Nurs 429 Ch. 24 – Flashcards

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endocrine gland
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A gland that secretes one or more hormones that are carried to target tissue or tissues by the blood rather than by a duct.
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estrogen
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The main female sex hormone secreted by the ovaries and adrenal glands.
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follicle-stimulating hormone
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Hormone secreted by the pituitary gland that causes the ovary to secrete estrogen and allows one ovum each month to complete maturation.
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goiter
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An enlarged thyroid gland that can be seen as a distinct swelling in the neck. It can occur with either hypothyroidism or hyperthyroidism.
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hyperthyroidism
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An abnormal increase in thyroid gland activity, causing high blood levels of thyroid hormones and symptoms of increased metabolism.
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hypothyroidism
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An abnormally low level of thyroid gland activity, causing low blood levels of thyroid hormones and symptoms of decreased metabolism.
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menarche
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The beginning of the years of menstruation in an adolescent female.
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menopause
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The cessation of menstrual periods and ovulation. Natural menopause occurs as a result of age-related changes in the ovary, causing it to no longer respond to hormone stimulation by secreting estrogen and ovulation.
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menstruation
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The periodic shedding of the uterine lining that occurs as a result of the cyclic changes of hormone levels in females.
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metabolism
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The energy use of each cell and the work performed within the body.
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perimenopause
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The transition time in a woman from having regular hormone cycles with menstrual periods to the time when menstrual periods have stopped for a full year.
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progesterone
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The female hormone that supports pregnancy by maintaining the thickened uterine lining.
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target tissue
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A tissue or organ that is affected or controlled by a specific hormone.
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thyroid crisis
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Severe hyperthyroidism, also known as thyroid storm, that occurs when the disease is not treated or when the patient is very stressed. The symptoms (fever; high blood pressure; and rapid, irregular heart rate) can develop quickly and lead to seizures or heart failure.
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thyrotoxicosis
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Another name for hyperthyroidism, causing the symptoms of an increased metabolic rate in all cells.
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The thryroid cells produce two thyroid hormones:
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thyroxine (T4) and triiodothyronine (T3).
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The most common dietary sources of iodine are
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saltwater fish and table salt to which iodide is added.
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Normal Range of T3
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70-205 ng/dL
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Normal Range of T4
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4-12 mcg/dL
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Normal Range of Thyroid Antibodies
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Titer <1:100
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Normal Range of TSH receptor antibodies
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Titer <130%
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Normal Range of TSH (thyroid stimulating hormones)
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2-10 microunits/mL
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The most common causes of hypothyroidism are
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infections of the thyroid gland, too little iodine or tyrosine in the diet, failure of the thyroid gland to form completely during fetal life, brain tumors, and treatment (surgery or radiation) for hyperthyroidism.
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Some drugs can also reduce thyroid gland function. The most common one is
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lithium
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severe type of hypothyroidism is called
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myxedema and requires immediate medical attention.
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Signs and Symptoms of Hypothyroidism in Infants and Children
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• Constipation • Excess facial and body hair • Mental retardation • Poor eater • Protruding tongue • Short stature • Sleeps excessively
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Signs and Symptoms of Hypothyroidism in Adults
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• Constipation • Decreased scalp hair, increased body hair • Edema of the face, around the eyes, and on shins • Feels cold all the time • Lacks energy, sleeps excessively • Lower than normal body temperature • Menstrual irregularities • No interest in sex • Slow heart rate • Slow respiratory rate • Speaks slowly • Thickened, waxy-feeling skin • Thick tongue • Thinks slowly • Weight gain
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The goal of drug therapy for thyroid problems is
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to ensure that the patient's entire body metabolism is as close to normal as possible.
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Thyroid hormone replacement drugs work
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just like the patient's own thyroid hormones. They enter the blood and go into all cells. Once inside the cell, the drug binds to receptors and activates the genes for metabolism.
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Side effect of thyroid replacement drugs
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In general, the side effects are really those of an overdose of the drug, and the symptoms are those of hyperthyroidism. They include rapid heart rate and high blood pressure, warm skin, a sensation of feeling too warm, sweating, difficulty sleeping, weight loss, and an increase in the number of bowel movements each day.
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Adverse effects of thyroid replacement drugs
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The most serious adverse effect of thyroid hormone replacement drugs is an increase in the activity of the cardiac and nervous systems. The increase in cardiac activity can overwork the heart and lead to angina pain, a heart attack, and heart failure. In the nervous system the increased activity can lead to seizures. Seizures are rare and can occur in any patient taking high doses of thyroid hormone replacement drugs but are more likely to occur in the patient who already has a seizure disorder.
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Do Thyroid hormone replacement drugs decrease or increase the action of drugs that reduce blood clotting (anticoagulants), especially warfarin (Coumadin)?
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They enhance the action of drugs that reduce blood clotting (anticoagulants), especially warfarin (Coumadin). This action can lead to excessive bruising and bleeding.
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How long should the patient wait between taking thyroid replacement drugs and fiber?
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Teach patients to take thyroid drugs 2 to 3 hours before or at least 4 hours after taking a fiber supplement.
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Thyroid hormone replacement drugs are pregnancy category
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A and safe to take during pregnancy. In fact, for a pregnant woman who has hypothyroidism, not taking the drug can lead to problems with the pregnancy and the fetus.
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Signs and Symptoms of Hyperthyroidism
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• Diarrhea • Difficulty sleeping • Feeling too warm most of the time • Fine tremors of the hands • Heartbeat irregularities • High blood pressure • Higher than normal body temperature • Menstrual irregularities • Rapid heart rate • Sweating • Thinning of scalp hair • Weight loss
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Symptoms Specific to Graves' Disease Only
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• Blurred vision • Bulging or protruding eyes (exophthalmia)
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Thyroid hormone replacement drugs change the effectiveness of insulin and other drugs for diabetes,
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and often drugs for diabetes need to be increased to prevent high blood sugar levels (hyperglycemia).
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but the most common type of hyperthyroidism is
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Graves' disease
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The effects of thyroid-suppressing drugs are usually not seen until
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3 to 4 weeks after they have been taken daily.
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Thyroid-suppressing drugs have many minor side effects. These include
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rash, loss of taste sensation, headache, muscle and joint aches, itchiness, drowsiness, nausea, vomiting, lymph node enlargement, and swelling of the feet and ankles
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A major adverse effect of thyroid-suppressing drugs is
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bone marrow suppression, which reduces the amount of blood cells. As a result the patient is less resistant to infection and more likely to be anemic.
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These drugs, especially propylthiouracil, can be
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hepatotoxic. (Propylthiouracil has a black box warning for liver damage.) These drugs can also damage the kidneys, but this occurs more rarely.
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Do Thyroid suppressing drugs decrease or increase the action of drugs that reduce blood clotting (anticoagulants), especially warfarin (Coumadin)?
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They enhance the action of drugs that reduce blood clotting (anticoagulants), especially warfarin (Coumadin). This action can lead to excessive bruising and bleeding.
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Thyroid-suppressing drugs are pregnancy category
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D drugs and can cause miscarriages and birth defects.
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Menopause symptoms are caused by
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low levels of estrogen and high levels of FSH.
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Hormone replacement therapy (HRT)
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is the replacement of naturally secreted estrogen and progesterone with exogenous hormones during the perimenopausal period. Providing low doses of estrogen increases blood estrogen levels, which helps with perimenopausal symptoms in two ways. First it relieves the direct problems from low estrogen levels. It also inhibits the feedback system and lowers the levels of FSH. This reduces the side effects of high FSH levels
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Symptoms Related to Reduced Estrogen Levels
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• Atrophy of vaginal tissue • Dry skin • Increased rate of osteoporosis • Painful intercourse • Reduced cervical mucus
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Symptoms Related to High Follicle-Stimulating Hormone Levels
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• Decreased mental concentration • Hot flushes • Night sweats • Sleep difficulties
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Common side effects of perimenopausal HRT include
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breast tenderness, breakthrough bleeding, fluid retention, weight gain, and acne. These occur with conjugated estrogen alone and when combined with progesterone. Fluid retention can cause or worsen hypertension.
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Adverse effects of perimenopausal HRT
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increase blood clotting, placing the patient at risk for thrombosis and emboli. Cigarette smoking worsens this risk. Results of increased clot formation include increased risks for heart attack, stroke, pulmonary embolism, and deep vein thrombosis.
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Which items are the most common sources of dietary iodine? (Select all that apply.) A. Saltwater fish B. Enhanced salt C. Red meat D. Whole grain E. Paprika
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Saltwater fish Enhanced salt
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Which body functions are controlled by thyroid hormone (TH)? (Select all that apply.) A. Digestion B. Bone formation C. Memory and learning D. Respiration E. Heart muscle function
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Bone formation Memory and learning Respiration Heart muscle function
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A goiter can be a symptom of which conditions? (Select all that apply.) A. Hyperthyroidism B. Hypothyroidism C. Normal thyroid activity D. Absence of a thyroid gland E. Graves' disease
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Hyperthyroidism Hypothyroidism Graves' disease
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People who are taking thyroid hormone replacement drugs typically must _______________ anticoagulant doses and __________________ diabetes medication doses. A. Decrease, decrease B. Increase, increase C. Decrease, increase D. Increase, decrease
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Decrease, increase
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Infants, children, and pregnant women need a ________drug amount per kilogram of body weight than an adult. A. Higher B. Lower C. Similar D. None; it should not be given to children or pregnant women
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Higher
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The pharmacy has sent a generic brand of thyroid replacement drug that is different from what the patient takes at home. What do you do next? A. Give the medication as long as it is the same drug type and dose. B. Hold the drug and contact the prescriber immediately. C. Tell the patient to take his or her own medication from home. D. Ask the pharmacy to send the same drug brand that the patient takes at home.
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Ask the pharmacy to send the same drug brand that the patient takes at home.
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For what signs should a patient who is taking a thyroid replacement drug notify his or her prescriber? (Select all that apply.) A. Pulse rate that is 20 beats higher than normal and that lasts for 1 day B. Pulse rate that is 20 beats higher than normal and that lasts for 1 week C. Irregular pulse rate D. Vomiting E. Improved, regular bowel movements
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Pulse rate that is 20 beats higher than normal and that lasts for 1 week Irregular pulse rate Vomiting
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What administration consideration is important to remember when giving thyroid replacement drugs? A. Give with a fiber supplement. B. Give in the evening. C. Give with warfarin (Coumadin). D. Give after taking vital signs.
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Give after taking vital signs.
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Graves' disease is the most common type of which disorder? A. Hypothyroidism B. Thyrotoxicosis C. Myxedema D. Thyroid storm
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Thyrotoxicosis
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Which factors can trigger a thyroid crisis or thyroid storm? (Select all that apply.) A. Missed dose of thyroid replacement hormone B. Pregnancy C. Infection D. Trauma E. Thyroidectomy
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Pregnancy Infection Trauma
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How long does it typically take for patients to show improvement with thyroid-suppressing drugs? A. 36 hours B. 3 days C. 3 weeks D. 3 months
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3 weeks
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Which type of endocrine medication can cause an increased risk of infection? A. Thyroid hormone replacement drugs B. Thyroid suppression drugs C. Perimenopausal hormone replacement drugs D. Conjugated estrogens
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Thyroid suppression drugs
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Which hormone is secreted by the hypothalamus in both males and females to start the hormonal changes needed for puberty? A. Follicle-stimulating hormone (FSH) B. Luteinizing hormone (LH) C. Gonadotropin releasing hormone (GnRH) D. Progesterone
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Gonadotropin releasing hormone (GnRH)
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Which hormone level is responsible for causing "hot flashes?" A. High level of follicle-stimulating hormone (FSH) B. Low level of FSH C. High level of estrogen D. Low level of estrogen
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High level of follicle-stimulating hormone (FSH)
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Women who are taking perimenopausal hormone replacement therapy (HRT) should quit smoking to reduce the risk of which disorder or disease? A. Lung cancer B. Cervical cancer C. Heart disease D. Blood clots
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Blood clots
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