Module 7 Endocrine Flashcards
What are the general functions of the endocrine system?
•a role in reproductive & CNS development in the fetus
•stimulating growth & development during childhood & adolescence
•sexual reproduction
•maintaining homeostasis
•Responding to emergency demands
What are the glands of the endocrine system?
-Hypothalamus
-pituitary
-thyroid
-parathyroid
-adrenals
Non really tested:
-pancreas
-ovaries
-testes
-pineal
What do glands do?
Make and release Hormones
Structure of hormones
-secretions in small amounts at variable but predictable rates
-regulated by a feedback system
-non-target (non specific) vs target (specific)
What are the H20 soluble (protein based) hormones?
•prolactin (nursing/breast milk)
•oxytocin (binding hormone- mood; contractions in pregnancy)
•growth hormone
•insulin & glucagon
•leptin- fat production
What are the lipid soluble (cholesterol based)
•testosterone & estrogen (sex hormones)
•cortisol (stress response)
Explain the role of the hypothalamus
•interrelationship w/the pituitary by releasing substances to stimulate or inhibit hormones of pituitary gland (they work together)
•also responsible for coordinating expressions like fear, anger, and pleasure
Explain the role of the pituitary gland
•hormones associated = T3 & T4
-Anterior:
•regulated by the hypothalamus
•secretes the tropic hormones, •secretes growth hormone, prolactin
-posterior:
•secretes ADH (fluid volume deficit)
•secretes oxytocin
Explain the role of the pineal gland
•located in the brain
•primary function: secrete melatonin
•helps regulate circadian rhythm & the reproductive system at the start of puberty.
night shift jobs may interfere with getting pregnant because the hormones are out of whack
Explain the role of the thyroid gland
•HIGHLY VASCULAR*
•located in the anterior part of the neck
•Thyroid hormones:
-thyroxine (T3)
-Triiodothyronine (t4)
-calcitonin (released when there’s too much Calcium in the blood)
Too much hormone leads to disorders/enlarged glands
Explain the parathyroid gland
When thyroid is high or low this gland kicks in to help regulate
•typically 2 pairs (4 total) behind thyroid gland
•major role to regulate calcium *
•PTH promotes calcium reabsorption the kidneys, promotes phosphate excretion, stimulates transfer from bone to blood, stimulates conversion of vitamin D to active form, leading to absorption in G.I. tract
Explain Adrenal gland function
Regulates off cholesterol*
•each gland has 2 parts: medulla & cortex
-medulla: secretes catecholamines
-cortex: secretes several steroid hormones:
•Glucocorticoids (most abundant/potent, glucose metabolism, anti-inflammatory)
•mineralocorticoids (aldosterone, promotes renal absorption, regulate sodium/K+)
•Androgens
Explain pancreatic structure
•responsible for insulin**
•has both endocrine & exocrine functions
•secretes 4 different types of secreting cells:
- “a” cells: make & secrete Glucagon
- “B” cells: make & secrete insulin
- “Delta” cells: secretes somatostatin (also has glucose control)
- “F” cells: secrete pancreatic polypeptide
What are gerontological considerations for endocrine system?
• decreased hormone production and secretion
• altered form on metabolism and biological activity
• decreased responsiveness of target tissues to hormones
• changes in circadian rhythms (less sleep)
• symptoms of endocrine issues in elderly may be perceived as normal aging changes (incorrect)
Explain SIADH (syndrome of inappropriate antidiuretic hormone) & symptoms
• Caused by over-production of ADH
• increased GFR /decreased sodium (dilution)
•S/S: low urine output, increased body weight, thirst, dyspnea, fatigue, hyponatremia symptoms (cerebral Edema seizure precaution)
Nursing management of SIADH
•fluid restriction
•daily weights
•I&O
Tx: if mild (Na over 125 mEq/L, they only need fluid restriction 800 -1000 mL/day
Severe: HYPER-tonic fluids
Meds:
•lasix (Furosemide -diuretic)
•conivaptan (vaprisol) & tolvaptan (samsca) Blocks activation of ADH from releasing raises sodium levels to try to balance the problem
HOB: flat, no more than 10°. Heart will regulate the problem to decrease ADH. 
Explain Diabetes Insipidus
•urine odorless/tasteless
•increased sodium/concentrated urine
• under production of ADH or decreased renal response to ADH
• usually acute with excessive fluid loss 2 - 20 L/day!!
Dx: water deprivation test, 8 to 12 hours without fluid
S/S: polyuria and polydipsia, tired, weakness, hypotension, tachycardia, hypernatremia (dehydration symptoms)
Med: desmopressin helps with decreasing polyuria
Nursing management for diabetes insipidus
Goal: maintain fluid and electrolyte balance -limit sodium intake
Assess: I&O, glucose, VS, LOC (hypernatremia)
Fluids: hypotonic or D5W
Meds:
-Desmopressin
-chlorpropamide & carbamazepine (tegretol) -anti-seizure med but helps increase thirst so Pt drinks more
-thiazide diuretics (decreases urine production- helps polyuria
-NSAIDS (indomethacin {indocin}) has anti-diuretic effect
Difference between DI VS. SIADH
DI:
-high urinary output
-low levels of ADH
-Hypernatremia
-dehydrated
-lose too much fluid
-excessive thirst
SIADH:
-low urinary output
-high levels of ADH
-hyponatremia
-over-hydrated
-retention of fluid
What are the 5 thyroid gland disorders?
•goiter
•Hashimoto’s thyroiditis
•hyperthyroidism
•Graves disease
•Hypothyroidism
Thyroid problems are the most common endocrine disorders
Goiter overview
•cause: iodine deficiency, hypo/hyperthyroidism
•TSH, T4, & thyroid antibodies are checked to verify function
•tx: depends on cause /severity
What goitrogen- rich foods may affect thyroid function? TEST
AVOID:
-broccoli
- kale
-cauliflower
-strawberries
-red wine
-soy products
-peanuts
-teas
-peaches
-mustard
Iodine rich foods to add to Pt diet TEST
-spinach
-figs
-lentils
-kidney beans
-potatoes
-oats
-soybeans
-quinoa
-almonds
Thyroiditis overview
•goiter could be d/t this disorder
• inflammation of the thyroid gland
•can be viral, bacterial, or fungal
-S/S: pain, localized in thyroid region are radiating to throat, ear, or jaw or systemic symptoms: pain, fever, aches, chills, fatigue, sweating
•most common: Hashimoto’s Thyroiditis
Hashimoto’s Thyroid overview
•attacks good cells/antibodies
•Pt’s are at risk for other immune disorders
•hallmark sign: goiter
•caused by: destruction of thyroid tissue by antibodies
•risk factors: female, family Hx, elderly, white ethnicity
•S/S: low energy, slow metabolism, painless, may be rapid enlargement, change in voice, cough, breathing issues
•Dx: draw labs
-T3/T4 initially elevated then decrease (increase inflammation, decreased thyroid tissue destroyed)
-TSH increased
-Antithyroid antibodies elevated
Nursing management for thyroiditis 
Tx:
Abx or surgical drainage if bacterial (recovery is weeks to months)
• thyroid replacement (levothyroxine)
•NSAIDs & corticosteroids for post-op discomfort
Tell patient to report:
shortness of breath(call 911), bleeding, swallowing problems
Hyperthyroidism
-Larger in size than normal, more common in women
- hyperactivity and thyroid gland
- types: Graves**, toxic, nodular, goiter, thyroiditis, excess iodine intake, pituitary tumor, thyroid cancer
-Thyrotoxicosis: (thyroid storm- excess T3/T4)
Graves Disease
• auto immune disease (75% d/t hyperthyroidism)
• causes: lack of iodine, smoking, infection, stress
• can go into remission or have Exacerbations
• progressive disease may destroy thyroid tissue
• often associated with other auto immune disorders.
S/S of Graves Disease
•Exophthalmos bulging eyes, might not be able to close eyelids which can cause ulcers infection, and dry eyes
•high metabolism causing weight, loss, nervousness, sweating, jitteriness, fatigue, palpitations
•Acropachy- swelling of fingers/nails deformed
•confusion (hard to diagnose an elderly patients)
•Graves’ dermopathy “pretibial Myxedema” - red thickening skin on shins and feet - rare/severe sign
Tx/ nursing management for Graves’ disease
Teach Pt do not abruptly stop medications. 20-40% the patients will go into spontaneous remission after 6 months-1 year.
Meds: first line = methimazole/Tapazole (anti-thyroid)
-iodine
-B-adrenergic blockers (blocks sns, decreases BP, HR, Jitters/anxiousness)
-may take 6-8 weeks to see results
Explain iodine therapy & RAI TEST
•reduces vascularity of thyroid to decrease bleeding during surgery
•Radioactive Iodine Therapy (RAI):
-radiation thyroiditis is possible -can cause dryness and irritation of mouth
-limit exposure to others use private bathroom, flush multiple times, separate laundry, don’t prepare food for others, avoid children and pregnant women for 7 days after therapy.
•gargle soda water 3-4x/day, Benadryl, antacids, lidocaine
Surgical therapy : thyroidectomy
90% of the thyroid must be removed to be successful
•subtotal/ total removal
•may be done via endoscopy or robotic surgery
•may be used if Pt needs rapid reduction in T3/T4
•high caloric/high protein (helps prevent tissue breakdown & to not lose too much weight)
Post-op care for thyroidectomy
monitor airway
•assess for bleeding (behind neck could be pooling)
•monitor calcium levels (d/t possibly removal of parathyroid)
•neck ROM (be very careful, support head when turning)
Complication of thyroidectomy & S/S TEST
Thyrotoxicosis - thyroid storm
S/S:severe tachycardia, shock symptoms, hyperthermia (106), agitation, delirium, seizures, abdominal pain, vomiting/diarrhea, coma
Book: 1155 table 49.11,49.12
Hypothyroidism
•deficiency of thyroid hormone
•primary: caused by destruction of thyroid tissue or defective hormone synthesis
•secondary: caused by a pituitary disease with decreased thyroid hormones
• iodine deficiency -most common cause in the world (not US)
• most common cause in the US is thyroid atrophy
S/S of hypothyroidism
•slowing of body processes
•tired, lethargic
• personality changes, impaired memory, slowed speech, decreased initiative, depressed appearance, weight gain
• Cardiovascular problems: decreased contractility, SOB on exertion, decreased cardiac output
• high serum cholesterol & triglycerides
•anemia (d/t decreased cardiac output, not perfusing to kidneys, decrease in blood production)
Complications: Myxedema (hypothyroidism)
• results from accumulation of hydrophilic, mucopolysaccharides, dermis, & other tissues
• skin becomes puffy, swollen, “mask-like” appearance
• myxedema coma is a medical emergency: subnormal temperature (keep pt warm), hypotension, hypoventilation, hyponatremia, hypoglycemia, lactic acidosis
•Tx: IV, thyroid replacement, support vital functions
Tx/ nursing management of hypothyroidism
•Goal: restore euthyroid state safely and rapidly, relieve symptoms, maintain positive self image, adhere to new medication regimen
• low calorie diet
• lifelong therapy of levothyroxine
• Carefully monitor patient with CVD, monitor HR>100 or irregular HR, report CP, weight loss, nervousness, tremors, or insomnia
Levels of hyperparathyroidism
Increased secretion of PTH
•Primary: due to increased secretion of PTH. Most common cause: adenoma in parathyroid gland
•Secondary: compensatory response to conditions that induce or cause hypocalcemia
•Tertiary: d/t hyperplasia of parathyroid glands and loss of neg feedback from Ca, kidney transplant
S/S of hyperparathyroidism
•Some people asymptomatic
•S&S related to high Ca levels (moving from bone to blood)
•Complication: osteoporosis, renal failure, kidney stones, pancreatitis, cardiac changes, and fractures
•Dx: Chem panel (BMP-electrolytes), uric acid, creat(kidneys), possibly bone density test if needed
Tx/ nursing management of hyperparathyroidism
•Parathyroidectomy (rapidly decreases calcium levels- look for tetany**)
(Meds aren’t tested)
•Conservative tx for asymptomatic or mild cases
•IV sodium calcium, loop duertics (furosemide)
•Bisphosphonates (alendronate (Fosamax)
•Calcimimetic agents (cinacalcet (Sensipar)
Hypoparathyrodism overview
*not very common
•hypocalcemia d/t lack of PTH
•most common cause: accidental removal of parathyroid glands or damage to vascular supply of glands
•usually occurs later in life, associated with other endocrine disorders
•severe hypomagnesemia can suppress PTH (ex: malnutrition, alcoholism, CKD)
S/S of hypoparathyroidism
•Review Hypocalcemia!
•Tetany, tingling in lips, stiffness in extremities
•Painful tonic spasms of smooth and skeletal muscles
•Lethargy
•Anxiety
•Personality changes
• Decrease Ca and PTH levels, Increased Phos
Tx/nursing management of hypoparathyroidism TEST
Goal: treat acute complications
•IV Ca for emergency tx of tetany. Give SLOW! (It’s harsh to veins, don’t give in hand)
•Rebreathing (decreased CO2 excretion , ph decreased leads to more available CA+)
•Long term nutritional therapy (high calcium food, CA+ supplement, vitamin D/magnesium) - continuous tele monitor, monitor vitals
Book 1161 rebreathing info*
Cushing syndrome overview
Cause: excess/chronic corticosteroids (prednisone)
•disorder of adrenal cortex
•seriously ill Pt
•Dx: midnight or late-night salivary cortisol, low-dose dexamethasone suppression test, 24 hr urine cortisol test. (Not tested just review)
S/S of Cushing’s syndrome TEST (possible SATA)
•weight gain most common
•moon face, buffalo hump
•hyperglycemia
•muscle wasting
•osteoporosis, back pain
•purplish red striae (stretch marks), acne
•menstrual disorders & hirsutism, impotence, gynecomastia
Tx/nursing management of Cushing’s syndrome
•Goal: Normalize hormonal secretions
•Tx underlying causes.
•Adrenalectomy if causes by adrenal tumor or hyperplasia (given short term steroids to respond to stress of surgery)
•Radiation therapy
•Drug therapy (if surgery is not an option): Ketoconazole & Mitotane (help inhibit sterogenosis) used with caution-toxic (normally tx cancer)
Book: 1164, 49.18 important*
Addison’s disease overview
•adrenocortical insufficiency
•may be with other autoimmune (DM type 1, pernicious anemia, celiac disease)
•TB is a big cause of Addison’s worldwide (not USA- 80% is autoimmune is US)
•other causes: amyloidosis, fungal infections, AIDS, cancer, adrenal hemorrhage
S/S of Addison’s disease
• anorexia, nausea weight loss
• progressive weakness, fatigue, joint pain
• bronze colored skin
• abdominal pain, diarrhea
• heart attack, orthostatic hypotension
•salt craving
Complications of Addison’s disease TEST
•Addisonian crisis: life- threatening emergency - triggered by: stress, sudden withdrawal of corticosteroid, hormone therapy, adrenal surgery, or sudden pituitary gland destruction
S/S: hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypo, glycemia, fever, weakness, confusion
• May lead to shock and circulatory collapse
Book: 1165
Tx/ nursing management of Addison’s disease
•monitor FVD & F&E
•lifelong hormone therapy
• corticosteroids may need to be increased during life stressors (adrenal gland was responsible, now removed)
• teach Pt S/S of Cushing’s disease- may cause Cushing’s, d/t surgery & become hypo
• Carry emergency kit with 100 mg IM hydrocortisone
•monitor daily weights, I&O’s, BP, increase salt intake
