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Endocrine Flashcards

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1
Q

what is hypopituitarism

A

under activity of the pituitary gland

most often caused by a benign pituitary tumor

other causes:
brain surgery
head trauma
infections of the brain
radiation
stroke
subarachnoid hemorrhage
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2
Q

hypopituitarism manifestations

A

hypogonadism

  • failure of the gonads
  • testes in males
  • ovaries in females

amenorrhea
infertility
breast and uterine atrophy
vaginal dryness

loss of libido
sexual dysfunction
loss of armpit and pubic hair

hypothyroidism
hypoadrenism
SIADH
diltuional hyponatremia

decreased GH

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3
Q

hypopituitarism diagnostic studies

A

history and physical exam
neuro-opthalmaological exam

X-ray of pituitary fossa and radio immunoassays of anterior pituiary hormones

CT scan or MRI
lab test:
serum ACTH
cortisol
estradiol
FSH
LH
TSH, T4
testosterone
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4
Q

hypopituitarism pharmacological care

A

hormone replacement therapy
steroid therapy

endocrine problems often amnifest differently in an older adult than a younger person

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5
Q

what is hyperpituitarism

A

anterior pituitary gland secretes too much GH

acromegaly occurs when growth plates are closed

gigantism occurs when growth plactes are still open

acromegaly: enlargement of hands, feet, face

overproductions of ACTH leads adrenal gland to overproduce cortison –> Cushings disease

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6
Q

hyperpituitarism manifestations

A

excess prolactin

  • headache
  • visual disturbances
  • growth failure
  • pubertal arrest with menstrual abnomralities in girl

excess ACTH
- weight gain with concurrent growth failure

excess GH causes:
- mild to moderate obestiy
-gigantism
- macrocephaly: overly large head
- cardiovascular disease
- coarse facila features
- tumors
0 endocrinopathies

physical changes of acromegaly are irreversible

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7
Q

hyperpituitarism diagnostic studies

A

hx and physical exam
CT
plasma homrone levels

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8
Q

hyperpituitarism care

A

microsurgery to remove tumor
- common treatment surgery for patient with pituitary tumors but can cause infertility

pituitary radiation
gamma knife radiation

growth hormone suppressant
- bromocriptine or octreotide

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9
Q

hyperpituitarism management

A

restrict soidum intake
assess signs for diabetes inspidus

treatment usually produces hypopituitiarism

lifelong hormone replacement therapy with regular check ups

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10
Q

what is diabetes insipidus

A

occurs when posterior pituitary fland makes TOO LITTLE antidiuretic hormone
- causing failure of tubular reabsorption of water in kidney

you being to pee a lot and often feel thirsty
- it fails to reabsorb so it just comes out

central DI is the most common form
- usually caused by damage to hypothalamus or pituitary gland

nephrogenic DI: defect in tubular reabsorption of water back into bloodstream

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11
Q

diabetes inspisidus manifestations

A 
polydipsia
polyuria
nocturia
dehydration
conspitation
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12
Q

diabetes inspidus diagnostic studies

A

water deprivation tests
- measures body’s inability to concentrate urine

osmotic stimulation
CT scan or MRI

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13
Q

diabetes inspidius pharmacological care

A 
pharmacological interventions:
desmopressin and vasopressin
chlorpropamide
carbamazepine
diuretics
surgical removal of a tumor

nephrogenic DI: if cause is due to lithium then discontinue or damage may become permanent

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14
Q

diabetes insipidius management

A

monitor findings of dehydration
measure urine and specific gravity

administer meds
monitor fluids and give IV fluids

intake and output
weigh daily

monitor and care for clients with increased intracranial pressure

health promotion:
- teach how record intake and output
- about prescribed medications and side effects
- avoid fluids with diuretic effects
(caffeinated beverages)
- check urine specific gravity
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15
Q

what is SIADH

A

too much ADH with water intoxification and a decrease in sodium concentration

you have too much water in your body

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16
Q

SIADH manifestations

A

changes in level of consciousness and mental status
tachycardia
hyponatremia
weight gain
urinary specific gravity will be greater than 1.030
hypertension

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17
Q

SIADH pharmacological care

A

diuretics:
furosemide
bumetanide

careful administration of hyperteonic 3% NaCl Iv solution
- too rapid of an infusion rate can cause permanent neurologic defects

osmotic diuretics - mannitol

vasopressor receptor antagonists

  • conivaptan
  • tolvaptan
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18
Q

SIADH management

A

monitor intake and output
sxs for fluid overload and hyponatremia

weigh daily
electrolytes and enruologic strokes

restrict fluid intake as ordered
sodium replacement therapy

seizure precautions

SIADH can be chronic and clients will need to learn to manage the condition at home
- should weigh themselves daily and adhere to prescribed fluid restriction typically 800-1000mL/ day

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19
Q

what is hypothyroidism

A

thyroid gland does not make enough thyroid hormones

myxedema crisis or come = loss of brain function
- happens as a result of severe, lnogstanding hypothyroidism

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20
Q

hypothyroidism causes

A

hashimotos thyroditis
atrophic thyroiditis

lithium
amiodarone
interferon alpha
genetics
radiation treatments to the neck or brain
radioactive iodine
surgical removal of all or part of thyroid gland

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21
Q

hypothyroidism manifestations

A 
early symptoms;
constipation
increased sensitivity to cold
fatigue
heavy menstrual period
joint and muscle pain
pale dry skin
depression
brittle hair and nails
weight gain

if left untreated:
decrease in taste and smell
hoarseness
puffy face
puffy hands and feet
slow speech
thickening of skin
thinning of eyebrows
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22
Q

hypothyroidism pharmacological care

A

most accurate and sensitive test to measure thyroid function is TSH level
- often first test done to evaluate thyroid function and monitor effectivenss of homrone replacement therapy

pharamacologic interventions:
levothyroixine
liothyronine

myxedema crisis/coma management will include:

  • mechanical ventilation
  • treatment of associated infection
  • correct hypothermia
  • IV thyroid hormone replacement therapy
  • conserve energy
  • avoid stress
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23
Q

hypothyroidism diagnostic studies

A

hx and physical exma

labs:
INCREASED:
- TSH
- cholesterol and triglycerides
- liver enzymes
- prolactin

DECREAED:

  • T3 and T4
  • serum sodium
  • serum glucose

CBC anemia

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24
Q

hypothyroidism management

A

meds
signs for myxedema
restful environment
protect client from cold

levothyroxine life threatening side effects: cardiac dysrhythmias
- check with HCP to switch to a different brand

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25
what is hyperthyroidism
overactive thyroid makes too much thyroid thyroitoxic crisis (thyroid storm) rare but potentially fatal ``` causes: Graes disease too much iodine thyroditis non-cancerous growth of thyroid gland over dosage of thyroid hormone ```
26
hyperthyroidism manifestation
difficuly concentrating fatigue hyperphagia - excessive or extreme hunger weight loss diarrhea goiter heat intolerance exopthalamos tachycardia palpitation restlessness thing, brittle hair pliable "plummers" nails irregular menstrual priods insomnia
27
hyperthyroidism diagnostic studies
hx and physical exam goiter hyperactive reflexes ``` labs: increased T3 and T4 increased radioactive iodine uptake presence of thyroid nodules decreased TSH levesl ```
28
hyperthyroidism pharmacological care
``` pharamcologic: radioactivie iodin methimazole antithyroid (propylthiouracil) beta adrenergic blocking agents (propanolol) ``` surgical intervention: thyroidectomy exopthalamos: classic finding of graves disease - cornea can become dry, irritated and devleop ulcerations
29
hyperthyroidism management
vital Hr quiet restful, cool environment diet therapy, extra fluids diet high in calories, protein and carbs stress avoidance energy conservation
30
what is hypoparathyroidism
parathyroid hormone produces too little parathyroid hormone results in hypocalcemia most common cause: injury to parathyroid glands during thyroid surgery other causes; low serum amgnesium levels metabolic alkalosis
31
hypoparathyroidism manifestations
neuromuscular irritability muscle weakness or cramping personality changes numbness of fingers and caropedal spams tetany - muscular spasms seizures laryngospasm dry, scaly skin and hair loss abdominal cramping
32
hypoparathyroidism diagnostic studies
hx and physical exma positive chvosteks facial signs - cheek positive trousseaus signs - BP cuff ECG shows abdnormal heart rhythms ``` labs: decreased: - calcium - magnesium - PTH levels - urine ``` increased: phosphate
33
hypoparathyroidism pharmacological care
calcium replacement therapy Vit D preparations calcium rich, low phosphorus diet
34
hypoparathyroidism management
monitor signs of tetany place an oral airway, suction equipment and tracheostomy tray at clients bedisde seizure precautions monitor vitals have calcium gluconate available if signs of low calcium reduce phosphrous intake, no: - fish - eggs - cheese - cereals
35
what is hyperparathyroidism
parathyroid secretes too much parathyroid hormone | results in hypercalcemia
36
primary hyperparathyroidism
enlargement of one or more of the parathyroid glands no known causes
37
secondary hyperparathyroidism
body produces extra parathyroid hormones because calcium levels are too low
38
tertiary hyperparathyroidism
parathyroid continues to produce too much even though calcium levels are back to normal occurs with kidney disease
39
hyperparathyroidism manifestations
constipation nausea and vomiting anorexia bone pain deminieralization deformities kdieny stones blurred vision muscle weakness and fatigue depression
40
hyparathyroidism diagnostic studies
hx and physical exam increase calcium decrease phosphorus x-rays and DEXA revel bone demineralization CT scan MRI ultrasound of the neck
41
hyparathyroidism pharmacological care
drink more fluids avoid thiazide type diuretics surgical interventions to remove parathyroid glands
42
hyperparathyroidism management
postoperatively, observe signs of hypocalcemia monitor laryngeal damage monitor renal involvement increase their fluid intake to dilue calcium levels in blood and urine consume a diet rich in calcium and vitamin D
43
what is addisons disease
decreased production of cortisol and aldosterone symptoms of addison disease do not become apparent until around 90% of the adrenal cortex is destroyed
44
addison diseae manifestation
``` fatigue weakness dehydrartion low BP decreased resistance to stress ``` hyperpigmentation and alopecia ``` weight loss pathological fractures depression lethargy emotional lability ```
45
addison crisis clinical manifestation
``` nausea and vomiting abdominal pain fever extreme weakness severe hypoglycemia, hyperkalemia and dehydration ``` BP falls which can lead to shock and coma death if not treated
46
addison diseasee diagnostic studies
hx and physical exam labs: ACTH stimulation test - low cortisol level hypoglycemia electrolytes - low sodium and high potassium 24 hour urine output
47
addison disease pharmacgologial care
hydrocortison fludrocortison acetate diet high in protein, carbs and sodium low in potassium
48
addisonian crisis interventions
emergency management IV hydrocortisone carefully monitor IV infusion of 0.9% NaCl or D5W/NaCl Iv glucose or glucagon insulin with dextrose in normal saline potassium-binding and excreting resin vitals
49
addison disease management
weigh daily monitor electrolytes preserve clients energy by assisting with ADLs collaborate with dietician measure intake and output monitor blood sugar levels health promotion; lifelong hormone replacement therapy avoid or manage stress add more sodium to diet avoid extra potassium have quick acting sugar increasing fluid intake to 2,000-3,000 ml/day * * clients with addison disease will require lifelong hormone therapy with glucocorticoids and mineral corticoids - taking these with an extended periods of time can lead to serous complication and side effects
50
what is cushings syndrome
occurs when adrenal galnd secrete too much cortisol overproduction can be due to: 1. cushings disease 2. tumors of the pituitary gland 3. tumors in other organs and glands in the body that produce cortisol or ACTH
51
cushings syndrome manifestation
upper body obesity with thin arms or legs buffalo hump moon face acne striae (purple marks) on abdomen, thighs, breasts easy bruising backache bone pain or tenderness excess hair growth on face, neck, chest, abdomen, thighs for women for men, impotent or have decreased libido personality changes fatigue
52
cushings syndrome diagnostic studies
hx and physical exam ``` labs: 3 standard tests - 24 hour urinary free cortisol - late night salivary cortisol - overnight dexmethasone suppression test ``` labs will include an increase in cortisol, sodium, and glucose a decrease in potassium if underlying cause for cushings syndrome is pituitary adenoma surgical removal of pituitary gland will most likely be required
53
cushings syndrome pharmacological care
if cause is by corticosteroid use, slowly decrease medication under medical supervision if cause is by pituitary tumor or tumor that release ACTH, the tumor will be removed (transphenoidal surgery) if cause if due to an adrenal tumor or other tumors, the tumor will be removed - if tumor cannot be removed then medicatioin will be needed to block the release of cortisol pharmacological interventions: - agents that inhibit steroidogenesis: - metyrapone - mitotane - ketocoriazole diet including sufficient calcium and vitamin D
54
cushings syndrome management
monitor signs of hypokalemia and vit health promotion: need for lifelong treatment medication management need to increase activities, slowly and gradually body changes from disease may reverse but can take months to years to see changes monitor signs of depression or difficulty coping
55
what is pheochromocytoma
benign tumor of the adrenal medulla causes the adrenal medulla to secrete too much epinephrine and norepinephrine
56
pheochromocytoma manifestations
``` abdominal pain chet pain irritabiltiy nervousness severe stress response unusual skin pallor palpitations with tachycardia severe headache diaphoresis weight loss tremors hypertension difficulty coping ```
57
pheochromocytoma diagnostic studies
adrenal biopsy abdominal CT scan MRI MIBG scintiscan - tet that uses injected radioactive material and special scanner to locate or confirm pheochromocytoma labs: -24 hour urine collection - increase catecholamines serum glucose levels a client with hypertension, especially if it severe and reffractory to medication should be evaluated
58
pheochromocytoma pharmacological care
pharamcological intervention: pre-operatively: - antihypertensives - antidysrhythmic beta adrenergic blocking: propanolol and nadolol tyrosin inhibitors alpha adrenergic blocking agents: post-operatively - phenoxybenzamine
59
pheochromocytoma management
vitals meds keep phentolamine available for treatment of a hypertensive crisis DO NOT palpate the abdomen if bilateral adrenalectomy is performed, lifelong steroid therapy will be required
60
what is diabetes mellitus
pancreas produced too little insulin or cells to stop responding to insuline results in hyperglycemia type 1: thought to be genetic autoimmune response type 2: lifestyle factors
61
diabetes mellitus manifestations
hyperglycemia fatigue weight loss with type 1 only blurred vision possible vaginal infections slow wound healing polydipsia polyuria polyphagia
62
diabetes mellitus diagnostic exams
hx and physical labs; fasting blood sugar oral glucose tolerance test glycosylated hemoglobin test
63
diabetes mellitus pharmacological care
eat foods high in nutrition and low in fat and calories exercise to lower glucose levels
64
meds for type 1 diabetes mellitus
insulin hypertensive meds: - ACE inhibitors - ARBs cholesterol-lowering drugs - statins Pramlinitide
65
meds for type 2 diabetes mellitus
oral hypoglycemic meds - sulfonylureas - meglitinides - biguanides - thiazolidinediones metofmrin is the first line therapy for most clients
66
diabetes mellitus management
teach about med interactions with insulin and oral hypoglycemic meds teach client to maintain: balanced diet eat carbohydrate shake with protein before strenuous exercise self monitor blood glucose carry rapid absorbing carbs self monitor blood glucose perform appropriate foot care wear a med alert bracelet receive regular eye exams
67
meds that can increase blood glucose levels
- glucocorticoids - thiazide diuretics - thyroid agents - oral contraceptive - estrogen
68
meds that can decrease blood glucose levels
``` aspirin alcohol oral anticoagulants beta blockers tricyclic antidepressants tetracyclines MAOIs ```
69
proper foot care for diabetes mellitus
wash feet daily with soap and water do not soak feet pat to dry, not rub attend to corn, calluses but never cut on your own lotion, but not in between toes cotton socks and can change if seaty no heating pads, electric blankets on feet do not wear circular garters
70
hypoglycemia manifestations
diaphoresis cold, clammy skin anxiety tremors headache slurred speech client will be weak nausea and experience mental confusion
71
hypoglycemia management
``` if client is conscious and able to swallow; give at least 15 g of carbs - 4 oz of orange juice - regular soda - 2 tbsp of raisins - 4-5 saltine cracklers - 4 tsp of sugar - 1 tbsp of honey or corn syrup ``` check blood sugar 15 min after intervention if still less than 70, then repeat the intervention
72
retinopathy
cause blindness
73
nephropathy
progressive decrease in kidney function eventually leading to end stage renal disease
74
neuropathy
deterioration of nervous system
75
what is diabetic ketoacidosis
acute complication of DM severe insulin deficiency and has sudden onset typically caused by undiagnose diabetes or the inadequacy of prescribed therapy
76
DKA manifestations
blood sugar greater than 300 pH less than 7.35 fruity sweet odor in breath Kussmauls rrespirations flushed appearance dry skin metabolic acidosis thirst polyuria anorexia vomiting can lead to shock and coma if not treted properly
77
DKA care
correct fluid depletion - IV fluids correct electrolyte depletion - potassium correct metbolic acidosis - by lowering the blood sugar with short acting insulin - given continuous infusion when blood sugar levels fall below 250, IV should be changed to dextrose containing solution - 0.9% NaCl - 5% dextrose
78
what is hyperosmolar hyperglycemic state (HHS)
complication of diabetes mellitus type 2 untreated high blood sugar levels in high serum osmolality without ketoacidosis has a gradual onset
79
HHS manifestations
severe hyperglycemia usually greater than 600 pH less than 7.4 negative ketones prfound dehydration altered level of consciousness usually precipitated by physcial stress, such as an infection in non-diabetics, HHS can occur due to tube feedings without supplemental water or because of a too rapid rate of infusion for parenteral nutrition
80
HHS pharmacological care
aggressive IV rehydration with normal saline or LR lowering the blood sugar with short-acting insulin (regular) when blood sugar levels falls below 250 --> IV solution should be changed to dextrose containing solution - 0.9% NaCl - 55 dextrose

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