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Adult Health II Exam 3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Primary goal of the endocrine system

A

Maintain homeostasis

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2
Q

Hormone release

A

— response to altered cellular environment
— maintain level of another hormone or substance

Positive and negative feedback loops

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3
Q

What are endocrine disorders caused by

A

HYPER or HYPO secretion of any hormone produced or secreted by gland

Hypo = replace the hormone synthetically

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4
Q

Nursing goals

A

Control symptoms experienced by hypo or hyper situation

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5
Q

Examples of positive feedback loops

A

— birth
— clotting cascade

The body tries to create hormones = keeps adding until desired outcome (clots when getting a cut)

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6
Q

Negative feedback loop

A

Changing response to stimulus decreases synthesis and secretion of a hormone
— thermostat = temperature control
— once appropriate level is reached -> stops creating desired hormone since homeostasis is reached
— levels are sensed = added or decreased based on circulating blood levels

Thyroid = body senses low T3 + T4 -> TRH stimulates TSH to stimulate more T3 + T4
— once desired levels are reached -> stops making hormones

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7
Q

Posterior pituitary disorders

A

DI
SIADH

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8
Q

Anterior pituitary disorders

A

Gigantism
Dwarfism
Acromegaly

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9
Q

Adrenal disorders

A

Cushings and addisons disease

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10
Q

Endocrine lab values

A

CBC
BNP
Clotting cascade
— PT:
— INR:
Electrolytes:
— sodium: 135-145
— potassium: 3.5-5.2
— calcium: 8.4-10.5
— magnesium: 1.5-2.5

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11
Q

What are the anterior lobe hormones?

A

— Adrenocorticotropic hormone (ACTH)
— follicle stimulating hormone (FSH)
— growth hormone (GH)
— luteinizing hormone (LH)
— prolactin
— thyroid stimulating hormone (TSH)

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12
Q

Posterior lobe hormones

A

— antidiuretic hormone (ADH)
— oxytocin

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13
Q

What are the two types of pituitary tumors?

A

Secretory = secrete TOO much hormone
— ex: hyperthyroidism
— disrupts negative feedback loop
— creates too much T3 + T4
— over-secretion = too much hormone in the blood

Non-secretory = causes pressure
— extra pressure can cause gland to become squished
— anything in the body does not enjoy extra pressure
— only so much room

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14
Q

Posterior pituitary tumors

A

ADH deficiency excess

Anti-diuretic hormone = body holds onto extra flood

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15
Q

Anterior pituitary tumors

A

Hypopituitarism and hyperpituitarism

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16
Q

Hypopituitarism

A

Deficiency of one or more anterior pituitary hormones results in metabolism problems and sexual dysfunction
— growth hormones stimulate liver
— sex hormones

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17
Q

Hyperpituitarism

A

— hormone over-secretion
— neurological symptoms may occur
— compression of brain tissue -> increased ICP
— galactorrhea, amenorrhea, and infertility

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18
Q

Diabetes insipidus

A

↓ ADH

EXCESSIVE urination + thirst -> always thirsty
HYPERnatremia
— dehydration
— any fluid into the body -> peed out

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19
Q

SIADH

A

↑ ADH

Water is retained
HYPOnatremia
— CONFUSION; NEURO IMPAIRMENT
— fix sodium SLOWLY

Sodium Is Always Down!

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20
Q

Nursing interventions for DI and SIADH

A

— close monitor of I&O
— daily weight
— blood chemistries
— electrolytes
— monitor neurological status

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21
Q

Gigantism

A

TOO MUCH growth hormone
— rare
— height and girth are affected
— grow very large
— cause = pituitary gland tumor
— remove tumor will fix excessive growth

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22
Q

Manifestations of gigantism

A

— headache
— vision problems
— nausea
— excessive sweating
— weakness
— insomnia
— delayed puberty
— irregular menstrual period

Tumor = putting pressure on pituitary gland

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23
Q

Dwarfism

A

Too little growth hormone

— supplemental growth hormone can be given = handled well

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24
Q

Acromegaly

A

Pituitary adenmoa
— hyper secretions happen AFTER puberty
— gradual changes

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25
Q

Manifestations of acromegaly

A

— enlarged tongue, lips, nose, hands, feet, and facial bone growth
— skeletal changes are PERMANENT
— organ enlargement

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26
Q

Dx and medical tx of pituitary tumors

A

— visual acuity and visual field tests = visual acuity can be affected
— CT and MRI
— lab -> pituitary hormones
— also look at thyroid gland labs
— measurement and target organ hormones

Tx:
— surgery
— remove/destroy tumor
— replacement hormones are required after destruction
Medications:
— bromociptine
— octreotide

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27
Q

What is a total hypophysectomy? What are the complications?

A

Scope through the nose
— poke through back of the nasal cavity into the brain
— transphynoidal approach

Swelling = diabetes insipidus
Risk for CSF leakage
— LOOK FOR CLEAR FLUID FROM NOSE

Visual disturbances
Post-op meningitis
Pneumocephalus = air in intracranial cavity
SIADH

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28
Q

Pre-op teaching

A

— AVOID ACTIONS THAT INCREASE INTRACRANIAL PRESSURE
Do not:
— cough
— sneeze
— blow nose
— sucking through straw
— bending over or straining during urination/defecation

TEACHING:
— deep breathing exercises
— dressing and packing in nose
— nurse will check visual acuity often
— need for accurate I&O = early signs for DI or SIADH
— head of bed AT LEAST 30 DEGREES FOR 2 WEEKS = reduce increased intracranial pressure

29
Q

Postoperative care

A

— neuro checks = visual acuity and visual fields
— accurate I&O
— incision/packing = keep DRY

30
Q

Complications for this procedure

A

— DI
— SIADH
— meningitis -> CSF leakage (clear drainage)
— CSF on pillow case -> disperses in halo pattern
— make sure to get sample of clear fluid coming from nose to identify type of fluid
— monitor for visual disturbances
— continuous post nasal drip
— swallowing more frequently = CSF leaking to back of throat

31
Q

Discharge instructions

A

Remember = hole has been poked through nasal cavity into the brain
— avoid increasing intracranial pressure

Report to surgeon:
— hunger
— thirst
— body swelling
— mood swings
— increased urine output (DI)
— weight lost
— continuous post nasal drip
— excessive swallowing = CSF leakage
— pain with bending neck = meningitis
— vision loss = damage to optic chia sim

Only use nasal medications/rinses as prescribed
Keep follow up appt 1 wk after d/c

32
Q

Function of aldosterone

A

Regulates blood volume
Sodium reabsorption and potassium excretion into renal tubules

Water follows sodium
Gets rid of potassium and reabsorbs sodium

33
Q

Function of cortisol

A

Stress hormone
— increased BG by inhibits insulin secretion promoting gluconeogenesis (metabolism is driven by glucose)
— increases breakdown of proteins and lipids = gluconeogenesis
— suppresses inflammatory and immune response
— increases sensitivity of vascular smooth muscle to norepinephrine and angiotensin II = vasoconstriction
— increases breakdown of bony matrix
— promotes bronchodilation (fight or flight response)

34
Q

Addison’s disease

A

Hypofunction of adrenal gland
— decrease ACTH and acdrenocortical steroids from adrenal cortex

Cause:
— autoimmune
— stopping corticosteroids abruptly (2-4 wk)
— taper corticosteroids to avoid

35
Q

CM of Addison’s disease

A

— hyperpigmentation
— fatigue
— weakness
— anorexia
— weight loss unexplained
— confusion/emotion liability
— going back and fourth between happy and sad
— hypoglycemia
— blood volume depletion

HYPERKALEMIA
— watch for cardiac arrhythmias
— put pt on tele
— tall peaked t waves -> vtach

HYPONATREMIA

36
Q

Acute adrenal crisis

A

Sudden loss of cortisol and aldosterone
— LIFE THREATENING
— typically after surgery, trauma, severe infection

CM:
— vomiting
— abd pain -> shunting of blood from GI tract
— low glucose
— low sodium
— HIGH POTASSIUM
— severe hypotension -> lack of aldosterone
— hypovolemic shock -> dehydration; not enough circulating volume

37
Q

Dx process

A

Early morning plasma cortisol provocation tests
— injection of ACTH admin blood draw 60 min later to measure cortisol
— performed to differentiate from secondary adrenal insufficiency
Secondary cause = distant; pituitary tumor affecting ACTH secretion
Primary = greater increase in plasma ACTH and lower than normal cortisol concentration
— fasting BG, electrolytes, BUN
— GLUCSE, SODIUM AND POTASSIUM

38
Q

Medical interventions

A

— restore circulation blood volume and prevent shock
— replace hormones -> hydrocortisone
— REPLACE FLUIDS -> LR
— restore volume!!
— tx hyponatremia and hyperkalemia = dialysis may be needed
— tx hypoglycemia
— admin fluids and monitor I&O
— monitor VS
— vasopressin’s for HYPOTENSION
— determine cause

39
Q

Nursing interventions

A

— monitor VS q 1-4 hr
— assess dysrhythmia or postural hypotension
— daily wt
— promote fluid balance
— monitor fluid deficit
— acute I&O
— monitor lab = BUN, creatinine, sodium, potassium
— give cortisol and aldosterone replacement therapy
— loop diuretics may be given but be careful with low circulating volume

Addisons= deficient of salt, sugar + steroid
Hyponatremia, hypoglycemia = not having cortisol and aldosterone

40
Q

Cushing’s syndome

A

Adrenal gland: adrenocortical EXCESS
— pheochromocytoma tumor 85%

CM:
— muscle wasting
— weakness
— fragile skin
— MOON FACE
— BUFFALO HUMP
— acne
— enlarged trunk
— small arms and legs
— MOST OF THE BODY IS IN THE TRUNK
— virilization = male sex hormones; dark facial hair, balding on head, loss of libido,
— LOW VOICE IS PERMANENT

RETENTION OF SODIUM AND WATER = HTN AND HF
— HYPERglycemia
— excess fluid volume
— EXACT OPPOSITE OF ADDISONS

41
Q

Dx of Cushing’s

A

— 3 tests: 2 must be abnormal for dx
— serum cortisol = blood level of cortisol
— urinary cortisol = 24 hr collection; proteins excreted vary for different people
— low dose dexamethasone suppression test

42
Q

Medical management

A

Surgery:
— if cause of pituitary tumor or primary adrenal hypertrophy
— adrenal insufficiency 12-48 hr post op
— support with HYDROCORTISONE
— since we are removing source of steroid = nothing to produce steroid we must give supplment at normal levels

Drug therapy:
— surgery not an option = not stable enough
** mitotane used to suppress ACTH if tumor cannot be removed

43
Q

Nursing interventions

A

— decrease risk for injury
— decrease risk for infection
— prep pt for surgery
— encourage rest and activity
— promote skin integrity
— improve body image
— improve coping
— monitor for potential complications

44
Q

ADRENAL TUMOR: PRIMARY aldosteronism

A

Caused by functioning tumor excessive production of aldosterone

CM:
— profound decline in POTASSIUM and hydrogen ions -> ALKALOSIS with increased bicarbonate
— HTN IS UNIVERSAL SIGN
— muscle weakness
— cramping
— fatigue
— excessive urine volume
— polyuria
— losing lots of fluid in the urine
— excessive thirst

45
Q

Medical management and nursing

A

Surgical removal of adrenal tumor
— tx HTN with spironolactone
— monitor potassium and creatinine for 4-6 wk while on drug therapy
— spironolactone -> hypokalemia

Nursing:
— post op care
— monitor surgical site for infections/bleeding
— assist with social services or rehab if needed
— make sure medications are received upon d/c

46
Q

Function of the thyroid

A

Control cellular metabolic activity
— influences every major organ system

47
Q

Function of parathyroid

A

Regulate calcium and phosphorus metabolism
— parathyroid glands are super small compared to the thyroid gland itself
— calcium and phos levels are always opposite

48
Q

Thyroiditis

A

Inflammation, fibrosis, lymphotis infiltration

Symptoms: neck pain, swelling, dysphagia

Three types:
— acute = infection
— subacute = granulomatous
— chronic = hashimoto’s (most common)

Surgery only needed when drug therapy is not successful

49
Q

Hyperthyroidism

A

Thyrotoxcois
Excessive output of thyroid hormones

Graves’ disease = most common
Excess secretion of T3 + T4

Other types:
— formation of nodues from iodine deficiency
— viral infection of thyroid gland
— excessive pituitary secretion of TSH (secondary hyperthyroidism)

50
Q

CM of hyperthyroidism

A

— nervous all the time
— excessive sweating
— poor heat tolerance = hot flashes
— cannot sit still
— high HR 120-140 at rest
— flushed (red) skin
— tremors
— high appetite but still losing weight
— weakness
— amenorrhea

Exophthalmos = bulging eyes -> permanent change
— thyroid enlargement
— bruit over thyroid arteries

51
Q

Lab and dx of hyperthyroidism

A

TSH will be low
T3 + T4 is high

Negative feedback loop = thyroid is producing more T3 + T4

Radioactive iodine update
— measure rate of iodine uptake by thyroid
— hyper = exhibit high uptake
— hypo = low iodine uptake

Fine-needle aspirate biopsy tissue sample to detect cancer

Thyroid scan
— radionuclide injected and test determines “hot” areas of increased activity and “cold” areas of decreased activity (cancer)
— entire body scan to assess for metastasis

52
Q

Thyroid storm

A

EMERGENT
— worsening of normal hyperthyroid s/s
— fast forward x4
— extremely high HR at rest
— develop HF, circulatory collapse, HIGH FEVER
— RARE

53
Q

Thyroid storm management

A

Fatal if not quickly recognized
— anti thyroid mediations
— plasmapheresis or dialysis to remove excessive T3 + T4 (methanazole)
— ablation or removal of gland
— cardiac monitor for dysrhythmias
— oxygen to tx dyspnea and possible HF
— beta blockers to slow sympathetic activity
— acetaminophen to decrease fever
— POTENTIAL SEIZURE ACTIVITY

54
Q

Nursing interventions for thyroid storm

A

SPECIAL ATTENTION TO FEVER AND HR
— monitor VS
— provide calm and quiet environment
— maintain cool room and reduce stimulation
— heat intolerance
— provide eye care -> dry eyes
— elevate HOB at night
— increased risk for seizures
— corticosteroids to reduce inflammation
— hypermetabolic state -> INCREASE CALORIES
— encourage 6 meals per day
— need for anti thyroid medications
— follow up with HCP
— provide support groups
— tx photophobia with dark glasses

55
Q

Medical management

A

Ablation/removal
— radioactive iodine therapy -> most common tx
— surgical removal of thyroid
— total thyroidectomy/ablation = will need lifelong thyroid hormone replacement

56
Q

Radioactive iodine therapy

A

Ablative dose of I-131 admin
— causes acute release of thyroid hormone as it is destroyed
— observe for thyroid storm

Fever >101.3 and HR >130 AFFECTS ORGANS
— abd pain
— diarrhea
— edema
— chest pain
— dyspnea
— delirium
— psychosis

Management:
— cooling blanket
— hydrocortisone
— methimazole impedes formation of thyroid hormone

57
Q

Precautions for hospitalized I-131 thyroid therapy patients

A

— wear gloves and shoe covers
— dosimetry badge = shows how much radiation exposed to
— minimize time spent w pt
— remain at least 3 ft away
— cluster care
— contaminated linen must be collected -> laundered separately
— pt must stay in room at all times
— pt must use disposable utensils
— no minors or pregnant visitors allowed
— radiation safety must clear the room before another patient gets admitted to the room

58
Q

Nursing post-op thyroidectomy

A

Observe for:
— hemorrhage
— resp distress
— ABCs
— hypocalcemia and tetany (parathyroid)
— laryngeal nerve damage
— thyroid storm

Admin hormone replacement
— Levothyroxine

59
Q

Hypothyroidism

A

Low levels of thyroid hormones
Autoimmune (hoshimoto’s), thyroid surgery, iodine deficiency, tumors, drugs

CM:
— fatigue
— c/o cold
— cold intolerance
— low HR
— weight gain
— poor appetite
— constipation

HIGH TSH and LOW T3 + T4

Slow motion = complete opposite as hyperthyroid (sped up)

Medical management = Levothyroxine

60
Q

Compensatory mechanism -> enlarged thyroid

A

Goiter
— abnormal enlargement of thyroid
— hypothalamus signals release of TSH binds to thyroid cells and causes thyroid to enlarge in attempt to trigger release of T3 + T4

61
Q

Nursing management of hypothyroidism

A

— modify activity
— risk for immobility problems
— monitor physical status
— VS and mental status (foggy feelings)
— keep room warm, NO HEATING PADS
— adequate nutrition and hydration
— enhance coping mechanism
— depressive episodes
— teach about medications and seeing provider for labs

62
Q

Myxedema crisis

A

EMERGENT 60% MORTALITY RATE
— undiagnosed and untreated hypothyroidism
— tissue and organs failure due to decreased metabolism

CM:
— mucinous edema = eyes, hands, feet, all over the body
— hypothermic = low body temp
— lethargy
— stupor
— coma
— cardiovascular collapse -> shock -> death
— “super slow motion”
— depressed resp drive
— VERY SENSITIVE TO SEDATING DRUGS -> body is already in super slow motion

63
Q

Nursing interventions for myxedema

A

Infective breathing pattern:
— observe and record rate and depth of resp
— auscultate lungs
— assess for resp distress
— assess client receiving sedation for resp adequacy
— resp status is adequate to meet oxygen demands

Decreased cardiac output:
— monitor circulatory status
— signs of inadequate tissue oxygenation
— assess for cold toes and peripheral pulses
— change in mental status
— fluid status and HR
— admin oxygen and mechanical ventilation as appropriate

64
Q

Thyroid cancer

A

Surgery tx = thyroidectomy; removal of cancer tissue
— suppressive doses of thyroid hormone for 3 mo after surgery
— genetic component

65
Q

Hyper parathyroidism

A

EXCESSIVE SECRETION OF PTH
— increased calcium in blood
— calcium in blood stream
— renal calculi = kidney stones

CM:
— skeletal pain
— HTN
— fatigue
— muscle weakness
— constipation
— dysrhythmias
— peptic ulcers and pancreatitis

Dx: elevated calcium, X-ray to look at bones, scans

Medical management:
— diuretics
— fluids
— mobility
— diet restriction -> calcium rich foods
— MEDS: phosphates, calcitonin
— surgery to remove parathyroid glands

66
Q

Nursing pre-op to remove parathyroid glands

A

Calcium must be stabilized
— full CBC

Teaching:
— limit coughing
— deep breathing exercises
— neck support
— monitor airway

67
Q

Post-op

A

Resp distress
— close to airway

Hypocalcemia crisis can occur
— tetany
— seizures
— trousseu’s sign -> occurs when BP cuff is on (wrist flops over)

Laryngeal nerve damage can occur

68
Q

Hypoparathyroidism

A

Decrease PTH secretion
— INCREASE phosphate and DECREASE calcium

Give supplemental vitamin D and calcium
— quiet environment
— free of bright lights to decrease neurological stimuli

Adult Health II Exam 3 (4 decks)

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