Study Guide for NURS 320 Exam 2

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Study guide for NURS 320 Exam 2 Alterations of hormonal regulation 1. What is the function of the endocrine system? - Differentiation of reproductive and CNS in fetus - Stimulation of growth and development - Coordination of the male and female reproductive system - Maintenance of internal environment - Adaptation to emergency demands of the body 2. What are the general characteristics of hormones...how do they operate...know the difference between water-soluble and lipid soluble hormones ...know the cellular mechanism of hormone action - Specific rates and rhythms of secretion. - diurnal, pulsatile and cyclic, and patterns depending on circulating substances - Operate with feedback systems - Affect only target cells with appropriate receptors. - The liver inactivates hormones, rendering the hormones more water soluble for renal excretion. - Lipid soluble hormones go inside the cell membrane. Water soluble has to have a carrier. Lipid are rapid and long lasting in response. Lipid soluble hormones usually go to nucleus. Water Soluble onset is short and response is short lived. 3. ADH is a posterior pituitary hormone--what is its function - Controls plasma osmolality; allowing reabsorption of water.

4. Table 17-5 pg 434 discusses the anterior pituitary hormones....

5. Diseases of posterior pituitary include SIADH and diabetes insipidus---what are these? Clinical manifestations and treatment...make sure you know the drug desmopressin Syndrome of inappropriate antidiuretic hormone secretion. - Hypersecretion of ADH - For diagnosis, normal adrenal and thyroid function must exist - Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypo-osmolality. Diabetes Insipidus - Insufficiency of ADH - Polyuria and polydipsia - Partial or total inability to concentrate urine - Neurogenic Insufficient amounts of ADH - Nephrogenic Inadequate esponse to ADH - Psychogenic - Pharm Treatment: Desmopressin. 6. What is the function of the thyroid gland...make sure you understand TRH, TSH, T3 and T4 - These hormones regulate the rate of cellular metabolism throughout the body. All the steps in synthesizing and releasing thyroid hormones are stimulated by thyroid- stimulating hormone (TSH) secreted by the pituitary gland. Another class of thyroid cells, the parafollicular or C cells, is found outside the follicles; C cells secrete calcitonin, a calcium-lowering hormone. - TRH - tropic, tripeptidal hormone that stimulates the release of TSH (thyroid-stimulating hormone) and

prolactin from the anterior pituitary. - TSH - Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone that stimulates the thyroid gland to produce thyroxine (T4), and then triiodothyronine (T3) which stimulates the metabolism of almost every tissue in the body. Affects growth and maturation of tissues, cell metabolism, heat production, and oxygen consumption. 7.Understand hyperthyroidism and hypothyroidism...clinical manifestations, and treatment...specifically: tapazole, lugol's solution, PTU, Armour, Synthroid - Hyperthyroidism - Thyrotoxicosis - Graves Disease - pretibial myxedema Hyperhyroidism resulting from nodular thyroid disease - goiter Thyrotoxic Crisis idism Hypothyro

Pr imary hypothyroidism ubacute thyroiditis utoimmune thyroiditis (Hashimoto disease) ainless thyroiditis ostpartum thyroiditis yxedema coma C ongenital hypothyroidism Thyroid carcinoma Pharm treatment: Desiccated thyroid (Armour) Levothyroxine (Synthroid) M P P A S

8. What is the function of the parathyroid-- understand hyperparathyroidism and hypoparathyroidism..clinical manifestations, and treatment - These glands secrete parathyroid hormone (parathormone), that regulates calcium and phosphorus metabolism. Hyperparathyroidism Primary hyperparathyroidism Excess secretion of PTH from one or more parathyroid glands Secondary hyperparathyroidism Increase in PTH secondary to a chronic disease Hypoparathyroidism Abnormally low PTH levels Usually caused by parathyroid damage in thyroid surgery 9. What is the function of the adrenal glands?

Adrenal cortex 80% of an adrenal glands total weight Zona glomerulosa Zona fasciculata Zona reticularis Adrenal medulla Innervated by the sympathetic and parasympathetic nervous systems Adrenal cortex Stimulated by adrenocorticotropic hormone (ACTH) Glucocorticoid hormones Direct effects on carbohydrate metabolism Anti-inflammatory and growth-suppressing effects Influence awareness and sleep habits Most potent naturally occurring glucocorticoid is cortisol Adrenal cortex Mineralocorticoid hormones Affect ion transport by epithelial cells Increase the activity of the sodium pump of the epithelial cells Cause sodium retention and potassium and hydrogen loss Most potent naturally occurring mineralocorticoid is aldosterone Regulated by the renin-angiotensin system Adrenal cortex Adrenal estrogens and androgens Estrogen secretion by the adrenal cortex is minimal The adrenal cortex secretes weak androgens Androgens are converted by peripheral tissues to stronger androgens such as testosterone Adrenal medulla Chromaffin cells (pheochromocytes) Chromaffin cells secrete the catecholamines epinephrine (majority) and norepinephrine Release of catecholamines has been characterized as a fight or flight response Catecholamines promote hyperglycemia

10. Disorders of the adrenal glands include Cushing's disease...what happens with this disorder, clinical manifestations and treatment...specifically Nizoral, and Mifeprex The symptoms from prolonged exposure to excessive glucocorticoid hormones. Glucocorticoids are naturally excreted by the adrenal glands; however, Cushing's syndrome is a side effect of the pharmacological use of steroids in the management of inflammatory illnesses (e.g., reactive airways disease or arthritis). Glucocorticoid excess from pituitary or adrenal adenomas or from the production of excess levels of adrenocorticotropic hormone by lung cancer is exceptionally rare (and is called Cushing's disease). The affected patient may complain of muscular weakness, thinning of the skin, easy bruising due to capillary fragility, weight gain, rounding of facial features (moon-like facies), cervicodorsal fat (buffalo hump) on the upper back, poor wound healing related to immunosuppression, decreased sexual drive and function, menstrual irregularities, insomnia, or psychological depression. 11. Addison's is a disorder of the adrenal cortex..what happens with this disease...clinical manifestations, and treatment...specifically the glucocorticoids..Cortef, Medrol, and dexamthasoneA rare illness marked by gradual and progressive failure of the adrenal glands and insufficient production of steroid hormones. Patients with Addison's disease make inadequate amounts of both glucocorticoids (e.g. cortisol) and mineralocorticoids. (e.g. aldosterone). Cortisol is important to glucose metabolism, affects protein, carbohydrate and fat metabolism, and helps to maintain blood pressure and cardiovascular function. Hypovolemia and hypotension may result from aldosterone deficiency. The patient may be symptom-free until the majority of adrenal tissue is destroyed. Early complaints are usually nonspecific, e.g., a feeling of weakness or fatigue. Subsequently, patients may notice lack of appetite, weight loss, nausea, vomiting, abdominal pain, craving for salt, and dizziness. Physical findings may include postural hypotension and increased skin pigmentation. Laboratory studies may reveal hyponatremia and hyperkalemia. If these findings are present, a cosyntropin stimulation test may be performed to establish the diagnosis.

Alterations in Urinary Tract Function 1. What can cause a urinary tract obstruction? Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract The obstruction can be caused by an anatomic or functional defect Obstructive uropathy

2.

What is hydroureter, what is hydronephrosis? -Hydroureter - The distention of the ureter with fluid owing to obstruction. - Hydronephrosis - Hydronephrosis is the distention of the pelvis and calyces of one or

both kidneys, resulting in thinning of the renal tubules because of obstructed urinary flow. When the obstruction is a stone or kink in one of the ureters, only one kidney is damaged. The obstruction causes backup, resulting in increased pressure in the kidneys. If the pressure is low to moderate, the kidney may dilate with no obvious loss of function.

3.

What causes kidney stones? What are clinical manifestations of kidney stones? Some kidney stones are treated with K+ citrate...know this drug..how else are kidney stones treated? Supersaturation of one or more salts Presence of a salt in a higher concentration than the volume able to dissolve the salt Precipitation of a salt from liquid to solid state Temperature and pH Growth into a stone via crystallization or aggregation What is a neurogenic bladder? Look at table 29-1 and table 29-2 on page 746 of patho book to understand types of in incontence and neuro bladder

4.

What is interstitial cystitis? What are clinical manifestations and treatment? - Interstitial cystitis Nonbacterial infectious cystitis - Manifestations Most common in women 20 to 30 years old Bladder fullness, frequency, small urine volume, chronic pelvic pain urinary frequency and nocturia - Treatment No single treatment effective, symptom relief 6. Renal tumors account for about 3.8% of new cancers. What is a renal adenoma, renal cell carcinoma - Renal Adenoma - A benign tumor originating in the renal tubules of the cortex that is similar in appearance to a renal cell carcinoma - Renal Cell Carcinoma - A malignancy arising from the renal tubule that produces hematuria, flank pain, and an abdominal mass. 7. Bladder cancer is the 5th common mali