Medical Nursing Week 4

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Gia_bella
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Medical Nursing Week 4
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2012-09-30 23:58:09
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Medical Nursing Week 4
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  1. Pituitary glands
    • Secretes hormones
    • controls hormone functions such as our temperature, thyroid activity, growth during childhood, urine production, testosterone production in males and ovulation and estrogen production in females.
  2. Anterior pituitary
    Posterior Pituitary
    • posterior pituitary stores and secretes:
    • Oxytocin,  and Antidiuretic hormone (ADH)

    • Anterior pituitary
    • When a pituitary tumor secretes too much ACTH (adreno corticotropic hormone), it causes the otherwise normal adrenal glands to produce too much cortisol.
  3. Endocrine System- controls the whole body
    Anatomy
    • Hypothalamus- Control system
    • Pituitary
    •  Adrenal
    • Thyroid and parathyroid
    • Pancreas
  4. Endocrine System
    Purpose
    • Controls the whole body
    • Metabolic and hormone regulation
  5. Endocrine System
    Pathologic Symptoms
    • PU/PD
    • Vomiting
    • Non-Specific- Diarrhea
  6. Endocrine System
    Diagnostic Tests
    • Blood Panel
    •    ACTH Stimulation Test- Adrenal
    •        1. Test for pituitary function, Cushings and Addisons
    •        2. ACTH gel (cortigel)
    •               2.2 u/kg IM
    •        3. Synthetic ACTH (cortrosyn)
    •              .25 mg IM or IV
    •        4. Measure plasma cortisol 0 and 1 hour cortrosyn 0 and 2 hours after cortigel
    • TSH Response Test (thyroid stimulating)
    •        1. TSH (thytropin)
    •            1 u/27kg  IV or IM
    •        2. Measure Plasma coritsol 0, 4 and 6 hours post TSH administration
    • Low Dose Dexamethasone Suppresion (corticoid steroid)
    •      1. DEX SP4
    •              0.01 mg/kg IV
    •      2.  Measure plasma at 0, 4hr, 8 hours post DEX SP4 administration
    •     3. Hyperadrenocorticism
    •             no suppression
    • High Dose Dexamethasone Suppresion
    •      1. Dex Sp4
    •            0.1 mg/kg IV
    •     2 measure plasma at 0 and 4 hours post DEx SP4 administration
    •    3. Differentiates pituitary- vs- adrenal hyperadrenalcorticism
    •   4. Adrenal  
    •        a. 100%- no suppression
    •    5. Pituitary
    •       b. 75% - have suppression 
    • Insulin assays- Fructosamine
    • Urinalysis
    • Radiographs
    • Ultrasound
  7. Endocrine System
    Disease Pancreas
    Clinical Signs and History
    Diabetes Mellitus- Low insulin, High blood glucose

    • Polydipsia and polyuria
    • Weight loss
    • Hepatomegaly
    • Cataracts- sugar crystalizes the lens
    • Vomiting and diarrhea
  8. Endocrine System
    Disease Pancreas
    Etiology
    • Insulin deficiency causing hyperglycemia (beta cells of pancreas)
    • All breeds are effected
    • Animals < 1 yr old are rarely effected
    • Genetic predisposition
    • Drugs
    •    Megestrol acetate
    •    Progesterone
    • Pancreatic diseases
    •    Neoplasia
    •     Pancreatitis
    •        Only if >90 of Beta cells destroyed
    • Type 1 (juvenile onset) - all animals
    •     Inadequate insulin production (most common in animals)
    • Type 11 (adult onset) in cats
    •   TIssue resistant to insulin- non insulin dependant
  9. Endocrine System
    Disease Pancreas
    Diagnostic Tests
    • Blood panel
    •   Glucose
    •   a.  >300 mg/ml on repeated tests
    •   Glycosuria
    •   a. May be seen in cats due to stress
    • Urinalysis- glucose in urine
    • Fructosamine blood leves (blood Protein)
    •   fructosamine in serum is direct measurment of glucose cencentration
    •   Used now to monitor control of diabetes
    •    If fructosamine levels high, then poor insulin control
  10. Endocrine System
    Disease Pancreas
    Treatment
    • Oral hypoglycemic agent
    •   Usually with cats
    •   Glipizide
    •     5mg PO Bid
    • Insulin
    •   Usually given SQ BID
    •   Some given SQ SID
    •   After insulin is given, animal is given a food meal
    • Types of Insulin
    •   Humulin R (regular)
    •   Humulain N (NPH)
    •   Humulin L (Lente)
    •   Humulin U (Ultralente) last the longest
    • Vetsulin- Pork/zinc (used common in dogs) off market
    • Glargine- recombinant DNA (cats) DNA that has been created artificially
    • Protomic zinc insulin (PZI)- cats off market
  11. Endocrine System
    Diet Management
    • W/D or DM- high protein in cats
    • Avoid diets high in fat and sugar content
    • Feed dogs twice daily
    • Cats can be free fed
    •   Obesity can occur
  12. Endocrine System
    Fructosamine levels
    Fructosamine levels measures bound proteins to glucose, so glucose level can be measured by fructosamine levels. Elevated fructosamine will take 4 days to increase.

    Determines if insulin level is correct- high fructoseamine level if insulin to low.
  13. Endocrine System
    Diabetic Ketoacidosis (DKA)
    • Blood sugar too high for too long
    •  Life threatening state of diabetes mellutus that causes secondary acidosis that leads to a metabolic body shut down
  14. Endocrine System
    Diabetic Ketoacidosis (DKA)
    Clinical Signs
    • Vomiting and diarrhea
    • Acetone breathe
    • Lateral and collapsed
    • Dehydration and kidney insult
  15. Endocrine System
    Diabetic Ketoacidosis DKA
    Diagnosis
    • Blood Panel
    •   Ph- acidosis <7.4 Ph about 7.2 or lower
    • Low electrolytes: Na, K, C1 and Hco3
    • Urinalysis-ketones
    • Hyperglycemia- glucose >500
  16. Endocrine System
    Diabetic Ketoacidosis DKA
    Treatment
    • Similar to diabetes- but longer term hospitalization and fluids
    • Regular insulin-drip or hourly Im injections CRI drip
    • Nacl fluids + KCL and Hco3 additives

    Buffereing agent in Iv Fluids
  17. Endocrine System
    Diabetic Ketoacidosis DKA
    Prognosis
    Very guarsded to poor
  18. Endocrine System
    Disease- Adrenal Gland
    Hypodrenocorticism (Addisons)
    Clinical signs and History
    • Acute collapse and weakness
    • Bradycardia
    • Hypovolumia and shock
    • Anorexia
    •     Vomiting and diarrhea
  19. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hypodrenocorticism (Addisons)
    Etiology
    • Deficiency of glucorticoids and mineral corticoids from adrenal gland cortex
    • Idiopathic
    • Immune mediated
    • Neoplasia
    • Infections
  20. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hypodrenocorticism (Addisons)
    Diagnostic Tests
    • X-ray
    • Blood Panel
    •   Hyperkalemia- High potassium levels
    •   Hyponatremia- Low Sodium
    • ACTH stimulation tests
    •    Low results seen in both pre and post samples
  21. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hypodrenocorticism (Addisons)
    Treatment
    • Shock
    •   fluid Therapy IV
    •     0.9% NaCL
    • Corticosteroid
    •   Dexamethasone
    •   Prednisolone
    • Long Term Medical Management
    •    Prednisolone- Prednisone
    •   0.2- 0.4 mg/ml/day PO
    • Fludrocortisone Acetate (florinef)
    •   0.02 mg/kg/day Po
    • Desoxycorticosterone Pivalate (DOCP)- shot once a month
    •    Mineral corticoid
    •    1-2 mg/kg IM or SQ every 25-28 days

    KCL- potassium chloride
  22. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hyperadrenalcorticism (Cushing Disease)
    Etiology
    • Excessive glucocorticoid secretion
    • 85% are naturally pituitary dependent 
    •     Excessive secretion of ACTH
    • Adrenal cortical tumors
    •    15% are adrenal dependent
    •    Of adrenal tumors, 50% are benign
    • Iatragenic hyperadrenalcorticism
    •     Excessive or prolonged administration of corticosteroids
    •     Adrenal cortex atrophied
  23. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hyperadrenalcorticism (Cushing Disease)
    Clnical Signs
    • PU/Pd
    • Excessive panting
    • lethargic and muscle weakness
    • Pendulous abdomen
    • Hepatomegaly
    • Alopecia
    • Thick and mineralized skin
    • Hyperpigmentation
  24. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hyperadrenalcorticism (Cushing Disease)
    Diagnosis
    • Blood panel
    •     Elevated alkaline phosphatase >1000IU/DL
    •     High cholesterol
    •     Stress leukogram
    • Radiographs
    •     Hepatomegaly- enlarged liver
    • Ultrasound
    •    Enlarged adrenal glands
  25. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hyperadrenalcorticism (Cushing Disease)
    Specific Blood Tests
    • ACTH stimulation tests
    •     High results determine cushings disease
    •    Does not differentiate pituitary from adrenal
    • Low dose dexamethasone suppression test
    •    No suppression determines Cushings Disease
    •    Does not differenttiate adrenal from pituitary
    • High dose dexamethasone suppression tests
    •     Differentiates adrenal from pituitary
    •    Adrenal tumors show no suppression
  26. Endocrine System
    Disease- Adrenal Gland   Dogs
    Hyperadrenalcorticism (Cushing Disease)
    Treatment
    • Pituitary
    •    Mitotane (O, P '-DDD or Lysodren
    •    Ketoconazole (nizoral)
    •    L-Deprenyl (eldepryl)
    •    Side Effects
    •          Anorexia and weakness
    •          Vomiting and diarrhea
    •          Icterus
    •          Hypoadrenocorticism
    • Surgery
    • Radiation therapy
    • Adrenal
    •     Mitotane
    •     Surgery is treatment of choice
    •         Adrenalectomy- surgical removal of one or both    adrenal glands
  27. Endocrine System
    Feline Hyperthyroidsim
    Etiology
    • Excessive concentrations of thyroid hormones
    • Functional thyroid adenoma (hyperplasia)
    • abnormal increase in the number of normal cells
    •     98% of cause in felines
    •     <2%  thyroid carcinoma, rather than dogs which are 68-87%
    •    >70% are bilateral
    • No breed specificity
  28. Endocrine System
    Feline Hyperthyroidsim
    Clinical Signs
    • Older Cats
    • Palapable thryoid glands
    • Weight loss with polyphagia
    • Diarrhea or excessive volumes of defication
    • Pu/PD
    • Thin and emaciated appearance
    • Cardiac murmur and gallop rhythm
    • Tachycardia
    • Many hyperthyroid cats will have cardiomyopathy or renal disease.
    • Cardiomyopathy- deterioration of the function of the myocardium
  29. Endocrine System
    Feline Hyperthyroidsim
    Diagnosis
    • Blood profile
    •   Elevated liver enzymes
    •    Elevated T3 and T4 values
    •    T3 suppression test (cytomel)
    •        Hyperthyroid if no suppression
    •        T3 suppresses TSH secretion
    •        Resting T4 levels taken
    •        cytomel (T3) 25ug po Tid for 7 doses
    •        then sample T4 and T3 levels on the morning of the 3rd day, 2-4 hours since the last dose
    • TSH stimulation test
    •    Take resting T4 sample then administer 0.1 mg/kg TSH IV
    • Second sample taken 4 hours later
    • Diagnosis of hyperthyroid increases T4 levels <50% of Baseline Value
    • Nuclear scintography Iodine
  30. Endocrine System
    Feline Hyperthyroidsim
    Treatment
    • Medical   
    •    methimazole (Tapazole)
    •       5mg for cat PO SID-TID
    • Radioactive Iodine (iodine 131)
    •     Treatment of choice
    •     Reoccurrence <3 %
    • Surgery
    •    Thyroidectomy
  31. Endocrine System
    Canine Hyperthyroidsim
    Introduction
    • Deficiency in thyroxine (T4) and triiodothyronine (T3)
    • Most common in older dogs and rare in cats
    • Primary hypothyroidism is caused by dysfunction of the thyroid gland
    •     Idiopathic follocular atrophy
    •     Lymphocytic thyroiditis
    • Prognosis is good with Thyroxine supplementation, hypothyroidism usually secondary problem not primary disease.
  32. Endocrine System
    Canine Hyperthyroidsim
    Clinical Signs
    • General
    •     Weight loss
    •     Lethargy
    •     Mental dullness
    • Dermatological
    •     Dry skin coat
    •    Alopecia
    •    Pruitis
    •    chronic alopecia
    •    Hyper pigmentation and hyperkeratosis (thickening of the skin)
  33. Endocrine System
    Canine Hyperthyroidsim
    Immun system
    Immunosuppressant
  34. Endocrine System
    Canine Hyperthyroidsim
    Neurological and Muscular
    • Muscle atrophy
    •      Especially Temporalis muscle of skull
  35. Endocrine System
    Canine Hyperthyroidsim
    Diagnosis
    • Clincal signs
    • High blood cholesteral Levels
    • Blood thyroid levels
    •     Primary use T4 Levels
    •          Normal dog   0.8-3.4 ug/dl
    •         Normal Cat  1.2-5.2 ug/dl
    • Serum canine CTSH test
    • Serum free T4 by equilibrium dialysis
  36. Endocrine System
    Canine Hyperthyroidsim
    Treatment
    • Sodium levothyroxine (T4) soloxine been proved to work better
    •          Will many time need medication for life supplementation
    •         Usually do not give T3 (T3 is the active form)
    • Recheck thyroid levels 2 months to alter medication dose if needed.
  37. Reproductive system
    anatomy
    • Gonads
    •     Testicles and ovaries
    • Uterus
    • Vagina and vulva
    • Penis
  38. Reproductive System
    Purpose
    Reproduction and procreation
  39. Reproductive System
    Pathological symptoms
    • Fertility problems
    • Birthing Problems
    • Mating difficulty
    • Lactation difficulty
  40. Reproductive System
    Diagnostics
    • Physical exam
    • Blood profile and urinalysis
    • Radiographs
    • Ultrasound
    • Biopsy
    • Semen evaluation
    • Vaginal cytology
  41. Reproductive System
    Disease
    Pyometra - pus uterus
    Etiology
    • Estrogen produces cervix dilation during estrus, therefore allowing bacteria to ascend into uterus.
    • Uterine body filled with pus
    •    Closed
    •    Open- pus vaginal discharge
  42. Reproductive System
    Disease
    Pyometra - pus uterus
    Clinical Signs
    • Usually 4-10 weeks after estrus
    • Fever and lethergy
    • Anorexia
    • Vomiting and diarrhea
    • Shock
  43. Reproductive System
    Disease
    Pyometra - pus uterus
    Diagnosis
    • Purulent vaginal discharge
    • Radiographs and ultrasound
    •     Visible uterus
    • Blood Panel
    •     Leukocytosis with a left shift
  44. Reproductive System
    Disease
    Pyometra - pus uterus
    Treatment
    • Surgery
    •    Ovarianhysterectomy
    • Antibiotics
    • Fluids
    • Medical Management
    •      Prostaglandins (PGF 2 alpha)
    •             works better if open pyometra
    •             Usually only used for breeding animals
  45. Prostaglandins
    Prostaglandins have a similar function to that of hormones in controlling smooth muscle contraction, blood pressure, inflammation, and body temperature

    Smooth muscle is responsible for the contractility of hollow organs, such as blood vessels, the gastrointestinal tract, the bladder, or the uterus.
  46. Reproductive System
    Disease
    Dystocia
    • Dog gestation 58-69 days Average 63
    • Cat gestation 56-71  days Average 63
    • Signs of labor
    • Decline in plasma progesterone 24 hours before labor
    • Body temperature drops <99 24 hours before labor
    • Water sac ruptures
    • Labor should occur normally 1-2 hours
    • Animal starts nestling, panting, trembline, and having abdominal contractions
    • Internal between babies should not be longer than 1-2 hours.
  47. Reproductive System
    Disease
    Dystocia
    Etiology
    • Prolonged gestation >70days dystocia
    • Uterine inertia  Tired uterus
    • Anatomical abnormalities
    •      pelvic stenosis (malformed)
    •     Malalignment
    • Metabolic abnormalities
    •       hypoglycemia
    •       hypocalcemia
    • Fetal Factors
    •    Oversized  
    •    malpresentation
    •         normal anterior dorsal (head first) and posterior dorsal (butt first)
  48. Reproductive System
    Disease
    Dystocia
    Clinical Signs of dystocia
    • Prolonged gestation >70 days
    • >24 hours in labor with no fetus
    • > 1 hour of active labor with no fetus delivered
    • > 4 hours between fetus
  49. Reproductive System
    Disease
    Dystocia
    diagnosis
    • Physical exam and history
    • Radiographs (more accurate than ultrasound)
    •    Number of fetus
    • Blood profile
    •      Calcium and glucose levels
    • Ultrasound
    •     Fetal viability
  50. Reproductive System
    Disease
    Dystocia
    Treatment
    • Surgery
    •    Cesarean section
    • Medical management
    •    Oxytocin
    •         1-20 units IM
    •         observe 10-30 minutes before next injection
    • Digital feathering- stimulating cervex
    •    Stimulating reflex contractions
    • 10% calcium gluconate
    •     0.5-1.51m/kg IV infusion slow
    •     watch for bradycardia
    • 5% Dextrose in water fluids
    • Repeat treatment up to 3 times, if has not delivered all of the babies within 1-4 hours
    • Then perform a cesarean section
  51. Reproductive System
    Disease
    Dystocia
    Neonatal resuscitation
    • Establish airway
    •   Remove placenta membrane if present
    •   Swing neonate upside down to expel fluids from airway
    • Suction mouth
    • Stimulate respiration and heart beat with thoracic massage and heat
    • Oxygen therapy
    • Drug therapy
    •    Doxapram  1-2 drops in mouth to stimulate
    •    Epinephrine 1-2 drops in mouth to stimulate
    •    Naloxone 1-2 drops in mouth if barbiturate used for cesarean section

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