Endocrine

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Author:
tiffanydawnn
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131298
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Endocrine
Updated:
2012-01-29 00:19:27
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Endocrine
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Endocrine
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  1. endocrine disorders
    • too much or too little
    • must understand normal hormone function
  2. pituitary gland
    • base of hypothalamus (brain)
    • "master gland" - regulates many body functions
    • anterior and posterior
  3. anterior pituitary
    • growth hormone (GH) - increases protein production and bone formation
    • thyroid-stimulating hormone (TSH) - stimulates release of thyroid hormones from thyroid
    • adrenocorticotropic hormone (ACTH) - stimulates release of hormones (glucocorticoids) from adrenal cortex
  4. posterior pituitary
    antidiuretic hormone (ADH/vasopressin) - causes renal tubules to reabsorb water from urine and return it to blood (decreases urine production)
  5. thyroid gland
    • anterior to trachea/inferior to larynx
    • secretes T3/T4 (TH) - controls metabolism
    • --initiated by TSH - negative feedback
    • --requires iodine
    • secretes calcitonin (tones it down)
    • --decreases excess serum calcium
    • --slows calcium releasing bone cells
    • --reduces intestinal absorption of calcium
    • --promotes excretion in kidneys
    • --opposite of PTH
  6. parathyroid glands
    • embedded on surface of thyroid
    • parathyroid hormone (PTH) - increases serum calcium, decreases serum phosphate
    • increases excretion of phosphate/decreases excretion of calcium in kidneys
    • mobilized skeletal calcium stores
    • increases calcium absorption in GI
    • requires vitamin D
    • opposite of calcitonin
  7. adrenal glands
    • pyramids on top of kidneys
    • adrenal medulla - epi/norepi
    • adrenal cortex - steroids
  8. adrenal medulla
    • short term stress response
    • epinephrine (adrenalin)
    • --increases blood glucose
    • --stimulates ACTH release
    • --increases cardiac contractility
    • --increased HR
    • --vasoconstriction in skin, mucous membranes, kidneys
    • --vasodilates coronary and pulmonary arteries
    • norepinephrine (noradrenalin) - vasodilates heart, brain, skeletal muscle
  9. adrenal cortex
    • long term stress response
    • mineralocorticoids (aldosterone)
    • --conservation of sodium/water
    • --maintains BP under stress
    • --release controlled by renin
    • --decreased BP > kidney > renin > AngI > AngII > aldosterone > Na, H2O reabsorbed
    • glucocorticoids (cortisol/cortisone)
    • --carbohydrate metabolism
    • --mobilize fatty acids
    • --excess depresses inflammatory response
  10. pancreas
    • behind stomach, behind spleen and duodenum
    • endocrine and exocrine gland
  11. hyperthyroidism
    • excessive TH
    • increased metabolism
    • etiology
    • --Graves' disease - autoimmune
    • --pituitary tumor - increase TSH secretion
    • --thyroiditis - inflammation of the thyroid (viral)
    • --cancer
    • --Synthroid
    • --toxic multinodular goiter - thyroid tumor
    • dx: elevated TSH, elevated T3/T4, increased radioactive iodine, thyroid Ab test (Graves')
  12. hyperthyroid manifestations
    • caloric/nutritional deficiencies
    • increased HR, SV, cardiac output, peripheral blood flow
    • weight loss
    • hypermotile bowels/DHR
    • heat intolerance/sweating
    • insomnia
    • palpations
    • smooth, warm skin
    • fine hair/hair loss
  13. Graves' Disease
    • autoimmune - Abs binds to TSH receptors in thyroid/causes hyperfunction
    • more common in females 20-40
    • goiter
    • proptosis/exophthalmos - forward eye displacement
    • fatigue
    • hand tremors
    • menstrual changes
    • Afib/angina/CHF in older patients
  14. thyroid crisis
    • extreme hyperthyroidism (RARE)
    • medical emergency
    • hyperthermia (102-106)
    • tachycardia
    • HTN
    • dyspnea
    • abd pain, DHR, vomiting
    • tx: cooling (no aspirin), fluids, glucose, electrolytes
  15. hyperthyroidism meds
    • potassium iodine/iodide
    • --large doses of iodine suppress thyroid function
    • --10-15 day therapy
    • methimazole (Tapazole), propylthiouracil (PTU)
    • --decrease TH production
    • assess for iodine allergy (give iodide instead)
    • administer at same time each day
    • monitor for s/s of hypothyroidism
    • tape eyes closed for sleep
  16. hyperthyroidism nursing dx
    • risk for decreased cardiac output r/t increased HR, increased SV, increased metabolic demands, increased O2 requirements
    • disturbed sensory perception: visual r/t proptosis/exophthalmos
    • imbalanced nutrition: less than body requirements r/t hypermetabolic state
    • disturbed body image r/t goiter, tremors, hair loss
    • anxiety r/t insomnia, mood changes
  17. hypothyroidism
    • insufficient TH
    • decreased metabolism
    • etiology
    • --Hashimoto's thyroiditis - autoimmune - Abs attack thyroid
    • --Cretinism - congenital/neonatal
    • --thyroidectomy/radiation
    • --antithyroid medications
    • --iodine deficiency
    • --amiodarone (Cordarone) - contains iodine
    • --Myxedema - severe hypothyroidism
    • --Cretinism - congenital (primary)
  18. hypothyroid manifestations
    • goiter
    • fluid retention/edema
    • decreased HR
    • decreased appetite
    • elevated cholesterol/triglycerides
    • weight gain
    • constipation
    • dry skin
    • dyspnea
    • pallor
    • hoarseness
    • muscle stiffness
  19. myxedema coma
    • severe hypothyroidism
    • medical emergency
    • decreased HR, BP, BGL, body temp, LOC
    • cardiovascular collapse
    • coma
  20. hypothyroid meds
    • levothyroxine (Synthroid) - give in AM, monitor TH levels
    • desiccated thyroid
    • liotrix
    • give same time daily, 1 hr before or 2 hrs after meals
    • monitor for s/s of hyperthyroidism
  21. goiter
    • enlargement of thyroid gland
    • visible on anterior neck
    • caused by hypo and hyperthyroidism
    • airway/swallowing
  22. hyperparathyroidism
    • excess PTH
    • increased serum calcium/decreased serum phosphate
    • increased bone decalcification (PTH mobilizes skeletal muscles)
    • increased calcium absorption in GI
    • retention of calcium by kidneys
  23. hyperparathyroidism manifestations
    • musculoskeletal:
    • --hypercalcemia (Ca > 10.2)
    • --osteoporosis
    • --pathologic fractures
    • --muscle weakness/atrophy (depressed neuromuscular excitability)
    • renal:
    • --renal calculi/failure
    • --metabolic acidosis
    • --polyuria
    • constipation
    • dysrhythmias
    • HTN
  24. hyperparathyroidism tx
    • fluids to dilute excess Ca
    • increase activity (push Ca back into bones)
    • biphosphonates (Zometa, Boniva, Fosamaz)
    • calcitonin
    • surgical removal of PT
  25. hypoparathyroidism
    • insufficient PTH
    • decreased calcium/increased phosphate
    • s/s hypocalcemia (Ca < 8): numbness/tingling around mouth and fingertips, muscle spasms (bronchial/abdominal), hypotension, bradycardia, dysrhythmias
  26. tetany
    • muscle spasms
    • assess Chvostek - tap facial nerve in front of ear
    • assess Trousseau - inflate BP cuff for 2-5 mins
  27. hypoparathyroid tx
    • dietary Ca
    • vitamin D (Calcitrol)
    • Forteo - synthetic PTH
  28. Cushing's syndrome
    • excess ACTH or glucocorticoid (cortisol) due to hyperfunction of adrenal cortex
    • STEROIDS, SALT, SUGAR
    • aka hypercortisolism
    • etiology:
    • --iatrogenic - long term steroid use
    • --Cushing's disease - ACTH hypersecretion from pituitary
    • --ectopic - ACTH secreting tumors
    • --adrenal - excess cortisol secretion
    • dx: cortisol level (increased) , ACTH level (increased), serum Na (increased), K (increased), glucose (increased), ACTH suppression test (ACTH should decrease)
    • tx: meds to suppress cortisol/ACTH, surgery (adrenalectomy)
    • --Mitotane (suppresses adrenal cortex
    • --ketoconazole - inhibits cortisol synthesis
  29. Cushing's manifestations
    • increased blood glucose
    • increased Na and H20 - excess aldosterone secreted by adrenal in addition to cortisol
    • --HTN
    • decreased K
    • buffalo hump, moon face, abdominal obesity, skinny arms (fat redistribution) - carb metabolism changes
    • muscle weakness/wasting - protein metabolism changes
    • immunosuppression
    • facial hair
    • bruising, thin skin, delayed wound healing - loss of collagen
    • osteoporosis, fractures, renal calculi - calcium absorption changes
    • emotional instability
  30. Cushing's nursing dx
    • fluid volume excess r/t excess cortisol leading to increased sodium and water reabsorption
    • electrolyte imbalance
    • risk for infection
    • risk for injury
    • hyperglycemia
    • impaired skin integrity
    • impaired tissue integrity
  31. Addison's disease
    • deficient cortisol (gluco) and aldosterone (mineral) from adrenal cortex
    • aka chronic adrenal insufficiency, hypercortisolism
    • etiology:
    • --autoimmune
    • --adrenal hemorrhage
    • --tumors
    • --abrupt steroid withdrawal
    • dx: serum cortisol (decreased), Na (decreased), K (increased), BUN (increased), glucose (decreased), plasma ACTH, 24 hour urine, CT scan
    • tx: hydrocortisone (replaces cortisol), fludrocortisone/Florinef (replaces aldosterone), increased Na in diet
  32. Addison's manifestations
    • hyperpigmentation
    • poor stress response
    • decreased Na
    • --dizziness
    • --confusion
    • --neuromuscular irritability
    • decreased fluid volume
    • --hypotension
    • --syncope
    • increased K
    • --dysrhythmias
    • hypoglycemia
    • lethargy
    • weakness
    • anorexia
  33. Addisonian crisis
    • medical emergency
    • triggered by stress (trauma, surgery, acute illness, abrupt steroid W/D)
    • high fever
    • weakness
    • severe abd pain
    • severe vomiting, DHR
    • hypotension and circulatory collapse
    • shock
    • coma
    • tx: fluids, glucocorticoids
  34. Addison's nursing dx
    • fluid volume deficit
    • hypoglycemia
    • electrolyte imbalance
    • decreased tissue perfusion
  35. pheochromocytoma
    • excess catecholamines (epi, norepi) from adrenal medulla
    • stimulates sympathetic nervous system
    • BP 200-300/150-175
    • peripheral vasoconstriction
    • tachycardia
    • risk of kidney failure, stroke
    • tx: adrenalectomy
  36. hyperpituitarism
    • excess secretions from anterior pituitary
    • benign adenomas most common cause
    • excess GH, prolactin, ACTH
    • causes gigantism, acromegaly
    • tx: transsphenoid hypophysectomy
  37. gigantism
    • excess growth hormone before puberty
    • causes abnormal height with normal proportions (before epiphyseal plates close)
  38. acromegaly
    • excess growth hormone after puberty (after epiphyseal plates close)
    • causes enlarged hands, feet, forehead, maxilla
  39. transsphenoid hypophysectomy
    • through sphenoid up nose to remove pituitary
    • monitor nasal drainage for CSF
    • monitor for s/s meningitis
  40. diabetes insipidus
    • deficient ADH from posterior pituitary
    • neurogenic - disruption of hypothalamus or pituitary (head trauma, surgery)
    • nephrogenic - kidneys not sensitive to ADH (renal failure)
    • s/s:
    • --polyuria (up to 12L/day)
    • --dilute urine - low specific gravity, low osmolality
    • --concentrated blood - high serum osmolality
    • --polydipsia
    • --dehydration
    • --dilutional hypernatremia (fluid volume deficit causes increased Na level)
    • tx: DDAVP (IV or intranasal), hypotonic fluids
  41. SIADH
    • increased ADH from posterior pituitary
    • caused by ectopic ADH production (cancer), head injury, pituitary surgery
    • s/s:
    • --water retention
    • --decreased urine output
    • --concentrated urine - high specific gravity, high osmolality
    • --dilute blood - low serum osmolality
    • --hyponatremia - aldosterone suppressed
    • --mushy brain - brain cells swell - AMS, HA
    • tx: fluid restriction, demeclocycline (tetracycline - increases output), diuretics
  42. serum osmolality
    amount of chemicals dissolved in blood

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