NRS 202- EXAM 1 > ENDOCRINE > Flashcards

ENDOCRINE Flashcards

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1
Q

What does the endocrine system do?

A

Plays vital role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions

Its a negative feedback mechanism and helps maintain homeostasis.

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2
Q

What are the major hormone secrecting glands?

A

Hypothalamus
Pineal
Pituitary
Thyroid
ParaThyroid
Thymus
Adrenals
Islets of langerhan in the pancreas.

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3
Q

Anterior Pituitary Glad Hormones

A

FSH< LH< prolactin, ACTH, TSH and GH

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4
Q

If your Anterior Pituitary is Hyperactive what will you see?

A

Hyper: Cushing’s syndrome, gigantism, acromegaly

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5
Q

If your Anterior Pituitary is Hypoactive what will you see?

A

Hypo: dwarfism, panhypopituitarism

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6
Q

Posterior Pituitary Gland Hormones

A

Posterior:

ADH, vasopressin
Oxytocin

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7
Q

If your Posterior Pituitary is Hyperactive what will you see?

A

SIADH

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8
Q

If your Posterior Pituitary is Hypoactive what will you see?

A

Diabetes Insipidus

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9
Q

What is Diabetes Insipidus?

A

a rare disorder where the kidneys can’t balance water, causing excessive urination (polyuria) and extreme thirst (polydipsia) because the body lacks the hormone vasopressin (ADH) or the kidneys can’t respond to it, leading to large volumes of dilute urine, but unlike diabetes mellitus, it’s not related to blood sugar levels, which remain normal. It’s caused by issues with ADH production or kidney response, with types including central (brain/pituitary issue), nephrogenic (kidney problem), and gestational (pregnancy-related).

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10
Q

Diabetes Insipidus Causes:

A

Causes: injury to hypothalumus or (posterior) pituitary gland (hence HYPO)

Tumors ect.

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11
Q

Diabetes Insipidus Result:

A

Result: deficient production of ADH (aka antidiuretic hormone, aka vasopressin)

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12
Q

Etiology of Diabetes Insipidus:

A

Etiology: trauma to head, surgery, infection, inflammation, brain tumors, cerebral vascular disease, or idiopathic.

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13
Q

The difference between Diabetes Insipidus and Diabetes M:

A

DI does not have issues with blood sugar
DM does.

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14
Q

Diabetes Insipidus Clinical manifestations

A

NO ADH:
Kidneys step on the gas pedal=increase urine (greater than 250ml/hr)

=dilute urine (specific gravity 1.001-1.0025)

=thirsty (somebody get this kid a big gulp)

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15
Q

DI Assessments and Diagnostic

A

-Fluid deprivation test for 8-12 hrs or until 3%-5% body weight loss
-Frequent weights
-Plasma and urine osmolality test at start and end of test
I-f pt unable to increase specific gravity and osmolality of urine = likely has DI
-Na+ levels rise

If tachycardic and excessive weight loss, or hypotension = STOP the test

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16
Q

ALL DI assessments and diagnostics

A

Fluid deprivation test
ADH plasma levels test
Trial desmopressin therapy
IV Hypertonic saline infusion
Tumor assessment

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17
Q

RN management of DI

A

-Ongoing assessment (dehydration, low cardiac output=affects kidneys and brain)
-I/O, vitals
-Pt education (follow-up, dangers, prevention and complications, emergency measures
-Med teaching
-Medical bracelet

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18
Q

What is SIADH?

A

Too much urination,

Remember: Posterior Pituitary gland secretes ADH. In this case, it secretes mucho-much (hence, “hyper”). Essentially, somewhere the negative feedback loop was kicked to the curb

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19
Q

Causes of SIADH

A

Usually non-endocrine origin
Broncho-genic carcinoma (malignant lung cells)
Severe pneumonia, pneumothorax,
Trauma to the head (central nervous system)
Brain surgery or tumor or infection

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20
Q

Medical Management of SIADH

A

Syndrome “usually” self limiting
Eliminate underlying cause
Restrict fluid intake
Diuretic drugs (e.g. Lasix)
Hypertonic solution if hyponatremic

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21
Q

Nursing Managment of SIADH

A

Strict fluid I/O
Daily weight
Urine/blood chems
Neuro-assessments
pt education
do they look dehydrated?
check the heart, check skin turgor.

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22
Q

What are the hormones in the thyroid gland?

A

T3, T4, calcitonin

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23
Q

What is contained in thr thyroid hormone?

A

Iodine

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24
Q

What controls the release of TSH?

A

Thyroid-stimulating hormone, also known as TSH
is controlled by the anterior pituitary gland.

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25
What does the thyroid gland control?
cellular metabolic activity
26
Which is more potent and rapid acting? T3 or T4?
T3
27
Calcitonin is secreted by what?
The thyroid, if theres too much calcium in the blood stream, the thyroid will secrete more calcitonin and increase calcium deposit in the bone.
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Diagnostic Tests for the Thyroid
TSH 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)
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What meds can alter a thyroid test?
Amiodarone, aspirin, cimetidine, diazepam, estrogens, furesomide, glucocorticoids, heparin, lithium, phenytoin (other anticonvulsants), propranolol
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What are some Thyroid disorders?
Cretinism Hypothyroidism Hyperthyroidism Thyroiditis Goiter Thyroid cancer
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What is hypothyroidism?
Hashimoto Disease: this is a type of hypothyroidism. it is autoimmune thyroiditis This means there is more than 95% dysfunction of the thyroid.
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Causes of Hypothyroidism:
Autoimmine disease atrophy of thyroid gland with aging infiltrative cancer of the thyroid iodine deficiency medications like lithium radioactive iodine therapy for hyperthyroidism thyroidectomy radiation to the head and neck in treatment for head and neck cancers.
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Clinical manifestations of Hypothyroidism
coarse dry brittle hair loss of lateral eyebrows pallor large tounge lethargy and impaired memory periorbital edema and puffy face deep coarse voice diminished perspiration, cold intollerance weight gain slow pulse, enlarged heart gastric atrophy constipation peripheral edema muscle weakness mennorhagia, unreagular cycles.
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What is Hyperthyroidism?
Graves Disease: (autoimmune disorder & most common cause); thyrotoxicosis: excessive output of thyroid hormone (thyroid storm)
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Causes of Hyperthyroidsm
autoimmune toxic multinodular goiter, toxic adenoma
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Are men or women more effected by hyperthyroidsm?
women are effected 8 times more than men
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clinical manifestations of hyperthyroisdism
Nervousness; rapid pulse; heat intolerance; tremors; skin flushed, warm, soft, and moist; exophthalmos; increased appetite; weight loss; elevated systolic BP; cardiac dysrhythmias fine hair nervousness eyes pop out sweating, heat intollerance goiter increased appetite weight loss fine tremor oliogomennorhea warm soft moist
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Treatment of Hyperthyroidism
Hyperthyroidism Radioactive 131I therapy Medications: Propylthiouracil and methimazole Sodium or potassium iodine solutions Dexamethasone Beta-blockers Surgery; subtotal thyroidectomy
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Treatment of hypothyroidism
Pharmacologic; Supportive
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What is a thyroidectomy?
Treatment of choice for thyroid cancer Modified or radical neck dissection, possible radioactive iodine to minimize metastasis Preoperative goals: reduction of stress and anxiety to avoid precipitation of thyroid storm Preoperative education: dietary guidance to meet patient’s metabolic needs, avoidance of caffeinated beverages and other stimulants, explanation of tests and procedures, and head and neck support used after surgery
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Nursing Interventions for the patient with 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
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What are the parathyroid glands?
Four glands on the posterior thyroid gland Parathormone regulates calcium and phosphorus balance
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What happens with increased parathromone?
Parathormone tells kidney, intestine, and bone to redirect calcium back into blood = elevated blood calcium levels Parathormone also lowers phosphorus level
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What is hyperparathyroidism?
= too much parathormone=bone decalcification=hypercalcemia in blood=tissue calcification=renal calculi
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manifestations of hyperparathyroidism
the 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
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treatment of hyperparathyroisism
Treatment: surgical removal of abnormal parathyroid tissue, hydration therapy
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What is hypoparathyroidism?
too little parathormone= intestines reduce dietary calcium absorption, less calcium escapes bone to enter blood, kidneys don’t salvage calcium but excrete more phosphorous=hypocalcemia in blood/hyperphospatemia think: leads to hypocalcemia and hyperphospatemia
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causes of hypoparathyroidism
Causes: Abnormal parathyroid development Destruction of the parathyroid glands (surgical removal or autoimmune response) Vitamin D deficiency
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signs and symptoms of hypoparathyroidism
Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes
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medical management of hypoparathyroidism
Increase serum calcium level to 9 to 10 mg/dL Calcium gluconate IV Pentobarbital 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
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medical management of Hyperparathyroidism
Parathyroidectomy Hydration therapy—fluid intake of 2000 mL or more daily Maintain mobility Don’t restrict calcium
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What is hypercalcemic crisis?
Occurs with extreme elevation of serum calcium levels Results in neurologic, cardiovascular, and kidney symptoms that can be life threatening
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Treatment for hypercalcemic crisis
Rapid rehydration with large volumes of IV isotonic saline fluids Combination of calcitonin and corticosteroids is administered in emergencies to reduce the serum calcium level by increasing calcium deposition in bone
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What is tetany
Tetany: general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements
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what is the Chvostek sign
a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye
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what is the Trousseau sign
carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff
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what are the adrenal glands?
adrenal medula adrenal cortex
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what does the adrenal medula do?
Functions as part of the autonomic nervous system releases Catecholamines; epinephrine and norepinephrine
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What does the adrenal cortex do?
releases Glucocorticoids Mineralocorticoids Androgens
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what causes a Adrenocortical Insufficiency
Addison’s disease (primary): dysfxn 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. As well as adrenalectomy (obviously) 2ndary: adrenal suppression by exogenous steroid use, dysfxn of hypothalamus-pituitary gland-adrenal gland feedback loop)
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What is Addisonian crisis?
Life threatening! S/S: Severe hypotension Cyanosis Fever N/V Shock Pallor Headache Abdominal pain/diarrhea Confusion/restlessness
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diagnostics for Adrenocortical insufficiency
Diagnostic tests: adrenocortical hormone levels, ACTH levels, ACTH stimulation test
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Medical/ nurse management for Adrenocortical insufficiency
Restore blood circulation (ie IV fluids) Corticosteroid/IV hydrocortisone Vasopressors Bed position (recumbent/legs elevated Abx if infection triggered crisis Patient undergoing stress (e.g. illness, surgery, 3rd trimester pregnancy) MUST have supplemental corticosteroid med therapy Discharge teaching: how to take steroids, S/s monitoring, diet (more salt)
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Causes of Cushings Syndrome
Excessive adrenocortical activity or corticosteroid medications (most common cause) Hyperplasia of adrenal cortex (2ndarry)=excessive glucocorticoid production
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Dx tests for Cushings Syndrome
Dx test: Serum cortisol, urinary cortisol, low-dose-Dexamethasone suppression test. (2of3 must be abnormal to definitive dx positive syndrome)
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What is Cushings Syndrome?
Cushing's syndrome is a hormonal disorder from prolonged exposure to high cortisol levels, causing symptoms like weight gain (especially the trunk), a round face, thin limbs, easy bruising, high blood pressure, high blood sugar, fatigue, and skin changes (purple stretch marks). It's caused by medications or the body making too much cortisol, often due to tumors in the pituitary or adrenal glands.
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Clinical Manifestations of Cushings Syndrome
Hyperglycemia; central-type obesity with “buffalo hump;” heavy trunk and thin extremities; fragile, thin skin; ecchymosis; striae; weakness; lassitude; sleep disturbances; osteoporosis; muscle wasting; hypertension; “moon-face”; acne; infection; slow healing; virilization in women; loss of libido; mood changes; increased serum sodium; decreased serum potassium
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Cardiovascular Symptoms of Cushings Syndrome
Heart Failure Hypertension
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Dermatologic Symptoms of Cushings Syndrome
Acne Ecchymosis Petechiae Striae
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Endocrine/Metabolic Symptoms of Cushings syndrome
Adrenal suppress. Altered Ca metabolism Buffalo hump Hyperglycemia Hypokalemia/Sodium retention Impotence Menstrul Irreg Metabolic alkalosis Moon face/Truncal obesity
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GI Symptoms of Cushings syndrome
Pancreatitis Peptic Ulcer
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Immune system symptoms of cushings syndrome
Decreased inflammatory response Impaired wound healing Risk for infxns
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muscular system symptoms of cushings syndrome
Muscle weakness Myopathy
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skeletal symptoms of cushings syndrome
Aseptic necrosis of femur Ostoporis Spontaneous fractures Vertebral compression fractures
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opthalmic symptoms of cushings syndrome
Cataracts Glaucoma
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psychiatric symptoms of cushings syndrome
Mood alterations (think roid rage) Pyschoses
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Cushings Syndrome Management
Depends on cause: If Pituitary origin (ie tumor), surgery If adrenal gland, adrenalectomy Nursing management depends on manifested signs/symptoms
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In adrenocortical insufficiency a patient under stress needs what?
Patient undergoing stress (e.g. illness, surgery, 3rd trimester pregnancy) MUST have supplemental corticosteroid med therapy usually they take it in the morning and afternoon with meals This tries to mimic how your adrenal glands work normally. If the patient is in stress they will need more than usual.
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Nursing Interventions for the Patient with Cushing’s Syndrome
Maintaining adequate cardiac output Decreasing risk of injury and infection Promoting skin integrity Improving body image Improving coping Monitoring and managing potential complications Addisonian crisis Patient education
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Which medication blocks synthesis of thyroid hormone? Dexamethasone Methimazole Potassium iodide Sodium iodide
B. Methimazole Rationale: Methimazole blocks synthesis of thyroid hormone. Dexamethasone, potassium iodide, and sodium iodide suppress release of thyroid hormone
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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.
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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.
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What should the nurse teach a client on corticosteroid therapy in order to reduce the client's risk of acute adrenal insufficiency?
always have enough on hand to avoid running out 👉 Never abruptly stop steroids → always have enough medication on hand
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NRS 202- EXAM 1
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