Endocrine DIsorders Flashcards by Tyece Henry

risk factors for hypothyroidism

Hashimoto Disease
Thyroidectomy
Head and neck cancer
Women > Men
Elderly

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early clinical manifestations for hypothyroidism

fatigue to somnolence,
loss of libido to amenorrhea,
apathy to mental and physical sluggishness,
nonpitting edema to pleural and pericardial effusions
hair loss, brittle nails, and dry skin are common
constipation
Paresthesia (numbness and tingling of the fingers) and nerve entrapment syndrome
hearing loss may occur

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late signs of hypothyroidism

slow speech
subdued emotional responses
apathy
absence of sweating
cold intolerance
constipation
thickening of skin (due to accumulation of mucopolysaccharides in subcutaneous tissues)
dyspnea
weight gain
thinning of hair
alopecia
deafness
On assessment, patients usually present with swelling of eyelids, pitting edema, bradycardia, hypotension, and hypothermia

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the most extreme, severe stage of hypothyroidism resulting in pt being hypothermic and unconscious

myxedema coma

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why is myxedema coma life threatening

leads to swelling of the tongue and respiratory drive is depressed

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management of hypothyroidism

hormone replacement
restoration of euthyroid state as safely and rapidly as possible

levothyroxine (synthroid)

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teaching necessary for use of levothyroxine

It may take 8 weeks to see the full effect
∙ Report signs of hyperthyroidism
∙ Tachycardia, heart palpitations,
weight loss, insomnia, anxiety ∙ Monitor T4 & T3 levels
∙ Take once a day (in the morning before breakfast) ∙ Take at the same time everyday
∙ Take on an empty stomach

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causes of hyperthyroidism

Enlarged thyroid gland
Thyroiditis
Graves’ disease
Over medication- hypothyroidism
Thyroid nodules

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clinical manifestations of hyperthyroidism

Exophthalmos
Weight loss
Tachycardia / Atrial Fibrillation
Hyperthermia
Decreased fertility
Increased peristalsis
Loss of bone minerals

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complications of hyperthyroidism

Thyrotoxicosis
Thyrotoxic crisis or thyroid storm

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what is the difference between thyrotoxicosis and thyroid storm

Thyrotoxicosis is a common endocrine condition that may be secondary to a number of underlying processes.

Thyroid storm (also known as thyroid or thyrotoxic crisis) represents the severe end of the spectrum of thyrotoxicosis and is characterized by compromised organ function

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management of hyperthyroidims

Nutritional therapy
Radioactive iodine
-Beta-adrenergic blocking agents
Surgery
Antithyroid agents

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goals for management of hyperthyroidism

Block adverse effects of thyroid hormones
Suppress hormoneover secretion
Prevent complications

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diet for pt with hyperthyroidism

high in carbs and proteins

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radio active iodine: What does it do? How long does it take to become effective or for symptoms to resolve?

destroy overactive thyroid cells
2-3 months

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Thyroidectomy: What is your role for this patient following surgery? What should you assess? How should you position your patient? What complications should you monitor for?

administer preop medications
possibly iodine
position in fowler’s position
monitor for bleeding, hematoma

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assessment of pt with thyroid disorders

History
Assessment
-Cardiovascular assessment
-Respiratory Assessment
-HEENT
-Skin, hair, and nails
Monitor vital signs

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planning for pt with thyroid disorders

Experience relief of symptoms
Maintain a euthyroid state
Maintain a positive self-image
Comply with lifelong thyroid replacement therapy
Improve nutritional status
Improve coping ability
Maintenance of normal body temperature
Absence of complications

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nursing diagnoses for hypothyroidism

Activity intolerance
Constipation
Impaired memory
Altered body temperature

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nursing diagnoses for hyperthyroidism

Altered nutrition
Ineffective coping
Altered body temperature
Discomfort

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thyroid disorders implementation for acute care

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Skin care
Vital signs, weight, IandO, edema
Cardiovascular response to hormone
Energy level
Mental alertness

education for thyroid disorders

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Encourage patient to be an active participant
Comfort
Education to patient and families
Low-calorie diet
Written instructions important
Need for lifelong therapy
Thyroid medicine in morning on empty stomach
Side effects of medication
Do not switch brands

expected outcomes for thyroid disorders

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Have relief from symptoms
Maintain euthyroid state
Avoid complications
Adhere to lifelong therapy

function of the thyroid gland

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produce T3, T4, and calcitonin (iodine needed)
gives you energy

function of parathyroid gland

produces and secretes PTH - controls calcium in blood

risk factors for hyperparathyroidism

Tumor or hyperplasia CKD

clinical manifestations of hyperparathyroidism

Symptoms of hypercalcemia -bone pain -Arrhythmias -cardiac arrest (bounding pulses) -kidney stones -muscle weakness ↓ (DTR) -Excessive urination Complications -Ventricular dysrhythmias -Hypercalcemic crisis Musculoskeletal symptoms

diagnostics for hyperparathyroidism

Labs- Serum calcium Radioimmunoassay Bone scans Ultrasound MRI

management of hyperparathyroidism

Parathyroidectomy Hydration Patient mobility Nutrition Medication Emotional support

possible medications for treatment of hyperparathyroidism

Phosphates, calcitonin, & IV or oral bisphosphonates

risk factors for hypoparathyroidism

Thyroidectomy Parathyroidectomy Radical neck dissection

clinical manifestations of hypoparathyroidism

Symptoms of hypocalcemia Anxiety Delirium ECG changes Hypotension Complications -Seizures -Tetany

management of hypoparathyroidism

Parenteral PTH Calcium Gluconate Supplements Dietary changes

function of adrenal medulla

releases catecholamine hormones epinephrine and norepinephrine

function of adrenal cortex

secretes glucocorticoids, mineralocorticoids, and androgens

primary addison's disease

Insufficiency of the adrenal cortex Corticosteroids- glucocorticoids, mineralocorticoids, and androgens

secondary addison's disease

Lack of pituitary ACTH Glucocorticoids and Androgens

life threatening addisonian crisis

∙ Profound fatigue ∙ Dehydration ∙ Renal failure ∙ Rapid respiration ∙ Hyponatremia ∙ Hypokalemia ∙ Cyanosis ∙ Fever ∙ Nausea/vomiting Think SHOCK! * Hypotension * Weak rapid pulse Treatment: Fluid resuscitation & high-dose hydrocortisone

diagnostics of addison's disease

Serum cortisol <165 nmol/L Plasma ACTH > 22.0 pml/L ↑ Potassium ↓ Chloride, sodium, glucose CT scan, MRI

management of addisonian crisis

Shock management High-dose IV hydrocortisone replacement 0.9% saline solution and 5% dextrose Vasopressors q

acute care for addison's disease

Antibiotics Correct fluid and electrolyte imbalance -Assess vital signs and neurologic status -Daily weight -Accurate I and O

teaching for admin of corticosteroids

report ss of corticosteroid deficiency carry ID and wear bracelet emergency kit how to admin IM hydrocortisone

High levels of serum cortisol Too much ACTH

cushing syndrome

common causes of cushin syndrome

Iatrogenic administration of exogenous corticosteroids ACTH-secreting pituitary adenoma Adrenal tumors Ectopic ACTH production by tumors

symptoms of excess glucocorticoids

hypertension, obesity, osteoporosis, fractures, impaired immune function, impaired wound healing, glucose intolerance, and psychosis

symptoms of excess mineralocorticoids

hypertension, hypokalemia, low birth weight, failure to thrive, hypertension, polyuria and polydipsia, and poor growth

symptoms of excess androgens

Acne. Changes in female body shape. Decrease in breast size. Increase in body hair in a male pattern, such as on the face, chin, and abdomen (called hirsutism) Lack of menstrual periods (amenorrhea) Oily skin

diagnostic studies for cushing syndrome

Urine free cortisol Salivary cortisol Dexamethasone suppression test (takes 1 mg med - returns next morning for labs) Radioimmunoassay measurement of ACTH Serum Cortisol CT Ultrasound MRI

management for cushing syndrome

adrenalectomy hydrocortisone education Risk for falls Risk for infection Promote periods of rest Skin care Dietary changes Family education

other clinical manifestations of cushings

moon face buffalo hump ecchymosis purple striae slow wound healing thin skin

Endocrine DIsorders Flashcards

(50 cards)