Endocrine Flashcards
what does the anterior pituitary secrete
Growth Thyroid Stimulating Adrenocorticotropic Follicle-stimulating Luteinizing Prolactin
what does the posterior pituitary secrete
Antidiuretic
Oxytocin
growth hormone (anterior pituitary)
AKA: GH
Target: Most tissue
Action: Stimulates growth by promoting protein synthesis and fat metabolism
Thyroid-stimulating
AKA: TSH
Target: Thyroid Gland
Action: Stimulates thyroid hormone secretion and thyroid gland growth
Follicle Stimulating
AKA: FSH Target: Ovaries /seminiferous tubules Action: Follicle maturation/estrogen secretion Spermatogenesis
Luteinizing
AKA: LH Target: Ovaries /testes Action: Ovulation/progesterone production Testosterone production
Antidiuretic Hormone
AKA: ADH Stored: PPG Produced: Hypothalamus Target: Kidneys Action: Decreases urine production
Oxytocin
Stored: PPG
Produced: Hypothalamus
Target: Uterus/Mammaries
Action: Uterine contraction & Milk ejection
Thyroxine & Triiodothyronine
thyroid
AKA: T3 & T4
Target: Most body cells
Action: Metabolism, G&D
Calcitonin
thyroid
Target: Bone
Action: Inhibits bone breakdown and decreases blood calcium
Parathyroid hormonoe
AKA: PTH Target: Bone, Kidney, GI Action: Increases blood Ca+ Increasing bone breakdown Increasing GI absorption of Ca+ Decreasing urine excretion of Ca+
Thymosin
thymus
Target: Immune Response Tissue
Action : Immune system development and function
Melatonin
pineal gland
Target: Hypothalamus
Action: Inhibits gonadotropin-releasing hormone
Inhibits reproduction
Regulates daily rhythms
Mineralocorticoids
adrenal cortex
AKA: aldosterone
Target: Kidney
Action : Increases Na+ and H20 absorption
Glucocorticoids
adrenal cortex
AKA: cortisol Target: Most Body Cells Action : Increases blood glucose Inhibits inflammation Immune response
Androgens
adrenal cortex
AKA: Testosterone & Estrogen (gonadotropins)
Target: Most Body Cells
Action : Sex characteristics and reproduction
Catacholamines
adrenal medulla
AKA: Epinephrine & Norepinephrine Target: Heart, vessels, liver, adipose tissue Action : Stress response Increased HR, BP, RR, BG Increased skeletal muscle perfusion
Glucagon
pancreas
Target: Liver
Action : Increases blood glucose by increasing glycogen breakdown in liver
Insulin
Target: Liver, skeletal muscle, adipose tissue
Action : Decreases blood glucose by increasing cellular uptake and metabolism of glucose.
rapid acting insulin
aspart (NovoRapid)
glulisine (Apidra)
lipsro (Humalog)
short acting insulin
regular (Humalin R and Novolin grToronto)
Intermediate acting insulin
NPH (Humalin-N and Novolin geNPH)
Long lasting insulin
detemir (Levimir)
glargine (Lantus)
what is the action and uses of insulin
Action
Transports glucose molecules into the cells
Uses
Type 1 Diabetes
Type 2 Diabetes when uncontrolled with oral agents
Diabetic Ketoacidosis
Hypokalemia (when given with glucose)
Adverse Reactions of insulin
Hypoglycemia
Hyperglycemia
Contraindications and Precautions
C:Hypersensitivity to drug and Hypoglycemia
P:Renal impairment
Hepatic disease
Pregnancy & lactation
Sulfonylureas examples?
glyburide, glipizide
Sulfonylureas actions and uses
A:Stimulate beta cells in pancreas to produce insulin
Uses
Type 2 Diabetes
Patients with responsive beta cells
adverse reaction of sulfonylureas
Hypoglycemia
Anorexia, nausea, vomiting, epigastric pain, weight gain
Contraindications of sulfonyureas
DKA, infection, renal impairment
nonsulfonylureas examples
metformin
nonsulfonylureas uses and action
A: Affects circulating insulin by reducing glucose production in the liver, slowing GI absorption of carbs, and decreasing tissue insulin resistance
Uses
Type 2 Diabetes
Patients with insulin resistance
nonsulfonylureas adverse reactions?
Metallic taste, bloating, cramping, flatulence
contraindications for nonsulfonyllureas
Heart failure
Renal disease
>80
Pregnancy
pharmacology GH example?
somatropin
Pharmacology-
Growth Hormone
action and uses
Children: Produces skeletal growth in with open epiphyseal plates
Adults: Supplement natural GH production
Uses
Children: promote growth in GH deficiency
Adults: Chronic renal failure, HIV, or pituitary disease
Pharmacology-
Growth Hormone adverse reactions
Hypothyroidism
Insulin resistance
Swelling, joint pain, muscle pain
Pharmacology-
Growth Hormone contraindications and precautions
C:Hypersensitivity to drug
Epishyseal closure
Pituitary tumor
P:Thyroid disease
Diabetes
Pregnancy & Lactation
Pharmacology-
Gonadotropins Examples
Gonadropropin, clomiphene, cetrorelix, nafarelin
Pharmacology-
Gonadotropins actions and uses
Action: Supplements natural hormone production
Uses: Women: Induce ovulation
Boys: Cryptorchism,
Men: Induce sperm production
Pharmacology-
Gonadotropins adverse reactions
Hotflashes Breast tenderness Hemoperitoneum Nausea, Vomiting Headache, irritability, restlessness
Pharmacology-
Gonadotropins contraindication and precautions
C: Hypersensitivity to drug Thyroid dysfunction Adrenal dysfunction Liver disease Ovarian cysts Hormone driven cancers Pregnancy P: Epilepsy Migraines Asthma Cardiac dysfunction Lactation
Pharmacology-Vasopressin Examples
vasopressin, desmopressin
Pharmacology-Vasopressin action and uses
Action: Regulates reabsorption of water by the kidneys
Secreted by pituitary when water must be conserved
Uses: Diabetes insipidus
Preventing/treating postop abdominal distention & gas
Pharmacology-Vasopressin adverse reactions
Tremor, sweating, vertigo
Nasal congestion
Nausea, vomiting, abdominal cramps
Water intoxication (in overdose)
Pharmacology-Vasopressin contraindication and precautions
C: Hypersensitivity to the drug
P: History of seizures Migraine headaches Asthma Congestive heart failure Pregnancy & lactation
Pharmacology-
Antithyroid Drugs Example
action and uses
Methimazole, radioactive iodide
Pharmacology-
Antithyroid Drugs
Action Inhibits thyroid hormone production Uses Hyperthyroidism Thyroid cancer
Pharmacology-
Antithyroid Drugs
adverse reactions
Cold symptoms Nausea, vomiting Paresthesias Agranulocytosis Hepatitis
Pharmacology-
Antithyroid Drugs
contraindication and precautions
C: Hypersensitivity to the drug
Breastfeeding
I-131 – pregnancy and lactation
P: Pregnancy
Oral anticoagulants
Pharmacology-Thyroid Hormones Exapmples
levothyroxine
Pharmacology-Thyroid Hormones action and uses
Action
Supplement natural hormone production
Uses
Hypothyroidism
Pharmacology-Thyroid Hormones adverse reactions
Signs of hyperthyroidism
Pharmacology-Thyroid Hormones contraindication and precautions
C: Hypersensitivity to drug
Adrenal cortical insufficienty
Hyperthyroidism
P: Cardiac disease & lactation
Pharmacology-Corticosteroids Examples
Mineralocorticoid: fludrocortisone
Glucocorticoid: cortisone, prednisone
Pharmacology-Corticosteroids action and uses
Action Supplement natural hormone production Uses Addison’s disease Inflammatory disorders (RA, allergies, etc)
Pharmacology-Corticosteroids adverse reactions
Fluid/Lyte disturbances Blood sugar elevation Weight gain Buffalo hump Oily skin and acne
Pharmacology-Corticosteroids contraindication and precautions
C: Hypersensitivity to drug
Serious infections
P: Renal disease Hepatic disease Hypothyroidism GI disease Pregnancy Administration of certain vaccines
prediabetic mellitus?
leads to type two, heart and stroke prob.
impaired fasting glucose –> 100 to 125
impaired glucose tolerance –> 140-199 lasting 2h
can treat with wt. loss and increase activity
hyperglycemia
elevated blood glucose lvl.
pancreatitis
cushing syndrome–> adrenocorticoids excessive
gluccorticoids
loop diuretics, levadopa, oral contraceptives,TPN
Type one diabetes mellitus patho/etiology
insulin dependent
autoimmune
absent insulin production by beta cell in islets of pancreas
usually develop in childhood can breakdown fats and protein instead of glucose = ketones
Type two diabetes mellitus patho/etiology
non-insulin dependent
insulin resistance or insufficient insulin production
more common in adults (40-64) and obese kids
assessment for diabetes mellitus?
glycosuria or blood glucose of >180 kussmauls'r resperations POLYURIA POLYDIPSIA POLYPHAGIA
Signs and symptoms of diabetes mellitus
Type 1 –> abrupt
Type 2–> gradual
wt. loss, weakness, thirst, fatigue, dehydration and change in visual acuity
Diagonistic for diabetes mellitus
develop infection easily (increase glucose =bacterial growth)
glucose may be detected in urine –> ketones
blood sugar –>before 90-130 and >180 after meals
glycosylate hemoglobin increase should be (
medical management for diabetes mellitus
diet/wt. loss exercise insulin oral anti-diabetic agents adjuvent drugs pancreas transplant islet cell transplant
Nursing management for diabetes mellitus
med. and allergy hx, symptoms and duration, drug regimen, monitor blood glucose/urine, consult with diet,
check for change in skin, vital signs, edema, visual acuity, muscle atrophy or loss of sensation
Diabetic ketoacidosis
a type of metabolic acidosis, occurs when there is an acute insulin deficiency or inability to use whatever insulin the pancreas secretes
patho/etiology od DKA
can be triggered by infection
has ketones in urine
when amt of glucose transported across the membrane decreases the liver increases production of glucose –> excessive H20, K+, Na+ to be excreted
Medical management of DKA
reduce blood glucose,, correct F/E imbalance, clear urine of ketones
IV insulin or isotonic fluids
watch so don’t end up hypoglycemic
Nursing management of DKA
monitor IV, vital signs, blood glucose and urine, I&O
check cardiac leads–> heart conduction
Hyperosmolar Hyperglycemic Nonketoic Syndrome
an acute complication of diabetes—> hyperglycemic without the ketones blood glucose over 500 but ph is normal
patho/ etiology of HHNS?
serious illness where metabolic needs exceed the limit of available insulin. Fluid move form intra to extracellular, diuresis occurs with subsequent loss of Na+ and K+
more common: undiagnosed DM, older adults with type 2, drugs that elevate glucose, kidney dialysis, & TPN
Assessment findings of HHNS
hypotension, mental changes, extreme thirst, dehydration, tachycardia, possible fever, increse BG, paralysis lethargy, coma, seizures, S/S hypoNa+ and K+
Medical managment of HHNS
administer insulin, correct F/E imbalance,
Nursing managemetn of HHNS?
measure blood glucose, assesses for F/E, assess for dehydration, observe neurological and cognitive function, protect if cognitive impair
hypoglycemia patho/etiology?
to much insulin in the blood stream
caused from: not eating and still taking insulin, not eating sufficient cal, or exercise more than usual possible with alcohol intake
assessment finding for hypoglycemia
weakness, headache, nausea, drowsiness, nervousness, hunger, tremors, personality change, double vision has rapid onset and if not treated –> coma or seizures
Medical managmetn of hypoglycemia
15g of simple carbohydrates ASAP
if unconscious use glucose gel
do twice if unresponsive Dr. –> glucogan
Peripheral Neuropathy
pathological changes in nerves can affect motor, sensory, and autonomic nerves 10 or more years
patho/etiology of peripheral neuropathy
poor glucose control
motor: muscle atrophy, feet widen, deformities change in gait
sensory: parasythesis, abnormal sens. loss of feeling
autonomic: slows food in stomach, affects bladder, and orothstatic hypotension
peripheral neuopathy assessment findings
pain, skeletal muscle small, feet swell, dizziness, disturbed sensation, digestion, urinary, or sexual dysfunction
medical management of peripheral neuopathy
diet/exercise, medication control, several meds can reduce pain , TENS, elastic compression stocking, urinate q3h
Nursing management of peripheral neuopathy
teaching: inspect foot, wash feet, dry thoroughly between toes, toenail short and straight across, use moisturizer, well fitting shoes, call if cut of foot
diabetic retinopathy
refer to the progressive decrease in renal function that occurs with diabetes mellitus (usually type 1)
patho/etiology of diabetic retinopathy
glomerular deterioration resulting in impaired filtration of blood during urine formation
assessment finding of diabetic retinopathy
inadequate glucose control, vision changes, can cause blindness, and edema
medical managment of diabetic retinopathy
yearly eye checks, ACE inhibitors, seal leakeage in retina blood vessels, vitectomy, ovinehyaluronidase to clear vision
nursing managment of diabetic retinopathy
therapeutic regimen
explain purpose, explain symptoms and when to report
vascular disturbances
affect many tissue and organs more susceptible to atherosclerosis and atherosclerosis
patho/etiology of vascular disturbances r/t
thicken of atrial walls, coronary artery disease is increased, brain may be insensitive to leptin–>over eating
assessment findings for vascular disturbances r/t DM
pale, cool skin, leg cramps, gangrene, skin ulcer, chest discomfort, MI at earlier age, hyperlipidemia,
Medical management of vascular disturbances rt DM
lipid lowering measures,, low fat diet, exercise, medication, drugs that reduce platelet aggregation, no smoking, amputation of gangrene, closely monitor BG
nursing mangagment for vascular disturbances r/t DM
medical proficient, individualized care r/t S/S, check BC regularly, comfort care.
Diabetic Insipidus
excretion of extremely large volumes of urine
Neuogenic–> secretion of ADH is norm
Central–> renal tubules partially or completely fail –> insufficent ADH
patho/etiology of Diabetic Insipidus (Central)
ADH regulates absorption of water in kidney tubules, increased circulation fluid- released to responce of thirst, fluid/volume lost –> lowers B/P, ADH incrases B/P by signally peripheral arterioles to constict
patho/etiology of diabetic insipidus (neurologic)
ADH (lack) –> large vol. of diluted urine–> dehydration with F/E loss
head trauma, brain tumor, or after hypophysectomy, lithium, demeclocycline, amphoterician B or elevated prostglandin E
assessment finding of diabetic insipidus?
20L/day or diluted urine (specific gravity 1.002 or less)
thirst is excessive, limited activity, weakness, dehydration, wt. loss
diagnostic of diabetic insipidus?
fluid deprivation test (withhold fluids for 5 to 6 hours) then test urine volume and osmolarity
or
give demopressin -> if urine becomes more concentrated symptoms are from ADH if it continues it is nephrogenic
medical management of diabetic insipidus?
IV fluids if cannot take in adequate oral
nephrogenic DI–> HCP reduces amt of excreted Na+ gives thiazide, spiruolactone prevent hypokalemia
restrict intake of protein to decrease work of kidneys
nursing managment of diabetic insipidus?
correct fluid imbalance, watch I&O, measure urine q 30min, daily wt., consume sufficient fluids, teach to conserve fluids (air conditionor)
patho/etiology of acromegaly
GH over secreted after the long bones have sealed. Pituitary insensitive to feedback inhibiting horomones such as somotostatin and insulin –> stimulating bone growth and enlarged organs
assessment findings of acromegaly
increase blood glucose, hyperlipemia, huge bones, thick tongue/lips, heart liver and spleen enlarged, muscle weakness, masculine features
what is medical managment of acromegaly
surg--> hypophysectomy radiation treatment (4-6wk), if pituiatry is removed need replacement drugs
Nursing management of acromegaly
help cope with physical changes, pace activities, relieving discomfort, evaluate pain, encourage self-care, check increased cranial pressure, monitor drainage, avoid drinking from straw
panhypopituitarism (simmond’s disease) patho/etiology
rare, events such as post partum emboli, hemorrhage, surgery or tumor, can be from TB affects all the hormones of anterior pituitary
panhypopituitarismm assessment findings
gonads atrophy, s/s hypothyroidism, hypoglycemia, adrenal insuffiency, ages prematurely, pale,
medical management of panhypopituiarism
replacement hormone
if untreated its fatal
GH necessary for children
Nursing managment of panhypopituitarism
administer ALL meds as prescribed, adhere to med, monitor blood lvls, assess mental status, emotional state, energy level, and appitite (4-6 sm. meals)
Syndrome of Inappropraite Antidiuretic Hormone Secretion patho/etiology?
renal absorption rather than excretion
causes –> lung tumor, CNS disorder, brain tumor, head trauma or drugs such as (vasopressin, general anesthetic agents, oral hypoglycemics, tricyclin antidepressants)
*Na+ and osmolarity decreased Urine one are increased
SIADH assessments findings?
water retaining, headache, muscle cramps, anorexia, N/V, muscle twitching, change in LOC
SIADH medical managment?
treament aimed at underlying cause, osmotic diuretics (mannitol), loop diuretic(furosemide), severe hyponatremia, 3%Sodium chloride solution
Nursing managmenent of SIADH?
closely monitor I&Oand vitals, carely assess LOC, check for fluid overload(confusion, pulmonary congestion, hypertension), check for hyponatremia(weakness, cramps, anorexia, N/V, irritability, headache, wt gain without edema), inform medication and compliance
Hyperthyroidism (Grave’s disease) patho/etiology
no etiology –> may be autoimmune accompanies thyroid tumors, pituitary tumors, hypothalmic tumors
results from stres, infection, increased metabolism rate because over secretes T3 and T4
Graves disease assessment findings
restlessness, highly excitable, fine tremors, cannot tolerate heat, has increased appitite but experiances wt. loss, visual changes, bulging eyes (exopthamas), incrase neck swelling
Medical management of grave’s disease?
antithyroid drugs, potassium iodine, radiation, subtoatl thyroidectomy, partial or total
Diagnositic of graves disease?
protein bound iodine, FT3 and T4 are elevated, TSH decrased
Nursing management of graves disease?
monitor HR and B/P, sleep pattern, daily wt., promote rest, increase caloric intake, take while for drugs to work, encourage frequent meals, after treatement adjustment to drugs are need
