NURS 271 FINAL STUDY GUIDE WITH COMPLETE
SOLUTION BASED ON FINAL EXAM, REAL TEST
Care of Patients with Endocrine Problems
answers: may not see daily but will see some and addition to their other problems
Hyperthyroidism
answers: excessive thyroid hormone secretion from the thyroid gland
Thyrotoxicosis/thyroid storm: extreme state of hyperthyroidism, rare, but happens
when it is untreated or poorly treated, sudden worsening of symptoms from
infection, trauma, stress, or manipulation of thyroid gland during surgery, life
threatening situation = excessive thyroid hormone (increase metabolic rate =
unintentional weight loss)
answers: a. Fever
b. Tachycardia: 200 bpm = inability for heart to fill = deficit amount of blood and
oxygen to other tissue and organs
c. Elevated systolic BP
d. GI symptoms: abdominal pain, vomiting, diarrhea
e. Agitation: restless = confusion = psychosis = seizures = death
Treatment: prevent from shivering by cooling = increases heat production by 500%
= increase temperature, replace fluids and monitor glucose = insulin resistance,
monitor electrolytes and respiratory, lower HR (heart can't fill, not pumping
enough blood to organs), reduce thyroid synthesis and secretion: T3 and T4
answers: Cause: antibodies bind and stimulate TSH receptors = thyroid synthesis
and secretion = thyroid gland increase in size = toxic goiter
Graves Disease: most common form of hyperthyroidism, don't know what causes
it, heredity, more common in women
, answers: Autoimmune disorder: antibodies are made and attach to TSH receptors
and bind to thyroid gland = increase size and overproduction of hormones,
pituitary gland stops producing TSH = too much T3 and T4 = autoantibodies
(immune system) that attack healthy cells
Heat intolerance = caused by increase production of T4, increase metabolism, and
increase in unintentional weight loss
answers: Thyroid hormones: increased but TSH is decreased, involved in brain
development and metabolism
T3-Triiodothyronine
T4-Thyroxine
Overview of Thyroid Hormones
Cortisol: stress hormone, chronic stress, long period of time = decrease in immune
system, elevation in BP, and increase in glucose in blood stream: gluconeogenesis
= formation of new glucose in the liver under stressful situations, metabolism of
protein
answers: fight or flight, hypothalamus controls release = cortisol releasing
hormone = ACTH: anterior pituitary gland = release cortisol from adrenal cortex,
control metabolism, heart, brain, etc., T3 and T4
Thyroid Releasing Hormone (TRH): hypothalamus = anterior pituitary gland =
TSH
Thyroid Stimulating Hormone (TSH) = T3 and T4
T3 & T4 Thyroid Hormones: too much = hyperthyroidism and too little =
hypothyroidism
answers: Growth hormone, somatotropin: growth, metabolism, protein synthesis:
hypothalamus = growth hormone releasing hormone = causes growth hormone to
be produced in the anterior pituitary
This is the chain
,answers: 1. Hypothalamus produces Thyroid releasing hormone (TRH)
2. Anterior pituitary gland produces TSH
3. Thyroid produces T3/T4
Pathophysiology of Hyperthyroidism
Primary: problem with thyroid gland itself, secreting too much T3/T4, grave's
disease, antibodies = trick body into making too much T3/T4 or small tumor =
excess T3/T4
answers: Secondary: problem with pituitary gland = tumor causes excess secretion
of TSH = thyroid gland thinks it needs more T3/T4, thyroid gland is just taking
orders
Tertiary: problem with hypothalamus, dysfunction with hypothalamus = producing
too much TRH = TSH = T3/T4, thyroid gland is just taking orders
answers: Flip the chain backwards
1. Thyroid produces T3/T4
2. Pituitary gland produces TSH
3. Hypothalamus produces TRH
Exophthalmos: Thyroid Eye Disease, grave's disease, wide eyed look = edema on
extraocular muscles, increase in fatty tissue behind the eye = pushes eyes forward,
pressure on optic nerve, impairs vision
eye lids don't close all the way, over time = dry out eyes = ulcerations, infection,
lid lag: eyelid stays up = no protection
answers: Patients may complain of:
Blurred vision
Diplopia- Double vision
, Eye pain
Photophobia-Sensitivity to light
Immune cells that invade thyroid gland = accumulate in the eye socket = move eye
forward and outward
answers: Treatment: stabilize treatment, damage already done on eye = not
reversible, so address problem as soon as possible
Pharmacological Management: reducing hormone, euthyroid: normal thyroid state,
prevent complications from occurring
answers: Propylthiouracil (PTU): prevents new formation of thyroid hormone,
inhibiting thyroid hormone from binding to iodine and presents conversion of T4 to
T3 in tissues or Methimazole (Tapazole)
Antithyroid Drugs
Radioactive Iodine Therapy: PO, concentrated in thyroid gland and radiation
destroys thyroid tissue over several weeks, need long term thyroid replacement =
not producing normal amounts = hypothyroidism
Preferred Treatment
answers: Beta-adrenergic blocking drugs: HR increased, metabolism is increased
Propranolol- Non-Cardioselective: block beta 1 and 2 = bronchoconstriction
Metoprolol- Cardio-selective: respiratory issue
Surgical Treatment for Hyperthyroidism
answers: removing part of thyroid gland, life long treatment, partial removal of
thyroid gland, but sometimes they remove too much - hypothyroidism, total:
tumor, swelling, inflammation, cancer = completely remove = no more thyroid
hormone
SOLUTION BASED ON FINAL EXAM, REAL TEST
Care of Patients with Endocrine Problems
answers: may not see daily but will see some and addition to their other problems
Hyperthyroidism
answers: excessive thyroid hormone secretion from the thyroid gland
Thyrotoxicosis/thyroid storm: extreme state of hyperthyroidism, rare, but happens
when it is untreated or poorly treated, sudden worsening of symptoms from
infection, trauma, stress, or manipulation of thyroid gland during surgery, life
threatening situation = excessive thyroid hormone (increase metabolic rate =
unintentional weight loss)
answers: a. Fever
b. Tachycardia: 200 bpm = inability for heart to fill = deficit amount of blood and
oxygen to other tissue and organs
c. Elevated systolic BP
d. GI symptoms: abdominal pain, vomiting, diarrhea
e. Agitation: restless = confusion = psychosis = seizures = death
Treatment: prevent from shivering by cooling = increases heat production by 500%
= increase temperature, replace fluids and monitor glucose = insulin resistance,
monitor electrolytes and respiratory, lower HR (heart can't fill, not pumping
enough blood to organs), reduce thyroid synthesis and secretion: T3 and T4
answers: Cause: antibodies bind and stimulate TSH receptors = thyroid synthesis
and secretion = thyroid gland increase in size = toxic goiter
Graves Disease: most common form of hyperthyroidism, don't know what causes
it, heredity, more common in women
, answers: Autoimmune disorder: antibodies are made and attach to TSH receptors
and bind to thyroid gland = increase size and overproduction of hormones,
pituitary gland stops producing TSH = too much T3 and T4 = autoantibodies
(immune system) that attack healthy cells
Heat intolerance = caused by increase production of T4, increase metabolism, and
increase in unintentional weight loss
answers: Thyroid hormones: increased but TSH is decreased, involved in brain
development and metabolism
T3-Triiodothyronine
T4-Thyroxine
Overview of Thyroid Hormones
Cortisol: stress hormone, chronic stress, long period of time = decrease in immune
system, elevation in BP, and increase in glucose in blood stream: gluconeogenesis
= formation of new glucose in the liver under stressful situations, metabolism of
protein
answers: fight or flight, hypothalamus controls release = cortisol releasing
hormone = ACTH: anterior pituitary gland = release cortisol from adrenal cortex,
control metabolism, heart, brain, etc., T3 and T4
Thyroid Releasing Hormone (TRH): hypothalamus = anterior pituitary gland =
TSH
Thyroid Stimulating Hormone (TSH) = T3 and T4
T3 & T4 Thyroid Hormones: too much = hyperthyroidism and too little =
hypothyroidism
answers: Growth hormone, somatotropin: growth, metabolism, protein synthesis:
hypothalamus = growth hormone releasing hormone = causes growth hormone to
be produced in the anterior pituitary
This is the chain
,answers: 1. Hypothalamus produces Thyroid releasing hormone (TRH)
2. Anterior pituitary gland produces TSH
3. Thyroid produces T3/T4
Pathophysiology of Hyperthyroidism
Primary: problem with thyroid gland itself, secreting too much T3/T4, grave's
disease, antibodies = trick body into making too much T3/T4 or small tumor =
excess T3/T4
answers: Secondary: problem with pituitary gland = tumor causes excess secretion
of TSH = thyroid gland thinks it needs more T3/T4, thyroid gland is just taking
orders
Tertiary: problem with hypothalamus, dysfunction with hypothalamus = producing
too much TRH = TSH = T3/T4, thyroid gland is just taking orders
answers: Flip the chain backwards
1. Thyroid produces T3/T4
2. Pituitary gland produces TSH
3. Hypothalamus produces TRH
Exophthalmos: Thyroid Eye Disease, grave's disease, wide eyed look = edema on
extraocular muscles, increase in fatty tissue behind the eye = pushes eyes forward,
pressure on optic nerve, impairs vision
eye lids don't close all the way, over time = dry out eyes = ulcerations, infection,
lid lag: eyelid stays up = no protection
answers: Patients may complain of:
Blurred vision
Diplopia- Double vision
, Eye pain
Photophobia-Sensitivity to light
Immune cells that invade thyroid gland = accumulate in the eye socket = move eye
forward and outward
answers: Treatment: stabilize treatment, damage already done on eye = not
reversible, so address problem as soon as possible
Pharmacological Management: reducing hormone, euthyroid: normal thyroid state,
prevent complications from occurring
answers: Propylthiouracil (PTU): prevents new formation of thyroid hormone,
inhibiting thyroid hormone from binding to iodine and presents conversion of T4 to
T3 in tissues or Methimazole (Tapazole)
Antithyroid Drugs
Radioactive Iodine Therapy: PO, concentrated in thyroid gland and radiation
destroys thyroid tissue over several weeks, need long term thyroid replacement =
not producing normal amounts = hypothyroidism
Preferred Treatment
answers: Beta-adrenergic blocking drugs: HR increased, metabolism is increased
Propranolol- Non-Cardioselective: block beta 1 and 2 = bronchoconstriction
Metoprolol- Cardio-selective: respiratory issue
Surgical Treatment for Hyperthyroidism
answers: removing part of thyroid gland, life long treatment, partial removal of
thyroid gland, but sometimes they remove too much - hypothyroidism, total:
tumor, swelling, inflammation, cancer = completely remove = no more thyroid
hormone
