Endocrine System Study Guide PDF

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Study guide for endocrine lectures...

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Homeostasis & Regulation: Hormonal Regulation Physiological Process  Maintain balance o Control of Hormonal Secretion:  Negative feedback  Positive feedback  Biological rhythms  Central nervous system control Risk factors o Hormonal supplement therapy, advanced age, obesity, sedentary lifestyle, genetics, chromosomal deficiencies/abnormalities, family history, especially autoimmune responses/conditions, stress, trauma, chronic medical conditions, cancer treatment Assessment  Baseline history includes: o Gender, age, past medical history, current conditions, current medications, psychosocial history, family history, history about basic physiological functions 

Diagnostic Testing  Hormone levels – direct testing (serum or urine) of hormone levels  Stimulation and suppression testing – test done to evaluate the process of hormone stimulation and suppression  Imaging – ultrasound, MRI, scans  Biopsy – analysis of gland tissue Collaborative Care  Health promotion: o Education, diet, exercise, weight control, injury avoidance, avoidance of environmental hazards, stress management, maintaining routine sleep-wake patterns, screening (thyroid & diabetes)  Treatment interventions: o Diet/nutrition therapy, fluid/electrolyte management, pharmacotherapy, surgical options (hypophysectomy, adrenalectomy, thyroidectomy, parathyroidectomy), radiation, psychological support, patient education Hypopituitarism  Decrease in one or more pituitary hormones (anterior or posterior)  One deficiency is “selective hypopituitarism”  Total failure of pituitary is “panhypopituitarism”  Manifestations/conditions dependent on the hormone deficiency  Treatment – replacement therapy, radiation and/or surgery Hyperpituitarism  Increase in one or more pituitary hormones (anterior or posterior)  Tumors usually cause for excess anterior hormone production  Clinical manifestations related to specific hormone excess  Management aimed at decreasing hormones levels and treating manifestations

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Surgery: transsphenoidal hypophysectomy o Patient will not require larger doses of insulin after surgery  They may be sterile for the rest of their lives  Will need to take a thyroid hormone for the rest of their lives  Will need to take steroids for the rest of their lives o Avoid activities that increase pressure at site o Monitor patient for:  Meningitis  CSF leakage – CSF contains glucose, mucous does not  Diabetes insipidus – involves ADH  Increased ICP o Post-op care:  Neuro exam, I&O (monitor drainage), urine specific gravity, desmopressin or vasopressin, IV access, increase HOB, mouth care

Pituitary Disorders (Anterior)  Growth Hormone Excess: Gigantism – excessive secretion before the closure of the epiphyses  Growth Hormone Excess: Acromegaly – excessive secretion after the closure of the epiphyses o Clinical manifestations:  Enlargement of tissues, facial features, tongue  Joint pain  Muscle weaknesses  Visual changes  Hyperglycemia o Treatment:  Surgery – transsphenoidal hypophysectomy  Radiation Pituitary Disorders (Posterior)  Antidiuretic Hormone (ADH) o Overproduction – Syndrome of inappropriate antidiuretic hormone (SIADH) o Deficiency – diabetes insipidus (DI)  Central (pituitary)  Nephrogenic (kidney)

SIADH vs. DI  SIADH o o o o  DI o o o o

Fluid retention Dilutional hyponatremia Concentrated urine Decreased urine output Increased urine output Dilute urine Dehydration Hypernatremia

Adrenal Glands (Cortex)  Steroids: o Glucocorticoids (sugar) o Mineralcorticoids (salt) o Androgens (sex) o Function of these steroids?  Cushing’s Syndrome o Collaborative management:  Acute care priorities  Adrenalectomy: post-op care  Care of patient taking steroids  Addison’s Disease o Deficiency of everything!! o Collaborative management:  Acute care priorities  Patient teaching o Don’t have enough so need to ADD some more

Hyperaldosteronism (Conn’s syndrome) o Primary and secondary etiology o Manifestations – hypertension and hypokalemia o Collaborative care Adrenal Gland (Medulla)  Pheochromocytoma (tumor of the adrenal medulla) o Manifestations: hypertension, palpitations, hyperglycemia, headache, and sweating o Releases excess amounts of epi – do not palpate abdomen o Collaborative treatment: medications & surgery  Check BP & HR!!  High risk of stroke and heart attack 

Parathyroid Disorders  Hyperparathyroidism – high calcium; treatment is geared toward treating calcium imbalances  Hypoparathyroidism – low calcium

Thyroid Disorders  Abnormalities o Goiter o Nodules o Thyroiditis o Hypothyroidism/hyperthyroidism

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Thyroid testing o Physical exam o Serum testing (TSH, T4/T3) o Ultrasound o Thyroid uptake and scan Goiter o Hypertrophy and enlargement of the thyroid o Caused by excessive TSH stimulation from inadequate thyroid hormones o Can be caused by goitrogens (foods or drugs that suppress gland function)  Enlargement of gland  Interferes with iodine uptake – cabbage is known to do this o Surgery may be necessary o What is a priority nursing diagnosis for this patient?  Airway Nodules o Palpable deformity o May be benign or malignant o Major sign of thyroid cancer is a hard, painless, nodule on an enlarged gland  The presence of a nodule does not automatically mean that it is cancerous o Ultrasound, CT scan, thyroid scan, MRI, Fine Needle Aspiration (FNA) Thyroiditis o Inflammation of thyroid – causes the gland to be hyperthyroid initially (low TSH) o Can be viral, bacterial, fungal, or autoimmune o Can lead to hypothyroidism (Hashimoto’s) o Usually thyroid hormones are elevated but then may become depressed o TSH low, then elevated  If it is untreated then hyperthyroidism (low TSH) slowly develops into hypothyroidism (high TSH) o Treatment depends on cause and manifestations Hyperthyroidism o Most common form – Graves’ disease  More common in women o Manifestations?  Increased BP, HR, RR, feel hot, diaphoresis, hyperactive, insomnia, restless, anorexia, low body weight  Priority is the cardiac concerns – increase for heart attack and stroke due to the increased BP and HR  Exophthalmos (bulging eyes) – physically cannot close their eyes; at risk for corneal abrasion, trauma, dryness; caused from accumulation of ocular fluid o Thyrotoxic crisis (thyroid storm)  Manifestations are heightened – severe tachycardia, HF, shock, fever, restlessness, seizures, delirium, coma, N/V/D  Life threatening emergency  Etiology – stress, surgery, trauma, infection  Treatment aimed at reducing circulating hormones, manifestations, and decreasing effects of metabolic rate

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Collaborative care  Drug therapy – anti-thyroid drugs (PTU), iodine, beta adrenergic blockers (cardiac effects), sedatives (help relax), Tylenol (fever), insulin (hyperglycemic because of raised carb and fat metabolism from T3 & T4), oxygen  Radioactive iodine therapy  Surgical therapy Nursing care  Care related to manifestations – avoid caffeine, meditate, Post-op care  Airway – trach tray at bedside; concerned for airway or laryngeal stridor  Assess for bleeding  Semi-fowler’s or high fowler’s – avoid flexion of neck, neutral position of neck  Monitor vital signs (look for Trousseau’s) and which electrolyte imbalance? – calcium (when thyroid is removed, the parathyroids may have also been removed so concerned for hypocalcemia)  Diet – permitted to take fluid as soon as tolerated and soft diet the next day

Hypothyroidism  Insufficient circulating hormones  One of the most common disorders in US  All infants in US are screened at birth  Primary or secondary etiology  Manifestations? o Bradycardia, decreased GI motility (constipation), sluggish, no energy, slow metabolism, increased weight, always cold o Priority is still heart but it’s slow now – decreased perfusion, at risk for heart failure because of increased demand on the heart  Myxedema o Note the striking resolution of his puffiness (myxedema) after treatment o Myxedema life threatening form of hypothyroidism with exaggerated manifestations o Myx is the Greek word for mucin which accumulates in hypothyroidism o Edema means swelling o TSH level is high o Collaborative care  Nutritional therapy – low in calories, high in fiber, fluids (FOOD QUESTION!!!)  Patient teaching – exercise, diet, medication  Thyroid hormone replacement – need frequent blood work  Myxedema – possible mechanical ventilation, glucose, IV thyroid supplements, fluid regulation, monitor for heart failure...