Med Surg Chap 52

Epinephrine

100 pg/mL

T3 andT4 are responsible for

Iodine uptake

Graves disease

Autoimmune disorder that results from an excessive output of hormones caused by abnormal stimulation of the gland by circulating immunoglobulin

Cushing disease nursing interventions

Decrease risk of injury, decrease risk of infection, preparing the pt for surgery, encouraging rest and activity, promoting skin integrity, improving body image, improving coping, monitoring and managing potential complications, and promoting home care

Eosinophilic tumors

Develop early in life

Thyroidectomy preop education

Dietary guidance to meet pt metabolic needs, avoid caffeine and other stimulants, explanation of tests and procedures, and head and neck support after surgery

Nonfunctional tumors

Do not secrete hormones

Hyperparathyroidism

Elevated serum calcium, bone decalcification, renal calculi, apahty, fatigue, muscle weakness, nasua and vomiting, constipation, HTN, cardiac dysrhythmia, and psychological manifestations

Three principle types of tumors represent an overgrowth:

Eosinophilic, basophilic, and chromophobic

SIADH

Excess ADH released caused by trauma, stroke, malignancy, meds, or stress

SIADH is

Excessive ADH secretion from the pituitary gland

Cushing syndrome results from

Excessive adrenocortical activity

Cushing syndrome

Excessive adrenocortical activity or corticosteriod medications

Primary aldosteronism

Excessive production of aldosterone causes a distinctive pattern of biochemical changes

Pts with SIADH cannot

Excrete a diluted urine, retain fluid, and develop a sodium deficiency

Hypothyroidism CM

Extreme fatigue and reports of hair loss, brittle nails, dry skin, numbness and tingling of the fingers

Anterior pituitary gland

FSH, LH, prolactin, ACTH, TSH, and GH

T or F: Extreme fatigue, hair loss, brittle nails, and dry skin are common clinical manifestations of hyperthyroidism

False, hypothroidism

Anterior pituitary

Female stuff, ACTH, TSH, and GH

Adrenal medulla

Functions as part of the autonomic nervous system, catecholamies, epi and norepinephrine

Adrenal cortex

Glucocorticoids, mineralocorticoids, and androgens

Simple goiter may be caused by

Goitrogenic substances. It is compensatory hypertrophy caused by stimulation by the pituitary gland

Chromophobic tumors effects

Obese and exhibit fine, scanty hair, pasty complexion, and small bones. They experience HA, loss of libido, and visual defects

Hyperparathyroidism caused by

Overproduction of parathyroid hormone by the parathyroid glands and is characterized by bone decalcification and development of renal calculi containing calcium

Hypoparaythyroidism

Parathormone deficiency caused by surgery, thyroidectomy, parathyroidectomy, or radical neck dissection

Hyperparathyroidism tx

Parathyroidectomy, hydration therapy, encourage mobility, reduce calcium excretion, encourage fluid, and restrict calcium

Primary hyperparathyroidism is dx by

Persistent elevation of calcium and an elevated concentration of parathromone

Eosinophilic tumors CM

Person may be more than 7 ft tall and large in proportion yet weak and lethargic, acromegaly (large hands and feet)

Parathormone lowers

Phosphorus level

Functional tumors

Secrete hormones

Eosinophilic tumor effects

Severe HA and visual disturbance bc of pressure on the optic nerve

Pheochromocytoma CM

Severity depends on amt of epinephrine and nonrepinephrine secretions. Typical symptoms are: HA, diaphoresis, and palpitations in pts with HTN

Corticosteroid therapy

Suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection

SIADH stands for

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Medical management of hypothyroidism

Synthetic levothryroxine replacement therapy

Thyroid hormones

T3, T4, and calcitonin

Thyroid produces

T3, T4, and calcitonin

Following thyroid surgery, the patient should be monitored closely for signs of ____ an indicator of a disturbance in calcium metabolism due to injury or removal of the parathyroid gland

Tetany

Hypoparathyroidism CM

Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospams, larygneal spasm, carpopedal spasm, anixety, irritability depression, delirium, and ECG changes. Positive Chvostek's and Trousseau's signs

Hypo anterior pituitary gland

Dwarfism

TSH

0.4-4.5 mU/L

T4

0.9-1.7 ng/dL

Norepinephrine

100-550 pg/mL

T3

80-200 ng/dL

Posterior pituitary

ADH, vasopressin, and oxytocin

Posterior pituitary gland

ADH, vasopressin, and oxytocin

Hypoparathyroidism is caused by

Abnormal parathyroid development, destruction of parathyroid glands, and vitamin D deficiency

Myxedema

Accumulation of mucopolysaccharides in subQ and other interstitial tissues

Occurs when the adrenal cortex function is inadequate to meet the patient's need for cortical hormones

Addison's disease

Adrenocortical insufficiency is caused by

Addison's disease, adrenal suppression by exogenous steroid use

TB and histoplasmosis are the most common infections that destroy

Adrenal gland tissue, causing Addison's disease

Adrenocortical Insufficiency (Addison Disease)

Adrenal glands are damaged and can't produce sufficient amts of cortical hormones

Tx of pheochromocytoma

Adrenalectomy is definitive tx. Bilateral adrenalectomy may be necc if tumors are present

Adrenocortical insufficiency dx tests

Adrenocortical hormone levels, ACTH levels, and ACTH stimulation test

Parathormore regulates

Calcium and phosphorus balance

SIADH nursing management

Close monitoring or fluid I & O, daily wght, urine and blood chemistry, and nuerologic status f

Thyroid disorders

Cretinsim, hypothryroidism, hyperthyroidism, thryoriditis, goiter, and thyroid cancer

Oversecretion of the anterior pituitary gland most commonly involves ACTH or growth hormone and results in ___ or acromegaly

Cushing syndrome

Basophilic tumors give rise to what?

Cushing syndrome with feature largely to hypoadrenalism including: masculinization, amenorrhea in females, truncal obesity, HTN, osteoporosis, and polycythemia

Hyper anterior pituitary gland

Cushing, gigantism, and acromegaly

Hypo posterior pituitary gland

DI

Hyperparathyroidism hydration therapy

Daily fluid intake of 2000 ml or more is encouraged to help prevent calcium formation

Chromophobic tumors produce

No hormones but destroy the pituitary gland causing hypopituitarism

An autoimmune disorder, is the most common cause of hyperthyroidism.

Grave's disease

Hyperthyroidism is caused by

Graves disease, toxic multinodular goiter, and toxic adenoma

The five H's of pheochromocytoma:

HTN, HA, hyperhidrosis (excessive sweating), hypermetabolism, and hyperglycemia

Hypothyroidism cause in adults is

Hashimoto disease

Hypothyroidism is caused by

Hashimoto's disease

DI is caused by

Hormonal abnormality and isn't related to diabetes. Lack of vasopressin

Cushing syndrome CM

Hyperglycemia, buffalo hump, heavy trunk and thin extremities, fragil, thin skin, ecchymosis, straie, weakeness, sleep disturbances, osteoporosis, muslce wasting, HTN, moon face, acne, infection, slow healing, loss of libido, modd changes, increased serum sodium, and decreased serum potassium

The major action of the ____ is controlling the release of pituitary hormones

Hypothalamus

Tx of DI

Replace ADH, ensure adequate fluid replacement, and to identify and correct underlying intracranial pathology

If parathyroids are removed immediately give what?

IV gluconate

Hashimoto disease

Immune system attacks the thyroid gland. The cause my be due to a dysfunction of the pituitary or hypothalamus

Medical management of hypoparathyroidism

Increase serum calcium level to 9-10 mg/dL, caclim gluconate IV

Calcitonin is secreted in response to high plasma calcium level and

Increases calcium deposit in bone

Adrenalectomy complications

Intraperative increased BP due to the massive release of catecholamines, postop decreased BP and massive fluid requirement following the fluid shifts that follow catecholamine control

Increased parathormone elevates blood calcium by increasing calcium absorption from the

Kidney, intestine, and bone

Hyper posterior pituitary gland

SIADH

Diabetes insipidus (DI)

Most common disorder of posterior pituitary gland and characterized as a deficiency of ADH. Kidneys fail to reabsorb water. Polydipsia and polyuria

Endemic (Iodine- deficient) goiter

Most common type of goiter that occurs due to iodine intake

Adrenocortical insufficiency CM

Muscle weakness, anorexia, GI symptoms, fatigue, dark pgimentation of skin and mucosa, hypotension, low blood glucose, low serum sodium, high serum potassium, apathy, emotional lability, and confusion

Hyperthyroidism CM

Nervousness, irritable, apprehensive, palpitations, rapid pulse, cant tolerate heat, tremors, increased appetite, wght loss, fatigue, and changes in bowel function

Patho of DI

Neurologic issues, lack of vasopressin (increase intravascular volume and decrease urine output) in brain

Diabetes insipidus

Piutary gland produces insufficient ADH, hence the kindeys make a lot of urine

Thyroidectomy postop care

Potential hypocalcaemia related to injury or removal of parathyroid glands

Hyperparathyroidism CM

Pts may have no symptoms at all. Apathy, fatigue, muscle weakness, HTN, or cardiac dysrhythmias

DI CM

Pts will have enormous daily output of diluted urine with specific gravity of 1.001-1.005. Urine contains glucose and albumin

Medical management of hyperthyroidism

Radioactive 131 therapy, surgery (subtotal thyroidectomy)

Thyroidectomy preop goals

Reduction of stress and anxiety to avoid precipitation of thyroid storm

Acute hypercalcemic crisis occurs with extreme elevation of serum calcium levels and can be life threatening

True

T or F: Thyroidectomy is the treatment of choice for thyroid cancer

True

True or False: Hypothyroidism affects women 5-8 times more than men

True

True or false: Almost all pituitary tumors are benign

True

T or F: Iodine is essential to the thyroid gland for the synthesis of its hormones

True, 1511

T or F: The major function of the parathyroid hormone is the regulation of serum calcium

True, 1527

Pheochromocytoma

Tumor that is usually benign and originates in the adrenal medulla. Excessive epi and norepi

Calcitonin

When normal serum (blood) calcium levels (8-10) become to high, calcitonin is released from thyroid