Endocrine Lecture Flashcards
When would you give insulin to a non-diabetic?
- Hyperkalemia pt; end stage renal disease pt missed dialysis will be hyperkalemic. You’d also give with DW50
- Pts on glucocorticoids
Anterior Pituitary: Major Hormones
•ACTH is involved in the synthesis of corticosteroids.
•GH also known as somatotropin, stimulates growth through carbohydrate, protein and fat metabolism.
•FSH assists in the maturation of the ovaries in females and in spermatogenesis in males.
•LH is involved in ovulation in females and the production of testosterone in males.
• Prolactin stimulates the mammary glands for milk production.
•TSH controls the secretion of T4 and T3 thyroid hormones.
Where are these hormones produced/released: TSH, TRH, T3 & T4
Ant pit, hypothalamus, thyroid
Hypoalbuminemia and hyperthyroidism—why? (Test Q)
B/c when bind to albumin, T3 & T4 will be inactive.
When not enough, more free T3 & T4.
- for ex, d/t liver disease
Oxytocin
Breast tissue contraction
Labor contractions
Circadian homeostasis- prime brain for rest n sleep
Strengthen emotion bonds b/t mom n baby and also other relations
Causes of hypopituitarism
•Pituitary tumors
•CNS infections
- •Meningitis
•Head trauma related to increased intracranial pressure
•Infarction of the pituitary gland due to hypoperfusion/bleeding
Nursing interventions for ^^ ICP
No coughing
No vomiting
- administer Zofran
Head of bed
Common diuretics
PO, IV: Laxis - loop diuretic
PO only: Spironolactone ((also given to young women w acne bc blocks testosterone))
(Not taken together)
PO, IV: Bumex
Coritsol basal functions
Keep immune system in check; immunosuppression
Glucose levels steadily high enough
Alertness
Clinical Manifestations: Hypopituitarism
Low ACTH:
—> Decreased glucocorticoids
•Hypoglycemia
•Decreased cortisol levels
•Decreased ability to handle stress
—> Decreased mineralocorticoids
•Hyponatremia
•Hypotension
•Hyperkalemia
Low TSH —> Decreased levels of T3 and T4
•Decreased metabolic rate
•Weight gain
•Thinning of hair
•Decreased libido
Spironolactone
K sparing diuretic
((also given to young women w acne bc blocks testosterone))
What is atrial natriuretic peptide? ANP
Atrial myocytes release in resp to increased atrial stretch.
Important nursing consideration for fluid overload
Breathing! Crackles heard? Pulmonary edema
What is ADH? How regulated?
Aka vasopressin
Increase water reabsorption in kidneys
//
Plasma osmolarity; blood volume; BP
Hypothalamus produces it; post pit stores and releases
//
Receptors detecting:
Osmolarity - osmoreceptors of hypothalamus (most sensitive)
Fluid vol - myocytes @ atria, ventricles, pulmonary vessels ^ sns to ^ adh
(If stretched, decrease adh n ^anp, bnp
BP - baroreceptors @ carotid sinus, aortic arch ^ sns to ^ adh
(Stretch —> down adh)
Does K serum lvls affect aldosterone lvls?
Yes.
•Alterations in plasma potassium concentration have opposite and independent effects on renin secretion by the kidney and on aldosterone secretion by the adrenal gland. Renin secretion tends to be inhibited by hyperkalemia and stimulated by potassium depletion. In contrast, increases of plasma potassium directly stimulate aldosterone secretion. This effect of potassium on aldosterone serves as a protective mechanism against the development of hyperkalemia. Conversely, hypokalemia inhibits aldosterone production.
Blood transfusion : Pump vs Bolus
Only bolus in trauma hospitals
Define Addison’s disease
Hypothalamic-pituitary-adrenal axis disturbance or primary adrenal failure
•Adrenal insufficiency (AI) is a life-threatening condition characterized by the failure of adrenocortical function.
•Impaired secretion of glucocorticoids (GCs) only or of GCs and mineralocorticoids (MCs) and adrenal androgens.
•The disorder may be caused by adrenocortical disease, primary adrenal insufficiency (PAI), known as Addison’s disease
Clinical manifestations
- hypoglycemia
- low ability cope w stress
Primary Nursing Dx
- Fluid volume deficit
Addisonian crisis - how to respond?
Bolus of high dose steroids
How to decrease serum K+ levels? Test Q
- Insulin w dextrose: brings K+ into cell
- Kayexalate: PO liquid; binds to K+ in GI tract and pt poops it out.
- Lokelma; PO or enema if PO not possible; however ensure GI organs are intact
- Albuterol binds to K like insulin and brings it into the cell
When might you see excess dilute urine?
Diabetes Insipidus
Diabetes
When might SIADH occur?
Transsphenoidal hypovasectomy
Head injury
What is an important measure for hyponatremia, ICP, head injury
Seizure pads
Collab with PT before getting them up or letting them walk independently
Patient education for adrenal disorder pt
What signs to look for and at what stage they should come to the hospital
Patient education for adrenal disorder pt
What signs to look for and at what stage they should come to the hospital