“A little less conversation...a little more ENDO!”

Hyperthyroidism is caused by?

● Excessive secretion of the pituitary gland.

A pt is dx as having hyperthyroidism and is admin propylthiouracil. The action of this drug

is to:

● Depress the formation of thyroxine.

While taking an antithyroid drug. The pt should be observed for s/e, including?

● Skin Rash.

Pre-Op teaching for a subtotal thyroidectomy should include:

● Talking may be difficult after sx.● ROM exercises of the neck should be

practiced. However- Hyper-extension of the neck should be avoided!

Post-operatively the pt devloped laryngeal stridor (harsh vibrations) w/ each brath. Calcium

Gluconate was admin to tx?

● Tetany.

What can be common during the rehabilitation stage following a thyroidectomy?

● A period of hypothyroidism soon after sx.

Mrs. Easton does not want to eat her lunch because she feels tired and has a H/A. The

nurse should?

● Encourage her to eat her sandwich.

Hormone secretion is regulated through a?

● Negative feedback system.

Pituitary Tumors

● Tumors- Any tumor in the brain (whether benign or malignant) needs to come out.

● Reason: There is no room in the cranium for it and it will press against surroundings. Increasing ICP.

● If malignant, may do radiation. either alone or with sx.

● If they are removing it sx it is called a Hypophysectomy-Most of the time,they generally do it endoscopically. Transphenoid (through the nasal cavity.)

● May have to be done via craniotomy (if large tumor)

Pre-Op and Post-Op Hypo-physectomy.

● Pre-Op-Baseline neuro assessment.

● Pt teach to avoid coughing (anti-tussive),avoid bending over, and straining-(Colace) stool softener- pulls water out of the intestine.

● Show incentive spirometer.

● Post-Op 1) Neuro Assessment (based on the glaskow coma scale.)

● 2) Monitor urine specific gravity.(Monitoring for diabetes insipidus.)

● 3) They will have a mustache dressing. Must check for glucose for CSP.

True or False: Pt's should expect a small amount of bloody mucus from the nose.

Following a Hypo-Phesectomy?

● True.● Teach the pt to avoid blowing their nose,

if necessary do so gently.● In addition:*Tell the pt to use mouthwash

NOT to brush teeth until incision heals.

What position should a pt be in Post-Thyroidectomy? Why? What else should

you check? #1 Concern?

● Post-Op- #1 Concern is Airway● Semi-fowlers Position (to decrease

swelling.)● May need trach kit & suctioning equipment at

bedside. ● Check that the dressing is not too tight. If

the dressing was loose and now is tight...it indicates swelling!

What specific med should pt's avoid Post-Thyroidectomy? What should you monitor?

#1 Comp?

● Pt's should avoid aspirin- It binds to the same protein as the thyroid hormone. It may lead to thyroid storm.

● V/S-Check for bleeding. Check under the pt's pillow for potential bleeding (wear gloves.)

● Monitor Ca levels r/t accidental removal of the parathyroid. This will most likely occur 24-72 hours post-op

● May develop Tetany r/t low Ca levels. Keep calcium gluconate at the bedside.

● #1 Comp: Thyroid Crisis!

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A pt dx w/ type 1 diabetes is receiving Humalog, (a rapid-acting insulin)by sliding scale. The order reads blood glucose level: <150, zero (0) units;

151 200, three (3) units; 201 to 250, six (6) units; >251, contact health-care provider. The (UAP) reports to the nurse the client’s glucometer

reading is 189. How much insulin should the nurse administer to the pt?

● Three (3) units.

● The client’s result is 189, which is between 151 and 200, so the nurse should administer 3 units of Humalog insulin subcutaneously.

● TEST-TAKING HINT:The test taker must be aware of the way the HCPs write medication orders.HCPs order insulin on a sliding scale according to a range of blood glucose levels.

The nurse administered 28 units of Humulin N, an intermediate-acting insulin,to a pt dx w/ type 1 diabetes at 1600. Which

intervention should the nurse implement?

● Ensure the pt eats a bedtime snack.

● Humulin N peaks in 6 to 8 hours, making the pt at risk for hypoglycemia around midnight, which is why the pt should receive a bedtime snack.

Which electrolyte replacement should the nurse anticipate being ordered by the MD for the pt dx w/

DKA who has just been admitted to the ICU?

● Potassium.

● The pt in DKA loses potassium from increased urinary output, acidosis, catabolic state, and vomiting.Replacement is essential for preventing cardiac dysrhythmias secondary to hypokalemia.

Which arterial blood gas results should the nurse expect in the pt dx w/ diabetic ketoacidosis?

- pH 7.30, PaO2 90, PaCO2 30, HCO3 18.

This ABG indicates metabolic acidosis,which is expected in a pt dx w/ diabetic ketoacidosis.

The nurse is preparing to administer a.m. med to pts. What med should the nurse question before

administering?

● Pancreatic enzymes to the pt who has finished breakfast.

● Rational: Pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal tract.

The nurse is preparing to administer a.m. med to pts. What med should the nurse question before

administering?

● Pancreatic enzymes to the pt who has finished breakfast.

● Rational: Pancreatic enzymes must be administered with meals to enhance the digestion of starches and fats in the gastrointestinal tract.

A pt dx w/ Cushing’s disease has developed 1+ peripheral edema. The pt has received intravenous fluids at 100 mL/hr via IV pump for the past 79 hours. The pt received IVPB medication in 50 mL of fluid every 6 hours for 15 doses. How many mL of

fluid did the pt receive?

● 8,650 mL

The pt dx w/ Cushing’s disease has undergone a unilateral adrenalectomy. Which d/c instructions

should the nurse discuss w/ the pt?

● Explain the signs and symptoms of infection and when to call the MD.

●

The nurse is admitting a pt to the neuro intensive care unit who is post-op transsphenoidal hypophysectomy.

Which should warrant immediate intervention?

● The pt has an output of 2,500 mL since surgery and an intake of 1,000 mL

● Rational:The output is more than double the intake in a short time. This pt could be developing diabetes insipidus,a complication of trauma to the head.

The 68-year-old pt dx w/ hyperthyroidism is being treated w/ radioactive iodine therapy. What

intervention should the nurse discuss w/ the pt?

● Explain it will take up to a month for symptoms of hyperthyroidism to subside.

● Rational: Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the pt is followed closely for three 3 to 4 weeks until the euthyroid state is reached.

What s/s should make the nurse suspect the pt is experiencing a thyroid storm?

● Hyperpyrexia and extreme tachycardia.

● Rational: Hyperpyrexia (high fever) and heart rate above 130 beats per minute are signs of thyroid storm, a severely exaggerated hyperthyroidism.

What s/s indicates to the nurse the pt is experiencing hyperparathyroidism?

● A positive Chvostek’s sign.

What lab data makes the nurse suspect the pt w/ primary hyperparathyroidism is experiencing a

comp?

● A serum creatinine level of 2.8 mg/dL.

● Rational: A serum creatinine level of 2.8 mg/dL indicates the pt is in renal failure, which is a complication of hyperparathyroidism. The formation of stones in the kidneys r/t the increased urinary excretion of calcium and phosphorus occurs in about 55% of pts w/ primary hyperparathyroidism and can lead to renal failure.

A male pt has recently undergone sx removal of a pituitary tumor.Dr.Wong prescribes corticotropin(Acthar),20 units I.M.

q.i.d. As replacement therapy.What is the mechanism of action?

● A) It decreases cyclic adenosine monophosphate (CAMP) production & affects the metabolic rate of target organs.

● B) It interacts with plasma membrane receptors to inhibit enzymatic actions.

● C) It interacts w/ plasma membrane receptors to produce enzymatic actions that affect protein, fat, andcarbohydrate metabolism.

● D) It regulates the threshold for water resorption in the kidneys

● Answer: C

● Rationale: Corticotropin interacts w/ plasma membrane receptors to produce enzymatic actions that affect protein,fat, & carbohydrate metabolism. It doesn’t decrease camp production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

The pt is 3 days post-op unilateral adrenalectomy. Which d/c

instructions should the nurse teach?● A) Discuss the need for

lifelong steroid replacement.

● B) Instruct the pt on administration of vasopressin

● C)Teach the pt to care for the suprapubic Foley catheter.

● D)Tell the pt to notify the HCP if the incision is inflamed.

● Answer: D● Rational: Any inflammation of the incision indicates an

infection and the pt will need to receive antibiotics, so the HCP must be notified.

What question should the nurse ask when assessing the pt for an endocrine dysfunction?

● “Have you had any unexplained weight loss?

● Weight loss w/ normal appetite may indicate hyperthyroidism.

What endocrine D/O should the nurse assess for in the pt who has a closed head injury with

increased intracranial pressure?

● Diabetes Insipidus.

● Rational: Diabetes insipidus can be caused by brain tumors or infections, pituitary sx, cerebrovascular accidents, or renal and organ failure, or it may be a complication of a closed head injury w/ increased intracranial pressure.

Which action by the nurse is most important following a hypophysectomy?

● Performing a routine neurologic assessment

A pt whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transphenoidal hypophysectomy. Before sx,

the nurse reviews pre-op & post-op instructions given to the pt earlier. Which post-op instruction should the nurse emphasize?

● A) “You must lie flat for 24 hours after sx.”

● B) “You must avoid coughing, sneezing, and blowing your nose.”

● C) “You must restrict your fluid intake.”

● D)“You must report ringing in your ears immediately.”

● Answer: B

● Rational:After a transsphenoidal hypophysectomy,the pt must refrain from coughing, sneezing, & blowing the nose for several days to avoid disturbing the sx graft used to close the wound. The HOB must be elevated,to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential comp of hypophysectomy.