N420 Exam 3 Endocrine

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N420 Exam 3 Endocrine
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2014-12-06 21:37:18
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Exam 3 Endocrine
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  1. What is Diabetes Insipidus?
    HypOsecretion of ADH (causes DIURESIS)
  2. In a pt with DI, monitor for signs of ______.
    • dehydration
    • (and electrolyte values)
  3. Treatment for a pt with neurogenic DI.
    synthetic vasopressin/DDAVP
  4. What meds may be prescribed for severe or chronic DI?
    vasopressin or desmopressin (DDAVP, Stimate, Minirin)
  5. How may DDAVP (for chronic or severe DI) be administered?
    • injection
    • intranasal
    • oral
  6. What happens with SIADH secretion? What are the results?
    • Excess ADH is released
    • -results in water retention & dilutional     hyponatremia
  7. For a pt with SIADH, restrict ______ and administer _______ as prescribed.(saunders)
    • fluid intake
    • diuretics & IV fluids & meds that inhibit ADH-induced water reabsorption & produce diuresis
  8. Clinical manifestations of thyroid storm.
    (Saunders)
    • fever  > 101.3
    • HR >130
    • wt loss, diarrhea, abdom pain
    • edema, chest pain, dyspnea, palpitations
    • altered mental status
  9. What is pheochromocytoma?
    (Saunders p. 646)
    • Adrenal gland tumor (benign)
    • ---excessive amounts of Epi & NE are secreted

    • *associated with HTN crisis
    • *often genetic - sceen family
  10. Normal range of urinary catecholamines.
    (Saunders p. 646)
    • up to 14mcg/100mL of urine
    • (elevated in pheochromocytoma)
  11. Primary treatment for pheochromocytoma.
    (Saunders p. 646)
    Removeal of adrenal gland
  12. Complications associated with pheocromocytoma.
    (Saunders p. 646)
    • HTN crisis (HTN retinopathy & nephropathy)
    • cardiac enlargement, dysrhythmias
    • HF, MI
    • increased platelet aggregation
    • stroke
  13. For a pt with pheochromocytoma, promote ______ environment; and provide what kind of diet?
    (Saunders p. 646)
    • nonstressful environment with rest
    • high in calories, vitamins, & minerals
  14. What in particular should you avoid in a pt with pheochromocytoma?
    (Saunders p. 646)
    • stimuli that can cause HTN crisis
    • Such as: increased abdom pressure & vigorous abdom palpation
  15. What happens after an adrenalectomy?
    (Saunders p. 646)
    • catecholamine levels drop, which can result in cardiovascular collapse,
    • hypotension, and
    • shock
  16. HypErthyroidism is a form of __________.
    (Saunders p.647)
    Thyrotoxicosis
  17. Clinical manifestations of thyroid storm.
    (Saunders p. 648)
    • fever
    • tachycardia
    • systolic HTN
    • N/V/D
    • agitation, tremors, anxiety
    • As progresses:
    •       irritability, resltlessness, confusion, seizures
    •       delerium & coma
  18. Causes of DI.
    Neurogenic (tumor or head trauma): ADH not produced or excreted

    Nephrogenic: ADH excreted but kidneys do not respond or absorb water
  19. Treatment for pt with nephrogenic DI.
    • Low salt, low protein diet
    • Remove cause (lithium?)
    • Hydrochlorothiazide
    • NSAIDs
  20. Critical lab values indicative of pheochromocytoma.
    • plasma Epi > 400
    • plasma NE > 2,000

    (put in IV then draw blood 30 min later to avoid false elevations due to stress of needlestick)
  21. Typical presentation of a pt with pheochromocytoma.
    • Five H's:
    • Hypertension (severe)
    • Headache
    • Hyperhydrosis (excessive sweating)
    • Hypermetabolism
    • Hyperglycemia (conversion of liver and muscle glycogen to glucose due to epi secretion)
  22. What should a pt with pheochromocytoma avoid?
    • bright lights & overstimulation
    • coffee, tea, chocolate
  23. What is Cushing's disease?
    oversecretion of cortisol by adrenal cortex
  24. Diet for pt with Cushing's.
    • low Na+
    • low CHO
    • high protein
  25. What is Addison's Disease?
    Deficiency in cortical hormones (cortisol, aldosterone, androgens)
  26. ACTH levels in primary and secondary Addison's disease.
    • Primary = High ACTH
    • Secondary = Low ACTH
  27. In a pt with Addison's disease, a s/s of too HIGH of a dose of hormone replacement.
    • edema
    • wt GAIN
  28. In a pt with Addison's disease, a s/s LOW of too  of a dose of hormone replacement.
    • postural hypotension
    • wt LOSS
  29. What dietary changes should a pt with Addison's disease make in times of illness, very HOT weather, or other stressful situations?
    increase salt intake
  30. Normal osmolality.
    Just under 300
  31. Normal Na+ level.
    135-145
  32. What is SIADH?
    Too much ADH (too much water!)
  33. What is osmolality?
    • how concentrated the blood is
    • lower osmolality = more dilute
  34. What happens to osmolality in pts with SIADH?
    • SERUM osmolality is Decreased
    • URINE osmolality is Increased (H20 retained)
  35. Treatment for SIADH.
    • Loop diuretics (Lasix)
    • Fluid restriction
    • Correction of hyponatremia
  36. Why would a pt with SIADH have a decreased LOC?
    hyponatremia
  37. What should you prepare for post-thyroidectomy?
    • laryngeal edema
    • have at bedside: trach set, O2, suction, calcium gluconate
  38. Teach pts to take steroids when?
    WITH meals to prevent gastric irritation.
  39. When should pts taking steroids contact HCP?
    N/V  >12-24 hrs
  40. _________ is the hallmark of pheochromocytoma.
    Hypertension
  41. The pt with Cushing's syndrome experiences _____kalemia, _____glycemia, & _______ WBC count.
    • hyper
    • hyper
    • increased
  42. Primary problems of Addison's disease.
    • sudden profound weakness;
    • severe abdominal, back, and leg pain;
    • hyperpyrexia followed by hypothermia;
    • peripheral vascular collapse;
    • coma; and
    • renal failure.
  43. Signs and symptoms of adrenal insufficiency after adrenalectomy.
    • weakness,
    • hypotension,
    • fever, and
    • mental status changes
  44. A pt with SIADH will have _____  urine osmolality and _____ serum osmolality
    • high
    • low
  45. In a pt with DI, what is the level of specific gravity?  Urine osmolality?
    • lower than 1.005
    • low (50 to 200 mOsm/L)
  46. What type of diet is prescribed for a pt with Addison's disease?
    • high–complex carbohydrate 
    • high-protein diet
    • increase salt intake during:
    •        hot weather,
    •        before strenuous exercise, and
    •        in response to fever, vomiting, or diarrhea
  47. Normal urine specific gravity.
    1.002-1.030

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