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How does the endocrine system differ from the central nervous system to maintain homeostasis?

endocrine is scattered and less organized, uses hormones rather than direct communication, more diffuse, more prolonged, less rapid response to change

1

what's the difference between endocrine and exocrine glands?

endo secretions pass directly into bloodstream
exo secretion by a gland through a duct

2

compare positive and negative feedback loops

positive release of a specific hormone when circulating levels of that hormone is low
negative when circulating level of hormone is high, release of more hormone is inhibited until a lower level is reached

3

pituitary gland

master gland
controls or influences all other influences all other endocrine glands in the entire body
thyroid stimulating hormone - stims the thyroid to secrete hormone
adrenocorticotropic hormone - controls amount of corticoid hormone secreted by the adrenal cortex
antidiuretic hormone - reabsorption of water, kidneys stimed to promote water balance

4

Thyroid

thyroxine (T4)
triiodothyronine T3 - used to regulate body metaboism, development of nervous system, growth and development
thyroid hormones increase sensitivity of the cvs to sns activity

5

parathyoid

smallest glands in the human body
two within i
each lobe of the thyroid
size related to amount of calcium in diet. if calcium levels low, the size of the gland increases
parathyroid hormone - helps increase calcium levels via negative feedback loops to release bone calcium into the blood stream

6

pancreas

endocrine functions for blood glucose regulation (islets of langerhans, insulin, glucagon, and somatostatin)
exocrine functions assists with digestion (digestive enzymes)

7

adrenal glands

helps body deal with stress
superior aspect of the kidney
inner medulla
outer cortex

8

medulla hormones

catecholamines (epi, norepi, dopamine) - elevates blood glucose, promotes lypolysis, elevate free fatty acids in plasma (provides alternate energy source)' increase alertness, increased metabolic rate
prepares fight or flight
sympathetic nervous system innervation

9

adrenal cortex

steroid hormone factory
glucocorticoids - cortisol - responsible for glucose homeostasis, immunosuppression, antihistamine
mineralcorticoids - aldosterone - promotes sodium reabsorption, which means water will follow so it also help in water balance

10

pituitary assessment

adh - volume deficit, overload, assessment for hydration status, mucous membranes, tissue turgor, central venous pressure, sudden changes
lab tests include adh hormone levels, and serum osmolality (increased osmolality will stimulate the release of adh, decreased osmolatilty inhibits adh

11

thyroid assessment

normal thyroid not palpable
tenderness, enlargement, nodules, hypoactivity or hyperactivity
tsh -increased tsh levels mean hypothyroidism, decreased levels mean hyperthyroidism
can be influenced by glucocorticoids, dopamine, dobutamine, amiodarone, lasix

12

adrenal insufficiency

tachycardia
hypotension
decreased cortisol levels
electrolyte abnormalities
at risk for cva
headache
diaphroresis
altered loc
hyponatremic
low urine output
dehydrated
respond poorly to fluid, vasopressors and inotropes
rapid deterioration

13

pheochromocytoma

adrenal medulla tumor
increased epi and norepi secretion
results in hypertensive crisis

14

underlying abnormality of diabetes insipidus and two classifications

a loss of action of adh on kidneys
central - absence of adh from posterior pituitary, usually manifests within 24 hours of injury, causes traumatic brain injury, brain death
nephrogenic - defective end-organ responsiveness, can be caused by drugs (lithium, aminoglycosides such as vancomycin) contrast dyes, hypokalemia
psychogenic - compulsive water drinking
hallmark characteristic - very dilute urine and lots of it

15

signs of symptoms of diabetes inspidus

large quantity of dilute urine, altered mental status, tachycardia, hypotension, low cvp, excess thirst

16

lab results of diabetes insipidus

increased serum sodium
increased serum osmolality
decreased urine osmolality
decreased urine specific gravity

17

how will synthetic adh affect diabetes insipidus?

central - lower urine output
nephrogenic - unchanged because the renal system isn't responding to adh regardless

18

medical mangement of diabetes insipidus

restore fluid volume hypotonic solutions
maintain electrolyte balance
treat underlying condition
monitor ins and outs
ddavp - strong antidiuretic action
hydrochlorothiazide - excretes sodium into urine, so decreases serum osmolality and will slow urine output via water wasting
iv vasopressin

19

SIADH

waterlogged
excessive adh release
medication, head trauma, malignant bronchiogenic oat cell carcinoma(secretes adh)
severe overhydration
disrupts electrolytes and sodium balance (dilutional hyponatremia)

20

signs and symptoms of SIADH

asymptomatic
neurological lethargy or disorientation
sodium levels 115, at risk for seizure
gastrointestinal symptoms

21

lab results for SIADH

decreased urine output
increased urine osmolality
decreased serum osmolality
serum sodium low
exclusion of dehydration

22

management of SIADH

fluid restriction
very slow correction of hyponatremia to a max of ten per day or 0.5 per hour (at risk for locked in syndrome pontenmyelinolysis, cerebral edema)
monitor for neuro status
treat underlying cause

23

what are the main characteristics of dka?

hyperglycemia
dehydration
ketoacidosis
metabolic acidosis
electrolyte imbalance

lack of appropriate insulin administration
undiagnosed diabetes

24

dka pathophysiology

an absolute or relative lack of insulin
hyperglycemia
glucose can't get into cells
dehydration - osmotic diuresis because the extra sugar leaves the blood and takes water with it
electrolyte imbalances
ketoacidosis - fat and protein stores used for energy, releases free fatty acids, ketones produced

25

signs and symptoms of dka

dehydration
tachycardia
hypotension
cns

26

lab results in dka

electrolyte imbalances (sodium and potassium decreased)
ketones present in serum and urine
ph low
bicarb low

27

management of dka

fluid resuscitation- severe cases can be up to 9 Lo f fluid, monitor electrolytes
administration of insulin - infusion to steadily normalize glucose levels, monitor blood glucose samples
monitor and replace electrolytes - consider bicarb if pH <7, insulin helps move potassium into cells also
watch for third spacing and cerebral edema

28

how is hyperosmolar hyperglycemic state different than dka?

slower onset, days to weeks,
blood glucose is higher than dka
extremely dehydrated
insulin deficiency
no acidosis
no ketones
bicarb normal to mild decrease
potentially in elderly patients in type two diabetes
no significant changes in respiratory status

29

management of hyperosmolar hyperglycemic state

rehydration - prevent fluid overload
electrolyte correction - only after urinary output established
frequent lytes and abg
iv insulin - must give fluids before insulin, once blood glucose levels starts to decrease, patient will need to receive dextrose
treat precipitating factor