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Week 5-6 Endocrine

Endocrine System, Drugs and Disorders

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