Endocrine Flashcards
pituitary gland location
base of brain
adrenal gland location
top of kidneys
thyroid gland location
anterior part of neck
parathyroid gland location
on thyroid gland
pancreas location
posterior to stomach
pituitary gland function
promotes body tissue growth. water absoprtion by kidney. sexual development and function.
adrenal gland function
sodium and electrolyte balance.
thyroid gland function
body metabolism rate. produces T3 and T4
parathyroid gland function
controls calcium and phosphorus metabolism
pancreas function
carb metabolism. produces insulin and glucagon
hemoglobin a1c (glycosylated hemoglobin a) meaning
how well blood glucose has been controlled for the past 3-4 months (90-120 days)
hypopituitarism patho
decreased secretion of pituitary hormones
hypopituitarism s/s
obesity. reduced cardiac output. sexual dysfunction. low blood pressure. fatigue. tumors.
hypopituitarism care
hormone replacement. emotional support.
hyperpituiitarism (acromegaly) patho
increase secretion of growth hormone usually caused by tumors
hyperpituiitarism (acromegaly) s/s
large hands and feet. thick and protruding jaw. joint pain. arthritis. visual changes. sweating. pily rough skin. prganomegaly. hypertension. atherosclerosis. cardiomegaly. heart failure. dysphagia. deepening in voice. thick tongue. narrowing airway. sleep apnea. increase blood sugar. colon polyps
hyperpituiitarism (acromegaly) care
radiation. removal of pituitary tumor (hypophysectomy). care for arthritis.
hypophysectomy
removal of pituitary tumor via craniotomy
hypophysectomy complications
IICP. bleeding. meningitis. hypopituitarism.
hypophysectomy post op care
neuro checks.
elevate HOB
check for IICP
check and report s/s DI (excessive urine output)
antibiotics
pain and fever meds
oral mouth rinse
no toothbrush or use ultra soft toothbrush for 10 days to 2 weeks
REPORT POSTNASAL DRIP OR CLEAR NASAL DRAINAGE = CSF
diabetes insipidus patho
decrease secretion of ADH (vasopressin, antidiuretic hormone)
diabetes insipidus s/s
large amounts of diluted urine. polydipsia. dehydration. decreased skin turgor. dry mucous membrane. low urine specific gravity. fatigue. ortho hypotension. tachycardia.
diabetes insipidus care
INCREASE FLUIDS. monitor I&O daily weights and specific gravity. VS. neuro checks. cardiac status. safe environment. check for s/s dehydration. give vasopressin or desmopressin (watch for water intoxication s/s of headache and confusion)
SIADH patho
syndrome of inappropriate antidiuretic hormone secretion
too much ADH released
SIADH s/s
syndrome of inappropriate antidiuretic hormone secretion
may cause cerebral edema. at right for seizures. fluid volume overload. changes in loc. weight gain without edema. hypertension. tachycardia. n/v. hyponatremia. low urine output. concentrated urine
SIADH care
syndrome of inappropriate antidiuretic hormone secretion
RESTRICT FLUIDS. loop diuretics to promote diuresis BUT ONLY IF SODIUM IS AT LEAST 125. vasopressin antagonist. check cardiac and neuro. safe environment. check for IICP. seizure precautions. elevate HOB to 10 degrees. I&o. daily weights.
addison’s patho
decreased secretion of adrenal cortex hormones: kidney (gluucocorticoids, mineralocorticoids, androgen)
addison’s s/s
dehydration. hypotension. hyponatremia.
hyperkalemia. hypercalcemia.
fatigue. weight loss. GI issues. bronze hyperpigmentation of skin
addison’s care
I&O. weight.give glucocorticoid/mineralocorticoid.
monitor for addisonian crisis . lifelong glucocorticoid replacement (increase during stressful times). avoid people with infections. no strenuous exercise because it is stress on body. high protein and carb diet. calcium and vit d supplements.
addisonian crisis
life threatening adrenal insufficiency caused by stress infection trauma surgery or withdrawal of corticosteroid use.
addisonian crisis s/s
hyponatremia. hyperkalemia. hypoglycemia. shock. weakness. irritable. confused. severe headache. severe abdominal leg and back pain
addisonian crisis care
glucocorticoids IV. IVF. restore electrolyte balance. neuro checks. I&O. prevent infection. bed rest. quiet environment.
cushings (hypercorticolism) patho
increased production of cortisol or giving too much glucocorticoids for long periods
cushings (hypercorticolism) s/s
hyperglycemia. hypernatremia. hypertension. hypokalemia. hypocalcemia. muscle wasting. weak. moon face. buffalo hump. obese stomach and thin legs. weight gain. hirsutism (male features in a woman). fragile skin that bruises easily. red purple striae on abdomen and thighs
cushings (hypercorticolism) care
I&O. weights. radiation. hypophysectomy. adrenalectomy with lifelong glucocorticoid replacement. protect from post op thrombus.
pheochromocytoma patho
catecholamine producing tumor on adrenal medulla (kidneys) that secretes increased amounts of epi and norepi
pheochromocytoma testing
24 hr urine: keep on ice. get rid of 1st void then collect every urine for 24 hrs. if one void is discarded or missed the test is restarted.
pheochromocytoma s/s
hypertension. severe headaches. palpitations. flushing. sweating. chest or abdomen pain. n/v. heat intolerance. weight loss. tremors. hyperglycemia.
pheochromocytoma care
adrenalectomy. monitor for hypertensive crisis. no smoking. no caffeine. no changing position quickly. give beta blockers for hypertension. check blood sugar. rest. quiet environment. high calorie mineral and vitamin diet.
* *AVOID STIMULI THAT CAN CAUSE HYPERTENSIVE CRISIS SUCH AS ABDOMINAL PRESSURE AND VIGOROUS ABDOMINAL PALPATION**
adrenalectomy
surgical removal of adrenal gland on the kidneys. will only need life long glucocorticoid and mineralcorticoid replacement if there is a removal of both glands.
adrenalectomy pre op care
check electrolytes and correct any imbalance. assess for dysrhythmias and hyperglycemia. prevent infections give glucocorticoids
adrenalectomy post op care
report to MD is urine output is less than 30ml/hr because it would lead to kidney injury and shock. daily weights. electrolytes. blood sugar. check for s/s of hemorrhage and shock with 1st 24-48 hrs. check for paralytic ileus. give IVF. give glucocorticoids and mineralocorticoids. pain meds. prevent atelectasis (incentive spirometry and cough deep breath). hormone replace
hypothyroidism patho
decrease secretion of the thyroid hormone causing decrease in body metabolism (T4 is low TSH is high)
hypothyroidism s/s
everything slows down. fatigue. weak. paresthesias. intolerance to cold. weight gain. dry skin and hair. loss of body hair. bradycardia. constipation. myxedema (puffiness and edema around eyes and face). menstrual changes. cardiac enlargement and heart failure.
hypothyroidism care
thyroid replacement = levothyroxine. low calorie low cholesterol low saturated fat. daily exercise. roughage and fluids to prevent constipation. warm environment. no sedative or opioids because they can lead to myxedema coma. monitor for thyroid replacement overdose (tachycardia, chest pain, restlessness, nervous, insomnia).
myxedema coma
persistently low thyroid production caused by illness, rapid decreased of thyroid meds, anesthesia, surgery, hypothermia, sedative and opioids
myxedema coma s/s
EVERYTHING SLOWS ALL THE WAY DOWN OR IS LOW!! hypotension. bradycardia. hypothermia. hyponatremia. hypoglycemia. edema. respiratory failure. coma
myxedema coma care
maintain airway. aspiration precautions. give IVF. give levothyroxine. give glucose IV. give corticosteroids. hourly temps. keep warm. check changes in mental status.
hyperthyroidism (graves disease)patho
increased secretion of T3 and T4 hormones causing increased body metabolism (TSH is low)
hyperthyroidism (graves disease) s/s
EVERYTHING SPEEDS UP!! mood swings. tremors. heat intolerance. weight loss. smooth soft skin and hair. palpitations. cardiac dysrhythmias (tachycardia and afib). diarrhea. exophthalmos. sweating. hypertension. goiter (enlarged thyroid gland).
hyperthyroidism (graves disease) care
rest. sedatives. cool and quiet environment. daily weights. high calorie diet. no stimulants. antithyroid meds (propylthiouracil/methimazole). iodine prep. propranolol for tachycardia. radioactive iodine therapy. thyroidectoomy. elevate HOB if pt has exophthalmos and give low salt diet artificial tears wear dark glasses and tape eye lids at night.
thyroid storm
life threatening condition where pt has uncontrolled hyperthyroidism. caused by manipulation of thyroid gland during surgery and release of too much thyroid hormone into the blood (from stress or infection)
thyroid storm s/s
elevated temp. tachycardia. hypertension. n/v/d. tremors. anxiety. agitation. restless. confusion. seizures. delirium. coma.
thyroid storm care
patent airway. ventilation. antithyroid meds. iodides. propranolol. gglucocorticoids. check VS and cardiac dysrhythmias. give fever meds (no aspirin). cooling blanket.
thyroidectomy
removal of thyroid gland.
thyroidectomy pre op care
VS. weight. electrolytes. check for hyperglycemia. give antithyroid meds iodides propranolol and glucocorticoids to prevent thyroid storm.
thyroidectomy post op care
monitor for respiratory distress. have trach set oxygen and suction at bedside. assess for hoarseness. limit talking. no neck flexion or stress on suture line. monitor laryngeal nerve damage (airway obstruction, dysphonia, high pitched voice, stridor). check for hypocalcemia and tetany (means there was trauma to the parathyroid) give calcium gluconate for tetany. monitor for thyroid storm.
**MAINTAIN SEMI FOWLERS POSITION AND MONITOR FOR EDEMA AND BLEEDING BY CHECKING DRESSING AND BEHIND THE NECK.
tetany s/s
cardiac issues. carpopedal spasm. dysphagia. muscle and abdominal cramps. numbness and tingling. positive chvostek and trousseau. visual issues. wheezing dyspnea. seizures
hypoparathyroidism patho
decreased secretion of parathyroid hormone. can occur after thyroidectomy because of parathyroid being removed as well.
hypoparathyroidism s/s
hypocalcemia. hyperphosphatemia. numbness and tingling. muscle cramps. positive chvostek and trousseau. hypotension. s/s of tetany
hypoparathyroidism care
check for low Ca+ and tetany. seizure precaution. trach o2 and suction at bed. calcium gluconate for hypocalcemia. high calcium low phosphorus diet. calcium and vitamin d supplements. thiazide diuretic if taking vitamin d.
hyperparathyroidism patho
increased secretion of pararthyroid hormone
hyperparathyroidism s/s
hypercalcemia and hypophosphatemia. muscle weakness. fatigue. skeletal pain. bone deformities. fractures. GI issues. weight loss. constipation. hypertension. cardiac issues. renal stones.
hyperparathyroidism care
I&O. check cardiac issues. check VS. move patient slowly because of skeletal pain and fracture risk. increase fluids. furosemide to lower Ca+. IVF NS. calcitonin to decrease skeltal calcium release and increase renal calcium excretion. parathyroidectomy. high fiber moderate calcium. exercise. no prolonged inactivity.
parathyroidectomy
removal of the parathyroid. can be transplanted in the forearm or near sternocleidomastoid muscle
parathyroidectomy pre op care
monitor electrolytes (mag, calcium and phosphate). calcium levels need to be NEAR normal.
parathyroidectomy post op care
monitor for respiratory distress. place trach o2 and suction at bedside. position in semi fowlers. check neck for bleeding. check for hypocalcemic crisis (tingling and twitching). check for tetany. check for laryngeal nerve damage (airway issues). give vitamin d and calcium.
diabetes
insulin deficiency.
DM I: no insulin produced, fat used for energy (keto)
DM II: lack of insulin
*OBESITY IS MAJOR RISK FACTOR
diabetes s/s
3Ps: polyuria polydipsia polyphagia increased blood sugar (70-110) weight loss (DM I) blurred vision slow wound healing vaginal infections weak and paresthesias poor feet circulation atherosclerosis
diabetes diet
complete diet just stay consistent. carb counting. take in account weight meds activity level and other health issues
diabetes exercise
exercise lowers blood sugar and decreases insulin resistance and glucose intolerance. adjust diet when exercising. need a snack before exercising to prevent hypoglycemia. DO NOT WORK OUT IF BLOOD SUGAR >250 AND KETONES IN URINE! exercise same time each day when glucose is peaking (NOT WHEN INSULIN IS PEAKING). do not inject insulin in area of body that will be exercised. CHECK BLOOD SUGAR BEFORE DURING AND AFTER!
only IV insulin
regular and short (lispro aspart glulisine)
dawn phenomenon
hyperglycemia when waking. need to increase pts insulin dose or change the timing of the dose
somogyi phenomenon
elevated blood sugar at bedtime. hypoglycemia around 2-3 am and rebound hyperglycemia when waking. pts complain of early morning headache night sweats and nightmares. need to decrease insulin does and increase bedtime
insulin pumps
continous subcutaneus insulin infusion worn on belt or pocket. change needle q 2-3 days. continous basal rate and the pt can give a bolus. rapid acting and regular short acting insulin only.
self monitoring blood sugar
finger prick. alternate sites. wash hands before and after. calibrate monitor. check expiration date on strips.
diabetes urine testing.
not reliable for blood sugar levels. used to check for ketones.
hypoglycemia
blood sugar less than 70 caused by too much insulin too little food or too much exercise. if patient is hypoglycemic but does NOT have recommended emergency foods give anything.
hypoglycemia s/s
COOL AND CLAMMY NEEDS SOME CANDY!! hunger. palpitations. sweating. tachycardia. tremors. confusion. drowsiness. slurred speech. numbness of lips and tongue. loss of consciousness. seizures
hypoglycemia priority nursing actions
check blood sugar.
give 15g simple carb (juice or glucose gel)
recheck blood sugar in 15 mins
give another 15 g simple carb if <70 (can repeat three times)
recheck then give 50% dextrose IV or glucagon subq/IM
when pt recovers have pt eat a snack (carb and protein)
document
**DO NOT GIVE ANYTHING ORALLY IF THE PATIENT IS UNCONSCIOUS OR UNABLE TO SWALLOW. IT INCREASED RISK OF ASPIRATION. INJECT GLUCAGON OR GIVE IV 50% DEXTROSE
DKA
life threatening increase of blood sugar >300
positive ketones in urine (DM I)
DKA s/s
hyperglycemia. dehydration. ketosis. acidosis. kussmauls respirations (fruity). 3Ps: polydipsia polyuria polyphagia. weight loss. dry skin. sunken eyes. coma.
DKA care
increase IVF due to dehydration with NS or 1/2 NS.
give IVF with dextrose when blood sugar is 250-300
IV insulin
check potassium level and cardiac monitoring
IV insulin
short insulin only!!!
prepare with NS or 1/2 NS
always use IV pump
continuous until injections can be started again
check for fluid overload and urine output
check potassium and blood sugar
check IICP
*CHECK FOR IICP. IF BLOOD SUGAR FALLS TOO FAST BEFORE BRAIN HAS TIME TO EQUAL OUT, WATER IS PULLED FROM BLOOD TO CSF AND BRAIN CAUSING CEREBRAL EDEMA AND IICP
HHS
hyperglycemia >800
withOUT ketones or acidosis (DM II)
HHS s/s
hyperglycemia. dehydration. electrolyte loss.
DKA JUST WITHOUT ACIDOSIS AND KETOSIS
kussmauls respirations (fruity). 3Ps: polydipsia polyuria polyphagia. weight loss. dry skin. sunken eyes. coma.
HHS care
IVF for dehydration
replace electrolytes
give insulin
diabetic retinopathy
chronic impairment of retinal circulation that causes hemorrhage. leads to permanent blindness.
diabetic retinopathy s/s
change in vision
blurred vision from edema
sudden loss of vision from retinal detachment
cataracts
diabetic retinopathy care
SAFETY!!! prevent hypertension monitor blood sugar laser therapy (phtocoagluation) virectomy (remove hemorrhages and prevent retinal detachment) remove cataract
diabetic nephropathy
decrease kidney function
diabetic nephropathy s/s
microalbuimnuria thirst fatigue anemia weivht loss malnutrition UTIs neurogenic bladder
diabetic nephropathy care
control hypertension control blood sugar I&O check BUN creatinine and albumin levels restrict protein sodium and potassium intake no nephrotoxic meds dialysis kidney transplant pancreas transplant
diabetic neuropathy
deterioration of nervous system
diabetic neuropathy s/s
nonhealing ulcers on feet gastric paresis erectily dysfunction paresthesias decreased reflex decreased sensation to light and sound poor pulses postural hypotention skin break down incontinence impotence
diabetic neuropathy care
control bp control blood sugar foot care pain meds bladder training estrogen lube for women cranial nerve decompression
diabetic foot care
inspect feet daily report to MD if red or breaks in skin no hot water heating pads or hot tubs/baths wash with warm water and dry no foot soaks do not cross legs or wear tight garments lotion feet but not in between toes loose socks and well fitting shoes do not go bare feet clean cotton socks and change them daily do not wear same shoes 2 days in a row no open toe shoes or flip flops break in new shoes gradually cut toenails straight across after softened in bath smooth nails with emery board no smoking
pre op for diabetics undergoing surgery
check with MD about withholding oral DM meds/insulin
discontinue long acting meds 24-48 hrs before sugery
metformin discontinued 48 hrs before and not restarted till renal function is normal
insulin adjusted
check blood sugar
IVF
post op for diabetics undergoing surgery
IV glucose/IV insulin till feeds are tolerated
check blood sugar (especially if taking TPN)
prevent hypoglycemia
at risk for poor wound healing (increase protein diet)
diabetic sick day rule
always give insulin even without appetite
test blood sugar q 4 hrs
test for ketones with each void (report to MD)
follow usual meal plan
increase fluids to decease ketones
rest
report to MD if vomiting, fruit breath, deep rapid respiration decreasing level of consciousness or persistent hyperglycemia
