Lecture 8 Endocrine

Question 1

what hormones come from the posterior pituitary?

Answer 1

ADH
oxytocin

Question 2

what hormones come from the anterior pituitary?

Answer 2

GH
ACTH
TSH
FSH and LH
prolactin

Question 3

what controls the pituitary gland?

Answer 3

hypothalamus

Question 4

what hormones are insufficient in hypopituitarism

Answer 4

TSH
GH
ADH

Question 5

what causes diabetes insipidus?

Answer 5

hypopituitarism of the posterior pituitary because ADH is low

Question 6

what are the clinical manifestations of DI

Answer 6

weight loss
polyuria w/ low spec gravity and low osmolarity
extreme thirst
hypovolemia
hypernatremia
low BP

Question 7

what are the diagnostic tests for DI?

Answer 7

urine osmolarity - normal is 200-800
specific gravity - normal is 1.005-1.025

Question 8

how is DI treated?

Answer 8

desmopressin
fluid replacement
identify and correct underlying cause

Question 9

what condition comes from hyperpituitarism?

Answer 9

SIADH
increased ADH

Question 10

what can cause SIADH

Answer 10

pituitary tumor is most common

lung cancer, pneumonia, pneumothorax, tumors, head injury, medications

Question 11

clinical manifestations of SIADH

Answer 11

weight gain
oliguria
increased spec gravity and osmolarity
hypervolemia
hyponatreamia

Question 12

diagnosing SIADH

Answer 12

urine specific gravity and urine osmolarity

Question 13

how is SIADH treated?

Answer 13

reverse the cause
restrict fluid
diuretics
hypertonic fluids for severe hyponatremia

Question 14

what to monitor for SIADH

Answer 14

s/s of fluid overload
daily weights, I/Os
s/s of hyponatremia and neuro status

Question 15

how is pituitary tumor diagnosed?

Answer 15

MRI
CT
pituitary hormone labs

Question 16

what kind of tumors are common in the pituitary?

Answer 16

benign, slow growing tumors

Question 17

treating pituitary tumors

Answer 17

meds - octreotide, bromocriptine
radiation
surgery - hypophysectomy

Question 18

Hypophysectomy care

Answer 18

avoid increased ICP
oral care every 4 hours but no tooth brush until healed
humidifier
head of bed elevated

Question 19

what hormones does the thyroid produce?

Answer 19

T4 - thyroxine
T3 = triiodothyronine
calcitonin

Question 20

what is the function of the thyroid

Answer 20

control the metabolism

Question 21

what is the function of calcitonin

Answer 21

responds to high calcium in blood, puts calcium back into the bones

Question 22

how do thyroid hormones get to the bloodstream?

Answer 22

they are synthesized with iodine
they are bound to binding hormones - TBG, transthyretin, albumin
then released into bloodstream

Question 23

what is the path of hormones involved in thyroid function?

Answer 23

hypothalamus releases TRH
anterior pituitary releases TSH
thyroid releases T3 and T4

Question 24

hypothyroidism hormone levels

Answer 24

T3 and T4 are low
TSH is high in response to low T3 and T4

Question 25

what causes hypothyroidism?

Answer 25

hashimoto disease - immune system attacks thyroid radiation thyroidectomy medications - amiodarone and lithium

Question 26

clinical manifestations of hypothyroidism

Answer 26

fatigue, lethargy, sluggishness weight gain w anorexia cold intolerance dry skin, nails, hair weakness constipation irritable

Question 27

hypothyroidism complications

Answer 27

respiratory muscle weakness ACS

Question 28

what is myxedema

Answer 28

severe hypotension respiratory depression hypothermia lethargy coma

Question 29

hypothyroidism treatment

Answer 29

levothyroxine, lifelong med therapy levothyroxine increases effects of warfarin and sedative effects of opioids

Question 30

what causes hyperthyroidism

Answer 30

grave's disease = autoimmune excess iodine inflammation tumors

Question 31

hyperthyroidism hormone levels

Answer 31

increased T3 and T4 decreased TSH

Question 32

clinical manifestations of hyperthyroidism

Answer 32

goiter nervous, anxious, tremors arrhythmias, tachycardia heat intolerance increased appetite and weight loss diarrhea increased BP sweating exopthalmos

Question 33

thyrotoxicosis - thyroid storm

Answer 33

fever tachycardia abdominal pain decreased alertness elevated BP diarrhea

Question 34

treating thyroid storm

Answer 34

decrease body temp - ice packs, tylenol hydrocortisone humidified O2 IV fluid with dextrose digoxin or propranolol for arrhythmias

Question 35

treating hyperthyroidism

Answer 35

methimazole, propylthiouracil beta blockers radioactive iodine thyroidectomy

Question 36

hyperthyroidism nursing interventions

Answer 36

tele for thyroid storm heart failure manifestations small frequent meals, high calorie and protein daily weights avoid coffee, spice, alcohol

Question 37

thyroid cancer stats

Answer 37

3x more common in women is 90% of all endocrine cancers

Question 38

thyroidectomy care

Answer 38

monitor airway w trach kit at bedside notify provider at first sign of resp distress monitor for hematoma monitor hypocalcemia r/t parathyroid injury semi-fowler w pillows supporting neck avoid turning and talking too much