Endocrine Reading Flashcards
- Describe the effects of aging on the endocrine system.
Aging lowers your hormone levels and tends to cause some disorders that will generally only occur in elder age groups
lowers metabolism, ADH production, and estrogen
Assessment of the thyroid
Vital signs
Integument
Height and weight
Mental and emotional status
Head and neck
Thorax
Abdomen
Extremities photographs
If the thyroid gland is palpable on the throat this poses a serious concern as you should not be able to feel the thyroid gland unless inflamed or has an issue going on with i
- What is a hypophysectomy and why is it done?
surgical removal of the pituitary gland as tx for pituitary tumor
- Give 3 top priorities in postoperative hypophysectomy care
stroke
- vision loss
- meningitis
- CSF leak
- DI - can be permanent in 2-5% and treated by medication
- What is the significance of a ‘halo’ on a drip pad after a hypophysectomy?
The halo is cerebrospinal fluid around blood
- Test for blood glucose with dipstick
Bad thing can need to be let out through lumbar puncture
- How does increased ADH levels impact fluid volume?
Increased ADH level cause and excess of water and a decrease of sodium
- An increase in the release of ADH makes your body hold on to water causing fluid volume retention while depleting the levels of electrolytes that you have
Normally caused by pituitary surgery, trauma, head injury, CVA or infection like meniginitis or a malignant tumor
S/S SIADH
a. Fluid volume excess
b. Weight gain without peripheral edema
c. HA, altered LOC risk for seizure
d. Concentrated amber urine
e. Fatigue
f. N/V
g. Think spongebob for this
S/S DI
a. Severe thirst
b. Weight loss
c. Excessive dilute urine will be extremely sticky
d. Trouble sleeping
e. Fever
- What impact does SIADH and/or DI have on sodium, other electrolytes, and osmolality?
SIADH = low Na, BUN, Hct
- serum osmolality low
- urine osmolality HIGH (concentrated)
DI = high Na
- serum osmolality HIGH
- urine osmolality LOW (DILUTE POLYURIA)
- What medications are used to treat SIADH and DI? Give major side effects and patient education needs
DI - Desmopressin acetate
- 2. Erythema of injection sites, nasal irritation, hyponatremia, doesn’t raise BP
3. Cant use concurrent loop diuretics or glucocorticoids and must hold is creatinine clearance <50mL/min
4. Drug choice for DI and is more effective than vasopressin
5. Must monitor I&O, serum and urine osm, daily weight, assess for hypo/hypervolemia
6. No alcohol, medical alert bracelet and how to administer, nasal spray is the cheapest and most common
DI - Vasopressin
1. Very similar to their natural hormone
2. Promotes renal conservation of water
3. Vasoconstriction and increases BP, HA, chest pain and water intoxication
4. Don’t use if they have chronic renal failure
5. Monitor BP, HR, EKG, I&O, urine osm, dehydration vs. fluid overload
6. Teach no alcohol, medic alert ID band, limit fluid intake
7. Very important to know that they are on this drug
SIADH priorities
i. Safety and precautions for seizures depending on their sodium levels
ii. Can restrict fluid as this is the easiest way to help with fluid retention; may restrict to 800-1200 mL a day counting IV/IVPB and frozen items, if severe enough we will restrict to 500 mL
iii. Daily weight
iv. Strict I&Os
v. VS, CV, and neuro checks frequently
DI priorities
i. Identify and correct underlying issue
ii. Replace ADH
iii. Monitor VS, CV, and neuro frequently
iv. Daily weight and strict I&Os
- Top patient teaching needs for SIADH and DI.
SIADH = report wt gain, slow Na gradually, fluid restrictions, seizure and electrolyte balance
DI = Meds (vasopressin and DDAVP), REHYDRATE, Na restrictions, daily wt, risk of skin tears
- Does a goiter determine if a patient has hyper or hypo thyroidism?
No, goiter can occur in hyper, hypo, and eu-
- What a 3 classic signs of Grave’s Disease?
goiter
bulging eyes
raised red rash
- How are TSH, T3 and T4 levels impacted in hyper or hypo thyroidism?
a. TSH is a measurement for testing thyroid function and manages thyroid replacement therapy; produced by pituitary gland and stimulates the production of T3 and T4
i. Both T3 and 4 will be high in hyperthyroidism while low in hypo
b. T3 accurately measures hyperthyroidism and evaluates the thyroid levels after admin of iodine
c. T4 measures free and unbound thyroxine levels in your bloodstream
- Name 5 manifestations of hyperthyroidism
a. Nervous tremor
b. Weight loss and hunger
c. Weakness and fatigue
d. Graves disease (may have goiter, exophthalmos, or raised red rash)
e. N/V/D
f. Increased BMR (T,P,R, and BP)
- Name 5 manifestations of hypothyroidism
a. Lethargy and fatigue
b. Weight gain
c. Dry skin and hair
d. Constipation
e. intolerance to cold
- How do manifestation of hyper/hypo thyroidism differ in the older adult?
Double the wt loss from anorexia as well
dysrhythmia to heart failure more common
- What medications are used to treat hyperthyroidism? Common side effects & key patient teaching points
lifelong antithyroid med - PTU (hypothyroidism, agranulocytosis, fetal harm) - not abrupt stop
Iodine 131 : radioactive precautions (radiation sickness, bone marrow suppression, hypothyroid) - not for pregnant or children
Strong iodine solution = iodism toxicity (avoid ionized foods)
Thyroidectomy
- What medications are used to treat hypothyroidism? Common side effects & key patient teaching points
levothyroxine (Synthroid) = thyrotoxicosis
Extremes; jitters, grumpy, thyroid storm
- not for acute MI, stroke, or thyroid storm
- in morning before breakfast
- List 3-5 priorities in post thyroidectomy care.
head & neck support (pillows, no rocking forward with head to strain the neck, use arms to side for pushing)
HOB for swelling
feeding tubes?
incision painful to swallow for 24 hours - pain meds before food
Incision & airway: bleeding (anterior and side collarbones), airway obstruction
thyroid hormone: depends on the amount left, if total lifelong thyroid replacement, weaning can occur but usually very slow
- What are the nutrition requirements or precautions for patients with hypo / hyperthyroidism?
a. Iodine is a main component
b. Hyper affects the metabolism of fats, carbs, and proteins
- What are manifestations and top priorities of care in Thyroid Storm/Crisis?
a. Temp >101.3
b. Increased HR, systolic HTN
c. Agitation, confusion, seizure
d. Exaggerated s/s of hyperthyroidism
e. Manage
i. Stabilize CV function (beta blockers
ii. Oxygen
iii. Replace fluids and electroltyes
iv. PTU, corticoids, lithium, or iodinated contrast
v. Calm environment
- What are manifestations and top priorities of care in myxedema?
a. Non pitting edema
b. Possible coma and CV collapse
c. Decrease T4, Na, and glucose and increase TSH
d. s/s of hypothyroidism
e. manage
i. replace T4
ii. treat precipitating factors
iii. respiratory and CV support
iv. increase body temperature
v. maintain fluid, electrolyte and acid-base
- Give at least 5 manifestations of hyperparathyroidism
a. Hyperparathyroidism
i. Dysrhythmias and increase BP
ii. Bone pain
iii. N/V and abdominal pain
iv. Decreased DTR
v. Psychosis and cognitive function
vi. Think WEAK for signs of high calcium levels; bones, stones and abdominal moans
- Give at least 5 manifestations of hyperparathyroidism
i. Decrease BP and dysrhythmias
ii. Positive trousseau/chvosteks
iii. Muscle cramps or seizures
iv. Bronchospasms and difficulty swallowing
v. Irritability and paresthesia
vi. Think CRAMPS for signs of low calcium;
- What electrolyte(s) does parathyroid function impact? How is that manifested?
a. Calcium as calcium is regulated by PTH hormone
b. If serum ca increases
i. Parathyroid increases PTH level and Ca is drawn from bone and increases serum Ca levels
c. if serum Ca decreases
i. thyroid increases calcitonin which decreases serum Ca
- What are 3 priorities in patient education for parathyroid disorders
Monitor Ca levels
PTH
Vitamin D
- What medication(s) are used in treating parathyroid disorders? Give important patient education information.
HYPER=NS gtt, loop diuretics, BIsphosphonates, Calcitonin
Dialysis (greater then 15)
Surgery (not unless stabilized)
-irrigate and excrete Ca-
hypo =Immediate treatment: Calcium gluconate IV then Ca carbonate
Vitamin D
Quiet environment
- What are priorities of care after a parathyroidectomy?
Monitor electrolytes
Monitor for tingling in extremities or face
Monitor voice pattern & quality
- What is the difference between Cushing’s and Addison’s? Give 5 manifestations of each.
Cushing’s =osteoporosis
muscle wasting - hand and arm bruising and thinning(SIADH but with fat)
weakness
LOC and mood change moonface
psychosis
Buffalo hump - fat glob on back
straie - tiger strips
Addison’s = dysrhythmia hypovolemia, POSTURAL HYPOTENSION
Skin: hyper-pigmentation,
MS: muscle & joint pain, muscle weakness & tremor
Mental status: depression, emotional lability, confusion
- What electrolytes are impacted by adrenal gland hyper or hypo function?
K
Na
Aldosterone
Cortisol
- Give 3-5 priorities in patient education for Cushing’s and Addison’s
Monitor BP
- List top priorities in caring for a patient in Addisonian Crisis.
Shock management
High-dose IV hydrocortisone replacement (glucocorticoid)
Monitor for Cushing
D5NS
Frequent VS & neuro assessment
I&O, daily wt.
QUIET WITH REST Protect from extremes- light, noise, temperature
Protect from infection
- What medications are used to treat hyper and hypo adrenal function? Give major adverse effects and patient teaching points
Hyper = Cushing’s
- lower steroid treatment
Hypo = Addison’s
-Glucocorticoid & Mineralocorticoid
- What is the difference between glucocorticoids and mineralocorticoids?
Gluco =carb metabolism (genesis, lower utilization peri,inhibit uptake, and promote storage)
- protein metabolism
- fat metabolism
- CV function
Minerals = RAAS = Aldosterone
Promotes sodium & potassium hemostasis**
- List 3-5 manifestations of pheochromocytoma?
a. 5 h’s; HA, HTN, heat, hypermetabolism, hyperhidrosis
b. Diaphoresis
c. Palpitationa w HTN
- Give top 3 priorities in caring for a patient with pheochromocytoma
a. Surgery iss the best option adrenalectomy
b. Manage rest and activity
c. Monitor BP and fluid
d. Must be on a high calorie diet
- What are priorities of care following an adrenalectomy?
Home health
MedicAlert bracelet
Avoid: extremes of temperature, infection, & stress
Teach: adjust medication & when to call HCP
Lifetime replacement therapy
