Medsurg Endocrine
Mineralocorticoids effect what?
(Effects electrolytes) Primarily aldosterone - conserves sodium and water and lose potassium
In hyperaldosteronism you want to treat HTN, what is the best drug for that? What are some other drugs?
(Spironolactone:aldactone (diuretic)= drug of choice) (Eplerenone (Inspra) newer & more expensive drug. Has fewer side effects). For aldactone It is K+ sparing. Be careful with using salt subsitutes because some have K+ & should be avoided.
What are goals for postop parathyriodectomy?
- swelling/ airway -Increase fluids: to prevent renal calculi. 2000ml or more a day. -Mobility: encourage mobility to reduce calcium excretion. Bed rest increases calcium excretion and the risk of renal calculi. -Diet: avoid restricted or excess calcium
Postoperative for thyroidectomy
-Monitor for bleeding: check behind the neck for pooling of blood -Monitor respirations: swelling. Airway obstruction. Assess for recurrent laryngeal nerve damage by listening for hoarseness. Could have vocal cord paralysis—airway obstruction—trach kept st bedside at all times. -Assess Voice (stridor indicates increased swelling: emergency!!) but discourage talking -Tell pt to report any pressure. Edema -Elevate HOB to decrease edema -Pain relief -Monitor for hypocalcemia. Tetany can occur(review s/s) -Support the neck . No tension on suture line. Keep personal items close,
Preoperative for thyroidectomy
-Reduce stress and anxiety to avoid precipitation of -thyroid storm -Stop ASA or other anticoags -6 small meals a day -Avoid stimulates -No smoking or alcohol
PTH raises the blood calcium level by ?
-breaking down the bone (where most of the body's calcium is stored) and causing calcium release -increasing the body's ability to absorb calcium from food -increasing the kidney's ability to hold on to calcium that would otherwise be lost in the urine
What are the 5 H's of phenochromocytoma ?
1. HTN (severe 250/150 or more) 2.) headache 3.) hyperhidrosis (excessive sweating), 4.)hypermetabolism 5.) hyperglycemia
What are the four major actions of glucocorticoids?
1.) Mood changes—depressed, become psychotic, some have energy, insomnia, mean. 2.)Alters your defense mechanisms:supresses the immune system. At risk for infection. 3.)Make you break down fats and protein 4.)Inhibit insulin—makes blood sugar go up. Check BS when you have pt on steroids.
Drugs used for hyperthyroidism 7?
1.)Propylthiouracil 2.)Methimazole (tapazole) 3.) Sodium iodide 4.)Potassium iodide 5.)SSKI 6.)Dexamethasone 7.)betablocker (propranolol)
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R, taken at 6:30 AM will reach peak effectiveness by: a) 2:30 PM. b) 12:30 PM. c) 10:30 AM. d) 8:30 AM.
8:30 AM. Explanation: Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration
For hyporarathyroidism the goal is to increase the serum calcium level to what?
9-10mg/dL
Hyperparathyroidism=___________=______________
=Hypercalcemia=Hypophosphatemia
Hypoparathyroidism=___________=______________
=Hypocalcemia=Hyperphosphatemia
Which nursing diagnosis is most appropriate for a client with Addison's disease? a) Hypothermia b) Excessive fluid volume c) Urinary retention d) Risk for infection
Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria
What are the causes of Addison's disease?
Autoimmune or idiopathic atrophy of adrenal gland is responsible for majority of cases Surgical removal of both adrenal glands Infection of adrenal glands TB & Histoplasmosis Adrenal suppression by prescription corticosteroid (may occur in as little as 2-4 wks)
If you don't receive prompt treatment for Cushing syndrome, other complications may occur, such as:
Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet High blood pressure (hypertension) Diabetes Frequent or unusual infections Loss of muscle mass and strength
_________ is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing it deposition in bone.
Calcitonin
Causes of hypoparathyroidism
Causes: abnormal parathyroid development, destruction of the parathyroid glands (surgical removal or autoimmune response), and vitamin D deficiency
Causes of hyperparathroidsim
Causes: tumors, hyperplasia, and chronic hypocalcemia (renal failure)
What is top priority of phenochromocytoma unitl the tumor is removed?
Control of BP
What are somethings you need to know for pts having adrenalectomy?
Corticosteroid replacement if bilateral surgery. If 1 gland is removed; replacement therapy is needed temporarily Nursing management: frequent v/s to detect early signs and symptoms of adrenal insufficiency, crisis or hemorrhage. Frequent rest periods can reduce the pts stress & anxiety level.
A hypophysectomy is the treatment of choice for which endocrine disorder? a) Acromegaly b) Pheochromocytoma c) Cushing's syndrome d) Hyperthyroidism
Cushing's syndrome Explanation: A hypophysectomy is the treatment of choice for patient diagnosed with Cushing's syndrome resulting from excessive production of ACTH by a tumor of the pituitary gland.
A patient is having diagnostic testing for suspected hyperthyroidism. What diagnostics correlate with this endocrine disorder?
Decrease in serum thyroid-stimulating hormone (TSH) • Increased T3 • Increased T4 • Increase in radioactive iodine uptake
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). What would the nurse expect to find?
Decreased serum osmolarity, and high urine sodium levels
With SIADH, serum sodium levels and serum osmolarity are_____. Urine sodium levels and osmolarity are ________.
Decreased, high
Hypercalcemic Crisis
Extreme elevation of serum calcium (>13 mg/dl) Leads to life-threatening neurologic, cardiovascular and kidney symptoms Treatment: Rapid rehydration with large volumes of IV isotonic saline fluids. Goal is to maintain urine output of 100-150 ml/hr. Calcitonin Can give phoshates to decrease serum calcium level and move calcium into the bone
The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for?
Fluid deprivation test
What info do you need to educate pt on after an adrenalectomy?
Importance of follow-up care to ensure that pheochromocytoma does not recur undetected. Educate on the use of corticosteriods: purpose, schedule, risks of skipping a dose, or stopping it abrptly.
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse assist the client with preparing for?
Magnetic resonance imaging (MRI) or CT scan
What are the functions of the thyroid?
Main function is to control cellular metabolism. They also influ cell replication and are important for brain development. It affects virtually every system in the body including the basal metabolic rate, serum cholesterol levels, and vascular resistance.
Diagnosis for hypoparathyroidism
Positive Chvostek's sign Positive Trousseau's sign Serum PTH check Blood chemistry Electrocardiogram (may show abnormal heart rhythms) X-rays (calcifications) Bone density studies
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? a) Rapid, thready pulse b) Slow, shallow respirations c) Arm and leg trembling d) Cool, moist skin
Rapid, thready pulse Correct Explanation: This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.
Dilutional hyponatremia occurs in which disorder?
SIADH.Patients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
What is the function of insulin?
Secreted by the beta cells An anabolic, or storage, hormone Transports and metabolizes glucose for energy Stimulates storage of glucose in the liver and muscle Signals the liver to stop the release of glucose Enhances storage of dietary fat in adipose tissue Accelerates transports of amino acids into cells Insulin also inhibits the breakdown of stored glucose, protein and fat
Thyroid produces what three hormones?
T3 and T4 and calcitonin
What are the thyroid binding hormones?
TBG (thyroxine-binding globulin), transthyretin, and albumin
______ has an influence on the release of TSH and is secreted by the hypothalamus
TRH
What is the function of glucagon?
The effect of glucagon is chiefly to raise the blood glucose by converting glycogen to glucose in the liver. Glucagon is secreted by the pancreas in response to a decrease in the level of blood glucose.
What is HA1C?
The measurement of glucose control that is a result of the glucose molecule attaching to hemoglobin for the life of the red blood cell. Is an important blood test used to determine how well pts are controlling their diabetes. Hemoglobin A1c provides an average of their blood sugar control over a six to 12 week period and is used in conjunction with home blood sugar monitoring to make adjustments in their diabetes medicines. Is usually done every 3 months
low-dose dexamethasone suppression test:
Used to test Cushings syndrom. Give med late in the evening or at bedtime and blood test is done at 8 p.m. In normal subjects, daily doses of Dexamethasone can suppress the coordinated functions of the hypothalamus, pituitary and adrenal glands. Dexamethasone often fails to suppress the function of the hypothalamus, pituitary, and adrenal glands in patients with Cushing's disease or syndrome.
Adrenal sex hormones effect what?
When secreted in normal amts, they have little effect, but when secreted in excess, they produce male traits in women, female traits in males and premature sexual deve in children
Therapeutic use of corticosteriods is the most common cause
adrenocortical insufficiency (Addison's disease)
Too much_________causes the body to hold onto sodium and water and to get rid of potassium in unsafe amounts. This, in turn increases the amount of fluid in your body, and therefore increases your blood pressure.
aldosterone
In Addison's disease we do not have enough ______ so we _____ Na and H2O and ______ K+.
aldostrone,lose,retain
TSH, FSH, and LH are secreted by_________?
anterior lobe of the pituitary gland.
strategies for exophthalmus
cool compresses, wearing sunglasses, eye lubricants, and elevating the head of the bed), and increasing caloric, small frequent meals/push fluids, and calcium intake
In hypothyroidism T3 and T4 _________, and TSH _________.
decrease, increase
What are the causes of Cushing's syndrome?
glucocorticoid medications, adrenal tumors that secrete glucocorticoids, pituitary tumors that secrete ACTH and cortisol, and paraneoplastic syndrome
What are goals for pre op parathyroidectomy?
goal to decrease Ca level as much as possible: bleeding time is important
Patients with primary hyperaldosteronism will classically have:
high aldosterone levels and suppressed renin levels (i.e. very low). They will often also have low potassium levels.
The most common sign of primary hyperaldosteronism is :
high blood pressure (hypertension) that does not respond to standard blood pressure medications.
Following a thyriodectomy a pt should be monitored closely for signs of tetany which include?
hyperirriatability of the nerves, with spasms of the hands and feet and muscle twitching. Laryngospasm, although rare, may occur and obstruct the airway
Disease progression= Addisonian Crisis: characterized by:
hypotension, cyanosis, fever, n/v, and classic signs of shock. Slight overexertion such as exposure to cold, acute infection or decrease in salt intake can lead to circulatory collapse, shock or death.
In hyperthroidism T3 and T4_________, and TSH _______.
increase, decrease
_______Secretes the (PTH), which works opposite of calcitonin to regulate serum calcium levels (Ca=8.5-10.2 & Phos=2.4-4.1)
parathyroid gland
The best screening tests to determine if a patient has primary hyperaldosteronism are simple blood tests that measure the levels of:
potassium, aldosterone, and renin in the blood.
PAC:PRA ratio is the first test used in patients suspected to have primary hyperaldosteronism measures what?
the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio. The levels of aldosterone and renin are measured in the blood. A high ratio of PAC to PRA suggests primary hyperaldosteronism.
Major use if iodine in the body is by the _______?
thyroid gland
Which hormones are secreted by the posterior lobe of the pituitary gland?
vasopressin and oxytocin.
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? (Select all that apply.) a) Intravenous isotonic saline solution in large quantities b) Administration of calcium carbonate c) Monitoring the patient for fluid overload d) Administration of a bronchodilator e) Administration of calcitonin
• Administration of calcitonin • Intravenous isotonic saline solution in large quantities • Monitoring the patient for fluid overload Explanation: Acute hypercalcemic crisis can occur in patients with hyperparathyroidism with extreme elevation of serum calcium levels. Serum calcium levels greater than 13 mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening (Fischbach & Dunning, 2009). Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin (Shane & Berenson, 2012). Calcitonin promotes renal excretion of excess calcium and reduces bone resorption. The saline infusion should be stopped and a loop diuretic may be needed if the patient develops edema. Dosage and rates of infusion depend on the patient profile. The patient should be monitored carefully for fluid overload
Choice Multiple question - Select all answer choices that apply. A nurse is providing postoperative care to a client recovering from a hypophysectomy. Which of the following would be included in the care plan? Select all that apply. a) Closely monitor nasal packing and postnasal drainage. b) Assess for neurologic changes. c) Encourage deep breathing and coughing. d) Offer a straw when drinking liquids.
• Assess for neurologic changes. • Closely monitor nasal packing and postnasal drainage. Explanation: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
