endocrine

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Author:
dxc358
ID:
301517
Filename:
endocrine
Updated:
2015-04-26 09:48:20
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endocrine
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drugs/disorder
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  1. Deficiency of GH from Anterior Pituitary
    Dwarfism
  2. s/s of deficiency of GH in adults
    • excess body fat 
    • fatigue, weakness
    • hypercholesterolemia
    • decalcification of bone
    • skeletal and muscle weakness
    • delayed puberty
    • hypopituitarism
  3. treatment for deficiency of GH
    (growth failure) Dwarfism
    Somatropin

    (drug that mimic GH) promotes growth

    • corticosteriod
    • levothyroxine
    • sex hormone
  4. Excess secretion of GH from Anterior Pituitary
    • Gigantism (early in life)
    • Acromegaly (adult life)
  5. s/s of excess GH (Acromegaly)
    • Excessive growth in:
    • feet, hands
    • supercillary ridge
    • molar eminences, nose and chin
    • sever headache/visual disturbance (tumor pressure in optic nerve, color discrimnation, diplopia (double vision) or blindness)
  6. drug treatment for Acromegaly
    Octreotide** (sandostatin)

    (inhibits production of GH)

    • hypophysectomy (removal of tumor)
    • bromocriptine (parlodel)
  7. hyposecretion of Posterior Pituitary
    • Deficiency of ADH (vasopressin)
    • water reabsorption is turned off

    (antidiuretic hormone)
  8. deficiency of ADH
    Diabetes Insipidus
  9. s/s of Diabetes Insipidus
    • Polydipsia (excessive thirst)-"Don't hold pee"
    • Polyuria (large volume of dilute urine)- increase urine output
    • Dilute urine w/ specific gravity of 1.001 to 1.005 **normal gravity 1.015 to 1.030**
    • Serum osmolarlity increase
    • Decrease Blood Pressure (hypotention)
    • Dehydration (poor skin turgor, hypotention and weakness)
    • Craves cold water
  10. Assessment and Diagnostic of DI
    Fluid Deprivation test

    (withhold fluid for 8 to 12 hours)
  11. Drug to treat DI
    DDVAP (Desmopressin)

    (mimic action of ADH)
  12. Hypersecretion of Posterior Pituitary
    SIADH (Increase ADH)
  13. s/s of Excess ADH (SIADH)
    • ADH keeps secretion from Post. Lobe causes water retention
    • Bounding Pulse
    • Decrease Na (hyponatremia)<135
    • Distended Jugular vein
    • cellular Edema (fluid Overload)
    • Concentrated Urine - increase specific gravity >1.030
  14. special consideration for SIADH (hypersectetion of ADH)
    Acetaminophen, nicotine, estrogen, diuretics, narcotics antidepressents  --**increases ADH secretion**

    a/c , morphine, dilantin--**decrease ADH
  15. Treatment for SIADH
    • corticosteroids
    • high sodium/protein diet

    • Furosemide (Lasix)(Loop diuretic)
    • *Demolocycline vasopressin antagonist
  16. Hypersecretion of Thyroid Gland
    Hyperthyroidism
  17. Cause of Hyperthyroidism
    • Most common cause: Grave Disease (autoimmune disorder)
    • Thyrotoxicosis (goiter) 
    • Thyroid storm (a life-threatening condition manifested by Cardiac Dysrhythmia, Fever and Neurological Impairment)
  18. Drugs for hyperthyroidism
    • Methimazole/Tapazole (block synthesis of TH)-antithyroid med
    • Propylthiouracil (PTU)- antithyroid med ( block synthesis of hormone conversion of T3 & T4)
    • Propranolol (Ideral)- Beta-blocker & metoprolol (Lopressor)
    • Sodium iodide (SRO-TH)
    • potassium iodide (SRO-TH)
    • SSKI (SRO-TH)
    • Dexamethasone (SRO-TH)
  19. Nursing consideration for Propylthiouracil (PTU)
    (Antithyroid med)
    • monitor cardiac parameters
    • observe for conversion of Hypothyroidism
    • must be given by mouth
    • watch for rash, N/V
    • agranulocytosis
    • lupus sydrome
  20. Nursing consideration for Methimazole/ Tapazole (Antithyroid med)
    • More toxic than PTU
    • watch for rash and other symptoms as for PTU
  21. Nursing consideration for Sodium Iodide
    (suppress release of TH)
    • Given 1 hour after PTU or methimazole
    • watch for edema, hemorrhage and GI upset
  22. Nursing consideration for Potassium iodide
    (suppress release of TH)
    • Discontinue for Rash
    • watch for signs of toxic iodinsim
  23. Nursing consideration for Saturated solution of Potassium iodide (SSKI) (suppresses release of TH)
    • Mix with juice or milk
    • Give with straw to prevent staining in teeth
  24. Nursing consideration for Dexamethasone
    (suppress release of TH)
    • Monitor I&O
    • Monitor Glucose
    • May cause Hypertention, N/V, anorexia and infection
  25. Nursing consideration for Propranolol (Inderal) (beta-blocker) - Metoprolol (Lopressor)
    *remember LOL*
    • Monitor Cardiac status
    • Hold for bradycardia or decrease cardiac output
    • use with caution in patients with heart failure
  26. Treatment for Hyperthyroidism
    • Radio active Iodine (destroys thyroid gland) **watch for contamination with others after**
    • Thyroidectomy
    • iodine therapy (necessary to make T3 and T4)
  27. s/s of Hyperthyroidism
    • Nervousness
    • palpitation
    • tachycardia
    • poor heat toleration
    • tremors
    • flush warm moist skin
    • weight loss
    • increase appetite
    • elevated systolic BP
    • Exopthalmus
    • may lead to heart failure
    • decrease TSH, Increase T3
  28. Cause Hypothyroidism
    • Most common cause Hashimoto's (autoimmune attack thyroid gland)
    • Lacks iodine
    • Cretinism (children)
    • Thyroidectomy
    • occurs most in women 5X
    • Thyroiditis
  29. s/s of Hypothyroidism
    • Fatigue
    • hair loss
    • brittle nails
    • dry skin
    • numbness/ tingling in fingers
    • menstrual disturbance
    • Subnormal Temp and pulse
    • weight gain
    • loss of libido
    • Cold sensitivity
    • subdued mental and emotional response
    • slow speech
    • tongue enlarge
    • hands/ feet increase in size
    • cardiac and respiratory complication
    • *Myxedema** ( life-threatening condition- hypothermic and unconscious)
  30. Treatment for Hypothyroidism
    • Vital signs
    • ABG,
    • Restrict fluid (if so with caution)
    • Passive rewarming blanket- no external heat
  31. Drugs for Hypothyroidism
    Synthetic Levothyroxine (Synthroid, Levothroid)
  32. special consideration for Hypothyroidism
    preventing med interaction Levothyroxine
    • Osteoporosis
    • Hypnotic and sedatives must be adusted
    • anticoagulants, indocin, dilatin and antidepressents increase effectiveness of thyroid replacement- risk of bleeding
  33. Adrenocortical Insuffiency
    Addison's disease

    hyposecretion of ATCH
  34. s/s of Addison's disease
    • dark pigmentation
    • muscle weakness
    • Low sodium < 135
    • High potassium >3.5
    • Low Glucose
    • Hypotention
    • mental status change
    • **Addisonian Crisis* (shock, hypotention, rapid weak pulse, rapid RR, pollar , extreme weakness) -adminster IV fluid glucose, sodium replacement
  35. Dx for Addison's disease
    • adrenocortical hormone level
    • ACTH level
    • ATCH stimulation test
  36. meds for Addison's disease
    • Corticosteroids therapy:
    • hyrdocorticode (Cortef)
    • Prednisone/ Orasone*
    • Dexamethasone/Decadron*

    taper does when d/c
  37. Hypersecretion adrenal activity
    Cushings syndrome
  38. s/s of Cushing
    • weight gain
    • hyperglycemia-developing of DM
    • central type obesity
    • Buffalo Hump
    • Moon face
    • increase Na.> 145
    • decrease K+ < 3.5
    • Hirtustism
    • acne
    • libido
    • osteoporosis (hypocalcemia- give Vitamin D and calcium)
    • hypertention
    • thin extremities
    • heavy trunk
  39. Dx for Cushing
    dexamethasone supression test
  40. Drug for Cushings
    • Cytadren (antiadrenal)
    • aminoglutethimide
  41. Treatment for Cushings
    • adrenolectomy
    • Hypophysectomy (if pituitary) 
    • *high protein/calcium/ vitamin D
  42. oversecretion of Epi and Norepi
    Phenochromocytoma
  43. cause of Phenochromocytoma
    • Tumor usually Benign originate from chromaffin cells in the adrenal medulla
    • cause of High Blood pressure
  44. S/S of Phenochromocytoma
    • The Five "H":
    • hypertension
    • headache
    • hyperhidrosis (excessive sweating)
    • hypermetabolism
    • Hyperglycemia
  45. Diagnostic finding for Phenochromocytoma
    • urine and plasma level of catecholamine and metanephrine (MN)
    • MN and VMA
  46. treatment for Phenochromocytoma
    • propranolo, inderal - (beta-blocker)
    • phenoxybenzamine (Dibenzyline) - (alpha-blocker)
    • Nipedipine (procardia) - (calcium-blocker)

    • Hypertensive crisis* - Sodium nitroprusside (Nitropress), phentolamine (oraVerse) or nicardioine
    • lidocaine (Xylocaine) ot esmolol (brevibloc)-control cardiac arrhythmia
    • corticoidsteriod replacement if bilateral adrenolectomy
  47. cause of Hypoparathyroid
    • surgery thyroidectomy (most common)
    • parathyroidectomy
    • radial neck dissection
    • vitamin D deficiency
  48. s/s of Hypoparathyroid
    • Tetany (chief symptom)
    • numbness, tingling in extremities
    • stiffness in hands and feet
    • bronchospasm
    • layngeal spasm
    • anxiety
    • carpopedal spasm
    • irritabililty
    • depression
    • delirium
    • EKG changes
  49. Diagnostic for hypoparathyroid
    • Chvostek's sign (sharp tapping of facial nerve in front of ear)
    • Trousseau's sign (carpal and pedal spasm by occluding blood flow to the arm)
    • Hyperphosphatemia
    • hypocalcemia < 8.4
  50. treatment for Hypoparathyroid
    • Calcium Gluconate!
    • Vitamin D supplement
    • high calcium and low phosphorus diet
    • pentobarbital (decrease neuromuscular irritability)
    • parathormone administration
    • free of noise, drafts, bright lights and sudden movement
  51. med for Hypoparathyroid
    Sedative (pentabarbital)
  52. cause of hyperparathyroid
    • excess parathormone
    • 2x to 4x more in women
    • Increase Calcium (Hypercalcemia) >10.2
    • Hypophosphatemia
    • elevated blood calcium by increasing calcium absorption from kidneys, intestine and bone
  53. s/s of Hyperparathyroid
    • Hypercalcemia > 10.2
    • Hypophosphatemia
    • bone decalcification
    • apathy
    • muscle weakness
    • N/V
    • constipation
    • Hypertension
    • cardiac Dyrhythmias
    • psychological manifestation 
    • Renal Calculi (kidney stones)*
  54. Treatment for Hyperparathyroid
    • Parathyoidectomy
    • hydration therapy
    • encourage motility
    • reduce calcium excretion (thiazide diuretics are avoided- further elevate calcium levels)
    • encourage fliud
    • avoid diet/ or restrict calcium
    • Calcitonin*- decrease serium calcium levels
    • dialysis
  55. Consideration for Hyperparathyroid
    • Hypercalcemic Crisis:
    • rare-life threatening disease r/t decompensated Ca+ levels >15
    • hypercalcemia leading to renal failure and altered mental status

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