Term
Hypothalamus role/function |
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Definition
Link between the endocrine system and the CNS Controls response to stress Receives info from most body parts |
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Term
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Definition
Sensors in the endocrine system detect changes in hormone levels and adjust hormone secretion to maintain normal levels. |
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Term
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Definition
Increasing levels of one hormone cause another gland to release a hormone |
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Term
Age-related changes: Pituitary |
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Definition
Decreased: ACTH, TSH, FSH |
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Term
Age-related changes: Thyroid |
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Definition
Increased fibrosis Decreased activity |
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Term
Age-related changes: Pancreas |
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Definition
Delayed and decreased hormone release Decreased sensitivity |
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Term
Age-related changes: Adrenal medulla |
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Definition
Decreased response to norepinephrine |
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Term
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Definition
Protruding eyes Seen in hyperthyroidism |
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Term
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Definition
Checking for hypocalcemia Inflate a BP cuff above the AC space to a point greater than the systolic BP. Keep inflated for 2-5 minutes. Normal finding: NO carpal spasm in response to compression of the arm by the BP cuff POSITIVE: muscular contraction including flexion of the wrist |
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Term
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Definition
Checking for hypocalcemia Tap your finger in front of the patient's ear at the angle of the jaw. A POSITIVE sign causes facial grimacing r/t repeated contractions of the facial muscle. Normal finding: no grimacing in response to the tapping. |
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Term
Progression for endocrine-related health assessment |
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Definition
Start distally and work proximally |
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Term
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Definition
Controls rate of body metabolism and growth |
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Term
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Definition
Thyroxine: T4 Triiodothyronine: T3 Thyrocalcitonin: Calcitonin |
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Term
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Definition
Control of blood calcium and phosphate ion concentrations Inhibits bone resorption and increases calcium excretion by the kidneys. |
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Term
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Definition
Osteoclasts break down bone and release the minerals resulting in a transfer of calcium from the bone fluid to the blood |
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Term
Essential element needed for the production of T3 and T4 |
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Definition
Adequate supply of iodine |
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Term
Control for the secretion of T3/T4 |
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Definition
Thyrotropin: TSH, thyroid-stimulating hormone |
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Term
TSH is secreted from the: |
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Definition
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Term
Hypothyroidism chemical etiology |
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Definition
Inadequate amount of TH being secreted |
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Term
Hypothyroidism present from birth: |
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Definition
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Term
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Definition
Stunted growth Abnormal bone formation Mental retardation Low body temperature Sluggishness |
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Term
Hypothyroidism demographics |
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Definition
Most common in women aged 30-60 |
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Term
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Definition
Chronic, untreated hypothyroidism in adults |
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Term
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Definition
Autoimmune Atrophy of gland with aging Congenital defects of gland Therapy for hyperthyroidism may cause this later on Medications Iodine deficiency Radiation Cancer/collagen diseases Ingestion of large amounts of goitrogenic foods |
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Term
Therapy for Hypothyroidism |
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Definition
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Term
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Definition
Turnips Peaches Large amounts of leafy green veggies Cabbage Soybeans |
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Term
Clinical manifestationof hypothyroidism: |
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Definition
Goiter Fatigue, weakness, muscle stiffness Hair loss, brittle nails Coarse, dry skin Non-pitting edema, periorbital edema GI: constipation, decreased appetite, weight gain Reproductive: menstrual irregularities, infertility, decreased libido CV: hypotension, bradycardia, cardiac enlargement Extremities: decreased reflexes, hand/foot paresthesias Slow speech Cold intolerance Memory impairment, personality changes, depression |
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Term
Myxedema coma: Description and triggers |
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Definition
Life-threatening Severe stage of hypothyroidism Triggered by: acute illness or trauma OR failure to take prescribed medications |
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Term
Myxedema coma: Clinical manifestations |
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Definition
Unconsciousness Hypothermia Hypoventilation Fluid retention, generalized edema all over Hyponatremia Hypoglycemia Lactic acidosis: blood isn't circulating well Metabolic acidosis |
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Term
Hypothyroidism: Diagnostic findings |
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Definition
Decreased T4 Decreased T3 Decreased T3 RU Elevated serum cholesterol |
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Term
Hypothyroidism: Diagnostic findings r/t TSH levels |
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Definition
Primary problem: Thyroid Serum TSH will be elevated Primary problem: Pituitary Serum TSH will be decreased |
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Term
Medications to treat hypothyroidism |
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Definition
Levothyroxine: Levoxyl, Synthroid Liothyronine: Cytomel Liotrix: Thyrolar, Euthyroid |
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Term
Surgical options to treat hypothyroidism |
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Definition
Subtotal thyroidectomy Surgeon will attempt to leave a portion of the gland in. |
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Term
Medical management of myxedema |
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Definition
ABCs Airway: patent Respirations/ventilatory support CV status: may need vasopressors to maintain BP F/E balance Acid/base balance: may have to give sodium bicarbonate Parenteral thyroxine Limit sedation. Watch for dig toxicity Correct hypothermia Treat precipitating factors |
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Term
Myxedema Crisis: Chest pain |
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Definition
Advise patient to report chest pain: As we increase body temp we increase metabolism. Increased metabolism increase myocardial O2 use This could cause angina or MI |
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Term
Patients on thyroid replacement would benefit by taking which supplement? How should the patient take it? |
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Definition
Calcium supplement is recommended. 4 hour time lapse between taking hormone and calcium supplements. |
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Term
Patients on thyroid replacement therapy and insulin |
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Definition
Monitor glucose carefully! Blood sugar may decrease once we increase metabolism. This patient may ultimately need less insulin. |
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Term
Patients on thyroid replacement therapy. Signs of excess hormones: |
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Definition
Weight loss Difficulty sleeping Signs of hyperactivity |
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Term
Hyperthyroidism Describe: Alternate name: |
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Definition
Disorder caused by excessive delivery of TH to the tissues.
Thyrotoxicosis |
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Term
Hyperthyroidism Effect on the body: |
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Definition
Increased metabolism: CHO, protein and lipid metabolism increases: caloric and nutritional deficiencies Increased: HR, CO, BP, Oxygen consumption, temperature |
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Term
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Definition
Autoimmune stimulation: Graves' Disease Thyroiditis Excessive ingestion: thyroid replacement hormone/iodine Medications: i.e. amiodorone Neoplasms: cancerous goiter, pituitary adenoma |
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Term
Hyperthyroidism Clinical manifestations: |
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Definition
Nervousness, insomnia, fine tremors of hand Tachycardia, dysrhythmias, palpitations, ventricular hypertrophy, HF, angina Increased systolic pressure Heat intolerance Diaphoresis, warm, flushed skin: warm & clammy Fine, thin hair Weight loss, muscle wasting, weakness, fatigue Amenorrhea, decreased libido Diarrhea Exophthalmos: bulging of eyes, photophobia Goiter |
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Term
Thyroid storm (thyroid crisis) Describe: Caused by: Prognosis: |
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Definition
Extreme state of hyperthyroidism Usually brought abruptly by: -stressor -manipulation of thyroid during surgery: injury -infection Usually fatal if left untreated |
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Term
Thyroid storm Clinical manifestations: |
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Definition
Hyperpyrexia: 102-106 Tachycardia (130+), systolic HTN, dysrhythmias(a-fib, PVCs) Abdominal pain: vomiting, diarrhea, weight loss Respiratory distress Confusion, delirium, seizures, coma |
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Term
Hyperthyroidism Diagnostic findings: |
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Definition
TA test (thyroid antibody): elevated with Graves' Serum TSH: -anterior pituitary issue:elevated, producing too much - thyroid: decreased, not putting out enough Serum T4: increased Serum T3: increased RAI uptake: increased Scan: look at size & vascularity Auscultation: bruit if gland is enlarged enough |
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Term
Hyperthyroidism Medical management: |
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Definition
Iodine solutions: Lugol's, SSKI, Sodium iodide Anti-thyroid drugs: Tapazole, PTU Beta blockers: rapidly control SNS symptoms Radioactive iodine: I-131 |
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Term
Hyperthyroidism Surgical management |
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Definition
Thyroidectomy Hopefully a subtotal thyroidectomy: leave a little of gland Give anti-thyroid meds prior to surgery to reduce hormone levels Give iodine prior to surgery to reduce vascularity and size |
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Term
Hyperthyroidism Eye protection: |
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Definition
Use tinted glasses or shields Artificial tears to moisten eyes Cover or tape lids closed at night if they don't close Elevate HOB, 45 degrees to promote decrease in peri-orbital fluid Instruct patient to report eye pain or vision changes |
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Term
Hyperthyroidism Nursing interventions: |
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Definition
Cool, quiet environment Minimize stress Rest periods Daily weights: weight loss is an issue Diet: high in CHO, proteins, calories, minerals/vitamins Avoid stimulants: caffeine, chocolate, cold meds Medication education NO aspirin: elevates T4 levels |
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Term
Thyroidectomy: post-op care |
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Definition
Monitor VS, I&O Comfort measures Monitor for hemorrhage/hematoma formation Monitor for respiratory distress Voice rest Monitor for tetany r/t hypocalcemia from injury to parathyroid during surgery |
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Term
Thyroidectomy: Important items to have on hand post-operatively: |
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Definition
Suction machine Trach tray in room Calcium chloride or calcium gluconate at bedside with syringe: if excessive tetany could lead to laryngeal spasms |
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Term
Tetany r/t thyroidectomy Pathophysiology: |
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Definition
Injury to parathyroid gland during surgery Release of calcitonin: will cause serum calcium to drop |
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Term
Tetany r/t thyroidectomy Pathophysiology: |
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Definition
Injury to parathyroid gland during surgery Release of calcitonin: will cause serum calcium to drop |
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Term
Parathyroid glands Secrete: This secretion does what? |
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Definition
Parathormone (parathyroid hormone): PTH PTH regulates Ca and phosphorus -resorption (transferring Ca from bone to blood) -excretion |
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Term
Parathyroid glands Calcium/Phosphorus balance |
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Definition
IF serum calcium goes UP, there are too many + ions, so kidneys excrete phosphorus to keep the ions balanced. IF serum calcium goes DOWN, PTH will go up to make the bones release more calcium (negative feedback) |
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Term
Parathyroid glands PTH levels and Vitamin D |
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Definition
Increased PTH increases the activation of vitamin D Need vitamin D to help with calcium absorption from intestines. |
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Term
Hypoparathyroidism Describe: Cause: |
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Definition
Abnormally low levels of PTH Cause: damage to or removal of parathyroid gland during thyroidectomy or radical neck dissection |
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Term
Hypoparathyroidism leads to calcium/phosphorus issues. Describe: |
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Definition
Hypocalcemia: decreased resorption of calcium from bones AND increased excretion of calcium by the kidneys. Hyperphosphatemia from decreased renal excretion r/t the hypocalcemia: body is holding on to phosphorus. Decreased activation of vitamin D: calcium in the intestines isn't absorbed as well |
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Term
Hypoparathyroidism Clinical manifestations: |
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Definition
Tetany or muscle cramps/spasms r/t hypocalcemia -Positive Trousseau's or Chvostek's Hyperactive reflexes Paresthesias Dysrhythmias Bronchospasm Irritability, memory impairment, depression |
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Term
Hypoparathyroidism Diagnostic findings: |
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Definition
Low PTH: patient should be NPO 8h prior to test Low serum Ca levels High serum phosphate levels Increased bone density |
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Term
Hypoparathyroidism Medical Management |
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Definition
IV Calcium gluconate: treating tetany Oral calcium supplements: calcium citrates are best Large doses of vitamin D Phosphate binders: Amphojel, Basaljel |
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Term
Hypoparathyroidism Nursing Interventions: |
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Definition
Monitor VS Assess for dysrhythmias Monitor calcium and phosphate levels Initiate seizure precautions r/t low calcium Quiet environment Monitor for hoarseness/stridor: laryngeal spasm or bronchospasm Diet: high calcium/low phosphorus |
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Term
Hypoparathyroidism Administration of calcium gluconate |
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Definition
IV Administer slowly 1 gram total: 200 mg. per minute is rate Monitor for digoxin toxicity |
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Term
Hyperparathyroidism Describe: Causes: |
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Definition
Increase in secretion of PTH. This affects the kidneys and bones: increased resorption of calcium and excretion of phosphate by kidneys Causes: tumor or hyperplasia of glands or renal disease |
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Term
Hyperparathyroidism Relationship between calcium and phosphorus: |
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Definition
Increased release of calcium from the bones (increased resorption!) hypercalcemia and increased excretion of phosphate via the kidneys (hypophosphatemia) |
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Term
Hyperparathyroidism Implications for bones: |
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Definition
Decalcification of bones: bones are releasing calcium which leads to demineralization. Bone deformities, pathologic fractures, bone pain |
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Term
Hyperparathyroidism Clinical manifestations: |
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Definition
Apathy, fatigue, weakness Abdominal pain, anorexia, N/V, peptic ulcers, pancreatitis Constipation HTN Dysrhythmias Renal stones Bone deformities, pathologic fractures, bone pain Increased sensitivity to cardiac glycosides: increased potential for dig toxicity r/t hypercalcemia |
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Term
Hyperparathyroidism Diagnostic findings: |
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Definition
Persistent elevated serum calcium levels Decreased phosphate levels Elevated PTH Decreased bone density Ultrasound and biopsy to help with diagnosis |
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Term
Hyperparathyroidism Medical management: |
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Definition
Surgical removal of glands: if all are removed patient will be on hormone replacement for life. Force fluids: decrease formation of renal calculi Cranberry juice: alkalinize the urine Avoid thiazide diuretics Avoid immobilization: do weight-bearing exercise! Avoid vitamin D supplements Bisphosphanates: move the calcium from the blood back into the bone. IV saline and Lasix: dilute and diurese |
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Term
Hyperparathyroidism Nursing interventions: |
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Definition
Monitor VS Monitor for dysrhythmias Monitor for dig toxicity IV Saline and diuretics as ordered Monitor I&O; strain urine for stones Encourage 2000 cc fluid per day and cranberry juice Diet: low calcium/high phosphate Keep patient active |
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Term
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Definition
Adrenal medulla Adrenal cortex |
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Term
Adrenal medulla Position: Function: |
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Definition
Center of gland Secretes catecholamines to deal with stress |
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Term
Adrenal cortex Position: Function: |
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Definition
Outer portion of gland Secretes corticoids |
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Term
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Definition
Norepinephrine Epinephrine Dopamine |
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Term
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Definition
Glucocorticoids: Cortisol (SUGAR) Mineralocorticoids: Aldosterone (SALT) Androgens: Androgens (SEX) |
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Term
Adrenal gland disorders: Medulla Cortex |
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Definition
Medulla: Addison's and Cushing's Cortex: Pheochromocytoma |
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Term
Addison's Disease Describe: |
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Definition
Hyposecretion of adrenal cortex hormones Fatal if left untreated |
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Term
Addison's Disease Etiology: |
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Definition
Autoimmune destruction: most common cause Adrenoleukodystrophy: genetic x-linked disorder Surgical removal of adrenals TB, AIDS, histoplasmosis ACTH deficiency: if it is a pituitary issue Abrupt withdrawal of long-term steroids: always taper |
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Term
Addison's Disease Clinical manifestations: |
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Definition
Hypotension: Postural Hyponatremia Hypoglycemia Hyperkalemia Hyperpigmentation GI: anorexia, N/V, diarrhea, weight loss Lethargy, fatigue, weakness Confusion, dizziness Menstrual changes/impotence |
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Term
Addison's Disease Addisonian Crisis Describe: Clinical manifestations: |
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Definition
Often brought on by: surgery, infection, trauma, abrupt d/c of steroids Primary symptoms: Fever/dehydration, weakness, severe abdominal pain, N/V/D, hypotension, circulatory collapse, shock. |
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Term
Addison's Disease Diagnostic findings: |
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Definition
Hypos: hypoglycemia, hyponatremia, hypotension Hypers: hyperkalemia Serum cortisol: decreased BUN: elevated r/t dehydration (24-h urine test) Urinary levels of 17 hydroxycorticoids/17 ketosteroid: decreased (not there for kidneys to excrete) Abnormal ACTH Abnormal ACTH stimulation test results |
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Term
Addison's Disease Abnormal ACTH levels |
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Definition
IF anterior pituitary gland is the issue: levels will be low IF adrenal cortex is the issue: levels will be high |
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Term
Addison's Disease Medical Management: |
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Definition
IV D5NS Hydrocortisone: Solu-Cortef or SoluMedrol -begin with IV and switch to PO FLorinef: PO, patient will retain sodium and water, get BP up Diet: increase Na/decrease K+ Vasopressors: if hypotension persists |
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Term
Addison's Disease Nursing interventions: |
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Definition
Administer hormone replacement Monitor VS Do orthostatic checks Monitor Na and K+ levels Daily weights/I&O Encourage oral intake of 3000 mL/day Increase Na intake Monitor for hypoglycemia in diabetic patient Decrease stress Avoid: heat, cold, infection, over-exertion, emotional distress, fatigue |
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Term
Addison's Disease Patient education: |
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Definition
Take steroids with food Diet: low K+/high Na and protein Daily weights: report gain or loss Emergency kit with IM cortisone Monitor for stressors and increase cortisone as instructed Stress management techniques Avoid strenuous activity, especially in heat |
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Term
Addison's Disease Drug interactions |
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Definition
Steroids: may decrease effectiveness of contraceptives Anticoagulants and insult: may decrease effectiveness of steroids |
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Term
Corticosteroid therapy Metabolic effects: |
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Definition
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Term
Corticosteroid therapy Effect on pituitary and adrenal glands |
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Definition
Suppress both: this is the reason we taper the dose. This gives the glands a chance to "wake up" and get back to work! |
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Term
Corticosteroid therapy Effect on CNS: |
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Definition
Changes function Causes: irritability and insomnia |
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Term
Corticosteroid therapy Administration: |
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Definition
Best to give in the morning (0600-0800) Reflects our body's natural rhythms and the way we normally secrete these hormones IF BID, give the larger dose in the morning, lower dose in the afternoon. |
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Term
Corticosteroid therapy Side effects: generalized |
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Definition
Na retention Water retention Increase in appetite Sweating: for some patients |
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Term
Corticosteroid therapy Side effects: CV |
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Definition
HTN, r/t fluid retention HF, r/t accelerated atherosclerosis |
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Term
Corticosteroid therapy Side effects: GI |
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Definition
Peptic ulcer Ulcerative esophagitis |
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Term
Corticosteroid therapy Side effects:Integumentary |
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Definition
Petechiae, ecchymosis, purpura: r/t decreased platelet aggregation Hirsuitism Thinning of skin Striae Redistribution of fat: buffalo hump, moon face, apple appearance |
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Term
Corticosteroid therapy Side effects:Endocrine |
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Definition
Impaired glucose metabolism: hyperglycemia Menstrual dysfunction Growth retardation |
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Term
Corticosteroid therapy Side effects:Musculoskeletal |
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Definition
Osteoporosis Muscle weakness and wasting |
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Term
Corticosteroid therapy Side effects:Neurologic |
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Definition
Personality changes Irritability HA Vertigo Insomnia Seizures |
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Term
Corticosteroid therapy Side effects:Ophthalmologic |
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Definition
Glaucoma Cataract formation |
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Term
Corticosteroid therapy Side effects:Electrolytes |
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Definition
Hypokalemia r/t Na retention |
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Term
Corticosteroid therapy Side effects: infection |
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Definition
Masked signs of infection Increased susceptibility to infection Blunted immune response to infections |
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Term
Corticosteroid therapy Nursing Care: |
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Definition
Administer with food or milk Patient may need antacids Patient should avoid infectious people/situations Get flu vaccine Monitor for S/S of infection Instruct patient NEVER to d/c abruptly. Always TAPER Alert women to contraception info: use additional forms Diet restrictions: Na, fat, calories Dietary additions: protein, high K+ |
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Term
Cushing's Syndrome (hypercortisolism) Describe: |
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Definition
Characterized by a hypersecretion of glucocorticoids from the adrenal cortex. Metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer. |
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Term
Cushing's Syndrome (hypercortisolism) Etiologies: |
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Definition
Pituitary adenoma Ectopic production of ACTH by malignancies -Bronchogenic cancer -Oat cell cancer -Lymphomas Hyperplasia of the adrenal cortex Long-term use of corticosteroids |
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Term
Cushing's Syndrome (hypercortisolism) Clinical manifestations |
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Definition
Truncal obsesity (apple shape) Moon face: round in shape Buffalo hump Weakness, muscle-wasting in excremities Thinning of skin, striae, easy bruising, poor wound healing Hirsutism, menses cessation Osteoporosis: vertebral compression fractures Hypokalemia Edema Hypertension Insomnia, emotional lability, psychosis Peptic ulcers Increased susceptibility to infection |
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Term
Cushing's Syndrome (hypercortisolism) Diagnostic findings: |
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Definition
Serum cortisol levels: elevated ACTH suppression test: determine where the problem is Serum ACTH levels: altered 24-hour urine test: elevated levels of 17hyrdoxycorticosteroids and 17ketosteroids Serum glucose: elevated Hypernatremia Hypokalemia |
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Term
Cushing's Syndrome (hypercortisolism) Medical management: |
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Definition
Adrenalectomy Hypophysectomy: resect pituitary (avoid if possible) Reduce amount of corticosteroids to lowest amount possible Medications, if surgery is not an option |
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Term
Cushing's Syndrome (hypercortisolism) Medications: |
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Definition
Mitotane: suppresses adrenal cortex activity Aminogluthemide or ketoconazole: inhibits cortisol synthesis Octreotide: suppresses ACTH secretion |
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Term
Cushing's Syndrome (hypercortisolism) ACTH suppression test |
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Definition
Determine whether the problem is with the adrenal glands or the anterior pituitary: Give steroids and see if there is a decrease in ACTH production. IF NO decrease, then problem is with the anterior pituitary |
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Term
Cushing's Syndrome (hypercortisolism) Nursing interventions: |
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Definition
Monitor VS Assess for HTN Safe environment: protect from infection and falls Maintain skin integrity Diet: low in calories; low in Na; high in K+; high in protein r/t muscle wasting; high in calcium, vitamin C, vitamin D REST Monitor for Addisonian crisis and hypovolemic shock IF surgery is performed or steroids are stopped suddenly |
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Term
Pheochromocytoma Describe: |
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Definition
Catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include: chest, bladder, abdomen, and brain. Typically it is a benign tumor, but it can be malignant. |
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Term
Pheochromocytoma Clinical manifestations: |
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Definition
5 H's HTN (200/150 or somewhere close to this) Headache Hyperhidrosis: excessive sweating Hypermetabolism Hyperglycemia **In addition: Tremors Flushing Tachycardia; palpitations Anxiety: bundle of nerves |
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Term
Pheochromocytoma Diagnostic findings: |
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Definition
Serum catecholamines: elevated Serum metaneprhine: elevated 24-hour urine test: elevated levels of catecholamines, metanephrine, VMA Ultrasound, MRI, CT |
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Term
Pheochromocytoma Medical management: |
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Definition
Bed rest Alpha adrenergic blockers: Regitine, Nipride Ca Channel blockers: Procardia, Cardene Beta blockers: Inderal Catecholamine synthesis inhibitor: Metyrosine |
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Term
Pheochromocytoma Nursing interventions: |
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Definition
Bed rest Monitor VS Avoid chilling: will drive BP up Diet: high calorie Avoid stimulants: caffeine, nicotine Education: adrenalectomy |
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Term
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Definition
Commonly referred to as the Master Gland Controlled by the hypothalamus Divided into anterior/posterior lobes |
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Term
Anterior pituitary releases these hormones: |
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Definition
Stimulating hormones: ACTH TSH LH FSH GH Prolactin |
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Term
Posterior pituitary releases these hormones: |
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Definition
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Term
Hypopituitarism: hypofunction of anterior pituitary Etiology |
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Definition
Destruction by: tumor, infection, surgery, radiation, hypovolemia, trauma, disease |
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Term
Hypopituitarism: hypofunction of anterior pituitary Results- Childhood: Adulthood: |
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Definition
Childhood: limited growth - dwarfism Adulthood: shrinkage of glands- thyroid, adrenals, gonads with resultant hypofunction |
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Term
Hypopituitarism: hypofunction of anterior pituitary Diagnosis: |
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Definition
Skull x-ray CT scan Decreased: *plasma stimulating-hormone levels * hormone levels |
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Term
Hypopituitarism: hypofunction of anterior pituitary Treatment: |
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Definition
Replacement of missing hormones |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Etiology: |
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Definition
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Term
Hyperpituitarism: hyperfunction of anterior pituitary Results- Childhood: Adulthood: |
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Definition
Childhood: gigantism if it occurs b/f epiphyseal closure Adulthood: acromegaly |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary Acromegaly: describe |
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Definition
Forehead enlarges Maxilla lengthens Coarse facial features Voice deepens Hands and feet enlarge Headache Visual changes HTN Cardiomyopathy Hyperlipidemia Diabetes |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary Effects: |
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Definition
Excess ACTH over-stimulates adrenals Excess PRL causes irregular or absent menses, decreased fertility, failure to lactate |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary Diagnosis: |
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Definition
Skull x-ray CT Increased plasma hormone levels |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary Treatment: |
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Definition
Pituitary irradiation Hypophysectomy Somatostatin analogues: Ocreotide Lanreotide acetate Dopamine receptor agonist: Parlodel |
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Term
Posterior pituitary disorders Describe: |
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Definition
Usually related to excessive OR deficient amounts of ADH |
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Term
Normal progression when serum osmolality decreases: |
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Definition
ADH secretion decreases and kidneys excrete more water |
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Term
Normal progression when serum osmolality increases (hyperosmolality): |
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Definition
ADH secretion increases and kidneys reabsorb more water |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Describe: |
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Definition
Characterized by increased amounts/levels of ADH in the absence of serum hyperosmolality Causes water retention and dilutional hyponatremia leading to water intoxication. |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Etiology: |
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Definition
Malignant tumor Head injury Pituitary surgery Some medications: Vincristine (chemo), TCA, Phenothiazines |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Clinical manifestations: |
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Definition
Headache Lethargy, irritability, seizures Weigh gain HTN Tachycardia |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Diagnostic findings: |
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Definition
Serum ADH: elevated Hyponatremia: <135 Urine osmolality: increased Urine specific gravity: increased [normal: 1.010-1.020] Serum osmolality: decreased [normal: 280-295] |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Medical management: |
|
Definition
Treat underlying cause Fluid restriction: 1000 cc per day Diuretics: will also lose Na and K+ Declomycin: antibiotic which increases Na levels Tolvaptan Hypertonic saline solution: not given much bc of neuro issues. |
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Term
Diabetes Insipidus (DI) Describe: |
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Definition
Hyposecretion of ADH resulting in failure of tubular absorption of water in kidneys. Body will continue to excrete copious amounts of urine. |
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Term
Diabetes Insipidus (DI) Two types: |
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Definition
Neurogenic DI Nephrogenic DI |
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Term
Diabetes Insipidus (DI) Neurogenic DI Describe: Causes: |
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Definition
Disorder with hypothalamus or posterior pituitary gland causing ADH insufficiency. Causes: TBI (total body irradiation), neoplasms, surgery, genetic |
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Term
Diabetes Insipidus (DI) Nephrogenic DI Describe: Causes: |
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Definition
Renal tubules are not sensitive to ADH Causes: drugs, renal disease |
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Term
Diabetes Insipidus (DI) Clinical manifestations |
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Definition
Polydipsia Polyuria Fatigue, muscle weakness, muscle pain Weight loss, dehydration Hypernatremia Dilute urine: low specific gravity Hypotension Tachycardia |
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Term
Diabetes Insipidus (DI) Diagnostic findings: |
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Definition
ADH levels: decreased (if neurogenic); normal (if nephrogenic) Urine specific gravity: decreased Hypernatremia Serum osmolality: increased, more particles present, more concentrated Fluid deprivation test: patient is unable to concentrate urine Trial of desmopressin: should decrease urine production |
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Term
Diabetes Insipidus (DI) Fluid deprivation test: |
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Definition
NPO for 12 hours Check urine osmolality and serum osmolality before and after test. Finding: Kidneys cannot concentrate or hold onto the urine A healthy person will hold onto the urine |
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Term
Diabetes Insipidus (DI) Medical management of Neurogenic DI |
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Definition
Identify and treat the underlying cause Ensure adequate fluid replacement: large amounts of IV fluid Pharmacologic: Desmopressin (DDAVP): intranasal Vasopressin: SQ, IV Diabinese: increase the action of the vasopressin the patient does have |
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Term
Diabetes Insipidus (DI) Medical management of Nephrogenic DI |
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Definition
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Term
Diabetes Insipidus (DI) Nursing interventions: |
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Definition
Monitor VS Daily weights I&O: urinary output, concentration Monitor for dehydration Check serum osmolality Monitor electrolytes Patient education: Medic Alert bracelet LIFELONG hormone replacement Avoid foods or liquids with diuretic action: ETOH |
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