Endocrine Flashcards
What hormones does the thyroid glad produce?
T3
T4
Calcitonin
Calcitonin action
Decreases serum Ca levels by taking Ca out of the blood and putting it into the bone
What do you need in your diet to make hormones?
Iodine (completely different action than iodine drugs)
What does the thyroid hormone give you?
Energy
Another name for hyperthyroidism
Graves Dz
Graves Dz
Too much energy
S/S of graves dz
Weight LOSS Exophthalmos (bulging eyes, irreversible) Increased appetite, fast GI Increased BP, HR Enlarged thyroid Nervous/irritable Decreased attention span Sweaty, HOT
How to diagnose graves dz
Increased T4, thyroid scan
What must the client do 1 week prior to thyroid scan?
Discontinue iodine containing meds
Amiodarone
Anti arrhythmic
Contains high levels of iodine, affects thyroid function
Tx for Graves dz
Anti-Thyroid drugs, iodine compounds, beta blockers, radioactive iodine, sx
Anti thyroid meds
Propylthiouracil (PTU), methimazole
- Stop thyroid from making hormones
- Used prep to stun thyroid
Iodine compounds
Potassium iodine
- Decrease size/vascularity of the gland
- All endocrine glands are VERY vascular
- Give in milk or juice, use straw (stains teeth)
Beta blockers
Propranolol
- Decreases myocardial contractility
- Can decrease CO
- Decreases HR, BP
- Decreases anxiety
- Don’t let you release epi and norepi
Who do you not gibe beta blockers to?
Asthmatics (can precipitate an attack) or diabetics (will hide symptoms of hypoglycemia)
Radioactive iodine
- One dose
- Given PO liquid or tablet
- Not used in pregnancy
- Destroys thyroid cells leading to hypothyroid
- Follow radioactive precautions (stay away from babies and don’t kiss anyone for 24 hours)
- Watch for thyroid storm-rebound effect post radioactive iodine
Post op thyroidectomy
- Partial or complete
- Support neck, place personal items close to them
- Elevate HOB
- Check for bleeding behind neck, under skin (pooling)
- Client needs calories before and after
What could hoarseness after thyroidectomy mean?
Recurrent laryngeal nerve damage
What could feelings of pressure mean after a thyroidectomy?
Vocal cord paralysis. Paralysis of both cords means airway obstruction and requires immediate trach
- Have trach ready at bedside
- Check for swelling, hypocalcemia (parathyroid removal)
Another name for myxedema
Hypothyroid
S/S of myxedema
- Weight GAIN, slow GI
- COLD
- Fatigue, no energy
- Amenorrhea
- Slow and slurred speech
- No expression
- Possibly totally immobile client
- Do not give them a heating pad, they can’t tell if it gets too hot
Cretinism
When hypothyroid is present at birth, very dangerous and can lead to slowed mental and physical development if not detected
Tx of myxedema
Levothyroxine, thyroglobulin, liothyronine
- Take these meds forever
- Makes their energy increase
- Increased BP/HR and CAD
PTH
Pulls Ca from the bone and places it in the blood
Partial parathyroidectomy
2 parathyroids are removed, PTH secretion decreases
What do you monitor for after partial parathyroidectomy?
Rigid/tight muscles
Tx of hyperPTH
Partial parathyroidectomy
Tx of hypoPTH
IV Ca, phos binding drugs
What do you need your adrenal glands for?
To handle Stress
Two parts of the adrenal gland
Adrenal medulla
Adrenal cortex
What does the adrenal medulla secrete?
Epi and Norepi
Pheochromocytoma
Benign tumors that secrete epic and norepi in boluses
S/S of pheochromocytoma
Increased BP/HR
Flushing/diaphoretic
Dx of pheochromocytoma
VMA (vanillylmandelic acid) test: 24 hour urine specimen to look for increased levels of epic and norepi
-Anything with vanilla will alter test, stay away for a week prior
What are epi and norepi also called?
Catecholamines
What to remember about 24 hour urine specimens
- Throw away first void
- Keep last void
Tx of pheochromocytoma
Sx to remove tumors
What does the adrenal cortex secrete?
Glucocorticoids, mineralocorticoids, sex hormones
What do glucocorticoids do?
Change your mood (insomnia, depressed, psychotic, euphoric) Alter defense mechanisms, immunosuppressed Breakdown fats and proteins Inhibit insulin (monitor BG)
Mineralocorticoids are what?
Aldosterone
Aldosterone action
Retain Na and water, excrete K
Cortisol
ACTH from pituitary stimulates cortisol to be made. They are steroids
Not enough steroids, think what?
Shock, high K
No aldosterone
Addison’s Dz
Adrenocortical insufficiency, not enough steroids (glucocorticoids, mineralocorticoids, sex hormones)
S/S of Addison’s
Initially, s/s of hyperkalemia
Then, anorexia/nausea, hyper pigmentation of skin and mucous membranes, white patchy areas of depigmented skin (vitiligo), decreased bowel sounds, GI upset, hypotension, decreased Na, increased K and hypoglycemia
Losing weight, low BP, fluid volume deficit
Tx of Addison’s
Combat shock-Give Na in diet, processed juice/broth
I&O, daily weights, drugs
Drugs for addison’s
Fludrocortisone (aldosterone)
DAILY WEIGHTS-keep within 2-3 lbs of normal weight
Addisonian Crisis
Severe hypotension and vascular collapse
Cushing’s Dz
Too many glucocorticoids, mineralocorticoids, sex hormones
S/S of too many glucocorticoids
Growth arrest Thin extremities/skin (lipolysis) Risk of infection Hyperglycemia Psychosis then depression Moon faced (fat redistribution/fluid retention) Truncal obesity (fat redistribution, lipogenesis) Buffalo hump (fat redistribution)
S/S of too many minerals
High BP
CHF
Weight gain
Fluid volume excess
S/S of too many sex hormones
Oily skin/acne
Women with male traits
Poor sex drive/libido
If the client has too much mineralocorticoid, what will the serum K do?
Decrease
If you did a 24 hour urine on a client with too much minerals, would the cortisol levels be high or low?
High
Tx of cushing’s
Adrenalectomy (unilateral or bilateral), if both are removed they’ll need a lifetime replacement
Quiet environment
Diet before treatment-high K, protein, and Ca, low Na
Avoid infection
What might appear in the urine of cushing’s dz pt?
Glucose and ketones
What do steroids do to the serum Ca?
Decrease it by excreting it through the GI tract
