Endocrine I Flashcards
List the 3 hormones that the Thyroid Gland produces?
Hormones T3, T4 and Calcitonin
What is the action of Calcitonin?
Calcitonin decreases serum calcium levels by taking calcium out of the blood and pushing it back into the bone.
What does the body need Iodine for?
To make hormones ( This is dietary iodine -what you eat)
What does Thyroid Hormone give us?
Energy
What does Hyperthyroid mean?
What is the name of the disease known to hyperthyroidism?
Too Much Energy Graves Disease ( Think Don Knots)
List the Signs and Symptoms of Hyperthyroidism
Nervous Irritable Decreased Attention Span - wild energy cannot focus Decreased Weight Increased Appetite Increased G.I. -borborygmi Increased BP and Pulse - Arrhythmia's/palpitations Sweaty/Hot Exophthalmos Thyroid bigger - Hypertrophy
How is Hyperthyroidism Diagnosed?
- By checking blood levels - Increased Serum Thyroxine (T4)
- Thyroid Scan - Hypertrophy
- Ultrasound/MRI/CT
If a Pt. is going for a thyroid scan what must they discontinue and for how long?
Discontinue any iodine containing medication, 1 week prior to the thyroid scan and must wait 6 weeks to restart medications.
What Anti-arrithythmic drug contains high levels of iodine and may affect thyroid function?
Amiodarone - (Cordarone)
How do we treat Hyperthyroidism?
MEDICATIONS:
1. Anti-thyroids
2. Iodine Compounds
3. Beta- Blockers - supportive therapy
4. Radioactive Iodine Therapy
AND
5. Surgery - ThyroidectomyDescribe the Actions of Anti-thyroids
Known as: Methimazole (Tapazole) or Proplthiouracil (PTU)
- Stops the thyroid from making thyroid hormones.
- Its used for PRE-OP to stun the thyroid.
- We want this Pt. to b/c Euthyroid - EU = NORMAL
Describe the Actions of Iodine Compounds
-Known as: Potassium Iodine (SSKI and Lugol’s solutions).
- Given PRE-OP to decrease the chance of bleeding.
- Decrease the size and vascularity of the gland.
- All endocrine glands are very vascular.
- Given in milk or juice , and use straw b/c stains teeth.
Describe the Actions of Beta Blockers (lol) Supportive Therapy.
Known as: Propanolol (Inderal)
- Decreases myocardial contractility
- Could decrease cardiac output
- Decreases HR, BP
- Decreases Anxiety
Describe the Actions of Radioactive Iodine Therapy (One dose):
- Fight or Flight Hormones
- Given PO - either liquid or tablet form
- RULE OUT PREGNANCY FIRST
- Destroys thyroid cells - HYPOTHYROID
- Expect Hypothyroidism
- Follow Radioactive Precautions-no babies/kissng for 1 wk
- THINK: Unsealed Radio Precautions for Oncology.
- Watch for thyroid storm (thyrotoxicosis /thyrotoxic crisis). It is hyperthyroidism x100. Can be a rebound effect post-radioactive iodine. - Its Emergency = heart attack.
What patients should you not give Beta Blockers to?
Asthmatics and Diabetics - can hide hyperglycemia
Describe the Action of Beta Blockers
Beta Blockers block EPI and NOR-EPI so you can remain calm. HR and BP do not increase therefore decreasing Myocardial contractility and brain perfusion.
Signs and Symptoms of Thyroid Storm
Nervous, Shaky,Jittery
Cold/Clammy
Increased HR
Hyperglycemia
What does the nurse assess after a Thyroidectomy (Partial/Completely)?
Post Op: Priority - Hemorrhage
Assess for hemorrage by - reports feelings of pressure in the neck area b/c swelling and bleeding can occur.
Assess for bleeding at incision site and behind neck.
Assess for recurrent laryngeal nerve damage by listening for hoarseness /weak voice. Can lead to vocal cord paralysis.
Paralysis in both vocal cords = airway obstruction and will require immediate tracheotomy.
What is important to have at the bedside of a Thyroidectomy (Partial/Completely) Pt? For what reasons?
Trach Set
- Swelling
- Recurrent laryngeal nerve damage
- Hypocalcemia
- Assess for parathyroid removal by deceased calcium
- Not sedated
What are the Signs and Symptoms of Hypocalcemia
- Rigid Tight Muscles
- Seizures
- Tetany
- Laryngeal Spasm
Eye care is important for a client with Hyperthyroidism. What should the nurse teach the patient if they are unable to close their eyes?
- Hypoallergenic tape may be applied to close lids.
- Dark glasses may be worn if photosensitivity is present.
- Artificial Tears are used to prevent drying of the eyes.
- Tx. of hyperthyroidism does not correct eye/vision probs.
What should the nurse teach the Pt. after Thyroidectomy (Partial/Completely)?
- Teach how to support neck-pillows to support neck
- Put personal items close to them- b/c suture line
- Positioning: Elevate HOB to decrease edema
- Nutrition (pre/post op: Pt. needs more calories b/b burning so many.
What are the Signs and Symptoms of Hypothyroidism?
- No Energy- Fatigue
- No Expression
- Speech slow, slurred, to tired to talk.
- Weight Increase
- G.I. Slow
- Cold - no heating pad b/c can’t tell if its hot.
- Amenorrhea (no period)
- Pt. maybe totally immobile
- Can be confused with depression
- Long term S&S
- puffiness
- facial edema
- tongue perfusion
- myxedema
How is Hypothyroidism diagnosed?
Thyroxine (T4) Decrease
TSH Increase
Opposite lab values for Hyperthyroidism
How is Hypothyroidism Treated?
- Levothyroxine (Synthroid) - most common
- Liothyronine (Cytomel)
- Take on empty stomach
- ppl. with Hypothyroidism tend to have CAD.
- Monitor for rhythm changes
- Monitor for MI when these medicines are started.
- Take meds forever
- Energy increases when start these taking meds
Describe Parathyroid Problems
The Parathyroids secrete PTH, which makes you pull calcium from the BONES and place it in the blood. Therefore, the serum calcium level goes up!
If you have too much parathormone in your body, the serum calcium level will be _______?
High
If you do not have a parathormone in your body, the serum calcium level will be ______?
Low
Hyperparathyroidism is AKA: _______ and _______?
Hypercalcemia and Hypophosphatemia
What are the Signs and Symptoms of Hyperparathyroidism?
Too much PTH Serum calcium is HIGH Serum phosphorus is low Sedated - Calcium acts like a sedative. Too much Calcium = To little Phosphorus
How do we treat Hyperparathyroidism?
Partial Parathyroidectomy - when you take out 2 of your parathyroids PTH secretions decreases.
Post-Op - Monitor for bottoming out to Hypocalcemia
Monitor for S&S of Hypocalcemia 1
- Rigid Tight Muscles
- Seizures
- Tetany
- Laryngeal Spasm
Hypoparathyroidism is AKA: _______ and _______?
Hypocalcemia and Hyperphosphatemia
What are the Signs and Symptoms of Hypoparathyroidism?
Not enough PTH
Serum calcium is LOW
Serum phosphorus is HIGH
Not Sedated
How do we treat Hyporparathyroidism?
- IV Calcium
- Phosphorus binding drugs - Sevelamer - help increase calcium and decrease phosphorus
What do we need adrenal gals for?
To handle stress
You have 2 parts to your adrenal glands. What are they?
Adrenal Medulla
adrenal Cortex
What does the Adrenal Medulla do?
Describe a Adrenal Medulla problem?
Secretes epinephrine and norepinephrine.
Pheochromocytoma - benign tumors that secrete epi and norepi in boluses. Tend to be familial, so screen the family.
What are the Signs and Symptoms of Adrenal Medulla problem?
Increased BP Increased HR Increased Palpitations Flushing/Extremity diaphoretic Headache
How are Adrenal Medulla problems diagnosed?
Catecholamine levels: VMA ( vanillylmandelic acid) test or Metanephrine (MN) test.
24 hour urine specimen is done monitor for increased levels of EPI and NOREPI ( AKA: Catecholamines).
With 24 hour urine, throw away the first voiding and keep the last voiding.
Avoid activities that may increase Epi and Norepi - No stress
What foods alter VMA and MN tests?
Anything with Vanilla Caffeine Vitamin B Fruit juices Bananas
How do you treat Adrenal Medulla problems?
Surgery to remove tumors
What must you avoid doing to a Pt. with suspected pheochromocytoma and why?
Palpating the Abdomen because may cause sudden release of catecholamine and severe hypertension.
What does the Adrenal Cortex consist of?
Glucocorticoids
Mineralocorticoids
Sex hormones
Even though the body secretes steroids normally, the adverse effects are going to be more pronounced when the Pt. is receiving oral steriods.
What are the 4 major Actions Glucocorticoids?
- Change your mood - depressed, psychotic, euphoric, insomnia. Can get mean, crazy, depressed etc.
On Prednazone - betametriazone - Alter Defense Mechanism
- immunosuppressed - caution when assigning roommates
- High risk for infection - Breakdown Fats and Proteins
- help regulate glucose metabolism - Inhibit Insulin
- help regulate glucose metabolism
- Hyperglycemic
- Do blood glucose monitoring
Describe Mineralocorticoids: Aldosterone
- Make you retain sodium and water
- Make you lose Potassium
What happens when you have to much Aldosterone?
- Fluid Volume Deficit
- Serum Potassium Down
What happens when you do not have enough Aldosterone?
- Fluid Volume deficit
- Serum Potassium UP = Hyperkalemic
List 3 Sex Hormones
- Testosterone
- Estrogen
- Progesterone
What happens when you have to many sex hormones?
Hirsutism
Atony - muscle loss
irregular menstrual cycle
What happens when you don’t have enough sex hormones?
Decreased axillary/pubic hair
Deceased libido
Adrenocorticotropin hormones ( ACTH) are made in the _________ and they stimulate ________ to be made.
Pituitary
Cortisol
Cortisol is a hormone of the _________.
Adrenal Cortex
Increase in ACTH = Increase in ______ ______.
Cortisol Level
Too many steroids is AKA?
Hypercortisolism
What causes Adrenal Cortex Problems?
Not enough steroids
Shock
Hyperkalemia
Hypoglycemia
Describe Addisons Disease
Adrenocortical insufficiency - not enough steriods.
They do not have enough Glucocorticoids, Mineralocorticoids and Sex hormones
Aldosterone (Mineralocorticoids).
Lose sodium and water therefore retain potassium
Serum Potassium will be High.
What r the Signs and Symptoms of Addisons Disease?
Extreme Fatigue
Nausea, Vomiting and Diarrhea
Anorexia/ Weight Loss
Hypotension
Confusion
Decrease sodium, increased potassium and Hypoglycemia
Hyperpigmentation-bronzing color of the skin and mucous membranes
White patchy area of depigmented skin ( Vitiligo)
How do you treat Addisons Disease?
-Combat shock - losing sodium/water = losing volume
-Increase Sodium in Diet
-Processed fruit Juice/Broth (has lots of sodium).
-I&O and daily weight - b/c FV problem
-Losing Sodium/Water = Low BP
-Decreased weight
-FVD
-Medications: Prednisolone (Prednisone) - given twice a day in split doses. Pt. will take 2/3 of the dose in the morning and 1/3 in the evening.
Fludrocortisone - is aldosterone (need)
-Steriods make Blood Sugar go down.
-Daily weights and BP must be monitored.
If Pt. is taking Medications that require weight to be monitored daily keep weight in what range? and report a gain of? Also, report changes in BP____?
- 2-3lbs or 1-2 kgs of their normal weight
- Report gain > 5lbs ( 2.27 kg)
- BP Increase
Define Addisonian Crisis
Can occur with infections, emotional stress, physical exertion or stopping steroids abruptly.
Severe Hypotension
Vascular collapse
Describe Cushing’s Disease
Too Many Steroids!!!
- Glucocorticoid
- Mineralocorticoids (Aldosterone)
- Sex hormones
Signs and Symptoms of Cushings Disease
Glucocorticoid:
- Growth Arrest
- This extremities/Skin (lipolysis).
- Hyperglycemia
- Psychosis to depression
- Moon faced - fat distribution or fluid retention
- Truncal Obesity - Fat Redistribution: Lipogenesis.
- Buffalo Hump - fat redistribution
Sex hormones:
- Oily Skin/Acne
- Women with Male Traits
- Poor Sex Drive (Libido)
Mineralocorticoids (Aldosterone):
- High Bp
- CHF
- Weight Gain
- FVE
- since the Pt. has to much Mineralocorticoids (Aldosterone), the serum potassium will be LOW.
If you did a 24 HR Urine on a Cushing’s Pt. the
Cortisol (steroid) levels would be High or Low?
High
How do you Treat Cushing’s Disease?
Adrenalectomy ( Unilateral or Bilateral)
* IF both are removed thru lifetime replacement
Quiet Environment - can’t handle stress
Diet:
- Increase K+
- Decrease Na
- Increase Protein
- Increase Ca
Avoid Infection - steroids suppress immune system
The Nurse is monitoring lab values of a client on long-term steroid therapy. Which values would the nurse expect to be altered in the urine? SATA.
- Protein
- Glucose
- Ketones
- RBC’s
- Uric Acid
Gluecose
Ketones
Protien in urine = Kidney damage
RBC’s and Uric Acid = Kidney Stones
