NURS 371: Test 1 Outline - Endocrine System - PDF

NURS 371: Test 1 Outline Chapter 45: Endocrine Part1: A&P Review Anterior Pituitary: GH, TSH, ACTH Posterior Pituitary: ADH Thyroid: T3, T4 Parathyroid: PTH, Calcium, Phosphate Adrenal Cortex: Corticosteroids, Mineralocorticoids, Androgens Hypothalamus stimulates the pituitary Part2: Thyroid Iodin...

NURS 371: Test 1 Outline Chapter 45: Endocrine Part1: A&P Review Anterior Pituitary: GH, TSH, ACTH Posterior Pituitary: ADH Thyroid: T3, T4 Parathyroid: PTH, Calcium, Phosphate Adrenal Cortex: Corticosteroids, Mineralocorticoids, Androgens Hypothalamus stimulates the pituitary Part2: Thyroid Iodine is necessary to produce thyroid hormones TSH: 0.5-5.0 T4: Thyroxine T3: Triiodothyronine Assess allergy to iodine and/or shellfish for any test with contrast media Hyperthyroidism: Everything is HIGH! Excess T3, T4 Decreased TSH Graves’ disease- most common cause Symptoms: o Nervousness, restlessness, insomnia, anxiety o Fatigue o Palpitations, tachycardia o Fine tremor o Weight loss o Heat sensitivity, sweating o Increased appetite o Amenorrhea – absence of period o Diarrhea o Ophthalmopathy (Exophthalmos) – bulging eyes § Common with Graves’ Disease  Glands may be soft, enlarged, and tender Treatment: o Anti-Thyroid Meds (1 YEAR) § Propylthiouracil (PTU), Methimazole § Propranolol (Beta-Blocker for BP) § Radioactive Iodine Therapy Goal: eliminate thyroid cells with one dose May cause hypothyroidism Neck soreness, nausea, upset stomach, dry mouth, change in taste, tender/swollen glands Increase fluid immediately after Avoid kissing/sex, sharing bed/food, AVOID kids & pregnant women o Avoid Goitrogen rich foods § Red wine, soy, peanuts, teas, cauliflower, broccoli, mustard, strawberries o Subtotal or total thyroidectomy § May need levothyroxine for life (thyroid hormone replacement) § May need Calcium/Vitamin D d/t damage/removal of parathyroid glands § Hypocalcemia – assess for tetany and Trousseau/Choveks sign § Hoarseness – 1 wk § Semi-Fowler position § Complications: Hemorrhage, Airway Obstruction, Laryngeal Nerve Damage Nursing Care: o Assess daily weights, I&O, lab values o High calorie & protein diet o Lubricate eyes o Cooling measures Toxic Multinodular Goiter: Benign tumor, typically large Can cause overproduction of T3 &T4 Thyroid Storm/Thyrotoxicosis Medical Emergency – Fatal if untreated Severe hyperthyroidism – sudden onset D/T infection, stress, PE, abrupt d/c of meds, metabolic disorders Symptoms: Temp >101.3, HR >130, exaggerated hyperthyroid s/s, altered mental status Hypothyroidism: Decreased T3, T4 Excess TSH Primary: dysfunction of thyroid gland o Hashimoto disease- most common cause Secondary: Dysfunction of pituitary or hypothalamus Symptoms: o Extreme fatigue o Hair loss o Dry skin, brittle nails o Change in voice/hoarseness o Menorrhagia or amenorrhea o Weight gain o Cold intolerance o Constipation § Severe S/S: Myxedema – coma Bradycardia Low body temp High cholesterol Treatment: o Thyroid Replacement § Levothyroxine (LIFELONG) Dosage based on TSH Take on empty stomach; in the AM Med overdose: S/S hyperthyroidism Nursing Care: o Assess mental status o Daily weight, I&O o Cardiac Status o Bowel Elimination Thyroid Cancer Good prognosis Papillary carcinoma – most common Symptoms: o **Hoarse voice o Dysphagia  Diagnosis: o Ultrasound o Radioactive Iodine Uptake Scan o CT, MRI, PET Scan o Fine needle biopsy o Labs Treatment: o Radioactive Iodine & surgery – best survival rate Complications: o Hypocalcemia o Infection o Hemorrhage o Airway obstruction o Thyrotoxicosis (d/t stress of surgery) Part3: Pituitary & Adrenal Gland Disorders Anterior Pituitary Gland Disorders TSH, GH, ACTH Growth Hormone Insufficiency “Dwarfism” Genetic Association Average height: 4 ft Tx: Synthetic GH injections, Spinal stabilization surgery Growth Hormone Excess Hypersecreting tumor: pituitary adenoma Genetic association Gigantism o Childhood o Tall & Obese o Proportionate bone growth Acromegaly o Adulthood o Bone growth with increased width and thickness § Treatment: Decrease GH secretion w meds Radiation therapy to decrease size of adenoma Posterior Pituitary Gland Disorders Antidiuretic Hormone (ADH) Vasopressin Potent vasoconstrictor Keeps water IN Regulates fluid volume via kidneys Diabetes Insipidus “diuresis increases” Most common disorder of posterior pituitary LACK of ADH Excessive diuresis – fluid loss – hypovolemia Types: o Central (neurogenic) – most common o Nephrogenic – kidneys o Psychogenic – excessive water intake Symptoms: o Dilute urine – Increased UO o Polydipsia o Dehydration o Decreased skin turgor – not in older adults o Weight loss o Hemoconcentration of blood o Decrease BP o Increase HR o CNS changes o Hypernatremia Treatment: o Replace fluids o Correct hypernatremia o Synthetic ADH o Hormone replacement Syndrome of Inappropriate Antidiuretic Hormone (SIADH) “too many letters.. too much fluid” Over secretion of ADH Fluid retention – hypervolemia  Causes: o Lung Cancer o Head trauma o Brain surgery/tumor o Infection Symptoms: o Hyponatremia o Anorexia, nausea, muscle cramps, weakness, irritability, confusion o LOC changes (Decreased reflexes) o Fluid retention o Concentrated Urine § Decreased UO and/or weight gain (without edema) o Hemodilution Treatment: o Replace Na Slowly § Seizure precautions d/t hyponatremia o Fluid restriction § Monitor s/s fluid volume overload § Weight § I&O o Diuretics § Monitor K o Tx underlying condition Adrenal Gland Disorders Adrenal Cortex (Inner Portion): epi & norepi Adrenal Cortex (Outer Portion): mineralcorticosteroids & glucocorticosteroids Glucocorticosteroids “sugar hormones” o Cortisol § Stress hormone Mineralcorticosteroids “salt hormones” o Aldosterone Adrenal Cortex Hyposecretion: Addison’s Disease Need to “add” hormone Adrenal Insufficiency Hypo-Cortisolism “too little” cortisol and/or aldosterone  Symptoms (slow onset): o “Too little “Cortisol § Muscle weakness § Anorexia, n/v, weight loss § Hypoglycemia § Hyper-pigmentation of the skin/mucous membranes o “Too little” Aldosterone § Dehydration – blood volume depletion- decreased cardiac output § Hypotension § Hyponatremia – confusion § Hyperkalemia – cardiac arrest Causes: o Autoimmune disease o Infections o Surgical removal of adrenal glands o Anterior pituitary gland damage Diagnostics: o Decreased Cortisol o Increased ACTH o Decreased BS o Increased potassium (K) o Decreased Sodium (Na) Treatment: o Hormone Replacement § Steroids for insufficient cortisol o Encourage high Na diet Adrenal Cortex Hypersecretion: Cushing’s Syndrome Have “extra cushion” of hormone Hyper-Cortisolism Excess production of steroids by adrenals Symptoms: o Truncal obesity o Buffalo Hump o Moon Face o Hirsutism (facial hair) o Bone demineralization o Hyperglycemia o Mood changes  o HTN, Heart failure, edema Diagnosis: o Increased cortisol levels o Increased Sodium (Na) o Decreased Potassium (K) Treatment: o Wean steroid use o Restrict Na o Adrenalectomy (if tumor is cause) o Trans-Sphenoidal hypophysectomy § Monitor nasal packing/dressing CSF leak (clear/white drainage) § Watch for DI § Lifelong hormone treatment Adrenal Medulla Hypersecretion: Pheochromocytoma Benign Tumor (excess epi & norepi) Symptoms: o Severe HTN o Severe headache o Hyperhidrosis (severe sweating) o Palpations o Angina Treatment: o BP to prevent HTN crisis § Multiple meds needed o Surgical removal of tumor § Lifelong steroids Hematology – RBC Plasma Transport vehicle for materials carried in blood Erythrocytes Most abundant cell Produced in bone marrow Hemoglobin (Hg) Protein in RBCs Carries oxygen to organs and tissues Returns carbon dioxide from organs and tissues to lungs Bone Marrow Biopsy Aspiration of fluid and BM cells Dx of anemia, thrombocytopenia, leukemia, tumors, causes of infections, to stage diseases Complete Blood Count (CBC) WBC RBC: measures # of RBC in 1 mm of blood RBC Indices Hemoglobin: total amount of Hg in blood Hematocrit: % of RBCs in total volume of blood Platelets RBC Abnormalities Normocytic & Normochromic o Normal size & color Macrocytic & Normochromic o Large size & normal color § B12 deficiency, Folic acid deficiency Microcytic & Hypochromic o Small size & pale color § Iron deficiency anemia Anemia Not a disease!! Deficiency in: o # of erythrocytes (RBCs) o Quantity of Hg o Volume of packed RBCs (Hct) Causes: o Blood loss o Decreased RBC production o Destruction of RBCs Iron Deficiency Anemia Most common Decreased production of RBCs by bone marrow Causes: o Blood loss – menses, GI, anticoagulants o Inadequate dietary intake – vegetarians o Malabsorption Symptoms: o Smooth, red tongue – sometimes swollen o Brittle ridged nails o Fatigue o Activity intolerance o Dyspnea o Pallor o Palpitations o Cardiac arrhythmias o Tachycardia o Tachypnea Labs: o Decreased Ferritin o Decreased Hg & Hct Treatment: o Treat underlying disease o Replace Iron § Meats, dried fruits, dark green vegetables, beets, beans, raisins, whole grains o Oral supplements § Ferrous Sulfate Give on empty stomach § Increase vitamin C intake to increase absorption Citrus, tomatoes, broccoli o Parenteral Iron § Venofer & InFed o Transfusion of PRBCS Anemia of Inflammation “Amenia of Chronic Disease” 2nd Most common Decreased production of RBCs Low iron levels in blood  Causes: o Chronic Inflammation o Chronic Kidney Disease – d/t decreased production of erythropoietin o Autoimmune Disorders o Infectious Diseases o Malignant Diseases Treatment: o Treat underlying disease o Medication § Erythropoietin (Procrit, Epogen) Synthetic form of erythropoietin SubQ or IV Increase production or RBCs especially w CKD and cancer pts Pernicious Anemia Deficiency of Vitamin B12 Lack of intrinsic factor At Risk: o Inadequate dietary intake – vegan o Malabsorption o Old Age o Alcoholism Symptoms: o Anorexia o N/V o Abdominal pain o Sore, red, beefy tongue o Paresthesia of feet/hands – Think about safety!! o Ataxia o Muscle Weakness Labs: o Decreased Hg & Hct o Decreased B12 Treatment: o B12 Oral replacement o Increase dietary sources of animal protein Folic Acid Anemia “Megaloblastic Anemia” Large, abnormal RBCs At Risk: o Diet deficiency o Malabsorption o Alcohol abuse Symptoms: Same as B12 Deficiency o Anorexia o N/V o Abdominal pain o Sore, red, beefy tongue o Ataxia o Muscle Weakness Treatment: o Replacement therapy o High folic acid diet § Leafy green vegetables, citrus, breads, cereals, rice, pasta, nuts Aplastic Anemia Causes: o Damage to bone marrow stem cells o Pancytopenia – decreases all blood cell types § Rare, but critical Symptoms: o Fatigue o Dyspnea o Glossitis o Bleeding gums o Infection risk o Bruising, Bleeding Labs: o CBC § Low neutrophils, Hg, PLTs Treatments: o Identify and remove cause o Prevent complications – infection & hemorrhage o Immunosuppressive therapy o Stem Cell transplant Hemolytic Anemia RBCs are destroyed faster than they can be made – hemolysis Sickle Cell Anemia “S” shaped RBC Cells sickle in response to low O2 Causes vaso-occulsion o Decreased blood flow to organs and tissues o Can be fatal Causes: o Genetic Link o African Americans (1 in 36) Symptoms: o Hypoxia o Pain o Jaundice o Thrombosis **At risk for MI and stroke Risk for crisis (SCC): o Hypoxia o Infection o Stress o High AltitudE Treatment: o Prevention of SCC o Stem Cell transplant o Hydration o Oxygenation o Pain relief o Transfusions Hemochromatosis “Iron overload” Causes: o Genetic o Excess Fe deposits in organs – liver, skin, pancreas o Excess absorption from GI tract – too much Hg Symptoms: o Fatigue  o Arthralgia o Abdominal pain o Weight loss o Bronze or darkened skin color o Cardiomyopathy o Arrhythmias o Diabetes o Hepatomegaly o Cirrhosis Labs: o Increased ferritin & transferrin o Increased Iron o Increased Hg Treatment o Periodic Therapeutic Phlebotomy o Decrease Fe in diet Therapeutic Phlebotomy 1. Removes RBCs from the body 2. Bone marrow is stimulated to produce more RBCs 3. Iron stores are depleted as iron is used to produce RBCs Polycythemia Increased volume of RBCs Primary: (Polycythemia Vera) – neoplasm Secondary: Response to hypoxia (COPD, OSA) Hyperviscosity: Hypercoagulation and impaired circulation Symptoms: o Visual disturbances o Paresthesia o TIAs o Thrombophlebitis o Angina o Skin changes – ruddy complexion (plethora) Treatment: o Therapeutic phlebotomy o Treat underlying cause o Decrease blood volume – GOAL!