Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
93 Cards in this Set
- Front
- Back
|
What are the five functions of the endocrine system
|
1) Differentiate reproductive and CNS in fetus
2)Stimulation of growth and dev in childhood and adolescence 3)Coordinate reproductive system 4) Homeostasis 5) Initiate corrective and adaptive responses |
|
|
Definition of Autocrine
|
Within Cells
|
|
|
Definition of Paracrine
|
Local cells
|
|
|
Definition of Endocrine
|
Remote Cells
|
|
|
Release of hormones regulated by
|
Chemical factors (blood sugar ex)
Endocrine factors Neural Control |
|
|
Characteristics of Endocrine organs
|
Ductless glands that secrete their substances directly into the blood
|
|
|
Two important groups of hormones from the Hypothalamus
|
Releasing hormones
Inhibiting hormones |
|
|
Pituitary gland
|
Pea size gland, located under the hypothalamus
|
|
|
Anterior Pituitary
|
Accounts for 80% of the gland by weight.
Growth hormone Prolactin - stimulates breast development necessary for lactation |
|
|
Posterior Pituitary
|
Composed of nerve tissue and is essentially an extension of the hypothalamus
|
|
|
Antidiuretic Hormone
|
Secreted by posterior pituitary
regulates fluid volume by stimulating reabsorption of water in the renal tubules (vassopressin) |
|
|
Oxytocin
|
Secreted by the Posterior Pituitary
Stimulates ejection of milk into mammary glands and contraction of uterine smooth muscle (later is regulated by positive feedback) |
|
|
Iodine
|
Necessary for the synthesis of thyroid hormones
|
|
|
Thyroxine (T4)
Triiodothronine (T3) |
The two major thyroid hormones that affect metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and development, and brain functions
|
|
|
Calcitonin
|
Produced by the thyroid in response to high levels of circulating Calcium
Inhibits calcium resorption (loss); increases storage in boon, and increases excretion |
|
|
Parathyroid glands
|
small, oval structures, usually arranged in pairs behind each thyroid lobe
|
|
|
Parathyroid hormone
|
PTH- regulates the blood level of calcium
|
|
|
Adrenal medulla hormones
|
catecholamines- norepinephrine and epinephrine (essential for the body's response to stress)
|
|
|
Adrenal Cortex
|
Outer part of the adrenal gland that secretes more than 50 steroid hormones classified as either: glucocorticoids, mineralocorticoids, and androgens. (cholesterol is precursor)
|
|
|
Corticosteroid
|
Any of the hormones synthesized by the adrenal cortex
|
|
|
Cortisol
|
Most abundant and potent glucocorticoid
Regulates blood glucose Antiinflammatory Stress response |
|
|
Aldosterone
|
Potent mineralocorticoid that maintains extracellular fluid volume.
|
|
|
Adrenal androgens
|
Secreted in small amounts by the adrenal cortex
Stimulate pubic and axillary hair growth and sex drive in females (converted to estrogen) |
|
|
The most common non-specific symptoms of endocrine disorders
|
Fatigue and depression
Often accompanied by changes in energy, alertness, sleep patterns, mood, affect, weight, skin, hair, and sexual function |
|
|
Acromegaly
|
Excessive secretion of GH in adults= overgrowth of the bones and soft tissues
|
|
|
What causes overproduction of GH
|
Almost always caused by a benign pituitary tumor
|
|
|
Syndrome of Inappropriate antidiuretic hormone (SIADH)
|
Overproduction or oversecretion of ADH
Fluid retention (low output and weight gain); Dilutional hyponatremia (Serum NA <134 mEq/l or serum osmolarity < 280 mOsm/kg), concentrated urine |
|
|
Diabetes Insipidus
|
Decreased production or secretion of ADH
Characterized by increased thirst (polydipsia) and increased urination (polyuria) the primary characteristic of DI, may exhibit hypovolemic symptoms |
|
|
Goiter
|
Hypertrophy and enlargement of the thyroid gland caused by excess TSH stimulation
|
|
|
Hashimotos thyroiditis
|
Chronic autoimmune disease in which thyroid tissue is replaced by lymphocytes and fibrous tissue. Most commone cause of goiterous hypothyroidism.
|
|
|
Cause of acute Thyroditis
|
Bacterial or fungal infection
Have an abrupt onset and the thyroid gland is painful |
|
|
Thyrotoxicosis
|
Refers to the physiologic effects or clinical syndrome that results from excess circulating levels of T3 and/or T4
|
|
|
Graves Disease
|
The most common form of hyperthyroidism (75%)
Autoimmune disease Manifestations include: increased metabolism, goiter, increased sensitivity to sympathetic nervous system Exophthalmos- protrusion of the eyeballs |
|
|
Thyrotoxic crisis
|
Also called thyroid storm
Acute, rare condition in which all hyperthyroid manifestations are heightened Caused by stressors in a patient with prexisting hyperthyroidism |
|
|
Iodine therapy
|
In large doses rapidly inhibits synthesis of T3 and T4, and blocks their release into circulation
Decreases the vascularity of the thyroid gland, making surgery safer and easier |
|
|
Nursing interventions of hyperthyroidism
|
Related to increased metabolic state (increase nutrition) and to counteract stimulation of sympathetic nervous system (calming interventions)
|
|
|
Hypothyroidism
|
One of the most common medical disorders in the US
Generally effects people over the age of 65 |
|
|
Most common cause of hypothyroidism worldwide
|
Iodine deficiency
|
|
|
Cretinism
|
Thyroid hormone deficiency during fetal or early neonatal life.
All infants in the US are screened for |
|
|
Clinical manifestations of hypothyroidism
|
Fatigue, lethargy, mental changes (impaired memory, slowed speech, somnolence, etc...), long periods of stage altered sleep
Decreased cardiac output and contractility, anemia |
|
|
Myxedema
|
Occurs in patients with severe long-standing hypothyroidism
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues causes facies: puffiness, periorbital edema, and masklike affect |
|
|
Nursing management of hypothyroidism
|
Low-cal diet
Assess for weight gain, mental changes, iodine containing meds, bradycardia, dry, thick cold skin, thick brittle nails, parasthesia, and muscular aches and pains Meds (synthroid) |
|
|
Hyperparathyroidism
|
Oversecretion of PTH, associated with increased serum calcium levels and low PO4
Most common cause is benign tumor (primary) Chronic renal failure (secondary) loos of feedback loop (transplant): tertiary |
|
|
Clinical manifestations of hyperparathyroidism
|
weakness. loss of appetitie, constipation, increased need for sleep, emotional disorders, and shortened attention span
Major signs: osteoporosis, fractures, and kidney stones. |
|
|
Post op complications for hyperparathyroidism
|
Major complications associated with hemorrhage and fluid and electrolyte disturbances
Tetany- condition of neuromuscular hyperexcitability associated with sudden decrease in calcium levels |
|
|
Cause of acute Thyroditis
|
Bacterial or fungal infection
Have an abrupt onset and the thyroid gland is painful |
|
|
Thyrotoxicosis
|
Refers to the physiologic effects or clinical syndrome that results from excess circulating levels of T3 and/or T4
|
|
|
Graves Disease
|
The most common form of hyperthyroidism (75%)
Autoimmune disease Manifestations include: increased metabolism, goiter, increased sensitivity to sympathetic nervous system Exophthalmos- protrusion of the eyeballs |
|
|
Thyrotoxic crisis
|
Also called thyroid storm
Acute, rare condition in which all hyperthyroid manifestations are heightened (severe tachycardia, temp > 105) Caused by stressors in a patient with prexisting hyperthyroidism |
|
|
Iodine therapy
|
In large doses rapidly inhibits synthesis of T3 and T4, and blocks their release into circulation
Decreases the vascularity of the thyroid gland, making surgery safer and easier |
|
|
Cushing Syndrome
|
Spectrum of clinical abnormalities caused by an excess of corticosteroids, paticularly glucocorticoids
Exogenous= corticosteroids (prednisone) Endogenous= adrenocorticotropic hormone (ACTH), secreting tumor |
|
|
Clinical manifestations of Cushing syndrome
|
Truncal obesity
Moonface Purplish red striae Histruism in females Menstrual disorders Impaired skin integrity |
|
|
Diagnose Cushing syndrome
|
24 hour urine collection for free cortisol
50-100 mcg/day in adults indicates Cushing |
|
|
Surgery on the adrenal glands
|
Poses risk because they are highly vascular (hemorrhage)
Can release large amounts of hormones= BP, fluid and electrolyte imbalances |
|
|
Addison's disease
|
Hypofunction of the adrenal cortex causes reduction of all three clases of adrenal corticosteroids
Most common cause is an autoimmune response, usually not noticed until 90% of cortex is destroyed |
|
|
Manifestations of Addison's disease
|
Very slow onset: weakness, fatigue, weight loss, and anorexia, skin hyperpigmentation
Severe insufficiency can lead to hypotension, tachycardia, dehydration, hyponatremia, etc... possible shock |
|
|
Acute nursing intervention for Addison's disease
|
Assess vital signs every 30 minutes to 4 hours depending on instability
|
|
|
Interventions for Addison's disease
|
Unable to tolerate stress= need to manage via medications and techniques
Patient should carry an emergency kit at all times |
|
|
Effects of corticosteroid therapy
|
Antiinflammatory action
Immunosuppression Maintenance of normal BP Carbohydrates and protein metabolism= can lead to glucose intolerance |
|
|
Hyperaldosteronism
|
sodium retention and K+ and H+ secretion leads to hypertension and hypokalemic alkalosis
Clincal signs: hypertension and headache, weakness and fatigue that can lead to tetany. |
|
|
Pheochromocytoma
|
Rare condition characterized by a tumor of the adrenal medulla that produces excessive catecholamines
|
|
|
Clinical manifestations of pheochromocytoma
|
Severe, episodic hypertension accompanied by severe, pounding headache, tachycardia with palpitations, profuse sweating, and unexplained abdominal or chest pain
|
|
|
Thyroiditis
|
Inflammatory process with different causes and different treatments.
Recovery in weeks or months. |
|
|
Nodules
|
Hard painless nodules (around the thyroid) are bad
Evaluate with radiologic testing US, CT, MRI, FNA, thyroid scan |
|
|
FNA
|
Fine needle aspiration
|
|
|
"Hot" nodules
|
Thyroid takes in iodine in a radioactive scan = benign
|
|
|
"Cold" nodules
|
Thyroid does not take in radioactive scan = malignant
|
|
|
Hyperthyroidism diagnostics
|
Decreased TSH, increased free T4
RAIU helps differentiate between Graves or thyroiditis |
|
|
Hyperthyroidism treatments
|
Medications: antithyroid drugs (PTU, Tapazole) not curative.
Beta blockers-slow down metabolism Large doses of Iodine Radioactive iodine therapy subtotal thyroidectomy |
|
|
Nursing care for thyroid disorders
|
HOB up, no flexion, tingling, pain meds, diet, trach tray, O2, suction equip, etc.
|
|
|
Goitrogens
|
substances that suppress the function of the thyroid gland by interfering with iodine uptake, which can, as a result, cause an enlargement of the thyroid (patients should avoid)
|
|
|
Treatment of hyperparathyroid
|
Surgery: endoscopic approach with autotransplantation in upper arem
Nursing care: avoid immobility |
|
|
Hypoparathyroidism
|
Rare, iatrogenic, cause is usually due to decreased parathyroid hormone
|
|
|
Symptoms of hypoparathyroidism
|
Decreased calcium level, tingling of the lips, parasthesias, respiratory diffuculty
|
|
|
Nursing care of hypoparathyroidism
|
Calcium infusion, Vitamin D replacement, lifelong tx
|
|
|
Hormones of the anterior pituitary
|
TSH
ALTH FSH (follicle stimulating hormone) LH (leutinizing hormone) GH Prolactin |
|
|
Why would you ask about "Ring, hat, and shoe size."?
|
Assess for growth hormone excess (photos also helpful)
Oral glucose challenge test is the definitive diagnostic |
|
|
Clinical manifestations of growth hormone excess
|
Enlargement of the hands and feet. Thickening of the face.
sleep apnea Signs of diabetes mellitus Cardiomegaly HTN Visual difficulties Headache |
|
|
Surgical care for growth hormone excess
|
Transphenoidal approach- up through the nose (94% effective)
|
|
|
Radiation therapy for growth hormone excess
|
Procedure where radiation is delivered to specific areas ( nursing: vitals, neurochecks, seizures, headaches, pin discomfort) If surgery was not completely successful
Usually end up with hypo function and have to give drugs to replace (sandostatin, dostinex, somaver) |
|
|
Why do you have to send clear nasal drainage to the lab following surgery for growth hormone excess?
|
To check for cerebrospinal fluid
|
|
|
Preop instructions following surgery for growth hormone excess
|
Antibiotics, nose drops
Avoid coughing, sneezing, valsava maneuver in order to prevent CSF leak No teethbrushing for 10 days |
|
|
Possible complications following transphenoidal or radiosurgery for growth hormone excess?
|
Diabetes insipidus, caused by cerebral edema
|
|
|
Most frequent pituitary tumors?
|
Prolactinomas (prolactin-secreting adenoma)
Ovulatory and menstural problems, decreased libido, headache, visual impairment, and lactation |
|
|
What are the most common hormone deficiencies associated with hypopituitarism?
|
GH
FSH LH |
|
|
Characteristics of Diabetes Insipidus
|
"High and dry"
Decreased ADH Increased urination and thirst (polydipsia) Nocturia Dehydration Hypernatremia (150 mEq/l or greater) Urine specific gravity < 1.005 Elevated serum osmolarity > 300mOsm/kg decreased urine osmolarity |
|
|
Serum osmolarity
|
Tells how much water is on board, the "thickness or concentration of the solution
The higher the serum osmolarity, the less fluid on board |
|
|
Characteristic of SIADH
|
"low and wet"
Increased ADH Decreased urine output Hypertension Weight gain and fluid retention Hyponatremia (130mEq/l or less) Urine sg > 1.030 Decreased serum osmolarity < 280 mOsm/kg Increased urine osmolarity |
|
|
Water deprivation test
|
Used to differentiate causes of polyuria, including:
Central DI Nephrogenic DI SIADH Psychogenic polydipsia Adminster ADH, only in central DI does urine osmolarity increase |
|
|
Patient teaching with water deprivation
|
Severe dehydration may occur
Test is 6 hours long Assess urine Administer 5 units of ADH |
|
|
Thyroid scan
|
Take radioactive isotopes, and scan for hot and cold nodules: cold nodules malignant
|
|
|
Radioactive iodine uptake (RAIU)
|
Measures thyroid activity, iodine is administered and then the uptake is measured with a scanner.
2-4 hour 3-19% (normal) 24 hours 11-30% (normal) |
|
|
When do you take a cortisol sample?
|
Morning: cortisol has a diurnal variation, levels higher in the morning.
|
