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PNC 104 lecture > Chapter 39: nursing care of patients with disorders of the endocrine system > Flashcards

Chapter 39: nursing care of patients with disorders of the endocrine system Flashcards

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1
Q

endocrine disorders: too much or too little hormone activity

A
  • production/secretion
  • tissue sensitivity

may be primary or secondary disorder

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2
Q

diabetes insipitus (DI)

A
  • too little antidiuretic hormone l eads to increased urine output and syndrome of inappropriate ADH (SIADH)
  • too much ADH: decreased urine output
    DI=”dry inside”
    SIADH = “soaked inside”
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3
Q

pathophysiology of DI

A
  • insufficient ADH
  • kidneys do not reabsorb water
  • diurese 3-15 liters per day
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4
Q

causes of diabetes insipidus

A
  • pituitary tumor
  • head trauma
  • surgery
  • drugs
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5
Q

signs and symptoms of DI

A
  • polyuria
  • polydipsia
  • nocturia
  • dilute urine
  • dehydration
  • hypovolemic shock
  • decreased LOC
  • death
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6
Q

diagnostic tests for DI

A
  • urine specific gravity <1.005
  • plasma osmolality increased
  • ct scan or MRI for cause
  • water deprivation test
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7
Q

therapeutic interventions for DI

A
  • hypotonic IV fluids
  • hypophysectomy if tumor
  • IV or SQ vasopressin
  • DDAVP (synthetic vasopressin)
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8
Q

nursing dianosis for DI

A
  • “deficient fluid volume related to failure of regulatory mechanisms”
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9
Q

expected outcome for a patient with DI as their nurse

A
  • patients fluid balance maintained as evidenced by urine specific gravity between 1.005 and 1.03, skin turgor WNL, stable daily weight
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10
Q

pathophysiology of SIADH

A
  • too much ADH
  • water retention
  • hyponatremia
  • decreased serum osmolality
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11
Q

causes of SIADH

A
  • nervous system disorders
  • cancer
  • pulmonary diseases
  • medications that stimulate ADH release
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12
Q

signs and symptoms of SIADH

A
  • weight gain without edema
  • dilutional hyponatremia <135 milliequivalents per liter
  • serum osmolality <275 milliosmoles per kg
  • concentrated urine >1.03
  • muscle cramps and weakness
  • brain swelling, seizures, death
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13
Q

diagnostic tests for SIADH

A
  • serum/urine sodium
  • serum/urine osmolality
  • ct scan or MRI for underlying cause
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14
Q

therapeutic interventions for SIADH

A
  • eliminate cause
  • surgical removal of tumor
  • fluid restriction
  • hypertonic saline IV
  • furosemide (Lasix)
  • conivaptan (vaprisol)
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15
Q

nursing diagnoses for SIADH

A
  • “excess fluid volume related to compromised regulatory mechanism”
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16
Q

expected patient outcome

A
  • patients fluid balance maintained as evidenced by weight, intake and output, serum sodium within normal limits
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17
Q

pathophysiology of growth hormone deficiency

A
  • deficient growth hormone in childhood
  • growth not affected in adults
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18
Q

causes of growth hormone deficiency

A
  • pituitary tumor
  • heredity
  • psychosocial
  • malnutrition
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19
Q

signs and symptoms of growth hormone deficiency

A
  • grow only to 3-4 feet (5th percentile)
  • slowed sexual maturation
  • may have cognitive disabilities
  • other symptoms depend on other pituitary hormones involved
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20
Q

signs and symptoms of growth hormone deficiency in adults

A
  • fatigue, weakness
  • excess body fat
  • hypercholesterolemia
  • decreased muscle and bone mass
  • sexual dysfunction
  • risk for cardiovascular disease
  • risk for cerebrovascular disease
  • decreased quality of life
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21
Q

diagnostic tests for growth hormone deficiency

A
  • gh level
  • gh response to induced hypoglycemia
  • MRI for tumor
  • x rays
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22
Q

therapeutic interventions for growth hormone deficiency

A
  • synthetic GH administered SQ or IM: somatrophin (humatrope)
  • surgery if tumor
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23
Q

nursing diagnosis for growth hormone deficiency

A

“ineffective health management related to knowledge deficit”

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24
Q

expected patient outcomes with growth hormone deficiency

A
  • patient will have necessary knowledge to manage self care as evidenced by statement and demonstration of self care activities
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25
pathophysiology of acromegaly
- excess gh in adults - bones grow in width, not length - organs and connective tissues enlarge
26
causes of acromegaly
- pituitary hyperplasias - pituitary tumor - hypothalamic dysfunction
27
signs and symptoms of acromegaly
- change in shoe or ring size - nose, jaw, brow enlarge - teeth may be displaced - difficulty speaking and swallowing - sleep apnea - headaches, visual changes - diabetes mellitus - arthritis - sexual dysfunction
28
diagnosis for acromegaly is determined by
- gh level - gh response to oral glucose - bone x rays - ct scans or MRI
29
therapeutic interventions for acromegaly
- treat cause - hypophysectomy - medications to block GH
30
hypophysectomy
lifelong thyroid hormone (TH), steroid, sex hormone replacement - removal of the pituitary gland - minimally invasive endoscopic surgery - baseline neurological assessment
31
preoperative care teaching for hypophysectomy
- teach to avoid actions that increase pressure on surgical site: ex coughing, sneezing, straining - teach deep breathing exercises, incentive spirometry
32
postoperative care for hypophysectomy
- neurological assessment - urine for specific gravity (risk for DI) - nasal packing and mustache dressing - no coughing, sneezing, blowing, straining, bending - report cerebrospinal fluid drainage - hormone replacement therapy w/ target hormones
33
patient education for a hypophysectomy
- blow nose gently - take stool softeners and antitussives as needed - take care w/ brushing teeth - take hormones as prescribed - call if fever, drainage, frequent urination, thirst
34
thyroid hormone imbalances
hypothyroidism hyperthyroidism
35
pathophysiology of hypothyroidism
- TH deficiency - metabolic rate reduced - primary = not enough TH - secondary = not enough thyroid stimulating hormone (TSH)
36
cases of hypothyroidism
- congenital - inflammatory - iodine deficiency - thyroidectomy - autoimmune (Hashimoto thyroiditis)
37
signs and symptoms of hypothyroidism
- fatigue - bradycardia - constipation - mental dullness - cold intolerance - hypoventilation - dry skin and hair - weight gain - heart failure - hyperlipidemia - myxedema (swelling and thickening of skin, rare due to long untreated hypothyroidism where body cannot maintain homeostatis/multi organ system failure)
38
complications of hypothyroidism
- myxedema coma
39
signs of myxedema coma
- hypothermia - decreased vital signs and level of consciousness - respiratory failure - death
40
diagnostic tests for hypothyroidism
- t3 and t4 - TSH high in primary - TSH low in secondary - serum cholesterol and triglycerides
41
therapeutic interventions
- levothyroxine
42
levothyroxine (synthroid)
- hormone - maintain 0.1 to 0.2mg per day
43
therapeutic interventions for myxedema coma
- hormone - monitor vital signs - warming blanket - mechanical ventilation - IV fluids - IV levothyroxine (Synthroid)
44
nursing diagnoses for hypothyroidism
- activity intolerance - risk for impaired skin integrity - imbalanced nutrition
45
pathophysiology of hyperthyroidism
- increased metabolic rate - increased beta receptors - primary: too much TH - secondary: to much TSH
46
causes of hyperthyroidism
- autoimmune (Graves disease) - multinodular goiter - toxic adenoma - thyroiditis - pituitary tumor (secondary) - synthroid overdose
47
signs and symptoms of hyperthyroidism
- hypermetabolic state - heat intolerance - increased appetite - weight loss - frequent stools - nervousness - tachycardia, palpitations - tremor - heart failure - warm, smooth skin - exophthalmos (Graves disease) - "bulging eyes"
48
signs and symptoms of hyperthyroidism in elderly
- heart failure - atrial fibrillation - fatigue - apathy - depression
49
complications of hyperthyroidism
- thyrotoxic crisis (thyroid storm)
50
thyrotoxic crisis
- tachycardia, hypertension - fever, dehydration - coma - death
51
diagnostic tests for hyperthyroidism
- elevated t3 and t4 - TSH low in primary - TSH high in secondary - TRH stimulation test - thyroid stimulating immunoglobulin - CT scan or MRI if tumor suspected
52
therapeutic interventions for hyperthyroidism
- methimazole (tapazole) - beta blockers - radioactive iodine (131i or RAI) - thyroidectomy
53
therapeutic interventions for thyrotoxic crisis
- IV fluids - cooling blanket - beta blockers - acetaminophen (avoid aspirin***) for fever - oxygen
54
nursing diagnoses for hyperthyroidism
- hyperthermia - diarrhea - imbalanced nutrition - disturbed sleep pattern - anxiety - risk for injury
55
nursing care of the patient receiving radioactive iodine in hospital
- limit time spent w/ patient - glove and gown - avoid if pregnant - take precautions w/ urine, emesis, body fluids - double flush toilet - call radiation safety officer for emesis or incontinence
56
nursing care of the patient receiving radioactive iodine at home
- avoid close contact for a week - sleep alone - wash hands carefully after urinating - avoid oral contact - drink fluids - avoid pregnancy for at least a year
57
pathophysiolgy of goiters
- enlarged thyroid gland - elevated TSH - hyperplasia (increase in number of tissues in organ)
58
causes of goiters
- low TH - iodine deficiency - virus - genetic - goitrogens (compounds that can interfere w/ the thyroid's ability to produce hormones)
59
signs and symptoms of goiter
- enlarged thyroid - ypothyroid or hyperthyroid, or euthyroid - dysphagia - difficulty breathing
60
euthyroid
normal thyroid function
61
diagnostic tests for goiter
- thyroid scan - TSH, t3, t4
62
therapeutic interventions for goiter
- treat cause - avoid goitrogens: you can limit exposure by eating vegetables that are a variety of colors and including iodine-containing foods like seafood and shellfish. cruciferous vegetables to be avoided (broccoli, cabbage, cauliflower, etc) - treat hypothyroidism or hyperthyroidism - thyroidectomy if size causing symptoms
63
nursing care for goiter
- monitor breathing (stridor) - swallowing evaluation - dietary consultation
64
tumor of the thyroid gland
- usually benign - more common in women
65
causes of cancer of the thyroid gland
- hyperplasia - radiation - genetics
66
signs and symptoms of the thyroid gland
- hard painless nodule - dysphagia - dyspnea if obstruction - TH usually normal
67
diagnostic tests for cancer of the thyroid gland
- thyroid scan shows "cold spot" - biopsy
68
therapeutic interventions for cancer of the thyroid gland
- radioactive iodine - chemotherapy - thyroidectomy (partial or total)
69
preoperative nursing care for thyroidectomy
- monitor breathing and swallowing - assess nutrition status - monitor vital signs - administer iodine or antithyroid drugs to achieve euthyroid state
70
teach postoperative care of thyroidectomy
- gentle range of motion - support neck during position changes - incentive spirometer
71
postoperative nursing diagnoses for thyroidectomy
- ineffective airway clearance - risk for acute injury (tetany, thyrotoxic crisis) - acute pain - ineffective health management-
72
complications of thyroidectomy
- thyrotoxic crisis - tetany
73
parathyroid hormone
- hypoparathyroidism - hyperparathyroidism
74
pathophysiology of hypoparathyroidism
- decrease in parathyroid hormone (PTH) - calcium stays in bones - hypocalcemia - hyperphosphatemia
75
causes of hyparathyroidism
- heredity - accidental removal of parathyroids during thyroidectomy
76
signs and symptoms of tetany
- neuromuscular irritability - numbness and tingling of fingers and perioral area - muscle spasms - cardiac arrhythmias
77
hypoparathyroidism signs and symptoms
- positive chvostek sign - positive trousseau sign
78
79
diagnostic tests for hypoparathyroidism
- PTH low - serum calcium low - positive chvostek sign - positive trousseau sign
80
acute therapeutic interventios for hypoparathyroidism
- IV calcium gluconate
81
long term therapeutic interventions for hypoparathyroidism
- oral calcium with vitamin D
82
nursing diagnosis for hypoparathyroidism
- risk for injury related to hypocalcemia and tetany
83
pathophysiology of hyperparathyroidism
- overactivity - increased pth - hypercalcemia - hypophosphatemia
84
causes of hyperparathyroidism
- parathyroid hyperplasia - benign parathyroid tumor - heredity
85
signs and symptoms of hyperparathyroidism
- fatigue - depression - confusion - nausea and vomiting - kidney stones - joint pain - pathological fractures - arrhythmias - coma - cardiac arrest
86
diagnostic tests for hyperparathyroidism
- serum calcium elevated - 24 hour urine for calcium - phosphate decreased - pth elevated - x rays for bone density
87
therapeutic interventions for hyperparathyroidism
- oral or IV fluids to diluate calcium - furosemide (lasix) - cinacalcet (sensipar) - calcitonin, alendronate - estrogen therapy (women) - parathyroidectomy
88
nursing diagnosis for hyperparathyroidism
- risk for injury (fracture, complications of hypercalcemia)
89
pheochromocytoma
- adrenal disorder - tumor of adrenal medulla - secretes epinephrine and norepinephrine - usually benign - hereditary or cause unknown
90
signs and symptoms of pheochromocytoma: fight or flight
- hypertension - tachycardia - palpitations - tremor - diaphoresis - anxiety - headache - vision changes - risk for stroke - risk for organ damage
91
diagnostic tests for pheochromocytoma
- 24 hour urine for metanephrines and VMA ---> no caffeine or medications before test - CT scan or MRI to find tumor
92
therapeutic interventions for pheochromocytoma
- calcium channel blockers - alpha blockers - beta blockers - adrenalectomy
93
hyposecretion in adrenal cortex hormone imbalance
addison disease
94
hypersecretion in adrenal cortex hormone imbalance
cushing syndrome
95
pathophysiology of addison disease
- deficient cortisol. and/or aldosterone - and/or androgens
96
causes of addison disease
- autoimmune - AIDS - cancer - pituitary or hypothalamus problem **abrupt discontinuance of long term steroids
97
signs and symptoms of addison disease
- hypotension - sodium loss - potassium retention - hypoglycemia - weakness - fatigue - bronze skin - nausea and vomiting
98
diagnostic tests for Addison disease
- serum and urine cortisol level - blood glucose - electrolytes - blood urea nitrogen and hematrocrit levels - adrenocorticotropic hormone (ACTH) stimulation test
99
complications of Addison disease: adrenal crisis
- profound dehydration - hypotension - hypoglycemia - shock - coma - death
100
therapeutic interventions for Addison disease
- glucocorticoids and mineralocorticoids daily for life - double or triple in times of stress - high sodium diet
101
nursing diagnoses for Addison disease
- risk for deficient fluid volume - ineffective health management
102
crisis prevention
never abruptly discontinue long term steroids!
103
pathophysiology of cushing syndrome
- excess adrenal cortex hormones - cortisol - aldosterone - androgens
104
causes of cushing syndrome
- hypersecretion of ACTH - hypersecretion of cortisol - prolonged use of exogenous glucocorticoids
105
physical appearance signs and symptoms of cushing syndrome
- thinning hair - red cheeks - fat pads - moon face - easy bruising - striae - pendulous abdomen - thin extremities - slow wound healing - osteoporosis/pathologic fractures
106
signs and symptoms of cushing syndrome
- salt and water retention - hypokalemia - thin, fragile string - acne - facial hair in women - amenorrhea
107
diagnostic tests for cushing syndrome
- based on appearance - plasma and urine cortisol - ACTH - dexamethasone suppression test
108
therapeutic interventions for cushing syndrome
- surgery if tumor - reduce dose of steroid - change schedule of administration - symptom control - diabetes treatment - low sodium, high potassium diet
109
nursing diagnoses for cushing syndrome
- excess fluid volume - risk for impaired skin integrity - risk for infection - risk for unstable blood glucose - disturbed body image
110
preoperative care for adrenalectomy
- monitor electrolytes, glucose - preoperative teaching
111
postoperative care for adrenalectomy
- monitor for adrenal crisis - lifelong hormone replacement
112
when you have a nodule do not....
palpate/touch

PNC 104 lecture (3 decks)

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