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Chapter 41 and 42

front 1

hyposecretion of hormones from anterior pituitary gland; deficiency of one of the anterior pituitary hormones results in changes in metabolic or sexual function

back 1

hypopituitarism

front 2

in children before the closure of the epiphyses, ______ (small stature) develops

back 2

dwarfism

front 3

a lack of GH in adults does not affect bone length, but does affect bone

back 3

density and osteoporosis may develop

front 4

clinical manifestations of decreased glucocorticoids associated with hypopituitarism?

back 4

  • hypoglycemia
  • decreased cortisol levels
  • decreased ability to handle stress

front 5

clinical manifestations of decreased mineralocorticoids associated with hypopituitarism?

back 5

  • hyponatremia
  • hypotension
  • hyperkalemia

front 6

clinical manifestations of growth hormone associated with hypopituitarism?

back 6

  • decreased bone density
  • decreased muscle strength
  • increased risk of bone fractures

front 7

clinical manifestations of thyroid-stimulating hormone (TSH) associated with hypopituitarism?

back 7

think decreased levels of T3 and T4

  • decreased metabolic rate
  • weight gain
  • thinning of hair
  • decreased libido

front 8

aldosterone controls?

back 8

Na+ and water

front 9

lack of ACTH with a resultant decrease in glucocorticoids and mineralocorticoids is a life-threatening emergency because the pt is unable to maintain adequate fluid volume status, which may lead to circulatory collapse

back 9

panhypopituitarism

front 10

what do pt's VS look like with hypopituitarism?

back 10

  • hypotensive
  • tachycardia

front 11

what must we teach our patients about taking hormone at home?

back 11

taking hormone supplements in the morning mimics the normal release of these hormones

front 12

hypersecretion of hormones from anterior pituitary gland; usually related to a hypersecreting tumor

back 12

hyperpituitarism

front 13

in children before the closure of the epiphyses, _____ (large stature) develops

back 13

gigantism

front 14

an excess of GH in adults does not affect bone length because of closure of the epiphyses but does affect bone density, and ______ (thickening of bones, particularly of the hands, feet, and facial bones) may develop

back 14

acromegaly

front 15

clinical manifestations of increased glucocorticoids associated with hyperpituitarism?

back 15

  • hyperglycemia
  • increased cortisol levels

front 16

clinical manifestations of increased mineralocorticoids associated with hyperpituitarism?

back 16

  • hypernatremia
  • hypertension
  • hypokalemia

front 17

clinical manifestations of GH associated with hyperpituitarism?

back 17

  • increased bone density
  • coarse facial features
  • mensural irregularities

front 18

clinical manifestations of thyroid-stimulating hormone (TSH) associated with hyperpituitarism?

back 18

think increased T3 and T4

  • increased metabolic rate
  • weight loss
  • exopthalmos

front 19

vital signs with hyperpituitarism?

back 19

  • HTN
  • think FVE: SOB, peripheral edema, crackles, dyspnea
  • increased heart rate

front 20

review nursing interventions for a pt after transphenoidal hypophysectomy

back 20

pt 925

front 21

A nurse is caring for a client who is being evaluated for acromegaly. Which of the following manifestations should the nurse expect to find during assessment? Select all that apply.

A. Loss of color discrimination

B. Coarse facial features

C. Enlarged distal extremities

D. Hepatomegaly

E. Moon face

back 21

A, B, C, D

front 22

where are your adrenal glands located?

back 22

on top of each kidney

front 23

the adrenal cortex secretes?

back 23

  • glucocorticoids (cortisol)
  • mineralocorticoids (aldosterone)
  • sex hormones (androgens and estrogens)

front 24

primary glucocorticoid and its actions include carbohydrate, fat, and protein metabolism; suppression of the immune response; and control of the body's stress response

back 24

cortisol

front 25

primary mineralocorticoid, and its primary actions are to promote sodium and water reabsorption and potassium excretion in the kidneys?

back 25

aldosterone

front 26

what happens if exogenous corticosteroids are discontinued abruptly?

back 26

Addisonian crisis (acute adrenal crisis)

front 27

adrenal insufficiency that may result from destruction of the adrenal glands or insufficiency or Addison's disease

back 27

adrenal cortical insufficiency

front 28

adrenal cortical insufficiency (Addison's crisis) is a decrease/increase in glucocorticoids and mineralocorticoids

back 28

decrease

front 29

patients presenting with acute adrenal insufficiency require emergency stabilization with IV fluids and glucose, along with IV administration of glucocorticoids

back 29

***

front 30

clinical manifestations of adrenal cortical insufficiency/Addison's crisis?

back 30

  • decrease in cortisol and aldosterone
  • bronzed hyperpigmentation R/T ^ MSH
  • weakness
  • weight loss
  • fatigue
  • nausea
  • abd pain
  • gastroenteritis
  • emotional lability
  • decrease in pubic and axillary hair
  • dehydration and hypotension

front 31

what is our volume like in adrenal cortical insufficiency/Addison's crisis?

back 31

FVD

  • high K+
  • low Na+ and water
  • low BS
  • low BP

front 32

what replacement is necessary for adrenal insufficiency?

back 32

replacement of cortisol

front 33

The nurse correlates which clinical manifestation with the pathophysiology of adrenal insufficiency?

A. Heat intolerance

B. Weight gain

C. Peripheral edema

D. Hypoglycemia

back 33

D. Hypoglycemia

front 34

A patient has been receiving doses of prednisone for treatment of RA for the past 3 months. If this medication is suddenly discontinued, for which complication is the patient at risk?

A. Hypovolemia

B. Hypernatremia

C. Hypothermia

D. Hyperglycemia

back 34

A. Hypovolemia

front 35

adrenal cortex disorder in which there is an excessive secretion of glucocorticoids and mineralocorticoids

back 35

adrenal cortex hyperfunction; Cushing's

front 36

clinical manifestations of adrenal cortex hyperfunction/Cushing's?

back 36

  • emotional disturbance
  • enlarged sells turcica
  • moon face
  • buffalo hump
  • cardiac hypertrophy (HTN)
  • osteoporosis
  • breast atrophy
  • adrenal tumor or hyperplasia
  • obesity
  • abd striae
  • thin, wrinkled skin
  • amenorrhea
  • decreased muscle mass
  • purpura
  • skin ulcers (poor wound healing)
  • decreased inflammatory and immune responses

front 37

clinical manifestations of adrenal cortex hyperfunction/Cushing's related to overproduction of cortisol?

back 37

decreased inflammatory and immune responses

front 38

what is our fluid like in adrenal cortex hyperfunction/Cushing's?

back 38

FVE

  • SOB
  • crackles
  • peripheral edema
  • dyspnea
  • decreased UOP
  • HTN
  • increased heart rate

front 39

safety alert

back 39

pg 938

front 40

what are the electrolytes and BS doing in adrenal cortex hyperfunction/Cushing's?

back 40

  • increased BS
  • increased Na+ and water
  • decreased K+

front 41

patients who have an adrenalectomy are at risk for?

back 41

Addison's; will need steroids

front 42

possible complications from adrenal cortex hyperfunction/Cushing's?

back 42

  • osteoporosis
  • adrenal crisis- w/ abrupt withdrawal of corticosteroid
  • elevated BG
  • GI bleeding
  • uncontrolled HTN
  • cardiac dysrhythmias

front 43

rare catecholamine secreting tumors of the adrenal medulla; secrete epi and norepi

back 43

pheochromocytoma

front 44

clinical manifestations of pheochromocytoma?

back 44

  • tachycardia
  • HTN
  • headaches
  • palpitations
  • hyperhydrosis
  • hypermatabolism
  • hyperglycemia

front 45

treatment for pheochromocytoma?

back 45

adrenalectomy is the definitive treatment

front 46

vital signs in pheochromocytoma?

back 46

  • extremely high BP
  • tachycardia

front 47

pheochromocytoma is/is not life threatening

back 47

is life threatening

front 48

what is important to remember about the morning of adrenalectomy?

back 48

administer glucocorticoid to avoid adrenal insufficiency

front 49

A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make?

A. It is caused by the lack of production of insulin by the pancreas.

B. It is caused by the lack of production of aldosterone by the adrenal gland.

C. It is caused by the overproduction of growth hormone by the pituitary gland.

D. It is caused by the overproduction of parathormone by the parathyroid gland.

back 49

B. It is caused by the lack of production of aldosterone by the adrenal gland.

front 50

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching?

A. Limit intake of potassium-rich foods

B. Restrict sodium intake

C. Increase carbohydrate intake

D. Decrease protein intake

back 50

B. Restrict sodium intake

front 51

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)

A. Alopecia

B. Tremors

C. Moon face

D. Purple striations

E. Buffalo hump

back 51

A, C, D, E

front 52

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

A. Hyperpigmentation

B. Intention tremors

C. Hirsutism

D. Purple striations

back 52

A. Hyperpigmentation

front 53

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortiolism?

A. A client who has a butterfly rash on his face

B. Moon face

C. A client who has a positive Chvostek's sign

D. A client who has muscle hypertrophy

back 53

B. Moon face