The Endocrine System- MEDSURG 2 STUDY GUIDE.docx

The Endocrine System There are 2 different parts of the pituitary gland: anterior and posterior pituitary. T3 is more potent, T4 is converted into T3. (The number indicates how many atoms are attached.) It is converted by removing an iodine atom from the T4 molecule. Low calcium level will stimulat...

The Endocrine System There are 2 different parts of the pituitary gland: anterior and posterior pituitary. T3 is more potent, T4 is converted into T3. (The number indicates how many atoms are attached.) It is converted by removing an iodine atom from the T4 molecule. Low calcium level will stimulate release of the parathyroid. High calcium level will inhibit release of the parathyroid. Deficiency of the parathyroid: muscle cramp/ twitching Severe: seizure Adrenal medulla releases epinephrine and norepinephrine. Primary glucocorticoid is cortisol; increases glucose levels and counteracts inflammatory response. Pancreas is endocrine (into the blood stream) and exocrine (through a duct). Care if patients with pituitary, thyroid, parathyroid & adrenal disorders The pituitary is the master gland. Hypophysectomy: surgical removal of the pituitary gland through the nose. Do not brush teeth, cough, sneeze, blow nose or bend forward. Nasal drip pad. Expected: bloody or mucous like Report: watery drainage. (Could be cerebrospinal fluid.) Diabetes insipidus Copious amounts of excessive water. ADH is not sufficient; not absorbed or secreted through the urine. Does not affect blood glucose, causes high sodium. Constantly thirsty due to sodium. Example: trying to fill a bucket with holes. s/s: hypotension, tachycardia, SOB, diuresis, weakness, fatigue diagnosis: urine specific gravity, water deprivation test. Desmopressin: replacement of the anti-diuretic hormone. SIADH Holding on to fluid, hyponatremia, diminished urine output. Make sure we implement fluid restrictions of 500 ml-1000 ml/day. Administer sodium chloride, diuretics, and demeclocycline to increase excretion. When using a med to control hormones- monitor closely. Goiter Iodine needs to be diluted and through a straw; it can stain the teeth. Hyperthyroidism s/s: weight loss and nervousness (early). Similar to cardiac issues. Thiamazole: main drug used to treat hyperthyroidism. Ablation therapy: contradicted in pregnancy. Antithyroid medication: adhere to medication regime; avoid alcohol and aspirin. Last resort: thyroidectomy. Post op: Fowler’s position, vitals 5-15 mins, monitor calcium closely (8.4-10.6), muscle tetany, tingling, tremors, increased restlessness. Thyroid regulates calcium. Thyroid Crisis (Thyroid Storm) Temperature rises to 106 degrees, increase pulse 200+, RR rapid. Hypoparathyroidism Everything slows down; constipation, decrease in appetite but increase in weight. Levothyroxine (Synthroid) daily, for rest of life, same time every day on empty stomach. Myxedema if levothyroxine is stopped abruptly. s/s: positive Chvostek and trousseau sign, tetany, numbness of hands/feet. Lifelong issue. Hyperparathyroidism Benign enlargement of the parathyroid. Treatment: Surgical removal, vitamin D supplement. Causes: tumor, neck trauma, vitamin D deficiency, renal failure. Pheochromocytoma Rare tumor of the adrenal medulla; removal of the tumor, can cause hypertensive crisis. Addisons Disease (Adrenal Insufficiency) Early signs are vague. Late: fluid and electrolyte imbalances. Treat: steroid medications: Prednisone, Fludrocortisone Patient may have orthostatic hypotension, fatigue. Cushing’s syndrome (excess adrenocortical hormone) Excessive secretion of ACTH by the pituitary or by prolonged use of steroids. s/s: buffalo hump, moon face, enlarged abdomen, striae on stomach, bruising, impotence and amenorrhea (absence of erection or period), hypertension, and weakness. Treatment: glucocorticoids, medication, radiation, microsurgery on the pituitary. CARE OF PATIENTS WITH DIABETES & HYPOGLYCEMIA Normal glucose range 70-100 or 70-120. Beta cells make insulin. Symptoms of type 1 diabetes: polydipsia, polyuria, polyphagia, rapid weight loss, irritability, weakness/fatigue, nausea/vomiting. Type 2 Diabetes Commonly: excessive weight gain, family history, poor healing, blurred vision, itching, drowsiness, fatigue, tingling or numbness. HA1c les than 6.5; the goal is normal blood sugar and A1c. Older adults are more prone to hypoglycemia. They bottom out quicker and may now show signs. Management: diet and exercise; medicine: Metformin. Avoid injecting insulin into an area that will soon receive extra exercise. Peak times and duration of Insulin Rapid acting- 15 mins; 3-5 hours. Intermittent- 1-1.5 hours; 5-7 hours. Long acting- 2-4 hours; 24 hours; Glipizide. Table 37.3, P. 890- Make flash cards! Islet cell transplantation: 2-4 donor pancreas needed; can cause necrosis of the kidney. Treat for hypoglycemia until blood glucose level is obtained. Hypoglycemia is rapid, hyperglycemia is over time. Sugar is a protein to sustain blood sugar. Diabetic Ketoacidosis Kussmaul respirations: pH low (acidotic), trying to blow off excess CO2, compensated ketoacidosis. s/s: polydipsia, polyuria, fruity breath, hypotension, dry mucous membranes, sunken eyeballs, almost coma state. Regular insulin in DKA; only insulin for IV. Never walk around barefoot if you are a diabetic; wear socks/shoes. Identification bracelet is important to diabetics. What to do on sick days? Monitor blood sugar more closely. (p.901) Somogyi effect: Blood sugar spikes up at night. Check blood sugar at 3 a.m. Dawn phenomenon: blood sugar spikes up early in the morning. Check blood sugar between 4 a.m-8 a.m. (this is the hours when it usually spikes) Hyperglycemia causes thickening of vessels long term. (Atherosclerosis) Can also cause: Neuropathy, metabolic syndrome, retinopathy, diabetic neuropathy, peripheral vascular disease (vessels stretched). Hypoglycemia (nondiabetic) Causes: Gastrectomy and surgical bypass. s/s: rapid HR, tremulousness, weakness, anxiety, nervousness, hunger. Patient needs smaller more frequent meals; high in protein, low in carbs. Carbohydrates should be complex; eliminate anything white. The child with a metabolic condition Tay Sachs disease: usually in Jewish, no treatment; Palliative care. Classification of Diabetes Mellitus Type 1 & 2 Gestational diabetes Other genetic defects: defects in chromosomes 6,7,12, & 20. Sickness and stress will increase blood sugar; also puberty. Type 1 diabetes in children can cause bed wetting. Random glucose level >200. Fasting glucose >126. Glucose tolerance: not reliable in children HbA1C under 7.5% (adults under 6.5%) Kussmaul respirations in DKA, parent and child education is important. Do not aspirate insulin. Regular insulin: Clear, NPH: cloudy (p.730, how to admin insulin) Regular insulin is only IV insulin. Insulin needs to be refrigerated until opened then it is good for 28 days at room temperature. Know how to mix insulin! P.730 Insulin shock Administer sugar; ½ orange juice, hard candy, box or raisins, or commercial product (glucose tablet). Glucagon for severe hypoglycemia. Diabetic out of hypoglycemia state may become combative. Somogyi First sign is a.m blood sugar is elevated; check at 3 a.m. Type 2 diabetes: metformin is the only approved oral medication for children and adolescents.