem.

FSH stimulates sperm production in the testes

Anterior Pituitary Hormone FSH (follicle-stimulating hormone) Target Tissue & Actions:

Female: Ovary; Stimulates estrogen secretion and follicle maturation; Male: Testis; Stimulates spermatogenesis

Anterior Pituitary Hormone LH (luteinizing hormone or Leydig cell-stimulating hormone) Target Tissue & Actions:

Female: Ovary; Stimulates ovulation and progesterone secretion; Male: Testis; Stimulates testosterone secretion

Functions of thyroid hormones:

Fetal development, particularly neural and skeletal systems; Control metabolic rate of all cells; Promote sufficient pituitary secretion of growth hormone and gonadotropins; Regulate protein, carbohydrate, and fat metabolism; Exert chronotropic and inotropic cardiac effects; Increase red blood cell production; Affect respiratory rate and drive; Increase bone formation and decrease bone resorption of calcium; Act as insulin antagonists

Gestational Diabetes

First appears in pregnancy and disappears after pregnancy is terminated

SIADH interventions

Fluid restriction, monitor for 2lb/day weight gain, diuretics, hypertonic saline infusions (e.g. 3% NaCl). Demeclocycline (thrush is a side effect). Monitor for signs of fluid overload: bounding pulse, neck vein distention, crackles in lungs, pulmonary edema. Keep the patient safe in the event of severe hyponatremia. Regular neurological assessment.

The client with diabetes insipidus has dry lips & mucous membranes and poor skin turgor. Which intervention does the nurse provide first?

Forces fluids * dry lips & mucous membranes are indications of dehydration, which can occur with diabetes insipidus.

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients?

Glucagon release *glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep.

Cells that respond to peptide hormones usually do so through a sequence of biochemical reactions involving receptor and kinase activation. In order for cells to respond, it is necessary for first and second messengers to communicate. This is possible because ________.

G protein acts as the link between first and second messengers

Other types include:

Genetic defect beta cell or insulin Disease of exocrine pancreas Drug or chemical induced Infections Other genetic syndromes.

Principal Hormones of the Endocrine Glands: Adrenal cortex

Glucocorticoids (cortisol)

To best determine how well a client with diabetes mellitus is controlling blood glucose, which test will the nurse monitor?

Glycosylated hemoglobin (HbA1c)

Diet Therapy

Goals of diet therapy Principles of nutrition in diabetes Protein, fats and carbohydrates, fiber, sweeteners, fat replacers Alcohol Food labeling Exchange system, carbohydrate counting Special considerations for type 1 and type 2 diabetes

What is the most frequent cause of hyperthyroidism?

Graves disease; usually has goiter, exophthalmos, pretibial myxedema

The client is taking fludrocortisone (Florinef) for adrenal hypo function. The nurse instructs the client to report which symptom while taking this drug?

Headache

Which organ is responsible for synthesizing ANP?

Heart

Hypercorticolism labs

High salivary cortisol levels ACTH high with adrenal Cushing's, but low when r/t chronic steroid use. Increased BG Decreased lymphocytes Increased Na Decreased Ca Decreased K

Which hormone levels should the nurse expect to change in response to a client receiving a continuous cortisol infusion over a 24 hr period when the endocrine negative feedback mechanism is functioning properly?

Higher than normal serum cortisol levels, lower than normal serum ACTH levels.

Assessment

History Blood tests: to diagnose diabetes Fasting blood glucose test: two tests > 126 mg/dL Oral glucose tolerance test: blood glucose > 200 mg/dL at 120 minutes Glycosylated hemoglobin assays (HbAiC, A1C) >8% Glucosylated serum proteins and albumin

In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose?

Homeostasis

Negative Feedback System

Hormone secretion depends on the need of the body for the final action of that hormone. A hormone is secreted to correct the incorrect amount of another hormone, thereby causing an opposite action of the initial condition.

Chemical substances secreted by cells into the extracellular fluids that regulate the metabolic function of other cells in the body are called ________.

Hormones

Which statement is true about hormones and their receptor sites?

Hormones need a specific receptor site to work.

Often thyroid replacement therapy is based on what?

How high the TSH level is rather than how low the T3 & T4 level are

Eicosanoids do not include ________.

Hydrocortisones

Absence of Insulin

Hyperglycemia Polyuria hyperosmolarity Polydipsia Polyphagia Dehydration: Hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration ABG's: DECREASED pH, HCO3, and PaCO2 Hypokalemia, hyperkalemia, or normal serum potassium levels

Hyperglycemic-hyperosmolar-nonketotic syndrome

Hyperglycemia, hyperosmolarity, dehydration, absence of ketosis, depression of sensorium Seen with Type 2 DM

Complications of Insulin Therapy

Hypoglycemia Lipoatrophy Dawn phenomenon Somagyi's phenomenon

Hyperpituitarism Surgery

Hypophysectomy: Decreases hormone levels, relieve's headaches, may reverse changes in sexual functioning. Body changes, organ enlargement not usually reversible. Mustache pad, monitor for CSF leakage. Elevate HOB 30. Avoid coughing, bending, straining at BM, etc. Monitor for menigitis. Hormone replacement therapy for the rest of their life. Decreased sense of smell, Vasopressin therapy.

The size and shape of a pea; produces hormones that stimulate other endocrine glands

Hypophysis

Endocrine glands

Hypothalamus Pituitary Adrenal Thyroid Islet cells of the pancreas Parathyroid glands Gonads

Endocrine glands:

Hypothalamus (a neuroendocrine gland); Pituitary gland (brain); Adrenal glands (kidneys); Thyroid gland (throat); Islet cells of the pancreas; Parathyroid glands (throat); Gonads (tstes and ovaries)

The nurse is teaching the client about the correct procedure for a 24 hour urine test for creatinine clearance. Which statement by the client indicates a need for further testing?

I should not eat any proteins while I am collecting urine for this test. *eating protein does not interfere with collection or testing of the urine sample.

Prediabetes

Impaired Fasting Glucose (IFG) of 100 mg/dL to 125 mg/dL

Excessive PRL secretion

Inhibits gonadotropins resulting in galactorrhea, amenorrhea and infertility

The client has been diagnosed with hyperpituitarism resulting from a prolactin secreting tumor, and bromocriptine mesylate (parlodel) has been prescribed. As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain?

Inhibits the release of some pituitary hormones.

A client is hospitalized for pituitary function testing. Which of the nursing actions included in the clients plan of care will be most appropriate for the RN to ask the LVN to do?

Inject regular insulin for the growth hormone stimulation test

Hypothyroidism results in what?

Increase in TSH secretion which enlarged thyroid

Hyperaldosteronism

Increased aldosterone cause Na retention and K and H excretion so: hypernatremia, hypokalemia, metabolic alkalosis, HTN Interventions: Adrenalectomy, Spironolactone to increase K retention

Diabetic ketoacidosis

Increased depth/rate of respirations Increased urine output Tachycardia Orthostatic hypotension

Which lab result indicates that fluid restrictions have been effective in treating SIADH?

Increased serum sodium

Pharmacokinetics of Insulin

Injection site Absorption rate Injection depth Time of injection Mixing insulins

The client has undergone a trans-sphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing ICP in the client?

Instructs the client not to strain during a bowel movement

What hormone helps with the synth of proteins?

Insulin

Insulin therapy:

Insulin therapy: Rapid Acting Humalog; Novolog Short-acting insulin (Regular) Humulin R, Novolin R (Regular Insulin) Intermediate Humulin N; Novolin NPH Combinations: NPH/Regular Long Acting Glargine (Lantus)

Principal Hormones of the Endocrine Glands: Pancreas

Insulin, Glucagon, Somatostatin

what is basal insulin?

Intermediate and Long acting insulin. it's continual and steady. ex Lantus/Levamir

Chapter 67

Interventions for Clients with Diabetes Mellitus

Risk for Injury Related to Disturbed Sensory Perception: Visual

Interventions include: Blood glucose control Environmental management Incandescent lamp Coding objects Syringes with magnifiers Use of adaptive devices

Ineffective Tissue Perfusion: Renal

Interventions include: Control of blood glucose levels Yearly evaluation of kidney function Control of blood pressure levels Prompt treatment of UTIs Avoidance of nephrotoxic drugs Diet therapy Fluid and electrolyte management

Potential for Hyperglycemic-Hyperosmolar Nonketotic Syndrome and Coma

Interventions include: Monitoring Fluid therapy: to rehydrate the client and restore normal blood glucose levels within 36 to 72 hr Continuing therapy with IV regular insulin at 10 units/hr often needed to reduce blood glucose levels

Potential for Diabetic Ketoacidosis

Interventions include: Monitoring for manifestations Assessment of airway, level of consciousness, hydration status, blood glucose level Management of fluid and electrolytes Drug therapy goal: to lower serum glucose by 75 to 150 mg/dL/hr Management of acidosis Client education and prevention

The nurse is teaching the client about maintaining a proper diet to prevent a endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish?

Iodized salt for cooking. *dietary deficiencies in iodine- containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food prep.

Thyroxine is a peptide hormone, but its mechanism is different from other peptide hormones. Which of the following statements is true concerning this difference?

It does not require a second messenger to effect a response

With hyperthyroidism is TSH elevated or decreased?

It is decreased

With hyperthyroidism is T3 and T4 elevated or decreased?

It is increased.

Renin

Its release is triggered by a decrease in extracellular fluid volume, which can occur from blood loss, sodium loss, or posture changes (low BP triggers release). Renin converts renin substrate (formerly called angiotensinogen), a plasma protein made in the liver, to angiotensin I. Angiotensin I is converted by a converting enzyme to form angiotensin II, the active form of angiotensin. In turn, angiotensin II stimulates the secretion of aldosterone. Aldosterone causes the kidney to reabsorb sodium and water to bring the plasma volume and osmolarity back to normal.

Posterior Pituitary Hormone Vasopressin (antidiuretic hormone [ADH]) Target Tissue & Actions:

Kidney; Promotes water reabsorption

Ketones in urine=?

Lack of insulin

Pancreas

Lies behind the stomach and has endocrine and exocrine functions. Islets of Langerhans performs the endocrine functions. Has 3 distinct cell types: Alpha Cells - secrete glucagon Beta Cells - sectete insulin Delta Cells - secrete somatostatin

Which of the following organs is affected by thyroid hormone in adults?

Liver

Which organ does not have hormone production?

Liver

Adrenal hypofunction manifestations

Loss of aldosterone and cortisol action. Decreased gluconeogenesis, Depletion of liver and muscle glycogen leading to Hypoglycemia and reduced nitrogen secretion Anorexia and weight loss K, Na and H2O imbalances

Functions of glucocorticoid hormones

Maintain blood glucose level by increasing hepatic gluconeogenesis and inhibiting peripheral glucose use; Increase lipolysis, releasing glycerol and free fatty acids; Increase protein catabolism; Degrade collagen and connective tissue; Increase the number of polymorphonuclear leukocytes released from bone marrow; Exert anti-inflammatory effects that decrease the migration of inflammatory cells to sites of injury; Maintain behavior and cognitive functions

Chronic Pain

Maintenance of normal blood glucose levels Anticonvulsants Antidepressants Capsaicin cream

Anterior Pituitary Hormone PRL (prolactin) Target Tissue & Actions:

Mammary glands; Stimulates breast milk production

Cardiovascular disease

Managed (ADA) by: BP at 130/80; LDL<100mg/dl(pts with CVD) and <70 for those without CVD);Retinopathy (vision) problems Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction

When caring for DM, what is significance of MED?

Medications Exercise Diet

Anterior Pituitary Hormone MSH (melanocyte-stimulating hormone) Target Tissue & Actions:

Melanocytes; Promotes pigmentation

Hypopituitarism

Metabolic and sexual dysfunction Deficiencies of TSH and ACTH are most serious Can be caused by anorexia nervosa or rapid weight loss, head trauma, shock or severe hypotension, brain tumors, infection or postpartum hemorrhage (see Sheehans)

A first-step oral HG commonly prescribed is?

Metformin

Biguanides

Metformin (Glucophage)

Adrenal Cortex

Mineralocorticoids - (Aldosterone) Glucocorticoids/Corticosteroids - (Cortisol)

Cushings manifestation

Moon face, buffalo hump, truncal obesity, weight gain HTN, Increased risk for thromboses, dependent edema, capillary fragility: bruising and petechiae Muscle atrophy, Osteoporosis (necrosis of femur head, slow healing of bones) Thin skin, striae (cortisol destroys collagen), increased pigmentation Increased risk for infection, decreased immune function, decreased inflammatory response, Emotional lability, mood swings, irritability

Hyperpituitarism

Most common cause: pituitary adenoma

Pheochromocytoma

NE and Epi releasing tumors in the adrenal medulla. Manifests: HTN, severe headache, profuse diaphoresis, flushing, apprehensiveness, angina, N/V. TCA's, glugagon, reglan, naloxone can cause HTN crisis here. Avoid tyramine Interventions: surgery, adrenalectomy. BP stabilized with B-Blockers several weeks before surgery

When stridor, dyspnea, or other symptoms of airway obstruction appear after thyroid surgery occur what should be done?

Notify the RRT immed.

Hypercortisolism interventions

Nutrition: salt and fluid restriction Drugs: interfere with ACTH production (Periactin) or cortisol synthesis (ELipten, Cytadren Metopirone). Lysodren may be used for inoperable adrenal tumors, cytotoxic Monitor I/O's and weight, sg <1.005 indicates fluid overload Radiation for some adenomas Surgical: hypophysectomy or adrenalectomy Teach: avoid activities that can lead to skin trauma, safety to avoid bone density issues (fractures), GI bleeds can occur since cortisol inhibits mucous production (Zantac). Continually monitor for infection (cortisol reduces immune function)

HHS Hyperglycemic-Hyperosmolar State

Onset: Gradual Precipitating factors: Infection, Poor fluid intake Manifestations: Altered central nervous system function with neurologic symptoms. Dehydration or electrolyte loss: polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma Serum glucose: >600 mg/dl Osmolarity >320 mOsm/L Ketones: negative

DKA Diabetic Ketoacidosis

Onset: Sudden Precipitating factors: Infection, inadequate insulin dose Manifestations: Ketosis: Kussmaul respiration, "fruity" breath, nausea, abdominal pain. Dehydration or electrolyte loss: polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma Serum glucose: >300 mg/dl Ketones: present

Excessive ACTH secretion

Overstimulation of corticosteroids: glucocorticoids, mineralocorticoids and androgens leading to Cushings

Produces hormones that regulate glucose levels in the body

Pancreas

Produces a hormone that controls blood levels of calcium and potassium by their removal from bone tissue

Parathyroid

Principal Hormones of the Endocrine Glands: Parathyroid

Parathyroid hormone (PTH)

Assessment

Patient history Nutrition history Family history and genetic risk Current health problems

Type 2 Diabetes

Peaks in 50s, but increasingly occurs earlier. thirst, fatigue, blurred vision, vascular or neural complications. Insulin resistance, dysfunction pancreatic beta cell/insufficient insulin or resistance. Hereditary. 60%-80% are obese. Only 20%-30% require insulin

Addisons Disease

Primary and secondary Secondary is most often due to sudden cessation of long term high dose corticosteroid therapy Na can drop suddenly and K can rise just as suddenly Hyponatremia, hyperkalemia, hypercalcemia, vitiligo, hyperpigmentation, N/V, salt craving, anorexia, fatigue, weakness Labs: low serum cortisol, low FBG, low Na, high K, and increased BUN

Mineralocorticoids

Produced by the adrenal cortex to help control the body's sodium and potassium content; body fluids and electrolytes. Aldosterone - the main one; maintains extracellular fluid volume.

A client presents to the ED with acute adrenal insufficiency & the following vitals: HR 118 BP 84/44 pulse ox 98% & temp 98.8 oral. Which intervention does the nurse prioritize for this client?

Providing isotonic fluids

what is prandial insulin?

Rapid and short acting Associated w/meals. rapid-novalog and humalog short acting-humulin, novolin

Endocrine glands must use the ____________________ to transport secreted hormones to target tissues. ANS: blood

Rationale: Endocrine glands are "ductless" and use the blood to transport the selected hormone to the target tissue.

The client has not taken the prescribed levothyroxine sodium (Synthroid) and is admitted to the emergency department for myxedema coma. Number the following nursing diagnoses in order of priority. ANS: 3_ Disturbed Thought Processes related to lethargy 4_ Hypothermia related to decreased metabolic rate 5_ Constipation related to decreased motility of the gastrointestinal tract 2_ Decreased Cardiac Output related to decreased metabolism 1_ Ineffective Breathing Pattern related to fatigue

Rationale: Myxedema coma is characterized by coma, respiratory failure, hypotension, hyponatremia, and hypothermia. In the unstable client, the priority of care is always airway, breathing, and circulation. Therefore, the nurse's priority, together with that of the medical staff, is to ensure an adequate and patent airway, monitor vital signs and intervene as necessary. Once an airway and circulation are managed, the client's neurologic status is checked. As cardiac output increases, perfusion to the client's brain increases and the client's level of consciousness should improve. Hypothermia must be managed to prevent further cardiovascular compromise, such as cardiac dysrhythmias.

Excessive thyroid hormone secretion leads to hyperthyroidism. The manifestation of hyperthyroidism is called ____________________. ANS: thyrotoxicosis

Rationale: This is a state of hypermetabolism affecting metabolism in all body organs.

SIADH causes

Recent head trauma CVD TB or other pulmonary disease Cancer Drugs (Chlorpropamide, Vincristin, Carbamazepine, Opioids, TCA's, Cyclophosphamides, DDAVP

A client with a possible adrenal gland tumor is admitted to the medical unit for testing and treatment. Which nursing action will be most appropriate for the charge nurse to delegate to the nursing assistant?

Remind the client to avoid drinking coffee & sudden position changes. *drinking caffeinated beverages and changing positions suddenly are not safe for a client with a potential adrenal gland tumor bc of the effects of catecholamines.

chelaters

Removed unwanted products from the body (ex can attach to iron, calcium, etc)

Type I

S/S: 3 P's; weight loss, weakness

Type 2

S/S: Type 1 + visual blurring vascular or neural complications

Virtually all of the protein or amino acid-based hormones exert their effects through intracellular ________.

Second messengers

The nurse is reviewing these lab results for a client admitted w/ a possible pituitary disorder. Which information has the most immediate implication for the clients care?

Serum sodium 110 mEq/L * normal range for serum sodium is 135-145. A result of 110 is considered hyponatremia & is extremely dangerous. The client is at risk for increased ICP, seizures, & death.

Gynecomastia

Side effect of testosterone therapy

Insulin Regimens

Single daily injection protocol Two-dose protocol Three-dose protocol Four-dose protocol Combination therapy Intensified therapy regimens

Hypoglycemia

Skin: Cool & clammy Mental Status: Anxious, nervous, irritable, confused, seizure, coma Symptoms: double/blurred vision, hunger, tachycardia, palpitations Glucose: <70 mg/dl No Ketones

Hyperglycemia

Skin: Warm & moist Mental Status: from alert to stuporous, obtunded, or frank coma Symptoms: Rapid, deep (Kussmaul) respirations, fruity breath, Acidosis; hypercapnia; abdominal cramps, N/V Dehydration: decreased neck vein filling, orthostatic hypotension, tachycardia, poor skin turgor Glucose: >250 mg/dl Ketones present

Management of hypothyroidism

Start at lowest dose of thyroid hormone

Step therapy re diabetes:

Step 1: lifestyle changes Step 2: Oral hypoglycemics Step 3: oral HGs[2 of them] Step 4:oral HGs [3 of them] Step 4b: oral HGs [3] and Insulin Step 5: Insulin alone

Laboratory tests

Stimulation/suppression tests - to verify if capable of normal hormone production Assays - measures the level of a specific hormone in blood or other body fluids Urine Tests - hormone levels and the metabolites of specific hormones Tests for glucose - measures the result of pancreatic islet cell function Imaging assessment - to veiw the sella turcica Other diagnostic assessment - needle biopsy

Client Education

Storage and dose preparation Syringes Blood glucose monitoring Interpretation of results Frequency of testing Blood glucose therapy goals

Adrenal Glands

Tent-shaped organs on top of each kidney Adrenal Cortex (outer edge) - makes up about 90% of the gland

A client is referred to a home health agency after a tran-sphenoidal hypophysectomy. Which action will the RN case manager delegate to the home health aide who will see the client daily?

Test any nasal drainage for the presence of glucose.

An elementary school student asks a nurse about injecting steroids. What does the nurse know is most commonly involved in steroid abuse?

Testosterone

Principal Hormones of the Endocrine Glands: Testes

Testosterone

Goals for Triglycerides Goals for Cholesterol

Tgs=under 150 LDL under 100 HDL over 40

Urine Tests

The ADA recommends testing urine for ketones during acute illness or stress, when blood glucose levels consistently exceed 300 mg/dL (16.7 mmol/L), during pregnancy, or when any symptoms of ketoacidosis are present (ADA, 2003s). Ketone testing is recommended for diabetic clients following a weight loss program Urine testing for renal function Urine testing for glucose

The client with Cushing's begins to laugh loudly & inappropriately , causing the family in the room to be uncomfortable. What is the nurses best response?

The disease can sometimes affect emotional responses.

neuroendocrine regulation

The endocrine system works with the nervous system to regulate overall body function

Normal development of the immune response is due in part to hormones produced by the ________.

Thymus gland

Produces the body's major metabolic hormones

Thyroid

The only amine hormone to act like a steroid is ________.

Thyroid Hormone

Principal Hormones of the Endocrine Glands: Anterior Pituitary

Thyroid-stimulating hormone (TSH), also known as thyrotropin; Adrenocorticotropic hormone (ACTH, corticotropin); Luteinizing hormone (LH), also known as Leydig cell-stimulating hormone (LCSH); Follicle-stimulating hormone (FSH); Prolactin (PRL); Growth hormone (GH); Melanocyte-stimulating hormone (MSH)

Exogenous hyperthyroidism

Too much thyroid medication

Principal Hormones of the Endocrine Glands: Thyroid

Triiodothyronine (T3); Thyroxine (T4); Calcitonin

ACTH stimulates the adrenal cortex to release corticosteroid hormones

True

All adenohypophyseal hormones except GH affect their target cells via a cyclic AMP second-messenger

True

All of the following hormones are secreted by the adenohypophysis: ACTH, FSH, and LH

True

All peptide hormone synthesis requires gene activation that produces mRNA

True

Atrial natriuretic peptide is a hormone that controls blood pressure in part by increasing the urinary excretion of sodium

True

Both "turn on" factors (hormonal, humoral, and neural stimuli) and "turn off" factors (feedback inhibition and others) may be modulated by the activity of the nervous system

True

In humans, melatonin may inhibit sexual maturation

True

Iodine is an essential element required for the synthesis of thyroxine

True

LH is also referred to as a gonadotropin

True

Many hormones synthesized in the gastrointestinal tract are chemically identical to brain neurotransmitters

True

Oxytocin is a strong stimulant of uterine contractions

True

The antagonistic hormones that regulate the blood calcium level are calcitonin-parathormone

True

The beta cells are the pancreatic islet cells that produce insulin

True

The prime metabolic effect of cortisol is gluconeogenesis

True

The thyroid gland is a large gland that controls metabolic functions throughout the life of an individual

True

While glucagon is a small polypeptide, it is nevertheless very potent in its regulatory effects

True

In circumstances where the body requires prolonged or increased levels of a hormone, the DNA of target cells will specify the synthesis of more receptors on the surface of the cells of the target organ. This is known as ________.

Up-regulation

Type 1 Diabetes

Usually younger than 30 yr at onset but can occur at any age. Abrupt onset, thirst hunger, polyuria, weight loss Viral infection triggers, Pancreatic beta-cells are destroyed Pt is usually nonobese and is always insulin dependent

Posterior Pituitary Hormone Oxytocin Target Tissue & Actions:

Uterus and mammary glands; Stimulates uterine contractions and ejection of breast milk

Principal Hormones of the Endocrine Glands: Posterior pituitary

Vasopressin (antidiuretic hormone[ADH]); Oxytocin

hyperviscosity

Waldenstrom's Macroglobulinemia (impairs blood flow, sludging in retinval vessels and cerebral vasculatrue)

SIADH Manifestations

Water retention, dilutional hyponatremia,

The nurse is caring for the client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in her shift. What does the nurse do?

Wears a face mask when caring for the client

The client with Cushing's disease says that she has lost 1 lb. what does the nurse do next?

Weighs the client

Example of Negative Feedback

When blood glucose levels start to rise above normal, the hormone insulin is secreted. Insulin increases glucose uptake by the cells, causing a decrease in blood glucose levels.

A client has been admitted to the med surg unit with a dx of diabetes insipidus. The physician has requested desmopressin DDAVP. How does DDAVP decrease urine output?

Works as an anti diuretic hormone in the kidneys.

Wound Care

Wound environment Debridement Elimination of pressure on infected area Growth factors applied to wounds

hypovolemia

a blood disorder consisting of a decrease in the volume of circulating blood

hypoperfusion

a deficiency of blood passing through an organ or body part

Gastroparesis

a delay in gastric emptying that can cause hypoglycemia.

Which of the following would be associated with the action of steroids on cells?

a hormone-receptor complex that interacts directly with the cell's DNA

Dehydration

a serious reduction in the body's water content

Microalbuminuria

a small amount of albumin in the urine is a sign of Kidney disease.

Hypothalamus

a small area of nerve and glandular tissue located beneath the thalamus on each side of the third ventricle in the brain. Has both endocrine and nonendocrine functions.

To have metabolic syndrom, must have 3 of which?

abdominal obesity[greater than 40 inches for men, greater than 35 inches for women. hyperglycemia[fasting glucose levels over 100] hypertension[over 130/85] triglycerides over 150 low HDL [under 40-50]

Hyperglycemia

abnormally high blood sugar usually associated with diabetes

Anterior Pituitary Hormone ACTH (adrenocorticotropic hormone, corticotropin) Target Tissue & Actions:

adrenal cortex; Stimulates synthesis and release of corticosteroids and adrenocortical growth

The ______ ______ secretes norepinephrine and epinephrine.

adrenal medulla

Type 2 DM: etiology patho risk factors SS insulin use other meds/txs

adult onset insulin resistance. impaired insulin secretion. body can't use Insulin as well Family history, obesity, sedentary lifestyle, ethnicity, HTN, elevated lipid levels Microvascular Disease, though may have none Possible insulin use Diet, exercise, weight loss, oral hypoglycemics

which ethnicities are more prone to metabolic syndrome?

african americans hispanic asian native americans

Serum potassium level controls secretion of ______.

aldosterone; The adrenal cortex secretes aldosterone when the serum potassium level increases above normal by as little as 0.1 mEq/L.

Endocrine system disorders

are related to either an excess or a deficiency of a specific hormone or to a defect at its receptor site. The onset can be either slow and insidious or abrupt and life threatening.

Type 1 DM: etiology patho risk factors SS Insuline use Other meds/tx

autoimmune disease beta cells are destroyed. low or NO insulin produced. presence of Abs. Recessive HLA gene is risk factor SS-Polydipsia, Polyuria, Polyphagia Insulin use required Oral hypoglycemics are NOT effective. Diet and Exercise imp. Tx- dependent on insulin

The second-messenger mechanism of hormone action operates by ________.

binding to specific receptors and employing the services of G proteins and cAMP

Dietary interventions

blood glucose monitoring, exercise program, weight control.

The major targets of growth hormone are ________.

bones and skeletal muscles

Calcium and phosphorus balance occurs through the actions of _______.

calcitonin

Parathyroid Glands bottom of p. 1417

come back here

Which of the following is not a change that may be caused by hormonal stimulus?

direct control of the nervous system

Sometimes prolonged excessive exposure to high hormone concentrations causes a phenomenon known as ________.

down-regulation

Hormones often cause a cell to elicit multiple responses; this is because ________.

during protein kinase activation, enzymes phosphorylate many other enzymes

Thyroid hormone exerts its influence by ________.

entering some cells and binding to intracellular receptors within the nuclei.

Steroid hormones exert their action by ________.

entering the nucleus of a cell and initiating or altering the expression of a gene

Catecholamines include

epinephrine and norepinephrine

Risk for Injury Related to Hyperglycemia

hot,dry skin; dehydrated, rapid deep Kussmaul typye with fruity order respirations, MS is alert to coma; acidosic, abdominal cramps, N/V, orthostatic hypotension, tachycardia, poor skin tuger, glucose > 250. positive ketones.

One of the least complicated of the endocrine control systems directly responds to changing blood levels of ions and nutrients. Which of the following describes this mechanism?

humoral stimulation

Too much parathyroid hormone causes?

hypercalcemia & hypophosphatemia

Several hormones are synthesized in the hypothalamus and transported to the anterior pituitary gland. The mechanism of transportation from hypothalamus to anterior pituitary gland is through the ________.

hypophyseal portal system

Tropic hormones ________.

include ACTH and TSH

Glucocorticoids enable the body to deal appropriately with stress. They accomplish this by ________.

increasing blood glucose, fatty acid, and amino acid levels and enhancing blood pressure

Low serum calcium levels (inhibit/release) release of calcitonin. Elevated serum calcium levels (inhibit/release)its secretion. (chose one)

inhibit; increase

ADH ________.

is inhibited by alcohol

The hypothalamic-hypophyseal tract ________.

is partly contained within the infundibulum

The neurohypophysis or posterior lobe of the pituitary gland is not a true endocrine gland because ________.

it is only a hormone storage area that receives hormones from the hypothalamus for release

What is insulin's role in K+ mvt?

moves K into the cell

Hormones

natural chemicals that exert their effects on specific tissues (Target Tissues)

Hormone secretion depends on the need of the body for the final action of that hormone. When a body condition starts to move away from the normal range and a specific action or response is needed to correct this change, secretion of the hormone capable of causing the correcting action or response is stimulated until the need (demand) is met. As the correction occurs, hormone secretion decreases (and may halt). This type of control for hormone synthesis is called _______ ______ because the hormone causes the opposite action of the initial condition change.

negative feedback

hyperosmolarity

of the extracellular fluids secondary to hyperglycemia, more solute in relation to the solvent.

Calcitonin lowers serum calcium and serum phosphorus levels by reducing bone resorption (breakdown). Its actions are opposite of ________ hormone.

parathyroid

Cellular responses to hormones that initiate second-messenger systems include ________.

possible activation of several different second-messenger systems

What are three other factors that increase calcitonin release?

pregnancy, a high-calcium diet, and an increased secretion of gastrin.

Gonadocorticoid(s) ________.

production by the adrenal gland is insignificant compared with sex hormone release from the gonads during late puberty

Adrenal hypofunction interventions

promote fluid balance, monitor for fluid deficit, hyponatremia, hyperkalemia and prevent hypoglycemia, daily weights, record I/O's. Monitor VSs q1-4h, monitor labs for increased BUN and Hct. Replacement therapy for cortisol and aldosterone: hydrocortisone, fludrocortisone (mineralocorticoid)...

Growth hormone ________.

promotes long bone growth during the formative years

Dietary intake of _____ and _____ is needed to produce thyroid hormones.

protein; iodine

Nephropathy

reduction in kidney function that leads to kidney failure

Oxytocin ________.

release is an example of a positive feedback control mechanism

Polyuria

renal disorder characterized by the production of large volumes of pale dilute urine

suggestions for pre-diabetic screening:

screen ppl over 45 and with bmi over 25. screen for ppl any age who are overweight with risk factors

Thryoid Stimulating Hormone (TSH)

secreted by anterior pituitary in response to low thyroid hormone levels, which stimulates the thyroid gland to secrete more thyroid

ACTH ________.

secretion is regulated by a hypothalamic secretion

Thyroid hormone (a small iodinated amine) enters target cells in a manner similar to ________.

steroid hormones, because both diffuse easily into target cells

The parathyroid glands maintain adequate levels of blood calcium. This is accomplished through ________.

targeting the bone and activating osteoclasts so that calcium will be released

Aldosterone

the chief mineralocorticoid produced by the adrenal cortex, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. Aldosterone secretion is regulated by the renin-angiotensin system, serum potassium ion concentration, and adrenocorticotropic hormone (ACTH).

Give an example of a simple negative feedback hormone response.

the control of insulin secretion; When blood glucose levels start to rise above normal, the hormone insulin is secreted. Insulin increases glucose uptake by the cells, causing a decrease in blood glucose levels. Thus the action of insulin (decreasing blood glucose levels) is the opposite of or negative to the condition that stimulated insulin secretion (elevated blood glucose levels).

Neuroendocrine regulation

the endocrine system works with the nervous system to regulate overall body functions

The ability of a specific tissue or organ to respond to the presence of a hormone is dependent on ___

the presence of the appropriate receptors on the cells of the target tissue or organ

Types of Diabetes

type 1 and type 2

Insulin, a small (51-amino-acid) protein, is synthesized by the beta cells of the pancreas. This hormone is released ________.

when the body's glucose level rises