Endocrine part 2/Neuro

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foxyt14
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285930
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Endocrine part 2/Neuro
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2014-10-16 15:32:36
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endocrine neuro
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endocrine 2nd half and neuro
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  1. Parathyroid hormone  regulates
    calcium and phosphorous levels
  2. All types of hyperparathyroidism leads to
    hypercalcemia and hypophosphatemia
  3. Target organs of the parathyroid
    • bone
    • kidneys
    • GI tract
  4. Normals for calcium and phospherous
    • ca = 8-11
    • phos = 2-4
  5. What are your calcium levels for severe hyperparathyroidism?
    >15
  6. Clinical manifestations of hyperparathyroidism
    • all have to do with hypercalcemia:
    • osteoporosis-drawing of ca out of bone, making them brittle
    • nephrolithiasis-kidney stones
    • N/V
    • memory change
    • depression
  7. Little mnemonic for hyperparathyroidism
    • Moans-feel cruddy from n/v
    • Bones-osteoperosis
    • Groans-pain from kidney stones
  8. How do you diagnose hyperparathyroidism?
    • PTH and serum CA levels
    • MRI, CT for possible tumor

    Bone density test done as preventative and notice osteoporosis and do further tests of calcium levels
  9. When does a person get a parathyroidectomy?
    when the person has primary hyperparathyroidism that is affecting the kidneys, has peptic ulcers, pancreatitis
  10. How does the parathyroidectomy get performed?
    removal of 3 parathyroid glands and replacement of the 4th (resection) in the forearm or sternoclidomastoid.....

    still allows for calcium levels to be regulated.
  11. What is a drug to decrease serum calcium levels?  How does it work?
    Fosamax

    decreases rate of bone resorption, decreasing serum calcium levels
  12. Potential post op complications from parathyroidectomy
    • respiratory distress...secondary to tracheal edema
    • hemorrhage....vascular area around this gland
    • transient hypoparathryoidism
    • hypocalcemia
  13. How can you tell a person post op from parathyroidectomy may be starting to have issues with respiratory distress?
    • hoarse voice
    • loss of voice
    • difficulty swallowing

    laryngeal paralysis is a problem post op
  14. s/s of hypocalcemia
    • nervousness
    • irritability
    • tetany
  15. Chovteks tests.....and how
    hypocalcemia

    tape cheek...if it twitches, then hypocalcemia
  16. Trouseaus tests...and how?
    inflate BP cuff on patient and hold it there for 3 minutes....

    will make the hand point in if have hypocalcemia
  17. Post op care after parathyroidectomy
    • watch for tetany
    • admin calcium gluconate prn
    • monitor I&O

    TEACH importance of exercise and dietary intake of CA and low phospherous
  18. If a person is getting calcium gluconate I need to watch for....
    hypotension and arrhythmias
  19. All types of hypoparathryroidism leads to
    hypocalcemia and hyperphosphatemia
  20. A person who has hypoparathryoidism will have signs of
    neuromuscular hyperactivity

    • muscle cramps
    • stiffness
    • twitchy
    • fatigue
  21. Clinical manifestations of hypoparathyroidism
    • All related to hypocalcemia
    • decreased co
    • dysrhythmias
    • fatigue
    • weakness
    • irritability
    • headache
    • paresthesia of lips, hands, feet
    • chronic spasms
  22. How do you prevent tetany?
    check PTH levels and admin calcium gluconate as needed
  23. How much calcium should we have a day?  Taken with?
    • 1.5-3 grams/day
    • V. D, helps with absorption in GI tract
  24. Characteristics of hyperparathyroidism
    • increased bone resorption
    • elevated serum ca levels
    • decreased serum phos levels
    • decreased neuromuscular irritability
    • hypercalciuria/hyperphosphaturia
  25. What are you at risk for getting when you hyperparathyroidism?  Why?
    kidney stones

    you have hypercalciuria and hyperphosphaturia....which causes causes kidney stones
  26. Characteristics of hypoparathyroidism
    • decreased bone resorption
    • depressed serum calcium levels
    • elevated serum phosphate levels
    • increased neuromuscular activity that may progress to tetany
    • hypercalciuria/hypophosphaturia
  27. Can you get kidney stones with Hypoparthyroidism too? Why?
    yes cuz have hypercalciuria too
  28. Calcium containing foods....phosphorous containing foods?
    calcium-dairy, green leafy, whole grains

    phosphorous-dark sodas, pumpkin seeds, romano cheese, salmon, scallops, veal, tofu, beans, lentils
  29. 3 drugs to treat hyperparathyroidism....and how do they work?
    • Calcitonin-human
    • Calcitonin-salmon
    • Didronel

    bone resorption inhibitor
  30. 3 meds for hypoparathyroidism....and how do they work?
    • Calderol
    • Rocaltrol
    • Drisdol

    Increases intestinal absorption of calcium
  31. Hypercortisolism's AKA....
    Cushings Syndrome
  32. What is Cushings Syndrome
    excessive corticosteroids...partically glucocorticoids/cortisol
  33. People at risk to get Cushings Syndrome?  Why?
    COPD and people with auto immune diseases

    cuz they are on high doses and long term treatments with corticosteroids
  34. S/S of Cushings Syndrome
    • Buffalo hump
    • thin extremities
    • thin/fragile skin
    • sick lots...leukocytosis
    • hyperpigmentation of skin
  35. With Cushings Syndrome the person has a lot of......, causing......
    aldosterone

    • hypervolemia
    • hypertension
    • edema
    • sodium and water retention
    • hypokalemia
  36. Key labs for Cushings syndrome....
    everything is too high, but K is low

    extra blood sugar, blood volume, sodium
  37. Dx studies for Cushings syndrome/hypercortisolism
    • 24 hr urine for free cortisol
    • plasma cortisol, ACTH
    • lab of electrolytes (increased glucose, decreased K)
    • CT/MRI for tumors
  38. Goal of collaborative management for cushings syndrome
    normalize hormone secretion
  39. Pre operative care for a person with Cushings  having hypophysectomy or adrenalectomy
    • Correct F&E Imbalances-na, k, glucose
    • watch for dysrhythmias from hypokalemia
    • prevent infection using aseptic technique
    • Start glucocorticoid therapy
  40. If a person has Cushings, they have too much cortisol.  But prior to surgery we are going to admin cortisol....why?
    When we remove the adrenal gland they will have experience an adrenal crisis if we don't....so give ACTH so this doesn't happen
  41. Post op care for a person after an adrenalectomy
    • watch for symptoms indicating cardiovascular collapse from insufficient glucocorticoids
    • watch for hypotension
    • decreased UO
    • weak/rapid pulse
    • *teach life long corticosteroid treatment
  42. Nursing management for a person with Cushings
    • H & P...asking if they have had a pit. tumor, adrenal tumor or long term steroid treatment
    • teach about dose adjustments with stress/sick
    • wear medic alert bracelet
  43. What is the problem with adrenocortical insufficiency?
    • inadequate secretion of ACTH
    • dysfunction of hypothalamic-pituitary control mechanism
    • complete or partial destruction of adrenal glands
  44. Primary adrenal insufficiency's AKA-
    Addisons Disease
  45. Describe Addison's Crisis
    stressful event-surgery, trauma or severe infection

    the major problem is profound hypotension and shock
  46. When a person with Addisons is describing how they feel what will they say?
    • tired
    • GI problems
    • menstrual problems
    • impotence
    • weight loss
  47. What assessment findings will I see in a person who has Addisons disease?
    Low everything, but high K

    • skin changes
    • hypoglycemia
    • hypotension
    • tachy
    • hyponatremia
    • fever
    • HYPERKALEMIA
    • dehydration
    • N/V
  48. ACTH Stimulation test?
    measures how well the adrenal glands respond to ACTH

    • draw blood and check cortisol levels
    • give injection of cosyntropin
    • after 30 - 60 min draw blood and check cortisol levels

    increase in ACTH is normal...18-20 higher
  49. Goal for treatment of Addison's/Adrenalcortical insufficiency
    F&E balance
  50. Interventions for Addison's
    • monitor and replace gluco and mineralcorticoids
    • teach patient side effects and long term treatment problems of corticosteroids
    • add sugar, volume, salt
    • D5NS
  51. Problems with taking steroids long term
    • risk for infection
    • edema
    • increased bp
    • mood swings
    • weight gain
    • high blood sugar
    • osteoporosis
  52. If a person with Addisons is going to have surgery or is under a lot of stress....what do they do?
    increase dose by 50%
  53. How do you take your hydrocortisone/prednisone orally?
    • with meals/food...watch for GI irritation
    • 2/3 in am
    • 1/3 in pm
  54. If a persons on cortisone/hydrocortisone/prednisone they need to call the doctor if....
    • rapid weight gain
    • round face
    • fluid retention

    with...severe diarrhea, vomiting, fever
  55. If a patient is on Fludrocortisone for Addisons/hypofunction of the adrenal gland what needs to be monitored?
    • watch for hypertension
    • report weight gain/edema...cuz sodium related fluid retention is possible
  56. Hyperaldosteronism is usually from?
    AKA?
    • Adrenal Tumor
    • Conn's Tumor
  57. S/S of Conn's Syndrome
    • hypokelemia
    • hypertension
    • headache
    • fatigue
    • muscle weakness
    • arrhythmias
  58. How do you treat Conn's syndrome?
    • surgery...adrenalectomy
    • carefully monitor VS
    • Watch electrolytes
  59. What is commonly given to a person with Conn's Syndrome?
    K sparing diuretic....it will decrease K and increase na

    Is this right?
  60. What's pheocromocytoma?
    tumor of the adrenal medulla producing excess epinephrine and norepinephrine
  61. S/S of pheocromocytoma
    • severe episodic HTN
    • headache
    • tachy
    • profuse sweating
  62. How is pheocromocytoma treated?
    • CT/MRI to locate tumor....and surgery
    • Calcium channel blockers...correct cardio complications
    • 24 hour urine collection
  63. What in the urine is a positive ID for pheocromocytoma
    • vanillamandelic acid
    • metanephrines
  64. Why is an injury to the occipital lobe bad?
    #1 priority?
    It encases the brain stem and is the vasomotor center....it controls

    • RR
    • HR
    • BP

    #1 watch ABC!!
  65. Which area of the brain is the most fragile and requires attention the fastest?
    temporal lobe
  66. Where are lumbar punctures done?
    between L2-L3
  67. What lines the interior of the skull?
    dura mater....tough mother
  68. Where does the outer layer of the brain dura terminate?
    foramen magnum
  69. What is the innermost layer of the brain....it covers the entire surface of the brain?
    Pia Mater
  70. What lies above the dura, between the skull and the dura mater
    epidural
  71. What lies below the dura, between the dura mater and the arachnoid space?
    Subdural
  72. What is below the arachnoid layer, between the arachnoid layer and the pia mater?
    Subarachnoid
  73. What space does the CSF flow in?
    subarachnoid space
  74. Left hemisphere vs. Right hemisphere....most people are???
    • Language ....left
    • Perception....right

    most are left
  75. What connects the 2 hemispheres of the brain?
    Corpus Collasum....important for seizure control
  76. What is a Corpuscalistotomy?
    its a surgery to stop a person seizures from going from focal to generalized
  77. We live in our......? why do we say this?
    brain stem

    it controls HR, BP and RR

    When it doesnt function we die....or need interventions fast
  78. Which cranial nerves are in the mid brain?  What do they control?
    • 3 and 4
    • make pupils round
  79. What cranial nerves are in the PONS?
    5-8
  80. If this area of the brain isnt functioning you will need mechanical support
    medulla....controls respirations and BP
  81. 3 parts of the brain stem
    • Mid brain
    • Pons
    • Medulla
  82. What part of the brains vasculature provides blood to the brain?
    anterior circulation...

    • internal carotid
    • opthalmic
    • anterior and cerebral arteries
  83. What does the Circle of Willis do?
    it is at the base of the skull and is a protective mechanism that insures the brain has adequate blood flow

    it is where the arteries meet...anterior and posterior arteries
  84. What part of the brain will be responsible for shunting blood if there is a problem with circulation?
    Circle of Willis
  85. How much CSF do we make an hr?
    20cc
  86. What part of the brain absorbs CSF?
    arachnoid villi
  87. What can cross the blood brain barrier?
    ???
  88. Venous circulation is emptied by....
    gravity....it doesnt have valves
  89. Why dont people lie flat when we know they have ICP?
    cuz venous return isnt allowed to use gravity then to empty....therefore increasing ICP
  90. When a person is deteriorating neurologically, how will we see their orientation change....what order?
    • #1 Event
    • #2 Time
    • #3 Place
    • #4 Person
  91. stuporous
    can only be aroused by vigorous and continuous external stimuli
  92. obtunded
    duller indifference to external stimuli, and response is minimally maintained
  93. Lowest score for glascow coma....highest?
    • 3
    • 15
  94. What kind of light do you use to assess pupil size?
    ambient light....low key
  95. If pupils are in the midposition this means....
    CN #3 is ok
  96. This change in the pupils signifies an increase of ICP
    ovoid pupil shape
  97. If a person has a keyhole shaped pupil, what does this mean?  What do I do?
    orbital fx

    CT of orbit
  98. Sluggish pupils means?
    increase in ICP...CN #3 is compromised
  99. Non reactive pupils means....
    cerebral ischemia
  100. Hippus
    when pupils constrict then bound right back....increased ICP
  101. Disconjugate
    when eyes dont track together
  102. Sum up Broca's area
    cant find words on their own, but can repeat stuff perfectly
  103. Sum up Wenicke's area
    cant understand messages, they babble about nothing I am asking them about.

    words dont have meaning
  104. What's the problem with dysarthria?
    problem with oral control of the tongue....CN #12

    person sounds drunk
  105. 3 primitive reflexes

    How can you tell if it is a reflex or the person means to do it?
    • Babinski
    • Sucking
    • finger squeeze

    tell them to let go of your finger....if they do it, then it is not a reflex and they have neuro function
  106. Rule for increase in temp and increase in ICP
    for every 1 c increase in temp, the ICP increases 10%
  107. With an increase in ICP what happens to the BP?
    • increased systolic....not diastolic
    • widened pulse pressure

    seen in advanced stages of ICP
  108. What is the sign of advanced ICP?
    bradycardia
  109. How do you describe respirations?
    abnormal respirations with 20 seconds of apnea

    NOT RR of 9
  110. Cranial Nerves saying....
    Oh, oh, oh, to touch and feel a gross, veiny, slimy heart
  111. 12 cranial nerves
    • olfactory
    • optic
    • occulomotor
    • trochlear
    • trigeminal
    • abducens
    • facial
    • auditory
    • glossopharyngeal
    • vagus
    • spinal accessory
    • hypoglossal
  112. Which CN are tested together to look at eyes?
    3,4,6
  113. Which CN are tested together to test swallowing?
    9 and 10
  114. Which CN tells you about smell?
    #1 olfactory
  115. How do you test CN #V...Trigeminal?
    flick fingers in front of their eyes and they should twitch
  116. How do you test the facial CN #7
    make sure face is symmetrical....make them make a smile
  117. How do you know the auditory CN #8 is working?
    the person is following commands
  118. How do you test the optic CN #2?
    How many fingers am I holding up?
  119. Which CN is important to test when a person has a suspected spinal cord injury?  How?
    #11, spinal accessory

    turn head, shrug shoulders
  120. How do you test CN #12, hypoglossal?
    listen to see if they ares slurring their speech, watch them eat and have them do tongue tricks
  121. How do you test CN 3, 4, and 6?
    Occulomotor, Trochlear, Abducens
    PERRLA and make an "H" with finger in the air and make sure they track your drawing
  122. What happens with the eyes with increased ICP
    dilated, sluggish pupils
  123. Ptosis
    sluggish pupil with droopy eye lid....increased ICP
  124. When there is increased ICP, what is shunted first?  Then????
    • CSF
    • intravascular blood
  125. Modified Monro-Kelly Hypothesis
    the skull is a rigid compartment.  If one component increases in volume, another must decrease in volume or intracranial pressure will rise
  126. Normal ICP with a lumbar puncture and with a transducer
    80-180 lumbar

    0-15 with transducer
  127. Compliance
    the ability of the brain to adapt to increasing pressure without increasing ICP
  128. Hypertension and the brain
    increased systemic arterial pressure causes vasoconstriction in the vessels of the brain
  129. Hypotension and the brain
    decreased systemic arterial pressure causes vasodilation in the vessels of the brain
  130. Describe chemical autoregulation of ICP
    PaCO2 >45 and PaO2 <50 (hypoxemia) cause vasodilation and increased ICP
  131. When do auto regulatory mechanisms fail when it comes to managing intracranial pressures?
    • when ICP >40
    • Cerebral injury
    • Profoundly elevated BP....a MAP >130
  132. Whats CPP and what level is normal?
    Cerebral Perfusion Pressure

    60-100
  133. How do you calculate Cerebral Perfusion Pressure?
    Mean Arterial Blood Pressure - ICP

    MAP=1 systolic + 2 Diastolic/3

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