NR 283 Pathophysiology Final Exam Concept Review

NR 283 Pathophysiology Final Exam Concept Review ***For all previous content covered on previous exams, please consult your previous concept review sheets. This is not an all-inclusive list for topics to be covered. Please be sure to consult your syllabus and learning plan. This is a comprehensive final. ***Be sure to cover pathophysiology, etiology, clinical manifestations, nursing considerations, diagnostic tests for the following topics: Endocrine Too much ADH ( SIADH- Syndrome of Inappropriate Diuretic Hormone antidiuretic hormone ) secretion leads to water intoxication and hyponatremia Causes include trauma, stroke, malignancies (often in the lungs or pancreas), medications, and stress S/S include signs of fluid volume overload, changes in level of consciousness and mental status changes, weight gain, hypertension, tachycardia, anorexia, nausea, vomiting, hyponatremia, concentrated urine, decreased urine output, serum osmolality decreased Nursing considerations include monitoring vital signs and cardiac and neurological status, providing a safe environment, particularly for the patient with changes in level of consciousness or mental status, monitoring intake and output and weight daily; monitoring fluid and electrolyte balance, monitoring serum and urine osmolality; restriction of fluids DI (Diabetes Insipidus)- Kidney tubules fail to reabsorb water Etiology includes stroke or trauma or may be idiopathic S/S include excretion of large amounts of dilute urine, polydipsia, dehydration (decreased skin turgor and dry mucous membranes), inability to concentrate urine, increased urine output, urine very dilute, Low urinary specific gravity, fatigue, muscle pain and weakness, headache, postural hypotension that may progress to vascular collapse without rehydration, tachycardia, hypernatremia Nursing Considerations: monitor vital signs and neurological and cardiovascular status, provide a safe environment, particularly for the patient with postural hypotension; monitor electrolyte levels and for signs of dehydration; maintain patient intake of adequate fluids; monitor intake and ouput, weight, serum osmolality and specific gravity of urine; instruct the patient to avoid foods and/or liquids that produce diuresis Hyperthyroidism- Too much thyroid hormone (T3 and T4) Characterized by an increased rate of body metabolism Common cause is Graves’ disease, also known as toxic diffuse goiter S/S include: personality changes such as irritability, agitation and mood swings, nervousness and fine tremors of the hands, heat intolerance, weight loss, smooth, soft skin and hair, palpitations, cardiac dysrhythmias such as tachycardia or atrial fibrillation, diarrhea, protruding eyeballs (exophthalmos) may be present, diaphoresis (sweating), hypertension, enlarged thyroid gland (goiter) Nursing Considerations: Provide adequate rest, provide a cool and quiet environment, provide a highcalorie diet, obtain daily weight, avoid administration of stimulants, administer sedatives as prescribed, administer antithyroid medications, administer blood pressure medication for tachycardia, prepare for thyroidectomy if prescribed Hypothyroidism- Hyposecretion of thyroid hormones (T3 and T4) Characterized by a decreased rate of body metabolism Causes: autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid surgery, certain medications S/S: lethargy, fatigue, weakness, muscle aches, paresthesias, intolerance to cold, weight gain, dry skin and hair and loss of body hair, bradycardia, constipation, generalized puffiness and edema around the eyes and face (myxedema), forgetfulness and loss of memory, menstrual disturbances, cardiac enlargement, tendency to develop heart failure, goiter may or may not be present Hyperparathyroidism- Hypersecretion of parathyroid hormone (PTH) Causes: Tumor, Hyperplasia, Genetics; secondary causes-severe calcium or vitamin D deficiency, chronic kidney failure S/S: Hypercalcemia and hypophosphatemia, fatigue and muscle weakness, skeletal pain and tenderness, bone deformities that result in pathological fractures, anorexia, nausea, vomiting, epigastric pain, weight loss, constipation, hypertension, cardiac dysrhythmias, renal stones Nursing Considerations: Monitor vital signs, particularly blood pressure; monitor for cardiac dysrhythmias, monitor for intake and output and for signs of renal stones, monitor skeletal pain, move the patient slowly and carefully; encourage fluid intake, administer furosemide (Lasix) as prescribed to lower calcium levels, administer phosphates, which interfere with calcium reabsorption as prescribed, administer calcitonin as prescribed to decrease the skeletal calcium release and increase renal excretion of calcium, monitor calcium and phosphorus levels, prepare the patient for parathyroidectomy as prescribed Hypoparathyroidism-Hyposecretion of parathyroid hormone (PTH) Can occur following a thyroidectomy because of removal of parathyroid tissue S/S: Hypocalcemia and hyperphosphatemia, numbness and tingling in the face, muscle cramps and cramps in the abdomen or extremities, positive Trousseau’s and Chvostek’s sign, signs of overt tetany such as bronchospasm, laryngospasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias, seizures; hypotension, anxiety, irritability, depression Nursing Considerations: Monitor vital signs, monitor for signs of hypocalcemia and tetany, initiate seizure precautions, place a tracheostomy set, oxygen and suctioning equipment at bedside, prepare to administer calcium gluconate intravenously for hypocalcemia, provide a high-calcium, low-phosphorus diet, instruct the patient on administration of calcium supplements as prescribed, instruct the patient on administration of vitamin D supplements as prescribed, vitamin D enhances the absorption of calcium from the GI tract, instruct the patient on administration of phosphate binders as prescribed to promote the excretion of phosphate through the gastrointestinal tract, instruct to wear a Medic-Alert bracelet Cushing’s Syndrome/Disease- is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the pituitary gland Cushing’s syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocoritcoids in large doses for several weeks or longer (exogenous or iatrogenic) S/S: generalized muscle wasting and weakness, moon face, buffalo hump, truncal obesity with thin extremities, supraclavicular fat pads, weight gain, hirsutism (masculine characteristics in females), hyperglycemia, hypernatremia, hypokalemia, hypocalcemia, hypertension, fragile skin that bruises easily, reddish-purple striae on the abdomen and upper thighs Nursing Considerations: Monitor vital signs, particularly blood pressure, monitor intake and output and weight, monitor laboratory values, particularly the white blood cell count, and serum glucose, sodium, potassium, and calcium levels; provide meticulous skin care, allow the patient to discuss feelings related to body appearance, administer chemotherapeutic agents as prescribed for inoperable adrenal tumors; prepare the patient for radiation as prescribed if the condition results from a pituitary adenoma; prepare the patient for removal of pituitary tumor (hypophysectomy, transsphenoidal adrenectomy) if the condition results from increased pituitary secretion of ACTH, prepare the patient for adrenalectomy if the condition results from an adrenal adenoma; glucocorticoid replacement may be required following adrenalectomy Addison’s Disease-Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralcorticoids) • Can be primary or secondary • The condition is fatal if left untreated S/S: Lethargy, fatigue and muscle weakness, gastrointestinal disturbances, weight loss, menstrual changes in women, impotence in men, hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia, hypotension, hyperpigmentation of the skin (bronzed) with primary disease Nursing Considerations: Monitor vital signs, particularly blood pressure, weight, and intake and output, monitor white blood cell (WBC) count; blood glucose, potassium, sodium, and calcium levels; administer glucocorticoid or mineralcorticoid medications as prescribed; observe for addisonian crisis caused by stress, infection, trauma, or surgery Patient education: avoid individuals with an infection, diet: high protein and high carbohydrate, normal sodium intake, avoid strenuous exercise and stressful situations; need for lifelong glucocorticoid therapy; avoid over-the-counter medications, wear a medic-alert bracelet, signs and symptoms of complications such as underreplacement and overreplacement of hormones Hyperaldosteronism- Hypersecretion of mineralcorticoids (aldosterone) from the adrenal cortex of the adrenal gland Most commonly caused by an adenoma S/S: Symptoms related to hypokalemia, hypernatremia, and hypertension; headache, fatigue, muscle weakness, nocturia, polydipsia, polyuria, paresthesias; visual changes; low urine specific gravity and increased urinary aldosterone level; elevated serum aldosterone levels Nursing Considerations: Monitor vital signs, particulary blood pressure; monitor for signs of hypokalemia and hypernatremia; monitor intake and output and urine for specific gravity; Spironolactone (Aldactone) may be prescribed to promote fluid balance and control hypertension; this is a potassiumsparing diuretic and aldosterone antagonist, and patients need to be monitored for hyperkalemia, particularly those with impaired renal function or excessive potassium intake; administer potassium supplements as prescribed; prepare the patient for adrenalectomy; maintain sodium restriction, as prescribed, preoperatively; administer glucocorticoids preoperatively, as prescribed, to prevent adrenal hypofunction; monitor the patient for adrenal insufficiency postoperatively; instruct the patient regarding the need for glucocorticoid therapy following adrenalectomy; instruct the patient about the need to wear a Medic-Alert bracelet Pheochromocytoma-Catecholamine-producing tumor usually found in the adrenal medulla, but extra adrenal locations include the chest, bladder, abdomen, and brain; typically is benign tumor but can be malignant Excessive epinephrine and norepinephrine secreted S/S: paroxysmal or sustained hypertension, severe headaches, palpitations, flushing and profuse diaphoresis, pain in the chest or abdomen with nausea and vomiting, heat intolerance, weight loss, tremors Complications: hypertensive crisis, hypertensive retinopathy and nephropathy, cardiac enlargement, dysrhythmias, heart failure, myocardial infarction, increased platelet aggregation, and stroke; death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm Nursing Considerations: Monitor vital signs particularly blood pressure and heart rate; monitor for hypertensive crisis; monitor for complications that can occur with hypertensive crisis, such as stroke, cardiac dysrhythmias, myocardial infarction; prepare to administer antihypertensive agents to control hypertension; monitor serum glucose level; promote rest and a nonstressful environment; provide diet high in calories, vitamins, and minerals; prepare for an adrenalectomy It is important to avoid stimuli that can precipitate a hypertensive crisis, such as increased abdominal pressure and vigorous abdominal palpation Diabetes Mellitus (DM)- A group of diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both Normally, a certain amount of glucose circulates in the blood. Major sources of glucose are absorption of ingested food in the GI tract and formation of glucose by the liver from food substances Diabetes is especially prevalent in the elderly; as many as 50% of people older than 65 years of age has some degree of glucose intolerance. People 65 years and older account for almost 40% of people with diabetes. Risk Factors  Family history  Obesity  Race/ethnicity- (African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders)  Age- greater than or equal to 45 years old  Impaired fasting glucose or impaired glucose tolerance  Hypertension  HDL/Triglyceride level- HDL less than or equal to 35 and or triglyceride level greater than or equal to 250  History of gestational diabetes or delivery of babies over 9 lbs 7