Pituitary
This condition is the result of hyperpituitarism, with excess growth hormone, which occurs after the epiphyseal closure of bones.
What is acromegaly
Patient presents with weight loss, increased appetite, fatigue, poor heat tolerance, and profuse perspiration. What's going on?
What is increased thyroid hormone production, or hypERthyroidism
Patient presents with renal calculi, low back pain, hyporeflexia, muscle weakness, lethargy and confusion. Diagnosis?
What is hyperparathyroidism
*Creating excess PTH --> hypercalcemia
This disease is the result of overproduction of ACTH, causing increase production of cortisol by the adrenal cortex
What is Cushing's disease
This hormone is produced by the beta cells of the islet of Langerhans in the pancreas
What is insulin
Anti-diuretic hormone (ADH) is produced in the hypothalamus and secreted by the posterior pituitary gland. When there's resistance to or deficiency of ADH, this condition can occur
What is diabetes insipidus
*Not enough anti-diuretic = more diuretic = water loss through urine
A person on thyroid replacement medication should take their medication when?
What is in the morning, on an empty stomach
The two hallmark signs of hypoparathyroidism
What are Chvostek's sign and Trousseau's sign
*Chvostek - hyperexcitable cranial nerve 7 - facial twitching. Trousseau - BP cuff -> hand draws into wrist but fingers extend
This condition's clinical manifestations include moon face, humpback, purple striae on abdomen, hirsutism (hair growth), thin extremities, weight gain, water retention, trouble sleeping, amenorrhea, and sleep disturbances
What is Cushing's Disease
What is insulin
-If blood glucose is normal, we often give insulin + dextrose together to prevent hypoglycemia, while still allowing the insulin to bring K+ from blood into the cells.
A patient with SIADH presents with a sodium level of 114 mEq/L. Which action should the nurse take first?
A. Consult with the dietitian about increased dietary sodium.
B. Restrict fluid intake to 600 mL/day.
C. Handle the client gently by using turn sheets for re-positioning.
D. Instruct UAP to measure intake/output.
What is B, restrict fluid intake.
*SIADH causes dilutional hyponatremia. Adding sodium to diet won't help if retaining fluid & diluting the sodium. Strict I&Os are just monitoring, and we're looking for what the nurse would do first. Reducing fluid intake will help increase sodium level.
This type of diet should be followed by someone with Myxedema (multiple answers)
What is...
1. avoiding foods high in iodine that interfere with thyroid hormone replacement
2. High fiber, high protein, low calorie, low sodium, and increased fluid intake
(severe, advanced hypothyroidism causing waxy skin, non-pitting edema, low body temp, AMS)
For a patient with hypoparathyroidism, diet should be high in...
What is calcium
This condition's clinical manifestations can include bronze skin, muscle weakness, lightheadedness on rising, weight loss, salty food cravings, decreased stress tolerance, anxiety, irritability, confusion, weak/irregular pulse, hypotension, GI complaints...
What is Addison's Disease
Patient presents with altered mental status, blood glucose of 810mg/dL, has a history of T2D, and negative for ketones. Diagnosis?
A patient presents with altered mental status. Family reports the pt has gained 10lbs in 1 week, and the pt hasn’t been able to urinate or eat. Pulse 115, BP 180/92. Sodium level is 90. You suspect this condition.
What is SIADH
*increased ADH production = anti-diuretic = not able to urinate. Retaining fluid, diluting sodium.
This autoimmune disorder attacks the thyroid gland by using antibodies to destroy T3 and T4 and causes increased TSH levels
What is Hashimoto's Thyroiditis
*TSH is increased because pituitary sends more to help the failing thyroid as T3/T4 are decreasing --> hypothyroidism
The increase in this hormone causes calcium to leave the bones and accumulate in the blood
*hyperparathyroidism
The diet of someone with Addison's Disease should be (2 things)
What is high sodium, low potassium
*aldosterone helps excrete K+ and retain Na. In Addison's, adrenal gland impaired, too low of aldosterone, so risk of hyperkalemia & hyponatremia
This is what happens when blood glucose levels rise between 3-8am in preparation for waking up. The glucose levels will be normal around 2-3am.
What is dawn phenomenon
*This is treated by adjusting basal insulin dose and giving at bedtime.
These medications have to be given after pituitary gland removal (list 2).
!! [BONUS: how is the pituitary gland removed?] !!
What are... [hormone replacements]
-cortisol (hydrocortisone, prednisone); thyroid hormone (levothyroxine); desmopressin (DDAVP); testosterone (men); estrogen/progesterone (women); growth hormone if needed.
-Removal is transsphenoidal (minimally invasive - through the nose)
Treat this condition with the use of antithyroid drugs (thionamides), iodine, and beta-blockers
What is hyperthyroidism
*symptoms: tremors, high HR, anxiety - treat w/ methimazole, PTU, propanolol
These could be complications from long-term hypocalcemia (list 2)
What are... decreased heart contractility leading to cardiac failure, bone deformity, severe tetany, laryngospasm (lower threshold for neuronal activation and contraction of muscles/excitability), respiratory stridor, anoxia, paralysis of vocal cords
A person with Addison's disease will require lifelong treatment with these
What are steroids (glucocorticoids and mineralocorticoids)
This occurs when a rapid decrease in blood glucose causes the release of glucose-elevating hormones (epinephrine, cortisol, glucagon); usually occurs during the night, but manifests as elevated glucose in the morning.
What is the Somogyi effect or phenomenon.
*BGL usually low during 2-3am, body tries to counteract it by secreting cortisol + adrenaline, resulting in high BGL in the AM.