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PNC 104 lecture > Chapter 39: nursing care of patients with disorders of the endocrine system > Flashcards

Chapter 39: nursing care of patients with disorders of the endocrine system Flashcards

1
Q

endocrine disorders: too much or too little hormone activity

A
  • production/secretion
  • tissue sensitivity

may be primary or secondary disorder

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2
Q

diabetes insipitus (DI)

A
  • too little antidiuretic hormone l eads to increased urine output and syndrome of inappropriate ADH (SIADH)
  • too much ADH: decreased urine output
    DI=”dry inside”
    SIADH = “soaked inside”
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3
Q

pathophysiology of DI

A
  • insufficient ADH
  • kidneys do not reabsorb water
  • diurese 3-15 liters per day
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4
Q

causes of diabetes insipidus

A
  • pituitary tumor
  • head trauma
  • surgery
  • drugs
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5
Q

signs and symptoms of DI

A
  • polyuria
  • polydipsia
  • nocturia
  • dilute urine
  • dehydration
  • hypovolemic shock
  • decreased LOC
  • death
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6
Q

diagnostic tests for DI

A
  • urine specific gravity <1.005
  • plasma osmolality increased
  • ct scan or MRI for cause
  • water deprivation test
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7
Q

therapeutic interventions for DI

A
  • hypotonic IV fluids
  • hypophysectomy if tumor
  • IV or SQ vasopressin
  • DDAVP (synthetic vasopressin)
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8
Q

nursing dianosis for DI

A
  • “deficient fluid volume related to failure of regulatory mechanisms”
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9
Q

expected outcome for a patient with DI as their nurse

A
  • patients fluid balance maintained as evidenced by urine specific gravity between 1.005 and 1.03, skin turgor WNL, stable daily weight
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10
Q

pathophysiology of SIADH

A
  • too much ADH
  • water retention
  • hyponatremia
  • decreased serum osmolality
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11
Q

causes of SIADH

A
  • nervous system disorders
  • cancer
  • pulmonary diseases
  • medications that stimulate ADH release
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12
Q

signs and symptoms of SIADH

A
  • weight gain without edema
  • dilutional hyponatremia <135 milliequivalents per liter
  • serum osmolality <275 milliosmoles per kg
  • concentrated urine >1.03
  • muscle cramps and weakness
  • brain swelling, seizures, death
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13
Q

diagnostic tests for SIADH

A
  • serum/urine sodium
  • serum/urine osmolality
  • ct scan or MRI for underlying cause
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14
Q

therapeutic interventions for SIADH

A
  • eliminate cause
  • surgical removal of tumor
  • fluid restriction
  • hypertonic saline IV
  • furosemide (Lasix)
  • conivaptan (vaprisol)
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15
Q

nursing diagnoses for SIADH

A
  • “excess fluid volume related to compromised regulatory mechanism”
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16
Q

expected patient outcome

A
  • patients fluid balance maintained as evidenced by weight, intake and output, serum sodium within normal limits
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17
Q

pathophysiology of growth hormone deficiency

A
  • deficient growth hormone in childhood
  • growth not affected in adults
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18
Q

causes of growth hormone deficiency

A
  • pituitary tumor
  • heredity
  • psychosocial
  • malnutrition
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19
Q

signs and symptoms of growth hormone deficiency

A
  • grow only to 3-4 feet (5th percentile)
  • slowed sexual maturation
  • may have cognitive disabilities
  • other symptoms depend on other pituitary hormones involved
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20
Q

signs and symptoms of growth hormone deficiency in adults

A
  • fatigue, weakness
  • excess body fat
  • hypercholesterolemia
  • decreased muscle and bone mass
  • sexual dysfunction
  • risk for cardiovascular disease
  • risk for cerebrovascular disease
  • decreased quality of life
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21
Q

diagnostic tests for growth hormone deficiency

A
  • gh level
  • gh response to induced hypoglycemia
  • MRI for tumor
  • x rays
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22
Q

therapeutic interventions for growth hormone deficiency

A
  • synthetic GH administered SQ or IM: somatrophin (humatrope)
  • surgery if tumor
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23
Q

nursing diagnosis for growth hormone deficiency

A

“ineffective health management related to knowledge deficit”

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24
Q

expected patient outcomes with growth hormone deficiency

A
  • patient will have necessary knowledge to manage self care as evidenced by statement and demonstration of self care activities
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25
Q

pathophysiology of acromegaly

A
  • excess gh in adults
  • bones grow in width, not length
  • organs and connective tissues enlarge
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26
Q

causes of acromegaly

A
  • pituitary hyperplasias
  • pituitary tumor
  • hypothalamic dysfunction
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27
Q

signs and symptoms of acromegaly

A
  • change in shoe or ring size
  • nose, jaw, brow enlarge
  • teeth may be displaced
  • difficulty speaking and swallowing
  • sleep apnea
  • headaches, visual changes
  • diabetes mellitus
  • arthritis
  • sexual dysfunction
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28
Q

diagnosis for acromegaly is determined by

A
  • gh level
  • gh response to oral glucose
  • bone x rays
  • ct scans or MRI
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29
Q

therapeutic interventions for acromegaly

A
  • treat cause
  • hypophysectomy
  • medications to block GH
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30
Q

hypophysectomy

A

lifelong thyroid hormone (TH), steroid, sex hormone replacement
- removal of the pituitary gland
- minimally invasive endoscopic surgery
- baseline neurological assessment

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31
Q

preoperative care teaching for hypophysectomy

A
  • teach to avoid actions that increase pressure on surgical site: ex coughing, sneezing, straining
  • teach deep breathing exercises, incentive spirometry
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32
Q

postoperative care for hypophysectomy

A
  • neurological assessment
  • urine for specific gravity (risk for DI)
  • nasal packing and mustache dressing
  • no coughing, sneezing, blowing, straining, bending
  • report cerebrospinal fluid drainage
  • hormone replacement therapy w/ target hormones
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33
Q

patient education for a hypophysectomy

A
  • blow nose gently
  • take stool softeners and antitussives as needed
  • take care w/ brushing teeth
  • take hormones as prescribed
  • call if fever, drainage, frequent urination, thirst
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34
Q

thyroid hormone imbalances

A

hypothyroidism
hyperthyroidism

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35
Q

pathophysiology of hypothyroidism

A
  • TH deficiency
  • metabolic rate reduced
  • primary = not enough TH
  • secondary = not enough thyroid stimulating hormone (TSH)
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36
Q

cases of hypothyroidism

A
  • congenital
  • inflammatory
  • iodine deficiency
  • thyroidectomy
  • autoimmune (Hashimoto thyroiditis)
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37
Q

signs and symptoms of hypothyroidism

A
  • fatigue
  • bradycardia
  • constipation
  • mental dullness
  • cold intolerance
  • hypoventilation
  • dry skin and hair
  • weight gain
  • heart failure
  • hyperlipidemia
  • myxedema (swelling and thickening of skin, rare due to long untreated hypothyroidism where body cannot maintain homeostatis/multi organ system failure)
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38
Q

complications of hypothyroidism

A
  • myxedema coma
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39
Q

signs of myxedema coma

A
  • hypothermia
  • decreased vital signs and level of consciousness
  • respiratory failure
  • death
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40
Q

diagnostic tests for hypothyroidism

A
  • t3 and t4
  • TSH high in primary
  • TSH low in secondary
  • serum cholesterol and triglycerides
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41
Q

therapeutic interventions

A
  • levothyroxine
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42
Q

levothyroxine (synthroid)

A
  • hormone
  • maintain 0.1 to 0.2mg per day
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43
Q

therapeutic interventions for myxedema coma

A
  • hormone
  • monitor vital signs
  • warming blanket
  • mechanical ventilation
  • IV fluids
  • IV levothyroxine (Synthroid)
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44
Q

nursing diagnoses for hypothyroidism

A
  • activity intolerance
  • risk for impaired skin integrity
  • imbalanced nutrition
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45
Q

pathophysiology of hyperthyroidism

A
  • increased metabolic rate
  • increased beta receptors
  • primary: too much TH
  • secondary: to much TSH
46
Q

causes of hyperthyroidism

A
  • autoimmune (Graves disease)
  • multinodular goiter
  • toxic adenoma
  • thyroiditis
  • pituitary tumor (secondary)
  • synthroid overdose
47
Q

signs and symptoms of hyperthyroidism

A
  • hypermetabolic state
  • heat intolerance
  • increased appetite
  • weight loss
  • frequent stools
  • nervousness
  • tachycardia, palpitations
  • tremor
  • heart failure
  • warm, smooth skin
  • exophthalmos (Graves disease) - “bulging eyes”
48
Q

signs and symptoms of hyperthyroidism in elderly

A
  • heart failure
  • atrial fibrillation
  • fatigue
  • apathy
  • depression
49
Q

complications of hyperthyroidism

A
  • thyrotoxic crisis (thyroid storm)
50
Q

thyrotoxic crisis

A
  • tachycardia, hypertension
  • fever, dehydration
  • coma
  • death
51
Q

diagnostic tests for hyperthyroidism

A
  • elevated t3 and t4
  • TSH low in primary
  • TSH high in secondary
  • TRH stimulation test
  • thyroid stimulating immunoglobulin
  • CT scan or MRI if tumor suspected
52
Q

therapeutic interventions for hyperthyroidism

A
  • methimazole (tapazole)
  • beta blockers
  • radioactive iodine (131i or RAI)
  • thyroidectomy
53
Q

therapeutic interventions for thyrotoxic crisis

A
  • IV fluids
  • cooling blanket
  • beta blockers
  • acetaminophen (avoid aspirin***) for fever
  • oxygen
54
Q

nursing diagnoses for hyperthyroidism

A
  • hyperthermia
  • diarrhea
  • imbalanced nutrition
  • disturbed sleep pattern
  • anxiety
  • risk for injury
55
Q

nursing care of the patient receiving radioactive iodine in hospital

A
  • limit time spent w/ patient
  • glove and gown
  • avoid if pregnant
  • take precautions w/ urine, emesis, body fluids
  • double flush toilet
  • call radiation safety officer for emesis or incontinence
56
Q

nursing care of the patient receiving radioactive iodine at home

A
  • avoid close contact for a week
  • sleep alone
  • wash hands carefully after urinating
  • avoid oral contact
  • drink fluids
  • avoid pregnancy for at least a year
57
Q

pathophysiolgy of goiters

A
  • enlarged thyroid gland
  • elevated TSH
  • hyperplasia (increase in number of tissues in organ)
58
Q

causes of goiters

A
  • low TH
  • iodine deficiency
  • virus
  • genetic
  • goitrogens (compounds that can interfere w/ the thyroid’s ability to produce hormones)
59
Q

signs and symptoms of goiter

A
  • enlarged thyroid
  • ypothyroid or hyperthyroid, or euthyroid
  • dysphagia
  • difficulty breathing
60
Q

euthyroid

A

normal thyroid function

61
Q

diagnostic tests for goiter

A
  • thyroid scan
  • TSH, t3, t4
62
Q

therapeutic interventions for goiter

A
  • treat cause
  • avoid goitrogens: you can limit exposure by eating vegetables that are a variety of colors and including iodine-containing foods like seafood and shellfish. cruciferous vegetables to be avoided (broccoli, cabbage, cauliflower, etc)
  • treat hypothyroidism or hyperthyroidism
  • thyroidectomy if size causing symptoms
63
Q

nursing care for goiter

A
  • monitor breathing (stridor)
  • swallowing evaluation
  • dietary consultation
64
Q

tumor of the thyroid gland

A
  • usually benign
  • more common in women
65
Q

causes of cancer of the thyroid gland

A
  • hyperplasia
  • radiation
  • genetics
66
Q

signs and symptoms of the thyroid gland

A
  • hard painless nodule
  • dysphagia
  • dyspnea if obstruction
  • TH usually normal
67
Q

diagnostic tests for cancer of the thyroid gland

A
  • thyroid scan shows “cold spot”
  • biopsy
68
Q

therapeutic interventions for cancer of the thyroid gland

A
  • radioactive iodine
  • chemotherapy
  • thyroidectomy (partial or total)
69
Q

preoperative nursing care for thyroidectomy

A
  • monitor breathing and swallowing
  • assess nutrition status
  • monitor vital signs
  • administer iodine or antithyroid drugs to achieve euthyroid state
70
Q

teach postoperative care of thyroidectomy

A
  • gentle range of motion
  • support neck during position changes
  • incentive spirometer
71
Q

postoperative nursing diagnoses for thyroidectomy

A
  • ineffective airway clearance
  • risk for acute injury (tetany, thyrotoxic crisis)
  • acute pain
  • ineffective health management-
72
Q

complications of thyroidectomy

A
  • thyrotoxic crisis
  • tetany
73
Q

parathyroid hormone

A
  • hypoparathyroidism
  • hyperparathyroidism
74
Q

pathophysiology of hypoparathyroidism

A
  • decrease in parathyroid hormone (PTH)
  • calcium stays in bones
  • hypocalcemia
  • hyperphosphatemia
75
Q

causes of hyparathyroidism

A
  • heredity
  • accidental removal of parathyroids during thyroidectomy
76
Q

signs and symptoms of tetany

A
  • neuromuscular irritability
  • numbness and tingling of fingers and perioral area
  • muscle spasms
  • cardiac arrhythmias
77
Q

hypoparathyroidism signs and symptoms

A
  • positive chvostek sign
  • positive trousseau sign
78
Q
A
79
Q

diagnostic tests for hypoparathyroidism

A
  • PTH low
  • serum calcium low
  • positive chvostek sign
  • positive trousseau sign
80
Q

acute therapeutic interventios for hypoparathyroidism

A
  • IV calcium gluconate
81
Q

long term therapeutic interventions for hypoparathyroidism

A
  • oral calcium with vitamin D
82
Q

nursing diagnosis for hypoparathyroidism

A
  • risk for injury related to hypocalcemia and tetany
83
Q

pathophysiology of hyperparathyroidism

A
  • overactivity
  • increased pth
  • hypercalcemia
  • hypophosphatemia
84
Q

causes of hyperparathyroidism

A
  • parathyroid hyperplasia
  • benign parathyroid tumor
  • heredity
85
Q

signs and symptoms of hyperparathyroidism

A
  • fatigue
  • depression
  • confusion
  • nausea and vomiting
  • kidney stones
  • joint pain
  • pathological fractures
  • arrhythmias
  • coma
  • cardiac arrest
86
Q

diagnostic tests for hyperparathyroidism

A
  • serum calcium elevated
  • 24 hour urine for calcium
  • phosphate decreased
  • pth elevated
  • x rays for bone density
87
Q

therapeutic interventions for hyperparathyroidism

A
  • oral or IV fluids to diluate calcium
  • furosemide (lasix)
  • cinacalcet (sensipar)
  • calcitonin, alendronate
  • estrogen therapy (women)
  • parathyroidectomy
88
Q

nursing diagnosis for hyperparathyroidism

A
  • risk for injury (fracture, complications of hypercalcemia)
89
Q

pheochromocytoma

A
  • adrenal disorder
  • tumor of adrenal medulla
  • secretes epinephrine and norepinephrine
  • usually benign
  • hereditary or cause unknown
90
Q

signs and symptoms of pheochromocytoma: fight or flight

A
  • hypertension
  • tachycardia
  • palpitations
  • tremor
  • diaphoresis
  • anxiety
  • headache
  • vision changes
  • risk for stroke
  • risk for organ damage
91
Q

diagnostic tests for pheochromocytoma

A
  • 24 hour urine for metanephrines and VMA —> no caffeine or medications before test
  • CT scan or MRI to find tumor
92
Q

therapeutic interventions for pheochromocytoma

A
  • calcium channel blockers
  • alpha blockers
  • beta blockers
  • adrenalectomy
93
Q

hyposecretion in adrenal cortex hormone imbalance

A

addison disease

94
Q

hypersecretion in adrenal cortex hormone imbalance

A

cushing syndrome

95
Q

pathophysiology of addison disease

A
  • deficient cortisol. and/or aldosterone
  • and/or androgens
96
Q

causes of addison disease

A
  • autoimmune
  • AIDS
  • cancer
  • pituitary or hypothalamus problem
    **abrupt discontinuance of long term steroids
97
Q

signs and symptoms of addison disease

A
  • hypotension
  • sodium loss
  • potassium retention
  • hypoglycemia
  • weakness
  • fatigue
  • bronze skin
  • nausea and vomiting
98
Q

diagnostic tests for Addison disease

A
  • serum and urine cortisol level
  • blood glucose
  • electrolytes
  • blood urea nitrogen and hematrocrit levels
  • adrenocorticotropic hormone (ACTH) stimulation test
99
Q

complications of Addison disease: adrenal crisis

A
  • profound dehydration
  • hypotension
  • hypoglycemia
  • shock
  • coma
  • death
100
Q

therapeutic interventions for Addison disease

A
  • glucocorticoids and mineralocorticoids daily for life
  • double or triple in times of stress
  • high sodium diet
101
Q

nursing diagnoses for Addison disease

A
  • risk for deficient fluid volume
  • ineffective health management
102
Q

crisis prevention

A

never abruptly discontinue long term steroids!

103
Q

pathophysiology of cushing syndrome

A
  • excess adrenal cortex hormones
  • cortisol
  • aldosterone
  • androgens
104
Q

causes of cushing syndrome

A
  • hypersecretion of ACTH
  • hypersecretion of cortisol
  • prolonged use of exogenous glucocorticoids
105
Q

physical appearance signs and symptoms of cushing syndrome

A
  • thinning hair
  • red cheeks
  • fat pads
  • moon face
  • easy bruising
  • striae
  • pendulous abdomen
  • thin extremities
  • slow wound healing
  • osteoporosis/pathologic fractures
106
Q

signs and symptoms of cushing syndrome

A
  • salt and water retention
  • hypokalemia
  • thin, fragile string
  • acne
  • facial hair in women
  • amenorrhea
107
Q

diagnostic tests for cushing syndrome

A
  • based on appearance
  • plasma and urine cortisol
  • ACTH
  • dexamethasone suppression test
108
Q

therapeutic interventions for cushing syndrome

A
  • surgery if tumor
  • reduce dose of steroid
  • change schedule of administration
  • symptom control
  • diabetes treatment
  • low sodium, high potassium diet
109
Q

nursing diagnoses for cushing syndrome

A
  • excess fluid volume
  • risk for impaired skin integrity
  • risk for infection
  • risk for unstable blood glucose
  • disturbed body image
110
Q

preoperative care for adrenalectomy

A
  • monitor electrolytes, glucose
  • preoperative teaching
111
Q

postoperative care for adrenalectomy

A
  • monitor for adrenal crisis
  • lifelong hormone replacement
112
Q

when you have a nodule do not….

A

palpate/touch

PNC 104 lecture (3 decks)

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