[Exam 3] Chapter 52: Assessment and Management of Patients with Endocrine Disorders ( Page 1502-1524, 1527-1532, 1534-1540, 1541-1543 ) Flashcards
What does the endocrine system affect?
Most cells, organs, and body functions
Endocrine system is closely linked with what?
Neurologic and immune systems
Endocrine System: What kind of feedback mechanism is this?
Negative
Endocrine System: Amines and Amino Acids produce what?
Epinephrine, norepinehprine and thyroid hormones
Endocrine System: Peptides (Protein), Polypeptides do what? and Produce what?
Act on cell surface
Follicle Stimulating Hormone (FSH), Growth Horomone (GH), Thyrotropin Releasing Hormone (TRH)
Endocrine System: Steroid hormones do what?
Act inside the cell, and these include corticosteroids
Endocrine System: Fatty Acid Derivatives produce what?
Eicsanoid and Retinoids
What is a Paracrine action?
When a hormone acts locally in the area where they are released.
What is a Autocrine Action?
When hormones act on actual cells from which they were released
What are some major hormone secreting glands?
Hypothalamus (Controls Pituitary), Pituitary (Mastery Gland, Anteroir responsible for Thyroid), Thyroid, Parathyroid (Responsible for Calcium Levels), Adrenals, and Islets of Langerhans (In Pancreas)
Endocrine System: What major hormone secreting glands will we not talk about?
Testes, Ovaries, Pineal, and Thymus.
What will as assess when performing an assessment of the endocrine?
Change in energy level? Tolerance to heat/cold. Weight loss/gain. Thirst and frequency of urination. Fat and fluid distribution. Memory/Concentration/Mood.
Vision changes, joint pain.
VS. Palpate Thyroid.
Endocrine System: What visual changes may be observed with an endocrine dysfunction?
Facial hair in women, “moon face”, “buffalo hump”, exophthalmos (abonormal protrusion of one or both eyeballs), vision changes, edema, obesity of trunk, and increased size of feet and hands.
Endocrine System, and Labs/Diagnostics: What tests should be done?
Serum levels of hormones
Presence of autoantibodies
Blood Glucose
Urine Test to measure hormone metabolites
Stimulation and Suppression Tests
CT, MRI, Ultrasound
Endocrine System, and Labs/Diagnostics: Serum levels of hormones evaluated because
It may provide information to determine the presence of hypofunction or hyperfunction of the endocrine system and the site of dysfunction
Endocrine System, and Labs/Diagnostics: What are autoantibodies?
A lot of the diseases studied are autoimmune diseases.
This means that the body is attacking its own body or hormone.
Endocrine System, and Labs/Diagnostics: Blood Glucose is useful because
theyre many endocrine disorders that involve glucose
Endocrine System, and Labs/Diagnostics: Urine Tests are used to measure what?
Hormone metabolites, which is the end products of hormones excreted by the kidneys
Endocrine System, and Labs/Diagnostics: Why are stimulation tests performred?
To confirm hypofunction of an endocrine organ. Determines how endocrine gland responds to administration of stimulating hormones that are normally produced or released by the hypothalamus or pituitary gland
Endocrine System, and Labs/Diagnostics: In a stimulation test, if the specific endocrine gland responds to the stimulation, this means that the specific disorder may be where?
In the hypothalamus or pituitary
Endocrine System, and Labs/Diagnostics: What are Suppression tests used for?
To detect hyperfunction of an endocrine organ. They determine if organ is not responding to the negative feedback mechanisms that normally control secretion of hormones from the hypothalamus or pituitary gland
Endocrine System, and Labs/Diagnostics: CT/MRI shows what?
Blood flow through an organ as well as structural components
Endocrine System, and Labs/Diagnostics: Ultrasound shows what?
Tells you the function of an organ
Endocrine System, and Labs/Diagnostics: Stimulation Example: Pt given TSH and if T3/T4 leveles rise, this means that the problem lies where?
Posterior Pituitary. Thyroid was able to produce T3/T4 with no problem. Problem was not enough TSH was being produced to make T3/T4
What does Exogenous mean?
Hormone given from outside the body
What deos Endogenous mean?
Body produces the hormone itself.
What is the Pituitary Gland also known as?
Hypophysis, or master gland
Where is the Pituitary Gland located?
Located on the inferior aspect of the brain
Why is the Pituitary Gland considered the master gland?
Because it releases hormones that affect the rest of the glands of the body
What does the Anterior Pituitary release?
FSH, LH, Prolactin, GH, ACTH, and TSH
Anterior Pituitary Gland: What does ACTH or Adrenocorticotropic Hormone stimulate?
Production and release of cortisol from the cortex of the adrenal gland
Anterior Pituitary Gland: What does TSH stimulate?
Causes the thyroid gland to make triodothyronine (T3) and Thyroxine (T4)
Posterior Pituitary Gland: What does this release?
Vasopressin or Anti-Diuretic Hormone (ADH)
Posterior Pituitary Gland: What does Vasopressin or ADH do?
Controls the secretion of water by the kidneys , secretion is stimulated by high serum osmolality or low blood pressure. If osmolaity increased after eating something salty, it ADH will increase amount of water you hold onto.
What can hyper production of the Anterior Pituitary cause?
Cushing Syndrome
What can hypo production of the Anterior Pituitary cause?
Addisons Disease
What can hypo production of the Posterior Pituitary cause?
Diabetes Insipidus (DI)
What can hyper production of the Posterior Pituitary cause?
Syndrome of Inappropriate Diuretic Hormone (SIADH)
What is released by the posterior pituitary gland?
ADH/Vasopressin
Oxytocin
Anterior Pituitary: ACTH stimulates what?
Adrenal Cortex to produce -> (Cortisol)
Anterior Pituitary: If not enough Cortisol produced, what does patient have?
Addisons Disease
Anterior Pituitary: If too much Cortisol produced, what does patient have?
Cushings Disease
Anterior Pituitary: TSH stimulates what?
Thyroid to produce T3, T4, Storing Iodine, Calcium Levels
Anterior Pituitary: Too much T3/T4 results in
Graves Disease
Anterior Pituitary: Too little T3/T4 results in
Hashimoto Disease
Posterior Pituitary: ADH controls what?
The secretion of water
Posterior Pituitary: Increase in ADH =
Increase in holding water
Posterior Pituitary: Too little ADH released results in
Diabetes Insipidus (DI)
Posterior Pituitary: Too much ADH released results in
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
Posterior Pituitary - ADH/Vasopressin: Too much SIADH causes you to retain what?
Fluids
Posterior Pituitary - ADH/Vasopressin: Patient holding onto extra fluid with SIADH has what electrolyte imbalance?
Hyponatremia (Dilutional). This dilutes all of our salt out.
Posterior Pituitary - ADH/Vasopressin: Treatment for SIADH?
Fluid restriction and lasix.
Posterior Pituitary - ADH/Vasopressin: Too little ADH released results in?
Diabetes Insipidus
Posterior Pituitary - ADH/Vasopressin: What is Diabetes Insipidus?
When abnormally large volumes of dilute urine are excreted as a result of deficient production of ADH, also has low specific gravity
Posterior Pituitary - ADH/Vasopressin: How does the patient feel thirst wise with Diabees Insipidus?
Extremely Thirsty, because they are dehydrated
Posterior Pituitary - ADH/Vasopressin: What Electrolyte dysfunction does Diabetes Insipidus corrleate to?
Hypernatremia. Water has been lost but the salt got to stay.
Posterior Pituitary - ADH/Vasopressin: Treatment for Diabetes insipidus?
Desmopressin, an exogenous ADH
Thyroid: What are the hormones here?
T3, T4, and Calcitonin
Thyroid: What is stored, specifically in the thyroid?
Iodine
TSH from the anterior pituitary controls the release of?
Thyroid hormone
Thyroid: What are the Thyroid hormones responsible for?
Controls cellular metabolic activity
Thyroid: Increase in thyroid hormones results in what?
Increase in metabolic activity
Thyroid: Is T3 or T4 faster?
T3 is more potent and rapid-acting than T4
Thyroid: When is Calcitonin secreted?
If Calcium level in blood is high, Calcitonin will lower the blood plasma calcium levels and increases calcium deposit into the bone
Thyroid: What are the Thyroid Diagnostic Tests that can be conducted?
TSH, Seerum Free T4 , T3/T4.
T4 Resin Uptake
Thyroid Antibodies
Radioactive Iodine Uptake
Fine Needle Biopsy
Thyroid Scan, Radioscan, or Scintiscan
Serum Thyroglobulin
Thyroid and Serum-Free T4 Test: What does this test?
Direct measure of free thyroxine, the only metabolically active fraction of T4. Ranges from 0.9-1.4
Thyroid and T4 Resin Uptake Test: What does this test?
Indirect measure of unsaturated TBH (which binds to T4). Purpose is to determien amount of thyroid hormone bound to TBG and number of available binding sites
Thyroid and Thyroid Antibodies Test: What does this test?
Some Hypo and Hyper Thyroid diseases can be autoimmune diseases and can show whether the antibodies are attacking the thyroid or the hormone itself.
Thyroid and Radioactive Iodine Uptake Test: What does this test?
Iodine made radioactive. Measures the rate of iodine uptake by the thyroid gland. Patient given tracer dose of iodine and a count is made over thyoid gland which detects and counts from the breakdown of iodine in the thyroid. Causes damage to thyroid tissue.
Thyroid and Fine-Needle Biopsy Test: What is this?
To help determine if person has Graves, Hashimoto, or Thyroid Cancer. Is a biopsy
Thyroid and Thyroid Scan, Radio Scan, or Scintiscan Test: How is this performed?
Iodine 123/131 injected and scintillation detector moves camera back and forth across area to be studied. Determines size and shape of thyroid
Thyroid and Serum Thyroglobulin Test: What is this?
This is only released by the Thyroid. Thus they will do a blood draw and it can determine if thyroid tissue is growing, even once thyroid is removed
Hypothyroidism causes what disease?
Hashimoto
What is Hashimoto disease?
Autoimmune disease in which the body produces antibodies against the thyroid. Causes thyroid cell death and becomes unable to produce sufficient T3/T4, which causes metabolism to slow
Thyroid and Hashimoto: How long for symptoms to show up?
Slow onset, occuring over months to years
Thyroid and Hashimoto: Occurs most often to who?
Middle age and older women
Thyroid and Hashimoto: Signs anad Symptoms?
Thinning Hair
Intolerance to Cold (Metabolism generates heat)
Brittle Nails and Dry Skin
Numbness/Tingling of Fingers
Low PR and Body Temp
Constipation
Fatigue (Everything slows down)
Thyroid and Hashimoto: This can also be what type of disease?
Autoimmune, meaning it may be attacking its own body
Thyroid and Hashimoto: Risk Factors For getting this?
Middle/Older Women
Autoimmune Disease
Genetic Predisposiiton
Radiation Exposure
Thyroid and Hashimoto: What complications can this leadt to?
Bradycardia can lead to cardiac complications
Myxedema Coma
High Cholestrol
Arthroclerosis (Monitor HR because decrease in metabolism of fats and lipids can lead to this)
Thyroid and Hashimoto: What are some nursing diagnosis for this?
Decreased CO
RF Impaired Integrity
Fatigue
Constipation
Thyroid and Hashimoto: Those with Decreased CO should do what?
Keep environment warm to reduce shivering so metabolic demand is lowered to decrease demands on heart
Thyroid and Hashimoto: What does a low TH cause to the body?
Decrease in HR and Stroke Volume, ,Athrosclerosis, or fluid in pericardial sac from edema
Thyroid and Hashimoto: How to reduce risk of Constipation?
Low calorie fluids or water, high fiber diet. And Activity wtih rest periods (Careful of demands on heart)
Thyroid and Hashimoto: What to do with RF Impaired Skin Integrity?
Alcohol free soaps and lotions and to make sure you use warm water instead of hot
Thyroid and Hashimoto: What are the goals fro someone with this?
Prevent complications , Maintain CO, and Prevent Injury
Thyroid and Hashimoto: What should you monitor for medication wise?
Increased effects of anticoagulants and digoxin
Medical Management of Hypothyroidism: What should you do for this?
Start Synthetic Levothyroxine Replacement Therapy.
Take 1 hour prior or 2 hours after eating. Required for life and needs adjustments
Medical Management of Hypothyroidism: What happens if you pairi Levothyroxine Replacemenet Therapy with Hyponotic, Sedative Agents, or Nacrotics?
Its metabolism is lower and can knock out respiratory system. You should reduce this dose.
Medical Management of Hypothyroidism: What should you monitor for if someone is on Levothyroxine Replacement Therapy and is on an anticoagulant?
Monitor for bruising, bleeding gums, and blood in the urine
Medical Management of Hypothyroidism: TH Drugs can potentiate the effects of what drugs?
Anticoagulants and Digoxin