10 ENDOCRINE FINAL COMBINED
person with a triglyceride level of ______ or greater at risk for T2DM
150 mg/dL or greater
DI: serum electrolytes become _________ while urine electrolytes become ____________?
concentrated, dilute
Two types of DI
nephrogenic, central
DI subjective data
Excessive thirst (polydipsia) Report of excessive voiding (polyuria) Nocturia (waking up to urinate) Craving for ice water Fatigue Weakness Headache
complications of DM macrovascular
-Damage to the large blood vessels providing circulation to the brain, heart, and extremities(similar to atherosclerosis) coronary artery disease stroke peripheral vascular disease
DI risk factors
-autoimmune disease -> damage to hypothalamus -genetics -vascular disease affecting hypothalamus or pituitary -> stenosis of vessels leading pituitary. -Hypercalcemia -> damage to kidneys -Severe, persistent hypokalemia -> damage to kidneys -traumatic head injury -> central -surgery in the area close to hypothalamus or pituitary -> potential trauma, swelling, loss of function in cells. -Lithium toxicity -> nephrogenic type -Pyelonephritis -Renal disease
DM1 patho
-beta cells are destroyed -reduced or no insulin is produced -without insulin cells cannot get glucose through the cell membrane -cells cannot carry out normal metabolic pathway using glucose and body instead has to burn fat -results in ketone build up, metabolic acidosis
DM2 patho
-insulin resistant! -cells dont respond well to insulin or body doesn't produce enough insulin -glucose cant enter cells at all or entry reduced -cells cant carry out normal metabolic pathway using glucose and body has to burn fat -causes metabolic acidosis
Which of the following patients is at most risk for Type 2 diabetes?* A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided.
A 28 year old male with a BMI of 49. Type 2 diabetes risk factors are related to lifestyle....being obese is a risk factor (BMI >30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2.
Which of the following patients are at risk for developing Cushing's Syndrome?* A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. B. A patient taking glucocorticoids for several weeks. C. A patient with a tuberculosis infection. D. A patient who is post-opt from an adrenalectomy.
A patient taking glucocorticoids for several weeks.
Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy?* A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter
A. A patient is at risk for experiencing thyroid storm after a thyroidectomy because of manipulation of the thryroid gland that could cause excessive T3 and T4 to enter into the bloodstream during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 'F are classic signs of thyroid storm and this requires nursing intervention.
. A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after the procedure?* A. Glucocorticoid replacement therapy B. Avoiding avocadoes and pears C. Declomycin therapy D. Signs and symptoms of Grave's Disease
A. Glucocorticoid replacement therapy
Which of the following is not a typical sign and symptom of Cushing's Syndrome?* A. Hyperpigmentation of the skin B. Hirsutism C. Purplish striae D. Moon Face
A. Hyperpigmentation of the skin
In Cushing's Disease and Syndrome there are:* A. Increased cortisol production B. Low potassium and glucose levels C. Increased production of aldosterone and cortisol D. Decreased production of cortisol and aldosterone
A. Increased cortisol production
secondary adrenal insufficiency is the result of decreased _________in the body
ACTH
Addisons Complications
Acute adrenal insufficiency (often occurs when there is a sudden drop in the level of corticoids—often happens when steroids are not tapered) Hypoglycemia—increased sensitivity to insulin with decreased corticoids Hyperkalemia/ Hyponatremia—lack of aldosterone
A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient's family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient's blood pressure is 70/45. What disorder is this patient most likely experiencing?* A. Addisonian Crisis B. Cushing Syndrome C. Thyroid crisis D. Hashimoto thyroiditis
Addisonian Crisis
The _____ ______ secrete insulin which are located in the _______.* A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver D. Beta cells, pancreas
Beta cells, pancreas
Hyperthyroidism risk factor: Autoimmune disorder Graves Disease
Body attacks thyroid causes us to over produce T3 and T4 (hypermetabolic state)
___________ is an autoimmune disorder where the body attacks the thyroid gland that causes it to stop releasing T3 and T4. The patient is likely to have the typical signs/symptoms of hypothyroidism, however, they may present with what other sign as well?* A. Myxedema coma; joint pain B. Thyroid storm; memory loss C. Hashimoto's Thyroiditis; goiter D. Toxic nodular goiter (TNG); goiter
C: Hashimoto's Thyroiditis; goiter
Addisons Subjective
Can come on slowly (chronic Addison's) or quickly (acute adrenal insufficiency) Salt Craving Weakness Fatigue Nausea Dizziness
SIADH Risk factor: medications that impact
Carbamazepine Cyclophosphamide SSRIs can cause secretion of more ADH or enhance the action on the renal tubules
Adrenocorticotropic hormone (ACTH) is stimulated to be released by _________?
Corticotropin-Releasing Hormone [CRH])
Addison's Disease is:* A. Increased secretion of cortisol B. Increased secretion of aldosterone and cortisol C. Decreased secretion of cortisol D. Decreased secretion of aldosterone and cortisol
D. Decreased secretion of aldosterone and cortisol
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition?* A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss
D. Hair loss
A patient with Addison's Disease should consume which of the following diets?* A. High fat and fiber B. Low potassium and high protein C. High protein, carbs, and adequate sodium D. Low carbs, high protein, and increased sodium
D. Low carbs, high protein, and increased sodium
A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? Polyphagia Bradycardia Dehydration Hyperglycemia
Dehydration Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration. Polyphagia is a finding of diabetes mellitus, not insipidus. Hyperglycemia is a finding of diabetes mellitus, not diabetes insipidus. Tachycardia, not bradycardia, is a manifestation of diabetes insipidus.
DM1
Deranged metabolic state that results from destruction of beta cells in the pancreas
Cushing's Syndrome Subjective Data
Emotional liability Weakness Fatigue Joint pain
SIADH: Subjective Data
Headache (increased serum volume) Cramping (hypocalcemia and hypomagnesemia) Weight gain (excess fluid) Neurological changes (hyponatremia-cerebral edema)
A nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect? Heat intolerance Dry skin Bradycardia Drowsiness
Heat intolerance -The client who has an acute overdose of levothyroxine will exhibit insomnia, not drowsiness. -The client who has an acute overdose of levothyroxine will exhibit tachycardia, not bradycardia. -The client who has an acute overdose of levothyroxine will exhibit sweating and hyperthermia, not dry skin. -The client who has an acute overdose of levothyroxine will exhibit heat intolerance, sweating, and hyperthermia. These manifestations are indications of excessive levels of thyroid hormone that could lead to death.
DM complications
Hyperglycemia Hypoglycemia Electrolyte imbalance Cardiovascular disease (builds) Diabetic retinopathy (damage to retinas- increase glucose- small VESSELS big sugar molecules)
Hyperthyroidism risk factors
Hypothalamus dysfunction Pituitary dysfunction Hyperactivity of the thyroid gland Goiter (enlargement of thyroid gland Inflammation of the thyroid Autoimmune disorder (Graves' disease)
Thyroid: _____________ releases thyrotropin-releasing hromone (TRH) which acts on the ________________ pituitary
Hypothalamus; anterior pituitary
Your patient has been diagnosed with primary adrenal insufficiency. Based on this, you would expect that the patient would have: Decreased ACTH levels Increased ACTH levels Increased Cortisol levels Increased Aldosterone levels
Increased ACTH levels
Effects of thyroid hormone
Increases metabolic rate Increases cardiac output Increases ventilation Increases GI motility ncreased neural activity
A client has been diagnosed with an acute Addisonian crisis. Which of the following lab values would be expected for this individual? Blood glucose 259 K+ 5.8 Ca 9.0 Na 158
K+ 5.8 Individuals with Addisonian crisis will have a deficiency in aldosterone that causes hyperkalemia and hyponatremia. They will also have hypoglycemia.
A Type 2 diabetic may have all the following signs or symptoms EXCEPT:* A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing
Ketones present in the urine
mineralcorticoids
Maintain sodium/potassium balance (example is aldosterone)
DM2 Risk factors
Obesity (modifiable) Insulin resistance Sedentary lifestyle (modifiable) Hypertension Elevated lipids (modifiable) Age (non-modifiable) Genetics (non-modifiable)
What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?* A. DKA occurs mainly in Type 1 diabetics. B. Ketones are present in the urine in DKA. C. Cheyne-stokes breathing will always present in DKA. D. Severe hypoglycemia is a hallmark sign in DKA. E. Options C & D
Options C & D
hormonal disorders: secondary
abnormal in the anterior pituitary
hormonal disorders: tertiary
abnormal in the hypthalamus
hormonal disorders: TERTIARY
abnormal in the peripheral gland
primary adrenal insufficiency is the result of dysfunctional _____________?
adrenal glands
You are caring for a patient who has been experiencing weight gain, weakness, and hypertension. Upon examination you notice that the patient does have a buffalo hump, truncal obesity and stretch marks. Which of the following possible causes would be the most likely for this patient? Adrenal hyperplasia Adrenal hypoplasia Removal of the pituitary gland Hypothalamus dysfunction
adrenal hyperplasia
ACTH-independent most often results from _____________________
adrenal hyperplasia/neoplasia
adrenal gland cortex
aldosterone, cortisol, androgens
ACTH causes ?
an increase in the production and release of cortisol
Adrenocorticotropic hormone (ACTH) is produced and secreted by the _____________?
anterior pituitary
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?* A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.
assessment finding of crackles throughout the lung fields
DM1 risk factors
autoimmune disorders idiopathic
dawn effect
characterized by increased fasting BGL and or insulin requirements during the early morning hours not triggered by a preceding hypoglycemic event (in contrast to Somogyi)
The suggestive mechanism for SIADH in positive pressure ventilation is activation of ____________ both aortic and cardiopulmonary that respond to marked changes in intrathoracic pressure
baroreceptors
SIADH Risk factor: tumors in which organs
brain (excessive production of ADH) and lung (ectopic ADH)
Diabetes Insipidus (DI) (opposite of SIADH)
deficient levels of anti-diuretic hormone (ADH) aka vasopressin cant concentrate urine, polyuria (too much urination) and excessive thirst
Cushings syndrome can be ACTH ____________ or ACTH _______________
dependent or independent
hyperthyroidism (meth)
disease that results from an excess of thyroid hormone (stimulant)
diabetes definition
disorder of carbohydrate, protein, and fat metabolism caused by lack of insulin or decreased insulin efficacy
Addisons: Hypoglycemia
due to decreased corticoids (increased sensitivity to insulin)
Addisons: hyperkalemia/hyponatremia
due to lack of aldosterone
Hypothyroidism : risk factors
dysfunction of hypothalamus dysfunction of anterior pituitary dysfunciton of thyroid thyroidectomy other tx for hyperthyroidism iodine deficiency too much iodine Autoimmune disease (Hashimoto thyroiditis)
Somogyi effect
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic event
DI: pathophysiology
either the production of ADH or the bodys ability to use ADH is interrupted Body excretes fluid at a much higher rate than normal Serum electrolytes become concentrated and urine electrolytes dilute
goiter
enlargement of the thyroid gland
SIADH pathophysiology
excessive release of ADH serum saturated with fluid, excess fluid build up in body reduced urinary output serum electrolytes become dilute urine electrolytes are concentrated worried about the development of hyponatremia as a result of the fluid imbalance
You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient?* A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity
fluid volume overload
Cushings syndrome
hypersecretion of cortisol
Parathyroid gland produces ______________ which _____________?
parathyroid hormone (PTH) which increases Ca levels in serum
A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching? "My son might complain of feeling shaky when he has a low blood glucose level." "The onset of low blood glucose usually occurs slowly." "My son might have nausea and vomiting with hypoglycemia." "Sweating can occur with hyperglycemia."
"My son might complain of feeling shaky when he has a low blood glucose level." Hypoglycemia typically occurs rapidly, within minutes. A shaky feeling is a consistent finding of hypoglycemia. The appearance of pallor and sweating occurs with hypoglycemia, rather than hyperglycemia. Nausea and vomiting occur with hyperglycemia, rather than hypoglycemia.
SIADH Risk factor: Increased intrathoracic pressure
(mechanical ventilation) reduces the filling of the arteries causing the body to think that it needs to hang on to more fluid
person with a fasting blood glucose of ______ or greater at risk for T2DM
150 mg/dL or greater
person with abdominal girth of _______ or greater at risk for T2DM
35 inches or greater
Risk factors of Cushings Syndrome
Adrenal hyperplasia Cancer of the adrenal gland Pituitary carcinoma Chemo Asthma Allergies Chronic inflammatory diseases Small-cell lung CA (can secrete its own ACTH)
Addisons Disease: patho
Adrenocortical insufficiency due to destruction/ dysfunction of the adrenal cortex.
Addisons Risk factors
Autoimmune dysfunction Adrenalectomy Cancer TB Steroid withdrawal (modifiable) Hypophysectomy Sepsis Trauma Stress (modifiable)
The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Note: Select all that apply* A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland
B, C, and E. T3 and T4 burn calories (not store them) and increases body temperature (not decrease).
In Cushing's disease, the _______ is secreting too much ACTH (Adrenocorticotropic hormone) which is causing an increase in cortisol production.* A. Adrenal cortex B. Pituitary gland C. Thyroid gland D. Hypothalamus
B. Pituitary gland
Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______.* A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH
B: Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing?* A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter
B: Myxedema Coma...The red flags in this question are the patient's signs/symptoms and the report from the family the patient hasn't been taking the prescribed Synthroid. The patient is showing signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not treated).
A client has been diagnosed with diabetic ketoacidosis. Which of the following interventions would help to counteract the client's acidosis directly? Isotonic fluids Insulin Bicarbonate Oxygen
Bicarbonate
Which of the following symptoms do NOT present in hyperglycemia?* A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria
Blood glucose <60 mg/dL
A nurse is assessing a female client who is at risk for developing type 2 diabetes mellitus. The nurse should identify that which of the following manifestations increases the client's risk for developing type 2 diabetes? Fasting blood glucose 98 mg/dL Blood pressure 138/98 mm Hg Triglyceride level 100 mg/dL Abdominal girth 32 inches
Blood pressure 138/98 mm Hg A female client who has a blood pressure greater than 130 mm Hg systolic and 85 mm Hg diastolic is at risk for type 2 diabetes. Fasting blood glucose 98 mg/dL (100 or >) Triglyceride level 100 mg/dL (150 or >) Abdominal girth 32 inches (35 inches or >)
Which of the following would be considered a symptom of SIADH? Weak, thready pulse Weight loss Crackles in the lungs Hypotension
Crackles in the lungs results from an increase in the amount of ADH in the body and therefore results in fluid retention. This causes hypertension, weight gain, and peripheral edema in addition to respiratory issues associated with fluid overload.
A client is suffering from complaints of weakness and fatigue. She complains of changes in her skin and delayed healing. Upon examination you notice that she has a rounded face and fat deposit on the back of her neck. Based on this information you suspect that the client is suffering from: Addison's disease Diabetes insipidus SIADH Cushing's syndrome
Cushing's syndrome
Cushing's Syndrome: objective data
Delayed healing Thin skin Moon face Buffalo hump Truncal obesity Hypertension Elevated blood sugar Bruising Petechiae Muscle atrophy-especially in arms and legs Osteoporosis-mineral loss due to altered metabolism Striae Increased risk for infection Decreased inflammatory response Hirsutism Acne Hypernatremia, hypokalemia
A client has just returned from the operating room after having a craniotomy to resect a brain tumor. As you are monitoring the client in the postoperative period, you notice an hourly urine output (UOP) that has increased from 45 mL in the previous hour to 850 mL this hour. The nurse is concerned that the client is developing which of the following issues: SIADH Cushing's Syndrome Diabetes insipidus (DI) Hyperthyroidism
Diabetes insipidus (DI) It is possible for clients to develop DI in the period after brain surgery. This is because the surgery can affect the pituitary and can hinder the development and release of ADH. The other issues listed would not be an acute concern for this individual.
additional DM complications (most of which are severe)
Diabetic nephropathy (damage to kidneys- increase glucose- small VESSELS big sugar molecules) HHS (Type II) Ketoacidosis à metabolic acidosis à treat rapidly Cardiac arrest Death
SIADH
Excessive ADH (vasopressin) secretion; causes fluid retention and potential electrolyte imbalances
DI complications
Hypovolemia (not perfusing organs) Cardiac arrest (potassium, lack of perfusion) Cardiac dysrhythmias Seizures
Cushings syndrome complications
Perforation of the viscera—caused by weakened stomach lining due to increased cortisol Pathologic bone fractures—due to hypocalcemia Immunosuprression
complications of DM: microvascular
Retinopathy -blindness neuropathy nephropathy disorders of GI
A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?* A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient
SIADH
Your client has complaints of headache and is confused. He is coughing, has a full, bounding pulse, and peripheral edema. You suspect which of the following hormonal changes would cause this issue: SIADH Diabetes Insipidus Cushing's Syndrome Addison's Disease
SIADH
concerned with the following electrolyte imbalance with SIADH ______________?
SIADH
TSH acts on the thyroid gland to cause _____________________ to be released from the thyroid gland
T3 and T4
The thyroid gland produces
T3, T4, Calcitonin (lowers Ca levels in serum)
The levels of T3 and T4 regular levels of _______ and ______ to maintain homeostasis
TRH and TSH
Which of the following s/s would be associated with hyperthyroidism? Tachycardia Bradycardia Weight gain Facial edema
Tachycardia
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to?* A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism
The answer is D: Hypothyroidism...Iodine helps make T3 and T4....if a person does not consume enough iodine they are at risk for developing HYPOTHYROIDISM.
Type I diabetes results in metabolic acidosis because of: A reduction in glucose in the body Aerobic metabolism The accumulation of glucose The buildup of ketones in the body
The buildup of ketones in the body
Why would an individual with hypothryoidism have a goiter? The thyroid has enlarged because it is over-producing T3 and T4. The thyroid is growing in response to serum calcium levels. The thyroid has enlarged to try to produce more T3 and T4 even though it is not producing it. TRH stimulates the growth of the thyroid gland.
The thyroid has enlarged to try to produce more T3 and T4 even though it is not producing it.
You are caring for a client who has a hypothalamus that is not functioning. How would this affect the release of T3 in this patient? There would be more T3 in the serum There would be less T3 in the serum It would not affect the amount of T3 It depends
There would be less T3 in the serum
Type 1 diabetics typically have the following clinical characteristics:* A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine
Thin, young with ketones present in the urine
DM objective data
Think of DKA pts responded to, especially guy we IO and coded Increased urine output (polyuria) Decreased skin turgor (polyuria) Dry mucous membranes (polyuria) Weak, thready pulse Weight loss (body switched to burning fat) Kussmaul respirations (DKA-metabolic acidosis) Fruity breath odor (ketones) Altered level of consciousness (acidosis, hypovolemia) Impaired wound healing Seizures
DI objective data
Think volume depletion · Tachycardia (trying to get more fluid to body) · Hypotension (not enough pressure due to lack of volume) ·Diminished skin turgor (dehydrated) ·Dry mucous membranes (dehydrated) ·Large observed amounts of urine ·AMS ·Dysrhythmias
hyperthyroidism complications
Thyroid crisis (storm) sudden or building over production T3 & T4 High fever, extreme tachycardia (150's/160's), angina (can't perfuse heart well), agitation, restlessness
SIADH risk factors
Tumors (brain and lung) Increased intrathoracic pressure—reduces the filling of the arteries causing the body to think that it needs to hang on to more fluid Head injury CVA (stroke) and other CNS disruptions Medications—can cause secretion of more ADH or enhance the action on the renal tubules
A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings? Diaphoresis Palpitations Exophthalmos Weight gain
Weight gain Exophthalmos is an expected finding in clients who have Graves' disease, which is a form of hyperthyroidism. Palpitations are an expected finding in clients who have hyperthyroidism. The nurse should expect to find weight gain in clients who have hypothyroidism, even with no change in dietary intake. Diaphoresis is an expected finding in clients who have hyperthyroidism.
Addisons Objective
Weight loss Hyperpigmentation Vomiting Orthostatic hypotension old fashioned hypotension Dehydration Hyponatremia and hyperkalemia
Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)?* A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.
a patient diagnosed with small cell lung cancer
Adrenal crisis
can occur with abrupt withdrawal of medications causing Cushing's or removal of tumor to treat the problem—can send them into Addisonian crisis
adrenal medulla hormones
catecholamines are produced (epinephrine and norepinephrine)
SIADH complications
cerebral edema central pontine myelinolysis - rapid change in sodium levels causes demyelination of the brainstem
SIADH Objective Data
hyponatremia full, bounding pulse (fluid) confusion, lethargy, seizures (hyponatremia) coma tachycardia hypotension JVD crackles pink and frothy sputum (pulmonary edema)
Cortisol is important to ___________?
gluconeogenesis, suppression of immune function, and metabolism
hyperthyroidism pathophysiology
hyperactivity of thyroid increased metabolic state mimics excessive sympathetic nervous system stimulation
ACTH-dependent results from __________________ of ACTH from ____________ most often
hypersecretion of ACTH from pituitary
Where is the anti-diuretic hormone PRODUCED in the body?* A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Medulla
hypothalamus
central DI
hypothalamus not creating ADH or pituitary not storing/properly releasing ADH
ADH is produced in _________ and released by ________ pituitary
in the hypothalamus and released by the posterior pituitary
major component of T3, T4 is ____________?
iodine
Diabetic hyperglycemic hyperosmolar syndrome (HHS)
is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) level without the presence of ketones
nephrogenic DI
kidneys do not respond to ADH
The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH.* A. high, low B. absent, absent C. low, high D. low, low
low, high
The thyroid helps control __________?
metabolism and calcium homeostasis
glucocorticoids
play role in metabolism as well as inflammation (example is cortisol)
Which of the following signs and symptoms is NOT expected with Diabetes Insipidus?* A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst
polyphagia
Where is the anti-diuretic hormone SECRETED in the body?* A. Hypothalamus B. Thyroid C. Posterior Pituitary gland D. Anterior pituitary gland
posterior pituitary gland
Hyperthyroidism risk factor: hyperactivity of thyroid gland
primary hyperthyroidism o Increase in T3 and T4, decrease in TSH and TRH
Hypothyroidism risk factors: dysfunction of thyroid
primary hypothyroidism o Decreased T3 & T4, increased TSH and TRH
DM2
progressive;Deranged metabolic state that results from inability of cells to respond to insulin and/or decreased insulin production
Hypothyroidism: Objective Data: (slowing down, low metabolic rate)
· Myxedema (severely advance hypothyroidism) · Coarse, brittle hair · Weight gain · Edematous face · Bradycardia · Decreased perspiration · Constipation · Peripheral edema · Weakness
Hyperthyroidism risk factor: pituitary dysfunction
secondary hyperthyroidism o Decrease in TRH, Increase in TRH and T3/T4
Hypothyroidism risk factors: dysfunction of anterior pituitary
secondary hypothyroidism o Decreased T3 & T4, decreased TSH, increased TRH
SIADH causes serum electrolytes to become ____________ while urine electrolytes are ____________>
serum is dilute, urine are concentrated with electrolytes
androgens
sex hormones that cause sexual development as well as increased muscle mass etc.
Addisons can come on ______________ or ________________
slowly with chronic addisons or acute with acute adrenal insufficiency
what cancer can secrete it's on ACTH
small cell lung cancer
Hypothyroidism
state of having decreased thyroid hormone decrease in normal metabolic functioning
Addisons modifiable risk factors
steroid withdrawl (taper) stress
Hyperthyroidism risk factor: hypothalamus dysfunction
tertiary hyperthyroidism o Increase in TSH, TRH, T3, T4
Hypothyroidism risk factors: dysfunction of hypothalamus
tertiary hypothyroidism o Not creating enough TRH o Decreased TRH, TSH, T3 and T4
hypothyroidism: complications
· Myxedematous coma o Coma, hypothermia, cardiovascualar collapse
TRH (thyrotropin releasing hormone) causes the anterior pituitary to increase the release of _____________?
thyroid stimulating hormone (TSH)
Addisons Disease
to little salt, sugar, and sex (aldosterone, cortisol, androgens, estrogens)
DM subjective data
· Increased sense of hunger · Increased thirst (big sugars pull water into serum and excreting fluid) · Headache (hyperglycemia-fluid shift) · Nausea · Abdominal pain · Neuropathy (glucose molecules in serum for long time- damage to vessels and nerves (amputations) · Paresthesia (glucose molecules in serum for long time-damage vessels and nerves-amputations)
Hyperthyroidism subjective data (meth)
· Nervousness (meth) · Irritability (meth) · Fatigue (meth, chronic stimulant) · Insomnia (meth) · Emotional instability (meth) · Increased appetite (body burning through reserves) · Palpitations (over stimulated) · Shortness of breath · Muscle Cramps (increased Calcitonin hypocalcemic) · Heat intolerance (metabolism is elevated)
Subjective Data: Hypothyroidism (everything is kind of slowed down)
· Weakness (Which hormone?) Decrease in calcitonin (INREASE IN SERUM Ca!!) · Fatigue · Cold intolerance · Decreased hearing acuity · Mental dullness · Lethargy
hyperthyroidism: objective data (meth)
· Weight loss · Tachycardia · Excessive sweating · Fine muscle tremor · Exophthalmos · Thin hair · Thin skin · Goiter