Term
| Pituitary and hypothalamus |
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Definition
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Term
| You can have an imbalance of pituitary hormone (either too much or little) |
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Definition
| Either problem is dangerous and both can be caused by a tumor. In the case of a tumor it needs to be removed. Life long hormone replacement is necessary. |
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Term
| Anterior pituitary hormones |
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Definition
Growth hormone (GH)
Thyroid stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH) |
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Term
| Posterior pituitary horome |
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Definition
| anti diuretic hormone (ADH) |
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Term
Anterior Pituitary Gland Disorders
Excess GH
Patho |
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Definition
Results in an overgrowth of ones and soft tissues
Usually caused by a benign pituitary tumor
Males and females equally affected
Manifests in the 20's and 30's |
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Term
| Excess GH in children known as |
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Definition
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Term
| Excess in adults known as |
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Definition
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Term
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Definition
| Sleeping (It's pulsating) |
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Term
| IGFI (Insulin Gorwth Factor) |
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Definition
| stimulates growth of bone and tissue |
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Term
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Definition
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Term
Excess Growth hormone
Clinical Manifestations |
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Definition
enlarged hands and feet
tuft of clubbed fingers
Joint pain
enlarged facial structures
Coarse facial features
Speech difficulties (enlarged tongue)
Deep voice (hypertrophy of vocal cords)
Sleep apnea
Thick, leathery (oily) skin
Peripheral neuropathy
Muscle weakness
Manifestations of Diabetes Mellitus |
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Term
excess GH
Some things to look for |
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Definition
| Polyuria, polydipsia, polyphagia, blood sugar is high! |
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Term
| Blood sugar is high you can experience |
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Definition
| s\s of polyuria and polydipsia (regardless of why it's high, and your BG goes up with increased GH) |
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Term
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Definition
Assess 1st (like ring size, hat size, shoe size)
IFG-1 levels
OGTT: Oral glucose challange-GH inhibited by glucose (If you're given glucose the GH should fall-won't with acromegaly)
MRI\CT\Ophthamolig Exam |
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Term
| Once we diagnose it, our goal is |
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Definition
to return GH to normal by: Collabrotive Care
Surgery
Irradiation try to get pituitary to work
Drug therapy (any growth hormone antagonist or somatostatin: most common is sandostatin\octreotide)
Combination of above |
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Term
Excess GH
Nursing management: Interventions |
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Definition
Assessment (size change, apnea, trouble swallowing, vision troubles, other hormone changes)
Activities-surgeries, blood glucose increase (we want to decrease it)
Teaching (Look up) pg 1207-1211 |
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Term
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Definition
More rare
Decrease in one or more of the pituitary hormones
rare disorder
Most common caues is pit. tumor
Comeone hormone deficiencies involve GH and LH and FSH
Ascemic changes->lead to decrease blood flow |
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Term
| S\S of pituitary tumor Clinical Manifestations |
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Definition
Headache
Visual changes
Anosmia-loss of smell
Seizures
Other symptoms dependents upon the target organ affected |
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Term
Hypophysectomy
Interventions |
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Definition
Assess (Cog, neuro status, vitals, urinary, I' and O's, pain, HOB 30
If pt. has drainage from nose do a gluocose check
Do good oral care (no teeth brushing for 10 day)
-head up and pressure off
Spinal fluid-give antibiotics
Watch for DVT, bed sores, pnemonia, don't cough or sneeze! |
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Term
| In a healthy individual a person's serum osmolality and urine osmolality will |
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Definition
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Term
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Definition
| Serum osmolality will be high (concentrated) and I won't e able to make much urine so it too will e concentrated, therefore the urine osmolality will also be high |
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Term
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Definition
| then serum osmolality will be low (dilute) and I will be able to make lots of urine d\t the FVE so my urine osmolality will also be low |
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Term
| The only time the serum osmolality doesn't match is |
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Definition
when there is a disease process going on
SIAHD or DI |
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Term
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Definition
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Term
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Definition
| over production\release of ADH |
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Term
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Definition
Results of excess or sustained release of ADH
Many causes-most common is malignancy (Look at pg 6 of notes for chart) |
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Term
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Definition
Lot like FVE, except 1 thing urine output)
Hyponatremia (muscle pain, cramps weakness)
Dyspnea on exerion
Fatigue
Dulled sensoruim
Low serum osmolality
LOW URINE OUTPUT and high osmolality
Weight gain
Vital signs (look up changes)
Bounding pulse\distended neck veins
Fluid retention\increased ody weight
Agitation\confusion |
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Term
SIAADH IMPORTANT
Diagnostics |
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Definition
Urine osmolality (300-1300) above
Serum Osmolaity (275-295)below
Serum sodium (135-145) below
Urine specific gravity (1003-1030) above |
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Term
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Definition
Based on underlying cause of disorder
Goal of treatment:
Normalizes fluid volume
Normalize osmolality
Fluid restriction
Hypertonic saline IV
Medications (diuretic) |
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Term
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Definition
Assess Lung sounds, bounding pulses, weight, bowel sounds, LOC, BP (increased), avtivities-fluid restri. and diet
Teaching-Oral care, increase sodium |
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Term
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Definition
Deficient production or secretion of ADH
Decreased renal response to ADH
Results in electrolyte imbalances |
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Term
DI
Clincial manifestations |
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Definition
FVD except for few things
Increased thrist
increased urination
low urine specific gravity
Serum osmolality elevated (how high it goes depends on how much the client can drink to compensate for losses)
Hyeprnatremia
Fluid volume deficiet (look at clin. man for FVD) |
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Term
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Definition
Water deprivation test-hold fluids and give vasopressing
Request hourly monitoring (weight, urine and serum osmolalities, HR and P)
Pt must be observed through entire procedure to prevent drinking water
MONITOR HR |
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Term
DI
Collaborative Care & Nursing Managment |
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Definition
Determination and treatment of the primary cause
Goal of treatment
Maintenance of fluid and electrolyte imbalance-monitor fluid volume status w\i and o, daily weight, labs
Hormone replacement-DDAVP
Drug therpay-Indocin (increases renal response to ADH) |
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Term
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Definition
Regulated by TSH
TSh increased t3\t4 down-hypo
TSH decreased t3\t4 up-hyper |
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Term
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Definition
Thyroxine (T4)
Trilodothyronine (t3)-most potent\greater metabolic effects
Calcitonin-produced in repsonse to high serum Ca levels |
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Term
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Definition
| metabolic rate, caloric requirements, oxygen use, carb and lipid metabolism, growth and development, brain function, other nervous system activities |
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Term
| Disorders of the thyroid gland |
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Definition
Enlargement: Goiter
Palpable Deformity\Nodules:benign\malignant
Inflammation: Thyroiditis
Overactive\Hyperfuction: Hyperthyroid
Underactive\Hypofunction: Hypothydroid |
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Term
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Definition
Enlarged thyroid gland
Usually d\t overproduction or underproduction of thyroid hormone or to nodules developing in gland itself. |
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Term
| Hypertrophy caused by excess |
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Definition
TSH stimulation, browth-stimulating immunoglobulins, or food\drugs taht inhibit thyroid function
Treated with thyroid hormone or surgery |
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Term
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Definition
Palpable deformity of the thyroid gland
May be benign or malignant-95% benign |
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Term
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Definition
Thyroid ultrasound (1st)
CT or MRI
Thyroid scan
Fine needle aspiration(most effective for determination of malignancy)
Treatment: Surgical |
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Term
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Definition
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Term
Graves' disease
Precipitating factors |
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Definition
| insufficient iodine supply, infection, and stressful life events |
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Term
Graves' disease
Characterized by |
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Definition
| remission and exacerbation regardless of treatment |
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Term
Graves' disease
May progress to |
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Definition
| destruction of the thyroid tissue-> hypothyroidsm |
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Term
Hyperthyroidism
Clinical Manif. |
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Definition
Goiter
Bruits upon auscultation
Exophthalmos
Weight loss
Heat intolerant
Nervousness
Irritale
Palpitations\Tachy
Hair loss
pt 1264 |
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Term
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Definition
Anorexia
apathy
Fatigue
Depression
Weight loss
Atrial fibrillation
Confusion
Angina |
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Term
| Hyperthyroidism Complications |
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Definition
Thyrotoxic crisis or thyroid storm
Acute onset, rare
Clinical manifestation are heightened (severe tachy, shock, hyperthermia, restlessness, agitation, seiures and pain, NVD, delirium and coma)
Considered a life threatening emergent evernt
Thought to be caused y stressful situations in patient with pre-existing hyperthyroidism |
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Term
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Definition
ophthalmolgic exam
EKG
Free T4 and TSH levels
Radioactive iodine scane |
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Term
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Definition
Drug Therapy
Anti-thyroid drugs (PTU, Tapazole-inhibit the thyroid hormones synthesis)
Iodine
B ad. lockers-symptom relief
Radioactive iodine therpay-tx of choice for nonpregnant
Surgical\nurtirional therapy |
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Term
Thyroid gland disorders
Interventions |
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Definition
Assess (hypermetaloic state, monitor HR, weight, vital signs, breathing, air way, pulse ox, Iv fluids)
Activities-HO up (swollen eyes) promotes drainage by eleation, eyedrops, low light, tape eyelids, reduce salt intake |
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Term
Subtotal thyroidectomy
Interventions |
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Definition
| Vitals, pain meds, I's and O's SCDs, SMI, support heat with pillows, head lower down move head a lot, avoid neck flexion decrease calcium levels-twitching bleeding numbness\tingling around lips, watch heart and neck (airway) Set UP TRACH AT BEDSIDE |
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Term
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Definition
| Insufficient circulating thyroid hormone |
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Term
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Definition
Primary-r\t destruction thyroid tissue
Secondary-r\t pituitary disease with decrease TSH |
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Term
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Definition
Iodine deficiency
Atrophy of the tyroid gland
Surgical removal of thyroid gland
Radioactive Iodine therapy |
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Term
Hypothyroidism
Compliations |
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Definition
Myxedema coma
Medical emergency
Precipitated by infection, drugs, exposure to cold, and trauma |
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Term
Hypothyroidism
Clinical Manifestation |
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Definition
| sunormal temperature, hypotension, hypoventilation |
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Term
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Definition
TSH high and T4 low
Primary: thyroid (not working)
secondary: pituitary (not working) |
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Term
Hypothyroidism
Collab. Care |
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Definition
Hormone replacement (Levothyroxine [Synthroid])
Nutritional therapy |
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Term
Hypothyroidism
Nursing management |
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Definition
assess comprehension level, skin (is it dry)
Activities increase activity, stool softeners
Watch dosing! |
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Term
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Definition
4 parathyroids
Four oval glands (in pairs)
rich blood supply via thryoid artery
Secretes parathyroid hormone (PTH)
Regulates the blood level of calcium, PTH acts on bone, kidneys, and indirectly on the GI system |
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Term
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Definition
increased secretion of PTH
(3 classes)
Leads to hypercalcemia and hypophosphatemia |
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Term
| HyperParathyroidClin. Manifestations |
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Definition
Weakness, loss of appetite, constipation, fatigue, kidney stones, shortened attention span, osteoporosis, fractures, dysrhythmias, emotional disorders
pg. 50-12
Serious-renal failure, pancreatitis, cardiac changes, long bone rib vertebral fractures |
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Term
HyperParathyroid
Diagnostics |
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Definition
PTH level elevated
Serum calcium level >10mg\dL
Serum phosphorus level <3mg\dl
one denisty scan to detect bone loss |
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Term
HyperParathyroid
Collab. CAre |
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Definition
| Parathyroidectomy, nonsurgical: Annual examination, avoidance of immobility, dietary measures, medications |
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Term
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Definition
| Drink soda, give diuretics, foxamax, increase fluid intake |
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Term
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Definition
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Term
HyperParathyroid Nursing management
Interventions for parathyroidectomy |
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Definition
asses vitals, watch alcium
activities-be up an moving, pushes clacium into bones
Teaching-teach signs hypo and hyper calcemia
Decreased calcium worry about heart and larynx spasms |
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Term
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Definition
inadequate circulating PTH
Results in ypocalcemia
Most common cause is Iatrogenic
Other causes include chronic kidney diesease, vitamin D deficiency, and hypomagnesemia |
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Term
Hypoparathyroid
Clinical Manifestation |
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Definition
table 50-12 pg. 1274
(Hypocalcemia)
Tingling of lips, fingertips and feet, increased muscle tension, muscle paresthesias and stiffness, painful tonic spasm of smooth and skeletal muscle feeling constriction in throat, respiratory compromise, anxiety, dysphagia, laryngospsasms |
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Term
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Definition
| Seru calcium levels low, PTH levels low, phosphate levels high |
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Term
Hypoparathyroid
Collab. Care |
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Definition
Management of acute symptoms
Normalize calcium levels
Prevention of long term complications |
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Term
Hypoparathyroid
Nurse. manage interventions |
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Definition
| assess-watch calcium, vitals, get trach for airway, Need IV calcium (toxic to tissue so use pic line) Kursov -oral calcium, oral vitamin D, manage acute symptoms |
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Term
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Definition
Contains two parts-medulla and cortex
Each part has own distinct function
function independently of each other |
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Term
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Definition
inner part of gland, secretes catecholamines, epinephrine-major hormone (75%)
Norepinephrine (25%)
Dopamine |
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Term
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Definition
Outer part of the gland
Secretes steroid hormones (Glucocorticoid, mineralocorticoid, anddrogens) |
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Term
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Definition
regulates metabolism
Increases blood glucose levels
plays critical role in physiological stress resposne (spec. BP) |
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Term
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Definition
Most abundant and potent glucocortiocoid, secreted in diurnal pattern, decreases the inflammatory response
Peaks in the AM |
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Term
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Definition
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Term
Mineral Corticoids
Functions |
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Definition
| Maintains fluid and sodium and potassium balance |
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Term
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Definition
Potent
Acts on renal tubule-Na and H20 reabsorption and Potassium release |
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Term
| Aldosterone synthesis is stimulated by |
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Definition
| Angiotensis 2, hyponatremia, and hyperkalemia |
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Term
| Effects of corticosteroids |
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Definition
anti-inflammatory action (arthritis)
immunosuppression
Maintenance of normal BP
Carohydrate and protein metabolism |
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Term
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Definition
| watch for infection, blood sugars, weight gain, cause severe acne, tapper doses, |
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Term
Complications with corticosteroids
pg. 1283 |
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Definition
Hypertension
Elevated BG levels
reduces resistance to infections and cancers
healing is delayed
Inhibits antibody response to vaccination
Long term therapy places pt at risk for osteoporosis
Predisposition to PUD
Mood and Behaviors change |
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Term
Corticosteroid therapy
Important considerations |
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Definition
steroids taken for longer than 1 week will suppress adrenal prduction
Doses must be tapered and not aruptly stopped
causes hyperglycemia
increases risk for infection
table 50-21, pg 1283 |
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Term
Cushing Syndrome and Disease
Patho |
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Definition
| excess of corticosteroids, particularly glucocorticoids |
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Term
Cushing Syndrome and Disease
Causes |
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Definition
Iatrogenic (most common)-prolonged use of high doses of corticosteroids (ie prednisone)
Cortisol secreting neoplasm of adrenal cortex
ACTH secreting tumor from carcinoma of lung or other malignancy outside of pituitary or adrenal
ACTH secreting pituitary tumor-cushing's |
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Term
Cushing Syndrome and Disease
Diagnostics |
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Definition
24 hours urine collection for free cortisol
Dexamethasone suppression test (If you give a steroid see if body try to not make anymore. You won't see lab go down if they have cushing)
Plasma cortisol levels may be elevated
CT scan and MRI of pituitary and adrenal glands
Plasma ACTH levels |
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Term
| Collaborative Care (treatment) |
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Definition
Surgical therapy-pit. tumor removal
Adrenalectomy
Drug therapy
and others (decrease corticosteroids if able) |
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Term
Cushing Syndrome and Disease
Nurse. man. interventions |
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Definition
| assess blood sugar, blood pressure, weight gain, s\s infections, fluid status, hypervolemia, body image, protein wasting, increased BP and BS |
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Term
Addison's Disease (Adrenal insufficiency)
Patho |
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Definition
Primary form of adrenocortical insufficiency
all three classes of steroids are reduced
Most common cause is autoimmune response
Occurs most often in adults less than 60 years of age
Affects both genders equally, autoimmune form occurs most frequently in white femals |
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Term
Addison's Disease (Adrenal insufficiency)
Clinical Manifestations |
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Definition
| Progressive weakness, fatigue, weight loss, anorexia, skin hyperpigmentation, ORTHEOSTATIC HYPOTENSION, Hyponatremia, hyperkalemia, NVD |
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Term
Addison's Disease (Adrenal insufficiency)
Complication-Addisonian Crisis |
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Definition
| Life threatening emergency phase of acute adrenal insufficiecy |
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Term
Addisonian Crisis
Severe manifestations |
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Definition
| hypotension, tachy, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, confusion, abdominal pai, severe vomiting and diarrhea |
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Term
Addison's Disease (Adrenal insufficiency)
Diagnostics |
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Definition
| Cortisol levels, ACTH stimulation test, metabolic panel, CC, EKG, CT and MRI |
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Term
Addison's Disease (Adrenal insufficiency)
Diagnostics |
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Definition
| Cortisol levels, ACTH stimulation test, metabolic panel, CC, EKG, CT and MRI |
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Term
Addison's Disease (Adrenal insufficiency)
Collab. Care |
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Definition
Hormone replacemen
emergency management of addisonian crisis |
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Term
Addison's Disease
Interventions |
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Definition
| give in divided doses, higher dose in morning, mineralcorticoid (aldosterone)-given in moring, Made alert and |
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Term
|
Definition
| excessive aldosterone secretion |
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Term
Hyperaldosteronism
Two types |
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Definition
primary-most commonly caused by adrenocortical adenoma
Secondary-non-adrenal cause of elevated aldosterone |
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Term
Hyperaldosteronism
little facts yo |
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Definition
Affects both genders equally
occurs most often between 30 and 50 years of age |
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Term
Hyperaldosteronism
Clinical Manifestations |
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Definition
| Hypernatremia! hypertension, headache, HPOKALEMIA, generalized muscle weakness, fatigue, cardiac dysrhythmias, glucose intolerance, metabolic alkalosis |
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Term
Hyperaldosteronism
Diagnostics |
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Definition
| Plasma aldosterone levels, electrolytes, CT and or MRI |
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Term
Hyperaldosteronism
collab care |
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Definition
Adrenalectomy
low sodium diet
Medications |
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Term
|
Definition
caused by a tumor of adrenal medulla
rare
Excessive amounts of catecholamines (epinephrine, norepinephrine)
Most commonly occurs in young to middle aged adults |
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Term
Pheochromocytoma
Clincial man |
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Definition
| severe hypotension!, pounding headache, tachy, palpitations, diaphoresis, abdominal or chest pain |
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Term
Pheochromocytoma
Diagnostics |
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Definition
24 horu urine collection
Catecholamine metaolites
Factionanted catecholmines
creatine
Serum cat. elevated during attck
Ct and or MRI for tumor localization |
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Term
Pheochromocytoma
Collab care |
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Definition
Surgical terapy\adrenalectomy
drug therapy (beta and alpha adrenergic blockers to prevent HTN crisis during surgery |
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