Endocrine and new grad stuff

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foxyt14
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Endocrine and new grad stuff
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2014-10-06 20:32:08
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Endocrine System N176
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Endocrine system plus new grad stuff
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  1. Adrenal Cortex secretes
    • mineralcorticoids  (Aldosterone)
    • glucocorticoids (cortisol)
    • Androgens
  2. Adrenal Medulla secretes
    • epinephrine
    • norepinephrine
  3. Ovaries secretes
    • progesterone
    • estrogen
  4. Pancreas secretes
    • glucagon
    • insulin
    • Somatostatin
  5. Thyroid secretes
    • thyroxine T4
    • Triodothyronine T3
    • thyrocalcitonin
  6. Parathyroid secretes
    parathromone
  7. Anterior pituitary gland secretes
    • adrenocorticotropic hormone (ACTH)
    • melanocyte
    • TSH
    • Gonadotropic hormone (LH and FSH)
    • Prolactin
    • Growth Hormone
  8. Posterior pituitary gland secretes
    • ADH
    • Vasopressin
    • Oxytocin
  9. Testes secretes
    Androgens (Testosterone)
  10. The adrenal cortex influences F&E balance through the secretion of.....how?
    aldosterone

    it increases sodium retention and potassium excretion by the kidneyes
  11. How does the adrenal cortex raise blood glucose levels?
    by releasing glucocorticoids (cortisol)
  12. How does the anterior lobe of the pituitary gland stimulate thyroid and adrenocortical secretion?
    by secreting TSH and ACTH
  13. What does the posterior pituitary gland do?
    promotes water retention by secreting ADH, thus decreasing urine output
  14. Where does the synthesis of the 2 posterior pituitary hormones (ADH, Oxytocin) occur?
    hypothalamus
  15. Clinical manifestations of hyperthyroidism
    • tremors
    • tachy
    • exophthalmos (bulging eyes)
    • diarrhea
  16. Clinical manifestations of hypothyroidism
    • weight gain
    • dry brittle hair
  17. Clinical manifestations of Cushings Disease
    • weight gain
    • Hirutism (excessive body hair)
    • buffalo hump
    • moon face
  18. Clinical manifestations of Addison's disease
    • fatigue
    • weight loss
    • skin hyperpigmentation
    • orthostatic hypotension
  19. What does the endocrine system do?
    • consists of glands and hormones
    • hormones regulate metabolic processes and energy production
    • balance F&E
    • provide stress response

    it is a communication system that links all of the other body systems
  20. What part of the brain makes and secretes inhibiting hormones?
    hypothalamus
  21. Positive feedback loop vs. Negative feedback loop
    positive stimulates the release of hormones when levels are low.

    negative stops the release of hormones when levels are high
  22. How is endocrine dysfunction treated?
    • replace missing hormones
    • or
    • suppress the hormone when levels are too high
  23. What does prolactin do?
    stimulates mammary tissue growth and lactation
  24. What does thyrocalcitonin do?
    regulates calcium and phosphorous levels

    stops calcium reabsorption from bone and prevents bones from being broken down and the release of calcium in to the blood
  25. What does cortisol do?
    • promotes carb, protein and fat metabolism
    • increases tissue response to other hormones
    • part of the stress response
  26. What does aldosterone do?
    increases sodium retention and K excretion
  27. How does aldosterone have a direct impact on CO?
    by increasing sodium retention, fluid volume is increased, which increases blood pressure....increasing CO
  28. LH and FSH do what?
    affect growth, maturity and functioning of primary and secondary sex organs
  29. What does ADH and Vasopressin do?
    Na and water reabsorption-promotes reabsorption of water by the distal tubules and collecting ducts of the kidney, thus decreasing urine output

    vasoconstriction
  30. What stimulates the ejection of milk from the mammary glands and stimulates uterine contractions?
    oxytocin
  31. What do T3 and T4 do?
    regulates metabolic activity of all cells and processes of cell growth and tissue differentiations
  32. Where is T3 converted to T4?
    in the liver and peripheral tissues
  33. What does parathormone do?
    regulates calcium and phosphorous blood levels

    promotes bone breakdown and increases intestinal absorption of calcium and the excretion of phosphorous in the kidneys
  34. What does thyrocalcitonin do?
    regulates calcium and phosphorous blood levels

    decreases serum calcium by preventing calcium reabsorption from the bone
  35. Which hormone increases and decreases calcium levels
    thryocalcitonin decreases and parathormone increases
  36. What do epi and norepi do?
    • stress response....
    • elevate bp
    • convert glycogen to glucose
    • increase hr
    • increase cardiac contractility
    • dilate bronchioles
    • prolongs effects of sympathetic nervous system
  37. What does insulin do?
    promotes metabolism of cholesterol, proteins and fat, thus decreasing blood glucose levels
  38. What does glucagon do?
    mobilizes glycogen stores causing an increase in blood glucose levels
  39. Somatostatin
    decreases secretion of insulin, glucagon, growth hormone and several GI hormones
  40. What is the sign of low serum cortisol?
    during stress the person will still have low bp
  41. How do you check a hormone problem?
    figure out if the problem is with the gland?   Or is it the problem in the axis...so you must look above the gland for the problem.
  42. How do you figure out where the problem is if a person has low cortisol....specifics.
    primary problem-this is a result of the gland not kicking out cortisol (gland isn't functional)

    • secondary problem-draw cortisol levels and give the patient synthetic cortisol. 
    • wait an hr
    • draw cortisol levels again
    • if cortisol increased, then the problem is somewhere in the axis
    • but if the give synthetic cortisol and no change (cortisol level stays low) then the gland is the problem
  43. What's the problem with hyper-pituitaryism?  What's usually the problem?
    no negative feedback causing secretion of hormone in excess

    benign tumor on the pituitary gland
  44. 2 problems result of excess growth hormone
    gigantism and acromegaly
  45. Gigantism
    from too much GH prior to the closure of the growth plates

    causes rapid proportional growth in the length  of all bones
  46. Acromegaly
    occurs after the growth plates have closed

    • results in lg features
    • cardiomegaly w/ LV hypertrophy
    • CHF
    • HTN
    • increased glucose
    • visual problems
    • hoarseness
  47. Who recognizes acromegaly a lot of the time?
    the dentist....changes in x ray.  Will ask to see an old/wedding picture of the client for comparison

    or you notice a change in shoe size....these changes are subtle
  48. How do you dx acromegaly?
    • Hx and physical
    • MRI of brain (tumor causes)
    • Test looking at growth hormone response to glucose
  49. Describe how growth hormones response to glucose can dx acromegaly
    GH is inhibited by glucose.

    • give GH x2 along with 75-100g of glucose
    • GH level should decrease, but if you have acromegaly it wont decrease
  50. What is the goal of care for a person with acromegaly?
    to return GH levels back to normal....done with meds, surgery, radiation
  51. Surgery to correct acromegaly
    Hypophysectomy

    • surgery to snip out the tumor on the pituitary gland
    • can get to the sinuses and then pituitary gland thru the nose or upper lip

    will decrease  hormone levels, reverse soft tissue body changes

    skeletal changes will stay and may still have visual problems
  52. Post op care for the person having hypophysectomy surgery
    • Neuro checks....brain surgery
    • Monitor fluid balance....watching for output greater than input (dumping urine)
    • Teach don't cough, sneeze, blow nose
    • Teach don't brush teeth....floss till incision heals
    • Monitor nasal drip for s/s of CSF leak
    • Monitor BM to prevent constipation....strain = increased ICP
  53. Transphenyodal Hypophysectomy
    through the nose surgery
  54. Importance of hormone replacement after hypophysectomy
    hormone replacement is important and all anterior pituitary hormones need to be monitored

    • GH
    • TSH
    • LH
    • FSH
    • ACTH
    • MSH
  55. Why can a person after hypophysectomy surgery dump urine?
    Because they can have transient diabetes insipudus....this means they are not secreting enough ADH so they diurese....dump urine
  56. 3 meds to treat Acromegaly/Gigantism
    and why are they used?
    • Sandostatin
    • Dostinex
    • Somavert

    usually as  a bridge for treatment while prepping for surgery
  57. How does Sandostatin work?
    decreases GH levels
  58. How does Dostinex work?
    blocks the secretion of GH
  59. How does Somavert work?
    blocks the uptake of GH
  60. What is the patient with acromegaly/gigantism most concerned with?
    body image
  61. What's the problem with Cushings Disease?
    high levels of glucocorticoids and mineralcorticoids

    • cortisol
    • Aldosterone
  62. What's the result of hypopituitaryism?
    • growth retardation from low levels of GH
    • metabolic abnormalities from low ACTH and TSH
    • sexual immaturity from low FSH and LH
  63. What is panhypopituitarianism?
    partial or total failure of production of all the anterior pituitary hormones
  64. Which 2 hormones are the most fatal to be deficient in?
    ACTH and TSH
  65. What causes hypopituitaryism?
    • tumor
    • surgical hypophysectomy
    • radiation
    • trauma
  66. Clinical manifestations of hypopituitaryism
    • headache
    • visual changes
    • seizures
    • weakness
    • decreased energy
  67. Deficiencies of gonadotropins with hypopituirarism causes....
    infertility in men and women

    delayed onset of puberty in males

    ovarian failure, amenorrhea and loss of secondary sex characteristics in females
  68. How do you dx hypopituitarism?
    • Hx and physical
    • MRI, CT
    • Labs to measure hormones....all!!
    • GH
    • ACTH
    • Cortisol
    • T3, T4
    • Testosterone/progesterone/Estrogen
  69. Collaborative care for the treatment of hypopituitarism
    lifelong hormone replacement
  70. Contraindication meds for persons with hypopituitarism?
    males....cant take testosterone if have had prostate cancer

    females....cant take estrogen if have had breast cancer, phlebitis or problems with pulmonary embolism
  71. What is the desired effects of giving a person with hypopituitarism testosterone?
    Testosterone-return of secondary sex characteristics, libido, deep voice and no problems with sterility
  72. What will happen if a person with hypopituitarism gets estrogen/progesterone prior to puberty?
    their epiphyses will close
  73. Estrogen therapy causes....
    DVT and HTN
  74. What do you teach a person who is on estrogen therapy?
    cant take if you have hx of clots, breast cancer or htn.

    Teach:  watch blood pressure and drink plenty of fluids
  75. What can cause disorders of ADH?
    • TBI
    • anything that affects the hypothalamus, pituitary gland or post transhypophosectomy surgery
  76. What causes Diabetes Insipidus?
    deficiency in ADH....without ADH you will have massive diuresis
  77. Clinical manifestations of Diabetes Insipidus
    • Excessive thirst from dehydration
    • Increase in frequency of urine
    • dilute urine
    • hypernatremia
    • hypotension....that can lead to hypovolemic shock
  78. Diabetes Insipidus will have the following labs:
    Specific gravity-
    Serum Osmolality-
    Urine output-
    Na levels
    • Specific Gravity <1.005
    • Serum Osmolality 300+
    • Urine output of >250 cc/hr for 2 hrs
    • Na levels >145
  79. How do you treat Diabetes Insipidus?
    • It is self limiting
    • replace F&E with hypotonic saline solution (.45% saline or D5)  cc for cc
    • medications
    • low sodium diet
  80. Test to dx Diabetes Insipidus
    • withhold water and test urine, plasma osmo, urine spec. gravity and BP
    • give ADH and then remeasure urine osmo
  81. 2 meds to treat Diabetes Insipidus
    DDAVP and Diabinaase
  82. How does DDAVP work for Diabetes Insipidus?
    given PO, IV or nasal spray

    know it is working quickly....will see decreased UO to normal levels, increase in specific gravity and serum osmolality with be normal
  83. When do you take Diabinaase for Diabetes Insipidus and how does it work?
    when you haven't lost all of your ADH

    makes kidneys more responsive to ADH that is still there
  84. 2 specific ways to get Diabetes Insipidus
    24-48 hrs after brain injury to the pituitary or hypothalamus this can occur

    Post transhypophysectomy from GH increase.
  85. What do I need to teach a person who just had hypophysectomy?
    Once discharged from the hospital watch out for s/s of Diabetes Insipidus

    typically occurs 24-48 hours after surgery
  86. SIADH-what is it and who is at risk to get it?
    Syndrome of Inappropriate Antidiuretic Hormone secretion

    too much ADH....causing hyponatremia

    old people and people with small cell lung cancer
  87. Patho of SIADH
    Too much ADH causes water retention resulting in dilutional hyponatremia and expansion of the extracellular fluid volume.  Increase in plasma volume causes and increase in glomerular filtration rate and inhibits the release of renin and aldosterone

    Concentrated urine with normal kidney function
  88. Labs for a person with SIADH
    • Serum Na <134
    • Serum Osmolal <280
    • Urine specific Gravity >1.005
  89. What is the main problem with SIADH
    risk of seizures
  90. S/S of SIADH
    • Hyponatremia
    • decreased LOC
    • headache
    • lethargy
    • seizures
    • coma
    • confusion
  91. How do you treat SIADH?
    • Fluid restriction
    • Admin. hypertonic solutions-D5NS, D5LR
    • Seizure precautions
    • frequent turning
    • oral hygiene
  92. VS you will see in a person with SIADH
    increased BP, but low sodium
  93. When you give a hypertonic IV solution to a person with SIADH what do I need to do?
    • monitor them q 1hr for neurologic dysfunction
    • serial electrolyte checks q4-6 hrs
  94. When a person has a serum Na of >125 why can I give Lasix?
    because the Lasix will make you lose the water but keep the sodium....causing an increase in sodium levels
  95. When a person has a serum Na of >125 why would I give Lithium or Declomycin?
    cuz they block the effect of ADH on the renal tubules making urine dilute....increasing sodium levels
  96. What is thyrotoxicosis
    s/s that appear when excess TH stimulates the body....the feedback loop has failed

    patient ends up hypermetabolic w/ increased nervous system activity
  97. What is thyroid hormones effect on the body?
    • increases SV and HR
    • which increases BP and then CO
    • increases blood glucose levels
    • increases protein degredation and fat metabolism
  98. How do you get hyperthyroidism?
    • over function of the gland
    • thyroid adenoma-tumor
    • Pituitary adenoma...causes increase in TSH
    • over treatment of myxedema (hypothyroidism)
    • thyroid carcinoma
    • graves disease
  99. Example of primary and secondary hyperthyroidism
    • Thyroid Adenoma-primary
    • Pituitary Adenoma-secondary
  100. What causes Graves Disease?
    Auto Immune Disease

    TSH antibodies bind to receptors keeping them activated causing TH to continue to be produced....= hyperthyroidism
  101. How do you get a goiter?
    over active thyroid gland causes it to hypertrophy
  102. S/S of hyperthyroidism/Graves Disease
    • Exopthalmos-protruding eyes
    • Heat Intolerance
    • Increase HR and BP
  103. What does thyrocalcitonin do?
    it's job is to decrease calcium levels by preventing bone resorption
  104. What's a thyroid storm?
    a potentially fatal acute episode of thyroid overactivity...

    death from impact on heart...CHF to shock
  105. What can cause a thyroid storm?
    • goiter being vigorously palpated
    • undiagnosed or under treated hyperthyroid
    • infection, stress, surgery when you have hyperthryoidism
    • thyroid ablation
    • med OD
    • Inadequate prep of clients for thyroid surgery
  106. S/S of thyroid storm
    • fever 105
    • tachy
    • systolic htn
    • agitation
    • anxiety
    • confusion
    • psychosis
    • seizures
    • HEAT INTOLERANCE
    • ABD pain
    • N/V
    • BM...diarrhea
    • Increase BG and BP
  107. What's the medication to give first if a person is having a thyroid storm?  Why?
    Inderall

    blocks the effects on the heart
  108. Two anti thyroid meds and how do they work
    PTU...impairs synthesis of TH, and allows the thyroid to store more TH

    Methimazole....blocks the action of TH in the body
  109. Describe Iodine therapy for hyperthyroidism
    • It is used to reduce the vascularity of the gland before surgery....called SSKI
    • It also inhibits the release of thyroid hormones into circulation, by increasing the glands ability to store more TH
    • Give PTU with it so the thyroid can store more hormone
  110. What medication shouldn't a person with hyperthryroidism take?  Why?
    Aspirin/Salicylites

    causes the release of more TH
  111. Pre op for a person having a thyroidectomy
    • check thyroid levels
    • VS
    • control cardiac problems
    • prepare for possible airway complications post op
  112. Post op care for a person after a thyroidectomy
    • Assess for respiratory compromise...neck surgery
    • Monitor VS closely
    • Assess for tetany
    • Teach about needs to do lab follow up and daily thyroid hormone replacement for life
  113. Why am I watching for tetany in a person post thyroidectomy?
    cuz will probably take out parathyroid too...which regulates calcium.  So watch for hypocalcemia
  114. Cretinism
    congenital hypothryoidism
  115. Mixedema
    soft tissue edema...puffy face
  116. S/S of hypothyroidism
    • fatigue
    • hemodynamic compromise issues
    • brady
    • hypotension
    • constipation
    • cold intolerance
    • weight gain
  117. What causes mixedema coma and give examples
    extreme stressor plus hypothyroidism

    • acute illness
    • abrupt withdrawl of thyroid meds
    • anesthesia
    • sedatives
    • narcotics
    • surgery
    • hypothermia
  118. Dx of hypothyroidism
    • H&P....had hyperthyroidism...thyroidectomy
    • Labs....
    • TSH
    • Free T4
  119. Treatment for hypothyroidism
    • Synthroid/Levothyroxine
    • prevent cardiac and arterial damage
  120. First time a person takes synthroid what do I monitor?
    cardiovascular status...especially in older patients

    • chest pain
    • arrhythmias
    • increased BP
  121. What is the most important nursing dx for hypothyroidism/myxedema?
    Knowledge deficit of life long thyroid replacement, and avoid sedatives
  122. Nursing management for a person with mixedema coma
    • *Maintain a patent airway
    • replace fluids
    • IV Levothyroxine
    • Admin glucose IV
    • Admin corticosteroids
    • Monitor temp and gradually warm them
    • VS
    • Watch for LOC change
  123. Least aggressive thyroid cancer and how is it treated?
    Papillary adenoma

    surgery...excellent prognosis
  124. Most aggressive thyroid cancer and how is it treated?
    Anaplastic carcinoma

    highly malignant, treat palliatively using surgery, radiation, chemo. prognosis is grave.

    Temporary trach
  125. Which thyroid cancer will the patient have a temporary trach?
    Anaplastic Carcinoma...

    Post op watch for airway issues and tetany from hypocalcemia
  126. What do you teach a patient who is on levothyroxine?
    it causes increased myocardial O2 requirements....report chest pain and arrhythmias
  127. Any medication that replaces TH watch for these problems
    • diarrhea
    • cramps
    • tachy
    • heat intolerance
    • weight loss

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