Chap 52: Endocrine Disorders Flashcards
(41 cards)
what is a hypophysectomy, its surgical complications?
Removal of the pituitary gland. Surgical complications include: risk for increased ICP, potential for adrenal insufficiency, risk for altered fluid and electrolyte imbalance: r/t reduced ADH, secondary adrenal insufficiency: low Na, high K, Ca, and BUN.
What are the specific nursing interventions for a patient who has undergone a hypophysectomy?
- hourly neuro checks-24hrs then q4h. (mental status, pupils, vision, strength, including reflexes)
- STRICT I & O
- No coughing, tooth brushing, sneezing, bending at waist.
- Monitor for CSF discharge from nose.
- Monitor for DI or SIADH
What does the antidiuretic hormone do? What happens with hypo ADH levels? ?S/S and Rx
ADH: controls full body water.
Hypo S/S: high Na, Excessive urine output, extreme thirst, high K, acidosis
Rx: Central: Admin of DDAVP, (monit for S-T changes)
Renal: thiazide diuretics prostaglandin inhibitors: ibuprofen, indomethacin, and salt depletion.
What causes hyperpituitarism
hypersecretion of growth hormone or adrenocorticotropic hormones. Causes may include: pituitary tumor, hypothalamus trauma, radiation, vascular lesion, disease of hypothyroidism.
what are the S/S of hyperpituitarism?
Extreme weight loss, SIADH, Cushing’s Syndrome, Emaciation, galactorrhea, prolactinoma, acromegaly (adults), and gigantism (kids).
how is hyperpituitarism diagnosed and treated?
Diagnosed: blood tests, urine tests, high dose dexamethasone, suppression test, MRI, CT, OGTT, (normal: GH levels go down after drinking glucose) visual acuity, P/E. Rx: surgery, medication to shrink tumor, decrease prolactin levels, Bromocriptine, cabergoline (dopamine agonists), radiation
What is hypopituitarism and its causes?
Hypopituitarism is the under secretion/release of pituitary hormones. Causes: tumor, disease, hypothalmic disease, trauma, surgery, destruction of pituitary gland.
what are the S/S of hypopituitarism?
S/S: weight gain, lethargy, atrophy of all endorcine glands and organs, hair loss, impotence, hypometabolism, hypoglycemia
What is the Dx and Rx for hypopituitarism?
Dx: history and physical, visual acuity fields, CT, MRI, serum levels.
Rx: Replace hormone, surgery
what are the results of hyperpituitarism:
GH: Acromegaly, Gigantism ACTH: Cushing’s Syndrome,, Prolactin: galactorrhea, prolactinoma, ADH: SIADH, TSH: hyperactive thyroid, FSH: excess of sex hormones, LH: excess of sex hormones. Oxytocin: uterine contractions
what are the results of hypopituitarism?
GH: dwarfism, ACTH: Addison’s, TSH: low thyroid, FSH: low estrogen, testosterone, LH: low progesterone, testosterone, Prolactin: low breast milk, ADH: DI,
What are the causes and S/S of hypo ADH
Causes: primary: hypothalamus, posterior pit, deficit, Secondary: tumor, infection, brain injury, brain infarct.
S/S: full body dehydration, intense thirst DI, Increased Na, Increased urinary output, increased water loss.
how is too little ADH diagnosed and treated?
Dx: Labs, I&O, weight changes, decrease in specific gravity, decrease in urine osmolarity= <200mOsm/kg UO: >4L/24hr.
Rx: Central: DDAVP, Mon: S-T changes
Renal: Thiazide diuretics, prostaglandin inhibitors: ibuprofen, indomethacin, and salt depletion.
What is the cause and S/S of too much ADH: SIADH?
Cause: malignant tumors, lung cancer, increased doses nicotine. Tricylics and thiazides may trigger SIADH.
S/S: Water retention, I > O, weight gain, dilutional hyponatremia, low serum Na.
Monitor fluids, neuro, V/S, mucous membranes
How is SIADH diagnosed and treated?
Dx: Fluid retentioin, hyponatremia (unknown cause)
Rx; Stop cause, restrict fluids, may use HYPERtonic saline solution.
Low Na: seizures
What is hypothyroidism caused by? What are the S/S
causes: usually r/t autoimmune, thyroiditis, AB that cause hashimotos.
S/S: fatigue, hair loss, brittle nails, hoarseness, husky voice, thickened skin, slowed speech and mental acuity. MYXEDEMA: severe hypothyroidism
how is hypothyroid diagnosed and treated:
Dx: CRT, US, biopsy, TSH, (after injection; large response= hypothyroidism). Too little uptake of RAI.
Increase in TSH, Decrease in T3 and T4
Rx: Thyroid replacement, emergent Rx of hypoxia, rewarming, Rx of BP/HR,
what are the s/s of Myxedema? causes
decreased temp, hr, bp, rr, tissue perfusion
causes: acute illnes/infection, surgery, anesthesia, hypothermia (pt with hashimotos)
What are the causes and s/s of HYPER thyroidism?
Causes: t/t Graves disease, toxic nodules, thyroiditis.
S/S: tachy, weight loss, sleeplessness, anxiety, heat intolerance, hair changes, diarrhea, decreased menses, weakness, exopthalmos, goiter
How is hyperthyroidism Dx and Rx
Dx: thyroid scan, thyroid antibodies, overproduction of T3, US, needle biopsy, CRT, RAI: excessive take up of RAI
Blood: decrease in TSH, increases in T3 and T4
Rx: monitor dysrhythmias, oxygen, give NS, steroids (IV and high dose), Thyroid hormone blockers: PTU, Iodine, decrease temp. AVOID ASPIRIN
What are the s/s of Thyroid Storm?
Causes: stress, surgery, trauma, MI, PE, infection
S/S: agitation, delirium, fever, tachycardia
what are increased risks for untreated hypothyroidism
increased pulm/card. risk, atherosclerosis, poor left vent function, pleural and pericardial effusions
what are surgical complications for patients who have hypothyroidism
hypotension, regulating body temp, prob. with sedation/anesthesia, post op heart failure, alt. mental status, myxedema coma.
patients who are treated with RAI need to avoid:
pregnant women, nursing mothers, children: time, distance, and space
