Patho Exam 2 Endocrine
Card Set Information
Patho Exam 2 Endocrine
Endocrine problems: hyperthyroidism, hypothyroidism
State the cause of Hyperthyroidism
Anything that increases levels of circulating thyroid hormone (TH) - its all about energy
List risk factors for Hyperthyroidism
Women age 30 to 40
What is Primary Thyrotoxicosis?
Not caused by elsewhere
Too much of a good thing
Toxic multinodular goiter
Follicular thyroid cancer (rare)
List clinical manifestations for Hyperthyroidism
Reflects Increased Basal Metabolic Rate
CV- tachycardia, palpitations, angina, chest pain
Neuro- hyperactive reflexes, sleeplessness, nervousness
GI- Inc appetite with wt loss, inc gastric motility, diarrhea
Eye syndrome- exophthalamos (tissue buildup behind orbit)
Dec or absent menses
Inc thyroid hormone levels
What is the pathophysiology of Graves Dx?
Thyroid antibodies (autoimmune)
Rate of onset
: slow insedious
What does Graves Dx result in?
Inc thyroid hormone (TH) levels
Inc iodide uptake
Inc rate of thyroid gland metabolism leads to goiter
What characteristics must be present to have Graves Dx?
Hyperthyroidism- test serum level
What is a Thyrotoxic Crisis (Thyroid Storm)?
Stressors (infection or lung/ heart disorders)
Dead in 48 hours
Huge outflow of thyroid hormone
List manifestations of Thyrotoxic Crisis
Think catecholamines- epinephrine (fight or flight)
Agitation or delirium
What is the prototype drug for Antithyroid agents?
State MOA of propylthiouracil (PTU)
Blocks hormone synthesis by inhibiting conversion of T4 to T3 in peripheral circulation
What is the therapeutic use of propylthiouracil (PTU)?
Restore euthyroid (nml levels- not too high or too low) and metabolic levels
State the MOA of Radioactive Iodine (131I)- tx for hyperthyroidism
Localized radiation effect, slowing thyroid production
State mode of delivery for Radioactive iodine (131I)
Capsule or solution
List Nsg implications of Radioactive iodine (131I)
Localized radiation therapy- safe to be around, gone in 2-3 days
Lugol solution is a strong iodine solution with K+ that protects thyroid to some extent, it slows it down w/o knocking it down
What is the cause of hypothyroidism?
Anthing that decreases levels of circulating thyroid hormone (TH)
Ex. Hashimoto's thyroiditis or overtreatment of hyperthyroidism
List risk factors for Hypothyroidism
More common in aging people
Describe S&S of Hypothyroidism
Opposite of hyperthyroidism (or no energy)
Bradycardia, dyspnea, low energy, constipation, dry hair and skin, cold, inc menses, depressed, no energy
List major S&S of Congenital Hypothyroidism (Cretinism)
Neuro- floppy, dull appearing facial features, hypotonia, hoarse sounding cry
Integumentary- dry, brittle hair, and low hairline
Musculoskeletal- thick, protruding tongue, large fontanelles, broad and short
GI- poor feeding, choking episodes, constipation
What is Hashimoto Thyroiditis?
Aka Hashimoto dx or lymphocytic thyroiditis
all about size not fxn!
List clinical manifestations of Hashimoto Thyroiditis
Enlarged thyroid gland
Sx typical of hypothyroidism (hypoactive goiter)
What is Myxedema (Hypothyroid Crisis)?
Severe or prolonged thyroid deficiency
A crisis level lack of metabolism that can kill
pts in infurmed condition- nsg home, chronic illness
What is the clinical presentation for Myxedema?
Altered mental state
"myxedema coma" from too little energy
List clinical presentations of severe Myxedema
State the natural and synthetic drugs for Thyroid agents
Natural- Thyroid (Armour thyroid)
Synthetic- Levothyroxine (Synthroid) synthetic T4
What is the MOA for thyroid agents?
Exogenous replacement of thyroid hormone to achieve euthyroid levels and normalize metabolism
What are the indications and contraindications of Levothyroxine Na (Sythyroid)?
: CHD (do not overwork the heart) and allergy
List SE and Interactions for Levothyroxine Na (Synthyroid)
: associated with overdose
Cholestyramine (antilipemic agent)- binds to thyroid hormone in GI track- dec absortion of thyroid
List pt teaching for Synthyroid
Take in AM, on empty stomach, at least 30 minutes before eating (to give you energy)
S&S of hypo and hyperthyroidism
List monitoring for levothyroxine (Synthyroid)
Relief of symptoms of hypothyroidism
Absence of symptoms of hyperthyroidism
Labs of Serum TSH and T4 levels
What are the major post pituitary problems?
Syndrome of inappropriate Antidiuretic hormone secretion (SIADH)
Diabetes Insipidus (DI)
What are the problems of Anterior Pituitary gland?
High levels of antidiuretic hormone (ADH) in absence of nml physiologic stimuli for its release
(high levels w/o reason to be there)
List common causes for SIADH
Ectopically produces ADH - adenocarcinomas
Transient SIADH- post-pituitary surgery
List Sx of Hyponatremia
Dyspnea (movement of fluid)
Dulled sensorium, confusion, lethargy
Muscle twitching, convulsions
Impaired taste, anorexia, vomitting, cramps
: irreversible damage, coma, death
What is the prototype drug for Demeclocycline?
What is the classification and drug use of Demeclocycline?
Tetracycline broad-spectrum antibiotic
Treatment of persistent SIADH
What is the MOA of Demeclocycline (Declomycin)?
Interferes with renal response to ADH
Define Diabetes Insipidus
Inability to concentrate urine due to insufficiency of ADH
Body water floods out- causing dilute urine
What does DI do to neurogenic (central)?
Causes head trauma, brain death
What does DI do to nephrogenic (renal)?
Causes CRF, lithium, water based urine
List clinical manifestations for DI
Polyuria and polydipsia
Dec urine specific gravity and osmolality (like water)
Serum osmolality concentrated in body
What is the prototype drug for Neurogenic DI?
What is the MOA of Desmopressin (DDAVP)?
Synthetic ADH, replacement therapy
What is the delivery mode for Desmopressin?
What are the common SE of Desmopressin?
None, except for nasal
What are the nsg implications for Desmopressin?
Monitor and baseline data- serum and urine osmolality, and fluid balance/ weight (I&O)
What is the client teaching for Desmopressin?
Careful adjustment of water intake w/ tx to avoid water intoxication and dilutional hyponatremia (do not overload)
Missed dose? Take now, do not double
Nasal may be irritating
What drug is given for nephrogenic DI?
What is HCTZ therapy used for?
Paradoxical effect in DI (dec polyuria, inc osmolality)- reverses Sx
Taken with K+ sparing diuretic
What is Addison's Dx?
Primary adrenocortical insufficiency
Dx of adrenal cortex
Results in loss or lack of cortisol hormones
Idiopathic, autoimmune, or other
Can result in permanent gland damage
What does Addison's Dx cause a decrease in?
Discuss early clinical manifestations of Addison's Dx
Results from sodium and water problems
Slow degenerative destruction w/ rapid onset
Anorexia, wt loss
Weakness, malaise, apathy
Skin hyperpigmentation (very tan appearance)
What causes Addisonian (Adrenal) Crisis?
Sudden insufficiency of serum corticosteroids from...
sudden loss of adrenal gland
sudden increase in stres in chronic condition
sudden cessation of corticosteroid drug therapy
What are the Sx of Addisonian (Adrenal) Crisis?
Sudden penetrating pain in the lower back, abdomen, or legs
Severe vomitting and diarrhea
Loss of conciousness- coma (severe sodium/ water balance)
What is the drug therapy for Addison's Dx?
Replace those deficient hormones
Cortisol- hydrocortizone (Cortef) 1-2 x/day
Aldosterone- mineralocorticoid (fludrocortisone- Florinef) and inc salt intake
What are Nsg Implications for Addison's Dx?
Closely follow Rx dosing schedule
Never abruptly stop therapy
Replacement therapy is lifelong (chronic dx)
Dosage will need to be inc during stress- 3x3 (3 times dose for 3 days)
Always maintain emergency supply
Wear Medic Alert bracelet
How do you treat Addisonian Crisis and why?
IV- hydrocortisone, saline, and dextrose (replace what is lost)
B/c PO- dec hydrocortisone and aldosterone until achieved over days