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NU 340 > Ch. 54 > Flashcards

Ch. 54 Flashcards

1
Q

major endocrine glands

A
  • hypothalamus
  • pituitary
  • thyroid
  • parathyroid
  • pancreas
  • adrenals
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2
Q

hypothalamus: location

A

lower middle of the brain

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3
Q

hypothalamus: function

A
  • link between endocrine and nervous system
  • “master” gland that stimulates pituitary
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4
Q

hypothalamus: selected hormones

A
  • corticotropin-releasing hormone
  • growth hormone- releasing hormone
  • vasopressin (ADH)
  • thyrotropin-releasing hormone
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5
Q

pituitary: location

A

below the hypothalamus

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6
Q

pituitary: function

A
  • also called a master gland or “executive” hypothalamus
  • anterior or posterior pituitary are different; both are connected to the hypothalamus
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7
Q

pituitary: selected hormones

A
  • anterior pituitary: TSH
  • ## adrenocorticotropic hormone (ACTH)
  • posterior pituitary: vasopressin
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8
Q

thyroid: location

A

in front and to the sides of the trachea

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9
Q

thyroid: function

A
  • controls metabolic rate- how fast cells create energy from food
  • helps regulate calcium
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10
Q

thyroid: selected hormones

A
  • thyroxine (T4)
  • triiodothyronine (T3), Calcitonin
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11
Q

parathyroid: location

A

behind or next to the thyroid

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12
Q

parathyroid: function

A

regulates blood calcium

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13
Q

parathyroid: selected hormones

A

parathyroid hormone (PTH)

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14
Q

pancreas: location

A

behind the stomach

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15
Q

pancreas: function

A

controls glucose levels and produces digestive enzymes

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16
Q

pancreas: selected hormones

A
  • insulin
  • glucagon
  • somatostatin
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17
Q

adrenals: location

A

on top of each kidney

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18
Q

adrenals: function

A

medulla: fight-or-flight response; blood pressure regulation

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19
Q

adrenals: selected hormones

A
  • glucocorticoids (cortisol)
  • mineralocorticoids (aldosterone)
  • ## androgens (testosterone)
  • adrenalin (epinephrine)
  • noradrenalin
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20
Q

anterior pituitary hormones

A
  • Adrenocorticotropic (ACTH)
  • Thyroid-stimulating (TSH)
  • Growth hormone
  • Gonadotropic hormones
    -Follicle-stimulating (FSH)
    -Lutenizing (LH)
    -Prolactin
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21
Q

posterior pituitary hormones

A
  • oxytocin
  • ADH (vasopressin)
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22
Q

Arginine Vasopressin Deficiency/Resistance
(AVP-D or AVP-R) aka Diabetes Insipidus

A
  • Posterior pituitary does not secrete ADH, so kidneys start excreting more water and ECF decreases to the point of shock.
  • OR—inability of kidney to respond to ADH (as in drug induced)
    Blood becomes concentrated and urine output increases and it is very dilute
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23
Q

primary AVP-D

A

(neurogenic) disorder in pituitary or hypothalamus
- e.g. tumor

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24
Q

secondary AVP-D is caused by

A

(neurogenic) craniotomy, trauma, or surgery
- e.g. skull trauma, CVA can get AVP-D or SIADH

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25
Q

drug induced AVP-R

A

i.e. lithium, alcohol, general anesthesia interfere with kidney’s response to ADH

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26
Q

s/sx of AVP-D or AVP-R

A

Urine output >4L in 24 hours(polyuria)
Sudden onset thirst(polydipsia)
Dehydration (because of excess UO)
Hypotension and tachycardia (hypovolemia)
Changes in LOC: lethargy to possible coma
Vision changes
Weight loss
Headache

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27
Q

AVP-D or AVP-R: labs

A
  • *Serum Na+ ↑ (blood is concentrated)
  • *urine Na+ ↓ (dilute urine)
  • *Specific Gravity ↓ (dilute urine)
  • Hematocrit and hemoglobin↑
  • BUN↑
  • Serum vasopressin↓ (ADH- AP isnt producing enough: cause of AVP-D)
28
Q

AVP-D or AVP-R: interventions

A
  • Administer ADH like medications- Desmopressin acetate or vasopressin (works to decrease UO; increase USG)
  • Maintain fluid volume
  • Monitor I&O
  • Assess VS
  • Daily Weight
  • Check labs (electrolytes)
  • Encourage PO fluids
29
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A
  • Too much ADH is produced resulting in FVE
  • ECF becomes very dilute due to water retention resulting in hyponatremia
30
Q

causes of SIADH

A
  • Drugs increase action or production of ADH; e.g. morphine, metoclopramide, anti-depressants
  • Tumors in lungs, pancreas, prostate, brain secrete ADH or vasopressin like substance
  • Infections –meningitis, encephalitis can affect pituitary
  • Head injury affecting pituitary
  • Cancer in kidney decreasing response to ADH
31
Q

s/sx of SIADH

A

Decreased urine output
Hyponatremia
HTN, tachycardia
↓hematocrit, serum Na+, BUN
Weight gain and edema
Altered LOC because brain doesn’t like low Na+

32
Q

SIADH labs

A
  • Serum Na+ ↓
  • Urine Na ↑
  • ADH ↑
33
Q

SIADH interventions

A

Treat underlying cause (stop drugs, treat infection)
Diuretics
Hypertonic saline (to treat low serum Na, increase IV FV)
Fluid restriction
Monitor daily weights
Monitor I&O

34
Q

pathophysiology of adrenal glands

A
  • Two adrenal glands sit on top of the kidneys
  • Pituitary secretes ACTH which stimulates adrenal glands to release hormones.
35
Q

adrenal medulla is the ___ layer

A

inner layer of the kidneys

36
Q

adrenal cortex is the __ layer

A

outer layer of the kidneys

37
Q

adrenal medulla hormones

A
  • epinephrine and norepinephrine (fight or flight)
38
Q

adrenal cortex hormones

A
  • Glucocorticoids (cortisol)
  • Mineralocorticoids (aldosterone)
  • Sex hormones (testosterone, estradiol, progesterone)
39
Q

glucocorticoids (cortisol): fx

A
  • Essential for life
  • Stimulate gluconeogenesis (production of cortisol in the liver)
  • Provide amino acids and glucose during stress
  • Suppress immune system and anti-inflammatory properties
  • Stimulate fat breakdown
40
Q

causes of increased cortisol

A

Trauma, burns, infection, shock, pain, fear, emotional upset, hypoxia, exercise

41
Q

mineralcorticoids (aldosterone)

A

Control body sodium and potassium content
- Promotes Na and H2O reabsorption and potassium excretion in renal tubules

42
Q

major adrenal cortex diseases

A
  • addison’s diseas
  • cushing’s disease
43
Q

addison’s disease

A
  • not enough steroids
44
Q

cushing’s disease

A
  • too many steroids
45
Q

adrenal gland hypofunction

A

Adrenocortical steroids may decrease from inadequate secretion of ACTH.
Dysfunction of hypothalamic-pituitary control mechanism
Direct dysfunction of adrenal tissue
Addisonian crisis vs. Addison’s disease

46
Q

addisonian crisis: definition, sx, treatment

A

someone with Addison’s who is not adequately controlled
(not enough cortisol or aldosterone)

s/sx
- severe hypotension (ie 70/40)
- severe hypoglycemia
- hypovolemic

RX: rapid infusion of IV fluids (ie 500mL/hr); IV glucose (dextrose), IV steroids (corticosteroid)

47
Q

addison’s disease

A
  • not enough steroids- cortisol, aldosterone
48
Q

causes of addison’s disease

A

primary:
- Autoimmune antibodies attack adrenal tissue
- metastatic cancer
secondary:
pituitary tumors
Hypopituitarism if pituitary isn’t working can’t trigger adrenals
Sudden withdrawal of steroid medication (tapering medication of chronic steroid causes addison’s)

49
Q

s/sx of addison’s disease

A
  • bronzing pigmentation of the skin
  • vascular collapse
  • hyperkalemia
  • hyponatremia
  • hypoglycemia
  • hypotension
  • GI involvement
  • progressive weakness
  • confusion
  • apathy
  • psychosis
50
Q

treatment of addison’s disease

A

IVFs
Monitor for arrhythmias due to hyperkalemia
Correct hyperkalemia
IV glucocorticoids or mineralocorticoids

51
Q

addison’s disease labs

A

Serum cortisol level <10 µg/dL in the morning
Urine decreased corticosteroid concentrations
Serum Na+ (low) and K+ levels (high)
Blood glucose (low)
Serum ACTH –depends on cause

52
Q

addison’s crisis sx/tx

A

Hypotension, shock, coma
- Requires rapid fluid and steroid replacement

53
Q

adrenal gland hypofunction: goals

A

Promote fluid balance
Monitor for fluid deficit
Prevent hypoglycemia

54
Q

addison’s disease: teaching for steroids

A

Take with food
Never stop taking abruptly
Watch for weight gain
Increase dose in times of stress
Anticoagulants and insulin decrease
effectiveness
will take this medication for life

55
Q

addison’s disease: diet

A

intervention to treat low Na+ and high K+
- follow a high salt diet (french fries, hot dogs, chicken nuggets)
- avoid foods high in potassium (bananas, leafy greens, citrus)

56
Q

addison’s disease: interventions

A
  • teaching for steroids
  • diet
  • steroid use makes you more susceptible to infection
57
Q

adrenal gland hyperfunction

A
  • hypersecretion by adrenal cortex results in Cushing’s syndrome/disease, hypercortisolism, or excessive androgen production.
58
Q

hypercortisolism (cushing’s disease): causes

A

Caused by an excess of cortisol
Can be caused by drug therapy for another health problem
pituitary or adrenal tumor

59
Q

s/sx of cushing’s disease

A

Mood changes (depression, euphoria, irritability)
Skinny arms and legs
Muscle weakness
Poor wound healing
Buffalo hump (posterior neck fat pad) and truncal obesity (thin arms and legs)
Hyperglycemia and Glycosuria
Osteoporosis
Fluid volume excess
HTN
Hypokalemia
Sodium imbalances
Voice deepening, beard growth, menstrual irregularities, thinning hair, ruddy complexion

60
Q

hypercortisolism (cushing’s disease): incidence and prevalence

A

Most common non-drug cause – pituitary adenoma
Women are affected more than men
More commonly caused by exogenous corticosteroids

61
Q

cushing’s manifestations

A
  • pear-shape (gynecomastia), truncal obesity, skinny legs and arms
  • edema, no spots
  • slow wound healing
  • moon-face
  • higher risk for osteoporosis
62
Q

cushing’s labs

A

Serum cortisol (high)
Serum ACTH (depends on the cause)
High Na, Low K
High blood sugar

63
Q

cushing’s treatment

A

Depends on cause- need to reduce cortisol levels
- pituitary adenoma: remove tumor
- steroids: decrease dose

64
Q

cushing’s interventions

A

Daily weights
I&O
VS
Assess for hypervolemia s/sx
Restrict fluids and Na in diet
Monitor blood sugar
Help patient cope with body image (psychosocial)

65
Q

cushing’s evaluation

A

Maintain fluid and electrolyte balance
Remain free from injury
Remain free from infection
Not experience acute adrenal insufficiency

66
Q

ADH

A

antidiuretic hormone
- fluid volume balance

NU 340 (26 decks)

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