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AH II
endocrine
| Question | Answer |
|---|---|
| problems with endocrine disorders | testing is exhausting, change in physical appearance & emotional response, permanent lifestyle changes |
| hormones secreted by thyroid | T4=thyroxin, T3=triiodothyronine, calcitonin |
| anterior pituitary gland | secretes TSH which stimulates the thyroid gland to secrete thyroid hormones |
| thyroid nodule/tumor | usually benign, easily treatable, may produce excessive amounts of hormone, leads to hyperthyroidism or thyrotoxicosis |
| hot spot | thyroid nodule, dark on scan, =hyperthyroidism |
| cold spot | light on scan, =hypothyroidism |
| goiter | hyperfunctioning thyroid |
| hyperthyroidism | to much hormone produced |
| T4 | binds to protein, good indicator of thyroid function, norm 5-12 |
| T3 | binds to erythrocytes, norm 80-200 |
| patho of hyperthyroidism | increased serum T3 &T4, increased metabolic rate, sympathetic nervous system resoponseto stimulantion, cardiac & peripheral blood flow, increased carb, protein, &lipid metabolism, all body systems are stimulated |
| cause of hyperthyroidism | autoimmune reaction, increased TSH, thyroiditis, toxic goiter, neoplasms |
| signs & symptoms of hyperthyroidism | rapid heart rate, trembling hands, wt loss, muscle wk, warm moist skin, hair loss, staring gaze, fatigue, palpitations, heat intolerance, nervousness, insomnia, breathless, increased BMs, light/absent menstruation |
| hyperthyroidism nursing interventions | monitor VS, rest, monitor risk for injury due to hyperactivity, social interaction issues, saline eye drops, ointment @ night |
| hyperthyroidism diet | high protein, high fat, high calorie diet |
| graves disease | autoimmune, produce antibodies that attach to thyroid & produce excess hormones, cause unkown, runs in family (no genetic link), common in women 20-40 |
| symptoms of graves disease | enlarged thyroid, proptosis (exophthalmos) starring gaze, fatigue, hand tremors, sleeplessness, A-fib, angina, CHF in older clients |
| S/S of proptosis/ exophthalmos | staring gaze, usually bilateral, unable to close lid, corneal damage, blurred vision, diplopia, eye pain, irreversable |
| thyroid storn (thyrotoxicosis) | not same as graves, acute thyroid hyperactivity, severe tachycardia, delerium, dehydration, extreme irritability & hyperactivity |
| diagnosing hyperthyroidism | low TSh, high radioactive uptake and excretion, decreased TRH during stimulation test, increased T3 & T4 levels |
| Tx of hyperthyroidism | beta blockers, anti thyroid drugs, radioactive iodine thrapy/oblation, surgical subtotal thyroidectomy |
| drug to Tx hyperthyroid tremors | beta blockers |
| anti-thyroid drugs | methimazole & propylthiouracil= inhibit synthesis of TH, block use of iodine, need to monitor, PT, INR |
| possible complications after thyroidectomy | respiratory obstruction, laryngeal edema, vocal cord paralysis, thyroid storm, hypocalcemia |
| symptoms of thyroid storm | high fever, severe tachycardia, delirium, severe hyperactivity |
| symptoms of hypocalcemia | tetany from accidental removal of parathyroid gland, chvostek sign, trousseau sign, lower extremities shaking |
| nursing interventions after thyroidectomy | monitor HR, high calorie diet, monitor swallowing, eye drops, hypothermia blanket |
| hypothyroidism | deficient TH, slow metabolism, decreased heat production, decrease O2 consumption by tissue, increased cholesterol & lipid levels (not metabolized) |
| cause of hypothyroidism | congenital defects of thyroid, defective hormone synthesis, IODINE DEFICIENCY,antithyroid drugs, chronic autoimmune disease, treatable not curable |
| drugs that cause hypothyroidism | antithyroid drugs=lithium,dilantin,dopamine,glucocorticoids, oblation or surgery for hyperthyroidism |
| cretinism | congenital defect of the thyroid, small stature, arrested mental development, a cause of hypothyroidism |
| hashimotos disease | most common type of hypothyroidism, antibodies destroy thyroid tissue, thyroid tissue becomes fibrous, low TH levels, goiter develops to create more TH |
| myxedema (severe hypothyroidism) | results from long untreated hypothyroidism, develops after stress/trauma, |
| S/S of myxedema | dry waxy swelling w/abnormal deposits of mucin in the skin (lower extremities), non pitting edema in pretibia & orbital area, coma from decreased K, increased Ca, hypoventilation, respiratory acidosis, hypotension, slow metabolism, arrythmias |
| symptoms of hypothyroidism | decreased HR & CO, increased lipids & cholesterol, anemia, fluid retention, anorexia, wt gain, constipation, slow movements, muscle cramp, dry scaly skin, thick brittle nails, periorbital edema, swollen tongue, normal to slight enlarge thyroid, hypothermi |
| Tx of hypothyroidism | levothyrosine (synthroid), surgical removal of goiter |
| nursing issues in hypothyroidism | wt. gain, excessive sleep, fatigue, intolerance of cold, allow rest, constipation, atherosclerotic heart disease, skin breakdown |
| parathyroid gland | 4 on top of thyroid gland |
| hyperparathyroidism | increased PTH |
| normal function of parathyroid gland | increase bone reabsorption of calcium & phosphorus balance |
| causes of hyperparathyroidism | adenoma (benign), hyperplasia (all 4 glands enlarged), relationship between serum calcium & PTH disturbed |
| Sx of hyperparathyroidism | bone/joint pain, polyuria, polydipsia, gravel in urine, nausea,anorexia, constipation,ileus,abdominal pain,possible pancreatitis (calcium diposites) |
| Dx of hyperparathyroidism | increased Ca & PTH, decreased phosphate, increased urine Ca & phosphate, pain, GI ulcer, pancreatitis, demineralization of bones/fractures |
| Tx of hyperparathyroidism | NOT FOSOMAX, IV hydration, lasix, low calcium diet, low vit. D, surgical removal |
| nursing issues w/ hyperparathyroidism | fractures, kidney stones (strain urine), low calcium diet, encourage fluids (3000 ml, cranberry), constipation |
| hypoparathyroidism | Low PTH usually from damage or removal of parathyroid gland, decreased Ca, increased phosphate, chvostek & trousseau signs, circumoral parathesia, numb tingle fingers |
| life threatening complications of hypoparathyroidism | acute tetany, resp. insufficiency, laryngospasm, monitor airway, trach kit, IV calcium gluconate then oral |
| Tx of hypoparathyroidism | calcium gluconate,oral calcium, Vit. D, PTH replacement, high Ca low phosphate diet, treat tetany, seizures |
| adrenal glands medulla | secrete epinephrine, norepinephrine |
| adrenal gland cortex | secretes corticosteroids |
| minerslocorticoids | aldosterone |
| glucocorticoids | cortisol,cortisone, released when stressed, affect carb metabolism |
| cushings syndrome | hypercortisolism, overactive adrenal cortex, pituitary over stimulation, excessive corisol or ACTH |
| cushings affects who | women30-50, any age drug induced (long term steroids) |
| Sx of cushings | central obesity, muscle waste & weak extremities, thin skin, abdominal striae, steroid diabetes, E-lyte imbalance, dysrhythmias, edema, hypertension, osteoporosis, compression fractures, increased susceptibility infection, hirsutism (facial hair) |
| cushings meds | tx symptoms, adrensl blocking agents, ACTH reducing agents |
| Tx of cushings | meds to treat symptoms, surgery to remove tumor or whole gland, possible removal of pituitary |
| nursing issues with cushings | fractures, blood sugar, daily wt,risk for infection, skin integrity (no tape), activity intol., mood swings, appearance change, depression |
| cushing syndrome diet | low cal, low carb, high protein |
| addisons disease | adrenal insufficiency, destruction/dysfunction of adrenal cortex, decreased cortisol aldosterone & androgens |
| causes of addisons | autoimmune, seem with AIDS,TB,type I diabetes, metastisize, bilateral adrenalectomy, hemorrhagic infarction from trauma, glucocorticoid use |
| adrenal metastisizes from | lung, breast, GI melenomas |
| Sx of addisons | slow onset, insidious, fatigue, irritablility, wt loss, N &V, postural hypotension, loss of 90% of adrenal cortices |
| Dx of addisons | hormone levels, lytes, glucose |
| addisonian crisis | acute adrenal insufficiency |
| cause of addisonian crisis | stress (pregnancy, surgery, infection) without appropriate hormone replacement |
| Sx of addisonian crisis | sudden penetrating pain in back, abdomen, or legs due to severe elyte imbalance, changed mental statusm, hypovolemia, hypotension, loss of consciousness, shock, high K+ level |
| Tx of addisonian crisis | correct fluid & elyte level (kayexalate enema), correct hypoglycemia, replace steroids (hydrocortisone) |
| pheochromocytoma | benign tumor of adrenal medulla, produces epi or norepi, stimulate SNS, |
| Dx of pheochromocytoma | increased epi and norepi in blood |
| cause of pheochromocytoma | unknown, rare, runs in families |
| patho of pheochromocytoma | increased blood glucose, hypertension, increased metabolic rate, |
| Sx of pheochromocytoma | glucosuria, hypertension, diaphoresis, agitation, tachycardia, palpitations, emotional instability |
| acute attack of pheochromocytoma | profuse sweating, dilated pupils, cold extremities |
| Tx of pheochromocytoma | adrenalectomy |
| pituitary gland | contols many glands, primary disease uncommon, indirectly can cause disease process |
| what pituitary gland secretes | somatotropin ( growth hormone) & several gland stimulating hormones |
| giantism | excessive GH (before puberty), abnormal ht, proportional body, rare |
| acromegaly | enlarged extremities, excessive GH in adulthood, connective tissue & bone continue to grow |
| characteristics of acromegaly | forhead & maxilla grow, voice deepens, enlarged hands & feet, nerve entrapment = pain |
| diabetes insipitus | hyposecretion of ADH, injury to pituitary |
| cause of diabetes insipitus | CVAs, trauma, head injury |
| patho of diabetes insipitus | kidney tubules fail to reabsorb water |
| kinds of diabetes insipidus | neurogenic, gestational, nephrogenic, dipsogenic |
| assessment for diabetes insipidus | polyuria 24L, polydipsia, dehydration, inability to concentrate urine, low specific gravity (1.006 or less), fatigue,muscle pain,tachycardia, postural hypotension,confusion |
| nursing intervention for diabetes insipidus | VS, neuro check, CV status, safety, lytes,dehydration,I&O, daily wt, increased plasma osmo, increased Na, avoid caffine, med alert bracelet |
| Tx of diabetes insipidus | IV fluids, oral fluids, ADH replacement (desmopressin), pressin tannate oil |
| Syndrome of Inappropriate Antidiuretic Hormone (SIADH) | excessive ADH too much = hold fluids |
| cause of SIADH | trauma, CVA, lung or pancrease malignancy, some meds, stress, small cell cancers produce ectopic ADH |
| key issues of SIADH | water retention, hyponatremia, low serum osmolality, continual release of ADH |
| assessment of SIADH | hyponatremia, fluid volume excess |
| Sx of SIADH | fatighe, anorexia, nausea, decreased mental status, coma, seizure, wt gain jugula vein distension, tachycardia, tachypnea, rales |
| Nursing interventions for SAIDH | monitor urine & serum labs, watch mental status, daily wt, I &O |
| Tx of SIADH | hypertonic IV fluid, sodium restriction, diuretics, replace elyte loss, demeclocycline to increase free water clearance, treat underlying cause (CVA, malignancy) |
Created by:
aclelan
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