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156 Cards in this Set
- Front
- Back
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Medulla stores...
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Epinepherine and norepinepherine
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Endocrine
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hormones secreted into the blood stream
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Exocrine
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hormones secreted through the ducts
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hypothalamus secretes
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ADH and Pitocin
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The hypothalamus is resposible for maintaining what within the body?
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Homeostasis
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Hypothalamus controls...
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Temperature
Respiration blood pressure |
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Hypophysectomy
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removal of the pituitary gland
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Pituitary (Hypophysis) compromised of what 2 lobes
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Anterior (Neuro-hypophysis)
Posterior (adeno-hypophysis) |
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Posterior (neuro-hypophysis) does what?
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Stores and releases ADH and pitocin made in the hypothalamus.
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Pitocin
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contraction of the uterus
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ADH
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Anti-diuretic hormone- makes you retain water
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Anterior (adeno- hypophysis) secretes what?
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endorphins in response to pain, exertion and stress
STH (Somato (body) trophic (growth) Hormone (GH)) MSH Melanocyte- stimulating hormone TSH (thyroid stimulating hormone) Gonadotrophic |
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MSH (Melanocyte-stimulating hormone)
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regulates pigmentation of skin
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TSH (thyroid stimulating Hormone)
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stimulates to produce T3 and T4
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Gonadotrophic
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sexual organs and hormones produced by them.
LH ICSH FSH PRL |
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ACTH (adeno cotico tropic hormone)
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Stimulates cortex of the adrenals to produce the 3 S's
SEX SALT SUGAR |
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Sex hormone
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androgen (testoterone and estrogen)
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Salt hormone (minerocorticosteroids)
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aldosterone (balances water and sodium) MAIN HORMONE****
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Sugar hormone (glucocorticosteroid)
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cortisol
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Cortisol
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coping chemical/homeostasis, it manages stress..
Makes you hyperglycemic (increases sugar) |
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Thyroid regulates
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hypercalcemia
Calcium: BLOOd---->BONE |
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Aredia
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calcitonin substitute
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Parathyroid deals only with..
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Hypocalcemia
calcium: BONE---->BLOOD |
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Craziness with calcium and thyroid and parathyroid...
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Because hypercalcemia has a different organ (thyroid). If you are hypercalcemic, thyroid works with calcitonin. When blood has low calcium, hypothalamus tells parathyroid to produce OTH which takes calcium from bone/teeth to maintain calcium supply.
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Pancreas secretes...
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Insulin, glucagon, sandostatin and glycogen that enters the bloodstream
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Pancreas excretes...
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amylase
lipase trypsin pepsin through a duct into GI system |
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Thymus produces...
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antibodies and T cells
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Transohynoidalectomy
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removal of pituitary
*N.I. Periodically check for leakage of CSF under upper lip gauze. |
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outragiuosly high cortisol can cause ....
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cushings syndrome
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Synthetic T4 drug
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Synthroid
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Synthroid is given because...
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because thyroid is in atrophy and is not producing the hormone.
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Gonadotrophics are given because...
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with the pituitary gone..estrogen will need to be replaced. This keeps gonads alive and well. If not, they will shrivel and she will be menopausal at 30.
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Cortisol can be given which route...
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IM
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Cortisol keeps us ....
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homeostatic... When the body incours any kind of stress cortisol is produced to keep body functioning properly during stress. **NEVER stop cortisol b/c it causes withdrawal reactions b/c body needs it for balance**
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DDAVP
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temporary ADH drug
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considerations for a person on DDVAP...
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People without ADH lose up to 20-30L of fluid a day. Speecific gravity is the test. Specific gravityof 1 in these pts. Their urine is flying through them withouttaking any waste with them. Once Specefic gravity begins to climb (1.010 -1.025) THEY CAN BACK OF THIER ddvap.Things are calming down and thier ADH is coming down and being used as it should be.
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Rule of thumb with steroids...
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do not drop off fast. keep us in homeostasis.
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Hypothyroidism
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underactive state of teh thyroid gland, resulting in the absence or decreased secretion of thyroid hormone.
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"Simple Goiter"
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Unilateral because gland isnt good. Non toxic. seen in hypothyroidism
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lack of what can shut down the thyroid...
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Iodine in the diet
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Hypothyroidism is caused by...
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Autoimmune disease (Hashimoto)
Thyroidectomy Overuse of antithyroid drugs Malfunction of the pit. gland Use of radioactive Iodine Inflammatory conditions Toxemia of pregnancy |
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What happens if you keep producing TSH and stimulating the thyroid?
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Heart will go into arrythmis and eventually MI
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Goiter
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Hypothalamus keeps stimulating the thyroid; when thyroid is being over stimulated,, it gets bigger like a muscle.
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In hypothyroidism the hypothalamus...
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reads that you are too low in T3 and T4 and pours out TSH. Not helping since the problem is in the thyroid. TSH from the hypothalamus is HIGH; T3 and T4 from thyroid (where the problem lies) are LOW.
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S/S of Hypothyroidism
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Prolonged Menses
Metabolism slows down sleepy course hair decreased met. weight weight gain Bradycardia simple goiter |
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If T4 is low and TSH is low...
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the problem is with the pituitary.
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Myxedema
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hypothyroidism in adulthood.
thyroid goes down |
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Myxedema Coma
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life threatening
the heart muscle gets flabby, increasing in size, leading to decreasing cardiac output and decreased tissue perfusion. May be impaired skin integrity d/t dryness and cracking. TX: Synthroid. |
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A reallly large goiter that is causing swallowing or breathing problems will require a...
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thyroidectomy
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Cretinism
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hypothyroidism in utero
born with low thyroid |
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S/s of cretinism
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hoarse cry
very lethargic cant keep body heat up difficult nursing resp. difficulty |
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hyperthyroidism
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increased synthesis of thyroid hormone from overactivity or change in the thyroid gland.
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Thyrotoxicosis
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problem with the hypothalamus
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toxic multinodular goiter
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healthy thyroid gets big uniformaly big thick neck
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foods that slow down thyroid function...
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strawberries
peaches cruciferous foods (cauliflower) |
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causes of hyperthyroidism
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graves disease
increased TSH secretion thyroid adenomas pit. tumors psychological or phys. stress infection DKA Excessive Iodine intake Sx toxemia of pregnancy |
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S/S of hyperthyroidism
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increased metabolism
brittle hair emotionally labile weight loss despite increased appetite manic behavior arrythmias tachycardia palpitations Exophthalmos bruit or thrill over thyroid |
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Exophthalmos
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bulging eyes
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Graves Disease
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hyperthyroidism
High T3 and T4 Toxic multinodular goiter exophthalmos |
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Tx for hyperthyroidism
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Remove and start Synthroid
SSKI (saturated solution of Potassium Iodine) Radioactive Iodine |
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SSKI
(Saurated solution of Potassium Iodide) |
decreases vascularity around the thyroid to decrease resposiveness; the hope is that the thyroid burns out so that you have to have it removed and you can just start getting synthroid.
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watch for what with an increased thyroid...
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racing heart and h/a
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thyroid storm
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can be caused by manipulation (even sx)
temp 102-106 (may be rapid) tachycardia high htn diarrhea, tremors, psychosis and seizures |
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Tx for a thyroid storm
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decrease temp
fluid and electrolytes decrease HTN |
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Calcitonin
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hypothalamus senses hypercalcemia and stimulates thyroid to porduce calcitonin to take calcium out of the bloodstream to put back into bones and teeth.
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TA test
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thyroid antibodies test
Elevelted with Hypo |
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TSH
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decreased in primary hyperthyroidism
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parathyroid has how many glands
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4 total....2 on each side of thyroid
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cushings syndrome
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HIGH CORTISOL
hypersecretion of glucocorticosteroids |
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S/s of Cushings syndrome
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Buffalo hump
moon face redistribution of fat spindly extremeties/ thick midriff hyperglycemic HTN High in Na+ and decrease in K+ |
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Tx for Cushings Syndrome
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Get rid of adrenals
No antidote |
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Addisons disease
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LOW CORTISOL
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S/S of Addisons disease
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hypotensive
High in K+ and Low in Na+ Poor response to any kind of stress |
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Tx for Addisons Disease
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give cortisol in the form of prednisone.
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Routes for steroids...
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never give SQ b/c its hard on the tissue. IM, IV, PO only
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Route of ACTH...
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Thick and oily and comes in injection; so usually you dont take this; just give cortisol PO
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17Keto and 17Hydroxy steroids
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test that checks out entire activity of the adrenal cortex.
24 hour urine test checks the activity or function of the cortex |
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Iatrogenic
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treatment causes an illness
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pheochromocytoma
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benign tumor on the exterior adrenal that pushes on the medulla.
Increases BP because of pushing out NE and epi Go to MD because you are lightheaded/dizzy because of high BP *Drugs and diurectics dont affect it* |
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VMA
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24 hour urine test given for phenochromocytoma. anything with vanilla will throw the test; take a jug home for 2 days . do not eat any chocolate, tea, fruits, caffiene.(for 2days) High VMA is conclusive
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disorders of the anterior pituitary...
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acromegaly
gigantism dwarfism |
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acromegally
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enlarged extremities
progressive as your GH goes up over time; excess as an adult. Usually as the result of a pit. tumor. |
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S/S of acromegally
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large forehead
lengthening of the maxilla deep voice peripheral nerve damage CHF,HTN,CVA, Diabetes, arthalgia |
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Tx of acromegally
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surgical removal and sandostatin
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gigantism
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excess in a child
usually the result of a tumor it occurs before the closure of the epiphyseal plates thus ccausing excessive growth "all over" until puberty. |
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Growth hormone will go to any place in the body that has...
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cartilage
(started as carpel tunnel syndrome) ex: TMJ |
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Disorders of the Post. Pit.
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SIADH
Diabetes Insipidous |
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SIADH
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Too much ADH production
Holding fluid but not edematous Hyponatremia |
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Sodium level for SIADH
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115
too much fluid dilutes it |
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Tx for SIADH
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add Sodium
Give 3% NaCl |
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ABX for SIADH
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tetracycline (Demecyclocycline)
increases urine flow |
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Nursing considerations with SIADH
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Restrict fluids to 1 liter per day
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manifestations of SIADH
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may be caused by barbituates, anesthesia and pit. sx
very much like water intoxification LOC changes d/t swelling in brain cells from so much fluid water retention without the edema |
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Diabetes Insipidus
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Too little ADH production
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what blocks ADH
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alcohol and caffiene
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Causes of ADH
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unknown
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"urinate out of control"
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ADH which stops diuresis is very low.
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ADH is made...
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in the hypothalamus but distributed by neuropophysis (post. Pit)
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How much water do you lose with Diabetes insipidus
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20-40 liters in one day. Water does not stay in the body long enough to take out all waste.
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specific gravity will be low in...
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diabetes insipidus
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Tx for diabetes insipidus
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DDAVP
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route for DDVAP
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nasal spray or PO
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what tx can be used for bed wetting...
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DDVAP
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Pineal gland is responsible for...
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Melatonin
Circadian rhythym |
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Low light=
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High melatonin
--depression and blocked gonads |
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High Light=
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low melatonin
--fertility is high because gonads are not blocked |
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Seasonal Affective disorder
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30 minutes of full spectrum light to treat is like 3-4 hours outside in the sun.
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Di Geaorge Syndrome
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not enough antibodies or T cells; compromised immune system.
Usually found in children |
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DiGeorge Syndrome S/S
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lack of antibodies
usually develop cardiac problems hypocalcemic "fish mouth" in children may have low set ears ; down slanting eyes -veery prone to infection -no cure |
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Alpha cells
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Glucagon
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Beta cells
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Insulin
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Delta cells
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Somatistatin gastric enzymes that blocks secretion of glucagon and insulin
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what is the catalyst that takes sugar to the muscle?
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Insulin
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Regular insulin start
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30 min.
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regular insulin peak
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4 hours
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regular insulin length
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8 hours
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NPH insulin start
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1.5 hours
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NPH insulin peak
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12 hours
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NPH length
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24 hours
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70/30 insulin starts
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.5 hour
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70/30 insulin peak
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12 hour
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70/30 length
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24 hour
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Novolog/Humalog/Lispro insulin start
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5-15 min.
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Novolog/Humalog/Lispro insulin peak
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2 hours
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Novolog/Humalog/Lispro insulin length
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4 hours
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Lantus insulin start
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2 hours and stays at that level
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Lantus insulin length
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24 hours
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what does ACTH IM and cortisol PO do?
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keeps hypothalamus stimulated so cortisol does not dry up.
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"hot and dry"
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sugar high
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"cold and clammy"
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need some candy
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diabetic coma
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if in a diabetic coma we always assume they arer hypoglycemic
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cold and clammy
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hypoglycemic
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hyperglycemia
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you have limited or no diaphoresis
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HBA1C
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determines how long term non compliance over the past 120 days
You want a 6-7 score. Shows the life of the RBC. Shows how abused the RBC is over its 120 day lifespan. |
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If you are unsure with a diabetic of being hyper or hypo....
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always treat as if hypo...can always give sugar and sugar can not kill you.
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Diabetic is allowed how many carbs per meal
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9 (27 per day)
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1 carb =
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15 grams
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1 unit of insulin will cover how many grams of carbs
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15
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Byetta
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stimulates the islets for type 2 DM. It helps to produce and activate a hormone in the GI tract causing slower absorption of food. and will increase insulin productiona little.
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Amlyn/Simalyn
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slows down the gi tract digestion
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DKA
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BGL > 250
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HHNS
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BGL > 600
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1 unit of insulin can lower the WBG...
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50 and cover 15 gms of carbs
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Exybera
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Inhaled hormone but is not good for children or anyone with resp. disorders
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Dawn Phenomenon
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GH causes blood glucose to elevate. Between 3 and 8 am the blood sugar will rise. We release for GH at night so WBG goes up some.
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which is the biggest of the four pancreatic enzymes
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AMylase
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Diabetic reaction to ketones
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Hyperglycemic
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Insulin reaction to ketones
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Hypoglycemic
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Pancreatitis
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Inflammation of the pancreas. Too much sugar precipitates it (ETOH abuse issue)/. Lots of alcohol makes it really hard.
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S/S of pancreatitis
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High amylase
position called knee chest; buddha position |
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Tx for pancreatitis
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NPO and posssibly a salem sump for decompression
antacid anticholerngic to rest stomach maybe even tpn IV fluids No fat, alcohol, spicy foods, or cafffiene |
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Metformin
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kicks sugar into the cell...
Type 2 med |
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Jenuvia
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stimulates pancreas islets and slows up GI ttract absorption.
TYpe 2 med |
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Janumet
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only works when you eat
BGL does not go lower (no hypo effect) type 2 med combo metformin and jenuvia. |
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Drawing up insulin
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Air in cloudy first then air in clear then draw from clear.
---cloudy then clear. |
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what do you give if you suspect hypoglycemic
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OJ
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