ENDOCRINE

ENDOCRINE

1. Anterior Pituitary Disorders

   • Hypersecretion of GH
     • Acromegaly
       • overgrowth of bones & tissues d/t hyper secretion of GH
         • what can be affected by this?
           • cardiovascular system: cardiomegaly, ventricular hypertrophy, hypertension, and hepatomegaly
   • Hypofunction of Pituitary
     • Hyposecretion of GH resulting in growth retardation
       • increased prolactin levels
         • decreased gonadotropin levels
           • galactorrhea
             • decreased libido
               • excessive hair growth
                 • decreased sperm count/impotence in men
                   • vision changes

2. Hypophysectomy

   • Nasal packing (2-3days)
   • mouth breathing required since nose is packed
     • oral care
   • NO teeth brushing, coughing, sneezing, nose blowing, bending over
   • Neuro assessment
   • nasal drainage?
     • test for glucose
   • ATBx
   • medicate for pain
     • no narcotics
   • deep breathing exercises
   • monitor for complications
     • CSF leak
       • Infection
         • meningitis?
           • stiff neck? headache? fever?
             • ICP
               • DI

3. THYROID

   • HYPOthyroidism
     • increased TSH
       • low T3 & T4
     • clinical manifestations
       • myexedema
       • weight gain
       • depressed, fatigue, lethargic
       • muscle weakness
       • dry hair, brittle nails
       • COLD INTOLERANT
       • menstrual changes
     • treatment
       • synthroid/levothyroid
         • admin in am on empty stomach
         • admin same time each day
         • started on low doses due to cardiovascular changes
       • liothyronine (cytomel)
         • replacement of T3
         • rapid onset not for longterm
   • HYPERthyroidism
     • decreased TSH
       • high T3 & T4
     • clinical manifestations
       • nervous,irritable excitable
       • weight loss
       • increased HR, HTN
       • chest pain, flushed skin, bulging eyes
       • decreased libido, menstraul changes
       • bruit
       • hair loss, brittle nails
     • treatment
       • radioactive Iodine 131
         • used to destroy part of thyroid, most pt end up with hypothyroidism
       • radioactive iodine 123
         • short acting no radiation precaution
       • PTU & Tapazole

4. Parathyroid

   • HYPERparathyroid
     • excess PTH
       • which causes HYPERcalcemia
         • and decreased phosphorus
           • decreased bone density
     • Clinical manifestations
       • weakness
       • fatigue
       • weight loss
       • n/v
       • mental change
       • memory loss
       • bone pain
     • treatment
       • Adequate fluid intake
       • NS IV to promote excretion
       • Etidronate (Didronel)
         • reduces bone reabsorption reducing calcemia
       • Calcitonin (calcimar, Cibcalcin)
         • hormone that regulates serum calcium by keeping calcium inside the bone
       • hydration
         • 2L daily
           • loop diuretic
       • oral/IV phosphate
   • HYPOparathyroid
     • decreased PTH
       • which causes HYPOcalcemia
     • clinical manifestations
       • hypocalcemia
         • numbness/tingle of fingers & toes
           • perioral numbness
             • tetany
               • trousseau/chvostek
                 • cardiac symptoms
     • treatment
       • increased calcium diet
       • low phosphorus diet
         • no milk products
       • calcium supplement with D5W
         • not NS - will excrete calcium in urine
       • calcitrol (rocaltrol)
       • Vitamin D analog
       • oral calcium supplement

5. ADRENAL CORTEX DISORDERS

   • CUSHINGS DISEASE
     • hypocalcemia
     • hyperglycemia
     • hypokalemia
     • hypernatremia
     • secreting too many hormone
     • cushiness disease can be exogenous
       • too many steroids
     • cushiness disease can be endogenous
       • caused from pituitary or adrenal gland
     • manifestations
       • moon face/buffalo hump
       • truncal obesity
       • personality change
       • increased acid production
       • male: gynecomastia
       • females: Amenorrhea, Hirsutism
     • medications
       • steroids
       • H2 blockers
       • PPI for acid
     • Surgical treatment for Cushings
       • removal of tumor
       • removal of adrenal gland
     • Nursing care for patients with cushings
       • high glucose levels since cushiness causes insulin resistance
       • fluid overload: monitor bp, weight, electrolytes, skin breakdown, i&o
         • patient should monitor weight at home (>3 lbs a week or >1-2 lbs daily - notify HCP)
       • sm freq meals, fluid restriction, sodium restriction
       • monitor for signs of infection
   • ADDISONS DISEASE
     • hypercalcemia
     • hypoglycemia
     • hyperkalemia
     • hyponatremia
     • mineral and glucocorticoid deficency
     • manifestations
       • sweating
       • GI disturbance
       • weakness
       • weight loss
       • postural hypotension
       • mental confusion
     • medications
       • prednisone (cortisol)
       • Florinet (aldosterone)
     • surgical treatment for addisons
       • remove tumor
         • remove adrenal gland
     • Addisons Crisis
       • prolonged fatigue
       • dehydration
       • vascular collapse
       • renal system shuts down
       • decreased NA
       • increased potassium
       • treatment
         • fluids, steroids, insulin drip for high K, may give Kaxeylate, for low glucose give D5w or D10
       • hypotensive
       • tachycardic
       • if pt suddenly stops taking steroids for 24 hr
         • a sudden drop in hormones causes life threatening crisis
           • addisons crisis can also occur with removal of both ADRENAL GLANDS
     • Nursing care for patients with Addisons
       • monitor Vs, fluid, electrolytes
       • protect pt from stress
         • protecting addisons patient from stress includes
           • temperature changes
           • noise and light
       • no symptoms r/t medications and deficiencies

6. POSTERIOR PITUITARY

   • SIADH
     • fluid restrictions 800-1000
     • hypertonic saline to promote diuresis
     • potassium supplement
     • monitor daily weight, i&o, urine specific gravity, LOC, s/s for hyponatremia
     • flat HOB to reduce ADH release
     • seizure precaution
     • potential heart failure and pulmonary edema
   • DI
     • when the posterior pituitary is NOT secreting enough ADH
       • primary concern/problem for DI
         • excess water loss ---resulting in dehydration and hypovolemia
           • severe weight loss, hypotension, symptoms of shock, hypernatremia, hyperosomolaity

7. HYPERALDOSTERISIM

   • excessive aldosterone secretion
     • hypertension & hypokalemic alkalosis
     • edema freq not present
     • symptoms h/a, muscle weakness, fatigue, cardiac arrhythmia, parethsias, nocturia, polydipsia
     • treatment?
       • removal of secreting adenoma by adrenalectomy
       • spirolactone (aldactone) to increase potassium
       • important to monitor fluid and electrolytes and BP

8. Pheochromocytoma

   • 5 H's!!!
     • H/A
     • hypertension
     • hyperhidrosis (excessive sweating)
     • hyperglycemia
     • hypermetabolism
   • functional chromatin cells produce excess catecholamines
     • these tumors are malignant or benign
       • tumor may be in adrenal medulla or other parts of the body
         • symptoms?
           • sever, episodic hypertension
           • severe Headache
           • tachycardia and profuse diaphoresis
           • dx?
             • 24 hr urine sample