Endocrine Disorders: Cushing's & Addison's Disease

• Hormones originate in the endocrine system, specifically the hypothalamus.
• The pituitary gland involves SIADH (Syndrome of Inappropriate Antidiuretic Hormone) and diabetes insipidus.
• Adrenal glands, which produce steroids, are located on the kidneys.

Cushing's Disease

• Cushing's disease can be caused by prednisone.
• Symptoms include ascites, buffalo hump, facial hair, and thin extremities.
• It is associated with elevated levels of steroids, sodium, and sugar

Patient Care

• Patients should avoid large crowds during flu season to prevent illness.
• Monitor sugar intake to prevent poor healing and salt intake to avoid hypertension.
• Low potassium can result in flat T waves, and low calcium can lead to osteoporosis.

Addison's Disease

• Addison's disease is treated with corticosteroids.
• Symptoms include a thin frame and bronze skin, with a risk for dehydration, so avoid giving diuretics.
• Patients may experience hypotension and should stand slowly, with potential for low sodium, high potassium (tall peak T waves), and low calcium.
• Increase salt, sugar, and steroids intake for treatment.

SIADH

• SIADH is characterized by little urine production.
• There is too much water in the body.
• Serum levels will be low, while urine specific gravity will be high (over 1.030) and urine electrolytes will be high.

Diabetes Insipidus (DI)

• DI is characterized by excessive urine production.
• Serum levels are high, and urine levels are low.

Pancreatitis

• Expect fever, inflammation, infection (elevated WBC), and pain with pancreatitis.
• Patients will be on TPN (Total Parenteral Nutrition).
• TPN patients have high glucose levels (TPN high in fructose), which can lead to weight loss and low albumin.
• Elevated BUN, creatinine, WBC, temperature, and glucose levels should be addressed.
• Gentamicin is administered only if BUN (5-25) and creatinine (.5-1.3) levels are within the normal range.

Fluid Monitoring

• There should only be a 300 mL difference between intake and output.
• Bladder flushes or irrigations are subtracted from output.
• NG tube flush is included in intake, not NG irrigation.

Warfarin and Bleeding Risk

• Never open a patient on warfarin due to the risk of bleeding out.

Esophageal Varices

• EGD (esophagogastroduodenoscopy) is used to look for esophageal varices.
• Patients with esophageal varices may have portal hypertension.

Hepatic Encephalopathy

• Hepatitis C patients with high ammonia levels over 45 will experience confusion (Hepatic encephalopathy).
• Treat with lactulose (laxative) and diuretics.

Hyponatremia

• For low sodium, give diuretics and restrict fluid.
• The body needs to pee and the cells will swell.

Dumping Syndrome

• Dumping syndrome is GERD (Gastroesophageal Reflux Disease).
• Avoid sugar as it will digest quickly.
• Increase proteins and fats as they break down slower.
• Lower water intake to slow digestion (no water with meals).
• Lay down after meals to slow digestion.

EKG Interpretation

• The P wave pushes the atrial to the ventricle.
• The QRS complex represents ventricle contraction.
• Atrial fibrillation (A-Fib) can lead to blood clots if the blood doesn't move, increasing the risk of stroke.
• Ventricular fibrillation (V fib) is ventricle contraction without atrial contraction (check patient first).
• Premature ventricular contractions (PVC) is ventricle contracts prematurely without atrial contraction.
• Anemia can cause a fast heart rate.
• Cardioversion is used on A&O (alert and oriented) patients who are anxious and short of breath with V tach EKG.

Acid-Base Balance

• Diarrhea is metabolic acidosis (low pH, high CO2, low HCO3).
• Vomiting is metabolic alkalosis (high pH, low CO2, high HCO3).
• Respiratory acidosis (low pH, high CO2, low HCO3).
• Respiratory alkalosis (high pH, low CO2, high HCO3).
• COPD patients typically have a normal pH (compensated).
• Asthma patients' pH will be off.
• Uncompensated conditions have an abnormal pH and one other abnormal value.
• Fully compensated conditions have a normal pH.
• Partially compensated conditions have all values (pH, CO2, HCO3) off.

Dehydration

• Hemoglobin (Hg) and hematocrit (Hct) go together and are low with severe dehydration.

Cardiac Issues

• Having indigestion for a long period could be cardiac related.

Asthma Attack

• Asthma attack patients have low pH and high CO2.

Fluid Shifts

• When the body sweats, fluid is pulled from the vascular system to the cell and out of the body.

Congestive Heart Failure (CHF)

• In left-sided heart failure, the left ventricles are stretched, causing BNP to increase.
• BNP is used to test for CHF.

Left-Sided Heart Failure Symptoms

• Shortness of breath, pink frothy sputum, fatigue from lack of oxygen, anxiety from fear of difficulty breathing, tachycardia, cyanosis, confusion, and crackles upon auscultation.

Left-Sided Heart Failure Interventions

• Administer a diuretic first, then give oxygen (O2).
• Teaching involves advising the patient to rest and monitor their weight every morning.
• Weight gain could indicate fluid buildup.

Right-Sided Heart Failure

• In right-sided heart failure, the right ventricle backs up into the organs and causes swelling.

Right-Sided Heart Failure Symptoms

• Jugular vein distention (JVD), enlarged organs, ascites, edema in the legs, fatigue, and swelling in hands and feet.
• Elevate legs and apply compression socks before moving around.

Intermittent Claudication

• Angina of the leg occurs when the arterial system carries oxygen to the body, which is essential for pain relief.
• Oxygen needs to reach the pain; patients should stop walking and dangle their leg to increase blood flow.
• Venous system carries blood up to the heart.
• Arterial system carries blood with oxygen down the body.