Endocrine Disroders Week 1 PDF

DISORDERS OF THYROID GLAND HYPERTHYROIDISM Medical term to describe the signs and symptoms associated with an over production of thyroid hormone. 3 basic concepts of 1.Increased metabolic rate due to hypersecretion of T3 hyperthyroidismhormone. 2.Increased body heat production due to hypersecrea...

DISORDERS OF THYROID GLAND HYPERTHYROIDISM Medical term to describe the signs and symptoms associated with an over production of thyroid hormone. 3 basic concepts of 1.Increased metabolic rate due to hypersecretion of T3 hyperthyroidismhormone. 2.Increased body heat production due to hypersecreation of T4 hormone. 3.Hypocalcemia (hypersecreation of thyrocalcitonin) ETIOLOGY – 1. More common in females, below 40 years. 2.Severe emotional stress. 3.Autoimmune disorder. CLINICAL MANIFESTATIONS A. Thyroid disturbances1.Increase appetite-patient needs 6 full meal. 2.Weight loss. 3.Tachycardia 4.Hypertension 5.Diaphoresis 6.Diarrhea 7.Excessive heat 8.restlessness,Irritability, CLINICAL MANIFESTATIONS 2.OPHTHALMOPATHYEXOPHTHALMOS-Protrusion of the eyeball,due to accumulation of fluids at the fatpads behind the Eyeballs,pushing the Eyeball forward. Patient not able to close The eyes. 3.Dalyrimple’s sign (thyroid stare)a. b. Bright eyed stare. Infrequent blinking. 4.DERMOPATHYa. Warm , flushed sweaty skin. b.Thickened hyper pigmented skin. INVESTIGATIONS 1.T3-Triiodothyronine Metabolism & growth It will be raised. 2.T4-Thyroxine Catabolism, Body heat production It will be elevated. 3.TSH-Thyroid stimulating hormone. It will decrease. MANAGEMENT 1.Rest-Provide noise free & cool environment. 2.Dieta.Increase calorie b.Low fiber diet c. 6 meals per day. 3.Promote safety. 4.Protect the eyesa. Put artificial tears at regular intervals. b. Wear dark glasses when going out under the sun. 5.Replace fluid & electrolyte losses. 6.PHARMACOTHERAPY a.Beta –Blockers: Inderal To control tachycardia & hypertension. b.IODIDES : Lugol’s solution It consist of SSKI(saturated solution of potassium Iodide) -It inhibit release of thyroid. -Mix with fruit juice,with ice or with glass of water to enhance taste. -Provide drinking straw. c.Thioamides : Tapazole 7.SURGICAL MANAGEMENT THYROIDECTOMY(Removal of thyroid gland) is performed. a. Subtotal thyroidectomy b. Total thyroidectomy PRE-OPERATIVE CARE1.Promote euthyroid state toa. control thyroid disturbance. b.stable vital signs. 2. Administer Iodides as ordered-To reduce the THYROIDECT OMY POST-OPERATIVE CARE 1.POSITIONa. Semi-fowler’s position. b. head & neck erect. 2.Prevent Hemorrhage by putting ice coller over the neck. 3.Keep tracheostomy set available for the first 48 hours. 4.Ask the patient to speak every hour to assess the laryngeal nerve damage. Semi fowler’s position Ice coller Steam inhalation 5.Monitor body temperature ,if elevates it is sign of thyroid crisis. 6.Monitor blood pressure. 7.Steam inhalation to soothe irritated airway. 8.Advice to support neck when getting up from the bed. 9.Obsreve the sign & symptoms of potential complicationsa.Hemorrage b.Airway obstruction. c.Thyroid crisis. d.Myxedema. HYPOTHYROID ISM It is a condition in which thyroid gland doesn't produce sufficient amount of thyroid hormones. CAUSES 1.Autoimmune 2.Surgery 3.Radiation therapy ( radioactive iodine) 4.Antithyroid drugs 5.Thyroditis 3 basic concepts are: 1.Decrease metabolic rate (hyposecreation of T3) 2. Decrease body heat production ( hyposcreation of T4) 3.Hypercalcemia ( hyposecreation of thyrocalcitonin ) CLINICAL MANIFESTATIONS 1.Obesity 2.Anorexia 3.Bradycardia 4.Cold intolerence 5. Constipation 6.Slowed physical & mental reaction. 7.Brittle nails 8.Irregular menstruation. 9.Coarse,dry,sparse hair CLINICAL MANIFESTATIONS MANAGEMENT 1.Monitor vital signs. Be alert for signs & symptoms of cardio vascular disorder. 2.Dieta. Low calorie b. High fiber 3.Provide warm environment during cold climate. High Fiber Diet, WARM CLOTHS 4.PHARMACOTHERAPY 1.PROLOID ( THYROGLOBULIN) 2.Synthyroid ( Levothyroxine ) 3.Dessicated thyroid extract 4.Cytomel ( Liothyronine) NURSING RESPONSIBILITY 1. Monitor Blood Pressure & Pulse rate before administration. 2. Start with low dose & gradually increase the dose. COMPLICATION Myxedema coma is complication of hypothyroidism. It is severe stage of hypothyroidism, in which the client is hypothermic & unconscious. Management: 1.Administer I/v thyroid hormone. 2.Correction of hypothermia. 3.Maintenance of vital functions. 4.Treat the cause. THANK YOU DISORDERS OF PITUITARY GLAND HYPERPITUITARISM • Hyperpituitarism is excessive production of growth hormone. • It is also called as Acromegaly and Gigantism HYPERPITUITARISM ACROMEGALY 1.Occurs after the epiphyseal closure,causing thickening & transverse growth. 2.Occurs between the age of 30-50 years. 3.Develops slowly. GIGANTISM 1.It occurs before epiphyseal closure. 2.Affects infant & children. 3.Develops abruptly. CLINICAL MANIFESTATIONS ACROMEGALY 1.An enlarged jaw. 2.Thickened tongue. 3.Enlarged & weakened hands. 4.Oily & leathery skin. 5 disturbance in sleep. 6.Loss of appetite GIGANTISM 1.Muscular hypertonia. 2.Exophthalmos 3.Highly arched palate. 4.Disturbanc in sleep 5.Loss of appetite 6.Headache HYPERPITUITARISM ACROMEGALY GIGANTISM CAUSES 1.Benign tumor of pituitary gland. 2.60% to 80% tumors causes hyperpituitarism. TREATMENT 1.Surgery-Transphenoidal hypophysectomy or pituitary microsurgery is performed. 2.Medicine-Bromocriptine,which inhibit GH synthesis. 3.Octreotide is medicine which shrinks tumor. 4.Diet-Salt restricted diet. HYPOPITUITAR ISM HYPOPITUITARISM Deficient secretion of the anterior pituitary hormones is marked by- Dwarfism - Metabolic dysfunction - Sexual immaturity - Growth retardation CAUSES 1.Tumors 2.Congenital defects 3.Pituitary ischemia. 4.Partial or total hypophysectomy. 5.Radiation therapy. 6.head injury. TYPES 1.PANHYPOPITUITARISM-(SIMMOND’S DISEASE) It is the total absence of all pituitary secretions. 2.SHEEHAN’S SYNDROMEIt is due to postpartum pituitary necrosis due to severe bleeding. CLINICAL MANIFESTATIONS 1.Headache due to tumor. 2.Weight loss. 3.Hair loss. 4.Amenorrhea. 5.Atrophy of all endocrine glands. 6.Hypometabolism. MANAGEMENT 1.Hormon Replacement Therapy(HRT)-Thyroid & cortisol hormone replacement. 2.Radiation 3.SurgeryHypophysectomy-removal of the pituitary gland. RADIATION THERAPY DIABETES INSIPIDUS • Diabetes insipidus (DI): condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. (ADH secretion from the pituitary gland) • The most common disorder related to posterior lobe dysfunction CAUSES • Insufficient secretion of Anti-diuretic hormone (vasopressin), which controls water balance and blood pressure • DI may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, traumatic brain injury, infections of the nervous system, post hypophysectomy, failure of renal tubules to respond to ADH, and the use of specific medications CLINICAL MANIFESTATIONS • An enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005 occurs. • The urine contains no abnormal substances such as glucose or albumin. • Intense thirst, the patient tends to drink 2 to 20 L of fluid daily and craves cold water. • In adults, the onset of DI may be insidious or abrupt DIAGNOSTIC & MANAGEMENT • Plasma and urine osmolality studies are performed and urine for specific gravity. • Medical Management: The objectives of therapy are • (1) To replace ADH • (2) To ensure adequate fluid replacement • (3) To identify and correct the underlying intracranial pathology. PHARMACOLOGIC THERAPY • Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH (nasal sprays twice a day). • Chlorpropamide (Diabinese) and thiazide diuretics are also used in mild forms of the disease because they potentiate the action of vasopressin • Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors (ibuprofen [Advil, Motrin], indomethacin [Indocin], and aspirin) are used to treat the nephrogenic form of DI. NURSING MANAGEMENT • The nurse is responsible to: • Reviews the patient history and physical assessment • Educate the patient, family, and other caregivers about follow-up care, prevention of complications, and emergency measures. • Specific verbal and written instructions should include the dose, actions, side effects, and administration of all medications and the signs and symptoms of hyponatremia • Demonstration of medication administration to ensure that the patient received the prescribed dosage • Advised The patient to wear a medical identification bracelet and carry required medication and information about DI at all times. THE END