Question | Answer |
Name the Anterior Pituitary Hormones | TSH (Thyroid Stimulating Hormone)
ACTH (Adrenocorticotropic Hormone)
LH (Luteinizing Hormones)
ICSH (interstitial cell stimulating Hormones
FSH (follicle stimulating hormone)
PRL (Prolactin hormone)
GH (growth hormone)
MSH (melanocyte hormone) |
Name the Posterior Pituitary Hormones | Vasopressin/ADH/Anitdiuretic Hormone
Oxytocin |
Name the Hypothalmus Hormones | CRH(Corticotropin-releasing hormone)
TRH (Thyrotropin-releasing hormone)
GNRH(gonadotropin-releasing hormone)
GHIH/Somatostatin (Growth hormone inhibiting hormone)
PIH (prolatin inhibiting hormone)
MIH (melanocyte inhibiting hormone) |
Name the Thyroid Hormones | T3 (Triiodothyroxine)
T4 (Thyroxine)
Calcitonin |
Name the Parathyroid Hormones | PTH (parathyroid hormone) |
Name the Adrenal Cortex Hormones | Glucocorticoids/Cortisol
Mineralocorticoids/Aldosterone |
Name the Ovary Hormones | Estrogen
Progesterone |
Name the Testicular Hormones | Testosterone |
Name the Pancreas Hormones | Insulin
Glucagon
Somatostatin/GHIH |
Name the Adrenal Medulla Hormones | Catecholamines : Epinephrine and Norepinephrine |
TSH: Regulated by & Action? | regulated by
Low thyroid level
stress
pregnancy
hypothalmus: release thyropin
Action: sythesis & release of thyroid hormone. |
ACTH: Regulated by & Action? | Regulated by:
Stress
Hypoxia
low steriod levels
anxiety
biological clock
Action: sythnesize and release of corticosteroids
Hypothalmus: releasing corticotropin |
LH: regulated by & action? | regulated by:
low sex hormone
hypothalmus:releasing gonadotropin
Action: stimulates ovaries & progesterone secretion |
ICSH: regulated by & action? | regulated by:
low sex hormone
Hypothalmus: release of gonadotropin
action: stimulates testostetone secretion and spermatogenesis |
PRL: regulated by and action? | regulated by:
low estrogen levels
breast feeding
hypothalmus: release of prolactin inhibiting hormone
action: breast milk production
progesterone secretion in ovaries |
FSH: regulated by and action? | regulated by:
low sex hormones
Hypothalmus release of gonadotropin
action:
female: stimulates estrogen secretion
follicle maturation
Male: begins spermatogenesis |
GH: regulated by and action? | regulated by:
exercise
stress
increased growth hormone
high protein diet
pain
hypoglycemia
hypothalmus:releasing ghrh or ghih
action: promotes growth the bkdwn of fats, proteins for metab. antag. for insulin |
MSH: regulated by and action? | regulated by:
hypothalmus:melanocyte-inhibiting hormone
action: promotes pigmentation |
ADH: regulated by and action? | regulated by:
low Na & osmolarity
low blood volume & BP
Pain, anxiety, trauma, morphone, anesthetic, CHF, diuretic use & stress
Action: promotes retention of H2O and Na |
Oxytocin: regulated by and action? | regulated by:
sex stimulation
preg
breast feeding
stress
action:
stimulate uterine contraction to propel sperm or delivery fetus
ejectin of breast milk. |
Testosterone: regulated by and action? | regulated by:
ICSH from anterior Pituitary
Action:
male characteristics
increased muscle mass
increased bone density |
Estrogen: regulated by and action? | regulated by:
FSH from anterior pituitary
action:
female sex characteristics and maturity
reproductive activity. |
Progesterone | regulated by:
LH from anterior pituitary
action:
decrease uterine contractions
increased reproductive ability in uterus' endometrium
increase Na, H2O, Cl reabsorption by kidneys |
Mineralocorticosteriod/Aldosterone
regulated by and action? | regulated by:
renin-angiotensin cycle (for increased retention of Na and H20)
Na concentration low
K concentration is Hi (stimulates excrete of K)
stress
action: f&e balance (hold Na and H2O and excrete K) |
Glucocorticosteriod/Cortisol
regulated by and action? | regulated by
ACTH from anterior pituitary
CRH from hypothalmus
low steriods stim release of ACTH which stim cortisol secretion
Sleep/wake cycle: hi:am/ low:pm
Stress: rel. cortisol
Action: inc BG, inc. convert AA to GLU, brkdwn prot, fat, carbs |
Catecholamines (epi and norepi)
regulated by and action? | regulated by
fight or flight response: inc stress = inc catecholamine release.
epi= inc system (HR BP R)
Norepi = dec sys (HR BP R)
action: inc HR, BP, CO, bronchodil pupil dil, dec GI motilty and pain aware, inc urine out, BMR, sweat, insulin secr |
T3: Triidothyroxine | produced by the follicular cells: Iodine carrying thyroid hormone
action:
regulated BMR, promoes catab of fats, prot, carbs
maintains GH secretion
antag for insulin
maintains CO and HR
increases produc of RBC |
T4: thyroxine | can be converted to T3 if T3 is low in the body.
action:
regulated BMR, promoes catab of fats, prot, carbs
maintains GH secretion
antag for insulin
maintains CO and HR
increases produc of RBC |
Calcitonin | regulated by serum Ca level
low= suppress release
hi= incre release.
fxn: opposite of parathyroid
inc bone fomration
dec serum Cal and Phos levels
promotes Ca and Na excrete in urine |
PTH: | regualted by Ca serum level
action: synth of PTH to maintain Ca in blood by inc absorp fr bones and GI; dec renal excrete of Ca
sm chgs can lead to tetany, nerve prob, arrhythm, blood coag prob. |
Glucagon | increase BG level |
Insulin | Promote synthesis and storage |
Somatostatin | inhibits secretion of glucagon and insulin |
Hyperthyroidism: general info | more common in women 20-40
cause by emotional/phys stress
occurs w/excessive amts of thy horm
may/may not have nodules
AKA thyrotoxicosis |
Hyperthyroidism: pathophys. | inc thyroid hormone=increase SNS response (inc in heart stimulation= CO and peripheral bld flow)
increased O2 consumption
inc Body Temp
inc metab for prot, fats, carbs.
hyperglycemis of from GLU intol
neg N2 balance
weight loss from inc BMR |
Hyperthyroidism: Diagnostics/Labs | Hi T3, T4
Norm TSH
Thyroid Scan is positive for absorbed rasioactive iodine >35%
US to chk for thy size and masses
EKG to chk for arrhythmias and CV complications. |
Types of Hyperthyroidism and S&S
GRAVES: | S&S:
enlarged thy gland (goiter)
Inc HR, BP, BMR
Wt loss, heat intol, bulging eyes, sweaty, vitiligo, tremeors, clubbing, D, menstrual chgs, Card. Arrhyth, anxiety, restlessness. |
Types of Hyperthyroidism and S&S
THYROID STORM: | S&S:
Severe: shock ,coma, death
HR >130
T>100-106
Systolic HTN
A-fib or flut
agitation, tremors, anxiety
faint, seizures, confusion, restlessness,
vascular collapse and shock. |
Drug treatments for hyperthyroidism
drugs that lower the production of thyroid hormones (t3,t4)BUT dont destroy the thyroid tissue. | PTU/Propylthiouracil or Tapazole/Methimazole: can cause agranulocytosis - Notify MD of any flu like symptoms; stop after 1 yr to test thyroid fxn w/o meds
Lugol's sol'n = iodine sol'n; take after meals to dec GI upset; stain teeth; metallic taste. |
Drug treatments for hyperthyroid to control S&S of hyperthyroidism | Beta-adrenergic Blockers
ex:
inderal(propanolol) & Atenolol (Tenormin)
Works to slow tachycardia, decrease diaphoresis, decrease heat tolerance, dec anxiety and palpitation, reduce tremors, muscle weakness, mental agitation, reduce cardiac arrhythmias |
Drug treatments for hyperthyroid to destroy overactive cells and surrounding tissue with radiation. | Radioactive iodine (131I)
destroys overactive thy. cells &surrounding thy. tissue by low-energy radiation.
one dose; occass. another is needed.
takes 6-8 wks to wk
pt on PTU/Inderal:1st few weeks.
SE: hypothy,SOB fr enlg gland; x-placenta (no prego) |
Thyroidectomy (Pre-Op treatment) | pt is stable before OR give Lugol's to lower thy hormone.
monitor for CV problems
high carb & protien diet b/c of inc BMR
demonstrate how to support neck incision with hands behind neck.
no pressure on incision. |
thyroidectomy (Post-op treatment) | Semi-fowler's: keep stress off incision
humified air=thin secretions
monitor: speak ability:R/O laryngeal nerve injury/complic of resp/airway for swelling/trach tray in rm.
hypothy S&S:replace PRN;
tetany,+chvostek's/trousseau's=hypoCa
hemmorhage |
Hypothyroidism: general info: | insufficient thyroid hormone level
most commonly women 30-60.
pts with DM more likely to have. |
Hypothyroidism: pathophys | thyroid level is low;
inc thy gland activity = goiter develops;
DZ progression:atrophy of the gland = goiter disappears.
S&S: dec HCl in stomach & GI motilty, HR, T, BMR. Anemia r/t dec RBC prod; imp neuro fxn. |
Hypothyroid: diagnostics | T3, T4 decreases
TSH be inc or normal or low depending on type of hypothyroidism |
Types of Hypothyroidism and S&S
- Myxedema | Adult onset
low T3, T4 level, BMR, T, R, HR, BP.
anorex, constip, slow speech, cold intol, puffy face and eyes, thin/coarse/loss of hair, yellow/scaly skin
fatigue, relaxed DTR |
Types of Hypothyroidism and S&S
-Cretinism | congenital
(thy glad dysfxn: failure to properly develop)
S&S:slightly long & heavy baby
after 3m no tx:
puffy face, thick neck, broad flat nose, poor muscle tone, short legs,
distend ABD, hoarse cry, lethargy, resp distress, cyanosis, constipation |
Severe hypothyroidisam and S&S
-Myxedema Coma | causes: illness or hypothermia or rapid withdrawal from thryoid meds
S&S: more extreme symptoms of hypothyroidism |
Hypothryoidism: replacement treatment | goal: to replace thryoid to normal levels
restore glucocorticoids to normal levels
meds start low and dbl q 2wk til at maintanence.
raised to fast: CV comps (dec CO, low BP, dec urine out, mental chgs.)
ex: Thyroid USP/Synthroid/Levothroid |
Hyperparathyroidism: causes | excessive PTH levels often from a benign tumor
VIT D excess
CA mets in bone
acute Renal Fail. |
Hyperparathyroidism: Diagnostics and Labs | Labs show high Ca, low Phos, and High PTH
may develop kideney stones or Ca deposits. |
hyperparathyroidism S&S | resembles hypercalcemia
ORTHO:inc bone resorpt, pathological fxr,muscle weakness, atrophy, fatigue,
NEURO:dec neuromusc irritab, seizures, HA
RENAL: stones,hi Ca levels
CV: HTN
GI: distress, N/V, wt loss, constip |
hyperparathyroidism medical tx: | if no SX
Lasix to inc excrete of Ca fr kidneys
Force IVF NS to inc Ca excrete
monitor for S&S of hypercalcemia
oral phos to keep Ca in bone
Calcitonin inc renal cleareance of Ca;dec bone release of Ca
Mithramyacin to dec Ca levels (cytotoxic:KID&LIV |
Hyperparathyroidism Surgical Tx: Pre-OP | use meds to decrease Ca levels
show hoe to position hands to keep pressure off the incision line post op |
Hyperparathyroidism Surgical Tx: Post-OP | monitor rest status and/or tetany
monitor Ca levels and for hypoCa
diet high in Ca since natural source is being removed
encourage wt bearing exercises. |
Hypoparathyroidism: causes | parathyroidectomy, damage,or tumor, or after thryoidectomy, idiotpathic r/t various medical conditions (MD, pernicious anemia, hypothyroidism, adreanl insuff)
associated with HypoCa. |
Hypoparathyroidism: diagnostics | Labs: low serum Ca, PTH and Hi Phos
hypomagnesium may also occur. |
Hypoparathyroidism: S&S of Tetany or low Ca | paresthesia, muscle spasms, tetany
cardiac arrhythmias, convulsions,
+ chvostek's and Trousseaus'
lethargy. |
hypoparathyroidism: DRUGS to simulate what PTH does for the body | VIT D, Ergocalciferol or calcitrol (Rocaltrol)
***Calcitrol is very expensive
VIT D is converted to Calcitrol in the kidney and is a cheaper method. |
Hypoparathyroidism: Diet high in Ca | Diet high in Calicium: oral Ca salts that include VitD..
dark green veggies, saybean, tofu
avoid high phos food (dairy, processed cheese) |
Hypopituitarism: Causes | severe malnut, idiopathic, pituitary tumors, parital or total hypophysectomy (surgical removal of the gland), trauma, infection, congenital defects |
Hypopituitarism: pathphys | no problem noted until 75% of ant. pit is non-fxn'al.
hyposecretion comes from:
absence of gland tissue or atrophy
deficit in 1 or more ant pit hormones:
lack of GH, low gonadotropins (LH, FSH, ICSH)
low TSH (hypothy), low ACTH (addison's), |
Hypopituitarism: S&S | determined by which hormomes are lacking. |
Panhypopituitarism | a parital or total failure of all anterior pituitary hormones as well as ADH is also deficient from the post pituitary. |
Hyperpituitarism: Causes | hypersecretion from pituitary tumors (adenomas)
PRL secreting tumors are most common
GH producing tumors are 2nd most common
ACTH (corticotropin) tumors 3rd most common)
can also be RT hyperplasia or hypothalmic fxn |
Hyperpituitarism: Pathophy | primary adenomas invade the pituitary.
neuro S&S fr complic fr Inc Press on NS, visual defects,HA, ICP
S&S hormone secrete in excess
PRL:amenorrhea/infert/galactorrhea
GH:gigantism/acromegaly
ACTH:cushings |
Hyper/hypopituitarism: S&S nutritional alterations | high ACTH (Cushings): fat depositions and truncal obesity
Low ACTH (Addison's): dec muscle mass & strength; dec albumin and GLU levels. |
Hyper/hypopituitarism: F&E imbalance: | High ACTH: FVE (edema, neck vien distention, adventitious lung sounds)
Low ACTH: FVD (orthstatic hypotension, dry mucous membranes, poor skin turgor) |
Hyper/hypopituitarism: CV changes | changes to BP, pulses, skin color, EKG changs, triglycerides, cholestrol, and electrolytes |
hyper/hypopituitarism: other changes | fatigue, stress intolerance, emotional instability are seen with TSH and/or ACTH changes, changes in body characteristics with alterations of GH. low gondaotropins will cause alterations in reproductive glands. |
hypopituitarism nursing interventions | drugs are chosen based on which hormones are low and are taken for a long time.
instruct them about side effects & the need to be compliant |
hyperpituitarism nursing interventions | DRUG: Parldel (bromocriptine mesylate) is the drug of choice. it decreases PRL (prolactin) level & can allow for gonadotropin fxn to rtn to normal. Also is used for acromegaly pts as it reduces tumor size & decreases GH levels.
Sx tx: hypophysectomy |
Hypophysectomy (the removal of pituitary gland or tumor on pituitary gland).PURPOSE: | remove tumor &/or dec the hormone levels
relieve the S&S (HA)
possibly reverse some sex chg, visual chg, visceral enlargement are not reverisible. |
Hypophysectomy (the removal of pituitary gland or tumor on pituitary gland). SX TX: Post-OP | neuro chgs occur fr cerebral edema:
visual chgs, disorientation/Alt LOC
dec extremity strength
tx=prevent inc ICP, no coughing/bending.
give ABx.
Transiet DI: I&O, give Vasopressin, monitor spec grav.
CSF leak: Elev HOB, GLU in nasal drain., HA. |
Diabetes insipidus (ADH deficit) Causes: | nephrogenic: inherited defect where renal tubules don't respond to ADH
1-dary: pit. gland defect
2-dary: tumors in hypothal or pit., metz:lung/breast, head trauma, infect., Pit removal SX, CVA, cerebral aneurysm
Drug-related: lithobid or excess ETOH |
diabetes insipidus: pathophy | disorder or H2O metab & electrolyte imbalance caused by deficit of ADH.
urine is dilute and excessive.
dehydration from massive diuresis
pt is extremely thirsty. |
diabetes insipidus: Assessment | S&S:
polyuria, extreme thirst (40glasses of water/day)
dehydration from massive diuresis 4L/day.
asses for hypovolemic shock.
urine will be clear, no glu, low spec grav,low osmolarity. |
diabetes insipidus: Treatment | replace fluids, but monitor for FVE
DRUGS: Vasopressin to short term replacement
Long term: Lypressin or Desmopressin
Sx remove of tumor (hypophysectomy)
give ABx if RT to infection |
Diabetes insipidus: NIs | I&O, sp grav, wt gain, lytes, constipation, IVF monitor to keep on time, encourage I=O.
pt needs to understand hormone replacement tx and will be compliant. pt to wear medi bracelet, monitor for Post-op S&S of hypophysectomy. |
SIADH (syndrome inappropriate antidiuretic hormone secretion): Causes | idiopathic, CA, non-malignant pulmonary tissue, CNS disorders, various drugs. |
SIADH: pathophy | hyponatremia,
ADH continues to be secreted even though the plasma osmolarity is low.
ADH continues to be secreted even though the pt has FVE, problems such as hyponatremia, concn urine, inc in ECF and water retention. |
SIADH: Assessment | Ask about medical cond assoc w/ SIADH
S&S of H2O gain, fluid retention, hi urine sp grav, low urine output, hyponatremia, S&S of hypoNa (lethargy, weakness, wt gain,N,V, edema, loss of app, convulsion), chg LOC, seizures, coma, inc HR, dec T and DTR |
SIADH: treatment | restrict water intake, Mannitol to excrete H2O but spare Na, replace Na in IV or PO, Sx remove of tissue secreting ADH excess, radiate tumor. |
SIADH: dc teching | monitor I&O, wt at home
teach about S&S of SIADH and hypoNa
monitor Na with f/u visits to MD
need diet high in Na (low levels) and K (r/t diuretic use. |
Addison's -adrenal insuff: pathophy | lack mineralocorticoids (aldosterone)
less K is excreted=hyperK
inc Na and H2O excreted=HypoNa & Hypovolemia
increase K retent promote reabsorp. of H ions = metab acid.
lack of glucocorticoids (cortisol)
dec BG and glycogenesis, gastric acid,GFR, |
Addison's - adrenal crisis: | total failure of the adrenal cortex and can occur quickly. life threatening. |
Addisons'/adrenal insuff: Diagnostics | low BG and cortisol,Na,
high K, BUN
XRAY,MRI,CT scans to check for tumors on pituitary, aneurysm, or emplty sella turcica
ACTH stim test done to see if it's pit dependent. |
Addison's/adrenal insuff: S&S | Ortho:fatigue
GI: wt loss, N,V,D,dehydration
CV: hypotension, dec CO, EKG chgs
Metab: hypogly, Low Na, high K
neuro: lethargy,
GU: low output, sex dysfxn
Skin: bronzing, chgs in hair distrib. |
Addison's/adrnal crisis: S&S | neuro: confusion,
CV: dec CO, vascular collapse, shock, death
GI: N,V, dehydration
Metab: fever, Low Na, high K, hypogly
GU: renal fail or dec Urine output |
Addison's/adrenal insuff & crisis: treatment | IV: Florinef (tx mineralocorticoids) Cortef (tx Glucocorticoids)
HyperK: give Kayexalate, monitor for dysrhythm, dec CO, heart blocks, fibs,asystole.
HypoGly: S&S of low Gly, give glucagon, keep simple carbs near
treatment shock w/ IVF and vasopressors |
addison's/adrenal insuff & crisis: other nursing considerations | may need life time steroid replacements and then must monitor for Cushings.
wear medi bracelet
dont' stop glucocorticoids abruptly - can set up addisons crisis. |
Cushing's/adrenal excess: causes | high glucocorticoids condition.
pit. tumor (ACTH secreting tumor)
adrenal tumor
inc secretion of catecholamines from adrenal medulla,
overdose from steriods or glucocorticoids. |
Cushings/adrenal excess: pathophy | w/excess mineralocorticoids (aldosterone)
wt gain, fluid retention
w/ excess Glucocortocids (cortisol)
delayed S&S for infection
Delayed inflammation response |
Cushigns/ adrenal excess: Diagnostics | Labs: elev BG
high Na, low K, low Ca
elev WBC r/t infection
high cortisol levels
UA: high Ca, high K, high Glu
Xray, MRI, CT & arteriography to chk for lesions or tumors
Dex suppression test to determine if pituitary dysfunction. |
Cushing's/ adrenal excess: S&S | moon faced, truncal obesity
muscle atrophy, muscle wasting
thin skin, petechiae, bruising
thin bones,compression fxr
DM, hypergly
HTN (+ for adrenal tumor)
wt gain, high Na and H2O retention
low K and cardiac arrhythm
gynecomastia, amenorrhea, ele |
Cushing's/ adrenal excess: treatment | diet: hi protein & Ca; low carb, Na
DRUGS: to interfere ACTH prod or w/adrenal hormone syth
Mitotane (Lysodren)
Aminoglutethimide (Elipten or Cytadren)
Radiation Tx if RT CA
SX: hypophysectomy if RT pit tumor |
Phenochromocytoma (another type of adrenal excess) | R/t adrenal benign tumors
result in an increase in catecholamines
S&S elev P, BP,Na BG, glycogenolysis,glycouria
tx:bil adrenalectomy |
Hyperaldosteronism (elevated mineralocortocoids) | fr tumors of adrenal gland that produce excessive amts of aldosterone or mineralocorticoids
S&S HTN, hypoK,Hi Na and metb alkalosis,
TX: peform an adrenalectomy after K is back to normal. |
Corticosteroids: Actions | Glucocorticoids:
anti-inflam resp RT more inhibit of prostaglandins
anti-infective RT supp of lymphocytic activity & immunosupp
antag of insulin * inc of conversion of glu fr proteins.
Mineralocorticoids: f&e balance, Na retention w/ promoting K loss |
Therapeutic uses for Corticosteroids | replacement treatment for Addison's in low doses
anti-inflamm tx
allergic rxns-bronchial asthma or contact dermatitis
neoplastic dz - leukemia or lymphoma
prevent organ rejection
tx for shock. |
Corticosteroid SE's | inc effects of ETOH & DIG
dec effects of anti-coags, oral DM and anticonvul
PO:GI upset
Top:rash
Metab:induced cushings
GI:pancreatitis,N,V, peptic Ulcers, hemmor
CV:HTN &embolism
MuscSkel:inc weakness
Hormone:men:gynecomastia
female:male charac. |
Corticosteroid nursing interventions | don't stop or chg abruptly
need to try to mimic normal syst, bio. clock
take every other day
take with food
watch for masking of infections
high K, prot, Ca, low Na and carb diet
stress may alter dose by 2-3 times |