Anterior Pituitary d/o
The anterior hypophysis produces stimulating hormones that affect the function of other glands. Those hormones are involved in growth, metabolism, reproduction, and blood pressure. Together with the posterior hypophysis, this gland is considered a.....?
what is a "master gland"
A patient's lab work revealed low ADH. A nurse understands that indicates .......disorder.
What is Diabetes Insipidus
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Disorder of water balance regulation
This part of the gland releases hormones that control fluid and electrolyte balance, carbohydrate, protein, and fat metabolism, immune function, and sexual development.
What is the adrenal cortex
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Glucocorticoids affect the body’s response to stress, carbohydrate, protein and fat metabolism, and immune function. The adrenal cortex produces mineral corticoids that help control fluid & electrolyte balance; and androgens that play a crucial role in sexual development
Parathyroid hormone regulates calcium and phosphorus balance. The nurse understands that the relationship between these two electrolytes is....
What is an inverse relationship
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Increased PTH elevates blood calcium by increasing calcium absorption from the kidneys, intestines, & bone. Increased PTH lowers phosphorus level.
A nurse is reviewing laboratory results and noticed low T3 and T4 levels and elevated TSH. What does it indicate?
hypothyroidism
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T3 &T4 are produced by the thyroid gland, so they are low in hypothyroidism.
TSH is produced in the anterior pituitary gland and is increased to stimulate the thyroid to produce more.
A patient is diagnosed with Grave's disease. A nurse anticipates a medication order as the first-line treatment choice:
What is methimazole ( Thionamide)
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Antithyroid agent: Inhibits the synthesis of thyroid hormone by blocking the oxidation of iodine in the thyroid gland.
Propylthiouracil ( PTU) is used less d/t liver toxicity
How does the diabetic patient prevent the development of diabetic complications in other organs?
proper management and glycemic control
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glucose management, diet, medication adherence, exercise, regular monitoring ( A1C), foot care
The patient experienced severe head trauma that resulted in hypoxia and reduced blood flow to the pituitary gland. The patient presented with signs of decreased pituitary function. What therapy would you expect?
What is " hormonal replacement"
A patient presents with signs of hypervolemia, bounding pulse, disorientation, water retention, decreased urine output, high urine specific gravity, and serum Na <110 mEq/L. The nurse suspects.......
What is SIADH
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Syndrome of inappropriate ADH. ADH is secreted even when plasma osmolarity is low or normal=>water retention=> fluid overload => dilutional hyponatremia ( low Na)=> d/t increased blood volume, kidneys inhibit the release of renin and aldosterone=> Na loss in urine
Adrenal gland insufficiency is characterized by the inability of the body to produce an adequate amount of cortisol and aldosterone to meet the needs for cortical ( steroid) hormones. This will result in low cortisol and low aldosterone levels.
What is Addison's disease
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Primary cause: an autoimmune disorder, adrenalectomy, adrenal cancer, abdominal radiation
Secondary cause: Problem in hypothalamus/pit. gland that results in decreased Adrenocorticotropin levels ( pituitary tumor, hypophysectomy, radiation to the brain), or a sudden cessation of long-term Steroid use
Hyperexcitability of cranial nerve 7 that develops with low Ca levels. The nurse taps the patient's side of the face, resulting in facial twitching.
What is Chostek's sign
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in hypoparathyroidism=> low Ca
The nurse is completing a health assessment of a 42-year-old female with suspected Grave's disease. Assessment reveals tachycardia, heat intolerance, weight loss and goiter. What is the metabolic state of this patient?
What is hypermetabolism ( increased metabolic rate) due to hyperthyroidism
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Hyperthyroidism causes an increased metabolic rate. Everything is fast.
The most important intervention to reduce the chance of Thyroid storm prior to thyroidectomy is:
1. a reduction of stress and anxiety
2. medications to lower the thyroid level to get to normal levels
A 68-year-old patient with type 2 diabetes mellitus and peripheral neuropathy comes to the clinic for a routine follow-up. During the assessment, you notice the patient is wearing tight-fitting dress shoes. The patient states, "I just bought these shoes last week. They're a little snug, but I'm sure they'll stretch out." You observe redness on both heels and the lateral aspect of the right foot. The patient reports no pain or discomfort in the feet.
What is the priority nursing action?
Instruct the patient to stop wearing the shoes immediately and assess feet for blisters or skin breakdown
A nurse is caring for a client after a hypophysectomy. The nurse noticed clear nasal drainage from the client's nostril. The initial nursing action would be to.......
What is "testing the drainage for glucose"
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To determine if it is CSF
A nurse checks the patient's labs. The labs show: urine specific gravity 1.004, serum Na 143 mEq/L, high H/H 20g/dl and 54%, BUN 25 mg/dl, Creatinine 1.5 mg/dl. The patient has dry mucous membranes, BP 90/52, HR 126, and polyuria. The nurse is concerned for.....
What is dehydration
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Fluid volume depletion is a danger for pts with diabetes insipidus d/t reduced ability of the distal and collecting renal tubules to concentrate urine=> large volume of water being excreted
A client reports that she has gained weight and that her face and body are "rounder", while her legs and arms have become thinner. A nurse also notes bruised areas on the skin and facial hair.
What is Cushing's disease
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classic signs of moon face (rounded), edema, truncal obesity, facial hair.
Virilization is characterized by the appearance of masculine traits and the recession of feminine traits.
A nurse provides discharge teaching to a patient with hypoparathyroidism. She recommends following .....diet?
What is a high Ca and low phosphorus diet
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Diet high in calcium and vitamin D and low in phos. (Foods that are high in calcium and low in phosphorus include dairy products, canned salmon, and calcium-fortified foods). Do not overdo dairy because it would increase phosphorus levels.
A nurse is providing discharge teaching to a patient with thyrotoxicosis and recommends wearing dark-colored glasses. What rationale will the nurse provide to the patient?
What is the effect of exophthalmos
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Mild exophthalmos ( bulging eyes) leads to corneal irritation. There is increased pressure and retrobulbar connective tissue, and extraocular muscle volume expansion due to fluid retention.
A client verbalized the recent onset of feelings of sadness and depression. As good practice, what should we check to rule out as a cause of these symptoms?
What are thyroid levels
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Hypothyroidism contributes to these symptoms. Checking thyroid levels and TSH is a good practice. Those symptoms would most likely improve with the treatment.
Why should patients stop metformin 24 hours prior IV contrast imaging ( and restart metformin 48 hours after this test) or stop metformin before surgery and resume after being able to resume oral intake
potential for lactic acidosis and kidney injury
The patient, after hypophysectomy, developed the following symptoms: temp 38.8, changes to LOC, photophobia, and stiff neck.
What is a post-op infection complication ( meningitis)
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Pt teaching to observe for these signs
A client is diagnosed with DI. A nurse assesses the client, knowing which symptom most indicates this disorder.
What are polydipsia and polyuria
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DI is characterized by a hyposecretion of the antidiuretic hormone and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic signs.
A nurse cares for a patient with Addison's disease. She anticipates frequent cardiac assessment and telemetry monitoring, close electrolyte monitoring, dietary restrictions, and physician orders for thiazide diuretics and Kayexalate. Why?
What is hyperkalemia prevention
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Addison's disease interventions focus on hyperkalemia prevention, fluid balance, management of hypoglycemia, and hormonal replacement.
Results from injury to the parathyroid glands during thyroid surgery
What is hypocalcemia
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Calcium levels will be monitored closely after surgery to make sure the parathyroid glands are not affected. Watch for signs of hypocalcemia- like tetany (hyperexcitability of nerves & muscles); muscle spasms, numbness/tingling. Remember, Chvostek’s & Trousseaus’ signs are positive , indicates low Ca level
If Ca is low=> calcium gluconate iv
The nurse is administering a solution diluted in milk to the patient with hyperthyroidism. The patient stated that the milk helped to disguise the strong, bitter taste.
What is the Saturated Solution of Potassium Iodine (SSKI)=iodine solution
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Super saturated potassium iodide solution (SSKI) is traditionally given about 10 days prior to surgery for patients with Graves' disease to decrease thyroid hormone levels and gland vascularity in addition to any other medication they may be taking for symptoms. Must be diluted in a glass of water or beverage.
It is similar to Lugol’s solution
A 32-year-old pregnant female came to the ED complaining of fever, restlessness, and a racing heart. A nurse noted BP 154/92, HR 125, and T3/T4 elevated. What does the nurse suspect:
What is a thyroid storm
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Thyroid storm: a life-threatening event that occurs in patients with uncontrolled hyperthyroidism. Can be triggered by some stressor; trauma, surgery, infection, pregnancy, vigorous palpation of a goiter.
Key manifestations: fever, tachycardia, HTN, confusion, restlessness, seizures.
Differentiate between key features of DKA and HHS.....
DKA (diabetic ketoacidosis)=> hyperglycemia, metabolic acidosis, ketonuria ( due to profound insulin deficiency)
HHS ( hyperosmolar hyperglycemic state)=> profound hyperglycemia ( >600), no ketones and no acidosis (b/c there is still some insulin to prevent lipolysis and ketone production), profound dehydration ( high blood osmolality), common in older adults
A nurse provides post-op teaching about avoiding harsh coughing, bending over at the waist, blowing the nose, and straining to have a BM. Why?
What is patient education to prevent hemorrhage
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It increases pressure on the incision site and the risk of bleeding.
The nurse provides patient teaching to a client diagnosed with neurogenic DI. The medication given to the patient will replace ADH and decrease urination.
What is desmopressin acetate ( DDAVP)
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A preferred drug for the treatment of neurogenic DI is desmopressin acetate (DDAVP)=synthetic vasopressin, which comes in IV, Sq, oral, and intranasal forms. For acute cases, IV is used. In chronic DI, a nasal spray or oral is used. Irritation of the mucous membranes may occur with the spray.
The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, Ca, vit.D, which other dietary restriction is most important?
What is Na restriction
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Restricting sodium is important for reducing fluid retention. Increasing protein is necessary to offset increased protein catabolism that results in loss of muscle mass. Ca and vit.D for bone health
A 67-year-old male patient presents with muscle weakness, joint pain, constipation, loss of appetite, fatigue, and increased urination. Diagnostic studies revealed the presence of kidney stones. What condition do you suspect? A nurse anticipates an order of medication that prevents further bone loss and strengthens bones.
Hyperparathyroidism=> bisphosphonate (Fosamax)
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hyperpharathyroidism= too much PTH=> too much serum Ca, low serum phosphorus=> bones brittle, joint pain; Ca excreted into urine=> kidney stones; into intestine=> constipation
Bisphosphonate - helps prevent bone loss and strengthen bones
The client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside this equipment: ________________ in case of this emergency situation.
What is tracheostomy
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In case of tracheal edema and airway obstruction
Medication used for emergency treatment of tetany after subtotal thyroidectomy.
What is calcium gluconate
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Or calcium chloride to treat hypocalcemia
A 58-year-old patient who received a kidney transplant 6 months ago takes prednisone 10 mg daily as part of their immunosuppressant regimen. The patient has type 2 diabetes mellitus and uses insulin glargine 20 units at bedtime and insulin lispro with meals. At today's clinic visit, the patient reports fasting blood glucose levels ranging from 180-220 mg/dL over the past 2 weeks, compared to their usual range of 100-130 mg/dL. The patient denies changes in diet or activity level.
What is the most appropriate nursing action?
Notify the healthcare provider about the need to adjust the patient's insulin doses
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Prednisone causes hyperglycemia. => transplant recipients taking corticosteroids should have periodic monitoring of glucose levels, and glucose intolerance is an expected side effect
Initial treatment for a CSF leak after transsphenoidal hypophysectomy would most likely involve....
What is " enforcing bed rest with the HOB elevated"
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To decrease pressure on the graft site
A nurse obtained the client's weight in the morning and noted a 1 kg weight gain since yesterday. The client also complained of muscle twitching this morning and was irritable and restless. The nurse recognizes worsening fluid overload and signs of......
What is hyponatremia
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Patients with SIADH are at risk of fluid overload, which is why we need to measure weight, I/Os, and fluid restriction. The loss of Na in urine and further dilution caused by fluid overload lead to hyponatremia. If the patient complains of neuro changes such as restlessness, irritability, twitching muscles, and seizures, it indicates low Na levels
The client was instructed to participate in regular weight-bearing exercise and increase dietary and supplemental intake of Ca of 1500 mg/day as a strategy to offset the effects of prolonged cortisol excess. why?
What is osteoporosis
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Bone resorption is a complication of Cushing's disease, which leads to osteoporosis
A home health nurse conducts a visit with a new client who was discharged from the hospital with a diagnosis of Hyperparathyroidism. The nurse recommends removing all loose rugs from the floor and adding grip bars and shower seats in the shower. What is it and why?
What is an injury prevention intervention
________________________________________ Because of the significant bone density loss and risk of fractures
A homeless patient was brought into the ED via ambulance in respiratory distress. The assessment revealed crackles, facial edema, tongue thickness, hypotension, hypothermia, hypoglycemia, bradycardia, and hyponatremia. The labs indicate very low thyroid levels. A patient stopped taking Synthroid because she could not afford it.
What is myxedema
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A life-threatening complication of hypothyroidism
A nurse provides patient teaching on how to use thyroid hormone replacement therapy. A nurse states that it is vital to take this medication in the morning 30-60 mins prior to breakfast. A nurse also emphasizes that other medications, such as iron, antacids, or calcium supplements, should not be taken within 4 hours.
What is levothyroxine sodium ( Synthroid)
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It has to be taken on an empty stomach
Other meds increase its effect
A client with type 1 DM is only responsive to painful stimuli with a blood sugar of 42. What is the first action taken by the nurse?
give dextrose IV push