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168 Cards in this Set
- Front
- Back
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what does the endocrine system manage?
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growth, energy production, regulation of fluid/electrolyte balance, resistance to stress, reproduction
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What is an endocrine disorder?
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too much or too little hormone activity
-production/secretion -tissue insensitivity |
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Effects of Aging on the Endocrine System
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Reduced GH
-decreased muscle mass -increased fat Reduced TH -decreased BMR Reduced insulin |
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Hypothalamus
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Maintains homeostasis
links the CNS to Endocrine system via the pituitary gland |
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What does the hypothalamus excrete?
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releasing hormones and inhibiting hormones
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Does the posterior pituitary gland produce hormones?
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No-only secretes them
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what hormones does the Posterior pituitary gland secrete?
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ADH
Oxytocin |
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What hormones does the Anterior Pituitary Gland produce/secrete
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GH
TSH ACTH Prolactin FSH LH |
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SIADH
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Syndrome of inappropriate anti-diuretic hormone
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Causes of Growth Hormone Imbalance
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Tumor, congenital, psychosocial
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Too much growth hormone
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Giantism
Acromegaly |
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Too little growth hormone
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Dwarfism
in children: short stature in adults: affects tissue maintenance and repair |
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S/Sx of GH defecit
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Weakness
Hypoglycemia Sexual Dysfunction Rosk for CV disease Risk for cerebrovascular disease |
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Diagnosis of GH deficit
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GH level
GH Response to induced hypoglycemia CT/MRI for tumor |
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Treatment for GH Deficit
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Synthetic GH (SQ or IM)
Surgery if tumor |
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What is acromegaly?
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Excess GH in adults
Bones grow in thickness, not length Organs and connective tissue also grow |
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Causes of Acromegaly
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pituitary hyperplasia
pituitary tumor hypothalamic dysfunciton |
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S/Sx of acromegaly
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Changes in shoe/glove size
Nose, jaw, brow enlarge Teeth may be displaced Difficulty swallowing/speaking Headaches/visual changes Diabetes Arthritis |
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Diagnosis of Acromegaly
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GH Level
Bone X-ray examination |
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Treatment of Acromegaly
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Surgery if tumor
-lifelong hormone replacement Bromocriptine may reduce GH level Treat underlying cause |
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Nursing Dx for acromegaly
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Disturbed body image
Ineffective coping Knowledge deficit Risk for injury Disturbed sensory perception |
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Nursing interventions for Acromegaly
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Provide opportunities to verbalize feelings
provide info on support groups, disease and treatments STRESS NEED FOR LIFELONG HORMONE REPLACEMENT WITH SURGERY |
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Most important Nursing Dx for all endocrine surgeries
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STRESS NEED FOR LIFELONG HORMONE REPLACEMENT WITH SURGERY
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What does ADH do?
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responsible for reabsorption of water
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Too little ADH
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causes water loss
Diabetes Insipidus |
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too much ADH
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causes water retention
SIADH |
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S/Sx of Diabetes Insipidus
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Polyuria
Polydipsia Nocturia Dilute Urine Dehydration Hypovolemic Shock Decreased LOC Death, if not corrected |
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S/Sx of SIADH
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*Symptoms of fluid overload
Weight gain without edema Dilutional hyponatremia Concentrated urine Muscle cramps and weakness Brain swelling Seizures Death |
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Diagnosis of SIADH and Diabetes Insipidus
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Check serum osmolality
check urine for specific gracity check for ADH secreting tumor (CT or MRI) |
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Diagnosis of Diabetes Insipidus
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Urine SG <1.005
Increased plasma osmolality Water deprivation test |
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Normal range for specific gravity
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1.010 - 1.025
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Diagnosis of SIADH
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Urine is concentrated
increased urine SG PLasma osmolality is decreased |
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What fluid related nursing diagnosis is most appropriate for SIADH?
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Excess fluid volume
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How will yo umonitor fluid balance in SIADH?
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Daily weights, I&O, Fluid restriction, lung sounds
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What will urine look like in a pt with SIADH?
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concentrated
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Why does a head injury place one at risk for Diabetes Insipidus?
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damage to the hypothalamus
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what symptoms do diabetes insipidus and diabetes mellitus have in common?
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polyuria
polydipsa |
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will SG be high or low in Diabetes Insipidus?
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low
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Will osmolality be increased or decreased in DI?
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increased
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What nursing Dx is a pt with DI at risk for?
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Deficient fluid volume
Risk for injury r/t electrolyte imbalance |
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Treatment of diabetes insipidus
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Hypophysectomy if tumor
IV or SQ vasopressin w/IV fluids Long term intranasal DDAVP Thiazide diuretic if nephrogenic |
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Treatment of SIADH
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Eliminate cause
-surgery if tumor Treat the symptoms -fluid restriction -hypertonic saline -lasix or declomycin |
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What is a hypophysectomy?
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Removal of the pituitary gland
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Preop teaching for hypophysectomy
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avoid actions that increase pressure on the site
Deep breathing, IS, NO COUGHING post-operatively |
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What does declomycin do?
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blocks renal reabsorption of ADH
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Simple SIADH
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ADH increased
SG increased Osmolality decreased |
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Simple DIabetes Insipidus
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ADH decreased
SG decreased Osmolality increased |
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Post-op care after hypophysectomy
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Neurological assessment
Urine for SG Nasal Packing No coughing, sneezing, blowing, straining, or bending HRT with target hormones |
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What do the Thyroid and Parathyroid effect?
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Skeletal System
Once in the body, they control metabolism |
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Hypothyroidism
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deficit of thyroid hormones
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Hyperthyroidism
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excessive secretion of thyroid hormones
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Diagnosis of hypothyroidism
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T3 & T4 low
TSH high in primary TSH low in secondary |
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Treatment of Hypothyroidism
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Hormone replacement (Synthroid)
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Synthroid doses
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Start at 0.05mg/d
maintain 0.1 - 0.2mg/d |
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S/Sx of Hypothyroidism
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Intolerance to cold
Hair loss Lethargy Dry skin Anorexia facial and eyelid edema Apathy Receding hairline Brittle hair and nails Thick tongue (slow speech) |
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Myxedema
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Extreme Hypothyroidism
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Myxedema Coma Symptoms
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Hypothermia
Decreased VS and LOC Respiratory Failure Death |
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Treatment for Myxedema
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Monitor VS
Cardiac/Resp support Warming blanket IV Synthroid Slow fluid replacement |
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Causes of Hyperthyroidism
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Grave's Disease
Pituitary tumor Thyroid cancer Synthroid overdose |
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S/Sx or Hyperthyroidism
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Finger Clubbing
Tremors Diarrhea Menstural changes Heat intolerance Enlarged Thyroid Weight loss Muscle Wasting Localized edema |
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diagnosing Hyperthyroidism
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Elevated T4
CT/MRI if tumor suspected |
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Treatment of Hyperthyroidism
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Block adverse effect of thyroid hormone
Stop oversecretion PTU Tapazole Inderal Radioactive iodine Thyroidectomy |
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Nursing Dx for hyperthyroidism
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Hyperthermia
Imbalanced Nutrition Anxiety Risk for Injury Activity Intolerance Knowledge Deficit |
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What is the highest risk for radioactive Iodine and thyroidectomy as treatment for hyperthyroidism?
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Hypothyroidism
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Goiter
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Enlarged Thyroid due to elevated TSH
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Causes of Goiter
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Low TH
Iodine deficiency Virus Genetic Goitrogens Some medications |
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S/Sx of Goiter
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Dysphagia
Dyspnea |
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Diagnosing Goiter
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Thyroid scan
TSH, T3, T4 |
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Treatment of Goiter
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Treat cause
Avoid goitrogens Thyroidectomy is size causing symptoms |
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Thyroid Cancer
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More common in women
Most tumors are benign Hard painless nodule Dysphagia Dyspnea if obstruction TH usually normal |
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Thyroidectomy
Preoperative Nursing Care |
Monitor breathing and swallowing
Assess nutrition status Monitor vital signs Teach postoperative care -gentle ROM -Support neck during position changes -incentive spirometer |
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Thyroidectomy
Post-operative Nursing care |
Monitor VS, bleeding, swelling (airway), voice
Trach set at bedside Semi-Fowlers position Pain control |
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Thyroidectomy
Post-operative Nursing care (continued) |
Support head and neck
Provide gentle ROM Encourage deep breathing Consult dietician |
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Complications of thyroidectomy
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Thyrotoxic crisis
Tetany |
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Parathyroid Hormone
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regulates blood level of calcium/phosphorus in the body
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What does PTH act on?
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bone, kidney, and indirectly on the GI tract
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Hypoparathyroidism
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decreased secretion of PTH
Hypocalcemia |
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Hyperparathyroidism
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increased secretion of PTH
Hypercalcemia |
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S/Sx or hyperparathyroidism
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Fatigue
Muscle weakness Depression N/V Kidney Stones Dysrhythmias Joint pain Pathologic fractures Cardiac arrest Coma |
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Diagnosing Hyperparathyroidism
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Elevated serum calcium
Decreased phosphate PTH elevated Bone density x-ray EKG changes |
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Treatment of Hyperparathyroidism
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IV NS to dilute calcium
Lasix Calcitonin Mithramycin Parathyroidectomy Increase ambulation |
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Causes of Hypoparathyroidism
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Heredity
Atrophy of the gland Accidental removal of parathyroids during thyroidectomy |
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S/Sx of Hypoparathyroidism
Tetany |
Neuromuscular irritability
Numbness and tingling of fingers and perioral area Muscle spasms Cardiac arrhythmias Seizures |
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Diagnosing Hypoparathyroidism
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PTH low
Serum calcium <9 Positive Chvostek's sign Positive Trousseau's sign |
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Parathyroid Hormone
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regulates blood level of calcium/phosphorus in the body
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What does PTH act on?
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bone, kidney, and indirectly on the GI tract
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Hypoparathyroidism
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decreased secretion of PTH
Hypocalcemia |
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Hyperparathyroidism
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increased secretion of PTH
Hypercalcemia |
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S/Sx or hyperparathyroidism
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Fatigue
Muscle weakness Depression N/V Kidney Stones Dysrhythmias Joint pain Pathologic fractures Cardiac arrest Coma |
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Diagnosing Hyperparathyroidism
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Elevated serum calcium
Decreased phosphate PTH elevated Bone density x-ray EKG changes |
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Treatment of Hyperparathyroidism
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IV NS to dilute calcium
Lasix Calcitonin Mithramycin Parathyroidectomy Increase ambulation |
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Causes of Hypoparathyroidism
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Heredity
Atrophy of the gland Accidental removal of parathyroids during thyroidectomy |
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S/Sx of Hypoparathyroidism
Tetany |
Neuromuscular irritability
Numbness and tingling of fingers and perioral area Muscle spasms Cardiac arrhythmias Seizures |
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Diagnosing Hypoparathyroidism
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PTH low
Serum calcium <9 Positive Chvostek's sign Positive Trousseau's sign |
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Treatment of Hypoparathyroidism
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Rebreathe from paper bag
Long term treatment: -Calcium Supplement -Thiazide Diuretics |
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Treatment of Tetany
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IV calcium gluconate
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5 H's of pheochromocytoma
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Hypertension
Headache Hyperhydrosis Hyperglycemia Hypermetabolism |
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Adrenal gland hormones
hint* 3 S's |
Glucocorticoids (Sugar)
Mineralcorticoids (Salt) Androgens (Sex) |
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Diseases of the Adrenal cortex
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Addison's
Cushing's |
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Disease (tumor) or the Adrenal Medulla
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Pheochromocytoma
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What does the Adrenal Medulla secrete?
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Norepinephrine
Epinephrine |
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What does the Adrenal Cortex secrete?
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Aldosterone
ATCH Androgen/Estrogen |
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What is Pheochromocytoma?
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Tumor of chromaffin cells of the adrenal medulla
-usually benign -Cause unknown Can be Fatal! |
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S/Sx or pheochromocytoma
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the 5 h's
tachycardia anxiety vision changes |
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Diagnosis of pheochromocytoma
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24 hour urine
CT or MRI to find tumor |
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Why 24 hour Urines for pheochromocytoma?
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looking for metanephrines and VMA
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Treatment of Pheochromocytoma
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Beta-Blockers
Alpha-Blockers Adrenalectomy |
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Nursing care of pt with pheochromocytoma
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Monitor VS
Calm, quiet environment No caffeine Replacement corticosteroids |
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Nursing Diagnoses for pheochromocytoma
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Risk for Injury
Alteration in cardiac function Knowledge deficit -Drug therapy -S&S of hypocalcemia |
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Addison's Disease
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not enough cortisol
-and/or not enough aldosterone/androgens |
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Signs and Symptoms of Addison's disease
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Bronze coloring of the skin
Changes in distribution of body hair GI disturbances Weakness Hypoglycemia Postural Hypotension Weight Loss |
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Symptoms of Adrenal Crisis
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Profound fatigue
Dehydration Vascular Collapse Renal shut down Decreased serum Na Increased serum K |
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Causes of Addison's Disease
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Can be Autoimmune
-OR- AIDS CA Pituitary or Hypothalamus problem Abrupt discontinuance of steroids |
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Treatment of Addison's Disease
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COMBAT SHOCK!
glucocorticoids and mineralcorticoids daily for life Possible high sodium diet |
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Complications of Addison's Disease
(decrease in cortisol) |
Adrenal Crisis
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Nursing Diagnoses for Addison's Disease
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Risk for fluid volume deficit
Risk for knowledge deficit |
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Nursing interventions for Addison's
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Monitor daily weights, I&O, glucose, electrolytes, VS
Teach hormone replacement Encourage medic-alert Identify stressors and how to cope |
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Most important prevention for Addisons
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Never abruptly discontinue steroids!!
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Cushing's Disease
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Excess Adrenal cortex hormones
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S/Sx of Cushing's Disease
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Personality Change
Moon face Buffalo hump Purple striae Bruises and petechiae Thin extremities |
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Diagnosis of Cushing's
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Based on appearance
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Treatment of Cushing's
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Surgery if tumor
Every-other-day schedule for steroids Symptom control -lasix -calcitonin |
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Nursing Diagnoses for Cushing's Disease
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Excess fluid volume
Risk for impaired skin integrity Risk for infection Body image disturbance Knowledge deficit |
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Normal pH Range
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7.35 - 7.45
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Normal PCO2 Range
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35 - 45
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Normal HCO3 Range
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22 - 26
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Increased ADH causes...?
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fluid retention
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What is Angiotensin used for?
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vasoconstriction
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S/Sx of Heat Exhaustion
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Headache
Fatigue Weakness Moist skin/Sweating decreased BP (orthostatic) Increased Pulse Anxiety/Confusion |
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Causes of Heat Exhaustion
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decreased fluid intake
increased heat exposure increased activity |
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Normal range for Potassium
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3.5 - 5.0
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Normal Range for Calcium
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9 - 11
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Normal Range for Phosphorus
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3.0 - 4.5
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blood pH range
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7.4 - 7.5
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Causes of Respiratory Acidosis
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Drug Overdose
Airway obstruction COPD Chest trauma pulmonary edema |
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Causes of Metabolic Acidosis
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Aspirin
Shock Severe Diarrhea Renal failure Diabetic Ketoacidosis |
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what happens to K+ levels with acidosis
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K+ levels increase
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Causes of Respiratory Alkalosis
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Anxiety
Pregnancy High altitude Fever Hypoxia |
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Causes of Metabolic Acidosis
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Loss of gastric juices
Potassium wasting diuretics Overuse of antacids |
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Glomerular Filtration Rate
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amount of renal filtrate formed by the kidney in 1 minute
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Normal GFR (glomerular filtration rate)
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100 - 125mL/minute
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Common Urine Lab Tests
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Urinalysis
Urine Culture Composite Urines |
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Common blood tests used for renal conditions
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Serum creatinine
BUN Uric Acid K+ levels electrolytes |
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Best indicator of renal function
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Serum Creatinine
Creatinine Clearance Test |
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Creatinine Clearance
Normal Range |
85-125 mL/Minute
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Normal Serum Creatinine
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0.6 - 1.5 mL/dl
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Normal BUN
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15 - 30
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Risk factors for Pressure ulcers
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immobility
Impaired circulation Impaired sensory perception Elderly Very thin or obese |
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Prevention of pressure ulcers
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assess daily
cleanse and dry daily clean incontinence promptly DO NOT massage reddened areas Shift weight Q15minutes positioning Q2hours |
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Braden Scale
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Sensory perception
Moisture Activity Mobility Nutrition Friction and Shear |
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Interventions for pressure ulcers
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Remove all pressure
Debride Cleanse Maggot Therapy Only Use 4-15 PSI |
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Stage I Pressure Ulcer
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Skin intact
Red Does not blanch |
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Stage II Pressure Ulcer
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Partial thickness skin loss
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Stage III Pressure Ulcer
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Full thickness skin loss
May have eschar |
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Stave IV Pressure Ulcer
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Damage to Muscle, bone and/or support structures
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Herpes Simplex I
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Above the waist
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Herpes Simplex II
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Below the waist
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Herpes Virus
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Lies dormant in the body and recurs with stress
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How long is herpes contagious?
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until scabs form
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treatment of herpes
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Acyclovir
Antibiotics for secondary infection Avoid triggers of recurrence |
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Herpes Zoster
Shingles |
follows nerve distribution
-can be very painful Usually one-sided |
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Cellulitis
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inflammation of skin/connective tissue
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S/Sx of cellulitis
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warmth
redness edema pain/tenderness fever lymphadenopathy |
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How is cellulitis diagnosed
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C & S
Blood Cultures |
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Risk factors for malignant skin lesions
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UV rays
fair skin genetic tendency chemicals x-ray therapy immunosuppresive therapy |
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Prevention of malignant skin lesions
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SUNSCREEN!!!
limit sun exposure wear protectvie clothing report changes in moles |
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μακάριος, -α, -ον
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blessed
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Therapeutic interventions for acute stage of burns
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Clean, debride, dress
prevent infection Skin grafting, if needed Control pain Maintain F/E balance Maintain Nutrition Monitor for complications |
