Endocrine Disorders
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| show | Too much or too little hormone activity (hypo or hyper) Production/secretion. Tissue sensitivity.
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| Primary disorder | show 🗑
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| show | Caused by problems outside the gland
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| Disorders of Posterior Pituitary (neurohypophysis) | show 🗑
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| Diabetes Insipidus - Pathophysiology | show 🗑
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| show | Polyuria, Polydipsia, Nocturia, Dilute Urine, Dehydration, Hypovolemic Shock, Decreased LOC, Death.
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| Diabetes Insipidus - Diagnosis | show 🗑
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| show | IV or SQ Vasopressin. Intranasal DDAVP. Thiazide Diuretics if Nephrogenic. Hypophysectomy if tumor.
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| show | Indicator of kidneys ability to reabsorb water & chemicals from glomerular filtrate. Aids in evaluating hydration status & detecting problems r/t to secretion of ADH.
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| Serum Osmolality Increased | show 🗑
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| show | Pt deprived water for 6 hrs. Body weight & urine osmolality tested hourly. (urine continues to be diluted, & body weight decreases, DI is suspected)
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| Water deprivation test Stage II: | show 🗑
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| show | Replace ADH, Used to control polydipsia & polyuria, regulates reabsorption of water by kidneys, Tx restores normal urination & thirst. Also used post-op for preventing & treating abdominal distention & dispelling gas interfering w/abdominal x-ray studies.
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| Vasopressin IV adverse reactions | show 🗑
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| Water intoxication | show 🗑
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| show | Synthetic ADH(desmopressin) usually 2x day. for longer term replacement
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| show | Nasal, IV, orally, or SubQ.
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| What happens if pt can't take meds on a routine basis. | show 🗑
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| Thiazidee Diuretics if nephrogenics | show 🗑
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| show | If tumor - Removal of pituitary gland.
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| show | Baseline neurological assessment, pre-op teaching(deep breathing, incentive spirometry, avoid coughing, sneezing, straining post-op
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| Post-op care of pt undergoing hypophysectomy | show 🗑
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| DI Nursing Diagnosis | show 🗑
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| show | Too much ADH, Water retention, hyponatremia, decreased serum osmolality
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| SIADH - Causes | show 🗑
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| show | Weight gain, w/o edema (in vascular system), Dilutional hyponatremia, Serum osmolality decreased, concentrated urine, Muscle cramps and weakness, brain swelling because of the hyponatremia, seizures, death.
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| SIADH - Diagnostic tests | show 🗑
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| Serum/Urine Sodium | show 🗑
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| Serum/urine osmolality | show 🗑
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| show | Involves administering a specific amt of water, then measuring blood and urine sodium and osmolality hourly for 6 hours. Pt with SIADH retains water instead of excreting it; unsafe fluid overload, so not done frequently.
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| show | Eliminate cause, surgical removal of tumor, fluid restriction. Hypertonic saline IV(NACL 3% administered cautiously. No more than 50cc/hr. Lasix or Declomycin.
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| show | A tetracycline antibiotic that decreases the availability of ADH, Do not put on fluid restriciton w/this med.
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| Lasix | show 🗑
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| show | A gain of 1lb of fluid is equal to approx 1 pint (480 mL) of fluid.
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| show | Excess fluid volume r/t compromised reglatroy mechanism.
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| Disorders of Anterior pituitary | show 🗑
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| Growth Hormone | show 🗑
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| dwarfism - pathophysiology | show 🗑
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| show | Pituitary tumor, failure of pituitary to develop, psychosocial, malnutrition
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| show | Grow only to 3-4 feet(5th percentile), slowed sexual maturation, may have menta retardation, other symptoms, depending on other pituitary hormones involved.
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| show | Excess GH in adults, bones grow in width, not length, organs and connective tissues also enlarge.
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| Acromegaly - Causes | show 🗑
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| show | Corticotropin is an anterior pituitary hormone that stimulates the adrenal cortex to produce and secrete adrenocotical hormones, primarily the glucocorticoids.
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| show | Diagnostic testing of adrenocortical function, managing acute exacerbations of multiple sclerosis, nonsupurative thyroiditis, & hypercalcemia assoc w/cancer. Used as anti-inflammatory & immunosuppressant drug. Should avoid vaccinations w/live virus.
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| Three hormones produced by the thyroid gland | show 🗑
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| show | T3-10% of thyroid secretion, remainder converted from T4 in the tissues. Coversion requires the presence of Iodine. Increase energy production & protein synthesis, increase cellular reaspiration of glucose & fatty acids, which increases the mtabolic rate.
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| show | TSH from anterior pituitary
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| show | Deficient production of thyroid hormone, metabolic rate reduced. Primary=not enough thyroid hormone, Secondary=not enough TSH
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| show | Congenital, inflammatory, iodine deficiency, thyroidectomy, autoimmune(hashimoto's thyroiditis-most common)
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| show | T3 & T4 low, TSH High in Primary, TSH low in secondary.
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| show | Fatigue, bradycardia, constipation, mental dullness, cold intolerance, hypoventilation, dry skin and hair, weight gain, heart failure, hyperlipidemia, myxedema.
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| Hypothyroidism - Complications | show 🗑
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| Myxedema Coma - Therapeutic interventions | show 🗑
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| show | Hormone replacement, Thyroid med should not be changed by pt to the cheapest generic brand, slight variation in level of hormone DANGEROUS!
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| show | Labelled "NO Substitutions". Levothyroxine(levothroid, levoxyl, synthroid). Amour(desiccated thyroid) older version.
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| show | drug of choice for hypothyroidism, inexpensive, once a day dosage, more uniform potency. Not therapeutic for several weeks(needs several wks to work).
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| Amour adverse reactions | show 🗑
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| Educating patient on hypothyroidism medication | show 🗑
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| show | Increased metabolic rate, increased beta receptors, Primary=too much thyroid hormone, secondary=Too much TSH.
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| show | Autoimmune (Grave's Disease) most common. Multinodular goiter, pituitary tumor(secondary), synthroid overdose.
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| Hyperthyroidism - S/S | show 🗑
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| show | Thyrotoxic Crisis (Thyroid storm)
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| show | Life threatning, tachycardia, hypertension, extremely high fever, diaphoresis, dehydration, coma, death.
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| show | IV fluids, cooling blanket iodine, propranolol(inderal), Acetaminophen(avoid ASA) for fever, oxygen.
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| show | Elevated T3 & T4, TSH(low in primary, high in secondary), TSI thyroid stimulating immunoglobulin is present in Grave's disease, CT/MRI if tumor suspected.
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| Thyroid Storm - Medications | show 🗑
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| show | Inhibit the manufacture of thyroid hormones, but do not affect existing thyroid hormones circulating in the blod or stored in thyroid gland. Therapeutic effects may not be observed for 3-4 weeks.
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| show | Antithyroid drugs or thyroid antagonists, therapeutic effects may not be observed for 3-4 weeks.
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| PTU & Tapazole - Adverse reactions | show 🗑
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| show | Take drugs @ reg intervals around the clock (ex. every 8 hours), take as directed. Notify promptly any sign of infection, record weight 2x a week & notify of sudden gain/loss. Give instructions on monitoring & recording pulse rate to bring to DR. visits.
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| show | May be given orally w/Tapazole or PTU to prepare for thyroid surgery. Suppresses release of thyroid hormone by decreasing vascularity of thyroid gland (Iodine effects how much blood gets to the thyroid)
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| show | Given to interrupt sympathetic nervous system effects. Pt w/hyperthyroidism likely to have cardiac symtoms such as tachycardia or palpitations, this is given as adjunctive tx utnil therapeutic effects of antithyroid drug obtained.
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| Radioactive Iodine | show 🗑
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| show | Limit time spent w/pts, outer door closed, glove and gown, avoid if pregnant, visitors discouraged, take precautions with urine, emesis, body fluids, double flush toilet, instruct to drink lg amt of water to promote release of radioactive iodine.
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| Nursing care pts receiving radioactive iodine (in home) | show 🗑
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| Radioactive Iodine - adverse reactions | show 🗑
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| show | Non toxic goiter is enlargement of thyroid gland from TSH stimulation which occurs due to inadequate thyroid hormone synthesis.
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| show | Enlarged thyroid gland, elevated TSH, hyperplasia
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| show | Low thyroid hormone, Iodine deficiency, Rare in USA, Virus, Genetic, Goitrogens(substances that interfere with the body's use of iodine, turnips, cabbage, broccoli, PTU, sulfonamides, lithium, aspirin
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| show | Enlarged thyroid, hypothyroid, hyperthyroid or euthyroid, dysphagia, difficulty breathing.
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| Goiter - Diagnosis | show 🗑
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| Goiter - Diagnosis (cont) | show 🗑
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| Goiter - Therapeutic intervention | show 🗑
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| Goiter - nursing care | show 🗑
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| Thyroid Cancer | show 🗑
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| Thyroid Cancer - Causes | show 🗑
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| show | Hard painless nodule, dysphagia, dyspnea if obstruction, thyroid hormone usually normal.
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| show | Thyroid scan shows "cold spots", biopsy, fine needle aspiration biopsy and local anesthesia, 21 gauge needle inserted into nodule; tissue from thyroid w/drawn and placed on slide for exam. common sore throat after surgery.
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| show | Radioactive iodine, chemo, thyroidectomy (partial or total)
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| show | Monitor breathing & swallowing, assess nutrition status, monitor vital signs, Iodine or antithyroid drugs to achieve euthyroid state(usually takes 6 weeks)Saturated potassium iodide to reduce the vascularity of the gland. Teach post op care.
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| show | Monitor for resp distress, due to hemorrhage, edema, or laryngeal spasms, assess signs of hypocalcemia(paresthesia of mouth, toes, fingers, generalized muscle twitching), hoarseness, Monitor VS, O2 saturation, & dressing q 15 min. progressing to q 4hrs,
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| show | Rare since use of antithyroid drugs before surgery have become routine. Tetany, caused by low calcium levels if parathyroid glands accidentally removed(tingling, muscle spasms, twitching, cardiac dysrhythmias.)
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| Parathyroid Glands | show 🗑
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| Parathyroid Glands - target organs | show 🗑
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| PTH | show 🗑
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| show | Decrease in PTH, Calcium stays in bones, hypocalcemia, hyperphosphatemia.
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| show | Heredity, Accidental removal of parathyroids during thyroidectomy
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| show | Tetany(not enough calcium), neruomuscular irritability, numbness and tingling of fingers and perioral area, muscle spasms cardiac dysrhythmias. Positive chvostek's sign(tap face - spasm of face is positive indicating hypocalcemia. Positive trousseau's
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| show | PTH Low, Serum Calcium low
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| Hypoparathyroidism - Therapeutic Interventions | show 🗑
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| show | Parathyroid overactivity, increased PTH, hypercalcemia, hypophosphatemia
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| Hyperparathyroidism - Causes | show 🗑
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| Hyperparathyroidism - S/S | show 🗑
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| show | Serum calcium elevated, phosphate decreased, PTH elevated, X-rays for bone density
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| show | IV NS to dilute calcium, furosemide(lasix)to increase urine excretion of calcium. Calcitonin, alendronate(fosamax) prevent calcium rlease from bone.
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| show | bisphosphonates, alendronate(fosamax), ebandronate(boniva), risedronate(actonel), Zoledronic acid(zometa, reclast) Take w/6-8oz water in a.m., do not lie down 30mins after taking, wait 30mins before taking other food or drink. reverse progression of osteo
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| Calcitonin(miacalcin | show 🗑
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| Hyperparathyroidism - Nursing implications | show 🗑
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| Hyperparathyroidism - Estrogen therapy | show 🗑
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| show | Located on top of each kidney, consists of inner adrenal medulla and outer adrenal cortex.
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| show | Cells secrete catecholamines & are sympathomimetic.
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| show | secreted in lg amts(4x) increase HR, increase contractions, stimulates vasoconstriciton in skin, stimulates vasodilation in skeletal muscles, Dilates bronchioles, decreases peristalsis, stimulates liver to convert glycogen to glucose, increase use of fats
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| Norepinephrine | show 🗑
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| show | Uncommon, tumor of chromaffin cells of adrenal medulla, secretes epinephrine and norepinephrine, usually benign, cuase unk.
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| Pheochromocytoma - S/S | show 🗑
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| Pheochromocytoma - Diagnosis | show 🗑
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| show | Beta blockers (propranolol), reduce fight or flight symptoms. Alpha blockers (phenoxybenzamine) dilate blood vessels to control hypertension. Adrenalectomy.
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| show | Risk for injury r/t hypertensive crisis.
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| show | Secretes steroid hormones, mineralcorticoids (aldosterone). promotes salt retention. Glucocorticoids(Cortisol) affect carb metabolism, sex hormones. Male androgens, female estrogen.
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| show | Hyposecretion=Addison's disease, Hypersecretion=Cushing's disease
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| show | Targe organ the kidneys, increases reabsorption of sodium ions and excretion of potassium ions by kidney.
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| Cortisol | show 🗑
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| show | Rare, deficient Cortisol and/or aldosterone, and /or androgens
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| Addison's Disease - Cause | show 🗑
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| show | Hypotension, sodium loss, potassium retention, hypoglycemia, weakness, fatigue, bronze skin, N/V.
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| Addison's Disease - Diagnosis | show 🗑
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| Addison's Disease - Complications | show 🗑
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| Adrenal Crisis - Therapeutic Interventions | show 🗑
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| show | Anti-inflammatory activity of these hormones makes them valuable for suppressing inflammation and modifying immune response, but they have many adverse reactions.
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| show | GI upset, take orally w/meals or snacks. Increased BS, abnormal fat deposits(moon face, buffalo hump), decreased extremity size, edema hypertension, euphoria, thinned skin w/purpura, glaucoma, peptic ulcers, retardation.
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| Glucocorticoids- medication | show 🗑
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| show | Long term. these medications stop production of seroids by the body, so if the medication is suddenly stopped, the body may be unable to function.
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| show | Stopping the drug suddenly leads to steroid withdrawal syndrome, anorexia, N/V, lethargy, HA, fever, joint pain, skin peeling, myalgia, weight loss, and hypotension. Abruptly stopping drug may also result in rebound of Sx. of condition being treated.
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| Mineralcorticoids | show 🗑
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| show | NEVER ABRUPTLY STOP STEROIDS! Taper dosage gradually, decreasing dosage daily to allow the adrenal gland to return to normal funtion. this will help prevent a secondary adrenal insufficiency.
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| Cushing's Syndrome - Pathophysiology | show 🗑
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| Cushing's - Causes | show 🗑
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| Cushing's - S/S | show 🗑
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| show | Based on appearance, Plasma and urine cortisol, ACTH, Dexamethasone suppression test(elevated plasma cortisol levels in response to dexamethasone admin are assoc w/cushing's syndrome)
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| Cushing's - Therapeutic interventions | show 🗑
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| show | Monitor electrolytes, glucose, preop training.
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| adrenalectomy post op | show 🗑
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