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NSG 470 - Exam 3 > Thyroid, Parathyroid, + Adrenal Glands Disorders > Flashcards

Thyroid, Parathyroid, + Adrenal Glands Disorders Flashcards

1
Q

endocrine system

A

cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions

hormones released by hypothalamus + pituitary gland control other endocrine glands

**negative feedback system

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2
Q

anterior pituitary hormones

A

ACTH (adrenocorticotropic hormone)
TSH (thyroid stimulating hormone)

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3
Q

thyroid hormones

A

T4 (thyroxine)
T3 (tri-iodothyronine)
calcitonin

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4
Q

parathyroid hormone

A

PTH (parathyroid hormone)

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5
Q

adrenal hormones

A

cortisol (glucocorticoid)
aldosterone (mineralcorticoid)

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6
Q

hypothalamus

A

function - maintain homeostasis

links NS w/ endocrine system via pituitary gland

secretes inhibiting or releasing hormones which stim or inhibit hormone release from anterior pituitary

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7
Q

posterior pituitary hormones

A

hypothalamus produces + releases ADH (vasopressin) + oxytocin
*Pituitary gland stores and releases when needed

ADH - inc water absorption into blood by kidneys

Oxytocin - stimulates contractions during labor and mild secretion in lactating women

hyperfunction - Syndrome of Inappropriate ADH (SIADH)
hypofunction - diabetes insipidus (DI)

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8
Q

anterior pituitary hormones

A

ACTH (Corticotropin) - stimulates adrenal cortex to produce cortisol

Thyroid Stimulating Hormone (TSH) - stimulates thyroid gland to secrete T3 + T4

growth hormone (GH) - essential to early years maintaining healthy body composition + growth in children, adults - aids healthy bone and muscle mass, + fat distribution

luteinizing hormone (LH) - works with FSH to ensure normal functioning of ovaries and testes

follicle-stimulating hormone (FSH) - works with LH to ensure normal functioning of ovaries and testes

prolactin - stimulates breast milk production

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9
Q

endocrine disorders

A

thyroid - hypothyroidism, hyperthyroidism

parathyroid - hypoparathyroidism, hyperparathyroidism

adrenal glands - Addison’s disease (adrenal insufficiency), Cushing’s disease (hypercortisolism)

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10
Q

TSH

A

inhibits or releases thyroid hormones

T3 + T4 = control cellular metabolic activity
*neg feedback system –> if T4 high, TSH dec; if T4 low, TSH inc
iodine in thyroid hormone

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11
Q

calcitonin (thyrocalcitonin)

A

secreted in response to high plasma calcium level

reduces serum calcium level by moving calcium back into bone

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12
Q

hypothyroidism

A

inadequate amounts of thyroid hormones –> dec metabolic rate affects all body system

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13
Q

primary hypothyroidism

A

dysfunction of thyroid gland, most common type

causes: autoimmune thyroiditis (Hashimoto’s Thyroiditis) - antibodies attack thyroid cells (genetic)
surgical removal of part/all thyroid gland, radiation
Other: thyroiditis d/t viral infection, Iodine (too much, too little), congenital
meds: amiodarone, lithium, Interferon, Interleukin-2, Immunotherapy

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14
Q

secondary hypothyroidism

A

failure of anterior pituitary gland to stimulate thyroid gland by inadequate secretion of TSH (tumor or radiation)

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15
Q

tertiary hypothyroidism

A

failure of hypothalamus to produce thyroid releasing hormone (TRH)

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16
Q

hypothyroidism s/s

A

*everything slows down

fatigue, forgetfulness, depression, weight gain, thinning of hair, dry, flaky skin, brittle nails, constipation, intolerance to cold, abnorm menstrual cycle, weakness, lethargy, bradycardia, hypotension, edema, can accelerate atherosclerotic disease

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17
Q

hypothyroidism diagnostics

A

radioisotope I-123 uptake will be low in hypothyroidism

contraindicated: pregnancy, iodine, shellfish allergy
if recent radiology exam - wait ~8 weeks
low iodine diet

EKG: sinus bradycardia, cardiac dysrhythmias

T3/T4: decreased

TSH: increased
Antibody tests (TPO/Anti-tg): increased if autoimmune dx is underlying cause

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18
Q

hypothyroidism tx

A

hormone replacement w/ Levothyroxine/Synthroid/Euthyrox/Euthroid (synthetic T4)
- armour thyroid: dried pig thyroid (t3/t4) - diff to regulate bc of variable serum levels
- liothyronine (t3)

lifetime med
take 1st thing in AM on empty stomach w/ 6-8 oz water ONLY
pt must wait 60 mins before eating, drinking, or taking other med to allow for med absorption

NO supplements w/ calcium, Vit D, Mg+, minerals, iron for @ least 4 hrs from levothyroxine
take same time everyday
dose starts low + is titrated up based on blood work (TSH +/- Free T4 or thyroid panel tsh, t3, t4)

elderly - only tx if symptomatic w/ lowest dose necessary risk of afib or tachycardia
can affect digoxin or warfarin levels + may need inc insulin

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19
Q

hypothyroidism nursing management

A

monitor weight, cardiovascular changes (low BP + HR, dysrhythmias), chest pain, edema, bowel movements (stool softeners, inc fluid, ambulation, cathartics), respiratory (ABGs, incentive spirometer, RR, lung sounds)

safety if mental changes, gradual activity w/ freq rest periods, anti-embolism stockings, activity intolerance, med admin, reassure pt, dietitian (low cal, high bulk, encourage fluids)

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20
Q

hypothyroidism pt education

A

meds - lifetime, when/how, avoid calcium + vit D supplements, iron for 4 hrs, same time everyday

pt not self-adjust or stop med if symptoms improve

follow up with provider + blood work

any testing instructions (I-123 scan, ultrasound)

diet to promote weight loss + improve bowel function

CALL PROVIDER IF s/s hyperthyroidism, risk of thyrotoxicosis (Acute)

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21
Q

myxedema coma

A

LIFE THREATENING - untreated hypothyroidism, poorly treated or due to major stressors

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22
Q

myxedema coma s/s

A

cardinal features:
1. hypothermia
2. altered mental status
3. CV depression (hypotension, bradycardia)

respiratory failure, hyponatremia (dec free water excretion + dec kidney perfusion), hypoglycemia (insulin eliminated slow), coma

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23
Q

myxedema coma nursing mgmt

A

ABCs
monitor for acute coronary syndrome/MI
ECG
BP - monitor for hypotension
monitor for mental status
ABGs - hypoxia, hypercapnia, respiratory acidosis
monitor body temp, extra blankets (AVOID heat sources –> vasodilation, vascular collapse)
fluid replacement
IV bolus levothyroxine –> IV levo til stable then oral
monitor for hypoglycemia
monitor for infection (UTI, sepsis)

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24
Q

hyperthyroidism

A

excessive circulating thyroid hormones
inc metabolic rate + oxygen consumption
EVERYTHING IS FAST

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25
Q

hyperthyroidism causes

A

Graves disease (toxic diffuse goiter) - autoimmune disease caused by excess stimulation of thyroid by circulating immunoglobulins

thyroid storm (thyrotoxicosis) - excess output of thyroid hormone

thyroiditis (immunotherapy, infection)

toxic nodular goiter - thyroid nodule caused by excess T4 + T3

exogenous hyperthyroidism (high dose of thyroid hormone)

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26
Q

hyperthyroidism s/s

A

nervousness, jittery, anxious feeling
tachycardia, palpitations
tremors
heat intolerance
excess sweating
freq stools
insomnia
inc appetite
weight loss
exophthalmos - edema is extraocular muscles + fat tissue behind eyes (graves) –> eyelid retraction, delayed movement
inc systolic BP
cardiac dysrhythmias - afib

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27
Q

hyperthyroidism diagnostics

A

labs
inc: TSH
dec: T4, T3, TSI (graves) + TRAB (graves)

tests
thyroid ultrasound - assess for nodules
EKG changes - tachycardia, a fib
radioactive iodine uptake (I-123 scan) or thyroscan - elevated uptake indicates hyperthyroid
contraindicated: pregnancy, iodine, shellfish allergy
if recent radiology exam w/ iodine contrast wait
~8 week
low iodine diet

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28
Q

hyperthyroidism nursing mgmt

A

minimize activity/planned rest periods
calm, cool environment, cool showers, reduce room temperature
increased calories/protein
I+Os, mon weight
eye protection prn
monitor temp (inc greater than 1 deg = report thyroid crisis)
monitor EKG for cardiac dysrhythmias
avoid excess palpation of thyroid gland
admin meds
prepare for surgery

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29
Q

hyperthyroidism tx

A

meds
thionamides: inhibits synthesis of thyroid hormone (doesnt remove present hormones)

methimazole/tapazole - tx of choice (mon CBC for agranulocytosis (ANC<0.1), thrombocytopenia and inc LFTs for liver toxicity)

propylthiuracil (PTU) - use if methimazole not tolerated (liver toxicity - elevated LFTs, dark urine, jaundice)

sodium or potassium iodide (Lugol’s soln, SSKI): inhibits release of thyroid hormone (used short term before surgery)

beta-blockers: treat tachycardia palpitations

other tx
radioactive I-131 therapy: destroys hormone producing cells in 1-3 tx (destruction of thyroid tissue); likely to become hypothyroid, req lifetime hormone replacement
post RAI: avoid preg woman, children under 1 wk; use diff toilet, flush x3 after use, separate clothing wash, dont share saliva

Surgery: subtotal or totaly thyroidectomy (some or full hormone replacement

30
Q

thyroidectomy post op

A

monitor + manage ABC: laryngeal spasm, swelling
monitor bleeding + hematoma formation: check posterior dressing
assess pain + provide pain relief
semi fowlers
assess voice - hoarseness-laryngeal nerve injury
NPO until cleared by speech w/ swallow test

pt education:
potential hypocalcemia, check Chvostek’s sign - tap face (facial twitch), Trousseau’s sign - bp cuff (palmar flexion), assess for c/o numbness/tingling around mouth and distal extremities, muscle cramping or spasm

31
Q

thyroid storm (thyrotoxicosis or thyroid crisis)

A

sudden surge of thyroid hormones in blood = greater increase in metabolism

32
Q

thyroid storm causes

A

uncontrolled hyperthyroidism (Grave’s dx, infection, trauma, emotional stress, DKA, dog toxicity, after RAI)

33
Q

thyroid storm s/s

A

hyperthermia (fever), htn, delirium, vomiting, ab pain, tachydysrhythmias, chest pain, dyspnea, palpitations

34
Q

thyroid storm nursing mgmt

A

ABCs (airway/oxygenation)
tx hyperthermia w/ cooling blankets, ice packs, tylenol (NO aspirin = inc free T4)
trach tray in room for emergency intubation
IV hydration to prev vascular collapse; monitor I/Os

admin methimazole or PTU to prev further synthesis + hormone release
admin sodium iodide to dec T4 output from thyroid gland - 1 hr after methimazole or PTU
admin b-blockers to block sympathetic NS
glucocorticoids if adrenal insufficiency is suspected or tx shock

35
Q

parathyroid gland

A

4 glands on posterior thyroid gland

makes PTH - to maintain normal calcium level in blood
PTH –> bone release calcium into blood, helps intestines absorb calcium from food, help kidney hold onto calcium + return it to blood instead of out in urine

phosphorus inverse relationship w/ calcium

calcitonin = secreted when high plasma calcium –> moves calcium into bone

36
Q

hypoparathyroidism

A

low calcium levels, low PTH levels and high phosphorus levels

37
Q

hypoparathyroidism causes

A

destruction or injury during neck surgery
autoimmune disease
congenital
neck radiation
vitamin D def

38
Q

hypoparathyroidism s/s

A

intermittent muscle spasms or muscle twitch
laryngospasm/stridor/wheezing
numbness or tingling around mouth, finger/hands, toes/feet
confusion/seizures
heart failure/arrythmias

39
Q

severe hypocalcemia

A

tetany, chovstek’s and trousseau signs = CNS/neuromuscular irritability

40
Q

tetany

A

general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions (hypocalcemia)

41
Q

chovstek’s sign

A

a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the ipsilateral mouth, nose, and eye (hypocalcemia)

42
Q

trousseau sign

A

carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff (hypocalcemia)

43
Q

hypocalcemia mgmt

A

restore calcium + electrolyte balance
supportive care for acute, life-threatening attack or tetany
cardiac monitoring
recombinant human PTH = inc Ca in blood
calcium gluconate IV (acute tetany) + Vit D (Calcitriol) needed
magnesium replacement
quiet environment, no drafts, no bright lights, no sudden movement
high calcium diet + low phosphorus
oral calcium + vit D for life

44
Q

hyperparathyroidism

A

overactive parathyroid gland + elevated PTH level

Elevated PTH –> hypercalcemia –> bone thinning and kidney stones

45
Q

hyperparathyroidism causes

A

adenoma (benign tumor)
hyperplasia of parathyroid gland
multiple endocrine neoplasia type 1
familial hypocalciuric hypercalcemia

46
Q

hyperparathyroidism s/s

A

no symptoms or vague if only slightly over

Severe/higher calcium levels: Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias

47
Q

hyperparathyroidism tx

A

(parathyroidectomy)
Hydration
Bisphosphonates (Zometa/Alendronate)—calcium back into bone
Cinacalcet dec amount of PTH the parathyroid glands make and lowers calcium levels in the blood

48
Q

hypercalcemic crisis

A

extreme elevation of serum calcium
CND depression –> neurologic, cardiovascular, and kidney symptoms (life threatening)

49
Q

hypercalcemic crisis tx

A

Rapid rehydration w/ IV isotonic saline fluids
Combo calcitonin and corticosteroids (emergencies)
Bisphosphonates
Goal: reduce serum calcium level by inc calcium deposition back into bone

50
Q

parathyroid diagnostics

A

Serum calcium, ionized calcium, PTH level, Vitamin D level, renal function
Ultrasound of neck
3D/4D CT scan of neck
Bone Mineral Density (DEXA) scan

51
Q

adrenal cortex

A

secretes:
mineralocorticoids (aldosterone - reabsorption of Na + excretion of K by kidneys)

glucocorticoids (cortisol - suppresses immune response, assist in stress response, BP maintenance + CV function, glucose, protein + fat metabolism

androgens/estrogen - fem/males traits

52
Q

adrenal medulla

A

secretes:
Catecholamines (epinephrine & norepinephrine –> vasoconstriction)

Epinephrine (fight or flight response = bronchiole dilation, inc BP, HR, BG)

53
Q

Addison’s disease

A

adrenocortical insufficiency

destruction of adrenal cortex –> dec hormone production –> dec aldosterone + cortisol

54
Q

Addison’s disease causes

A

primary: autoimmune disorder, infection, bilateral adrenalectomy, hemorrhage into gland, neoplasms, radiation

secondary: pituitary tumor, hypophysectomy, hypopituitarism, immunotherapy, abrupt cessation of long-time steroid use, radiation

55
Q

Addison’s disease s/s

A

Fatigue/muscle weakness
Weight loss/Appetite loss
ab pain
n + v
diarrhea
dehydration/dec urine output/salt craving
confusion/decreased coordination/anxiety/irritability
Hypotension/orthostasis
Dark bronze pigmentation of skin and mucosa/Vitiligo

56
Q

addison’s disease diagnostics

A

Hypoglycemia, Hyponatremia, Hyperkalemia, Hypercalcemia, increased WBC, increased renal function

diagnostics: serum ACTH and am cortisol levels, 1mg Dexamethasone suppression test, ACTH stimulation test

57
Q

adrenal crisis

A

most serious complication of addison’s disease (life threatening)
rapid decline of cortisol + aldosterone

critical hypotension, hypoglycemia, hyponatremia, hyperkalemia

58
Q

dec cortisol

A

Liver: dec hepatic glucose output -> Hypoglycemia –> Coma/Death
Stomach: dec digestive enzymes –> vomiting, cramps,diarrhea –> Hypoglycemia/Hypotension –> Shock –> Coma/Death

59
Q

dec aldosterone

A

Kidney: Na+/H2O loss and K+ retention –> Hypoglycemia/Hypotension –> Shock –> Coma/Death
Heart: Arrythmias and decreased cardiac output –> Hypotension –> Shock –> Coma/Death

60
Q

adrenal crisis precipitating factors

A

Infection/Sepsis
Trauma
Stress: AMI, surgery, anesthesia, volume loss, hypoglycemia
Adrenal Trauma –> Hemorrhage
Abrupt Steroid cessation
Adrenal gland thrombosis

61
Q

adrenal crisis mgmt

A

immediate IV steroids (hydrocortisone) - acute crisis - start w/ 100mg then 50 mg q 6 hrs
IV fluids - bolus NS for vol replacement + tx of salt wasting
tx hypoglycemia (D 50)
tx hyperkalemia
vasopressors (hypotension)
fludrocortisone when stable
antibiotics (infection)
VTE prophylaxis (hospitalized)
small, freq meals w/ high sodium, high protein, low potassium

62
Q

Addison’s disease med mgmt

A

glucocorticoids: oral hydrocortisone/prednisone/cortisone
(adrenocorticoid replacement therapy)
20mg in am and 10mg in afternoon ~4pm
Inc dose during stress (double dose for 2-3 days in times of illness)
Admin w/ food (gastric effects)

mineralcorticoid: fludrocortisone (prev dehydration/hypotension)
HTN potential SE
observe for cushing (moon face, edema, weight gain)
inc during pd of stress

63
Q

addisons nursing mgmt

A

PREV SHOCK
mon fluid/electrolytes
admin IV fluids
mon for dehydration; orthostatic vitals
I/O, daily weights
IV hydrocortisone
vasopressors (htn)
ECG, mon for arrthymias
mon + tx hyperkalemia
sodium-bicarb (acidosis + move K into cell)
mon + tx hypoglycemia
safe, quiet, calm environment
recumbent pos w/ elevated legs

64
Q

adrenal insufficiency probs

A

risk for fluid volume deficit = encourage fluid + foods high in Na; admin hormone replacement

activity intolerance + fatigue = avoid stress + activity; maintain quiet, non-stressful environment

self care deficit = weakness, fatigue, muscle wasting, altered sleep pattern

risk for infection = avoid crowds, s/s infection, inc daily hydrocortisone

65
Q

addison’s disease pt teaching

A

teach about dx, s/s, crisis
med adherence (dont stop hydrocortisone replacement)
avoid stress, strenous activity in hot weather, infection (crowds)
take med in noon + am
high protein, high carb, adequate Na intake
inc med dose during illness
med alert bracelet
emergency IM steroid (dexamethasone or hydrocortisone) - seek ER

66
Q

Cushing’s syndrome causes

A

long term corticosteroid use
excess cortisol (adrenal cortex)
pit tumor produces ACTH –> stims AC to secrete extra cortisol
ectopic prod of ACTH from cancer (lung - most common)
androgen + mineralcorticoids (oversecreted)

other: chemotherapy, immunotherapy, autoimmune

67
Q

cushing’s syndrome

A

hypersecretion of cortisol = hypercortisolism

adrenal gland disease

68
Q

cushing’s s/s

A

moon face
buffalo hump
purple striae of abdomen, breasts, upper arm
truncal obesity w/ thin legs
aseptic necrosis (femur)
osteoporosis
compression fracture of spine + spontaneous fracture
HF, HTN
acne, thin skin, ecchymosis
muscle weakness/myopathy
mood alterations
fluid/sodium retention
infection w/out fever
dec inflam response
poor wound healing
hirsutism
thinning, bald hair
hyperglycemia
altered calcium metabolism
hypokalemia
irreg menstruation
metabolic alkalosis
hyperglycemia
peptic ulcer disease

69
Q

cushings labs

A

inc: plasma cortisol, 24 hr urine, glucose, sodium, ACTH levels

dec: potassium, calcium, leukocytes

diagnostics: MRI of brain/pit, CT/MRI of adrenal, CT cap

70
Q

Cushing’s nursing mgmt

A

I/Os, daily weight
assess + tx hypovolemia
mon for htn, hypokalemia, crisis
safety
encourage physical activity
skin care
infection control/handwash
mon for GI bleed (black stools)
hyperglycemia

post op: HOB elev., nasal packing, freq mouth care, avoid inc ICP (nose blow,cough), mon CSF leak, n/v, diarrhea

hydrocortisone post op: daily weight, mon vitals, lytes, glucose, infection, stress dose/emergency IM

NSG 470 - Exam 3 (7 decks)

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