Understanding Medical Surgical Nursing Ch 37
Terms
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- Insufficient hormone activity may be the result of 1_____ of an endocrine gland or 2_____ of the target tissue to its hormone.
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1 hypofunction
2 insensitivity - ectopic hormone production
- hyperactive gland caused by self-administration of too much replacement hormone
- antidiuretic hormone (ADH)
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AKA vasopressin
synthesized in hypothalamus
stored & secreted by posterior pituitary
decrease = diabetes insipidus
increase = syndrome of inappropriate antidiuretic hormone (SIADH) - nephrogenic diabetes
- sufficient ADH exists but kidneys do not respond to it
- osmolality
- ionic concentration of dissolved substances per unit of solvent
- diabetes insipidus
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caused by ADH deficiency usually due to tumors/trauma to pituitary gland
occasionally caused by pt drinking large amounts of water in absence of true disease
S/S: polyuria - nocturia - high serum osmolality - low urine osmolality - decreased urine specific gravity - polydipsia - psychogenic
- of mental origin
- polyuria
- excessive urination
- nocturia
- excessive urination at night
- polydipsia
- extreme thirst
- hypovolemic
- low volume of blood in circulatory system
- hypophysectomy
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surgical removal of pituitary gland
check postop pt for DI & CSF leakage (contains glucose unlike surgical discharge) - When doing a nursing assessment of a pt w/DI, place special attention on 1_____ balance. 2_____ 2_____ are the most reliable method for monitoring the amount of fluid that is being 3_____.
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1 fluid
2 daily weights
3 lost - syndrome of inappropriate antidiuretic hormone (SIADH)
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results from too much ADH in body causing excess water to be reabsorbed by kideny tubules & collecting ducts
results in decreased urine output & fluid overload
certain cancers, several drugs, and head trauma or surgery can cause SIADH
S/S: weight gain - serum osmolality less than 275 mOsm/kg - concentrated urine - muscle cramps & weakness - lethargy - seizures - coma - 1_____ mL of ice chips equal approximately 2_____ mL of water.
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1 100
2 50 - growth hormone (GH)
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AKA somatotropin
responsible for normal growth of bones, cartilage, & soft tissue
synthesized & secreted by anterior pituitary
excess = acromegaly
deficit = dwarfism - dwarfism
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AKA short stature
occurs when GH is deficient in childhood
may be due to pituitary tumor/failure to develop, infection, trauma, & extreme stress
S/S CHILDREN: growth may reach 3-4 feet max w/norm body proportions - sexual maturation slowed - sometimes accompanied by mental retardation
S/S ADULTS: weakness - hypoglycemia - sexual dysfunction - skin changes - headaches - mental slowness - visual disturbances - acromegaly
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excess of GH that affects adults (usually in 30s or 40s)
if GH excess occurs as child, result is gigantism
caused by oversecretion of GH
S/S: nose/jaw/brow/hands/feet enlarge - teeth may be displaced - tongue thickens - kyphosis due to vertebral changes - headaches - diabetes mellitus - osteoporosis & arthritis may occur - hyperplasia
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abnormal increase in number of cells in tissue/organ
is NOT a tumor - amenorrhea
- absence /cessation of menstruation
- Triiodothyronine (1____) and thyroxine (2_____) are secreted by the 3_____ gland. These hormones may be collectively referred to as 4_____ 4_____ (TH). Deficient secretion of these hormones results in 5_____; excess TH results in 6_____.
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1 T3
2 T4
3 thyroid
4 thyroid hormone
5 hypothyroidism
6 hyperthyroidism - cretinism
- hypothyroidism occuring in infancy
- myxedema
- hypothyroidism that develops in an adult
- hypothyroidism
-
occurs when thyroid gland fails to produce enough TH despite enough TSH being secreted
cause can be due to congenital defect, inflammation, iodine deficiency, autoimmune dx, postpartum pituitary necrosis
S/S: reduced metabolism - fatigue - weight gain - bradycardia - constipation - mental dullness - feeling cold - SOB - dry skin & hair - water retention - hyperthyroidism
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excessive amounts of circulating thyroid hormone
increases metabolism, number of beta-adrenergic receptor sites & activity of NE resulting in 'fight-or-flight' response
S/S: heat intolerance - increased appetite w/weight loss - increased bowel movements - nervousness - tremor - tachycardia - thyrotoxic crisis
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AKA thyroid storm
severe hyperthyroid state that can occur in hyperthyroid pts who are untreated or who are experienceing another illness or stressor
can result in death in as little as 2 hrs if untreated - euthyroid
- having normal thyroid gland function
- goiter
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enlargement of thyroid gland
may be due to increased TSH levels, iodine deficiency, enviornmental factors, or food/medications
S/S: thyroid gland enlarged - interference w/swallowing or breathing - s/s of hypo or hyperthyroidism may be present - goitrogens
- foods/medications that block body's use of iodine & result in goiter
- cancer of the thyroid gland
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rare but the most common cancer of endocrine system
possible causes include thyroid hyperplasia, radiation exposure, iodine deficiency, & prolonged exposure to goitrogens
S/S: hard, painless nodule on thyroid gland - difficulty breathing or swallowing - voice may change
** many pts have NORMAL TH levels - hypoparathyroidism
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decreased PTH activity
most common causes are heredity & accidental removal during thyroidectomy
S/S: hypocalcemia - numbness/tingling of fingers - muscle spasms/twitching - +Chvostek's sign - +Trousseau's sign - lethargy - Chvostek's sign
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method for assessing pt for hypocalcemia
tap on pt's facial nerve just in front of ear - spasm of face = + hypocalcemia - Trousseau's sign
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method for assessing pt for hypocalcemia
place sphygmomanometer on pt's arm & pump to above pt's systolic pressure - spasm of thumb & fingers occurs w/i 3 min if pt has hypocalcemia - hyperparathyroidism
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overactivity of one or more parathyroid glands causing increase in PTH
usually result of hyperplasia, benign tumor, heredity, or cancer
S/S: hypercalcemia - fatigue - depression - confusion - polyuria - anorexia - N/V - peptic ulcers - joint pain - pathological fractures