ATI Medsurg Exam 3 - Endocrine, HIV, Shock/Sepsis, Kidneys

3 hormones that come from posterior pituitary (everything else is anterior!) - ADH, vasopressin, & oxytocin what are steroids derived from? - cholesterol where are steroids produced? - adrenal glands and gonads are steroids or non-steroids hydrophobic? - steroids = hydrophobic non-steroids = hydrophilic what are non-steroids derived from? - proteins/peptides endocrine tumors are usually benign/malignant and slow/fast-growing - benign and slow-growing overgrowth of what 3 kinds of cells leads to endocrine tumors - eosinophils, basophils, chromophobe cells what kind of tumor accounts for 90% of all tumors - hypopituitary chromophobe tumors 3 types of tumors - primary secondary/functional non-functional what does acromegaly occur? - after closure of growth plates gigantism involves the overgrowth of what 3 things? - long bones, connective tissue, and visceral organs S/S of acromegaly - protruding jaw, thick phalanges, overgrowth of visceral organs S/S of gigantism - tall enlarged proportions, weakness, lethargy when is gigantism present? - during early life what is DI? - excessive water loss thru urine if you have DI, you have a deficiency of which hormone? - ADH aka vasopressin primary cause of DI - head trauma nephrotic DI - kidneys can't respond to ADH dipsogenic DI - excessive water intake (dilutes the ADH) UO of someone with DI - 250 mL/hr ( 3 L/day) urine characteristics with DI - diluted, no abnormal substances! big symptom of DI - pt craves cold water DI can quickly lead to... - dehydration & hypotension why does fluid restriction not work with DI? - it just creates an insatiable thirst → hypernatremia and worse dehydration blood osmolality to dx DI - blood osmolality 295 how does a fluid deprivation test work? - withhold fluid for 8-12 hours → measure plasma and osmolality before and after what is the point of doing a trial dose of desmopressin? - osmolality may return to normal what to monitor for with desmopressin in tx for DI? - tachycardia, excessive weight loss, hypotension with what medical condition do you need to be cautious with when using desmopressin and why? - CAD bcc vasoconstriction what can chlorpropamide & thiazides do with desmopressin? - can slightly potentiate the effects patho of SIADH - negative feedback fails → ADH is constantly being produced common causes of SIADH - head trauma SCLC infection CNS issue (ex. stroke, guillain-barre) chlorpropamide S/S of SIADH - concentrated small amts of urine, fluid retention, HTN + tachycardia, hyponatremia, confusion, seizures, anorexia bc the excess water makes them feel full mgmt for severe SIADH - hypertonic NaCl IV infusion what is the largest endocrine gland? - thyroid 3 hormones of the thyroid - thyroxine (T4) triiodothyronine (T3) calcitonin what does calcitonin do? - it's secreted in response to high calcium levels → increases deposits into bones and out of blood what to assess for before thyroid dx tests - allergies to iodine, shellfish, contrast pt consumption of kelp or seaweed S/S of hypothyroidism - lethargy slow mentation weight gain constipation cold intolerance what is myxedema? - decompensated state of severe hypothyroidism most common form of hypothyroidism - Hashimoto what meds increase risk of hypothyroidism? - sedatives and opioids S/S of myxedema - swelling of face and extremities thicken of skin, especially on lower legs myxedema can also be precipitated by recent ______ - infection avg dose range of levothyroxine - 75-150 mcg/day how is levothyroxine given/managed? - start at a low dose and titrate up until desired TSH levels achieved what to monitor for in pts taking Levo for long-standing hypothyroidism? - cardiac dysfunction for what condition is passive rewarming used? - hypothyroidism what lifestyle changes would you promote to a patient with hypothyroidism? - weight loss and normal bowel habits what happens with a myxedema coma? - pt becomes hypothermic and unconscious 3 most common causes of hyperthyroidism - Graves disease toxic multinodular goiter toxic adenoma who is most at risk for Graves disease? - women 20-40 y/o manifestations of Graves disease - exophthalmos heat intolerancce rapid pulse tremors flushed skin increase appetite AND weight loss physical assessment of the thyroid with Graves disease - enlarged may pulsate may hear bruit or feel a thrill labs expected with Graves disease - decreased TSH & increased T4 + update of iodine pt education for antithyroid meds - take 30 mins before breakfast can take for several weeks until symptoms are relieved med mgmt for hyperthyroidism is usually a combination of _____, _____, and ____ - antithyroid agents radioactive iodine & surgery what to monitor for in pts taking radioactive iodine - signs of thyroid storm true or false: a single dose of iodine is usually efffective - true when is radioactive iodine contraindicated? - during pregnancy what are the 2 main complications of hyperthyroidism mgmt? - recurrent hyperthyroidism & permanent HYPOthyroidism most common cause of a goiter/thyroid tumor - iodine deficiency who is 3x more likely to develop thyroid cancer? - women ofc when is a thyroidectomy recommended? - for malignancies, hyperthyroidism that's unresponsive to tx, and large goiters 5 complications of a thyroidectomy and their interventions - bleeding/hemorrhage → assess dressing and site airway obstruction, edema → trach kit always on hand laryngeal nerve injury → asses for speech changes dysphagia → soft diet Ca disturbance can lead to spasms → monitor for tetany (Chvostek's sign) function of PTH - elevates Ca & lowers Phosphorous main cause of hyperparathyroidism - tumor/hyperplasia manifestations of hyperparathyroidism (it can be asymmptomatic tho) - apathy fatigue/weakness NV constipation HTN dysrhythmias tx of hyperparathyroidism and why - rehydration to excrete all the extra Ca and prevent calculi what Ca level indicates a hypercalcemic crisis? - 13 what fluids are given for rapid rehydration while maintaining UO? - isotonic fluids (NS) 2 causes of HYPOthyroidism - autoimmune & vitamin D deficiency manifestations of HYPOparathyroidism - tetany paresthesia respiratory spasms anxiety/depression, irritability, delirium ECG changes tx for HYPOparathyroidism - Ca and Vitamin D deficiency what does the adrenal MEDULLA produce? - catecholamines, epi, and norepi what does the adrenal CORTEX produce? - the gluco- and mineralocorticoids and androgens what is pheochromocytoma? - rare tumor on the adrenal gland peak occurance for pheochromocytoma - 40-50 y/o if pheochromocytoma is untreated... - can cause potentially fatal HTN patho of Addison's disease - low cortisol etiology of Addison's disease - usually autoimmune what meds can cause Addison's disease - rifampin barbituates ketoconazole