Endocrine ppt

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Endocrine ppt
2011-06-26 19:15:01

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  1. What consists of the Endocrine System







  2. Regulation of Hormones
    *Simple Factors

    *Negative Factors

    *Positive Factors

    *Complex Factors
  3. Simple Factors
    based upon blood levels of a particular substance
  4. Negative Feedback
    gland responds by increasing or decreasing the secretion of a hormone (PTH, insulin)
  5. Positive Feedback
    increases target organ beyond normal (Oxytocin)

    Oxytocin: hormone comes from the petuitary
  6. Complex Feedback
    usually involves several glands (T3-T4 release)

    Hypothalamus which will influence the anterior pituitary (TSH) which will go to the thyroid (T3-T4)

    If hyperthyroid (elevated T3 and T4): pts will have a low TSH

    If Hypothyroid: pt will increase TSH, low (T3, T4)
  7. Rhythms
    - originating in brain structures

    - “circadian rhythms”

    - Steroids rise in early morning and decline toward evenings

    - Growth hormones peak during sleep
  8. Hypothalamus
    Important part of endocrine system

    Produces hormones

    Works closely with pituitary

    Secretes many hormones

    - releasing and inhibiting hormones

    - neurons: influence the brainstem and spinal cord and coordinates the ANS, endocrine system and behavior responses such as fear and anger
  9. Pituitary
    “master gland”

    Located under the hypothalamus at the base of the brain

    Anterior and Posterior
  10. Anterior Pituitary
    Larger portion

    Regulated by hypothalamus through releasing and inhibiting hormones

    Growth Hormone (GH)

    - effects on all body tissue

    - growth and development of skeletal muscles and long bones

    - role in protein, fat and CHO metabolism


    Tropic Hormones
  11. Prolactin
    breast development and lactation
  12. Tropic Hormones
    Control the secretion of hormones by other glands


    Under the influence of the hypothalamus (TSH< ACTH< FSH, LH, MSH)
  13. Posterior Pituitary
    Composed of nerve tissue and is an extension of the hypothalamus

    ADH and Oxytocin

    - hormones produced in hypothalamus but travel down nerve tracts to Post. Pituitary

    - stored in pituitary until released

    Hormones not regulated by the hypothalamus
  14. ADH
    is regulated by fluid volume and plasma concentration

    When stimulated the renal tubules reabsorb water

    Creating a concentrated urine

    • released to response of fluid outcome, it retains water only and keeps in body
    • where you need it
  15. Oxytocin
    Stimulates the production of milk into mammary ducts

    Contract uterine smooth muscle

    Released by stimulation of touch receptors in the nipples of lactating women
  16. Gigantism
    Pituitary Disorder (Anterior)

    excessive secretion before the closure of the epiphyses
  17. Acromegaly
    Pituitary Disorder (Anterior)

    excessive secretion after the closure of the epiphyses

    when you are an adult and you stop growing but your hands and feet get larger
  18. Antidiuretic Hormone Overproduction
    Pituitary Disorder (Posterior)

    • SIADH
    • “Syndrome of Inappropriate antidiurectic hormone”

    Fluid retention

    Dilutional hyponatremia

    Concentrated urine

    putting out too much ADH, drowning in their fluid
  19. Antidiuretic Hormone Deficiency
    DI – “Diabetes Insipidus”

    Increased urine output

    Dilute urine

    urine is almost plain water and they get very dehydrated
  20. Thyroid Gland
    T4 (thyroxine) & T3 (triiodothyronine)

    Function is the production, storage and release of these hormones

    We need these hormones for metabolism, T4 and T3 speeds up

    Iodine is necessary for T4 & T3 hormone production

    Affects metabolic rate, growth and development, CHO and lipid metabolism etc

    Stimulated by TSH
  21. Thyroid Calcitonin
    Produced by thyroid – in response to high levels of calcium

    Inhibits resorption of bone, increase calcium in the bone, increase renal excretion of calcium
  22. Parathyroid
    Usually 4 glands

    Small oval structures embedded behind each thyroid lobe

    Secrete PTH (parathormone)
  23. Parathormone
    Increases calcium
  24. Parathyroid Glands
    PTH increases bone resorption, resulting in calcium release into blood, and promotes the reabsorption of calcium and excretion of phosphorus

    Activates Vitamin D which enhances the intestinal absorption of calcium
  25. Adrenal Glands
    Small paired highly vascular

    Located on top of kidneys

    Consists of two parts: Medulla and Cortex
  26. Adrenal Medulla
    Releases catecholamines

    Effect on all body systems
  27. Adrenal Cortex
    Releases more than 50 steroid hormones

    *glucocorticoids (cortisol)

    *mineralcorticoids (aldosterone)

    * androgens
  28. glucocorticoids (cortisol)
    - effect on glucose metabolism

    - antiinflammatory action

    -stress response

    -released by negative feedback (CRH and ACTH)
  29. mineralcorticoids (aldosterone)
    - released in response to fluid volume and altered potassium levels
  30. What is the action of aldosterone in the body?
    retains sodium and water and relese/excrete potassium
  31. How is aldosterone secreted?
    renin angiotension stimulates the adrenal cortex to secrete aldosterone
  32. Corticosteroids

    Adrenal Cortex Disorders
    Excess: Cushing Syndrome

    *effects related to excess of glucocorticoids
  33. Addison’s Disease

    • Generally all three corticosteroids are
    • reduce

    Not just steroids too little (need to add more)
  34. Pheochromocytoma

    Adrenal Cortex Disorders

    *Tumor of adrenal medulla

    *Severe hypertension

    Too much epinephrine

    HR goes up

    First check bp high risk for stroke and heart attack
  35. Pancreas
    (Islets of Langerhans)

    Glucagon – Alpha Cells

    Insulin– Beta cells
  36. Glucagon
    Increases Sugar
  37. Insulin
    lowers your blood sugar
  38. Thyroid Disorders/ Abnormalties




  39. Tests of Thyroid Function
    Serum T4

    Serum T3

    Thyroid scan with RAI (Radioactive iodine uptake)
  40. Goiter
    Hypertrophy and enlargement of the thyroid

    • Caused by excessive TSH stimulation from
    • inadequate thyroid hormones

    • Can be caused by Goitrogens
    • - foods or drugs that suppress gland function

    - enlargement of gland

    - interfere with iodine uptake

    Surgery may be necessary

    Nursing diagnosis: airway, body image, GI
  41. Nodules:
    Palpable deformity

    May be benign or malignant

    Major sign of thyroid cancer is a hard, painless, nodule on an enlarged gland

    Ultrasound, CT scan, thyroid scan, MRI Fine Needle Aspiration (FNA)
  42. Thyroiditis
    Inflammation of thyroid

    Can be viral, bacterial, fungal, or autoimmune

    Can lead to hypothyroidism (Hashimoto’s)

    Usually Thyroid hormones are elevated but then may become depressed

    TSH low then elevated

    Treatment depends on cause and manifestations
  43. Hyperthyroidism
    Thyrotoxicosis – s/s resulting from excessive circulating T4, T3 or both

    More common in women

    Highest frequency is 20-40 years of age

    Most common form is Graves disease (autoimmune disorder)

    Pts loose blink reflex, they can damage eyes

    It occurs because of fluid buid up behind the eye an pushes the eye forward

    A pt is diagnosed with hyperthyroidism, ( the condition oriiginating in the thyroid)

    Increased T4 And decreased TSH
  44. Thyrotoxic crisis (thyroid storm)
    Manifestation are heightened (severe tachycardia, heart failure, shock, fever, restlessness, seizures, delirium, coma, N-V-D)

    Life threatening emergency

    Etiology? (stress, surgery, trauma, infection)

    Treatment aimed at reducing circulating hormones, manifestations and decreasing effects of metabolic rate
  45. Hyperthyroidism Collaborative Care
    Drug therapy:

    • Antithyroid Drugs
    • *Iodine
    • *B-Adrenergic Blockers
    • *Sedatives
    • *Tylenol
    • *Insulin

    Radioactive Iodine Therapy

    Surgical Therapy
  46. Hyperthyroidism Nutritional Therapy
    Foods – high in calorie, protein, carbohydrates,


    Possible anti-diarrheal meds

    Weigh daily, I/O

    Why high in everything: because they are loosing weight and they are burning off everything

    Limit exercise, like walking
  47. Hyperthyroidism Nursing Care
    Care related to manifestations… What can a nurse do to ease….??? Ease: no big meals before bed, limit noises, no caffiene, music, get in a good sleep pattern

    Post-op care related to thyroidectomy

    Eye Care: Tape the eyelids close at night if needed
  48. Post-op Thyroidectomy
    Airway– tracheostomy tray at bedside WHY?

    Assess for bleeding. How? Where?

    • Position– Semi Fowlers – avoid flexion of neck,
    • neutral position of neck,

    Monitor vital signs and which electrolyte imbalance?

    Diet– permitted to take fluid as soon as tolerated and soft diet the next day
  49. Discharge Care for Hypothyroidism
    Education s/s hypothyroidism and when to call doctor

    Diet– lower caloric intake

    Medication instructions

    Regular exercise

    Regular follow-up
  50. Hypothyroidism
    Insufficient circulating hormones

    One of the most common disorders in U.S.

    All infants in U.S. are screened at birth

    Primary or secondary etiology
  51. What can the nurse expect to assess in the patient with hypothyroidism?
    Weight gain, constipation, fatigue, bradycardia, slugish, will feel cold, high colesteral levels

    Cardiac: HR is slow and cant maintain cardiac output, high risk for congestive heart failure
  52. Hypothyroidism Myxedema
    Myxedema is the medical term for hypothyroidism. Myx is the Greek word for mucin, which accumulates in hypothyroidism. Edema means swelling.
  53. Myxedema is Lifethreatening and
    Hypothyroidism not treated or stressed hypothyroidism

    Exaggerated hypothyroidism s/s

    Alert to hypoglycemia and hyponatremia

    Low sodium, low blood sugar,
  54. Hypothyroidism Treatment
    Mechanical ventilation

    IV thyroid supplements

    Isotonic fluids (if hyponatremic – hypertonic solution)

    IV glucose

    Monitor for heart failure
  55. Hypothyroidism Collaborative Care
    Nutritional Therapy

    High in protein, low in calories

    High in fiber


    • Patient and Family Teaching (health teaching p.
    • 1459)

    Thyroid Hormone replacement
  56. Hypothyroidism

    What can the nurse expect to find in the TSH level?
    TSH: will be high
  57. Hyperparathyroidism
    caused by overproduction of parathyroid hormone by the parathyroid glands

    characterized by bone decalcification and the development of renal stones containing calcium

    Fractures and kidney stones , PTH is pulling calcium out of the bone
  58. Hyperparathyroidism Manifestations:

    Manifestations of hypercalcemia
  59. Hyperparathyroidism Diagnosis
    PTH levels

    Serum calcium and phosphorus levels

    Dexa Scan (dual energy x-ray absorptiometry)

    Ultrasound, ECG

    Phosphorus is low bc calcium is high
  60. Hyperparathyroidism Collaborative Care

    Conservative treatment for hypercalcemia


    Increase salt – increase Ca+ excretion

    Limit Ca+

    Medications: (depends if primary or secondary hyperthyroidism)

    Try to lower calcium, prevent injury and prevent kidney stones

    Fluids will hel flush kidney stones out

    Limit calcium: limit dairy, spinach, green veggies
  61. Hyperparathyroidism Nursing Management
    Safety due to weakness

    Ambulate as tolerated

    Physical therapy


    Observe for medication side effects

    Report any s/s of back pain

    Strategies to relieve constipation

    Ambulation will take calcium and put it back in the bone

    Might want to give phosphorous ;you want to observe for too much phosphorus
  62. Hypoparathyroidism Etiology
    Inadequate PTH (Uncommon)

    Most common cause is the result of removal with thyroid surgery
  63. Hypoparathyroidism Manifestations
    Related to low serum calcium levels
  64. Hypoparathyroidism Collaborative Care
    Treat acute tetany

    Maintain normal serum Ca+ levels

    Vit D supplement (chronic conditions)

    Adequate rest periods – monitor activity level

    Monitor EKG and cardiac complications(CHF)

    Long-term drug therapy and nutrition

    High in calcium

    Low in phosphorus (limit meats, poultry, cereals)