Endocrine Nursing – Flashcards
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Endocrine System
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~Regulates and integrates body's metabolic activities ~Works with CNS to do so ~Hypothalamus is the "command center" ~Maintains homeostasis (overarching goal)
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Endocrine Glands
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Pituitary Thyroid Adrenal Pancreas Parathyroid
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Endocrine Disorders
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~Hyposecretion or hypersecretion of hormones ~Hyporesponsiveness of hormone receptors (Target organs dont detect hormones or receptors cant turn off release of hormones so levels rise) ~Inflammation of Glands ~Gland tumors
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Pituitary Gland
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Master gland that regulates many body functions; Located in skull beneath hypothalamus (stimulated by the hypothalamus) 2 parts: Anterior and Posterior
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Anterior Pituitary
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Secretes -TROPIC hormones that stimulate other glands
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Growth Hormone: AP
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GH; stimulates growth (bones/muscles)
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Prolactin: AP
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PRL; stimulates production of breast milk (mammary glands)
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Gonadotropic hormones: AP
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FSH = follicle stimulating hormone (ovaries) LH = leutinizing hormone (testes)
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Thyroid Stimulating Hormone
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aka TSH; stimulates synthesis and release of thyroid hormones (T3, T4)
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Posterior Pituitary
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Secretes "effector" hormones (they create an effect) ADH
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ADH: PP
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Secreted to decrease urine production during hypovolemia, pain, stress
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Oxytocin: PP
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Causes contraction of smooth muscles in the reproductive organs during childbirth and lactation
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Hyperpituitarism
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Excess production/secretion of one or more trophic hormones; Usually a result of benign tumor Symptoms caused by pressure on optic nerve causing visual changes or excess growth hormone Excess secretion in child = GIGANTISM; adults = ACROMEGALY
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Gigantism
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Growth hormone hypersecretion; begins BEFORE puberty and before closure of epiphyseal plates Abnormally tall >7ft
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Acromegaly
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Overproduction of growth hormone; Condition marked by enlarged extremities, forehead, tongue, lengthened maxilla and deepened voice
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Rx: Acromegaly
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Surgical removal OR irradiation of pituitary tumor Octreotide - suppress anterior pituitary gland (decreases GH levels) Side Effects - cholesterol gallstones develop in 25% of pts
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SIADH
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Excessive levels of ADH are produced; suppresses aldosterone Causes: malignant tumors, head injuries, pituitary surgery, use of barbiturates, anesthetics or diuretics
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SIADH (Cont.)
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Aldosterone suppression causes increased renal excretion of Na+ causing WATER TO MOVE INTO THE CELL Results: HYPONATREMIA, water intoxication (Brain Swells) S/S: headache, altered mental status, lethargy and irritability
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Rx: SIADH
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Correct underlying cause Correct hyponatremia with IV hypertonic saline Restrict fluids to <800 mL/day Demeclocycline (creates excess urine flow)
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Nursing Care: SIADH
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Monitor daily weights and fluid intake and output
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Diabetes Insipidus
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Inadequate secretion of ADH causing an abnormal INCREASE IN URINE OUTPUT Caused by brain tumors, infections, pituitary surgeries, CVA's, ARF Symptoms: polyuria and polydipsia; urine appears colorless due to the inability of the kidneys to concentrate urine
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Rx: Diabetes Insipidus
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Correct underlying cause Administer IV hypotonic fluids Increase oral fluids Replace ADH hormone Desmopressin acetate (intranasally, orally or parentally)
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Nursing Care: Diabetes Insipidus
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Observe for: changes in VS and UO, dehydration, high Na+, low urine SG and osmolality, high serum osmolality If untreated, can lead to circulatory collapse, CNS damage
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Thyroid Gland
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Located in the anterior neck; Secretes T3 and T4 which controls normal growth, development and controls metabolism and protein synthesis.
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Non-Toxic Goiter
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Occurs primarily in young females; Gland enlarges to compensate for LOW secretion of T3 and T4 Type 1 (Endemic) and Type 2 (Sporadic)
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Endemic: Non-Toxic Goiter
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Lack of dietary IODINE (leads to inadequate synthesis of TSH); "Goiter belts"
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Sporadic: Non-Toxic Goiter
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Ingestion of foods/drugs that decrease T4 production; Spinach, peanuts, lithium, iodides
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Toxic Goiter
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Usually a result of Graves disease; Can compress vessels/larynx/esophagus/trachea; antibodies mimic TSH (increase TH)
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Nursing Care: Goiter
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Monitor: stridor/respiratory distress Monitor: dysphagia Goal: T3 and T4 and TSH will be normal
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Hyperthyroidism (Graves Disease)
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Overactive thyroid that produces too much TH; usually caused by an immune system disorder known as Graves' disease Heightened SNS Increased HR, SV Glucose tolerance increases Caloric deficiencies
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Hyperthyroidism: S/S
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Fast metabolism Thin Tachycardia Hyperactive Bulging eyes (humans) Heat intolerance Anxiety DOE Weight loss Tremors Palpitations
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Eye Changes (Graves Disease)
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Enlarged thyroid gland (toxic goiter) Proptosis (forward displacement of eye) Exophthalmos (forward protrusion of the eyeball or inability of eyelids to completely cover eye)
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Treatment: Graves Disease
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**Radioactive Iodine Therapy - absorption into thyroid destroys some of cells producing T4 and T3 Surgery - Subtotal thyroidectomy Anithyroid Drugs ~Propylthiouracil ~Methimazole
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Subtotal Thyroidectomy
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Indicated when thyroid press on esophagus or trachea causing breathing or swelling problems Leaves enough of the gland in place to produce adequate amounts of TH
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Total Thyroidectomy
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Indicated to treat cancer of the thyroid; Means lifelong hormone replacement
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Thyroidectomy: Nursing Preop Care
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~Client should be in euthyroid state (thyroid levels WNL) ~Antithyroid drugs to reduce hormone levels ~Iodine prep to decrease vascularity and size of thyroid gland (decrease risk of hemorrhage) ~Teach client to support neck by placing both hands behind neck when sitting up in bed, coughing, or ambulating
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Thyroidectomy: Nursing Preop Care
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~Answer questions: allow client to verbalize concerns. Incisions is made at base of throat (concern about appearance may rise) ~Teach client that scar will eventually be only a thin line and jewelry or scarf conceal ~Teach client to expect horseness, doesn't indicate nerve damage and will diminish with time and healing
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Thyroidectomy: Nursing PostOp Care
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~Administer analgesics as ordered and monitor effectiveness ~Place client in semi-fowlers position after recovery from anesthesia ~Support head and neck with pillows ~Perform assessment and monitor for complications
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Thyroid Crisis
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Extreme state of hyperthyroidism leading to: hypermetabolism, epinephrine overproduction Causes: infx, trauma, DKA, CVA, MI (all affect metabolism) Life threatening, abrupt onset S/S: tachycardia, fever, systolic hypertension, NVD, abdominal pain, agitation, restlessness, tremors
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Treatment: Thyroid Storm
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Rapid treatment is IMPORTANT! Antithyroid meds IV propanolol (tachyarrythmias) Fever control Replaces Fluids/Lytes Relieve respiratory distress Inhibit T4 conversion by giving steroids Monitor T3 and T4 (increased)
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Hypothyroidism
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Defecit in T3 and T4; Metabolism slows down dramatically Common in females from 30-60 y.o.
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Hypothyroidism: S/S
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~Early: fatigue, sensitivity to cold, weight gain ~Accumulation of non-pitting edema ~Puffy face, enlarged tongue, voice hoarse/husky Myxedema coma is a complication
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Hypothyroidism: Causes
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~Iodine deficiency (necessary for TH synthesis) ~Thyroidectomy ~Inflammation ~Autoimmune thyroiditis (Hashimoto's Thyroiditis)
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Hashimoto's Thyroiditis
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Autoimmune disorder when antibodies destroy thyroid tissue; Thyroid becomes fibrous tissue, so TH levels DECREASE
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Myxedema
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Life-threatening complication of untreated hypothyroidism usually triggered by acute illness or trauma Rx: IV hydrocortisone and IV Levothyroxine
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Myxedema: S/S
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Severe metabolic disorders (hyponatremia, hypoglycemia, lactic acid acidosis, hypothermia) Cardiovascular collapse Coma
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Treatment: Hypothyroidism
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Focus on diagnosis, prevention of complications Replacement of deficient TH
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Labs: Hypothyroidism
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Decrease in TH, especially T4 Same diagnostic tests used for hyperthyroidism with opposite results
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Meds: Hypothyroidism
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LevoTHYROxine Sodium (T4) GOLD STANDARD LioTHYROnine sodium (T3) Liotrix (T3-T4 combo)
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Nursing Duties: Hypothyroidism Meds
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~Give 1 hr before meals or 2 hrs after ~Potential for anticoagulants and digitalis ~Monitor for S/S of coronary insuffiency: chest pain, dyspnea, tachycardia ~Monitor effects on insulin ~Take pulse report >100
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Labs: TSH
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Measures TSH and T4 Pt should avoid SHELLFISH prior to test
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Labs: T4
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Determines hypo or hyper thyroidism
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Labs: T3
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Diagnoses hyperthyroidism INDIRECTLY
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Labs: T3RU
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Indirect measure of free thyroxine
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RIA
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Measures DIRECT thyroid activity Client should not eat or drink 6-8 hours before test
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Adrenal Gland: Cortex
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Produces: mineralocorticoids (e.g. aldosterone) Glucocorticoids (e.g. cortisol) Adrenal androgens, estrogens (control male/female traits) Goal: Maintain hemostasis
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Adrenal Gland: Medulla
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Produces: Catecholemines (epinephrine and norepinephrine) Goal: Maintain hemostasis
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Cushing Syndrome
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Excess Glucocorticoids; Caused by: ~ACTH hypersecretion by a pituitary tumor ~Cortisol hypersecretion by an adrenal tumor ~Glucocorticoid therapy (long term)
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Cushing Syndrome: S/S
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Moonface Buffalo hump Thin arms and legs Emotional Instability Fatigue Poor Wound Healing Ecchymosis Purple striae on abdomen
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Cushing Syndrome: Labs
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~High serum CORTISOL (spike 1.5 hr before you awake) ~High 24 HOUR urine for cortisol ~Abnormal ACTH levels ~CT or MRI + for tumor in pituitary
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Cushing's Syndrome: Complications
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~Increased Ca+ resorption from bone (fractures) ~Increased gastric secretions, less mucous (GERD) ~Fat metabolism disorders (Lipodystrophy) ~Increased hepatic gluconeogenesis, insulin resistance (DM and poor healing)
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Cushing's Syndrome: Meds
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Inoperative pituitary or Adrenal Malignancies Mitotane (suppresses activity of adrenal cortex) Aminogluthemide (inhibits cortisol synthesis) Somatostatin analog (suppresses ACTH secretion)
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Adrenalectomy: Preop Teaching
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Removal of tumor, one gland or bilateral and lifelong hormone replacement therapy
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Adrenalectomy: Preop Nursing Care
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~Request dietary consult (diet high in vitamins and proteins) ~careful meds and surgical asepsis ~Monitor results of lab tests of lytes and glucose ~teach client to cough and perform deep breathing exercises (potential for pneumonia)
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Addison's Disease
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A hypofunction of adrenal gland that results in dysfunction/destruction of adrenal cortex; Causes chronic deficiency of cortisol, aldosterone and adrenal androgens Common in women and adults under age 60
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Addison's Disease: S/S
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Hx of recent infx, chronic steroid use or adrenal surgery Fatigue, cravings for salty foods, irritability, NVD, dehydration, decreased urine output Possible discoloration of skin, areas of vitiligo (r/t changes in melanocyte-stimulating hormone) Lab abnormals: serum and urine cortisol (LOW)
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Addisonian Crisis
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Critical deficiency in mineralocorticoids and glucocorticoids; Medical Emergency Labs: Low Na High BUN, K+, Hgb and Hct Low Plasma Cortisol level
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Treatment: Addisonian Crisis
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IV Hydrocortisone NS boluses
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Addisonian Crisis: Nursing Care
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~Focused Assessment during anticoagulant therapy, open heart surgery and trauma treatment ~Teaching to prevent is essential ~Monitor I&O's ~Monitor cardiovascular status, vital signs, pulses, monitor K+ levels ~Daily weights ~Encourage fluid intake of 3000 ml daily
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Addison's Disease: Stabilization
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Increased Na+ in diet Hydrocortisone (orally) to replace cortisol Fludrocortisone (orally) to replace mineralcorticoids
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Parathyroid
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Glands (usually 4-6) are embedded on posterior surface of lobes of thyroid gland Secrete PTH (controls calcium levels and bone formation) Acts by increasing renal excretion of phosphate, decreasing excretion of calcium and increasing bone resorption
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Diagnostics: PTH
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Identify hypo- or hyper- parathyroidism and to monitor the respone to PTH therapy
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Diagnostics: Calcium
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Check for serum Ca+ excess or deficit Assess: tetany, + chvosteks and Trousseau's
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Hyperparathyroidism
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Increased secretion of PTH (increased resorption of Ca+ and excretion of PO4) ~hypercalcemia, hypophosphatemia ~increased bicarbonate excretion and decreased acid excretion ~metabolic acidosis, hypokalemia ~bone decalcification, renal calculi
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Hyperparathyroidism: Treatment
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Decrease elevated serum Ca+ levels Drink fluids Avoid immobilization Thiazide diuretics Large doses of Vitamin A and D Acids containing Ca+ and Ca+ supplements
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Hyperparathyroidism: Meds
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Inhibit bone reabsorption and decrease hypercalcemia for short term use and may relieve bone pain Aredia Fosamax Zometa Calcitonin Surgical removal of parathyroid glands
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Hypoparathyroidism
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Abnormally low PTH levels ~Impaired renal regulation of Ca+ and PO4 ~Decreased activation of vitamin D results in decreased absorption of Ca+ by intestines
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Hypoparathyroidism: S/S
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Tetany or Convulsions, Muscle Spasms, Facial Grimacing, Arrhythmias, Paresthesias
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Hypoparathyroidism: Treatment
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Increase Ca+ levels: IV Ca+ gluconate (reduce tetany) Increase dietary Ca+ supplements Increase vitamin D therapy
