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NURS363 - Practice of Nursing IV > Week 9: Endocrine Function Alterations > Flashcards

Week 9: Endocrine Function Alterations Flashcards

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1
Q

Endocrine System plays a vital role in…

A

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

coordinating and regulating long term changes in fxn of all body organs and tissues to maintain homeostasis

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2
Q

Endocrine involves a ___ ___ system

A

negative feedback system

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3
Q

4 categories of hormones

A

amines and amino acids

peptide (protein): act on cell surface

steroid - act inside the cell

fatty acid derivative

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4
Q

Major Hormone Secreting Glands

A

Hypothalamus

Pineal

Pituitary

thyroid

Parathyroid

adrenals

islets of Langerhans (Pancreas)

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5
Q

Posterior Pituitary Gland

A

regulates fluid balance and facilitates childbirth and prostate gland function

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6
Q

What 2 Hormones does the Post. Pituitary release

A

ADH/Vasopressin

Oxytocin

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7
Q

Anterior Pituitary Gland

A

produces and release several different hormones (most of which regulate secretion of other hormones)

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8
Q

Important Anterior Pituitary Hormone

A

TSH - Thyroid Stimulating Hormone

Stimulates the thyroid gland which will then determine the rate of cellular metabolism

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9
Q

Thyroid Gland

A

determines rate of cellular metabolism

in children, hormones are responsible for normal development of skeletal, muscular, and nervous system

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10
Q

Thyroid Hormones

A

ACTH - Adrenocorticotropic Hormone

FSH - Follicle Stimulating Hormone

LH - Luteinizing Hormone

PRL - Prolactin

GH - Growth Hormone

Calcitonin

Thyroxine (T4) and Triiodothyronine (T3)

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11
Q

Parathyroid Glands

A

Monitor and maintain circulating concentration of calcium ions

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12
Q

Pancreas

A

endocrine gland and organ

regulates blood glc concentrations and is associated with DM

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13
Q

Adrenal Medulla

A

increases cellular energy use and muscular strength, endurance, and mobilizes energy reserves

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14
Q

What hormones does the Arenal Medulla Release

A

catecholamines

EP and NEP

mobilized glycogen reserves

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15
Q

Adrenal Cortex

A

hormones that play a vital role for bodies survival and affects metabolism of many different tissues

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16
Q

Adrenal Cortex Hormones

A

Glucocorticoids: cortisol, corticosterone, etc

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17
Q

Female Gonads and Hormones

A

ovaries

regulates secondary sexual characteristics and reproduction

estrogen

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18
Q

Male Gonads and Hormones

A

regulate secondary sexual characteristics and reproduction

testes

androgens and FSH

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19
Q

Common Lab Tests for Endocrine Disorders

A

Pituitary - GH and water deprivation test

thyroid - TSH, T3, T4

Parathyroid - serum calcium and phosphate

Adrenal - cortisol, aldosterone, urinary 17 ketosteroids

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20
Q

Urine Tests

A

to measure the amount of hormones or the end products of hormones excreted by the kidneys

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21
Q

Stimulation Tests/Suppression Tests

A

diagnostic tests for endocrine disorders

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22
Q

Endocrine Imaging Studies

A

MRI

CT

Thyroid Scan

Radioactive Iodine (RAI) Uptake Test

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23
Q

Purpose of the posterior pituitary gland

A

to regulate fluid balance and facilitates childbirth and prostate gland function via ADH/Vasopressin and oxytoxcin

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24
Q

Hypersecretion of the Posterior Pituitary Gland Causes

A

SIADH

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25
Q

Hyposecretion of the Posterior Pituitary Gland causes

A

DI

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26
Q

Hypophysis

A

Pituitary Gland

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27
Q

95% of Pituitary Gland tumors are …

A

benign

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28
Q

Surgery to Correct the Pituitary Gland is called…

A

Hypophysectomy

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29
Q

The most common Posterior Pituitary disorder is

A

diabetes insipidus (DI)

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30
Q

Anterior Pituitary Gland Purpose

A

to produce and release several different hormones like FSH, LH, prolactin, ACTH, TSH, GH

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31
Q

Hypersecretion of the Anterior Pituitary Gland causes

A

Cushing Syndrome

Gigantism

Acromegaly

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32
Q

Hyposecretion of the Anterior Pituitary Gland causes

A

Dwarfism

Panhypopituitarism

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33
Q

SIADH

A

Syndrome of inappropriate antidiuretic hormone

Posterior Pituitary Gland - Hyperexcretion

excessive amount of serum ADH, resulting in water intoxication and hyponatremia

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34
Q

Causes of SIADH

A

malignant tumors on the posterior pituitary gland

hypersecretion of ADH by the hypothalamus

ventilation (increased intrathoracic pressure)

trauma

pain

stress

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35
Q

Assessment Findings of SIADH

A

fluid volume excess

thirst

neurologic changes r/t swelling of brain cells

seizures

NO edema - its between the cellular and extracellular spaces

increased BP

crackles

distended jugular veins

I > O

weight gain

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36
Q

Diagnostic/Lab Tests for SIADH

A

high urine osmolality

low serum osmolality

decreased H&H, BUN, Na Levels (Hyponatremia)

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37
Q

Nursing Dx for SIADH

A

FLUID OVERLOAD

Alteration in thought process

insufficient nutrients

fatigue

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38
Q

Nursing Education for SIADH

A

Information about the disease process

medications are lifelong

oral intake plan (fluid and sodium)

daily weight

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39
Q

Nursing Interventions for SIADH

A

Restrict oral fluids including ice chips to 800ml/day

Monitor intake/output

Monitor serum sodium, and urine osmolality, and specific gravity

Weigh daily

Assess changes on LOC, cognition

Meds: Declomycin, Vasopressin, Diuretics

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40
Q

Diabetes Insipidus (IS/DI)

A

Results from excessive water loss caused by hyposecretion of ADH or kidney’s inability to respond to ADH –> polyuria –> severe dehydration

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41
Q

Assessment Findings for IS

A

assess for hx of head injury, brain surgery, infection, or tumor

medication list

assess LOC

VS (hypotension)

skin turgor

I&O

weight (loss)

polydipsia

polyuria

bowel sounds (constipation) (from dehydration)

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42
Q

Diagnostic/Lab Tests for IS

A

low urine osmolality

positive water deprivation test

hypernatremia (increased sodium)

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43
Q

Nursing Dx for IS

A

Dehydration (most common)

Reduced cardiac output

potential for interrupted skin integrity

possible constipation

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44
Q

Nursing Education for IS

A

information about disease process

wear medi alert brecelet

keep I&O log

weight

skin care

normal bowel elimination

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45
Q

Nursing Interventions for IS

A

monitor I&O hourly

weight daily - report weight loss!!!

monitor urine labs!!!

encourage fluid intake greater than urine output !!!

skin protection PRN

meds: Supplemental ADH, replacement IV fluids

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46
Q

What UO should be reported to a provider with IS

A

UO greater than 200 mL an hour for 2 consecutive hours or one hour with over 500 mL

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47
Q

Thyroid Hormones

A

T3

T4

Calcitonin

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48
Q

___ is contained in thyroid hormone

A

iodine

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49
Q

What controls the release of thyroid hormones

A

TSH from the anterior pituitary gland

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50
Q

Largest gland in the body is

A

the thyroid gland )

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51
Q

The thyroid gland controls…

A

cellular metabolic activity

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52
Q

Which is more potent and rapid acting T3 or T4

A

T3

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53
Q

When is calcitonin released from the thyroid gland

A

in response to high plasma calcium levels and it increase calcium deposit in bones

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54
Q

What shape is the Thyroid gland

A

butterfly shaped in the neck

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55
Q

HPT Axis

A

Hypothalamic - pituitary - thyroid axis

Hypothalamus –(TRH)–> stimulate pituitary gland to release TSH –> Stimulates thyroid to release T3/4–>high levels of T3/4 feedback loops to inhibit TRH production and release (negative feedback)

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56
Q

Grave’s Disease

A

excessive secretion of thyroid hormone from the thyroid gland, leading to increased basal metabolic rates

rates higher in women than men

hyperthyroidism

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57
Q

Assessment findings for Grave’s Disease

A

clinical manifestation’s vary depending on amount and time:

assess health hx, VS, neck (goiter), eyes (exophthalmos), resp effort increase, energy level, irritability, weight pattern, sleep pattern

potential thyroid storm/crisis

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58
Q

Thyroid Storm/Crisis/Thyrotoxicosis

A

Life threatening extreme hyperthyroidism from long term stress or manipulation of the gland

s/s include elevated temp (fever above 101.3), extreme tachycardia (above 100), and other exaggerated hyperthyroid s/s and neuro changes

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59
Q

Tx for Thyroid Storm

A

acetaminophen (ASA would displace thyroid hormone from proteins and make things worse)

hypothermia mattress

ice packs

cool environment

IV fluids

beta blocker, propanolol/inderal

antithyroid medications/PTU

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60
Q

Diagnostic/Lab Tests

A

elevated T3, T4, free T4

Decreased TSH

positive RAI uptake scan and thyroid scan

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61
Q

Nursing Dx for Grave’s Disease

A

possible reduced CO

disturbances in vision

threat to airway

insufficient nutrients

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62
Q

Nursing interventions for Grave’s Disease

A

related to lifelong antithyroid medications: ablative radioactive I-131, or partial/total thyroidectomy

meds: antithyroid meds for life (potassium iodide, Tapazole, and/or PTU)

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63
Q

Patient Education for Grave’s Disease

A

Medication usage and LIFELONG usage

Daily weight

environment temp cool and stress free

activity-rest balance

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64
Q

Patient Education for Grave’s Disease patients with Exophthalmos

A

Eye protection and potential altered visual field

regular eye exam

report any changes in vision or appearance

eye protection

moisten eyes

elevate HOB

eye patch at night

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65
Q

What sort of diet should Grave’s disease have

A

high carbohydrate and protein diet including snacks (burns fast)

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66
Q

What is a common tx (non-med) for Grave’s Disease (Hyperthyroidism)

A

Ablative radioactive I-131

OR

Thyroidectomy (partial or total)

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67
Q

Ablative radioactive I-131

A

thyroid gland absorbs I-131 which destroys some thyroid cells over a period of 6-8 weeks

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68
Q

Never do an ablative radioactive I-131 on…

A

someone pregnant

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69
Q

Always be using what during a Ablative radioactive I-131

A

RADIATION PRECAUTIONS

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70
Q

Patient Instructions for Ablative radioactive I-131

A

Drink with a straw

use a private toilet

no handling others food

avoid contact with persons (no children)

use disposable utensils and plates

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71
Q

What may be done once an ablative radioactive I-131 is performed

A

once thyroid hormone levels out it may indicate a thyroidectomy, but the hyperthyroidism needs treatment before surgery options

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72
Q

Pre-Op Patient Education for a thyroidectomy

A

Deep breathing cough

instruct to hold hands behind neck during cough, sitting and turning (supports neck and gland region)

teach to expect hoarseness

instruct on wound care pre and post op

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73
Q

Post Op Patient Education for a thyroidectomy

A

provide comfort/pain

monitor for hemorrhage

promote patent airway

prevent tetany (hypocalcemia)

maintain patent IV

avoid/minimize talking: Assess for laryngeal nerve damage

prevent infection

monitor for hypothyroidism

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74
Q

Why can tetany occur following a thyroidectomy

A

removal of parathyroid gland can cause low calcium

75
Q

Hypothyroidism

A

insufficient amount of thyroid hormone (TH) being secreted by the thyroid gland, causing decreased BMR, decreased hear production, and effects on all body systems

76
Q

Assessment Findings for Hypothyroidism

A

depends on condition severity: health hx, LOC, VS, resp., activity tolerance, and comfort

Goiter again, myexedema crisis, everythging slows down

77
Q

Myexedema Crisis

A

Life threatening crisis of hypothyroidism

precipitated by trauma, infection, etc

non pitting edema in connective tissue occurs with neuro changes

high mortality if untreated

78
Q

Diagnostics/Lab Tests with Hypothyroidism

A

Decreased T4

NORMAL T3

Increased TSH

79
Q

Therapeutic Management of Hypothyroidism is done…

A

via medication to replace T4

80
Q

Nursing Dx of Hypothyroidism

A

reduced CO

excess nutrients

constipation

impaired skin integrity

sexual dysfunction

body image

81
Q

Nursing Education for Hypothyroidism

A

information about the disease and medications work

medicalert bracelets

medication lifelong - same time 1 hour prior to a meal

hold med if HR >100

weight changes

82
Q

Nursing Interventions for Hypothyroidism

A

medication

environmental comfort

activity-rest periods

bowel elimination

83
Q

Medications for Hypothyroidism

A

thyroid hormone replacement (levothyroxine/Synthroid, triiodothyronine/Cytomel); raise BMR

84
Q

When should hypothyroidism meds be given

A

at the same time daily 1 hour before a meal

85
Q

Hypothyroid Meds are held if…

A

HR >100

86
Q

Parathyroid Gland location

A

behind the thyroid gland

can be embedded in thyroid tissue

87
Q

Hyperparathyroidism

A

increased parathyroid hormone (PTH) secretion form parathyroid glands located in the neck

PTH increases Calcium

88
Q

Who is at higher risk for hyperparathyroidism

A

older adults and women most at risk

89
Q

Hyperparathyroidism Assessment Findings

A

health hx

VS

ECG

elimination

nutrition

activity exercise

LOC

may be asymptomatic, or polyuria, renal calculi, etc

90
Q

Diagnostic/Lab Tests for Hyperparathyroidism

A

Elevated serum levels of total calcium

increased PTH

decreased phosphate

possible bone changes

91
Q

Therapeutic Management of Mild Hyperparathyroidism

A

increase fluids

avoid thiazide diuretics

weight bearing activity

avoid vitamin A and D and calcium supplements

92
Q

Therapeutic Management of Acute Hyperparathyroidism

A

decrease serum Ca with IV NS

diuretics and phosphate replacement

surgery to remove PT glands

93
Q

why are thiazide diuretics contraindicated with hyperparathyroidism

A

because they can raise calcium levels even more

94
Q

Nursing Dx for Hyperparathyroidism

A

pain

reduce mobility

potential for injury

elimination issues

95
Q

Nursing Education for Hyperparathyroidism

A

disease process

medication

s/s of hypocalcemia

96
Q

Nursing Interventions for Hyperparathyroidism

A

promote safety and comfort

strain all urine to detect stones

increase fluids

activity - rest periods

promote nutrition

pre-post op care

prevent tetany caused by surgery postop (chvostek and tousseau signs)

meds: analgesia, diuretics, IV NS to excrete calcium, phosphate, calcitonin

97
Q

Tetany

A

general muscle hypertonia with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements

98
Q

Chvostek 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 mouth, nose, and eye

99
Q

Trousseau Sign

A

carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a BP cuff

100
Q

Hypoparathyroidism

A

low PTH levels causing hypocalcemia, usually caused by damage or surgical removal of the thyroid

101
Q

Assessment Findings of Hypoparathyroidism

A

health hx

VS

ECG

Elimination

nutrition

activity exercise

LOC

GI symptoms!!

signs fo hypocalcemia (anxiety, HA, tremor, spasm, tetany, seizure)

102
Q

Diagnostics and Lab Tests for Hypoparathyroidism

A

decreased serum PTH, total calcium, free calcium, increased serum phosphate

103
Q

Therapeutic Management for Hypoparathyroidism

A

Supplemental Calcium and Vitamin D (possible via calcium gluconate IV and/or pentobarbital to decrease neuromuscular irritability)

104
Q

Nursing Dx of Hypoparathyroidism

A

potential for injury

anxiety

knowledge deficit

105
Q

Nursing Education for Hypoparathyroidism

A

disease process

medicalert bracelet

VITAMIN C and VITAMIN D EVERYDAY

Diet HIGH IN CALCIUM AND VITAMIN D

106
Q

Nursing Interventions for Hypoparathyroidism

A

promote safety/comfort: neuromuscular

activity-rest periods/quiet environment

promote nutrition

meds: calcium supplement oral or IV, vitamin D oral

107
Q

Foods high in Vitamin C and D

A

beans

greens

tomatoes

cheese

milk

108
Q

Adrenal Glands

A

2 glands on the upper portion of the kidneys

Has a medulla and cortex

effects stress response, lyte and fluid volume, and glucose metabolism

109
Q

Arenal Medulla

A

center of the adrenal gland releasing catecholamines

fxns as part of the autonomic NS

110
Q

Adrenal Cortex

A

outside of the adrenal gland releasing steroid hormones

111
Q

What are the important catecholamines released by the adrenal medulla

A

EP and NEP (90% of secretion is EP for fight or flight)

112
Q

What are the important steroid hormones released by the adrenal cortex

A

glucocorticoids (important influence on glc metabolism)

mineralocorticoids (lyte metabolism)

androgens (sex hormones)

113
Q

Pheochromocytoma

A

Tumors (benign often) from the Adrenal medulla (Catechol.)

Rare neuroendocrine tumor

Causes release of high amounts of EP and NEP (Catecholamines)

If undetected and untreated can be fatal

90% of tumors are in the medulla with 10% in extra adrenal chromatin tissue elswhere

114
Q

What age and gender is more likely to have pheochromocytoma

A

any age but peaks at 40-50 y/o

Effects men and women equally

115
Q

Classic Triad of Pheochromocytoma Symptoms =

A

Headache

Diaphoresis

Palpitations

HDP TRIAD ——-

116
Q

Other S/S of Pheochromocytomqa

A

Anxiety

Lightheaded when getting up

attacks or symnptoms may be paroxysmal

5 H’s

HA

HTN

Hyperhidrosis (sweating)

Hypermetabolism (fever)

Hyperglycemia

TIAs

tremor

Flushing

postural hypotension

Cafe Au Lait Spots

117
Q

Cafe Au Lait Spots

A

pigmented birthmarks that are benign

not causing pheochromocytoma ailment themselves but may indicate disorders esp if multiple spots are present

118
Q

Labs for Pheochromocytoma

A

24 hour urine catecholamine and metabolite catch (most conclusive test)

plasma metanephrine testing

119
Q

Imaging Tests for Pheochromocytoma

A

Abdominal CT Initially

MRI Follow up

EKG - Tachyarrhythmias

GENETIC TESTING per endocrine society guidelines

lifelong follow up biochemical testing annually

120
Q

Pre Op Interventions for Pheochromocytoma Removal

A

Meds: 1st Alpha Adrenergic Blocking agents to prevent CV complication and then 2nd Beta Adrenergic Blocking Agents

Monitor BP and bed rest until stable with the HOB elevated

High sodium diet to prevent post op hypotension

Surgical removal of the adrenal gland if the source

Personalized management

all occurs 7-14 days pre-surgery

121
Q

The definitive tx of Pheochromocytoma is…

A

either a singular or dual adrenalectomy

122
Q

What is needed if a bilateral adrenalectomy is done

A

corticosteroid replacement needed

123
Q

Post Op Care Following an Adrenalectomy for Pheochromocytoma

A

(Catecholamine Withdrawal)

Hypotension support (diet with enough salt and water)

hypoglycemia support

monitor for ectopic sites until stable: EKG, arterial pressures, fluid/lyte balance, blood glc levels

maintain IV access

124
Q

Patient Education follow Pheochromocytoma surgery

A

need regular follow up care, chance for reoccurrence

general diet

self monitoring BP

regular monitoring labs and urines

medications - corticosteroids if both adrenal glands removed with regular compliance

125
Q

Why can hypoglycemia and hypotension occur post op for Pheochromocytoma adrenalectomy

A

sudden withdrawal from large catecholamine amounts

126
Q

Addison’s Disease

A

ADRENOCOTICAL INSUFFICIENCY

Adrenal suppression by exogenous steroid use

Adrenal glands damaged and cannot make sufficient cortical steroids

127
Q

S/S of Addison’s Disease

A

muscle weakness, myalgia

anorexia, weight loss, low blood sugar

NVD

Fainting and salt craving

GI symptoms

fatigue, irritable, depressed

dark pigmentation of skin and mucosa - knuckles, knees, elbows, mucous membranes, hair loss (in women esp) AND vitiligo — occurs months/years before the disease

low blood Glc
low serum sodium
high serum K

apathy, emotional lability, confusion

dehydration, hypotension

potential Addisonian crisis

128
Q

Diagnosis Tests for Addison’s Disease

A

adrenocortical hormone levels, ACTH levels, ACTH stimulation test

129
Q

What is the most common cause of Addison’s Disease

A

corticosteroid use

130
Q

What are the 3 types/origins of Addison’s Disease

A

Primary - Adrenal Gland

Secondary - Pituitary

Iatrogenic - Result of Therapeutic Use of Corticosteroids

131
Q

Primary Addison’s Disease

A

partial or complete destruction of adrenal cells - 80-90% from autoimmune destruction from autoimmune adrenalitis

can also be due to infection of Tb or AIDS

132
Q

Secondary Addison’s Disease

A

Pituitary Gland issue

inadequate secretion of ACTH resulting in a deficiency of cortisol, aldosterone

133
Q

Iatrogenic Addison’s Disease

A

result of therapeutic use of corticosteroids

suppressed adrenal gland release of glucocorticoids after only 2-4 weeks of steroid use

chronic steroid administration suppresses the HPS axis and eventually causes adrenal atrophy

134
Q

What is onset of Addison’s Disease like

A

insidious onset - symptoms develop slow, often over several month

135
Q

What may the initial Addison’s disease diagnosis present as

A

may present in ER in circulatory shock

they compensate until they crash and it is precipitated by stress (infection, environmental temp)

136
Q

Important Labs for Addison’s Disease

A

8 am serum cortisol test for hypocortisolism

Rapid ACTH stimulation test (cortrosyn, cosyntropin, or synacthen) (complex interpretation)

“short corticotrophin test”

imaging: CT of abdomen (adrenal) or MRI scan (pituitary)

137
Q

Primary Adrenocortical Insufficiency should show what levels on lab tests

A

Increased plasma ACTH and a serum cortisol lower than normal

This means decreased blood glc, decreased serum Na, hyperkalemia, increased WBC

138
Q

Medical Tx for Addison;s Disease

A

hormone replacement therapy to correct steroid levels (cortisol, corticosteroid injections, double or triple in stress)

monitor due to infection risk increase

life long supervision

serial labs of lytes, plasma renin, fasting blood glucose level

monitor long term complications

139
Q

What are some of the long term complications of corticosteroid use for Addison’s Disease

A

osteoporosis

gastric ulcers

depression

glaucoma

cataracts

140
Q

Important Considerations for the Nurse with a Patient with Addison’s Disease

A

noting illness and stressors participating problems!!!

fluid and lyte status, VS, orthostatic BP

Note s/s of insufficiency like weight loss, muscle weakness, fatigue

Medication

monitor for s/s of Addisonian crisis

141
Q

What may be a big sign of volume depletion with Addison’s Disease

A

a drop in SBP 20 mmHg or more - could lead to stress and crisis

142
Q

Main important Nursing Management Pieces for Addison’s Disease Tx

A
  1. Replacement Corticosteroids - lifelong, regular, sick day emergency kit
  2. Diet - hyponatremia and hypovolemia could occur
  3. Times to replace sodium and increase fluids
  4. Assess tolerance of position changes with BP check in lying, sitting and standing
  5. Sensible activity limitations, lifestyle changes (avoid strenuous activity and hot humid weather)
  6. Temp increase in corticosteroids when stressed
  7. Sick Day Rules
143
Q

In what situations should someone with addison’s disease replace sodium and increase fluids

A

heavy exercise

hot weather

GI symptoms including NVD

144
Q

What is diet like in addison’s disease

A

consume adequate fluid, sodium, potassium

need HIGH PROTEIN and HIGH CARB DIET

excessive weight gain or edema indicates cortisol replacement too high - see provider

145
Q

What situations indicate temp increase in corticosteroid dose for someone with Addison’s Disease

A

surgery

infection

illness

life events

hot weather

146
Q

Sick Day Rules of Adrenocortical Insufficiency (Addisons Disease)

A
  1. Double dose routine oral glucocorticoid with fever and illness - bed rest - and double oral glucocorticoid when taking antibiotics for infection or before small outpatient procedures like dental work
  2. Inject Gluco. IM/IV incase of severe illness trauma, fasting for procedure, persistent vomiting, or during surgery - safety box available with 100 mg of hydrocortisone IV/IM followed by 200 mg hydrocortisone through cont IV infusion every 6 hours
147
Q

Nursing Dx for Addison’s Disease

A

Disturbed body image

Self care deficit related to weakness, fatigue, muscle wasting, altered sleep patterns

Risk for injury related to weakness

risk for fluid volume deficit

activity intolerance and fatigue

risk for infection

knowledge deficit

148
Q

Interventions for Addison’s Disease Risk for Fluid Deficit

A

monitor for s/s of fluid volume deficit

encourage fluids and foods

select foods high in sodium

administer hormone replacement as prescribed

149
Q

Interventions for Addison’s Disease Activity intolerance

A

avoid stress and activity until stable

perform all activities for patient when in crisis - transferring, ADLs, etc

maintain a quiet, nonstress environment

measures to reduce anxiety

150
Q

Nursing education for Addison’s Disease

A

if having elective surgery hold exercise until 7-10 days later, monitor for infection, have foods high in Na esp during GI disturbances and hot weather

carry emergency care kit of cortisone IM injection

instruct how to give self IM injection

need increased treatment before procedures

medical regime compliance lifelong

medic alert bracelet, medical information card

151
Q

Addisonian Crisis

A

Life threatening adrenal insufficiency emergency

critically low corticosteroid levels that can cause shock, hypotension, rapid weak pulse, rapid respiration rate, pallor, and weakness - CRISIS

152
Q

What things precipitate Addisonian Crisis

A

Stress - trauma, infection, recent surgery, cold exposure (cannot release cortisol for stress!)

Decreased NA intake

Dehydration

not taking prescribed steroid replacement

adrenalectomy

removal pituitary (tumor) (ACTH secondary)

153
Q

S/S of Addisonian Crisis

A

Mental Status Changes (Confusion, agitation, lethargy)

Muscle Weakness

HA, Abdominal Pain, Nausea, Weakness

Postural hypotension or Shock

Hyperthemia (as high as 105 F)

Labs: Hyponatremia, Hyperkalemia, Hypoglycemia

154
Q

The priority of addisonian crisis tx is what

A

Prevent irreversible shock

155
Q

5 S’s of Addisonian Crisis Tx

A

Support

Search for precipitating illness

Salt

Sugar

Steroids (IV Corticosteroids)

156
Q

Other Treatment Modalities for Addisonian Crisis

A

Vasopressin

Hydrocortisone

Antibiotics

IV fluids

shock tx: recumbent, D5 and NS, cortisol, VS monitor, legs elevated, correct hyperkalemia, fix volume deficit and hypotension, treat precipitating factor

157
Q

Cushing Syndrome

A

Adrenal Gland Disorder

Excessive adrenocortical activity or corticosteroid medications

opp of Addison’s Disease

158
Q

S/S of Cushing Syndrome

A

Hyperglycemia

Central type obesity with buffalo hump

heavy trunk and thin extremities

fragile thin skin

ecchymosis

striae

wakness

lassitude

sleep disturbances

osteoporosis

muscle wasting

HTN

MOON FACE

acne

infection

slow healing

virilization in women, loss of libido

mood changes

increased serum sodium

decreased serum potassium

159
Q

Lab for Cushing Syndrome Dx

A

Dexamethasone Suppression Test

160
Q

2 Types of Cushing Syndrome

A

ACTH Dependent - Pituitary Tumor or Ectopic ACTH Production

ACTH Independent - Medications, hyperfunction, ectopic cortisol production

161
Q

Almost all cushing disease has..

A

pituitary adenomas (micro ones)

162
Q

ACTH Dependent Cushing’s Disease

A
  1. Pituitary adenoma - hypersecretion of ACTH. No normal cortisol feedback and continue to stimulate cortisol production and release
  2. Ectopic ACTH -tumors producing it elsewhere in the body like lung, pancreas, thymus
163
Q

ACTH Independent Cushing Disease

A
  1. Iatrogenic - cortisol meds as anti inflammatory
  2. Primary adrenal gland hyper function - hyperplasia or tumor
  3. Ectopic cortisol production -tumor elsewhere making cortisol
164
Q

What gender and age is most likely to get Cushing disease

A

women 20-40 (5x more likely than men)

165
Q

What is the virilization of women from Cushing Disease

A

androgen excess leading to masculine traits and recession of female traits

excess hair (Hirtuism), breast atrophy, menses cease, voice deepens

166
Q

3 Lab Tests to Diagnose Cushing Disease

A
  1. Serum Cortisol
  2. urinary Cortisol
  3. Low dose dexamethasone or Decadron suppression test

2/3 of these need to be abnormal for diagnosis

167
Q

Other Lab Diagnostics for Cushing Disease

A

CBC - WBC >11,000/mm^3

Metabolic Panel - Hyperglycemia (cortisol) and Hypokalemia (aldosterone - Kidneys excrete K+)

Abdominal CT scat, MRI Brain scan on pituitary, Chest and Abdominal CT scan

Lab tests for relevant hormone levels

168
Q

Medical Tx for Cushing Syndrome

A

Surgery to remove a tumor

targeted tumor radiation after removal of pituitary tumors

lifelong cortisol replacement after pituitary removal

routine monitoring for reoccurrence

taper corticosteroid use

169
Q

Nursing Assessments for Cushing Syndrome

A

activity level and ability to carry out self care

skin assessment

changes in physical appearance and patient responses to these changes

emotional status

medications

mental function

Hx of level of activity, ability for ADLs

skin for breakdown and such

patient responses to changes, depression, awareness of environment

170
Q

Nursing Dx of Cushing Disease

A

risk fo injury

risk for infection

self care deficit

impaired skin integrity

disturbed body image

disturbed thought processes

171
Q

Nursing Management for Cushing Syndrome risk for Injury R/t weakness

A

accident proof environment, concern falls and fractures

ambulation assistive devices

diet: high protein, calcium, vitamin D, low sodium, watch calorie intake

172
Q

Nursing management for Cushing Syndrome risk for infection r/t altered protein metabolism and inflammatory response

A

(Increased susceptibility to injury or infection secondary to immunosuppression caused by excessive cortisol)

avoid those who are ill

infection and inflammation are marked

monitor for changes that may indicate infection

offer age appropriate vaccinations particularly influenza, herpes zoster and pneumococcal vaccinations due to increased risk of infection

173
Q

Nursing management for Cushing Syndrome self care deficit related to weakness, fatigue, muscle wasting, altered sleep patterns

A

encourage rest and consistent sleep patterns

moderate activity

relaxing, quiet environment for rest and sleep

174
Q

Nursing management for Cushing Syndrome impaired skin integrity related edema, impaired healing, and thin and fragile skin

A

meticulous skin care

avoid adhesive tape

frequent position change

frequent assessment bony prominences

monitor for DVT

175
Q

Nursing management for Cushing Syndrome disturbed body image r/t altered physical appearance, impaired sexual fxning, decreased activity level

A

weight gain and edema modified by low carb, low sodium diet

high protein diet may decrease other bothersome symptoms

176
Q

Nursing management for Cushing Syndrome disturbed thought processes related to mood swings, irritability, and depression

A

explain disease to patient and family members

coping methods to deal with mood swings, irritability, depression

report psychotic behavior - potential

encourage patient and family to verbalize feelings and concerns

177
Q

Other Important Nursing Considerations for Management of Cushing Syndrome

A

Addisonian Crisis or shock can occur from sudden corticosteroid withdrawal

Monitor blood glc, HTN, hyperglycemia, weight gain

Teach self monitoring BP, BG, Weight

medic alert bracelet (for dentists)

keep adequate supply of corticosteroid medication (avoid running out)

goal forming

patient and family education

178
Q

Goals for Cushing Syndrome

A

decreased risk of injury

decreased risk of infection

increased ability to carry out self care activities

improved skin integrity

improved body image

improved mental function

absence of complications

179
Q

Corticosteroid Therapy

A

suppresses inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection

big for adrenal insufficiencies and inflammation

180
Q

Patient Education for Corticosteroid Therapy

A

Timing of doses

Need to take as prescribed, tapering required to discontinue or reduce therapy

Potential SE and measures to reduce SE

181
Q

What are the various Corticosteroid Use SE and why are they important to teach about

A

Cardiovascular, HTN, Fluid retention, hypokalemia, embolism,. atherosclerosis

immune effects, increased infection risk, masked infection signs

ophthalmologic changes, glaucoma, corneal lesions

muscle issues - wasting, poor healing, osteoporosis

Metabolic effects - increased insulin resistance, steroid withdrawal

Appearance changes

They are important because we need to be able to educate and do collaborative intervention against these things

182
Q

___ disease occurs when the adrenal cortex function is inadequate to meet the patients needs for cortical hormones

A

Addison

183
Q

Over secretion of the anterior pituitary gland most commonly involves ACTH or GH and results in ___ syndrome or acromegaly

A

Cushing

NURS363 - Practice of Nursing IV (17 decks)

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