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44 Cards in this Set
- Front
- Back
causes of insufficient hormone
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hypofunction of endocrine gland
insensitivity of target tissue to hormone |
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causes of excess hormone activity
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hyperactive gland
ectopic hormone reproduction excess self administration of replacement hormone |
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diabetes insipidus pathophys
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lack of ADH = adequate water reabsorptoin by distal tubules prevented
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diabetes insipidus etiology
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tumor or trauma to pituitary gland
psychogenic = drinks too much water drugs |
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diabetes insipidus S&S
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polyuria
nocturia polydipsia dehydration hypotension hypovolemic shock enlarged bladder + kidney damage |
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diabetes insipidus diagnostic tests
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urine specific gravity less than 1.005
CT scan, MRI to check for pituitary tumor water deprivation test = urine diluted with intake? |
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diabetes insipidus interventions
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hypotonic IV fluids (0.45% saline) = replace intravascular volume with adding sodium
replacement of ADH vasopressin (IV or sub-q) thiazide diuretics - dercrease urine flow if no ADH hypophysectomy (removal of pituitary gland) |
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diabetes insipidus nursing care
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I&O
daily weights intake/output skin turgor (poor) monitor serum electrolytes changes in LOC |
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Syndrome of inappropriate antidiuretic hormone (SIADH) pathophys
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too much ADH = kidneys absorb excess water = decrease urine output, fluid overload
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Syndrome of inappropriate antidiuretic hormone (SIADH) etiology
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lung cancer, pancreatic cancer, hodgkin's disease = ectopic site of production
drugs head trauma brain tumor complication of diabetes insipidus |
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Syndrome of inappropriate antidiuretic hormone (SIADH) s&S
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fluid overload - weight gain without edema
dilutional hyponatremia |
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S&S of dilutional hyponatremia
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bounding pulse
elevated/normal BP headache personality changes nausea diarhhea convulsions coma |
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Syndrome of inappropriate antidiuretic hormone (SIADH) diagnostics tests
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serum ADH high
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Syndrome of inappropriate antidiuretic hormone (SIADH) interventions
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eliminate cause
tumor removal restrict fluids (800-1000 mL/24 hours) hypertonic saline fluids oral salt |
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Syndrome of inappropriate antidiuretic hormone (SIADH) nursing care
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monitor fluid balance
vitals weight I&O urine specific gravity skin turgor edema report change in LOC, monitor for seizures |
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dwarfism pathophys
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short stature
growth hormone deficient in childhood |
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dwarfism etiology
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pituitary tumor
failure of pituitary to develop infection, trauma to pituitary malnutrition |
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dwarfism S&S
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children grow only 3-4 ft tall - normal body proportions
slowed sexual maturation adults: weakness, hypoglyemia, sexual dysfunction, skin changes, increased risk of cardiovascular/cerebrovascular disease; headaches, mental slowness, visual disturbances |
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dwarfism diagnostic tests
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measure amount of GH
MRI |
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dwarfism interventions
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administer growth hormone
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dwarfism care
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assess mental status, ability to cope, understanding of treatment plan
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acromegaly pathophys
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excess of GH
affects adults in 30-40s (gigantism in children) bones increase in size, enlargement of facial features, hands, feet long bones increase in width but not length subq ct increases = fleshy appearance internal organs/glands enlarge elevated blood glucose |
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acromegaly etiology
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pituitary hyperplasia
pituitary tumor hypothalamic dysfunction |
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acromegaly S&S
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change in ring/shoe size
nose, jaw, brow, hands, feet enlarge teeth displaced tongue thickens - dysphagia sleep apnea kyphosis headache diabetes mellitus osteoporosis, arthritis erectile dysfunction, amennorhea |
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acromegaly diagnostic tests
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serum growth horomone
radiographs = abnormal bone growth MRI if tumor |
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acromegaly interventions
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treat causes
bromocriptine (Parlodel), octreotide (Sandostatin) to decrease GH levels hypophysectomy - replacement of thyroid hormone, corticosteroids, sex hormones |
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acromegaly care
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assess of impaired eye sight, chewing, swallowing, sleep apnea
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pituitary tumors
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most benign
cause: visual disturbances, symptoms of increased pressure in brain, hormone imbalances hypophysectomy (transephenoid, transfrontal) |
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pre-op of hypophysectomy
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baseline neurological assessment
avoid actions that increase pressure on surgical site - coughing, sneezing, nose blowing, straining at bowels, bendings from waist deep breathing |
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post-op of hypophyectomy
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neurological assessments
urine specific gravity (diabetes insipidus may occur) nasal packing - monitor for CSF (glucose) hormone replacement therapy (thyroid, glucocorticoids, intranasal desmopressin, sex hormones) |
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hypothroidism pathophys
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creatinism in infants
myxedmea in adults primary - not enough TH even though there is enough TSH secondary - low levels of TSH tertiary - inadequate release of TRH |
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hypothroidism etiology
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primary = congenital defect, inflammation of thyroid gland, iodine deficiency
hashimotos = autoimmune seondary/tertiary = postpartum pituitary necrosis, treatment of hyperthyroidism |
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hypothroidism S&S
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reduced metabolic rate
fatigue, weight gain, bradycardia, constipation, mental dullness, feeling cold, shortness of breath, decreased sweating, dry skin and hair |
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hypothroidism complications
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myxedema coma - stress (infection, trauma, cold)
hypothermia, decreased respirations depressed mental function, lethargy blood glucose drops cardiac output drops nonpitting edema requires intubation and mechanical vent give synthroid |
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hypothroidism diagnostic tests
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T3 and T4 low
TSH high or low, depends on cause |
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hypothroidism interventions
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synthetic thyroid hormone
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hypothroidism education
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consistent use of med
regular blood tests to monitor TSH |
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hyperthyroidism pathophys
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excessive amounts of circulating thyroid hormone
primary - thyroid gland causes excess hormone release secondary - excess TSH tertiary - excess TRH |
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hyperthyroidism etiology
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Grave's disease - autoimmune disorder
multinodular goiter- thyroid nodules secrete excess TH pituitary tumor may secrete excess TSH thyroid tumor may secrete TH radiation exposure |
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hyperthyroidism S&S
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hypermetabolic state - heat intolerance, increased appetite with weight loss, increased frequency of bowel movements
nervousness, tremor, tachycardia, palpitattions heart failure main, psychotic expothalamus |
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hyperthyroidism complications
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thyrotoxic crsis - if untreated or under stress
following thyroid surgery can cause death in 2 hours S&S - tachy, hypertension, high fever, dehydration, restlessness, delirium |
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hyperthyroidism diagnostic tests
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serum T3 and T4 elevated
TSH low in primary thyroid scan to locate tumor only physician should palpate gland |
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hyperthyroidism interventions
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Propylthiorcil (PTU) meethimazole (Tapazole), inhibit synthesis of TH
Propanolol (Inderal) is beta blocking medication oral iodine radiocative iodine to destroy portion of thyroid gland surgery |
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hyperthyroidism care
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monitor vitals, lung sounds
assess for anxiety monitor bowel function asses for eye injury |