Endocrine

Question 0

what’s the difference between endocrine and exocrine glands?

Answer 0

endo secretions pass directly into bloodstream

exo secretion by a gland through a duct

Question 1

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

Answer 1

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

Question 2

compare positive and negative feedback loops

Answer 2

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

Question 3

pituitary gland

Answer 3

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

Question 4

Thyroid

Answer 4

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

Question 5

parathyoid

Answer 5

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

Question 6

pancreas

Answer 6

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

Question 7

adrenal glands

Answer 7

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

Question 8

medulla hormones

Answer 8

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

Question 9

adrenal cortex

Answer 9

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

Question 10

pituitary assessment

Answer 10

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

Question 11

thyroid assessment

Answer 11

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

Question 12

adrenal insufficiency

Answer 12

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

Question 13

pheochromocytoma

Answer 13

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

Question 14

underlying abnormality of diabetes insipidus and two classifications

Answer 14

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

Question 15

signs of symptoms of diabetes inspidus

Answer 15

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

Question 16

lab results of diabetes insipidus

Answer 16

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

Question 17

how will synthetic adh affect diabetes insipidus?

Answer 17

central - lower urine output

nephrogenic - unchanged because the renal system isn’t responding to adh regardless

Question 18

medical mangement of diabetes insipidus

Answer 18

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

Question 19

SIADH

Answer 19

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

Question 20

signs and symptoms of SIADH

Answer 20

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

Question 21

lab results for SIADH

Answer 21

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

Question 22

management of SIADH

Answer 22

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

Question 23

what are the main characteristics of dka?

Answer 23

hyperglycemia
dehydration
ketoacidosis
metabolic acidosis
electrolyte imbalance

lack of appropriate insulin administration
undiagnosed diabetes

Question 24

dka pathophysiology

Answer 24

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

Question 25

signs and symptoms of dka

Answer 25

dehydration tachycardia hypotension cns

Question 26

lab results in dka

Answer 26

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

Question 27

management of dka

Answer 27

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

Question 28

how is hyperosmolar hyperglycemic state different than dka?

Answer 28

``` 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 ```

Question 29

management of hyperosmolar hyperglycemic state

Answer 29

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

Question 30

hypothyroidism

Answer 30

bradycardia, cold intolerance, facial edema, lethargy, decreassed metabolic rate, weight gain, constipation, dry skin, hypothermia, hypoventilation, hyponatrmia, hyproreflexia, hypotension, can go to myxedema coma which them requires supportive treatment

Question 31

hyperthyroidism

Answer 31

tremor, weight loss, heat intolerance, arrythmias, diaphroesis, hypoglycemia, hypermetabolic rate caused by adenomas, familial, goiters

Question 32

thyroid storm/crisis

Answer 32

hyperthermia (41), dehydration, hypertension, tachyarrythmias, pulmonary edema, agitation' tremors, coma caused by trauma, infection treatment - beta blockers, ventilation, coolers, calcium channel blockers, lower bp, sedation, decrease circulating thyroid hormone hydrocortisone, nutritional support, extreme cases require surgical ablation

Question 33

Adrenal crisis

Answer 33

``` shock drop in extracellular fluid volume hyponatremia and hyperkalemia excess of stress hormones without matching cortisol levels profound weakness, dehydration hypoglycemia ```

Question 34

what are the five s of adrenal crisis management

Answer 34

``` steroids - hydrocortisone salt replacement sugar replacement support of physiologic functioning search for underlying cause ```