Endocrine System Flashcards
What are four key hormones produced by the hypothalamus?
Corticotropin releasing hormone, thyroid releasing hormone, growth releasing hormone, gonadotropin releasing hormone
Hormones released from the anterior pituitary gland
TSH, prolactin, FSH, luteinizing hormone, ACTH, growth hormone
Hormones released from the posterior pituitary gland
ADH, oxytocin
The thyroid gland produces
T3 (triiodothyronine), T4 (thyroxine), calcitonin
Effects of epinephrine and norepinephrine on body
Vasoconstriction, increased HR and BP, bronchodilation, pupil dilation, increased blood flow to muscles, increased blood glucose levels
Epinephrine has more effect on the _________ as opposed to norepinephrine that has more of an effect on
Heart; blood vessels
Normal T3 range
70-204
Normal T4 range
4-12
Normal TSH range
0.5-5
Normal fasting blood glucose should be less than
100
A 2 hour oral glucose tolerance test should be less than
140
HgbA1C should be less than
6%
A deficiency in one or more of the pituitary gland hormones that are released
Hypopituitarism
S/S of hypopituitarism
Delayed growth, amenorrhea, impotence (males), hypothyroidism, fatigue, weakness, weight loss, hypoglycemia, hyponatremia, orthostatic hypotension
Diagnoses of hypopituitarism
ACTH stimulation test
Hypopituitarism treatment
Hormone replacement depending on deficiency: corticosteroids, thyroid, growth, sex
Oversecretion of pituitary gland hormones
Hyperpituitarism
S/S of hyperpituitarism
Increased ICP (headache, N/V), acromegaly, arthralgia (joint pain), S/S of Cushing’s disease, sexual dysfunction
Hyperpituitarism treatment
Surgical: hypophysectomy (removal of part or all of pituitary gland)
Meds: dopamine agonist (inhibits GH or prolactin secretion), somatostatin for acromegaly
Hypophysectomy nursing care
monitor for S/S of CSF leak (halo sign around drainage, headache, sweet taste of drainage, drainage positive for glucose)
Hypophysectomy patient education
Avoid activities that can increase ICP: coughing, sneezing, blowing nose, bending at waist, straining during bowel movements; transphenoidal (nasal) route: decreased sense of smell is expected for first month following procedure; oral route: do not brush teeth for two weeks. Flossing and rinsing mouth with water is okay; life-long hormone replacement is needed
S/S of growth hormone deficiency
Short stature, reduced muscle mass, increased fat, delayed puberty
Growth hormone deficiency treatment
Growth hormone replacement (Somatropin IM)
Somatropin nursing consideration
Stop treatment once X-Ray shows epiphyseal closure (x-rays needed throughout therapy)
S/S of growth hormone excess
Depends on onset of disorder…
Prior to epiphyseal closure: gigantism - excessive height, arthritis
After epiphyseal closure: acromegaly - enlarged hands and feet, protruding jaw, kyphosis, arthritis, enlarged larynx (causes a deep and hollow voice)
Growth hormone excess treatment
Hypophysectomy
Under which circumstances would the body release ADH?
In response to low blood volume, low blood pressure, hypernatremia, increased blood osmolarity
S/S of diabetes insipidus (DI)
Large amounts of dilute urine, polydipsia, dehydration, hypotension, anorexia
Labs associated with DI
Urine Specific Gravity <1.005 (dilute urine), Urine Osmolarity <200, Serum osmolarity >300, hypernatremia (Note: decreased sodium level in urine but INCREASED sodium level in blood because body is getting rid of a lot of fluid so blood will be concentrated)
Medication for treatment of DI
Vasopressin, desmopressin
Nursing care for patients with DI
Monitor I&Os, urine specific gravity, and daily weight
Excess release of ADH from posterior pituitary gland, causing kidneys to reabsorb water
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
S/S of SIADH
Very small amount of very concentrated urine, fluid volume excess (tachycardia, HTN, crackles, JVD, weight gain, headache, weakness, muscle cramping), hyponatremia (confusion)
Labs associated with SIADH
Urine specific gravity >1.03 (concentrated), urine osmolarity elevated, serum osmolarity decreased <270, hyponatremia (NOTE: blood will be dilute due to extra fluid volume)
SIADH treatment
Diuretics, vasopressin antagonist, HYPERTONIC saline
SIADH nursing care
Monitor I&Os, weight daily, restrict fluids and replace Na as ordered, monitor for fluid volume excess and pulmonary edema, continually monitor neurologic status and implement seizure precautions (d/t hyponatremia)
Insufficient secretion of hormones (aldosterone, cortisol, androgens) from the adrenal cortex
Adrenocortical insufficiency
What is one of the key causes of PRIMARY adrenocortical insufficiency?
Addison’s Disease (autoimmune disorder)
Examples of SECONDARY causes of adrenocortical insufficiency
Abrupt discontinuation of corticosteroid therapy, issue with pituitary gland or hypothalamus
S/S of adrenocortical insufficiency
Weakness, fatigue, weight loss, hypotension, dehydration, hypoglycemia, bronzed skin appearance
Labs associated with adrenocortical insufficiency
Elevated: potassium, calcium, BUN
Decreased: cortisol, sodium, glucose
Adrenocortical insufficiency treatment
Hydrocortisone, Kayexalate and insulin (for hyperkalemia) (NOTE: if giving insulin, you will also need to administer glucose because hypoglycemia is a side effect of insulin and patients with adrenocortical insufficiency are also hypoglycemia d/t inadequate cortisol)
Adrenocortical insufficiency patient education
Additional doses of corticosteroids may be needed during times of illness or stress
Life-threatening disorder caused by adrenal insufficiency
Addisonian Crisis
Causes of Addisonian Crisis
Infection, stress, trauma, abrupt d/c of corticosteroids
S/S of Addisonian Crisis
Weakness, fatigue, SEVERE hypotension that can cause shock, dysrhythmias
Addisonian Crisis treatment
IV glucocorticoids and fluids with dextrose, identify and treat underlying cause
Addisonian Crisis nursing care
Monitor vitals, I&Os, weight, S/S of shock (decreased LOC, decreased UOP), monitor dysrhythmias, provide patient with bed rest and quiet environment
Overproduction of cortisol by the adrenal cortex
Cushing’s Disease
S/S of Cushing’s Disease
Buffalo hump, moon face, truncal obesity, weight gain, fluid retention, peptic ulcer disease, diabetes, bone loss, weakness, emotional instability, increased risk for infection
Labs associated with Cushing’s Disease
Elevated: glucose, sodium, cortisol (in saliva)
Decreased: potassium, calcium
Treatment for Cushing’s Disease
Hypophysectomy, adrenalectomy, ketoconazole (inhibits cortisol synthesis)
Cushing’s Disease nursing care
Restrict fluid and sodium, encourage increased intake of potassium, calcium, and protein, monitor for fluid volume overload and pulmonary edema, protect patient from skin breakdown, protect patient from bone fractures, protect patient from GI bleeding (DO NOT give meds like NSAIDs or aspirin!), prevent infection
Tumor on the adrenal gland which causes excess secretion of catecholamines norepinephrine and epinephrine from the adrenal medulla
Pheochomocytoma
S/S of pheochromocytoma
Tachycardia, hypertension, headache, diaphoresis, SOB
Pheochromocytoma treatment
Surgical removal of tumor, adrenalectomy, antihypertensives prior to surgery
Pheochromocytoma nursing consideration
DO NOT palpate abdomen (triggers sudden release of catecholamines which can result in severe hypertension)
Adenoma or hyperplasia in adrenal gland causing excess amounts of aldosterone to be secreted
Hyperaldosteronism
S/S of hyperaldosteronism
Hypertension, hypernatremia, hypokalemia (d/t aldosterone reabsorbing sodium and water and excreting potassium, headache, weakness
Hyperaldosteronism treatment
Adrenalectomy, spironolactone
Hyperaldosteronism nursing care
Monitor BP, I&Os, potassium levels, encourage patient to consume low sodium and high potassium diet
An autoimmune disorder that is the primary cause of hypothyroidism and causes antibodies to attack and destroy the thyroid tissue
Hashimoto’s disease
S/S of hypothyroidism
Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle nails, depression
Labs associated with hypothyroidism
Primary: elevated TSH, decreased T3, T4
Secondary or Tertiary: decreased TSH, T3, and T4
Hypothyroidism treatment
Levothyroxine or Liothyroxine (give BEFORE meals with full glass of water)
Hypothyroidism nursing care
Encourage frequent rest periods, encourage low-calorie high-fiber diet, increase room temperature
Severe, life-threatening hypothyroidism d/t untreated hypothyroidism, abrupt d/c of thyroid meds, or infection/illness
Myxedema coma
S/S of myxedema coma
Hypoxia, decreased CO, decreased LOC, bradycardia, hypotension, hypothermia
Myxedema coma nursing care
Maintain patent airway, assist with intubation or mechanical ventilation, monitor cardiac rhythm and administer large doses of thyroid meds, warm the patient
Autoimmune disease that is the most common cause of primary hyperthyroidism
Grave’s Disease
S/S of hyperthyroidism
Tachycardia, hypertension, heat intolerance, exophthalmos, weight loss, insomnia, diarrhea, warm sweaty skin
Labs associated with hyperthyroidism
Primary: low TSH, elevated T3 and T4
Secondary or Tertiary: elevated TSH, T3, and T4
Hyperthyroidism treatment
Thyroidectomy, PTU, iodine solutions, BB
Hyperthyroidism nursing care
Increase calorie and protein intake, monitor I&Os, weight, and vitals, tape eyelids closed from sleep and provide eye lubricant
Life-threatening condition characterized by excessively high levels of thyroid hormone brought on by infection, stress, DKA, or thyroidectomy
Thyrotoxicosis or thyroid storm
S/S of thyrotoxicosis
Severe hypertension, chest pain, dysrhythmias, dyspnea, delirium, fever, N/V
Thyrotoxicosis treatment
BBs, Antithyroid medications, antipyretics
Thyrotoxicosis nursing care
Maintain patent airway, monitor for dysrhythmias
Thyroidectomy post-op nursing care
Semi-fowler’s position, support head and neck with sandbags or pillows to keep in neutral midline position, monitor for bleeding (dressing and behind neck), monitor for parathyroid damage (numbness and tingling around mouth, muscle twitching, positive Chvostek sign, positive trousseau sign)
Thyroidectomy patient education
Avoid extreme neck extension or flexion, thyroid replacement will need to be taken for rest of life
Decreased or insufficient secretion of PTH causing decreased calcium levels
Hypoparathyroidism
S/S of hypoparathyroidism
S/S of hypocalcemia: muscle cramps, numbness, tingling, positive chvostek and trousseau sign, tetany, seizures, dysrhythmias
Labs associated with hypoparathyroidism
Decreased: PTH, calcium (<9)
Elevated: phosphorous
** calcium and phosphorus have an inverse relationship
Hypoparathyroidism treatment
Calcium gluconate, calcium and vitamin D supplements, phosphate binders
Hypoparathyroidism nursing care
Implement seizure precautions, provide patient with high calcium low phosphorus diet, provide patient with phosphorus binders with meals
Hypersecretion of PTH from the parathyroid glands
Hyperparathyroidism
Labs associated with hyperparathyroidism
Elevated: PTH, calcium
Decreased: phosphorus
S/S of hyperparathyroidism
S/S of Hypercalcemia: fatigue, muscle weakness, bone pain and deformities, N/V, weight loss, constipation, hypertension, kidney stones, dysrhythmias
Hyperparathyroidism treatment
Furosemide (Lasix), calcitonin, phosphates to elevate levels, parathyroidectomy
Hyperparathyroidism nursing care
Implement safety precautions (risk for falls and fractures), low-calcium high-phosphorus diet, increased fluid intake (prevent constipation and kidney stones)
Risk factors for Type II diabetes
Obesity, inactivity, hypertension, hyperlipidemia, smoking, genetics, race (African American, Hispanic, American Indian)
S/S of hyperglycemia
Polydipsia, polyphagia, polyuria, warm and dry skin (warm and dry, sugar is high!), dehydration, weak pulses, decreased skin turgor, fruity breath, kussmaul respirations (increased rate and depth), N/V, weakness, lethargy
Diagnosis of Diabetes
2 or more of the following labs on separate days:
Casual blood glucose >200
Fasting blood glucose >126
Glucose >200 with oral glucose tolerance test
HgbA1c > 6.5%
A patient with diabetes should aim to keep their Hgb A1c below ___%
7
Diabetic foot care
Inspect feet DAILY using mirror, check shoes for object before putting feet in, apply moisturizer to feet but NOT between toes, wear cotton socks, wear close-toed shoes, shoes should be properly fitted, cut toenails straight across (NO rounding), do NOT use heating pads on feet
Diabetes illness care
Monitor blood glucose levels frequently, DO NOT skip insulin, monitor urine for ketones, prevent dehydration (drink 3L water/day), notify provider if: sick for more than 1 day, temp >38.6 C, glucose over 250, urine positive for ketones
Hypoglycemia is defined as a blood glucose level under
70 mg/dL
S/S of hypoglycemia
Hunger, irritability, confusion, diaphoresis, headache, shakiness, blurred vision, pale cool skin (cold and clammy, eat some candy!), decreased LOC that could progress into coma
Nursing care for the conscious hypoglycemic patient
Give them 15 g of a readily absorbed carbohydrate (half cup of juice or soda, or 8 ounces of milk), recheck blood glucose in 15 minutes, once blood glucose is over 70 provide the patient with a snack that contains both a protein and a carbohydrate
Nursing care for the unconscious hypoglycemic patient
IM or subcutaneous glucagon, when patient regain consciousness and can safely swallow provide them with a snack
Life-threatening complication of diabetes that causes increased blood glucose And ketones in the blood and urine
Diabetic ketoacidosis (DKA) — rapid onset, more common and type I diabetics
DKA risk factors
Infection/illness, stress, untreated or undiagnosed type one diabetes
Labs associated with DKA
Blood glucose >300, ketones in urine and blood, metabolic acidosis, hyperkalemia
Labs associated with HHS
Blood glucose >600, NO ketones in urine or blood, NO metabolic acidosis
Complication of diabetes characterized by severe hyperglycemia and dehydration with a gradual onset and that is more common in type two diabetics
Hyperglycemic hyperosmolar state (HHS)
HHS risk factors
Older age, inadequate, fluid intake, decreased kidney function, infection, stress
Complications of diabetes
Cardiovascular disease, which can lead to MI and stroke, diabetic neuropathy, nephropathy, retinopathy, gastroparesis, which can impair digestion, tooth decay, gum disease, sexual dysfunction
