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Endocrine 68WM6

QuestionAnswer
Ablation Therapy and Side Effects Used to destroy Hypertrophied tissue Normally done as an outpatient Contraindicated in pregnancy Radiation risk to pregnant healthcare proividers Side effects Chronic hypothyroidism Abdominal pain, n/v, diarrhea, sore throat, neck pain and edema
Surgical Management of Hyperthyroidism Subtotal Thyroidectomy 5/6th of thyroid removed Risk of excessive bleeding
Preoperative Teaching for Hyperthyroidism Instruct patient how to support head while turning in bed or rising Teach deep breathing techniques Teach need for voice rest post-op Discuss possible complications Keep environment calm, room cool
Postoperative Care for Subtotal thyroidectomy Maintain semi-fowler’s position Avoid hyperextension of head Maintain suction and tracheotomy kit at bedside Provide cool mist humidification Check vital signs q 4 hours Assess swallow reflexes before giving liquids
What kind of diet is a post op subthyroidectomy on? Clear, cool liquids Progression from soft to regular as tolerated
What is a major complication of hyperthyroidism? Tetany
What is Tetany? Numbness or tingling Carpopedal spasm Tachycardia, tachypnea, hypertension Laryngeal spasm Positive Chvostek’s Sign Positive Trousseau’s Sign
What is the treatment for tetany? IV Calcium Gluconate Should always be available postoperatively
What is a Thyroid Storm? Manipulation of thyroid Over-release of thyroid hormone in the blood stream Appears within 12 hours post-op
What are the signs and symptoms of a Thyroid Storm? Exaggerated hyperthyroidism Severe hypertension, tachycardia Hyperthermia up to 106F Cardiac dysrhythmias, heart failure
What is the treatment for a thyroid Storm? Treatments IV fluids Sodium iodide and Corticosteroids Antipyretics and oxygen as needed
What should the nurse teach the hyperthyroidism patient? Follow-up medical management Periodic Thyroid Function Tests Incision site care Signs/symptoms of infection Diet modification Lifelong hormone replacement
Where is the Thyroid Gland located? Just below the larynx on either side of the trachea.
What does the Thyroid gland regulate? Metabolism, growth and development, and activity of the nervous system.
What is Goiter? Develops when thyroid gland enlarges Low circulating T3 level signals the pituitary gland Attributed to inadequate dietary intake of iodine
What are some signs and symptoms of Goiter? Subjective Assessment Dysphagia, hoarseness, or dyspnea Objective Assessment Increase in goiter size Voice changes Adequacy of food and fluid intake
How is Goiter Diagnosed? History and Physical
How is Goiter Treated? Medical Management Oral Potassium iodine Iodine rich foods Surgical Management Cosmetic removal of gland
What are some possible complications of Goiter? Thyroid storm, bleeding, and tetany
What dietary information is important for the patient to know when he/she has a goiter? The importance of taking in adequate dietary intake of iodine.
What are the three types of Thyroid cancer? Papillary (Most common, least harmful)Follicular(rare but deadly) Anaplastic
Thyroid cancer more frequently occurs in___________ ______________. Female Caucasians
What are the signs and symptoms of Thyroid Cancer? Presence of a firm, fixed, painless nodule, palpable on examination Rarely, symptoms of hyperthyroidism Patient coping and support system Progression of tumor Response to 131I therapy
How is Thyroid Cancer diagnosed? Thyroid scan "Cold" scan(Malignant) "Hot" scan Thyroid Function Tests (TFT) Needle biopsy
What is the treatment for Thyroid Cancer? Total thyroidectomy Radical neck dissection with metastasis Radiation Chemotherapy Radioactive iodine treatment
What is the risk involved in needle biopsy? Possibility of “seeding” adjacent tissue with cancer cells causing metastasis.
What possible complications are associated with total thyroidectomy? Thyroid storm, tetany, excess bleeding.
ONLY organs that can use free serum glucose without insulin? Brain and Kidney
Body attempts to rid itself of the excess glucose by excreting it in to the urine Glycosuria
To excrete the increased glucose, the kidneys require extra water for dilution Polyuria
Because the kidneys require extra water, the client develops excessive thirst Polydipsia
Insulin Dependent Diabetes Mellitus Type I- Little or no endogenous insulin produced Requires injections of insulin
Non-Insulin Dependent Diabetes Mellitus Type II) Causes Decrease tissue responsiveness to insulin Caused by receptor defects Insulin resistance Decrease secretion of insulin from beta cells Abnormal hepatic regulation
Strong genetic component and associated with obesity Type 2 diabetes also is more common in what ethnicicty's? African-American, Hispanic, American Indian
What are the cardinal manifestations of diabetes? Gycosuria, polyuria, polydepsia, and polyphagia
Type 1 Diabetes 3 P's? Polyuria Polydipsia Polyphagia
What are 2 goals for diabetic clients? Helping achieve normal blood glucose level < 126 mg/dl. Prevention and treatment of acute complications
Diabetes treatment consists of? Education Monitoring Meal planning Medication Exercise
What are the goals of the management of diabetes? Change nutrition & exercise habits that lead to improved metabolic control Maintain near normal blood glucose by balancing food intake with insulin or oral diabetic agents and activity levels
Postprandial blood sugar (PPBS) Fasting client is given a measured amount of carbohydrate solution orally Alternate method – Client eats a measured amount of foods containing carbohydrates, fats and proteins Blood drawn 2 hours after completion Blood glucose > 160 mg/dl indicates DM
HgbA1c Measures the amount of glucose bound to hemoglobin within the RBC
What test can confirm 8 weeks later the adherance to insulin medication regiment? HgbA1c
What patient teaching can be done by the nurse to help manage diabetes? Proper diet and nutritional therapy Medications Home testing of blood glucose Importance of exercise
What is considered low blood sugar? below 65
What should the nurse consider when helping plan meals? Insulin dependent clients are usually given mid afternoon and bedtime snacks Clients engaging in strenuous exercise should be encouraged to eat more food
What are some signs and symptoms of hypoglycemia? Faintness Sudden weakness Diaphoresis Irritability Hunger Palpitations Trembling Drowsiness
When administering insulin what should the nurse do before giving the injection to the patient? Always have the dose drawn up in the syringe checked by another nurse prior to administration Always draw up regular insulin first Open bottles kept at room temperature Extra bottles stored in refrigerator
What should the nurse be aware of before administering oral hypoglycemics? Compounds that stimulate the beta cells to produce insulin Not a substitute for insulin Client must have some functioning insulin production for these medications to be effective
Precose (Acarbose) Non Sulfonylureas- Acts by delaying the digestion of ingested carbohydrates Results in smaller rise of blood glucose after a meal Used alone or in conjunction with sulfonylureas
Glucovance combined glyburide/metformin, recently been approved by the FDA.
Actos (Pioglitazone HCL) effective for the treatment of insulin resistive patients.
Sulfonylureas Tolbutamide (Orinase), Chlorpropanamide (Diabinese), Glipizide (Glucotrol), Gylburide (Micronase) Stimulate beta cells to produce insulin Improves use of insulin at receptor sites Increases the effectiveness of existing insulin Can NOT be used in clients with little or no pancreatic activity Can cause hypoglycemia
Quanitative Meal Planning Emphasis on total amount of complex carbohydrates consumed rather than the type 45 – 50 % total kcals from COOH 10 – 20 % total kcals from protein No more than 30 % total kcals from fat
Qualitative Meal Planning Unmeasured and more unstructured Stresses moderation when selecting food from the food pyramid Reduce use of simple carbohydrates, saturated fats and alcohol Food intake evenly throughout the day
What are some benefits of exercise for the diabetic patient? Improves circulation Helps metabolize carbohydrates, decreasing insulin requirements Lowers cholesterol and triglyceride levels Decreases blood pressure Helps control weight Improves muscle tone and cardiovascular function
In case hypoglycemia occurs during exercise the patient should carry what on them when exercising? a form of “easy to eat” Carbohydrates
What are the two ways insulin is made? Beef and Pork Biosynthetic
What are the three categories of insulin? Short acting (regular, Humulin or novulin insulin) Intermediate acting (NPH, insulin) Long acting (lantus insulin)
What syringe/needle should a select when preparing to administer insulin? U100 Each 1ml contains 100U of insulin Syringe contains total of 1ml Marked in 2 unit increments Gauge 25 – 32 Smaller gauge = less tissue trauma
Who is a candidate for a pancreas transplant? Type I diabetic with renal failure Usually transplant kidney as well Requires life long immunosuppressive therapy
Islet cell transplantation are harvested from human donors and pigs Injected into the client’s peritoneum Begin producing insulin Require immunosuppressives Many clients require little or no exogenous insulin therapy
When caring for a patient with diabetes what should the nurse notify the physician of? nausea/vomiting/poor appetite
Why should insulin not be injected into the muscle? enters the bloodstream too quickly and could cause hypoglycemia
What are the three injection site for insulin injections? Abdomen – except 2 inches around the navel Upper arm Anterior or lateral aspects of thigh, hips or buttocks
How can the nurse prevent lipodystrophy? Rotate the injection sites.
What should the nurse teach the diabetic patient regarding skin care? Compromised integrity makes more susceptible to infection Elevated glycosylated hemoglobin in the RBCs impedes the release of oxygen in the tissue Elevated glucose levels facilitate the proliferation of some pathogens
What should the nurse teach the diabetic patient regarding foot care? Poor circulation and decreased nerve sensation (neuropathy) increases likelihood of ulcer development Can lead to gangrene Thoroughly wash with soap and water everyday Dry feet and inspect for cracks, blisters, or foreign objects area between toes
Neuropathy Any abnormal condition characterized by inflammation and degeneration of the peripheral nerves
What are some early signs and symptoms of diabetes ketoacidosis? Weakness Drowsiness Vomiting Thirst Abdominal pain Dehydration Hot, dry skin Flushed cheeks Dry mouth
What are some late signs and symptoms of Diabetes ketoacidosis? Kussmaul’s breathing Sweetish odor on breath Acetone Hypotension Rapid weak pulse Restlessness Stupor, coma, Death
What is the medical management of diabetic ketoacidosis? Reduction of elevated blood glucose levels and decrease acidosis IV Insulin infusion to maintain BG 200 – 250mg/dl
Late Signs and Symptoms of Hypoglycemia? Convulsions Unconscious Brain damage Death
How do you diagnose and treat hypoglycemia? Check vital signs Do Finger Stick Monitor for worsening/relief of symptoms Encourage PO intake of complex CARB after symptoms subside Observe closely for 1-2 hrs post symptoms Notify charge nurse/physician of client status
How can the nurse restore a normal glucose level in a conscious patient? 4 oz orange juice or regular soft drink ½ candy bar or one granola bar Dextrose tablets or glucose paste 5 – 6 lifesavers 4 animal crackers
What are the early signs and symptoms of ketoacidosis Weakness Drowsiness Vomiting Thirst Abdominal pain Dehydration Hot, dry skin Flushed cheeks Dry mouth
What are some causes of hypoglycemia? Overdose of insulin or oral hypoglycemic agent Inadequate food intake; delayed meal Excessive physical activity
Insulin a hormone secreted in response to the increased levels of glucose in the blood (secreted by beta cells).
What is the only insulin that can be given IV? Regular or Short Insulin
: A 48-year-old is diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The purpose of the metformin, in this situation, is to decreases glucose production by the liver; decreases intestinal absorption of glucose; improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.
Where should insulin be injected? Sites: arms, thighs, abdomen or buttocks. Rotate sites to prevent lipodystrophy (atrophy of subcutaneous fat). Rotate on specific pattern.
How should NPH and regular insulin be drawn up in the same syringe? Always draw up short acting insulin in syringe prior to drawing up of longer acting insulin (clear to cloudy). When regular and another insulin are mixed in the same syringe, it must be administered within 5***** minutes.
Alpha-glucosidase inhibitors are given ______ times a day with the ______ bite of the meal because food increases absorption. three, first
What should the nurse teach the patient about Biguanides (Metformin)? explain the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required.
Meglitinides are administered how long beforemeals? 30 minutes.
Thiazolidinediones are given with or without regard to meals. True or False True
When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, which are Irritability and confusion are early signs of hypoglycemia.
The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill. Patients should NEVER adjust their doses.
Thyroid gland is located where? Butterfly shaped, with one lobe lying on either side of the trachea. Lies just below the larynx. Lobes are connects by the isthmus
The thyroid gland is very vascular and receives approximately ____to ______ of blood per minute 80 to 120 mL
What does the thyroid secrete and what is necessary for the manufactor of these two hormones? Thyroxine (T4). Triiodothyronine (T3). Iodine is essential to the manufacturing of both hormones.
Calcitonin (hormone) purpose is to? released by the thyroid gland. Decreases blood calcium levels by by causing calcium to be stored in the bones.
Where is TSH released from and what does it do? Regulates the thyroid functions and is released by the pituitary gland in the hypathalamus
Which vitamin promotes calcium absorption from the GI tract? Vitamin D, phosphorus inhibits calcium absorption. The pH affects the amount of circulating free ionized calcium. When pH is decreased (acidic), there is more free calcium because it has been released from protein-binding sites.
The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5 1/2 NS). What effect may saline solution have on calcium chloride? Calcium for IV use should be mixed with D5W, not a saline solution. Sodium encourages calcium loss.
Levothyroxine (Synthroid) may be safely interchanged with other brands without any concern to the patient True or false? False, It is recommended that patients not switch brands to avoid a variance in therapeutic effects and adverse effects.
Thyroid replacement therapy and establishing treatment goals with a patient, the nurse explains that knowing some of the adverse effects ? tachycardia, dysrhythmias, weight loss, and fever
Propylthioruracil (PTU) is used for hyperthyroidism
Radioactive iodine isotopes will? absorbs high concentrations of radioactive iodine, which destroys the hyperactive thyroid tissue with essentially no damage to other tissues in the body.
Which nursing diagnosis may appear on a hyperthyroid patient’s care plan? Hyperthyroidism is caused by an excess amount of thyroid hormones. Patients typically exhibit the following symptoms: rapid, bounding pulse (even during sleep); cardiac enlargement; palpitations; and dysrhythmias. Patients are nervous and easily agitated
The primary treatment for hypothyroidism is: a. Levothyroxine. b. Radioactive iodine. c. Propylthiouracil. d. Methimazole. a.Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine replaces both hormones.
When administering electrolyte replacement therapy by IV push what should the nurse keep in mind? Administer slowly. High concentrations may cause cardiac arrest. Rapid administration may cause tingling, sensation of warmth, and a metallic taste. Halt infusion if these symptoms occur, and resume infusion at a slower rate when they subside.
The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5 1/2 NS). What effect may saline solution have on calcium chloride? Calcium for IV use should be mixed with D5W, not a saline solution. Sodium encourages calcium loss.
When administering T3 what is the heart rate that you would hold medication? Greater than 100 bpm.
What might Levoxyl do when administered PO with liquids? Rapidly swell and desintergrate.
Do not administer calcium chloride how? IM, should be administered IV patient shouldremain recumbent for 30-60 minutes after injection.
What is a common side effect of calcium? Metallic taste and constipation
Identify the location and function adrenal glands? Small, yellow glands that lie atop the kidneys Adrenal medulla releases two hormones during stress "Fight or Flight“ Epinephrine Norepinephrine
Adrenal cortex Divided into three separate layers. Each layer secretes a particular hormone (steroid)
Mineralcorticoids Involved in water and electrolyte balance, and indirectly manage blood pressure Primary mineralcorticoid is Aldosterone
Aldosterone Causes retention of sodium; with sodium comes water to increase circulating blood volume Causes wasting of potassium and hydrogen
cortisol (primary glococorticoid) Involved in glucose metabolism Provides extra energy in times of stress Also exhibits anti-inflammatory properties
Sex hormones Androgens - male hormones Estrogens- female hormones In adults, their impact on the system is insignificant
Name the three types of steroids released by the adrenal glands? Mineralcorticoids Glucocorticoids Sex hormones
What causes Adrenal Hyperfunction (Cushings) Hyperplasia of adrenal tissue resulting from over stimulation by ACTH Tumor of the adrenal cortex ACTH-secreting neoplasms outside the pituitary gland Occasionally, overuse of corticosteroid drugs
What is Adrenal Hyperfunction (Cushings) Rare condition in which the plasma levels of adrenocortical hormones are increased Body's protective feedback mechanism fails, with resultant excess secretion of the adrenal hormones: glucocorticoids, mineralcorticoids, and sex hormones
Subjective Signs of Cushings? Irritable with decreased ability to concentrate Mental changes may develop Emotional instability, with severe mood swings and occasionally psychosis Depression very common with possibility of suicide
Objective signs of Cushings? Hypertension common Upper and lower extremity muscle wasting May develop moon face and buffalo hump Presence of ecchymoses and petechiae Skin becomes thin and fragile Weight gain, edema and abdominal enlargement, with development of striae
How is Cushings Diagnosed? Diagnosis usually based on clinical appearance and lab results Hyperglycemia, hypernatremia, hypokalemia Plasma cortisol elevated Plasma ACTH may be increased or decreased, depending on location of a tumor
In Cushings how are tumors diagnosed? Adrenal angiography (to identify tumors) 24-hr urine test for 17 - ketosteroids and 17-hydroxysteroids shows increased presence Abdominal CT, ultrasound to identify tumors
How is Cushings treated? Treatment is directed toward the causative factor Adrenalectomy for adrenal tumor Pituitary tumors may be irradiated or removed surgically (Transphenoidal hypophysectomy)
Mitotane (Lysodern)Action Indications and Side Effects cytotoxic agent that is toxic to adrenal glands Indications Inoperable adrenocortical cancer Action- May suppress function of adrenocortical tissue S/E depression, vertigo, hypertension, orthostatic hypotension, hepatotoxicity, GI upset Mac Rash
What kind of diet should a patient taking Mitotane (Lysodern) be on? Diet- Lowered in sodium, reduce calories and carbohydrates FOODS HIGH IN POTASSIUM
What are some nursing interventions for Cushings Syndrome? Strict I&O Examine extremities for increased or decreased edema Inspect skin daily, especially over bony prominences, for open lesions, ulcers, & ecchymosis Use of heel/elbow protectors & eggcrate mattress Monitor blood glucose level, provide insulin
What are some causes of Addisons Disease? Adrenalectomy Pituitary hypofunction Longstanding steroid therapy Idiopathic adrenal atrophy Cancer of the adrenal cortex Tuberculosis Autoimmune response
What is Addisons Disease? Inadequate secretion of glucocorticoids (cortisol) & mineralcorticoids (aldosterone) by adrenal glands Deficiencies in aldosterone and cortisol produce disturbances of the metabolism of carbohydrates, fats, & proteins
Subjective signs of Addisons Disease? Presence of nausea, anorexia and craving for salt Postural hypotension Vertigo, weakness, and syncope (reluctance to attempt normal activities) Severe headache, disorientation, abdominal pain Anxious and apprehensive with poor management of stress
Objective signs of Addisons Disease? Changes in the color of the mucous membranes and skin, with darkly pigmented areas Weight loss, vomiting and diarrhea Hypoglycemia Abnormally low or high temperature Hyponatremia, and hyperkalemia (signs of impending adrenal crisis)
How can Addisons Disease be diagnosed? Hyponatremia, hypoglycemia, hyperkalemia 24-hr urine shows decreased levels of 17-ketosteroids and 17-hydroxysteroids Fasting plasma levels of cortisol & aldosterone are low
What is the medical management of Addisons Disease? Prompt restoration of fluid and electrolyte balance Replacement of deficient adrenal hormones Initial IV replacement – Hydrocortisone Chronic replacement - Fludrocortisone acetate (Florinef) Diet high in sodium and low in potassium
What are some nursing interventions for Addisons Disease? Strict I&Os, offer fluids! daily weights, & skin turgor VS, attention to temp and B/P Monitor steroid therapy Keep environment stress free Addisonian crisis- severe drop in BP, N/V, & increase in temp, cyanosis leading to vasomotor collapse
What are some things the nurse needs to teach the patient about addisons disease? drug therapy Signs/symptoms of illness/infection & importance of contacting / notifying physician avoiding stress, overexertion, diarrhea, infection, decreased intake of salt, cold exposure and surgery medical alert Jewelry
Deficiencies in aldosterone and cortisol will produce what type of metabolic disturbances? Deficiencies in aldosterone and cortisol produce disturbances of the metabolism of carbohydrates, fats, proteins, as well as sodium, potassium, and water
What is a Addisonian Crisis? an acute, emergency, life-threatening state of profound adrenal cortical insufficiency that occurs when the adrenal glands suddenly fail
What are the signs and symptoms of addisonian crisis? Sudden, severe drop in B/P (hypotension) Anorexia, nausea and vomiting Extremely high temperature Diarrhea, abdominal pain Profound weakness Headache, restlessness or fever
What is the treatment for addisonia crisis? is an emergency: death may occur from hypotension and vasomotor collapse Corticosteroids via an intravenous solution of normal saline and glucose Antibiotics are administered due to extremely low resistance to infection
Addisonian Crisis occurs when there is a sudden failure of the adrenal glands. It may be caused by extreme stress, uncomplicated surgery, salt deprivation, infection, trauma, exposure to cold, or overexertion. What type of symptoms would you observe? Symptoms may include anorexia, nausea and vomiting, diarrhea, abdominal pain, headache, hypotension, restlessness, and fever.
The principle manifestation of pheochromocytoma is _________. hypertension
What is Pheochromocytoma? Chromaffin cell tumor, usually found in the adrenal medulla, that causes excessive secretion of epinephrine and norepinephrine Tumors almost always benign; about 10% are malignant
What are some signs and symtpoms of Pheochromocytoma? Presence of severe headache, palpitations, anxiety Severe hypertension Tremors, nervousness, dizzy and dyspnea Nausea and intolerance to heat Paresthesias (an abnormal sensation, such as burning, prickling, tickling, or tingling)
What is the treatment for Pheochromocytoma? Surgical removal if tumor - may require removal of adrenal gland Blood pressure control
Adrenalectomy surgical removal of the adrenal gland(s), usually to remove a cancerous tumor (usually unilateral)
How is a adrenalectomy performed? Surgically approached by means of an abdominal or flank incision under and following the position of the 12th rib
What is some pre op care of the adrenalectomy patient? Reduce anxiety and ensure an understanding of surgery Ensure preparation for surgery and knowledge of possible post-operative events Bedrest to control vital signs IV corticosteroid prep the morning of surgery Allow time to discuss events and concerns
What is some post op care of the adrenalectomy patient? Review surgical record for completed procedure/interventions Monitor for complications of general anesthesia Observe for hemorrhage, atelectasis, and pneumothorax Monitor appropriate replacement of steroids
What is the diet of the post op adrenalectomy patient? free from stimulants, such as coffee, tea and soft drinks containing caffeine
In the postoperative period following an adrenalectomy, the patient is closely monitored for signs and symptoms of hemorrhage, atelectasis and pneumothorax. Why are these signs and symptoms a concern? Because the adrenals are located close to the diaphragm and inferior vena cava.
Anterior Pituitary (adenohypohysis) releases: GH (Growth Hormone) TSH (Thyroid Stimulating Hormone ACTH (Adrenocorticortropoin Hormone)
Posterior Pituitary releases: ADH (Anti-diuretic Hormone) Oxytocin
Explain stimulation of the pituitary gland, that is negative feedback loop? Hormones are released in response to low circulating hormones or decreased organ function.
Acromegaly An overproduction of somatotropin (growth hormone or GH) in the adult Causes: Idiopathic hyperplasia of the anterior pituitary gland Tumor growth
What are the signs and symptoms of acromegaly? Enlargement of the cranium and lower jaw Separation and malocclusion of the teeth Bulging forehead, bulbous nose, thick lips Enlarged tongue and generalized coarsening of facial features Hands and feet become enlarged
How is acromegaly diagnosed? Based on the patient’s history and the clinical manifestations Computed Tomography (CT Scan) and cranial radiographic evaluation Laboratory test- confirm elevated serum Growth Hormone (GH) levels
What is the treatment for acromegaly? Bromocriptine mesylate (Parlodel) Antipartkinsonian drug that inhibits the release of GH Monitor for the following side effects: headache, nausea, nasal congestion and abdominal cramps
What medications can be given to treat acromegaly? Somatostatin analogues (which inhibit GH) Octrotide (sandostatin), especially in patients who are not candidates for surgery or radiation therapy
What surgical procedures may be done to correct acromegaly? Cryosurgery- use of sub-freezing temperatures to destroy tissues Transphenoidal hypophysectomy- removal of tumor tissues through the nose Irradiation procedures using proton bean therapy have been used to destroy GH- secreting tumors
What are some nursing interventions for acromegaly? Assist with ADL’s Monitor discomfort and provide pain relief Body image Monitor for complications
What is some patient teaching that can be done for acromegaly? Teach/assess understanding of treatment regimen understanding of complications and need to contact physician Teach/assess understanding of spacing activities to prevent fatigue Teach the patient exercises that can be done to help prevent muscle atrophy
What is the cause of gigantism? Usually results from an over secretion of somatotropin (GH) as a result of hyperplasia of anterior pituitary
What are the signs and symptoms of gigantism? Subjective Assess understanding of disease process Assess emotional state Objective Height measurement Muscle strength determination
How is gigantism diagnosed? the GH suppression test
How can gigantism be treated? Surgical removal of tumor tissue Irradiation of the anterior pituitary gland Replacement of pituitary hormones post intervention, as indicated
What are some nursing interventions and patient teaching for gigantism? Primarily include complications of children with increased growth rates Provide emotional support Patient teaching Teach/assess understanding of condition Teach/assess understanding importance of regular follow-up with and endocrinologist
Are the physical manifestations of acromegaly reversible? NO
What is dwarfism? Deficiency in growth hormone Most cases are idiopathic Small number can be attributed to autosomal-recessive trait In some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and gonadotropins
What are the signs and symptoms of dwarfism? Child is a great deal shorter than their peers Well proportioned and well nourished but appear younger than their chronological age Underdeveloped jaws may lead to problems with dentition as the permanent teeth erupt Sexual development is usually normal
How is dwarfism diagnosed? Radiographic evaluation Decreased plasma levels of growth hormone
What is the treatment of dwarfism? Medication regimen GH injection Other hormonal replacements as needed Surgery for removal of tumors
What are some nursing interventions for dwarfism? Early identification of children with growth problems Emotional support Encourage child to engage in activities with peers to avoid self-esteem problems which are common with dwarfism treatment regimen Emphasize the child's abilities and strengths
Identify two characteristics of patients with dwarfism? Child is great deal shorter than peers Well proportioned, but smaller Sexual development is usually normal but delayed May produce normal offspring
What is the purpose of growth hormone and what occurs when there is not enough or too much? Stimulates growth in all organs. Mobilizes food molecules, causing an increase in blood glucose concentration. Dysfunctions of the GH are: Hypersecretion: Gigantism (pre-adult). Acromegaly (mature adult). Hyposecretion: dwarfism
Diabetes Insipidus Disorder of the posterior pituitary in which ADH is deficient Transient or permanent
Diabetes Insipidus Causes Primary (malfunction of the posterior pituitary) Secondary to other conditions (head injury, intracranial tumor, intracranial aneurysm, or infarct) Infections, such as encephalitis or meningitis, have been known to cause diabetes insipidus
Diabetes Insipidus Signs and Symptoms polyuria & intense polydipsia Dilute urine, looking much like water, with a low specific gravity (1.001-1.005) Urinary output may exceed 3 to 4 L in a 24-hour period (average is 1.5 L/day) Urine output exceeds 200mL an hour <2 hrs
How is Diabetes Insipidus diagnosed? Based on clinical manifestations, urinary specific gravity and urinary ADH measurement Urine specific gravity < 1.005 (normal 1.005-1.030) Serum sodium level > 145 mEq/L (normal 135-145 mEq/L) Water deprivation test Radiographic evaluation
How is Diabetes Insipidus treated? Intramuscular, subcutaneous, or nasal-spray administration of ADH preparation Eliminate coffee, tea, and other beverages containing caffeine because of their possible diuretic effect Monitor fluid and electrolyte balance
What are some nursing interventions for Diabtetes Insipidus? Monitor fluid and electrolyte balance The patient should be instructed to wear medical alert jewelry, with the diagnosis of diabetes insipidus Teach/assess understanding of disease process and medical regimen
What are some patient teaching for Diabtetes Insipidus? Teach importance of medication regimen to maintaining health Patient must remain under medical supervision for monitoring of the metabolic state, because the condition may worsen with time
List three clinical manifestations of Diabetes insipidus? Polyuria Urine specific gravity <1.005 Hypernatremia
Which drug mimics the antidiuretic hormone? Vasopressin mimics the antidiuretic hormone.
When reviewing the medication profile of a patient with a new order for desmopressin, the nurse is aware that which of the following drugs is may have an interaction when desmopressin is taken? a. aspirin b. digoxin c. lithium d. penicillin c) Lithium may cause a decreased therapeutic effect of desmopressin.
When a patient is receiving vasopressin, which of the following therapeutic responses would the nurse expect to see? a. Improved appetite. b. Increased serum albumin levels. c. Increased serum potassium levels. d. Decreased urinary output. d. Decreased urinary output.
Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) ADH regulates the body's water balance Synthesized in the hypothalamus, and stored in the posterior pituitary gland Released in response to hypernatremia, decreased fluid volume and stress Released from posterior pituitary
Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH)Risk Factors Malignancies Oat-cell cancer of the lung Duodenal cancer Pancreatic cancer Nonmalignant pulmonary diseases Tuberculosis Lung abscess Pneumonia
What are the signs and symptoms of Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) Subjective Vague complaints Weakness, muscle cramps, anorexia, nausea, and headache Objective Hyponatremia Hyponatremia may trigger diarrhea
How is Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) Diagnosed? Hyponatremia (Sodium < 135 mEq/L) BUN/Creatinine is low to normal Urine specific gravity > 1.032, and urine Sodium will be elevated
How is Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) treated? Fluid restriction Electrolyte management Medication regimen Declomycin Lithium Carbonate Eliminate cause
What are some nursing interventions for Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH)? Monitor/maintain fluid and electrolyte status Neuro checks Strict I&O Daily weight Lung sounds Q2-4 hours High sodium fluids Maintain patient comfort
What are some patient teaching for Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH)? What S&S need to be reported Can reoccur after discharge Keep the patient and family members informed with simple explanations, such as that pain and anxiety can aggravate SIADH
Parathyroid Glands function? Secrete parathyroid hormone (parathromone) Increases the concentration of calcium and regulates the amount of phosphorus in the blood. Release increases reabsorption of calcium and magnesium from kidney tubules
Calcium Primary element which makes muscles contract & gives bones rigidity Normal conduction of electrical currents along nerves Essential element of the clotting process
Phosphorus Inverse proportion to calcium Important for energy storage and transfer Component of bones and teeth Decreased levels- poor growth
Hypoparathyroidism Decreased parathyroid hormone release, resulting in decreased levels of serum CA Idiopathic form of this disorder is a rare Inadvertent removal or destruction of one or more of the tiny parathyroid glands during thyroidectomy is the most common cause
Hypoarathyroidism signs and symptoms? Hypocalcemia, hyperphosphatemia Neuromuscular hyperexcitability Involuntary and uncontrollable muscle spasms Hypocalcemic tetany Severe hypocalcemia Laryngeal spasm, stridor, cyanosis with increased risk of asphyxia Calcification of basal ganglia
How is hypoparathyroidism diagnosed? Hypocalcemia (serum), increased urinary calcium Hyperphosphatemia (serum), decreased urinary phosphorous Recognition of hypoparathyroid tetany as may be seen after a thyroidectomy
How is hypoparathyroidism treated? Intravenous calcium gluconate or calcium chloride Vitamin D Bronchodilators may be ordered Endotracheal intubation and mechanical ventilation may be necessary A diet high in calcium and low in phosphorus is usually recommended
Nursing Interventions for hypoparathyroidism? signs/symptoms of hypocalcemia Keep at bedside: crash cart. After any thyroid surgery, the client is observed for signs and symptoms of hypoparathyroidism Monitor for signs of hypercalcemia with IV replacement therapy
Patient Teaching for hypoparathyroidism? Teach/assess understanding of medication and dietary regimen Teach/assess understanding of signs/symptoms of hypocalcemia and need to contact physician
What causes hyperparathyroidism? Hypertrophy/Hyperplasia of gland tissue Adenoma-(87-93%) (tumor in glandular tissue)
What is hyperparathyroidism? Overproduction of parathyroid hormone (parathormone) Increased urinary excretion of phosphorus Bones become demineralized as calcium leaves and enters the bloodstream
What are some clinical manifestations of hyperparathyroidism? Hypercalcemia as calcium leaves the bone and accumulates in the bloodstream Skeletal pain, pain on weight bearing, and pathological fractures Kidney stone formation
What are some signs of hyperparathyroidism? skeletal deformity or abnormal bone movement Monitor urine for quantity, hematuria and stones Vomiting, weight loss Hypertension and cardiac dysrhythmias Bradycardia Decreased LOC stupor or coma, pain muscle weakness, fatigue, nausea, constipation
What is the medical management of hyperparathyroidism? Removal of hypertrophied gland tissue or of an individual tumor Observe for signs and symptoms of hypoparathyroidism Post-op management similar to that of patient with thyroidectomy
What are some nursing interventions for hyperparathyroidism? Maintain fluid and electrolyte balance Strict I&O Strain all urine Diuretics Monitor labs Assess for signs of hypocalcemia Monitor/prevent pain
What is some patient teaching for hyperparathyroidsim? Teach/assess understanding of diet restrictions Teach/assess understanding of good body mechanics Teach/assess signs/symptoms of stone formation/electrolyte abnormality
Created by: alexandra.bell