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  1. Adernal cortex fails to produce enough cortisol and aldosterone
    May be from pituitary problems or autoimmune disease
    Addison's disease
  2. Overproduction of the hormone cotrisol
    common due to over administration of steriods or tumor
    Cushing's Syndrome
  3. What kind of tumors mostly cause Cushing's syndrome?
    • Lung or Pancreas
    • but could be adrenal tumors
  4. Cushing's diagnosic tests
    • 24-Hour urine for free cortisol
    • *Levels of 50-100 mcg/day in adults indicate a cushings
    • High-Dose decamethasone suppression test used for borderline results of 24-hour urine cortisol
    • CT and MRI of pituitary and adrenal glands
    • CBC
    • Electoylyte panals (false postives can occur in alcoholics and liver failure)
    • High or normal ACTH levels indicate ACTH-dependent Cushing's disease-(hormone produced by pituitary)
  5. Normal signs and symptoms of cushings
    • thinning hair
    • red cheeks
    • buffalo humo
    • supraclavicular fat pad
    • Thin extremeties with muscle atrophy
    • thin skin and subcutanous tissue
    • Acne
    • Moon face
    • increased body and facial hair
    • weight gain
    • striae
    • pendulous abdomen
    • ecchymosis resulting from easy bruising
    • slow wound healing
  6. Medical treatment for cushing
    Pituitary adenoma
    Adrenal tumors or hyperplasia (overgrowth of cells)
    • PA- surgical removal of tumor and/or radiation
    • AT- Adernalectomy
  7. Cushings Drug therapy
    • Miotane
    • Suppresses cortisol production
    • Alters peripheral metabolism of cortisol
    • Decrease Plasma and urine corticosteriod levels
    • Metyrapone
    • Nizoral
  8. Adrenalectomy pre op
    • Optimal physical condition
    • Control hypertension and hyperglcemia
    • Hypokalemia must be corrected
    • High protein diet helps correct protien
  9. Adrenalectomy Post op
    • Risk of hemmorage, always have 4-6 units of blood waiting
    • Hormone are going to be crazy because of manipulation of organ
    • BP, Fluid status, and electrolyte levels tend to be unstable because of the hormone fluctuations
    • High doses (4-5g) of corticosteroids adminsisterd for several days
    • Monitor I&Os
    • Critical period for circulatory instablitiy ranges from 24-
    • 48 hours
    • Morning urin levels of cortisol are measured to evaluate the effectiveness of surgery
  10. Nursing diagonosis for cushing
    • Risk for infection
    • Imbalanced nutrition r/t decreased appetite
    • Disturbed self-esteem related to altered body image
    • Impaired skin intergrity
  11. All 3 classes of adrenal corticosteroids are DECREASED Glucocorticoids, mineralocorticoids, androgens
    Tuberculosis also could influence steroids
    HIV Pts have changes in steroids
    Addisons disease
  12. Symptoms of addisons disease
    • Weakness
    • Weightloss
    • Nausea
    • Diarrhea
    • Seen primarily in
    • Areas exposed to sun
    • Pressure joints·
    • Over joints·
    • In skin creases, especially palmar creases
    • salt craving
    • hypoglycemia
    • irritabiltity
    • depression
  13. Diagnostic tests Addisons
    • ACTH stimulation test (best one)
    • -blood cortisol, urine cortisol, or both are measured before and after a synthetic form of ACTH is given by injection.
    • (if no increase in cortisol levels may indicate addison)
    • CBC
    • Electrolyte Panels
    • Hyperkalemia
    • Hypochloremia
    • Hyponatremia
    • Hypoglycemia
    • Urine Cortisol Levels
    • will typically low
    • CT scans, MRI's
  14. Medical Management of addisons
    • Hydrocortisone
    • Most commonly used as replacement therapy
    • Glucocorticoid dosage must be increased during times of stress to prevent addisonian crisis
    • Oral corticosteriods -fludrocortisones (florinef) to replaces aldosterone
  15. Nursing Management addisons
    • Glucocortcoids proper adminstration: Given 2/3 in am and 1/3 at night
    • Mineralcorticoids given once daily in am
    • Compliance w long term medications
    • stess management
    • monitoring infection
    • EDUCATION- monitoring vitals esp BP bid and salt intake and k+
    • Montitoring an addisons crisis
    • Keep an emergency kit at all times (hydrocortisone syringes, medic alert bracelet)
  16. Thyroid scan
    • No caffine day before test
    • 2 day test
    • Must be NPO day of test
    • 1) give iodine, scan leg and thyroid
  17. Thyroid
    Fine needle biopsy
    • informed consent
    • done under ultrasound
    • invasive
    • watch for bleeding
  18. Causes of hypothyroid
    • Hashimotos thyroiditis
    • Autoimmune disease
    • surgical removal of thyroid
    • radiation therapy
    • little intake of iodine
    • medications
    • congential
  19. Symptoms of hypothyroidism
    • Hairloss
    • Lethargy
    • dry skin
    • muscle aches and weakness
    • constipation
    • intolerance to cole
    • receding hair line
    • facila and eye edema
    • dull blank expression
    • extreme fatigue
    • thick tongue slow speech
    • anorexia
    • brittle hair and nails
    • menstral disturbances
  20. Late clinical manifestations of hypothyroidism
    • bradycardia
    • weight gain
    • decreased loc
    • thickened skin
    • cardiac complications
  21. Medical Management of hypothyroidism
    • Replacement of hormone
    • Levothyroxine (synthroid)
    • monitoring weight
    • monitoring cardiovascular status - chf is possible
    • monitor for hyperthyroidsm
    • Laboratory follow up post during therapy
    • *TSH goal is to keep in normal range
  22. Levothyroxine (Synthroid)
    When do you adminiser?
    • First thing in the morning
    • wait 30-60 min to eat
    • dosage is based on T3 or T4
  23. Nusing diagnosis for hypothyroidism
    • Alteration in cardiac output
    • Ineffective breathing pattern
    • Thought processes disturbed
    • alteration in nutrition
    • altered bowel elimination
    • fluid volume excess
    • activity intolerance
  24. Nursing interventions for hypothyroidism
    • Assess vital sign (not cardiovascular) if they dont feel good bp
    • Assess nutritional status (note fluid volume)
    • Maintain warm enviroment, alernate activtiy with rest
    • pervention and treatment constipation
    • avoid sedatives, narcotics, sleep aids
    • Encourage high fiber
    • monitor side effects of medications
  25. Levothyroxine (synthroid)
    monitoring needed
    • Carefully monitor patients with cardiovascular diseases
    • Monitor heart rate and report pulse greater that 100bpm
    • Promptly report chest pain, weightloss, nervousness, tremors, insomina
  26. Causes of hyperthyroidism
    • Grave's disease- most common
    • toxic nodular or multinodular goiter
    • thyroiditis
    • excessive replacement of thyroid hormones
  27. Signs and symptions for hyperthyroidism
    • Intolerance to heat
    • Finger clubbing
    • Tremors
    • Diarrhea
    • menstral changes
    • fine straight hair
    • bulging eyes
    • enlarged thyroid
    • tachycardia
    • increase systolic bp
    • breast enlargement
    • weightloss
    • muscle waisting
    • localized edema
  28. Medical Management for hyperthyroidism
    Antithyroid medication
    Radioactive iodine
    Beta Blockers
    • AM- PTU, Tapazole
    • RI-SSKI and Lugol's solution
    • Thyroidectomy
    • BB- Inderal, corgard, tenormin, lopressor - (asthma)
  29. Nursing diagnosis for hyperthyroidism
    • Imbalanced nutrition less than body requirements
    • hyperthermia
    • fatigue/activity intolerance
    • potential complications: cardiovascular
    • impaired sleep patterns
    • impaired coping
  30. Nursing interventions hyperthyroidism
    • Activity assessment
    • Vital signs (cardio check)
    • Encourage rest, cooler room temperature
    • Monitor post iodine treatment: may not take effect for days to weeks
    • Monitor lab values
  31. Post op care for thyroidectomy
    • Have trach set and calcium gluconated bedside
    • watch for output for j&p
    • Routine post op vital signs
    • monitor airways
    • place in semi fowlers position
    • monitor drain output
    • monitor for laryngeal stridor and laryngeal paralysis
    • Monitor calcium levels. Check for tetany
    • Check Chevostek and Trousseau signs- if low give a tum or calcium gluconate
  32. Complications: Severe Hyperthyroidism
    • Thyroid Storm
    • Life threatening event , rapid onset
    • Caused by infections, trama, stress
    • Key features: Fever, Tachycardia, and Systolic Hypertention
  33. Complications: Severe Hypothyroidism
    • Myedema Coma: heart muscle flabby decreased o2 to heart, brain
    • This is a life threatening problem
    • Results in tissue and organ failure
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