Endocrine System Functions & Disorders Flashcards
Overview of the endocrine system
The endocrine system is made up of glands, organs, and hormones. The endocrine system works with the nervous system to regulate body function and maintain homeostasis through feedback loops. Endocrine glands include the hypothalamus, pituitary gland, adrenal glands, thyroid gland, parathyroid glands, islet cells of the pancreas, and gonads.
Acromegaly: Manifestations, Diagnostics, Interventions, Medications, Therapeutic Measures, Client Education & Referral
-hypersecretion of growth hormone (GH) that occurs after puberty
Manifestations:
1.Enlargement of skeletal extremities; increase in adult height; change in ring and/or shoe size
2.Protrusion of the jaw and orbital ridges
3.Headache, visual problems, and blindness
4.Muscle weakness
5.Organ enlargement
6.Decalcification of the skeleton
7.Endocrine disturbances similar to hyperthyroidism
Diagnostic Procedures:
1.Serum studies, showing elevated GH levels
2.CT and MRI of pituitary may show pituitary tumor.
3.X-rays show abnormal bone growth.
Nursing Interventions:
1.Provide emotional support.
2.Provide symptomatic care.
3.Prepare client for surgery or radiation if indicated for tumor treatment.
Medications:
1.Octreotide—synthetic GH analogue
2.Bromocriptine mesylate or pergolide—dopamine agonists
Therapeutic Measures:
1.Surgical removal of pituitary gland (i.e., transsphenoidal hypophysectomy); surgery is generally the first treatment option.
2.Replacement therapy will be needed following surgical removal of the pituitary gland and may be needed following radiation therapy.
a.)Corticosteroids
b.)Thyroid hormones
3.Radiation therapy
Client Education and Referral:
1.Medication adherence
2.Continued compliance with follow-up appointments with all providers
Gigantism
-hypersecretion of GH that occurs in childhood prior to closure of the growth plates
Manifestations:
Proportional overgrowth in all body tissue
DiagnosticProcedures/CollaborativeCare:
same as acromegaly
Dwarfism: Manifestations, Diagnostics, Interventions, Medications
-hyposecretion of GH during fetal development or childhood that results in limited growth congenital or result from damage to the pituitary gland
Manifestations:
1.Head and extremities are disproportionate to torso.
a.)Face may appear younger than peers’.
2.Short stature; slow or flat growth rate
3.Progressive bowed legs and lordosis
4.Delayed adolescence or puberty
Diagnostic Procedures:
1.Comparison of height/weight against growth charts; slowed growth rate will be noted.
2.Serum growth hormone level; most providers will also evaluate other hormonal levels to ensure that no secondary deficiencies exist.
3.MRI of the head (to assess pituitary gland)
Nursing Interventions:
1.Teach child and family adaptive measures available for ADLs.
2.Teach child and family how to administer supplemental GH.
a.)The earlier the therapy is initiated, the better the prognosis.
b.)GH therapy does not work in all children.
3.Provide positive feedback to child to promote positive self-esteem.
Medications:
Human growth hormone injections
Diabetes Insipidus: Manifestations, Diagnostics, Interventions, Medications, Therapeutic Measures, Client Education & Referral
-a deficiency of antidiuretic hormone (ADH or vasopressin) due to a disorder of the posterior pituitary gland that results in the inability of the kidneys to conserve water appropriately. DI is caused by head trauma, tumor, surgery, radiation, CNS infections, malignant tumors, or failure of renal tubules. The underlying cause of DI should be identified and treated.
Manifestations:
1.]Urine Chemistry (dilute)
a.)Decreased urine specific gravity
b.)Decreased urine osmolality
2.]Serum Chemistry (concentrated)
a.)Hypernatremia
b.)Increased serum osmolality
3.]Polyuria and Polydipsia
a.)Increased urinary output
b.)Clients may crave ice water in excessive amounts.
4.Dehydration, weight loss, muscle weakness, and dry skin
5.Hemoconcentration
Diagnostic Procedures:
1.]Water (fluid) Deprivation Test
a.)Monitor body weight, vital signs, hourly urine output
b.)Assess serum and urine osmolality
2.]Vasopressin Test
a.)Performed only if fluid deprivation test is inconclusive.
b.)IV vasopressin is administered.
c.)Client urine and serum chemistries will improve.
3.]MRI of hypothalamus and pituitary
4.]24-hr urine
Nursing Interventions:
1.]Weigh client daily.
2.]Monitor urine output and urine specific gravity.
3.]Assess the client’s blood pressure and heart rate.
4.]Maintain fluid and electrolyte balance.
5.]Monitor for diabetes insipidus.
Medications:
1.]Desmopressin acetate
2.]Vasopressin
3.]If DI is nephrogenic in origin, thiazide diuretics will be prescribed.
Client Education and Referral:
1.]Lifetime vasopressin replacement therapy
2.]Report weight gain or loss, polyuria, or polydipsia to the provider.
3.]Monitor fluid intake and urine output.
4.]Avoid foods with diuretic action.
SIADH:Manifestations, Diagnostics, Interventions, Medications, Therapeutic Measures
-the excessive release of ADH resulting in the inability to excrete an appropriate amount of urine, thus developing fluid retention and dilutional hyponatremia. Caused by neoplastic tumors, head injury, meningitis, respiratory disorders, and some medications (e.g., vincristine, phenothiazines, tricyclic antidepressants, thiazide diuretics) and nicotine.
Manifestations:
1.]Urine Chemistry (concentrated)
a.)Increased urine specific gravity and osmolality
2.]Serum Chemistry (dilute)
a.)Hyponatremia
b.)Decreased serum osmolality
3.]Mental confusion, irritability, lethargy, and seizures (due to hyponatremia)
4.]Weakness, anorexia, nausea, and vomiting (due to hyponatremia)
5.]Increased ADH (vasopressin) levels
6.]Weight gain
Nursing Interventions:
1.Restrict oral fluids to 500 to 1,000 mL/day.
2.Monitor I&O.
3.Weigh client daily.
4.Monitor for increased BP, tachycardia, hypothermia.
5.Monitor mental status frequently; initiate seizure precautions.
Medications:
1.]Hypertonic saline infusion (3% to 5% sodium chloride)
2.]Loop diuretics; used to treat hypervolemic hyponatremia
3.]Demeclocycline
4.]Vasopressin receptor antagonists
a.)Conivaptan
Therapeutic Measures:
Treat the underlying cause with surgery, chemotherapy, and/or radiation.
Addison’s Disease (Adrenal insufficiency): Manifestations, Diagnostics, Interventions, Medications, Therapeutic Measures
-the hyposecretion of adrenal cortex hormones, caused by autoimmune disease, TB, histoplasmosis, adrenalectomy, tumors, HIV; can be induced by abrupt cessation of steroid medications
MEMORY HINT: With Addison’s, you need to add cortisol.
Manifestations:
1.Weakness and fatigue
2.Nausea and vomiting
3.Hyperpigmentation
4.Hypotension; increased heart rate
5.Hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia
6.Craving salty foods
7.Emotional lability and depression
8.Diminished libido
Diagnostic Procedures:
1.Serum adrenocortical hormone levels
2.ACTH stimulation test
3.Electrolyte panels
4.Abdominal/renal CT scan
Nursing Interventions:
1.Assess blood pressure and heart rhythm.
2.Monitor fluid and electrolyte balance.
3.Monitor and treat hypoglycemia.
4.Monitor for Addisonian crisis (also known as adrenal crisis): characterized by signs of shock (hypotension, tachycardia, tachypnea, pallor). It occurs secondary to stressors such as infection, trauma, surgery, pregnancy, or emotional stress. The client will require IV fluid replacement and IV steroids and may require respiratory support.
5.Monitor for adverse effects of hormone replacement therapy, which are the same manifestations as hypersecretion of the adrenal cortex.
Medications:
1.]adrenocorticoid replacement
a.)Hydrocortisone
b.)Prednisone
c.)Cortisone
Client Education and Referral:
1.]Provide emotional support to the client and provide instruction on lifelong disease management (e.g., medications, prompt treatment of infection and illness, and stress management).
2.]Educate about lifelong medication replacement, including the potential need for increased steroid therapy during times of stress or illness.
a.)Teach manifestations of excessive or insufficient hormone replacement
b.)Instruct client to promptly notify the provider in cases of infection, injury, and stress. Doses of hormones will need to be individually adjusted during these times.
3.]Teach the client indications of Addisonian crisis.
4.]Teach the client to avoid using caffeine and alcohol.
5.]Teach the client to have appropriate medical identification at all times in case of emergency.
6.]Advise the client to eat a high-protein and high-carbohydrate diet.
