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56 Cards in this Set

  • Front
  • Back
Endocrine System
Assess for
Health hx:
fatigue and energy level affects on ADLs
Tolerance to heat and cold changes in weight
Changes in sexual function and secondary characteristics.
changes in mood memory and ability to concentrate and altered sleep patterns.
Calcitonin: or thyrocalcitonin.
Secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.
T4
Function
weak, maintains body metabolism in a steady state.
T3
function
5x potent, more rapid metabolic action.
•Influence cell replication and are important in brain development.
•Necessary for normal growth.
•Widespread effects on cellular metabolism, influence every major organ system.
Cretinism
fetal
because of general depression of metabolic activity during fetal and neonatal development, results in stunted physical and mental growth.
Cretinism
Adults-
manifests as lethargy, slow mentation, and generalized slowing of body functions.
Hypothyroidism
•Results from the suboptimal levels of hormone.
Hypothyroidism
•Common cause in adults;
autoimmune thyroiditis.
Hyper can lead to Hypo.
Hypothyroidism
Clinical Manifestations
Fatigue
dry skin/nails
hair loss
menstrual changes
constipation.
Hypothyroidism
Clinical Manifestations
Severe
subnormal temp and pulse rate
Mental and personality changes
elev cholesterol atherosclerosis
CAD
poor LVF.
Extreme Hypothyroidism
myxedema
hypothermic
unconscious
Synthroid/Levothroid.
•Drug interactions:
hypoglycemics
dilantin
digoxin
tricyclic antidep
anticoag
NSAIDs
sedative/hypnotic agents
Hypothyroid
Supportive therepy
–ABGs, for CO2 retention, possible ventilation
–Fluids, caution; danger of water intoxicaiton.
–Avoid heating pads; increases O2 requirement and may lead to vascular collapse.
–BS; hypoglycemia, use concentrated glucose to avoid fld overload
–Myxedema; IV Levothyroxine cautiously until consciousness is restored.
Hypothyroidism
Elderly
fatigue
muscle aches
mental confusion
depression
apathy
decreased mobility or activity
significant wgt loss and constipation
Hyperthyroidism
caused by
abnormal stimulation of the thyroid gland by circulating immunoglobulin
Emotional shock, stress, or infection
thyroiditis and excessive ingestion of thyroid hormone
Hyperthyroidism
clinical manifestations
Nervousness, emotionally hyperexcitable, irritable, and apprehensive. Palpitations, pulse rapid at rest. Tolerate heat poorly tolerated and perspire unusually freely
Skin is flushed and salmon color.
Hyperthyroidism
clinical manifestations
Elderly:
dry skin
diffuse pruritus
fine tremor of hands
exophthalmos
Hyperthyroidism
Assessment Findings
Enlarged thyroid
–Soft and may pulsate
–Bruit over the thyroid arteries
Hyperthyroidism
Diagnostic findings
–Decreased TSH
–increased T4
–increase in radioactive iodine uptake.
THYROID STORM:
severe disease, usually abrupt onset
Fatal if untreated.
high fever
extreme tach (>130)
altered mental state (delirium psychosis, somnolence, coma)
GI (wgt loss, diarrhea, abd pain)
CV (edema, cp, dyspnea, palpitations)
Anti Thyroid med used during pregnancy
PTU
Thyroiditis
•Acute, subacute, chronic
•Characterized by: inflammation, fibrosis or lymphocytic infiltration.
Acute Thyroiditis
Caused by
bacteria (staph aureus), fungi, mycobacteria or parasites
Acute Thyroiditis
s/s
Anterior neck pain
swelling
fever
dysphagia
dysphonia
pharyngitis or pharyngeal pain.
warmth
erythema
tenderness
Acute Thyroiditis
tx
antibiotics
fluid replacement
surgical rx for abscess.
Medulla gland secretes
catecholamines
Cortex outer gland secretes
steroid hormones
Catecholamines:
function
regulate metabolic pathways to promote catabolism of stored fuels to meet caloric needs, prepares to meet a challenge (fight or flight response)
Adrenal Cortex
3 types of hormones:
Glucocorticoids
Mineralocorticoids
Adrenal sex hormones (Androgens)
Glucocorticoids:
function
important influence on glucose metabolism (elevating blood glucose levels). Secreted in response to ACTH. In the form of corticosteroids are used to inhibit inflammation and suppress allergic manifestations.
Glucocorticoids:
Side Effects
development of diabetes, osteoporosis, peptic ulcer, increased protein breakdown and redistribution of body fat.
Large doses can inhibit the release of ACTH and endogenous glucocorticoids. Result in atrophy and insufficiency.
Mineralocorticoids:
function
major effects on electrolyte metabolism.
Secreted in response to Angiotensin II, elevates B/P, concentration is increased when renin is released in response to decreased perfusion pressure.
Release is also increased by hyperkalemia
Aldosterone; long-term regulation of sodium of sodium balance.
Adrenal Sex Hormones
Exert effects similar to that of the male sex hormone
Small amts of Estrogen
ACTH controls secretion
Normal amounts of un-noticeble effects, excess amt- masculainization
Pheochromoytoma
overview
-orinates in the Adrenal medulla
- Usually benign
- familial
-occurs with multiple endocrine neoplasia type 2
Multiple endocrine neoplasia type 2
medullary thyroid carcinoma, parathyroid hyperplasia or tumor.
Pheochromoytoma
clinical manifestations
-Headache
-diaphoresis
-Palpatations with HTN
-Other(hyperglycemia, vertigo, blurring, tinnitus, air hunger, polyurina, N/V/D, feeling of impending doom, tachycardia.
Pheochromoytoma
assessment and dx findings
-5 H's
-HTN
-HA
-Hyperhydrosis
-hyper metabolism
-hyperglycemia
24 urine for catecholamines and metanephrines
CT/MRI
Can effect 24 hour urine results
-caffeine
-tobacco
-amphetimines
-decongestants
-bronchodilators
-stress
Pheochromoytoma
medical management
-dx
-EKG monitoring
-Phenoxybenamine
-nifedipine
-Adrenalectomy
Phenoxybenamine
desired effect
dizziness
Addison's Ds
overview
-adrenal insufficiency
-autoimmine or idopathis
-surgical removal of both adrenal glands causes this
Addison's Ds
most common cause
therapeutic use of corticosteroids.
Addison's Ds
clincal manifestations
-muscle weakness
-anorexia
-GI disturbance
-fatigue
-emaciation
-dark mucous menbranes/skin
-hypotension
-low BS
-mental status change
-depression
-emotional lability
-apathy
confusion
Addisons Ds
Severe cases
chronic dehydration due to marked depletion of Na and water due to disturbance in metabolism.
Addison's Crisis
clinical manifestations
-cyanosis
-shock(pallor, apprehension, rapid/weak pulse, rapid respirations, low BP)
-Ha
-N/V/Abd pain/D
-confusion
-death
Addison's crisis
medical management
-24 hour urine
- prevent shock with IV fluids
-recumbant position legs up
-hydrocortisone IV
-vasopressin for hypotension
-abx
- adrenal replacement
Addison's Crisis
RN management
-Assessment
- Restore fluid balance
-improve activity intolerance
- promoting home care
Cushings Syndrome
overview
- Results from excessive activity
- caused by corticosteroids
- pituitary tumor prodices ACTH and stimulates thae cortex to increase hormone secretion
- normal feedback mechinisms become ineffective and the usual diurnal pattern of cortisol is lost
Cushings Syndrome
clincal manifestations
-arrest in growth
-obesity
- MS changes with glucose intolerance
-buffalo hump
-fragile skin
-muscle weakness/wasting
-nocturnal diuresis
- osteoporosis
- kyphosis
- retention of Na and water
-HTN
-HF
-Moon face
-Suseptible to infection
- hyperglycemia or DM
-hirsutism
-psychosis(long term)
Cushings Syndrome
assessment and dx findings
-dexamethasone testing(most sensistive)
- plasma and urine cortisol levels (inc)
- electrolytes
-CT/MRI for tumor
-24 hour urine
Cushings Syndrome
medical managment
-surgical removal of adrenal gland
-reduce the corticosteroid
Aldosterone
overview
-conserve body sodium
Primary Aldosteronism
overview
- kidneys excrete less NA and more potassium and hysrogen
- excessive productionr/t to timors
-causes a pattern of biochemical changes and a corresponding set of clinical signs.
Primary Aldosteronism
clincal manifestations
-profound decline in K and hydrogen
-Increase PH and biacarbonate
-HTN
-polyuria
-polydypsia
Hypokalemia
-muscle weakness
-cramping
-fatigue
-glucose intolerance
Primary Aldosteronism
assessment/dx findings
-inc Na
-dec k
-inc aldosterone
-low renin
-adrenal venous sampling bilaterally*
-adrenalectomy tx