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Nsg 210 Ch. 42
Endocrine Disorders
| Question | Answer |
|---|---|
| What is diff bn exocrine and endocrine glands? | exocrine: release secretions into ducts, ie: liver, pancreas, breast lacrimal endocrine: release directly into bloodstream |
| These are chemicals secreted into body fluids by one or group of cells which exert a physiological control over target tissues and works with the nervous system. | Hormones |
| What are the four categories hormones and separated in to? | 1. amines/amino acids(epi,noreip, thyroid) 2. peptides(TRH, FSH, GH) 3. steroids(corticosteroids) 4. fatty acid derivatives(eicosanoid, retinoids) |
| The hypothalamus releases what hormones? | corticotropin-releaseing hormone(CRH) thyrotropin-releasing hormone(TRH) growth hormone(GHRH) gonadotropin releasing hormone(GnRH) |
| The hypothalamus releases hormones to do what? | control the release of pituitary hormones |
| The Ant. Pit releases what hormones controlled by the releasing factors secreted by the hypothalamus? | GH(somatostatin), ACTH (adrenocorticotropic), TSH(thyroid stimulating), FSH(follicle stimulating), LH(Lutenizing), Prolactin |
| The Post. Pit releases what hormones and enter the circulation and delivered to their target organs? | ADH, oxytocin |
| The adrenal cortex releases what hormones? | mineralcorticosteroids(aldosterone), glucocorticoids(cortisol), DHEA |
| What hormones are released by adrenal medulla? | epi, norepi |
| What three hormones does the thyroid release? | T3, T4, calcitonin |
| What hormones do these produce? pancreas? kidney? ovary? testes? | pan: insulin, glucagon, somatostatin kid: renin, erythropoietin ovar: estrogen, progesterone test: androgens(testosterone) |
| What is diff bn peptide and steroid based hormones? | Peptide are water based that react on the receptor sites on cell surface and act fast. Steroid are lipid soluble that penetrate the cell membrane and act slower. |
| Name some changes you might fine on assessment with endocrine disorders | buffalo hump, exothalamus, hirstuism, moon face, acromegaly, edema, skin texture |
| urinary levels of epi, norepi, and dopamine may be measured in pt suspected of tumors of the adrenal medulla. What is this disorder called? | pheochromocytoma |
| In stimulation tests used for dx, if the endocrine gland responds to this stimulation, then where is the dyfx likely to be? | the hypothalamus |
| Which gland is referred to as the master gland? | pituitary or hypophysis, but is controlled by the hypothalamus |
| Stress, excercise and low glucose cause this hormone to be released and is inactivated by the liver | GH |
| An increase in osmolality of the blood or decrease in BP causes this hormone to be released | vasopressin, ADH |
| Hypersecretion of the ant. pit. gland commonly involves ACTH and GH resulting in what diseases? | Cushing's syndrome and acromegaly or gigantism in children |
| undersecretion (hyposecretion) is termed ______ and involves all ant pit hormones. | panhypopituitarism |
| what is most common disorder of post. pit. dysfx? | Diabetes Insipidus(DI): lg amt of dilute urine excreted by a lack of ADH |
| What are the three main pituitary tumors found because of an overgrowth? | 1. eosinophalic 2. basophillic 3. chromophobic |
| Eosinophalic tumors present how? | leads to gigantism in children, acromegaly in adults, muscular weakness, lethargic |
| Basophillic tumors leads to? | Cushing's r/t hyperadrenalism(ACTH) with truncal obesity, htn, osteoporosis, masculinization, amenorrhea |
| Chromophobic tumors present how? | 90%, destroys rest of pit. hypopituitarism: fine hair, obese, headaches r/t overgrowth of tumor so, ICP, loss of libido, polyuria, polyphagia, decr of BMR and temp. |
| What is med mgmt if pt gets a total hypophysectomy? | hormone replacement for life |
| Octreotide, lanretotide, pegvisomant are drugs to do what? bromocriptine(Parlodel)? | reduce production of GH Parlodel: dopmamine agonist(friend) that reduces production and release of GH |
| A pt. shows up with a Sp. Gravity of 1.001-1.005, polyuria, polydipsia, what is dx and tx and nsg mgmt? | DI so give DDAVP. May incr BP by vasoconstriction, so monitor |
| SIADH may cause hyponatremia, so do you give Na in the tx? | No, hyponatremia is caused by over load of fluid, so limit fluids and Na levels will come back to normal |
| what is the primary fx of thyroid hormone | control cellular metabolic activity, influence cell replication in brain dev. |
| This hormone increases calcium deposition in bone | calcitonin |
| inadequate secretion of thyroid hormone in fetal and neonate dev results in what disorder? | cretinism: stunted physical mental growth. In adults, manifests as lethargy, slow mentation, slowing of body fx |
| Over secretion of thyroid hormone enlarges the gland leading to what? | goiter, which is lack of iodine. TSH is released to over produce T3 and T4. Treat with iodine |
| The single best screening test of thyroid fx is what? What test is best to confirm abnormal TSH? Best indicator of hyperthyroidism? | A measure of TSH concentration Free T4, 4.5 - 11.5 T3 levels, norm: 70-220 |
| What is best procedure b4 thyroid tests in pt taking thyroid meds? | put them on Cytomel for 1 mo to allow other drugs to clear body, stop Cytomel for 10 days then do test. |
| Medications that alter thyroid test results | estrogen, opioids, steroids, propranolol, heparin, furosemide, phenytoin, salicylates, lithium, amiodarone, iodine |
| what is myxedema | thyroiditis(Hashimoto's disease) extreme sx of severe hypothyroidism seen as lethargy, alopecia, thick skin, hypothermia, brittle nails, husky voice, depression..T3/T4 low, TSH is high |
| Medical mgmnt of hypothyroidism? Nsg mgmt? | Synthroid, Levothyroid(T4) In Europe: Citamel(T3) Nsg: Opiods, sedatives will have prolonged effect, so use cautiously |
| A decr in iodine, manic behavior, sped up things, Graves Disease can all point to what thyroid disorder? | hyperthyroidism |
| S/s hyperthyroidism(thyrotoxicosis)? medical mgmt? | exophthalmos(bug eyes), irritability, rapid HR at rest, palpitations, flushed complexion, fine tremor, incr appetite, decr wt, fatigue, amenorrhea, dysrhythmias, osteoporosis med: radioactive iodine I-131, not for pregnant, PTU in preg/I-123 for nursing |
| What are other med mgmt for thyrotoxicosis? Nsg? | Antithyroid meds - Propacil, PTU, methimazole(Tapazole) which impede thyroid from making more hormone Nsg: relapse or recurrent hyper and permanent hypo can occur so watch |
| What are causes of hypothyroidism? | Hashimoto's syndrome, atrophy of thyroid gland, hyper therapy, lithium, iodine compounds, radiation to head/neck, iodine deficiency |
| what s/s in elderly may present with hypothyroidism that is unique? hyper? | depression afib, angina, wt. loss |
| What is goal of radioactive iodine therapy? | I-131 is to destroy overactive thyroid cells. |
| what is a complication of hyperthyroidism? | thyroid storm: cardiac dysrhythmias, high fever, delerium psychosis, tachy, so lower temp, O2 therapy, dextrose IV fluids, PTU to impede thyroid formation, iodine, Tapazole..salicylate worsen |
| What does propranolol help control with hyperthyroidism? | nervousness, tachycardia, tremor, anxiety, heat intolerance |
| What is the cause of acute thyroiditis? Tx? | infection by bacteria/fungi/mycobacteria/parasite causing inflammation of gland Tx: antibiotics and fluid replace |
| What is role of parathyroid? | regulate calcium/phosphate metabolism, incr PTH = incr ca in blood/decr phosphorous decr PTH = incr Ca |
| hyperparathyroidism? tx? nsg? | bone decalcification, renal calculi(kidney stones), constipation tx: remove abnorm para tiss, push fluids >200ml/day, encourage mobility and avoid thiazide diuretics(decr renal excretion of Ca) |
| What level of Ca means hypercalcemic crisis | >15mg/dl, life threatening, rehydrate, diuretics, calcitonin, phosphate therapy and dialysis |
| What is chief s/s of hypoparathyroidism? Tx? Nsg? | tetany: Trousseau's sign(BP cuff) and Chvostek's sign(face spasm) Tx: incr Ca to 9-10mg/dl, IV Ca gluconate, trach tray for resp distress. Nsg: Give Vit. D for absorption of Ca |
| Adrenaline is secreted as what hormone from where? | catecholamines, epi, norepi, in adrenal medulla |
| Glucocorticosteroids produced by the adrenal cortex is known as | hydrocortisone |
| Increased hydrocortisone secretion results in in elevated | blood glucose levels |
| the presence of glucocorticosteroids in the blood inhibits | release of CRH from hypothalamus and ACTH from pituitary |
| What medical mgmt is available to replace glucocorticosteroids | corticosteroids like Solu-Medrol to inhibit inflammatory in tiss injury and suppress allergic reactions |
| What are the SE of corticosteroids | possible dev of DM, osteoporosis, peptic ulcer, muscle wasting from protein breakdown, poor wound healing and redistribution of body fat |
| This hormone effects electrolyte metabolism produced by the adrenal cortex and is secreted in response to Angiotensin II | mineralocorticoids namely aldosterone |
| Aldosterone's main fx | incr Na absorption in exchange for potassium or hydrogen ions. It has long term effects on Na balance |
| Pt comes in with BP 350/200 dx with pheochromocytoma along with the 5 H's: HTN, HA, hyperhidrosis(extreme sweating), hypermetabolism, hyperglycemia, what are you going to give them first | Nipride, Regitine, for BP emergency |
| What tests can be done to dx it as pheochromocytoma | CT, MRI, ultrasound to locate tumor 24h catecholamine urine and plasma test for epi/norepi |
| Surgical tx involves an adrenalectomy, what is a caution when handling the tumor? Nsg mgmt? | not to release the epi/norepi and spike BP Nsg: bed rest, elevate HOB, instruct to take steroids and not skip, stop meds |
| What suppression test is helpful to determine catecholamines when urine/plasma tests fail | Clonidine(Catapres) and suppresses release of neurogenically mediated catecholamines, but not in pheochromocytoma pt |
| Other drugs to help in surgery: Dibenzyline(alpha blocker), Procardia(CC), Inderal, metyrosine | Dib: used after BP stable to prepare for surgery Pro: prevent catecholamine-induced coronary vasospasm and myocarditis Ind: beta-adrenergic blocker for dysrhythmias and not respond to alpha blockers |
| What is the main s/s of Addison's Disease? S/s of Addison's crisis? | bronze like skin, hypotension, muscle weakness crisis: cyanosis, fever, shock(incr P, low BP, pallor, incr R) from dehydration, hypothermia |
| Addison's disease is a result of? Med mgmt? nsg mgmt? | decr cortisol levels in blood med: IV hydrocortison(Solu-Cortef) with D5NS, corticosteroid inj for emerg Ndg: educate to wear Med alert bracelet(critical) |
| This syndrome has an excess of adrenocortical activity, what is it called? Key s/s? | Cushing's syndrome buffalo hump, moon face, heavy trunk, thin extremities, oily fragile skin, hirsutism, decr libido, depression |
| With the dexamethasone test for Cushing's syndrome, what is being tested for? | If give 1mg at 11p and get cortisol levels next morn and are <5mg/dl, then hypothalamic-pituitary-adrenal axis is fx |
| Med mgmt of Cushing's | if tumor, remove or radiate adrenalectomy is primary adrenal hypertrophy is prob reduce corticosteroids if cause |
| Nsg mgmt for Cushing's | encourage activity, high protein diet for body image |
| Cushing's is also caused by over secretion of what adrenal hormones | glucocorticoids and androgens You find growth stops, obseity, musculoskeletal changes with glucose intolerance |
| What test is most diagnositc of Cushing's? What can falsely raise cortisol levels to make this test effective? | dexamethasone suppression test stress, obesity, depression, antiseizure meds, estrogen, rifampin |
| Cushing's syndrome usually has (high, low) potassium and sodium? | low K, high/normal Na, with high BP most prominent sign |
| Med mgmt of Addison's | Aldacterone |
| Acute pancreatitis | eating itself with Turner's sign(red on flank) and Cullen's sign(blue at umbilicus) |
| chronic pancreatitis | |
| Whipple's procedure | maintain pylorus, remove 1/2 stomach, head of pancreas, join to jejunum |
Created by:
palmerag
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