endocrine problems
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| 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
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| labs for Hypothyroidism | History and PE Thyroid function tests Elevated TSH Low T3 and T4 Thyroid scan Radioactive Iodine uptake test
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| 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
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| Medication for hypothyroidism | Synthyroid (thyroid replacement hormone) Take on an empty stomach each am. (1 hr before breakfast)
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| Complications of hypothyroidism | Myxedema Coma Atherosclerosis Hyperthyroid (if too much RX) Hypoglycemia Thyroiditis (Hashimoto’s)
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| Nursing Diagnoses for hypothyroidism | Activity intolerance Self care deficit Risk for injury Altered body image Altered bowel elimination: Constipation
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| 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
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| 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
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| hyperthyroidism | Avoid OTC that contain IODINE: cough syrups, bronchodilators, salt substitutes
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| S/S hyperthyroidism | Nervousness Hyperexcitable Palpitations Hand tremors Rapid pulse Insomnia Heat intolerance Severe weight loss and increase appetite Amenorrhea Osteoporosis exophthalmos
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| Labs for hyperthyroidism | Decreased TSH Increased T3 and T4 Soft gland might pulsate Bruit heard over thyroid
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| 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
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| Nursing interventions for hyperthyroidism cont. | Monitor voice q 30 min Be prepared to administer Ca Gluconate Observe for hemorrhage,
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| 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
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| Pharmacology of hyperthyroidism | Potassium iodide SSKI Lugol’s solution Propylthiouracil Radioactive iodine 123 I or 131 I Beta adrenergic blockers Hydorcortisone
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| Complications of hyperthyroidism | thyroid storm, heart failure, anxiety, mania
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| Thyroidectomy | Prior to surgery, patient must be euthyroid to prevent Thyroid Storm- hypermetabolic state Pain management Prevent hemorrhage
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| 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.
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| S/S thyroidectomy | Hyperthyroidism Thyroid Cancer
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| Nursing interventions for thyroidectomy | Decrease stress on suture line Check behind the neck for bleeding Support the neck Calcium gluconate on hand Trach set
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| medications for thyroidectomy | Preop rx: Tapazole, SSKI, PTU Iodine prep Propranolol
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| medication for thyroidectomy | Post op rx: Synthyroid
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| Complications of thyroidectomy | Resp obstruction Hemorrhage Hypocalcemia Tetany Injury to laryngeal nerve Thyroid storm
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| 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
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| S/S of Cushing’s | Weakness, delayed wound healing Ruddy complexion Depressed, freq infections Buffalo hump Moon face, bruising Hyperglycemia
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| S/S of Cushing’s | Masculine traits Menstrual prob and impotence Risk for infection
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| 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
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| Complications of Cushings | hypertension, osteo, DM, Addison’s crisis, shock,death
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| 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
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| Addison’s Disease | Cortisol= replaced with glucocorticoid such as hydorcortisone
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| 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
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| 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
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| Nursing Interventions for addison's | Go to ER if n,v or diarrhea Teach About Addisonian crisis Risk for osteo, hypotension, hypoglycemia, shock, death
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| medications for addison's | Mineralocorticoids Glucocorticoids = prednisone, hydrocortisone Addisonian Crisis: NS, IV Glococorticoids, antipyretics, antiemetics
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| 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
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| 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
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| 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
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| hypoparathyroid teaching | Take Calcium in divided doses Carbonate form with food Citrate form without food Vit D and phosphate binders
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| 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
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| True Hypoparathyroidism | Paresthesia around lips and mouth, fingers, toes Tetany = + Chvostek’s and +Trousseau’s Fragile nails Seizures Cardiac disfunction Dental problems
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| 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
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| treatment for hyperparathyroidism | Fluids Activity NO Thiazide diuretics – They promote Ca retention Diuretics Estrogen for Females SURGERY
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| Thyroid Cancer | Papillary Follicular Anaplastic Thyroid lymphoma medullary
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| 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
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| SIADH S/S | Anorexia, n/v,weight gain, weakness, anger Lethargy, h/a, seizure, coma Low NA Decrease urine No edema
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| Diabetes Insipidus | Polyuria as much as 20L/d Spec. grav 1.005 or less Polydypsia Insomnia Hypovolemia, hypernatremia Mental dullness
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| 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.
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| Pituitary Gland disorders | Acromegaly - Excess growth hormone- thicken hands, face, and feet.
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| 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.
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