Nursing disorders of the endocrine system Flashcards
1
Q
What are the glands of the endocrine system?
A
The pituitary gland, the pineal gland, the thyroid gland, the parathyroid gland, the adrenal glands, the pancreas, the ovaries, the testes
2
Q
What hormones are produced in the anterior pituitary gland?
A
TSH (thyroid stimulating hormone), ACTH (adrenocorticotropic hormone), STH (somatotrophic hormone), FSH (follicle stimulating hormone), LH (luteinizing hormone), ICSH (interstitial cell stimulating hormone) and prolactin
3
Q
What hormones are released from the posterior pituitary gland?
A
Antidiuretic hormone (ADH) and oxytocin
4
Q
What hormones are released from the thyroid gland?
A
Thyroxin (T4) and tri-iodothyronine (T3), thyrocalcitonin
5
Q
What hormone is produced by the parathyroid gland?
A
Parathyroid hormone, which is also called parathormone
6
Q
What hormones are produced by the adrenal medulla?
A
Adrenaline and noradrenaline
7
Q
What hormones are produced by the adrenal cortex?
A
Corticosteroids and mineralocorticoids
8
Q
What hormones are produced by the pancreas?
A
Insulin, glucagon, somatostatin
9
Q
What hormones are produced by the ovaries?
A
Oestrogen, progesterone, relaxin
10
Q
What hormones are produced by the testes?
A
Testosterone, oestrogen
11
Q
What is thyrotropin releasing hormone?
A
A hormone that is produced by the hypothalamus in the brain - it stimulates the pituitary gland to produce TSH, which then stimulates the thyroid to release T4 and T3 from the thyroid gland.
If there is a deficiency in T4 or T3, this is noted in the brain, and as a result more TRH is produced - this is a negative feedback loop.
12
Q
What is the effect of too much TRH?
A
There is no real effect - remember it is not the cause of hyperthyroidism
13
Q
What is the effect of too little TRH?
A
That is the cause of hypothyroidism, as it causes an underactive thyroid
14
Q
Which species is affected most by hypothyroidism?
A
The condition mainly affects dogs but rarely affects cats too - it is the overall decrease in thyroid activity
15
Q
What are the symptoms of hypothyroidism?
A
- sensitivity to cold, and cold to the touch
- brittle, dull coat
- lethargy
- bilateral thickening of the coat, with dorsal alopecia
- thickened skin
- rapid weight gain
- bradycardia
16
Q
What is the treatment for hypothyroidism?
A
The treatment is lifelong - thyroid extract will be given daily, usually in tablet form such as Thyforon. Regular blood tests are required to monitor the disease and response to the medication
17
Q
What nursing interventions are important for hypothyroid patients?
A
Consider treatment in the context of their symptoms - they will be cold, so it is important to keep them warm. Their nutrition should be considered to prevent further weight gain, and HR should be regularly checked to monitor any bradycardia. Medication should be given accurately, as prescribed.
18
Q
What species is most affected by hyperthyroidism?
A
Mostly cats, but dogs can also be affected in rare cases. The patient will have an overactive thyroid, and be producing more T4 than they require. The body may attach the thyroid because of the overproduction of T4, which can cause a vicious cycle.
19
Q
What are some potential causes of hyperthyroidism?
A
Poor immunity, neoplastic changes, autoimmune disorders, or excessive intake of iodine, which may be from food or environment
20
Q
What is a food source with particularly high levels of iodine that cat owners should be advised against feeding?
A
Oily fish - salmon, sardines, mackerel, trout
21
Q
How is hyperthyroidism diagnosed?
A
Using a T4 blood test
22
Q
What are the symptoms of hyperthyroidism?
A
- hyperactivity and vocalisation
- polyphagia - the cat will never be satiated
- PU/PD
- tachycardia
- unkempt coat
- vomiting and diarrhoea
23
Q
What are some possible treatments for hyperthyroidism?
A
There may be medical management - felimazole/thyronorm given daily
Radioactive iodine therapy
Or surgical removal of the thyroid via a thyroidectomy
24
Q
What are some important nursing interventions for hyperthyroid patients?
A
- regular BP monitoring alongside normal TPRs
- regular grooming if it is tolerated
- accurate giving of prescribed medication
- a low sugar and starch diet to prevent diabetes developing
- monitoring urine output and kidney function
25
What is hyperparathyroidism?
Excessive production of parathyroid hormone from the parathyroid glands - it can be caused by hyperplasia, neoplasia, (primary hyperparathyroidism) or renal disease, nutritional disease (secondary hyperparathyroidism).
26
What are some possible causes of hyperprarthyroidism?
It can be primary (the problem is directly at the source) e.g. neoplasia or hyperplasia
Or secondary (the problem originates elsewhere in the body) e.g. renal disease or nutritional disease
27
What is primary hyperparathyroidism?
Hyperparathyroidism that originates at the parathyroid gland. May be neoplasia (for example adenoma, usually non-cancerous), or hyperplasia (overgrowth of the parathyroid gland, which is normally seen in older animals).
28
What is secondary hyperparathyroidism?
Hyperparathyroidism that originates away from the parathyroid gland e.g. renal disease results in increased phosphates, or nutritional disease e.g. poor diet, low calcium:phosphorus ratio, and lack of vitamin D3
Feeding diets high in phosphates, but insufficient in calcium, such as red meats and offal, causes this
29
What are some clinical signs of primary hyperparathyroidism?
- polydipsia
- polyuria
- inappetence
- lethargy
- weakness
The excessive hormone production then leads to hypercalcaemia
30
What are some possible side effects of secondary hyperparathyroidism?
There will be a lack of calcium in the body so it will be sought from other sources, such as bone - this can result in pathological fractures, lameness, and bone deformities such as osteoporosis
31
What is hypercalcaemia?
Elevated levels of calcium in the blood, which may be a result of primary hyperparathyroidism, malignant tumours (lymphoma and anal sac adenocarcinoma are the most common), hypoadrenocorticism, and chronic kidney disease
32
What are some of the most common causes of hypercalcaemia in dogs?
Primary hyperparathyroidism, malignant tumours (lymphoma and anal sac adenocarcinoma are the most common), hypoadrenocorticism, and chronic kidney disease
33
What are some nursing considerations for patients who are hypercalcaemic?
- monitor vital signs closely, especially HR
- monitor blood concentrations of calcium via blood tests
- IVFT with a lot of saline for diuresis
- monitor demeanour
34
What is hyperadrenocorticism?
Also known as Cushing's disease, it is the result of an dysfunctional adrenal (or pituitary) gland, and overproduction of corticosteroids
35
What species are usually affected by hyperadrenocorticism?
Dogs and ferrets are usually affected, but not cats
36
What are the two types of hyperadrenocorticism?
It may be pituitary based or adrenal based -
usually related to neoplastic changes and a tumour pressing on the respective gland. It may also be iatrogenic, and a result of long term glucocorticoid use
37
What percentage of cases of Cushing's are pituitary based?
80% of all cases
38
Define IATROGENIC
Refers to conditions caused by adverse effects of medical treatments or medications - not necessarily the result of negligence but can be related
39
What are some symptoms of hyperadrenocorticism?
- a sparse coat
- ascitic abdomen
- PU/PD
- lethargy
- paresis
40
How could Cushing's disease be diagnosed?
- an ACTH stimulation test
- endogenous ACTH assay
- low dose dexamethasone screening
- high dose dexamethasone screening
- abdominal ultrasound and/or radiographs
41
What is the treatment for Cushing's disease?
Treatment depends on whether the disease is pituitary or adrenal based -
if pituitary based, there will be drug therapy, usually some kind of chemotherapy
If adrenal based, the adrenal gland is normally removed, with the lack of adrenal gland causing no issues for the patient
42
What are some nursing interventions for Cushingoid patients?
Providing plenty of water and giving regular toilet breaks. There should be a low fat diet, and regular socialisation with the nurse to maintain mental wellbeing
43
What is hypoadrenocorticism?
Also known as Addison's disease, it originates with a problem in the adrenal gland. There is a reduction in steroid secretion by the gland, causing electrolyte imbalances, and then dehydration.
44
What age of animal is normally affected by hypoadrenocorticism?
Female patients between the ages of 4-7
45
What are the symptoms of hypoadrenocorticism?
- anorexia
- weakness
- vomiting and diarrhoea
- bradycardia
- hypotension
46
How are patients with hypoadrenocorticism treated?
With regular administration of steroids and regular blood tests to monitor for electrolyte imbalances
47
What do alpha cells produce?
Found in the pancreas, they produce glucagon, which increases blood glucose
48
What do beta cells produce?
Found in the pancreas, they secrete insulin, which decreases blood glucose
49
What do delta cells produce?
Found in the pancreas, they secrete somatostatin, which helps to maintain homeostatic balances
50
What are gamma cells?
Found only in the pancreas, they break down pancreatic peptides
51
What are the two types of diabetes mellitus?
Type 1, a complete insulin deficiency, which tends to affect dogs
Type 2, where the patient becomes resistant to insulin, which tends to affect cats and humans
52
Describe type 1 diabetes
A form of diabetes mellitus in which the patient has an absolute lack of insulin, as the animal's immune system is destroying its own beta cells. This type of diabetes is incurable. It is most common in dogs
53
Describe type 2 diabetes
A type of diabetes mellitus in which the patient becomes resistant to insulin, which is affected by obesity. Fat cells have a resistance to insulin and impedes its function. This type of diabetes commonly affects cats and humans and can be managed and even reversed through diet and insulin.
54
What is ketoacidosis?
A life threatening, uncontrolled form of ketosis - it is a type of metabolic acidosis caused by high concentrations of ketones, which are formed due to the breakdown of fatty acids and the deamination of amino acids, and a lack of insulin in the blood. The levels of ketones become unchecked, and the blood becomes acidic. It can often be smelled on a patient's breath (ketotic breath) and is usually only seen in unmanaged diabetic patients.
55
What are ketones?
They are products produced by the liver during the process of breakdown of fats. Their presence indicates that the body is breaking down its fat reserves for energy instead of glucose, which can be a normal process. In diabetic patients it can become dangerous and result in DKA
56
Define KETOSIS
A normal response to fasting; a state in which the body will used its stores of ketones from fat as its main energy source, in the absence of glucose.
57
What treatment is involved for DKA patients?
- fluid therapy to rehydrate the patient, correct acidosis and electrolyte imbalances
- short acting soluble insulin is given to reduce blood glucose levels in a controlled manner
- glucose, phosphate and electrolyte levels are measured very closely
58
What is the Somogyi effect?
A rebounding high blood sugar in response to low blood sugar - potentially a spike in blood glucose after a period of hypoglycaemia overnight. The body responds to hypoglycaemia by releasing counter regulatory hormones such as glucagon and adrenaline, which spur the liver to convert its stores of glycogen into glucose. The skeletal muscles also produce lactate, which the liver converts into even more glucose
59
In what form is glucose stored?
Glycogen. It is stored in the liver, as the liver cannot store glucose
60
What is the possible cause of the Somogyi effect?
Overuse of insulin - the animal appears unstablised when in fact doses of insulin are too high
61
How can a Somoygi effect be assessed?
Via a full 24hr glucose curve - a rapid drop in blood glucose levels of is seen in the hours immediately after insulin injection
62
How should a patient with a potential Somogyi effect be treated?
The patient should be started back on low insulin doses, which should be incrementally increased until the desired dosage and effect is achieved.
If there is persistent hyperglycaemia, which is not affected by insulin administration, insulin resistance should be considered.
63
What is diabetes insipidus?
Also known as ADH deficiency, it is an impairment in the production of ADH, or a lack of response to it. Generally it is failure of the kidneys to reabsorb water
64
What species is most affected by diabetes insipidus?
Dogs, although it can affect cats
65
What are the two forms of diabetes insipidus?
Central DI, or nephrogenic DI
66
Describe central diabetes insipidus
There is a complete deficiency of ADH hormone from the pituitary gland. It may be congenital or a result of damage to the hypothalamus, possibly through tumours or head trauma
67
Describe nephrogenic diabetes insipidus
This is a type of DI in which the collecting tubules in the kidney fail to respond to ADH
68
How will patients with diabetes insipidus present?
- marked PU/PD
- polyphagia
- very dilute urine, they will be isothenuric
- weight loss
- cachexia
- vomiting, especially after drinking large volumes of water
69
Define ISOTHENURIA
A condition in which the patient's urine is the same concentration as protein free plasma; around 1.008
70
How is diabetes insipidus diagnosed?
A vet may use a combination of USG, dipstick and sediment analysis, alongside an ADH response test. A water deprivation test may be done to determine if the patient has central or nephrogenic DI, but these are becoming more controversial
71
How is central diabetes insipidus treated?
With DDAVP (desmopressin acetate) a synthetic hormone that decreases urine output by mimicking ADH. It is given intranasal, injected, or via tablet.
72
How is nephrogenic diabetes insipidus treated?
With thiazide diuretics
73
What nursing considerations are there for diabetes insipidus patients?
To provide water, and monitor inputs and outputs. They should be allowed to toilet regularly, and kept clean around their back end in case of accidents. Normal TPRs as standard
74
What is diabetes mellitus?
A metabolic condition caused by a lack of insulin, or relative lack of insulin in the body. The lack of insulin often causes hyperglycaemia, which can cause the majority of clinical signs
75
What is usually the pathology of diabetes mellitus in dogs?
Usually they have type 1 diabetes, with the condition being a result of immune mediated destruction of beta cells in the pancreas
76
What is usually the pathology of diabetes mellitus in cats?
Usually they have type 2 diabetes, and they are obese. Fat cells in the body resist the function of insulin cells, so despite being able to produce it, it is ineffective.
77
What happens if diabetes mellitus is left untreated?
Fat stores are broken down in a process called ketosis, which can spiral out of control and lead to ketoacidosis. The patient will be dehydrated, acidotic, and have electrolyte abnormalities.
78
How do patients with diabetes mellitus present?
- PU/PD
- polyphagia
- obesity
The patient may develop glucosuria, glaucoma, cataracts, or a plantigrade stance
More developed cases will have vomiting, diarrhoea, anorexia, weight loss, depression, ataxia, and collapse, as these are the signs of ketoacidosis
79
What is glucosuria?
Glucose in the urine. May be seen in diabetes mellitus cases
80
What tests can be run to help diagnose diabetes mellitus?
Blood and urine tests - fructosamine can give a good idea of long term glucose levels.
Blood glucose curves are helpful to assess responses to insulin
81
What is the key to managing diabetes mellitus patients?
Consistency and routine in feeding times and insulin administration, diet and exercise. Owner education on how to watch out for signs of issues, and how to administer insulin correctly, is key
82
What is the normal routine for insulin administration for canine diabetes mellitus patients?
Insulin is usually given twice per day at the same time as meals. Diet should be high fibre, low protein, and low fat, and exercise should be regular, and consistent day to day
83
What are the two different sizes of insulin syringes?
Either 100iu/ml or 40iu/ml - these go hand in hand with different concentrations of insulin
84
What is the normal routine for insulin administration for feline diabetes mellitus patients?
Insulin is normally given twice per day around meal times - diet should be high protein or high fibre and low carbohydrate and can be given adlib or with insulin injection. Exercise and extra feeding can be difficult to regulate in cats especially if they are outdoor.
85
What is particular about diabetes mellitus in cats that is not true for dogs?
In some cases insulin therapy can be stopped if the cat enters remission
86
What is hyperglycaemia?
High levels of glucose in the blood, which can be a result of over or under dosing insulin.
87
How does an overdose of insulin result in hyperglycaemia?
Due to the Somogyi effect, which is a physiological response to hypoglycaemia which results in the production of several protective hormones to reverse it. Insulin is sometimes then increased to try to combat the hyperglycaemia, when in fact it is making it worse, and the dose should instead be lowered
88
What hormones are produced as part of the Somogyi effect?
- catecholamines
- cortisol
- growth hormone
- glucagons
89
What is hypoglycaemia?
Low levels of glucose in the blood, which can be a result of an insulin overdose, but is common in young and unmanaged animals
90
How will patients with hypoglycaemia present?
- lethargic
- ataxia
- muscle twitching
- severe seizures
Immediate action is required
91
What immediate action is required for hypoglycaemic patients?
Rubbing honey or glucose syrup on the gums, or administering IV dextrose as instructed by the vet. Without treatment, the patient may enter a hypoglycaemic coma and die
92
