Med Surg-NUR 425 Exam 4 Study Guide PDF

**Med Surg-NUR 425 Exam 4 Study Guide** **Negative feedback concept-Inhibit and release** **Pituitary disorders** - Hypopituitarism (Anterior Pituitary)-Underproduction of Hormones release by the pituitary gland. -Hypothalamus send signal to the Pituitary Gland - **Causes/Risk f...

**Med Surg-NUR 425 Exam 4 Study Guide** **Negative feedback concept-Inhibit and release** **Pituitary disorders** - Hypopituitarism (Anterior Pituitary)-Underproduction of Hormones release by the pituitary gland. -Hypothalamus send signal to the Pituitary Gland - **Causes/Risk factors** - Benign Tumor-Pituitary adenoma - StrokePituitary infarction - Postpartum Hemorrhage - Head trauma - **Cues/function for each hormone: ACTH, GH, TSH** - ACTH-Tropic Hormone- Target Organ is Adrenal Cortex and will signal to release Glucocorticoids-cortisol or mineralocorticoids-Aldosterone or cortoid steroids. (reponds to stress) - -Decrease Glucocorticoids Decrease glucose, cortisol and stress -Decrease MineralocorticoidsDecrease Blood Pressure and sodium and Increase in Potassium **Treatment: Hydrocortisone/Prednisone** TSH-Target Organ is Thyroid- and will send signal to release T3 and T4, Increase basal metabolic rate in all cells - Decrease T3 and T4 Decrease metabolic rate ,weight gain,thinning hair, and decrease libido GH-Target Organ is Bones and tissues- To grow - Decrease Bone Density, Muscle Strength and Increase risk of fractures. **Treatment: Somatropin (Genotropin) and adequate intake of calcium and vitamin D** - Hyperpituitarism (Anterior Pituitary)-Hypersecretion of the hormones from the anterior pituitary gland - **Causes/Risk factor** - Hypersecreting Tumor - Females more than Males - Genetic Association - **Cues for each hormone: ACTH, GH, TSH** - **Too much ACTH** Cushing Diasease- Increase glucocorticoid levels , increase cortisol levels, Hyperglycemia - **Too much GH-**Acromegaly-Thickening of bones: Hands, feet and face. Also hypertrophy - **Too much TSH** Increase levels T3 and T4 -- Increase metabolic rate, Weight loss, exophthalmos and thyroid storm - **Medical management** - Ketoconazole or Mitotanecushings-ACTH - Propylthiouracil (PTU) Methimazole-TSH \*Transsphenoidal Hypophysectomy-GH Removal of the pituitary gland - Radiation - OctreotideDecrease growth hormone - Pasireotide Shrink Tumor - Bromocriptine-Tx for Acromegaly **Nursing actions** - Vital Signs - Neuro Assessment - I & O - Daily Weights - Monitor Labs-Glucose and Electrolytes - Education-Disease Process - Meds Hypophysectomy --nursing to monitor for CSF leakage, Increase of the ICP, Meningitis, Diabetes insipidus **Thyroid disorders** - Hypothyroidism/Myxedema/Myxedema coma - **Risk factors/Causes** - Hashimoto's autoimmune - Surgery for hyperthyroidism or goiter - Iodine deficiency - Females 30-60 - **Cues** - Low metabolic rate-Low energy, Low appetite - Fatigue, weight gain, increase sleep - Susceptible to cold temps **Myxedema** - Severe form of Hypothyroidism - Decrease CO, contractility - Cardiomegaly,pericardial effusion - Decrease pulse - Decreased GI motility Constipation/distention - **Medical Management** - Levothyroxine(Synthoid T4)-Start low and increase to tx -Annual thyroid function tests -Take in morning to align with metabolism Lifelong drug Myxedema Coma a complication of untreated Hypothyroidism - Hypoxia, Hypercapnia, electrolyte imbalances, hypothermia - Bradycardia, Hypotension - Hypoglycemia, Hyponatremia, constipation, weight gain - Sensitive to sedatives, analgesics and anesthetic agents-May lead to respiratory failure. - **Evaluate effectiveness of treatment** - - **Nursing Actions** - Vital Signs - Serum Ca-If removal of Thyroid/parathyroid - Daily weights - Skin Assessments-turn/reposition - Meds: Levothyroxine, caution with sedatives - Warming blanket - Educate- Report Chest pain, decrease metabolismrisk of higher cholesterol levels - Cues of hypothyroidism and hyperthyroidism - Hyperthyroidism \[thyrotoxicosis\] - **Risk factors/Causes** - Women aged 20-40 - \*Graves disease most common cause - Autoantibodies attach to TSH cell receptor sites - Triggered by stress, current infections - Excessive iodine intake - Thyroid adenoma - **Cues** - Tachycardia - GI motility - Appetite - Cardiac Dysrhythmias - Thyroid bruit - Weight loss, Hair loss - Insomnia - Fatigue - Nervousness - Heat intolerance - Irregular to absent menses - Exophthalmos - Goiter - **Medical management** - Cardiac function and body temperature - Adequate fluid intake - Cardiac monitoring-Beta Blocker **Prescriptions** - Propylthiouracil(PTU) - Methimazole(Tapazole) - Lithium carbonate(Lithonate) **Thyroidectomy** - Post op nursing actions: Oral suctions at bed side, bleeding precaution on the neck, Tetany (Monitor voice), Semi flowler (decrease work of breathing, prevent aspiration),Tracheostomy kit at bedside, Assessment every 1-2 hours. - Interpret lab values - Nursing actions - Complication of hyperthyroidism is Thyroid crisis aka thyroid storm **Cues** - Tachycardia - Fever - HTN - ALOC(Confusion and agitation) - Abdominal pain - Tremors - Goieter, weight loss and diarrhea - Hypoglycemia **Medical management** - Priorities- Airway and fluid resuscitation - Antithyroid meds - Iodine Preparations - Beta blockers - Glucocorticoids **Nursing actions** - Closely Monitor for respiratory compromise - Dysrhythmias - Seizures - VS, I&O,Daily Weights - Labs: increase T3/T4 and decrease on TSH - Eye visual changes-Corneal abrasions exophthalmos - Cooling blanket **Evaluate the effectiveness of treatment** **Parathyroid disorders** **Hypoparathyroidism** **Risk factors** - Autoimmune disorder - Surgery most common **Cues/Manifestations** - Decrease calcium levels - N/T around mouth, in hands and feet - Severe muscle cramps - Spasms of hands and feet - Tetany severe cases **Treatments/prescriptions** - Supplemental calcium and Vitamin D **Nursing actions** - Assess cues for Hypocalcemia - Vital signs-Hypotension - Cardiac monitoring-Prolonged QT - Ionized calcium levels-Free ,active form - Serum magnesium-Low interferes with PTH synthesis low calcium - Alkalosis increase calcium binding to proteindecrease free calcium - Neuromuscular activity-decrease free calciumexcessive neuronal firing - Diet high in Calcium(Dark green veggies,soy, fruits) and low in phosphorus - Teach signs and symptoms of hypocalcemia and hypercalcemia **Hyperparathyroidism** **Risk Factor:** - Women higher risk than men **Cues/Manifestation** - Prolonged PR and Short QT intervals - GI-anorexia, constipation and abdominal pain - Lethargy - Confusion - Psychosis - Muscle weakness - Fatigue - Bone pain/fracture - Nephrolithiasis **Treatments/prescriptions** - IV fluids and then furosemide - Calcitonin - Phosphate **Nursing actions** - Administer oral phosphates as ordered - Administer calcium binders - Use lift sheet - Strain urine - Education- Signs of hypocalcemia - Low calcium diet - Increase fluids and fiber **Diabetes type 1**  **Risk Factors ** - - - - - - - - - - - - - - - - - - - - - - - - - **Nursing actions ** - **Diabetes type 2**  Study Guide Questions: - Hypoglycemia: Is less than 70 - What causes hypoglycemia: - Exercise - Alcohol - Insulin Peak Times **Risk factors ** - obesity  - Sedentary lifestyle - Aging - Family history - HDL\< 35 or triglycerides\> 250 - Prediabetes **Cues** - Slow onset-over months - Polyuria,polydipsia and polyphagia - Weight gain - Fatigue/Malaise - Recurrent vaginal yeast - Visual disturbances - Poor wound healing - CV Disease Renal insufficiency **Prescriptions/Management of care** - Education - Monitor for complications - Metformin (Glucophage) - Dulaglutide(Trulicity) **Acute and long-term complications** Microvascular --Eyes, Kidney, Neuropathy Macrovascular-Brain, Heart, Extremities **Nursing actions** - VS - I&O - CBC - A1C - GLUCOSE monitoring - BUN,Cr - Urine for microalbuminuria - Insulin or oral glucose control - Skin assessment - Capillary refill time - Self management - Carbohydrate intake at meals **Five Math questions**