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NURS 2501 > Endocrine system > Flashcards

Endocrine system Flashcards

1
Q

Endocrine system - Anatomy

A
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2
Q

Regulation of blood calcium

A
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3
Q

Hypothalamus & Pituitary Glands

A
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4
Q

Hormones secreted by anterior pituitary (adenohypophysis)

A
  1. TSH (thyroid stimulating hormone) - thyroid
  2. ACTH (adrenocorticotropic hormone) - adrenal cortex
  3. GH (growth hormone) - bones + tissues
  4. Gonodotropic hormones - LH + FSH
  5. Prolactin - mammary glands
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5
Q

Hormones secreted by adrenal cortex

A
  1. Glucocorticoids - Cortisol
  2. Mineralocorticoids - Aldosterone
  3. Androgens - Testosterone
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6
Q

Acromegaly (adulthood) - cause, S/s

A

due to GH secreting tumor

  1. Enlargement of hands + feet
  2. Elongation of jaw bone
  3. Enlargement of visceral organs - hepatomegaly , cardiomegaly
  4. Hyperglycemia - GH blocks action og insulin
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7
Q

Prolactin secreting tumors - S/s

A
  1. Galactorrhea
  2. Hypogonadism
  3. Impotence
  4. Amenorrhea
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8
Q

Excess ACTH - S/s

A
  1. Cushing’s syndrome
  2. Weight gain + HTN
  3. Masculinization (facial hair, deep voice) , amenorrhea
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9
Q

Hypophysectomy - monitor !

A

surgical removal of the hypophysis (pituitary gland) - transphenoidal approach

! Electrolytes - DI ? SIADH ? ; I+O; Dont band head below waist for 2 weeks; oral hygiene - no toothbrush, warm saline rinses ; humidified O2 (mouth breathers)

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10
Q

Parlodel (bromocriptine mesylate)

A

Dopamine receptor agonist

TX: prolactin or GH secreting tumors; Parkinson disease

NC: PO, take with food ( GI upset - nausea + constipation (Fiber 25g))

SE: Postural hypotension - get up slowly ;Orthostatic BP

  • **BP drops 20 - HR increase 20 **
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11
Q

Sandostatin ( octreotide)

A

Somatostatin analogs

TX: inhibits GH secretion; used pre-op to shrink the GH secreting tumor

NC: must be given parenterally - subcut, IV or IM

SE: **Decreased GI and gallbladder motility ** - gallbladder disease - bile duct stones + gallstones

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12
Q

Hormones secreted by Hypothalamus and stored + released by the Posterior pituitary gland

A
  1. Oxytocin - ejection of milk
  2. ADH - stimulates reabsorption of water by the kidneys ; vasoconstrictor
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13
Q

Diabetes Insipidus (DI) - S/s

A

Decrease in ADH

Polyuria - dehydration - increased serum osmolarity - polydipsia ; urine is dilute - low specific gravity

Hypernatremia

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14
Q

Hypernatremia - S/S

A

_135-145 _

  1. Thirst - craving cold water
  2. Sticky mucus membranes
  3. Increased T + HR
  4. Weak, irritable
  5. Mental confusion
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15
Q

Fluid Deprivation Test

A

DX of DI

Pt. has no fluids - monitor Q1 - weight, urine output, Na level.

Dehydration triggers kidneys to concentrate urine

Stop :

  1. Severe hypernatremia
  2. Loose more than 3-5 % of body weight
  3. Hypovolemia - shock
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16
Q

DI - TX

A
  1. Vasopressin - strong vasoconstrictive !!!! - CAD, PVD, Raynaud’s
  2. DDAVP - Desmopressin acetate - synthetic without strong vasoconstr. properties - IV, nasal spray, PO
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17
Q

SIADH - S/S

A

Increase in ADH

Water retention - decreased serum osmolarity - dilutional Hyponatremia - Oliguria - increased urine osmolarity and sp. gravity

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18
Q

SIADH - TX

A
  1. Na = or > 125 - Fluid restriction - to balance Na and H2O - explain to pt. and family
  2. Na< 125 - S/s of hyponatremia develope -

3% Hypertonic Saline - small amount, slowly ( 12 in 24 hrs increase)

!!! Cerebral edema

  1. Demectocycline (Declomycin) - antibiotic - off label use - inhibits ADH secretion
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19
Q

Cushing’s disease - causes

A

adrenal or pituitary tumors; steroids (Prednisone)

Increase in glucocorticoids (Cortisol)

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20
Q

Cushings - S/s

A
  1. Truncal obesity (alteration in fat metabolism)
  2. Moon face
  3. Buffalo hump
  4. Thin arms + legs (increase breakdown of protein )
  5. Thin skin - increase fragility of capillaries - bleeding
  6. Generalized weakness + lethargy
  7. GI distress - increase acid
  8. Risk for infection - poor healing
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21
Q

Cushings - labs

A
  1. Hyperglycemia - monitor sugar; tx: insulin
  2. Hypokalemia - retaining Na + H2O - increase in aldosterone - HTN - I+O, weights
  3. Hypocalcemia - osteoporosis
22
Q

Cushings - DX

A
  1. H+P
  2. Dexamethasone (Decadron) suppression test - give lil dose PO (11pm) - to see if adrenal glnad shuts off; if doesnt - tumor - adrenal? pituitary?
  3. 24 hour urine (free cortisol levels) - waste first; signs everywhere ; lab for instructions - ice? preservatives?
23
Q

Cushings - TX

A
  1. Pituitary ? - Hypophysectomy
  2. Adrenal ? - Adrenalectomy
  3. reduce/discontinue exogenous steroids
  4. Na restriction, low carbs diet

Increase Ca + vit D , protein and ambulation

Fluid restrictions

Emotional support

24
Q

Addisonian Crises

A

Causes - both adrenal glands removed , abruptly stopped taking steroids (due to nausea?)

Life threatening event !!!

Decrease in Na and BP

Increase in K - tx: insulin drip (push K into the cell); Kayexalate (NG, PO, enema) and HR

TX: IV steroids replacement

Fluid replacement

Hypoglycemia - D5W, D10W, Glucagon

25
Q

Addisons - S/s

A

Decrease in mineral (aldosterone) and glucocorticoids (cortisol)

  1. Lethargic, weakness
  2. Hypoglycemia - sweating, confusion, shakiness, tremors
  3. Postural hypotension
  4. Weight loss - due to GI disturbances
  5. Bronze pigmentation of skin
  6. Mental instability - severe psychosis
26
Q

Addisons - TX

A

Lifelong hormone replacement therapy (Pt. and family teaching )

  1. Cortisone , Hydrocortisone, Prednisone - in the am with breakfast - decrease GI upset - replace glucocorticoids
  2. Florinef (fludrocortisone) - replace mineralocorticoids

Wear med. alert bracelet

27
Q

Primary Aldosteronism

A

Increase in aldosterone

  1. Na + H2O retention
  2. Decrease in K + hydrogen ions - metabolic alkalosis

DX: Abnormal electrolytes

Renin (decrease) - aldosterone (increase) stimulation test

TX: correct electrolytes imbalances ; Adrenalectomy (abdom. insicion) if hyperplasia or tumor of adrenal gland

28
Q

Pheochromocytoma

A

adrenal medulla disorder - tumor

Increase in catecholamines - epinephrine + norepinephrine

29
Q

Pheochromocytoma - S/s - 5 Hs

A
  1. Headache - vasoconstriction
  2. Hypertension - severe - stroke ! - Hypertensive crisis
  3. Hyperhidrosis - excessive sweating
  4. Hyperglycemia - liver starts converting glycogen to glucose
  5. Hypermetabolism

** Tachycardia

30
Q

Vanillylmandelic acid (VMA) - 24 hour urine test

A

DX of Pheochromocytoma

by-product of cathecholamine metabolism

+ CT and MRI of adrenal gland

31
Q

Pheochromocytoma - NC

A
  1. Avoid stimulants - coffee, chocolate
  2. Do not palpate the abdomen - prevent tumor stimulation
  3. Pre-op - TX BP+ HR - Regitin
32
Q

Regitin

A

alpha-adrenergic blocker; tx of HTN (phenochromocytoma); also tx of extravasation of vasoconstrictive meds (e: dopamine) to vasodilate the area

33
Q

Hypertensive crisis - TX

A
  1. Nipride - vasodilator (smooth muscle relaxant) - IV drip - immediate reduction of BP - _Monitor BP - A-line _
  2. CCB
34
Q

Hormones secreted by thyroid gland

A
  1. T3 - triiodothyronine - 20% more potent
  2. T4 - thyroxine - 80 %
  3. Calcitonin - decrease blood calcium levels - buildup of bone
35
Q

Hyperthyroidism - S/s

A
  1. Nervous + irritable
  2. Palpitations, chest pain - increased metabolism - increased catecholamines
  3. Flushed skin
  4. heat intolerance
  5. Weight loss
  6. Goiter
  7. Bulging eyes - Exophthalmos - fatty deposits behind eyes - Graves disease (autoimmune)- artificial tears, patch eyes (at night)
36
Q

Hyperthyroidism - DX

A
  1. Labs - Increase in TSH
  2. Thrill + bruit over thyroid gland -palpate
  3. Radioactive iodine 123 (short acting, no precautions) thyroid scan
  4. Ultrasonography + EKG
37
Q

Hyperthyroidism - TX - Radioactive iodine 131

A

Long acting; Goal - destroy part of the thyroid gland - get pt. into euthyroid state (normal)

SE: Hypothyroidism

Radiation precautions 2 weeks - 1mo (avoid children, pregnant women)

Avoid products with iodine - multivitamins, cough syrup, table salt

38
Q
  1. Propylthiouracil (PTU)
  2. Tapazole (Methimazole)
A

Antithyroid medications - black box warning

  1. SE: liver failure
  2. SE: birth defects

Takes time to work - 3-4 weeks for improvement

39
Q

Lugol’s solution

SSKI

A

Iodine solutions - TX of hyperthyroidism

Pt. drinks - mix with milk or water; use straw; - decreases amount of T3 + T4

Can be used pre-op to shrink thyroid gland - reduce vascularity ( decrease blood flow )

40
Q

Thyroidectomy - subtotal or total (cancer)- post op NC

A
  1. Support neck
  2. Assess voice - laryngeal nerve damage ? - speak
  3. Airway !!! - edema ? bleeding ?
  4. Stridor - emergency - blocked airway
  5. Vitals, trach tray at bedside
  6. Check dressing (look behind) ; JP
41
Q

Thyroid Storm or Crises - S/s

A

due to uncontrolled hyperthyroidism (Grave’s disease) - often triggered by stressor ( trauma, infection, post-op)

  1. Tachycardia
  2. Hypertension - tx: beta-blockers
  3. Fever - even 1 degree increase - report
42
Q

Thyroid storm - TX

A
  1. Cooling blankets; ice packs; Tylenol ( No Aspirin !!!)
  2. O2
  3. Fluid, glucose, antithyroid meds - Propylthiouracil + Tapazole
43
Q

Hypocalcemia - S/s

Ca 9-10.5

A

due to hypoparathyroid; parathyroid gland can be removed during thyroidectomy

  1. Numbness + tingling - fingers, toes, around mouth
  2. Chvostek’s (facial nerve twitching) + Troussea’s signs (carpopedal spasm)
  3. Laryngeal spasm + hyperreflexia

* Watch for tetany

44
Q

Hypocalcemia - TX

A
  1. Calcium gluconate IV - mix with D5W not NS
  2. Phosphate binding meds - Phoslo ( calcium acetate); Dialume (aluminum hydroxide); Renagel
  3. Diet high in Ca + Vit D; low in P - milk + dairy products high in both
45
Q

Hypoparathyroid - S/s

A
  1. Decrease in PTH
  2. Hypocalcemia
46
Q

Hyperparathyroid - S/s

A
  1. Increase in PTH
  2. Hypercalcemia - decrease in excitability of NS - hypoactive
  • brittle bones
  • kidney stones (55%)
  • muscle weakness
  • fatigue and mental confusion
  • over time - stenosis
47
Q

Hyperparathyroid - DX

A

PTH levels

Increase in Ca levels

Decrease in P levels

X-rays of bones

48
Q

Hyperparathyroid - Parathyroidectomy

A

remove 2-3 out of 4 glands to get pt in normal state

  1. Hydration !!! 2L/day - helps flush kidneys, prevent formation of kidney stones
  2. Loop diuretics - help toexcrete Ca
  3. Ambulation, exercise to strengten the bone
  4. Oral or IV Phosphate
  5. Diet low in Ca
  6. Calcitonin - pushes Ca back into the bone - High allergic reaction !!!
49
Q

Hypothyroidism - S/s

Screening @ age 35 (every 5 years after)

A
  1. Extreme fatigue
  2. Hair loss
  3. Dry skin, brittle nails
  4. Cold intolerence
  5. Facial + Eyelid edema - deposits of mucus
  6. Bradycardia
  7. Weight gain
  8. Flat affect, slow mental process
50
Q

Myxedema

A

severe hypothyroidism - can lead to coma - thickening + swelling of the skin

51
Q

Synthroid

Levothyroid

A

synthetic thyroid replacement - life long ;

Takes time to work - 3-4 weeks

Admin. in am on an empty stomach ; same time each day; full glass of water

Monitor labs - start on low dose - increased metab. - increase demand for O2

52
Q

Hypothyroidism - labs

A

Increase in TSH

Decrease in T3 + T4

NURS 2501 (11 decks)

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