Chap 52: Endocrine Disorders

Question 1

what is a hypophysectomy, its surgical complications?

Answer 1

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.

Question 2

What are the specific nursing interventions for a patient who has undergone a hypophysectomy?

Answer 2

1. hourly neuro checks-24hrs then q4h. (mental status, pupils, vision, strength, including reflexes)
2. STRICT I & O
3. No coughing, tooth brushing, sneezing, bending at waist.
4. Monitor for CSF discharge from nose.
5. Monitor for DI or SIADH

Question 3

What does the antidiuretic hormone do? What happens with hypo ADH levels? ?S/S and Rx

Answer 3

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.

Question 4

What causes hyperpituitarism

Answer 4

hypersecretion of growth hormone or adrenocorticotropic hormones. Causes may include: pituitary tumor, hypothalamus trauma, radiation, vascular lesion, disease of hypothyroidism.

Question 5

what are the S/S of hyperpituitarism?

Answer 5

Extreme weight loss, SIADH, Cushing’s Syndrome, Emaciation, galactorrhea, prolactinoma, acromegaly (adults), and gigantism (kids).

Question 6

how is hyperpituitarism diagnosed and treated?

Answer 6

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

Question 7

What is hypopituitarism and its causes?

Answer 7

Hypopituitarism is the under secretion/release of pituitary hormones. Causes: tumor, disease, hypothalmic disease, trauma, surgery, destruction of pituitary gland.

Question 8

what are the S/S of hypopituitarism?

Answer 8

S/S: weight gain, lethargy, atrophy of all endorcine glands and organs, hair loss, impotence, hypometabolism, hypoglycemia

Question 9

What is the Dx and Rx for hypopituitarism?

Answer 9

Dx: history and physical, visual acuity fields, CT, MRI, serum levels.
Rx: Replace hormone, surgery

Question 10

what are the results of hyperpituitarism:

Answer 10

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

Question 11

what are the results of hypopituitarism?

Answer 11

GH: dwarfism, ACTH: Addison’s, TSH: low thyroid, FSH: low estrogen, testosterone, LH: low progesterone, testosterone, Prolactin: low breast milk, ADH: DI,

Question 12

What are the causes and S/S of hypo ADH

Answer 12

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.

Question 13

how is too little ADH diagnosed and treated?

Answer 13

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.

Question 14

What is the cause and S/S of too much ADH: SIADH?

Answer 14

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

Question 15

How is SIADH diagnosed and treated?

Answer 15

Dx: Fluid retentioin, hyponatremia (unknown cause)
Rx; Stop cause, restrict fluids, may use HYPERtonic saline solution.

Low Na: seizures

Question 16

What is hypothyroidism caused by? What are the S/S

Answer 16

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

Question 17

how is hypothyroid diagnosed and treated:

Answer 17

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,

Question 18

what are the s/s of Myxedema? causes

Answer 18

decreased temp, hr, bp, rr, tissue perfusion

causes: acute illnes/infection, surgery, anesthesia, hypothermia (pt with hashimotos)

Question 19

What are the causes and s/s of HYPER thyroidism?

Answer 19

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

Question 20

How is hyperthyroidism Dx and Rx

Answer 20

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

Question 21

What are the s/s of Thyroid Storm?

Answer 21

Causes: stress, surgery, trauma, MI, PE, infection

S/S: agitation, delirium, fever, tachycardia

Question 22

what are increased risks for untreated hypothyroidism

Answer 22

increased pulm/card. risk, atherosclerosis, poor left vent function, pleural and pericardial effusions

Question 23

what are surgical complications for patients who have hypothyroidism

Answer 23

hypotension, regulating body temp, prob. with sedation/anesthesia, post op heart failure, alt. mental status, myxedema coma.

Question 24

patients who are treated with RAI need to avoid:

Answer 24

pregnant women, nursing mothers, children: time, distance, and space

Question 25

what are some extra precautions for patients who have RAI therapy

Answer 25

separate linens/utensils, rinse sink/tub X 3, increase water, flush X 3.

Question 26

What is Addison’s disease, S/S

Answer 26

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

Question 27

What is the difference between primary and secondary adrenal insufficiency

Answer 27

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

Question 28

what are some causes for Addison’s disease

Answer 28

TB, histoplasmosis, abrupt cessation after long term >2weeks of glucocorticoids (steroids)

Question 29

What are S/S and causes for Addisonian Crisis

Answer 29

S/S: severe headache, profound fatigue, hypotension, dehydration, hyponatremia, hyperkalemia,

Causes: overexertion, stress, decreased salt intake

Question 30

what is Cushing’s Disease? what are some causes

Answer 30

Metabolic disorder in which there is hypersecretion of ACTH.
Causes: ant. pit oversecretion of ACTH, adrenal adenoma, glucocorticoid excess (meds)

Question 31

What is the difference between Cushing’s Disease and Cushing’s Syndrome?

Answer 31

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

Question 32

how is Addison’s Dx and Rx?

Answer 32

Dx: admin of ACTH stimulation test. Cortisol levels do not increase.
Rx: steroids, salt intake, prevent dehydration

Question 33

how is Cushing’s DX and Rx

Answer 33

Dx: Dexamethasone suppression test: High cortisol and low ACTH=adrenal disease
high ACTH + cortisol= pit or hypothalmic dsyfunction
Rx: radiation, surgery, adrenal enzyme inhibitors

Question 34

What are the S/S of Cushings:

Answer 34

S/S: skin striae, hirsuitism, balding, hypervolemia, edema, decrease in muscle mass, osteoporosis, mood swings, sleep difficulties, decreased WBC,
Labs: Hypernatremia, Hyperglycemia, Hypokalemia, Hypocalcemia

Question 35

What are the causes of hypoparathyroidism

Answer 35

injuries during thyroid/neck surgery, RAI treatment

Question 36

What are the S/S of hypoparathyroidism

Answer 36

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

Question 37

what is the Dx and Rx for hypothyroidism

Answer 37

Dx: blood levels of Ca and PTH
Rx: Calcium and active Vit. D

Question 38

What are the causes of hyperparathyroidism

Answer 38

Primary: adenoma, Secondary: hyperplasia w/increased PTH to compensate for prolonged hypocalcemia. Tertiary: continuous stimulation

Question 39

What are the S/S of hyperparathyroidism

Answer 39

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

Question 40

what is the Rx of hyperparathyroidism

Answer 40

NS, diuretics, phosphates, dialysis, calcitonin

Question 41

nursing interventions for hyperparathyroidism

Answer 41

increase hydration, water, walk, avoid HCTZ, treat depression