X Patient w Endocrine Disorder - Burke Ch 34 Flashcards
1
Q
2 chief coordinating and communicating body systems?
A
Endocrine
Nervous
2
Q
Endocrine system regulates….
A
all body systems
3
Q
Endocrine system composed of ?? glands
A
ductless
4
Q
How does Endocrine system communicate with body?
A
through Hormones
5
Q
What are hormones?
A
chemical messengers that travel through the bloodstream to target organ
6
Q
Hormones respond at what pace?
A
slower and long lasting
7
Q
When the hormone reaches its target , what kind of change?
A
Metabolic
8
Q
Endocrine system affects what systems?
A
Metabolic, Reproduction, Growth and others
9
Q
How does Nervous system communicate?
A
Electricity. Immediate and short lived
10
Q
Master Gland?
A
Pituitary
11
Q
Parts of Pituitary Gland?
A
Anterior
Posterior
12
Q
Anterior Pituitary secrete how many hormones?
A
6 hormones
5, Tropic
1, Prolactin
13
Q
what are 6 hormones secreted by Anterior Pit
A
- GH, growth hormone
- TSH, Thyroid Stim Hormone
- ACTH, Adrenocorticotropic Hormone
- Melanocyte Stimulating Hormone
- FSH, Follicle Stim Hormone
- Prolactin
extra? LH, Leuteinizing Hormone
14
Q
What does ACTH do? where released from?
A
- Anterior Pit
- Adrenocorticotropic Hormone stimulates Adrenal Cortex to release glucocorticoids. SUGAR (manage glucose in blood)
15
Q
What does LH do? where released from?
A
- Anterior Pit
- Leuteinizing Hormone stimulates ovulation and secretion of sex hormones, males/female
16
Q
What does FSH do? where released from?
A
- Anterior Pit
- Follicle Stim Horm stimulates ovary development and egg/sperm production
17
Q
What does Prolactin do? where released from?
A
- Anterior Pit
- Prolacting stimulates mammary gland to prod milk
18
Q
How many hormones released by Posterior Pit?
A
- 2 hormones
1. Oxytocin
2. ADH
19
Q
What does Oxytocin do? where released from?
A
- Posterior Pit
- Oxytocin stimulates uterine contraction, release of milk
20
Q
What does ADH do? where released from?
A
-Posterior Pit
-stimulate kidney to conserve H2O.
DOWN urine production
UP BP, constrict arterioles
21
Q
Largest gland?
A
Thyroid
- very vascular, receives 80-100ml blood p/min
- need iodine to function
22
Q
Thyroid secretes what?
A
- T3, Triiodothyrine
2. T4, Thyroxine
23
Q
TSH regulates?
A
- Metabolism
- Nervous
- Growth
24
Q
Where is Parathyroid? What does it secrete?
A
- back of thyroid
- releases Parathormone (parathyroid hormone)
25
Parathormone is an antagonist to what?
Calcitonin. Causes UP in serum Ca.
26
If Ca LO, what is result?
spasms, Tetany
27
Parathyroid hormone UP Ca in blood. How?
* Stimulates production of the biologically-active form of vitamin D within the kidney.
* Facilitates mobilization of calcium and phosphate from bone. To prevent detrimental increases in phosphate, parathyroid hormone also has a potent effect on the kidney to eliminate phosphate (phosphaturic effect).
* Maximizes tubular reabsorption of calcium within the kidney. This activity results in minimal losses of calcium in urine.
28
If Ca UP, what is result?
affects heart, Death
29
Where are Adrenal glands?
On top of kidneys. (AD, Renal)
30
Parts of Adrenal Gland?
```
Adrenal Cortex (outer)
Adrenal Medulla (inner)
```
31
3 hormones produced by Adrenal Cortex
1- Mineralocorticoid (SALT)
2-Glococorticoid (SUGAR)
3-Androgens (SEX Hormones) Testosterone, Estrogen
32
Mineralocorticoid does what?
- H2O/Electrolyte balance
- Aldosterone, main hormone, regulates Na, K
- Indirectly manages BP
33
Glococorticoid does what?
- secretes CORTISOL under stress like pregnancy, hemorrhage, injuries
- glucose metabolism
- stress hormone
- Secretes reserve energy for stressful times
- anti-inflammatory effect. PREDNISONE
34
2 hormones secreted by Adrenal Medulla?
Fight or Flight. Similar cells to Sympathetic NS
- Epinepherine (Adrenolin)
- Nor Epinepherine
35
Nervous System Pic
https://upload.wikimedia.org/wikipedia/commons/thumb/5/55/NSdiagram.svg/512px-NSdiagram.svg.png
36
Epinephrine and Nor Epi do what?
- UP HR, UP BP
- stimulate liver to release Glucose reserves for immediate energy to run or fight
- bronchodilation
- dilation of blood vessels to heart and muscles
- constrict blood vessels to digestive tract
37
Hypothalmus does what?
- links Nervous system and Endocrine via Pituitary Gland
- controls body temp, hunger, thirst, sleep, fatigue
- responsible for some activities of Autonomic NS
38
What kind of gland is the Pancreas?
-Exocrine and Endocrine
| long slender, upper abdomen
39
2 hormones secreted by Pancreas?
- Insulin (responds to UP BG)
- Glucagon (responds to LO BG)
P (pancreas)
I (insulin)
G (glucagon)
40
Ovaries, produce what 2 hormones?
- abdominal area, almond shape.
1) Estrogen: produce secondary sex characteristics (i.e. menstruation, pubic hair, axillary hair, maturation of reproductive organs (uterus), breast dev, leg hair etc)
2) Progesterone: maintain prep of repro organs that were initiated by Estrogen.
41
Placenta what kind of gland? Secrete hormones?
- Temporary endocrine gland expelled after pregnancy.
- when you devlop a Placenta, ovaries become inactive.
- Placenta secretes estrogen and progesterone to maintain pregnancy
42
Male Sex Gland details
- Testes, oval, in scrotum (outside body)
- release Testosterone - develop male secondary sex characteristics (pubic hair, axiliary hair, facial hair, maturation of sex organs, deep voice, muscle, body mass, formation of sperm)
43
Thymus location and hormone released
- in upper thorax behind sternum
- larger in children than adults. shrink as they grow.
- releases Thymosin: immune system
44
Pineal gland location, purpose and hormone released.
- close to Thalmus
- controls biological clock, sleep/wake cycle, biorhythm
- secretes Melatonin (affects reproductive cycle, inhibit reproductive activity, prevents sexual maturation in child until puberty, sleep/wake cycle, mood, menstrual cycle)
45
Acromegaly
- overproduction of growth hormone in adult (due to disfunction in hypothalmus, affects pituitary)
- Idiopathic hyperplasia of ANTERIOR pituitary gland
- tumor growth in anterior pit gland
- changes IRREVERSIBLE
- affects adults in 30/40s
46
Idiopathic Hyperplasia
unexplained increase in # of cells
47
S/S of Acromegaly
7-9yrs to diagnose and start seeing facial changes
- enlarged cranium and lower jaw
- separation and malocclusion (misalignment) of teeth
- bulging forehead
- bulbous nose
- thick lips, enlarged tongue (can cause sleep apnea, disphasia
- generalized coarsening of facial features
- enlarged hands/feet
- enlarged heart, liver, spleen
- UP subcutaneous conn tissue (flesh appearance)
- enlarged glands
- impaired tolerance of carbs = UP BG
48
Dysphagia v Dysphasia
Dysphagia: Difficulty in swallowing. (G for GI tract)
Dysphasia / Aphasia: A language disorder in which there is an impairment of speech and of comprehension of speech.
49
Acromegaly cont'd
| Clinical Manifestation
- muscle weakness (can dev arthritis & osteoperosis, excell GH on muscle)
- Hypertrophy of joints w pain/stiffness
- Males (ED, impotence)
- Females (deepended voice, inc facial hair, amenorrhea (no menses))
- Partial/complete blindness w press on optic nerve due to tumor
- severe headaches
- excessive sweating
50
Acromegaly cont'd
| Med Mgmt/Nursing Interventions
Medications:
- Parloadel - helps muslce regidity, decreases GH. Stimulates Dopamine receptors
- Sandostatin - Inhibints GH secretion
- Pegvisomant (Somavent) - GH Antagonist
Procedures:
- Cryosurgery - freeze to destroy tumor
- Transspendoidal removal of tissue - surgically remove up nose
- Proton Beam Therapy - destroy tissue
- Soft, easy to chew diet
- Analgesics
- Hypophysectomy - removal of pituitary gland
- UP risk of injury due to visual impairment
- monitor BG. Can't handle carbs (like DM?)
51
GH
from Ant Pit. Growth Hormone, promotes growth in long bones, muscles
52
TSH
from Ant Pit. Thyroid Stimulating Hormone. Stimulate Thyroid to release Thyroxine and Triidothyronine
53
ACTH
from Ant Pit. Releases Adrenocorticotropic Hormone, stimulates Adrenal Cortex to secrete glucocorticoid (sugar).
54
Hypothalmus stimulates ANT PIT to release which hormones?
FLAT PEG
FLAT:
FSH/LH, ACTH, TSH
(TROPIC hormones. Stimulate other endocrine glands)
PEG:
GH, Prolactin
(stimulates part of body directly. E for endorphins)
55
Posterior Pit
from Ant Pit.
made in hypothalmus, STORED and released in Post Pit
- ADH (stim collecting ducts in kidney to retain water)
- Oxytocin (uterine contractions)
56
FSH/LH
from Ant Pit.
Follicle Stimulating Hormone
Leutinizing Hormone
ovulations, secretion of sex hormones
57
Prolactin
from Ant Pit.
| mammary gland, prod of milk
58
Oxytocin
from Pos Pit.
| uterine contraction, release of milk
59
ADH
from Pos Pit.
stimulate kindney collecting ducts to conserve H2O.
UP BP, constrict arterioles
60
Thyroid releases
TSH - thyroid stim hormone
T3 - Triiodothryroxine
T4 - Thyroxine
61
Parathyroid releases
PTH - Parathormone
UP Ca, muscle contractions, bone growth
62
Acromegaly Dx Tests
- Cat Scan
- MRI
- Cranial Xrays
- Opthalmic Exam - to see changes in vision, pressure on optic nerve
- look for UP GH
63
GH does what to insulin?
- Suppresses insulin
| - Decrease in insulin action
64
Glucose will do what to GH?
it will suppress GH release (they give you Glucose Load, collect blood over short time to see if GH is still being released. This is a FIRM diagnosis and they w investigate more
65
If you remove Pituitary Gland, what meds do you take?
Hormones for life
66
Disorders of Pituitary Gland
- Acromegaly
- Gigantism
- Dwarfism
- Diabetes Insipidus
67
Disorders of the Thyroid and Parathyroid Gland
- Hyperthyroidism
- Hypothryroidism
- Simple Goiter
- Cancer of Thyroid
- Hyperparathyroidism
- Hypoparathyroidism
68
Disorders of the Adrenal Glands
- Adrenal Hyperfunction (Cushing's Syndrome)
- Adrenal Hypofunction (Addison's Disease)
- Pheochromocytoma (Cell Tumor)
69
Gigantism Etiology/Pathophysiology
- Overproduction of GH
- d/t hyperplasia of ANTERIOR pit gland
- occurs in CHILD before closure of Epiphyses
- GENETIC
70
Gigantism caused by ?
Hyperplasia of ANTERIOR pit gland
71
Gigantism occurs in ?
CHILD b4 closure of Epiphyses.
72
Difference btwn Acromegaly and Gigantism?
Acromegaly - Adults
| Gigantism - Children
73
Gigantism: UP GH released because there is a defect in ? sending message to Pit?
Defect in Hypothalmus
74
What does the Hypothalmus and Pit gland share?
blood vessels
75
Gigantism: Clinical Manifestions
- UP Height
- UP muscle and visceral development
- UP weight
- Normal body proportions
- Weakness
- Osteoperosis
- delayed sexual dev
76
Gigantism: Med Mgt/Nurse Intervention
- Sx removal of tumor
- Irradiation of ANT PIT gland (radiation affects BP, can cause arrhythmia in child?)
- early intervention **
- problems with self image (girls more traumatized)
77
What does a GH Suppression test indicate? (similar OGTT)
GH suppression tests help to diagnose GH excess. sample of blood is drawn after 10-12 hours fasting. person given glucose solution (usually 100 grams of glucose) to drink. Blood samples drawn at timed intervals and tested for GH to see if the pituitary gland is sufficiently suppressed by the dose of glucose.
78
Dwarfism: Etiology/Phathophysiology
-Deficiency in GH (usually idiopathic)
79
Dwarfism: Clinical Manifestions/Assess
| Proportional Dwarfism
in Proportional Dwarfism:
- Abnormally short height
- normal body proportion
- appear younger than age
- dental problems d/t underdeveloped jaws
- delayed sexual development
- coping skills
- most children 3-4'
- risk for Cardiac Disease
- some mental slowness, NOT MR (mental retardation)
80
Causes of Dwarfism
- Malnutrition during pregnancy
- Trauma/Infection of pituitary gland
- Lack of ACTH, TSH, Gonads
81
Dwarfism: Medical Mgt/Nur int
- GH injections (genetically engineered)
- removal of tumor
- risk
82
3 Types of Dwarfism
| (SAD), ASD
- Achondroplasia (most common)
- Spondyloepiphyseal Dysplasia (SED), less common
- Diastrophic Dysplasia, rarest
83
Achonoplasia
- 1/26,000 - 40,000 babies
- evident at birth
- large head
- prominent forehead
- flat bridge of nose
- protruding jaw
- misaligned teeth
- long trunk
- short arms/lets
- bow legs
- flat, broad, short feet
- often double jointed
84
Spodyleopiphyseal Dysplasias (SED)
- less common
- 1/95,000 births
- shortened trunk
- apparant 5-10yrs old
- clubbed feet
- cleft palate
- serious osteoarthritis in hips
- weak hands and feet
- barrer chested appearance
85
Diastrophic Dysplasia
- rarest form
- 1/100,00 births
- short forearms/calves
- deformed hands/feet
- limited ROM
- cleft palate
- ears have cauliflower appearance
86
Dwarfism: Subjective Data
- their understanding
- emotional response
- family history (may have developed good coping skills)
- When was growth retardation first noticed
- normal intelligence
87
Dwarfism: Objective Data
measurable
- height/weights (usually given GH)(taken every visit to monitor growth)
- Xrays of wrist (they can tell bone age)
- skull xray (tumor)
- ?Lower GH based growth (NPO after midnight?)
- approach w respect /dignity
- support groups avalable
88
DI - Diabetes Insipidus - Etiology/Pathophysiology
(Die ADH)
- Deficiency of ADH
- permanent or transient metabolic disorder of the POST PIT
- UP Urine
- Hypothalmus makes Vasopressin, PIT stores it
- Kidneys need ADH
89
DI - Clinical Manifestation (S/S)
- Polyuria (diluted), reducing intake has no effect on concentration of urine
- may lead to severely dehydration
- Lethargic
- dry skin, poor turgor
- constipation
90
DI - Med Mgt, Nur int
- ADH preparations
| - limit caffeine d/t diuretic props
91
ADH Preparations
-DDAVP (synthetic antidiuretic)
Desmopressin
-Vasopressin (Pitrecin) (IM, intra nasal)
-Vasopressintannate (IM)
-Lycine Vasopressin (Diapid), Intra Nasal
92
DRUG: Desmopressin
Desmopressin is a synthetic replacement for vasopressin, the hormone that reduces urine production. It may be taken nasally, IV, or oral or sublingual tablet. Wikipedia
Brand names: Stimate, Ddavp
Pregnancy risk: Category B (No evidence of risk in humans)
Drug classes: Vasopressin analogue
93
NEUROgenic DI
most common type
- damage to HYPOTHALMUS or PIT
- head injury, trauma, surgert
- Deficiency of ADH/Vasopressin
- Infection: Incephalitis (inflam of brain), Meningitis (infec of brain covering, meninges)
94
NEPHROgenic DI
2nd most common
- -d/t kidney or nephron dysfunction
- not responding to ADH (it is being secreted, but no response)
95
DI causes
- kidney disease, polycystic kidney disease
- gestational problem
- ETOH/substance abuse
96
DI main problem
when fluid intake doest keep pace w urine output => Dehydration + Hypernatrimia
-not enough fluid in blood stream
97
DI Dx tests
-Specific Gravity (concentration of chems in urine) usually LO in DI.
98
DI S/S
2-20L p/2hrs
- Ployuria
- Polydipsia
- UP NA - Hypernatremia
- Lethargic
99
DI - Nursing Interv
No cure
- daily weight (b4 breakfast, same time)
- wear Med alert bracelet
- stay under med supervision
- can worsen
- monitor urinary output (especially in unconscious and pedes)
- monitor I&O, skin turgor, oral mucous membrane
100
DI Prognosis
Survivors on meds for life
101
SIADH (Syndrome of Inappropriate ADH)
(Si, ADH, more more)
- PIT secreting TOO MUCH ADH
- Kidneys reabsorb too much H2O
- LO urine output
- UP fluid volume
- HYPONatremia
- Hemodilution (blood elements lowered)
- Fluid overload w/o Peripheral Edema.
- NO Peripheral Edema
102
ADH does what?
control body fluid volume
103
SIADH causes
- tumor, meds, CA malignancies
- pulmonary disorders
- nervous system disorders
- stressful procedure (ADH released in stress)
104
Untreated SIADH can lead to
HYPONatremia (Water retention) ==> H2O Intoxication
-serum Na LO (
105
SIADH S/S (Subjective)
- muscle cramps
- weakness
- anorexia
- nausea
- HA
106
SIADH S/S (Objective)
- blood work (Hyponatremia = diarrhea)
- disorientation
- irritability
- bloating/puffiness (face/fingers)
- LO urine output. Fluid intake w exceed urine output
- Excess fluid stays IN Vasular System, not in interstitial spaces to cause peripheral edema.
107
Does SIADH cause Peripheral Edema? Why/WhyNot?
NO peripheral edema.
| fluid stay is VASCULAR SYSTEM, NOT into intestitial spaces.
108
How does SIADH lead to Neurological problems? S/S?
As H20 UP, brain cells expand. Intoxication. ==> neurological symptoms:
- Lethargy
- personality changes
- seizures
- deep tendon reflexes diminish/dissapear
- HYPONatremia
109
SIADH Dx tests
- monitor Na levels (HYPO Natremia)
- LO Blood Urea
- LO Creatinin
- UP Na in urine/LO Na in Blood
110
Treatment/Nurs Interv
- fluid restriction to equalize fluid, control intake
- IV hypertonic saline solutions to correct Na imbalance
- eliminate tumor if present
- Meds: Declomycin, Lithiium Carbonate, Lasix
- assess pt condition
- neuro exams q3-4hrs
- austcultat lungs q2-4hrs (crackels if fluids present, UP fluid volume)
- monitor lab results
- daily weight (same time, same scale, same clothes)
- minimize discomfort
- pt education
- avoid salty foods
- frequent oral care
111
SIADH Prognosis
- very treatable
| - dangerous if untreated ==> coma, death
112
SIADH MEDS
Diuretics, interfere s anti diuretic action of ADH and causes Polyuria
Declomymcin
Lithium Carbonate
Lasix
113
HypoNatremia d/t SIADH S/S
- ADD
- Athletes drink Gatorade
- prevent dehydration
- women more susceptible.
- per lb lost in sweat, should drink PINT of H2O, per hour during HI endurance activities.
114
Hyperthyroidism - Etiology/Phys
aka Graves Disease
- Overproduction of Thyroid hormone
- Exaggeration of metabolic processes
- exact cause unknown
- Autoimmune Disorder (2% women, less men)
- 30-50 yrs
115
Hyperthyroid - S/S
-edema, anterior neck (enlarged thyroid)
-exothalmus (bulging eyes) Peri orbital
/both eyes, bilateral. Sometimes lid won't close, dry eye/
-inability to concentrate, memory loss
-dysphagia
-hoarseness
-UP appetite (metabolism of fats/carbs
-weight loss
-nervousness
-emotional lability (up down mood swings)
-UP metabolism
-more strain on cardio system as u get older
-Dysrythmia (ht failure)
- smoking DOUBLES probability of developing
116
More Hyperthyroid S/S
- insomnia
- tachycardia HTN
- warn flush skin
- fine hair
- amenorrhea
- UP temp. Intolerance to heat
- diaphoresis
- hand tremors
- hyperactivity
- clumsiness
117
Hyperthyroidism med mgt/nursing int
- Meds : PTU, methimazole (tapazole)
- radioactive Iodine (ablation therapy), gold standard Rx. Iodine 131.
- subtotal thyroidectomy (5/6 of thyroid removed)
118
Subtotal Thyroidectomy
Partial thyroid removed, 5/6th
W delay Sx when patient in a euthyroid state
119
Euthyroid
state of having normal thyroid gland function.
120
Radioactive Iodine (ablation therapy)
-Reverses overacting but can cause hypothyroid
121
How does radioactive Io work? Side effects
Absorbed into thyroid to destroy tissue but doesn't damage surrounding tissue
w pass via urine/saliva over several days. passes faster f younger. depends on dosage
S/E: Nausea
normal thyroid function - 8-12wks
repeat in 6mos if necessary
122
Ideal Ablation Therapy pts
- past child bearing age
- used for ht disease
-pts who develop hyperthyroid after surgery
- pts who are poor surgical risk
-pts w unusually small thyroid glands
-see results in 4-6 mos.
-normal thyroid function in 1 session for 60%
-2nd dose in 3-6 months if needed
- some need 2-3 doses
Colorless and tasteless
123
How to administer Radioactive Iodine
- cordless and tasteless
- swallowed in H2O
- Administer w latex gloves
- latex gloves when disposing of urine feces sheets?
124
Radio Active Iodine - S/S
- Thyroid Tendinitis
- Radiactive Thyroiditis (w/in first few days/weeks)
- Nausea, Vomiting
- can lost taste temporarily
- can become hypo thrroid
125
Radio Active Iodine - Med
Block production of Thyroid hormones:
-PTY
100-154mg - q6-8hrs
up to 900mg p/day
-Tapazole
5-20mg q8hrs
Dailymaintenance 5-15mg / day
126
What do anti-thyroid meds do?
- block T3/T4
- can be used long term (1-2yrs)
- or to get pt bakc to Euthyroid state
- can take up to 3 wks to see improvement of symptoms
- after med dc, pt can gradually return to hyperthyroid state
- taken on strict schedule
127
Anti-Thyroid meds S/S
- bone marrow supp
- hepatotoxicity
- agrandulocytosis - LO WBC (susceptible to infection)
- Nephro Toxicity
- fetal abnormalities
- rash or pruritis (itchy skin)
- monitor pts on anticoagulants: PT and PTT (prothrombin time, bleeding time)- black tarry stool, bleeding gums, bruisnig, nose bleeds
128
```
K Iodide (SSKI) does what?
(Potassium Iodide)
```
-blocks release of thyroid hormone in thyroid storm and hyperthyroidism
129
SSKI (K Iodide) S/S
- can leave metallic taste in mouth
- burning in mouth/throat
- not in pregnancy
130
Hyperthyroidism Thyroidectomy Pre-Op
- stress free environment
- limit visitors
- quiet/cool room - decreased perspiration
- assess skin integrity (for pts perspiring alot)
- teach proper head support w turning in bed, sitting, standby (both hands behind head to immobilize when being moved)
131
How does thyroid storm result from a thyroidectomy?
liquid leaking from thyroid during removal
132
Hyperthyroidism - med mgt/nurs interv POST- OP
Post-Op
- voice rest 48hrs, voice checks q2-4hr (check for hoarseness, voice changes. Mild hoarseness expected)
- avoid hyperextension of neck
- Tracheotomoy tray at bedside (in case need a traech after Sx)
- assess for s/s of internal, external bleeding
- assess for tetany (LO Ca)
- assess for Chvostek's (LO Ca)
- carpal pedal ?
- Assess for Thyroid crisis
- avoid coffee/tea
- Some larangeal nerve damage
- UP nutrition to support UP metabolism, High Colric Foods
- soft foods
- B vitamins
- bed in semi fowlers (support head/neck w pillows)
133
Removal of parathyroid would result in what?
Tetany - muscle spasms, face d/t LO Ca
134
Test for Trousseau's Sign
more sensitive, LO Ca
| hold BP cuff tight to induce spasm in hand/fingers. Finger w adduct (obstetrician hand)
135
Test for Chvostek's Sign
Light tap of cheeks to see twitching in lips
| LO Ca and LO Mg
136
Signs of Internal/External bleeding
black tarry stool, bleeding gums, bruisnig, nose bleeds
137
Thyroid Crises/Storm
- rare
- usually d/t manipulation of thyroid gland during sx, release hormones
- if happens, would in first 12hrs, post op
- can result in death within 2 hrs
- all S/S exaggerated
- N/V
- severe tachycardia
- HTN
- Rapid respiration
- UP 106*, hyperthermic
- extremely restlessness
- cardiac dystrythmia
- delerium
- HT failure
- death
138
Hyperthyroidism Rx
- K iodid
- Corticosterioids
- anti pirotic
- PTU/Tapazole
- O2
139
HypoNatremia d/t SIADH
- LO Na (due to hyper volemia), body not excreting fluid
- can have many causes such as diuretics
- addison disease
- dehydration
- vomiting
- diarrhea
- kidney dysfunction
- heart failure
- cirrhosis of liver
140
HYPOThyroidism - Etiology/Pathos
- insufficient secretion of thyroid hormones
- slowing of metabolic pocess
- failure or insufficient TSH from PIT
141
HYPOthryroidism is one of more common disease in US
- MORE common than Hyper thyroid
- 8% women (30-6-)
- 2% men (Over 50)
142
Myxedema
HYPOthryroidism that develops in ADULTHOOD
- H2O retention, puffiness in eye/fcae/feet
- fluid can accumulate around HT
143
Cretinism
congenital HYPOthryroidism (infancy)
144
HYPOthyroidism - S/S
- hypothermia (intolerance to cold)
- weight gain
- depression
- impaired memory, slow thought process
- lethargic
- anorexia
- constipation
- atherosclerosis ==> CAD (coronary heart disease)
145
more HYPOthyroidism - S/S
- LO libido (problems w conceiving, repro system, maintaining pregnancy)
- menstrual irreg
- thin hair
- skin thick and dry
- enlarged facial appearance (mask like facial)
- low, hoarse voice
- bradycardia
- hypotension
- exercise intolerance
- LO ability to perform activities
- Myxederma Illeus (sluggish illeus) Assess abdomen for distention. Can be reversed w thyroid hormone)
146
Hypothyroidism Rx
Meds: Thyroid Replacing Hormones - LIFELONG. Can't stop abruptly. Take consistently as Rx or can have Myxedema Coma.
- Synthroid (T4)
- Levothyroid
- Proloid
- Cytomel (T3)
147
Myxedema Coma
loss of brain functioning d/t long standing LO levels of thyroid hormone in blood
148
more Hypothyroidism Rx
```
-TRH test: to determine where defect is. Usually in PIT.
(Inject TRH hormone then look at brain to assess uptake.)
-patient teaching to take meds on time
-see doc regularly
-monitor BM
-UP Protein/Fiber diet
-push fluid
-avoid carbs/sugar
-remain under care of cardiologist
-keep room warm during baths (68-74*)
```
149
Before giving Thyroid replacement hormones, what should be done?
- need baseline weight and bowel habits.
- asses early signs of HYPER (when on meds)
- obtain labs/bloodwork
- consider other medical conditions
- avoid OTC meds w Iodine esp when on Synthroid (T4)
150
Simple Goiter - Etioloty/pathos
- enlarged thyroid d/t LO Iodine
- enlargement d/t accumulation of colloid in thyroid follicles
- usually d/t insufficient DIETARY intake of Iodine
- Blood levels T3 too LO to signal PIT to decrease TSH secretion
151
MED: Synthroid (T4)
.
152
MED: Cytomel (T3)
.
153
MED: Levothyroid
- on empty stomach
- early am (~6am)
- monitor s/s
- dont' switch betwn brand and generic
154
MED:Proloid
.
155
why aren't there many goiter cases in the US?
we have Iodized salt and Iodine deficiency is not common in this country
156
Goiter cases in US are usually dietary or clinical?
Clinial: usually over or under production of I d/t glands or eating goiter producing foods that suppress manufacturing of TSH. Interferes w thyroids ability to process Iodine.
157
Goiter Producing Foods
- soy beans
- cabbage
- spinach
- peanuts
- peaches
158
Sm - Mod Goiters can be treated how?
w pill form thyroid hormones to supply thormone and cause PIT to make less TSH.
159
Simple Goiter S/S
- enlarged thyroid gland
- dysphagia
- hoarseness
- dyspnea
160
Simple Goiter Rx
- SSKI (Potassium I) blocks release of TSH.
- diet UP Iodine
- Surgery: thyroidectomy (r/f thyroid storm, bleeding, tetany
161
Diet HIGH in Iodine foods?
- lobster
- cranberries
- cod
- shrimp
- baked potatoes
- milk
- navy beans
- yogurt
- turkey breast
162
Cancer of Thyroid
Prognosis - POOR
- rare, 25/1,000,000 in US
- UP female, white
- UP w age
163
Thyroid Ca - etiology/pathos
-malignancy of thyroid tissue, very rare
164
Thyroid Ca - S/S
-firm, FIXED, small, round mass or nodule on thyroid
165
Thyroid Ca - Rx
- total thyroidectomy
- thyroid hormone replacement
- if metastasis present, radical neck dissection, radiation, chemo, radioactive Iodine (liquid)
166
Hyperparathyroidism - Etiology/Pathos
Prognosis - GOOD w Rx
30-70yr, women 2ce likely
-sometimes d/t chronic renal failure
-overactive parathyroid, UP production of PTH (UP Ca in blood, antagonist to Calcitonin)
-hypertrophy of one or more parathyroid glands
167
PTH
Parathyroid hormone - ANTAGONIST to Calcitonin ==> UP Ca in blood. (OUT of bones)
168
Calcitonin
naturally occurring hormone. helps regulate calcium levels in body and involved in process of bone building.
169
delicate balance of Ca in blood
- LO Ca = Overstim of muscles (Tetany)
| - UP Ca = HT function impaired
170
HyperParaThyroidims S/S
- hypercalcemia (UP Ca, leave bones and into blood, demineralization, weak bones)
- skeletal pain, pain on weight bearing (legs)
- pathological fractures UP risk
- kidney stones (UP serum Ca)
- constipation
- impaired HT function, HTN, Erythmias
LO Neuro Function:
- fatigue
- drowsiness
- Nausea
- anorexia
- personality changes
- disorientation
- paranoid
171
HyperParaThyroid - Dx test
- xray (to show decalcification)
- blood PTH levels
- phosphate levels
- bone density measurement
- MRI/Cat scan (if suspect tumor)
172
HyperParaThyroid - possible causes
- Cushing's Syndrome
- UP Vit D
- tumor
173
HyperParaThyroid - Rx
- removal of tumor
| - removal of one or more parathyroid glands
174
HyperParaThyroid - Pre-Op
- restore E fluids
- monitor I and O
- Diuretics, Lasix. WONT USE THIAZIDE diruretics because of LO renal extretion of Ca. It leave Ca in body. Will remain hypercalcemic
- screen urine for stones w mesh
- diet LO Ca (no dairy, antacids)
- UP cranberry juice (acidic), LO stone formation
175
HyperParaThyroid - Post-Op
- analgesics for pain
- ptx w often retain fluid after surgery and have LO fluid out.
- asses for Hypocalcemia (tetany, arythmia, carpal pedal spasms)
- Monitor I and O (LO urine output)
- CaGluconate (IV for tetany)
- teach good body mechanics to prevent patho fractures
- screen urine for stone
176
HYPOParaThyroidism - Etiology/Pathos
- LO parathyroid hormone
- LO serum Ca
- inadvertent removal or destruction of one or more parathyroid glands during thryoidectomy
177
HYPOParaThyroidism - S/S
- neuromuscular hyper-excitability
- involuntary and uncontrolled muscle spasms
- tetany
- laryngeal spasms (diff breathing, up to 60sec)
- stidor
- cyanosis
- parksinson like syndrome
- chvosek's and trousseau's signs (LO Ca)
178
HYPOParaThyroidism - Rx
- Calcium Gluconate or Ca Chloride IV
| - Vit D (help absorbtion of Ca)
179
Calcium Gluconate
minearl supplement for Ca. Rx for Hypocalcemia
In IV, can be irritating, administer SLOWLY (1ml/min)
can cause severe necrosis. monitor IV to prevent infultration.
180
Ca Chloride IV
treat hypCa when need FAST UP in Ca. - Ion hormone
181
HYPOParaThyroidism - Post OP
- monitor for HYPERcalcemia
- vomiting disorientation
- weakness
- abdominal pain
- respiratory distress, adverse response to Ca therapy
- syncope (fainting)
- bradycardia
- hypotension
- UP Ca Diet (dk green veges, soy, sardines)
182
Cushing's Syndrome
| (Adrenal HYPERfunction) - Pathos
women, 30-50
- excessive CORTICOSTEROIDS, esp Cortison
- UP adrenocortical hormones (mineralocorticoids, glucocorticoids)
- Hyperplasia of adrenal tissue, d/t over stim by PIT
- tumor in Adrenal Cortex
- ACTH secreting tumor outside PIT
- overuse of corticosteroid drugs (anti-inflam drugs, Prednisone, Decadron)
183
MED: Prednisone, Decadron
Anti Inflamattory
| -itching, allergic reactions, asthma, several allergies, skin conditions, exzema, chrons, ulcerative colitis
184
Cushing's S/S
- moonface (puffy face)
- buffalo hump (d/t fat deposits at back of neck)
- thin arms/legs (muscle wasting, weakness d/t altered protein metabolism)
- hypokalemia, proteinuria (LO K)
- UP Ca in urine (kidney stones)
- Susceptible to infection (poor would healing, suppressed immune response)
- depression
- loss of libido (ED in men)
- Osteoporoesis (d/t lack of Ca absorbtion ==> Kyphosis)
- Memory/Attention dysfunction
185
more Cushing's S/S
- ecchymoses and petechiae (bleeding under skin, broken b vess, loss of collagen/connective tissue)
- weight gain d/t fat deposits
- adbominal enlargement
UP Androgens (male sex hormones)
- Hirsutism in women
- menstrual irreg
- deep voice
- acne
- amenuria (stop menstruation)
- UP muscle mass
- body image/self esteem
186
Cushing's Rx
- adrenalextomy for adrenal tumor
- Radiation or removal af PIT tumors (Lysodren, Cytadren)
- LO Na, HI K diet
187
MED: Lysodren
suppresses activity of adrenal cortex. can be toxic to adrenal gland.
monitor signs of Hepatotoxicity (jaundice, GI upset, puritis)
188
MED: Cytadren
inhibits cortisol syntheseis
S/E drowsiness, loss appetite, N, anorexia
189
Cushings Dx Tests
- UP Plasma Cortisol
- urine
- ketosteroids
- blood work
- ACTH levels/X ray (if suspect PIT tumor)
190
Cushings Rx (nursing intv)
- gentle handling of skin
- air flow mattress
- turn pt frequently
- elbow/heel protectors
- talk about feelings
- teach re meds
- med alert bracelet
- wound care
191
(Adrenal HYPOFunction)
| ADDISON's Disease
adrenal glands secreting LO Glucocorticoids and mineralocorticoids d/t
- Adrenalectomy
- PIT hypofunction
- Long time steroid use, abruptly stopped
- sever LO cortisol deficiency
- can lead to circulatory collaps, shock, death
- PRIMARY: Adrenofunction hypofunctioning
- SECONDARY: lack of PIT ACTH homone
192
Addison's Disease - PRIMARY
Adrenofunction hypofunctioning
193
Addison's Disease - SECONDARY
Lack of PIT ACTH hormone
194
Addison's Disease - S/S
-SLOW onset
-no symptoms until 90% gland destroyed
-CA can metasticise ==> Adrenal Gland
-
195
Most common cause of Addisons
Autoimmune - Adrenal tissue destroyed by Antibodies of pts own Adrenal Cortex.
196
Addisoin's (adrenal HYPOfunction)
.
197
Addisoin's (adrenal HYPOfunction) - causes
-Adrenalectomy
-TB or other infectoins can lead to hypofunctioning
-autoimmune response (MOST COMMON cause)
Adrenal tissue destroyed by Antibodies of pts own Adrenal Cortex.
198
Addisoin's (adrenal HYPOfunction) - S/S
- related to imbalance of hormone, nutrients, E
- N/Anorexia
- Syncope. Postural Hypotension
- HA
- Disorientation, Irratibility, Depression
- abdominal pain, low back pain
- Anxiety
- muscle joint pain
LO sex hormone, body hair loss, effects WOMEN more.
199
Addison't affects women more
Cushing affects men, ED
200
more Addison's (hypo) SS
- dark pigments skin and mucous membranes
- weight loss
- Vomitting
- Diarrhea
- HYPOglycemia, fatigue
- pt complains of deep penetrating leg pain
- convulsions
- UP temp
Adrenal CRISIS
- HYPOnatremia
- HYPERkalemia
- Abnormally HI or LO temp. more commonly HI)
201
What causes hyperpigmentation in Addison's Pts
dark pigments skin and mucous membranes (Excess ACTH to produce Melanin. Hyperpigmentation) often pre-ceeds other symptoms by months - years
202
S/S of Addisonian's CRISIS (Adrenal Crisis)
Adrenal CRISIS
- HYPOnatremia
- HYPERkalemia
- Abnormally HI or LO temp. more commonly HI)
203
Addison's - Caused by?
Insuficient or suddenly LO Cortisol d/t
- surgery
- trauma
- sever infection
- abrupt off corticosteroid meds
204
Addison's - nurse interv
- pt monitored closely for HYPOtension, weak pulse, rapid?
- can develop confusion from circulatory collapse, shock, death
- cardiac dysrythmias LO K
- keep person warm, low light, hydrocortisone infection, Dopamine, Epinepherine
205
Addison's - Rx
- restore E fluids, balance
- replacement of Adrenal hormones (Meds, Florinef)
- Diet HI Na and LO K
- monitor skin turgor
Adrenal Crisis:
IV corticosteroids in solution of glu and saline
206
MEDS: Florinef
replace mineralocorticoids
207
Pheochromocytoma - Pathos
- chromaffin cell tumor, usually in adrenal medulla
| - cause excessive EPI and NOR EPI (affect HT, Metabo, BP)
208
Pheochromocytoma - S/S
HTN (severe 300/175)
| -result in stroke, kidney damage, retinopathy
209
Pheochromocytoma - Rx
surgical removal of tumor
