NURS 2501 > Endocrine system > Flashcards

Endocrine system Flashcards

(52 cards)

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1
Q

Endocrine system - Anatomy

A
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2
Q

Regulation of blood calcium

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3
Q

Hypothalamus & Pituitary Glands

A
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4
Q

Hormones secreted by anterior pituitary (adenohypophysis)

A
  1. TSH (thyroid stimulating hormone) - thyroid
  2. ACTH (adrenocorticotropic hormone) - adrenal cortex
  3. GH (growth hormone) - bones + tissues
  4. Gonodotropic hormones - LH + FSH
  5. Prolactin - mammary glands
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5
Q

Hormones secreted by adrenal cortex

A
  1. Glucocorticoids - Cortisol
  2. Mineralocorticoids - Aldosterone
  3. Androgens - Testosterone
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6
Q

Acromegaly (adulthood) - cause, S/s

A

due to GH secreting tumor

  1. Enlargement of hands + feet
  2. Elongation of jaw bone
  3. Enlargement of visceral organs - hepatomegaly , cardiomegaly
  4. Hyperglycemia - GH blocks action og insulin
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7
Q

Prolactin secreting tumors - S/s

A
  1. Galactorrhea
  2. Hypogonadism
  3. Impotence
  4. Amenorrhea
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8
Q

Excess ACTH - S/s

A
  1. Cushing’s syndrome
  2. Weight gain + HTN
  3. Masculinization (facial hair, deep voice) , amenorrhea
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9
Q

Hypophysectomy - monitor !

A

surgical removal of the hypophysis (pituitary gland) - transphenoidal approach

! Electrolytes - DI ? SIADH ? ; I+O; Dont band head below waist for 2 weeks; oral hygiene - no toothbrush, warm saline rinses ; humidified O2 (mouth breathers)

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10
Q

Parlodel (bromocriptine mesylate)

A

Dopamine receptor agonist

TX: prolactin or GH secreting tumors; Parkinson disease

NC: PO, take with food ( GI upset - nausea + constipation (Fiber 25g))

SE: Postural hypotension - get up slowly ;Orthostatic BP

  • **BP drops 20 - HR increase 20 **
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11
Q

Sandostatin ( octreotide)

A

Somatostatin analogs

TX: inhibits GH secretion; used pre-op to shrink the GH secreting tumor

NC: must be given parenterally - subcut, IV or IM

SE: **Decreased GI and gallbladder motility ** - gallbladder disease - bile duct stones + gallstones

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12
Q

Hormones secreted by Hypothalamus and stored + released by the Posterior pituitary gland

A
  1. Oxytocin - ejection of milk
  2. ADH - stimulates reabsorption of water by the kidneys ; vasoconstrictor
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13
Q

Diabetes Insipidus (DI) - S/s

A

Decrease in ADH

Polyuria - dehydration - increased serum osmolarity - polydipsia ; urine is dilute - low specific gravity

Hypernatremia

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14
Q

Hypernatremia - S/S

A

_135-145 _

  1. Thirst - craving cold water
  2. Sticky mucus membranes
  3. Increased T + HR
  4. Weak, irritable
  5. Mental confusion
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15
Q

Fluid Deprivation Test

A

DX of DI

Pt. has no fluids - monitor Q1 - weight, urine output, Na level.

Dehydration triggers kidneys to concentrate urine

Stop :

  1. Severe hypernatremia
  2. Loose more than 3-5 % of body weight
  3. Hypovolemia - shock
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16
Q

DI - TX

A
  1. Vasopressin - strong vasoconstrictive !!!! - CAD, PVD, Raynaud’s
  2. DDAVP - Desmopressin acetate - synthetic without strong vasoconstr. properties - IV, nasal spray, PO
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17
Q

SIADH - S/S

A

Increase in ADH

Water retention - decreased serum osmolarity - dilutional Hyponatremia - Oliguria - increased urine osmolarity and sp. gravity

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18
Q

SIADH - TX

A
  1. Na = or > 125 - Fluid restriction - to balance Na and H2O - explain to pt. and family
  2. Na< 125 - S/s of hyponatremia develope -

3% Hypertonic Saline - small amount, slowly ( 12 in 24 hrs increase)

!!! Cerebral edema

  1. Demectocycline (Declomycin) - antibiotic - off label use - inhibits ADH secretion
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19
Q

Cushing’s disease - causes

A

adrenal or pituitary tumors; steroids (Prednisone)

Increase in glucocorticoids (Cortisol)

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20
Q

Cushings - S/s

A
  1. Truncal obesity (alteration in fat metabolism)
  2. Moon face
  3. Buffalo hump
  4. Thin arms + legs (increase breakdown of protein )
  5. Thin skin - increase fragility of capillaries - bleeding
  6. Generalized weakness + lethargy
  7. GI distress - increase acid
  8. Risk for infection - poor healing
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21
Q

Cushings - labs

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A
  1. Hyperglycemia - monitor sugar; tx: insulin
  2. Hypokalemia - retaining Na + H2O - increase in aldosterone - HTN - I+O, weights
  3. Hypocalcemia - osteoporosis
22
Q

Cushings - DX

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A
  1. H+P
  2. Dexamethasone (Decadron) suppression test - give lil dose PO (11pm) - to see if adrenal glnad shuts off; if doesnt - tumor - adrenal? pituitary?
  3. 24 hour urine (free cortisol levels) - waste first; signs everywhere ; lab for instructions - ice? preservatives?
23
Q

Cushings - TX

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A
  1. Pituitary ? - Hypophysectomy
  2. Adrenal ? - Adrenalectomy
  3. reduce/discontinue exogenous steroids
  4. Na restriction, low carbs diet

Increase Ca + vit D , protein and ambulation

Fluid restrictions

Emotional support

24
Q

Addisonian Crises

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A

Causes - both adrenal glands removed , abruptly stopped taking steroids (due to nausea?)

Life threatening event !!!

Decrease in Na and BP

Increase in K - tx: insulin drip (push K into the cell); Kayexalate (NG, PO, enema) and HR

TX: IV steroids replacement

Fluid replacement

Hypoglycemia - D5W, D10W, Glucagon

25
Addisons - S/s
Decrease in mineral (aldosterone) and glucocorticoids (cortisol) 1. Lethargic, weakness 2. **_Hypoglycemia_** - sweating, confusion, shakiness, tremors 3. Postural hypotension 4. Weight loss - due to GI disturbances 5. Bronze pigmentation of skin 6. Mental instability - severe psychosis
26
Addisons - TX
Lifelong hormone replacement therapy (Pt. and family teaching ) 1. **_Cortisone , Hydrocortisone, Prednisone_** - in the am with breakfast - decrease GI upset - replace glucocorticoids 2. **_Florinef (fludrocortisone)_** - replace mineralocorticoids Wear med. alert bracelet
27
Primary Aldosteronism
Increase in aldosterone 1. Na + H2O retention 2. Decrease in K + hydrogen ions - metabolic alkalosis DX: Abnormal electrolytes Renin (decrease) - aldosterone (increase) stimulation test TX: correct electrolytes imbalances ; Adrenalectomy (abdom. insicion) if hyperplasia or tumor of adrenal gland
28
Pheochromocytoma
adrenal medulla disorder - tumor Increase in catecholamines - epinephrine + norepinephrine
29
Pheochromocytoma - S/s - 5 Hs
1. Headache - vasoconstriction 2. Hypertension - severe - stroke ! - Hypertensive crisis 3. Hyperhidrosis - excessive sweating 4. Hyperglycemia - liver starts converting glycogen to glucose 5. Hypermetabolism \*\* Tachycardia
30
Vanillylmandelic acid (VMA) - 24 hour urine test
DX of Pheochromocytoma by-product of cathecholamine metabolism + CT and MRI of adrenal gland
31
Pheochromocytoma - NC
1. Avoid stimulants - coffee, chocolate 2. Do not palpate the abdomen - prevent tumor stimulation 3. Pre-op - TX BP+ HR - Regitin
32
Regitin
alpha-adrenergic blocker; tx of HTN (phenochromocytoma); also tx of extravasation of vasoconstrictive meds (e: dopamine) to vasodilate the area
33
Hypertensive crisis - TX
1. **_Nipride_** - vasodilator (smooth muscle relaxant) - IV drip - immediate reduction of BP - **_Monitor BP - A-line _** 2. CCB
34
Hormones secreted by thyroid gland
1. T3 - triiodothyronine - 20% more potent 2. T4 - thyroxine - 80 % 3. Calcitonin - decrease blood calcium levels - buildup of bone
35
Hyperthyroidism - S/s
1. Nervous + irritable 2. Palpitations, chest pain - increased metabolism - increased catecholamines 3. Flushed skin 4. heat intolerance 5. Weight loss 6. Goiter 7. Bulging eyes - **_Exophthalmos_** - fatty deposits behind eyes - ***_Graves disease_*** (autoimmune)- artificial tears, patch eyes (at night)
36
Hyperthyroidism - DX
1. Labs - Increase in TSH 2. Thrill + bruit over thyroid gland -palpate 3. Radioactive iodine 123 (short acting, no precautions) thyroid scan 4. Ultrasonography + EKG
37
Hyperthyroidism - TX - Radioactive iodine 131
Long acting; Goal - destroy part of the thyroid gland - get pt. into euthyroid state (normal) SE: Hypothyroidism Radiation precautions 2 weeks - 1mo (avoid children, pregnant women) Avoid products with iodine - multivitamins, cough syrup, table salt
38
1. Propylthiouracil (PTU) 2. Tapazole (Methimazole)
Antithyroid medications - black box warning 1. SE: liver failure 2. SE: birth defects Takes time to work - 3-4 weeks for improvement
39
Lugol's solution SSKI
Iodine solutions - TX of hyperthyroidism Pt. drinks - mix with milk or water; use straw; - decreases amount of T3 + T4 Can be used pre-op to shrink thyroid gland - reduce vascularity ( decrease blood flow )
40
Thyroidectomy - subtotal or total (cancer)- post op NC
1. Support neck 2. Assess voice - laryngeal nerve damage ? - speak 3. Airway !!! - edema ? bleeding ? 4. Stridor - emergency - blocked airway 5. Vitals, trach tray at bedside 6. Check dressing (look behind) ; JP
41
Thyroid Storm or Crises - S/s
due to uncontrolled hyperthyroidism (Grave's disease) - often triggered by stressor ( trauma, infection, post-op) 1. Tachycardia 2. Hypertension - tx: beta-blockers 3. Fever - even 1 degree increase - report
42
Thyroid storm - TX
1. Cooling blankets; ice packs; Tylenol ( No Aspirin !!!) 2. O2 3. Fluid, glucose, antithyroid meds - Propylthiouracil + Tapazole
43
Hypocalcemia - S/s Ca 9-10.5
due to hypoparathyroid; parathyroid gland can be removed during thyroidectomy 1. Numbness + tingling - fingers, toes, around mouth 2. Chvostek's (facial nerve twitching) + Troussea's signs (carpopedal spasm) 3. Laryngeal spasm + hyperreflexia \* Watch for tetany
44
Hypocalcemia - TX
1. Calcium gluconate IV - mix with **_D5W_** not NS 2. Phosphate binding meds - **_Phoslo_** ( calcium acetate); **_Dialume_** (aluminum hydroxide); **_Renagel_** 3. Diet high in Ca + Vit D; low in P - milk + dairy products high in both
45
Hypoparathyroid - S/s
1. Decrease in PTH 2. Hypocalcemia
46
Hyperparathyroid - S/s
1. Increase in PTH 2. Hypercalcemia - decrease in excitability of NS - hypoactive * brittle bones * kidney stones (55%) * muscle weakness * fatigue and mental confusion * over time - stenosis
47
Hyperparathyroid - DX
PTH levels Increase in Ca levels Decrease in P levels X-rays of bones
48
Hyperparathyroid - Parathyroidectomy
remove 2-3 out of 4 glands to get pt in normal state 1. Hydration !!! 2L/day - helps flush kidneys, prevent formation of kidney stones 2. Loop diuretics - help toexcrete Ca 3. Ambulation, exercise to strengten the bone 4. Oral or IV Phosphate 5. Diet low in Ca 6. Calcitonin - pushes Ca back into the bone - **_High allergic reaction !!!_**
49
Hypothyroidism - S/s Screening @ age 35 (every 5 years after)
1. Extreme fatigue 2. Hair loss 3. Dry skin, brittle nails 4. Cold intolerence 5. Facial + Eyelid edema - deposits of mucus 6. Bradycardia 7. Weight gain 8. Flat affect, slow mental process
50
Myxedema
severe hypothyroidism - can lead to coma - thickening + swelling of the skin
51
Synthroid Levothyroid
synthetic thyroid replacement - life long ; Takes time to work - 3-4 weeks Admin. in am on an empty stomach ; same time each day; full glass of water Monitor labs - start on low dose - increased metab. - increase demand for O2
52
Hypothyroidism - labs
Increase in TSH Decrease in T3 + T4
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