Endocrine Flashcards
Thyroid Gland
Produces T3, T4 and Calcitonin. Relies on dietary iodine to make hormones. Thyroid hormones give us ENERGY.
Calcitonin
Decreases serum calcium levels by taking calcium out of the blood and pushing it back into the bone.
Hyperthyroidism : Diagnosis
Diagnosis:
T4 will be increased and TSH would be down
Thyroid scan: Client must discontinue any iodine containing meds 1 week prioir to the thyroid scan and must wait 6 weeks to restart medications
U/S, MRI and CT
Hyperthyroidism : Signs and Symptoms
Signs/Symptoms ( Could be confused with mania) Nervous Irritable Attention span DOWN Appetite UP Weight DOWN Sweaty/Hot Exophthalmos GI fast BP and Pulse up (increased workload of the heart) Arrthymias/palpitations Thyroid would be bigger
Hyperthyroidism: Medications - 4 kinds
Anti-thyroids: methimazole or propylthiouracil
Stops the thyroid from making thyroid hormones. Used pre-operatively to stun the thyroid.
Iodine Compounds: Different than dietary iodine. Decreases the size and vascularity of the thyroid gland, decreasing the bleeding risk. Put in milk or juice, as it can stain the teeth
Beta Blockers - supportive therapy. Decreases myocardial contractility. Could decrease Cardiac Output, HR and BP. Decreases Anxiety. Potential to decrease perfusion. Do not give to asthmatics or diabetics ( blocks symptoms of hypoglycemia)
Radioactive Iodine Therapy
One dose. Given PO. Rule out pregnancy. Destroys thyroid cells, causing hypothyroidism. Follow radioactive precautions. Stay away from kisses and babies for one week.
WATCH FOR A THYROID STORM. can lead to a heart attack or MI. Can be a rebound effect post-radioactive iodine.
Partial/Complete Thyroidectomy : Post op
Priority: Hemorrhage
Report feelings of pressure in the neck area ( Bleeding or swelling)
Check for bleeding at incision site anteriorly and posteriorly
Assess for recurrent laryngeal nerve damage by listening for hoarseness and weak voice, as it could lead to vocal cord paralysis, leading to an airway obstruction - needs a trach
Trach should be at the bedside for swelling, paralysis of vocal cords, hypocalcemia (follow the serum calcium levels), PTH removal (lead to hypocalcemia - NOT ENOUGH SEDATIVE)
SUPPORT THE NECK - no tension on the suture line
Elevated HOB to decrease edema
More calories
Parathyroid
Secrete PTH which makes you pull calcium from the bone and place it in the blood, therefore serum calcium goes up. Too much - High CA, Too little - low CA
Hyperparathyroidism = Hypercalcemia = hypophosphatemia
SEDATED.
Bones are brittle, Kidney stones, DTR are decreased, Muscle tone decreased, Arrthymias, LOC is down, Pulse down and Respirations down
Treatment:
Partial parathyroidectomy - take out two PT and PTH secretion decreases as well as serum calcium.
Ventilator and Dialysis
Monitor for hypocalcemia post op ( tight rigid muscles, airway spasms, seizure, arrhythmia)
Hypoparathyroidism = Hypocalcemia = Hyperphosphatemia
Not enough PTH, Low calcium - Not enough sedative
Muscle tone increased, SEIZURE, airway spasm, Chvostek/Trousseus, Arrthymias, LOC changes, Swallowing problems
Treatment: IV calcium, phosphorus binding drugs.
Adrenal Medulla - Function, Issues and Treatment
Produces epinephrine and Norepinephrine ( the fight or flight hormones)
Pheochromocytoma: Benign tumors that secrete epi and norepi in boluses. Tend to be familial, so screen the family
Signs/Symptoms:
BP is increased, HR is increased, palpitations. Flushing/extremely diaphoretic with a headache.
Diagnosis: Catecholamine levels: VMA and MN test and a 24 hour urine specimen is done and looking for increased levels of epi and norepi. Throw away the first urine and keep the last. KEEP CALM.
Surgery is needed to remove the tumors
Avoid palpating the this client’s abdomen as it will cause severe hypertension with sudden onset
Adrenal Cortex
Produces glucocorticoids, mineral-corticoids and sex hormones ( all are steroids). Even though the body produces these naturally, the adverse effects are going to be more pronounced when the client is receiving oral or IV steroids.
Glucocorticoids
Important for Cushing’s and Addison’s questions.
Changes your mood - presents in lots of different ways
Alter defense mechanisms - Immunosuppression/ High risk for infection
Breakdown Fats and Proteins
Inhibit insulin
Hyperglycemia
(assists in regulating glucose metabolism)
Monitor chem strips q6h even without diabetes diagnosis
Mineralcorticoids
Aldosterone
Makes you retain sodium and water, loses potassium
too much aldosterone: Cushings/Conn’s / FVE and hypokalemia
Too little: Addison’s, FVD and hyperkalemia
Sex Hormones
Testosterone, Estrogen and Progesterone
Too much sex hormone: Hirsutism, acne and irregular menstrual cycle
Too little: Decreased axillary/pubic hair, decreased libido
Adrenal Cortex Issues
Not enough steroids, Shock, Hyperkalemia, hypoglycemia
Addison’s Disease
Adrenocortical insufficiency - not enough steroids - Not enough aldosterone. Lose water and sodium and retain potassium - so hyperkalemia and FVD.
Signs/Symptoms:
Extreme fatigue
N/V/D
Anorexia/Weight loss
Hypotension
Confusion
Decreased sodium, increased potassium and Hypoglycemia
Hyperpigmentation - bronzing color of the skin and mucous membranes
White patchy area of depigmented skin (vitiligo)
Treatment: Combat shock through IV fluids Increase sodium in diet In/outs and daily weights BP monitoring
Medications:
Prednisolone - given twice a day in split doses - 2/3 in the morning and 1/3 at night
Fludrocortisone - is aldosterone
Addisonian Crisis
Can occur with infections , emotional stress, physical exertion or stopping steroids abruptly
Severe hypotension and vascular collapse, hypoglycemia.
Prednisone/Corticosteroids: Uses, contraindications, Onset, MoA, Advantages, Side/Adverse effects, Nursing interventions, Client education
Uses: Used to prevent nausea and vomiting caused by chemotherapy and also to prevent allergic reactions to chemo. Also used Addison’s disease.
Contraindicated in fungal infections, seizure disorder and pregnancy
Onset: 1 hour
MoA: Helpful in treating cancer as well as other illness. Considered chemo drugs. They are anti-inflammatory agents that suppress the inflammatory process that is associated with tumor growth. Blocks steroid specific receptors on the surface of the cel which slows the growth.
Advantages: Gives a sense of well being and euphoria.
Side Effects: Increased appetite, Fluid retention, Hypokalemia, Risk for infection, Hyperglycemia, Increased Fat distributions, Muscle weakness
Adverse effects: Seizures, circulatory collapse, infection
Nursing Interventions: monitor Serum glucose and electrolytes ( especially potassium and calcium), Daily weight and I&O
Client education: Take with food or milk, notify provider if fever of 38 degrees, don’t take aspirin and avoid the SUN
Fludrocortisone/ Mineralocorticoid: Uses, contraindications, Onset, MoA, Advantages, Side/Adverse effects, Nursing interventions, Client education
Used in Addison’s disease and Adrenal insufficiency
Contraindications: Children <2 y/o, hypersensitivity
PO
Interactions: Increased BP with sodium foods or medications, Decreased fludrocortisone action with barbiturates, phenytoin. Decreased potassium with thiazides and loop diuretics.
MoA: retains sodium and promotes loss of potassium. water and hydrogen from distal renal tubules.
Disadvantage: Can cause a negative nitrogen balance
Side Effects: Flushing, Headache, HTN, Weight Gain, Hypokalemia, Sweating, Dizziness, Tachycardia, Hyperglycemia
Adverse Effects: Seizures, Circulatory collapse, Embolism, Anaphylaxis
Nursing Interventions: Daily weight, I&O, Assess for edema, V/s q4h, Monitor electrolytes, Administer with food or milk for less GI symptoms
Education: Notify if weight gain > 5 pounds, chest pain, Don’t discontinue abruptly, avoid exposure to disease
Glucocorticoids: Uses, contraindications, Onset, Side/Adverse effects, Nursing interventions, Client education
Uses: Inflammation, allergies, cerebral edema, Septic Shock, Meningitis, Asthma, MS, Irritable bowel syndrome, autoimmune disease and organ transplant
Contraindicated in ulcerative colitis and seizure disorders
Interactions: Increased side effects with ETOH, salicylates, digoxin, diuretics, NSAIDS
Increased dexmethasone action with salicylates, estrogens, indomethacin, NSAIDS
Side Effects: Depression, Sweating, Mood changes, Hypernatremia, Hypokalemia, Flushing, Headache and insomnia
Adverse effects: Seizures, Circulatory collapse, HF, GI bleeding, muscle wasting, osteoporosis, HTN, Cardiomyopathy, thromboembolism, hyperglycemia, Cushings, Delayed wound healing
Interventions: IM injection - avoid the deltoid, Daily Weight, monitor vital signs, I&O, monitor for signs of infection. monitor fluids, electrolytes (potassium and calcium) and glucose. Do not stop abruptly.
Education: Avoid OTC products, DONT STOP ABRUPTLY
Glucocorticoid agents
Betamethasone (Celestone) Dexamethasone (Decadron), prednisone (Deltasone), methylprednisolone (Solu-Medrol) Prenisolone (Prelone)
Mineral corticoid agents
Fludrocortisone
Corticosteroid agents
Prednisone, Methylprednisolone (Solu-Medrol), Dexamethasone (Decadron)
Cushing’s syndrome: Signs + Symptoms, Treatment.
Too many steroids = hypokalemia
Signs and Symptoms:
Growth arrest, thin extremities/skin (lipolysis), increased risk of infection, hyperglycemia, Psychosis to depression, Moon Face ( fat redistribution or fluid retention), Truncal obesity, Buffalo Hump
TOO MANY GLUCOCORTICOIDS
Oily skin/acne, woman with male traits TOO MUCH SEX HORMONES
High BP, CHF, Weight Gain, Fluid volume excess, Hypokalemia, Hypernatremia, Hypocalcemia
Treatment: Adrenalectomy (unilateral or bilateral)/will require lifetime replacement of steroids if both are removed. A quiet environment, avoid infection.
Diet before treatment: Low sugar, High potassium, low sodium, increase protein and increase calcium
Type 1 Diabetes
They have little to no inulin - pancreas is shit
Usually diagnosed in childhood
First sign maybe DKA
Appears abruptly, despite years of beta cell destruction
Polyuria, polydipsia and polyphagia
Oral hypoglycaemic agents will not work with this patient because they don’t have insulin
Type 1 Diabetes Patho
Patho: You need to have insulin to carry glucose out of the blood and into the cell - since there is no insulin, the glucose just builds up in the blood. The blood becomes hypertonic and pulls fluid into the vascular space - the kidneys filter excess glucose and fluids ( polyuria and polydipsia) - the cells are starving so they start breaking down protein and fat for energy - when you break down fat you get KETONES ( an acid) so the client goes into metabolic acidosis with Kussmaul Respirations
