Care Of Patients With Endocrine Disorders

Front 1

causes of insufficient hormone

Back 1

hypofunction of endocrine gland
insensitivity of target tissue to hormone

Front 2

causes of excess hormone activity

Back 2

hyperactive gland
ectopic hormone reproduction
excess self administration of replacement hormone

Front 3

diabetes insipidus pathophys

Back 3

lack of ADH = adequate water reabsorptoin by distal tubules prevented

Front 4

diabetes insipidus etiology

Back 4

tumor or trauma to pituitary gland
psychogenic = drinks too much water
drugs

Front 5

diabetes insipidus S&S

Back 5

polyuria
nocturia
polydipsia
dehydration
hypotension
hypovolemic shock
enlarged bladder + kidney damage

Front 6

diabetes insipidus diagnostic tests

Back 6

urine specific gravity less than 1.005
CT scan, MRI to check for pituitary tumor
water deprivation test = urine diluted with intake?

Front 7

diabetes insipidus interventions

Back 7

hypotonic IV fluids (0.45% saline) = replace intravascular volume with adding sodium
replacement of ADH
vasopressin (IV or sub-q)
thiazide diuretics - dercrease urine flow if no ADH
hypophysectomy (removal of pituitary gland)

Front 8

diabetes insipidus nursing care

Back 8

I&O
daily weights
intake/output
skin turgor (poor)
monitor serum electrolytes
changes in LOC

Front 9

Syndrome of inappropriate antidiuretic hormone (SIADH) pathophys

Back 9

too much ADH = kidneys absorb excess water = decrease urine output, fluid overload

Front 10

Syndrome of inappropriate antidiuretic hormone (SIADH) etiology

Back 10

lung cancer, pancreatic cancer, hodgkin's disease = ectopic site of production
drugs
head trauma
brain tumor
complication of diabetes insipidus

Front 11

Syndrome of inappropriate antidiuretic hormone (SIADH) s&S

Back 11

fluid overload - weight gain without edema
dilutional hyponatremia

Front 12

S&S of dilutional hyponatremia

Back 12

bounding pulse
elevated/normal BP
headache
personality changes
nausea
diarhhea
convulsions
coma

Front 13

Syndrome of inappropriate antidiuretic hormone (SIADH) diagnostics tests

Back 13

serum ADH high

Front 14

Syndrome of inappropriate antidiuretic hormone (SIADH) interventions

Back 14

eliminate cause
tumor removal
restrict fluids (800-1000 mL/24 hours)
hypertonic saline fluids
oral salt

Front 15

Syndrome of inappropriate antidiuretic hormone (SIADH) nursing care

Back 15

monitor fluid balance
vitals
weight
I&O
urine specific gravity
skin turgor
edema
report change in LOC, monitor for seizures

Front 16

dwarfism pathophys

Back 16

short stature
growth hormone deficient in childhood

Front 17

dwarfism etiology

Back 17

pituitary tumor
failure of pituitary to develop
infection, trauma to pituitary
malnutrition

Front 18

dwarfism S&S

Back 18

children grow only 3-4 ft tall - normal body proportions
slowed sexual maturation
adults: weakness, hypoglyemia, sexual dysfunction, skin changes, increased risk of cardiovascular/cerebrovascular disease; headaches, mental slowness, visual disturbances

Front 19

dwarfism diagnostic tests

Back 19

measure amount of GH
MRI

Front 20

dwarfism interventions

Back 20

administer growth hormone

Front 21

dwarfism care

Back 21

assess mental status, ability to cope, understanding of treatment plan

Front 22

acromegaly pathophys

Back 22

excess of GH
affects adults in 30-40s (gigantism in children)
bones increase in size, enlargement of facial features, hands, feet
long bones increase in width but not length
subq ct increases = fleshy appearance
internal organs/glands enlarge
elevated blood glucose

Front 23

acromegaly etiology

Back 23

pituitary hyperplasia
pituitary tumor
hypothalamic dysfunction

Front 24

acromegaly S&S

Back 24

change in ring/shoe size
nose, jaw, brow, hands, feet enlarge
teeth displaced
tongue thickens - dysphagia
sleep apnea
kyphosis
headache
diabetes mellitus
osteoporosis, arthritis
erectile dysfunction, amennorhea

Front 25

acromegaly diagnostic tests

Back 25

serum growth horomone
radiographs = abnormal bone growth
MRI if tumor

Front 26

acromegaly interventions

Back 26

treat causes
bromocriptine (Parlodel), octreotide (Sandostatin) to decrease GH levels
hypophysectomy - replacement of thyroid hormone, corticosteroids, sex hormones

Front 27

acromegaly care

Back 27

assess of impaired eye sight, chewing, swallowing, sleep apnea

Front 28

pituitary tumors

Back 28

most benign
cause: visual disturbances, symptoms of increased pressure in brain, hormone imbalances
hypophysectomy (transephenoid, transfrontal)

Front 29

pre-op of hypophysectomy

Back 29

baseline neurological assessment
avoid actions that increase pressure on surgical site - coughing, sneezing, nose blowing, straining at bowels, bendings from waist
deep breathing

Front 30

post-op of hypophyectomy

Back 30

neurological assessments
urine specific gravity (diabetes insipidus may occur)
nasal packing - monitor for CSF (glucose)
hormone replacement therapy (thyroid, glucocorticoids, intranasal desmopressin, sex hormones)

Front 31

hypothroidism pathophys

Back 31

creatinism in infants
myxedmea in adults
primary - not enough TH even though there is enough TSH
secondary - low levels of TSH
tertiary - inadequate release of TRH

Front 32

hypothroidism etiology

Back 32

primary = congenital defect, inflammation of thyroid gland, iodine deficiency
hashimotos = autoimmune
seondary/tertiary = postpartum pituitary necrosis, treatment of hyperthyroidism

Front 33

hypothroidism S&S

Back 33

reduced metabolic rate
fatigue, weight gain, bradycardia, constipation, mental dullness, feeling cold, shortness of breath, decreased sweating, dry skin and hair

Front 34

hypothroidism complications

Back 34

myxedema coma - stress (infection, trauma, cold)
hypothermia, decreased respirations
depressed mental function, lethargy
blood glucose drops
cardiac output drops
nonpitting edema
requires intubation and mechanical vent
give synthroid

Front 35

hypothroidism diagnostic tests

Back 35

T3 and T4 low
TSH high or low, depends on cause

Front 36

hypothroidism interventions

Back 36

synthetic thyroid hormone

Front 37

hypothroidism education

Back 37

consistent use of med
regular blood tests to monitor TSH

Front 38

hyperthyroidism pathophys

Back 38

excessive amounts of circulating thyroid hormone
primary - thyroid gland causes excess hormone release
secondary - excess TSH
tertiary - excess TRH

Front 39

hyperthyroidism etiology

Back 39

Grave's disease - autoimmune disorder
multinodular goiter- thyroid nodules secrete excess TH
pituitary tumor may secrete excess TSH
thyroid tumor may secrete TH
radiation exposure

Front 40

hyperthyroidism S&S

Back 40

hypermetabolic state - heat intolerance, increased appetite with weight loss, increased frequency of bowel movements
nervousness, tremor, tachycardia, palpitattions
heart failure
main, psychotic
expothalamus

Front 41

hyperthyroidism complications

Back 41

thyrotoxic crsis - if untreated or under stress
following thyroid surgery
can cause death in 2 hours
S&S - tachy, hypertension, high fever, dehydration, restlessness, delirium

Front 42

hyperthyroidism diagnostic tests

Back 42

serum T3 and T4 elevated
TSH low in primary
thyroid scan to locate tumor
only physician should palpate gland

Front 43

hyperthyroidism interventions

Back 43

Propylthiorcil (PTU) meethimazole (Tapazole), inhibit synthesis of TH
Propanolol (Inderal) is beta blocking medication
oral iodine
radiocative iodine to destroy portion of thyroid gland
surgery

Front 44

hyperthyroidism care

Back 44

monitor vitals, lung sounds
assess for anxiety
monitor bowel function
asses for eye injury