Endocrine DIsorders Flashcards
risk factors for hypothyroidism
Hashimoto Disease
Thyroidectomy
Head and neck cancer
Women > Men
Elderly
early clinical manifestations for hypothyroidism
fatigue to somnolence,
loss of libido to amenorrhea,
apathy to mental and physical sluggishness,
nonpitting edema to pleural and pericardial effusions
hair loss, brittle nails, and dry skin are common
constipation
Paresthesia (numbness and tingling of the fingers) and nerve entrapment syndrome
hearing loss may occur
late signs of hypothyroidism
slow speech
subdued emotional responses
apathy
absence of sweating
cold intolerance
constipation
thickening of skin (due to accumulation of mucopolysaccharides in subcutaneous tissues)
dyspnea
weight gain
thinning of hair
alopecia
deafness
On assessment, patients usually present with swelling of eyelids, pitting edema, bradycardia, hypotension, and hypothermia
the most extreme, severe stage of hypothyroidism resulting in pt being hypothermic and unconscious
myxedema coma
why is myxedema coma life threatening
leads to swelling of the tongue and respiratory drive is depressed
management of hypothyroidism
hormone replacement
restoration of euthyroid state as safely and rapidly as possible
levothyroxine (synthroid)
teaching necessary for use of levothyroxine
It may take 8 weeks to see the full effect
∙ Report signs of hyperthyroidism
∙ Tachycardia, heart palpitations,
weight loss, insomnia, anxiety ∙ Monitor T4 & T3 levels
∙ Take once a day (in the morning before breakfast) ∙ Take at the same time everyday
∙ Take on an empty stomach
causes of hyperthyroidism
Enlarged thyroid gland
Thyroiditis
Graves’ disease
Over medication- hypothyroidism
Thyroid nodules
clinical manifestations of hyperthyroidism
Exophthalmos
Weight loss
Tachycardia / Atrial Fibrillation
Hyperthermia
Decreased fertility
Increased peristalsis
Loss of bone minerals
complications of hyperthyroidism
Thyrotoxicosis
Thyrotoxic crisis or thyroid storm
what is the difference between thyrotoxicosis and thyroid storm
Thyrotoxicosis is a common endocrine condition that may be secondary to a number of underlying processes.
Thyroid storm (also known as thyroid or thyrotoxic crisis) represents the severe end of the spectrum of thyrotoxicosis and is characterized by compromised organ function
management of hyperthyroidims
Nutritional therapy
Radioactive iodine
-Beta-adrenergic blocking agents
Surgery
Antithyroid agents
goals for management of hyperthyroidism
Block adverse effects of thyroid hormones
Suppress hormoneover secretion
Prevent complications
diet for pt with hyperthyroidism
high in carbs and proteins
radio active iodine: What does it do? How long does it take to become effective or for symptoms to resolve?
destroy overactive thyroid cells
2-3 months
Thyroidectomy: What is your role for this patient following surgery? What should you assess? How should you position your patient? What complications should you monitor for?
administer preop medications
possibly iodine
position in fowler’s position
monitor for bleeding, hematoma
assessment of pt with thyroid disorders
History
Assessment
-Cardiovascular assessment
-Respiratory Assessment
-HEENT
-Skin, hair, and nails
Monitor vital signs
planning for pt with thyroid disorders
Experience relief of symptoms
Maintain a euthyroid state
Maintain a positive self-image
Comply with lifelong thyroid replacement therapy
Improve nutritional status
Improve coping ability
Maintenance of normal body temperature
Absence of complications
nursing diagnoses for hypothyroidism
Activity intolerance
Constipation
Impaired memory
Altered body temperature
nursing diagnoses for hyperthyroidism
Altered nutrition
Ineffective coping
Altered body temperature
Discomfort
thyroid disorders implementation for acute care
Skin care
Vital signs, weight, IandO, edema
Cardiovascular response to hormone
Energy level
Mental alertness
education for thyroid disorders
Encourage patient to be an active participant
Comfort
Education to patient and families
Low-calorie diet
Written instructions important
Need for lifelong therapy
Thyroid medicine in morning on empty stomach
Side effects of medication
Do not switch brands
expected outcomes for thyroid disorders
Have relief from symptoms
Maintain euthyroid state
Avoid complications
Adhere to lifelong therapy
function of the thyroid gland
produce T3, T4, and calcitonin (iodine needed)
gives you energy
function of parathyroid gland
produces and secretes PTH - controls calcium in blood
risk factors for hyperparathyroidism
Tumor or hyperplasia
CKD
clinical manifestations of hyperparathyroidism
Symptoms of hypercalcemia
-bone pain
-Arrhythmias
-cardiac arrest (bounding pulses)
-kidney stones
-muscle weakness ↓ (DTR)
-Excessive urination
Complications
-Ventricular dysrhythmias
-Hypercalcemic crisis
Musculoskeletal symptoms
diagnostics for hyperparathyroidism
Labs- Serum calcium
Radioimmunoassay
Bone scans
Ultrasound
MRI
management of hyperparathyroidism
Parathyroidectomy
Hydration
Patient mobility
Nutrition
Medication
Emotional support
possible medications for treatment of hyperparathyroidism
Phosphates, calcitonin, & IV or oral bisphosphonates
risk factors for hypoparathyroidism
Thyroidectomy
Parathyroidectomy
Radical neck dissection
clinical manifestations of hypoparathyroidism
Symptoms of hypocalcemia
Anxiety
Delirium
ECG changes
Hypotension
Complications
-Seizures
-Tetany
management of hypoparathyroidism
Parenteral PTH
Calcium Gluconate
Supplements
Dietary changes
function of adrenal medulla
releases catecholamine hormones epinephrine and norepinephrine
function of adrenal cortex
secretes glucocorticoids, mineralocorticoids, and androgens
primary addison’s disease
Insufficiency of the adrenal cortex
Corticosteroids-glucocorticoids, mineralocorticoids, and androgens
secondary addison’s disease
Lack of pituitary ACTH
Glucocorticoids and Androgens
life threatening addisonian crisis
∙ Profound fatigue ∙ Dehydration
∙ Renal failure
∙ Rapid respiration ∙ Hyponatremia
∙ Hypokalemia
∙ Cyanosis
∙ Fever
∙ Nausea/vomiting
Think SHOCK!
* Hypotension
* Weak rapid pulse
Treatment:
Fluid resuscitation & high-dose hydrocortisone
diagnostics of addison’s disease
Serum cortisol <165 nmol/L
Plasma ACTH > 22.0 pml/L
↑ Potassium
↓ Chloride, sodium, glucose
CT scan, MRI
management of addisonian crisis
Shock management
High-dose IV hydrocortisone replacement
0.9% saline solution and 5% dextrose
Vasopressorsq
acute care for addison’s disease
Antibiotics
Correct fluid and electrolyte imbalance
-Assess vital signs and neurologic status
-Daily weight
-Accurate I and O
teaching for admin of corticosteroids
report ss of corticosteroid deficiency
carry ID and wear bracelet
emergency kit
how to admin IM hydrocortisone
High levels of serum cortisol
Too much ACTH
cushing syndrome
common causes of cushin syndrome
Iatrogenic administration of exogenous corticosteroids
ACTH-secreting pituitary adenoma
Adrenal tumors
Ectopic ACTH production by tumors
symptoms of excess glucocorticoids
hypertension, obesity, osteoporosis, fractures, impaired immune function, impaired wound healing, glucose intolerance, and psychosis
symptoms of excess mineralocorticoids
hypertension, hypokalemia, low birth weight, failure to thrive, hypertension, polyuria and polydipsia, and poor growth
symptoms of excess androgens
Acne.
Changes in female body shape.
Decrease in breast size.
Increase in body hair in a male pattern, such as on the face, chin, and abdomen (called hirsutism)
Lack of menstrual periods (amenorrhea)
Oily skin
diagnostic studies for cushing syndrome
Urine free cortisol
Salivary cortisol
Dexamethasone suppression test(takes 1 mg med - returns next morning for labs)
Radioimmunoassay measurement of ACTH
Serum Cortisol
CT
Ultrasound
MRI
management for cushing syndrome
adrenalectomy
hydrocortisone
education
Risk for falls
Risk for infection
Promote periods of rest
Skin care
Dietary changes
Family education
other clinical manifestations of cushings
moon face
buffalo hump
ecchymosis
purple striae
slow wound healing
thin skin
