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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
hyperthyroidism causes
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)
26
hyperthyroidism s/s
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
27
hyperthyroidism diagnostics
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
28
hyperthyroidism nursing mgmt
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
29
hyperthyroidism tx
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
thyroidectomy post op
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
thyroid storm (thyrotoxicosis or thyroid crisis)
sudden surge of thyroid hormones in blood = greater increase in metabolism
32
thyroid storm causes
uncontrolled hyperthyroidism (Grave's dx, infection, trauma, emotional stress, DKA, dog toxicity, after RAI)
33
thyroid storm s/s
hyperthermia (fever), htn, delirium, vomiting, ab pain, tachydysrhythmias, chest pain, dyspnea, palpitations
34
thyroid storm nursing mgmt
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
parathyroid gland
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
hypoparathyroidism
low calcium levels, low PTH levels and high phosphorus levels
37
hypoparathyroidism causes
destruction or injury during neck surgery autoimmune disease congenital neck radiation vitamin D def
38
hypoparathyroidism s/s
intermittent muscle spasms or muscle twitch laryngospasm/stridor/wheezing numbness or tingling around mouth, finger/hands, toes/feet confusion/seizures heart failure/arrythmias
39
severe hypocalcemia
tetany, chovstek's and trousseau signs = CNS/neuromuscular irritability
40
tetany
general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions (hypocalcemia)
41
chovstek's sign
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
trousseau sign
carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff (hypocalcemia)
43
hypocalcemia mgmt
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
hyperparathyroidism
overactive parathyroid gland + elevated PTH level Elevated PTH --> hypercalcemia --> bone thinning and kidney stones
45
hyperparathyroidism causes
adenoma (benign tumor) hyperplasia of parathyroid gland multiple endocrine neoplasia type 1 familial hypocalciuric hypercalcemia
46
hyperparathyroidism s/s
no symptoms or vague if only slightly over Severe/higher calcium levels: Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias
47
hyperparathyroidism tx
(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
hypercalcemic crisis
extreme elevation of serum calcium CND depression --> neurologic, cardiovascular, and kidney symptoms (life threatening)
49
hypercalcemic crisis tx
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
parathyroid diagnostics
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
adrenal cortex
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
adrenal medulla
secretes: Catecholamines (epinephrine & norepinephrine --> vasoconstriction) Epinephrine (fight or flight response = bronchiole dilation, inc BP, HR, BG)
53
Addison's disease
adrenocortical insufficiency destruction of adrenal cortex --> dec hormone production --> dec aldosterone + cortisol
54
Addison's disease causes
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
Addison's disease s/s
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
addison's disease diagnostics
Hypoglycemia, Hyponatremia, Hyperkalemia, Hypercalcemia, increased WBC, increased renal function diagnostics: serum ACTH and am cortisol levels, 1mg Dexamethasone suppression test, ACTH stimulation test
57
adrenal crisis
most serious complication of addison's disease (life threatening) rapid decline of cortisol + aldosterone critical hypotension, hypoglycemia, hyponatremia, hyperkalemia
58
dec cortisol
Liver: dec hepatic glucose output -> Hypoglycemia --> Coma/Death Stomach: dec digestive enzymes --> vomiting, cramps,diarrhea --> Hypoglycemia/Hypotension --> Shock --> Coma/Death
59
dec aldosterone
Kidney: Na+/H2O loss and K+ retention --> Hypoglycemia/Hypotension --> Shock --> Coma/Death Heart: Arrythmias and decreased cardiac output --> Hypotension --> Shock --> Coma/Death
60
adrenal crisis precipitating factors
Infection/Sepsis Trauma Stress: AMI, surgery, anesthesia, volume loss, hypoglycemia Adrenal Trauma --> Hemorrhage Abrupt Steroid cessation Adrenal gland thrombosis
61
adrenal crisis mgmt
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
Addison's disease med mgmt
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
addisons nursing mgmt
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
adrenal insufficiency probs
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
addison's disease pt teaching
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
Cushing's syndrome causes
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
cushing's syndrome
hypersecretion of cortisol = hypercortisolism adrenal gland disease
68
cushing's s/s
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
cushings labs
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
Cushing's nursing mgmt
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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