Adrenal Flashcards
1
Q
Hypothalamus
A
relay station. Receives all the info from the body and sends message to the pituitary.
2
Q
Pituitary
A
takes the message and sends it to the gland
3
Q
Thyroid
A
metabolism, heartrate, contractility, energy, growth
4
Q
Parathyroid Gland
A
has to do with calcium regulation
5
Q
Kidneys and endocrine
A
produce erythropoietin and renin
6
Q
Heart and endocrine
A
produces naturistic peptide
7
Q
Difference between endocrine and exocrine glands
A
- Exocrine secretes through ducts
- Endocrine secrete directly into the bloodstream
8
Q
Amines & Amino acid derivatives
A
Act immediately
Epinephrine, norepinephrine, & thyroid hormones
9
Q
Peptides, Polypeptides, Proteins, & Glycoproteins
A
Act within seconds / minutes
TRH, FSH, & GH
10
Q
Steroids
A
Act in several hours
Corticosteroids
11
Q
Hormones
A
Regulate organ function
Endocrine system integrated with nervous system (Neuro-endocrine System)
Affect only target cells with specific receptors
Negative feedback loop
Trophic effects on target tissues (hyper or atrophic)
12
Q
Neuro Stock
A
pathway between the pituitary gland and the posterior
13
Q
Portal Pathway
A
pathway between the pituitary gland and the anterior
14
Q
Hypothalamus + Pituitary
A
makes ADH and Oxytocin and sends them to the posterior to store there
15
Q
Anterior Pituitary Hormones
A
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin (PRL)
Adrenocorticotropic hormone (ACTH)
Thyroid stimulating hormone (TSH)
Growth hormone (GH)
16
Q
Posterior Pituitary Hormones
A
ADH
Oxytocin
17
Q
GH is increased
A
deep sleep, stress, exercise, fasting and malnutrition
18
Q
GH is decreased
A
by obesity, hypothyroidism, and depression
19
Q
Causes of Hypopituitarism
A
Trauma, tumor, radiation therapy, or vascular lesion can cause it from working
20
Q
Acromegaly
A
Too Much Growth Hormone
Growth of all organs and tissues except of central nervous system. This is going to result in shorting out of the nerves because they cannot keep up with the growth
21
Q
S/SX of Acromegaly
A
o Tremors, paralysis, neuropathies
o Headaches
o Visual disturbances
o Endocrine Disorders
22
Q
TX of acromegaly
A
- Do an H+P
- Visual Acuity test
- CT or MRI to test for a tumor
- Hormone levels: what is being affected
- Surgery to take out the tumors
23
Q
If we need to take out the Pituitary
A
Monitor BP
Monitor blood sugars (Addisonian crisis)
REPLACE CORTISOL AND THYROID HORMONE (Especially if we took out the anterior)
Monitor for Diabetes Insipidus (having to do with posterior)
24
Q
transsphenoidal hypovisectomy
A
taking out the pituitary gland
25
External beam radiation
- Radiation slows down the release of the GH
- Going up through the nose and putting radiation therapy into the nose. Anything around that radiation is going to be cooked.
26
Drug Therapy for Acromegaly
Somatostatin: stops the growth hormone
27
Diabetes Insipidus
result of lack of ADH
28
DI causes
o Trauma to the head
o Infection in the brain
o Tumor
o Nephrogenic (Kidneys are not responding to ADH)
o Damage to the pituitary gland
29
Specific Gravity of someone with DI
1.001-1.005
30
Normal Specific gravity
1.005-1.030
31
Clinical Manifestations of DI
o High HR
o Weak pulses
o Blood is concentrated
o BP is high
o Sodium level is very high 150 or higher
o Increase H+H
o Increased BUN
o Can cause acute kidney damage
o Urine output: no action of the ADH on the tubules. More than 250 ml per hour. 18,000/day
o Urine is dilute
o Skin turgor: poor
o Tenting of the skin
o Mucous membranes are high
o Dehydration
o Excessively thirsty
o Craving for ice or cold water
o Signs of dehydration
o Lethargy to coma
o Ataxia: uncoordinated movements
32
Medications for DI
Desmopressin (ADH replacement hormone)
o Less output
o Stronger dilute
o Increase BP
o Decrease HR
o Decrease Na+
33
Nursing Interventions
o Monitor I+O hourly
o Weight patient daily
o Monitor specific gravity (higher)
o Blow nose before giving nasal spray
o Avoid alcohol is because it suppresses the ADH!
o Wear medical bracelet
34
SIAH
Syndrome of inappropriate Antidiuretic hormone
35
Clinical Findings for SIAH
o Headache: too much fluid
o N+V (electrolyte imbalance)
o Diarrhea
o Mental sluggishness
o Diminished deep tendon reflexes
o Weight gain
o Blood pressure increase
o Heart rate is going to increase
o Specific gravity is going to be greater than 1.03
36
Management of SIAH
o Treat underlying cause
o Clip aneurism in the brain
o If it is a stroke it will heal on its own
o Caused by tumor, take the tumor out.
o Fluid restriction
o Sodium restriction: salt is going to cells which makes you plump up
37
Medications for SIAH
Diuretics
38
Nursing Care for SIAH
o Hourly i+o
o Put out enough fluid
o Daily weights
o Urine and blood work
o If sodium is very low: 3% sodium chloride
This puts the salt right into the bloodstream to pull the water out of the cells
o They are at very high risk for seizures
o Prevent water intoxication
o Correct electrolyte disturbances
39
Thyroid hormone – T3, T4
Accelerates cellular reaction in most body cells
Increase BMR
Increases growth
Stimulates protein synthesis
Influences growth, development, and cell differentiation
Mitochondrial membranes bind thyroid hormones, which regulate energy metabolism
Exert chronotropic and inotropic cardiac effects
Increase bone formation and decrease bone reabsorption of calcium
Act as insulin antagonists
40
Iodine
required in order for the thyroid gland to make the thyroid hormone
41
Goiter
result of overgrowth of thyroid tissue
42
Hyperfunction of thyroid
Graves Disease
Receptors on our thyroid gland. Antibodies sit on the receptor sites and the thyroid gland thinks it is TSH so it makes a ton of thyroid hormone without stopping so the thyroid gets bigger and bigger
43
Thyroid toxicosis/Thyroid Storm:
critical hyperthyroidism
44
Hashimoto’s
excessive hypothyroidism
45
Diagnostic of thyroid disorders
Serum: TSH, T3 and T4
Serum free T4
T3 resin uptake test
Thyroid antibodies
Radioactive iodine uptake
Fine needle aspiration biopsy
Thyroid scan, radio scan
Serum thyroglobulin
46
Medications known to affect thyroid testing
amiodarone
aspirin
cimetidine
diazepam
estrogens
furosemide
glucocorticoids
heparin
lithium
phenytoin and other anticonvulsants
propranolol
47
Causes of Hypothyroidism
Autoimmune disease (Hashimoto thyroiditis, post-Graves disease)
Atrophy of thyroid gland with aging
Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma)
Iodine deficiency, iodine excess, and iodine compounds
Medications (e.g., Lithium)
Radioactive iodine (131I)
Therapy for hyperthyroidism
Thyroidectomy
48
Hypothyroidism
Deficiency of Thyroid Hormone (TH)
Slowed body metabolism
Decreased heat production
Decreased oxygen consumption by the tissues
49
Primary Hypothyroidism
Autoimmune thyroiditis - Hashimoto Disease
95% of cases
50
Secondary Hypothyroidism
Overtreatment of hyperthyroidism
Thyroidectomy
Radioactive iodine
51
Hypothyroid Manifestations
o Skin: dry, brittle
o Hair: dry and brittle
o Thickened secretions in my lungs
o Slow respirations
o Heart is going to be slower
o BP lower
o Psychologically depressed
o Apathetic
o Constipation
o Muscle aches and weakness
o Neurologically blah
o Metabolically: not metabolize things well
52
Myxedema
Elevated serum cholesterol
Rare life-threatening condition
Undiagnosed / under-treated patients
Stressors
53
Myxedema s/sx
hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive supportive and hemodynamic therapy if the patient is to survive.
54
Nursing Interventions of Hypothyroidism
Administer thyroid hormones
Provide stimulation
Monitor response to increased activity
Monitor for heat/cold intolerance
Monitor neurologic status
Monitor VS
Explain life-long therapy
55
Three hallmarks of Graves Disease
goiter, hyperthyroidism, exophthalmos
56
Medicaion for Hypothyroidism
Levothyroxine
57
Levothyroxine Considerations
o Major adverse effect if given at night: insomnia
o Give it first thing in the morning
o We want to prevent cardiac dysfunction and monitor EKG
o We want to prevent any medication interactions
o Administer the thyroid hormones
o You cannot switch back and forth between brand name or generic because of what they make the pills with
Synthroid is the name brand.
o Lifelong therapy
o Monitor lab levels
o Provide stimulation
58
Clinical Manifestations of Hyperthyroidism
o Skin: oily, hair loss
o Pulmonary
o Cardiovascular: high heart rate high BP
o Psychological: irritable, agitated, anxious restless
o Gastrointestinal: extremely high appetite (can eat 5000 calories a day), diarrhea
o Musculoskeletal: muscle wasting
o Neurological: on edge, premature osteoporosis
o Metabolic: heat intolerance
59
Complications of hyperthyroidism
o Exophthalmos: eye drops, tape them shut at night to protect them, keep HOB elevated, diuretics
Don’t go away after we correct hyperthyroidism until they do a surgical decompression
o Heart disease: high BP and high HR
Propranolol: asthma patients are contraindicated
60
Thyroid Storm
Fatal hyperthyroidism
s/sx: temp is greater than 101.3
HR: greater than 130
BP: high
Delirium and psychosis
61
Antithyroid medication
Propathyroid uracil: Blocks conversion of T4-T3
62
Thyroidectomy
o Removal of the thyroid
o They are now on levothyroxine for life
63
Nursing interventions for Hyperthyroidism
o Cardiac output
o Maintain a high calorie diet
o Watch weight daily (4.5lbs a day)
o High calorie high protein diet
o Watch body temperature
o Monitor s/sx of cardiac issues
64
Endemic Goiter
Enlargement of the thyroid gland due to lack of iodine
65
Nursing Interventions for someone getting thyroidectomy
o Pre op: lugals
o Post op: monitor for bleeding. HOB up because there will be swelling and trouble breathing. Stabilize the head with sandbags, check to the back of the head for bleeding
o Extreme swelling in the neck might require suction and a trach insertion kit
o Monitoring for complications
66
Parathyroid gland
Cites of actions for hormone: bones, kidneys and gut. Calcium is in the gut to neutralize acid. We are going to have a ton of acid in the gut if the parathyroid is accidentally taken out. Calcium is being pulled from bones, then our bones are going to get weak. Then the kidneys are not able to regulate all of the calcium in the blood
67
Hyperparathyroidism
if parathyroid is high in my blood, it is not in my gut or bones or kidneys. This means that the gut will have peptic ulcers, kidneys will develop stones, and then it will cause osteoporosis
68
Hyperparathyroid S/Sx
Anorexia
N/V
Constipation
Abdominal pain
Deep bone pain
Muscular weakness
Bone cysts/lesions
Bone fx
Elevated serum calcium levels and parathormone levels
Cardiac dysrhythmias
Renal calculi
Pyelonephritis
Peptic ulcer formation
Fatigue
Complications
69
Hypercalemic Crisis
Serum Calcium levels > 13 mg/dL
Need rapid hydration
Calcitonin promotes renal excretion
Bisphosphonates
Cytotoxic agents May need dialysis
70
Nursing Interventions for Hypercalcemia
Assess for s/sx renal calculi
VS
Strain the urine
Encourage fluid intake
Assist with ambulation
Limit fluids high in calcium
Provide cardiac monitoring
Medicate for bone pain
71
Hypocalcemia s/sx
Muscle Cramps
Mental changes
seizures
excessive muscle contractions
muscle cramps
72
Nursing Management of Hypocalcemia
Focus on correcting:
Hypocalcemia
Vitamin D deficiency
Hypomagnesemia
Give IV calcium gluconate
May need long-term therapy
Food high in Calcium and low in phosphorus
Medic alert bracelet
73
Adrenal Medulla
Part of Autonomic Nervous System
Secretes catecholamines
Regulate metabolic pathways
Fight-or-flight
74
Pheochromocytoma
Tumor of adrenal medulla (usually benign)
Equally common in women and men
Risk factors that stimulate a paroxysm of catecholamine release
Smoking
Micturition
Activities that displace abdominal organs
Drugs
W/O EARLY intervention at risk for cerebral hemorrhage & cardiac failure
75
Diagnosis of Pheochromocytoma
History and physical
24-hour urine for vanillylmandelic acid (VMA)
Plasma catecholamine levels
MRI/CT
76
Clinical Manifestations of Pheochromocytoma
Hyperglycemia
*HTN with pounding headaches
Headache
Hyperthyroidism
Tachycardia
Nausea / vomiting
Increased basic metabolic rate
Hyperglycemia / glucosuria
Increased urinary catecholamines
77
5 H's of Pheochromocytoma
Hypertension
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia
78
Addison’s Disease
Idiopathic atrophy or destruction
Hypofunction
Autoimmune process
Adrenalectomy
79
Addison's risk factors
History of endocrine disorders
Sudden stopping of glucocorticoids
Taking glucocorticoids > once every other day
Adrenalectomy
Tuberculosis
80
Addison’s Disease: Clinical Manifestations
Slow insidious onset
Fatigue
Irritability
Weight loss
Nausea/vomiting
Postural hypotension
Symptoms worsen as disease progresses and 90% of adrenal cortices are lost
81
Addison’s Disease: Diagnosis
Blood and urine hormonal assays
Serum cortisol
Plasma ACTH
Serum electrolytes
Blood glucose
CBC
CT / MRI
82
Nursing Management
Assessing patient
Monitor and manage for Addisonian crisis
Restore Fluid Balance
Improving Activity Tolerance
83
Medical Management of Addisons
Combating circulatory shock
Restoring circulation
Administering fluids / corticosteroids
Monitor VS
Place patient lying down with legs elevated
84
Addisonian Crisis
Sudden penetrating pain in back, abdomen, or legs
Depressed or changed mental status
Volume depletion
Hypotension
Loss of consciousness
Shock
Hypoglycemia
85
Cushing’s Syndrome
Most common cause
Long-term use of corticosteroids
Over-activity of adrenal cortex
Tumor of pituitary producing too much ACTH
86
Cushing’s Syndrome: Clinical Manifestations
Moon face
Buffalo hump
Truncal obesity
Weight gain
Malaise/weakness
Mood swings
Hyperglycemia (steroid diabetes)
Hypercalcemia
Hypokalemia
Abnormal fat distribution
87
Cushing’s Syndrome: Diagnostics
Labs
Plasma cortisol levels
Blood glucose & serum Na+
↑WBC, but ↓eosinophil and lymphocyte counts
Urinary free cortisol measurement
Low dose dexamethasone suppression tests
X-rays, CT scans, MRI
Arteriography
Overnight dexamethasone suppression test
88
Cushing’s: Medical Management
Adrenal enzyme inhibitors
ketoconazole
ACTH-reducing agents: cyproheptadine (Periactin) or somatostatin
89
Bilateral adrenalectomy
lifelong glucocorticoid & mineralocorticoid replacement
to treat cushings
