Term
| Hypothalamus role/function |
|
Definition
Link between the endocrine system and the CNS
Controls response to stress
Receives info from most body parts |
|
|
Term
|
Definition
| Sensors in the endocrine system detect changes in hormone levels and adjust hormone secretion to maintain normal levels. |
|
|
Term
|
Definition
| Increasing levels of one hormone cause another gland to release a hormone |
|
|
Term
Age-related changes:
Pituitary |
|
Definition
| Decreased: ACTH, TSH, FSH |
|
|
Term
Age-related changes:
Thyroid |
|
Definition
Increased fibrosis
Decreased activity |
|
|
Term
Age-related changes:
Pancreas |
|
Definition
Delayed and decreased hormone release
Decreased sensitivity |
|
|
Term
Age-related changes:
Adrenal medulla |
|
Definition
| Decreased response to norepinephrine |
|
|
Term
|
Definition
Protruding eyes
Seen in hyperthyroidism |
|
|
Term
|
Definition
Checking for hypocalcemia
Inflate a BP cuff above the AC space to a point greater than the systolic BP.
Keep inflated for 2-5 minutes.
Normal finding: NO carpal spasm in response to compression of the arm by the BP cuff
POSITIVE: muscular contraction including flexion of the wrist |
|
|
Term
|
Definition
Checking for hypocalcemia
Tap your finger in front of the patient's ear at the angle of the jaw.
A POSITIVE sign causes facial grimacing r/t repeated contractions of the facial muscle.
Normal finding: no grimacing in response to the tapping. |
|
|
Term
| Progression for endocrine-related health assessment |
|
Definition
| Start distally and work proximally |
|
|
Term
|
Definition
| Controls rate of body metabolism and growth |
|
|
Term
|
Definition
Thyroxine: T4
Triiodothyronine: T3
Thyrocalcitonin: Calcitonin |
|
|
Term
|
Definition
Control of blood calcium and phosphate ion concentrations
Inhibits bone resorption and increases calcium excretion by the kidneys. |
|
|
Term
|
Definition
| Osteoclasts break down bone and release the minerals resulting in a transfer of calcium from the bone fluid to the blood |
|
|
Term
| Essential element needed for the production of T3 and T4 |
|
Definition
| Adequate supply of iodine |
|
|
Term
| Control for the secretion of T3/T4 |
|
Definition
| Thyrotropin: TSH, thyroid-stimulating hormone |
|
|
Term
| TSH is secreted from the: |
|
Definition
|
|
Term
| Hypothyroidism chemical etiology |
|
Definition
| Inadequate amount of TH being secreted |
|
|
Term
| Hypothyroidism present from birth: |
|
Definition
|
|
Term
|
Definition
Stunted growth
Abnormal bone formation
Mental retardation
Low body temperature
Sluggishness |
|
|
Term
| Hypothyroidism demographics |
|
Definition
| Most common in women aged 30-60 |
|
|
Term
|
Definition
| Chronic, untreated hypothyroidism in adults |
|
|
Term
|
Definition
Autoimmune
Atrophy of gland with aging
Congenital defects of gland
Therapy for hyperthyroidism may cause this later on
Medications
Iodine deficiency
Radiation
Cancer/collagen diseases
Ingestion of large amounts of goitrogenic foods |
|
|
Term
| Therapy for Hypothyroidism |
|
Definition
|
|
Term
|
Definition
Turnips
Peaches
Large amounts of leafy green veggies
Cabbage
Soybeans |
|
|
Term
| Clinical manifestationof hypothyroidism: |
|
Definition
Goiter
Fatigue, weakness, muscle stiffness
Hair loss, brittle nails
Coarse, dry skin
Non-pitting edema, periorbital edema
GI: constipation, decreased appetite, weight gain
Reproductive: menstrual irregularities, infertility, decreased libido
CV: hypotension, bradycardia, cardiac enlargement
Extremities: decreased reflexes, hand/foot paresthesias
Slow speech
Cold intolerance
Memory impairment, personality changes, depression |
|
|
Term
Myxedema coma:
Description and triggers |
|
Definition
Life-threatening
Severe stage of hypothyroidism
Triggered by: acute illness or trauma OR failure to take prescribed medications |
|
|
Term
Myxedema coma:
Clinical manifestations |
|
Definition
Unconsciousness
Hypothermia
Hypoventilation
Fluid retention, generalized edema all over
Hyponatremia
Hypoglycemia
Lactic acidosis: blood isn't circulating well
Metabolic acidosis |
|
|
Term
Hypothyroidism:
Diagnostic findings |
|
Definition
Decreased T4
Decreased T3
Decreased T3 RU
Elevated serum cholesterol |
|
|
Term
Hypothyroidism:
Diagnostic findings r/t TSH levels |
|
Definition
Primary problem: Thyroid
Serum TSH will be elevated
Primary problem: Pituitary
Serum TSH will be decreased |
|
|
Term
| Medications to treat hypothyroidism |
|
Definition
Levothyroxine: Levoxyl, Synthroid
Liothyronine: Cytomel
Liotrix: Thyrolar, Euthyroid |
|
|
Term
| Surgical options to treat hypothyroidism |
|
Definition
Subtotal thyroidectomy
Surgeon will attempt to leave a portion of the gland in. |
|
|
Term
| Medical management of myxedema |
|
Definition
ABCs
Airway: patent
Respirations/ventilatory support
CV status: may need vasopressors to maintain BP
F/E balance
Acid/base balance: may have to give sodium bicarbonate
Parenteral thyroxine
Limit sedation. Watch for dig toxicity
Correct hypothermia
Treat precipitating factors |
|
|
Term
Myxedema Crisis:
Chest pain |
|
Definition
Advise patient to report chest pain:
As we increase body temp we increase metabolism.
Increased metabolism increase myocardial O2 use
This could cause angina or MI |
|
|
Term
Patients on thyroid replacement would benefit by taking which supplement?
How should the patient take it? |
|
Definition
Calcium supplement is recommended.
4 hour time lapse between taking hormone and calcium supplements. |
|
|
Term
| Patients on thyroid replacement therapy and insulin |
|
Definition
Monitor glucose carefully!
Blood sugar may decrease once we increase metabolism.
This patient may ultimately need less insulin. |
|
|
Term
| Patients on thyroid replacement therapy. Signs of excess hormones: |
|
Definition
Weight loss
Difficulty sleeping
Signs of hyperactivity |
|
|
Term
Hyperthyroidism
Describe:
Alternate name: |
|
Definition
Disorder caused by excessive delivery of TH to the tissues.
Thyrotoxicosis |
|
|
Term
Hyperthyroidism
Effect on the body: |
|
Definition
Increased metabolism: CHO, protein and lipid metabolism increases: caloric and nutritional deficiencies
Increased: HR, CO, BP, Oxygen consumption, temperature |
|
|
Term
|
Definition
Autoimmune stimulation: Graves' Disease
Thyroiditis
Excessive ingestion: thyroid replacement hormone/iodine
Medications: i.e. amiodorone
Neoplasms: cancerous goiter, pituitary adenoma |
|
|
Term
Hyperthyroidism
Clinical manifestations: |
|
Definition
Nervousness, insomnia, fine tremors of hand
Tachycardia, dysrhythmias, palpitations, ventricular hypertrophy, HF, angina
Increased systolic pressure
Heat intolerance
Diaphoresis, warm, flushed skin: warm & clammy
Fine, thin hair
Weight loss, muscle wasting, weakness, fatigue
Amenorrhea, decreased libido
Diarrhea
Exophthalmos: bulging of eyes, photophobia
Goiter |
|
|
Term
Thyroid storm (thyroid crisis)
Describe:
Caused by:
Prognosis: |
|
Definition
Extreme state of hyperthyroidism
Usually brought abruptly by:
-stressor
-manipulation of thyroid during surgery: injury
-infection
Usually fatal if left untreated |
|
|
Term
Thyroid storm
Clinical manifestations: |
|
Definition
Hyperpyrexia: 102-106
Tachycardia (130+), systolic HTN, dysrhythmias(a-fib, PVCs)
Abdominal pain: vomiting, diarrhea, weight loss
Respiratory distress
Confusion, delirium, seizures, coma |
|
|
Term
Hyperthyroidism
Diagnostic findings: |
|
Definition
TA test (thyroid antibody): elevated with Graves'
Serum TSH:
-anterior pituitary issue:elevated, producing too much
- thyroid: decreased, not putting out enough
Serum T4: increased
Serum T3: increased
RAI uptake: increased
Scan: look at size & vascularity
Auscultation: bruit if gland is enlarged enough |
|
|
Term
Hyperthyroidism
Medical management: |
|
Definition
Iodine solutions: Lugol's, SSKI, Sodium iodide
Anti-thyroid drugs: Tapazole, PTU
Beta blockers: rapidly control SNS symptoms
Radioactive iodine: I-131 |
|
|
Term
Hyperthyroidism
Surgical management |
|
Definition
Thyroidectomy
Hopefully a subtotal thyroidectomy: leave a little of gland
Give anti-thyroid meds prior to surgery to reduce hormone levels
Give iodine prior to surgery to reduce vascularity and size |
|
|
Term
Hyperthyroidism
Eye protection: |
|
Definition
Use tinted glasses or shields
Artificial tears to moisten eyes
Cover or tape lids closed at night if they don't close
Elevate HOB, 45 degrees to promote decrease in peri-orbital fluid
Instruct patient to report eye pain or vision changes |
|
|
Term
Hyperthyroidism
Nursing interventions: |
|
Definition
Cool, quiet environment
Minimize stress
Rest periods
Daily weights: weight loss is an issue
Diet: high in CHO, proteins, calories, minerals/vitamins
Avoid stimulants: caffeine, chocolate, cold meds
Medication education
NO aspirin: elevates T4 levels |
|
|
Term
| Thyroidectomy: post-op care |
|
Definition
Monitor VS, I&O
Comfort measures
Monitor for hemorrhage/hematoma formation
Monitor for respiratory distress
Voice rest
Monitor for tetany r/t hypocalcemia from injury to parathyroid during surgery |
|
|
Term
Thyroidectomy:
Important items to have on hand post-operatively: |
|
Definition
Suction machine
Trach tray in room
Calcium chloride or calcium gluconate at bedside with syringe: if excessive tetany could lead to laryngeal spasms |
|
|
Term
Tetany r/t thyroidectomy
Pathophysiology: |
|
Definition
Injury to parathyroid gland during surgery
Release of calcitonin: will cause serum calcium to drop |
|
|
Term
Tetany r/t thyroidectomy
Pathophysiology: |
|
Definition
Injury to parathyroid gland during surgery
Release of calcitonin: will cause serum calcium to drop |
|
|
Term
Parathyroid glands
Secrete:
This secretion does what? |
|
Definition
Parathormone (parathyroid hormone): PTH
PTH regulates Ca and phosphorus
-resorption (transferring Ca from bone to blood)
-excretion |
|
|
Term
Parathyroid glands
Calcium/Phosphorus balance |
|
Definition
IF serum calcium goes UP, there are too many + ions, so kidneys excrete phosphorus to keep the ions balanced.
IF serum calcium goes DOWN, PTH will go up to make the bones release more calcium (negative feedback) |
|
|
Term
Parathyroid glands
PTH levels and Vitamin D |
|
Definition
Increased PTH increases the activation of vitamin D
Need vitamin D to help with calcium absorption from intestines. |
|
|
Term
Hypoparathyroidism
Describe:
Cause: |
|
Definition
Abnormally low levels of PTH
Cause: damage to or removal of parathyroid gland during thyroidectomy or radical neck dissection |
|
|
Term
Hypoparathyroidism leads to calcium/phosphorus issues.
Describe: |
|
Definition
Hypocalcemia: decreased resorption of calcium from bones AND increased excretion of calcium by the kidneys.
Hyperphosphatemia from decreased renal excretion r/t the hypocalcemia: body is holding on to phosphorus.
Decreased activation of vitamin D: calcium in the intestines isn't absorbed as well |
|
|
Term
Hypoparathyroidism
Clinical manifestations: |
|
Definition
Tetany or muscle cramps/spasms r/t hypocalcemia
-Positive Trousseau's or Chvostek's
Hyperactive reflexes
Paresthesias
Dysrhythmias
Bronchospasm
Irritability, memory impairment, depression |
|
|
Term
Hypoparathyroidism
Diagnostic findings: |
|
Definition
Low PTH: patient should be NPO 8h prior to test
Low serum Ca levels
High serum phosphate levels
Increased bone density |
|
|
Term
Hypoparathyroidism
Medical Management |
|
Definition
IV Calcium gluconate: treating tetany
Oral calcium supplements: calcium citrates are best
Large doses of vitamin D
Phosphate binders: Amphojel, Basaljel |
|
|
Term
Hypoparathyroidism
Nursing Interventions: |
|
Definition
Monitor VS
Assess for dysrhythmias
Monitor calcium and phosphate levels
Initiate seizure precautions r/t low calcium
Quiet environment
Monitor for hoarseness/stridor: laryngeal spasm or bronchospasm
Diet: high calcium/low phosphorus |
|
|
Term
Hypoparathyroidism
Administration of calcium gluconate |
|
Definition
IV
Administer slowly
1 gram total: 200 mg. per minute is rate
Monitor for digoxin toxicity |
|
|
Term
Hyperparathyroidism
Describe:
Causes: |
|
Definition
Increase in secretion of PTH. This affects the kidneys and bones: increased resorption of calcium and excretion of phosphate by kidneys
Causes: tumor or hyperplasia of glands or renal disease |
|
|
Term
Hyperparathyroidism
Relationship between calcium and phosphorus: |
|
Definition
| Increased release of calcium from the bones (increased resorption!) hypercalcemia and increased excretion of phosphate via the kidneys (hypophosphatemia) |
|
|
Term
Hyperparathyroidism
Implications for bones: |
|
Definition
Decalcification of bones: bones are releasing calcium which leads to demineralization.
Bone deformities, pathologic fractures, bone pain |
|
|
Term
Hyperparathyroidism
Clinical manifestations: |
|
Definition
Apathy, fatigue, weakness
Abdominal pain, anorexia, N/V, peptic ulcers, pancreatitis
Constipation
HTN
Dysrhythmias
Renal stones
Bone deformities, pathologic fractures, bone pain
Increased sensitivity to cardiac glycosides: increased potential for dig toxicity r/t hypercalcemia |
|
|
Term
Hyperparathyroidism
Diagnostic findings: |
|
Definition
Persistent elevated serum calcium levels
Decreased phosphate levels
Elevated PTH
Decreased bone density
Ultrasound and biopsy to help with diagnosis |
|
|
Term
Hyperparathyroidism
Medical management: |
|
Definition
Surgical removal of glands: if all are removed patient will be on hormone replacement for life.
Force fluids: decrease formation of renal calculi
Cranberry juice: alkalinize the urine
Avoid thiazide diuretics
Avoid immobilization: do weight-bearing exercise!
Avoid vitamin D supplements
Bisphosphanates: move the calcium from the blood back into the bone.
IV saline and Lasix: dilute and diurese |
|
|
Term
Hyperparathyroidism
Nursing interventions: |
|
Definition
Monitor VS
Monitor for dysrhythmias
Monitor for dig toxicity
IV Saline and diuretics as ordered
Monitor I&O; strain urine for stones
Encourage 2000 cc fluid per day and cranberry juice
Diet: low calcium/high phosphate
Keep patient active |
|
|
Term
|
Definition
Adrenal medulla
Adrenal cortex |
|
|
Term
Adrenal medulla
Position:
Function: |
|
Definition
Center of gland
Secretes catecholamines to deal with stress |
|
|
Term
Adrenal cortex
Position:
Function: |
|
Definition
Outer portion of gland
Secretes corticoids |
|
|
Term
|
Definition
Norepinephrine
Epinephrine
Dopamine |
|
|
Term
|
Definition
Glucocorticoids: Cortisol (SUGAR)
Mineralocorticoids: Aldosterone (SALT)
Androgens: Androgens (SEX) |
|
|
Term
Adrenal gland disorders:
Medulla
Cortex |
|
Definition
Medulla: Addison's and Cushing's
Cortex: Pheochromocytoma |
|
|
Term
Addison's Disease
Describe: |
|
Definition
Hyposecretion of adrenal cortex hormones
Fatal if left untreated |
|
|
Term
Addison's Disease
Etiology: |
|
Definition
Autoimmune destruction: most common cause
Adrenoleukodystrophy: genetic x-linked disorder
Surgical removal of adrenals
TB, AIDS, histoplasmosis
ACTH deficiency: if it is a pituitary issue
Abrupt withdrawal of long-term steroids: always taper |
|
|
Term
Addison's Disease
Clinical manifestations: |
|
Definition
Hypotension: Postural
Hyponatremia
Hypoglycemia
Hyperkalemia
Hyperpigmentation
GI: anorexia, N/V, diarrhea, weight loss
Lethargy, fatigue, weakness
Confusion, dizziness
Menstrual changes/impotence |
|
|
Term
Addison's Disease
Addisonian Crisis
Describe:
Clinical manifestations: |
|
Definition
Often brought on by: surgery, infection, trauma, abrupt d/c of steroids
Primary symptoms: Fever/dehydration, weakness, severe abdominal pain, N/V/D, hypotension, circulatory collapse, shock. |
|
|
Term
Addison's Disease
Diagnostic findings: |
|
Definition
Hypos: hypoglycemia, hyponatremia, hypotension
Hypers: hyperkalemia
Serum cortisol: decreased
BUN: elevated r/t dehydration (24-h urine test)
Urinary levels of 17 hydroxycorticoids/17 ketosteroid: decreased (not there for kidneys to excrete)
Abnormal ACTH
Abnormal ACTH stimulation test results |
|
|
Term
Addison's Disease
Abnormal ACTH levels |
|
Definition
IF anterior pituitary gland is the issue: levels will be low
IF adrenal cortex is the issue: levels will be high |
|
|
Term
Addison's Disease
Medical Management: |
|
Definition
IV D5NS
Hydrocortisone: Solu-Cortef or SoluMedrol -begin with IV and switch to PO
FLorinef: PO, patient will retain sodium and water, get BP up
Diet: increase Na/decrease K+
Vasopressors: if hypotension persists |
|
|
Term
Addison's Disease
Nursing interventions: |
|
Definition
Administer hormone replacement
Monitor VS
Do orthostatic checks
Monitor Na and K+ levels
Daily weights/I&O
Encourage oral intake of 3000 mL/day
Increase Na intake
Monitor for hypoglycemia in diabetic patient
Decrease stress
Avoid: heat, cold, infection, over-exertion, emotional distress, fatigue |
|
|
Term
Addison's Disease
Patient education: |
|
Definition
Take steroids with food
Diet: low K+/high Na and protein
Daily weights: report gain or loss
Emergency kit with IM cortisone
Monitor for stressors and increase cortisone as instructed
Stress management techniques
Avoid strenuous activity, especially in heat |
|
|
Term
Addison's Disease
Drug interactions |
|
Definition
Steroids: may decrease effectiveness of contraceptives
Anticoagulants and insult: may decrease effectiveness of steroids |
|
|
Term
Corticosteroid therapy
Metabolic effects: |
|
Definition
|
|
Term
Corticosteroid therapy
Effect on pituitary and adrenal glands |
|
Definition
Suppress both: this is the reason we taper the dose.
This gives the glands a chance to "wake up" and get back to work! |
|
|
Term
Corticosteroid therapy
Effect on CNS: |
|
Definition
Changes function
Causes: irritability and insomnia |
|
|
Term
Corticosteroid therapy
Administration: |
|
Definition
Best to give in the morning (0600-0800)
Reflects our body's natural rhythms and the way we normally secrete these hormones
IF BID, give the larger dose in the morning, lower dose in the afternoon. |
|
|
Term
Corticosteroid therapy
Side effects: generalized |
|
Definition
Na retention
Water retention
Increase in appetite
Sweating: for some patients |
|
|
Term
Corticosteroid therapy
Side effects: CV |
|
Definition
HTN, r/t fluid retention
HF, r/t accelerated atherosclerosis |
|
|
Term
Corticosteroid therapy
Side effects: GI |
|
Definition
Peptic ulcer
Ulcerative esophagitis |
|
|
Term
Corticosteroid therapy
Side effects:Integumentary |
|
Definition
Petechiae, ecchymosis, purpura: r/t decreased platelet aggregation
Hirsuitism
Thinning of skin
Striae
Redistribution of fat: buffalo hump, moon face, apple appearance |
|
|
Term
Corticosteroid therapy
Side effects:Endocrine |
|
Definition
Impaired glucose metabolism: hyperglycemia
Menstrual dysfunction
Growth retardation |
|
|
Term
Corticosteroid therapy
Side effects:Musculoskeletal |
|
Definition
Osteoporosis
Muscle weakness and wasting |
|
|
Term
Corticosteroid therapy
Side effects:Neurologic |
|
Definition
Personality changes
Irritability
HA
Vertigo
Insomnia
Seizures |
|
|
Term
Corticosteroid therapy
Side effects:Ophthalmologic |
|
Definition
Glaucoma
Cataract formation |
|
|
Term
Corticosteroid therapy
Side effects:Electrolytes |
|
Definition
| Hypokalemia r/t Na retention |
|
|
Term
Corticosteroid therapy
Side effects: infection |
|
Definition
Masked signs of infection
Increased susceptibility to infection
Blunted immune response to infections |
|
|
Term
Corticosteroid therapy
Nursing Care: |
|
Definition
Administer with food or milk
Patient may need antacids
Patient should avoid infectious people/situations
Get flu vaccine
Monitor for S/S of infection
Instruct patient NEVER to d/c abruptly. Always TAPER
Alert women to contraception info: use additional forms
Diet restrictions: Na, fat, calories
Dietary additions: protein, high K+ |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Describe: |
|
Definition
Characterized by a hypersecretion of glucocorticoids from the adrenal cortex.
Metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer. |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Etiologies: |
|
Definition
Pituitary adenoma
Ectopic production of ACTH by malignancies
-Bronchogenic cancer
-Oat cell cancer
-Lymphomas
Hyperplasia of the adrenal cortex
Long-term use of corticosteroids |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Clinical manifestations |
|
Definition
Truncal obsesity (apple shape)
Moon face: round in shape
Buffalo hump
Weakness, muscle-wasting in excremities
Thinning of skin, striae, easy bruising, poor wound healing
Hirsutism, menses cessation
Osteoporosis: vertebral compression fractures
Hypokalemia
Edema
Hypertension
Insomnia, emotional lability, psychosis
Peptic ulcers
Increased susceptibility to infection |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Diagnostic findings: |
|
Definition
Serum cortisol levels: elevated
ACTH suppression test: determine where the problem is
Serum ACTH levels: altered
24-hour urine test: elevated levels of 17hyrdoxycorticosteroids and 17ketosteroids
Serum glucose: elevated
Hypernatremia
Hypokalemia |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Medical management: |
|
Definition
Adrenalectomy
Hypophysectomy: resect pituitary (avoid if possible)
Reduce amount of corticosteroids to lowest amount possible
Medications, if surgery is not an option |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Medications: |
|
Definition
Mitotane: suppresses adrenal cortex activity
Aminogluthemide or ketoconazole: inhibits cortisol synthesis
Octreotide: suppresses ACTH secretion |
|
|
Term
Cushing's Syndrome (hypercortisolism)
ACTH suppression test |
|
Definition
Determine whether the problem is with the adrenal glands or the anterior pituitary:
Give steroids and see if there is a decrease in ACTH production.
IF NO decrease, then problem is with the anterior pituitary |
|
|
Term
Cushing's Syndrome (hypercortisolism)
Nursing interventions: |
|
Definition
Monitor VS
Assess for HTN
Safe environment: protect from infection and falls
Maintain skin integrity
Diet: low in calories; low in Na; high in K+; high in protein r/t muscle wasting; high in calcium, vitamin C, vitamin D
REST
Monitor for Addisonian crisis and hypovolemic shock IF surgery is performed or steroids are stopped suddenly |
|
|
Term
Pheochromocytoma
Describe: |
|
Definition
| Catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include: chest, bladder, abdomen, and brain. Typically it is a benign tumor, but it can be malignant. |
|
|
Term
Pheochromocytoma
Clinical manifestations: |
|
Definition
5 H's
HTN (200/150 or somewhere close to this)
Headache
Hyperhidrosis: excessive sweating
Hypermetabolism
Hyperglycemia
**In addition:
Tremors
Flushing
Tachycardia; palpitations
Anxiety: bundle of nerves |
|
|
Term
Pheochromocytoma
Diagnostic findings: |
|
Definition
Serum catecholamines: elevated
Serum metaneprhine: elevated
24-hour urine test: elevated levels of catecholamines, metanephrine, VMA
Ultrasound, MRI, CT |
|
|
Term
Pheochromocytoma
Medical management: |
|
Definition
Bed rest
Alpha adrenergic blockers: Regitine, Nipride
Ca Channel blockers: Procardia, Cardene
Beta blockers: Inderal
Catecholamine synthesis inhibitor: Metyrosine |
|
|
Term
Pheochromocytoma
Nursing interventions: |
|
Definition
Bed rest
Monitor VS
Avoid chilling: will drive BP up
Diet: high calorie
Avoid stimulants: caffeine, nicotine
Education: adrenalectomy |
|
|
Term
|
Definition
Commonly referred to as the Master Gland
Controlled by the hypothalamus
Divided into anterior/posterior lobes |
|
|
Term
| Anterior pituitary releases these hormones: |
|
Definition
Stimulating hormones:
ACTH
TSH
LH
FSH
GH
Prolactin |
|
|
Term
| Posterior pituitary releases these hormones: |
|
Definition
|
|
Term
Hypopituitarism: hypofunction of anterior pituitary
Etiology |
|
Definition
| Destruction by: tumor, infection, surgery, radiation, hypovolemia, trauma, disease |
|
|
Term
Hypopituitarism: hypofunction of anterior pituitary
Results-
Childhood:
Adulthood: |
|
Definition
Childhood: limited growth - dwarfism
Adulthood: shrinkage of glands- thyroid, adrenals, gonads with resultant hypofunction |
|
|
Term
Hypopituitarism: hypofunction of anterior pituitary
Diagnosis: |
|
Definition
Skull x-ray
CT scan
Decreased:
*plasma stimulating-hormone levels
* hormone levels |
|
|
Term
Hypopituitarism: hypofunction of anterior pituitary
Treatment: |
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Definition
| Replacement of missing hormones |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Etiology: |
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Definition
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Results-
Childhood:
Adulthood: |
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Definition
Childhood: gigantism if it occurs b/f epiphyseal closure
Adulthood: acromegaly |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Acromegaly: describe |
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Definition
Forehead enlarges
Maxilla lengthens
Coarse facial features
Voice deepens
Hands and feet enlarge
Headache
Visual changes
HTN
Cardiomyopathy
Hyperlipidemia
Diabetes |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Effects: |
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Definition
Excess ACTH over-stimulates adrenals
Excess PRL causes irregular or absent menses, decreased fertility, failure to lactate |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Diagnosis: |
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Definition
Skull x-ray
CT
Increased plasma hormone levels |
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Term
Hyperpituitarism: hyperfunction of anterior pituitary
Treatment: |
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Definition
Pituitary irradiation
Hypophysectomy
Somatostatin analogues:
Ocreotide
Lanreotide acetate
Dopamine receptor agonist:
Parlodel |
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Term
Posterior pituitary disorders
Describe: |
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Definition
| Usually related to excessive OR deficient amounts of ADH |
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Term
| Normal progression when serum osmolality decreases: |
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Definition
| ADH secretion decreases and kidneys excrete more water |
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Term
| Normal progression when serum osmolality increases (hyperosmolality): |
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Definition
| ADH secretion increases and kidneys reabsorb more water |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Describe: |
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Definition
Characterized by increased amounts/levels of ADH in the absence of serum hyperosmolality
Causes water retention and dilutional hyponatremia leading to water intoxication. |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Etiology: |
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Definition
Malignant tumor
Head injury
Pituitary surgery
Some medications: Vincristine (chemo), TCA, Phenothiazines |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Clinical manifestations: |
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Definition
Headache
Lethargy, irritability, seizures
Weigh gain
HTN
Tachycardia |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Diagnostic findings: |
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Definition
Serum ADH: elevated
Hyponatremia: <135
Urine osmolality: increased
Urine specific gravity: increased [normal: 1.010-1.020]
Serum osmolality: decreased [normal: 280-295] |
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Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Medical management: |
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Definition
Treat underlying cause
Fluid restriction: 1000 cc per day
Diuretics: will also lose Na and K+
Declomycin: antibiotic which increases Na levels
Tolvaptan
Hypertonic saline solution: not given much bc of neuro issues. |
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Term
Diabetes Insipidus (DI)
Describe: |
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Definition
| Hyposecretion of ADH resulting in failure of tubular absorption of water in kidneys. Body will continue to excrete copious amounts of urine. |
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Term
Diabetes Insipidus (DI)
Two types: |
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Definition
Neurogenic DI
Nephrogenic DI |
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Term
Diabetes Insipidus (DI)
Neurogenic DI
Describe:
Causes: |
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Definition
Disorder with hypothalamus or posterior pituitary gland causing ADH insufficiency.
Causes: TBI (total body irradiation), neoplasms, surgery, genetic |
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Term
Diabetes Insipidus (DI)
Nephrogenic DI
Describe:
Causes: |
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Definition
Renal tubules are not sensitive to ADH
Causes: drugs, renal disease |
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Term
Diabetes Insipidus (DI)
Clinical manifestations |
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Definition
Polydipsia
Polyuria
Fatigue, muscle weakness, muscle pain
Weight loss, dehydration
Hypernatremia
Dilute urine: low specific gravity
Hypotension
Tachycardia |
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Term
Diabetes Insipidus (DI)
Diagnostic findings: |
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Definition
ADH levels: decreased (if neurogenic); normal (if nephrogenic)
Urine specific gravity: decreased
Hypernatremia
Serum osmolality: increased, more particles present, more concentrated
Fluid deprivation test: patient is unable to concentrate urine
Trial of desmopressin: should decrease urine production |
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Term
Diabetes Insipidus (DI)
Fluid deprivation test: |
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Definition
NPO for 12 hours
Check urine osmolality and serum osmolality before and after test.
Finding: Kidneys cannot concentrate or hold onto the urine
A healthy person will hold onto the urine |
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Term
Diabetes Insipidus (DI)
Medical management of Neurogenic DI |
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Definition
Identify and treat the underlying cause
Ensure adequate fluid replacement: large amounts of IV fluid
Pharmacologic:
Desmopressin (DDAVP): intranasal
Vasopressin: SQ, IV
Diabinese: increase the action of the vasopressin the patient does have |
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Term
Diabetes Insipidus (DI)
Medical management of Nephrogenic DI |
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Definition
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Term
Diabetes Insipidus (DI)
Nursing interventions: |
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Definition
Monitor VS
Daily weights
I&O: urinary output, concentration
Monitor for dehydration
Check serum osmolality
Monitor electrolytes
Patient education:
Medic Alert bracelet
LIFELONG hormone replacement
Avoid foods or liquids with diuretic action:
ETOH |
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