Endocrine Flashcards
Hyperthyroid. S/S, dx
Graves' disease a. S/S: • Nervous • Weight loss • Sweaty/hot • Exophthalmos • Attention span decreased • Appetite increased • Irritable • GI fast/diarrhea • BP increased • Thyroid enlarges b. Dx: • If you drew a serum T4 (thyroxine) level on this client would it be increased or decreased? Increased • Thyroid scan • Client must discontinue any iodine containing medication 1 week prior to the thyroid scan.
Thyroid gland
• Produces 3 hormones (T3, T4, Calcitonin)
• Calcitonin decreases serum Ca+ levels by taking the calcium out of the blood and
pushing it back into the bone.
• You need iodine to make hormones. (This is dietary iodine)
• Thyroid hormone gives us energy
Hyperthyroid treatment
1) Anti-thyroids: Propylthiouracil (PTU®), Methimazole (Tapazole®)
• Stops the thyroid from making thyroid hormone.
• It’s used preop to stun the thyroid.
• We want this client to become euthyroid
2) Iodine Compounds: Potassium Iodine (SSKI®), Strong Iodine Solution (Lugol’s solution®)
• decrease the size and the vascularity of the gland and decreases the risk for bleeding
• ALL endocrine glands are VERY VASCULAR!
• Give in milk or juice, and use straw. Why? Stains teeth
3) Beta Blockers: propranolol (Inderal®)
• Decreases myocardial contractility
• Could decrease cardiac output
• Decreases HR, BP
• decreses anxiety.
Testing strategy: Do not give beta blockers to asthmatics or diabetics.
4) Radioactive Iodine 1 (dose)
• Given PO (liquid or tablet form)
Rule out pregnancy first
• Destroys thyroid cells→hypothyroidism which is expected.
• Follow radioactive precautions.
Stay away from babies for 24 hours.
Don’t kiss anyone for 24 hours.
• Watch for thyroid storm (thyrotoxicosis and thyrotoxic crisis). It is hyperthyroidism multiplied by 100.
Could be rebound effect post-radioactive iodine
5) Surgery: thyroidectomy (partial/complete)
• Post op:
Teach how to support neck.
Put personal items close to them to protect suture line
• Positioning: HOB? Elevate to decrease edema
• Check for bleeding where? Behind neck for pooling
• Nutrition (pre & post op) needs more calories.
• Assess for recurrent laryngeal nerve damage by listening for hoarseness and weak voice.
• Could lead to vocal cord paralysis, if there is paralysis of both cords airway obstruction will occur requiring immediate trach.
• Teach to report any c/o pressure.
• Trach set at bedside
1) Swelling
2) Recurrent laryngeal nerve damage (vocal cord paralysis)
3) Hypocalcemia
Assess for parathyroid removal. How? S/S of hypocalcemia (rigid muscle, seizure, spasms)
Eye care is important for a client with hyperthyroidism. If the client can’t close their eyelids, hypoallergenic tape may be applied to close lids (to help prevent injury or irritation). Dark glasses may be worn if photosensitivity is present. Artificial tears are used to prevent drying of the eyes.
Treatment of hyperthyroidism DOES NOT correct any eye or vision problems.
Hypothyroid
- Hypothyroid (Myxedema):
a. S/S:
• No energy
• When this is present at birth it’s called cretinism (very dangerous, can
lead to slowed mental and physical development if undetected).
• Fatigue
• GI slow
• Weight up
• Cold
• Speech slow, slurred
• No expression
You may be taking care of a totally immobile client
b. Tx:
• Levothyroxine (Synthroid®), Thyroglobulin (Proloid®), Liothyronine (Cytomel®)
• meds forever?
• What will happen to their energy level when they start taking these meds? Increase.
c. People with hypothyroidism tend to have CAD
Parathyroid
- The parathyroids secrete PTH which makes you pull calcium from the bone and place it in the blood. Therefore, the serum calcium level goes up.
- If you have too much parathormone in your body the serum calcium level will be high.
- If you do not have any parathormone in your body the serum calcium level will be low.
Hyperparathyroidism
Hypercalcemia. Hypophosphatemia
a. S/S:
• Too much PTH
• Serum calcium is HIGH. Serum phos is LOW.
• Other S/S sedated
b. Tx:
• Partial parathyroidectomy – when you take out 2 of your parathyroids…. PTH secretion decreases.
• What are you going to monitor post op? Hypocalcemia. Will not be sedated and have tight rigid muscles.
Hypoparathyroidism
Hypocalcemia, hyperphosphatemia
a. S/S:
Not enough PTH
Serum calcium is low. Serum phos is high. Other S/S: not sedated
b. Tx:
• IV calcium
• Phosphorus binding drugs. Renegal, oscal
Adrenal medulla problem
• Pheochromocytoma Benign tumors that secrete epi and norepi in boluses a. S/S: • BP? Increases • HR and Pulse? Increases • Flushing/diaphoretic b. Dx: • VMA (vanillylmandelic acid) test: a 24 hour urine specimen is done and you are looking for increased levels of epi and norepinephrine (also called catecholamines). Tell them to stay calm cuz stress (anxiety, smoke, running) causes release. Do not use vanilla for 1 week.
With a 24 hour urine you should throw out the first voiding and save the last voiding.
c. Tx:
• Surgery to remove rumors
Adrenal cortex glucocorticoids
• Change your mood. Example: insomnia, depressed, psychotic, euphoric • Alter defense mechanisms Immunosuppressed High risk for infection • Breakdown fat and proteins • Inhibit insulin Hyperglycemic Do blood glucose monitoring
Adrenal cortex mineralocorticoids
Aldosterone • Make you retain Na & h2o • Make you lose K+ • Too Much Aldosterone. Fluid volume excess Serum Potassium: low • Not Enough Aldosterone. Fluid volume deficit Serum Potassium: high
Steroids other names
Adrenocorticotropin hormones (ACTH) are made in the pituitary and they stimulate cortisol to be made. Cortisol is a hormone of the adrenal cortex.
So no matter what “fancy” word the NCLEX® Lady uses…you will still get the same result…think “steroids”.☺
↑ACTH = ↑Cortisol level
Too many steroids = Hypercortisolism (just another word).
Addison’s disease
Adrenal cortex problem
a) Pathophysiology:
• They do not have enough glucocorticoids, mineralocorticoids, or sex hormones.
• Aldosterone (mineralocorticoids)
• Normally, aldosterone makes us retain Na and h2O and lose K+……Now we don’t have enough (insufficient) so we will lose na and H2O and retain K+.
• The serum K+ will be high.
b) S/S:
• Initially, the majority of the S/S are a result of the hyperkalemia.
Beginning with muscle twitching, then proceeds to weakness, then flaccid paralysis.
Other S/S:
• Anorexia/nausea
• Hyperpigmentation-bronzing color of the skin and mucous
membranes
• Decreased bowel sounds
• GI upset
• White patchy area of depigmented skin (vitiligo)
• Hypotension
• Decrease Na, increased K+ and hypoglycemia.
c) Tx:
Combat shock (losing Na and h2o)
Increase sodium in their diet
Processed fruit juice/broth (has lots of sodium) I & O and daily weight
If this client is losing Na and water their BP will probably be low
They will probably be losing weight
Nursing DX: Fluid Volume deficit
Will be placed on the mineralocorticoid drug Fludrocortisone (Florinef®). It’s aldosterone.
DAILY WEIGHTS are very important in adjusting their medication.
Rule: When on a medicine where weight has to be monitored daily, keep the weight within 2-3 lbs (+ or -) of their normal weight. Fluid retention=heart problems
Addisonian crisis
Addisonian Crisis = severe hypotension and vascular collapse
Never stop steroids immediately, they need to wean off of them
Cushings disease
Adrenal cortex problem
a) S/S:
These clients have too many glucocorticoids, mineralocorticoids, and sex hormones.
Too many glucocorticoids Growth arrest Thin extremities/skin (lipolysis) Increased risk of infection Hyperglycemia Psychosis to depression Moon faced (fat redistribution or fluid retention) Truncal obesity (fat redistribution; lipogenesis) Buffalo hump (fat redistribution)
Too many sex hormones
Oily skin/acne
Women with male traits
Poor sex drive (libido)
Too many mineralocorticoids High BP CHF Weight gain Fluid Volume excess
• Since the client has too much mineralocorticoid (aldosterone), the serum K+ will be low.
• If you did a 24 hour urine on this client the cortisol levels would be high.
b) Tx:
• Adrenalectomy (unilateral or bilateral)
*If both are removed→ lifetime replacement
• Quiet environment. (Can’t handle stress)
• Diet pre-treatment?
High K+ low Na High Protein high Ca
• Avoid infection.
• What might appear in their urine? Glucose and ketones (not protein)
Type 1 diabetes
70-110mg/dL
a. Type 1:
• They have little or no insulin.
• Usually diagnosed in childhood
• Causes: Auto-immune response (Type 1A) or Idiopathic (Type 1B)
• First sign may be DKA.
• Appears abruptly, despite years of beta cell destruction.
1) Pathophysiology:
You have to have insulin to carry glucose out of the vascular space into the cell…since there is no insulin, the glucose just builds up in the vascular space, the blood becomes hypertonic and pulls fluid into the vascular space…the kidneys filter excess glucose and fluids (polyuria and polydipsia) the cells are starving so they start breaking down protein and fat for energy (polyphagia)…when you break down fat you get ketones (acids)…Now have metabolic acidosis. Lungs will compensate by blowing off co2 and kussmauls
2) S/S:
• Polyuria. Think shock first
• Polydipsia
• Polyphagia
3) TX:
• No orals
• They have to have insulin.
