Final Endocrine Flashcards
Pituitary Gland
The master gland
Located at the base of the brain
Influenced by the hypothalamus
Directly affects function of other endocrine glands
Promotes worth of body tissue
Influences water absorption by the kidney
Controls sexual dev and function
Anterior Lobe Production (adenohypophysis)
ACTH (adrenocorticotrophic)
TSH (thyroid-stimulating hormone)
STH (somatotropic growth-stimulating hormone)
FSH (follicle-stimulating hormone)
LH (luteninizing hormone)
PRL (prolactin)
MSH (melanocyte-stimulating hormone)
Posterior Lobe Production (neurohypophysis)
ADH (vasopressin, anti diuretic hormone)
Oxytocin
Anterior Pituitary disorders
Acromegaly
Giantism
Dwarfism
Posterior Pituitary Disorders
Diabetes Insipidus
SIADH (Syndrome of Inappropriate Secretion of Antidiuretic Hormone)
Acromegaly
The hypersecretion of growth hormone (GH) by the anterior pituitary gland
Occurs in middle age after the closure of the epiphyses of the long bones
Assessment of acromegaly
Large hands and feet
Visual problems
Headaches
Hyperglycemia
Hypercalcemia
Deepened voice
Thickening and protrusion of the jaw
Increased hair growth
Joint pain
Diaphoresis
Oily, rough skin
Menstrual disturbances
Impotence
Acromegaly implementation
Provide emotional support
Encourage to express feelings related to altered body image
Provide frequent skin care
Provide pharmacological and nonpharmacological interventions for joint pain
Prepare client for radiation of pituitary gland if prescribed
Prepare client for hypophysectomy if planned
Giantism or gigantism
The hyper secretion of growth hormone by the anterior pituitary gland
Occurs in childhood before the closure of the epiphyses of the long bones
Giantism/Gigantism assessment
Overgrowth of long bones
Increased height in early adulthood
Deterioration of mental and physical status
Giantism/Gigantism Implementation
Provide emotional support to client & family
Encourage client and family to express related to altered body image Provide frequent
Prepared client for radiation of pituitary gland, if prepared
Prepare for hypophysectomy, if planned
Hypophysectomy
The removal of the pituitary gland
Complications of hypophysectomy
Increased ICP, bleeding, rhinorrhea, and meningitis
Post op of hypophysectomy
Similar to craniotomy care
Monitor vitals
Assess LOC
Asses neurological status
Monitor for increased ICP
Elevate to HOB
Monitor for adrenal insufficiency
And insisted corticosteroids as prescribed on time
Monitor fluids and electrolyte values
Monitor for temporary diabetes insipidus due to
antidiuretic hormone (ADH) disturbances
Avoid water intoxication
Instruct client to avoid sneezing, coughing, and
blowing nose
Instruct client in the administration of prescribed
medications
Dwarfism
The hyposecretion of growth hormone by the anterior pituitary gland
Occurs in childhood
Assessment of dwarfism
Retarded physical growth
Premature aging
Low intellectual dev
Dry skin
Poor development of secondary sex characteristics
Implementation for Dwarfism
Provide emotional support
Encourage client and family to express feelings
Prepare to admin hGH (human growth hormone)
Diabetes Insipidus
The hyposecretion of antidiuretic hormone and a deficiency of vasopressin
Results in failure of tubular reabsorption of water in the kidneys
Assessment of Diabetes Insipidus
Polyuria
Polydipsia
Dehydration
Decreased skin turn or
Inability to concentrate urine
Low urine specific gravity of 1.006 of less
Fatigue
Muscle pain and weakness
Headache
Postural hypotension
Tachycardia
Implementation of diabetes Insipidus
Monitor vital signs, neurological & cardiovascular
status
Monitor electrolyte values
Administer vasopressin (Pitressin) or DDAVP (desmopressin) as prescribed
Monitor I & O, weight, specific gravity of urine
Instruct client to avoid foods or liquids with a
diuretic-type action
Maintain intake of adequate amounts of fluids
Instruct client in administration of medications as
prescribed
Instruct client to wear Medic-Alert bracelet
Syndrome of Inappropriate Secretion of ADH (SIADH)
A disorder of the posterior pituitary gland in which a continued release of the antidiuretic hormone (ADH) occurs
Results in water intoxication
Assessment of SIADH
Changes in LOC
Mental status changes
Weight gain
Hypertension
Signs of fluid volume overload
Tachycardia
Anorexia
Nausea and vomiting
Hyponatremia
Implementation of SIADH
Monitor vital signs
Monitor neurological status
Monitor cardiac status
Protect the client from injury
Monitor I&O
Obtain daily weights
Restrict water intake as prescribed
Monitor fluid and electrolyte balance
Administer diuretics and IV fluids as prescribed
Adrenal Gland
Rests upon each kidney
Regulates sodium and electrolyte balance
Affects carbohydrate, fat and protein metabolism
Influences development of sexual characteristics
Sustains “fight or flight” response
Adrenal cortex
Outer shell of adrenal gland
Synthesizes:
Glucocorticoids (cortisol)
Mineralocorticoids (aldosterone)
Small amounts of sex hormones (androgens, estrogens)
Adrenal Medulla
Inner core of adrenal gland
Works as part of sympathetic nervous system
Produces:
Epinephrine
Noepinephrine
Disorders of the adrenal cortex
Addison’s disease
Cushing’s syndrome
Aldosteronism (Conn’s syndrome)
Disorders of the adrenal Medulla
Pheochromocytoma
Addison’s disease
Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids)
Fatal if left untreated
Assessment of Addison’s disease
Weakness
GI disturbances
Weight loss
Emotional disturbances
Bronze pigmentation to skin
Electrolyte imbalances
Hyponatremia
Hypokalemia
Hypotension
Hypoglycemia
Elevated BUN
Addison’s Disease Implementation
Monitor vital signs
Monitor weight and I&O
Maintain fluid and electrolyte balance
Monitor for infection
Instruct client in a high-protein, high-carbohydrate diet
Instruct client in the avoidance of stress
Instruct client to avoid individuals with an infection
Instruct client in the need for lifelong corticosteroids
Instruct client to avoid over-the-counter medications
Instruct client to avoid strenuous exercise
Instruct client to wear a Medic-Alert bracelet
Observe for Addisonian crisis secondary to stress, infection, trauma, surgery
Addisonian Crisis
A life threatening disorder caused by acute adrenal insufficiency
It is precipitated by infection, trauma, stress or surgery
Can cause Hyponatremia, hyerkalemia, hypoglycemia and shock
Assessment of Addisonian Crisis
Severe headache
Severe abdominal, leg and lower back pain
Generalized weakness
Irritability and confusion
Severe hypotension
Shock
Implementation for Addisonian Crisis
Monitor vital signs
Monitor neurological status, noting irritability and
confusion
Monitor I&O
Administer IV fluids as prescribed to restore electrolyte balance
Administer adrenocorticosteroids as prescribed on
time schedule
Protect client from infection
Maintain bedrest and provide a quiet environment
Cushing’s Syndrome
Condition resulting from the hypersecretion of glucocorticoids from the adrenal
Can result from the prolonged administration of corticosteroids
Assessment of Cushing’s Syndrome
Obesity with thin extremities
Moon face
Buffalo hump
Fragile skin that easily bruises
Hirsutism (masculine characteristics in females)
Mood swings
Muscular weakness
Signs of infection
Signs of osteoporosis
Hypertension
Hypokalemia
Hyperglycemia & glycosuria
Elevated WBC
Sodium and water retention
Implementation for Cushing’s Syndrome
Monitor I&O
Monitor weight
Monitor glucose levels and urinary glucose
Provide good skin care
Allow client to discuss feelings related to body
appearance
Provide high-protein, low-calorie diet with potassium supplements
Prepare client for adrenalectomy if prescribed
Prepare client for radiation if prescribed
Administer hormone replacement therapy as
prescribed
Administer steroids as prescribed if adrenalectomy
was performed
Administer chemotherapeutic agents as prescribed
Instruct client in the administration of medications
as prescribed
Instruct client to avoid infection and, stress
Instruct client in measures for adequate nutrition and rest
Aldosteronism (Conn’s Syndrome)
A hypersecretion of aldosterone from the adrenal cortex of the adrenal gland
Due to an adrenal lesion that is usually benign
Assessment of Aldosteronism (Conn’s Syndrome)
Generalized weakness
Increased thirst, nocturia and polyuria
Edema
Weight gain
Headache
Hypertension
Positive Chvostek’s sign
Increased urinary aldosterone
Hypokalemia
Hypernatremia
Metabolic alkalosis
Implementation for Aldosteronism (Conn’s Syndrome)
Monitor vital signs
Monitor weight
Monitor I&O
Assess muscular strength
Monitor for positive Chvostek’s sign
Monitor electrolytes
Maintain sodium restriction as prescribed
Administer potassium supplements as prescribed
Administer antihypertensives, such as spironolactone (Aldactone) as prescribed
Prepare client for surgical removal of tumor if prescribed
Pheochromocytoma
A catecholamine-producing tumor usually found in the adrenal gland but also may be found in the abdomen
Causes hypersecretion of the hormones of adrenal medulla and secretion of excessive amounts of epinephrine and norepinephrine
Typically benign but can be malignant
Death can occur from shock, CVA, renal failure, dysrhythmias and dissecting aortic aneurism
Treatment of Pheochromocytoma
Primary treatment is surgical excision of adrenal gland
Symptomatic treatment initiated if surgical excision is not possible
Complications associated with Pheochromocytoma
Hypertensive retinopathy and nephropathy, myocarditis, CHF, increased platelet aggregation and CVA
Assessment of Pheochromocytoma
Hypertension
Headaches
Hypermetabolism
Diaphoresis
Palpitation and tachycardia
Apprehension
Emotional instability
Hyperglycemia and clycosuria
Pain the chest/abdomen
N&V
Weight loss
Fatigue and exhaustion
Implementations for Pheochromocytoma
Monitor vital signs
Monitor cardiovascular, neurological, and renal status
Monitoring for hypertensive attacks such as hypertension can precipitate a CVA or sudden blindness
Keep phentolamine (Regitine) at the bedside for hypertensive crisis
Prepare to administer an alpha-adrenergic blocking agent, phenoxybenzamine (Dibenzyline), as prescribed to control blood pressure
Be alert to stimuli that can precipitate a paroxysm, such as increased abdominal pressure, micturition, and vigorous abdominal palpation
Avoid opiates preoperatively as they can precipitate a hypertensive crisis
Monitor urine for glucose and acetone
Promote rest and nonstressful environment
Provide a diet high in calories, vitamins, and minerals
Prohibit caffeine-containing beverages and food
Adrenalectomy
Surgical removal of an adrenal gland
Lifelong steroid replacement is necessary with a bilateral adrenalectomy
Temporary steroid replacement, up to 2 years, is necessary for a unilateral adrenalectomy
Risks for adrenalectomy
Catecholamine levels drop as a result of surgery, which can result in cardiovascular collapse, hypotension and shock and the client needs to be monitored closely
Hemorrhage can occur due to the high vascularity of the adrenal glands
Pre op implementation for adrenalectomy
Prepare client for surgical procedure
Monitor electrolytes and correct electrolyte imbalances
Assess for dysrhythmias
Monitor for hyperglycemia
Protect client from infections
Administer steroids as prescribed
Post op implementation of adrenalectomy
Monitor vital signs
Monitor I&O, and if urinary output is less than 30
mL per hour, notify the physician, as this may be indicative of impending shock and renal failure
Monitor daily weights
Monitor electrolytes
Monitor for signs of shock and hemorrhage, particularly during first 24 to 48 hours
Assess dressing
Monitor for paralytic ileus, as manifested by abdominal distention and pain, nausea, vomiting, diminished or absent bowel sounds, as paralytic ileus can develop from internal bleeding
Administer IV fluids as prescribed to maintain blood
volume
Administer pain medication as prescribed, remembering that meperidine (Demerol) can cause hypotension
Administer steroid replacement as prescribed
Instruct client in the importance of steroid therapy following surgery
Thyroid Gland
Located in the anterior part of the neck
Controls the rate of body metabolism and growth
Produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin
2 thyroid hormones produced by follicular cells
Thyroxine = tetraiodothyronine = T4
- contains 4 atoms of iodine
Triiodothyonine = T3
- contains 3 atoms of iodine
Hormone produced by parafollicular cells (C-cells)
Calcitonin - helps regulate calcium homeostasis
Control of thyroid hormones produced secretion
- low levels of T3 and T4 or low metabolic rate stimulate the hypothalamus to secrete thyrotropin releasing hormone (TRH)
- TRH enters the hypophyseal portal veins and is carried to the anterior pituitary gland, where it stimulates thyrotrophs to secrete thyroid stimulating hormone (TSH)
- TSH stimulates almost all aspects of thyroid follicular cell activity, including iodide trapping, hormone synthesis and secretion, and growth of follicular cells
- thyroid follicular cells release T3 and T4 into the blood until the metabolic rate returns to normal
- an elevated T3 inhibits release of TRH and TSH
Initial Hyperthyroid presentations
Goiter
Nervousness/Irritability
Palpitations (tachycardia)
Unexplained weight loss
Diarrhea
Sleep Disturbances (insomnia)
Vision changes (exopthalmos)
Amenorrhea/Oligomenorrhia
Later Presentations of Hyperthyroidism
Tremor
Muscle weakness and fatigue
Dyspnea
Dependent edema
Impaired mentation (confusion)
Incidental presentation of Hyperthyroid
Heat intolerance
Diaphoresis
Increased appetite
Initial Presentations of Hypothyroid
Depression and loss of concentration
Dry skin
Cold intolerance
Myalgias
Somnolence and fatigue
Menorrhagia
Later presentations of Hypothyroid
Goiter
Unexplained weight gain
Constipation
Myxedema
Memory loss/impairment
Incidental presentations of hypothyroid
Bradycardia
Habitual abortion / sterility
Anorexia
Primary Hypothyroidism
Problem with the thyroid
Thyroid is not making enough T3 and T4
Secondary Hypothyroidism
Problem with the Pituitary Gland
Pituitary gland is not making enough TSH
Causes the thyroid to not make enough T3/T4
Tertiary Hypothyroidism
Problem with the hypothalamus
Hypothalamus is not making enough TRH
Causes the Pituitary gland to not make enough TSH
Causes the thyroid to not make enough T3 and T4
Primary Hyperthyroidism
Problem with the thyroid
Thyroid is making too much T3 and T4
Secondary Hyperthyroidism
Problem with the Pituitary Gland
Pituitary gland is making too much TSH
Causes the thyroid to make too much T3 and T4
Tertiary Hyperthyroidism
Problem with the Hypothalamus
Hypothalamus makes too much TRH
Causes Pituitary to make to much TSH
Causes the Thyroid to make too much T3/T4
Radioactive Iodine Uptake (RAI)
A thyroid function test that measures the absorption of the iodine isotope to determine how the thyroid gland is functioning
THe amount of radioactivity is measured 2,6 and 24 hours after ingestion of the capsule
Results of Radioactive Iodine Uptake RAI
Normal value is 5% to 35% in 24 hours
Elevated values are indicative of: Hyperthyroidism, thyrotoxicosis, decreased iodine intake or increased iodine secretion
Decreased values indicate a low T4, the use of antithyroid meds, thyroiditis, myxedema, or hypothyroidism
T3 and T4 Resin Uptake Test
Blood tests for the diagnosis of thyroid disorders
T3 and T4
Regulate thyroid stimulating hormone
Results of T3 and T4 resin uptake test
If T3 is elevated: Hyperthyroidism and T3 toxicosis
T3 decreased: decreases with aging process or Hypothyroidism
If T4 is elevated: hyperthyroidism
Is T4 decreased: hypothyroidism
Thyroid- Stimulating Hormone (TSH) Test
Blood test used to differentiate the diagnosis of primary hypothyroidism
Normal values of T3 and T4
T3: 25% to 35%
T4: 3.8% to 11.4%
Thyroid-Stimulating Hormone (TSH) test Results
Normal: 0 to 6 µU/ml
Elevated values indicate primary hypothyroidism
Decreased values indicate hyperthyroidism or secondary hypothyroidism
Thyroid Scan
Performed to identify nodules or growths in the thyroid gland
A radioisotope of iodine or technetium is administered prior to the scanning
Preop care of thyroid scan
Make sure client had not received radiographic contrast agent within the past 3 months
Check with physician about discontinuing meds containing iodine for 14 days prior
Fast for 45 minutes after ingestion of oral isotope and scan done in 24 hours
NPO after midnight on day before test
Needle Aspiration of Thyroid Tissue
Aspiration of thyroid tissue for cytological examination
No special client prep
Light pressure is applied to the aspiration site after the procedure
Disorders of thyroid gland (hypothyroidism)
Cretinism
Myxedema
Disorders of the Thyroid Gland (Hyperthyroidism)
Grave’s disease
Thyrotoxicosis
Risk factors of thyroid disorders
Hereditary
Congenital
Trauma
Environmental
Secondary to other disorders
Causes of primary hypothyroidism
Most common type
Hashimoto’s thyroiditis - autoimmune
Causes of treatment related hypothyroidism
2nd most common kind
Radioactive iodine Tx or surgery for hyperthyroidism
Other causes of hypothyroidism
Iodine deficiency:
Endemic goiter
Endemic cretinism: most common cause of congenital hypothyroidism in deficient areas
Rare inherited enzyme deficiencies
Causes of secondary hypothyroidism
Failure of H-P axis d/t deficient TRH or TSH secretion
Cretinism
A severe thyroid hypofunction that results in hyposecretion of thyroid hormones in the fetus or soon after birth
Pot belly with umbilical hernial
Sensitivity to cold
Assessment of cretinism
Severe physical and mental retardation
Dry skin
Coarse, dry, brittle hair
Slow teething
Large tongue
Poop appetite
Constipation
Yellowish coloration to skin
Implementation for Cretinism
Provide emotional support
Provide warmth and skin care
Prevent injury
Prevent constipation
Encourage parents to discuss feelings
Administer hormone replacement of desiccated thyroid, thyroxine (synthroid), triiodothyronine (cytomel) as prescribed
Instruct parents regarding meds
Myxedema
A hypothyroid state resulting from a hyposecretion of thyroid hormones
Occurs in adulthood
Assessment of Myxedema
Slowed rate of body metabolism
Lethargy and fatigue
Intolerance to cold
Weight gain
Dry skin and hair, loss of body hair
Bradycardia
Constipation
Generalized puffiness and nonpitting edema
Forgetfulness and loss of memory
Menstrual disturbances
Cardiac disorders
Implementation for myxedema
Monitor vitals
Monitor for cardiac complications
Admin and monitor thyroid replacements
Instruct client in low-calorie, low-cholesterol, low saturated fat diet
Assess for anorexia and fecal impaction
Provide roughage and fluids (prevents constipation)
Provide warm envi
Avoid sedatives and narcotics
Monitor for overdose of thyroid meds
Myxedema Coma
Rare but serious disorder that results from a persistent, low thyroid production
What can precipitate a myxedema come
acute illness, rapid withdrawal of thyroid meds, anesthesia and surgery, hypothermia and the use of sedatives and narcotics
Assessment of myxedema coma
Hypotension
Hypothermia
Bradycardia
Mental depression
Mood swings
Hyponatremia
Hypoglycemia
Coma
Implementation for Myxedema coma
Maintain airway
Monitor vital signs and LOC
Assess temp frequently
Assess BP
Admin IV fluids
Monitor electrolytes and glucose level
Admin IV glucose
Keep client warm
Monitor for changes in mental status
Admin sodium IV
Admin corticosteroids
Avoid sedatives and hypnotics
Grave’s disease
Hyperthyroid state resulting from a hypersecretion of thyroid hormones
Also known as thyrotoxicosis
Assessment of Graves’ disease
Increased rate of body metabolism
Enlarged thyroid gland
Cardiac dysrhythmias (tachycardia & palpitations)
Protruding eyeballs (exophthalmos)
Hypertension
Heat intolerance
Diaphoresis
Weight loss
Smooth soft skin and hair
Nervousness and fine tremors of hands
Personality changes
Irritability and agitation
Mood swings
Implementation for Grave’s Disease
Provide adequate rest
Administer sedatives as prescribed
Provide cool and quiet environment
Obtain daily weights
Provide psychosocial support
Admin meds to block thyroid synthesis
Admin iodine prep which inhibits release of thyroid hormones
Admin meds for tachycardia
Prepare client for radioiondine and thyroidectomy
Thyroid Storm
An acute and fatal thyroid condition that occurs from manipulation of the thyroid gland during surgery and the release of thyroid hormones Admin into the bloodstream
Can also be caused by severe infection and stress
Assessment of Thyroid Storm
Fever
Diaphoresis
Dehydration
Tachycardia
Congestive heart failure and pulmonary edema
N&V and diarrhea
Systolic hypertension
Tremors
Irritability, agitation and restlessness
Delirium and coma
Implementation for Thyroid Storm
Monitor vitals
Decrease temp frequently Assess
Avoid palpating thyroid
Monitor I&O
Monitor fluid and electrolyte balance
Monitor for dehydration and overhydration
Monitor pulmonary and cardiac status
Admin iodine prep
Admin tachycardia meds
Admin glucocorticoids
Admin cardiac meds
Thyroidectomy
Removal of the thyroid gland
Performed if conditions where persistent hyperthyroidism exists
Preop implementation for Thyroidectomy
Obtain vitals and weight
Assessment electrolyte levels
Assess for hyperglycemia and glycosuria
Assess LOC
Assess for signs of thyroid storm
Admin antithyroid meds (deplete iodine and hormones)
Admin iodine to decrease vascularity of the thyroid gland
Thyroidectomy postop implementation
Monitor resp distress
Have tracheotomy set O2 and suction at bedside
Maintain semi-Fowler’s position
Monitor for signs for bleeding
Check dressing
Limit talking and assess level of hoarseness
Mon for laryngeal nerve damage
Monitor for signs of tetany
Prepare to admin calcium gluconate
Tetany
Involuntary muscle contractions
Signs of Tetany
+ chvostek’s sign
+ trousseau’s sign
Numbness of extremities and spasm of glottis
Irritability
Wheezing and dyspnea
Visual disturbances
Muscle and abdominal cramps
Parathyroid Gland
Located near the thyroid
Controls calcium and phosphorus
Produces parathyroid hormones Admin into (PTH)
Hypoparathyroidism
Condition caused by hyposecretion of parathyroid hormone by the parathyroid gland
Occurs following thyroidectomy from removal of parathyroid tissue
Assessment of Hypoparathyroidism
Hypocalcemia and elevated phosphorus levels
Numbness and tingling of extremities
Cramping
Signs of tetany
Signs of hypocalcemia
Increased neuromuscular irritability
Confusion
Visual problems
Depression
Signs of hypocalcemia
Weakness and tingling of the extremities Cramping Signs
Painful muscle spasms
Dysrhythmias
irritability
Anxiety
Implementations of Hypoparathyroidism
Monitor vital signs and cardiac status Admin iodine
Monitor tetany
Initiate seizure precautions
Place tracheotomy set, O2 and suctioning at bedside
High calcium low phosphorus diet
Quiet envi
Admin aluminum hydroxide (decrease phosphate levels)
Admin parathyroid hormones
Prepare to administer IV calcium gluconate
Teach client how to administer calcium carbonate and vitamin D
Implementation for Hyperparathyroidism
Monitor cardiac function and renal status
Monitor I&O
Provide hydration
Monitor fluid and electrolyte balance
Monitor calcium and phosphorus levels
Admin furosemide (lower calcium levels)
Admin IV saline (lower calcium)
Notify Dr immediately if drop in calcium
Assess for tingling and numbness
Admin phosphates (interfere w/ calcium absorption)
Admin meds to decrease skeletal calcium release
Admin cytotoxic antibiotics
Prepare for parathyroidectomy
Parathyroidectomy
Removal of one or more of the parathyroid glands
Preop implementation parathyroidectomy
Monitor electrolytes, calcium, phosphate and magnesium levels
Ensure calcium levels are decreased to near normal levels
Inform client that talking may be painful
Postop implementation for Parathyroidectomy
Monitor for resp distress
Tracheotomy set, oxygen, and suctioning at the
bedside
Monitor vital signs
Position in semi fowler’s
Assess neck dressing for bleeding
Monitor for hypocalcemic crisis (tingling and twitching)
Assess for + trousseau and Chvostek signs (tetany)
Monitor for changes in voice pattern and hoarseness
Instruct client in admin of calcium and vitamin D
