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BC3 - Endocrine

Anterior Pituitary Secretes growth hormone, thyroid stimulating hormone, adenocorticotropic hormone, Prolactin, Gonadotropic hormones
Counter regulatory Hormone Growth Hormone
Too Much GH causes giantism
Too little GH they need some additional hormones
Posterior Pituitary secretes Vasopressin or ADH
ADH is a potent vasoconstrictor
When ADH is released water is retained
ADH is inhibited by increase in fluid volume, hypothermia, B-adrenergic agonists and alcohol
Thyroid gland produces Calcitonin to inhibit high circulating calcium (increases Ca storage in the bones)
What is the main purpose of the thyroid gland to produce, store & release Thyroxine T4 and T3
Calcitonin takes calcium out of the blood and puts it back into bone (BUILDS BONES UP)
The parathyroid gland secretes Parathormone (PTH)
PTH pulls calcium out of bone and into the blood (BREAKS BONE DOWN)
PTH and Calcitonin are opposites of each other
PTH acts on bone, kidneys & indirectly the GI tract; inhibits bone formation
High levels of Vitamin D inhibit PTH
Low levels of Magnesiuim stimulate PTH
Decreased calcium causes tetany
Hyperparathyroidism occurs as we age which means osteoporosis occurs
Cortisol most potent and abundant glucocorticoid
Cortisol facilitates the breakdown of glycogen (inc. blood glucose levels)
Cortisol also has what type of action anti-inflammatory
Aldosterone acts on the renal tubule to keep sodium and excrete potassium and hydrogen ions
What happens to the endocrine system as we age increase in PTH leads to hypothyroidism
Tx of Hypothyroidism synthroid
Exophthalmos protrusion of the eyeballs from the orbits
Myxedema puffiness, periorbital edema, masklike affect
Goiter enlargement of the thyroid gland
Acromegaly occurs in adulthood - growth hormone excess
Tx of acromegaly Hypophysectomy is tx of choice; radiation tx is secondary tx method; drugs to reduce growth hormone levels
Specific post-op care of hypophysectomy Instruct to avoid coughing,sneezing, or straining with BM; elevate HOB 30 degrees; perform mouth care; discourage toothbrushing for 10 days
Hypofunction of the pituitary results from tumors, autoimmune disorders, infections, vascular disease or destruction of the gland (trauma , radiation, surgical procedures)
Symptoms of hypofunction of pituitary failure to grow, infertility, or amenorrhea
SIADH occurs from overproduction of ADH; occurs more frequently in the elderly (retain fluid)
S/S SIADH fluid retention, hypoosmolality, dilutional hyponatremia, hypochloremia, concentrated urine, normal or inc intravascular volume, normal renal function (BLOOD WOULD BE DILUTED)
SIADH patient has low urinary output, inc body weight w/o edema, lethargy, anorexia, confusion, HA, seizures, coma
TX of SIADH RESTRICT FLUIDS, suck on ice chips/candy; diet supplements of Na & K, diureetics
Diabetes Insipidus is the opposite of SIADH
Diabetes insipidus is the caus of reduced ADH (causing inc urinary output)
S/S of Diabetes Insipidus Polydipsia & Polyuria, low specific gravity, fatigue from nocturia
Hyperthyroidism is caused by increased synthesis and release of thyroid hormone
Thyrotoxicosis refers to physical effects of hypemetabolism r/t over secretion of T3 & T4; usually occur together in Graves Disease
Graves Disease Autoimmune disease (body attacks self); diffuse thyroid enlargement & excessive secretion; They are thin (hyperthyroidism)
Tx of Exophthalmos"Bug Eyes" apply artificial tears, restrict salt intake, elevate HOB, wear dark glasses, eyes may be lightly taped for sleep, exercise intraocular muscles
Hyperthyroidism Increased metabolism, Everything racing: ^ HR, ^ GI, ^ nervous - jittery. They are thin
Thyrotoxic Crisis is also called Thyroid Storm
Thyrotoxic Crisis is a life threatening condition caused by stressors: surgery, infection, trauma
Tx of Thyroid Storm must reduce circulating thyroid hormone; reduce fever, fluid replacement, and eliminate stressors
Dx of thyroid issues Radioactive iodine uptake tests and blood tests for TSH, T3 & T4
Tx of hyperthyroidism is based on age, severity, complicating features, patient preference
Tx of hyperthyroidism Antithyroid medications, B-adrenergic receptor blockers, thyroid ablation, subtotal thyroidectomy
What drugs inhibit synthesis of thyroid hormones PTU, Tapazole
What drugs are B-adrenergic blockers inderol & atenolol
What does iodine do quiets the thyroid gland down and treats crisis by inhibiting T3 & T4
Radioactive Iodine Therapy is done when patient is beyond childbearing years
Acute intervention for hyperthyroidism calm, quiet room; adequate rest, cool room, light bed covers, exercise large muscle groups to decrease tremors, restrict visitors
After thyroid surgery prepare room wit O2, suction, trach tray; teach how to support head; assess for hemorrhage; semi-fowlers; check for signs of tetany
After thyroid surgery, patient should avoid foods high in iodine
What foods are high in iodine red food dye, iodate in flour, public drinking sources, kelp tablets (seaweed), milk treated with iodine
When patient's return home they should reduce stress; follow-up is important; avoid high temperature; normal use od iodized salt is ok
Thyroid nodules a palpable deformity of the thyroid gland; can be benign or malignant
If the radiology evaluation of a thyroid nodule s hot it is benign
If the radiology evaluation of the thyroid nodule is cold it is higher risk of cancer
Tx of thyroid nodule surgical removal
Thyroiditis inflammation by bacteria, virus or fungus
Hashimoto's thyroiditis autoimmune disorder; most common type in US
Hyperparathyroidism "brittle bones & kidney stones"
Hypothyroidism in infancy cretinism- they have a thick protruding tongue, short - limited all their lives
Hypothyroidism in adults Insidious - middle to old age - comes on slowly - they are cold
S/S of hypothyroidism fatigue, lethargy, personality changes, impaired memory, slowed speech, decreased initiative, somnolence, cold, hair loss, dry skin, brittle nails, wt gain
Tx of hypothyroidism take thyroid replacement like synthroid; must be taken throughout the rest of ones life
Hypoparathyroidism rare - can happen if thyroid gland is removed
Tx of hypoparathyroidism Administer IV Calcium slowly to avoid hypotension; tetany can occur because of dec Ca levels; patient needs instruction on long term drug therapy and nutrition
Long-term Tx of hypoparathyroidism Vitamin D, supplement calcium, oral phosphate binders
Cushing's Syndrome is caused by excessive corticosteroids
Clinical Manifestations of Cushing's Weight gain, glucose intolerance, protein wasting, mood disturbances, Acne, HBP, Hirsuitism, Truncal obesity, Moon face, unxplained hypokalemia, Purplish striae
Diagnostic Findings of Cushing's Granulocytosis, Lymphocytopenis, Eosinopenia, Hyperglycemia, Glycosuria, Hypercalciuria, Osteoporosis
Tx of Cushing's Hypophysectomy (pituitary); Adrenalectomy (adrenal tumors); Drygs to suppress Cortisol
Nursing Mgmt of Cushing's Monitor f/e
Pre-operative care of Cushing's Hypokalemia is corrected with diet & K supplements, Manage ^BP
Post-operative care of Cushing's Constant assessment for glucocorticoid imbalance; Maintain bedrest until BP stabilizes; Constant vigilance to prevent infection; Risk for hemorrhage; f/e; keep IV line in place
Addison's Syndrome Hypofunction of Adrenal Cortex - DECREASED secretion; most common cause is autoimmune
S/S of Addison's Weakness/fatigue, Wt. loss/anorexia, loss of hair; "tan", low BP, Low Na but high K; N/V/D
Subjective Assessment of Addison's cramping/abd pain; exhaustion; profound weakness; lack of interest; inablility to tolerate stress
Complications of Addison's Low BP, Shock, Circulatory Collapse, Dehydration, Low Na, High K, Hypoglycemia, Fever, Weakness, Confusion
Care of Addison's Replacement of Glucocorticoids; IV hydrocortisone; Administer Na, fluids, and dextrose; may need reverse isolation
Teaching Plan for Addison's Take Glucocorticoids 2/3 in am - 1/3 in afternoon; Carry emergency kit at all times
Complications of Corticosteroids Hypertension, Slow healing, Inhibits antibody response to healing
Created by: okrecota