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Module 4 > UNIT 4 ENDOCRINE DISORDERS > Flashcards

UNIT 4 ENDOCRINE DISORDERS Flashcards

1
Q

What are the functions of the Endocrine System?

A
  1. Maintain & Regulate vital functions
  2. Responds to stress & injury
  3. Growth and Development
  4. Energy metabolism
  5. Balances
    -Fluids, Electrolytes and acid base balances.
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2
Q

What puts patients at risk for endocrine disorders?

A
  1. Age
  2. Trauma
    -Trauma to the endocrine system or nearby
  3. Heredity
  4. Environmental factors
    -Exposure to chemicals/radiation
  5. Consequences of other disorders
    • ex. COPD patients– due to the use of steroids for longer periods of time they tend to developed endocrine issues secondary to COPD
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3
Q

Why is exposure to toxins important to know about the endocrine system assessment?

A
  1. Certain toxins– like farm chemicals, dust, herbicides and pesticides can put the patient at risk for endocrine issues
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4
Q

Why is integument important in your physical assessment

(endocrine disorders)

A
  1. We want to know how their tolerance to heat and cold are and if there have been any changes as that could indicate issues within the endocrine system?
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5
Q

Why is height and weight important in your physical assessment

(endocrine disorders)

A
  1. We want to know if they have lost weight? What is there weight distribution like? Have they gained weight esp. in specific areas of the body.
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6
Q

What effect can the endocrine system have on a patients mental and emotional status?

A
  1. Many endocrine disorders effect memory and mood
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7
Q

Physical assessment for the endocrine system should include the assessment of what?

A
  1. Vital signs
  2. Integument
  3. Height and weight
  4. Mental & Emotional status
  5. Head & Neck
  6. Thorax
  7. Abdomen
  8. Extremities
  9. Photographs
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8
Q

How is your metabolism effected by the aging of the endocrine system?

A

Assessment
1. Decreased cold intolerance
2. Decreased Appetite
3. Decreased HR & BR

Nsg Actions
1. Monitor- thyroid labs
2. Monitor- thyroid meds
3. Layer clothing/ covers
4. Nutrition
5. Constipation
6. Cognition

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9
Q

How is your ADH production effected by the aging of the endocrine system?

A

Assessment
1. Dilute urine even w/low fluid intake

Nsg Actions
1. Increased risk of dehydration
2. Offer fluids q 2 hr if not contraindicated

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10
Q

How is your estrogen effected by the aging of the endocrine system?

A

Assessment
1. Decreased bone density
2. Skin dry, thin and fragile

Nsg Actions
1. Risk for injury
2. Handle w/care
3. Reposition/turn q2 hr
4. Moisturize skin

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11
Q

True or false: Thyroid levels have a huge roll in heat and cold tolerance?

A

True

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12
Q

In older adults w/ a negative UTI what can you check to try and r/o cause of confusion?

A
  1. Thyroid levels
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13
Q

True or false: Your thirst mechanism can be effected by your endocrine system

A

True

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14
Q

What part (anterior or posterior) pituitary gland effects more organs?

A

Anterior

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15
Q

What organs can your anterior pituitary gland effect?

A
  1. Bone and soft tissues
  2. Adrenal cortex
  3. Thyroid gland
  4. Testes
  5. Ovary/Corpus luteum
  6. Breast
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16
Q

What organs can your posterior pituitary gland effect?

A
  1. Kidney
  2. Uterus
  3. Breast
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17
Q

What disorders might you see associated with issues in the anterior pituitary?

A
  1. Acromegaly– enlarged growth
  2. Dwarfism
  3. Cushing syndrome
    -Cushing’s disease
    • Cushing syndrome
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18
Q

What disorders might you see associated with issues within the posterior pituitary gland?

A
  1. Diabetes Insipidus (DI)
  2. Syndrome of inappropriate antidiuretic hormone (SIADH)
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19
Q

What does SIADH do to your ADH levles?

A
  1. Increased ADH which leads to an excess of H20 and a decrease in Na+
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20
Q

What are the causes of SIADH?

A
  1. Pituitary surgery
  2. Head injury, CVA or infection
  3. Malignant tumors secret ADH independently
    -(lung, pancreas, & Hodgkin’s lymphphoma)
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21
Q

What do we need to assess for with a patient suffering from SIADH?

A
  1. Fluid volume excess
  2. Weight gain
  3. H/A, altered LOC, Risk for seizure
  4. Concentrated amber urine
  5. Fatigue, N/V
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22
Q

What does SIADH do to the urine osm. & specific gravity?

A
  1. Increases
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23
Q

What does SIADH do to the serum osm. hct, BUN, NA

A
  1. Decreases
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24
Q

How is SIADH managed?

A
  1. Balance fluid & electrolyte balance
  2. Monitor- VS, CV, & Neuro, Weight, I&O (due to fluid overload)
  3. Monitor labs- electrolytes, serum, & Urine osm.
  4. Safety- confusion and seizures
  5. Radiation
  6. Surgery
25
Q

What is typically the 1st intervention a nurse might do a SIADH patient?

A
  1. Restrict fluids (including IV fluids) to 800-1000ml in a 24 hour period. In severe SIADH patients we may have to restrict up to 500mL.
26
Q

What medications might be used in managing SIADH?

A
  1. Vasopressin antagonist- Declomycin (demeclocycline)
  2. Diuretics- lasix
  3. Sodium- PO or IV
27
Q

How many pounds gained in one day is concerning

A

2lbs per day or 5 lbs in a week

28
Q

What should the nurse be mindful of when caring for an SIADH patient?

A
  1. Altered thought processes
  2. Fatigue
  3. Nutrition- Less than requirements
  4. Knowledge deficit on patients behalf
29
Q

What should we educate our patients with SIADH on ?

A
  1. Medication
  2. Symptoms to report
  3. Fluid restrictions
  4. Daily wts.
30
Q

As the nurse what should we evaluate with SIADH patients

A
  1. Medication compliance
  2. Cognition
  3. Labs WNL
  4. Wt. & fluids monitored
  5. No seizures
31
Q

What is happening with your ADH in DI?

A

Decreased which leads to excessive H20 loss r/t Polyuria?

32
Q

What are the causes of DI?

A
  1. Primary- malfunction of posterior pituitary
  2. Secondary
    • trauma
    • CNS infection
    • CVA- recent
  3. Nephrogenic- kidney not sensitive to ADH
    -Electrolyte, medications, genetic
33
Q

What are we assessing for in patients with DI?

A
  1. Fluid volume decrease
  2. Polyuria
  3. Polydipsia
34
Q

What does labs look like in a DI patient?

A
  1. Decrease urine SG & osmolality
  2. Increase serum NA, Osmolality
35
Q

What does the appearance of urine look like in a DI patient?

A
  1. Clear almost see through
36
Q

True or false: With DI patients reducing fluid intake won’t reduce the amount of urine they put out?

A

True

37
Q

How do we test for DI testing?

A
  1. Fluid deprivation test- Take patients wt. prior to test–withhold fluids for about 8-12 hours and take weight every 2 hours.
    -What we are looking for is do they have 3-5% body weight loss
  2. Plasma levels of ADH & osmolality
  3. Urine osmolality
  4. Synthetic vasopressin trail.
38
Q

How should we manage DI?

A
  1. Identify and correct the underlying cause
  2. Fluid & Electrolyte balance
  3. Monitor- VS, CV, Neuro & Weight
  4. Replace ADH- DDAVP (Neurogenic DI)
  5. Surgery if pituitary
39
Q

What is the MOA of ADH- Vasopressin?

A

Promotes renal conservation of water

40
Q

What is ADH (Vasopressin) used for?

A

DI, Vasodilatory shock, nocturnal enuresis

41
Q

What are adverse effects of ADH (vasopressin)?

A

Vasoconstriction & Increase BP, H/A, Chest pain, water intoxication

42
Q

ADH (Vasopressin) is contraindicated for what patients?

A
  1. Contraindicated for kidney failure patients (dont repsond)
43
Q

What is the nsg care for ADH (vassopressin)?

A
  1. Monitor BP, HR, EKG, I&O, urine osm. dehydration vs. fluid overload
44
Q

What are patient teachings for ADH (vasopressin)

A
  1. No alcohol, medic alert ID, limit fluid intake, really important that this drug is maintained
45
Q

What is MOA of desmopressin acetate (DDAVP)

A

Decrease UO & Increase urine osm

46
Q

What is desmopressin acetate (DDAVP) use?

A

Neurogenic DI, Nocturnal enuresis

47
Q

What are some adverse effects of desmopressin acetate (DDAVP)?

A

Erythema of injection site, nasal irritation, hyponatremia (seizure), DOES NOT RAISE BP

48
Q

What are contraindications of desmopressin acetate (DDAVP)?

A
  1. No concurrent use of loop diuretic or glucocorticoids, hold if creatinine clearance <50mL/min
49
Q

What are the nsg care for desmopressin acetate (DDAVP)?

A
  1. Monitor I&O, serum & urine osm, dailty weight, assess for hypovolemia & hypervolemia
50
Q

What should our teachings consist of for desmopressin acetate? (DDAVP)?

A
  1. No alcohol, medical alert bracelet, how to administer (inj)
51
Q

What are some nursing problems we should keep in mind for dI management

A
  1. Fluid volume deficit
  2. decreased cardiac out put
  3. Knowledge deficit
  4. Risk-Skin integrity, constipation, injury (injury related to neuro or orthostatic hypotension)
52
Q

What should we educate our DI patients on?

A
  1. Medication- Rx & OTC
  2. Symptoms to report
  3. Fluid balance
  4. Daily wt.
53
Q

What should we evaluate with our DI patients?

A
  1. Medication administration
  2. Labs WNL
  3. Wt return to baseline
  4. Monitor: wt, & i&O
  5. Skin turgor WNL
54
Q

In DI what does the acronym DILUTE stand for?

A

D-dry
I- I&O, daily weight
L-Low specific gravity (in urine)
U-urinates lots
T- Treat= pituitary gland
E- Rehydrate

55
Q

How surgery might be used to treat pituitary tumors?

A
  1. Transsphenoidal pituitary surgery
    -Hypophysectomy
56
Q

What is the basic post op care of hypophysectomy?

A
  1. raise HOB
  2. Monitor I &O’s, electrolytes, osmolality
  3. Incision care
  4. D/C teaching
57
Q

What should we know about hypophysectomy post op care of the incision?

A
  1. Under upper lip along gum line or through the nose
  2. Abd incision-fat graft site
  3. Nasal drip pad
58
Q

What is the specific discharge teaching for hypophysectomy post op care?

A
  1. Brushing teeth
  2. Caution Re: Activity that increases ICP
  3. Corticosteroid & Thyroid replacement.
59
Q
A

Module 4 (29 decks)

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