patho pharm II -exam 2 - Endocrine Disorders 9 points

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patho pharm II -exam 2 - Endocrine Disorders 9 points
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patho pharm II exam Endocrine Disorders points
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patho pharm II -exam 2 - Endocrine Disorders 9 points
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  1. Define SIADH
    • Syndrome of Inappropriate ADH
    • Overproduction of ADH secretion without normal stimuli.
  2. Ectopic ADH = 
    and usual sources:
    • Ectopic ADH= Not from the pituitary
    • Usual sources are cancer cells- (Small cell adenocarcinoma is most common) 

    • Less common causes:
    • CNS disorders (brain tumor)
    • Pulmonary disorders (pneumonia, TB)
    • Drugs (Chemo)
    • psychosis, myxedema
  3. SIADH results in inappropriate _____ of water at distal tubules leading to water ______ or _______. 
    SIADH results in inappropriate reabsorption of water at distal tubules leading to water overload  or intoxication
  4. SIADH results in what clinical manifestations?
    • 1. Decreased urine output
    • 2. Edema - Water intoxication
    • 3. Hyponatremia- serum/ Hypernatremia- urine
    • 4. Hyposmolality- serum/ hyperosmolality -urine
    • 5. Fatigue, confusion, convulsions - twitches
    • 6. Anorexia, Abd cramps, N/V
    • 7. Dyspnea, HTN
  5. SIADH- diagnostic findings:
    Serum= Hyponatremia (dilutional), Hyposmolality

    Urine= Hypernatremia, Hyperosmolality, High urine specific gravity
  6. SIADH - nursing considerations/Interventions
    • Fluid volume excess
    • 1. Correct causitive problem- if possible
    • 2. Monitor of electrolyte/osmolality 
    • 3. Fluid restricion (<800-1000cc/day)
    • 4. Diuretics
    • 5. Sodium replacement - Hypertonic saline IV
    • 6. Pharm- lithium, demeclocycline interfere w. ADH action, Dilantin interfere w. ADH release

    ** Assess CNS changes, distention, BP, HR, UO, I&O
  7. Diabetes Insipidus = 
    Deficient ADH secretion
  8. Diabetes insipidus makes the body unable to _____ water resulting in ____  ____  _____ and tissue ______. 
    Diabetest insipidus makes the body unable to conserve water resulting in large volume diuresis  and tissue dehydration
  9. What is the most common type of Diabetes insipidus? 
    • Neurogenic: insufficient amounts of ADH
    •      - idiopathic
    •      - posttraumatic 
    •      - post-surgical

    Other uncommon types: nephrogenic: insuff response of kidneys to adh; and Psychogenic (rare): compulsive water drinking
  10. What is the cause of neurogenic diabetes insipidus?
    Lesions of the hypothalamus, pituitary stalk, posterior pituitary. 

    • May develop due to:
    • *brain tumor or head trauma
    • *cerebral -aneurysms, thrombosis, infetions 
    • *Immunologic disorders
  11. Pathophysiology of diabetes insipidus: 
    • Excretion of large amounts of dilute urine --> 
    • Inrease in serum osmolality --> Hypernatremia --> Dehydration --> Polydipsia 
  12. Clinical manifestations of Diabetes insipidus 
    • Polyuria, Polydipsia, Nocturia 
    • Dehydration
    • Hypernatremia - blood
    • Hyperosmolality - blood/ hyposmolality - urine
    • Tachycardia
    • Hypotension
  13. Diagnostic findings for Diabetes Insipidus 
    Serum = hyperosmolality, hypernatremia

    Urine= low specific gravity, hyposmolality, hyponatremia. 
  14. Diabetes Insipidus - Nursing considerations/treatment
    • (Fluid volume deficit)
    • 1. Administer hypotonic fluids (0.45 NS).. or oral 40-50 glasses/day (9-10 L)
    • 2. ADH replacement- Synthetic vasopressin (DDAVP) or drugs that potentiate endogenous ADH
    • 3.Monitor: I&O, daily wt, urine specific gravity measures, VS OFTEN
    • 4. Provide Skin and oral care
  15. Abnormal pituitary function results in ...
    • Abnormal ADH production= 
    • 1. SIADH
    • 2. Diabetes Insipidus
  16. What is Acromegaly?
    Late onset overproduction of growth hormone 
  17. What is gigantism? 
    Early onset overproduction of growth hormone. 
  18. Complications of Acromegaly
    • 1. Bony proliferation
    • 2. Peripheral nerve entrapment
    • 3. Insulin resistance
    • 4. HTN and heart failure
  19. Acromegaly is characterized by ...
    • Enlarged jaw, forehead, hands, feet and tongue
    • Increased sebaceous and sweat glands
    • Barrel chest
    • Weakness, muscular atrophy, footdrop, and sensory changes in the hands.
  20. Treatment for Acromegaly
    Surgical removal or radiation of tumor (the cause)
  21. Purpose of thyroid hormones and types
    • ◦Affects growth and maturation of tissues
    • ◦Helps regulate serum calcium

    • Types:
    •  ◦Thyroxine (T4) and Triiodothyronine (T3)
    • ◦Calcitonin - affects serum calcium levels
  22. Abnormal thyroid function results in...
    • Hyperthyroidism:
    •     1. Graves disease
    •     2. Nodular Thyroid Disease
    •     3. Thyrotoxic Crisis (aka thyroid storm)

    • Hypothyroidism:
    •     1. Primary
    •     2. Hashimoto
    •     3. Myxedema

    Thyroid Cancer
  23. Definition of Graves Disease
    Familial auto-immune disorder that causes hyperthyroidism because of negative feedback.

    *Generalized acceleration of body processes
  24. Pathophysiology of Graves disease: 
    Thyroid autoantibodies (TSI) stimulate thyroid gland --> also decreases thyroid regulators TSH and TRH --> Hyperthyroidism
  25. Graves disease is characterized by one or more of the following...
    • Hyperthyroidism
    • Goiter (visible enlargement of thyroid gland)
    • Opthalmopathy (eye disease)
    • Dermopathy (skin disease)
  26. Treatment for Graves disease= 
    • Drugs to suppress thyroid activity (PTU)
    • Radioactive Iodine
    • Surgery (thyroidectomy) 
  27. What are some clinical manifestations of hyperthyroidism?
    • 1. Fine hair/Hair loss
    • 2. Exopthalmos - bulging eyes , Goiter 
    • 3. Sweating
    • 4. Tachycardia, HTN
    • 5. Weight loss with INCREASED appetite
    • 6. Decreased libido and irregular menstration 
    • 7. Tremors, Muscle wasting
    • 8. decreased attention span, nervousness, insomnia
  28. Nodular Thyroid disease = 
    Goiter , Visible enlargement of the thyroid gland due to hyperthyroidism 
  29. Causes of Nodular thyroid disesase: 
    • Normal increases in TH (puberty, pregnancy)
    • Iodine deficiency
    • Viral Infection
    • Immunologic disorder
  30. Thyrotoxic Crisis causes =
    • "Thyroid Storm" 
    • -Under-treated hyperthyroidism
    • -Excessive stress
    • - Infection
    • -Pulmonary or cardiac disorders
    • -Inadequate treatment for thyroid surgery
  31. Clinical manifestations of thyrotoxic crisis =
    • Hyperthermia
    • Tachycardia, Hypertension
    • Heart failure (High output)
    • Agitation
    • Delirium
    • Hyperglycemia
    • N & V, Diarrhea, Dehydration
  32. Treatment and prognosis of thyrotoxic crisis
    • Propylthiouracil (PTU) -(Thyroid antagonist)
    • ◦Inhibits synthesis of T3 and T4
    • ◦Inhibits iodine uptake in thyroid gland

    Prognosis: Fatal within 48 hours if untreated.
  33. Definition of hypothyroidism: 
    Types:
    = Everything slows down. 

    • 1. Primary hypothyroidism – Decrease in amount of circulating TH
    • ◦Etiology: Non-bacterial inflammation, Viral infection, Thyroidectomy, Toxic effect of medications (Lithium, Amiodarone), Age

    • 2. Hashimoto Disease (Autoimmune Thyroiditis)
    • ◦Synthesis of thyroid hormone decreased
    • ◦Etiology: thyroid antibodies and infiltrating lymphocytes destroy thyroid tissue, Genetic disposition
  34. What is the most severe form of hypothyroidism?
    Myxedema - occurs secondary to altered composition of dermis and other tissues, and edema. 

    Clinical manifestations: Non-pitting edema, especially around eyes, Thickening of  tongue, Hoarseness

    Labs: Hyponatremia, Hypoglycemia, anemia, bradycardia, decreased o2, increased CO2 and pH
  35. Clinical manifestations of hypothyroidism:
    • Symptoms are proportional to degree of TH deficiency
    • All body systems affected
    • - Decreased metabolic rate
    • - Goiter may develop (Decreased TH à Increased TSH à Hypertrophy of thyroid cells àGoiter)
    • -Myxedema
    • **LOOK UP- Tissues become water logged due to separation connective tissue by increased amounts of protein and mucopolysaccharides (p. 637).
  36. Thyroid cancer: 
    Risk factors
    Dx
    Tx
    Risk factor: Ionizing radiation (Chernobyl – 1986)

    • Diagnosis
    • ◦Thyroid nodule on palpation
    • ◦Needle aspiration of nodule

    • Treatment
    • ◦Near-total thyroidectomy
    • ◦Total thyroidectomy
    • ◦Post-op radio-active iodine
    • ◦Levothyroxine
  37. Adrenal Cortical Hyperfunction =
    = Cushings syndrome: exaggerated actions of gluticosteroids cause excessive secretion of cotisol from adrenal cortex
  38. What is the cause of Cushingings syndrome? 
    • 1. Adrenal Tumor
    • 2. Corticosteroid medications such as prednisone, solu-medrol 
  39. What are some clinical manifestations of Cushing Syndrome? 
    • Weight gain (fat redist./water retention)
    • Moon Face
    • Buffalo hump (kyphosis)
    • Truncal Obesity (wt in abdomen) 
    • Glucose intolerance (Hyperglycemia)
    • Muscle wasting (protein catabolism)
    • Osteoporosis (protein wasting)- fractures, reduced height
    • Renal stones (HYPERCALCEMIA)
    • Collagen loss- fragile skin and capillaries, easy bruise, striae
    • Hyperpigmentation
    • HTN
    • Immunosuppression- Poor wound healing
    • Mood changes
    • Elevated androgens (Sx in women)- facial hair, acne, irreg . 
  40. Diagnosis of Cushing syndrome
    • Complicated and challenging!
    • Labs: Hyperglycemia*, Glycosuria, Hypokalemia, Metabolic alkalosis
    • Elevated serum ACTH & cortisol levels
    • MRIs, etc.
  41. Adrenal Cortical Hypofunction=
    • = Addison's Disease 
    • Hyposecretion of cortisal from adrenal cortex
  42. What is the cause of Addison's disease?
    • autoimmunity
    • genetics
    • exogenous glucocorticosteroids
    • ACTH hyposecretion
  43. Clinical manifestations of addisons disease:
    • (due to low cortisol & aldosterone)
    • Weakness and fatigue
    • GI dist- pain, diarrhea, anorexia
    • Hypoglycemia
    • Hyponatremia
    • Hyperpigmentation with areas of vitiligo -loss of pigment
    • Hypotention 
    • Confusion
    • Decreased tolerance of stress
  44. How is Addison's disease diagnosed? 
    • Hypoglycemia, Hyperkalemia, Hyponatremia
    • decreased cortisol in blood and urine
    • Altered ACTH levels

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