ENDOCRINE 2 Flashcards
1
Q
Risk Factors for Endocrine Problems
A
- age
- heredity
- congential factors
- trauma
- environmental factors
- consequence of other health problems or surgery
2
Q
Hypothalamus
A
- Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle.
- activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep and appetite.
3
Q
Hypothalamus hormones
A
- Corticotropin-releasing hormone (CRH)
- Gonadotropin-releasing hormone (GnRH)
- Growth hormone-inhibiting hormone (GHIH)
- Growth hormone-releasing hormone (GHRH)
- Melanocyte-inhibiting hormone (MIH)
- Prolactin-inhibiting hormone (PIH)
- Thyrotropin-releasing hormone (TRH)
4
Q
Testosterone/Androgen Replacement Therapy
treats hypopituitarism
A
- treats hypopituitarism
- used to replace deficient hormones or to treat hormone-sensitive disorders
- can cause bleeding if the client is taking oral anticoagulants (increase the effect of anticoagulants)
- can cause decreased serum glucose concentration, thereby reducing insulin requirements in the client with diabetes mellitus.
- hepatotoxic medications are avoided with the use of androgens because of the risk of additive damage to the liver.
- androgens usually are avoided in men with known prostate or breast carcinoma, because androgens often stimulate growth of these tumors.
5
Q
Androgen side effects
A
- masculine secondary sexual characteristics
*
6
Q
androgen/testosterone interventions
A
- monitor vital signs
- monitor for edema, weight gain, and skin changes
- assess mental status and neurological function
- assess for signs of liver dysfunction, including right upper quadrant abdominal pain, malaise, fever, jaundice and pruritis.
- assess for the development of secondary sexual characteristics.
- instruct the client to take medication with meals or a snack.
- instruct the client to notify the PHCP if priapism develops.
- instruct the client to notify the PHCP if fluid retention occurs.
- instruct women to use a nonhormonal contraceptive while on therapy.
- For women, monitor for menstrual irregularities and decreased breast size.
7
Q
Estrogens and Progestins (women with hypopituitarism)
A
- estrogens are steroids that stimulate femal reproductive tissue.
- progestins are steroids that specifically stimulate the uterine lining.
- estrogens and progestin preparations may be used to stimulate the endogenous hormones to restore hormonal balance or to treat hormone sensitive tumors (suppress tumor growth) or for contraception.
8
Q
Estrogen contraindications
A
- estrogens are contraindicated in clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of thromboembolism, known or suspected pregnancy or lactation.
- use estrogens with caution in clients with hypertension, gallbladder disease, or liver or kidney dysfunction.
- estrogens increase the risk of toxicity when used with hepatotoxic medications.
- barbiturates, phenytoin, and rifampin decrease the effectiveness of estrogen.
9
Q
Progestins are contraindicated
A
in clients with thromboembolic disorders and should be avoided in clients with breast tumors or hepatic disease.
10
Q
estrogen/progestin side effects and interventions
A
- breast tenderness, menstrual changes
- nausea, vomiting, and diarrhea
- malaise, depression, excessive irritability
- weight gain
- edema and fluid retention
- atherosclerosis
- hypertension, stroke, myocardial infarction
- thromboembolism (estrogen)
- migraine headaches and vomiting (estrogen)
- monitor vital signs
- monitor for hypertension
- assess for edema and weight gain
- advise client not to smoke
- advise the client to undergo routine breast and pelvic examinations.
11
Q
Bromocriptine mesylate (Parlodel)
A
- treats hyperpituitarism/acromegaly
- dopamine agonists: stimulates dopamine receptors in the brain and inhibit the release of GH and PRL (prolactin)
- in most cases, small tumors decrease until the pituitary gland is normal size
- large pituitary tumors usually decrease to some extent
- side effects of bromocriptine include orthostatic (postural) hypotension, headache, nausea, abdominal cramps, and constipation.
- give bromocriptine with a meal or a snack to reducce GI side effects.
- treatment starts with a low dose & is gradually increased until the desired level is reach.
- if pregnancy occurs, the drug is stopped.
- treac pts taking bromocriptine to seek medical care immediately if chest pain, dizziness, or water nasal discharge occurs because of the possiblity of serious side effects including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage.
12
Q
Octreotide (Sandostatin)
A
- treats hyperpituitarism/acromegaly
- inhibits GH release through negative feedback
- assess frequenct and consistency of stools and bowel sounds throughout therapy.
- use cautiously in gallbladder disease.
13
Q
Desmopressin acetate (DDAVP)
A
- treats diabetes insipidus
- a synthetic form of vasopressin given orally, as a sublingual “melt” or intranasally in metered spray
- the frequency of dosing varies with patient responses.
- teach patients that each metered spray delivers 10 mcg and those with mild DI may need only one or two doses in 24 hours
- for more severe DI, one or two metered doses two or three times daily may be needed.
- During severe dehydration, ADH may be given IV or IM.
- Ulceration of the mucous membranes, allergy, a sensation of chest tightness, and lung inhalation of spray may occur with the use of the intranasal preparations.
- if side effects occur or if the patient has an upper respiratory infection, oral or subcutaneous vasopressin is used.
- the parenteral form of desmopressin is 10 times stronger than the oral form, and the dosage must be reduced.
14
Q
vasopressin (Vasostrict)
A
- used in diabetes insipidus
- allows the permeability of the renal collecting ducts, allowing reabsorption of water.
- decreased urine output and increased urine osmolality in diabetes insipidus. Increased BP.
- contraindicated in chronic renal railure with increased BUN
- side effects: dizziness, pounding sensation in head, abdominal cramps, flatulence, sweating.
- monitor BP, Hr and ECG periodically throughout therapy and continuously throughout cardiopulmonary resuscitation.
- monitor urine osmolality and urine volume frequently.
- monitor for S&S of water intoxication (confusion, drowsiness, headache, weight gain, difficulty urinating, seizures and coma.
15
Q
Chlorpropamide (Diabinese)
A
- management of neurogenic diabetes inspidus
- lowers blood sugar by stimulating release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. may also decrease hepatic glucose production
- side effects: photosensitivity, hypoglycemia
- monitor CBC periodically during therapy.. Notify health care provider promptly if decrease in blood counts occurs.
16
Q
Tolvaptan (Samsca, Jynarque)
A
- Used in SIADH
- vasopressin receptor antagonists
- Promotes water excretion without causing sodium loss.
- Tolvaptan has a black box warning that rapid increases in serum sodium levels (those greater than a 12 meq/L increase in 24 hours) have been associated with central nervous system demyelination that can lead to serious complications and death.
- In addition, when this drug is used at higher dosages or for longer than 30 days, there is significant risk for liver failure and death.
- administer tolvaptan only in the hospital setting so serum sodium levels can be monitored closely for the development of hypernatremia.
17
Q
demeclocycline (Declomycin) a tetracycline antibiotic
A
- used for milder SIADH
- an oral antibiotic , may help reach fluid and electrolyte balance, although the drug is not approved for this problem.
- water excretion without sodium loss.
18
Q
Fludrocortisone (FLorinef)
A
- causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule.
- maintenance of sodium balance and BP in patients with adrenocortical insufficiency.
- used for hypofunction of the adrenal gland.
- monitor the patient’s blood pressure to assess for the potential side effect of hypertension.
- instruct the patient to report weight gain or edema because sodium intake may need to be restricted.
19
Q
Liothyronine (Cytomel, T3, Triostat)
A
- thyroid supplementation in hypothyroidism.
- Treatment or suppression of euthyroid goiters.
- Diagnostic agent for suppression tests to differentiate mild hyperthyroidism from thyroid gland autonomy.
- Treatment of myxedema coma (IV fomulation)
- replacement of or supplementation to endogenous thyroid hormones.
- principle effect is increasing metabolic rate of body tissues.
- Side effects: insomnia, irritability, headache, arrhythmias, tachycardia, weight loss, heat intolerance.
- Assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.
- toxicity manifests as hyperthyroidism.
20
Q
Methimazole (Northyx, Tapazole)
&
Propylthiouracil (PTU)
A
- used in hyperthyroidism
- block thyroid hormone production by preventing iodide binding in the thyroid gland.
- The response to these drugs is delayed because the patient may have large amounts of stored thyroid hormones that continue to be released.
- Teach patients to check for weight gain, slow heart rate, and cold intolerance, which are indications of hypothyroidism and the need for a lower drug dose.
- teach patients to avoid crowds and people who are ill because the drug reduces the immune response, increasing the risk for infection.
- Teach patients taking propylthiouracil to report darkening of the urine or a yellow appearance to the skin or whites of the eyes, which indicate possible liver toxicity or failure, a serious side effect of propylthiouracil.
- Remind women taking methimazole to notify their PHCP if they become pregnant necause the drug causes birth defects and should not be used during pregnancy.
21
Q
Levothyroxine (T4) (Synthroid)
A
- Purpose: management of hypothyroidism and myxedema coma
- thyroid hormones
- Side effects: weight loss, arrhythmias, tachycardia, insomnia, irritability, nervousness, heat intolerance, menstrual irregularities, thyroid storm, hypertension
- PO; onset 24 hours
- PO: take at same time daily to maintain blood level; take on empty stomach (30 before eating)
- do not switch brands unless directed.
- avoid OTC meds with iodine and iodized salt, soybeans, tofu, turnips, walnuts, some seafood, some bread
- medication controls symptoms and treatment is lifelong
- separate antacids, iron, and calcium products by 4 hours
22
Q
Lithium (Lithmax, Lithobid)
A
- manic episodes of bipolar i disorder (treatment, maintenance, prophylaxis)
- alters cation transport in nerve and muscle. May also influence reuptake of neurotransmitters.
- May cause hyper or hypothyroidism.
23
Q
Prednisone (Deltasone)
A
- Used in adrenal insufficiency
- instruct the patient to report illness because the usual daily dosage may not be adequate during periods of illness or severe stress.
24
Q
Furosemide
A
- used in hyperparathyroidism
- helps reduce serum calcium levels
- a diuretic that increases kidney secretion of calcium, is used along with IV saline in large volumes to promote calcium excretion
25
Q
H2 receptor blockers
cimetidine, famotidine, nizatidine, ranitidine
A
- used in cushings disease where there is hypercortisolism
- cortisol inhibits production of the thick, gel-like mucus that protects the stomach lining, decreases blood flow to the ares and triggers the release of excess hydrochloric acid
- h2 receptor blockers inhibit the gastric proton pump and prevent the formation of hydrochloric acid.
26
Q
Spironolactone
A
- Used in hyperaldosteronism.
- a potssium sparing diuretic and aldosterone antagonist
- when surgery cannot be performed, spironolactone therapy is continued to control hypokalemia and hypertension.
- Because spironolactone is a potassium sparing diuretic, hyperkalemia can occir in patients who have impaired kidney function or excessive potassium intake.
- Advise the patient to avoid potassium supplements and food rich in potassium.
- hyponatremia can occur with spironolactone therapy, and the patient may need to increase dietary sodium.
- Instruct patients to report symptoms of hyponatremia, such as mouth dryness, thirst, lethargy or drowsiness.
- Teach them to report any additional effects of spironolactone therapy, including gynecomastia, diarrhea, drowsiness, headache, rash, urticaria (hives), confusion, erectile dysfunction, hirutism, and amenorrhea.
27
Q
Magnesium Sulfate
A
- to correct hypoparathyroidism caused by hypomagnesemia
- acute hypomanesemia is corrected with 50% magnesium sulfate in 2-mL doses (up to 4 g daily) IV.
28
Q
Phenoxybenzamine
A
- used before therapy for pheochromocytoma
- the patient’s blood pressure is stabilized using adrenergic blocking agents such as phenoxybenzamine (Dibenzyline) starting 7 to 10 days before surgery because of the increased risk for severe hypertension during surgery.
- drug dosages are adjusted until blood pressure is controlled and hypertensive attacks do not occur.
29
Q
Calcitriol (Rocaltrol)
A
- Hypoparathyroidism
- treats acute vitamin D deficiency/hypocalcemia
- promotes the absorption of calcium and decreases parathyroid hormone concentrations
- side effects: pancreatitis, headache, weakness, abdominal pain
- avoid concurrent use of antacids containing Mg
- observe client for hypocalcemia.
30
Q
Calcitonin (Miacalcin)
A
- treatment of hyperparathyroidism
- decreases the release of skeletal calcium and increases kidney excretion of calcium.
- it is not effective when used alone because of its short duration of action.
- therapeutic effects are enhanced if calcitonin is given with glucocorticoids.
31
Q
metyraprone (Metopirone)
A
- Treatment of hypercortisolism (Cushing’s disease)
- decreases cortisol production
- , is a medication which is used in the … Metyrapone test may aid in verifying the cause of Cushing’s syndrome.
32
Q
Plicamycin (Mithracin)
A
33
Q
Anterior pituitary hormones
A
- Thyroid stimulating hormone (TSH), also known as thyrotropin
- Adrenocorticotropic hormone (ACTH, corticotropin)
- Luteinizing hormone (LH), also known as Leydig cell-stimulating hormone (LCSH)
- Follicle-stimulating hormone (FSH)
- Prolactin (PRL)
- Growth Hormone (GH)
- Melanocyte-stimulating hormone (MSH)
34
Q
Posterior pituitary
A
- vassopressin (antidiuretic hormome [ADH])
- oxytocin
35
Q
thyroid
A
- triiodothyronine (T3)
- thyroxine (T4)
- calcitonin
36
Q
Parathyroid
A
- Parathyroid hormome (PTH)
37
Q
Adrenal Cortex
A
Glucocorticoids (cortisol)
mineralocorticoids (aldosterone)
38
Q
ovary
A
estrogen
progesterone
39
Q
testes
A
testosterone
40
Q
pancreas
A
insulin
glucagon
somatostatin
41
Q
Thyroid-stimulating hormone or thyrotropid (TSH)
A
targets the thyroid
stimulates synthesis and release of thyroid hormones
42
Q
adrenocorticotropic hormone, corticotropin (ACTH)
A
targets the adrenal cortex
stimulates synthesis and release of corticosteroids and andrenocortical growth
43
Q
Leuteinzing Hormone (LH) (known as leydig cell-stimulating hormone in males)
A
- targets the ovary and testes
- stimulates ovulation and progesterone secretion
- stimulates testosterone secretion
44
Q
follicle-stimulating hormone (FSH) (know as interstitial cell- or Sertoli cell-stimulating hormone in males)
A
- targets the ovary and testis
- stimulates estrogen secretion and follicle maturation
- stimulates spermatogenesis
45
Q
Prolactin (PRL)
A
- targets the mammary glands
- stimulates breast milk production
46
Q
Growth Hormone
A
- Targets bones and soft tissue
- promotes growth through lipolysis, protein anabolism, and insulin antagonism
47
Q
Melanocyte-stimulating hormone (MSH)
A
- targets melanocytes
- promotes pigmentation
48
Q
Vasopressin (antidiuretic hormone [ADH])
A
- Targets the kidneys
- promotes water reabsorption
49
Q
Oxytocine
A
- targets the uterus and mammary glands
- stimulates uterine contractions and ejection of breast milk
50
Q
Functions of Glucocorticoid hormones
A
- Prevent hypoglycemia by increasing liver production (gluconeogenesis) and inhibiting peripheral glucose use.
- maintain excitability and responsiveness of cardiac muscle
- increase lipolysis, releasing glycerol and free fatty acids
- increase protein catabolism
- degrade collagen and connective tissue
- increase the number of mature neutrophils released from bone marrow
- exert anti-inflammatory effects that decrease the migration of inflammatory cells to sites of injury
- maintain behavior and cognitive functions
51
Q
Catecholamine REceptors and Effects of Adrenal Medullary Hormone Stimulation on Selected Organs and Tissues
A
- Heart, beta 1 receptors, increased heart rate and increased contractility
- blood vessels, alpha & beta 2, vasoconstriction and vasodilation
- GI tract, alpoha and beta, increased sphincter tone and decreased motility
- Kidneys, Beta2, increased renin release
- bronchioles, beta2, relaxation; dilation
- bladder, alpha, beta2, sphincter contractions, relaxation of detrusor muscle
- skin, alpha, increased sweating
- fat cells, beta, increased lipolysis
- liver, alpha, increased gluconeogenesis and glycogenolysis
- pancreas, alpha, decreased glucagon and insulin release, beta, increased glucagon and insulin release
- eyes, alpha, dilation of pupils
52
Q
Functions of Thyroid Hormones in Adults
A
- Control metabolic rate of all cells
- Promote sufficient pituitary secretion of growth hormone and gonadotropins
- regulate protein, carbohydrate, and fat metabolism
- exert effects on heart rate and contractility
- increased red blood cell production
- affect respiratory rate and drive
- increase bone formation and decrease bone resorption of calcium
- act as insulin antagonists.
53
Q
Aging
decreased antidiuretic hormone (ADH) production
A
- Urine is more dilute and may not concentrate when fluid intake is low
- The patient is at greater risk for dehydration.
- assess the older patient more frequently for dehydration.
- if fluids are not restricted because of another health problem, teach UAP to offer fluids at least every 2 hours while awake.
54
Q
Aging
decresed ovarian production of estrogen
A
- Bone density decreases
- skin is thinner, drier, and at greater risk for injury
- perineal and vaginal tissues become drier, and the risk for cystitis increases.
- Teach the patient to engage in regular exercise and weight bearing activity to maintain bone density.
- Handle the patient carefully to avoid injury from pathologic fractures.
- Avoid pulling or dragging the patient.
- use minimal tape on the skin
- help patients confined to bed or chairs change positions at least every 2 hours
- Teach the patients to use skin moisturizers
- perform or assist the patient to perform perineal care at least twice daily.
- unless another health problem requires fluid restriction, encourage all women to drink at least 2 liters of fluids daily.
- teach sexually active older women to urinate immediately after sexual intercourse.
- teach sexually active women that using vaginal lubricants with sexually activity can reduce discomfort and the risk for tissue damage.
55
Q
Aging
decreased glucose tolerance
A
- weight becomes greater than ideal along with:
- elevated fasting blood glucose level
- elevated random blood glucose level
- slow wound healing
- frequent yeat infections
- polydipsia
- polyuria
- obtain a family history of obesity and type 2 diabetes.
- encourage the pt to engage in regular exercise and to keep body weight within 10 lb of idea.
- teach patients the signs and symptoms of diabetes and instruct them to report any of these to the PHCP
- suggest diabetes testing for any patient with:
- persistent vaginal candidiasis
- failure of a foot or leg skin wound to heal in 2 weeks or less
- increased hunger and thirst
- noticeable decrease in energy level
*
56
Q
Aging
Decreased generalized metabolism
A
- There is less tolerance for cold
- appetite is decreased
- heart rate and BP are decreased
- can be difficult to distinguish from hypothyroidism. Check for additional signs and symptoms of:
- lethargy
- constipation (as a change from usual bowel habits)
- decreased cognition
- slowed speech
- body temperature consistently below 97 degree F.
- Heart rate below 60 bpm
- Teach patients to dress warmly in cool or cold weather.
57
Q
Always palpate the thyroid gently in an adult
A
who has or is suspected to have hyperthyroidism because vigorous palpation can stimulate a sudden release of thyroid hormones and cause a thyroid storm.
58
Q
Observe the patient’s general appearance and
A
assess height, weight, fat distribution, and muscle mass in relation to age.
59
Q
When examining the head, focus on abnormalities of facial structure, features, and expressions, such as
A
- Prominent forehead or jaw
- round or puffy face
- dull or flat expression
- exophthalmoas (protruding eyeballs and retracted upper lid)
60
Q
check the lower neck for
A
a visible enlargement of the thyroid gland.
61
Q
Observe skin color and look for areas of
A
pigment loss (hypopigmentation) or excess (hyperpigmentation). Fungal iskin infections, slow wound healing, bruising, and petechiae are often seen in patients with adrena hyperfunction.
62
Q
Vitiligo
A
(patchy areas of pigment loss) is seen with primary hypofunction of the adrenal glands and is caused by autoimmune destruction of melanocytes in the skin.
63
Q
Inspect the fingernails for malformation, thickness, or brittleness,
A
all of which may suggest thyroid gland problems. Examine the extremities and the base of the spine for edema, which suggests impaired fluid and electrolyte imbalance.
64
Q
Check the trunk for any abnormalities in chest size and symmetry.
A
Truncal obesity and the presence of a “buffalo hump” between the shoulders on the back may indicate adrenocortical excess.
65
Q
Striae
A
(reddish-purple stretch marks) on the breasts or abdomen are often seen with adrenocortical excess.
66
Q
Assess the patient’s hair distribution for signs of endocrine gland dysfunction.
A
Changes include hirsutism (excessive body hair growth, especially on the face, chest, and center abdominal line of women), excessive scalp hair loss, or changes in hair texture.
67
Q
Distribution and quantity of pubic hair are often affected in
A
hypogonadism.
68
Q
Thyroid gland palpation
A
Palpate the thyroid gland by standing either behind or in front of the patient. The posterior approach may be easier. Having the patient swallow sips of water during the examination helps you palpate the thyroid gland, which is not easily felt when normal.
69
Q
Auscultate the chest to assess cardiac rate and rhythm to use later
A
as a means of assessing treatment effectiveness. Some endocrine problems include dysrhythmias.
70
Q
If an enlarged thyroid gland is palpated, auscultate the area of enlargement for bruits
A
Hypertrophy of the thyroid gland causes an increase in vascular flow, which may result in bruits.
71
Q
Many endocrine problems can change a patient’s behaviors, personality, and psychological responses.
A
Assess the patient;s coping skills, support systems, and health-related beliefs.
72
Q
Salivary levels of steriod hormones (cortisol, testosterone, progesterone, and estradiol)
A
accurately reflect blood levels of these hormones. Protein hormones, such as those from the pituitary gland and thyroid gland, cannot be accurately assessed using saliva.
73
Q
Assay
A
- An assay measures the level of a specific hormone in blood or other body fluid.
- The most common assays for endocrtine testing are antibody-based immunologica assays and chromatographic assays, which include mass spectrometry.
- It is a substance, usually a peptide or steroid, rpoduced by one tissue and conveyed by the bloodstream to another to effect physiological activity.
- It is also a synthetic compound that acts like a hormone in the body.
74
Q
Measurement of specific hormone blood level does not always distinguish
A
between the normal and the abnormal.
75
Q
Stimulation tests
A
- For patients who might have an underactive endocrine gland, a stimulus may be used to determine whether the gland is capable of normal hormone production.
- This method is called provocative testing.
- Measured amounts of selected hormones are given to stimulate the target gland to maximum production.
- Hormone levels are then measured and compared with expected normal values.
- Failure of a hormone level to rise with provacation indicates hypofunction.
76
Q
Endocrine Changes with Aging
“GET”
A
Gonads
Endocrine pancreas
Thyroid gland
77
Q
Suppression Tests
A
- Suppression tests are used when hormone levels are high or in the upper range of normal.
- Example to determine Cushing’s, dexamethasone is given in pill form. The next morning a blood test is done to see if the medication decreased the hormone level.
- Failure of suppression of hormone production during testing indicates hyper function.
78
Q
Blood Tests endocrine testing
A
- check your laboratory’s method of handloing the hormone test samples for tube type, timing, drugs to be administered as part of the test, etc. For example, blood samples drawn for catecholamines must be placed on ice and taken to the laboratory immediately.
- Explain the procedure and any restrictions to the patient.
- If your are drawing blood sampples from an IV line, clear the line throughly. Do not use a double- or triple-lumen line to obtain samples; contamination or dilution from another port is possible.
- Emphasize the importance of taking a drug prescribed for the test on time. Tell the patient to set an alarm if the drug is to be taken during the night.
79
Q
For Urine Tests:
A
- Instruct the patient to being the urine collection (whether for 2, 4, 8, 12 or 24 hours) by first emptying his or her bladder.
- Remind the patient to not save the urine specimen that begins the collection. The timing for the urine collection begins after this specimen.
- Tell the patient to note the time of the discard specimen and to plan to collect all urine from this time until the end of the urine collection period.
- To end the collection, instruct the patient to empty his or her bladder at the end of the timed period and add that urine to the collection.
- Check with the laboratory to determine any special handling of the urine specimen (e.g. Is a preservative needed? Does the container need to be kept cold?
- If needed, make sure that the preservative has been added to the collection container at the beginning of the collection.
- Tell the patient about any preservative and the need to avoid splashing urine from the container because some preservatives make the urine caustic.
- if the specimen must be kept cool or cold, instruct the patient to place the container in an inexpensive cooler with ice. The specimen container should not be kept with food or drinks.
80
Q
Urine Tests
A
- hormone levels and the metabolites of specific hormones in the urine are often measured to determine endocrine function
- many endocrine hormones are secreted in a pulsatile fashion.
- a 24 hour urine collection better reflects the overall function of certain glands, such as the adrena gland.
81
Q
Imaging Assessment
A
- Anterior, posterior, and lateral skull x-rays may be used to view the sella turcica.
- Erosion of the sella turcica indicates invasion of the wall from an abnormal growth.
- MRI with contrast is the most sensitive method of imaging the pituitary gland.
- CT scan can evaluate the pituitary gland, but it is also used to evaluate the adrenal glands, ovaries, and pancreas.
- Ultrasound evaluates the thyroid, parathyroid glands, ovaries and testes.
82
Q
Other Diagnostic Assessment
A
- Needle biopsy is used to indicate the composition of thyroid nodules.
- Should check with MD if blood thinners should be stopped.
- It is a relatively safe and quick outpatient procedure to determine if surgical intervention is needed.
83
Q
Piuitary Glands
A
- If one hormone is affected, it is called selective hypopituitarism.
- If decrease in production of all the anterior pituitary hormones (rare condition) it is called panhypopituitarism.
- It is divided into two lobes at the base of the brain
- anterior lobe: adenohypophysis
- posterior lobe: neurohypophysis
84
Q
Hypopituitarism
A
- Most life-threatening deficiencies- ACTH and TSH
- Deficiency of gonadotropins
- Growth hormone stimulates liver to produce somatomedins that enhance growth activity.
85
Q
Hypopiuitarism Causes
A
- Benign or malignant pituitary tumors can compress and destroy pituitary tissue.
- Pituitary function can be impaired by malnutrition or rapid loss of body fat.
- Shock or severe hypotension reduces blood flow-hypofunction and infarction.
- Other-hed and brain trauma, brain tumors or infection, radiation or surgery of head and brain and AIDS.
- Idiopathic hypopituitarism has an unknown cause.
86
Q
Hypopituitarism Assessment
A
- Look for changes in physical appearance
- Assess changes in vision (especially peripheral vision for changes or loss)
- Limited eye movement.
- DECREASED Anterior Pituitary HORMONES
- growth hormone: decreased bone density, pathological fractures, decreased muscle strength, increased serum cholesterol levels
- Gonadotropins (Luteinizing hormone [LH}0, follicle-stimulating hormone [FSH]) : women; amenorrhea, anovulation, low estrogen levels, breast atrophy, loss of bone density, decreased axillary and pubic hair, decreased libido. Men; decreased facial hair, decreased ejaculate volume, reduced muscle mass, loss of bone density, decreased body hair, decreased libido and impotence.
- thyroid-stimulating hormone (thyrotropin) (TSH): decreased thyroid hormone levels, weight gain, intolerance to cold, scalp alopecia, hirsutism, menstrual abnormalities, decreased libidio, slowed cognition, lethargy.
- Adrenocorticotropic hormone (ACTH); decreased werum cortisol levels, pale, swallow complexion, malaise and lethary, anorexia, postural hypotension, headache, hypoglycemia, hyponatremia, decreased axillary and pubic hair (women)
- Decreased Posterior Pituitary Hormones
- Vasopressin (antidiuretic hormone [ADH]): Diabetes Insipidus: greatly increased urine output, low urine specific gravity (<1.005), hypotension, dehydration, increased plasma osmolarity, increased thirst, output does not decrease when fluid intake decreases.
87
Q
Hypopituitarism interventions
A
- lifelong replacement of dificient hormones
- androgen therapy for virulization “Men”
- most effective is parenteral & transdermal
- Estrogens and progesterone - “Women”
- Risk for hypertension and thrombosis.
- Growth hormone
- may be treated with subcutanceous injection of human GH at night to mimic normal GH release.
88
Q
Pituitary Gland Problems
A
- Anterior Pituitary
- Hyperpituitarism
- Hypopituitarism
- Posterior Pituitary
- These problems can be caused by damage to the posterios pituitary or hypothalamus:
- Diabetes Insipidus
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
89
Q
Causes of Hyperpituitarism
A
- Hormone oversecretion occurs with pituitary tumors or hyperplasia
- pituitary adenoma (benign tumor) : most common are prolactin secreting tumors
- One hormone is produced in excess PRI, ACTH, or GH
90
Q
Gigantism
A
- Onset of growth hormone hypersecretion occurs before puberty
- painful bones and joints
91
Q
Acromegaly
A
- Onset may be gradual with slow progression
- Early detection and treatment are essential to prevent irreversible changes in soft tissues
- Some changes are reversible but skeletal changes are permanent.
92
Q
Hyperpitiutarism Assessment
A
- Ask about family history
- asku about any changes in hat, glove, ring, or shoe size and the presence of fatigue
- ask specifically regarding headaches & changes in vision
- Hypersecretion of PRL often reports sexual function difficulties
- changes in appearance and target organ function occur with excessive anterior pituitary hormones
93
Q
Hyperfunction Growth Hormone (GH) Acromegaly key features
A
- Thickened Lips
- coarse facial features
- increasing head size
- lower jaw protrusion
- enlarged hands and feet
- joint pain
- barrel-shaped chest
- hyperglycemia
- sleep apnea
- enlarged heart, lungs and liver
94
Q
Hypersecretion of Prolactin
A
- hypogonadism (loss of secondart sexual characteristics)
- decreased gonadotropin levels
- galactorrhea (milky nipple discharge)
- increased body fat
- increased serum prolactin levels
95
Q
Hyperfunction
Adrenocorticotropic Hormone (ACTH)
Cushing’s Disease (pituitary)
Key features
A
- elevated plasma cortisol levels
- weight gain
- truncal obesity
- moon face
- extremity muscle wasting
- loss of bone density
- hypertension
- hyperglycemia
- striae and acne
96
Q
Thyrtropin (Thyroid-Stimulating Hormone [TSH])
Hypersecretion features
A
- elevated plasma TSHA dn thyroid hormone levels
- weight loss
- tachycardia and dysrhythmias
- heat intolerance
- increased GI motility
- fine tremors
97
Q
Hypersecretion of Gonadotropins (LH and FSH) Key features
A
- Men:
- elevated LH and FSH levels
- hypogonadism or hypergonadism
- Women:
- normal LH and FSH levels
98
Q
hypophysectomy
A
- surgical removal of the pituitary gland and tumor is the most common treatment for hyperpituitarism.
- successful surgery decreases hormone levels, relieves headaches, and may reverse changes in sexual functioning,
99
Q
hyperpituitarism interventions
A
- nonsurgical
- drug therapy
- dopamine agonists: bromocriptine mesylate and cabergoline
- other drugs: somatostatin analogs especially octreotide and lanreotide
- octreotide inhibits GH release through negative feedback
- Pevisomant blocks GH receptor activity and blocks production of insulin-like growth factor (IGF).
- Radiation Therapy
- does not have immediate effects in reduction
- drug therapy
100
Q
gigantism
A
- abnormally high liner growth due to the excessice action of IGF-1 before the closure of the epiphyseal growth plates in childhood
101
Q
acromegaly
A
- disorder of the IGF-1 which causes excessive growth of the hands, feet, jaw and internal organs in adulthood
- mri shows pituitary tumor in 90% of acromegalic patients
- the best confirmatory test for acromegaly is the oral glucose suppression test.
- in acromegaly, glucose does not suppress growth hormone
102
Q
Hypophysectomy
A
- selective adenomectomy leaves normal pituitary tissue undisturbed.
- surgical removal of pituitary gland and tumor through a transphenoidal approach.
103
Q
Hypophysectomy preoperative care
A
- teach client that the procedure will decrease hormone levels
- relieve headaches
- may reverse changes in sexual function
- Procedure will not reverse body changes, organ enlargement or visual changes.
- client will have packing for 2-3 days
- client will need to breathe through mouth
- may have a mustache dressing under the nose
- no brushing teeth, coughing, sneezing, blowing nose or bending forward is allowed.
104
Q
hypophysectomy procedure
A
- client is in a semi-sitting position
- transsphenoidal incision just above the upper lip
- if an endoscopic or tesnsphenoidal approach can not be done a craniotomy is required.
105
Q
Hypophysectomy postoperative care
A
- assess
- vision, mental status, altered LOc, decreased strength in extremities
- diabetes insipidus
- CSF leakage
- infection
- increased ICP (intercranial pressure)
- avoid bending
- avoid constipation
- frequent mouth care every 4-6 hours
- no brushin teeth for 2 weeks
- expect numbness in area of incision
- will experience decreased sense of smell for 3-4 months
- hormone replacement with vasopression to maintain fluid balance to prevent diabetes incipidous.
106
Q
The patient after hypophysectomy
A
- Monitor the patient’s neurologic status hourly for the first 24 hours and then every 4 hours.
- monitor fluid balance, especially for output greater than intake.
- encourage the patient to perform deep-breathing exercises.
- instruct the patient not to cough, blow the nose, or sneeze
- instruct the patient to use dental floss and oral mouth rinses rather than toothbrushing until the surgeon gives permission.
- instruct the patient to avoid bending at the waist to prevent increasing intercranial pressure.
- monitor the nasal drip pad for the type and amount of drainage.
- Teach the patient methods to avoid constipation and subsequent straining.
- teach the patient self-administration of prescribed hormones.
107
Q
One cause of hyperpituitarism is multiple endocrine neoplasia, type 1, in which there is inactivation of the suppressor gene MEN1.
A
MEN1 has an autosomal-dominat inheritance pattern and may result in a benign tumor of the pituitary, parathyroid glands, or pancreas. In the pituitary, this problem causes excessive production of growth hormone and acromegaly. Ask a patient with acromegaly whether either parent also had this problem or has had a tumor of the pancreas of parathyroid glands.
108
Q
Teach patients taking bromocriptine to seek medical care immediately if
A
chest pain, dizziness, or watery nasal drainage occurs because of the possibility of serious side effects, including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage.
109
Q
Assessment of the patient who has undergone nasal hypophysectomy for hyperpituitarism
A
- Assess cardiovascular status:
- vital signs, including apical pulse, pulse pressure, presence or absence of orthostatic hypotension, and the quality/rhythm of peripheral pulses.
- Assess cognition and mental status.
- Assess condition of operative site:
- Observe nasal area for drainage:
- if present, note color, clarity and odor
- test clear drainage for the presence of glucose
- Observe nasal area for drainage:
- Assess neuromuscular status:
- Reactivity of patellar and biceps reflexes
- oral temperature
- handgrip strength
- steadiness of gait
- distant and near visual acuity
- pupillary responses to light
- Assess kidney function:
- Observe urine specimen for color, odor, cloudiness, and amount.
- Ask about:
- headaches or visual disturbances
- ease of bowel movements
- 24-hour fluid intake and output
- over-the-counter and prescribed drugs taken
- Assess patient’s understanding of illness and adherence with treatment:
- symptoms to report to health care provider
- drug plan (correct timing and dose)
110
Q
Posterior Pituitary Abnormalities
A
- The posterior pituitary gland secretes:
- Vasopressin
- Antidiuretic hormone (ADH)
- Two common disorders
- Diabetes Insipidus
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
111
Q
Diabetes Insipidus (DI)
A
- Lithium can cause DI
- Water metabolism problem cause by an ADH deficiency
- either decrease in ADH synthesis or
- inability of the kidneys to respond to ADH
- Classifications
- nephrogenic-inhertied disorder
- primary-defect in hypothalamus or pituitary
- secondary
- drug-related
112
Q
Diabetes Insipidus Assessment
A
- Symptoms of dehydration
- increase in frequency of urination and excessive thirst
- dehydration and hypertonic saline tests used for diagnosis
- urine diluted with low specific gravity (<1.005)
