Endocrine Disorders Worksheet

ENDOCRINE DISORDERS PITUITARY (Growth Hormone and ADH) Disorder Patho Labs Signs and Symptoms Tests Nursing Interventions Treatments DIABETES INSIPIDUS SIADH Posterior Hypo-pituitary Posterior Hyper-pituitary No Vasopressin(AHD)… which Excessive amounts of promotes water reabsorption vasopressin(ADH) Excessive water is absorbed by the kidneys Serum sodium… >145 Serum sodium… <120 Urine osmolality… <300 Urine osmolality… >1400 Urine specific gravity… <1.005 Urine specific gravity…>1.030 Serum ADH… decreased Serum ADH… increased Serum osmolality… increased Serum osmolality…decreased Excessive thirst/urination Can lead to dilutional hyponatremia (water Hypotension intoxication) Hypovolemia Barely urinate at all(oliguria) Extreme dehydration Increased serum sodium Need hypotonic solution cause they’re CNS symptoms: headache, lethargy, confusion, coma hypernatremic and seizures Take I&O’s q1hr Monitor HR, BP, and CVP DAILY WEIGHTS Monitor for dehydration ADH replacement (DDAVP) Dwarfism Anterior Hypo-pituitary This occurs right after puberty and the defining moment is when your growth plate closes Giantism/Acromegaly Anterior Hyper-pituitary Increased growth hormone Giantism- before puberty Acromegaly- after puberty Male- gynecomastia, baldness, higher voice, little muscle mass, small penis and poor libido Giantism- bones grow extremely large so very tall and lengthy Acromegaly- large facial features and hands Fluid restriction -help improve body image -FALL RISK Must have 30mL/hr of urine -help improve body image Should be on seizure precaution monitor I&O’s DAILY WEIGHT Monitor LOC FLUID RESTRICTION(500mLGrowth hormone somatropin Surgical treatment- FLUID REPLACEMENT 1L) Salt tablets Lasix (in some case) 3% saline (cannot replace too rapidly) Need a hypertonic solution because they have way too much fluid Must be sure client is clear of malignancy Very expensive IM injection 9x/week. Females- given estrogen and progesterone Males- given testosterone hypophysectomy/transsphenoidal approach At risk for bleeding, meningitis/encephalitis, CSF leakage (look for glucose) Medications -Vasopressin administrationDiuretic potent vasoconstrictor -Desmopressin(DDAVP) (nasal spray) If they are having an extreme episode they can receive this IV or subQ Treat according to chronological age. Growth Hormone, somatropin given prior to the closure of the epiphsis. Parlodel-takes the place of prolactin, decreasing prolactin secretion Complications Fall risk because of orthostatic Fall risk because of hypotension orthostatic hypotension Hormone replacement can lead to blood clots Huge risk for falls because bones can break and they cant support themselves Hormone replacement can lead to DVT Surgical risksNo tooth brushing for 2 weeks Hormone replacement for life Check for meningitis -smoking makes it worse! Overproduction of opposite gender hormone NO SMOKING Hypotension and hypovolemia could lead to shock Kidneys cannot concentrate urine and retain water Notes Losing a ton of water, can pee up to 3L a day ADRENAL (Cortisol and Aldosterone) Disorde ADDISONS Patho Hypometabolism -Can be caused by destruction or dysfunction of entire adrenal cortex -Addison’s can happen from not tapering off of steroids and having levels too low Subnormal levels of cortisol Labs Signs and Symptoms -SKIN HYPERPIGMENTATION -Fatigue -Weight loss/anorexia -Orthostatic hypotension -Hyponatremia -Hyperkalemia -NVD S-sodium and sugar are low T-tired and weak E- electrolytes (NA , K and CA ) R- reproductive changes O- orthostatic hypotension I- increased pigmentation D- diarrhea (NVD) CUSHINGS Hypermetabolism C-an be caused from too much steroid -24 hour urine sample for cortisol (50100mcg) Give them corticosteroid before -High dose dexamethasone suppression test used for borderline results of 24-hour test -WEIGHT GAIN -Trunk obesity -Moon face -Women can have menstrual problems -Hirsutism(women grow facial hair) V-ery thin extremities but heavy torso Lots of water weight b/c of sodium -Hyperglycemia -Protein wasting= weakness S- skin fragile T- truncal obesity R- round face E- ecmosis S- sugar is up S- striae E- excessive body hair D- dorsal cervical fat pad (buffalo hump) Pheochromocytoma Tumor in the adrenal medulla -excessive excretion of catechplamines -SEVERE hypotension -heart palpitations -headaches - episodic sweating(diaphoresis) Tests Nursing Interventions Treatments Medications -FALL RISK r/t ortho. hypotension -Frequent assessment is necessary -#1 goal: decrease stress -Fluid replacement and regulate electrolytes -take daily weights -administer steroid diligently -ambulatory and home care -instruct how to take BP -TAKE STEROID WITH FOOD -family must know how to give IM shot -carry emergency kit everywhere -wear medical bracelet Hydrocortisone- most commonly used as replacement therapy -doses for steroids are doubles for minor stressors and tripled for major stressors (surgery, fever/flu) High-Dose Hydrocortisone Replacement Therapy • Large volumes of 0.9% saline and 5% dextrose administered to reverse hypotension and electrolyte imbalances until BP returns to normal Related to excess steroids: -Delayed wound healing, insomnia 24- hour urine for cortisol Give them steroid before -Insomnia- Sleep with lights off, no naps, exercise -Gradually discontinue steroid therapy if the patient is noticing Cushing’s symptoms -Low sugar, high protein and cardiac diet High protein diet Can take out adrenal gland (adrenalectomy) -Must take steroids for forever -This could lead to cushing b/c OD steroid -Could lead to addisons b/c of too little steroids -Mitotane (Lysodren) -Suppresses cortisol production -Alters peripheral metabolism of cortisol ↓ Plasma and urine corticosteroid levels NEVER PALPATE ABDOMEN Calcium channel blockers for HTN Beta Blockers to decrease arrhythmias Complications Notes Addisonian crisisP-rotein wasting can lead to weakness in -Could be caused by an abrupt stop in extremities steroid -Protein loss leads to osteoporosis, bone and -Could be caused by extreme stress back pain -Have super high metabolism so they -High risk for INFECTION will be super skinny -They are going to become a cardiac and a THE PATIENT MUST COME TO ER IF: diabetic patient -orthostatic hypotension: sit up dizzy -hyponatremia: LOC, headaches -hyperkalemia: heart palpitations -NVD MUST WEAR MEDICAL BRACELET Cushing Addison’s Sodium ↑ ↓ potassium ↓ ↑ glucose ↑ ↓ calcium ↓ ↑ Thyroid (Metabolism) Disorder Patho HASHIMOTOS (myxedema) Hypothyroidism and Hypo-metabolism Myxedema GRAVES Hyperthyroidism and Hyper-metabolism Excessive hormone secretion Graves- caused from insufficient amount of iodine, infection, stress Labs Serum T3 … decreased Serum T4 …. Decreased Free T4 index …. Decreased TSH …. Increased serum T3 … increased serum T4 …. Increased free T4 index … increased TSH …. Decreased in Graves Signs and Symptoms Anemia -Dry coarse brittle hair that can be lost -thin and brittle nails -really fat -super cold -depression -constipation -no sex drive -impaired memory -bradycardia, dysrhythmias -hypoventilation, dyspnea -hoarseness in voice… get goiters often(enlargement of tissue) MYXEDEMA: -swelling of eyes -puffy face -mask like appearance -Everything is fast and happening now! -Think about running- sweat, lose weight, increase metabolism -Thinning hair/ thing and brittle nails -tremors, heart palpitations -increased appetite -tachycardia -rapid shallow breaths -light sensitivity -insomnia/restlessness … brain is moving too fast to sleep LARGE SPLEEN AND LIVE GRAVES: -Bulging of the eyes (exophthalmos) -swollen neck Treatments -Must do biopsy of goiter to check for cancer -hormone replacement treatment Nursing Interventions -take meds every morning at the same time -look for signs of hyperthyroidism MYXEDEMA COMA: -Give fluids and oxygen -RR must be at least 8 breaths or we must intubate -give Synthroid Medications Levothyroxine (Synthroid) Must take in morning on empty stomach (P 134 – table 4-23 HESI BOOK) -Anti-thyroid meds (not curative) - radioactive iodine therapy (cannot be pregnant!!) - subtotal thyroidectomy (most common) - Scar is in between collar bone – watch airway - Mostly always causes damage to parathyroid - Check signs for hypo parathyroid (low calcium, hyper reflexes, seizures, tremors, check trousseaus and chevoskis signs, dysrhythmias and low heart rate - Can cause larynx spasms so then we have trouble talking, breathing or swallowing - If someone goes into respiratory distress we must INTUBATE Cold sheet -At risk for pressure ulcers -Graves: need eye drops -Check for bruit over thyroid gland -Monitor for hypothyroid symptoms -Teach the patient it takes a while for the medications to begin to work - post-op, check gag reflex before eating -post-op patient must be in semi-fowlers (only use 1 pillow) - post op, Watch for hemorrhaging of incision site -evaluate hoarseness of voice THYROID STORM: - Need to get hormone levels down - either give fluids or manage respiratory distress depending on patient - reduce fever -manage stressors Propylthiouracil (PTU) Methimazole (Tapazole) If drug doses are too high you can see hypothyroid symptoms Complications -at risk for respiratory distress because thyroid can put pressure on airways MYXEDEMA COMA: -subnormal temperature -hypotension -hypoventilation -no fever !! Notes Thyroid Cancer Notes:  Removal of Thyroid: Post op care includes vigilance for: COMPLICATIONS: ***THINK WHERE THE THYROID IS - Respiratory distress – ABC’s Hemorrhage of incision site Postoperative complications -hemorrhage of incision site -airway obstruction -watch for surge of hormone right after surgery because it releases whatever is left THYROID STORM: FEVER TACHYCARDIA SYSTOLIC HYPERTENSION RESTLESSNESS, CONFUSION, PYSCHOTIC, SEZIURES Parathyroid (Calcium and Phosphate)… important for muscle contraction Disorder Patho HYPOPARATHYROIDISM Insufficient secretion of the parathyroid glands Labs Low serum calcium levels in blood -all the calcium builds up in the bones POST OP THYROIDECTOMY: -tetany (spasms, irritabily, tingling of fingers, laryngospasms) -dysrhythmias -positive chevoskis sign -positive trousseau’s sign Signs and Symptoms Tests Treatments Nursing Interventions Medications Complication s -avoid extending patients neck -if in storm, give fluids, check pulse ox and check for respiratory distress - calcium gluconate 10% - Vitamin D (helps absorption of Ca+) - PTH-parathyroid hormone Patient is at risk for seizures and laryngeal spasms STORM/COMA: A temp change of nearly 2 degrees (0.5 Celcius) classifies them in a storm or coma HYPERPARATHYROIDISM Over activity of one or more or the parathyroid glands -Happens when remove thyroid gland High serum calcium levels in blood -all the calcium comes out of bones and goes into blood -hypercalcemia -kidney stones -weak and brittle bones -muscle weakness -neuropathic atrophy -abdominal pain/peptic ulcer disease -pancreatitis -constipation -HYDRATION… 0.9% normal saline - Give them a diuretic after this to get rid of all this fluid along with the calcium to avoid heart damage -FALL RISK… prevent injury -monitor their I&O’s -monitor their cardiac output -Hydration –.9% NS due to ability to both expand volumes & inhibit the reabsorption of calcium in the kidneys -Loop diuretics – Lasix after patient is hydrated -Calcitonin-decreases release of calcium form bones -Glucocorticosteriods – decrease the release of calcium in the bones by decreasing the absorption of calcium in the GI tract -If this goes on for long term it will turn into osteoporosis POST OP: -hypocalcemia and tetany can occur - Check trousseau’s and chevoskis signs - Monitor for damage to laryngeal nerves Notes TRACH SET MSUT BE IN THEIR ROOM ready to be intubated -Reduces bone density -seen often in renal failure patients