Endocrine

Question 1

endocrine system function

Answer 1

plays role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions

-closely connected to nervous and immune systems
-negative feedback mechanism

Question 2

pituitary

Answer 2

“master gland”

Question 3

pituitary tumors

Answer 3

mostly benign and slow growing, primary or secondary, functional or non-functional,
- they can cause clinical symptoms from: pressure they exert on surrounding tissues, endocrine dysfunction they cause, dysfunction affects on target organs

Question 4

pituitary tumors mgmt

Answer 4

• hypophysectomy: surgical removal of pituitary gland
• radiation
• meds that inhibit growth hormone (symptom mgmt)
• replacement therapy: CC, thyroid

Question 5

Hypophysectomy mgmt

Answer 5

monitor neuro status and vision, mustache dressing, administer hormone replacement PRN

-monitor for halo sing (clear drainage surrounded by yellow or slight serosang. drainage (CSF), post-nasal drop, meningitis (kernigs)

-avoid coughing, sneezing, blowing nose, bending forward, and brushing teeth x2 weeks

Question 6

diabetes insipidus

Answer 6

deficiency of ADH (vasopressin) results in excretion of large volumes of dilute urine and extreme thirst

-not insulin or sugar related

Question 7

Central DI

Answer 7

caused by head trauma, surgery, infection, inflammation, cerebral vascular disease, or idiopathic

Question 8

Nephrogenic DI

Answer 8

caused by kidney injury, meds, hypokalemia, hypocalcemia

Question 9

DI manifestations

Answer 9

• > 250 mL dilute urine/hour
• specific gravity of 1.001-1.005 (low)
• urine contains no glucose or albumin
• intense thirst
  -focused assessments: neuro, hemodynamic monitoring

Question 10

DI labs

Answer 10

urine specific gravity (1.001-1.005= low), osmolality (usually high for dehydration), UA

Question 11

DI diagnosis

Answer 11

Fluid deprivation test- withhold fluid for 8-12 hours, giving water makes s/s worse (solutes in their blood like Na) would intensify and worsen signs of confusion/seizures- all neuro signs

• plasm and urine osmolality done at beginning and end
• inability to increase urine osmolality and specific gravity is a characteristic of DI (Q2 checks- usually have a foley)

Question 12

DI mgmt

Answer 12

replace ADH, fluid replacement

nephron: mgmt with thiazide diuretics, sodium restriction, and prostaglandin inhibitors (aspirin)

Question 13

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 13

think sí ADH- yes we have too much ADH
- failure of negative feedback system that regulates ADH
- pt can’t excrete dilute urine, retain fluids, and develop dilution hyponatremia

Question 14

SIADH mgmt

Answer 14

self-limiting, goal is to correct the underlying cause
- restrict fluids
- diuretics may be used
- hypertonic 3% saline in severe hyponatremia
- neuro assessment, kidney

Question 15

SIADH manifestations

Answer 15

low sodium osmolality, sticky/thick urine, HTN, edema

Question 16

hypothyroidism pharm

Answer 16

levothyroxine (synthroid)

Question 17

thyroid hormones

Answer 17

T3 & T4 (these control cellular metabolic activity), and calcitonin
-iodine is contained here
- TSH from the anterior pituitary controls the release of thyroid hormone

Question 18

hypothyroidism s/s

Answer 18

weight gain, cold intolerance, dry/course skin. brittle hair, hair loss, muscle weakness, slow reflexes, brady, depression, lethargy, mental sluggishness, constipation, normal appetite, HoTN, edema

Question 19

hypothyroidism education

Answer 19

no grapefruit juice
- take levo 30 min before breakfast

Question 20

Hyperthyroidism

Answer 20

a form of thyrotoxicosis- excessive output of thyroid hormone (commonly caused by grave’s disease- AI disorder)

Question 21

hyperthyroidism s/s

Answer 21

weight loss, heat intolerance, warm/moist skin, muscle tremors, hyperreflexia, tachycardia, anxiety, hyperactivity, increased appetite, HTN, irregular menses

Question 22

hyperthyroidism mgmt

Answer 22

reduce hyperactivity, prevent complications
meds: antithyroid meds, radioactive iodine and surgery

Question 23

thyroid storm (thyrotoxic crisis)

Answer 23

form of severe hyperthyroidism of abrupt onset (rare)- usually precipitated by stress

Question 24

thyroid storm manifestations

Answer 24

severe tachy (>130), hyperthermia/pyrexia (>101.3 F), delirium, agitation, extreme HTN, severe forms of hyperthyroidism disturbances

Question 25

thyroid storm mgmt

Answer 25

reduce body temp and HR and prevent vascular collapse
- humidified O2
- IV fluids with dextrose
- thyroid blocking meds- propylthiouracil and methimazole
- iodine (blocks conversion of T4 to T3)
- beta blockers

Question 26

thyroidectomy mgmt

Answer 26

observe for difficulty breathing, hematoma, hemorrhage and injury to laryngeal nerve
- voice changes and tetany should be reported immediately
- sensations of fullness or pressure at incision
- assess dressings, sides/back of neck for swelling
- ALWAYS have tracheostomy kit at bedside
- Calcium gluconate should be available for emergencies
- pain and hemodynamic mgmt
- limit talking

Question 27

Addison’s disease (adrenocortical insufficiency)

Answer 27

dysfunction of the hypothalamus-pituitary gland - adrenal gland feedback loop
- insufficient production of adrenal gland steroids, or sudden cessation of adrenocortical therapy
- consideration in any pt taking CC

Question 28

addison’s disease manifestations

Answer 28

bronze pigmentation of skin, change in distribution of body hair, Gi disturbances, weakness, hypoglycemia, postural hypotension, weight loss

Question 29

addison’s Dx

Answer 29

serum cortisol and plasma ACTH

Question 30

Addisonian crisis

Answer 30

HoTN, diagnosis, fever, n/v, signs of shock
- combat circulatory shock, pressers, abx if necessary, long term CC use may be necessary

Question 31

cushing’s syndrome

Answer 31

disease of hypersecretion from anterior pituitary or high CC use

Question 32

cushing’s syndrome manifestations

Answer 32

moon face, buffalo hump, muscle atrophy, thin extremities, stretch marks, weight gain and obesity, easy bruising, skin and bone thinning
- decreased libido, menstrual changes

Question 33

Cushing’s mgmt

Answer 33

surgical removal of tumor, radiation, adrenalectomy, s/s of adrenal insufficiency may develop in 12-24 hours, replace hormones

Question 34

corticosteroid therapy

Answer 34

used for adrenal insufficiency, suppressing inflammation, AI and allergic reactions, reducing transplant rejections

Question 35

corticosteroid side effects

Answer 35

moon face, weight gain, HTN, hyperglycemia

Question 36

corticosteroid patient education

Answer 36

Must taper dosage!! (too quick can result in adrenal insufficiency)