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What are the 5 functions of the Endocrine System?
•Maintain & regulate vital functions
•Response to stress & injury
•Growth & development
•Fluid, electrolyte & acid-base balance
Picture of the Endocrine System
What are the 6 Risk Factors for Endocrine Disorders?
•Consequences of other disorders
What health information should you obtain during an Endocrine assessment?
•Past health history
- •Surgery or other treatments
- –Esp. Radiation
An assessment for the system should involve what?
•Height & weight change
–Distribution of weight, unusual fat deposits
–Cognition and confusion
–Look for unual bruising, dry skin, skin color
–Changes in shape, size, swelling
–Increase in abd size
What does the hypothalamus link?
It links the nervous system & the endocrine system.
The hypothalamus secretes what two hormones?
Steroid hormones & protein hormones
REMEMBER: hormones can be classified in many ways such as steroid, protein, receptors, chemical structure
How long does it take for steroid hormones secreted from the hypothalamus to take effect?
several hours to take effect
How long does it take for protein hormones secreted from the hypothalamus to take effect?
REMEMBER: like the fight/flight; happens fast
What does GH stand for?
Where is GH secreted from?
What does GH do?
GH stand for growth hormone.
GH is secreted from Anterior pituitary.
GH stimulates growth of bone and muscle, promotes protein synthesis and fat metabolism, decreases carbohydrate metabolism.
What does ADH stand for?
Where is ADH secreted from?
What does ADH do?
ADH stands for Antidiuretic hormone.
ADH is secreted from Posterior pituitary.
ADH increases water reabsorption by the kidney.
What does TSH stand for?
Where is TSH secreted from?
What does TSH do?
TSH stand for Thyroid-stimulating hormone.
TSH is secreted from the Anterior pituitary.
TSH stimulates synthesis and secretion of thyroid hormone.
What does ACTH stand for?
Where is ACTH secreted from?
What does ACTH do?
ACTH stand for Adrenocorticotropic hormone.
ACTH is secreted form the Anterior pituitary.
ACTH stimulates synthesis and secretion of adrenal cortical hormones.
What are the 3 disorders of the Anterior pituitary?
1) Cushing's Syndrome
What are the 2 disorders of the Posterior pituitary?
1) Diabetes Insipidus (DI)
2) Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
What is Cushing's Syndrome?
Is it a disorder of the Anterior or Posterior Pituitary?
Cushing's Syndrome is excess ACTH affects adrenal glands.
It is a disorder of the Anterior Pituitary
Acromegaly is a disorder of the Anterior or Posterior Pituitary?
It involves excess or deficiency?
Excessive secretion of GH;causes progressive enlargement of peripheral body parts
Hypopituitarism is a disorder of the Anterior or Posterior Pituitary?
It involves excess or deficiency?
Can result from disease/deficiency of the pituitary gland itself or disease of the hypothalamus; the result is essentially the same
What is Acromegaly?
Excess GH after the epiphyseal plate closure
What is the Epiphyseal plate closure?
Once the body reaches maturity, all the cells responsible for new bone growth ossify or solidify into bone and this progression stops, thus bringing on epiphyseal closure. At this time the plate transforms into the epiphyseal line, the only remnant of the growth process.When problems occur with the epiphyseal closure of a bone or bones, changes in the body’s structure or height can be evident. For example, if epiphyseal closure occurs before full maturity is reached, normal height may not be attained. When closure does not occur, the long bones will continue to grow allowing the individual to surpass natural height. These abnormal changes can also affect the shape of the long bones and create irregular formation resulting in deformities.
What deformities are associated with Acromegaly?
Bone & soft tissue deformities R/T enlargement of the visera w/o increase in height
Other problems like disfigurement and sever complications and premature death
What age of adults and what gender are more at risk to develop Acromegaly?
middle aged/ males a little more than females
What is Gigantism?
Oversecretion of GH in the Anterior Pituitary results in gigantism in children; a person may be 7 or even 8 feet tall.
What are the Signs & Symptoms of Acromegaly?
- •Soft tissue thickening
- --Strictly on hands and soles of feet
- •Enlargement of hands & feet
- --said to have "spade" hands
- --their skin becomes oily
- •Enlarge forehead & jaw
- --Have changes in their bite, their teeth
- start getting out of alignment
- •Heart enlargement & HTN
- --"cardiomegaly" is what we worry about
- --left ventricular hypertrophy (use 12
- lead and echo before we send for CT
- scans and MRIs to get an idea of the
- condition of the heart
- --arthritis like symptoms
- --Feelings of Depression
- --More at risk of colon cancer and Type 1 diabetes
What President was thought to have Acromegaly?
What diagnostic tests or procedures are ran to diagnose Acromegaly?
- •Increase in GH & IGF-1 (insulin-like growth
- •MRI – pituitary
- --Or CT
- -Looking for enlargement and rule out
- any type of tumor
- •Photo comparison
- --That are several months to years old and
- look for changes in the hands and face
ALSO: Measure hats, and rings to see if sizes have increased
How is Acromegaly best diagnosed?
By measuring an increase in GH
Treatment for Acromegaly involves what three things?
When it comes to treatment of Acromegaly what is the #1 choice?
- Surgery= 1st treatment of choice
- –85 % cure rate
- –Best option
Why would the physician recommend radio therapy for a pt with Acromegaly?
- –For pts that can't tolerate going to the
What 2 medications can be used for treatment of Acromegaly?
- –octreotide (Sandostatin)
- •Can be used in combination if there is
- a large tumor
- --It is a synthetic analogue of GH.
- These medications inhibit the
- production or release of GH and may
- bring about marked improvement of
What is Hypopituitarism?
Is it involved with Anterior Pituitary or Posterior?
Pituitary gland decreases amounts of one or more pituitary hormones of the Anterior Pituitary.
What does Hypopituitarism result in?
decrease/loss of function in gland or organ hormone controls.
What are 3 causes Hypopituitarism?
- --trauma, surgery, tumor or infection
What 3 diagnostic tests or procedures are done to diagnose Hypopituitarism?
--Lab test on hormone levels
What are the 2 treatment options for Hypopituitarism?
Surgery or Hormone Replacement
What are the 2 Posterior Pituitary Disorders?
- Diabetes Insipidus (DI)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
What is Diabetes Insipidus (DI)?
Deficient production/secretion (hyposecretion) of ADH leading to excessive H20 loss r/t polyuria
What is the difference between Diabetes "Insipidus" and "Mellitus"?
"Insipidus" means: without taste
"Mellitus" mean: sweet or honey (sugar diabetes)
What are the 3 causes of Diabetes Insipidus?
- –Trauma or surgery (transsphenoidal
- •More common
- •Post surgery of radiation to pituitary
- –CNS infection
- •Menigitis, encephalitis
- –Nephrogenic-- electrolyte, medications,
- •Related to the kidneys
What are the Signs & Symptoms of Diabetes Insipidus?
- –High volumes urine
- •Foley cath is good option for DI pt
- •4-30 L in 24 hrs
- •Specific gravity/osmolatity: very dilute
- urine (water-like)
- –Can drink about 2-20 L
- •Neuro changes
Should you try to control DI by restricting or limiting fluid intake?
The disease cannot be controlled by limiting fluid intake,because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the patient to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration.
What 4 diagnostic tests are done to diagnose DI?
1) Fluid Deprivation test
2) Plasma Levels of ADH & osmolaltiy
3) Urine Osmolality
4) Synthetic Vasopressin trial
What is the Fluid Deprivation Test?
Test done to diagnose DI. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test.Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI. The patient continues to excrete large volumes of urine with low specific gravity and experiences weight loss,increasing serum osmolality, and elevated serum sodium levels. The patient’s condition needs to be monitored frequently during the test, and the test is terminated if tachycardia,excessive weight loss, or hypotension develops.
DI intervention/management involves what 7 things?
- •Fluid & electrolyte balance
- –Worried about Na 1st then K
- –Na will go up
•Identify & correct underlying cause
- •Replace ADH – Desmopressin (DDAVP)
- –How we can trat it
- –Admin through a nose spray
- •Monitor: VS (BP low, HR high), CV & neuro,
- •I & O
- -Hourly I&Os, measure PO intake by cc,
- want to know everything that goes in
- (IV, IVPB)
•Labs: electrolytes, serum & urine osmolaity
•Safety: related to neuro changes, and for someone that has low pressure, change positions slowly, fall precautions
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone
Excessive ADH that leads to H2O intoxication & decrease Na
What are the 3 causes of SIADH?
- •Head injury, CVA or infection
- --by direct stimulation of pituitary gland
•Malignant tumors secret ADH independently (lung,leukemia, & Hodgkin’s lymphoma)
What are the 5 Sign & Symptoms of SIADH?
- •Fluid volume excess
- --Holding onto water like a sponge
- •Wt gain w/o peripheral edema
- --these pts have all their fluid kept around
- the waist and their arms and legs are
- very skinny like spongebob
•Alter LOC, risk for seizure
- •Concentrated amber urine
- --Dark, sometimes like a tea color
What labs are done to diagnose SIADH?
--Increase urine Osm (small amounts of urine are very concentrated) & specific gravity
- --Decrease Serum Osm, Hct low, BUN
- (low bc of overhydration), Na (low)
–S/S related to Na imbalance
SIADH intervention and Management includes what 7 things?
•Fluid & electrolyte balance
- •Replace Na
- --PO supplements
- --Replace slowly
- •Declomycin (demeclocycline)
- --Possible treatment
- --It works on the tubules of the kidneys
- and fakes the body into diuresing
- •Monitor: VS, CV & neuro, weight (everyday)
- --1L of fluid= 1kg = 2.2 lbs
•I & O
- •Labs: electrolytes, serum & urine osmolality
- --Na below 120 then more serious
- neurological changes
Pituitary Medical Management includes what 3 options?
Surgery, Radiation, Medications
Are pituitary tumors usually benign or malignant?
Transphenoidal Pituitary Surgery involves what?
AKA as hypophysectomy
Is the surgical removal of the hypophysis (pituitary gland). It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing's syndrome due to pituitary adenoma.
During post op care of a patient that underwent Hypophysectomy should you elevate the HOB?
yes. you should elevate the HOB
During post op care of a patient that underwent Hypophysectomy what should you monitor?
I&O, electrolytes, osmolality
During post op care of a patient that underwent Hypophysectomy a pt may have a nasal drip pad. What should you monitor for and do if you see?
- –Monitor the condition or quality of what you see on the drip pad
- •Halo= CSF
- –Do glucose test
During post op care of a patient that underwent Hypophysectomy a pt having this kind of drain will be rare.
Where is the possible incision sites for a pt that underwent a Hypophysectomy?
- –Under upper lip along gum line or through
- the nose
- •Be careful when brushing hard here
- •Avoid alcohol content bc it will irritate
- –Abd incision- fat graft site
- •Will be small
- •May or may not have sutures
A pt coming back from a hypophysectomy surgery will probably have what for how long?
foley cath for 24-48 hrs
they will also be thirsty!
What important D/C teachings to be done for a pt that underwent a Hypophysectomy?
- –Brushing teeth
- •Oral care very important
- •Be careful when brushing hard at incision
- •Avoid alcohol content bc it will irritate area
- –Caution re: activity that increase ICP
- •Watch activity even after they go home
- •Watch for pressure that will increase
- intracranial pressure (coughing,
- straining, weight lifting, sneezing)
- •Don’t want to bend or get head lower
- than the waist for a month after
HYPOthyroidism= TSH, T4, and T3 (high or low) values.
Low or normal T3
HINT: T4 tells if hypo or hyper if it's high it hyperthyroidism; low is hypothyroidism
HYPERthyroidism= TSH, T4, and T3 (high or low) values.
High or normal T4
High or normal T3
=HYPERTHYROIDISM HINT: T4 tells if hypo or hyper if it's high it hyperthyroidism; low is hypothyroidism
A thyroid assessment includes what 4 things?
- •Physical Exam
- –Visualize neck, look for signs of swelling
- and nodules, check for tracheal shift (if
- extreme you will see), palpate and
- should not be able to feel them, have
- pt swallow and you will feel the muscles
- –Serum TSH
- –Free T4
- –Serum T3 , T4
What is Goiter?
Abnormal enlargement of the thyroid gland
Goiter can occur with what 3 things?
- Just bc there is a growth does not mean there is a goiter and thyroid is not funtioning properly. Run tests to check to find the problem
What cause Goiter?
Iodine deficiency. In this later condition, lack of iodine results in low levels of circulating thyroid hormones, which causes increased release of TSH; the elevated TSH causes overproduction of thyroglobulin (a precursor of T3 and T4) and hypertrophy of the thyroid gland.
Diagnostic procedures done to test the thyroid include these 5
•Radioactive iodine uptake
•Thyroid scan, radio scan
What is Hyperthyroidism?
Hypersecretion of T3 & T4
What 5 things can cause Hyperthyroidism?
–Decrease TSH from pituitary
- –Autoimmune reaction (Graves’ disease)
- •Most common cause
- –Inflammation/viral infection
- •Another common cause
- –Excessive dose of thyroid replacement
- •Ppl who want to lose weight so they
- overdose on thyroid meds
What is a Thyroid Storm/Crisis?
- Thyroid storm has a sudden onset. It can
- be fatal if left untreated. Have to be sent to ICU
What cause a Thyroid Storm/Crisis?
--Manipulation of thyroid gland
--Sudden alteration in medication
--Person having a MI has a thrown off hyperthyroid
--Vigorous palpitation of thyroid
4 S/S of Thyroid Crisis/Storm?
- –Temp >101.3
- •Elevated and can go as high as 106
- –Increased HR, systolic HTN
- •Greater than 130
- –Agitation,confusion, seizure
- •Due to all the activity
–Exaggerated S/S of hyperthyroidism
Treatment for Thyroid Storm/ Crisis pt includes:
Keep pt calm
Limit any kind of stimuli
Want them in a quiet area on the unit
Try to treat thyroid (may use cardiac meds to keep HR down)
A Thyroid Storm/Crisis pt is at greatest risk of what?
What is Thyroiditis?
Inflammation of the Thyroid
What are the 3 Types of Thyroiditis?
Acute Thyroiditis is..?
- – bacteria, fungal or parasites
Symptoms of Acute thyroiditis:
–Pain, swelling, dysphagia, dysphonia, & S/S of hyperthyroidism
•Onset is fast
•Confined to one side of the neck usually
•Fever and chills with certain infection
Treatment of Acute Thyroiditis:
antibiotic, fluid replacement
- –Function returns after treatment
- •Couple of days up to a couple of weeks
What is Subacute Thyroiditis?
Usually after some upper respiratory problem
Symptoms of Subacute Thyroiditis
–low-fever,fatigue, swelling, pain not as severe, trouble swallowing
Phase 1 of Subacute Thyroiditis show signs and symptoms of hyperthyroid at how many months?
hyperthyroid S/S (1-3 mo.)
Phase 2 of Subacute Thyroiditis show signs and symptoms of hyperthyroid at how many months?
hypothyroid S/S (9-12 mo.)
Treatment of Subacute Thyroiditis
function-- normal after 12-18 months to fully resolve
What is Chronic Thryroiditis?
What is it also know as?
Damage and destruction of thyroid, slow onset, does not have painful S/S
–Chronic lymphocytic -- autoimmune
- will never go back to normal
What are the symptoms of chronic thyroiditis (Hashimoto's Disease)?
painless, hypothyroid S/S
What are the treatment of chronic thyroiditis (Hashimoto's Disease)?
- Function: hypothyroidism permanent
- Thyroid will never go back to normal
What are the risk factors of chronic thyroiditis (Hashimoto's Disease)?
History of R.A., Addisons disease, Type 1 diabetes
When assessing a pt with hyperthyroidism you can expect what 8 cardinal things?
- –Increased Basal Metabolic Rate
- --caused weight loss
- –Exophthalmos (Graves)
- •Granopathene: Rash that shows up on
–Increased T, P, R, & BP
–Wt loss, Hunger
- –May have enlarged thyroid (goiter)
- •May or may not have enlarged thyroid
What nursing interventions should you monitor and assess for a pt with hyperthyroidism?
- •Have pt rest in cool quiet environment
- --Pts are irritable, nervous
- •Daily wt
- –Make sure they are keeping up their
- calorie count like they need to
- –May get by with low fiber diet bc we
- want the gut to slow down
•Monitor for thyroid storm
•Monitor for hypothyroidism after treatment
- •Education r/t lifelong therapy
- --avoid stimulants (starbucks, red bull,
- decongestants, diet pills)
- --Smoking stimulates thyroid so want
- them to stop smoking
- --Good patient teaching and warn of the
- risks of stopping suddenly
A hyperthyroid treatment includes what 4 treatment options?
- •Radioactive Iodine – I131
- --thyroid hormone replacement (post-op)
Anti-thyroid medications for hyperthyroid treatment include (2)?
methimazole (Tapazol) & propylthiouracil (PTU)
What is Radioactive Iodine I131?
–Permanent treatment for the hyperthyroid
- –Take po and it will go only to places where
- there is iodine uptake
- –It will absorb the iodine and damage or kill
- –Can be done on an outpatient basis
- depending on the dosage and the pts
–Results can be seen in about 1-2 months
- –Radioactive for 3 months or sometimes
- •Don’t want them/or other ppl handling their
- body wastes
- –Side effects: monitor thyroid levels incase
- they go to a hypothyroid state
Thyroidectomy is the treatment of choice for what?
For a thyroidectomy it can either be partial or total. The surgery may include:
–Modified or radical neck dissection
–Radioactive iodine to minimize metastasis
What nutrition pre-op teaching should you include for a pt going to thyroidectomy surgery?
Dietary guidance to meet metabolic needs
What things should you tech a pt to avoid during pre-op teaching of a thyroidectomy pt?
- •Caffeine & other stimulants
What things should you explain to a patient that is headed for thyroidectomy surgery?
- •Of tests and procedures
- –Demonstration of postoperative Head support
- --lifelong thyroid replacement may be
- •Total=lifelong treatment replacement
How do you want the HOB to be for a pt in post-op for thyroidectomy surgery?
--at least 30 degrees
--want gravity to help with part of swelling
What is the #1 priority of a pt in post-op after thyroidectomy surgery?
What should you teach your patient if they are trying to get up after thyroidectomy surgery?
Have pt roll on their side or use arms to raise up and support the back of the head.
The flatter the pt is, the more strain there is
Why should you watch for decrease in Ca for a post op thyroidectomy pt?
Low Ca leads to tetany
Will a person with thyroidectomy have to have lifetime thyroid replacement?
It depend on whether or not they have a total or partial thyroidectomy.
Total is lifetime, partial is not
What is hypothyroidism?
Insufficient T3 & T4
TSH = high
What causes hypothyroidism?
- –Antibody mediated destruction of
- thyroid (Hashimoto’s Disease)
–Iodine deficiency (goiter)
–Pituitary decrease secretion of TSH
What signs and symptoms are key to myedema coma?
Puffy face and soft tissue selling in edema around eyes, ptosis, enlargement of the tongue are key to myxedema coma
What is myedema coma?
What causes myxedema coma?
–Sudden d/c thyroid replacement
What 4 things should you assess for on myedema coma pt?
–Possible pleural effusion
In general.. Hypothyroid pts are usually?
- have cool, dry skin
- slow HR/bradycardic
- Low BP
- Extreme fatigue
- --sleep for 8 hrs and don't feel like they
- slept for 1
- --greater tendency for depression
- --gut slows down
What cause hypothyroidism?
Associated with CHF & MI
Hypothyroid assessment vary with what 2 things?
severity and length of time
Lab values for a hypothyroid pt will have high ____ & ____ and low ____, ____. They will also have decreased ____ and ____.
High TSH & lipis
Low T4, low/normal T3,
Decreased Basal Metabolic Rate
Will a hypothyroid pt have weight gain or weight loss?
weight loss bc of the decreased BMR
S/S of a hypothyroid pt:
•Dry Skin & hair
•Lethargy & Fatigue
•Intolerance to cold
Hypothyroid Care & Treatment involves what 4 things?
- •Keep warm
- –Teach ways to keep warm
- •Rest periods
- –Stagger activities
- •Encourage fluids & fiber intake
- –Bc they have problem with constipation
- •Thyroid replacement
- –Important that they do follow up in a
- month after starting treatment
Parathyroid Hormone (PTH) regulates ____ & ____.
Calcium and Phosphorus balance
Picture of the Parathyroid Gland
How many parathyroids do we have?
PTH increases blood Calcium, by increasing Calcium absorption from what 3 things?
kidneys, intestines, & bones
Calcitonin does what in the parathyroid gland?
decreases Ca in the blood
PTH does what to phosphorus levels?
decreases phosphorous level
Increased PTH leads to increase _____, and decrease _____?
Increased Ca (serum)
Primary Hyperparathyroidism involves enlargement of one or more of the parathyroid glands and does what to Ca levels?
Increases Ca levels. Increased Ca levels lead to muscle weakness.
Secondary hyperparathyroidism is excess ____ and low ____.
excess PTH 2nd to low Ca level
When it come to secondary hyperparathyroidism do you correct the PTH level or the Ca level?
Correct Ca and underlying problem helps parathyroid levels return to within normal levels
What are two possible causes of secondary hyperparathyroidism related to excess PTH and low Ca?
1) Vitamin D deficiency
2) Ca not absorbed from intestines
Secondary hyperparathyroidism related to renal failure is decreased ability to excrete what?
Secondary hyperparathyroidism related to renal failure is decreased ability to activate what?
Vitamin into usuble for of dihydroxy vitamin D.
Manifestations of hyperparathyrpidsim include what 8 things?
•Increase serum Ca & decrease Phos
Hyper Parathyroid =
Hyperparathyroid complications occur when Ca is greater than what?
>15 then they are considered a crisis
Hyperparathyroid complication pts show sign and symptoms of what?
Severe thirst associated with polyuria
GI tract can go either way but constipation most common
Confusion and coma
Med: use calcitonin to get Ca levels down
**At risk for kidney stones bc of excess Ca that circulates into the kidneys and crystalizes
Mneumonic for hypercalcemia
“Stones, Bones, Groans, Thrones & Psychiatric Overtones”
•Stones (renal/ biliary)
- •Bones (bone pain)
- –Bone deformity of prolonged
- •Groans (abd pain, N/V)
- –Don’t want to eat
•Thrones (polyuria, constipation/diarrhea)
- •Psychiatric Overtones (depression, impaired cognitive dysfunction [cant concentrate,
- confusion, can go all the way to coma])
- –Muscle weakness
- –HA, fatigue
Hyperparathyroid management includes reducing serum Ca by doing what 3 things?
Hyperparathyroid management includes using diuretics to do what?
Ex: lasix to promote excretion of Ca
Hyperparathyroid management includes using phosphates to do what?
get Ca back into bone and decrease serum Ca level
If a parathyroidectomy does not work what is another procedure option if hyperparathyroid is extremely critical?
During pre-op of a parapthyroidectomy you should monitor what 3 electrolytes?
Ca, Phos, Mg
The head of the bed should be elevated to how high for a parathyroidectomy pt.?
at least 30 degrees
What is the #1 priority for at pt post op parathyroidectomy?
airway and oxygenation!
You should monitor for tingling in what for a pt post op thyroidectomy.
tingling in extremities or face
A pt post-op parathyroidectomy may speak in a hoarse voice or whisper. You should monitor if they can talk in an normal tone or if they can talk at all. If pt is having difficulty then you may want to consider what?
If speech problems then look at therapy or rehab option
You should educate a post op parathyroidectomy pt to take Ca and vit D supplants as prescribed. You also teach them to guard and protect what?
guard throat and protect incision
Ypu should monitor what 2 things in a hyperparathyroid pt?
VS, esp BP
A hyperparathyroid pt need s to be taught safety precautions when..?
They are brought back form surgery. They need to know they need to roll on their side to protect their neck form straining when getting up. They also need to know their neck is probably sore form manipulating it during surgery.
Why does a hyperparathyroid pt need to be hydrated?
Due to excess Ca circulating there is a possibility of kidney stones. If the pt takes in at least 2000 mL of fluids then they decrease the risk of calcium callusing in the kidneys and forming kidney stones
For a hyperparathyroid pt a nurse should monitor for what two things?
monitor for tetany & dysrhythmias
A hyperparathyroid pt is at risk for ..?
What is hypoparathyroidism?
Deficiency of PTH related to decreased Ca
Manifestations a hypoparathyroid pt include what 5 things?
-- GI symptoms
- -- Irritable, nervous, tract
--Numbness & tingling: face or extremities
-- Muscle cramps: abd or extremities
-- Anxious, irritable, depression
A hypothyroid pt is at risk for what 2 things?
Bronchospasm, laryngeal spasm
Tetany usually happens when Ca levels are?
less than 6
What the normal Ca levels?
Positive Trousseaus and Chvosteks signs are a manifestation of what?
hypoparathyroidism bc of decreased Ca
Hypoparathyroidism has lab values of decreased ____ and ____; and increased ____?
Deceased PTH and serum Ca.
Increased serum phosphate
Someone is at risk of a hypoparathyroidism if they have had thyroidectomy and what was removed?
a part of the parathyroid gland
What is the goal for Calcium in hypoparathyroid management?
increase serum Ca to 9-10 mg/dL
Immediate treatment for hypoparathyroidism is?
Calcium gluconate IV or po
or Vitamin D
Ca rich foods include :
meat, dairy products, fish
For a hypoparathyroid pt, what might we do to decrease irritability?
Administer a sedation or anxiety medication. Provide a nice quiet environment
Diet for a hypoparathyroid pt would include a high ___, and low ___.
high Ca and low Ph
Nursing care for a hypoparathyroid pt include what 5 things?
•Assess for hypocalcemia
•IV Calcium gluconate
•Monitor for dysrhythmias
•Educate about medications & diet
Addison's disease is a disorder of the adrenal cortex or medulla?
Cushing's Syndrome is a disorder of the adrenal cortex or medulla?
Pheochromocytoma is a disorder of the adrenal cortex or medulla?
What are the 3 hormones of the adrenal cortex?
glucocorticoids, mineralcorticoids, androgens
What is Cushing's Syndrome?
–2nd to chronic excessive cortisol by adrenal cortex
–Large doses of glucocorticoids for several wks
What is Cushing's Disease?
- •(Metabolic disorder)
- – Increased secretion of cortisol 2nd to
- increased amount of ACTH by the
- –Stress leading to ACTH/corticotropin
- (A. Pituitary) leading to Corticosteriod
- leading to Cortisol (Adrenal Cortex)
S/S of Cushing's
•Mood & mental activity changes
•Masculine traits in women
•Red-purple Striae on abd & thighs
•Decrease K, Ca
•Increase Na, Glucose
•Trunk obese & thin extremities
•Muscle wasting & weakness
What are the 5 treatment options for management of Cushing's?
–Treat underlying cause (pituitary/adrenals)
–Chemo for adrenal tumors
–Radiation for tumors
- –Adrenalectomy for adrenal adenoma
- •Surgery of choice for adrenal
–Hypophysectomy for pituitary tumors
The nurse should monitor what 4 things for a Cushing's pt?
VS, esp Bp, I&O, weight
What labs need to be monitored for a pt with Cushing's?
WBC, Gluc, Na, K, & Ca
A pt with Cushing's will have what kind of skin?
Very fragile, use paper tape if you can, monitor for skin breakdown
The thought process for a pt with Cushing's will involve ____ and ____?
confusion and psychosis
A Cushing's pt is at risk for ____ & ____.
Injury & Infection
Bc They have high corticoid steroid levels so S/S of infection masks these pts
The #1 nursing diagnosis for a Cushing's pt is?
Disturbed body image
Is the body image of a Cushing's pt reversible?
–High additional weight in torso
- –Once they get treatment then the hump will go down, the striated stretch marks will
- leave scars
It important to remind Cushing's pt that they cannot stop what?
- –When they start treatment they
- don’t need to stop
It is important to educate a Cushing's pt to eat adequate what?
Adequate Ca intake
Why would it be good to educate a Cushing's pt that they may want to wear what?
–Medical alert bracelet to inform others they have a problem with their steroid levels
What is a bilateral adrenalectomy?
•Removal of adrenal gland
- –Bilateral: lifelong glucocorticoid &
- mineralcorticoid replacement
What is a unilateral adrenalectomy?
•Removal of adrenal gland
- –Unilateral: glucocorticoid replacement
- approx. 2 yrs
What are the 3 cautions you should be aware of for a pt that is having a adrenalectomy?
- –Catecholamine levels decrease & risk for
- Cardiovascular collapse
–Risk for hemorrhage
–Risk for renal failure
What is Addison's disease?
- •Adrenal cortex: adrenocortical insufficiency
- • Decreased glucocorticoid &
What are the 2 causes Addison's Disease?
–Sudden d/c of high dose steroids
- –Destruction of adrenal cortex
Decreased aldosterone & cortisol leads to..?
increased K, Decreased Na and glucose
Cardiac symptoms of Addison's Disease include?
atherosclerosis and CHF
GI symptoms of Addison's Disease include?
N/V, anorexia, diarrhea
Mental symptoms of Addison's Disease include?
depression, lethargy, emotional lability, confusion
Skin symptoms of Addison's Disease include?
Increase ACTH leads to hyper-pigmentation
Musculoskeletal symptoms of Addison's Disease include?
muscle and joint pain and muscle weakness and tremor
A pt with Addison's Disease will have what kind of lab vlaues?
Lab: decrease glucose, Na, and increase K
Monitor fluid and electrolyte balance
Diagnostic testing for Addison's disease include checking what 3 things?
- –Adrenocortical hormone levels
- •Cortisol levels:low
- –ACTH levels: high
- •Give ACTH and look for changes in
- cortisol level
- –ACTH / CTH stimulation test
- ridges in nails, dark pigmentation in palms and creases
- changing pigments in the bones, teeth could look dark
During Addison's management the nurse should monitor what 3 things?
Monitor: VS, weight, I &O
What labs should the nurse monitor in Addison's management?
Lab: WBCs, Glucose, Na, K, & CA
Addison's management involves lifelong therapy of what 2 things?
Glucocorticoids and Mineralocorticoid
How does the body of pt with Addison's disease respond to stress?
The body does not respond to stress well
Monitor bc it will affect HR
When stressed they are at risk for severe hypotension and shock
If the body is stressed for a pt with Addison's disease, you want to do what with the dosages of glucocoticoids and mineralocorticoids?
If stressed increase the dosages of glucocorticoids and mineralocorticoids
A medical alert bracelet is a good idea so ppl know you cannot be stressed and are taking glucos and minerals
A pt with Addison' disease should avoid exposure to what?
What kind of diet do you want a pt on Addison's disease to be on?
Diet:increase protein, carbs, and normal Na
An Addison's disease pt will be on glucocorticoid therapy for how long?
Should a pt with Addison's disease take OTC meds?
Be cautious bc some can stress the body or interfere with glucocorticoids
How should a pregnant women with Addison's disease handle her care?
- •Follow normal care but make more freqent
- –Extra precautions during labor and delivery
- •If not stabilized then the dr will do a
Addisonian Crisis is precipitated/caused by:
- –Abrupt d/c of corticosteroid use
S/S of Addisonian Crisis involve:
–Lab: decrease Na, glucose, increase K, sever decrease BP
–Cardiac: HA, tachycardic
–Abd, leg & low back pain, weakness
Management of Addison's Crisis involves:
•IV glucocorticoids then PO
•Monitor: VS, neuro status
- •Monitor Labs: Na, K, and glucose
- •Glucose low, K high
•Maintain fluid and electrolytes
•Environment: restful, quiet
•Protect from infection
What do the Adrenal Medulla Hormones do?
Functions as part of autonomic nervous system
What two catecholamines function as part of the adrenal medulla hormones?
epinephrine and norepinephrine
What is Phenochromocytoma?
•Catecholamine producing tumor is usually found in adrenal medulla
Pheochromocytoma does what to epi and norepi?
it increases both
Pheochromocytoma could result in what?
Severe life-threatening hypertension
Kidneys and Retina could become damaged
Most ppl are between the age of ___ that develop pheochromocytoma.
90% of pheochromocytoma are benign or malignant?
Majoriy of pts with pheochromocytoma are cured by ___?
S/S of Pheochromocytoma include what 3 things?
Triad of symptoms
When it comes to Pheochromocytoma, an example of HTN is?
When it comes to Pheochromocytoma, what are the "triad of symptoms"?
HA, diaphoretic, HTN, rapid HR
When it comes to Pheochromocytoma, what are the 5 H's?
Hyperhidrosis: excessive sweating
When it comes to Pheochromocytoma, what are the complications that could happen?
HTN crisis leading to renal and retina damage
AMI: stressing the heart/high risk of stroke
What is a 24 hr urine test for VMA done for?
- To test for pheochromocytoma, increase vanillylmandelic acid is positive result.
- it is metabolized with epi and norepi
What is a plasma testing done for?
Test for catecholamines for a pheochromocytoma. It is used for someone in crisis bc it is faster.
What is a clonidine suppression testing done for?
Test for pheochromocytoma
Does not affect catecholamines
What is the main thing that should be under control for a pheochromocytoma pt going to have a CT/MRI?
main concern is th eBP, must be under control before taking to CT/MRI. A beta blocker can be given to stabilize pt for CT/MRI or even surgery
What is the only treatment option procedure for a pt with pheochromcytoma?
- radiation and chemotherapy will not fix the problem, 1/3 of pts will continue to have HTN after surgery. Avoid stimulant when testing bc it will alter and delay results
What should the nurse assess for a pheochromcytoma pt?
assess for signs of HTN
How should the HOB be for a pheochromocytoma pt?
HOB elevated (fowlers and semifowlers)
What kind of diet should a pheochromocytoma pt be on?
- Need high calorie diet bc of hypermetabloic
What things should a pheochromocytoma pt avoid that will raise BP
Caffeine, nicotine, sudden position changes, lifting
The nurse should monitor a ECG for a pheochromocytoma pt to watch fow what 2 things?
dysrthymias and s/s of stroke