Princess & the Pea
List three clinical manifestations of acromegaly.
Enlargement of hands and feet
Thickening/enlargement of the boney and soft tissue of the face
Enlarged tongue
Joint pain
Sleep apnea
Skin changes
Barreled shape chest
Changes in voice characteristics
Severe headaches
Visual disturbances
Hyperglycemia
List the hormones of the adrenal glands.
glucocortocoids- cortisol
mineralocorticoids- aldosterone
catecholamines- epinephrine, norepinephrine
What manifestations would be expected in a patient with hypothyroidism?
Increased TSH, Decreased T3 and T4
fatigue, bradycardia, weight gain, hypotension, intolerance to cold, constipation, abnormal menstrual periods, low libido
The major function of the parathyroid gland and parathyroid hormone is:?
Regulation of calcium and phosphorus balance
When analyzing labs for a patient with SIADH, the nurse would expect the serum potassium to be ___, the serum osmolarity to be ___, urine volume to be __, urine osmolarity to be ___, and the urine sodium to be ___.
Decreased, decreased, decreased, increased, increased
There are three classes of medications used to treat acromegaly. List the classes and provide and example for each class.
Dopamine agonists: bromocriptine mesylate (Parlodel), cabergoline (Dostinex)
Somatostatin analogs: octreotide (Sandostatin), lanreotide (Somatuline)
Growth hormone receptor blocker: pegvisomant (Somavent)
List clinical manifestations of Addison's disease (adrenal insufficiency)
hyperpigmentation of the skin and mucous membranes
decrease in pubic and axillary hair
weakness
hypoglycemia
What is the medication used to treat hypothyroidism and what are some nursing considerations associated with this medication?
levothyroxine (Synthroid)
must be taken on an empty stomach, monitor for s/s of hyperthyroidism, monitor cardiac function
synthroid increases effect of warfarin and decreases the effect of digoxin
List clinical manifestations of hyperparathyroidism.
Possibly no symptoms.
Apathy, fatigue, muscle weakness, n,v,c, htn, dysrhythmias
List at least two pharmacological/non-pharmacological interventions for SIADH
Treating hyponatremia---fluid restriction <1000 mL/day, 3% Saline (severe hypoNa)
Meds--- Demeclocycline (Declomycin), vasopressin antagonists (tolvaptan, conivaptan)
Loop diuretics
A treatment of Diabetes Insipidus is to administer a synthetic form of what hormone?
List the names of the two medications.
ADH
Desmopressin (DDAVP) & Vasopressin (Pitressin)
List pharmacological treatments for Addison's disease.
Glucocorticoid-- hydrocortisone (Solucortef), dexamethasone (Decadron)
Mineralocorticoid-- fludrocortisone (Florinef)
What is a rare, but potential complication of hypothyroidism?
Myxedema
Parathyroidectomy, if renal function is compromised.
List the two medications used to treat Cushing's and list a nursing intervention for each.
Ketoconazole- adrenal corticosteroid inhibitor, monitor liver enzymes and for liver intoxication
Mitotane- selective destruction of adrenocortical cells, monitor for renal damage, liver tox, shock, and orthostatic hypotension
List a primary complication of Diabetes Insipidus.
Dehydration----
List the three hallmark signs of Cushing's
Moon face
Buffalo hump
Truncal obesity
Other manifestations include hyperglycemia, sodium/fluid retention, GI distress
What is another name for hyperthyroidism and list clinical manifestations of this disorder.
Graves disease- anxiety, restlessness, tachycardia, palpitations, heat intolerance, weight loss, increased appetite, thyroid enlargement, tremors, hyperreflexia, exophthamlos, diarrhea, goiter
T3 & T4 increased TSH decreased
Clinical manifestations of hypoparathyroidism?
Tetany- positive Chvostek and Trousseau, muscle hypotonia, tremor, spasms
What is a non-surgical treatment for hyperthyroidism?
Radioactive iodine therapy
Name the two diagnostic tests used to diagnose diabetes insipidus
Water deprivation test (ADH stimulation test)
Vasopressin test
What diagnostic test is specific to diagnosing Cushing's?
Dexamethasone Suppression test
List the pharmacological treatments for hyperthyroidism and nursing considerations for each.
Thionamides--- methimazole (MMI, tapazole), propylthiouracil (PTU)--- inhibits thyroid production
---monitor for leukopenia, thrombocytopenia, liver tox, must be taken with meals
Lugol's solution 5% elemental iodine, 10% potassium iodine, inhibits release of thyroid hormone
---short term (10 days pre-op), take with food, contraindicated with pregnancy, use a straw to avoid staining teeth, mix with juice or other beverage to mask taste
Beta blockers---manage symptoms tachycardia, palpitations
List treatments for hyperparathyroidism
Goal is to treat hypocalcemia-- calcitrol, calcium, mag, vitamin d---thiazide diuretic---PTH---calcium gluconate, pentobarbitol
What is a common treatment for thyroid tumor?
Subtotal or total thyroidectomy