Endocrine Conditions Flashcards
Addison Disease
Under secretion (hypofunction) of adrenal cortex
= depletion of glucocorticoids (CORTISOL); mineralcorticoids (ALDOESTERONE); Androgens
> > Loss of stress response = hypotension / hypoglycemia / Fatigued
Decreased appetite / Salt cravings
Hyper-pigmented/Tanned skin + lack of pubic/axillary hair (in females)
Tx
= STEROIDS “- sone”
= HIGH protein, carbs, fluid
Cushing’s Syndrome
Over-excretion of adrenal cortex = too much steroid in body»_space; s/e of steroids
- Hirsutism (excess hair)
- Hyperglycemia*
- Obesity (centrally/abdomen; back; “Moon face”)**
- HTN***
- Na and water retention
Tx: ADRENALECTOMY + taper steroids
Hyperthyroidism
How does it become life threatening? Sxs?
Dxs?
What are the txs?
Over-active thyroid (hypermetabolism) + overstimulated SNS due to Goiter or Grave’s disease.
Sxs = “S.W.E.A.T.I.N.G.”
THYROID STORM = hypermetabolic emergency
1. Very high temps/Fever
2. Very high BP
3. Very tachycardic
4. Psychotic delirium
Dxs:
- Increased T3/T4
- Decreased TSH
- (+) Radioactive Iodine test
Txs
= Anti-thyroid agents (Propylthiouracil) + Beta-adrenergic blockers
» immunosuppressant = expect low WBC
= Give radioactive iodine to destroy thyroid hormone synthesis
» No visitors with pt for first 24 hrs post
» Careful w/ urine
= Thyroidectomy
» Total = monitor for Tetany (hypocalcemia)
» Sub-total = monitor for Thyroid storm
Thyroid Storm
A medical emergency of hyperthyroidism.
1. Very high temps/Fever
2. Very high BP
3. Very tachycardic
4. Psychotic delirium
Tx
first = Give ice packs + admin O2 @10L
best = cooling blanket
Thyroidectomy (Total and Partial/Sub total)
What are post-op nursing care?
Phases?
Total
= require lifelong hormone replacement
= at risk for HYPOCALCEMIA
» check for Trousseau (swan hand) + Chvostek’s (facial twitch upon nerve tap)
Partial/ Sub total
= may need temporary hormone replacement initially
= at risk for THYROID STORM
Post-op <12 hr = MAINTAIN AIRWAY + HEMORRHAGE
» bc of neck edema d/t location of surgery
» Have proper safety equipment at bedside
Post-op 12-48 hrs: RISKS WITH SURGERY TYPE
» Tetany or Thyroid Storm
Post-op 48 hrs = INFECTION
Hypothyroidism
What is an important consideration for these pts?
Hypometabolism caused by low production of thyroid hormones (T3/T4).
Sx
= opposite of “SWEATING”
= Myxedema (thickening/swelling of skin)
Do not sedate pts IMPORTANT
= bc their SNS is already slow
= Never hold thyroid pills pre-op w/o doctor orders or else a big problem when given anesthetics/sedatives
Tx: Give thyroid hormones (SYNTHROID/Levothyroxine)
Graves Disease
An autoimmune endocrine disorder that causes hyperthyroidism.
Diabetes Insipidus
CENTRAL =insufficient ADH production due to disorder with pituitary gland
NEPHROGENIC = ADH resistance
> > Polyuria, dehydration, nocturia/insomnia
LABS
- Increased urine output = Decreased [USG]
- Hypernatremia
SIADH
What to monitor in severe cases?
Excessive production of ADH or unnecessary release of ADH
= excessive water retention
= low urine output, weight gain
= HTN
= LABS - decreased urine; increased [USG]
= Dilutional hyponatremia**
» Changes in MS + seizure precautions
Function of ADH
Retains water in the renals
Differences b/w Diabetes Insipidus & SIADH x3
Differences in:
- Water retention of renals
- Urine amounts/[urine specific gravity]
- Hypo (SIADH)/Hypernatremia (DI)
What is urine specific gravity?
The concentration of urine
Function of:
- Thyroid
- Parathyroid
- Pancreas
- Adrenal cortex
for fun, Calcium?
Thyroid = metabolism
Parathyroid = increases Ca and decreases phosphorous
Pancreas = fat breakdown + insulin/glucagon release
Adrenal cortex = corticoidsteroids
Calcium keeps neuromuscular excitability at a balanced level
- can be a diuretic + sedative
Hypoparathyroidism
Insufficient release of PTH = hypocalcemia + hyperphosphate
> > Tingling, numbness, muscle cramps
Tetany: Trousseau and Chvostek’s sign
Severe tetany: dysphagia, laryngospasm, seizures**
What is the relationship of Vit. D and calcium?
Vit. D increases the absorption of calcium
