NR 283 Final Exam Concept Review / NR283 Pathophysiology Final Exam Study Guide (Latest):
Pathophysiology: Chamberlain
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
SIADH- Syndrome of Inappropriate Diuretic Hormone Too much ADH (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 high-
calorie 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
