Unit 10 Endocrine Flashcards
How do hormones travel?
Through the blood stream
What does the endocrine system consist of?
body’s glands & their systems
The Hypothalamus is the link between what two systems?
Nervous and Endocrine
What hormone releasing gland is “In Charge” and stimulates organs?
The pituitary gland
What type of hormones does the pituitary gland release?
Tropic hormones
The pituitary gland releases what hormones and what are the target organs?
- Antidiuretic hormone ADH, Vasopressin (Kidneys)
- Thyroid stimulating hormone TSH (Thyroid)
- Adrenocorticotropic ACTH (Adrenal Gland)
What is the the function of ADH?
Regulation of fluid volume by stimulating reabsorption
What two things are regulated by ADH?
- Osmolality (substances in body fluids)
2. Volume of blood
If you have increased osmolality and decreased blood volume, what happens regarding ADH?
Stimulates ADH release which results in fluid being retained
With decreased osmolality and increased blood volume, what will happen regarding ADH?
ADH release is inhibited which results in fluid not being retained
Name the following electrolyte values: Urine specific gravity Na K Ca Mg Cl P
Urine specific gravity 1.010-1.025 Na: 135-145 K: 3.5-5.0 Ca: 9-11 Mg: 1.8-3 Cl: 96-106 P: 3.0-4.5
What are the ADH disorders?
Diabetes Insipidus (DI) - deficiency of ADH
Syndrome of Inappropriate ADH (SIADH)- excessive release of ADH
What are interventions for DI and SIADH?
Strict I&Os Urine specific gravity Urine & Serum osmolality Q4hr Weigh daily Educate family With DI---fluid replacement With SIADH---Fluid Restriction & Neuro assess
Is hypopituitarism or hyperpituitarism autoimmune?
hypopituitarism
For Diabetes Insipidus (DI) state whether the following will increase or decrease or whatever corresponds.
Urine output: Urine specific gravity: Urine osmolality: Serum osmolality: PT's weight: Blood Pressure: Medical treatment: Nursing Diagnosis:
Urine output: >250mL/hr Urine specific gravity: will be dilute Urine osmolality: decreased (think why) Serum osmolality: Increased (think why) PT's weight: decreased (poor skin turgor) Blood Pressure: decreased Medical treatment: DDAVP desmopressin synthetic ADH synthetic ex: vasopressin Nursing Diagnosis: FVD
For Syndrome of Inappropriate Diuretic Hormone (SIADH) state whether the following will increase or decrease or whatever corresponds.
Urine output: Urine specific gravity: Urine osmolality: Serum osmolality: PT's weight: Blood Pressure: Medical treatment: Nursing Diagnosis:
Urine output: decreased Urine specific gravity: > 1.025 Urine osmolality: increased Serum osmolality: decreased PT's weight: increased Blood Pressure: increased Medical treatment: Fluid restriction, Hypertonic solutions 3% saline Nursing Diagnosis: FVE
What can very low sodium induce?
Seizures
What is a transsphenoidal hypophysectomy?
Surgery to remove usually tumors (mostly benign) by pituitary gland through either nasal passageway or upper oral mucosa
What is the post-op care for a transsphenoidal hypophysectomy?
- Nasal packing 3-4 days
- Elevate HOB 15-30 degrees
- Prevent increased ICP (inter cranial pressure)
- Monitor for CSF (cranial fluid)
- Replace necessary hormones
- Assess for pain (HA and graft site)
- Check visual acuity
- Frequent oral care
- Monitor urine output
What could indicate CSF leak?
dark yellow ring on mustache dressing
What test is confirmatory for CSF leak?
Postive beta transferin test
What hormones are released from the Thyroid Gland?
T4-thyroxine
T3-tri-iodothyroxine
What happens if T3/T4 levels are high?
TSH is inhibited by the pituitary
What happens if T3/T4 levels are low?
TSH is released by the pituitary
What is the function of T4/T3?
Increases metabolism & energy requirements
What hormone does the parathyroid gland release
PTH- parathyroid hormone
What does PTH do?
- regulates calcium and phosphorus metabolism by acting on bone, kidney, and intestinal tract
- increases bone reabsorption thus increases the release of calcium from the bone into the blood stream
What is the most common type of Hyperthyriodism?
Grave’s Disease
Describe Grave’s disease.
- Autoimmune
- Abnormal immune system releases abnormal antibodies that mimic TSH, causing an overproduction of T3 and T4
Is Grave’s Disease more common in women or men?
Women
Is Grave’s Disease curable?
No, but it is treatable.
What is Goiter?
Enlarged thyroid
What can be assessed in Grave’s Disease?
- Goiter
- Weight loss
- Heat Intolerance
- Thin, brittle hair
- Easy fatigue
- Tachycardia/palpations
- Anxious/nervous/irritable
- Insomnia/difficulty concentrating
- +thrill (feel)
- +bruit (hear)
What is Exophthalmos and why does this happen?
Exophthalmos means bulging eye’s seen in Grave’s Disease because of increased deposit of fatty fluids.
What gland senses levels T3 and T4?
Pituitary gland
In Grave’s Disease, describe what happens with T3/T4 levels, TSH, and RAIU, and why.
- T3/T4 levels will be increased because of the overproduction of the thyroid gland, which will decrease TSH because the pituitary gland will detect high levels of T3/T4.
- RAIU (Radioactive iodine uptake) will be increased because Iodine is necessary for the synthesis of the thyroid.
What is important to stop ingesting before a PT does a Thyroid scan?
Iodine because it could show a false positive
What 3 categories of medication are given for Grave’s Disease, and what is/are the specific medication(s) for each?
> Anti-thyroid meds
- propylthiouracil (PTU)
- methimazole
> Iodines
-saturated solution of potassium iodine (SSKI)
> Beta adrenergic blockers
-propranolol
What is the side effect of anti-thyroid medications propylthiouracil (PTU) and methimazole?
Agranulocytosis- severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils causing a neutropenia in the circulating blood
What does propylthiouracil (PTU) do and how long does it take to work?
blocks thyroid hormone production and it takes a couple weeks
What does SSKI do and how must it be taken?
Saturated solution of potassium iodine (SSKI) decreases size of thyroid (it is short acting) and it is drinken through a straw because it can stain teeth.
Describe Radioactive Iodine Therapy (RAI) what is it used for?
Helps shrink thyroid. Takes about 6-8 weeks and 80% of PT’s become hypothyroid. Used for the treatment of Grave’s Disease (hyperthyroidism).
What is thyroid storm?
an exacerbation of symptoms of Grave’s Disease
What are Interventions for Grave’s Disease?
Radioactive Iodine Therapy (RAI)
Supportive Eye Care
Cardiac assessments
Surgery
What is a thyroidectomy?
removal of part or all of thyroid
What are post-op complications of Thyroidectomy?
Hypocalcemia
Laryngeal nerve damage
Hemorrhage
Airway obstruction (swelling post-op)
What are Trousseau’s and Chvstek’s signs and what do they indicate?
- Trousseau’s sign is a carpo-pedal spasm/flexion of wrist and hand indicating hypocalcemia.
- Chvstek’s sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve indicating hypocalcemia.
What decreases in Hypothyroidism or what becomes abnormal/impaired?
The following decrease with hypothyroidism:
- BMR (basal metabolic rate)
- GI motility (constipation happens)
- HR
- Energy leading to more fatigue
- Impairment of neurologic function
- Abnormalities in lipid metabolism
What is the most common type of Hypothyroidism?
Hashimoto
What lab finding are decreased or increased in Hypothyroidism and why?
- Decreased T3/T4
- Decreased RAIU (Iodine is necessary for synthesis of thyroid and with hypothyroidism you have less production of anything to do with the thyroid directly)
- Increased TSH because pituitary senses low T3/T4
What is the treatment for Hypothyroidism?
Levothyroxine sodium
Explain all the treatment details of Levothyroxine.
- Levothyroxine sodium is taken on an empty stomach
- Lifelong
- Taken early in the morning because it increases HR and metabolism (imagine if you took it at night)
- Couple of months until Levothyroxine sodium brings PT back to normal levels
- Check pulse daily and signs and symptoms of hypo/hyper-thyroidism
What is Myxedema Coma, what are clinical manifestations of it, and what usually causes it?
Myxedema Coma is a complication of hypothyroid like thyroid storm for Grave’s Disease and causes:
- hypotension, hypoglycemia, hypoxemia, hypercapnia (too much CO2 in blood), and significant drop in body temp.
- Usually caused when PT stops taking Rx, is sick, or is at end stage
How is Myxedema Coma treated in priority order?
Airway is most important, so the order is as followed:
O2, replace sugar, IV fluids, Give Levothyroxine
Where are the Adrenal glands located and what do they consist of?
Sides of the kidneys and are made up of the Adrenal Cortex (90%) and Adrenal Medulla (10%).
How is the pituitary gland divided?
30% posterior, 70% anterior
What hormones are excreted by the Adrenal Cortex, what do they do and what are the collectively known as?
Aldosterone (mineralo corticoid) - maintenance of extracellular fluid volume by holding onto sodium (Na) getting rid of potassium (K)
Cortisol (glucocorticoids)- metabolism of carbohydrates and protein
Androgens & Estrogens - sexual development of males and females
Collectively known as “steroids”
What are the hormones released by the Adrenal Medulla known as and what two are they?
Known as Catecholamines and they are epinephrine and non-epinephrine.
The adrenal medulla and its hormones are described as acting as what?
Fight or flight, the autonomic system
Hypo-function of Adrenal Gland is known as what?
Addison’s Disease.
What are the primary and secondary reasons for Addison’s Disease?
Primary: Adrenal Gland not producing enough hormones because of surgery, tumor, etc.
Secondary: Pituitary problem
What is the purpose of Adrenocorticotropic hormone (ACTH)?
Its key function is to stimulate the production and release of cortisol from the adrenal cortex of the adrenal gland.
What is the purpose of TSH?
TSH stimulates the thyroid to make the hormones T3/T4
PTs with hypo-function of Adrenal gland are at risk for developing what disease?
Tuberculosis
Describe what Addison’s disease is considered.
Mostly auto-immune and gradual
In hypo-function of Adrenal Gland (Addison’s Disease) what is there a decrease of?
Decrease of aldosterone, glucocorticoids (cortisol), and androgens.
Decrease in Aldosterone leads to what?
Decrease in Aldosterone leads to:
An increase in Na+ excretion which lowers BP leading to hypotension and and increase in K+ leading to hyperkalemia.
Describe the connection of Addison’s Disease to the pituitary gland with ACTH.
There is no inhibition of ACTH because of the decreased cortisol which means there is no negative feedback of ACTH.
What is physically observed with people who have Addison’s Disease?
Hyper-pigmentation, Bronze skin-ONLY IN PRIMARY ADDISON’s because in secondary pituitary doesn’t release MSH.
What are the 3 diagnostic evaluations of Addison’s Disease and details regarding them?
ACTH simulation test- Intramuscular, Cortisol levels decrease (in primary adrenal insufficiency)
Serum electrolytes: Na decreases, Potassium Increases, Glucose decreases. (think about why, you don’t have enough aldosterone)
24 hr urine free cortisol levels- decreased
What are the interventions for Addison’s Disease and explain.
-Replace glucocorticoids
>hydrocortisone PO, IV
-Replace mineralocorticoids
>fludrocortisone acetate
-Monitor I&O, weight QD, VS
-Teaching is important
>teach to eat salty diet
>to always wear medical alert bracelet (to not be mistaken for diabetic since symptoms are similar)
>take steroids in the morning with food to protect stomach
What is Addison’s crisis?
Extremely low levels of cortisol and aldosterone because of the adrenal glands hypo-functioning (Addison’s Disease) leading to extremely low sugar, low fluid volume, shock and then if not treated brain coma/death.
What are the interventions for Addison’s Crisis?
- Treat dehydration with D5 NS
- Replace steroids hydrocortisone/fludrocortisone
- Replace glucose with Dextrose 50%
- For hyperkalemia, insulin with dextrose (to shift K into cells)
What could be the causes of Cushing’s Syndrome (cortisol excess)?
- Adrenal tumor
- Long term high dose oral steroids
What is the difference between Cushing’s syndrome and Cushing’s Disease?
Cushing’s Disease is caused by the pituitary releasing to much ACTH -possibly because of a tumor, and
Cushing’s syndrome is excess cortisol secretion that doesn’t depend on stimulation from ACTH and is associated with disorders of the adrenal glands
What are the clinical manifestations of Cushing’s Syndrome (Cortisol excess)?
- Hyperglycemia
- Tissue wasting
- Weakness
- Poor wound healing
- Electrolyte imbalance (decreased K, increased Na)
- Hypertension
- Abnormal fat distribution (Moon face)
- Increased BP
- Increased susceptibility to infection (steroids are anti-inflammatory and could mask infection.
- Increased androgen production (increased acne, facial hair)
- mental changes such as memory loss & poor concentration
What are the diagnostic evaluations for Crushing’s syndrome?
- Hyperglycemia
- Electrolyte imbalance Na increased, K decreased
- 24 hr urine free cortisol levels increased
- Dexamethasone(steroid) suppression test
What is the Dexamethasone suppression test for and describe it.
Screening test for Crushing’s syndrome:
-Given at night. Pituitary should normally slow down, if cortisol level increased abnormal.
What are interventions that can be done for Crushing’s Syndrome?
- ) Surgery
a. Adrenalectomy (if adrenal problem)
b. Transsphendial hypophysectomy (if pituitary problem) - ) Radiation
- ) Medications
What is needs to be done regarding discontinuation of steroids?
They need to be tapered off to prevent Addison’s Crisis.
What are the two types of adrenalectomys?
Open and laparoscopic
What is the post-op care for an adrenalectomy?
- Monitor for hemorrhage (Vitals signs)
- Deep breathing, coughing, and incentive spirometer is needed. Pre-meditate so that they can, otherwise they’ll be in too much pain too do so.
- Monitor for hormone imbalances
- IV steroids
- Discharge teaching about lifetime steroid replacement needed if adrenal glands removed bi-laterally.
What can an excess of Catecholamine hormones be from?
And what does this mean?
Pheochromocytoma and it means overstimulation of sympathetic nervous leading to hyper metabolic state.
What is a Pheochromocytoma?
Usually benign tumor on adrenal medulla.
What are the signs and symptoms of Pheochromocytoma?
- Severe HPN
- Pounding headache
- Palpitations
- Profuse sweating
- Nervousness
What are the 5 H’s (s and s) to Pheochromocytoma
Hypertension, Headache, Hyperhydrosis, Hypermetabolism, Hyperglycemia
What are the 3 diagnostic evaluations for Pheochromocytoma and which is the most reliable?
> 24 hr Urinary Catecholamine and Metanephrine Test
-most reliable
> VMA (vanillymandelic acid) 24 hr urine
> MRI/CT (for tumors)
What is tetany?
neuromuscular irritability (tetany) muscle spasms caused by hypocalcemia
What is an euthyroid ?
having a normally functioning thyroid gland.
What is dilutional hyponatremia?
decreased serum sodium concentration associated with loss of sodium from the circulating blood through the gastrointestinal tract, kidney, skin, or into the “third space.” Accompanied by hypovolemic and hypotonic state.
What is thyrotoxicosis?
Overactive thyroid
Name 2 Anti-thyroid medications
propylthiouracil (PTU)
methamazole (Tapazole)
Name the Mineralocorticoid and the replacement Rx.
aldosterone; fludrocortisone (Florinef)
Name the Glucocorticoid and the replacement Rx.
cortisol; hydrocortisone
