The adrenal cortex influences F&E balance through the secretion of.....how?
it increases sodium retention and potassium excretion by the kidneyes
How does the adrenal cortex raise blood glucose levels?
by releasing glucocorticoids (cortisol)
How does the anterior lobe of the pituitary gland stimulate thyroid and adrenocortical secretion?
by secreting TSH and ACTH
What does the posterior pituitary gland do?
promotes water retention by secreting ADH, thus decreasing urine output
Where does the synthesis of the 2 posterior pituitary hormones (ADH, Oxytocin) occur?
Clinical manifestations of hyperthyroidism
exophthalmos (bulging eyes)
Clinical manifestations of hypothyroidism
dry brittle hair
Clinical manifestations of Cushings Disease
Hirutism (excessive body hair)
Clinical manifestations of Addison's disease
What does the endocrine system do?
consists of glands and hormones
hormones regulate metabolic processes and energy production
provide stress response
it is a communication system that links all of the other body systems
What part of the brain makes and secretes inhibiting hormones?
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
How is endocrine dysfunction treated?
replace missing hormones
suppress the hormone when levels are too high
What does prolactin do?
stimulates mammary tissue growth and lactation
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
What does cortisol do?
promotes carb, protein and fat metabolism
increases tissue response to other hormones
part of the stress response
What does aldosterone do?
increases sodium retention and K excretion
How does aldosterone have a direct impact on CO?
by increasing sodium retention, fluid volume is increased, which increases blood pressure....increasing CO
LH and FSH do what?
affect growth, maturity and functioning of primary and secondary sex organs
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
What stimulates the ejection of milk from the mammary glands and stimulates uterine contractions?
What do T3 and T4 do?
regulates metabolic activity of all cells and processes of cell growth and tissue differentiations
Where is T3 converted to T4?
in the liver and peripheral tissues
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
What does thyrocalcitonin do?
regulates calcium and phosphorous blood levels
decreases serum calcium by preventing calcium reabsorption from the bone
Which hormone increases and decreases calcium levels
thryocalcitonin decreases and parathormone increases
What do epi and norepi do?
convert glycogen to glucose
increase cardiac contractility
prolongs effects of sympathetic nervous system
What does insulin do?
promotes metabolism of cholesterol, proteins and fat, thus decreasing blood glucose levels
What does glucagon do?
mobilizes glycogen stores causing an increase in blood glucose levels
decreases secretion of insulin, glucagon, growth hormone and several GI hormones
What is the sign of low serum cortisol?
during stress the person will still have low bp
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.
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
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
2 problems result of excess growth hormone
gigantism and acromegaly
from too much GH prior to the closure of the growth plates
causes rapid proportional growth in the length of all bones
occurs after the growth plates have closed
results in lg features
cardiomegaly w/ LV hypertrophy
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
How do you dx acromegaly?
Hx and physical
MRI of brain (tumor causes)
Test looking at growth hormone response to glucose
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
What is the goal of care for a person with acromegaly?
to return GH levels back to normal....done with meds, surgery, radiation
Surgery to correct acromegaly
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
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
through the nose surgery
Importance of hormone replacement after hypophysectomy
hormone replacement is important and all anterior pituitary hormones need to be monitored
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
3 meds to treat Acromegaly/Gigantism
and why are they used?
usually as a bridge for treatment while prepping for surgery
How does Sandostatin work?
decreases GH levels
How does Dostinex work?
blocks the secretion of GH
How does Somavert work?
blocks the uptake of GH
What is the patient with acromegaly/gigantism most concerned with?
What's the problem with Cushings Disease?
high levels of glucocorticoids and mineralcorticoids
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
What is panhypopituitarianism?
partial or total failure of production of all the anterior pituitary hormones
Which 2 hormones are the most fatal to be deficient in?
ACTH and TSH
What causes hypopituitaryism?
Clinical manifestations of hypopituitaryism
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
How do you dx hypopituitarism?
Hx and physical
Labs to measure hormones....all!!
Collaborative care for the treatment of hypopituitarism
lifelong hormone replacement
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
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
What will happen if a person with hypopituitarism gets estrogen/progesterone prior to puberty?
their epiphyses will close
Estrogen therapy causes....
DVT and HTN
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
What can cause disorders of ADH?
anything that affects the hypothalamus, pituitary gland or post transhypophosectomy surgery
What causes Diabetes Insipidus?
deficiency in ADH....without ADH you will have massive diuresis
Clinical manifestations of Diabetes Insipidus
Excessive thirst from dehydration
Increase in frequency of urine
hypotension....that can lead to hypovolemic shock
Diabetes Insipidus will have the following labs:
Specific Gravity <1.005
Serum Osmolality 300+
Urine output of >250 cc/hr for 2 hrs
Na levels >145
How do you treat Diabetes Insipidus?
It is self limiting
replace F&E with hypotonic saline solution (.45% saline or D5) cc for cc
low sodium diet
Test to dx Diabetes Insipidus
withhold water and test urine, plasma osmo, urine spec. gravity and BP
give ADH and then remeasure urine osmo
2 meds to treat Diabetes Insipidus
DDAVP and Diabinaase
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
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
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.
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
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
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
Labs for a person with SIADH
Serum Na <134
Serum Osmolal <280
Urine specific Gravity >1.005
What is the main problem with SIADH
risk of seizures
S/S of SIADH
How do you treat SIADH?
Admin. hypertonic solutions-D5NS, D5LR
VS you will see in a person with SIADH
increased BP, but low sodium
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
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
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
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
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
How do you get hyperthyroidism?
over function of the gland
Pituitary adenoma...causes increase in TSH
over treatment of myxedema (hypothyroidism)
Example of primary and secondary hyperthyroidism
What causes Graves Disease?
Auto Immune Disease
TSH antibodies bind to receptors keeping them activated causing TH to continue to be produced....= hyperthyroidism
How do you get a goiter?
over active thyroid gland causes it to hypertrophy
S/S of hyperthyroidism/Graves Disease
Increase HR and BP
What does thyrocalcitonin do?
it's job is to decrease calcium levels by preventing bone resorption
What's a thyroid storm?
a potentially fatal acute episode of thyroid overactivity...
death from impact on heart...CHF to shock
What can cause a thyroid storm?
goiter being vigorously palpated
undiagnosed or under treated hyperthyroid
infection, stress, surgery when you have hyperthryoidism
Inadequate prep of clients for thyroid surgery
S/S of thyroid storm
Increase BG and BP
What's the medication to give first if a person is having a thyroid storm? Why?
blocks the effects on the heart
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
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
What medication shouldn't a person with hyperthryroidism take? Why?
causes the release of more TH
Pre op for a person having a thyroidectomy
check thyroid levels
control cardiac problems
prepare for possible airway complications post op
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
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
soft tissue edema...puffy face
S/S of hypothyroidism
hemodynamic compromise issues
What causes mixedema coma and give examples
extreme stressor plus hypothyroidism
abrupt withdrawl of thyroid meds
Dx of hypothyroidism
Treatment for hypothyroidism
prevent cardiac and arterial damage
First time a person takes synthroid what do I monitor?
cardiovascular status...especially in older patients
What is the most important nursing dx for hypothyroidism/myxedema?
Knowledge deficit of life long thyroid replacement, and avoid sedatives
Nursing management for a person with mixedema coma
*Maintain a patent airway
Admin glucose IV
Monitor temp and gradually warm them
Watch for LOC change
Least aggressive thyroid cancer and how is it treated?
Most aggressive thyroid cancer and how is it treated?
highly malignant, treat palliatively using surgery, radiation, chemo. prognosis is grave.
Which thyroid cancer will the patient have a temporary trach?
Post op watch for airway issues and tetany from hypocalcemia
What do you teach a patient who is on levothyroxine?
it causes increased myocardial O2 requirements....report chest pain and arrhythmias
Any medication that replaces TH watch for these problems