Endocrine alterations and nursing management Flashcards
Acromegaly: what gland is affected, what hormone is out of balance?
what symptoms are likely?
anterior pituitary, growth hormone is high
symptoms: thickening of bones and soft tissue, deepening of voice, visual distrubances, HA, hyperglycemia, sleep apnea, cardiomegaly
what are some complications of Transphenoidal Hypophysectomy
leaking cerebral spinal fluid
(and other)
drug therapy for acromegaly
not treatment of choice, but Ocreotide (sandostatin) can decrease GH levels
what would be a priority assessment after a transphenoidal hypophysectomy?
what is a complication
*neuro checks, bleeding, cerebrospinal fluid, airway, pain control, reduction of ICP, seizure monitoring
*position of patient should be elevated
Dexamethasone - steroid good for brain stuff
complication: diabetes insipidus
what is the thyroid responsible for?
metabolism
what causes goiters
anything that makes the thyroid gland work harder
-or a lack of iodine in the diet
commonly found in patients with graves disease
_____ is released from the hypothalmus
That in turn stimulates ____ from the ant pituitary
This stimulates ____ from the THyroid gland
TRH is released from the hypothalmus
That in turn stimulates TSH from the ant pituitary
This stimulates T3/T4 from the THyroid gland
The pt with primary hyperthyroidism will have lab results:
T3 and T4 will be _____
TSH will be ______
T3 and T4 will be high
TSH will be low
(b/c of negative feedback)
what is a test that will differentiate graves from other forms of thyroiditis
Radioactive iodine uptake (RAIU)
the pt with graves will show a diffuse, homogenous uptake, whereas the pt with thyroiditis will show an uptake of less than 2%
the nurse is caring for a pt with an elevated T3 T4, what symptoms
tachycardi, goiter, exophalamus, excess perspiration, feeling warm
(Treadmill man)
nursing management for hyperthyroidism
heart monitor, oxygen, adequate nutrition
nursing management for someone with exopthalmus
artificial tears, salt restriction to reduce periorbital edema, taping the eyes shut to help them sleep
hyperthyroidism treatment
radioactive iodine is the treatment of choice for non-pregnant patients
antithyroid drugs: Propylthiouracil (PTU), Methimazole (tapazole), beta blocker agents as well
any of the treatments can lead to hypothyroidism
post operative treatment of thyroidectomy
-hypocalcemia is a potential risk
-tetany can lead to laryngeal spasm, keep tracheostomy tray at bedside
support head manually when turning in bed to relieve the stress on the surgical site
interprofessional care for someone coming in with a thyroid storm
start an iv
-beta blockers like propanolol
put them on a cardiac monitor
-give them oxygen
seizure precautions
the pt with primary hypothyroidism will have _____ T3/T4 and ____ TSH
low and high
the pt with secondary hypothyroidism will have _____ T3/T4 and ____ TSH
low and low
to maintain normal thyroidhormone balance the hypothalamus releases
TRH
a deficiency in TSH will cause
hypothyroidism
TRH from the hypothalamus stimulates the release of
TSH
pt has a tumor that is affecting the function of the anterior pituitary gland the TSH release is excessie because of the tummor
secondary hyperthyroidism
the pt has dysfunction fo the thyorid gland and LOW T3 T4. and elevation TSH
primary hypothyroidism
myxedema coma
low T3T4, dry skin, brady, hypoTNS, low body temp
what time of day to give thyroid medications
in the morning on an empty stomach
what is a normal urine specific gravity?
what is normal calcium
1.001=1.030
8.5-10.5
what does parathyroid hormone do?
raise calcium
what is the hormone that lowers calcium
calcitonin
what is hyperparathyroidism
over secretion of PTH will lead to an increased serum calcium level, and low phosphorus levels
this will lead to deceased bone density and osteoporosis
treatment of hyperthyroidism
increase fluid intake, to dilute the serum calcium
-furosemide IV increases the renal excretion of calcium
-decrease consumption of calcium (No TUMS )
-strain the urine to look for stones
-surgical parathyroidectomy
post operative care of parathyroidectomy
major considerations:
hemorrhage, can compromise airway, monitor for tetany (tingling and laryngeal spasms), chvostek and trousseau’s signs,
hypocalcemia can develop quickly
encourage early ambulation
____ is released from the Hypothalamus
this stimulates ____ from the anterior pituitary
this stimulates ___ from the adrenal glands
(CRH) is released from the Hypothalamus
this stimulates (ACHT) from the anterior pituitary
this stimulates (corticosteroids, epinephrine, norepi) from the adrenal glands
CRH, ACHT,
corticosteroids, epinephrine, norepi
excess secretion of ACTH will result in
cushings syndrome
the adrenal medulla secretes what?
epi, norepi, dopamine
clinical manifestation of cushings syndrome
hypernatremia, metabolic alkalosis (bicarb loves sodium), hypokalemia
what things will stimulate aldosterone release?
decreased blood pressure, hyponatremia, hyperkalemia
why do people with addisons get hyperkalemia
** cardiac monitor **
they arent secreting aldosterone so they are holding on to the potassium
what would an ACTH stimulation test show for someone with addisons disease?
normally cortisol steroid levels would rise after synthetic admin of ACTH, but with addisons, the cortisol levels will remain the same level as baseline
Lab findings for addisons
sodium, potassium, bun, glucose
ECHT
sodium low, potassium high, bun high, glucose low
BUN would be high if we don’t have good hydration
ecg would be peaked
nursing considerations for addisons disease
daily weights
protect from stressors
add salt in the diet esp if they live in hot and humid environment
medications for addisons disease
hydrocortisone which includes both glucocorticoid and mineral corticoid
may need extra mineralcorticoid (fludrocortisone)
