Endocrine (hyper/hypothyroidism)

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Author:
alyn217
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201774
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Endocrine (hyper/hypothyroidism)
Updated:
2013-02-21 07:53:09
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AMS2T2
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Adult MedSurg 2
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  1. Disorders of the anterior pituitary?
    • Growth hormone excess--> Gigantism (children) or  Acromegaly (adults)
    •  Hypopituitarism--> Growth hormone deficiency-->
  2. pathophys of growth hormone excess
    • Anabolic hormone
    • GH produced by anterior pituitary
    • Stimulates liver to produce insulin-like growth factor-1 (ICF-1)
    • Stimulates growth of bones and soft tissues
    • Overproduction caused by benign pituitary adenoma (tumor)

    • Acromegaly (adults): 
    • Overgrowth of bones and soft tissues, large hands, tongue, feet, etc. 
    • Bones become thick and wide
    • Cardiomyopathy, enlarged visceral organs
  3. SnSs of growth hormone excess
    • Begin gradually in 30’s and 40’s
    • Enlarge hands and feet
    • Thickening and enlargement of face & head
    • Enlarged tongue
    • Sleep apnea
    • Cardiomegaly/HTN
    • Enlarged visceral organs
    • Local effects of tumor
    • Visual disturbance
    • Headache
    • Glucose intolerance (Antagonizes the action of insulin)
  4. Diagnostics for growth hormone excess
    • Serum GH, IGF-1 levels, IGF binding protein -3 levels
    • Definitive test: oral glucose challenge test
    • --GH normally falls
  5. Collaborative care for growth hormone excess
    • Surgery
    • --Hypophysectomy is treatment of choice
    • --Transsphenoidal approach
    • --Hormone replacement
    • Radiation
    • --Secondary treatment

    • Drugs
    • --Somatostatin analogs
    • --Octreotide (sandostatin)
    • --Dopamine agonists
    • --GH receptor antagonists
  6. Nursing management of GH excess
    • Nursing Assessment
    • S & S of abnormal tissue growth
    • Nursing Diagnoses
    • --Body Image
    • --Fluid volume deficit
    • --Sleep pattern
    • --Sensory perception

    • Implementation
    • --Preop teaching
    • --HOB elevated
    • --Check nasal drainage
    • --Analgesia
    • --Mouth care
    • --Transient DI
    • --Hormone replacement
  7. Hypotituitarism
    • Rare
    • Pituitary tumor most common cause
    • Deficiencies in anterior pituitary hormones can be life threatening
    • --Infertility may be first sign
    • --v TSH
    • --v ACTH: shock and adrenal insufficiency
  8. SnSs of hypopituitarism
    • Vary depending on target organ deficiency
    • --Reproductive
    • --Adrenal insufficiency-->hypotension
    • --Hypothyroid
    • --Signs from expanding tumor

    • Diagnostic Studies
    • CT
    • MRI
    • Pituitary hormones
    • Hormone levels
  9. Disorders of post-pituitary
    • Antidiuretic hormone secretion
    • Syndrome of Inappropriate ADH (SIADH)
    • --Oversecretion of ADH
    • Diabetes insipidus (DI)
    • Undersecretion of ADH
    • ADH is synthesized in hypothalamus and stored in posterior pituitary
    • Major role in regulation of water balance and osmolarity
  10. SIADH
  11. Etiology and SnSs of SIADH
    • One of the only times you want to restrict fluids.
  12. Collaborative care and nursing management of SIADH
    • Hard candy for thirst
  13. DI?
    • psychotics can be prone to fluid volume overload.
  14. Disorders of thyroid
    • Thyroid hormones regulate energy metabolism --Thyroxine (T4)
    • --Triiodothyronine (T3)
    • Thyroid enlargement is called a goiter
    • --Increased, decreased or normal hormone production
    • Storm: Every thyroid hormone is 
    • Myxedema coma:
    • Look them up.
  15. What is Grave's disease?
  16. SnSs of hyperthyroidism
    • shock-->coma
    • Treatment by decreasing thyroid hormones.
  17. What's a great antithyroid drug to know
    • Propylthiouracil (PTU)
    • Can also take
    • --Iodine (radioactive for non-pregant women)
    • --B-blockers
  18. Etiology of hypothyroidism
    • Common medical problem
    • Insufficient thyroid hormone
    • Causes
    • --Iodine deficiency (worldwide)
    • --Thyroid gland atrophy (U.S.)
    • --Primary: atrophy of gland
    • --Secondary: d/t tx of hyperthyroid
    • --Transient: illness (thyroiditis)
  19. SnSs of hypothyroidism
    • Hypometabolism
    • Often slow changes
    • Fatigue, lethargy
    • Mental changes
    • Cardiac
    • GI: generalized. 
    • Cold intolerance
    • Skin: dry, cold
    • Weight gain
  20. Nursing management of hypothyroid
    • Health promotion
    • Screen at risk groups
    • Interventions
    • Myxedema (ABCs)
    • Home care
    • Pt. education
    • Lifelong drug therapy
    • Know overdose and underdose S & S

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