Chap 52: Endocrine Disorders Flashcards
what is a hypophysectomy, its surgical complications?
Removal of the pituitary gland. Surgical complications include: risk for increased ICP, potential for adrenal insufficiency, risk for altered fluid and electrolyte imbalance: r/t reduced ADH, secondary adrenal insufficiency: low Na, high K, Ca, and BUN.
What are the specific nursing interventions for a patient who has undergone a hypophysectomy?
- hourly neuro checks-24hrs then q4h. (mental status, pupils, vision, strength, including reflexes)
- STRICT I & O
- No coughing, tooth brushing, sneezing, bending at waist.
- Monitor for CSF discharge from nose.
- Monitor for DI or SIADH
What does the antidiuretic hormone do? What happens with hypo ADH levels? ?S/S and Rx
ADH: controls full body water.
Hypo S/S: high Na, Excessive urine output, extreme thirst, high K, acidosis
Rx: Central: Admin of DDAVP, (monit for S-T changes)
Renal: thiazide diuretics prostaglandin inhibitors: ibuprofen, indomethacin, and salt depletion.
What causes hyperpituitarism
hypersecretion of growth hormone or adrenocorticotropic hormones. Causes may include: pituitary tumor, hypothalamus trauma, radiation, vascular lesion, disease of hypothyroidism.
what are the S/S of hyperpituitarism?
Extreme weight loss, SIADH, Cushing’s Syndrome, Emaciation, galactorrhea, prolactinoma, acromegaly (adults), and gigantism (kids).
how is hyperpituitarism diagnosed and treated?
Diagnosed: blood tests, urine tests, high dose dexamethasone, suppression test, MRI, CT, OGTT, (normal: GH levels go down after drinking glucose) visual acuity, P/E. Rx: surgery, medication to shrink tumor, decrease prolactin levels, Bromocriptine, cabergoline (dopamine agonists), radiation
What is hypopituitarism and its causes?
Hypopituitarism is the under secretion/release of pituitary hormones. Causes: tumor, disease, hypothalmic disease, trauma, surgery, destruction of pituitary gland.
what are the S/S of hypopituitarism?
S/S: weight gain, lethargy, atrophy of all endorcine glands and organs, hair loss, impotence, hypometabolism, hypoglycemia
What is the Dx and Rx for hypopituitarism?
Dx: history and physical, visual acuity fields, CT, MRI, serum levels.
Rx: Replace hormone, surgery
what are the results of hyperpituitarism:
GH: Acromegaly, Gigantism ACTH: Cushing’s Syndrome,, Prolactin: galactorrhea, prolactinoma, ADH: SIADH, TSH: hyperactive thyroid, FSH: excess of sex hormones, LH: excess of sex hormones. Oxytocin: uterine contractions
what are the results of hypopituitarism?
GH: dwarfism, ACTH: Addison’s, TSH: low thyroid, FSH: low estrogen, testosterone, LH: low progesterone, testosterone, Prolactin: low breast milk, ADH: DI,
What are the causes and S/S of hypo ADH
Causes: primary: hypothalamus, posterior pit, deficit, Secondary: tumor, infection, brain injury, brain infarct.
S/S: full body dehydration, intense thirst DI, Increased Na, Increased urinary output, increased water loss.
how is too little ADH diagnosed and treated?
Dx: Labs, I&O, weight changes, decrease in specific gravity, decrease in urine osmolarity= <200mOsm/kg UO: >4L/24hr.
Rx: Central: DDAVP, Mon: S-T changes
Renal: Thiazide diuretics, prostaglandin inhibitors: ibuprofen, indomethacin, and salt depletion.
What is the cause and S/S of too much ADH: SIADH?
Cause: malignant tumors, lung cancer, increased doses nicotine. Tricylics and thiazides may trigger SIADH.
S/S: Water retention, I > O, weight gain, dilutional hyponatremia, low serum Na.
Monitor fluids, neuro, V/S, mucous membranes
How is SIADH diagnosed and treated?
Dx: Fluid retentioin, hyponatremia (unknown cause)
Rx; Stop cause, restrict fluids, may use HYPERtonic saline solution.
Low Na: seizures
What is hypothyroidism caused by? What are the S/S
causes: usually r/t autoimmune, thyroiditis, AB that cause hashimotos.
S/S: fatigue, hair loss, brittle nails, hoarseness, husky voice, thickened skin, slowed speech and mental acuity. MYXEDEMA: severe hypothyroidism
how is hypothyroid diagnosed and treated:
Dx: CRT, US, biopsy, TSH, (after injection; large response= hypothyroidism). Too little uptake of RAI.
Increase in TSH, Decrease in T3 and T4
Rx: Thyroid replacement, emergent Rx of hypoxia, rewarming, Rx of BP/HR,
what are the s/s of Myxedema? causes
decreased temp, hr, bp, rr, tissue perfusion
causes: acute illnes/infection, surgery, anesthesia, hypothermia (pt with hashimotos)
What are the causes and s/s of HYPER thyroidism?
Causes: t/t Graves disease, toxic nodules, thyroiditis.
S/S: tachy, weight loss, sleeplessness, anxiety, heat intolerance, hair changes, diarrhea, decreased menses, weakness, exopthalmos, goiter
How is hyperthyroidism Dx and Rx
Dx: thyroid scan, thyroid antibodies, overproduction of T3, US, needle biopsy, CRT, RAI: excessive take up of RAI
Blood: decrease in TSH, increases in T3 and T4
Rx: monitor dysrhythmias, oxygen, give NS, steroids (IV and high dose), Thyroid hormone blockers: PTU, Iodine, decrease temp. AVOID ASPIRIN
What are the s/s of Thyroid Storm?
Causes: stress, surgery, trauma, MI, PE, infection
S/S: agitation, delirium, fever, tachycardia
what are increased risks for untreated hypothyroidism
increased pulm/card. risk, atherosclerosis, poor left vent function, pleural and pericardial effusions
what are surgical complications for patients who have hypothyroidism
hypotension, regulating body temp, prob. with sedation/anesthesia, post op heart failure, alt. mental status, myxedema coma.
patients who are treated with RAI need to avoid:
pregnant women, nursing mothers, children: time, distance, and space
what are some extra precautions for patients who have RAI therapy
separate linens/utensils, rinse sink/tub X 3, increase water, flush X 3.
What is Addison’s disease, S/S
Addison’s disease: hyposecretion of adrenal cortex hormones: glucocorticoids and mineralcorticoids cortisol, aldosterone,
S/S: bronze skin, hyponatremia, hypoglycemia, HYPERcalcemia, HYPERkalemia, lethargy, fatigue, weight loss, GI disturb. hypotension, menses/impotence
What is the difference between primary and secondary adrenal insufficiency
Primary: the problem is within the adrenal cortex, Hyperkalemia, met. acidosis, low Na, low BP, hypoglycemia, pigmentation is affected
Secondary: pituitary gland is not secreting enough ACTH S/S: met. alkalosis, high Na, high BP, increase in testosterone, hypoglycermia, K is ok. No pigmentation issues, no increase in testosterone
what are some causes for Addison’s disease
TB, histoplasmosis, abrupt cessation after long term >2weeks of glucocorticoids (steroids)
What are S/S and causes for Addisonian Crisis
S/S: severe headache, profound fatigue, hypotension, dehydration, hyponatremia, hyperkalemia,
Causes: overexertion, stress, decreased salt intake
what is Cushing’s Disease? what are some causes
Metabolic disorder in which there is hypersecretion of ACTH.
Causes: ant. pit oversecretion of ACTH, adrenal adenoma, glucocorticoid excess (meds)
What is the difference between Cushing’s Disease and Cushing’s Syndrome?
Cushing’s Disease: met disorder in which the hypersecretion of ACTH from the pituitary. Etiology may pit tumor.
Cushing’s Syndrome: met. disorder in which the hypersecretion is from the Adrenal cortex, and is usually the result of abrupt cessation of glucocorticoids
how is Addison’s Dx and Rx?
Dx: admin of ACTH stimulation test. Cortisol levels do not increase.
Rx: steroids, salt intake, prevent dehydration
how is Cushing’s DX and Rx
Dx: Dexamethasone suppression test: High cortisol and low ACTH=adrenal disease
high ACTH + cortisol= pit or hypothalmic dsyfunction
Rx: radiation, surgery, adrenal enzyme inhibitors
What are the S/S of Cushings:
S/S: skin striae, hirsuitism, balding, hypervolemia, edema, decrease in muscle mass, osteoporosis, mood swings, sleep difficulties, decreased WBC,
Labs: Hypernatremia, Hyperglycemia, Hypokalemia, Hypocalcemia
What are the causes of hypoparathyroidism
injuries during thyroid/neck surgery, RAI treatment
What are the S/S of hypoparathyroidism
cardiovascular: prolonged Q-T, increased risk of dysrhythmias
Neuromuscular: numbness, tingling of extremities, muscle cramping, tetany, bronchospasm, laryngospasm, brain fog, anxiety, depression, fatigue, irritability, memory loss, seizures
High phosphate/low calcium, normal Na
what is the Dx and Rx for hypothyroidism
Dx: blood levels of Ca and PTH
Rx: Calcium and active Vit. D
What are the causes of hyperparathyroidism
Primary: adenoma, Secondary: hyperplasia w/increased PTH to compensate for prolonged hypocalcemia. Tertiary: continuous stimulation
What are the S/S of hyperparathyroidism
S/S: hypercalcemia, polyuria, lethargy, anorexia, polydipsia, nausea, constipation, low phosphate
Bones, Stones, Moans, and Groans: osteoporosi, kidney stones, depression, and constipation, anorexia, and nausea
what is the Rx of hyperparathyroidism
NS, diuretics, phosphates, dialysis, calcitonin
nursing interventions for hyperparathyroidism
increase hydration, water, walk, avoid HCTZ, treat depression
