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Week 5-6 Endocrine
Endocrine System, Drugs and Disorders
| Question | Answer |
|---|---|
| Function of the Endocrine System? | Uses blood to transport secreted hormones to target tissues. |
| What are the 7 Endocrine Glands? | Hypothalamus, Pituitary, Adrenal, Thyroid, Islet cells of Pancreas, Parathyroid, Gonads |
| In general, what are the problems of Endrocrine Disorder? | Make excess hormones, Deficient of specific hormones, or have defective receptor sites |
| What do the layers of the adrenal cortex produce? | Mineralocorticoids (i.e. aldosterone) Glucocorticoids (i.e. Cortisol), Androgens, and Estrogens |
| 4 things Cortisol affects? | Carb/Fat/Protein Metabolism, body's response to stress, emotional stability, immune function |
| What is Adrenal Insufficiency? | Dec. production of adrenocortical steroids because of inadequate secretion of Adrenocorticotropic hormone (ACTH) |
| What causes an Adrenal Crisis? | Dysfunction in the Hypothalamus, or directly in the Adrenal gland |
| How does HYPOglycemia result from Adrenal Hypofunction? | less aldosterone/cortisol produced --->less gluconeogenesis ---> less blood glucose --> hypoglycemia |
| What 4 things does reduced aldosterone secretion cause? | Hyponatremia, Hypovolemia, Hyperkalemia (--> acidosis) |
| What is an Addisonian Crisis? | ACUTE adrenal insufficiency where need for cortisol/aldosterone is greater than supply; Life-threatening event |
| What causes an Addisonian Crisis? | Surgery, Trauma, Severe Infxn |
| What results from blood volume depletion with the loss of aldosterone? | Severe HTN |
| 5 Steps for Emergency Hormone Replacement Care of patient w/ ACUTE Adrenal Insufficiency? | 1.Rapid infusion of NS or D5W; 2.IV bolus of Solu-Cortef 100-300mg or Dexamethasone 4-12mg; 3.Add'l infusion of Solu-Cortef 100mg over 8hrs; 4. Hydrocortisone 50mg IM q 12hrs; 5. H2 histamine blocker for ulcer prevention |
| 6 Steps for Emergency HyperK+ Management care for ACUTE Adrenal Insufficiency? | 1.Give Insulin 20-50 units in D5NS to shift K+ to cells; 2.Admin. K+binding and excreting resin (Kayexalate); 3.Give non-K+sparing diuretic; 4.Initiate K+ restriction; 5.Monitor I&O; 6.Monitor heart rhythm&rate and EKG |
| 3 Steps for Emergency Hypoglycemia Management care for ACUTE Adrenal Insufficiency? | 1.Admin. IV glucose (Glucagon PRN); 2.Maintain IV access; 3.Monitor BS q h |
| 7 Primary causes for Addison's Disease? | Idiopathic autoimmune disease, TB, Fungal lesions, AIDS, Hemorrhage, sepesis, Adrenalectomy |
| Secondary causes for Addison's Disease? | Pituitary tumors, Postpartum pituitary necrosis (Sheehan's syndrome), Hypophysectomy, High dose Pituitary radiation, sudden cessation of long term high dose glucocorticoid tx |
| S/S of Neuro manifestations of Adrenal Insufficiency? | Muscle weakness, Fatigue, Joint/muscle pain |
| S/S of GI manifestations of Adrenal Insufficiency? | abd pain, N/V/D, constipation, anorexia, wt loss, SALT CRAVINGS |
| S/S of skin manifestations of Adrenal Insufficiency? | Vitiligo, Hyperpigmentation |
| S/S of CV manifestations of Adrenal Insufficiency? | Anemia, HYPOtension, HYPOnatremia, HYPERkalemia, HYPERcalcemia |
| Labs to look for with Adrenal Insufficiency? | Low serum cortisol, Low fasting BS, Low Na+, Elev. K+, Inc. BUN, Elev. ACTH and eosinophil count |
| What is most definitive test for adrenal insufficiency? | ACTH stimulation test |
| 3 goals of the nursing interventions for adrenal insufficiency? | Promote fluid balance, Monitor for fluid deficit, Prevent HYPOglycemia |
| Why is hydrocortisone given for adrenal insufficiency? | Corrects glucocorticoid deficiency |
| How can cortisol deficiency (Addison's disease) be permanent? | Chronic glucocorticoid tx d/t suppresseion OR acute autoimmune destruction of adrenal glands (70% of Addison's disease) |
| With increase in ACTH, there is HYPERpigmentation. Where on the body is that likely seen? | Skin folds and buccal mucosa |
| Diagnostic tests for Addison's disease (Adrenal Insufficiency)? | ACTH LEVELS, serum cortisol level (normal during stress of acute illness = abnormal) |
| When is cortisol level supposed to peak? | In early morning |
| What kind of diet for Addison's disease? | High Na+, Low K+; Encourage fluids, monitor hydration, weigh daily |
| What is Cushings Disease? and 4 causes? | Result of excess secretion of cortisol from adrenal cortex d/t 1.Adrenal cortex problem; 2.Pituitary gland secreting too much ACTH; 3.Drug therapy causes oversecretion of glucocorticoids 4. Pituitary adenoma |
| Why is glucose higher with Cushings? 3 | Liver stimulated to convert more glycogen to glucose, insulin receptors less sensitive, muscle mass loss because of reduced glucose uptake |
| What is a Total Hypophysectomy? | Surgical removal of pituitary gland performed by transsphenoidal/transfrontal craniotomy route |
| Pathophysiology of Pheochromocytoma? | Tumor in Adrenal medulla producing excess catecholamines, mainly Norepinephrine |
| What's another name for Adrenal Hyperfunction? | Cushings Disease |
| CV manifestation of Cushings? | HTN, Inc. thromboembolisms, edema, bruising, petechiae |
| Musculoskeletal manifestations of Cushings? | Muscle atrophy, Osteoporosis |
| Skin manifestations of Cushings? | Thinning skin, Striae, Inc. pigmentation |
| Immune system manifestations of Cushings? | Inc. risk for infection, Dec. immune function, Dec. inflammatory response |
| What does the Urine Test for Cushings measure? | Free cortisol and metabolites of cortisol and androgens |
| What do you monitor that measures fluid overload in Cushings? | Specific gravity below 1.005 |
| When do you take Cortisol Replacement Therapy? | First dose in morning, second between 4-6pm; take with meal/snack; weigh daily; Never skip a dose; Wear Medic-Alert bracelet, regular healthcare follow up, know how to give IM hydrocortisone |
| S/S of Pheochromocytoma? 12 | inc. BP, Palpitations, Pallor, Perspiration, Orthostatic hypotension,Wt loss, Constipation, Tremors, Hypertensive retinopathy, Hyperglycemia, Hypercalcemia |
| In Pheochromocytoma, 24 urine collection for...? | Vanillylmandelic Acid (VMA) |
| What do you avoid during 24 hour urine collection for Pheochromocytoma? | Bananas, Vanilla, Spices, Caffeine |
| Other names for Adrenal HYPERfunction? | Cushings Disease, Hypercortisolism |
| Patho of Adrenal Hyperfunction? | Hypersecretion of cortisol |
| S/S of Cushing Disease? | Fatigue, Thinning hair/skin, Moon face, Buffalo hump, Inc. body/facial hair, Slow wound healing |
| Labs to look for with Cushings? | INC. cortisol, glucose, sodium, WBC; DEC. calcium, potassium |
| Treatment for Cushings? | Adrenalectomy |
| Teaching for Cushings? | Lifelong adrenal hormones, Stay away from crowds, Inc. Ca+/Vit.D before surgery, NO tea/coffee |
| Why is patient with Cushings "Risk for Injury"? | Low Ca++, Loss of bone matrix |
| Other names for Adrenal HYPOfunction? | Addisons disease AND HYPOcortisolism |
| S/S of Addisons? 8 | Fatigue, Wt loss, Anorexia, SALT CRAVINGS, Hypotension, Skin changes, Fluid volume deficit, Emotional instability |
| Labs for Addisons? | DEC. cortisol, sodium, and glucose; INC. potassium |
| Treatment for Addisons? | Corticosteroid therapy |
| Side effects of Addisons? | Weight gain, Edema, Hypoglycemia |
| Another name for Hyperthyroidism? | Graves Disease AND Toxic Diffuse Goiter |
| S/S of Graves disease? 15 | Goiter (enlarged thyroid), Heat intolerance, Inc. appetite, Weight loss, Exopthalmus, Muscle fatigue, Diarrhea, Insomnia, Tremors, Finger clubbing, Breast enlargement, Facial flushing, Fine, straight hair, Tachycardia, Amenorrhea |
| What diagnostic labs look for in hyperthyroidism? | INC. T3/T4 and low TSH level |
| What is teaching for Thyroidectomy? | Check for bleeding, SpO2, Hemorrhage, Breathing, Damage to Laryngeal nerve, Accidental removal of parathyroid tissue, Airway obstruction |
| Where do you check for bleeding after a Thyroidectomy? | Behind the neck |
| What are signs that there may be a hemorrhage after a Thyroidectomy? | Persistent swallowing |
| How do you check for damage to laryngeal nerve after a Thyroidectomy? | Ask them to speak every couple of hours to see if nerve is intact or if they're hoarse |
| What S/S would you see if there was accidental removal of parathyroid tissue? | Signs of HYPOcalcemia; Tetany, Tingling, Numbness |
| S/S of HYPOthyroidism? | COLD INTOLERANCE, Hair loss, Receding Hairline, Fatigue, Dry skin, Anorexia, Brittle hair/nailsj Thick tongue, Slow speech, Constipation |
| What will labs show with HYPOthyroidism? | DEC. T3/T4 AND INC. TSH |
| What does ACTH stand for in Adrenal Insufficency? | Adrenocorticotropic hormone |
| What are causes of Thyroid Storm? | Severe stress, Infection, Injury, Abrupt cessation of thyroid meds, Trauma, DKA, Pregnancy, VIGOROUS palpation of goiter, Exposure to Iodine, RAI tx |
| S/S of Thyroid storm? | Hyperthermia, Delirium, SEVERE tachycardia, Vascular collapse, systolic |
| What are S/S that Thyroid Crisis is progressing? | Restlessness, Confusion, Psychosis, Sz, Coma |
| Treatment for Thyroid Storm? | Give Tylenol, Cooling measures, Inc. fluids (Dextrose), Iodine or Propylthrouracil (PTU) to block T3/T4 |
| Antithyroid drugs for Thyroid Storm? | PTU (propylthiourcil) 300-900 mg daily OR methimazole up to 60mg daily |
| Glucocorticoids for Thyroid storm? | Hydrocortisone 100-500mg IV daily OR prednisone 4-60mg IV daily OR Dexamethasone 2mg IM q 6hrs |
| Drugs for thyroid storm (other than antithyroids and glucocorticoids)? | Sodium iodide 2g IV daily OR Propranolol 1-3mg IV given over 3 min (should be connected to cardiac monitor and have CVP in place) |
| What is function of Parathyroid gland? | To maintain Ca. and Phos. homeostasis |
| Normal Phosphate level? | 2.5 - 4.5 |
| S/S of HYPERparathyroidism? | Renal calculi, fatigue, HA, depression |
| After parathyroidectomy, check for Ca levels. What signs might show? | Trousseaus sign and Tetany |
| Myexadema Coma is caused by? and what is it? | HYPOthyroidism = Crisis State |
| An auto immune disease that destroys the thyroid? | Hashimotos Thyroiditis inflamation of the thyroid gland? |
| if the TSH is high .. hyper or hypo thyroidism? | Hypo |
| If the TSH is low, what is the problem? | Pituitary, hypothalamus |
| Adverse effects of levothyroxine? | Tachycardia, HTN, Palpatations |
| Levothyroxine drug interactions? | Increases effect of anticoagulants and antidepressants, insuline (antidiabetics) and Digoxin |
| Patient should avoid _______ within 4 hrs of taking Levothyroxine. | Dairy |
| What is Congenital Hypothyroidism called? | Cretinism |
| 2 main Adrenal Dysfunctions? | Addisons = Adrenal Insufficiency; Cushings = Adrenal Hyperfunction |
| 2 severe Thyroid Dysfunctions | Graves = HYPERthyroidism; Myxedema Coma = Severe HYPOthyroidism |
Created by:
murse2014
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