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MedSurg - 341 > MedSurg 3 - Endocrine: Thyroid, Parathyroid & Pancreas (Chap 64) > Flashcards

MedSurg 3 - Endocrine: Thyroid, Parathyroid & Pancreas (Chap 64) Flashcards

1
Q

Thyroid Gland (anatomy)

A
  • Located in the anterior neck, directly below the circoid cartilage
  • Has 2 Lobes joined by ISTHMUS, the thin strip of tissue in front of the trachea
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2
Q

Thyroid Gland (Physiology)

A

Composed of Follicular Cells and Parafollicular cells:

** FOLLICULAR CELLS produce the thyroid hormones:
== Thyroxine (T4)
== Triiodothyronine (T3)

** PARAFOLLICULAR CELLS produce
== Thyrocalcitonin (TCT, or Calcitonin, which helps regulate serum calcium levels)

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3
Q

T4 to T3 conversion

A

Control of Metabolism occurs through T3 and T4. Both increases metabolism. T3 and T4 differ in nature but functions are the same.
== Circulating T3 and T4 are bound to plasma proteins. These free hormones moves into a cell then there T4 is converted to T3, which is the most active thyroid hormone.

** The conversion of T4 to T3 is impaired by stress, starvation, dyes, beta blockers, amiodorone, corticosteroids, and propyl-thiouracil (PTU). Cold temperatures increases the conversion.

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4
Q

T3 and T4 production

A

Dietary intake of Protein and Iodine is needed to produce thyroid hormones.

    • Iodine is absorbed in the intestinal tract as iodide. The thyroid gland withdraws iodide from the blood and concentrates it. After the iodide is in the thyroid, it combines with the amino acid Tyrosine to form T4 and T3.
    • These hormones bind to thyroglobulin and are stored in the follicular cells of the thyroid gland. With stimulation, T4 and T3 break off from thyroglobulin and are released into the blood.
    • They enter many cells, bind to the nucleus, and turn on genes important to metabolism.
    • Presence of T4 and T3 directly regulates Basal Metabolic Rate (BMR).
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5
Q

Thyrocalcitonin

- aka TCT or Calcitonin

A

Calcium and Phosphorus balance occurs through the action of Calcitonin (also called Thyrocalcitonin or TCT).
- Calcitonin is produced from the parafollicular cell of the thyroid gland.

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6
Q

Calcitonin

- function

A
  • Calcitonin lowers serum Calcium and serum Phosphorus levels by reducing bone resorption (breakdown).
  • Its actions are OPPOSITE of Parathyroid hormone.

** The serum calcium level determines calcitonin secretion.
If serum calcium is low, calcitonin secretion is decreased.
If serum calcium is high, calcitonin secretion is increased.

Therefore, the calcitonin secretion is DIRECTLY related to Calcium level.

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7
Q

PARATHYROID GLANDS (Anatomy)

A

Consist of 4 small glands located close to or within the back surface of the thyroid gland.

The chief cells of the parathyroid glands secrete Parathyroid Hormone (PTH).

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8
Q 
Parathyroid Hormone (PTH)
- function
A
  • Parathyroid Hormone regulates Calcium and Phosphorus Metabolism by acting on bones, the kidneys, and the Gi tract.
  • Bone is the main storage site of Calcium.
  • PTH and bone:
    ==== PTH increases bone resorption (bone release calcium into the blood from bone storage site), thus increasing serum calcium level.
  • PTH and Kidney:
    ==== PTH activates Vitamin D, which increases the absorption of calcium and phosphorus from the intestines.
    ==== In the kidney tubules, PTH allows calcium to be reabsorbed and put back into the blood.
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9
Q 
Parathyroid Hormone (PTH)
- production
A
  • Serum Calcium level determines PTH secretion.
    If Calcium level is high, PTH secretion is decreased.
    If Calcium level is low, PTH secretion is increased.
  • Serum Phosphorus level also determines PTH secretion.
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10
Q

PTH and Calcitonin

A

PTH and Calcitonin works together to maintain normal calcium levels in the blood and ECF.

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11
Q

Pancreas - Anatomy

A
  • Lies behind the stomach- has exocrine and endocrine functions
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12
Q

Pancreas-Function

A

Exocrine Function:== secretion of digestive enzymes through ducts that empty into the duodenumEndocrine Function:== the cells in the Islets of Langerhans perform the pancreatic endocrine functions. (abt 1 million islets are found throughout the pancreas)== the islets have 3 distinct cell types:* ALPHA Cells, secrete Glucagon* BETA Cells, secrete Insulin*** DELTA Cells, secrete Somatostatin

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13
Q

Glucagon and Insulin

A

Glucagon and Insulin affect the metabolism of:– Carbohydrate– Protein– Fat

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14
Q

Somatostatin

A

Somatostatin is secreted NOT only in the pancreas but also in the intestinal tract and the brain.Functions:== Inhibits the release of glucagon and insulin from the pancreas.== Inhibits the release of gastrin, secretin, and other GI peptides

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15
Q

Glucagon

A

Glucagon is a hormone that increases blood glucose levels. It is triggered by decreased blood glucose levels.

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16
Q

Insulin

A

– Insulin promotes the movement and storage of carbohydrate (CHO), protein, and fat.– It lowers blood glucose levels by enhancing glucose movement across cell membranes and into the cells of many tissues. – Basal levels of insulin are continuously secreted to control metabolism– Insulin secretion increases in response to an increase in blood glucose levels.

17
Q

Hyperthyroidism

A

Excessive thyroid hormone is secreted from the thyroid gland.

== THYROTOXICOSIS, the term for the clinical signs and symptoms regardless of the cause

18
Q

Endocrine Problem Assessment

A
  • Obtain patient history
  • Changes in:
    • Nutritional-metabolic
    • Activity-exercise
    • Elimination
    • Sleep-rest
    • Sexuality-reproductive
  • These data are combined with physical, psychosocial, and laboratory findings.
    • Ask past/present drugs (hydrocortisone,levothyroxine, oral contraceptives, anti-HTN meds, hormone drugs
19
Q

Thyroid Problems

A

more common in women

20
Q

Endocrine Problem Assessment

- Nutrition History

A
    • History of Nausea, Vomiting & Abdominal Pain
    • Increase or Decrease in food and fluid intake (Ex. DM causes thirst; Adrenal hypofunction triggers salt craving)
    • Rapid Changes in Weight without diet changes
    • Dietary Deficiency (esp protein and iodide containing foods)
    • Teach pt who does not eat saltwater fish to use iodized salt in food prep.
21
Q

Endocrine Problem Assessment

- Family History & Genetic Risk

A
  • Family history
    • obesity,
    • DM,
    • infertility,
    • thyroid disorder
22
Q

Endocrine Problem Assessment

- Current health Problem

A
  • Focus on patient’s reason seeking health care:
    • when did it start?
    • Have this treated in the past?
    • How current problem affects ADL?
  • Energy Level Changes:
    • ability to perform ADL?
    • sleeping longer? fatigue? generalized weakness?
23
Q

Endocrine Problem Assessment

- Current health Problem – con’t

A
  • Elimination Changes:
    • Amount and frequency of urination
    • Nocturia (wakes up to urinate)
    • Dysuria (pain when urinating)
  • Sexual & reproductive Function:
    • Change in menstrual cycle (flow, duration, frequency, excessive cramping, change in regularity)
    • For men, experiencing impotence?
    • Change in libido
    • Fertility problem
24
Q

Endocrine Problem Assessment

- Current health Problem – con’t

A
  • Physical Appearance Changes:
    • Hair Texture and Distribution
    • Facial Contours and Eye Protrusion
    • Voice Quality
    • Body proportions
    • Secondary sexual characteristics (for men – shaving less or for women – increase in facial hair) ** These changes may be associated with pituitary, thyroid, parathyroid, or adrenal dysfunction.
25
Q

Endocrine Problem Assessment

- Physical Assessment

A

An endocrine problem can change physical features bec of its effect on growth and development, regulation of sex hormones, fluid and electrolyte balance, and the body’s use of nutrients.

  • Use Head to toe approach. Observe general appearance.
  • Assess height, weight, fat distribution, and muscle mass
  • Facial Structure abnormalities
    • prominent forehead or jaw
    • round or puffy eyes
    • dull or flat expression
    • Exophthalmos (protruding eyeballs and retracted upper lids)
26
Q

Endocrine Problem Assessment

- Physical Assessment (con’t)

A
  • Check lower half of neck for invisible enlargement of thyroid gland (normally, thyroid tissue cannot be observed)
  • The isthmus maybe noticeable when patient swallows
  • Skin color
    • look for areas of pigment loss (hypopigmentation) or hyperpigmentation
  • Fungal skin infection, slow wound healing, brusing, and petechiae are often seen on adrenal hyperfunction.
  • Skin infections, foot ulcers, and slow wound healing are common among patients with DM.
27
Q

Endocrine Problem Assessment

- Physical Assessment (con’t)

A
  • Vitiligo (patchy areas of pigment loss with increased pigmentation of the edges) is seen with primary hypofunction of the adrenal glands and is caused by autoimmune destruction of melanocytes in the skin.
  • Finger nails for malformation, thickness, brittleness – these suggest thyroid gland problem.
  • Edema
    • fluid and electrolyte imbalance
  • Striae (reddish-purple stretch marks) on the breasts or abdomen are often seen with adrenocortical excess.
28
Q

Endocrine Problem Assessment

- Physical Assessment (con’t)

A
  • Hair Distribution
    • Hirsutism (excessive growth of body hair, esp on face, chest, linea alba of the abdomen of women)
    • Excessive hair loss
    • Changes in hair texture
  • Genitalia (in relation to patient’s age)
    • Size of scrotum and penis
    • size of labia and clitoris
    • Distribution & quantity of pubic hair are often affected in hypogonadism
29
Q

Thyroid Gland Assessment

- Palpation

A

Palpate to check for size, symmetry, general shape, presence of nodules or other irregularities

    • Palpate by standing behind or in front of the patient (posterior approach maybe easier)
    • Having the patient swallow sips of water helps palpate the thyroid gland
    • Ask patient to sit and lower the chin
    • Place your thumb at the back of patient’s neck with the fingers curved around to the front of the neck on either side of the trachea.
    • Ask the patient to swallow and then locate the isthmus of the thyroid as you feel it rising
30
Q

Thyroid Gland Assessment

- Palpation

A
    • To examine the thyroid,
    • Turn patient’s head to the right
    • Displace the thyroid cartilage to the right with the fingers of your left hand
  • -

MedSurg - 341 (7 decks)

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