Chapter 39: Nursing Care of Patients With Endocrine Disorders

Chapter 39: Nursing Care of Patients With Endocrine Disorders

• This chapter focuses on nursing care for patients with endocrine disorders
• Learning outcomes include identifying disorders related to pituitary, thyroid, parathyroid, and adrenal glands
• Understanding the pathophysiology of endocrine disorders is a key learning objective
• Students will learn about the causes, signs, symptoms, and current therapeutic approaches for each disorder
• Data collection methods for patients with endocrine disorders will be explored
• Developing nursing care plans for these patients is a crucial component
• Students should be able to evaluate the effectiveness of nursing interventions

Endocrine Disorders

• Endocrine disorders are characterized by too much or too little hormone activity, problems with production/secretion, altered tissue sensitivity
• Two types of disorders: primary (originates in the gland itself) and secondary (originates elsewhere)

Antidiuretic Hormone (ADH) Disorders

• Diabetes Insipidus (DI):

  • Characterized by insufficient ADH
  • Results in excessive urine output (3-15 liters per day)
  • Signs and symptoms include polyuria, polydipsia, nocturia, dilute urine, dehydration, hypovolemic shock, decreased level of consciousness, and even death
  • Diagnostic tests: urine specific gravity <1.005, increased plasma osmolality, CT/MRI, water deprivation test
  • Therapeutic interventions: hypotonic fluids, hypophysectomy (if tumor), IV or subcutaneous vasopressin, DDAVP (synthetic vasopressin)
  • Nursing diagnosis: Deficient Fluid Volume
  • Expected outcome: patient's fluid balance maintained as evidenced by urine specific gravity between 1.005 and 1.03, stable daily weight, and normal skin turgor

• Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

  • Characterized by too much ADH
  • Results in decreased urine output
  • Signs and symptoms include weight gain without edema, dilutional hyponatremia (<135 mEq/L), serum osmolality (<275 mOsm/kg), concentrated urine (>1.03), muscle cramps, weakness, brain swelling, seizures, and death
  • Diagnostic tests: serum/urine sodium, serum/urine osmolality, CT/MRI
  • Therapeutic interventions: eliminate cause (e.g., surgical removal of tumor), fluid restriction, hypertonic saline IV, furosemide (Lasix), conivaptan (Vaprisol)
  • Nursing diagnosis: Excess Fluid Volume
  • Expected outcome: maintained fluid balance as evidenced by stable weight, normal intake/output, and normal serum sodium levels

Growth Hormone Imbalance

• Growth Hormone Deficiency:

  • Deficient growth hormone (GH) in childhood, but growth not affected in adulthood
  • Causes: pituitary tumors, heredity, psychosocial issues, malnutrition
  • Signs and symptoms: growth limitation, slowed sexual development, potential mental retardation, fatigue and weakness (specifically in adults), excess body fat, hypercholesterolemia, decreased muscle and bone mass, sexual dysfunction.
  • Diagnostic tests: GH level
  • Therapeutic interventions: synthetic GH, surgery if necessary

• Gigantism and Acromegaly (excess GH):

  • Gigantism: excess GH in childhood, leading to excessive height
  • Acromegaly: excess GH in adulthood, resulting in bone thickening and organ enlargement
  • Pathophysiology: excess growth hormone causing bone growth in thickness and width, organ enlargement
  • Causes: pituitary hyperplasia/tumors, hypothalamic dysfunction.
  • Signs and symptoms: enlarged hands/feet, facial features, difficulty speaking/swallowing, headaches/vision changes, sleep apnea, diabetes mellitus, arthritis, sexual dysfunction, acral enlargement,
  • Diagnostic tests: GH level, GH response to oral glucose, bone x-rays, CT/MRI
  • Therapeutic interventions: treat cause, hypophysectomy if tumor, medications to block GH, hormone replacement, possibly long-term medical management

Thyroid Hormone Imbalance

• Hypothyroidism:

  • Deficiency in thyroid hormones (TH)
  • Causes: congenital factors, inflammatory issues, iodine deficiency, thyroidectomy, autoimmune (Hashimoto's thyroiditis)
  • Signs and symptoms: fatigue, bradycardia, constipation, mental dullness, cold intolerance, hypoventilation, dry skin/hair, weight gain, heart failure, hyperlipidemia, myxedema, myxedema coma
  • Diagnostic tests: low T3 and T4, high TSH (primary), low TSH (secondary), cholesterol/triglycerides
  • Therapeutic interventions: levothyroxine (Synthroid), monitor vitals, warming blankets, mechanical ventilation (severe), intravenous levothyroxine
  • Expected outcomes - patient maintains a stable level of hormone in the system, as evidenced by normal vitals and weight

• Hyperthyroidism:

  • Excess thyroid hormones (TH)
  • Causes: autoimmune (Graves' Disease), multinodular goiter, toxic adenoma, thyroiditis, pituitary tumor, Synthroid overdose
  • Signs and symptoms: hypermetabolic state, heat intolerance, increased appetite, weight loss, frequent stools, nervousness, tachycardia, palpitations, tremor, heart failure, warm smooth skin, exophthalmos (Graves’ disease), thyrotoxic crisis.
  • Signs/symptoms in Elderly: heart failure, atrial fibrillation, fatigue, apathy, depression
  • Diagnostic tests: elevated T3 and T4, low TSH (primary), high TSH (secondary), TRH stimulation test, thyroid-stimulating immunoglobulin (TSI), CT/MRI (if tumor suspected)
  • Therapeutic interventions: methimazole (Tapazole), beta-blockers, radioactive iodine, thyroidectomy, IV fluids (thyrotoxic crisis), cooling blanket, beta-blocker (for fever), acetaminophen, oxygen

Goiter

• Enlarged thyroid gland
• Causes: low TH, iodine deficiency, viral infection, genetic factors, goitrogens
• Signs and symptoms: enlarged thyroid, hypothyroidism/hyperthyroidism/euthyroidism, dysphagia, difficulty breathing, airway compromise (stridor)
• Diagnostic tests: thyroid scan, TSH, T3, T4
• Therapeutic interventions: treat cause, avoid goitrogens, treat hypothyroidism/hyperthyroidism, thyroidectomy (severe cases)

Cancer of the Thyroid Gland

• Tumor of the thyroid gland
• Usually benign, but can be malignant. More common in women
• Causes: hyperplasia, radiation exposure, genetic
• Signs and symptoms: hard, painless nodule, dysphagia, dyspnea (if obstruction), TH usually normal, possibly lymphadenopathy (swelling of lymph nodes)
• Diagnostic tests: thyroid scan ("cold spot"), biopsy.
• Therapeutic interventions: radioactive iodine, chemotherapy, thyroidectomy (partial or total), possibly further treatment depending on the type of thyroid cancer.

Parathyroid Hormone Disorders

• Hypoparathyroidism:

  • Insufficient parathyroid hormone (PTH)
  • Causes: heredity, accidental removal during thyroidectomy, autoimmune destruction
  • Signs and symptoms: tetany (neuromuscular irritability, numbness/tingling, muscle spasms, cardiac arrhythmias), Positive Chvostek/Trousseau signs, seizures, fatigue
  • Diagnostic tests: low PTH, low serum calcium. Positive Chvostek/Trousseau signs
  • Therapeutic interventions: IV calcium gluconate (acute), oral calcium with vitamin D (long-term), patient education on medication management and potential complications

• Hyperparathyroidism:

  • Excessive parathyroid hormone (PTH)
  • Causes: parathyroid hyperplasia, benign parathyroid tumor, heredity, medications
  • Signs and symptoms: fatigue, depression, confusion, nausea/vomiting, kidney stones, joint pain, pathological fractures, arrhythmias, coma, cardiac arrest, decreased bone density.
  • Diagnostic test: elevated serum calcium, decreased phosphate, elevated PTH, X-rays for bone density, 24-hour urine calcium collection
  • Therapeutic interventions: oral/IV fluids, furosemide (Lasix), cinacalcet (Sensipar), calcitonin, alendronate, estrogen therapy (women), parathyroidectomy

Pheochromocytoma

• Tumor of the adrenal medulla, secreting epinephrine and norepinephrine
• Usually benign, hereditary or unknown cause
• Signs and symptoms: fight-or-flight response (hypertension, tachycardia, palpitations, tremor, diaphoresis, anxiety), headache, vision changes, risk of stroke, risk of organ damage, potentially severe hypertension
• Diagnostic tests: 24-hour urine for metanephrines/VMA, plasma metanephrines, CT/MRI.
• Therapeutic interventions; calcium channel blockers, alpha blockers, beta blockers, adrenalectomy

Adrenal Cortex Hormone Imbalance

• Addison's Disease (hyposecretion):

  • Deficiency in cortisol, aldosterone, androgens
  • Causes: autoimmune, AIDS, cancer, pituitary/hypothalamus issue, abrupt steroid cessation, medications, infections
  • Signs and symptoms: hypotension, sodium loss, potassium retention, hypoglycemia, weakness, fatigue, bronze skin, nausea/vomiting, orthostatic hypotension
  • Diagnostic tests: serum/urine cortisol, blood glucose, electrolytes, blood urea nitrogen, hematocrit, ACTH stimulation test, ACTH levels
  • Therapeutic interventions: glucocorticoids and mineralocorticoids daily, double/triple dose during stress, high-sodium diet, education on medication management and signs for Addisonian crisis.
  • Complications: adrenal crisis (severe dehydration, hypotension, hypoglycemia, shock, coma, death), require rapid medical intervention.

• Cushing's Syndrome (hypersecretion):

  • Excess adrenal cortex hormones (cortisol, aldosterone, androgens)
  • Causes: ACTH hypersecretion, cortisol hypersecretion, prolonged use of exogenous glucocorticoids, tumors
  • Signs and symptoms: (as seen in image), salt/water retention, hypokalemia, thin/fragile skin, acne, facial hair in women, amenorrhea (women and men), central obesity, muscle wasting, hirsutism
  • Diagnostic tests: appearance, plasma/urine cortisol, ACTH, Dexamethasone suppression test
  • Therapeutic interventions: surgery if necessary, reduce steroid dose, change the administration schedule, symptomatic treatment (diabetes management, low sodium/high potassium diet), and careful monitoring to prevent adrenal insufficiency.

Adrenalectomy

• Preoperative care: monitor electrolytes, glucose, cortisol levels, and hydration status.
• Preoperative teaching
• Postoperative care: monitor for adrenal crisis, lifelong hormone replacement, education on signs/symptoms to report, potential for adrenal insufficiency.

Review Questions and Answers

• Details of review questions and answers are also provided in the document.

This quiz focuses on Chapter 39, which examines the nursing care for patients suffering from various endocrine disorders. Key topics include understanding the pathophysiology, identifying specific disorders related to endocrine glands, and developing effective nursing care plans. Students will also evaluate the effectiveness of their interventions for these patients.