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ENDOCRINE EXAM 12

BP FOR THE ENDOCRINE EXAM MONDAY

QuestionAnswer
TSH Thyroid Stimulating Hormone) is released from the anterior pituitary and Stimulates production and secretion of thyroid hormones and is regulated by Blood thyroxine levels, hypothalmic secretions.
Thyroid secretes T4 and T3 Increases oxygen consumption and heat production; stimulates, increases, and maintains metabolic processes.
The adrenal medulla secretes epinephrine (adrenaline) constricts blood vessels in skin, kidneys and gut, which increases blood supply to heart, brain, and skeletal muscles which leads to increased heart rate and BP. Raises blood glucose.
Obtaining a drug history is essential before a diagnostic exam for an older adult because side effects or interactions may contriute to changes in endocrine function. If older adult is cognitively impaired, a family member or the caregiver should provide info regarding meds and dosage history.
Effective teaching strategies for diagnostic tests include verbal and written instructions, including rationale for actions if possible. If the older adult has cognitive changes a family member or caregiver should be included in the instructions.
If a client has recently take a drug that contains iodine (some cough meds) or has had a radiographic contrast studies that used iodine, thyroid test results may be inaccurate. Other drugs (salicylates, corticosteroids) affect the results of thyroid tests. Be sure to enter on the lab request slip all drugs the client is taking or has taken within the past 3 months.
Radioimmunoassay determines the concentration of a substance in plasma. Venous blood samples are required. Radioactive substance is combined in the lab with blood to determine.
pituitary gland is divided into three lobes anterior, intermediate, and posterior.
Pituitary gland is called the master gland because it regulated the function of other endocrine glands.
the hypothalamus influences the pituitary gland
The anterior pituitary releases ACTH stimulates adrenal cortex to secrete cortisol and other steroids it regulates CRH from the hypothalamus and blood cortisol levels.
Oversecretion of the GHduring adulthood results in acromegaly
Oversecretion of the GH before puberty gigantism
A client with acromegaly has coarse features, a huge lower jaw, thick lips, thick tongue, bulging forehead, bulbous nose, large hands and feet.
Despite enlarged tissues with acromegaly, muscle weakness is common and hypertrophied joints become painful and stiff.
Acromegaly Diagnostic finding MRI and CT reveal pituitary enlargement. Bone radiographs show thickened long bones and skull bones.
Glucose tolerance test is the most reliable way of determining acromegaly bolus of glucose would cause a normal persons GH levels to lower but they maintain elevation in a person with acromegaly.
Self administration of Lypressin Nasal Spray Part 1 of 2 1. Hold Upright 2. Place nozzle in nostrile while in sitting position 3. Spray prescribed number of times in each nostril 4. Avoid exceeding the number of sprays per self-admin the excess is not absorbed and is wasteful.
Self administration of Lypressin Nasal Spray Part 2 of 2 5. Do not inhale med 6. Report nasal irritation to Doctor 7. Monitor urine output and level of thirst.
Hyperthyroidism's affect on Metabolism Increased with symptoms of increased appetite, intolerance to heat, elevated body temp, weight loss despite increased appetite.
Hyperthyroidism's affect on Cardiovascular System Tachycardia, moderate hypertension
Hyperthyroidism's affect on Central Nervous System Nervousness, anxiety, insomnia, tremors
Hyperthyroidism's affect on Skin and Skin structures Flushed, warm, moist
Hyperthyroidism's affect on Ovarian function Irregular or scant menses
Hyperthyroidism's affect on testicular function no change.
Hypothyroidism's affect on Metabolism Decreased, with symptoms of anorexia, intolerance to cold, low body temp, weight gain despite anorexia
Hypothyroidism's affect on Cardiovascular System Bradycardia, moderate hypotension
Hypothyroidism's affect on Central Nervous System Lethargy, Sleepiness
Hypothyroidism's affect on Skin and skin structures Pale, cool, dry; face appears puffy, hair coarse, nails thick and hard
Hypothyroidism's affect on Ovarian Function Heavy menses, may be unable to conceive, loss of fetus also possible.
Hypothyroidism's affect on Testes function Low Sperm Count
Older adults have an increased incidence of nodules and small goiters on the thyroid gland. Symptoms of thyroid disease in older adults often are atypical or minor and easily attributed to normal aging or other chromic conditions. Symptoms seen most often in older adults include: anorexia, weight loss, palpitations, angina and afib.
Hyperthyroidism is indicated by a thyroid scan that shows an increased uptake of radioactive iodine through the gland or confined to a single nodule.
Changes in hormone levels may accompany aging. Although lvls of T4 tend to remain constant, levels of T3 may decrease with age. The most reliable thyroid function test to diagnose hyperthyroidism in an older adult is a serum T4 level.
Agranulocytosis the most serious advese effect of antithyroid drugs. Occurs most often in the first 12 months of therapy and necessitates dCing the drug. Instruct the client to report sore throat, fever, chills, HA, mailse, weakness, or unusual bleeding/bruising.
Antithyroid drugs such as methimazole (tapazole) are administered every 8 hours around the clock, unless directed otherwise.
Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine.
The client with hyperthyroidism Nutrition Notes Part 1 of 3 Calorie needs increase betwee 10% and 50% above normal to replenish glycogen stores and correct weight loss. A high protein intake helps replenish losses from muscle catabolism.
The client with hyperthyroidism Nutrition Notes Part 2 of 3 Clients experiencing steady weight loss despite eating large amounts of food often are frustrated and discouraged. Encourage frequent meals and the intake of nutritionally dense foods (milky milk milkness)
The client with hyperthyroidism Nutrition Notes Part 3 of 3 After tretment restores normal metabolism, calories are adjusted downward to avoid excess weight gain.
Hypothyroidism is difficult to identify in older adults because symptoms closely resemble normal aging for example: anorexia, constipation, weight loss, muscular weakness and pain, joint stiffness, apathy and depression.
During initual therapy with thyroid replacement, the most common adverse reaction is signs of hyperthyroidism.
Early effects of thyroid replacement therapy may be observed within 48 hours of the initial dose. However, a complete therapeutic response to thyroid replacement therapy may not be evident until the client has concluded several weeks of therapy.
Dosage of thyroid replacement drugs are lower in older adults, and drug therapy is initiated slowly and increased cautiously. Older adults receiving thyroid replacement therapy are at increased risk for adverse reactions associated with cardiac function.
Untreated hypothyroidism becomes a risk factor for coronary artery disease, indicating a need for cardiac stress testing and lipid level monitoring.
Nutrition for the client with hypothyroidism 1 of 2. Until normal metabolism is restored, clients experience weight gain even if calorie intake is low. After hormone replacement therapy begins, the client may still need to follow a low-cal diet to attain or maintain normal weight. High Fiber :D
The client with hypothyroidism Nutrition Notes Part 2 of 2 Additional mods such as low-fat, low cholesterol, and low sodium diets are necessary if the client has cardio complications.
Corticosteroid Therapy for adrenal insufficency is lifelong. Teaching Plan 1 of 5 Never omit, increase, or decrease a dose. Lifetime corticosteroid replacement therapy is necessary. If the prescribed drug is not taken, adrenal insufficiency, which is life-threatening, will occur.
Corticosteroid Therapy for adrenal insufficency is lifelong. Teaching Plan 1 of 5 Seek medical ATTN for dosage readjustment whenever there is stress. The body has limited ability to handle stress of any kind. Examples of stress include an infection, a car accident, a family crisis, heavy work load, NURSING SCHOOL!.
Corticosteroid Therapy for adrenal insufficency is lifelong. Teaching Plan 1 of 5 Avoid exposure to infections and excessive fatigue. If an infection or other type of illness occurs. contact the Doc immediately. An increased med dose may be necessary.
Corticosteroid Therapy for adrenal insufficency is lifelong. Teaching Plan 1 of 5 Seek immediate med attn if vomiting, diarrhea, or any other condition prevents the med from being taken orally or interferes with proper drug absorption. parenteral admin will be necessary.
Corticosteroid Therapy for adrenal insufficency is lifelong. Teaching Plan 1 of 5 Wear ID such as a medalert tag or bracelet, stating that the wearer has adrenal insufficiency. If an accident or other problem occurs, med personnel must be made aware of the need for corticosteroids. Follow the diet recommended by doctors.
The client with Addisons disease must follow a diet that is high-protein, mod-carbs, low refined carbs, and frequent meals and snacks esp @ bedtime. This reduces the risk of hypoglycemia from excess insulin secretion. High Na (unless fludrocortisone is used). 2-3L of fluid/day. Potassium requirements.
Discharge instructions after adrenalectomy p 1 of 3 The functions of the adrenal glands include providing a physiologic response to stress, suppressing inflammation, raising blood sugar lvls, conserving sodium to maintain blood volume and BP and contributing hormones that affect sex characteristics.
Discharge instructions after adrenalectomy part 1 of 3 Follow the prescribed treatment regimen. Care for the surgical wound as directed. Adhere to the prescribed med schedule. Obtain sufficient sleep and rest to prevent fatigue and support ADL's.
Discharge instructions after adrenalectomy p 1 of 3 Eat a well-balanced diet. Keep appointments for blood tests. Avoid infections and stress. Carry ID indicating that the adrenal glands have been removed. Seek immediate med help if it is not possible to take your drugs.
ACTH stimulates the secretion of cortisol. Promotes and maintains the development of the adrenal cortex.
Glucose tolerance test is a test of the body's ability to metabolize carbs by administering a standard dose of glucose and measuring the blood and urine for glocose level at regular intervals thereafter.
Thyroid palpation be GENTLE!! Don't cause a thyroid storm!
Diabetes Insipidus can be caused by head trauma, brain tumors, infection of CNS, cranial surgery and sometimes idiopathic in origin.
The main characteristic of Diabetes Insipidus is excretion of large amounts of urine with a low specific gravity. A severe fluid volume deficit can occur if the pt cannot compensate for the condition by drinking lots of fluid.
Diabetes Insipidus S/S Extreme thirst, weight loss, poor skin turgor, decreased BP, tachycardia, weakness, dizziness, fluid volume deficit, CNS symptoms and shock can also occur.
SIADH ADH Excess. ADH is released into the blood stream. Opposite of DI. Excess ADH increased reabsorption of water into circulation from the renal tubules. Caused by: malignant tumors, pulmonary infections, head trauma, meningitis, stress, meds and addisons.
S/S of SIADH fluid retention, concentrated urine, muscle cramps, weakness, and weight gain without edema.
SIADH Tx fluid restriction. diuretics. Overall it depends on the cause
Any enlargement of a thyroid gland is called a goiter.
Simple Goiter iodine deficiencies in food and water causes this goiter.
Tx of goiter iodine and thyroid preps, removal, if they are really big.
Pheochromocytoma S/S hypertension not cured with medication, severe headache, excessive sweating, NV, palpitation, nervousness.
Addison's Disease Tx is to manage shock and immediate glucocorticoid replacement. Diet should be high in sodium and low in potassium. Glucocorticoids and Mineralcorticoids may be given.
Addisons Disease S/S weakness, fatigue, anorexia, weight loss, NVD, abdominal pain, hypoglycemia, increased sweating, HA, trembling, bronze skin color or hyperpigmentation, fluid electrolyte imbalances. HYPOTENSION
Addisonion crisis drop in bp, tachycardia, fever, weakness, confusion, restlessness, NV, fluid electrolyte imbalance and dehydration.
Cushings Disease is a hyperfunction of the adrenal cortex. Too many hormones. May rewuire surgery.
Cushings S/s Obese trunk with round moon face and buffalo hump, thin arms and legs due to protein deficits, very easy to bruise, frequent infecftions, secondary sex characteristic changes, easily irritated.
Acromegaly is excess growth hormone T after puberty. The bones increase in thickness and width, the hands and feet become enlarged and deformities of the spine and mandible develop. Big tongue. Impotence and females taking on male characteristics.
Tx of Acromegaly surgery, radiation, drug therapy, or combo of therapies.
Epinephrine is secreted by the adrenal medulla
Epinephrine increases the heart rate and force of contraction, stimulates vasoconstriction in skin and most viscera and vasodilation in skeletal muscles, dilates the bronchioles, decreases peristalsis, stimulates the liver to convert glycogen to glucose,
Created by: christinego