Patho Exam 2 Endocrine

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allison06
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10325
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Patho Exam 2 Endocrine
Updated:
2010-03-21 00:18:42
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Nursing Patho
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Endocrine problems: hyperthyroidism, hypothyroidism
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  1. State the cause of Hyperthyroidism
    Anything that increases levels of circulating thyroid hormone (TH) - its all about energy
  2. List risk factors for Hyperthyroidism
    • Women age 30 to 40
    • Family History
  3. What is Primary Thyrotoxicosis?
    • Not caused by elsewhere
    • Too much of a good thing
    • Graves Dx
    • Toxic multinodular goiter
    • Follicular thyroid cancer (rare)
  4. List clinical manifestations for Hyperthyroidism
    • Reflects Increased Basal Metabolic Rate
    • CV- tachycardia, palpitations, angina, chest pain
    • Neuro- hyperactive reflexes, sleeplessness, nervousness
    • GI- Inc appetite with wt loss, inc gastric motility, diarrhea
    • Heat intolerance
    • Eye syndrome- exophthalamos (tissue buildup behind orbit)
    • Dec or absent menses
    • Goiter
    • Inc thyroid hormone levels
  5. What is the pathophysiology of Graves Dx?
    • Thyroid antibodies (autoimmune)
    • Rate of onset: slow insedious
    • Multisystem syndrome
  6. What does Graves Dx result in?
    • Inc thyroid hormone (TH) levels
    • Inc iodide uptake
    • Inc rate of thyroid gland metabolism leads to goiter
  7. What characteristics must be present to have Graves Dx?
    • Hyperthyroidism- test serum level
    • Goiter
    • Exophthalmos
    • Dermopathy
  8. What is a Thyrotoxic Crisis (Thyroid Storm)?
    • Stressors (infection or lung/ heart disorders)
    • Rare
    • Dead in 48 hours
    • Huge outflow of thyroid hormone
  9. List manifestations of Thyrotoxic Crisis
    • Think catecholamines- epinephrine (fight or flight)
    • Tachycardia
    • Hyperthermia
    • N/V
    • Diarrhea
    • Agitation or delirium
    • Heart failure
  10. What is the prototype drug for Antithyroid agents?
    Propylthiouracil (PTU)
  11. State MOA of propylthiouracil (PTU)
    Blocks hormone synthesis by inhibiting conversion of T4 to T3 in peripheral circulation
  12. What is the therapeutic use of propylthiouracil (PTU)?
    Restore euthyroid (nml levels- not too high or too low) and metabolic levels
  13. State the MOA of Radioactive Iodine (131I)- tx for hyperthyroidism
    Localized radiation effect, slowing thyroid production
  14. State mode of delivery for Radioactive iodine (131I)
    Capsule or solution
  15. List Nsg implications of Radioactive iodine (131I)
    • Localized radiation therapy- safe to be around, gone in 2-3 days
    • Lugol solution is a strong iodine solution with K+ that protects thyroid to some extent, it slows it down w/o knocking it down
  16. What is the cause of hypothyroidism?
    • Anthing that decreases levels of circulating thyroid hormone (TH)
    • Ex. Hashimoto's thyroiditis or overtreatment of hyperthyroidism
  17. List risk factors for Hypothyroidism
    • Female
    • More common in aging people
    • Pregnancy
  18. Describe S&S of Hypothyroidism
    • Opposite of hyperthyroidism (or no energy)
    • Bradycardia, dyspnea, low energy, constipation, dry hair and skin, cold, inc menses, depressed, no energy
  19. List major S&S of Congenital Hypothyroidism (Cretinism)
    • Neuro- floppy, dull appearing facial features, hypotonia, hoarse sounding cry
    • Integumentary- dry, brittle hair, and low hairline
    • Musculoskeletal- thick, protruding tongue, large fontanelles, broad and short
    • GI- poor feeding, choking episodes, constipation
    • Myxedema
  20. What is Hashimoto Thyroiditis?
    • Aka Hashimoto dx or lymphocytic thyroiditis
    • Autoimmune disorder
    • all about size not fxn!
    • Inflammation/ Destruction
  21. List clinical manifestations of Hashimoto Thyroiditis
    • Enlarged thyroid gland
    • Sx typical of hypothyroidism (hypoactive goiter)
  22. What is Myxedema (Hypothyroid Crisis)?
    • Severe or prolonged thyroid deficiency
    • A crisis level lack of metabolism that can kill
    • pts in infurmed condition- nsg home, chronic illness
  23. What is the clinical presentation for Myxedema?
    • Altered mental state
    • "myxedema coma" from too little energy
    • Cold intolerance
  24. List clinical presentations of severe Myxedema
    • Cardiovascular collapse
    • Hypoventilation
    • Hypoglycemia
    • Lactic acidosis
  25. State the natural and synthetic drugs for Thyroid agents
    • Natural- Thyroid (Armour thyroid)
    • Synthetic- Levothyroxine (Synthroid) synthetic T4
  26. What is the MOA for thyroid agents?
    Exogenous replacement of thyroid hormone to achieve euthyroid levels and normalize metabolism
  27. What are the indications and contraindications of Levothyroxine Na (Sythyroid)?
    • Indications: Hypothyroidism
    • Contra: CHD (do not overwork the heart) and allergy
  28. List SE and Interactions for Levothyroxine Na (Synthyroid)
    • SE: associated with overdose
    • Oral anticoagulants
    • Digitalis
    • Cholestyramine (antilipemic agent)- binds to thyroid hormone in GI track- dec absortion of thyroid
  29. List pt teaching for Synthyroid
    • Take in AM, on empty stomach, at least 30 minutes before eating (to give you energy)
    • S&S of hypo and hyperthyroidism
  30. List monitoring for levothyroxine (Synthyroid)
    • Relief of symptoms of hypothyroidism
    • Absence of symptoms of hyperthyroidism
    • Labs of Serum TSH and T4 levels
  31. What are the major post pituitary problems?
    • Syndrome of inappropriate Antidiuretic hormone secretion (SIADH)
    • Diabetes Insipidus (DI)
  32. What are the problems of Anterior Pituitary gland?
    • Hypopituitarism
    • Hyperpituitarism
  33. Define SIADH
    • High levels of antidiuretic hormone (ADH) in absence of nml physiologic stimuli for its release
    • (high levels w/o reason to be there)
  34. List common causes for SIADH
    • Ectopically produces ADH - adenocarcinomas
    • Transient SIADH- post-pituitary surgery
  35. List Sx of Hyponatremia
    • Thirst
    • Dyspnea (movement of fluid)
    • Fatigue
    • Dulled sensorium, confusion, lethargy
    • Muscle twitching, convulsions
    • Impaired taste, anorexia, vomitting, cramps
    • Severe (100-115): irreversible damage, coma, death
  36. What is the prototype drug for Demeclocycline?
    Demeclocycline (Declomycin)
  37. What is the classification and drug use of Demeclocycline?
    • Tetracycline broad-spectrum antibiotic
    • Antibiotic therapy
    • Treatment of persistent SIADH
  38. What is the MOA of Demeclocycline (Declomycin)?
    Interferes with renal response to ADH
  39. Define Diabetes Insipidus
    • Inability to concentrate urine due to insufficiency of ADH
    • Body water floods out- causing dilute urine
  40. What does DI do to neurogenic (central)?
    • Causes head trauma, brain death
    • sudden onset
  41. What does DI do to nephrogenic (renal)?
    • Causes CRF, lithium, water based urine
    • Slow onset
  42. List clinical manifestations for DI
    • Polyuria and polydipsia
    • Dec urine specific gravity and osmolality (like water)
    • Serum osmolality concentrated in body
  43. What is the prototype drug for Neurogenic DI?
    • Desmopressin (DDAVP)
    • aka Vasopressin
  44. What is the MOA of Desmopressin (DDAVP)?
    Synthetic ADH, replacement therapy
  45. What is the delivery mode for Desmopressin?
    • Nasal spray
    • PO
    • IV
  46. What are the common SE of Desmopressin?
    None, except for nasal
  47. What are the nsg implications for Desmopressin?
    Monitor and baseline data- serum and urine osmolality, and fluid balance/ weight (I&O)
  48. What is the client teaching for Desmopressin?
    • Careful adjustment of water intake w/ tx to avoid water intoxication and dilutional hyponatremia (do not overload)
    • Missed dose? Take now, do not double
    • Tolerance possible
    • Nasal may be irritating
  49. What drug is given for nephrogenic DI?
    Hydrochlorothiazide (HCTZ)
  50. What is HCTZ therapy used for?
    • Paradoxical effect in DI (dec polyuria, inc osmolality)- reverses Sx
    • MOA unknown
    • Taken with K+ sparing diuretic
  51. What is Addison's Dx?
    • Primary adrenocortical insufficiency
    • Dx of adrenal cortex
    • Results in loss or lack of cortisol hormones
    • Idiopathic, autoimmune, or other
    • Can result in permanent gland damage
  52. What does Addison's Dx cause a decrease in?
    • Cortisol
    • Aldosterone
    • Androgens
  53. Discuss early clinical manifestations of Addison's Dx
    • Results from sodium and water problems
    • Slow degenerative destruction w/ rapid onset
    • Anorexia, wt loss
    • Weakness, malaise, apathy
    • Electrolyte imbalances
    • Skin hyperpigmentation (very tan appearance)
  54. What causes Addisonian (Adrenal) Crisis?
    • Sudden insufficiency of serum corticosteroids from...
    • sudden loss of adrenal gland
    • sudden increase in stres in chronic condition
    • sudden cessation of corticosteroid drug therapy
  55. What are the Sx of Addisonian (Adrenal) Crisis?
    • Sudden penetrating pain in the lower back, abdomen, or legs
    • Severe vomitting and diarrhea
    • Dehydration
    • Low BP
    • Loss of conciousness- coma (severe sodium/ water balance)
  56. What is the drug therapy for Addison's Dx?
    • Replace those deficient hormones
    • Cortisol- hydrocortizone (Cortef) 1-2 x/day
    • Aldosterone- mineralocorticoid (fludrocortisone- Florinef) and inc salt intake
  57. What are Nsg Implications for Addison's Dx?
    • Closely follow Rx dosing schedule
    • Never abruptly stop therapy
    • Replacement therapy is lifelong (chronic dx)
    • Dosage will need to be inc during stress- 3x3 (3 times dose for 3 days)
    • Always maintain emergency supply
    • Wear Medic Alert bracelet
  58. How do you treat Addisonian Crisis and why?
    • IV- hydrocortisone, saline, and dextrose (replace what is lost)
    • B/c PO- dec hydrocortisone and aldosterone until achieved over days

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