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6124 Exam 3
Hypothalamus
Characteristics
Anterior Pituitary Stimulated Through the Hypophyseal Portal
GHRH
GnRH
TRH
PIF
CRF Released During Stress
Posterior Pituitary Stimulated Through Neural Control
CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH
Cortisol Released
Androgens Released
Adrenal Medulla
Epinephrine & Norepinephrine
2 mins
Adrenal Gland (Advanced)
Characteristics
Adrenal Cortex
Zona Glomerulosa
Aldosterone
Zona Fasciculata
Cortisol
Zona Reticularis
Androgens
Adrenal Medulla
Chromaffin Cells
Epinephrine & Norepinephrine
2 mins
Thyroid Function Screening Tests
If TSH High
Free T4 (FT4)
If TSH Low
Free T4 (FT4) and T3 (Triiodothyronine)
Consider Serum Total T4 (Thyroxine)
Considerations
Only Total T4 Increases in Pregnancy
T4 is Converted to T3
Avoid for Inpatient Screening
2 mins
Hypothyroidism Assessment
Assessment
Weight Gain - Edema
Lethargy
Cold Intolerance
Bradycardia
Hypertension
Brittle Nails and Dry Skin
Constipation
Goiter
Prolonged Menses
Slowed Thinking
Diagnostic Tests
Decreased Free T4
Increased TSH
2 mins
Hypothyroidism Intervention
Medications
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Complication
Myxedema Coma
Nursing Considerations
Lifelong Replacement Hormone
Monitor Vital Signs
Fluids and Fiber
Low Calorie, Low Fat Diet
Medication Education
No Switching Brands
2 mins
Hyperthyroidism Assessment
Assessment
Heat Intolerance
Exophthalmos
Warm, Moist Skin and Silky Hair
Tremors
Goiter
Diarrhea
Weight Loss
Tachycardia
Hypertension
Amenorrhea
Diagnosis
Decreased TSH with Elevated Free T4
Radioactive Iodine Uptake (RAIU)
2 mins
Hyperthyroidism Interventions
Drug Therapy
Propylthiouracil (PTU)
Methimazole (Tapazole)
Iodine
Beta Blockers
Other Therapies
Radioiodine Ablation
Thyroidectomy
Complications
Thyrotoxicosis
Post-Surgery Hypocalcemia
2 mins
Graves' Disease Characteristics
Women 20-40 years old
Pathophysiology
Anti-TSH Receptor Antibodies
Symptoms
Ophthalmopathy
Exophthalmos
Hyperthyroidism
Goiter
Pretibial Myxedema
1 min
Graves' Disease Labs and Treatment
Labs
Decreased TSH
Increased T3
Increased T4
Radioactive Iodine Uptake (RAIU)
Treatment
Beta blocker
Methimazole
Radioiodine Ablation
1 min
Hashimoto's Thyroiditis
Symptoms
Hypothyroidism with Bouts of Hyperthyroidism
Enlarged, Nontender Thyroid
Mechanism
Autoimmune
Anti-Thyroid Peroxidase (TPO)
Anti-Thyroglobulin
Lab Findings
Hurthle Cells
Lymphoid Follicles
Associations
HLA-DR5 and HLA-DR3
Increased Risk Of Non-Hodgkin Lymphoma
2 mins
Thyroid Storm
Symptoms
Diarrhea
Liver Failure
Insulin Resistance
Tachycardia
Lid lag
Change in LOC (Altered Mental Status)
High fever
Treatment
Propranolol (Or Esmolol)
PTU (Thionamides) Initially
Iodine Solution (Lugol Iodine)
Glucocorticoids
Cooling Blanket
3 mins
Thyroid Storm Causes
Pathophysiology Causes
Sepsis
Thyroid Trauma
Surgery
Childbirth
Grave's Disease
Excessive Thyroid Hormone Ingestion
TSH-secreting Tumors
Hyperfunctioning Goiter or Nodule
McCune Albright Syndrome
2 mins
Hypoparathyroidism
Assessment
Hypocalcemia
Lethargy
Tetany
Arrhythmias
Diagnostic Tests
Decreased Calcium and Increased Phosphorus
Considerations
IV Calcium Chloride
Rebreather Mask
Lifelong Medications
Oral Calcium Supplements with Vitamin D
2 mins
Primary Hyperparathyroidism
Assessment
Hypercalcemia
Kidney Stones
Osteoporosis
Arrhythmias
Diagnostic Tests
Increased Calcium and Decreased Phosphorus
Considerations
Prevent Injury
Medication Education
Surgery
1 min
Addison's Disease
Mechanism
Chronic 1° Adrenal Insufficiency
Atrophy
Destruction
Symptoms
Deficiency In Cortisol And Aldosterone
Skin Hyperpigmentation
Increased POMC
Hypotension
Hyperkalemia
Acidosis
Addisonian Crisis
Diagnosis
ACTH (Cosyntropin) Stimulation Test
Treatment
Exogenous Cortisol
2 mins
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