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What are the functions of Thyroxine (T4) & Triiodothyronine (T3)?
To regulate protein synthesis & enzyme activity & to stimulate mitochondrial oxidation.
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What is the primary goal of the Thyroid gland?
- ^ bodies metabolism
- necessary for G&D in children
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What 3 hormones are secreted by the Thyroid gland?
Triiodothyronine (T3), Thyroxine (T4), Calcitonin
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Explain how the Feedback mechanism works.
Regulates T4 & T3 secretion from the thyroid gland via the hypothalamus releasing Thyrotropin releasing hormone (TRH), which stimulates the release of TSH (Thyroid stimulating hormone), which stimulates the release of T3 & T4.
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What is the etiology of Hypothyroidism?
Insufficient circulating thyroid hormone
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What are the causes of Hypothyroidism?
- Atrophy of gland w/aging
- Irradiation, iodine deficiency or excess, Hashimoto's thyroiditis
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What are the s/s of Hypothyroidism?
- Fatigue, lethargy
- <mental acuity
- Personality & mental changes
- <cardiac output & contractility
- <GI motility: constipation, achlorhyria
- Cold intolerance
- Myxedema ->facial puffiness, periorbital edema, masklike affect
- Weight gain
- Dry coarse skin
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What medications are used to Tx Hypothyroidism?
Levothyroxine (synthroid, levothroid); ^levels of T3 & T4 hormones
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What is a critical nursing assessment with a client on Levothyroxine?
Apical pulse & BP
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What are the s/e of Levothyroxine?
- Wt loss
- tremors
- insomnia
- nervousness
- HTN
- Tachycardia
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What is the etiology of Hyperthyroidism?
An ^in circulating T3 & T4 levels, which results form an overactive thyroid gland or excessive output of thyroid hormones
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Hyperthyroidism has two classifications, what are they?
- Grave's disease
- Thyrotoxicosis
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What are the s/s of the hyperthyroid issue known as Grave's disease?
- Tachycardia, palpitations
- Nervousness, irritability, hyperactivity, emotional lablility, <attention span
- ^appetite, wt loss
- Exophthalmos (Bulging eyes)
- insomnia
- warm sweaty skin w/velvety smooth texture
- Frequent stools-diarrhea
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What is the action of the drugs used to Tx hyperthyroidism? (Propylthiouracil {PTU}, Methimazole {Tapazole})
- Inhibits thyroid hormone synthesis
- *blocker drugs
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When are these drugs used?
- In Tx of Thyrotoxic crisis
- Preparation for subtotal thyroidectomy
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What are the s/e of the hyperthyroidism drugs (PTU & Tapazole)?
Blood disorders: <WBC & <platelets, HA, rash, hypothyroidism, GI upset, liver damage
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What are the nursing interventions for PTU & Tapazole (hyperthyroidism drugs)?
- Monitor: VS, Wt
- Admin before breakfast
- Check OTC labels before using
- Report s/e & s/s
- Medic alert bracelet
- Warn of Iodine effects & presense of iodized salt, shellfish, OTC cough meds
- Do NOT abruptly stop taking
- s/s of hypothyroidism
- s/s of hyperthyroidism
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What do the Parathyroid glands do?
Secrete PTH (parathyroid hormone), which regulates calcium levels in the blood.
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A decrease in serum calcium stimulates the release of what?
PTH, which ^calcium levels by mobilizing calcium from the bone, promoting calcium absorption from the intestine & promoting calcium reabsorption from the renal tubules.
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What 3 glands produce the hormone Calcitonin?
- Mainly Thyroid gland
- some by the Parathyroid & Thymus gland
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What is the action of the hormone Calcitonin?
- Inhibits calcium reabsorption by bone & ^renal excretion of calcium
- *counteracts the action of PTH
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The drug Calcitriol (Rocaltrol) is used to Tx which issues?
- Hypoparathyroidism
- Hypocalcemia in chronic renal failure patients
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What are the s/e of Calcitriol (Rocaltrol)?
Anorexia, N/V/D, drowsiness, HA, dizziness, lethargy, photophobia, hypercalciuria, hematuria, hyperphosphatemia
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What is the critical nursing assessment when a client is taking Calcitriol (Rocaltrol)?
Calcium levels
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What are the two parts to the Adrenal Glands?
- Adrenal Cortex
- Adrenal Medulla
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What does the Adrenal Cortex do?
produces 2 types of hormones or corticosteroids: Glucocorticoids (cortisol) & Mineralocorticoids (Aldosterone)
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What causes the Adrenal glands secrete Cortisol?
A <in serum cortisol levels ^CRF & ACTH secretions, which stimulate the adrenal glands to secrete & release cortisol.
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What is the action of Corticosteroids (hormones)?
Promote sodium retention & potassium excretion.
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A deficiency of corticosteroids can result in serious illness or death because of their influence on what bodily functions?
- electrolytes & carbohydrates, protein & fat metabolism.
- regulates serum glucose
- Suppresses inflammatory/immune response
- Supports adaptation during stress
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What does the Adrenal glands Medulla secrete?
Epinephrine & Norepinephrine
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A decrease in corticosteroid secretion is called what?
- Adrenal hyposecretion
- Adrenal insufficiency
- Addison's Disease
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An increase in corticosteroid secretion is called what?
- Adrenal hypersecretion
- Cushing Syndrome
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A sudden and complete failure of the Adrenal Cortex is life threatening & called what?
Adrenal Crisis
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What are the s/s of an Adrenal Crisis?
- Confusion
- Restlessness
- Nausea
- Vomiting
- Hypotension
- Circulatory collapse -> shock
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What are the medications used for replacement therapy in Addison's patients?
- Glucocorticoids: hydrocortisone
- methlyprednisolone
- prednisone
- triamcinolone
- dexamethasone (Decadron)
- Mineralcorticoid: Fludrocortisone acetate (Florinef)
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What should a client with Addison's be taught about potassium vs sodium?
- ^Na+ intake during excess heat/humidity
- <K+ d/t hyperkalemia
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In what forms can Corticosteroids (mineralocorticoids, glucocorticoids) be given?
- Inhalations
- Nasal sprays
- Opthalmic
- Otics
- Topicals
- IMs
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What is the action of the bodies natural Corticosteroids?
promote sodium retention & potassium excretion.
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Name some Corticoid drugs.
- Beclomethasone (Vanceril)
- Fluticasone (Flonase)
- Methylprednisolone (Solu-Medrol)
- Hydrocortisone
- Fludrocortsone (Florinef)
- **Inhaled forms cause fewer systemic effects
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What are the s/e of the Glucocorticoid drugs?
- Hyperglycemia (monitor w/DM clients)
- ^risk for infection
- Central obesity & Wt gain
- HTN
- Cardivascular, fluid, electrolytes
- Peptic ulcers
- Skin fragility
- Osteoporosis
- CNS-euphoria, insomnia, behavioral
- Growth failure
- Inhaled: thrush
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What are the Corticosteroid drugs indicated for?
- Respiratory disorders
- Allergic reactions
- Dermatologic disorders
- GI disorders
- Hemolytic disorders
- Joint inflammation
- Neoplastic diseases
- Rheumatic disorders
- Opthalmic disorders
- Organ replacement
-
What are the nursing implications for Glucocorticoids?
- Give oral forms with milk, food or nonsystemic antacids (AL, Ca, or Mg salts) to minimize GI upset
- Must avoid abrupt withdrawal
- Avoid contact w/large crowds & those w/infections
- Monitor for infections particularly fungal w/inhaled forms (oral or nasal)
- Instruct patients to use topical forms exactly as ordered
- Will need ^doses after stressful events such as surgery
-
What is Cushing's Syndrome?
- Overproduction of corticosteroids
- Excessive administration of steroids
-
What are the s/s of Cushing's Syndrome?
- Wt gain-Truncal obesity
- Acne
- Muscle wasting
- Osteoporosis, fractures
- Thin, fragile skin (moon face, buffalo hump)
- Hyperglycemia
- HTN
- Psychoses
-
What is Diabetes Mellitus?
- A chronic disease resulting from deficient glucose metabolism.
- Caused by insufficient insulin secretion from the beta cells.
-
Diabetes Mellitus is characterized by the "three P's". What are they?
- Polyuria: ^urine output
- Polydipsia: ^thirst
- Polyphagia: ^hunger
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What are the three types of Diabetes Mellitus?
- Type 1; insulin-dependent DM
- Type 2; non-insulin-dependent DM
- Gestational
-
Where is insulin released from?
- Beta cells of the islets of Langerhans in pancrease.
- Responds to ^in blood glucose
-
What is the fxn of insulin?
- Promotes uptake of glucose, amino acids & fatty acids
- Converts to glycogen for future glucose needed in liver & muscles
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What are the s/s of Hyperglycemia?
- Polyuria
- Polyphagia
- Polydipsia
- Wt loss
- Blurred vision
- Fatigue
- Fruity acetone odor of breath
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In Type 1 Diabetes (IDDM) the insulin makes little to no insulin. Which age groups are prone to Type 1 Diabetes?
Child, adolescent, young adult
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in Type 2 Diabetes (NIDDM), the pancreas produces insulin but what occurs with the receptors sites?
The insulin receptor sites are either decreased or defective.
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Who are at risk for Type 2 Diabetes Mellitus (NIDDM)?
Overweight, family Hx, Inactivity, certain ethnic groups, gestational diabetes, childhood obesity
-
What are the Tx options for Type 2 Diabetes Mellitus (NIDDM)?
- Weight loss
- diet & excercise
- oral hypoglycemics
-
What are the s/s of Type 2 DM?
- Polyuria
- Slow healing cuts or sores
- Numbness/tingling in hands or feet
- Blurred vision &/or dizziness
- itchy or dry skin
- Fatigue
- ^thirst
- Frequent infections
-
What are the complications to watch for with a client who has Diabetes Mellitus?
- Kineys: Nephropathy
- Nerve: Neuropathy
- Circulatory system: peripheral vascular disease
- Eyes: Retinopathy
- Heart: Atherosclerotic Heart disease
- Accelerated Atherosclerosis can lead to acute MI & Stroke
-
What are the medications used to Tx Type 2 DM (NIIDM)?
- Oral Anti-diabetic meds:
- -sulfonylureas
- -meglintinides
- -biguanides
- -thiazolidinediones (TZDs)
- -alpha-glucosidase inhibitors
- Insulins
-
Where do the Anti-diabetic drugs Sulfonylureas work in the body?
- Stimulate beta cells to ^insulin secretion
- Alters sensitivity of peripheral insulin receptors
in pancrease
-
How often are Sulfonylureas taken in a NIDDM patient?
Once a day
-
Name the three Sulronylureas used for NIDDM patients.
- Glyburide
- Glimepiride
- Glipizide
-
Why are the three Sulfonylureas (glyburide, glimepiride, glipizide) able to work in patients with NIDDM (type 2)?
Because in type 2 NIDDM the pancreas is still able to make some insulin
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What are the s/e of the three Sulfonylurea drugs? (glyburide, glimepiride, glipizide)
- Hypoglycemia
- Blood disorders
- Wt gain
- Seizures
- coma
-
What types of patients are Sulfonylureas cautioned in?
- Liver or kidney dysfunction
- elderly
- malnourished
- adrenal or pituitary insufficiency
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What is the action of the Meglintinide drugs (Starlix, Prandin) used for Type 2 NIDDM?
Stimulate beta cells to ^insulin secretion from the pancrease
-
What are the Meglintinide drugs used for Type 2 NIDDM?
- Nateglinide (Starlix)
- Repaglinide (Prandin)
-
What is the main purpose of using the Meglintinide drugs in Type 2 NIDDM patients?
- For <BS at mealtimes
- they have a <chance of hypoglyceia
-
What are the s/e of the Meglitinides (Starlix & Prandin)?
- URI symptoms
- HA
- Hypoglycemia
- Wt gain
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The Biguanides are used mainly for Type 2 NIDDM, what is their action? (Metformin/glucophage)
- <glucose production by the liver
- <intestinal absorption of glucose
- ^use of glucose by muscles & fat cells
-
What are the nursing implications with the Biguanide (Metformin/glucophage) drugs?
- Take w/meals
- Discontinue before giving contrast dye & restart after eval renal fxn
- s/e: dizziness, fatigue, HA, agitation, metallic taste, GI distress, lactic acidosis, hepatotoxicity
-
What is the action of the TZD drugs (Actos, Avandia) used to Tx Type 2 NIDDM?
<insulin resistance by stimulating receptors on muscle cells to ^uptake of insulin
-
What are the nursing implications with the TZD drugs Actos & Avandia?
- Monitor Wt
- s/e: URI's, hepatotoxicity, HA, edema, anemia, fluid retention, ^plasma volume
-
Alpha-Glucosidase Inhibitor drugs work in the GI tract & are used for Type 2 NIDDM, what is their action? (Precose, Glyset)
Inhibits enzyme that breaks down carbs, thus slows digestion.
-
What are the two Alph-Glucosidase Inhibitor drugs used to Tx Type 2 NIDDM?
- Acarbose (Precose)
- Miglitol (Glyset)
- *can be combined w/sulfonyurea
-
What are the nursing implications for the Alpha-Glucosidase Inhibitors (Precose & Glyset)?
- *give w/1st bite of each meal
- s/e: GI ->flatulence, diarrhea, abdominal pain, cramping
-
What are the contradictions with ALL oral anti-diabetic meds?
- Known drug allergy
- Severe Kidney disease
- Sever Liver disease
- Pregnancy
-
What are the nursing implications with ORAL anti-diabetic meds?
- **BLOOD GLUCOSE LEVELS
- *Liver & Kidney fxn tests
- know what your administering: d/t combo drugs
- ensure client can tolerate food & eat b4 admin
- ensure there are orders for when pt is NPO
- Teach: s/s hypo/hyperglycemia, avoid alcohol, medic alert bracelet
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