What is disease result in a thyroid dysfunction?
- Hyperthyroidism
- Hypothyroidism
- Goiter (Enlarged thyroid)
What are the signs/symptoms of hypothyroidism?
- Weight gain
- Hair loss
- Constipation
- Fatigue
- Depression
- Dry, coarse skin
- Bradycardia
- Muscle cramps
Thyroid hormone Replacement - Medication Type
Levothyroxine sodium (Synthroid)
Levothyroxine sodium - Action and Use
Natural/synthetic thyroid drug that mimics the effects thyroid hormone
Levothyroxine sodium - Side/Adverse Effects
- Headaches
- Tremors
- Isomnia
- Fever
- Diarrhea
- Weight loss
- Sweating
- Hypertension
- Tachycardia
- Heart palpation
- Increased appetite
Levothyroxine sodium - Precaution
Increases heart sensitivity - increases EP/NE
Levothyroxine sodium - Nursing consideration
- Vitals (HR,BP,RR)
- Renal function
- Assess for thyroid disease
- ECG - Check Cardiac function
- TSH lab values
- Provide education on use of medication - side effects and may take several weeks for therapeutic effect to show
What are the signs and symptoms of hyperthyroidism?
- Bulging eyes
- Facial flushing
- Hypertension
- Tachycardia
- Weight loss
- Muscle wasting
- Diarrhea
- Edema
- Finger clubbing
Anti-thyroid (Thyroid Antagonist)- Medication Type
Methimazole (tapazole)
Methimazole - Actions and Uses
- Reduces secretion of thyroid hormone
- Inhibits T4 conversion into T3 - decreases signs and symptoms of hyperthyroidism
Methimazole -Side/Adverse Effects
- Abdominal cramps
- Palpitations
- Hypertension
- Granulocytopenia (too many white blood cells)
Methimazole - Nursing considerations
- Assess TSH
- Monitor liver function
- Vitals (HR, BP)
- Assess nutrition
- Monitor pregnant women on medication - can cause congenital defects
Mineralocorticoids is produced where and what is the primary mineralcorticoid?
- Produced in Adrenal Cortex
- Aldosterone is primary mineralcorticoid
- Controlled by the renin-angiotensin-aldosterone system (RAAS)
- Excretes Potassium
Mineralocorticoids - Medication type and function
Fludrocortisone
- Replacement therapy for adrenal insufficiency
- Encourages excretion of potassium and conserves sodium and water - Acts like ALDOSTERONE
Fludrocortisone - Side/Adverse Affects
- Hypertension
- Edema
- CHF
- Cardiac enlargement
- Abdominal pain
- Headaches
- Fever
- Heart burn
- Hypokalemia
- Blurred vision
- Depression
Fludrocortisone - Precaution
Should not take when sick or have a viral infection can be fatal
Fludrocortisone - Nursing consideration
- Assess K+, Na+ and Mg+ levels
- Vitals (HR,BP)
- ECG
- Assess for Edema
- Assess mood/behaviour
- Assess kidney function
Glucocorticoids - Function
- Produced in Adrenal Cortex and secretes Cortisol
- Increases blood glucose
- Suppresses immune/inflammatory function
- Increases sensitivity to smooth muscle
Symptoms of low cortisol?
- Hypoglycemia
- Fatigue
- Weakness
- Nausea
- Vomiting
- Hypotension
What is Addison’s Disease?
- Auto-immune disorder
- Destruction of both adrenal glands
- Decrease in aldosterone and cortisol
- Kidneys unable to retain sodium and water so affects are dehydration
- Can lead to shock
Glucocorticoids - Anti-Inflammatory - Function
Suppress acute inflammatory responses by preventing cell-medicated immune reaction
Anti-Inflammatory Glucocorticoid- Medication types (3)
1) Short-Acting - hydro-cortisone (cream) and NSAID’s
2) Intermediate - Prednisone
2) Long-Acting - Dexamethesone
Hydro-cortisone - Action and Use
- Available in creams/ointment solution and used on the superficial skin layer
- Reduces inflammation
Hydro-cortisone - Side/Adverse effects
- Edema
- Burning
- Itching
- Irritation
- Dryness
- Folliculitis (hair follicles become inflamed)
Hydro-cortisone - Nursing considerations
- Educate on use of cream - do not over apply
- Assess risk of infection
- Assess for signs of Cushing’s Disease - not advisable to use if client has disease
- Skin assessment
- Assess for Edema
Prednisone - Action and Use
- Intermediate acting anti-inflammatory
- Taken orally
- Prevents inflammation response
- Suppress immune system
Treatment: Arthritis, Allergies and Immune disorders
Prednisone - Precaution
Avoid using if you have a fungal infection as can have an adverse effect
Prednisone - Side/Adverse effects
- Mood changes
- Blurred vision
- Bradycardia
- Urinary retention
- Dizziness
- Headaches
- Edema
- Weight gain
Prednisone - Nursing considerations
- Vitals (HR, BP)
- Assess Edema
- Assess mood/behavior
- Skin Assessment
- Increase fluid
- Assess input vs output
- LFT
- Kidney function
- WBC count
- Educate on use of medication - do not take if there is a risk of infection
Dexamethasone- Action and Use
- Long-Acting anti-inflammatory
- Taken orally and once/day in the AM
- Prevent the release of substances in the body that cause inflammation ex) Bradykinin and Histamine
Treatment: Severe skin conditions, Arthritis and Allergies
Dexamethasone- Side/Adverse Effect
- Depression
- Dizziness
- Blurred vision
- Urinary retention
- Bradycardia
- Numbess
Dexamethasone- Nursing Considerations
- Vitals (HR, BP)
- Increase fluid
- Assess intake vs output
- Assess Mood/behavior
- Assess skin condition and risks of infection
Insulin - Function and Production
- Produced by the pancreas naturally (Beta-cells)
- Medication treatment of metabolic disorder Diabetes Mellitus (Type 1 and 2)
- Lowers blood glucose levels
Diabetes Mellitus Type 1 - What is it?
- Destruction of insulin Beta cells
- Little or no insulin production
- Onset is abrupt and rapid - usually in Childhood
- Insulin dependent
Diabetes Mellitus Type 2 - What is it?
- Cell receptor sites resist insulin
- Below normal or above normal insulin production
- Can occur due to obesity
- Onset is slow
- Oral or insulin administration
- Can be reversed by lifestyle changes
Long term complications from Diabetes?
- Cardiovascular disease
- Hypertension
- Stroke
- Obesity
- Kidney failure
- Vision problems
- Nerve damage
- Mood/Behaviour changes
Insulin types (4)
1) Rapid acting - Humalog
2) Short -Acting/Regular - Humulin R
3) Intermediate Acting - Humulin N
4) Long - Acting - Lantus
Rapid - Acting Insulin - Onset, Peak and Duration
- Onset = 10-15 min
- Peak = 1-2 hours
- Duration = 3-5 hours
- Used at the start of a meal
- Works over a narrow/predictable time range
Short -Acting/Regular - Onset, Peak and Duration
- Onset = 30 min
- Peak = 2-3 hours
- Duration = 6.5 hours
- Taken 30-60 min before a meal so it allows time to work
Intermediate Acting - Onset, Peak and Duration
- Onset = 1-3 hours
- Peak = 5-8 hours
- Duration = 18 hours
- Usually cloudy insulin
- Works throughout the day
Long-Acting -Onset, Peak and Duration
- Onset = 90 min
- Peak = None
- Duration = 24 hours( cloudy) and 16-24 hours (clear)
- Can be clear and cloudy
- Works throughout the day
Ways to administer insulin?
- Pen - replaceable cartilages
- Pumps - continuous under the skin - SC diffusion devices
- Syringe
Insulin - Side/Adverse effects
- Hypoglycemia
- Headache
- Sweating
- Trembling
- Anxiety
- Confusion
- Irritability
- Rapid breathing
- Tachycardia
- Weight gain
Insulin - Nursing Considerations
- Promote proper nutrition
- Promote regular moderate exercise
- Educate on insulin therapy
- Assess blood glucose levels
- Vitals (HR, BP, RR)
- Respiratory Assessment
- ECG
- Assess mood/behavior
Oral anti-diabetics - Actions and Uses
- Stimulate beta cells to produce more insulin
- Increases receptor response to insulin
- Decreases glucose production by the liver
- Effective for Type 2 and well controlled diabetes
Oral anti-diabetics - Side/Adverse Effects
- Hypoglycemia
- Weight gain
- Edema
- Dizziness
- Fatigue
- Risk of liver disease
- Diarrhea
- Gas/Bloating
Oral-anti-diabetics - Nursing Considerations
- Assess blood glucose levels
- Assess edema
- Encourage healthy diet/exercise
- Assess LFT
- Intake/output
What are some behavior management techniques to minimize symptoms of endocrine disease?
- Adapt a healthy lifestyle (Nutrition, Exercise, No Smoking)
- Schedule follow ups with health provider
- Taking blood glucose levels regularly
- Blood tests – K+, Na+, Mg+, TSH, HbA1C, LFT’s
- Education on proper use of medication
- Signs and Symptoms of hypoglycemia and hyperglycemia
