Endocrine Flashcards
Patients experiencing acute adrenal insufficiency are most commonly those who are currently receiving or having recently been withdrawn from what kind of therapy?
Corticosteroid
Thyroid storm has an abrupt onset and is best categorized as a state of unregulated what?
Hypermetabolism
Neurogenic diabetes insipidus results from an insufficiency of which hormone?
Antidiuretic
Myxedema coma can occur in pateitns who have an extremely low metabolic state associated with what?
Hypothyroidism
Extreme hyperthyroidism with serious signs and symptoms
Thyroid storm
Syndrome on inappropriate ADH is associated with low levels of what?
Serum sodium
Controls and regulates the metabolic process
Hormones
Destruction of the adrenal gland itself
Addison’s disease
Which disease results in myxedema
Hypothyroidism
In what patients is hyperglycemic hyperosmolar syndome most commonly seen?
Newly diagnosed type 2 DM
Results from alterations in insulin secretion, insulin action, or both
Diabetes Mellitus
What is the most frequent form of hyperthyroidism?
Graves’ disease
What is the preferred energy source for the brain?
Glucose
Glucocorticoid and mineralocorticoid deficiency
Acute adrenal crisis
Hypersecretion of ADH
SIADH
Hypersecretion of cortisol
Cushing’s syndrome
Hypersecretion of insulin
Hypoglycemia
Hypersecretion of T3 and T4
Thyroid Storm
Hyposecretion of ADH
Diabetes Insipidus
Hyposecretion of insulin
Type 1 DM
Hyposecretion of T3 and T4
Myxedema Coma
What would not be a laboratory finding in a patient with SIADH?
Low urine sodium
Indicators for primary hyperthyroidism would include what lab values?
Low to normal TSH with elevated T3 and T4
What is cortisol released in response to?
Anterior pituitary release of ACTH
What often causes the hypothyroid state in secondary hypothyroidism?
Pituitary gland dysfunction
Which test can be performed to assess for the presence of adrenal insufficiency?
Cortisol stimulation test
What would the assessment findings for a pateint who is in a myxedema coma include?
Lethargy, edema, swollen tongue, and abdominal distension
What is the hallmark sign of SIADH?
Dilutional Hyponatremia
What is a potential cause of ectopic ADH secretion, causing SIADH?
Small cell carcinoma of the lung
What do the pituitary glands regulate?
The endocrine system
What does the hypothalamus regulate?
Body temperature
What do the gonads regulate?
The sex hormones
What do the adrenal glands regulate?
Steroids
What does the thyroid regulate?
Metabolism
What does the parathyroid regulate?
Serum calcium and phosphorus levels
What does the pancreas regulate?
Insulin
What steroids does the adrenal cortex make?
Mineralocorticoids and corticosteroids
Name a mineralocorticoid
Aldosterone
Name a corticosteroid
Cortisol
What steroid does the adrenal medulla make?
Catecholamines
Name the catecholamines
Epinephrine and Norepinepherine
What is the important history to gather when assessing the endocrine system?
Energy levels, elimination pattern, sexual and reproductive functions, and physical appearance
Which endocrine disease would cause a prominent forehead or jaw?
Acromegaly
Which endocrine disease would cause a round or puffy face?
Cushing’s
Which endocrine disorder would cause a dull or flat expression?
Hypothyroidism
Which endocrine disorder would cause striae?
Cushing’s
Which endocrine disorder would cause hirsutism?
Cushing’s
What laboratory testings would have to be done with an assessment of the endocrine system?
Stimulation/suppression tests, assays, and urine tests
What would cause primary pituitary dysfunction?
There would be a problem with the pituitary itself
What would cause secondary pituitary dysfunction?
A hypothalamic disorder
Deficiency of one or more anterior pituitary hormones
Hypopituitarism
Partial or total failure of all anterior pituitary hormones
Panhypopituitarism
What are the causes of primary pituitary dysfunction?
Hypophysectomy, non-secreting pituitary tumor, radiation, infarction, metastatic disease, and trauma
Why does a non-secreting pituitary tumor cause primary pituitary dysfunction?
The pressure of the tumor destroys the pituitary gland
Why does an infarction cause primary pituitary dysfunction?
It causes hypertrophy of the pituitary gland
Which metastatic disease is likely to cuase primary pituitary dysfunction?
Small cell carcinoma of the lung
What kind of trama causes primary pituitary dysfunction?
Closed head injury that puts pressure on the pituitary
What are the causes of secondary hypopituitarism?
Infection, trauma, tumors, congenital defects, and infiltrative processes
What infection generally causes secondary hypopituitarism?
Meningitis
What type of infiltrative processes generally causes secondary hypopituitarism?
Scaroidosis
What disorders are associated with hypopituitarism?
Sterility, loss of libido and secondary sex characteristics, ammenhorhea, decrease of spermatogenesis, and testicular atrophy
What is the second most common cause of hypopituitarism?
Growth hormone deficiency
What do you have to screen for before giving replacement growth hormone?
Cancer
What are the interventions for patients with hypopituitarism?
Improve body image
Why are females with hypopituitarism given estrogen and progesterone?
To replace lost LH and FSH
When can females with hypopituitarism not be given estrogen or progesterone?
Before puberty and the closure of the epiphyseal plates
What do females on estrogen and progesterone replacement need to ovulate?
Clomid
What are the side effects of estrogen and progesterone replacement therapy?
Blood clots and hypertension
What does testosterone given to males with hypopituitarism treat?
Gynocomastia, baldness, chest hair, high pitched voice, low muscle mass, poor libido and small peens
When should growth hormone be given?
Prior to the closal of the epiphyseal plates
What is a side effect of somatropin?
Bone pain
Over secretion of one or more pituitary hormones
Hyperpituitarism
What is the cause of primary hyperpituitarism?
Benign adenoma
Disease caused by the over secretion of growth hormone in children
Giantism
Disease caused by the over secretion of growth hormone in adults
Acromegaly
What disease is caused by excess ACTH?
Cushing’s
What drug treats hyperpituitarism?
Parlodel
How does parlodel work?
Suppresses the secretion of prolactin
What are the risks of radiation of the pituitary gland?
Hypopituitarism and optic nerve damage
What are the symptoms of hyperpituitarism?
Hyperpolactinemia
Removal of the pituitary gland or microadenoma?
Hypophysectomy
What are the nursing interventions for a patient who is post op with a transsphenoidal hypophysectomy?
No toothbrushing, dental flossing, or mouthwash for 1-2 weeks; avoid nasotracheal suctioning; no blowing nose, sneezing or coughing; avoid straining bowel movements; check for a CSF leak; and monitor for signs and symptoms of meningitis
What is the hallmark characteristic of acromegaly?
Large facial features
What is the purpose of the posterior pituitary?
Promotes water reabsorption
What is the pathophysiology of SIADH?
Excess ADH causes the reabsorption of water from the renal tubules, causing dilutional hyponatremia
What are the treatments for hyperpituitarism?
Drugs, radiation, or surgical management
Which condition causes an increase in milk production, gynecomastia, and altered sexual function
Hyperpolactinemia
What can cause SIADH?
Oat cell cancer metastasis, thymomas, non-malignant pulmonary problems, CNS disorders, and various drugs
Which disorders of the CNS causes SIADH?
CVA or infection
Which drugs cause SIADH?
Anesthesia, narcotics, or tricyclic antidepressants
Which disorder can produce ectopic ADH?
Non-malignant pulmonary problems
What are the clinical manifestations of SIADH?
Water retention, GI disturbances, edema, increased heart rate, hypothermia, increased urine Na levels, increased urine specific gravity, low serum Na, low plasma osmolarity, changes in LOC, seizures, coma, and sluggish deep tendon reflexes
Tumors behind the breast bone that make cells identical to ADH
Thymomas
What are the nursing interventions for patients with SIADH?
Restrict fluid intake to 500-600 mL/day, administer diuretic, maintain strict I/Os, take daily weights, and monitor for LOC changes
What is the pathophysiology for diabetes insipidus?
Decreased ADH causes decreased water reabsorption in the renal tubules, resulting in hypernatremia and excessive urine output
What can cause diabetes insipidus?
Generally head trauma, but also surgery or destruction of the proximal pituitary
How much can patients with diabetes insipidus void daily?
Up to 3 liters
What would the sodium levels of a patient with diabetes insipidus be?
Greater than 145 mEq/L
What are the clinical symptoms of diabetes insipidus?
Extreme thirst and dehydration, hypovolemia, tachycardia, poor skin turgor, low PA pressures, and low urine specific gravity
What is the treatment of diabetes insipidus?
Vasopressin or Desmopressin, maintain adequate hydration, monitor strict I/Os, administer IV and oral fluids, teach for life long med administration, and have the patient wear a medic alert band
What is vasopressin?
A potent vasoconstrictor
What is desmopressin?
A nasal spray that does not have the potency of vasopressin but has a longer lasting anti-diuretic effect
What kind of IV and fluids should a patient with diabetes insipidus be given?
Normal saline through two large bore IVs
What do patients newly diagnosed with diabetes insipidus need to be taught?
To always have their meds with them and always wear a med alert bracelet
What would the serum osmolality of a patient with diabetes insipidus be?
Greater than 295
What would the urine osmolarity of a patient with diabetes insipidus be?
Less than 100
What would the urine specific gravity of a patient with diabetes insipidus be?
Less than 1.005
What would the serum osmolarity of a patient with SIADH be?
Less than 280
What are the symptoms of Cushing’s syndrome?
Moon face, buffalo hump, decreased ability to fight infection and heal, weight gain, and increased glucose levels
Which steriods regulate the metabolism and increase blood sugar in response to physiologic stress?
Glucocoritcoids
Which steroids balance sodium and potassium?
Mineralocoritcoids
What does androgen contribute to?
Growth and development in both genders and sexual activity in women
What do androgens increase the instance of?
Myocardial infarctions
What is the leading endogenous cause of Cushing’s syndrome?
ACTH-secreting pituitary tumors
What are the clinical manifestations of Cushing’s syndrome?
Hyperglycemia, protein wasting, loss of collagen, mood disturbances, insomnia, irrationality, psychosis, hypertension, and acne
What causes Cushing’s syndrome?
Excess corticosteroids, particularly glucocorticoids
Who is Cushing’s disease most common in?
Women 20-40 years old
Why do patients with Cushing’s exhibit muscle wasting?
Cortisol has catabolic effects
Why do patients with Cushing’s exhibit hypertension?
Mineralocorticoids cause fluid retention, causing hypertension
What do the excess adrenal androgens seen in patients with Cushing’s syndrome cause?
Pronounced acne, virilization in women, and feminization in men
Why is hyperglycemia a clinical manifestation of Cushing’s syndrome?
Glucose intolerance is associated with cortisol-induced insulin resistance and there is increased gluconeogenesis by the liver
How is Cushing’s syndrome diagnosed?
24-Hour urine collection looking for free cortisol or a CT and MRI of the the pituitary and adrenal glands
What levels of free cortisol in urine indicate Cushing’s syndrome?
50-100 mcg/day
What indicates ACTH-dependent Cushing’s disease?
High or normal ACTH levels
What is the primary goal in treating Cushing’s syndrome?
Normalize hormone secretion
What imbalances are seen in patients with ectopic ACTH syndrome and adrenal carcinoma?
Hypokalemia and alkalosis
What is the treatment for Cushing’s caused by a pituitary adenoma?
Surgical removal of tumor and/or radiation and drug therapy
What conditions can lead to false positives in the diagnostic tests for Cushing’s syndrome?
Depression, stress, and alcoholism
What indicates an adrenal or exogenous etiology of Cushing’s disease?
Low or undetectable ACTH levels
What is the treatment for Cushing’s caused by an adrenal tumor or hyperplasia?
Adrenalectomy and drug therapy
What is the treatment for Cushing’s caused by ectopic ACTH-secreting tumors?
Treatment of the primary neoplasm and drug therapy
Suppresses cortisol production, alters peripheral metabolism of cortisol, and decreases plasma and urine corticosteroid levels
Mitotane (Lysodren)
Which drugs inhibit cortisol synthesis?
Metyrapone, ketoconazole, and aminoglutethimide
What are the side effects of drug therapy for Cushing’s syndrome?
Anorexia, nausea and vomiting, GI bleeding, depression, vertigo, skin rashes, and diplopia
What should you do if Cushing’s develops during use of corticosteroids?
Gradually discontinue therapy
What happens if you stop corticosteroid therapy too suddenly?
Life-threatening adrenal insufficiency
What nursing diagnoses should be implemented for a patient with Cushing’s syndrome?
Risk for infection, imbalanced nutrition related to decreased appetite, disturbed self-esteem related to altered body image, and impaired skin integrity
What are the goals for patients with Cushing’s syndrome?
Experience relief of symptoms, have no serious complications, maintain positive self-image, and actively participate in the therapeutic plan
What nursing interventions should be implemented for patients with Cushing’s syndrome?
Health promotion, acute intervention, patient monitoring, emotional support, preoperative care, postoperative care and home care
What is diplopia?
Double vision
What should the nurse monitor for a patient with Cushing’s syndrome?
Vital signs, daily weights, glucose, infection, signs and symptoms of abnormal thromboembolic phenomena
What needs to be controlled tightly pre-op for patients with Cushing’s syndrome?
Hypertension, hyperglycemia, and hyperkalemia
What preoperative care needs to be performed on a patient with Cushing’s syndrome?
Nasogastric tube, urinary catheter, IV therapy, central venous pressure monitoring, and leg compression devices
Why is the risk of hemorrhage increased post-op for patients with Cushing’s?
High vascularity of the adrenal glands
Why are the blood pressure, fluid balance, and electrolyte levels of a post-op patient with Cushing’s unstable?
Manipulation of the glandular tissues may release hormones into circulation
What should be reported to the doctor about post-op patients with Cushing’s?
Blood pressure, respirations, heart rate, skin, circulation, and infection
What should be closely monitored post-op for patients with Cushing’s?
Fluid intake and output, circulatory instability, and urine levels of cortisol
What is the critical period for circulatory instability post-op for patients with Cushing’s?
24-48 hours
What are the indications of hypocortisolism post-op for patients with Cushing’s?
Vomiting, increased weakness, dehydration, and profound hypotension
What are the side effects of surgery for patients with Cushing’s syndrome?
Painful joints, pruritus, peeling skin, and severe emotional disturbances
How long should the post-op patient with Cushing’s be on bed rest?
Until the blood pressure is stabilized
What should post-op patients with Cushing’s be taught to avoid?
Stress, extremes of temperature, and infections
What indicates that surgery for patients with Cushing’s has been successful?
They have no signs or symptoms of infection, attain weight appropriate for height, increase acceptance of appearance and maintain intact skin
What is Addison’s disease caused by?
Adrenocortical insufficiency
Which classes of adrenal corticosteroids are decreased in Addison’s disease?
Glucocorticoids, mineralocorticoids, and androgens
What are the possible causes of Addison’s disease?
Autoimmune disease, TB, infarction, fungal infection, AIDS, or metastatic cancer
Who does Addison’s disease most often affect?
Women younger than 60
When does Addison’s disease become evident?
When 90% of the adrenal cortex is destroyed
What are the primary features of Addison’s disease?
Progressive weakness, fatigue, weight loss, anorexia, and skin hyperpigmentation
Why does Addison’s manifest the symptoms it does?
Low androgens
Where is hyperpigmentation generally manifest in patients with Addison’s?
Areas exposed to the sun, at pressure points, over joints, in skin and especially palmar creases
What are the clinical manifestations for patients with Addison’s?
Orthostatic hypotension, hyponatremia, hyperkalemia, nausea and vomiting, and diarrhea
How can primary Addison’s be distinguished from secondary Addison’s?
Secondary lacks hyperpigmentation
What triggers a life-threatening Addisonian crisis?
Sudden, sharp decrease in adrenocortical hormones caused by stress from infection, surgery, trauma, hemorrhage, psychological distress or sudden withdrawal of corticosteroid replacement therapy
What are the manifestations of glucocorticosteroid and mineralocorticoid deficiencies in patients with Addison’s?
Hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion
What can the hypotension associated with Addison’s lead to?
Shock and circulatory collapse
Which diagnostic study indicates Addison’s disease?
Cortisol levels fail to rise over basal levels with ACTH stimulation
What abnormal laboratory findings would a patient with Addison’s exhibit?
Hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, increased BUN and low urine cortisol levels
What would the ECG of a patients with Addison’s exhibit?
Low voltage, vertical QRS axis, and peaked T waves
What is most commonly used as replacement therapy for patients with Addison’s disease?
Hydrocortisone
What is the most important teaching for patients with Addison’s disease?
Glucocorticoid dosage must be increased during times of stress to prevent an Addisonian crisis
What is the treatment for patients in Addisonian crisis?
Administer large volumes of NSS and 5% dextrose
What are the nursing interventions for patients with Addison’s?
Frequent assessment, monitoring vitals, daily weights, diligently administer corticosteroid therapy, protect against infection, assist with daily hygiene, and protect from extreme light, noise, and temperature
How often do the vitals of patients with Addison’s need to be taken?
Every 30 minutes to 4 hours for the first 24 hours
What is the priority nursing intervention for people with Addison’s?
Administer corticosteroid therapy diligently
Why do patients with Addison’s disease need to avoid extreme light, noise, and temperature?
They don’t have the physiological ability to cope with stress
Why do patients with Addison’s need to have their vitals monitored so closely?
To check for signs of fluid and electrolyte imbalance
Why do mineralocorticoids need to be given in the morning?
To reflect the normal circadian rhythm and decrease the side effects like GI irritaion
What indicates a need for corticosteroid dose adjustment?
Fever, influenza, tooth extraction, and physical exertion
What symptoms indicate an Addisonian crisis?
Vomiting and diarrhea
What is the discharge teaching for a patient with Addison’s disease?
Teach for signs and symptoms of corticosteroid deficiency and excess, always wear a medical alert bracelet, teach when to increase glucocorticoids, instruct how to take BP, carry emergency kit, teach how to give IM injections
What are the expected side effects of corticosteroid therapy?
Altered anti-inflammatory action, altered immunosuppression, inability to maintain normal BP, and altered carbohydrate and protein metabolism
What is the pathophysiology of hyperadolsteronism?
Excessive aldosterone secretion, causing sodium retention, hypokalemia, and extra hydrogen ion excretion
What is the hallmark of hyperaldosteronism?
Hypertension with hypokalemic alkalosis
What causes primary hyperaldosteronism?
Adrenocorticoid adenoma
What causes secondary hyperaldosteronism?
Renal artery stenosis, renin-secreting tumors, and chronic kidney disease
What does elevated aldosterone do to electrolytes?
Sodium retention and elimination of potassium, leading to hypernatremia, hypertension, and headache, and hypokalemia causing muscle weakness, fatigue, and cardiac dysrhythmias
What laboratory levels of a patient with hyperaldosteronism would be off?
Increased plasma aldosterone levels, increased sodium levels, decreased potassium levels, and decreased renin activity
What is the preferred treatment of primary hyperaldosteronism?
Surgical removal of the adenoma
What do patients with hyperaldosteronism need pre-surgery?
Low sodium diet, potassium sparing diuretic, antihypertensive agents, normal blood pressure and fluid electrolyte balance
What is pheochromocytoma caused by?
A tumor of the adrenal medulla producing catecholamines
Who is most susceptible to pheochromocytomas?
Young to middle aged women
What is the hallmark of pheochromocytoma?
Severe hypertension
How is pheochromocytoma generally diagnosed?
Blood pressure screenings
What can untreated pheochromocytoma lead to?
Diabetes mellitus, cardiomyopathy, and death
What are the clinical manifestations of pheochromocytoma?
Severe, episodic hypertension, severe, pounding headache, tachycardia with palpitations, profuse sweating, and abdominal or chest pain
What is the best diagnostic test for pheochromocytoma?
Measurement of urinary fractionated metanephrines and catecholamines in a 24 hour collection
How is a pheochromocytoma treated?
Surgical removal of the tumor, calcium channel blockers, sympathetic drugs and beta blockers
What do calcium channel blockers do for patients with pheochromocytoma?
Controls blood pressure
What do sympathetic blocking agents do for patients with pheochromocytoma?
Lower blood pressure and decrease the symptoms of catecholamine excess
What do beta blockers do for patients with pheochromocytoma?
Decrease dysrhythmias
What are the nursing interventions for patients with pheochromocytoma?
Monitor blood pressure and glucose closely and make the patient as comfortable as possible
Why do patients with pheochromocytoma need a lot of nourishment?
They are in a hyper metabolic state
Over activity of one or more the the parathyroid glands
Hyperparathyroidism
What are the classifications hyperparathyroidism?
Primary, secondary or tertiary
Who is hyperparathyroidism most common in?
Females older than 60
What is the pathophysiology of primary hyperparathyroidism?
Severity of hypercalcemia reflects the quantity of hyperfunctioning parathyroid tissue
Where does the excess serum calcium come from in patients with hyperparathyroidism?
Intestines, kidneys, and bones
What problems result from hyperparathyroidism?
Kidney stones, bone demineralization, myopathy, and hypercalcemia
What does hypercalcemia cause?
Hypergastinemia, abdominal pain peptic ulcer disease, pancreastitis and constipation
What causes primary hyperparathyroidism?
Adenoma or hyperplasia of the parathyroid gland
What causes secondary hyperparathyroidism?
The parathyroid glands are hyper plastic because of another organ’s dysfunction
Which patients are at risk for secondary hyperparathyroidism?
Patients with renal failure, Paget’s disease, multiple myeloma, or carcinoma with bony metastasis
What is the pathophysiology of secondary hyperparathyroidism?
Chronic renal failure hyperphosphatemia caused by a decrease in GFR
What are the clinical manifestations of hyperparathyroidism?
Back pain, joint pain, pathological fractures, polyuria, polydipsia, hypertension, thirst, nausea, anorexia, constipation, listlessness, depression, paranoia, and hypercalcemia
What would the labs of a patient with hyperparathyroidism be?
Serum calcium elevated, serum phosphate levels decreased, urine calcium and phosphate levels are high, and alkaline phosphatase is high
How is hyperparathyroidism treated?
Lower calcium levels, administer NSS, administer loop diuretics, administer anti-reabsorption agents, phosphates, calcitonin,and glucocorticosteriods
What should the diet of a patient with hyperparathyroidism be?
Low calcium and vitamin D
What are the nursing diagnoses for patients with hyperparathyroidism?
Risk for injury and altered nutrition
What is the surgical treatment for hyperparathyroidism?
Parathyroidectomy
What are the possible complications of parathyroidectomies?
Hypocalcemia and respiratory distress
What should parathyroidectomy patients be loaded with post-op?
Calcium
Hyposecretion of the parathyroid glands produce the reverse syndrome of hyperparathyroidism
Hypoparathyroidism
What are the clinical manifestations of hypoparathyroidism caused by?
Low serum calcium levels, elevated pH and alkalosis
What are the signs of acute hypoparathyroidism?
Tetany, Chvostek’s sign, and Trousseasu’s sign
What are the symptoms of chronic hypoparathyroidism?
Lethargy, thin, patchy hair, brittle nails, dry, scaly skin, personality changes, calcifications in eyes and basal ganglia and eventual cardiac problems
What findings diagnose hypoparathyroidism?
Chvostek’s sign, trousseaus’s signs, hyperactive deep tendon reflexes, circumoral paresthesia, numbness and tingling of the fingers, low calcium, low PTH, high phosphorous, decreased urine calcium, and opthalmic exam
What would a opthalmic exam of a patient with hypoparathyroidism reveal?
Cataracts
How should hypoparathyroidism be treated?
Administer calcium gluconate, vitamin D, PTH hormone, and treat seizures and laryngeal spasms
What should always be in the room of a patient with hypoparathyroidism?
Trach tray
Touching the facial nerve causes it to twitch
Chvostek’s sign
One of the most common medical disorders in the US affecting 10% of women and 3% of men over 65 years old, resulting from insufficient circulating thyroid hormone
Hypothyroidism
Hypothyroidism related to the destruction of thyroid tissue or defective hormone synthesis
Primary hypothyroidism
What is the most common cause of hypothyroidism?
Iodine deficiency, then atrophy of the gland
What is atrophy of the typhoid gland the end result of?
Hashimoto’s thyroiditis and Graves’ disease
What drugs can produce hypothyroidism?
Amiodarone and lithium
Hypothyroidism related to pituitary disease with lowered TSH secretion or hypothalamic dysfunction
Secondary hypothyroidism
Blood pressure cuffs makes arm pronate
Trousseau’s sign
Caused by thyroid hormone deficiencies during fetal or neonatal life
Cretinism
What do the clinical manifestations of hypothyroidism depend on?
Severity, duration, and age of onset
What are the cardiovascular symptoms associated with hypothyroidism?
Decreased cardiac output, decreased cardiac contractility, anemia, cobalamin, iron, and folate deficiencies, and increased serum cholesterol and trigylcerides
What are the respiratory symptoms associates with hypothyroidism?
Low exercise tolerance and shortness of breath on exertion
What are the neurological symptoms associated with hypothyroidism?
Fatigued and lethargic, personality and mood changes, impaired memory, slowed speech, decreased initiative and somnolence
What are the GI symptoms associated with hypothyroidism?
Decreased motility, achlorhydria common, and constipation
What are the integumentary symptoms associated with hypothyroidism?
Cold intolerance, hair loss, dry/coarse skin, brittle nails, hoarseness, muscle weakness and swelling, and weight gain
What are the reproductive symptoms associated with hypothyroidism?
Menorrhagia
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues causing puffiness, periorbital edema and a mask like effect
Myxedema
What are the compilations of myxedema?
Mental sluggishness, drowsiness, and lethargy
What are the characteristics of myxedema?
Subnormal temperature, hypotension, and hypoventilation
What precipitates a myxedema coma?
Infection, drugs, cold, or a trauma
How is a myxedema coma treated?
IV thyroid hormone replacement
What would the diagnostics labs of a patient with hypothyroidism show?
Elevated serum TSH, elevated free T4, lowered serum T3, lowered serum T4, and increased cholesterol, triglycerides and anemia
What should the diet of a patient with hypothyroidism be?
Low calorie
What drug to patients take to treat hypothyroidism?
Synthroid
What has to be monitored when a patient is on synthroid?
Angina and cardiac dysrhythmias
What are the nursing diagnoses for patients with hypothyroidism?
Imbalanced nutrition, activity intolerance, and disturbed thought process
What acute nursing care does a patient with myxedema coma require?
Mechanical respiratory support, cardiac monitoring, aspiration precautions, IV thyroid hormone replacement, and monitoring of core temperature
What discharge teaching is needed for a patient with hypothyroidism?
Prevent skin breakdown, emphasize the need for a warm environment, avoid sedatives, minimize constipation
What are the signs of a synthroid overdose?
Orthopnea, dyspnea, rapid pulse, palpitations, nervousness, and insomnia
How often should patients with diabetes and hypothyroidism check their blood glucose?
At least daily
What leads to thyroid cancer?
Hormones in food, lack of sun, and pollution
A sustained increase in the synthesis and release of thyroid hormones by the thyroid gland
Hyperthyroidism
Who is hyperthyroidism most common in?
Women 20-40 years old
What most commonly causes hyperthyroidism?
Graves’ disease, and then thyroiditis, toxic nodular goiter, exogenous iodine excess, pituitary tumors, and thyroid cancer
Physiological effects/clinical syndrome of hyper metabolism resulting from increased circulating levels of T3 and T4
Thyrotoxicosis
Autoimmune disease of unknown etiology caused by diffused thyroid enlargement and excessive thyroid hormone secretion
Graves’ disease
What percentage of hyperthyroidism results from Graves’ disease?
75%
What does Graves’ disease lead to?
Thyrotoxicosis
Thyroid hormone-secreting nodules independent of TSH
Toxic nodular goiters
What are the hallmark clinical manifestations of thyroid hormone excess?
Increased metabolism, increased tissue sensitivity to stimulation by sympathetic nervous system, ophthalmopathy, and intolerance to heat
What are the cardiovascular symptoms of hyperthyroidism?
Bruit over the thyroid gland, systolic hypertension, increased cardiac output, dysrhythmias, cardiac hypertrophy, and atrial fibrillation
What are the GI symptoms of hyperthyroidism?
Increased appetite, increased thirst, weight loss, diarrhea, splenomegaly, and hepatomegaly
What are the integumentary symptoms of hyperthyroidism?
Warm, smooth, moist skin, thin, brittle nails, hair loss, clubbing of fingers, diaphoresis, vitiligo
Protrusion of the eyeballs from the orbits
Exophthalmos
What causes exophthalmos?
Increased fat and edema in retroorbital tissues and impaired drainage from the orbit
What are the musculoskeletal symptoms of hyperthyroidism?
Fatigue, muscle weakness, proximal muscle wasting, dependent edema, and osteoporosis
What are the neurological symptoms of hyperthyroidism?
Fine tremors, insomnia, delirium, hyperreflexia of tendon reflexes, and inability to concentrate
What are the reproductive symptoms of hyperthyroidism?
Menstrual irregularities, amenorrhea, decreased libido, impotence, gynecomastia, and decreased fertility
Acute, rare, and life threatening condition in which all manifestations of hyperthyroidism are heightened
Thyrotoxic crisis
What is the cause of thyrotoxic crisis?
Additional stressors
What are the clinical manifestations of a thyrotoxic crisis
Tachycardia, heart failure, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain, nausea, vomiting, diarrhea, delirium, and coma
What is the treatment of thyrotoxic crisis?
Decrease thyroid hormone levels and treat symptoms
How is hyperthyroidism generally diagnosed?
Radioactive iodine uptake levels
Which laboratory studies are done to diagnose hyperthyroidism?
TSH, Free T4, and total T3 and T4
What are the primary treatment options for hyperthyroidism?
Antithyroid medications, radioactive iodine therapy, and subtotal thyroidectomy
What types of drug therapy are patients with hyperthyroidism on?
Antithyroid drugs, iodine, and beta adrenergic blockers
Why are patients with hyperthyroidism given beta adrenergic blockers?
To decrease the arrhythmias, tachycardia, and hypertension
How long do patients have to be on antithyroid hormones to have good results
4-8 weeks
What are the antithyroid medications?
Propylthiouracil (PTU) and methimazole (tapazole)
How does propylthiouracil work?
Blocks the conversion of T4 to T3
Used with other antithyroid drugs in preparation for thyroidectomy or treatment of a crisis
Iodine
How does iodine work to lower thyroid levels?
Decreases the vascularity of the thyroid gland
What are the types of iodine drugs?
Saturated solution of potassium iodine, and Lugol’s solution
When does the maximal effect of iodine occur?
1-2 weeks
Symptomatic relief of thyrotoxicosis resulting from beta adrenergic receptor stimulation
Beta adrenergic blockers
What are the beta adrenergic blockers?
Propranolol
What is the treatment of choice for non pregnant adults with hyperthyroidism?
Radioactive iodine therapy
How long does radioactive iodine therapy take to work?
2-3 months
What is the drug used to treat hypopituitarism?
Somatropin
What is the drug used to treat hyperpituitarism?
Parlodel
Why is it okay for radioactive iodine therapy to cause hypothyroidism?
Because it is easy to control and replace them
When is surgical therapy indicated for hyperthyroidism?
When the condition is unresponsive to drug therapy or there is tracheal compression or if there is a possible malignancy
What is the preferred surgical procedure to treat hyperthyroidism?
Subtotal thyroidectomy
How much of the thyroid has to be removed for a subtotal thyroidectomy to be effective?
90%
What needs to be achieved before a subtotal thyroidectomy can take place?
A euthyroid state
What are the post op complications of a subtotal thyroidectomy?
Hypothyroidism, hyperparathyroidism, damage of the parathyroid glands, hemorrhage, injury to laryngeal nerve, thyrotoxic crisis, and infection
What should the diet of a hyperthyroid patient be like?
High calorie, avoidance of caffeine, highly seasoned foods, and high-fiber foods, and a protein allowance of 1-2 g/kg
What are the nursing diagnoses or patients with hyperthyroidism?
Activity intolerance, risk for injury, imbalanced nutrition, anxiety, and insomnia
What are the goals for patients with hyperthyroidism?
Relief of symptoms, maintain nutritional balance, and control therapeutic pain
Where does treatment for hyper and hypothyroidism generally take place?
Outpatient settings
What should the environment of a patient with thyrotoxicosis be?
Calm, quiet, and cool room with light bed coverings
What should the nurse do for a patient with thyrotoxicosis?
Administer medications to block thyroid hormone production, administer IV fluids, ensure adequate oxygenation, monitor for cardiac dysrhythmias and decompensation, assist with exercise, apply artificial tears, elevate head of bed, restrict salt, and dark glasses
What pre-op teaching should be done for patients with hyperthyroidism?
Coughing, deep breathing, and leg exercises, range of motion for neck
How often should patients post-op subtotal thyroidectomy be checked for hemorrhage and tracheal compression?
Every 2 hours for 24 hours
What are the signs and symptoms of tracheal compression post-op subtotal thyroidectomy?
Irregular breathing, neck sweeping, frequent swallowing, and choking
What position should patients post-op subtotal thyroidectomy be in?
Semi-fowlers with head supported
When is hoarseness acceptable post-op subtotal thyroidectomy?
3-4 days
What are the side effects of radioactive iodine therapy?
Dryness and irritation of the mouth
