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
Hyperpituitarism cause
•Usually related to a hypersecreting tumor.
•Tumor may result in headaches or press on the optic nerve.
First thing u ask when someone losing peripheral vision?
- R/O Stroke
- R/O Tumor
First thing u ask when someone confused?
- R/O hypoglycemia, hypotension
- R/O stroke
- R/O UTI for geriatric pts
When someone falls and hits their head? First R/O:
- Do u take any blood thinners? Risk for hemmorhagic stroke
When someone exhibits trigeminal neuralgia, think..:
- R/O stroke
Nursing intervention for exophthalmos
Eye drops.
Corneal abrasion risk when eyes very dry.
Wear special glasses when go out during windy.
Meds for thyroid disorders
metimazole for hyperthyroidism
levothroxine for hypothyroidism
- usually only for those with entire thyroid gone. If only half removed, often the other half compensates.
Note: Glucocorticoids and faster acting than mineralcorticoids
.
Transsphenoidal hypovasectomy
Mentioned multiple times
I keep taking Tylenol but my fever is not going away for 2 weeks. R/O:
R/O Thyroid storm
R/O Lymphoma
Calcium channel blocker, Beta blocker, ACE, ARB
Note:
Can u give ACE, beta blocker and Ca channel blockers all at once?
ACE & ARB?
Yes b/c different MOAs.
No. Can never give ACE and ARB at once
Assessment considerations for endocrine disorder pts?
Enough to say, this person looks different from this morning.
•Vital Signs
•Neurological assessment
•Daily weight; I and O
•Serum electrolytes
•Neurovascular status
•Changes in size of hands and feet
Meds for hypersecreting tumor?
•Administer dopamine agonists
•Inhibit release of anterior pituitary hormones
•Administer somatostatin analogs
•Inhibit release of growth hormone
•Administer hormone supplements
•Replacement of sexual hormones is required to facilitate normal function and conception.
How does somatostatin work?
•Somatostatin is a hormone made naturally in the body. It is made by:
•a gland in the brain called the hypothalamus
•the stomach
•the pancreas
•the bowel
•Somatostatin does a number of things. It slows down or stops the production of a number of hormones such as insulin and gut hormones. It also controls the emptying of the stomach and bowel.
•A somatostatin analogue is a man made (synthetic) version of somatostatin. It slows down the production of hormones, especially the growth hormone and serotonin.
Nursing Interventions for a Patient After Transsphenoidal Hypophysectomy
•Vital signs: Hypotension and tachycardia are seen if the patient develops postoperative Diabetes Insipidus
•Fevers may develop with post op infection
•Intake and output: Lack of ADH leads to an increase in excretion of large amounts of dilute urine.
•Urine specific gravity; serum sodium and osmolality
Why avoid vaseline when pt on oxygen?
Flammable
Diabetes Insidious & Desmopressin
Note
DI nursing interventions
• Administer humidified oxygen
•Administer desmopressin or vasopressin as ordered
•Synthetic ADH is administered to cause water reabsorption in the kidneys.
•Maintain head of the bed at 45 to 60 degrees
•Provide adequate oral fluids
Education for DI pt
•Signs and symptoms of DI: Instruct patient to notify his or her healthcare provider for increased urine output and excessive thirst.
•Signs and symptoms of fluid overload: Instruct patient to notify his or her healthcare provider for weight gain.
•Avoid activities (coughing, sneezing, bending at the waist) after transsphenoidal hypophysectomy
•Report any increase in drainage of clear fluid from the nose after transsphenoidal hypophysectomy
- suspect CSF leakage
Clinical manifestations of DI
Polyuria, polydipsia, and nocturia are the primary clinical manifestations seen in patients with DI
Increased hemoglobin and hematocrit means
Plasma is concentrated.
How to respond to DI
Replace water loss by drinking fluids.
•IV fluid administration is indicated.
•Water losses are replaced with a hypotonic fluid (in relation to the patient’s serum osmolality) such as dextrose in water.
•Desmopressin (DDAVP), a synthetic analog of ADH
Desmopressin is key! Sometimes comes as spray. V expensive.
DI complications
• Dehydration and hypovolemia, progressing to circulatory collapse without adequate fluid administration.
•Hypernatremia is related to central nervous system dysfunction secondary to shrinkage of brain cells and results in confusion, neuromuscular excitability, seizures, or coma.
Vasopressors
Constrict vessels of nonessential organs to send more blood to the heart and brain.
Complication: Limb ischemia
“Vasopressor induced gangrene”
- if a concern, give via central line.
Safety precaution for DI?
Seizure precautions.
Hypernatremia —> brain cell shrinking may result in ALOC, seizures, or coma.
IV access should be checked my nurse on shift a few times a day; in case there is emergency, and IV is not patent, responsibility on nurse.
Note
Why vasopressors dont constrict in brain & heart?
Autoregulation
SIADH urine will be…
Concentrated.
What lab values gotten from Urinalysis?
Compare SIADH and DI
Anorexia
Loss of appetite
What Na+ lvl is there a seizure/coma risk; why
Sodium below 120 mEq/L
Cerebral edema risk
16G bore used when?
Placed in trauma units; emergency situations
Demeclocycline (Declomycin) and SIADH?
Test Q
Antibiotic; a tetracycline derivative, may also be used because it increases water excretion by the kidneys.
Parameters for oliguria
Less than 400 mL/24H
Note: Confusion and irritability may be seen in hyponatremia
Define hemodilution and hemoconcentration
