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Endocrine Lecture

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Leslie Wagner

on 19 March 2016

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Transcript of Endocrine Lecture

The Endocrine System
Leslie Wagner, MS-RN
Clemson University
NURS 303

Vasopressin (ADH):

Causes faster water absorption from kidneys to blood
Changes in ADH production cause diabetes insipidus and SIADH
Diabetes Insipidus
Caused by low ADH production
Less water reabsorbed from glomerular fitrate
More water lost in urine
Types
Symptoms
Nephrogenic
inherited/genetic
no kidney response to ADH
can also be a result of renal failure
Neurogenic
hypothalmus and pituitary gland are interrupted
Radiation
Cranial surgery
Other
CVA
Pituitary surgery
Polyuria
Polydipsia
Dehydration
Weakness
Weight loss
Anorexia
Treatment and Nursing Interventions
IV Fluids: hypotonic solutions
Strict I&Os
Daily Weights
Push fluids
F&E Imbalances
Meds: ADH replacement


Side Effects
Patient Education
TOO MUCH
NOT ENOUGH
SIADH: Syndrome of Inappropriate Antidiuretic Hormone
Over secretion of ADH
Increased glomerular filtration rate
Water retention and dilution
Etiology
Symptoms
FVE symptoms
Mental status changes
GI
Urine output and osmolarity
Treatment
Fluid Restriction
Drugs: 3% NS, loop diuretics (cautiously), demeclocycline
Monitor mental status
Treatment
Fluid restriction
IVF
Medications
Nursing:
Medication side effects
Gigantism and Acromegaly: Hypersecretion of Growth Hormone
Acromegaly Symptoms
Coarse features
Organ enlargement
Hyperglycemia
Bone pain and arthralgias
Peripheral nerve damage
Headache
HTN
Seizures
Treatment
Radiation
Drug therapy: steroids, hormone replacement
HR post operatively
Transsphenoidal hypophysectomy
Done through nose
Incision above lip, sutured shut when done
Reached through sphenoid sinus
Muscle graft to keep area closed and prevent CSF leak
Packed and dressed
Transsphenoidal Hypophysectomy: Post Op
Thyroid Gland
Function:
makes thyroid hormone (T3, T4) from iodine and protein
Metabolism regulation
Regulation:
Thyroid stimulating hormone (TSH) made in AP and stimulates thyroid hormone production
Hormones of the Thyroid Gland
Thyroxine
Thriiodothyronine
Thyrocalcitonin
Diagnostic Tests
Hyperthyroidism
Overactive thyroid
Metabolic process increases in entire body
Heightens SNS and triggers physiological response
Hypermetabolism results in caloric and nutritional deficiency
Hyperthyroidism: Graves Disease
Known also as toxic diffuse tumor
Autoimmune
TSH binding antibody
Classic characteristics:
Goiter
Exophthalmos
Pretibial myxedema
Other symptoms
(at rest)
Increased appetite
Fatigue/weakness
Sweating with heat intolerance
Sleep disturbances
Personality changes: psychosis
Hyperthyroidism: Treatment
Medications:
SKKI: iodine drops and preps
Liquid: Lugols
SE
Tapazole
PTU
Propanolol
Radioactive Iodine
Tracer dose
Given PO
2 weeks to 2 months for results
Isolation
Fluids are radioactive
Geiger counter test
Surgical Treatment: Thyroidectomy
Patients at risk for:
Respiratory distress
Hemorrhage
Tetany
Hyperthyroid crisis
Respiratory Distress
Related to swelling, tetany, or laryngeal nerve damage
Spasms: vocal cord damage
Laryngeal stridor
Trach set at bedside post-op
Hemorrhage
Gland vascularity
Symptoms
Nursing assessment
Tetany
Parathyroid gland involvement
Symptoms
Treament
Hyperthyroid Crisis: (Thyroid Storm)
TH may be released during surgery
Life threatening
Symptoms
Fever
Tachycardia
HTN
Treatment and Prevention
Anti-thyroid drugs
Inderal
Glucocorticoids
Nursing care
Hypothyroidism
Undersecretion or non secretion of T4
Etiology
Decreased tissue
Decreased synthesis
Inadequate TSH
Classifications: goitrous or non-goitrous
Diagnostics
Hypothyroidism: Treatment
Replace the hormone:
Synthroid
Levothyroxine
Replacement done gradually
Surgical: sub-total thyroidectomy
Report chest pain
Take meds in am
Do not change without consulting MD
Use caution with sedatives or opiods
Patient Teaching
Myxedema Coma
Airway
F&E balance
Increase temperature
Doses of thyroid hormone replacement
Initially IV then PO
Maintain schedule of meds and cardiac support
Treatment: Parathyroidectomy
Similar to thyroidectomy post op care
Suction, O2, trach set at bedside
Monitor swelling and airway patetncy
Check calcium levels
Patient provides head/neck support
Hypoparathyroidism
Decrease in PTH productions
Calcium in blood is low
Etiology:
Autoimmune
Injury
Accidental removal during thyroidectomy
Signs and Symptoms
Serum levels low
Numbness and tingling around the mouth
Muscle tremors/contractions
Tetany:
rapid drops in calcium can cause tremor and spasm
Laryngeal spasms and general convulsions
Treatment
Increase calcium levels
Calcium salts
parathormone extracts
Vitamin D
Weight bearing exercises: walking
Calcium gluconate in emergency
Adrenal Medulla: Normal Function
Secretes catecholamines: epinephrine and norepinephrine
"Fight or Flight"
Smooth muscle, cardiac muscle, and glandular activity affected
Adrenal Medulla Rush: Pheochromocytoma
Catecholamine producing tumor in the adrenal medulla
Symptoms:
Paroxysmal HTN
N/V
Sweating
Headache
Palpitations
Anxiety
Diagnostics: 24 hour urine, CT scans
Treatment: Adrenalectomy
Pre-Op
Alpha adrenergic blockers
Monitor S/S hypotension
Avoid abdominal palpation
No smoking or caffeine
Anesthesia and touching adrenal gland:
catecholamine release, risk for HTN crisis
Adrenalectomy
Adrenal Cortex: Normal Function
Secretes glucocorticoids
Regulate cell activity
Maintains an optimum internal environment for the body cells
Regulate the body’s ability to adapt to constant changes.
Cushing's Disease: Hyper function of the Adrenal Cortex
Cause:
Tumors in the anterior pituitary gland or adrenal cortex
Tumor stimulates ACTH
ACTH increases cortisol production
Cushing's syndrome
We give this to the patient secondary to something else
Symptoms
C: ataracts
U: lcers
S: kin; striae, thin, bruised, fragile
H: ypertention, hurtuism, hemorrhagic tenancies
I: nfections, poor wound healing
N: ecrosis
G: lycosuria
O: obesity (truncal with buffalo hump and moon face, osteoporosis
I: mmunosuppression
D: iabetes or hyperglycemia
Treatment
Medical:
Monitoring for FVE
Sodium restriction
Daily weights
Surgical:
Radiation
Adrenal tumor removed or adrenalectomy
Complications: Monitor s/s of shock
Hypotension
Low urine output
Tachycardia
Addison's Disease
Hypo function of adrenal cortex
Decreased function=decreased blood glucose and aldosterone
Salt and water imbalances occur due to increased excretion of them
Hypovolemia and hyponatremia result
Disease vs. Syndrome
When steroids are given to replace those that are missing, it does not cause symptoms (Addison's Disease)
When excess meds are given to treat chronic inflammatory disease, Cushing’s syndrome may result (COPD)
When the body makes excess steroids, Cushing’s disease results (Tumor: true Cushing's disease)
Causes
Typically unknown
Autoimmune destruction
Long term steroid withdrawl
TB
AIDS
Bilateral adrenalectomy
Pituitary tumors, metastatic cancers
Diagnostics
Low serum cortisol
Low fasting BS
Hyponatremia
Hypokalemia
Elevated BUN
ACTH stimulation test (adrenocorticotropic hormone)
Treatment
Corticosteroids and mineral corticoids
Hydrocortisone
Give meds with or right after meals
Hydration
Increase dietary sodium
Avoid stress
Monitor weight
Nursing Interventions
Steroid therapy
Medications shouldn't be stopped or adjusted without consulting MD
Patient will take the rest of their life
Usually 2/3 of total dose is given in morning and 1/3 in late afternoon to mimic normal pattern
Steroids mask infection:report low grade fever
Nursing Interventions
If a patient has a bilateral adrenalectomy he/she is at high risk of developing Addisonian crisis

Nursing Interventions
Steroids:
increase appetite
cause euphoria and sleeplessness
Thinning of the skin and bruising: expected
Give fluids high in Na+:
broth
cola
tomato juice.
Salt restriction or diuretic therapy should never be started without extreme caution
Monitor weight and BP and K+ levels
Addisonian Crisis
Often triggered after stressful events
Surgery
Acute systemic illness
Abrupt corticosteroid stop
Trauma
Acute crisis
Life threatening
Decreased aldosterone leads to decreased sodium reabsorption into the blood
Hypovolemic shock, coma, cardiac arrest and death.
Treatment: Hormone Replacement
Rapid NS or D5NS infusion
Solu-cortef bolus
Solu-cortef over next 8 hours
Hydrocortisone IM q12 hours
PPI or H2 blockers: ulcer prevention
Hyperkalemia Management
Give insulin in D50 to shift potassium into cells
Administer Kayexalate
Loop diuretics to lower K+; avoid potassium-sparing diuretics
Potassium restriction in diet
Monitor heart for irregularity
Hypoglycemia Management
IV glucose
Glucagon as needed
Monitor BS hourly until stabilized
DDAVP
Ectopic production
Transient Form
Medications
Gigantism
Acromegaly
Constant stimulation causes continuous growth
Nursing Considerations
Diabetes insipidus risk
CSF
Mental status changes
Infection
Patient Education
Blood chemistry: T3 and T4 levels
Urinalysis
Radioactive Iodine Uptake
Thyroid US
Non-invasive
Metabolites build up (proteins and sugars)
Decreased metabolism affects all organs
Heart becomes flabby and decreases cardiac output
Other organs become strained and fail
Causes
Trauma
Infection
Failure to take thyroid medications
CNS depressants
Symptoms: Same as hypothyroidism but more severe metabolic disorders occur
Treatment
Hyponatremia
Hypoglycemia
Hypothermia
Lactic acidosis
CV collapse
AMS
Extreme sensitivity to opioids
Treatment: Mild Hypercalcemia
Encourage fluids
Avoid:
Large doses of Vitamins A and D
Antacids containing calcium
Calcium supplements
Skin: delayed healing and hyperpigmentation
CV: postural hypotension, arrhythmia, tachycardia
CNS: lethargic, confused
MS: weak, muscle wasting, joint pain
GI: anorexia, N/V/D
Reproductive: menstrual changes
Symptoms
High fever
Weakness
Severe abdominal, lower back, leg pain
Severe vomiting
Hypovolemic shock
Hyperkalemia
Hypoglycemia
Post-Op
HTN vs. hypotension related to hemorrhage
Full transcript