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155 terms

2255 Endocrine

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What 2 hormones are produced by the hypothalmus and stored in the posterior pituitary
ADH, Oxytocin
What are the 2 hypothalamic hormones we are concentrating on
Thyropin-Releasing Hormone (TRH), Corticotropin-Releasing Hormone (CRH)
A gland responds to a low hormone level by releasing additional hormones, as the hormone level returns to normal the hormone release is inhibited this is considered what type of system
Negative feedback system (Simple)
The interaction of the hypothalamus, the anterior pituitary, and the thyroid, adrenal cortex, and gonads are all part of what type of system
Complex Negative Feedback System
List the 3 types of intrinsic rhythmicity
Rhythms originate in the brain structures, Circadian Rhythms (Diurnal) hormone levels fluctuate during a 24hr period, Ultradian Rhythms : longer than 24hrs
What hormones are produced by the anterior pituitary
GH, TSH, ACTH, Prolactin, FSH and LH
List the stimuli that will release the ADH (Anti-diruetic hormone) from the posterior pituitary
Increased serum osmolality, Decreased blood volume, Hypotension, Pain, N&V, Certain drugs (Lithium=hyponatremia)
This gland is located in the anterior portion of the neck in front of the trachea
Thyroid Gland
List the 2 thyroid hormones
Thyroxine (T4), Triiodothyrnine (T3), Calcitonin
What does Thyroxine (T4) and Triiodothyronine (T3) affect
Metabolism
What is Thyroxine (T4) and Triiodothyronine (T3) stimulated by
TSH from the anterior pituitary
What stimulates calcitonin to be produced by the thyroid
High calcium levels (may be malignancy)
What does the parathormone (PTH) from the parathroid glands regulate and what does it act on to regulate it.
Regulates calcium in the blood, acts on the Bone, Kidney and GI tract
What should the nurse be aware of with thyroid surgery and what must be checked before discharge
Respiratory distress due to inflammation, check calcium levels before discharge
What do the adrenal glands consist of
Inner Medulla and outer Cortex
What hormones does the adrenal medulla secrete
Epinephrine, Norepinephrine, and Dopamine
What are the functions of epinephrine
Fight or Flight, Induce release of free fatty acids, Increase BMR, Elevate blood glucose levels
What hormones does the adrenal cortex secrete
Glucocorticoids (Cortisol), Mineralocorticoids (Aldosterone), Androgens
With the pancreas where does endocrine activity occur
Islets of Langerhans
What 3 type of cells do the Islets of Langerhans have
Alpha, Beta, Delta
What does the Alpha, Beta, Delta cells produce of the pancreas
Alpha-Glucagon, Beta-Insulin, Delta-Gastrin, Somatostatin
What are the major endocrine alterations with aging
Decreased ovarian function (40-60yrs), Decreased ADH secretion (dehydration), Decreased thyroid hormone levels (might need replacement), Impaired glucose tolerance (might need oral hyperglycemic), Altered calcium homeostasis (osteoporosis)
This gland secretes hormones that maintain metabolic stability, carbohydrates, protein and fat metabolism
Thyroid Gland
What 3 hormones does the Thyroid Gland produce
Thyroxine (T4), Triiodothyrnine (T3), Calcitonin
These 2 thyroid glands primary functions is to control cellular metabolic activity and is important in brain development and normal growth
Thyroxine (T4), Triiodothyrnine (T3)
This thyroid hormone is secreted in response to high serum calcium
Calcitonin (Thyrocalcitonin)
___ is a condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormone
Cretinism
Name 3 unique appearances that an infant will have with cretinism
Dull look, puffy face, thick tongue that sticks out
What is essential for thyroid hormone synthesis
Iodine
Where does the thyroid get iodine
(Diet) From the blood absorbed by the GI tract and concentrates it within the cells
What influences Thyroid stimulating hormone release
Thyroid releasing hormone by hypothalamus
List 3 diagnostic tests for thyroid disorders
TSH Assay, Radioactive Iodine Uptake, Thyroid Scan
What is the single best screening test for thyroid disorders and at what interval must it be done
TSH Assay (Every 6 months)
What hormone is used to confirm an abnormal TSH (T3 or T4)
Free (Unbound) Thyroxine (T4)
What hormone is the Active form of the thyroid hormone and a good indicator of hyperthyroidism
T3
What is thyroid enlargement called (caused by increased TSH)
Goiter
What is the nurses main concern with goiter
Airway
What is the management of goiter and what teachings could be done with the patient
Iodine meds (Lugol's or SSKI, Thyroid hormones), Teach patient need for diet higher in iodine and use of iodized salt
A patient will have slowed body metabolism, decreased heat production and decreased oxygen consumption with this disorder
Hypothyroidism
In primary hypothyroidism TH levels are ___ and TSH levels are ___
TH-low, TSH-high
What is the cause of secondary hypothyrodism. TH and TSH levels with be both ___
Malfunction of pituitary or hypothalamus. Both TH and TSH levels will be low
Due to low TH secretion there will be a ___ in metabolic rate, an ___ in serum cholesterol and triglycerides and stimulatory hormone secretion is increased (TSH) as compensation which results in ___
decrease in metabolic rate, an increase in serum cholesterol and triglycerides and stimulatory hormone secretion is increased (TSH) as compensation which results in goiter
Describe the integumentary, Pulmonary, Cardiovascular, Hematologic, Gastrointestinal, Neurologic, Musculoskeletal and Reproductive systems with hypothyroidism
Integument (Dry coarse hair, cool dry scaly skin), Pulmonary (Dypsnea), Cardio (Bradycardia, hypotension, activity intolerance, dysrhythmias
What is the collaborative management for hypothyroidism
Correct thyroid deficiency (synthroid, Levothyroid, Assess labs), Minimize cardiac dysfunction (monitor for bradycardia, low urine output, hypotension, arrhythmias)
What is the term for extreme hypothyroid
Myxedema
What are the manifestations of Myxedema
Cellular metabolite build up of mucous and water, Non-pitting edema (eyes, hands, feet, between shoulders), Hypercholerterolemia, hyperlipidemia, and proteinemia may occur, tongue thickens voice becomes husky.
What is Myxedema coma precipitated by
Stressor (sugery, infections)
What happens to the heart with myxedema and what are other complications that may occur with myxedema coma
becomes flabby, chamber size increases results in decreased cardiac output and perfusion to the brain, (hypoventilation, hypothermia, hypotension, hypothermia, hypotension, hypoglycemia may occur)
What is the management of the myxedema coma
Maintain patent airway, replace fluids, monitor BP, Levothyroxine, glucose, steroids IV as ordered, cover patient with blankets (hypothermia), monitor mental status changes.
This is inflammation of the thyroid gland and an autoimmune disorder where thyroid tissue is DESTROYED causing decreased hormone levels and increased TSH levels and affects women more than men 30-50 years of age
Hashimoto's Disease
What are the manifestations Hashimoto's disease
Dysphagia, Thyroid enlargement
What is the management of Hashimoto's disease
Thyroid hormone replacement or surgery if affecting airway
What is the nursing management for a patient receiving Synthroid
Monitor labs, I&O, Weights, VS
What is the mechanism of action of Synthroid
Increases metabolic rate, Controls protein synthesis, Increases cardiac output, body temperature, and renal blood flow
What is the most common form of Hyperthyroidism
Grave's Disease
Hyperthyroidism will have ___ levels free T3&T4 and ___ levels of TSH
High levels of T3&T4 and low levels of TSH
What are the etiologies of hyperthyroidism
Grave's Disease, Thyroid carcinoma, Ingestion of thyroid hormone, Benign Adenomas, Subacute and Chronic Thyroiditis
This is an autoimmune disorder mediated by antibodies that activate TSH receptors. Excessive stimulation of Adrenergic nervous system or excess circulating TH
Grave's Disease
What are the 3 major characteristics of Grave's Disease
Hyperthyroidism, Thyroid Gland Enlargement, Exophthalmos
Describe the pathophysiology of hyperthyroidism
Excessive stimulation of SNS or excess circulating thyroid hormone leads to Hypermetabolism, Negative nitrogen balance, weight loss, cardiac system is stimulated. Results in altered secretion and metabolism of other hormones from Hypothalamic, Pitituitary, Gonadal
What are the clinical manifestations of Hyperthyroidism in the Integumentary, Pulmonary, Cardiovascular, Gastrointestinal, Neurologic, Musculoskeletal, Reproductive
Integument (Diaphoresis, warm moist skin, thinning of scalp hair), Pulmonary (SOB), Cardio (Palpitations, Tachycardia, chest pain), Gastro (weight loss, increased appetite, diarrhea), Neuro (Tremors, insomnia, irritability, paranoia), Muscle (weakness), Reproductive (amenorrhea, decreased menstrual flow, increased libido, impotence)
What do the lab values show for Grave's Disease (TH, Serum cholesterol)
TH levels increased, Serum Cholesterol decreased (Antibodies to TSH measured for Grave's)
What are the complications / interventions for Grave's Disease Exophalmus
May not regress with therapy, Treated with diuretics, steroids, eyedrops, radiation, or surgery, Have patient wear dard glasses, Elevate HOB at night, Restrict salt intake
What type of heart complications and rhythm are know for Grave's Disease
Heart disease, Tachycardia, Atrial Fib.
This complication of Grave's disease has an episode of acute thyroid overactivity and the patient will have a high fever, Tachycardia, and dehydration
Thyroid Storm
What is the therapies for hyperthyroidism
Antithyroid drug to decrease TH (Iodide, PTU, Tapazole), Radioactive Iodine Therapy (1-2 months to be effective), Beta blockers for HR, Potassium Iodide (Blockade of thyroid hormone release
What type of diet, environment and activity considerations should be made for hyperthyroidism
High calorie, High Protein diet (4000-5000 Cal), Daily Weight, Environment cool, Promote rest periods and VS
What is the pre-op preperation for a Total or Sub-total Thyroidectomy
Patient must be euthyroid (no activity of thyroid hormone), may take 2-3 months, Patient should be optimal weight
What should be monitored after a thyroidectomy
ABC's, dressing for bleeding (look under head), Respiratory obstruction, Laryngeal Edema, Vocal cord Injury (O2 suction, Trache set at bedside monitor for hoarseness, voice weakness) Monitor for hypocalcemia/Tetany
This presents as a hard, irregular painless nodule in an enlarged thyroid gland
Thyroid cancer
How is thyroid cancer confirmed
Biopsy
Can you use radioiodine uptake scan if you suspect thyroid cancer
no
What electrolytes does the parathyroid gland maintain
Calcium and Phosphate balance
What 3 body systems does PTH work on to reasorb calcium
Bone, Kidney, Intestine
What does chronic levels of PTH lead too
Bone damage, Hypercalcemia, Kidney Damage, PUD, Changes in mental function
List the pathophysiology in primary hyperparathyroidism
Calcium transported into the blood from the intestine, kidneys and bone
List the pathophysiology in secondary hyperparathyroidism
GFR decreases, Phosphate levels Increase, Calcium levels decrease, PTH secretion stimulated to decrease phosphate levels
What are the clinical manifestations of hyperparathyroidism for Musculoskeletal, Renal, Gastrointestinal, Neurologic
Muscle (Joint and bone pain, fatigue, weakness, osteoporosis, pathologic fractures), Renal (Hypercalciuria, Kidney stones, UTI, Polyuria), Gastro (N&V, Constipation, PUD, Pancreatitis), Neuro (Emotional instability, Memory Impairment, Psychosis, Confusion, Delirium)
What is the normal serum calcium level
8-11mg/dl
What is the normal serum phosporus level
2.5-4.5 mg/dl
What will hyperparathyroidism show in the levels of serum calcium, and phosporus
Increased Calcium, Decreased Phosporus
What will hyperparathyroidism show in the levels of serum alkaline phosphatase if there are bone disorders
Increased levels
What will the PTH Radioimmunoassay test show with hyperparathyroidism
High concentrations
Collaborative management of hyperparathyroidism. How will calcium levels be lowered
Hydration (NS) and Diuretics
What is the drug therapy for hyperparathyroidism
Phosphates (inhibit bone resorption), Calcitonin (increases Ca excreation), Mithracin (binds calcium), Gallium Nitrate (Ganite)
What should be encouraged with hyperparathyroidism
Mobility
What are 2 risks with hyperparathyroidism
Risk for injury related to demineralization of bones and Risk for altered urinary elimination (Stones)
What is the management with nutrition and fluids with hyperparathyroidism
Increase fluid intake, Acidify urine, Improve patients appetite, minimize constipation.
What should be monitored after a parathyroidectomy
Similar to thyroidectomy ABC's, dressing for bleeding (look under head), Respiratory obstruction, Laryngeal Edema, Vocal cord Injury (O2 suction, Trache set at bedside monitor for hoarseness, voice weakness) Monitor for hypocalcemia/Tetany
What are the etiologies of hypoparathyroidism
Accidental removal of gland during thyroidectomy, inadequate blood supply to glands
What will lab's values show with phophate and calcium with hypoparathyroidism
Increase phosphate, decreased calcium
Describe the pathophysiology of hypoparathyroidism
PTH deficiency, Decreased absorption in intestines, muscular irritability develops
What are the clinical manifestations of hypoparathyroidism for neuromuscular and cardiovascular
Neuromuscular irritability (positive Trousseau's and Chvostek's sign, Numbness and tingling of extremities, Cramps both GI and muscle, Hyperactive DTR's, Tetany) Cardio (arrhythmias)
What will tests with bone, brain and eye show with hypoparathyroidism
Increased bone density, Calcification in Brain, Calcification of ocular lens in eyes
What is the collaborative management of hypoparathyroidism (drugs to raise calcium)
Calcium gluconate, Oral calcium, Phosphate binders (Amphogel, Gelusil), PTH, Vitamin D, High Calcium low phosphate diet, (Cheese and milk have high phosphorus), Monitor for seizures and tetany
What hormones are released by the Adrenal cortex
Glucocorticoids, ACTH, Mineralcorticoids, Androgens
What regulates glucocorticoids
ACTH
What is the action of glucocorticoids
Promotes gluconeogenesis (maintains blood glucose levels), Inhibits inflammatory response to tissue injury, Suppresses allergic reactions
What is the action of ACTH (Adrenocorticotropic Hormone)
Regulates MSH (melanocyte stimulating hormone) and skin pigmentation
What is the action of mineralcorticoids
primary hormone is aldosterone, promotes sodium and water retention
What is the action of androgens
Increase in males=decrease in libido, impotence, Increase in females=acne, hirsutism, Decrease in females=amenorrhea, loss of body hair
What is the name of the disease for Adrenal insufficiency
Addison's Disease
Abrupt stopping of this can lead to Addison's Disease
Steroids
What are the manifestations of Addison's Disease (Musculoskeletal, Cardiovascular, Integumentary, Neurological, Gastrointestional)
Muscle (Weakness, fatigue, joint/muscle pain), Cardio (Anemia, Hypotension, Hyponatremia, Hyperkalemia), Integument (Vitiligo no uniform pigmentation, Hyperpigmentation), Neuro (mental confusion, mild depression), Gastro (Hypoglycemia, anorexia, weight loss, N&V)
What are the diagnostic findings of Addison's Disease (Cortisol, ACTH, Blood Glucose, Sodium, Potassium,
Decrease Cortisol, Increase ACTH, Decrease Blood glucose, Decreased sodium (sometimes), Increase serum potassium
This is an acute, Life threatening emergency caused by insufficient adrenocortical hormones
Addisonian Crisis
What is the Addisonian Crisis precipitated by
Stressor
What is the manifestation of Addisonian Crisis
Dehydration, Hypotension, Hyponatremia, Hypoglycemia
What is the treatment for the Addisonian Crisis
IV 0.9NS to restore volume, Replace steroids with hydrocortizone, Correct Lyte and blood sugar imbalances, monitor VS
With patient teaching with steroids
2/3 in morning, 1/3 in afternoon, Dietary modification during diaphoresis, Adjust doses for minor illnesses and stress, Teach to monitor BP, KEEP EMERGENCY STEROID INJECTION KIT AVAILABLE, Wear ID bracelet, Monitor for osteoporosis
What is the name of the mineralcorticoid and when should it be taken
Florinef (take in PM)
What drug is taken for hypotension with Addisonian Crisis
Midodrine hydrochloride is a vasopressor/antihypotensive agent
This disease is a rare and results from adrenal overactivity, pituitary tumors, non-endocrine tumors, or adrenal cancer
Cushing's Disease
What is Cushing's syndrome caused by
Long-term administration of steroids for treatment of illness
What are the clinical manifestations of adrenal hyperfunction (Cardiovascular, Integumentary, Musculoskeletal, General)
Cardio (HTN, Edema), Integument (Thin fragile skin, purplish red striae, bruises, poor wound healing, decreased s/s inflammation), Muscle (wasting, osteoporosis), General (Truncal obesity, Buffalo Hump, Moon Faces, Hirsutism, Acne)
What are the diagnostic findings of Cushing's (Sodium, Potassium, Blood glucose, Urinary and blood cortisol, WBC)
Na increased, K decreased, Blood glucose increased, urinary and blood cortisol increased, WBC increased (Leukocytosis maybe)
What is the management in adrenal hyperfunction (Drug therapy to inhibit corticosteroid synthesis), (Interferes with ACTH production)
Mitotane (Lysodren), Aminoglutethimide (Cytadren), Trilostane (Modrastane) INTERFERES - (Bromocriptine, Somatostatin)
What is the surgical management if increased pituitary secretion of ACTH
Transphenoidal Hypophysectimy or Hypophysectomy
What is the surgical management if hypercortisolism from adrenal adenomas or cancer
Partial or complete adrenalectomy or Laproscopic adrenalectomy
What is the pre-op care for an adrenalectomy or hypophysectomy
Correct Electrolytes, Monitor Blood Glucose (Treat hyperglycemia), Increase calorie and protein intake, Minimise risks for falls, Administration of glucocorticoids pre, intra, and post
Where is the incision for the transphenoidal approach
Above upper lip through sphenoid sinus
What is the post-op management for transphenoidal hypophysectomy
Monitor for DI, Monitor nasal drainage (Presence of glucose-csf), Light yellow color at edge of clear drainage = halo sign = csf, Complaint of headache may indicate leakage of csf
What should the patient be taught after transphenoidal hypophysectomy
No brushing teeth for 2-3 weeks, Avoid coughing, straining upon defecation post-op, Teach about replacement steroids
What needs to be monitored after an adrenalectomy in critical care and what should be prevented
Prevent shock and infection monitor VS, I&O, LABS, Electrolytes, prevent skin breakdown, pathologic fractures, GI bleeding
What is the primary cause of hyperaldosteronism
Conn's Syndrome from adrenal lesion
What is the secondary cause of hyperaldosteronism
Diuretic, Laxative abuse, Renal disease
What electrolyte imbalances does hyperaldosteronism lead to
Hypernatremia, Hypokalemia
What is the medical management of hyperaldosteronism
Decreased Na diet, Spironolactone, Increase Potassium in diet, of potassium supplements
This is a catecholamine producing tumor that arises mainly in the adrenal medulla
Pheochromocytoma
What is the peak incidence of pheochromocytoma
20-50
What cells of the SNS in the adrenal medulla form the benign tumor
Chromaffin cells
What is the mechanism of action of epinephrine
Constricts superficial blood vessels, Dilates brain, coronary vessels, muscles, Raises BP and Pulse dramatically, Increases CO, Increases RR, Stiumlates CNS, Dilates pupils, Increases alertness
What are the clinical manifestations of pheochromocytoma
Headache (worst ever had), Diaphoresis, Palpitations, Hypertension (persistent, fluctuating, paroxysmal), Symptoms of DM (Glucosuria increased BS), Anxiety emotional instibility, N&V
What are the 5 H's of sympathetic nervous system overactivity
Hypertension, Headache, Hyperhidrosis, Hypermetabolism, Hyperglycemia
What is the prep for a urinary VMA (24hr urine) for pheochromocytoma
No meds 2-3 days prior to test, No chocolate, tea, vanilla, fruits 2 days prior to test
What is the pro-op management (7-10 days) for pheochromocytoma
rest, relief from stress, dark room, increase calories, vitamins, no caffeine, monitor VS
What is the pharmacologic therapy pre-op for pheochromocytoma
Administer prescribed sedatives, Alpha blocking agents (Nipride, Regitine, Dibenzyline (long lasting), Inderal (if not responsive to alpha blockers)
What should be assessed for after an adrenalectomy
hypoglycemia, Lytes (K, Na) monitor for shock
What is the most common hormone secretion tumor with hyperpituitarism
Prolactin
What does prolactin inhibit and result in
Inhibits secretion of gonadal steroids, results in galactorrhea, amenorrhea, infertility
What drug reduces serum prolactin
Bromocriptine (Parlodel)
This hypersecretion is prior to puberty resulting in accelerated linear growth and result is excessive but proportionate height
Gigantism
This hypersecretion is after puberty causing growth of extremities caused from GH producing cells of the pituitary
Acromegaly
What are the clinical findings for acromegaly
Enlarged feet and hands, Protrusion of lower jaw, Joint enlargement and pain, Excessive sweeting (hands, feet, face), Coarse facial hair, Hyperglycemia, Airway narrowing-sleep apnea, Organomegaly
What is the drug therapy for hyperpituitarism
Octreotide (Sandostatin) - acts on anterior pituitary to inhibit GH for acromegaly, Bromocriptine (Parlodel) - decreases prolactin levels by inhibiting release used in hyperprolactinemia
What is the post-op management for transphenoidal hypophysectomy
No bending at waist or tying shoes, minimize constipation, avoid toothbrushing for 2 weeks
What drug might be needed to maintain fluid balance after a transphenoidal hypophysectomy
Vasopressin
This deficiency causes limited growth and dwarfism
Hypopituitarism
List some non-specific symptoms of hypopituitarism
weakness, fatigue, headache, sexual dysfunction, fasting hypoglycemia
What is the permanent hormonal replacement drug for hypopituitarism
Somatotropin (Growth hormone)
What is the side effect of somatotropin
fluid retention
What is the cause of Diabetes insipidus
ADH deficiency (Head trauma, MVA, Drugs, Infections)
What are the clinical manifestations with DI (Cardiovascular, Neurological, Renal, Gastrointestinal, Integument)
Cardio (Hypotension, Tachycardia, weak perpheral pulses, increased serum osmolality, Hemoconcentration), Neuro (Irritability decreased concentration), Renal (10-12L/24h UO dilute low specific gravity), Gastro (Weight loss, polydypsia), Integument (poor turgor, dry, cool, mucous membranes)
What are the diagnostis findings for DI (Na, Urine specific gravity, Serum osmolality)
Increased Na and osmolality, decreased urine specific gravity
What is the management of DI
IV administration of saline and glucose, Hormone replacement with ADH (Vasopressin, DDAVP (Desmopressin acetate for long term therapy as nasal preparation) correct underlying cause