1
Q
What is the role of the endocrine system?
A
To orchestrate cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions.
2
Q
The endocrine system works on a __________ feedback system to help maintain homeostasis (balance)
A
Negative
3
Q
What types of hormones are the endocrine system composed of?
A
- Amines and amino acids
- Peptides, polypeptides, proteins, and glycoproteins: act on cell surface
- Steroids: act inside the cell
- Fatty acid derivatives
4
Q
Which hormones does the Anterior pituitary gland excrete?
A
FSH (follicle stimulating hormone)
LH (Luteinizing hormone)
Prolactin
ACTH ( Adrenal cortical tropic hormone) - Fluid balance.
TSH (Thyroid stimulating hormone)
GH (Growth Hormone)
5
Q
What does hypersecretion of Anterior Pituitary hormones cause?
A
Cushing’s syndrome - Too much adrenal
Gigantism - Too much GH
Acromegaly -
6
Q
What does hyposecretion of Anterior Pituitary hormones cause?
A
dwarfism
panhypopituitarism
7
Q
What hormones do the posterior pituitary gland secrete?
A
ADH (Antidiuretic hormone) / Vasopressin (maintain pressure in vessels - incr BP)
Oxytocin - Love, Breast milk let-down
8
Q
What does hypersecretion of Posterior Pituitary hormones cause?
A
SIADH - Syndrome of inappropriate antidiuretic hormone.
9
Q
What does hyposecretion of Posterior Pituitary hormones cause?
A
DI - Diabetes insipidus
10
Q
What are the most common reasons for pituitary hormone dysfunctions?
A
Tumors (often benign)
Surgery :
11
Q
How do we treat pituitary disruptions ?
A
Surgery - hypophysectomy
12
Q
What is the cause of DI?
A
injury to hypothalamus or (posterior) pituitary gland which results in deficient production of ADH
13
Q
What is the etiology behind DI?
A
- trauma to head,
- surgery,
- infection,
- inflammation,
- brain tumors,
- cerebral vascular disease,
- idiopathic.
14
Q
How does DI manifest itself?
A
Without Antidiuretic hormone, the kidney will produce an increased amount of urine. The urine will be dilute (1.001- 1.0025) and the patient will be very thirsty due to the large amount of urine output.
15
Q
Patients w/ DI wil have a urine output of greater than _________ ml/hr
A
250 ml/hr
16
Q
What tests do we do to be able to diagnose a patient with DI?
A
- Fluid deprivation test for 8-12 hrs or until 3%-5% body weight loss (1 L fluid = approx 1 kg in body weight)
- Frequent weights
- Plasma and urine osmolality test at the start and end of the test - Test is positive for DI if patient is unable to increase specific gravity and osmolality of the urine.
- Assess Na+ lvls - if patient is losing a lot of fluid, Na+ lvls will be elevated.
17
Q
In what event should we stop the fluid deprivation test?
A
If the patient become tachycardic and there is excessive weight loss or hypotension - s&S of hypovolemia.
18
Q
What hormone lvl test do we do to diagnose DI?
A
ADH plasma lvl test - decreased ADH = DI
19
Q
What drug do we use in DI assessment that can potentially stop the symptoms of DI
A
We do a trial of desmopressin therapy
20
Q
Why would we do a tumor assessment if we suspect that our patient may have DI?
A
Because DI may be caused by a tumor on the posterior pituitary gland
21
Q
What ongoing assessment do we as nurses do for our DI patients?
A
- Assess for dehydration (skin turgor, cap refill, sunken eyes)
- Low cardiac output (high urine output) =affects perfusion to the kidneys and brain
- I/O,
- vitals (assess for tachycardia and bradycardia)
Pt education (follow-up, dangers, prevention and complications, emergency measures
22
Q
What patient education do we need to do for our DI patients?
A
- Educate them on signs of dehydration and what to do in event of.
- Medication education (why and how)
- Educate them on the importance of wearing a medical bracelet. This is important in the event of an emergency.
23
Q
What does SIADH stand for?
A
Syndrome of Inappropriate Antidiuretic Hormone
24
Q
Which hormone is SIADH involved in ?
A
Antidiuretic hormone, in this case, the posterior pituitary is secreting too much ADH (SI = too little ADH)
25
What are the causes of SIADH?
* Usually non-endocrine origin
* Broncho-genic carcinoma (malignant lung cells)
* Severe pneumonia, pneumothorax,
* rauma to the head (central nervous system)
* Brain surgery or tumor or infection
26
True / False
SIADH is self limiting.
True - We should understand the underlying cause of the disease and treat whatever is causing the hormonal imbalance.
27
Why should we limit intake in SIADH patients ?
Patients with SIADH hold on to fluid due to the hypersecretion of ADH. We should not give them more fluid as this may lead to hypervolemia.
28
What medication is often given to patients with SIADH?
Diuretics (Furosemide)
29
If patient can handle/need IV fluid, what type of fluid solution should we be giving them if they are hyponatremic?
Hypertonic IV solution.
30
What are the nursing managements of SIADH patients?
Strict fluid I/O
Daily weight : To assess for how much fluid patient is holding on to.
Urine/blood chems
Neuro-assessments
pt education
31
What are the 3 thyroid hormones?
T3, T4, Calcitonin
32
What is contained in the thyroid hormone?
iodine (iodine deficiency will affect the thyroid hormone)
33
What hormone stimulates the thyroid, from which part of the pituitary gland does it come from?
TSH ( thyroid stimulating hormone) from the anterior pituitary gland.
TSH control the release of thyroid hormone T3 & T4
34
Thyroid hormone help control :
Cellular metabolic activity.
35
Is T3 or T4 more rapid acting?
T3 is more potent and rapid-acting than T4
36
What is Calcitonin secreted as a response to?
Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone. this protects us from hypercalcemia which may affect our heart or muscles.
37
Calcitonin is secreted by the thyroid or parathyroid?
Thyroid
38
Where is the thyroid gland located?
In front of our trachea
39
Where does T3 go once its released from the thyroid?
Straight to the target organs
40
Where does T4 go once its released from the thyroid?
The T4 goes via the liver before it goes to the target organs - this is why T3 is more rapid acting and potent.
41
What diagnostic tests do we do when there is suspicion of thyroid dysfunction? - Long answer
* TSH lvl test.
* Serum-free T4
* T3 and T4
* T3 resin uptake
* Thyroid antibodies
* Radioactive iodine uptake (watch out for iodine or shellfish allergies)
* Fine-needle biopsy (assessing for tumors)
* Thyroid scan, radioscan, or scintiscan
* Serum thyroglobulin (assessing for autoimmune)
42
Which medications can alter the result of a thyroid hormone test? (Study these, they may be on the test!)
* Amiodarone,
* aspirin,
* cimetidine,
* diazepam,
* estrogens,
* furosemide,
* glucocorticoids,
* heparin,
* lithium (hypo)
* phenytoin (other anticonvulsants),
* propranolol
43
What is the most common autoimmune disease associated w/HYPOthyroidism?
Hashimoto's - autoimmune thyroiditis
44
What are causes of Hypothyroidism?
(Taken from chart 45-3)
* Autoimmune disease (Hashimoto thyroiditis, post-Graves disease)
*Atrophy of thyroid gland with aging
* Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma)
* Iodine deficiency or iodine excess,
* iodine compounds Medications (e.g., Lithium)
* Radioactive iodine (131I) Therapy for hyperthyroidism * Thyroidectomy Radiation to head and neck in treatment for head and neck cancers, lymphoma
45
What are the clinical manifestations of Hypothyroidism?
* Coarse, dry, brittle hair
* Lethargy and impaired memory
* Loss of eyebrows
* Pallor
* Periorbital edema and puffy face
* Large tongue
* Deep coarse voice
* Diminished perspiration, cold intolerance
* slow pulse, cardiomegaly (enlarged heart)
* Gastric atrophy
* Weight gain
* constipation
* Menorrhagia
* Muscle weakness
* Peripheral edema (hands and feet)
Hypothyroidism slows things down!
46
What is the most common form of Hyperthyroidism?
Graves disease
47
What type of disorder is Graves disease?
Autoimmune disorder - Antibodies attach to the receptors of the cells in the thyroid which triggers the thyroid to secrete excessive thyroid hormone (T3 & 4)
48
What is thyrotoxicosis?
Excessive output of thyroid hormone - which may lead to thyroid storm.
49
Apart from autoimmune disorder (Grave's), what are other causes of hyperthyroidism?
* toxic multinodular goiter
* toxic adenoma
50
True / False
Hyperthyroidism are mostly seen in men.
False : Affects women eight times more than men
51
What are the clinical manifestations of Hyperthyroidism?
* Nervousness (jittery and restless)
* rapid pulse
* heat intolerance
* tremors
* muscle wasting
* fine hair
* goiter
* Oligomenorrhea
* Pretibial myxedema
* skin flushed, warm, soft, and moist
* exophthalmos - bulging eyes.
* increased appetite - extremely high metabolism
* weight loss
* elevated systolic BP
* cardiac dysrhythmias
Hyperthyroidism speeds things up!
Thyroid storm will have all these manifestations in the extreme.
52
What medications do we give to manage Hypothyroidism?
Most common medication is Synthroid.
53
What supportive care many patients w/ hypothyroidism need?
Support with dealing with changes in physical appearance and lifestyle changes due to the disease.
54
Apart from medications, what type of treatment is there for hyperthyroidsm?
* Radioactive 131I Therapy
* Surgery : Subtotal thyroidectomy
55
What medications do we give to patients w/ hyperthyroidism?
* Propylthiouracil and methimazole (may be on test)
* Sodium or potassium iodine solutions
* Dexamethasone
* Beta-blockers
56
What is the treatment of choice for thyroid cancer?
Thyroidectomy
57
What is a Thyroidectomy?
Modified or radical neck dissection,
possible radioactive iodine to minimize metastasis ( in case there is cancerous involvement)
58
What are the pre-operative goals w/ a thyroidectomy?
* Reduction of stress and anxiety to avoid precipitation of thyroid storm. ( Stress is linked to developing thyroid storm)
* To manage this we may give them Ativan to keep them calm.
59
What preoperative education should we give our patients before a thyroidectomy?
* dietary guidance to meet patient’s metabolic needs,
* avoidance of caffeinated beverages and other stimulants ( we want them calm)
* explanation of tests and procedures
* head and neck support used after surgery
60
What are the nursing interventions w/ Hyperthyroidism?
* Maintaining adequate cardiac output
* Improving nutritional status
* Enhancing coping measures
* Improving self-esteem
* Maintaining normal body temperature
* Monitoring and managing potential complications
* Patient education
This is all r/t teaching the patient how they should be treating their symptoms.
61
Where are the parathyroid glands located? How many parathyroid glands are there?
Four glands on the posterior thyroid gland
62
What does Parathormone regulate?
Parathormone regulates calcium and phosphorus balance
63
Increased Parathormone increases :
Blood calcium.
PT tells kidney, intestine, and bone to redirect calcium back into blood = elevated blood calcium levels
( does the opposite of Calcitonin )
64
Parathormone lowers :
Phosphorus level
( Phosphorus has an inverse relationship w/ calcium )
65
Hyperparathyroidism will lead to :
* Bone decalcification
* Hypercalcemia in blood
* Tissue calcification - due to hypercalcemia
* Renal calculi - due to hypercalcemia
66
True / False
Primary hyperparathyroidism occurs two to four times more often in women
True
67
How does Hyperparathyroidism manifest itself?
Patient may have no symptoms or may experience signs and symptoms resulting from involvement of several body systems.
Apathy,
fatigue,
muscle weakness,
nausea,
vomiting,
constipation
hypertension, and cardiac dysrhythmias may occur ( hypercalcemia)
68
how do we treat hyperparathyroidism?
* surgical removal of abnormal parathyroid tissue
* hydration therapy (Iv or fluid intake of > 2000 ml/ day) - flush calcium out.
* Encourage mobility
* Don't restrict calcium
69
Define Hypoparathyroidism.
Intestines reduce dietary calcium absorption,
less calcium escapes bone to enter blood,
kidneys don’t salvage calcium but excrete more through urine.
70
Hypoparathyroidism may lead to hyper___________.
Phosphatemia.
71
Hypoparathyroidism may lead to hypo___________.
calcemia in blood
72
What causes Hypoparathyroidism?
* Abnormal parathyroid development
* Destruction of the parathyroid glands (surgical removal or autoimmune response)
* Vitamin D deficiency (hypocalcemia)
73
What are the clinical manifestations of Hypoparathyroidism?
* Tetany - lack of calcium
* numbness,
* tingling in extremities,
* stiffness of hands and feet,
* bronchospasm,
* laryngeal spasm,
* carpopedal spasm,
* anxiety,
* irritability,
* depression,
* delirium,
* ECG changes ( heart always affected w/ electrolyte imbalances)
74
How do we manage hypoparathyroidism?
* Incr. Ca lvll to 9-10 mg/dl
* Give calcium gluconate IV in a medical setting.
* Pentobarbital ( CNS depressant) to decrease neuromuscular irritability
* Parathormone may be administered; potential allergic reactions
* Quiet environment; no drafts, bright lights, or sudden movement
* Diet high in calcium and low in phosphorus
* Vitamin D - helps absorb calcium
75
What OTC medication may a patient take for hypoparathyroidism/ hypocalcemia?
TUMS x3/day and PRN w/ signs of Tetany (result from hypocalcemia)
76
What may a hypercalcemia crisis result in?
Neurologic, cardiovascular, and kidney symptoms that can be life threatening
77
How do we treat a hypercalcemic crisis?
* Rapid rehydration with large volumes of IV isotonic saline fluids - flush calcium out, dilute blood.
* Combination of calcitonin and corticosteroids is administered in emergencies to reduce the serum calcium level by increasing calcium deposition in bone (moves calcium from bloodstream into bone)
78
Define Tetany.
Sign of hypocalcemia.
Defined as general muscle hypertonia, w/ tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements
79
What is Chvostek sign, how do we assess for it?
Sign of hypocalcemia
With a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear this causes spasm or twitching of the mouth, nose, and eye
80
What is Trousseau sign, how do we induce it ?
Sign of hypocalcemia
A carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff.
81
The Adrenal medulla functions as part of which nervous system?
The autonomic nervous system
82
What hormones / neurotransmitters do the adrenal medulla secrete?
Catecholamines;
epinephrine and norepinephrine (adrenaline)
83
What hormones do the adrenal cortex secrete?
Glucocorticoids
Mineralocorticoids
Androgens (component of sex hormones)
84
What is the main cause of Adrenocortical Insufficiency?
* Addison’s disease (primary cause)
* Dysfunction of hypothalamus-pituitary gland-adrenal gland feedback loop = not enough production of steroids by adrenal glands
* Autoimmune 70—90% of time
* Some meds can cause this.
* adrenalectomy
85
What are secondary causes of Adrenocortical Insufficiency?
* Adrenal suppression by exogenous steroid use - if you take too many steroids / chronic steroid use the adrenal gland will stop producing and releasing these steroids.
86
What are the signs of an Addisonian crisis?
Happens w/ extreme adrenal insufficiency.
* Severe hypotension
* Cyanosis
* Fever
* N/V
* Shock
* Pallor
* Headache
* Abdominal pain/diarrhea
* Confusion/restlessness
This is life-threatening and a medical emergency!!
These symptoms are the opposite of the fight or flight symptoms.
87
What tests do we do to determine if our patient have adrenocortical insufficiency?
Adrenocortical hormone levels,
ACTH levels : Secreted by the anterior pituitary gland, and signals the adrenal gland to release hormones.
ACTH stimulation test
88
How do we test our patients for ACTH levels?
1) baseline blood level test of ACTH
2) Inject patient w/ synthetic ACTH
3 ) If the patient is not adrenal insufficiency then it should trigger the adrenal glands to release hormones/adrenaline.
4) If this release doesn't happen, then the patient most likely has adrenal insufficiency.
89
What are the medical managements of Adrenocortical Insufficiency ?
* Restore blood circulation (ie IV fluids) - insufficiency causes low BP
* Corticosteroid/IV hydrocortisone - We supplement the steroid hormones to reach homeostasis
* Vasopressors - maintain BP (after IV fluids)
* Abx if infection triggered crisis
90
What are the nursing managements of Adrenocortical Insufficiency ?
* Bed position (recumbent/legs elevated)
* Discharge teaching: how to take steroids, S/s monitoring, diet (more salt -adrenal glands normally help maintain salt w/ aldosterone )
91
What special precautions do we need to have in place for pregnant patients that have adrenocortical insufficiency? (may be on test)
3rd trimester pregnancy MUST have supplemental corticosteroid med therapy - the body needs increased adrenal hormones under stress and if they are already having an insufficient amount then this can lead to an addisonian crisis.
92
What special precautions do we need to have in place for patients w/ adrenocortical insufficiency who are undergoing stress (illness, surgery, life event) ? (may be on test)
MUST have supplemental corticosteroid med therapy - - the body needs increased adrenal hormones under stress and if they are already having an insufficient amount then this can lead to an addisonian crisis.
93
How much more medication do patients w/ adrenocortical insufficiency need to take under times of stress?
2-3 times more than what they are normally taking.
94
When do patients w/ adrenal insufficiency normally take their steroids? (may be on test )
In the morning and afternoon w/ meals.
95
Is the morning dose larger or smaller than the afternoon dose (Adrenal insufficiency medical treatment)
Morning dose is larger - this is to mimic how the adrenal glands normally functions.
In normal adrenal glands, a larger dose is secreted in the bloodstream to wake you up ( Diurnal rhythm) - levels taper off as the day progresses.
96
What is Cushings syndrome?
* Caused by excessive adrenocortical activity or corticosteroid medications (most common cause) e.g patients that are on immunosuppressive drugs and are taking steroids chronically.
* Hyperplasia of adrenal cortex (secondary) =excessive glucocorticoid production
97
How do we test for Cushing's syndrome?
Serum cortisol - will be high
urinary cortisol - will be positive
Low-dose-Dexamethasone suppression test.
(2 of these 3 must be abnormal to definitive dx positive syndrome)
98
What are the clinical manifestations of Cushing's syndrome? Very long answer.
* Hyperglycemia - too much cortisol.
* central-type obesity with “buffalo hump;”
* heavy trunk and thin extremities;
* fragile, thin skin; ecchymosis; striae;
* weakness;
* lassitude;
* sleep disturbances - cortisol at night keeps you awake, diurnal rhythm is lost.
* osteoporosis; : too much steroids lead to bone decalcification.
* muscle wasting;
* hypertension;
* “moon-face”;
* acne;
* infection - elevated cortisol may lead to infection.
* slow healing
* virilization in women - Women start to develop male features such as a beard.
* loss of libido;
* mood changes;
* increased serum sodium - increased aldosterone increases sodium retention.
* decreased serum potassium - high serum sodium = low serum potassium.
99
What endocrine/metabolic changes do we see with cushing's syndrome? (long answer)
Adrenal suppress.
Altered Ca metabolism
Buffalo hump
Hyperglycemia
Hypokalemia/Sodium retention
Impotence
Menstrul Irreg
Metabolic alkalosis
Moon face/Truncal obesity
100
What psychiatric manifestations may we see with cushing's syndrome?
Mood alterations (think roid rage)
Psychoses
101
What opthalmic effects can cushing's syndrome have?
* Cataracts
* Glaucoma
This may be caused by being hyperglycemic which may also eventually lead to diabetes.
102
How do we manage Cushing's syndrome?
Treatment depend on cause.
If Pituitary is the problem such as a tumor = surgery
If adrenal gland is the problem = adrenalectomy
Nursing management depend on the manifestation of the symptoms.
103
What are the nursing interventions for patients w/ cushing's syndrome?
* Maintaining adequate cardiac output - Cortisol may lead to HTN
* Decreasing risk of injury and infection (infection is a significant problem due to the high cortisol levels)
* Promoting skin integrity
* Improving body image (buffalo hump, moon face, large torso)
* Improving coping
* Monitoring and managing potential complications
* Addisonian crisis
* Patient education
104
Is the following statement true or false?
Oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in Graves disease.
False
Rationale: Oversecretion of ACTH or growth hormone results in Cushing’s syndrome. Graves disease results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins.
105
Which medication blocks synthesis of thyroid hormone?
Dexamethasone
Methimazole
Potassium iodide
Sodium iodide
Methimazole
Rationale: Methimazole blocks synthesis of thyroid hormone. Dexamethasone, potassium iodide, and sodium iodide suppress release of thyroid hormone
( MAY BE ON EXAM)
106
Is the following statement true or false?
A patient in acute hypercalcemic crisis requires close monitoring for life-threatening complications and prompt treatment to reduce serum calcium levels.
True
Rationale: A patient in acute hypercalcemic crisis requires close monitoring for life-threatening complications and prompt treatment to reduce serum calcium levels. Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin. Nurse must monitor closely for fluid overload.
107
What suppresses the release of Thyroid Hormone?
Dexamethasone
Potassium iodide
Sodium iodide
108
For any endocrine disorders, what assessments do we need to do as nurses?
* Detailed health hx
* Physical assessment (general and system specific)
109
For a patient who has hypothyroidism and is taking Synthroid, what education is important to teach them ?
Synthroid should be taken at 6 a.m - 2 hrs before any meal.
