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Endocrine system

endocrine problems

S/S Hypothyroidism  Extreme fatigue Dry skin, brittle nails, hair loss Cold intolerant Husky voice or hoarseness Fluid retention Weight gain Constipation Dull mental process, low b/p Menstrual problems
labs for Hypothyroidism  History and PE Thyroid function tests Elevated TSH Low T3 and T4 Thyroid scan Radioactive Iodine uptake test
Nursing interventions for Hypothyroidism  V/S Warm environment Alternate activity with rest Increase fluid intake to 2L/d High fiber diet Emotional support Teach life long Rx regime Avoid sedative or hypnotics Teach about RX *VIP! Look at S/S, then select your actions
Medication for hypothyroidism  Synthyroid (thyroid replacement hormone) Take on an empty stomach each am. (1 hr before breakfast)
Complications of hypothyroidism  Myxedema Coma Atherosclerosis Hyperthyroid (if too much RX) Hypoglycemia Thyroiditis (Hashimoto’s)
Nursing Diagnoses for hypothyroidism  Activity intolerance Self care deficit Risk for injury Altered body image Altered bowel elimination: Constipation
Hypothyroidism  Goiter- Decreased metabolic rate Often confused with the normal aging decline Caution use of hypnotics or sedatives Myxedema (hypothyroidism) due to a deficiency of thyroid hormone. (Adult form) Cretinism= infant form
Hyperthyroidism  Increased metabolic rate r/t increased circulating thyroid hormone Causes: Grave’s disease pg.890, emotional shock, stress, infection Thyroid Storm= most serious results in heart failure, mania, fever Goiter
hyperthyroidism  Avoid OTC that contain IODINE: cough syrups, bronchodilators, salt substitutes
S/S hyperthyroidism  Nervousness Hyperexcitable Palpitations Hand tremors Rapid pulse Insomnia Heat intolerance Severe weight loss and increase appetite Amenorrhea Osteoporosis exophthalmos
Labs for hyperthyroidism  Decreased TSH Increased T3 and T4 Soft gland might pulsate Bruit heard over thyroid
Nursing Interventions for hyperthyroidism  V/S, I&O, Weight Cool baths Administer antithyroid meds: propylthiouracil, Iodine Administer beta blockers prn Rest & Nutrition Prepare for thyroidectomy Trach set and support the head post surgery
Nursing interventions for hyperthyroidism cont.  Monitor voice q 30 min Be prepared to administer Ca Gluconate Observe for hemorrhage,
Nursing interventions for hyperthyroidism cont.  Give pain meds Begin levothyroxine and monitor TSH External cooling Corticosteroids to decrease swelling V/S and cardiac monitoring Monitor for Tetany Monitor for Thyroid Storm
Pharmacology of hyperthyroidism  Potassium iodide SSKI Lugol’s solution Propylthiouracil Radioactive iodine 123 I or 131 I Beta adrenergic blockers Hydorcortisone
Complications of hyperthyroidism thyroid storm, heart failure, anxiety, mania
Thyroidectomy  Prior to surgery, patient must be euthyroid to prevent Thyroid Storm- hypermetabolic state Pain management Prevent hemorrhage
Thyroidectomy  Prevent hypocalcemia Instruct on life long hormone replacement therapy Surgery is done on patients with cancer or those that do not respond to RX.
S/S thyroidectomy  Hyperthyroidism Thyroid Cancer
Nursing interventions for thyroidectomy  Decrease stress on suture line Check behind the neck for bleeding Support the neck Calcium gluconate on hand Trach set
medications for thyroidectomy  Preop rx: Tapazole, SSKI, PTU Iodine prep Propranolol
medication for thyroidectomy  Post op rx: Synthyroid
Complications of thyroidectomy  Resp obstruction Hemorrhage Hypocalcemia Tetany Injury to laryngeal nerve Thyroid storm
Cushing’s Syndrome  R/t pituitary tumor or adrenal cortex Known as: hypercortisolism Increase circulating adrenal hormones Treatment is adrenalectomy- removal of tumor  Or decrease the steroid use
S/S of Cushing’s  Weakness, delayed wound healing Ruddy complexion Depressed, freq infections Buffalo hump Moon face, bruising Hyperglycemia
S/S of Cushing’s  Masculine traits Menstrual prob and impotence Risk for infection
Nursing interventions for Cushing's  Diet: high protein, Vit. D and Ca, low Calorie, fat, and Na. Rich in Vit.K, low carb. Teach not to d/c steroids abruptly Medic alert bracelet Teach about RX: adrenal enzyme inhibitor (aminoglutethimide) Go to the physician regularly 
Complications of Cushings hypertension, osteo, DM, Addison’s crisis, shock,death
Addison’s Disease  Cause: adrenal insufficiency Immune system makes antibodies that attack self. May follow TB, HIV, or abrupt withdrawal of steroids Treatment is to replace the hormone not being produced: Aldosterone = mineralocorticoid
Addison’s Disease Cortisol= replaced with glucocorticoid such as hydorcortisone
s/s for Addison's  Fatigue, weight loss, no appetite Abd pain,polyuria, wt loss N/v, diarrhea, low b/p Skin change- darkening Fever, irritability Crave salt Hypoglycemia Hair loss
Nursing Interventions for addison's  High Na, Low K, increase fluids Take medications Avoid stress ID card Carry injectable cortisol for ER Carry glucose Increase meds during stress, URI
Nursing Interventions for addison's  Go to ER if n,v or diarrhea Teach About Addisonian crisis Risk for osteo, hypotension, hypoglycemia, shock, death
medications for addison's  Mineralocorticoids Glucocorticoids = prednisone, hydrocortisone Addisonian Crisis: NS, IV Glococorticoids, antipyretics, antiemetics
Pheochromocytoma Adrenal medulla hypersecretion- tumor Tumors release excess catecholamines mainly norepinephrine 5 Ps: PressurePalpitationsPallorPerspirationPain –h/a,chest,abdPresenting: s/s: hypertensive crisis24 hour urine test
s/s pheochromocytoma  Ortho hypotension Weight loss Constipation Tremors, pallor Retinopathy Hyperglycemia Hypercalcemia Treatment: surgery Alphadrenergic blocker: phenoxybenzamine (preop) Demser (preop) Metyrosine Ca channel blockers
Hypoparathyroidism  Occurs after neck surgery and hypocalcemia Tx: calcium supp. And Vit D in the form of Calcitrol 2L fluid/day Eye dr. q 1-2 yr – cataracts Maintain low nml cal without stones
hypoparathyroid teaching  Take Calcium in divided doses Carbonate form with food Citrate form without food Vit D and phosphate binders
hypoparathyroid teaching  Self monitor for Hypocalcemia: muscle spasm, tetany, decline mental status. Hypercalcemia (thirst, polyuria, decrease muscle tone, constipation) Diet – high in Ca and low in phos (processed cheese) food high in Ca Complication: renal stones
True Hypoparathyroidism  Paresthesia around lips and mouth, fingers, toes Tetany = + Chvostek’s and +Trousseau’s Fragile nails Seizures Cardiac disfunction Dental problems
Hyperparathyroidism  Elevated calcium levels r/t inappropriate release of PTH Cause : cancer Med induced: thiazides, lithium, aminophylline, steroids, vit D Leukemia Vit D intox C/o myalgia and weakness- fall
treatment for hyperparathyroidism  Fluids Activity NO Thiazide diuretics – They promote Ca retention Diuretics Estrogen for Females SURGERY
Thyroid Cancer  Papillary Follicular Anaplastic  Thyroid lymphoma medullary
SIADH  Hypersecretion of ADH Cause – small cell Ca of lung or medication Correct the Na level Water restriction Demeclocycline, Lithium, phenytoin Hypertonic Saline 3% and Lasix
SIADH S/S  Anorexia, n/v,weight gain, weakness, anger Lethargy, h/a, seizure, coma Low NA Decrease urine No edema
Diabetes Insipidus  Polyuria as much as 20L/d Spec. grav 1.005 or less Polydypsia Insomnia Hypovolemia, hypernatremia Mental dullness
Diabetes Insipidus  Diet:low na,low protein, thiazide diuretics Treatment: nasal DDAPV, tab. Or IV Fluid replacement, I&O, neuro.  If nasal congestion – rx not absorbed.
Pituitary Gland disorders Acromegaly - Excess growth hormone- thicken hands, face, and feet.
pituitary gland disorders Surgery transphenoidal approach to remove pituitary adenoma – produce ACTH= Cushing’sIncreased prolactin hormone produced- treat with medication:Parlodel, Dostinex, Pergonal. Surgery,radiation.
Created by: dreca2