chapter 39 exam 1 endocrine soukup

What is the primary role of Growth Hormone (GH) in the body?

Growth Hormone (GH)- Affects entire body by promoting protein synthesis, lipid/carb metabolism, and skeletal muscle growth  Too little = short stature  Too much = gigantism (childhood disorder), acromegaly (adult disorder) (correct)
Reduces skeletal muscle growth
Promotes lipid metabolism
Promotes carbohydrate synthesis

Which disorder is associated with an excess of Growth Hormone during childhood?

Gigantism (correct)
Osteoporosis
Cushing's syndrome
Addison's disease

What are the signs and symptoms of Growth Hormone Deficiency in children?

Hyperactivity
Stunted growth  Slowed sexual maturation  May have cognitive deficits  Other symptoms depend on other pituitary hormones involved (correct)
Increased sexual maturation
Excessive growth

What are the common signs and symptoms of Growth Hormone Deficiency in adults?

Fatigue, weakness  Excess body fat  Hyperlipidemia  Headaches  Decreased muscle and bone mass  Sexual dysfunction  Risk for cardiovascular disease  Risk for cerebrovascular disease  Decreased quality of life (A) Signup and view all the answers

Which diagnostic test typically used for Growth Hormone Deficiency?

GH level  GH stimulation test  MRI  X-rays  Therapeutic interventions  Synthetic GH  Somatropin (humatrope)  Surgery (C) Signup and view all the answers

Which of the following is a potential complication of acromegaly?

Signs and symptoms/Complications:  Nose, jaw, brow, hands, and feet enlarge  Change in ring or shoe size  Teeth become displaced  Tongue becomes thick  Skin changes  Thickened, oily, severe acne, excessive sweating  Hoarse voice  Sleep apnea  Weight gain  Visual disturbances  Headaches  Diabetes  HTN  In women:  Galactorrhea, irregular menstrual cycles  In men:  Impotence (C) Signup and view all the answers

What are the common skin changes associated with acromegaly?

Thickened, oily, and severe acne (B) Signup and view all the answers

What are diagnosis and treatment for acromegaly

GH level  Bone x-rays  CT scan or MRI  History and physical exam  Treatment:  Treat cause  Surgery  Hypophysectomy  Radiation  Drug therapy- block GH (C) Signup and view all the answers

What is pre-op care for a transsphenoidal hyophysectomy(basically a Removal of the pituitary gland  Minimally invasive endoscopic surgery)

Prepare patient for location of surgery & what they should expect after surgery  Baseline neurological assessment  Preoperative care teaching  Teach to avoid actions that increase pressure on surgical site (example, coughing, sneezing, straining).  Teach deep-breathing exercises, incentive spirometry.  Nasal packing and mustache dressing (D) Signup and view all the answers

What is post-op care for patients with transspenoidal hyophysectomy

Neurological assessment  HOB elevated at 30-degree angle- decreases ICP  Avoid vigorous coughing, sneezing, bending, straining with BM  Avoid brushing teeth for 10 days if upper lip incision  Urine for specific gravity (risk for DI)  Monitor urine output  Nasal packing and mustache dressing- (48-72 hrs. postop)  Report cerebrospinal fluid drainage  Monitor for clear leakage from nose, postnasal drip  Hormone replacement therapy with target hormones (D) Signup and view all the answers

What is the primary hormone responsible for increasing water reabsorption by kidney tubules?

Antidiuretic Hormone (ADH) (B) Signup and view all the answers

In Syndrome of Inappropriate Antidiuretic Hormone (SIADH), what happens to the blood osmolality and sodium levels?

Osmolality of blood increases with dehydration and decreases with over-hydration (B) Signup and view all the answers

What is the main cause of Diabetes Insipidus (DI)?

Underproduction or inability to respond to ADH (D) Signup and view all the answers

What happens in Diabtes insipidus

Excessive water excreted • Dehydration, decreased BP • Blood is concentrated, sodium levels high • High blood osmolality • Increased urine output, low urine osmolality, low specific gravity Hypo-Secretion: Diabetes Insipidus  Osmolality of blood increases with dehydration and decreases with over-hydration  Normal urine specific gravity- 1.005-1.03 (A) Signup and view all the answers

What happens in SIADH

Excessive water retention • Blood diluted, sodium levels low • Low blood osmolality • Decreased urine output, high urine osmolality and high specific gravity (D) Signup and view all the answers

What is the primary consequence of Diabetes Insipidus (DI) on urine output?

Increased urine volume with low specific gravity............................................Deficiency of production or secretion of ADH or inability of kidneys to respond to ADH  Excretion of large volumes of dilute urine  Renal tubules are unable to reabsorb water  Polyuria, increased serum osmolality (increased serum Na+ levels) (B) Signup and view all the answers

Which condition is a common cause of Diabetes Insipidus (DI)?

Pituitary tumor  Head trauma  Surgery  Drugs(Underproduction of antidiuretic hormone (ADH)  Unable to conserve fluids) (D) Signup and view all the answers

What is the characteristic serum osmolality finding in Diabetes Insipidus?

Increased serum sodium levels (B) Signup and view all the answers

Which of the following is a common symptom of Diabetes Insipidus (DI)?

Polyuria  Excretion of large quantities of urine w/ low specific gravity  Dilute urine  Polydipsia  Nocturia  Elevated serum osmolality- Hypernatremia  Dehydration  Hypovolemic shock  Decreased level of consciousness  Death (B) Signup and view all the answers

What is the primary nursing priority for a patient with Diabetes Insipidus (DI)?

riority nursing issue: Dehydration, promote fluids!  Body is putting out way too much fluid via the urine  Can cause weight loss  Lots of urine, not concentrated at all  Low specific gravity (< 1.005)  Watch for decrease in BP and increase in HR (B) Signup and view all the answers

What are diagnostic tests for diabetes insipidus

Urine specific gravity <1.005  Plasma osmolality (increased)  Urine osmolality  Serum sodium levels  CT or MRI  Fluid deprivation test  Glucose level (A) Signup and view all the answers

Nursing management for DI

Manage hydration- Free access to fluids!  Monitor pts. BP, HR, skin turgor, urine output, specific gravity, LOC  Daily weights (C) Signup and view all the answers

What are treatments for DI

Control w/ drug therapy (synthetic vasopressin- DDAVP)  Vasopressin should decrease the urine output  Vasopressin should concentrate urine  Therapeutic goal is maintenance of fluid and electrolyte balance  Hypotonic IV fluids  Replaces volume without extra sodium  Teach pt. about long term management  Monitor weight at home  Dietary measures  Signs/symptoms of dehydration (D) Signup and view all the answers

What is SIADH

Overproduction of Antidiuretic Hormone (ADH)  Conserve way too much fluid  Priority nursing issue: Fluid Overload-restrict fluids!  Body isn’t making nearly enough urine  Not a lot of urine, extremely concentrated  High specific Gravity (> 1.030) (A) Signup and view all the answers

What are the primary causes of SIADH

Occurs in nervous system disorders, malignancies, pulmonary disorders, specific drugs  Most common cause is a hormone-secreting tumor (lung cancer)  Fluid retention, low serum hypoosmolality, hyponatremia, concentrated urine (specific gravity, urine osmolality increased) (B) Signup and view all the answers

What are SIADH signs and symptoms

Signs and symptoms  Weight gain without edema  Dilutional hyponatremia (<135)  Low serum osmolality  Decreased urine output  Concentrated urine >1.03  Muscle cramps and weakness  High blood pressure  Headache  Brain swelling, seizures, coma, death (C) Signup and view all the answers

What are the diagnosti tests for SIADh

Diagnostic tests  Serum osmolality  Urine osmolality  Urine specific gravity  Serum sodium  ADH levels  CT scan or MRI for underlying cause (D) Signup and view all the answers

What are therapeutic interventions for SIADH

Therapeutic interventions  Eliminate cause  Surgical removal of tumor  Fluid restriction  Hypertonic saline IV or sodium supplements  Furosemide (Lasix)  Conivaptan (Vaprisol)- vasopressin receptor antagonist to block ADH (B) Signup and view all the answers

What is a key nursing intervention for a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) experiencing dilutional hyponatremia?

Implement fluid restriction (C) Signup and view all the answers

What is nursing management for SIADH

Nursing Management  Physical assessment- Fluid overload  Assessing changes in mental status  Protect the patient from injury- seizure precautions  Restricting fluid intake  Frequent oral care, hard candies  Obtain daily weights  Measure I&O  Teaching pt. self management – do they need to restrict salt? NO – already hyponatremic! (B) Signup and view all the answers