Endocrine System Flashcards
1
Q
What is the action of the endocrine system?
A
- Secrete products directly into the blood stream (hormones)
- Hormones regulate organ function along with the nervous system
- Neuro= fast
- hormonal= slow regulation
- Hormone concentration in blood is usually at a constant level. It is controlled by the negative feedback loop.
2
Q
What are the general S/S of Endocrine malfunction?
A
- changes in energy level/fatigue
- changes in heat/cold tolerance
- changes in weight
- changes in sexual function
- changes in secondary sexual characteristics (deep voice, beard, boobs)
- changes in mood, memory, ability to concentrate, and sleep patterns
3
Q
Pituitary Gland
A
- Under control of the hypothalamus
- Controls the function of most other endocrine glands
- Contains 2 lobes- anterior and posterior
- Anterior: GH, TSH, ACTH, Follicle stimulating and luteinizing hormones, prolactin, Melanocyte stimulating hormone
- Posterior: Oxytocin and ADH (Vasopressin)
- Although this is the master gland, most hyper/hypo conditions are due to the target gland itself.
4
Q
Disorders of the Pituitary
A
- May be due to organic defects or have an idiopathic etiology
- Single hormonal problem or a combination with other hormonal deficiencies
- Clinical manifestations depend upon the hormone involved
- May result in an overproduction or hormone deficiency
5
Q
Hypopituitary effects what target glands?
A
Usually the thyroid or the gonads.
6
Q
Pituitary tumors
A
- usually benign
- Usually result in overproduction
- If they have surgery
- Watch for spinal fluid coming from eh nose
- Check for glucose in the nasal drainage because spinal fluid has glucose in it.
- Notify the provider immediately
- Surgery to remove tumor is called hypophysectomy
- Diagnose through CT or MRI
- Blood work on: Pituitary hormones, GH
7
Q
Hormone classification
A
- Steroids (Hydrocortisone) • Penetrate the cell wall and works with the receptor • Modify cell metabolism • Take a while to work - Peptides (Insulin) • Reacts with the receptor site • Stimulates the cellular environment • Slow acting - Amines (epinephrine) • Fast acting • Works in seconds
8
Q
Growth Hormone Deficiency
A
- Consequences depend upon the degree of dysfunction
- Inhibits overall somatic growth, short height (dwarfism) in children
Diagnostic Evaluation: •Family history - Growth patterns and health history - Physical examination - Psychosocial evaluations - Radiographic survey - Endocrine studies
S/S:
- Short in stature
- Bones and muscles not strong
- Weight gain
- Not a lot of energy
- Quality of life is usually not good
- Prone to pathological fractures
Treatment
- Replacement of GH is successful in 80% of affected children. Can be given by the week. Dosage is increased as the time of epiphyseal closure nears. Stop giving once the growth plate closes
Nursing care:
- Identifying and assisting with the diagnosis
- Family support needs
- Emotional adjustment of the child
- Preparation for testing and medication administration
9
Q
Pituitary Hyperfunction
A
- Excess GH before closure of epiphyseal shafts results in overgrowth of long bones
- Diagnostic evaluation:
History of excessive growth during childhood•Evidence of increased levels of GH•Radiographic studies•Endocrine studies - S/S: Reach heights of 8 feet or more(Giantism), Vertical growth plus increased muscle, Weight generally in proportion to height. Typical facial features include overgrowth of:–Head–Lips, tongue, jaw, nose–Nasal, mastoid sinuses–Malocclusion of the teeth
- Excess GH after epiphyseal closure is called acromegaly
- Therapeutic management: •Surgical treatment to remove tumor•Radiation and radioactive implants•Hormone replacement therapy after surgery in some cases (Thyroid extract–Cortisones–Sex hormones)
- Nursing Care Management
•Early identification of children with excessive growth rates•Early treatment for improved outcomes•Emotional support•Body image concerns
10
Q
Precocious Puberty
A
- Defined as sexual development > age 9 in boys or > age 8 in girls
- Occurs more frequently in girls
- Potential causes: Disorder of gonads, adrenal glands, or hypothalamic-pituitary gonadal axis. 95% of cases have no known causative factor.
- Types
–Central precocious puberty •80% of children with this disorder due to early maturation & development of gonads & secondary sex characteristics
–Peripheral precocious puberty •Premature development of breasts, sexual hair, and menses
Therapeutic management:
- Treatment of specific cause if known
- May be treated with leuprolide (Lupron)–Slows prepubertal growth to normal rates–Treatment is discontinued at age for normal pubertal changes to resume
- Psychologic support for child and family
11
Q
Diabetes Insipidus (DI)
A
- The principal disorder of the posterior pituitary
- Results from hyposecretion of ADH
S/S:
- Produces uncontrolled diuresis
- Cardinal signs: polyuria and polydipsia
- First sign often enuresis
- Infants: At risk for dehydration, Constant wet diaper, irritability relieved with feedings of water, but not milk
- Excessive thirst
- Primary causes: familial or idiopathic
- Secondary causes: trauma, tumors, CNS infection, aneurysm
Diagnose
- Withhold fluids for 8-12 hours
- Will have 3-5% weight loss- because they are still peeing
- Check urine and plasma osmolality – will not have changed
- Specific Gravity=urine osmolality
Therapeutic Management:
- Instruct parents in difference between DI and diabetes mellitus
- Daily vasopressin (ADH) replacement
- Drug of choice: DDAVP–Nasal spray or IV administration–Requires treatment for life
Teach:
- Medication
- Pt. to wear a bracelet
- Carry medication with you at all times
12
Q
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
A
- Results from oversecretion of the posterior pituitary (increased ADH). Kidneys reabsorb a lot of water
Who is affected:
- Pituitary problems
- Respiratory problem
What can bring it on?
- Pain
- Stress
- Low sugar
Causes:
- Diabetes meds
- Anticonvulsants
- Chemotherapy
- Antipsychotics
- Aspirin and NSAIDs
- Head injury
- Lung cancer
- ***S/S: Fluid retention and hypotonicity, anorexia, nausea/vomiting, irritability, personality changes
- Symptoms disappear when ADH is decreased
- By keeping all of the fluid inside the body, they are diluting the electrolytes causing hyponatremia
- Lower blood osmolality
- Higher urine osmolality
Test: Restrict fluid, lay flat, look at labs
Nursing Management
- Restrict fluids to 1,000mL/day. If severe, restrict to 500mL/day
- Accurate I&O
- Observe for signs of fluid overload
- Seizure precautions
- Administer ADH-antagonizing medications (diuretics and thiazides)
- Child and family education
- Monitor labs for: Potassium, calcium, specific gravity
- Monitor LOC
- Replenish salt
13
Q
Adrenal Gland
A
- Acts as 2 different glands
–Medulla (Center) secretes catecholamines: 90% = epinephrine, 10% = norepinephrine, Fight or flight
–Cortex (Outer) secretes steroids
- Glucocorticoid hormone ( hydrocortisone,cortisol)
- Mineral corticoids (aldosterone & sex hormones)
- Without the cortex, stress could cause circulatory collapse
- Survival – nutritional, electrolyte and fluid replacement PLUS replacement of the appropriate adrenocortical hormones
- Aldosterone increases fluid release
14
Q
Adrenal cortex secretes what three groups of “steroids”?
A
–Glucocorticoids (cortisol, corticosterone)
–Mineralocorticoids (aldosterone)
–Sex steroids (androgens, estrogens, & progestins)
*Altered levels of these produce significant dysfunction
15
Q
Adrenal medulla secretes what?
A
catecholamines: epinephrine and norepinephrine
* Catecholamine-secreting tumors are the primary cause of adrenal medullary hyperfunction
