Anterior pituitary gland
Secretion of this hormone is controlled by the hypothalamus
- FSH.
- LH
- GH.
- ACTH( Stress)
- Prolactin (breast milk)
- TSH (Regulates how your body uses energy)
Posterior pituitary gland
Vasopressin(ADH)antidiuretic hormone-regulates water retention in the body
Oxytocin ( causes or strengthens labor contraction . controls bleeding after child birth .
Disorders of the posterior pituitary gland
diabetes Insipidus
Deficiency in anti -diuretic hormone which causes the kidney to be unable to conserve water properly.
- urine chemistry (dilute )
- urine specific grvity: 1.003-1030
- low urine specific gravity (person is drinking too much water)
- low urine osmolarity
Serum chemistry ( Concentrated)
Hypernatremia
High serum osmolarity
Polyuria and polydipsia(excess thirst)
increased urine output
dehydration , weight loss,muscle weakness, dry skin.Nursing intervention of
as low urine specific gravity
- monitor output and urine specific gravity
- weigh client daily
- Monitor blood pressure and heart rate.
- Maintain fluid and electrolyte balance.
Syndrome of inappropriate secretion of
antidiuretic hormone.(SIADH)
Retain a lot of water
- urine chemistry will be (concentrated)
- high urine specific gravity and osmolarity.
serum chemistry ( diluted ) -hyponatremia -decreased serum osmolarity mental confusion , irritable,lethargy,seizure. - weakness, anorexia, nausea, vomiting - increased ADH levels. -weight gain
Nursing intervention of SIADH
.- restrict oral fluids (500-1000ml/day)
- monitor input and output
- weigh the client daily
- monitor for HBP, tachycardia and hypothermia
- monitor mental status.
- initiate seizure precaution ,
medication - hypertonic saline infusion ( sodium chloride 3-5 %)
loop diuretic
Disorders of Adrenal gland
Produces cortisol, Aldestorone and sex hormone
Addison’s disease(hyposecretion of adrenal cortex hormone )
Caused by autoimmune disease, tb, histoplasmosis, adrenalectomny, tumors , HIV.
Manifestations _ weakness+ fatigue
- nausea and vomiting
- hyperpigmentation
- hypotension,increased heart rate
- hypoglycemia
- hyponatremia
- hyperkalemia(due to hypoaldesterone the function of aldesterone. is to excrete dietary potassium . _,
Nursing intervention of adrenal insufficiency.
Monitor blood pressure and heart rythm.
Monitor fluid and electrolyte balance .
Monter and treat hypoglycemia
Medication - cortisone , hydrocortisone, prednisone.
Cushions syndrome
Hyper-secretion of the glucocorticoids by hyperplasia of the adrenal cortex. ‘
Manifestation
Upper body obesity and thin extremities
Osteoporosis
Hyperglycemia, hypernatremia,hypokalemia., hypocalcemia.
4 s’s of cushion and Addisons disease.
Cushions syndrome Addison’s disease
Steroid- up. down ( need to add)
Sugar
Sodium
Skin. thin, fragile. hyperpigmentation
Thyroid gland has a rich blood supply producing t3 t4 and calcitonin
Hypothyroidism
Fatigue , weakness.. Increased sensitivity to the cold Weight gain. Depressi Menstrual disturbances. Hyperlipidemia(increase in fat and cholesterol in blood)and anemia -
Nursing intervention
- Provide low calorie, low fat, low cholesterol
- increase roughage and fiber.
- avoid sedatives
Medication _ levothyroxine(taken on empty stomach)
hyperthyroidism
Anxiety + irritability tachycardia diaphoresis Weight loss Exophthalmos Light or absent mensural cycle.
Diagnostic procedure
Elevated t3 and t4
Low TSH(pituitary senses a rise in TSH in the blood and stops producing
_ Can cause thyroid storm if left untreated manifestation include hypertension,tachycardia
Nursing intervention
- monitor vital signs
medication
_beta blocker to manage tachycardia,anxiety + tremors.
-propylithioracil (PTU) blocks production of thyroid hormone
-lodides decreases vascularity and inhibits the release of thyroid hormone(administer through a straw)
a)lugols solution
b) saturated solution of potassium iodide
Parathyroid -maintains calcium and phosphate levels.
Hypoparathyroidism.
_hyposecretion of the parathyroid hormone(PTH)resulting in hypocalcemia and hyperphosphatemia which is caused by the surgical removal of the parathyroid gland.
Manifestation of hypocalcemia
Paraesthesia- pins and needles
Muscle cramps and tetany ( spasm of hands , feet, cramps , spasm of voice box)
positive chovostek sign-tapping on the cheek causes muscle spasm and twitching around the mouth, throat and cheeks.
Trousseau’s sign- pressure from the blood pressure cuff induces muscle spasm in the distal extremity.
Severe tetany Cain cause dysphagia + seizures
Nursing intervention
- monitor ECG
- monitor signs - neuromuscular irritability
- provide high calcium low phosphate diet( protein rich foods such as meats, fish , nuts, beans , dairy )
Hyperparathyroidism
loss of calcium from bones into serum hypercalcemia and hypophosphatemia
Osteoporosis Hypercalcemia + hypophosphatemia Muscle weakness + fatigue. Skeletal + joint pain Polyuria + polydipsia HTN Cardiac dysarrythmia
Nursing intervention
- encourage a minimum of 2000ml fluids daily
- provide low calcium(calcium in green leafy vegetables such as okra, kale, spinach),low vitamin D diet..
- check pt’s urine
- reinforce teaching about safety measure to prevent fracture.
- encourage cranberry juice to lower urine PH.
Medication
Calcemimetics- mimics calcium blood and can cause the parathyroid to decrease release of parathormone.
Calcitonin - decreases the release of skeletal calcium and increases the kidney excretion of calcium.
Hydration and diuretics(furosemide) promotes excretion of excess calcium
Pancreas Has exocrine( pancreatic enzyme , lipase, trypsin and amylase) and endocrine(glucagon , soma statin)
Insulin lowers blood glucose
Type 1 diabetes -problem with beta cells that produce insulin and therefore insulin is not produced.
Type 2 diabetes-there is a resistance in insulin or inadequate production.
If the beta cells cannot produce enough insulin to meet the demands of glucagon type 2 diabetes develop.
Diagnosis criteria
Plasma glucose of 200mg/dl .
Fasting blood glucose of 126 mg/dl or greater.
Normal fasting blood glucose 70-105 mgldl
Manifestation Polyuria Polydipsia Polyphagia Falgue and weakness Loss of vision Type 1- sudden weight loss, nausea, vomiting, abdominal pain.
Possible complications
hypoglycemia_occurs when blood glucose is below 60 mg/dl
Which causes Decreased dietary intake,excess insulin production
Manifestations
Tachycardia
Diaphoresis
Weakness + fatigue.
Nursing intervention
Administer 15g of fast acting simple carbohydrates
3 or 4 glucose tablet for the equivalent of 15 g carbohydrates
4oz fruit juice or regular soda.
6-10 hard candies.
2-3 teaspoon or sugar or honey.
Follow the 15/15/15 rule
give 15g of fast acting carbs wait 15 min recheck if falls below 70 mg/ give another 15g of simple carb
give 7g of protein when glucose level is within normal limit.
2 tablespoons of peanut butter
1 oz cheese
8 oz of milk
hyperglycemia_ an elevated blood glucose, generally treated with sliding scale insulin to return serum blood glucose to normal.
- regular insulin
medication
Insulin pump-an external device that provides a basal dose of rapid acting or regular insulin
