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Nursing 102 > Endocrine Exam #2 > Flashcards

Endocrine Exam #2 Flashcards

1
Q

Hormones of the hypothalamus

A
  • Corticotropin releasing hormone (CRH)
  • Thyrotropin releasing hormone (TRH)
  • Growth hormone releasing factor/somatotropin releasing hormone
  • Gonadotropin releasing hormone (GnRH)
  • Prolactin releasing hormone (PRH)
  • Somatostatin (inhibits growth hormone release)
  • Prolactin inhibiting hormone
  • melanocyte hormone
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2
Q

Pituitary Gland (hypophysis)

A
  • master gland of endocrine system

- excretes hormones that have a regulatory effect over the endocrine glands

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3
Q

All activities of the pituitary are controlled by….

A

Hypothalamus

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4
Q

Anterior Pituitary

A

(Adenohypophysis) gland composed of cells that secrete protein hormones
-secretes 6 hormones

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5
Q

Posterior pituitary

A

(Neurohypophysis) “storage shed” for hypothalamus

  • directly connected to hypothalamus by nerve tract and composed of nerve tissue
  • secretes ADH
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6
Q

Rate of production

A

mediated positive and negative feedback circuits

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7
Q

Rate of delivery

A

high blood flow to target organ/cells deliver more hormone than low blood flow

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8
Q

Rate of degradation and elimination

A

hormones metabolized & excreted thru several routes dependent on biologic half life

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9
Q

Growth Hormone

A

(liver, adipose tissue)
-promotes growth indirectly. Control of protein, lipid, and carb metabolism.
(growth and metabolism) (growth and tissue repair)
-increases glucose therefore giving people diabetes

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10
Q

Thyroid stimulating hormone

A

(thyroid gland)

  • stimulates secretion of thyroid hormones –thyroid to secrete t3 and t4
  • secreted from cells thyrotrophs
  • helps control body metabolism and influence physical and mental growth
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11
Q

Adrenocorticotropic hormone (ACTH)

A

(adrenal gland, cortex)
-stimulates secretion of corticosteriods and glucocorticoid
-affects blood sugar, carb metab., influences sleep and protein breakdown.
controlled by CRH

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12
Q

-Prolactin

A

(mammary gland) (lactogenic hormone)

-milk production, lactogenic hormone

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13
Q

Gonadotropin hormones: FSH & LH

A

(ovary and testes)

-control reproduction function

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14
Q

B-lipotropin

A

(target organs)

-stimulate target organs to release hormones growth and development target organs

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15
Q

Growth Hormone (somatotropin)

A
  • is a major participant in several physiologic processes including growth and metabolism
  • pulsatile release pattern
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16
Q

Growth hormone effects on growth

A

increases protein synthesis, breakdown of fatty acids, breakdown glycogen to glucose liver, increase blood sugar/insulin antagonist

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17
Q

FSH: follicle stimulating hormone

A
  • stimulates the epithelial cells of the testes to release testosterone
  • —-male leydig cells are testicular cells that produce testosterone
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18
Q

LH: luteinizing hormone

A
  • women-ovarian follicle works with estrogen to cause release of ova from ovaries
  • ovary: release progesterone, development mammary glands fro milk secretion
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19
Q

Melanocyte-stimulating hormone

A

-stimulates production pigment cells in skin, eyes, and inside eyes

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20
Q

what is the first sign of a pituitary tumor?

A

infertility

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21
Q

Assessment of hypopituitarism

A
  • hormone deficiencies involving anterior pituitary lead to end organ failure
  • effects depend on specific hormone lacking
  • deficient in ACTH & TSH cause tendency towards shock
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22
Q

Diagnosing hypopituitarism

A
  • H&P
  • MRI/CT– for presence of tumor
  • lab values –direct/indirect measurement of hormone levels
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23
Q

Pituitary Dwarfism

A
  • hyposecretion of GH in childhood
  • normal body proportions and IQ
  • excessive body fat & poor muscle development
  • immature facial features, high pitch voice, slow nail growth, thin hair
  • sexual maturation may not occur or delayed puberty –normal sexual function
  • stunted growth – < 3rd percentile
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24
Q

1 Nursing goal for pituitary dwarfism

A

FIND & REFER

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25
Q

Nursing Management of pituitary dwarfism

A
  • if tumor- remove (hypophysectomy)
  • hormone replacement therapy - SQ GH injection
  • teach lifelong replacement, psychologic support
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26
Q

Hyperpituitarism in children

A

Gigantism

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27
Q

Hyperpituitarism in adults

A

Acromegaly

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28
Q

Gigantism

A
  • GH excess
  • GH secreting adenoma –onset BEFORE closure of epiphyseal plate
  • onset before closure of epiphyseal plate
  • long bones still capable of longitudinal growth.
  • caused by late ossification and hardening of bones
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29
Q

Signs and symptoms of Gigantism

A
  • muscle weakness
  • osteoporosis because of bones growing so fast and Calcium not being able to keep up
  • arthritic changes and cardiac hypertrophy
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30
Q

Treatment of Gigantism

A

-GH WNL, surgery, radiation, meds

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31
Q

Acromegaly

A
  • excessive GH secretion by overgrowth of bone and soft tissues
  • develops AFTER closure of epiphyseal plate so bones grow in thickness and width
  • relatively rare
  • usually begins gradually….3-4 decades of life
  • typically 7-9 years btwn onset of symptoms and diagnosis
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32
Q

Signs and symptoms of acromegaly

A
  • skin thick, leathery, oily
  • enlarged hands, feet, nose, sinuses, forehead prominent, and visceral organs.
  • hypertrophy of lips and tongue. (trouble swallowing and speaking
  • atherosclerosis–>cardiomegaly–>diabetes
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33
Q

Complications of cardiomegaly

A
  • alters glucose metabolism, hyperglycemia, symptoms of polydipsia and polyuria (hormone antagonizes action insulin)
  • alters fat, cho, protein and metabolism raising lipid levels leading to HTN and athersclerosis
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34
Q

Diagnosis of Acromegaly

A

GH levels > 50
BEDREST PRETEST
-oral glucose challenge response test is a definitive test
-CT, MRI, bone density
-H&P, c/o changes in dentures, hat, glove, ring, and shoe size

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35
Q

Surgery for acromegaly: hypophysectomy

A

-remove only tumor causing GH secretion (if complete pituitary removed will need hormone replacement thru-out life (decreased sensation of smell, taste, edema, bruising of eyes, nose, upper face)

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36
Q

Post-op care of transphenoidal adenectomy

A
  • I&O FREQUENTLY & HOB ^ 30 DEGREES
  • check for cerebrospinal fluid (question about nasal drip is constant swallowing or halo on gauze)
  • IV antibiotics for CSF leakage
  • avoid sneeze, cough, strain
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37
Q

Medications for acromegaly

A
  • somatostatin analogs = decrease GH WNL
  • dopamine agonists = suppresses GH secretion
  • GH receptor antagonists = blocks secretion
  • –most common: Octreotide (sandostatin)
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38
Q

Nursing care for Acromegaly

A
  • evaluate changes in physical size, appearance– question changes in hat, glove and ring size
  • good skin care
  • high calcium diet
  • pictures helpful bc changes occur slowly
  • emotional support for appearance
39
Q

Prolactinomas

A
  • prolactin secreting adenoma accounts for 40-60% all hyperfunctioning tumors
  • HAs, visual problems secondary to pressure optic chiasm
  • galactorrhea, menstrual abnormalities, infertility, and hirsutism
  • -drug therapy: first line Dopamine agonists,
  • surgery depending on tumor size, radiation limited
40
Q

Antidiuretic hormone (vasopressin) (ADH)

A
  • **conservation of body water by reducing urine output
  • *-channels transport solute-free water thru tubular cells back into blood leading to decreased plasma osmolarity & increased urine osmolarity
  • ADH binds to receptors in distal or collecting tubules of kidneys and promotes resorption of water back into circulation
41
Q

Plasma Osmolarity

A
  • concentration solutes in blood

- **ADH secretion also stimulated by decreased BP and increase in osmolarity

42
Q

Syndrome of inappropriate ADH (SIADH)

A
  • ADH released despite normal or low plasma osmolarity

- results from abnormal production or sustained secretion ADH

43
Q

Signs and Symptoms of SIADH

A
  • fluid retention (you can’t pee)
  • serum hypo-osmolality
  • concentrated urine with normal or increased intravascular volume and normal renal function
  • increased ADH renal absorption of H20 into circulation, ECF volume, decreased NA in urine
  • NO EDEMA
44
Q

Main signs and symptoms of SIADH

A
  • decreased Na leading to muscle cramps, twitching, and HA.
  • increased urine specific gravity
  • brain cells swell leading to neuro sings and symptoms–> lethargy, seizures, personality changes, coma and death
45
Q

SIADH diagnostics

A
  • simultaneous measurement of urine and serum and osmolality
  • **serum osmolality is less that urine osmolality because inappropriate excretion…concentrated urine and very diluted serum (DILUTE Na)
46
Q

Nursing care for SIADH

A
  • restore fluid volume and osmolality
  • diuretics, increase Na diet, Na and K supplements
  • **sometimes develop heart failure so may need lasix
  • HOB 10 degrees
47
Q

Diabetes Insipidus

A

(may be transient or lifelong)

  • deficiency of ADH: kidney tubules fail to reabsorb H20
  • excrete large amounts of dilute urine without glucose
  • polydipsia, polyuria–> DI increased even more
48
Q

Causes of DI

A

problems with hypothalamus or pituitary–brain tumor, injury, meds, infection
–decreased response to ADH, inadequate ADH,

49
Q

Assessment Diabetes insipidus

A
    • BP, SKIN TURGOR, I&O, DAILY WT
  • urine is dilute, clear, colorless
  • low specific gravity
  • polydipsia-thirst mechanism stimulated and insatiable. Crave cold drinks
  • combination of nocturia and polyuria
  • wt loss, poor turgor, hypotension, tachycardia, shock
  • hypernatremia
50
Q

Diagnosis of diabetes insipidus

A
  • **GOAL: maintain fluid and electrolyte balance
  • water deprivation test: evaluates kidneys ability to produce urine with no PO water intake
  • synthetic ADH hormone to determine is DI is caused by renal dysfunction
  • low Na diet and thiazide diuretics
51
Q

The adrenal gland

A
  • small vascular glands located on upper portion of kidneys

- two parts: adrenal cortex and adrenal medulla

52
Q

Adrenal Medulla

A
  • extension of SNS
  • secretes epi, norepi, and dopamine
  • fight or flight response
  • constriction of blood vessels and dilation of brinchioles
  • increase HR, CO, pupil dilation
53
Q

Adrenal Cortex

A

-secretes glucocorticoids, mineralcorticoids, androgens

54
Q

Glucocorticoids

A
  • **cortisol most abundant and potent
  • necessary for life
  • regulates blood glucose concentration- breaks down sugar for energy
  • promote metab of carbs
  • inhibit inflammation
55
Q

Mineralcorticoids

A
  • primarily aldosterone
  • maintains extracellular fluid volume
  • promotes reabsoprtion of Na and excretion of K
56
Q

Adrenal Androgens

A

-stimulate pubic, axillary hair and sex drive in women
-converted to estrogens in peripheral tissue
-major control - negative feedback
hypothalamus secretes CRH–CRH stimulates ant. pituitary to secrete ACTH –ACTH stimulates adrenal cortex to secrete cortisol

57
Q

Cushing Syndrome

A
  • caused by excess of corticosteroids particularly glucocorticoids
  • caused by adrenal tumors and ectopic ACTH production by tumors
58
Q

Signs and Symptoms of Cushing’s Syndrome

A
  • wt gain is most common
  • buffalo hump
  • sodium/water retention so monitor them.
  • susceptibility to infection is a complication of long time hormone use
  • hyperglycemia
  • monitor skin
  • purple striae on abdomen
  • mineral corticoid excess may cause HTN secondary to fluid retention
59
Q

Diagnosing Cushing’s syndrome

A
  • 24 hr urine for free cortisol
  • **plasma cortisol levels may be elevated with loss of diurnal variation
  • CT/MRI for tumor location
  • **hyperglycemia and POLYCYTHEMIA
60
Q

Nursing Care for Cushing’s syndrome

A
    • surgery adrenalectomy or hypophysectomy (pituitary adenoma) or meds to suppress
  • Mitotane: suppresses cortisol production, alters metabolism of cortisol and decreases plasma and urine
  • acceptance of appearance –meticulous skin care, observe Na & H20 retention
61
Q

Adrenalectomy

A
  • HTN and hyperglycemia must be controlled
  • hypokalemia is corrected with supplements
  • **may be hypotensive post-op until regulated by steroids
  • **high doses of cortisone pre/post op
62
Q

Post-op Adrenalectomy

A
  • ** if decreased urinary output due to Na retention
  • ** may be hypotensive until steroid therapy regulation
  • high doses of corticosteroids are administered IV during and several days after surgery to ensure adequate response to surgery
  • monitor I&O
  • wear medic alert bracelet at all times
  • avoid exposure to extreme temps, stress, and infection
63
Q

Hyperfunction of adrenal cortex

A
  • excessive aldosterone secretion which causes Na retention K & hydrogen ion excretion
  • ** hallmark of disease is hypertension & hyperkalemic alkalosis
64
Q

Signs and symptoms hyperfunctioning adrenal cortex

A
  • Na retention leads to hypernatremia, htn, HA
  • no edema
  • potassium wasting leads to hypokalemia- cardiac arrhythmias, muscle weakness, may lead to tetany
65
Q

Nursing care for hyperfunctioning adrenal cortex

A
  • surgical removal if adrenal gland with adenoma

- pre-op: low Na diet, k sparing diuretics, k supplements, CCBs to control BP

66
Q

Addison’s disease

A
  • adrenocorticol insufficiency
  • all 3 classes of adrenal corticosteroids are reduced -sugar, salt, sex
  • autoimmune response destroying adrenal tissue
  • insidious onset
  • progressive weakness, fatigue, wt loss, anorexia are primary features
  • Skin hyperpigmentation
67
Q

Addison’s disease tri-ad

A

hypotension, hyponatremia, hyperkalemia

–hypotension, hyperpigmentation and weakness

68
Q

Diagnosis and nursing care for Addison’s disease

A
  • **protect against stress!!
  • ** diet high in protein, high calorie, extra salt/sodium
  • ** maintain fluid and electrolyte balance
  • large amounts of NS and D5 are administered to reverse hypotension and electrolyte imbalance
  • wear medic alert bracelet
  • take corticosteroids early am to avoid GI distress
  • *-wt gain, moon face, edema, behavior changes, increased urination and thirst- S/S infection
69
Q

Pheochromocytoma

A
  • adrenal medulla tumor that produces excessive catecholamines (epi and norepi
  • severe hypertension
70
Q

Triad of Pheochromocytoma

A

-pounding HA, tachycardia, profuse sweating

71
Q

what is necessary for the synthesis of thyroid hormones?

A

Iodine

—iodized salt, fish, bread

72
Q

Thyroid gland

A

highly vascular organ regulated by TRH from hypothalamus and TSH from anterior pituitary

  • major function is production, storage, and release of 3 hormones that regulate metabolic processes
  • –t3, t4, and calcitonin
73
Q

T3 and T4 affect…

A

metabolic rate, caloric requirement, O2 consumption, growth and development, and carb and lipid metabolism

74
Q

calcitonin

A

produced by C cells in response to high circulating levels

–inhibits bone resorption from bone, increases bone storage and renal excretion of Ca and phosphorus-lowers serum Ca

75
Q

Radiologic studies for thyroid

A
  • radiologic uptake thyroid scan- direct measurement activity, evaluation solitary nodules
  • thyroid scan- evaluate nodules, benign= warm if malignant tumors= cold spots (bc doesn’t take up radioactive iodine)
  • thyroid ultrasound
76
Q

Simple negative feedback

A

hypothalamus–>TRH–>Ant. pituitary –> TSH –>T3 &T4

77
Q

Hyperthyroidsim

A
  • a sustained increase in synthesis and release of thyroid hormones by thyroid glands
  • thyroiditis, nodular goiter, exogenous iodine excess, pituitary tumors, thyroid cancer
78
Q

Most common form of Hyperthyroidism

A

Grave’s disease

79
Q

Grave’s disease

A
  • autoimmune disease of unknown etiology
  • thyroid enlargement and excessive thyroid hormone secretion
  • precipitating factors: insufficient iodine supply, infections, stress, genetic factors
80
Q

Hyperthyroidism Tri-ad

A

1) increased tissue sensitivity to stimulation of SNS
2) Goiter
3) exopthalmus

81
Q

Exopthalmos

A

-impaired drainage from orbit, increased fat and edema in retro-orbital tissues

82
Q

Grave’s disease may have what effect on the CV system?

A

-give you palpitations!

rapid HR and

83
Q

Signs and symptoms of Grave’s disease

A

^ HR, RR, appetite, thirst, wt loss

–nervousness, wt loss, appetite

84
Q

Thyrotoxic Crisis (thyroid storm)

A
  • increased thyroid hormone in blood
  • ** hyperthermia increase in temp to 105 degrees
  • tachycardia, HF, restless, agitation, seizures, abd. pain, N/V/D, coma
85
Q

Treatment and Therapy for Thyrotoxicosis

A
  • therapy aimed at reducing fever, fluid replacement and management of stressors
  • labs to see if FT4 is high and TSH low
  • Beta blockers for symptomatic relief and decrease HR
86
Q

why is iodine useful is treating thyrotoxic crisis

A
  • large doses of iodine inhibit T3 and T4 and block their release into circulation
  • available SSKI (sat sol potassium) & Lugol’s solution
  • decreases vascularity of thyroid making surgery safer and easier (bc thyroid very vascular)
  • long term iodine therapy not effective
87
Q

Anti-thyroid meds to treat thyrotoxic crisis

A

PTU and Tapazole inhibit the synthesis of thyroid hormones

88
Q

Surgical therapy for hyperthyroidism

A
  • subtotal thyroidectomy for those unresponsive to drug therapy with large goiters causing tracheal compression
  • **Hemorrhage ASSESS by gently slipping hand behind neck to check for blood
  • endoscopic thyroidectomy for small nodules
89
Q

euthyroid

A

normal function

90
Q

Nutrition for hyperthyroidism

A
  • high caloric may be ordered for hunger and prevention of tissue break down
  • avoid caffeine, highly seasoned foods, high fiber foods
  • –major problem in inadequate diet
91
Q

After thyroid surgery what is essential to keep at the bedside?

A

-suction equipment and tracheostomy tray

92
Q

Tetany

A

numbness and tingling toes and fingers is possible post-op along with circumoral muscle twitch

93
Q

Post-op of thyroid surgery

A
  • stridor or numbness so may need IV calcium
  • avoid goitrogens: rutabagas, turnips, and peanut skin
  • avoid caloric intake
94
Q

Thyroiditis

A
  • inflammatory process in thyroid with several causes

- viral, fungal, and autoimmune

Nursing 102 (11 decks)

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