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
What diet is high Ca + Vit. D with low phosphate?
Hypoparathyroid
High Calcium - green leafy veggies, tofu
Low phosphate = plant proteins > meat
Hyperparathyroidism
What to monitor for?
Overactive parathyroid due to parathyroid adenoma = hypersecretion of PTH = hypercalcemia + hypophosphate
> > POLYURIA, polydipsia, dehydration
decreased neuromuscular excitability = SLOW REFLEX and PERISTALSIS
skeletal pain
Monitor:
- Osteoporosis (fall precautions)
- Signs of Kidney Stones
- Dysrhythmias
Pancreatitis
- Cause?
- Acute vs Chronic Sxs?
- Tx (esp DIET)?
Inflammation of pancreas due to direct injury or obstruction of biliary duct = hypersecretion of p. enzymes
Caused by ETOH!!!
Acute
= severe pain post-eating in epigastric/upper L abdomen (relieved via LEANING FORWARD)
= N/V
Acute Complications
= CULLEN’S + TURNER’S sign ((BVs) from “SIRS”
= Hypocalcemia
= Hyperglycemia
Chronic (HARDENED P. TISSUE)
= chronic episodic pain in abdomen
= STEATORRHEA (malabsorption = fatty stool)
= Weight loss
= DM (Hyperglyccemia)
Diet
= small frequent bland meals, low in fat
= give pancreatic enzymes with food
What does Diabetes Insipidus and Mellitus have in common?
- Increased urine amount = decreased [USG]
- Polydipsia/Dehydration
Lantus (insulin) / Glargine / Detemir
Long-acting insulin
Duration = 12-24 hours
Can routinely give at bedtime
Lispro (Humalog) / Aspart
Short acting insulin
Peak = 30 min
GIVE WITH MEAL.
Regular insulin “R”
Rapid/short-acting insulin
Peak = 2 hrs
Can give in IV drip
NPH
Intermediate insulin
Peak = 8-10 hrs
DO NOT GIVE as IV DRIP
Difference between DM type 1 & 2.
What are the common Sxs?
DM 1
= Insulin-dependent
= Kid onset
= Ketone-prone
= EXERCISE!!
DM 2
= Insulin-resistant
= Adult onset
= Non-ketone prone
= DIET!!!!
Sxs
= Polyuria, polydipsia, Polyphagia
What to monitor when a diabetic pt is sick?
Body will be in a HYPERGLYCEMIC + DEHYDRATED state.
- Make sure to still give insulin despite pt not eating!!!
Acute complications of Diabetes x3
HYPOGLYCEMIA due to insufficient food or excessive insulin/med/exercise (“drunk in shock”)
= Changes in MENTAL STATUS
= SHOCK sxs - low BP / tachycardia / tachypnea/ cold, clammy skin / mottled
= GIVE JUICE + CARBS
= GIVE IM GLUCAGON OR IV DEXTROSE (unconscious)
DKA (DM 1)
*check if pt had viral resp. infection within 2 wks
= Dehydration and Dry (hot/flushed)
= Ketones (higher), Kussmaul breaths, K (high)
= Acetone breath, Acidosis (met.), Anorexia (nausea)
= GIVE IV FLUIDS
HHS (DM 2)
= Dehydration
= Warm, dry, flushed
= GIVE FLUIDS
Complications of Diabetes
- POOR TISSUE PERFUSION
- Renal injury
- Ischemic tissue - PERIPHERAL NEUROPATHY
- decreased sensation and voluntary neuromuscular movements
= (-) PINPRICK TEST
Normal blood glucose levels post-meals
4-8 mmol
Normal + abnormal A1C
Normal ≤6
Abnormal ≥ 8
What do you need to know about mixing insulins?
Always draw up the CLEAR (regular) insulin into the syringe first!!
What is a side effect of steroids administration?
Increases blood glucose.
For Diabetic pts, ensure they take their insulin!!
Hypoglycemia
- Sxs
- Nursing actions?
Cold clammy skin, irritable, pale, weak, diaphoretic
= GIVE CRACKERS/JUICE, followed by PROTEIN (milk)
= IM GLUCAGON or IV DEXTROSE (unconscious)
Hyperglycemia in Type 1/2 DM
- Sxs
- Nursing actions?
Type 1 - DKA
= Dehydration
= Ketosis (Ketouria, Kusmmaul’s, high K)
= Acidosis-met (Acetone/fruity breath, anorexia-N/V)
= GIVE FLUIDS, then IV INSULIN
Type 2 - HHS
= Dehydration
= GIVE GLUIDS
How to treat HYPERkalemia?
- D5W IV with insulin (hypotonic = drives into cells)
- Follow up with Kayexalate (trades Na with K to be excreted = diarrhea)
> > HYPERNATREMIA (bute easy to tx)
Fast correction of Metabolic acidosis
Sodium bicarb
Fast correction of HYPOcalcemia
Calcium gluconate
What to monitor in pt when giving insulin?
Glucose levels
- don’t run HYPOglycemic
K+ levels
- Any changes in level can cause major fluid shift
- Insulin shifts glucose + K from intravascular»_space; intracellular
