Endocrine System Flashcards
179 - Diagnostic Tests:
+ Fasting Blood Glucose (FBG)
+ Oral Glucose Tolerance Test (OGTT)
+ HgbA1c
FASTING BLOOD GLUCOSE: No foods or fluids for 8 hours before test.
+ Normal levels < 100 mg/dL
ORAL GLUCOSE TOLERANCE TEST: Fast for 10-12 hours before test. Take fasting blood glucose. Patient consume specific amount of glucose. Blood samples taken every 30 minutes for 2 hours. Normal levels < 140 mg/dL
HgbA1C: BEST INDICATOR of average blood glucose levels over the past 3-4 months.
+ <= 5.7% indicates no diabetes
+ Between 5.7 - 6.4% indicates pre-diabetes
+ > 6.5% INDICATED DIABETES
181 - Diabetes Insipidus:
+ What is it?, S/S and Labs
DIABETES INSIPIDUS: Deficiency of ADH, resulting in kidneys being unable to concentrate urine.
S/S: Large amounts of diluted urine, polydipsia, dehydration (tachycardia, hypotension, sunken eyes, dry mucus membranes, weakness, fatigue).
LABS:
+ URINE: DECREASED SPECIFIC GRAVITY (< 1.005), DECREASED OSMOLALITY (< 200 MOSM/L), DECREASED SODIUM.
+ BLOOD: INCREASED SERUM OSMOLALITY (> 300 mOsm/L), INCREASED SODIUM
DIAGNOSIS: Water deprivation test, Vasopressin test.
MEDS: ADH replacements (desmopressin or vasopressin). For intranasal administration, clear nasal passageway before inhalation.
182 - Syndrome of Inappropriate ADH (SIADH):
+ What is it? Causes and S/S
SIADH: Excessive release of ADH from the posterior pituitary gland, resulting in increased reabsorption of water (not sodium) by the kidneys.
CAUSES: Brain tumor, head injury, meningitis, medications.
S/S: SMALL AMOUNTS OF CONCENTRATED URINE. Fluid volume excess (tachycardia, hypertension, crackles, distended neck veins, weight gain), headache, weakness, muscle cramping, confusion, seizures, coma.
183 - Syndrome of Inappropriate ADH (SIADH)
+ Labs, Nursing care, Medications
LABS:
+ URINE: INCREASED SPECIFIC GRAVITY (> 1.030), OSMOLARITY, SODIUM
+ BLOOD: DECREASED SERUM OSMOLARITY (< 270 mEq/L), sodium
NURSING CARE:
+ Fluid restriction
+ Monitor I&Os (watch for hyponatremia!)
+ Weight patient daily
+ Provide hypertonic IV fluids (ex: 3% NaCl)
+ Administer furosemide (diuretic) as ordered.
185 - Hyperthyroidism:
+ What is it? Causes
HYPERTHYROIDISM: Excess thyroid hormones (T3 and T4) released from thyroid glands, resulting in hyper metabolic state.
CAUSES:
+ PRIMARY (Issue w/thyroid gland): Graves disease (most common cause, autoimmune issue) or thyroid nodule causes hypersecretion of T3/T4.
+ SECONDARY (Issue with pituitary gland): Anterior pituitary gland produces too much ?TSH (due to tumor),
+ TERTIARY (issue with hypothalamus): Hypothalamus produces too much TRH.
186 - Hyperthyroidism:
+ S/S, Labs, Nursing care
HYPERTHYROIDISM
S/S: Tachycardia, hypertension, heat intolerance, exophthalmos, weight loss, insomnia, diarrhea, warm/sweaty skin.
LABS: Increased T3/T4, decreased TSH (in primary hyperthyroidism).
NURSING CARE:
+ Nutrition: INCREASE PATIENT’S CALORIES, PROTEIN INTAKE. Monitor I&Os, weight.
+ Exophthalmos: Tape eyelids closed, provide eye lubricant.
187 - Hyperthyroidism: Meds, Complications, Surgery
HYPERTHYROIDISM
MEDS:
+ Propylithiouracil (PTU)
+ Beta Blockers (ex: propranolol)
+ Iodine solutions (mix w/juice to mask taste)
+ Radioactive iodine: Stay away from children for 2-4 days, flush toilet 3 times, do not share toothbrush, use disposable plates/utensils.
COMPLICATIONS: Thyroid Storm - excessively high levels of thyroid hormones, with high mortality rate.
+ CAUSES: infection, stress, DKA
+ SYMPTOMS: hypertension, chest pain, dysrhythmias, dyspnea, delirium.
SURGERY: Thyroidectomy (removal of thyroid gland). PATIENT WILL NEED THYROID REPLACEMENT THERAPY FOR THE REST OF THEIR LIFE.
188 - Thyroidectomy: Post-Procedure Nursing Care
POST-PROCEDURE NURSING CARE:
+ Place patient in high-Fowler’s position.
+ Prevent (and monitor for) hemorrhaging. Check dressing and back of neck for bleeding. Support patient’s head and neck with pillows/sandbags. Teach patient to avoid neck flexion or extension.
+ Have tracheostomy supplies available at bedside.
+ MONITOR FOR SIGNS OF PARATHYROID GLAND DAMAGE (i.e. S/S of hypocalcemia): numbness/tingling around mouth or toes, muscle twitching, positive Chvostek’s or Trousseau’s signs. Administer calcium gluconate for treatment of hypocalcemia.
+ Administer steroids (ex: prednisone) to decrease post-op edema.
189 - Hypothyroidism: What is it? Causes, S/S, Labs, Nursing care
HYPOTHYROIDISM: Inadequate production of thyroid hormones (T3/T4) by the thyroid gland.
CAUSES:
+ PRIMARY (issue w/thyroid gland): Most common type. Ex: Hashimoto’s disease (autoimmune disorder), cretinism (severe hypothyroidism in infants).
+ SECONDARY (issue w/pituitary gland): Anterior pituitary gland produces insufficient TSH (due to tumor).
+ TERTIARY (issue w/hypothalamus): Hypothalamus produces insufficient TRH.
S/S: Hypotension, bradycardia, lethargy, cold intolerance, constipation, weight gain, thin hair, brittle fingernails, depression.
LABS: Decreased T3 (< 79ng/dL), decreased T4 (<4mcg/dL), increased TSH (with primary hypothyroidism), anemia.
190 - Hypothyroidism: Nursing Care, Meds
NURSING CARE:
+ Encourage frequent rest periods
+ Encourage low-calorie, high-fiber diet and increased activity to promote weight loss and prevent constipation. No fiber laxatives (interferes with levothyroxine absorption).
+ Provide extra blankets, increase room temperature. No electric blankets.
MEDS: Levothyroxine - Start with low dose, gradually increase. Take 1 hour before breakfast w/full glass of water.
191 - Hypothyroidism: Complications
COMPLICATIONS:
HYPERTHYROIDISM (due to too much levothyroxine).
MYXEDEMA COMA - Severe hypothyroidism
+ CAUSES: Untreated hypothyroidism, infection/illness, abrupt discontinuation of levothyroxine.
+ SYMPTOMS: Hypoxia, decreased cardiac output, decreased LOC, bradycardia, hypotension, hypothermia.
+ NURSING CARE: Maintain patent airway, monitor ECG, warm patient, administer large doses of levothyroxine.
192 - Cushing’s syndrome: What is it? Causes, S/S, Labs
CUSHING’S SYNDROME: over-production of cortisol by the adrenal cortex.
CAUSES:
+ PRIMARY (Adrenal dysfunction): Over-secretion of cortisol by the adrenal cortex (r/t adrenal hyperplasia, tumor).
+ SECONDARY ( Pituitary dysfunction): Over-secretion of ACTH by the anterior pituitary gland (r/t tumor).
+ Long-term use of steroids for chronic conditions.
S/S: Increased infections, thin/fragile skin, edema, weight gain (moon face, buffalo hump, increased abdominal girth), hypertension, tachycardia, bone pain/fractures, hyperglycemia, gastric ulcers, hirsutism, acne.
LABS:
+ Elevated cortisol levels in saliva
+ INCREASED GLUCOSE, SODIUM LEVELS
+ DECREASED POTASSIUM, CALCIUM LEVELS]
193 - Cushing’s Syndrome:
+ Diagnosis, Nursing care, Medications, Therapeutic procedures/surgeries
CUSHING’S SYNDROME
DIAGNOSIS: Dexamethasone suppression test
NURSING CARE:
+ DIET: DECREASE SODIUM INTAKE, INCREASE INTAKE OF POTASSIUM, CALCIUM, AND PROTEIN.
+ Maintain safe environment due to increased risk of fractures.
+ Prevent infection.
+ Protect patient’s skin from breakdown.
MEDS: Ketoconazole (adrenal corticosteroid inhibitor), spironolactone (potassium sparing diuretic).
PROCEDURES/SURGERIES:
+ Cytotoxic agents for tumors causing condition.
+ Hypophysectomy (removal of pituitary gland)
+ Adrenalectomy (removal of adrenal gland): Hormone replacement therapy needed, monitor for adrenal crisis r/t drop in cortisol levels.
194 - Hypophysectomy: Post-procedure Nursing Care
HYPOPHYSECTOMY >> Monitor for signs of CSF Leak: \+HALO SIGN IN DRAINAGE (CLEAR IN CENTER, YELLOW ON EDGES). \+ SWEET-TASTING DRAINAGE. \+ CLEAR DRAINAGE FROM THE NOSE. \+ HEADACHE.
> > Teach patient to AVOID activities that increase ICP; coughing, sneezing, blowing nose, bending at waist, straining during bowel movements (increase fiber intake).
Decrease sense of smell expected for 3-4 months.
Do not brush teeth for 2 weeks (flossing and rinsing mouth OK).
195 - Addison’s disease:
+ What is it?
+ Causes, S/S, Labs
Addison’s disease: Inadequate secretion of hormones by adrenal cortex (aldosterone, cortisol, sex hormones).
CAUSES:
+ PRIMARY (adrenocortical insufficiency): damage or dysfunction of adrenal cortex (r/t autoimmune dysfunction, tumors).
SECONDARY ( pituitary dysfunction): pituitary tumor or hypophysectomy.
S/S: Weight loss, hyperpigmentation (bronze skin), lethargy, n/v, hypotension, dehydration.
LABS: INCREASED POTASSIUM AND CALCIUM. DECREASED SODIUM, GLUCOSE, CORTISOL.
