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Questions and Answers
If a patient with acromegaly undergoes a transsphenoidal hypophysectomy, which post-operative assessment finding would warrant the greatest immediate concern?
If a patient with acromegaly undergoes a transsphenoidal hypophysectomy, which post-operative assessment finding would warrant the greatest immediate concern?
- Complaints of increased thirst and urination
- Blood glucose level of 150 mg/dL
- Temperature of 101.5°F (38.6°C) and nuchal rigidity (correct)
- Mild headache reported as a 3 out of 10
A patient is being treated for Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which nursing intervention is most important to include in the patient's plan of care?
A patient is being treated for Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which nursing intervention is most important to include in the patient's plan of care?
- Encouraging increased sodium intake through diet.
- Monitoring neurological status frequently. (correct)
- Providing high-volume enemas to reduce fluid overload.
- Administering intravenous fluids at a rate of 150 mL/hr.
A patient with a history of Addison's disease is admitted to the hospital. Which nursing action is most important to implement?
A patient with a history of Addison's disease is admitted to the hospital. Which nursing action is most important to implement?
- Administering a scheduled dose of hydrocortisone. (correct)
- Monitoring for signs of hyperglycemia.
- Encouraging a low-sodium diet to prevent fluid retention.
- Limiting the patient's fluid intake to 1000 mL per day.
A patient is diagnosed with hyperparathyroidism. What electrolyte imbalance is most closely associated with this condition?
A patient is diagnosed with hyperparathyroidism. What electrolyte imbalance is most closely associated with this condition?
Following a thyroidectomy, a client reports tingling around the mouth and fingertips. Which electrolyte imbalance is the most likely cause?
Following a thyroidectomy, a client reports tingling around the mouth and fingertips. Which electrolyte imbalance is the most likely cause?
A patient with Cushing's syndrome is at increased risk for developing which condition?
A patient with Cushing's syndrome is at increased risk for developing which condition?
When caring for a patient with Diabetes Insipidus, which nursing assessment is most critical?
When caring for a patient with Diabetes Insipidus, which nursing assessment is most critical?
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What teaching point is most important for the nurse to emphasize?
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What teaching point is most important for the nurse to emphasize?
A patient diagnosed with hypopituitarism is prescribed hormone replacement therapy. What potential adverse effect should the nurse monitor for?
A patient diagnosed with hypopituitarism is prescribed hormone replacement therapy. What potential adverse effect should the nurse monitor for?
A patient is being evaluated for possible adrenocortical insufficiency. Which laboratory finding would the nurse anticipate?
A patient is being evaluated for possible adrenocortical insufficiency. Which laboratory finding would the nurse anticipate?
What is the primary reason for administering desmopressin to a patient with diabetes insipidus?
What is the primary reason for administering desmopressin to a patient with diabetes insipidus?
Which of the following assessment findings would be most concerning in a patient with hyperthyroidism?
Which of the following assessment findings would be most concerning in a patient with hyperthyroidism?
A patient with hypoparathyroidism is being discharged home. Which dietary instruction is most important for the nurse to provide?
A patient with hypoparathyroidism is being discharged home. Which dietary instruction is most important for the nurse to provide?
A patient is diagnosed with hyperaldosteronism. Which electrolyte imbalance is most consistent with this diagnosis?
A patient is diagnosed with hyperaldosteronism. Which electrolyte imbalance is most consistent with this diagnosis?
Following a transsphenoidal hypophysectomy, a patient reports a persistent headache and notes clear drainage from the nose. What action should the nurse take first?
Following a transsphenoidal hypophysectomy, a patient reports a persistent headache and notes clear drainage from the nose. What action should the nurse take first?
A patient with Cushing's syndrome reports increased facial hair and a deepening voice. Which hormonal imbalance is most likely responsible for these changes?
A patient with Cushing's syndrome reports increased facial hair and a deepening voice. Which hormonal imbalance is most likely responsible for these changes?
The nurse is caring for a client with hypothyroidism who is scheduled to start levothyroxine. Which assessment finding would warrant the nurse holding the medication and contacting the provider?
The nurse is caring for a client with hypothyroidism who is scheduled to start levothyroxine. Which assessment finding would warrant the nurse holding the medication and contacting the provider?
The nurse is teaching a patient with Addison's disease about managing their condition at home. Which statement by the patient indicates a need for further teaching?
The nurse is teaching a patient with Addison's disease about managing their condition at home. Which statement by the patient indicates a need for further teaching?
A client is being treated for Syndrome of Inappropriate Antidiuretic Hormone (SIADH) with fluid restriction. The patient reports a severe headache and muscle weakness. Which laboratory result should the nurse check first?
A client is being treated for Syndrome of Inappropriate Antidiuretic Hormone (SIADH) with fluid restriction. The patient reports a severe headache and muscle weakness. Which laboratory result should the nurse check first?
A client presents with polyuria, polydipsia, and a urine specific gravity of 1.001. Which hormone deficiency is most likely responsible for these manifestations?
A client presents with polyuria, polydipsia, and a urine specific gravity of 1.001. Which hormone deficiency is most likely responsible for these manifestations?
A client is diagnosed with hyperparathyroidism secondary to chronic kidney disease. Which treatment would the nurse anticipate being prescribed to manage this condition?
A client is diagnosed with hyperparathyroidism secondary to chronic kidney disease. Which treatment would the nurse anticipate being prescribed to manage this condition?
The nurse is monitoring a client who had a thyroidectomy for potential complications. Which finding should cause the most concern?
The nurse is monitoring a client who had a thyroidectomy for potential complications. Which finding should cause the most concern?
A patient with hyperthyroidism is being treated with methimazole. Which statement indicates effective teaching about this medication?
A patient with hyperthyroidism is being treated with methimazole. Which statement indicates effective teaching about this medication?
A nurse is assessing a patient with suspected hypocalcemia. Which assessment finding is most indicative of this electrolyte imbalance?
A nurse is assessing a patient with suspected hypocalcemia. Which assessment finding is most indicative of this electrolyte imbalance?
A client is about to start hormone replacement therapy. Which question will yield the most insight into potential contraindications?
A client is about to start hormone replacement therapy. Which question will yield the most insight into potential contraindications?
A client is taking desmopressin for diabetes insipidus. What outcome indicates that the medication is exerting a therapeutic effect?
A client is taking desmopressin for diabetes insipidus. What outcome indicates that the medication is exerting a therapeutic effect?
A client is being treated for hypercalcemia secondary to hyperparathyroidism. Besides hydration, what action is crucial in managing this electrolyte imbalance?
A client is being treated for hypercalcemia secondary to hyperparathyroidism. Besides hydration, what action is crucial in managing this electrolyte imbalance?
A nurse is caring for a client with diabetes insipidus who is receiving vasopressin. Which assessment finding most warrants holding the next dose and contacting the provider?
A nurse is caring for a client with diabetes insipidus who is receiving vasopressin. Which assessment finding most warrants holding the next dose and contacting the provider?
The nurse is assessing a client with Cushing’s syndrome. Which clinical manifestation indicates a need for meticulous skin care to prevent breakdown?
The nurse is assessing a client with Cushing’s syndrome. Which clinical manifestation indicates a need for meticulous skin care to prevent breakdown?
A client is being prepared for a thyroidectomy. What is an essential teaching topic to include in the preoperative teaching plan?
A client is being prepared for a thyroidectomy. What is an essential teaching topic to include in the preoperative teaching plan?
A client is undergoing testing for possible Cushing’s syndrome. Which test result would indicate that the client may have this condition?
A client is undergoing testing for possible Cushing’s syndrome. Which test result would indicate that the client may have this condition?
The nurse is assessing a client with hypoparathyroidism. Which of the following findings requires immediate intervention by the nurse?
The nurse is assessing a client with hypoparathyroidism. Which of the following findings requires immediate intervention by the nurse?
The nurse is reviewing potential interactions for a client diagnosed with diabetes insipidus who is prescribed desmopressin. Which combination should the nurse flag and contact the provider?
The nurse is reviewing potential interactions for a client diagnosed with diabetes insipidus who is prescribed desmopressin. Which combination should the nurse flag and contact the provider?
A client who had a thyroidectomy is at elevated harm risk for negative outcomes when which of the following findings is present?
A client who had a thyroidectomy is at elevated harm risk for negative outcomes when which of the following findings is present?
A client exhibiting which of the following symptoms would warrant being tested for diabetes insipidus?
A client exhibiting which of the following symptoms would warrant being tested for diabetes insipidus?
A client has been diagnosed with hypercortisolism, also known as Cushing's syndrome. What nursing interventions would be suitable for maintaining skin integrity?
A client has been diagnosed with hypercortisolism, also known as Cushing's syndrome. What nursing interventions would be suitable for maintaining skin integrity?
A client has been diagnosed with a tumor. As an oncology nurse, you are assessing the client, who also indicates that they have been experiencing hyperpituitarism. Which questions would you ask in order to properly assess the tumor causing the endocrine disorder?
A client has been diagnosed with a tumor. As an oncology nurse, you are assessing the client, who also indicates that they have been experiencing hyperpituitarism. Which questions would you ask in order to properly assess the tumor causing the endocrine disorder?
Flashcards
What is aldosterone?
What is aldosterone?
Maintains fluid balance and blood pressure through sodium and water retention
Age related hormone changes.
Age related hormone changes.
Decreases hormone production, secretion, and tissue responsiveness with age.
What is SIADH?
What is SIADH?
Excessive water retention leads to hyponatremia and hypo-osmolality, often with oliguria.
What is diabetes insipidus (DI)?
What is diabetes insipidus (DI)?
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What is hyperpituitarism?
What is hyperpituitarism?
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What is hypopituitarism?
What is hypopituitarism?
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What is hypercortisolism/Cushing's?
What is hypercortisolism/Cushing's?
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What is Addison's disease?
What is Addison's disease?
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Hypopituitarism and ACTH
Hypopituitarism and ACTH
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What is transsphenoidal hypophysectomy?
What is transsphenoidal hypophysectomy?
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Diabetes insipidus cause.
Diabetes insipidus cause.
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Syndrome of Inappropriate ADH (SIADH)
Syndrome of Inappropriate ADH (SIADH)
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Adrenal crisis
Adrenal crisis
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Hypercortisolism (Cushing's Syndrome)
Hypercortisolism (Cushing's Syndrome)
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Addison's disease management
Addison's disease management
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Hypothyroidism
Hypothyroidism
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Hyperthyroidism pathophysiology
Hyperthyroidism pathophysiology
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Hypoparathyroidism
Hypoparathyroidism
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Hyperparathyroidism
Hyperparathyroidism
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Study Notes
Here are some concise study notes based on the provided text:
Negative Feedback Loop
- Hormone release increases when its levels in circulation are low, illustrating an inverse relationship.
Age-Related Changes
- Hormone production, secretion, and tissue responsiveness decrease with age.
- Glucose levels tend to increase because of age-related insulin resistance.
- Metabolism slows down, including decreased appetite, impaired sleep quality, reduced heart rate, and lower blood pressure.
- There can be a decreased libido and erectile dysfunction.
- Synthetic ADH leads to increased urination and possible dehydration.
MRI Prep
- Screen for metal implants
Steroid Teaching
- When taking corticosteroids for 10-14 days, it is important to taper off the dosage to avoid adrenal insufficiency.
- Abrupt withdrawal from corticosteroids can lead to reduced blood pressure and hypoglycemia.
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
- Caused by increased ADH levels
- Leads to hyponatremia and hypoosmolality.
- Can present with fluid volume excess and oliguria.
- Lab findings include decreased sodium levels and increased urine specific gravity.
Diabetes Insipidus (DI)
- Results from decreased ADH
- Causes water loss and polyuria
- Possible to have hypotension
- Lab results show increased hematocrit and sodium levels, and decreased urine specific gravity.
Hyperpituitarism
- Characterized by increased GH levels
- Can lead to acromegaly and coarse facial features
- Menstrual irregularities are typical
Hypopituitarism
- Characterized by decreased GH levels
- Associated with reduced bone density, increased fracture risk, and decreased muscle strength.
Hypercortisolism (Cushing's)
- Increased cortisol levels
- Characterized by a buffalo hump, truncal obesity, moon face, hirsutism, and increased risk of fractures.
- May cause amenorrhea and hair growth (in females)
- Can cause hypernatremia and hyperglycemia.
- Causes immunosuppression
Adrenal Insufficiency (Addison's Disease)
- Results from decreased cortisol levels
- Characterized by bronze skin, weight loss, hypotension, and abdominal pain.
- Can cause hyponatremia, hypoglycemia, and hyperkalemia.
Hypopituitarism
- Decreased ACTH levels lead to hypoglycemia, decreased aldosterone and cortisol, hyponatremia, and hypotension.
- Decreased GH levels are associated with reduced bone density and muscle strength.
- Decreased LH can cause decreased estrogen in females and impaired sperm production in males.
- Decreased TSH causes decreased metabolic rate, thinning hair, and reduced libido.
Nursing Diagnoses - Hypopituitarism
- Risk of fluid volume deficit related to decreased glucocorticoids and mineralocorticoids secondary to decreased ACTH.
- Risk for falls related to osteoporosis and decreased bone density (due to decreased GH).
- Risk of hypoglycemia, hyponatremia, and hyperkalemia.
Assessment - Hypopituitarism
- Monitor vital signs for hypotension and tachycardia.
- Assess for hypoglycemia (ACTH affects glucocorticoid levels).
- Assess for changes in fertility.
- Monitor bone density.
Actions - Hypopituitarism
- Prevent falls and increase Vitamin D and calcium intake.
- Hormone replacement therapy may be necessary.
Teaching - Hypopituitarism
- Take hormones in the morning.
Perioperative: Transsphenoidal Hypophysectomy
- Monitor for increased ICP, diabetes insipidus, meningitis, and CSF leak.
- Prevent increased ICP by avoiding bending, coughing, or sneezing.
Complications of Transsphenoidal Hypophysectomy
- Monitor for hyperglycemia and hypertension after surgery.
Acromegaly Assessment
- Vital signs may show hypotension and tachycardia if diabetes insipidus is present, or fever if there is an infection or CSF leak.
- Assess neurological status and 1/O.
Acromegaly Actions
- Monitor urine for large quantities of dilute urine, indicative of diabetes insipidus, and check urine-specific gravity (lack of ADH results in a low specific gravity, <1.005).
- Monitor sodium and osmolality levels.
- Humidified oxygen administration may be needed.
- Desmopressin or vasopressin may be given.
- Elevate the head of the bed to 45-60 degrees.
- Encourage oral fluids and provide good mouth care.
Acromegaly Teaching
- Watch for signs of meningitis, diabetes insipidus, and fluid volume excess
- Use a soft toothbrush
- Do not increase ICP
- Report CSF leakage
Hyperpituitarism
- Often caused by a tumor.
- Increased ACTH can lead to increased glucocorticoids and mineralocorticoids, resulting in hyperglycemia, hypernatremia, hypertension, and hypokalemia.
- Signs of increased GH include increased bone density and coarse facial features, along with menstrual irregularities.
- Increased prolactin may result in hypogonadism, galactorrhea, and increased body fat.
- Increased TSH can cause increased metabolic rate, weight changes, and exophthalmos.
Nursing Diagnoses- Hyperpituitarism
- FVE: related to increased glucocorticoids and mineralocorticoids due to ACTH.
- Body image disturbance, pain, acromegaly, hyperglycemia, and hypertension.
Actions - Hyperpituitarism
- Administer dopamine agonists to inhibit the release of anterior pituitary hormones.
- Somatostatin analogs and hormone supplements may also be used.
Diabetes Insipidus (DI)
- Pathophysiology: Lack of ADH from hypothalamus, resulting in dilute urine.
- Clinical manifestations: Polyuria, polydipsia, nocturia, hemoconcentration, hypovolemia causing hypotension and tachycardia, and signs of FVD.
- Diagnosis: Urine specific gravity <1.005, urine osmolality <200 mOsm/kg, increased hematocrit and sodium levels.
- Management: Oral rehydration, IV hypotonic solutions, desmopressin, and vasopressin.
- Complications: Dehydration, hypovolemia, hypernatremia, and potential seizures.
Nursing Diagnosis - DI
- Fluid Volume Deficit
Actions - DI
- Administer desmopressin or vasopressin, provide oral fluids, and oral care.
Teaching - DI
- Medication information (TAD), importance of daily weights, and symptoms of fluid overload.
Syndrome of Inappropriate ADH (SIADH)
- Pathophysiology: Excessive ADH leads to fluid volume excess, hemodilution, hyponatremia, and hypoosmolality.
- Clinical Manifestations: Hyponatremia (potentially causing seizures if sodium <120 mEq/L), anorexia, nausea, malaise, headache, confusion, neurological signs, cerebral edema, and increased ICP.
- Diagnosis: Decreased urine output, increased urine specific gravity, hyponatremia, and decreased serum osmolality.
- Management: Treat hyponatremia, fluid restriction, 3% saline (if severe), vasopressin receptor antagonists, diuretics, demeclocycline (Declomycin), and IV mannitol.
- Complications: Hyponatremia, seizures, and coma.
Nursing Diagnosis - SIADH
- FVE
- High risk for injury
Teaching - SIADH
- Follow fluid restriction and watch for signs of fluid overload.
Adrenal Cortical Insufficiency (Addison's Disease)
- Pathophysiology: Decreased CRH, ACTH, glucocorticoids, and mineralocorticoids due to autoimmune destruction.
- Clinical Manifestations: Increased melanocyte stimulating hormone leads to bronzed skin, decreased cortisol and aldosterone, weakness, weight loss, fatigue, nausea, abdominal pain, emotional lability, hyperpigmentation, dehydration, hypotension, hypoglycemia, and hyperkalemia.
- Diagnosis: Hormone level testing, CT scan, and MRI.
- Management: Replacement of cortisol with medications.
- Complications: Acute adrenal insufficiency (adrenal crisis) leading to severe hypovolemia and hypotension. Loss of sodium and fluid, hyperkalemia, and hypoglycemia.
- Nursing Diagnosis: Fluid Volume Deficit, Unstable Glucose, Decreased Cardiac Output
- Assessment: hypotension, tachycardia, fluid loss, hypoglycemia, hyponatremia, hyperkalemia. Increased HCT levels and BUN.
Adrenal Cortex Hyperfunction (Cushing's)
- Pathophysiology: Excess glucocorticoid/cortisol, excess ACTH
- Clinical Manifestations: Hyperglycemia, fluid retention, hypokalemia, and abnormal fat distribution. Decreased muscle mass, virilization, breast atrophy, vocal changes, and inflammatory immune response. Osteopenia, osteoporosis, and increased risk of fracture.
- Management: Ketoconazole and adrenalectomy
- Complications: Hypercortisolism, osteoporosis, adrenal crisis, hyperglycemia, and GI bleed.
- Diagnosis:
- Signs of hypercortisolism: hypertension, hyperglycemia, edema, thin skin, fat maldistribution, decreased bone density, and decreased inflammatory and immune response.
Hyperthyroidism
- Pathophysiology: Increased metabolism, potentially due to Grave's disease, Increased T3 and T4, increased TSH, increased TRH.
- Clinical Manifestation: Increased HR and heart sounds, thyroid bruit, heat intolerance, increased GI and BM, increased appetite, weight loss, fatigue, nervousness, insomnia, absent menses, exophthalmos and goiter.
- Treatment: Manage cardiac functions and body temp with beta blockers fluids.
- Medications: Antithyroid, propylthiouracil, methimazole, Lithium carbonate, iodine preparations.
- Surgical Management: Thyroidectomy (take thyroid hormone throughout life)
- Nursing diagnosis: increase risk for cardiac output, hyperthermia, thyrold storm/thyrotoxicosis
- Complications: Airway comprimise, respiratory complications, dysthythnias, and seizures.
Hypoparathyroidism
- Patho: Hypocalcemia
- Clinical Manifestation: Circumoral numbness/tingling or in hands/feet, Severe muscle cramps, Spasms, tetany. Chvostek's & Trousseau's laryngospasm
- Diagnosis:calcium, phosphate, & PTH
- Nursing Diagnosis: high risk for ineffective airway clearance V Cardiac Output: hypocalcemia
Hyperparathyroidism
- Patho: hypercalcemia
- Clinical Manifestations: Polyuria, anorexia, Constipation, cardiac Changes, Peptic ulcer disease, bone pain, pathological fractures, renal Stones
- Diagnosis: pth levels
- Nursing Diagnosis:Increase fluid intake, oral or IV Vintake of calcium antacids vit D AVOID Thiazide diuretics
Type 1 Diabetes Mellitus (DM)
- Pathophysiology: Autoimmune process which destroys beta cells leading to a lack of insulin.
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