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Nsg 210 Ch. 42

Endocrine Disorders

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