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The very basics you need to know for diseases and disorders in nursing...

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Pituitary Gland: Hormones  Growth and Metabolism

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Cushing’s Syndrome (excessive cortisol) Truncal obesity (excess adipose in body trunk) o Protein wasting (slender extremities and very thin and friable skin) o Facial fullness, often called a moon face o Purple striae on the abdomen, breasts, buttocks, or thighs o Osteoporosis (a significant finding in premenopausal women) o Hypokalemia of uncertain cause What type of therapy/treatment causes too much cortisol aka Cushing’s Syndrome? o Long term use of corticosteroids: what diseases need this drug?  Asthma o

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Addison’s Disease: “Hypo function” o Deficiency of cortisol and aldosterone o Growth impairment: hair, secondary sex traits not exhibited properly  13 adolescents what would they look like?  Full thick beard? No  Big or Small joints? Small  A lot or little Pubic hair? Little to none o Thin, weak, Hyperpigmentation of skin areas exposed to the sun o low serum and urinary cortisol level, decreased fasting glucose, hyponatremia, hyperkalemia, and increased BUN = opposite of Cushing’s

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Acromegaly: Gigantism o Pituitary acromegaly adenoma o Growth hormone issue: Excess

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Hyperpituitarism: characteristics of? o Causes gigantism o Excessive height, facial hair

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When a state of panhypopituitarism exists, a syndrome called Simmonds cachexia is present o Part of Hypopituitarism, Muscle wasting, Organs decrease in size d/t lack of growth hormone

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Diabetes Insipidus o Kidneys don’t respond to ADH: “Nephrogenic DI” o Urine specific gravity 1.001-1.030, this lab value would be decreased

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Cardinal signs of pheochromocytoma (HIGH BP-diastolic) o Severe hypertension, hypermetabolism, and hyperglycemia o Diastolic pressure of 115 mm Hg or higher, severe pounding headache; and diaphoresis (profuse sweating)

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Cushions Disease: Trunk, Face, Skin = Excess fatty tissue

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Headache, or nuchal rigidity may be indications of meningitis

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addisonian crisis: adrenal insufficiency o Decreased levels of cortisol o Manifestations of an addisonian crisis include more severe symptoms of mineralocorticoid and glucocorticoid deficiency: hypotension, tachycardia, dehydration, confusion, hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia o Secondary factors that cause this disease: Stressors  Infection/Trauma

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How should the nurse explain the reasoning for taking hydrocortisone for Addison’s Disease OR Why should the patient take Hydrocortisone for Addison’s disease o To regulate/replace the cortisol/glucocorticoids levels in body

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“Syndrome of Inappropriate Antidiuretic Hormone.” SIADH = not peeing o The main symptoms of SIADH initially reflect the effects of dilutional hyponatremia and water retention: weakness, muscle cramps or twitching, anorexia, nausea, diarrhea, irritability, headache, and weight gain without edema

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Post-Operative: remove entire pituitary gland Pg.932 – 934 pt teaching box o Diet: monitor fluids I’s and O’s o Monitor to avoid Meningitis

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Older pt has decreased metabolism Pg.919 Age-Related changes in endocrine system o Diminished response to ADH so the older person is less able to compensate for inadequate fluid intake or excessive fluid loss and is at risk for dehydration. o Decline in GH and IGF-1, resulting in reduced protein synthesis, decreased lean body and bone mass, and reduced immune function. o Decline in cortisol secretion; usually balanced by decreased cortisol metabolism. o Decline in secretion of aldosterone and plasma renin activity, which decreases the efficiency of sodium conservation and adaptation to position changes. o Although not normal, hypothyroidism is more common, especially among women.

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Graves disease: type of hyperthyroidism o Considered Autoimmune disease that causes thyroid to be overactive o Overactive thyroid activity

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Parathyroid hormone/gland o Function: metabolization of calcium o Hyperparathyroidism s/s: heat intolerance, moist skin, bone pain, weaker bones = risk for fractures, urinary calculi.

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Hypothyroidism s/s select all apply o Hypo = Cold intolerance (not enough hormone to metabolize body can’t produce enough heat) VS Hyper = Heat intolerance (thinner because metabolism is increased) o Hypo: abdominal cramps, slow neurological response, confusion, dry skin and brittle hair/nails

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Hypoparathyroidism = hypocalcemia o Low calcium in blood = decreased CO

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Saturated solution of potassium iodide (SSKI) can be given to people who have been exposed to radiation to prevent damage to the thyroid gland. o The iodides most often used to treat hyperthyroidism o Use Straw! o Iodine solutions can cause discoloration of the teeth and gastric upset. These effects are minimized if the iodine solution is diluted with milk, fruit juice, or some other beverage and sipped through a straw

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Preop care, Thyroidectomy: deep breathing coughing support and supporting the head during position changes

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Chvostek sign and Trousseau sign may be elicited to detect hypocalcemia o Chvostek: cheek twitching o Trousseau: BP cuff, torniquet = exaggerated reflex

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Best response for older patients regarding medication dosage reduction o Decreased metabolism = Decreased excretion of drug  slower metabolic rate

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Sensitivity assessment ???

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Measurements of free and total T4 detect abnormal levels of thyroid hormones. Elevated T3 indicates possible Graves disease, toxic adenoma, and toxic nodular goiter. Elevated T4 indicates hyperthyroidism or excessive thyroid hormone replacement. T3 and T4 decrease with hypothyroidism

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Neck dressing, assessing for blood pooling

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Hyperthyroidism: frequent mood changes, nervousness, diarrhea, sensitive to heat, weight loss

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Hypothyroidism: bradycardia

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Hypothyroidism: Myxedema: face, hands o If ac is on give them blankets or turn off ac

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Diabetes: Cardiac problem o Hypotension: losing volume = hypovolemia...