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108 Cards in this Set
- Front
- Back
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What gland is the master gland, sending out all the stimulating hormones?
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Anterior pituitary
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What hormones does the posterior pituitary secrete?
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ADH and Oxytocin
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What hormones does the hypothalamus secrete? (7)
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1. Corticotropin-releasing hormone
2. Gonadotropin-releasing hormone 3. Growth hormone-inhibiting hormone 4. Growth hormoe releasing hormone 5. Melanocyte inhibiting hormone 6. Prolactin-inhibiting hormone 7. Thyrotropin releasing hormone |
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What is the FUNCTION of the hypothalamus?
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Controls involuntary functions, endocrine processes, temp, sleep, appetite
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What hormones do the anterior pituitary produce?
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Adrenocorticotropic hormone
Follicle-stimulating hormone (FSH) Growth hormone (HGH) Luteinizing hormone (LH) Melanocyte-stimulating hormone (MSH) Prolactin Somatotrophic growth-stimulating hormone Thyroid stimulating hormone (TSH) |
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What gland influences the anterior pituitary?
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Hypothalamus
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What functions do the pituitary gland have? (3)
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Promotes growth of body tissue
influences water absorption by the kidney controls sexual development and function |
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What does the adrenal cortex secrete? (2 types of hormones)
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glucocorticoids, mineralocorticoids
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What is the glucocorticoid and what does it do?
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Cortisone
Glucose metabololism, fluid and electrolyte balance, suppresses the inflammatory response to injury, immune response, resistance to stress |
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What is the mineralocorticoid, and what does it do?
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Aldosterone
Regulates electrolyte balance by promoting sodium retention and potassium excretion |
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Where is the adrenal medulla?
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Inner core of adrenal gland
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What does the adrenal medulla produce?
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Epinephrine and norepinephrine
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What does the thyroid gland produce and what does it do?
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T3, T4, thyrocalcitonin
Controls body metabolism |
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What does the parathyroid gland produce and what does it do?
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PTH
Controls calcium and phosphorus metabolism |
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What does the pancreas produce and what does it do?
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Insulin and glucagon
influences carb metabolism |
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What is the negative-feedback loop?
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Increased amounts of target gland hormones in the bloodstream decrease secretion of the same hormone and other hormones that stimulate its release
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What is radioactive iodine uptake used for, the normal levels, and what does increased/decreased indicate?
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Tests thyroid function
3-10% at 2-4hrs and 5-30% at 24hrs Increased means hyperthyroidism, decreased means hypothyroidism Contraindicated in pregnancy |
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Normal labs for T3 and T4
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T3 - 80-230ng/dL
T4: 5-12mcg/dL |
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Normal lab for thyroxine
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0.8-12ng/dL
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TSH blood test differentiates b/w...
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primary hypothryoidism
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Normal lab value for TSH and what gland produces TSH?
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0.2-5.4microunits/mL
Anterior Pituitary Decreased values indicate hyperthyroidism or secondary hypothyroidism |
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Is the level of radioactive medication in a thyroid scan dangerous to the pt?
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No
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What should you ask the pt before a thyroid scan.
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Have you had radiographic contrast agents within the past 3 months?
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Check with the physician about d/c what meds before thyroid scan?
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Iodine containing meds and thyroids meds
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What instructions should the pt receive with a thyroid scan?
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Remain NPO after midnight and fast for 45 min after ingestion of oral isotope. Scan will be performed in 24 hours.
If IV technetium is used, it is administered 30 min before the scan. |
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Nursing implications for needle aspiration of thyroid tissue
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No client prep necessary; apply light pressure to the aspiration site
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Glucose tolerance test (GTT)
How do they do it? |
2 hours after ingestion of glucose, blood sugar higher than 200 = diabetes
Blood sample drawn for determination of fasting blood glucose level, then client drinks a high-glucose drink. Blood samples taken at 30 min intervals for a min of 2 hours. |
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Client prep for glucose tolerance test
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Eat a diet with 150g of carbs for 3 days before test.
Avoid alcohol, coffee, and smoking for 3 days before test. Avoid strenuous exercise for 8 hours before and after the test. Withhold am insulin or oral hypoglycemic. |
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HbA1C normal lab and what does it reflect
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<7%; glucose control for past 3-4months
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Glycosylated serum albumin (fructosamine) lab and what does it reflect
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1.5-2.7 for nondiabetic
2-5 for diabetic glucose control over past 2-3 weeks |
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Symptoms of hypopitiutarism (5)
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Mild to moderate obesity (GH, TSH)
Reduced cardiace output (GH, ADH) Infertility, sexual dysfunction (gonadotropins, ACTH) Fatigue, low BP (TSH, ADH, ACTH, GH) Tumors of pitiutary cause headaches and visual defects (pitiutary is located near optic nerve) |
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Acromegaly is...
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Too much growth hormone after the epiphesial plates close
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Symptoms of acromegaly
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Enlarged bones and soft tissue in nose, tongue, and jaw (so check airway)
HTN, cardiomegaly Enlarged feet, hands, jaw, tongue Excessive sweating, body odor Hoarseness, joint pain, weakness |
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Acromegaly meds (3)
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Bromocriptine
Sandostatin Somavert (GH receptor antagonist) |
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Bromocriptine uses
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Parkinson's, acromegaly b/c it reduces GH, hyperprolactinemia
Dopamine agonist |
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Bromocriptine SE and what does it do
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Orthostatic hypotension, nausea, dizziness, drowsiness
Dopamine agonist Take with food or at bedtime to decrease SE. |
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Sandostatin what does it do and what is it used for?
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Acromegaly
Decreases GH, insulin, glucagon Helps with diarrhea b/c it suppresses gastroenterhepatic peptides. Monitor for hypoglycemia. |
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What is Sandovert used for?
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Acromegaly
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Treatments for acromegaly (2)
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Steriotactic radiation
Transphenoidal surgery - removal of pituitary tumor |
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What is transphernoidal surgery used for and what are the nursing implications?
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Pituitary tumor like in acromegaly
HOB raised. Deep breathing, no coughing. Oral care q4h with rinses and sponges. Neuro checks. Check for CSF fluid. (halo effect) |
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What syndrome can be caused by transphenoidal surgery as a complication?
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SIADH b/c the posterior pituitary can be affected by messing with the anterior.
So, monitor I&O CSF leak - check nasal drainage for glucose |
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What is diabetes insipidus?
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Hyposecretion of ADH by posterior pituitary caused by stroke, trauma, or idiopathic. Kidneys fail to reabsorb H2O
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s/s of diabetes insipidus
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Poluria of 4-24L/day
Polydipsia Dehydration Low urinary specific gravity (1.006 or lower) Postural hypotension Tachycardia Fatigue Muscle pain and weakness Headache |
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Interventions for diabetes insipidus
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Maintain intake of fluids.
I&O Avoid food that produce diuresis Safe environment (postural hypotension) Monitor VS and neuro status Medic-Alert bracelet |
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Meds for diabetes insipidus
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vasopressin
desmopressin (INJ, Nasal, PO) |
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ADH hormones and interventions
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vasopressin, desmopressin
Monitor for H2O intoxication (daily weights, BP, electrolyte levels) Teach pt to report signs of headache or SOB. |
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Syndrome of inappropriate antidiuretc hormone: what is it?
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To much ADH by posterior pituitary. Causes water intoxication and hyponatremia.
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Symptoms of SIADH
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Dark urine
Hyponatremia, Tachycardia/HTN Weight gain Changes in LOC Fluid volume overload |
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Treatment of SIADH
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Eat salt/protein
NS or hypertonic saline No more than 800-1000ml fluid/day HOB no more than 10 degrees Seizure precautions Divertion from thirst Diuretics |
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What is Addison's disease?
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AdDison's disease = DOWN
Not enough glucocorticoids from the adrenal cortex |
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s/s of Addison's disease?
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Low sugar and Na
High Ka and Ca GI disturbances, weight loss, bronzed skin, fatigue/weakness |
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What is the same thing as a corticosteroid?
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Glucocorticoid
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Adrenal cortex produces...
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glucoCORTicosteroids
mineraloCORTicosteroids |
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What do corticosteroids affect?
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glucose, protein, bone metabolism, suppress inglammation, immune response, antistress
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SE of corticosteroids
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Hyperglycemia
Na and H2O retention Low K and Ca Buffulo hump, moon face, truncal obesity Lower immune system All symptoms of Cushings. |
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What suffixes do corticosteroids have?
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-sone
-lone Hydrocortisone, pednisolone |
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Addison's disease interventions
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Avoid individuals with infection
High protein/carb diet with normal Na intake, low K Avoid strenuous exercise and stressful situations. Need for lifelong glucocorticoid therapy Emergency steroid kit |
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Addisonian crisis is...
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acute adrenal insufficiency precipitated by stress, infection, trauma, surgery, or abrupt withdrawal of exogenous corticosteroid use.
Causes low Na, glucose high K Shock |
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S/S of Addisonian crisis
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Severe abdominal, leg, and lower back pain
Profound weakness Irritability/confusion Severe hypotension Shock Severe headache |
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Interventions for Addisonian crisis
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Administer glucocorticoids IV then orally after the crisis
Monitor vitals, particularly BP. Monitor neuro status noting irritability and confusion I&O Lab values - Na, K, blood glucose IV fluids Protect client from infection Bedrest |
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3 S's of the adrenal glands
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Sugar
Salt Sex |
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What is Cushing's disease?
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Hypersecretion of adrenal cortex - too much glucocorticoids!
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Labs in Cushing's disease
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High salt and sugar
Low potassium and calcium |
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Cushing's disease symptoms
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moon face, buffulo hump, truncal obesity
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BP in Cushing's
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HIGH
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BP in Addison's
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LOW
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Treatments for Cushing's (surgical)
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hypophysectomy, transsphenoidal adenectomy if condition results from too much ACTH from pituitary
adrenalectormy if condition results from adrenal adenoma |
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What is Conn's disease?
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Hypersecretion of mineralocorticoids from the adrenal cortex from an adenoma
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S/S of Conn's disease
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Symptoms r/t hypokalemia, hypernatremia, and HTN
Polydipsia, polyurea Paresthesias Visual changes Low urine specific gravity Elevated serum aldosterone Metabolic alkalosis |
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Interventions for Conn's disease
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Monitor VS, especially BP
Monitor for low K and high Na |
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Medication for Conn's disease and what do you monitor for
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Aldactone - an aldosterone antagonist/K-sparing diuretic
Monitor for hyperkalemia |
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What is pheochromocytoma?
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Tumor in the adrenal medulla that produces excessive amounts of epinephrine and norepinephrine.
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What is a catecholamine?
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Fight or flight hormones produced in the adrenal medulla
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s/s of pheochromocytoma
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HTN
headache palpitation flushing and profuse diaphoresis pain in chest or abdomen with n/v heat intolerance weight loss tremors hyperglycemia |
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Main problem with pheochromocytoma
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HTN crisis
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Medication for pheochromocytoma
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Beta-blockers
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BIG THING TO AVOID IN PHEOCHROMOCYTOMA
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Things that preciptate HTN crisis like increased abdominal pressure, vigorous abdominal palpation, smoking, caffeine, sudden position changes.
Monitor serum glucose. Diet high in calories, vitamins, and minerals. |
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Surgical treatment for pheochromocytoma
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Adrenalectomy
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What to watch for with adrenalectomy
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Hypotension
Urinary output Cardiovascular collapse Hemorrhage Electrolyte and glucose levels |
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What is myxedema coma?
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Severe consequence of hypothyroidism.
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What do you do for myxedema coma?
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Maintain airway.
Aspiration precautions. Administer normal or hypertonic saline. Administer levothyroxine, glucose, and corticosteroids IV. Assess temp and BP freq. Keep client warm. |
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What is it called when a child has little or no thyroid hormone at birth?
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cretism
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Symptoms of hypothyroidism
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Lethargy/fatigue
Weakness, muscle aches, paresthesias Intolerance to cold Weight gain Dry skin and hair, loss of body hair Bradycardia Constipation Generalized puffiness and edema around the eyes and face (myxedema) Forgetfulness, loss of memory Menstrual disturbances Cardiac enlargement, tendency to develop CHF Possible goiter |
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Hypothyroidism interventions
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Administer Synthroid
Monitor HR and rhythm Low-calorie, low cholesterol, low-saturated fat diet Assess for constipation Provide warm environment Avoid sedatives Monitor for overdose of thyroid medications (tachycardia, chest pain, restlessness, nervousness, insomnia) |
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S/s of myxedema coma
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Hypotension
Bradycardia Hypothermia Hypoglycemia Generalized edema Respiratory failure Coma |
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What is Grave's disease?
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Hyperthyroidism
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S/S of hyperthyroidism
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Graves disease
goiter palpitations, cardiac dysrhythmias such as tachycardia or a fib exophthalmos HTN heat intolerance diaphoresis weight loss diarrhea smooth, soft skin and hair nervousness and fine tremors of the hands irritability, agitation, mood swings |
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Interventions for hyperthyroidism (Grave's disease)
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Adequate rest
Sedatives Cool environment Daily weight High-calorie diet Avoid stimulants Administer PTU to block thyroid synthesis Administer iodine preps that inhibit release of thyroid hormone Admenister propranolol for tachycardia Administer radioactive iodine therapy to destroy thyroid cells Prepare for thyroidectomy |
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Thyroid storm meds
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sodium iodide propranolol glucocorticoids
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Thyroid storm interventions
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Administer nonslicylate antipyretics (salicylates increase free thyroid hormone levels)
Use a cooling blanket |
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What can cause a thyroid storm?
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Surgery, infection, stress
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Interventions post op thyroidectomy
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Have trach, o2, and suction at the bedside
Monitor for respiratory distress limit client talking, assess level of hoarseness Monitor for hypocalcemia and tetany which can be caused by trauma to the parathyroid. Place in semi-Fowler's, assess for bleeding and edema. |
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Nursing considerations for Synthroid
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Give at least 4 hours apart from multivitamins, aluminum hydroxide, mg hydroxide, simethicone, ca carbonate, bile acid sequestrants, Fe, and sucralfate (Carafate) b/c these decrease absorption of thyroid replacements
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Meds Synthroid increases potency of (3)
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Oral hypoglycemics
Digitalis Anticoagulants |
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2 meds that decrease Synthroid levels
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Dilantin
Tegretol |
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Take Synthroid with or without food?
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Without
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Side effects of antithyroid meds
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Drowsiness, headache, fever
Diarrhea N/V Low WBC and platelets Alopecia and hyperpigmentation Iodism: vomiting, abdominal pain, metallic or brassy taste in the mouth, rash, sore gums and salivary glands |
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What is iodism?
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Too much iodine.
Characterized by vomiting, abdominal pain, metallic or brassy taste in the mouth, rash, sore gums and salivary glands |
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Take antithyroid meds with or without food?
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With
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Med to avoid with Graves disease
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aspirin and meds with iodine
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PTU causes...
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agranulocytosis, so contact doc if fever or sore throat occurs.
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Hypoparathyroidism causes...
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hypocalcemia and hyperphosphatemia.
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S/S of hypoparathyroidism...
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Numbness and tingling in the face
Muscle cramps Troussequ's sign, Chvostek's sign |
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Diet for hypoparathyroidism...
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High calcium, low phosphorus
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Hypoparathyroidism interventions...
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Trach set, O2, suctioning at bedside.
Administer calcium gluconate IV Seizure precautions |
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Hyperparathyroidism is...
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too much PTH, causes hypercalcemia.
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s/s of hyperparathyroidism
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fatigue, weakness
pathological fractures anorexia n/v epigastric pain HTN Constipation Dysrhythmias Renal stones Skeletal pain Weight loss |
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Hyperparathyroidism interventions
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Monitor BP
Administer Lasix to lower Ca levels. Administer calcitonin (calcimar) to decrease skeletal calcium release. |
