A little less conversation...

a little
more ENDO!

Hyperthyroidism is caused by?

Excessive secretion of the pituitary gland

! pt is dx as having hyperthyroidism and is
admin propylthiouracil "he action of this drug
is to#

Depress the formation of thyroxine

$hile ta%ing an antithyroid drug "he pt
should be observed for s&e' including?

(%in )ash

Pre-Op teaching for a subtotal thyroidectomy
should include#

"al%ing may be difficult after sx

)O* exercises of the nec% should be

practiced However+ Hyper-extension of
the nec% should be avoided!

,ost+operatively the pt devloped laryngeal
stridor -harsh vibrations. /& each brath 0alcium
1luconate /as admin to tx?

"etany

$hat can be common during the rehabilitation
stage follo/ing a thyroidectomy?

! period of hypothyroidism soon after sx

*rs Easton does not /ant to eat her lunch
because she feels tired and has a H&! "he
nurse should?

Encourage her to eat her sand/ich

Hormone secretion is regulated
through a?

Negative feedbac% system

,ituitary "umors

Tumors+ !ny tumor in the brain -whether benign or malignant.

needs to come out

Reason# "here is no room in the cranium for it and it /ill press

against surroundings 2ncreasing 20,

2f malignant' may do radiation either alone or /ith sx

2f they are removing it sx it is called a Hypophysectomy+*ost

of the time'they generally do it endoscopically Transphenoid
-through the nasal cavity..

*ay have to be done via craniotomy -if large tumor.

,re+Op and ,ost+Op Hypo-physectomy

Pre-Op-3aseline neuro assessment

,t teach to avoid coughing -anti+tussive.'avoid bending

over' and straining+-Colace. stool softener- pulls water out of
the intestine.

(ho/ incentive spirometer

Post-Op 4. Neuro Assessment -based on the glaskow coma

scale.

5. *onitor urine specific gravity-*onitoring for

diabetes insipidus.

6. "hey /ill have a mustache dressing *ust chec

for glucose for 0(,

True or !alse# ,t7s should expect a small
amount of bloody mucus from the nose
8ollo/ing 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.

$hat position should a pt be in
Post-Thyroidectomy? Why? $hat else should
you chec%? "# $oncern%

Post-Op+ 94 0oncern is Airway

&emi-fowlers Position -to decrease

s/elling.

*ay need trach %it : suctioning e;uipment at

bedside

0hec% that the dressing is not too tight 2f

the dressing was loose and now is tightit
indicates swelling!

$hat specific med should pt7s avoid Post-
Thyroidectomy? $hat should you monitor?
94 0omp?

,t7s should avoid aspirin+ 2t binds to the same protein as the

thyroid hormone 2t may lead to thyroid storm.

'(&+$hec for bleeding 0hec% under the pt7s pillo/ for

potential bleeding -/ear gloves.

)onitor $a levels r&t accidental removal of the parathyroid

This will most likely occur 2-!2 hours post-op

*ay develop Tetany r&t lo/ 0a levels <eep calcium

gluconate at the bedside

"# $omp# Thyroid $risis!

! pt dx /& type 4 diabetes is receiving Humalog' -a rapid-acting insulin.
by sliding scale "he order reads blood glucose level# =4>?' @ero -?. unitsA
4>4 5??' three -6. unitsA 5?4 to 5>?' six -B. unitsA C5>4' contact health+
care provider "he -D!,. reports to the nurse the clientEs glucometer
reading is 4FG Ho/ much insulin should the nurse administer to the pt?

Three *+, units

The clients result is !"#, which is between !$! and %&&, so the
nurse should administer ' units of (umalog insulin
subcutaneously.

T-&T-TA./N0 H/NT#The test taker must be aware of the way

the ()*s write medication orders.()*s order insulin on a
sliding scale according to a range of blood glucose levels.

"he nurse administered 5F units of Humulin N' an intermediate+
acting insulin'to a pt dx /& type 4 diabetes at 4B?? $hich
intervention should the nurse implement?

Ensure the pt eats a bedtime snac%

Humulin N pea%s in B to F hours' ma%ing the pt at

ris% for hypoglycemia around midnight' /hich is /hy
the pt should receive a bedtime snac%

$hich electrolyte replacement should the nurse
anticipate being ordered by the *D for the pt dx /&
D<! /ho has Hust been admitted to the 20D?

Potassium

"he pt in D<! loses potassium from increased

urinary output' acidosis' catabolic state' and
vomiting)eplacement is essential for preventing
cardiac dysrhythmias secondary to hypo%alemia

1hich arterial blood gas results should the
nurse expect in the pt dx w( diabetic
etoacidosis%
+ pH 23+45 PaO6 745 Pa$O6 +45 H$O+ #83
"his !31 indicates metabolic acidosis'
/hich is expected in a pt dx /& diabetic %etoacidosis

"he nurse is preparing to administer am med to pts
$hat med should the nurse ;uestion before
administering?

,ancreatic en@ymes to the pt /ho has

finished brea%fast

Rational# *ancreatic en+ymes must be administered

with meals to enhance the digestion of starches and
fats in the gastrointestinal tract.

"he nurse is preparing to administer am med to pts
$hat med should the nurse ;uestion before
administering?

,ancreatic en@ymes to the pt /ho has

finished brea%fast

Rational# *ancreatic en+ymes must be administered

with meals to enhance the digestion of starches and
fats in the gastrointestinal tract.

! pt dx /& 0ushingEs disease has developed 4I peripheral
edema "he pt has received intravenous fluids at 4?? mJ&hr via
2K pump for the past LG hours "he pt received 2K,3 medication
in >? mJ of fluid every B hours for 4> doses Ho/ many mJ of
fluid did the pt receive?

859:4 m;

"he pt dx /& 0ushingEs disease has undergone a
unilateral adrenalectomy $hich d&c instructions
should the nurse discuss /& the pt?

Explain the signs and symptoms of

infection and /hen to call the *D

"he nurse is admitting a pt to the neuro intensive care
unit /ho is post+op transsphenoidal hypophysectomy
$hich should /arrant immediate intervention?

"he pt has an output of 5'>?? mJ since

surgery and an inta%e of 4'??? mJ

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

"he BF+year+old pt dx /& hyperthyroidism is being
treated /& radioactive iodine therapy $hat
intervention should the nurse discuss /& the pt?

Explain it /ill ta%e up to a month for

symptoms of hyperthyroidism to subside

Rational# ,adioactive iodine therapy is

used to destroy the overactive thyroid cells.
After treatment, the pt is followed closely
for three ' to - weeks until the euthyroid
state is reached.

$hat s&s should ma%e the nurse suspect the pt
is experiencing a thyroid storm?

Hyperpyrexia and extreme tachycardia

Rational# (yperpyre.ia /high fever0 and

heart rate above !'& beats per minute are
signs of thyroid storm, a severely
e.aggerated hyperthyroidism.

$hat s&s indicates to the nurse the pt is
experiencing hyperparathyroidism?

! positive 0hvoste%Es sign

$hat lab data ma%es the nurse suspect the pt /&
primary hyperparathyroidism is experiencing a
comp?

! serum creatinine level of 5F mg&dJ

Rational# A serum creatinine level of %." mg1d2 indicates

the pt is in renal failure, which is a complication of
hyperparathyroidism. The formation of stones in the kidneys
r1t the increased urinary e.cretion of calcium and
phosphorus occurs in about $$3 of pts w1 primary
hyperparathyroidism and can lead to renal failure.

! male pt has recently undergone sx removal of a pituitary
tumorDr$ong prescribes corticotropin-!cthar.'5? units 2*
;id !s replacement therapy$hat is the mechanism of action?

A, 2t decreases cyclic
adenosine monophosphate
-0!*,. production : affects
the metabolic rate of target
organs

<, 2t interacts /ith plasma

membrane receptors to inhibit
en@ymatic actions

$, 2t interacts /& plasma

membrane receptors to
produce en@ymatic actions that
affect protein' fat'
andcarbohydrate metabolism

=, 2t regulates the threshold for

/ater resorption in the %idneys

!ns/er# 0

Rationale# 0orticotropin interacts /& plasma membrane receptors

to produce en@ymatic actions that affect protein'fat' :
carbohydrate metabolism 2t doesnEt decrease camp production
"he posterior pituitary hormone' antidiuretic hormone' regulates
the threshold for /ater resorption in the %idneys

"he pt is 6 days post+op unilateral
adrenalectomy $hich d&c
instructions should the nurse teach?

!. Discuss the need for

lifelong steroid replacement

3. 2nstruct the pt on
administration of
vasopressin

0."each the pt to care for

the suprapubic 8oley
catheter

D."ell the pt to notify the

H0, if the incision is
inflamed

Answer# =

Rational# !ny inflammation of the incision indicates an

infection and the pt /ill need to receive antibiotics' so the H0,
must be notified

$hat ;uestion should the nurse as% /hen
assessing the pt for an endocrine dysfunction?

Have you had any unexplained /eight loss?

$eight loss /& normal appetite may indicate

hyperthyroidism

$hat endocrine D&O should the nurse assess
for in the pt /ho has a closed head inHury /ith
increased intracranial pressure?

Diabetes 2nsipidus

)ational# 4iabetes insipidus can be caused by

brain tumors or infections, pituitary s.,
cerebrovascular accidents, or renal and organ failure,
or it may be a complication of a closed head in5ury w1
increased intracranial pressure.

$hich action by the nurse is most important
follo/ing a hypophysectomy?

,erforming a routine neurologic

assessment

! pt /hose physical findings suggest a hyperpituitary condition
undergoes an extensive diagnostic /or%up "est results reveal a pituitary
tumor' /hich necessitates a transphenoidal hypophysectomy 3efore sx'
the nurse revie/s pre+op : post+op instructions given to the pt earlier
$hich post+op instruction should the nurse emphasi@e?

A, Mou must lie flat for 5N

hours after sx

<, Mou must avoid

coughing' snee@ing' and
blo/ing your nose

$, Mou must restrict your

fluid inta%e

=,Mou must report ringing in

your ears immediately

!ns/er# <

Rational#!fter a transsphenoidal hypophysectomy'the pt must refrain

from coughing' snee@ing' : blo/ing the nose for several days to
avoid disturbing the sx graft used to close the /ound "he HO3 must
be elevated'to prevent tension or pressure on the suture line $ithin
5N hours after a hypophysectomy' transient diabetes insipidus
commonly occursA this calls for increased' not restricted' fluid inta%e
Kisual' not auditory' changes are a potential comp of
hypophysectomy