NUR119mod9

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TomWruble
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163029
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NUR119mod9
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2012-07-23 23:39:53
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nur119 mod9 endocrine final
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  1. 1. List 3 major functions ot the endocrine system.
    • → Controlling cellular metabolism
    • → Growth and development
    • → Tissue function
    • → Mood
  2. 2. Major organs of the endocrine system include:
    • → HYPOTHALAMUS
    • → PITUITARY
    • → THYROID
    • → PARATHYROID
    • → PANCREAS
    • → ADRENALS
    • → OVARIES
    • → TESTES
  3. 3. Tissues function through AAAA which act as messengers between body cells.
    hormones
  4. 4. Tissues which produce hormones:
    • GI: digestive hormones
    • KIDNEY: erytbropoctin
    • WBC: cytokines messengers stimulate growth of
    • blood cells
    • PROSTAGLANDINS: i.e. E which is produced by the stomach and duodenum/inhibits gastric acid secretion
  5. 5. What can also produce hormones resulting in excess hormone secretion?
    ???
  6. 6. What does the nervous system regulate?
    Immediate control of organs & muscles
  7. 7. What does the endocrine system regulate?
    Long-term regulation and control of organs & tissues
  8. 8. Which organ is considered the main connecting link which controls secretion from the pituitary gland?
    One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland (hypophysis).
  9. 9. What controls secretions of the posterior pituitary?
    • → ADH is control by serum osmolaity.
    • → Oxytocin, controlling the smooth muscle of the uterus is controlled by the ONLY positive feedback system in nthe body
    • → These hormones are manufactured in the HYPOTHALAMUS and stored in the posterior pituitary. 
  10. 10. What regulates function of the anterior pituitary?
    Negative feedback from the target glands: thyroid, adrenals and ovaries
  11. 11 Review characteristics of hormones.
    • → Some affect all cells
    • → Others affect specific target tissues
    • → One hormone can affect different tissues
    • → Several hormones can affect single tissues
    • → Some are cyclic.
  12. 12. Review other facts about hormones.
    • → Most hormones are constantly present in the blood
    • → Protein-derived hormones circulate unbound and active
    • → Steroid hormones & thyroid hormones are released as they are synthesized & are transported by specific carrier proteins
    • → Water soluble & protein-derived hormones have a short duration & are inactivated by enzymes present in the liver and the kidjney
    • → Lipidsoluble hormones have a longer duration of action
    • → Some hormones are inactivated by enzymes at receptor sites on target cells.
  13. Where do hormones bind with receptors?
    • → Bind with receptors in the cell membrane
    • → Bind with receptors inside the cell.
  14. 14. List 2 factors which determine a target cellsresponse, to hormones:
    • → # of receptors
    • → affinity of receptors for the hormone
  15. 15. Discuss 4 conditions which can alter the # of receptors.-
    • → Increased when there are low levels of hormones
    • → Decreased when there are excessive amounts of hormones
    • → Antibiodies destroy them
    • → Inadequate formation of receptors.
  16. 16. Review major hormones & their functions.
    → Hormone production & release is cyclic: daily or about every 28 days

    → Adrenal & Gonad hormone are STEROIDs; all others are PROTEIN hormones

    • Hypothalamus
    • → TRH (thyroid releasing hormone) → TSH/pit
    • → CRH → ACTH/pit

    • Anterior Pituitary
    • → TSH → rate of metabolism
    • → ACTH → corticoids and androgen from Adrenal
    • → FSH → eggs & sperm
    • → LH → estrogens & androgens
    • → GH or STH (somatotropic hormone) → all body tissues, particularly bones & skeletal muscles
    • → PL (prolactin) → brest milk
    • → MSH

    • Thyroid
    • → thyroxine(T4) and triiodothyronine(T3)
    • → Calcitonin → Dec blood Ca (see PTH)

    • Posterior Pituitary
    • → ADH: inc serum osmolaity → ADH → water retained by kidneys to dilute ...
    • → Oxytocin → child birth

    • Parathyroid
    • → PTH → Inc blood Ca

    • Adrenal
    • → Medulla → epinnephrine & norepinephrin
    • → Cortex → corticosteroid: Aldosterone → electrolytes

    • Pancreas
    • → alpha → Glucagon → Liver: break down & rel glycogen
    • → beta → Insulin
  17. 17. What are 5 reasons for hypofunction of endocrin glands?
    • → Absence/abnormally developed gland or  absence of enzyme for synthesis
    • → Damaged or destroyed due to impaired blood flow, infection, inflammation, autoimmune disease, neoplasm
    • → Atrophy - less function doe to age, drugs, disease, unknown factors
    • → Receptor deficits
    • → Enough receptors/hormone though metabolic disturbance (enzyme, protein, energy)
  18. 18. Give 3 reasons for byperfunction of endocrin glands:
    • → Excessive stimulation / enlargement of the gland
    • → Hormone producing tumor of the gland
    • → Hormone producing tumor of nonendocrine tissue (i.e. lung tumor)
  19. 19. Discuss characteristics of hormonal drugs.
    • → Derived natural from human, animals, syntbetic → more potent and more prolonged effects
    • → Physiologic use - giving small amounts for replacement or substitute.
    • → Pharmacologic use - larger doses used → greater effects than physiologic, e.g. steroids used for inflammatory effects
    • → Many therapeutic, as well as, adverse effects
    • → May alter effects of other hormones
    • → Used mainly for hypofunction.
  20. 20. What organ controls secretion of pituitary hormones?
    Hypothalamus
  21. 21. Complete the following table.
    • Hypothalamic hormone ←→ Anterior Pituitary Hormone
    • Corticotropin-releasing hormone ←→ ACTH
    • Growth hormone-releasing factor ←→ GH
    • Growth hormone inhibiting factor ←→
    • Thyrotropin-releasing hormone ←→ (TSH) → T3, T4
    • Gonadotropin-releasing hormone ←→ FSH, LH
    • Prolactin-releasing factor ←→ Prolactin
    • Prolactin-inhibiting factor
  22. 22. The posterior pituitary gland stores, but does not manufacture, which 2 hormones?
    • → ADH
    • → Oxytocin
  23. 23. What controls corticosteroid secretion?
    • → Hypothalamus
    • → Anterior Pituitary
    • → Adrenal Cortex
  24. 24 Which glucocorticoid accounts for most of glucocorticoid activity?
    • Cortisol:
    • → Antiinflammatory, antiallergic & antistress
    • → Inc breakdown of protein & fat
    • → Inc blood levels of glucose
    • → Steroids → Na retention → water retention, if Pt is HTN
    • → Admin steroids with food because they decrease the viscosity of gastric mucosa contributing to gastric ulcers
  25. 25. Review physiologic effects of glucocorticoids.
    • → Carbohydrate, protein, lipid metabolism
    • → Decrease inflammatory and immune responses
    • → Helps regulate blood pressure
    • → Maintains nerve exdtability & muscle strength
    • → Increase exaction of calcium contributing to development of osteoporosis
    • → Open bronchial airways / prevent release of histamine
    • → Decrease viscosity of gastric mucosa - contributing to gastric ulcer formation, so take glucocorticoids with food!
  26. 26. Which mineralcorticoid is responsible for most mineralcorticoidactivity?
    • Aldosterone
    • → Inc Na & water retension by kidneys to control fluid balance
    • → If body hangs oto Na, the K must go away (This is similar to the relationship between Ca & Phos)
  27. 27. How does aldosterone function?
    • → Controlled by renin-angiotensin system NOT by ACTH
    • → Hypovolemia causes the release of aldosterone which causes kidneys to retain Na, which attracts water and so water is also retained, leading to restored fluid balance
  28. 28. What is the prototype corticosteroid?
    Prednisone
  29. Review indications for corticosteroids.
    ???
  30. 30. List common corticosteroids.
    • → Vanceril
    • → Beconase
    • → Decadron
    • → Aerobid
    • → Nasalide
    • → Hydrocortisone
    • → Medrol
    • → Solu-Medrol
    • → Prednisone
    • → Azmacort
    • → Nasacort
    • → Ftorlnef
  31. 31. What are contraindications for steroid use?
    • → Diabetes
    • → Peptic ulcer disease
    • → HTN/CHF/ Renal insufficiency
  32. 32. What are some important considerations regarding steroids?
    • →Therapy is usually 10 days or less including taper
    • → Steroid inhailer: rinse mouth and wipe down mouthpiece to avoid oral thrush
  33. 33. What are adverse effects of steroid therapy?
    • → Healing is impaired for those on steroids
    • → Expect higher doses for those undergoing surgery or stressfull situations
    • → Less for older Pts.
    • → K depletion
    • → Moon face//buffalo hump = Fat deposits
    • → Diabetes  mellitus = Inc BS
    • → CNS = Mood sweings
    • → Musculoskeletal = ???
    • → Cardiovascular = HTN & CHF
    • → Gastrointestinal = Inc Apt & Peptic Ulcer
    • → Susceptible to infection & delayed wound healing = Depressed immunity & high BS
    • → Menstrual Irregularities/acne/facial hair = Possible
    • → Ocular = Glaucoma
    • → Skin = Thinning & Dry
  34. 34. What information should nurses teach patients about steroids.
    • → Take with food!!!!!!!!!!
    • → Avoid others with infection!!!!!
    • → Wash hands frequently!!!!!
    • → DECREASE SALT INTAKE
    • → Call doc: sore throat, fever or other signs of infection
    • → Stressful situations
    • → Weight gain of 5#/week
    • → Swelling
    • → Chest pain
    • → Mood swings
    • → Sleep difficulty
    • → Check BP and weight DAILY
  35. 35. Apply your knowledge. Your patient having elective abdominal surgery has been taking prednisone daily. What interventions will you consider regarding chronic steroid use?
  36. 35b. Another patient on your team the same day is on a steroid taper as follows: taperhydrocortisone dose (80 mg bid) 20 mg each day for three days. You are caring for the patienton the thiid day of the taper and administer 40mg for the morning dose. Your thoughts on thephysician order and the calculation of the 3rd day dose.
  37. 36. What 3 hormones does the thyroid produce?
    T3, T4 & Calcitonin
  38. 37. What is need for thyroid hormone production?
    Iodine from iodized salt
  39. 38. How are bound thyroid hormones delivered to the tissues?
    carried by TBG (thyroxine-bindign globulin) and albumin which protects the hormone from being degraded. 
  40. 39. What happens to released iodine?
    Iodine binds to plasma proteins and is released slowly over days once used by cells
  41. 40. Why are thyroid hormones important?
    • → Control cellular metabolism
    • → Critical for brain & Skeletal development 
  42. 41. What is a simple goiter & why does it develop?
    → Enlarged thyroid r/t I deficiency
  43. 42. How is simple goiter treated?
    Iodine & thyroid hormones
  44. 43. What is hypothyroidism?
    • Under production of T3 & T4 with elevated TSH
    • → In a  child it causes cretinism
    • → In an adult - Mixedema - sever thyroid deficiency
  45. 44. What do lab blood studies show for this Hypothyroid patient?
    Elevated TSH and dimished T3 & T4
  46. 45. What is the treatment for hypothyroidism & how long will treatment last?
    • Life-long with levothyrozine
    • → These druga are not interchangable
    • (Armour Thyrotab) 
  47. 46. What is hyperthyroidism?
    T3 & T4 high with low TSH
  48. 47. What will lab blood studies show for the hyperthyroid patient & why?
    TSH is not released by Anterior Pituitary because T3 & T4 are high (negative feedback)
  49. 48. What is the treatment for hyperthyroidism?
    • → PROPYLTHIOURACIL
    • → TAPAZOLE
    • → IODINE SOLUTIONS - potassium iodide (SSKI) → adminafetr meals and sip through straw to avoid discoloration of teeth
  50. 49. What other drug may be used for hyperthyroid patients with cardiac symptoms?
    ???
  51. 50. How long is drug therapy for hyperthyroid patients?
    ???
  52. 51. Discuss drug therapy monitoring for thyroid patients.
    ???
  53. 52. Review adverse effects of anthyroid/thyroid drugs.
    → irritability, tachy, nervousness, insomnia
  54. 53. List important points about insulin.
    • → Protein hormone
    • → Secreted by the beta cells in the pancreas
    • → Average daily secretion: 40 - 60 Units
    • → Insulin receptors located in the liver, muscle, and adipose
    • → With binding, insulin enters the cells as does potassium
    • → Insulin is filtered by the kidneys
    • → Major function: to provide adequate glucose in the blood for metabolism and energy
  55. 54. Complete the following table regarding diabetes.
    • → CHRONIC AUTOIMMUNE DISEASE
    • → Vascular problems: atherosclerosis (changes in the retina and kidney, HTN, MI, stroke, PVD)
    • → TYPE 1 - Usually starts before age 20
    • → TYPE 2 - Usually starts after age 40; less severe symptoms initially; easier to control; may be earlier r/t obesity
    • → Signs & symptoms - p. 781 / DKA - p. 786
  56. 55. Review facts about insulin
    • → Types - human, beef, pork
    • → Lispro (Humalog) - peak 0.5 - 1 hr / duration 2-4 hrs
    • → Lantus (Long - Acting)
    • → GI tract proteins destroy insulin

    • Short (Regular)
    • → Peak: 2-4 hr
    • Onset:
    • Duration:

    • Intermediate (NPH, Lente)
    • → Peak: 6-12 hrs
    • → Onset:
    • → Duration:

    • Long (UltraLente)
    • → Peak: 14-20 hrs
    • → Onset:
    • → Duration:

    • NPH 70%, Regular 30%, Peak - 4 - 8 hours
    • → 1 cc of insulin = 100 Units insulin!!!!!!!!
    • → Sliding scale insulin coverage - Regular insulin Before meals & @ H.S.
    • → Signs & symptoms of hypoglycemia - p. 787
  57. 56. Review the following oral hypoglycemics.
    • → SULFONYLUREAS: Increase secretion of insulin
    • → ALPHA-GLUCOSIDASE INHIBITORS: Delays digestion of CHO's in the GI tract; Take at the beginning of meal
    • → BIGUANIDE: Increases the use of glucose by muscle and fat cells; DC 48 hours before Dx tests with iodine; (Hypaque) r/t potential renal failure and development of lactic acidosis; resumed 48 hours after the test
    • → INSULIN ENHANCING AGENT: Increases the effectiveness of circulating insulin
    • → GLITAZONES: Stimulates receptors - restores
    • effectiveness of body's insulin
  58. How do oral hypoglycemics work?
    Increasing the secretion of insulin
  59. 57. List important points to remember regarding insulin administration.
    • → Wx for insuling Rx during PEAK & document
    • → Insulin is not refrigerated; keep on counter
    • → Polyuria, Polydipsia (THIRST), Polyphasia
    • Polydipsia Wipe with alsohol and then wipe to remove alcohol
    • → Speed:(H→L) Abdomen, Deltoid, Thigh, Hip
    • → Avoid Detoid for weight lifters → TOO fast absorb
    • → Only regular insulin for IV administration
  60. 58. Apply vow knowledge Your diabetic patient receives NPH insulin 32 units before breakfast and 10 units of NPH before dinner. Calculate when the patient is most likely to experience an insulin reaction. What signs and symptoms will you monitor for? How could you avoid this medication error? Your postop patient has a history of insulin dependent diabetes mellitus for 10 years. She takes NPH 20 units every morning. Her postop orders include a clear liquid diet to advance as tolerated. 80 units of NPH insulin AC dinner, and a sliding scale insulin coverage scale. At 5 p.m., her blood glucose is 116 and she has nocomplaint of nausea, a full liquid tray is ordered NPH insulin. 80 units, is administered at 5:30p.m. What error has occurred? What could the nurse have done to prevent it? What could the doctor have done to prevent it? What needs to be done at this point to keep the patient safe?
  61. 59. Review the roles of parathyroid hormone and calcitonin in regulating calcium.
    • Parathyroid hormone
    • From: parathyroid gland
    • Targets: bone, kidney, small intestine
    • Response:
    • 1) Inc breakdown of bone by osteoclasts
    • 2) Inc reabsorption of calcium by kidneys
    • 3) Inc absorption of calcium in the small intestine
    • 4) Inc vitamin D synthesis
    • 5) Inc blood calcium levels

    • Calcitonin
    • From: thyroid gland
    • Targets: bone
    • Response:
    • 1) Dec breakdown of bone by osteoclasts
    • 2) Prevention of large inc in blood calcium level
  62. 60. How does Vitamin D regulate calcium metabolism?
    • → It is needed to absorb calcium from the GI tract.
    • →Deficient vitamin D causes inadequate absorption of Calcium & Phosphorus
  63. 61 What regulates calcium and phosphorus?
  64. 62. Review these bone disorders:
    • → Hypocalcemia
    • → Hypercalcemia
    • → Osteoporosis
  65. 63. How do the following drugs assist with controlling calcium levels?
    • → Fosamax: Before meals on an empty stomach; Sit up for 1/2 hr; Not every day! once a week or month
    • → PhosLo: Lowers phosphate leading to INC Ca
    • → Calcium gluconate: Administer slowly, check pulse and blood pressure, have patient on a monitor.
    • → Calderol: ???
    • → Forteo (Parathyroid hormone): Used to inc Ca
    • → Lasix: Dec Ca
    • → Neutra-Phos: INC Phos → DEC Ca
    • → Prednisone: Ca++ absorption from intestine
    • → Sodium Chloride(0.9%) IV: ???
  66. 64. What is a normal calcium level?
    4.5 5.5 mEq/L
  67. 65. Review hallmark signs and symptoms of hyper and hypocalcemia.
  68. 66. Apply Your knowledge. Your patient had a subtotal thyroidectemy 2 days ago. During your morning assessment, she complains of tingling in the fingers. What additional data should you collect at this time?
  69. Normal Electrolyte Values - venous blood
    MPPCS

    • Sodium: 135-145 mEq/L
    • Potassium: 3.5-5.3 mEq/L
    • Calcium: 4.5-5.5 mEq/L
    • Magnesium: 1.5-2.5 mEq/L
    • Phosphate: 1.8-2.6 mEq/L
    • Serum Osmolality 280-300 mOsm/kg water

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