Endocrine Flashcards
Desmopressin acetate
Anti diuretic
Decreases UO
Establish baseline BP, pulse, weight, electrolytes, check PTT
Side effects:
Pain, redness, swelling at IV site,
HA, abdominal cramps, flushed skin, mild BP elevation.
Nausea with high doses
Levothyroxine
Thyroid hormone (T4)
Monitor: pulse (rate, rhythm; >100 or marked ^^ notify MD)
Observe for tremors, anxiety, appetite, sleep.
Can cause reversible hair loss at start for children.
Do not D/C lifelong therapy, take at same time daily (AM)
Full effect in 1-3 wks
Prednisone
Glucocorticoid
Monitor bone density, ht/wt in children.
Be alert to infection; Oral candidas
Never give live vaccine
Report s/s of: N/V, sore throat, fever, muscle aches, malaise, sever diarrhea, fatigue
Anti ulcers
Gastric acid secretion inhibitors;
Cimetidine
-do not take antacids within 1 hr
Ranitidine
Famotidine
Nizatidine
Assess for GI bleeding, monitor labs
Side effects; headache
Omeprazole
Proton pump inhibitor
Evaluate for GI relief.
Question discomfort, nausea, diarrhea
Take before eating.
Report: black, tarry stools
Esomeprazole
Proton pump inhibitor; gastric acid inhibitor.
Monitor for occult blood, HA
Take at least 1 hr before eating.
May open capsule, swallow without chewing
Methimazole
Anti thyroid
Treats hyperthyroidism
Teach pt take q8h
Avoid crowds & I’ll people, report pregnancy, monitor wt gain, slow heart rate, & cold intolerance
Propylithiouracil
Anti thyroid
Take q8h
Education same at Methimazole
Report darkening of urine (s/s of jaundice)
Lithium carbonate
Reduced manifestations of hyperthyroidism
TEMPORARILY
take q8h
Decreases UO
Teach pt to drink at least 3-4 quarts water/day
Check for wt gain, slow heart rate
Radioactive iodine therapy
Kills thyroid tissue. Pregnancy test must be performed prior to start.
Present in body fluids & stool for a few weeks after therapy.
Use radioactive precautions.
Max effects not seen for 2-3mths
Safety precautions for pt receiving radioactive isotope
- use toilet not used by others for at least 2 wks
- sit to urinate to avoid splashing
- flush 3 times
- if urine is spilled use paper towels to clean it up, bag in sealable bag & take to hospitals radiation therapy department.
- men with urinary incontinence should have condom cath; not diapers
- women should use facial tissue layers instead of gel-filled briefs
- using a laxative in second & third day of tx helps excrete contaminated stool faster
- wear machine washable clothing, & wash separately
- after washing clothes, run wash for full cycle with no clothes
- avoid close contact with pregnant, infants, young children, for 1st wk of therapy. After limit exposure to 1h per day
Safety precautions for radioactive therapy: saliva
-do not share toothbrush or toothpaste
-use disposable tissues (collect in ziploc & take to hospital)
-use disposable utensils, played, cups
-select foods that can be eaten completely & do not leave remnence
(Do not eat Fruit with core, meat with bone)
How to avoid ICP after pituitary sx
DO NOT:
- brush teeth
- cough
- sneeze
- blow nose
- bend at waist
- bend forward
- no straining
Care for pt after hypophysectomy
- Monitor neuro status q1h for 24h
- monitor fluid balance (esp, greater out than in cause Diabetes Insipidus)
- teach Deep breathing
- use dental floss & oral mouth rinse (cannot brush teeth until incision is healed)
- monitor nasal drip pad
- presence of halo sign may indicate CSF leak
- admin stool softener
Thyrotoxicosis
Condition caused by excessive amounts of thyroid hormone.
What do thyroid hormones do?
Stimulate the ❤️, increased stroke volume and heart rate
Goiter
- Hypertrophy of thyroid gland
- excessive TSH stimulation
- iodine deficient
Grave’s disease
Nursing care for 1st 24 hours post thyroid surgery
Monitor for complications;
- VS q15 min until stable then q30 min for 24 hrs
- place pt in semi-fowlers while awake
- avoid neck extension
- cough, deep breath q30 min -1h
Hemorrhage:
Most often occurs within 24hrs
Monitor dressing
Respiratory distress;
Can result from swelling, tetany, or damage to laryngeal nerve.
Laryngeal stridor (harsh, high pitched) heard in acute respiratory obstruction.
Keep emergency TRACH kit at bedside
Hypocalcemia
tetany can occur if parathyroid is removed.
Ask pt hourly about tingling around mouth, toes, fingers.
Assess for muscle twitching.
Calcium gluconate, or calcium chloride IV should be available in case of emergency
Thyroid storm causes
Caused by excessive thyroid hormone release.
Life-threatening event that occurs in pts with uncontrolled hyperthyroidism in Graves’ disease.
Often triggered by stressor;
- infection
- DKA
- pregnancy
Other triggers;
- over palpating of goiter
- exposure to iodine
- RAI therapy
Thyroid storm manifestations
-Fever
-Tachycardia
-Systolic HTN
May have GI problems;
-pain, N/V, diarrhea
-anxious, tremors
As crisis progresses:
- restless
- confused
- psychotic
May have
-seizures leading to COMA
Even with treatment, may lead to death
Emergency care of thyroid storm
- maintain airway
- give antithyroid drugs
- admin sodium iodide solution (2g)
- give propranolol (slowly over 3 min, have cardiac monitor, CVC in place)
- give glucocorticoids
- monitor for cardiac dysrhythmias (cont)
- monitor VS q30 min
- provide comfort measure, cooling blanket
- give non-salicylate antipyretics
- correct dehydration with NS
Eye care for hyperthyroidism
Graves’ disease
Eye and vision problems not corrected with tx for hyperthyroidism .
With mild symptoms teach pt to elevate HOB at night & use artificial tears
For photophobia use dark glasses, eye patches
If lids do not close completely, recommend using nonallergenic tape at bedtime
Myxedema
In HYPOthyroidism
Mucinous, instead of being cause by water.
Changes the pt’s appearance.
Non-pitting edema forms everywhere
S/S hyperthyroidism skin
- diaphoresis
- fine, soft, silky body hair
- smooth, warm skin
- thinning of scalp
S/S hyperthyroidism;
Pulmonary and cardiovascular
- SOB
- rapid, shallow respirations
- ⬇️ vital capacity
Cardio:
- palpitations
- chest pain
- ⬆️sys BP
- widened pulse pressure
- tachycardia
- dysrhythmias
S/S hyperthyroidism;
GI and musculoskeletal
- weight loss
- ⬆️appetite
- ⬆️stool
- hypoproteinemia
- muscle wasting
- muscle wasting
S/S hyperthyroidism;
Neurological
- blurred/double vision
- eye fatigue
- corneal ulcers
- ⬆️tears
- red conjunctiva
- photophobia
- eyelid retraction, lag
- hyperactive deep tendon reflexes (DTR)
- tremors
- insomnia
S/S hyperthyroidism;
Metabolic, psychological, reproductive
- ⬆️BMR
- heat intolerance
- low grade fever
- fatigue
- ⬇️attention span
- restlessness/irritable
- emotional lability
- manic behavior
- amenorrhea
- ⬆️libido
- goiter
- wide eyed (exophthalmos)
- ⬇️WBC
- enlarged spleen
Cortisone
Glucocorticoid
Take w/meals or snack
Can cause:
Insomnia, heart burn, anxiety, ab distention, increased diaphoresis, acne, mood swings,
Increased appetite, facial flushing, delayed wound healing
Hypothyroidism
Too little thyroid hormone.
Caused by thyroid sx, RAI tx, little iodide.
Pituitary tumor, trauma, infections
S/S hypothyroidism;
Skin
- cool, pale, yellow, dry, scaly, coarse
- thick brittle nails
- ⬇️hair growth
- poor wound healing
S/S hypothyroidism;
Pulmonary and cardiovascular
- hypo ventilation
- pleural effusion
- dyspnea
- bradycardia
- dysrhythmias
- enlarged ❤️
- ⬇️activity intolerance
- hypotension
S/S hypothyroidism;
Metabolic and musculoskeletal
- ⬇️BMR
- ⬇️temp
- cold intolerance
- muscle aches/pain
- delayed contract/relaxation
S/S hypothyroidism;
Neuro and psych
-slowing of intellectual functions Slowed speech, impaired memory -lethargy, somnolence -confusion -hearing loss -parasthesia -⬇️DTR
- apathy
- depression
- paranoia
- withdrawal
S/S hypothyroidism;
GI and reproductive
- anorexia
- weight gain
- constipation
- ab. Distention
- changes in menses
- ⬇️libido
- anovulation
- impotence
S/S hypothyroidism;
Other
- peri orbital edema
- facial puffiness
- non putting edema
- hoarseness
- thick tongue
- ⬆️ sensitivity to opioids
- weakness/ fatigue
- ⬇️UO
- easy bruising
- iron deficiency
- folate & B12 deficiency
Emergency care of pt during a myxedema coma
- maintain airway
- IV hypertonic or NS
- Levothyroxine sodium IV
- glucose IV
- corticosteroids
- check temp hourly
- cover with want blankets
- monitor for changes in mental status
- turn q2h
- institute aspiration precautions
Acute adrenal insufficiency
Addisonian crisis
Too little cortisol and aldosterone
S/S Addison’s disease
- muscle weakness, fatigue, joint/muscle pain
- anorexia, N/V, abdominal pain, constipation/diarrhea, wt. loss
- salt craving
- hyper pigmentation
- anemia, hypotension,
- hyponatremia,
- hyperkalemia, hypercalcemia
-depression, low libido, irritability
Addison’s diagnostic
ACTH stimulation test;
0.25-1mg IV
Check plasma cortisol levels at 30 min and 1 hr intervals
Primary: cortisol response ⬇️ or absent
Secondary: cortisol response ⬆️
Emergency care acute adrenal insufficiency
Addison crisis
Hormone replacement;
- rapid infusion NS or D5W
- initial hydrocortisone sodium succinate (solu-cortef) 100-300mg or dexmethasone 4-12mg IV bolus
- additional solu-cortef 100mg IV over 8 hrs
- hydrocortisone 50mg IM q12h
- give H2 histamine blocker (ranitidine)
Hyperkalemia management;
- insulin with dextrose in NS
- admin kayexalate
- loop or thiazide diuretics
- initiate K+ restriction
- monitor I&O
- monitor EKG & ❤️ for dysrhythmias
Cushing’s disease
Too MUCH cortisol
Problems with:
adrenal cortex, or anterior pituitary, hypothalamus, ectopic ACTH production
Cushing’s disease S/S
-moon face, truncal obesity, buffalo hump, weight gain
-HTN, ⬆️ risk for thrombotic events, edema, capillary fragility
(Bruising, petechiae)
- thin skin, striae, ⬆️pigmentation
- muscle atrophy, osteoporosis, pathological fx, ⬇️height with vertebral collapse, aseptic necrosis of femur head, slow/poor healing of bone fx
- neurotic/psychotic behavior, sleep difficulties, fatigue
- ⬆️ risk of infection, ⬇️ immune function
Cushing’s diagnosis
Salivary cortisol levels
(At midnight)
Normal: 20 ng/mL
⬆️ indicates hypercortisolism
-24hr urine
⬆️ blood glucose, sodium
⬇️ lymphocyte count, calcium, K+
Nutrition therapy for hypercortisolism
Restrictions of fluids and sodium intake to control fluid volume.
Level of sodium restriction depends on pt
Nursing care for hypercortisolism
Monitor for fluid overload
-I/O, daily weight, urine specific gravity (⬇️ 1.005 indicates fluid overload)
Notify HCP if 3lb gain/week or 1-2lbs in 24h
Emergency care for hypercortisolism
IV hydrocortisone 100 mg
IV NS
Continue IV hydrocortisone until PO can be tolerated.
Easy way to remember adrenals
Sugar
-glucocorticoids
Salt
-mineralcortocoids
Sex
-androgens
Too little hormone = ⬇️ sugar, salt, sex
Too much hormone = ⬆️ sugar, salt, sex
Adrenalectomy post-op
watch for addisonian crisis
Diabetes insipidus
Too little ADH
cause by decrease in ADH synthesis or inability of kidneys to respond to ADH
Diabetes insipidus s/s
Key manifestations: ⬆️ frequency in urination and excessive thirst
Other:
-hypotension, ⬇️ pulse pressure, tachycardia, weak peripheral pulses
- dilute, low specific gravity
- hypo-osmolar
- poor skin turgor, dry mucous membranes
-⬆️sensation, irritability, ⬇️ cognition, hyperthermia, lethargy ➡️ COMA
Diagnostic studies for Diabetes insipidus
24 hr fluid I/O without restrictions
DI is considered if UO is >4L during this period or is more than volume ingested
Low specific gravity (
Medications given to patients with DI
Desmopressin
Vasopressin
Chlorpropamide
All reduce urine output
Syndrome of inappropriate ADH
Aka SIADH
too much of vasopressin hormone
ADH continues to be released even when plasma is hypo-osmolar.
Occurs with many pathological conditions (cancer therapy), & certain drugs (SSRI’s)
SIADH s/s
Water retention
- loss of appetite, N/V
- weight gain (free water, not salt is retained) dependent edema usually not present
- hyponatremia
-lethargy, HA, hostility, disorientation, change in LOC, ⬇️ responsiveness, seizures, ⬇️ DTR
Diagnostic study for SIADH
Radioimmunoassay of ADH
Nursing care for SIADH
Restrict fluid intake, promote excretion of water.
- replace Na+
- interfere with action if ADH
- monitor for fluid overload, strict I&O
- pulmonary edema can occur quickly & can lead to DEATH
- assess orientation q2h, reduce stimulation, noise
- watch for seizures due to Na+ deficit
