Exam 3 - review session

interfering with prostaglandins (make inflammation happen and protect the gut) so it will make the gut have risk with bleeding, gastritis and it will hurt the kidneys

glucocorticoids

suppresses inflammation, interfering with the body's ability to show you are in trouble no fever or inflammation or pain signs

glucocorticoids

stimulates growth. controlled by PITUITARY

growth hormone

1) to much cortisol is? 2) to little cortisol is?

1) Cushings 2) addisions disease

1) stimulate GH 2) suppress GH

1) somatotropin 2) somatoSTATIN

Should not be moving around a lot Hypocortisol They would need a private room because they cannot handle any outside stimuli They will be hot Avoid stress

Addisonal crisis

How do you test for adrenal insufficiency

ACTH stimulation test

fluid build up because low protein levels so nothing stops fluid from leaking into tissues, fluid balance is a big problem

ascites

stimulate the patient and give huge dose of cortisol and see if the body response

dexamethasone test?= if the plasma levels don't go up and stay up then you would give them steriods

Long term steriod use, hirtuism, secondary problem, increased cortisol levels.

Cushing

made from cholesterol

gallstones

Go into anerobic metablism* and it will make the body make acid Not enough O2 because of low fluid state Pt will come in barely conscious, terrible color, pressure will be low, sugar high, potassium high, acid base balance will be all acidic, metabolic

DKA

Sugar is out of control, the higher the sugar in the body have the three polys, body is peeing a lot so you are losing fluid and retaining potassium, and the more you pee out the more you are in shock, life threatening condition

DKA

Take it close to a meal because steriods cause gastric ulcers

GC (steroids)

Pt with addisons disease and take Corticoid steriod replacements what are the common side effects (5)

Hypokalemia Muscle weakness Mood changes Hypocalcemia Immune system gone so risk for infection

Catch that when doing BP on patient As you are blowing up the cuff you will see spasm which means low calcium and it is dangerous

Truso's sign

what is abdomen preferred for insulin?

absorption and a little bit faster

Metformin - warn the patient that it causes hypoglycemia and you never give it with

ace inhibitors

to much GH, increased bone growth = wider bones

acromegaly

stimulates production of cortisol

adrenal corticoid tropic hormone (ACTH)

Sx - acid reflux, feel burning pain related to MI pain?, cell differentiates endoscopy to discover if you have this stay away from anything that can cause inflammation to esophagus such as citrus, alcohol, hot drinks

barret's esophagus

What can you give for hypoglycemia if milk is not available

bread, soda

cannot have gluten if you are allergic to gluten and the body is trying to digest it the bowel becomes inflamed, bloody stools and diarrhea

celiacs disease

ACTH secrete

cortisol

increases glucose and BP

cortisol? ACTH?

34 y/o females dx of hypothyrodism, what do you think signs and sx are (4)

decrease energy and fatigue weight gain 10lbs constipation menorrhegia - bad periods

The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:

decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. #

vasopressin = holds onto fluids

desmopressin

liver is supposed to be detoxifying and it isn't in liver disease so the pt NH4 levels of sky high and this is

hepatic encephalopathy

communicate between organ and tissues to make thing happen like growth, menopause and just overall trigger actions

hormones

Fruity breathe, dehydration, sweating, sluggish, slurred speech

hyperglycemia

heat intolerance

hyperthyroidism

How is hyperparathyrodism related to hypercalcemia = parathyroid hormone (PTH)

hypoPT = hypocalcemia so bones lose Ca so the bones become brittle, risk of fractures hyperPT = hypercalcemia

Irritable, tetany, not tired, restless

hypocalcemia

Tachycardia, BP down, fainting juice, milk, orange juice, candy

hypoglycemia

Renal system takes longer so stuff goes through BBB

infants

Pregnant patient there metabolism will be

slower

inside the cell that the hormones are targeting they are waiting to be stimulated and they have receptors for whatever hormones you are going to need

target cell

are stimulated by receptors

target cells

ADH equals?

vasopressin

1) inflammation, bloody stools, diarrhea 2) diarrhea 3) painful, loose, often, unpredictable, stress makes it worse, tends to show up in younger people, diarrhea, constipation

1) ulcerative colitis 2) IBS 3) Crohn's

1) block H+ ion and that interferes with gastric production 2) stops the acid from being made 3) anything you coat the stomach to decrease the acid exposure makes it so other medications cannot be absorbed so what do you do help this?1

1) H2 blockers 2) PPI 3) 2 hours before giving meds that coat the stomach or 4 hours after the coating meds

1) TSH levels HIGH = 2) TSH levels LOW =

1) hypothyroidism = body is making so much because the thyroid is low 2) hyperthyroidism

1) what is a chemical obstruction 2) what is a mechanical obstruction

1) ileus = from anesthesia, bowel not recovering as much as it should, vomiting, no visible signs in x-ray 2) tumor, need surgery to take it out

GI bleeding that is active will appear _____ ulcer bleeding/chronic eating away of lining is ____

1) red 2) melena

common reason is = alcoholism and gallstones labs = look for an increase in amylase and lipase Sx = bad appetite, anorexia leads to poor nutrition state and you could draw albumin levels at risk for diabetes*

pancreatitis

Hurt parathyroid = less calcium

parathyroid problem

pretty much in charge of everything

pituitary gland

problem with the actual organ

primary

The client with cirrhosis who has ascites receives 100 mL of 25% serum albumin I.V. Which finding would best indicate that the albumin is having its desired effect?

reduces ascites?

back flow of chyme because LES isn't working cannot lay down give H2 blockers and PPI, Pepto bismal

GERD

infection causes it can have inflammation treat with Quad treatment - antibiotics, H2 blockers, PPI, stomach lining protectant (pepto bismal)

H. Pylori

thyroid levels* are high, GRAVES DISEASE Sx = bludging eyes, weight loss, increase appetite, heat intolerance, achy, muscle weakness, tired all the time, aches and pains, loss of appetite and confusion, thristy all the time

HYPERthyroidism

An adult client with type 2 diabetes is taking metformin 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says:

If I know I will be having alcohol, I must not take metformin; I could develop lactic acidosis."

work inside the cell - cAMP, Calcium instigated by the first messenger and does what first messenger tell them to do

second messanger

A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?

Myxedema coma

What do you do for an intestinal obstruction

NG tubes are put in because we are trying to keep the gut from sending acid from bowel but the down side is acid base problems and dehydration*

Used in hypothyrodism - same thing as methal drug because it is trying to decrease thyroid levels

PTU

problem is with the signals so problems with the pituitary

secondary

Pt treated for hyperthyrodism would them need (2)

SEE = Restless, sweating, losing weight NEED= Periods of activty and rest

assessment labs for cushing's disease

Sodium levels, potassium, glucose, WBC count because it is bad for your immune system WBC are the only thing you can count on to see if there is an infection when you are on GC(steriods)****

Priority when caring for a patient that just had adrenal and thyroid surgery

Tachycaridic, hypotension, vascular collapse, shock, heart will be twitchy

A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply.

skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection

hypotension, dehydration, vomiting, diarrhea, sudden back pain, nothing left to give, body can no longer use the renin system

adrenal crisis

purpose = release cortisol when we need more energy the levels of cortisol will go up when it is healthy, levels subside the cortisol levels will decrease

adrenal gland

chronic problem, take steroids regularly for this*, adrenals are NOT WORKING and giving you cortisol when you need it so you will not be: tired, weak, no appetite, weight loss, hypotension, hypoglycemia, bad mood, headaches, sweating, menstrual irregulars, NVD

adrenal insufficiency

don't have supply of cortisol anymore so it is a depressed environment = everything negative

adrenal insufficiency

what basically says ok because you changed into II im going to increase my production and this will make the antidurietic hormone to increase which causes fluid retention

aldosterone

Which finding in the client who has returned from having a subtotal thyroidectomy would require a nurse to take immediate action?

facial muscle twitching

how do you treat adrenal crisis

give corticoid steroid and Five S's = sugar, salt, steroid (long acting), search, support

treatment for DKA

give volume first then give regular insulin in the IV

don't like to use them long term because it can cause peptic ulcers*, retain salt and water*, lose potassium*, kidney failure*, HTN

glucocorticoids

given a lot for organ transplants, serious allergies increase in stress

glucocorticoids

Two weeks after a partial thyroidectomy, a client is being seen for the postoperative follow-up appointment. The nurse is aware that the client is at increased risk for hypothyroidism. Which signs and symptoms would the nurse anticipate in a client with hypothyroidism? Select all that apply.

hair loss, dry skin cold intolerance

What causes it: lack of iodine, inflammation of thyroid, had to remove the thyroid because it had cancer, some medications, HASHEMOTO DISEASE = attack itself, immune system attack thyroid

hypothyroidism

cold intolerance, loss of hair, dry skin, over weight, they are in a depressive state, GOITER, you really cannot tell it is a problem unless you look for it

hypothyroidism

lose all the effects of body to retain Na and H2O, increase in potassium so the heart will not work properly, losing aldosterone

issues with losing cortisol

Hyperventilation and deep Happens with DKA

kussmaul respirations

hormones go right in to the cell and invade - steroids

lipid soluble

ascites is a major problem because you cannot breathe as deeply or out as deeply, BP will decrease Common sign = jaundice

liver disease

weak muscles - care about the heart

low potassium

what does the anterior pituitary hormone prolactin do?

mammory glands and pregnancy

Has to deal with thyroid. It will help you get rid of it if you have to much thyroid level

methymazole??

acetylcholine, ACH

neurotransmitters

Need enough albumin or you have to decrease dose because they do not have enough protein

older patients

it helps get the body ready for pregnancy, it is in the POSTERIOR PITUITARY

oxytocin

The nurse might expect to see which of these manifestations in the client who is hypocalcemic? Select all that apply.

tetany, prolonged QT interval, irritability

deal with metabolism measure it with stimulation and suppression test when you draw TSH test pay attention to T4 T4 is more specific for the thyroid problem - best indicator

thyroid

First 12 hours fever up, pressure up, heart rate up - if you don't stop it they are going to have a stroke

thyroid crisis

when do you go into adrenal crisis

trauma, shock, sepsis, something major happens

helps the body hold onto water

vasopressin

it equals antiduretic hormone

vasopressin

on top of the cell - TSH, vitamins and catecholamines

water soluble hormones

when is it a bad idea to give Miralax or other GI motility drugs

when there is an obstruction in the small bowel because it can cause the bowel to rupture

add more freq glucose checks, add more insulin and can cause hyperglycemia

when you give GC to a diabetic patient

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication?

with meals or with an antacid

Subtotal thyroid ectomy, the problem is

worry about to little Ca because they are twitchy (facial muscles) twitchy = hypocalcemia

Metformin and drinking

you cannot drink because pt will get lactic acidosis