Chapter 39 Nursing Care/with Endocrine Disorders

Front 1

pituitary disorders

Back 1

caused by hormone imbalance-general hypopituitrism or hyperpituitrism

Front 2

pituitary disorders-disorder related to Antidiuretic hormone imbalance-ADH

Back 2

also called arginie vasopressin AVP
is sythesized in the hypthalamus and stored and secreted by posterior pituitary gland

Front 3

insufficent ADH disorder

Back 3

diabetes insipidus
water loss

Front 4

excessive ADH disorder

Back 4

SIADH
water retention

Front 5

SSX of diabetes insipidus

Back 5

poluria, polydipsia, hypoantremia, increased serum osmolality(concentrated blood) and dehydration

Front 6

SSX of SIADH

Back 6

fluid retention, weight gain, hyponatremia

Front 7

diagnostic test for diabetes insipidus

Back 7

urine specific gravity, urine and plasma osmolaity

Front 8

diagnostic test for SIADH

Back 8

serum and urine sodium and osmolaity

Front 9

therapeutic interventions for diabetes insipidus

Back 9

synthetic ADH repalcement

Front 10

therapeutic interventions for SIADH

Back 10

treat cause

Front 11

priority nursing diagnosis for diabetes insipidus

Back 11

risk for deficient fluid volume:<BR>monitor weight daily, I &amp;amp; O, vitals, and urine specific gravity(decreased weight, output greater than intake, low BP, elevated pulse rate, and high urine specific gravity may indicate fluid deficit)
provide free access to oral fluids if the DI is not pyschogenic. If patients thirst mechanism is not intact, give patients fluids every hour
encourage the Pt. to participate in maintaining intake and output records, monitoring weight and checking urine specific gravity, if able.
report a drop in BP and a rising pulse to registered nurse or physcian(this may be signs of hypovolemic shock)

Front 12

priority nursing diagnosis for SIADH

Back 12

risk for excess fluid volume

Front 13

urine specific gravity test normal ranges

Back 13

1.010 to 1.025
if less than 1.005 in diagnosing diabetes insipidus-use of reagent strip by the bedside
hypovolemic shock occurs if fluid balnce is not restored
signs of hypotension, weakness. poor skin turgor

Front 14

Syndrome of Inappropiate antidiuretic hormone SIADH

Back 14

manifestations of dilutional hyponatemia:
bounding pulse
elevated or normal BP
muscle weakness
headache
personality changes
nausea
diarrhea
convulsions
coma

Front 15

Syndrome of Inappropiate antidiuretic hormone SIADH causes

Back 15

certain lung cancers, or Hodgkin's disease may be ectopic sites of production of ADH-like substance
some drugs-tricyclic antidepressants and general anesthetics may increase ADH secretions
head trauma or surgery or a brain tumor affecting pituitary function\
or complications of Diabetes Insipidus

Front 16

nursing diagnosis for SIADH

Back 16

excess fluid volume related to compromised regulatory mechanism
monitor daily weights, I & O, vitals, urine specific gravity(elevate BP, bounding pulse and low urine specific gravity may all indicate fluid overload)
maintain fluid restriction-fluids high in salt may help correct dilutional hyponatremia)
promote comfort and choice during fluid restriction
offer hard candy
provide ice chips(100 ml of ice chips egual to 50 ml of water)
provide calibrated cups
report change of consciousness immediateley and monitor the Pt for seizures(these are signs of serious fluid imbalance)

Front 17

disorder related to Growth Hormone Imbalance

Back 17

GH, also called somatotropin-responsible for normal growth of bones, cartilage and soft tissue(target organs)
GH is synthesized and secreted by the anterior pituitary gland

Front 18

disorder related to Growth Hormone Imbalance-Dwarfism

Back 18

GH is deficent due to pituitary
most common cause worldwide is malnutrition

a tumor, or failure of the pituitary to develop
infection or trauma to pituitary
neglect and severe emotional stress causing phychosocial dwarfism

Front 19

SSX of Dwarfism

Back 19

children grow to only 3 to 4 feet of height but have normal body proportions
sometimes accompanied by mental retardation
in adults: weakness, hypoglycemia, sexual dysfunction, skin changes and increased risk of cardiovascular disease.
headaches, mental slowness, and visula disturbances may occur

Front 20

diagnostic tests for dwarfism

Back 20

GH levels in blood are measured routine lab work

Front 21

therapeutic interventions for dwarfism

Back 21

in children administer GH

Front 22

nursing diagnosis for dwarfism

Back 22

disturbed body image R/T short statue
acceptance
proveide opportunity for Pt. to verbalize feelings
consult occup[ational therapist
provide information about support groups

Front 23

Acromegaly

Back 23

excess GH-rare
usually in 30's or 40's
if it occurs in children it is Giantism
bones increase in size in the hands, feet and facial features
long bones grow in width not lenght because the epiphydeal disks are closed
SC connective tissue increasess causing fleshy appearance
interanl oragns and glands enlarge
impaired tolerance of carbohydrates leads to elevated blood glucose

Front 24

SSX of Acromegaly

Back 24

changes in ring or boot sizes
the nose, jaw, brow and hands and feet enlarge
teeth become diplaced
the tongue becomes thick-difficulty in speaking and swallowing
sleep apnea
verbal changes lead to kyphosis
visual disturbances-tumor pressure on the optic nerve
diabetes mellitus may develop due to GH increases blood glucose and causes and increase workload of the pancreas

Front 25

diagnostic tests for Acromegaly

Back 25

serum GH levels are measured and radiographs show abnormal bone growth
large dose of glucose-glucose normally suppresses GH but if the hormone continues to be released after glucose-acromegaly is suspected
MRI is done to locate pituitary tumor

Front 26

therapeutic intervetions for Acromegaly

Back 26

aimed at cause
Parlodel or sandostatin may decrease GH levels
hypophysectomy or radiation may be indicated if there is a tumor
if pituitary is removed life long replacement of thyroid hormone, corticosteroids and sex hormoness is important to maintain homeostasis

Front 27

nusring diagnosis for Acromegaly

Back 27

disturbed body image R/T canges in appearance

Front 28

hypothyroidism

Back 28

in women 30 to 60
in infants-cretinism
in adult -myxedema

Front 29

hypothyroidism occurs when?

Back 29

thyroid gland fails to produce enough TH even though there is enough TSH stimulating hormone being secreted by the pituitary

Front 30

thyroid hormone abnormalties in Hyperthyroidism

Back 30

Primary- +TH goes up -TSH is down
secondary TH is up and TSH is up

Front 31

thyroid hormone abnormalties in hypothyroidism

Back 31

primary- TH is down and TSH is up
secondary- TH is down and TSH is down

Front 32

etiology of hypothyroidism

Back 32

congential defect, inflammation, iodine deficiency
Hasimoto thyroiditis is an autimmune disorder-eventually distroys the thyroid tissue
secondary or tertiary hypothyroidism may be caused by pituitary or hypothalamic lesion or postpartum pituitary necrosis-rare disorder in which the pituitary is destroyed following pregnancy and delivery

Front 33

SSX of hypothyroidism

Back 33

reduced metabolic rate
cardiovascular-bradycardia, decreased cardic output, cool skin, cold intolerance
neurological-lethargy, slowed movements, memory loss, confusion
pulmonary- dyspnes, hypoventialation
skin-cool, dry, brittle, dry hari
GI-decreased appetite, weight gain, constipation, increased serum lipid levels
reproduction- decreased libido, erectile dysfunction

Front 34

SSX of Hyperthyroidism

Back 34

cardiovascular-tacycardia, palpitations, increased cardia output, warm skin, heat intolerance
neurological-fatigue, restlessness, tremor, insommia, emotional instability
pulmonary-dyspnes
diaphoresis;wram, moist skin; fine, soft hair
GI=increased appetite, weight loss, freguent stools, decreased serum lipid levels
reproductive-decreased libido, erectile desfunction, amenorrhea

Front 35

hyperthyroidism

Back 35

usually diagnosed in young women
Graves disease is the most common cause
multigoiter is more common in older women

Front 36

hyperthyroidism

Back 36

primary-excess TH released
secondary-excess TSH from pituitary is released causing overstimulation of the thyroid gland
tertiary-excess TRH from the hypothalamus
high levels increase metabolic rate
increase the # of beta-adrenergic receptor sites in the body, which enhances the activity of norepinephrin-flight or flight response

Front 37

thyrotoxic crisis can result in ?

Back 37

death in 2 hours if untreated
SSX- tachycardia, high fever, hypertension(w/eventual heart failure and hypotension) dehydration, restlessness and delerium or coma

Front 38

thyrotoxic crisis-treatment is first given to treat the life threatening symptoms

Back 38

acetaminophen-for fever(asprin is avoided becasue it binds to T4)
IV fluids and cooling blanket
beta-adrenergic blocker-propranolol is given for tacycardia
oxygewn is given and HOB elevated because high metabolic rate requires more oxygen
after life thretening treatment is given the underlying thyroid problem is treated

Front 39

diagnostic test for hyperthyroidism

Back 39

serum levels of T3 & T4 are elevated
TSH is low if in primary hyperthyroidism
TSH is high if itis caused by pituitary
thyroid scan for tumor
should not be palpated-

Front 40

nursing diagnosis for hyperthyroidism

Back 40

hyperthermia R/T hypermatabolic state
monitor temp-temp may be elevated
administer analgesics
applying cooling blanket-set 1 to 2 degrees below current temp and wrap extremities

Front 41

goiter

Back 41

enlargement of the thyroid gland is enlarged in response to increased TSH levels
TSH is elevated because of low TH, iodine deficiency, pregnancy or viral, genetic or other conditions
if it is caused by iodine deficiency or other enviromental factors is called an edemic goiter
some food & medications are goitrogens-they interfere with the bodys use of iodine and include foods such as turnips, cabbage, broccoli, horseradish, cauliflower and carrots
goitrogenic medications include propylthioureacil, sulfonamides, lithium, salicylates(asprin)
goiter w/ hyperthyroidism is called a toxic goiter

Front 42

goiter SSX

Back 42

thyroid gland is enlarged and swelling in neck
can interfere w/ breathing and swallowing

Front 43

diagnostic test for goiter

Back 43

thyroid scan
serum T3 & T4 levels

Front 44

therapuetic interventions for goiter

Back 44

aimed at cause
goitrogen-list of food to avoid
iodine deficient-iodized salt is given
synthyroid may be given to reduce TSH levels
Thyroidectomy

Front 45

nursing care for goiter

Back 45

breathing and swa;lowing assessed
stridor-if airway is obstructed
stridor should be report to physcian immediately

Front 46

cancer of the thyroid gland

Back 46

SSX:
a hard painless nodule may be palpated
difficulty breathing or swallowing
changes in the voice
most have normal TH levels

Front 47

diagnostic tests for cancer of thyroid

Back 47

thyroid scan
cold indicates cancer

Front 48

nursing postoperative care for Pt. with thyroidectomy surgery

Back 48

monitor vitals, oxygen saturation, drain(if present), and dressing every 15 minutes initially progressing to every 4 hours
decresed BP w/ increased pulse should alert to possiblity of shock related to blood loss
tacycardia and fever, along with mental status changes may indicate thyrotoxic crisis
check back of neck for pooling of blood
observe for respiratory distress, incresed resp.,rate, dyspnes, or stridor
ask Pt to speak to detect horaness of the voice box which may indicate trauma to the laryngeal nerve
monitor Pt serum calcium level and watch for signs of tetany(low calcium)

Front 49

parathyroid glands

Back 49

secrete PTH in respoonse to low levels of calcium

Front 50

PTH

Back 50

raises serum levels by promoting calcium movement from bones to blood and by increasing absorption of dietary calcium

Front 51

decreased PTH is called

Back 51

hypoparathyroisism
and incresed PTH is hyperthyroidism

Front 52

SSX of hypoparathyroisism

Back 52

tetany
neuromuscular irritability
numbness of fingers and tingling
perioral area
muscle spasms
twitching
positive Chvostek's and Trousseaus' signs are early indications of tetany
chvosteks-tap on Pt facial nerve just in front of ear-spasm is postive results for hypocalcemia
Trousseaus-place a sphygmomanometer on Pt arm and pump it to above the Pt systolic pressure. Spasm in the thumb and fingers occur within 3 minutes if Pt has hypparathyroisism

Front 53

diagnostic test for hypoparathyroisism

Back 53

serum PTH, calcium and phosphate

Front 54

therapeutic interventions fro hypoparathyroidism

Back 54

calcium replacement, high calcium, low phosperous diet

Front 55

nurisng priority diagnosis for parathyroidism

Back 55

risk for injusry R/T tetany

Front 56

hyperparathyroidism

Back 56

excess PTH
SSXhypercalcemia, fatigue, pathological fractures-kidney stones, cardiac dysrhythmias, gastric secretions, abdominal pain, peptic ulcer
diagnostic tests-serum PTH, radiographs may show bone density, calcium and phosphate.
therapuetic-calcitonin, parathyroidectomy
Nursing diagnosis-risk for injury R/T to bone demineralization

Front 57

disorders of the adrenal glands

Back 57

a rare tumor in the adrenal medulla called pheochromocytoma causes hypersecretion of epinephrine and norepinephrine
hypersecretion of cortisol from the adrenal cortex results in Cushings syndrome
hypofunction of the adrenal cortex results in Addisons disease

Front 58

SSX of Pheochromocytoma

Back 58

arises from the chromaffin cells in the adrenal medulla
exagerated fight or flight synptoms-because of norepinephrine
hypertension
tacycardia(HR over 100)
palpitations
tremors
diaphorisis
feelings of apprehension
severe pounding HA
N/V
constipation
glucose may increase
unstable intermitent hypertension is most commone-diastolic>115-at risk for stroke, vision changes and organ damage

Front 59

diagnostic test for Pheochromocytoma

Back 59

24 hour urine test for metanephrine and vanillylmandelic acid(VMA)
Pt should avoid caffeine and medications for 2 days before the test-if results are elevated a CT scan or MRI for location of tumor

Front 60

interventions for Pheochromocytoma

Back 60

surgical removal of both adrenal glands-must be stabilized before surgery
alph-blocking medication(dibenzyline) dilate blood vessels to control acute hypertension
beta-blocker meds may be added to block beta-adrenergic receptors in the heart and lungs to reduce fight or flight symptoms

Front 61

adrenocortical insufficiency/addisons disease

Back 61

insufficient production of the hormones of the adrenal cortex

Front 62

adrenocortical insufficiency/addisons disease

Back 62

reduced levels of cortisol or aldosterone or both
and a deficiency in androgens may exist

Front 63

adrenocortical insufficiency/addisons disease

Back 63

in Primary-ACTH are up in an attempt to stimulate the adrenal cortex to synthesize more hormones
secondary-deficient ACTH fails to stimulate adrenal steroid synthesis

Front 64

adrenocortical insufficiency/addisons disease

Back 64

is thought to be autoimmune-gland destroys itselfin response to TB, fungal infection, AIDs and metastatic cancer
secondary AI-caused by dysfunction of the pituitary or hypothalamus

Front 65

SSX of adrenocortical insufficiency/addisons disease

Back 65

hypotension-lack of aldosterone(aldosterone causes sodium and water retention) if deficient sodium and water are lost casuing tacycardia and hypotension
low cortisol levels cause hypoglycemia, weakness, fatigue, weight loss, confusion, and psychosis
in primary AI-ACTH may cause hyperpigmentation of the skin-Pt is tanned or bronzed appearance
coma or death if not treated

Front 66

adrenal cortex think of salt, sugar, and sex

Back 66

aldosterone promtes salt
cortisol promotes sugar
androgens-are sex hormones