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78 Cards in this Set
- Front
- Back
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Acromegaly & Giantism
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a rare condition resulting from excess secretion of growth hormone (GH).
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Diag for excess GH/hyperfunctioning pituitary gland
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Serum GH lvls
Serum Glucose (glucose inhibs GH) CT or MRI to locate size of tumor |
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Collab care for excess GH/hyperfunctioning pituitary gland
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Colab care:
surg: transplenoidal hypophysectomy radiation: when surg has failed drug therapy: Acromegaly: octreotide (sandostatin), reduces gh lvls. Subq 3x a week |
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Describe Acromegaly
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Thickening of bones and soft tissue,
Anterior Pituitary disorder -Later age clinical mane: -bone enlargement -HTN -Heart failure |
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Giantism
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- Early age
- Anterior Pituitary disorder - backache, arthritis, joint pain |
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Assessment for acromegaly
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- signs of increasing physical size (shoe, ring, hat, glove)
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Most common drug used for Acromegaly
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-octreotide (sandostatin): a somatostatin analog that reduces GH lvls. Subq 3x a week
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Radiation therapy for GH excess
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- Used when surgery fails.
- Usually offered in combination with drugs that reduce -GH lvl - irradiation used to decrease size of tumor - gamm knife also used |
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Nursing management for excess GH post-op
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- check nasal dressing/drip for CSF
- elevate HOB - Neuro checks fluid replacement, I&O |
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Hypofunctioning of Pituitary gland clinical manifestation
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- decrease GH in kids: dawfisim
- decreased FSH in women: amenorrhea (absent of menstrual period), infertility |
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Diag studies for hypofunctioning Pituitary gland
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- pituitary hormone test
- CT, MRI for detecting tumors - Cerebral angiography |
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Collab & nursing management for hypofunctioning pituitary gland
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- Hormone therapy replacement
- surgical excision of tumor |
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Hyper-secretion of LH & FSH (tropic Hormones)
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- early onset menopause
- orchitis (inflamed testicles) |
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Hyper-secretion of prolactin (tropic Hormones)
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- inappropriate lactation in either gender
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Hyper-secretion of ACTH (tropic Hormones)
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- Cushing's disease
- excessive glucorticosteroid |
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Hypofunction
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too little hormones produced
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hyperfunction
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too much hormones produced
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What causes endocrine problems (Target organ)
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-organ failure/dysfunction
End the organ problem |
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What causes endocrine problems (control mechanism)
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- Pituitary failure/dysfunction
regulating hormone problem |
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List the anterior pituitary hormones
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- GH (somatotropin)
- TSH (thyrotropin) - ACTH (tropic hormone) - FSH, LH (tropic hormone) - MSH (tropic hormone) - Prolactins (tropic hormone) |
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List the posterior pituitary hormones
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- oxytocin
- ADH (vasopressin) |
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List the Thyroid hormones
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- Thyroxine (T4)
- Trilodothyronine (T3) - Calcitonin |
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List the parathyroid hormones
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- PTH (parathormone)
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List the adrenal medulla hormones
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- Epinephrine
- norepinephrine Fight or Flight hormones |
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List the adrenal cortex hormones
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- corticosteroids
- androgens - mineralcorticoids |
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List the pancreas hormones
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- insulin
- glucagon - somatostatin - pancreatic polypeptide |
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Functions of the Thyroid gland
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- regulate metabolism
- iodine is needed to produce thyroid hormones |
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Functions of the parathyroid gland
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- regulates calcium
- parathyroid hormone |
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Functions of the adrenal cortex
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sugar, salt, & sex
- Glucocorticoids/cortisol (SUGAR) - Mineralcorticoids/Aldosterone (SALT) - Androgen (SEX) |
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Gerontologic considerations
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- Decreased hormone production & secretion
- altered hormone metabolism & biologic activity - alterations in cardiac rhythms |
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Functions of the pancreas
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Endo & exocrine
- Exocrine: produce digestive enzymes, requires a duct - Endocrine: Islets of Langerhans (4 cell type), ductless. - Alpha cells -> Glucagon - Beta cells -> insulin - Delta cells -> somatostatin - F cells -> pancratic polypeptide |
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SIADH (too much ADH) clinical manifestations
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- increased ADH -> Oliguria (low urine output)
- increased body weight w/o peripheral edema - anorexia, N/V - muscle cramps - confusion, seizures, coma |
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SIADH (too much ADH) diagnostic studies
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- Urine: increase specific gravity & osmolality
- Blood: hyponatremia, decreased serum osmolality & HCT |
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SIADH (too much ADH) collaborative/nursing care
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- fluid restriction, strict I&O, urine sp gravity q1h
- bed rest, w/ HOB elevated <10 degress (enhance venous return to the heart. - must be together: - IVF 3% saline - Demeclocycline (blocks ADH at renal tubules) - daily weights - assess for changes in LOC - Seizure precaution - check for S&S of heart failure (dyspnea, peripheral edema) |
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What us Diabetes Insipidus
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- deficiency of production of or secretion of ADH (not enough), resulting from fluid or electrolyte imbalance
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Types of Diabetes insipidus
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-central DI (neurogenic): interference with ADH synthesis or release. Brain tumor, head injury, brain surgery, CNS infection
- Nephrogenic DI: inadequate renal response to ADH despite adequate amount present. Drug therapy (lithium), renal damage, or hereditary renal disease. - Primary DI: excessive water intake. Structural lesions in thirst center or psychologic disorder |
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Immediate goal for caring for a patient with DI
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re-establish fluid & electrolyte balance
-IVF hypotonic saline or D5W - low Na diet - thiazide diuretics |
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Hormone replacement for DI
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- Slightly diminished ADH: Diabinese (chlorpropamide)
- Severely diminished ADH: Piressin (vasopressin), DDAVP (desmopressin acetate). |
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clinical manifestations of Hyperthyroidism
(Graves or Toxic Goiter) |
- heat intolerance (cause thyroid storm)
- Dsypnea r/t O2 consumption - palpitation, tachycardia - fatigue, insomnia - fluid loss (dyspnea & sweating) - exophthalmus |
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Diagnostic studies for Hyperthyroidism
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- T3 & T4 levels increased
- TSH levels decreased (target organ cause) - TRH suppression test - Thyroid nuclear scan - Thyroid antibody studies |
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Collaborative care for Hyperthyroidism
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- Iodine
- Thyroid hormone antagonist --- PTU (prophylthiouracil --- Tapazole (methimazole) - beta blockers (inderal/propranolol) - high calorie diet (4000-5000) - radioactive iodine therapy - radiation therapy - thyroidectomy |
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nursing management of Hyperthyroidism
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- cool quiet room
- exophthalmus --- artificial tears & dark glasses --- elevate HOB --- tape eyes closed while sleeping Post OP - O2, suction, tracheostomy tray at bedside - maintain airway - semi fowlers - monitor vitals, assess for Tetany (involuntary muscle contractions) - assess for hoarseness and stridor |
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Complication of Thyroid Storm (thyrotoxicosis)
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- hyperthermia to 105
- severe tachycardia, systolic hypertension - shock delirium, coma |
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Collaborative care for Thyroid Storm
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- Lower temp (cooling blanket, cold bath, tylenol)
- O2 - bed rest - decrease stressors - monitor temp, I&O, neuro status, CV status Q1hr |
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Etiology of Hypothyroidism
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- Congenital (cretinism)
- Primary thyroid failure (hashimoto thyroid) - latrogenic (destruction by radiation or surgical removal) |
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Clinical manifestation of Hypothyroidism
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- cold tolerance
- Bradycardia - fatigue, lethargy - constipation (slow metabolism) - impaired memory - hair loss - weight gain |
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Diagnostic studies Hypothyroidism
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- T3 & T4 levels decreased
- TSH --- increased if thyroid problem --- decreased if hypothalamus /anterior pituitary problem |
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Collaborative care for Hypothyroidism
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- life long hormone replacement therapy
-- Synthroid (levothyroxine) |
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Nursing management of Hypothyroidism
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- O2
- meds as ordered - monitor vitals, daily weights - monitor for signs of edema -- take meds same time each day |
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Manifestations of Myexdema
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- hypotension
- hypoventilation (respiratory failure) - Hypothermia - Hypoglycemia - coma |
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Collaborative care for Myexdema
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- IV thyroid hormone repacement
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Etiology of Hyperparathyroidism
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Primary: increased PTH secretion, tumor
Secondary: hypocalcemia (conditions) Tertiary: feedback disruption |
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Clinical manifestations of Hyperparathyroidism
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"moans, groans, stones, & bones" r/t hypercalcemia
- muscle weakness, fatigue - increased need to sleep - anorexia, constipation - kidney stones - emotional disorders - mental changes |
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Diagnostics studies of hyperparathyroidism
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- increased serum PTH level
- increased serum Ca levels (>12mg) - decreased Phosphate (<3mg) |
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Collaborative care for hyperparathyroidism
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- parathyroidectomy (remove 3 of 4)
- IVF to correct dehydration - Lasix (Ca lowering diuretic) - Phosphorus supplements - Calcitonin to inhibit release of Ca - Calcimimetic to decrease PTH secretion |
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Nursing management for Hyperparathyroidism
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Post-op same as thyroidectomy.
-- monitor for signs of tetany -- have IV Ca gluconate readily available - monitor Ca, K, PO4, Mg levels - ecourage mobility to promote bone calcification - diet & exercise |
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Etiology of Hypoparathyroidism
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- Iatrogenic (most common)
- Hypomagnesium |
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Clinical manifestations of Hypoparathyroidism
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- Tingling of lips & fingers
- increased muscle parathesia, stiffness, and cramps - Dysphasia (swallowing) |
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Complications of Hypoparathyroidism
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- Tetany (positive Chvostek's & Trousseau's signs)
- Laryngospasm, respiratory compromise |
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Diagnostics studies for Hypoparathyroidism
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- serum PTH
- Serum Ca low & serum PO4 elevated |
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Collaborative care for Hypoparathyroidism
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- IV Ca (calcium gluconate)
- Ca supplements (1.5 - 3gm /day) - Vitamin D supplement (help use/absorb calcium) -High Ca /Low PO4 diet |
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Cushing disease Clinical manifestations
(adrenocortical hyperfunction) |
- Truncal obesity /w thin extremity
- Friable skin (bruise /tears easily) - moon face - purple striae on abdomens, breast, buttocks - hypertension |
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Complication of Cushings
(adrenocortical hyperfunction) |
- Glucose intolerance
- protein wasting - osteoporosis - immunosuppression |
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Diagnostics studies for Cushings
(adrenocortical hyperfunction) |
- blood: cortisol, ACTH, Na, K, glucose levels
- Urine: 24-hr urine for free cortisol - Dexamethasone suppression test |
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Collaborative care for Cushings
(adrenocortical hyperfunction) |
- transsphenoidal hypophysectomy
- Adrenalectomy (remove adrenal glands) - Drug therapy ---- Mitotane (lysodren) suppress cortisol production |
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Nursing management for Cushings
(adrenocortical hyperfunction) |
- glucose monitoring
- I&O, daily weights - assess wound healing - assess mental status - assess bone pain, ROM limitations - corticosteroids as ordered - assess for hypotension |
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Clinical manifestations of Addison's
(adrenocortical hypofunction) |
- weakness, fatigue, anorexia, weight loss
- hyperpigmentation - hypotension, hyponatremia, hyperkalemia - N/V, diarrhea - irritability, depression |
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Complication of Addison crisis
(adrenocortical hypofunction) |
- often fatal
- sudden pain in lower back, abdomen, or legs - severe vomiting, diarrhea, dyhydration - severely low BP - loss of conciousness |
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Diagnostics studies for Addisons
(adrenocortical hypofunction) |
- ACTH stimulation test
- increased K & BUN - decreased Na, Cl, & glucose - Hgb/Hct indicate anemia - decreased Urine free cortisol - ECG: peaked t-waves r/t hyperkalemia - CT, MRI |
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Collaborative care for Addisons
(adrenocortical hypofunction) |
- long term daily replacements
--- glucocorticoids - divide doses (2/3 in AM & 1/3 in PM) --- mineralcorticoids - Increased salt in diet |
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Nursing management for Addison disease
(adrenocortical hypofunction) |
- freq vitals
- I&O, daily weights - assess for fluid vol deficit - corticosteroids as ordered - protect against infection - protect against extreme of nose, light, & temp - Do not abruptly stop taking corticosteroid |
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Clinical manifestations of hyperaldosteronism
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- increase aldosteron: Na retention & K wasting
- Na retention-> hypernatremia, HTN, headache - K wasting -> hypokalemia (muscle weakness, fatigue, cardiac dysrhythmias, glucose intolerance, teatany) |
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Diagnostics studies for Hyperaldosteronism
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- increased Aldosterone & Na levels
- decreased K level & renin activity |
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Collaborative care for Hyperaldosteronism
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- replace K, then K sparing diuretic
- low Na diet - Aldosterone receptor antagonist (Aldactone) - Adrenalectomy - monitor BP closely - monitor for fluid & electrolyte imbalance |
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Etiology of Pheochromocytoma
(adrenal medulla) |
- Catecholamine producing tumor
- Tumor of the adrenal glands - Requires surgery |
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Clinical manifestations of Pheochromocytoma
(adrenal medulla) |
5 P's
- Pressure: HTN - Pallor - Palpitations - Perspirations (profuse) - Pain (pulsating headaches) |
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Diagnostics studies for Pheochromocytoma
(adrenal medulla) |
- Urine: 24-hr urine for VMA
- Blood: plasma catecholamine - CT, MRI |
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Collaborative care for Pheochromocytoma
(adrenal medulla) |
- surgery to remove tumor
- Ca channel blockers, beta blockers - Rise slowly (postural hypotension) - monitor blood glucose - bed rest, nutritional & emotional support |
