Stress Zone
What disorder is characterized by weakness, fatigue, wt loss, bronze skin color, hypotension, dehydration and hypoglycemia
Adrenocortical insufficiency (Addison's disease)
What is the difference between calcitonin and parathyroid hormone in terms of their effect on serum calcium
Calcitonin causes a decrease in serum calcium by putting it in the bones.
PTH causes an increase in serum calcium How?
Which hormone deficiency causes water loss or the body's inability to respond to it?
ADH
What disorder has an excess of ADH?
What disorder has a low amount of ADH?
Type 1 produces no insulin, Type 2 produces some insulin
The long bones continue to grow past puberty and into adulthood.
acromegaly
giantism in children
What is the tx? Somatropin (GH)
Given at night
Name some assessment/lab findings for DI
low urine specific gravity: <1.005)
low osmolarity: <280 mOsm/kg
UOP: > 4 Liters / 24 hr period
(can be 4-30L/day)
Don't palpate the abdomen or it could cause a sudden rush of______? What is the disorder
Catecholamines
pheochromocytoma
What do you want to teach to avoid? Tyramine
beer, chocolate, soy sauce, agged cheese, smoked or cured meats
What is the main cause of adrenal insufficiency?
autoimmunity
What is hyperparathyroidism?
Over-activity of the Parathyroid gland and overproduction of PTH
What medication is prescribed to treat SIADH?
Drug tx: vasopressin, diuretics, Hypertonic saline
Drug name: DDAVP
What complication can Type 1 go into when they get sick? Type 2?
DKA, HHS
What are the symptoms of pheochromocytoma?
What is the cause?
Elevated HR, Elevated temp, elevated glucose
Tumors cause increase secretion of epinephrine & norepinephrine
Hypophysectomy education & post-op care, complications
no brushing, mouth care, avoid coughing, sneezing
HOB elevated, neuro assessment, replacement hormones
CSF leak, seizures, DI,
What is Exophthalmos?
hyperthyroidism
Treatments?
What are the two main hormones released by the medulla of the adrenal gland?
norepinephrine epinephrine
What is hypoparathyroidism?
The underproduction of PTH and too low Calcium in the blood
S/S of hypocalcemia
Tx
Name 4 S/S of DI
increase urination
excessive thiirst
signs of shock
poor skin turgor
dry/cracked mucous membranes
weight loss
Signs & Symptoms of DKA
ketones in urine
metabolic acidosis
nausea/diarrhea/vomiting
respiratory depression/coma
The most potent glucocorticoid.
Cortisol
How does growth hormone respond to a glucose tolerance test in a patient with acromegaly?
During an oral glucose tolerance test, GH normally decreases because glucose inhibits GH secretion. In acromegaly, GH do not fall and some times increases.
What complication of hypothyroidism causes decreased cardiac output, decreased LOC, bradycardia, hypotension, and hypothermia?
Myxedema coma
A patient with Cushing's should be advised to increase dietary intake of which electrolyte?
Potassium
Too much cortisol-kidneys retain sodium and excrete potassium
When reviewing labs for a patient with primary hypothyroidism, which lab value does the nurse expect to be increased?
TSH
When abnormal, what should the nurse expect to be ordered?
T3, T4
In SIADH, What electrolyte is impaired the most and how... explain
sodium
dilutional hyponatremia
Signs & symptoms of HHS?
lethargy
blood sugar >1000
dry mouth
elevated HR
dry skin turgor
n/v/d
confusion, slurred speech
What hormone controls water excretion?
antidiuretic hormone
What is an ACTH stimulation test used to diagnose?
How is the test performed?
adrenal insufficiency - and the release of cortisol
Draw blood, administer ACTH (cosyntropin), draw labs in 30 minutes and 60 minutes
What disease process causes moon face & buffalo hump of the neck
Cushing's
What is the difference between Syndrome & Disease?
What are the two types of hormones secreted by the cortex of the adrenal glands?
glucocorticoids (regulate metabolism and immune response) and mineralocorticoids (balance salt & water to control BP)
What electrolytes are related to the thyroid?
Calcium, Phosphate
Name Causes of DI (primary, central, nephrogenic)
Primary: impaired hypothalamus or pituitary gland which end up in lack of ADH production or release
Central: result of tumor, head trauma, infectious process, brain surgery.
Nephrogenic: drug related, CKD
Treatment for DKA
IVF....SEVERAL LITERS
regular insulin
antiemetic
What hormone stimulates and maintains metabolism by regulating the thyroid gland?
thyroid stimulating hormone (TSH)
What is a 24-hr urine test used to diagnose?
How is it performed?
dump the 1st void and then start test
Dehydration, dry mucous membranes, hypotension, diluted urine
Diabetes Insipidus
Name the 3 types and causes
Name 2 causes of Cushing's.
Name 4 symptoms.
Causes-Prednisone, Pituitary or Adrenal Tumor
Symptoms-Buffalo Hump, Fat Pad, Moon Face, Weight Gain, Slow Wound Healing
What are nursing interventions/considerations for thyroidectomy?
monitor for hypocalcemia, hemorrhage, laryngeal nerve damage, infection, patent airway.
Limited ROM
IV calcium available
Choking, frequent swallowing, saturated dressings, fullness feeling at site.
O2, suction, trach tray
Name 4 nursing interventions for SIADH.
fluid restriction (500-1000 ml/24)
replace sodium slowly
educating the family/pt
I & O
Daily weight
oral rinse
monitor ECG
F & E replacement as needed
seizure precautions
Assessment: neuro checks, heart, lungs, skin
Treatment for HHS
IV fluids....liters (monitor for heart/lung overload)
regular insulin IV
neuro assessment
safety interventions
What hormone stimulates and regulates the adrenal cortex?
adrenocorticotropic hormone (ACTH)
What is emergency IV Calcium gluconate given for?
hypoparathyroidism
Treatment-calcium, mag, vit D
Monitor on tele for dysthymias, give iv calcium slowly, calcium level assessments
This occurs mostly in times of sickness or when stopping steroid therapy abruptly
Addison's crisis
What is treatment?
How is Addison's disease treated?
by replacing the lost hormones, which can vary from just aldosterone supplements to both aldosterone and cortisol supplements.
Tx: oral cortisol replacement (prednisone). possible mineralocorticosteroid (fludrocortisone)
What is the treatment for an overactive thyroid?
Propylthiouracil & Methimazole(anti-thyroid meds)
Radioactive idodine therapy
Surgical intervention
What is the treatment for DI?
Name medication and 2 additional treatments
desmopressin: Synthetic version of vasopressin
May be IV or IM depending on severity
manage dehydration, electrolyte imbalance, check daily weight, strict I & O
Heart and lung assessments: medications induce water retention ( fluid overload )
Will require life-long therapy
What happens to potassium in DKA? Is the level low or elevated?
Comes out of the cell so level is high. Needs insulin to drive the potassium back into the cell.
What hormone promotes reabsorption of sodium and the excretion of potassium by the kidney?
aldosterone
What is the medication of choice for hypothyroidism?
What is some education that should be given to the patient when taking this drug?
synthroid ( levothyroxine )
Monitor for irregular HR or tachycardia, insomnia
Lifelong replacement...don't stop abruptly
What are symptoms of thyroid storm? What is it caused by?
Elevated temp, elevated HR & BP,
response to a stressful incident or
hyperthyroidism that is unmanaged