Care of Patients with Endocrine Disorders Chapter 37
How is SIADH diagnosed?
urine and serum osmolality tests; blood urea nitrogen (BUN); hemoglobin; hematocrit; creatinine clearance; elevated urine sodium is present
How is hypofunction of the pituitary diagnosised?
history; physical examination; diagnostic studies; laboratory blood test to measure levels of pituitary hormone; MRI & CT to determine the presence or absence of a pituitary tumor
How is a goiter diagnosed?
history; physical examination; increased, normal, or decreased hormone production
What are the treatments of pituitary tumors?
hormone therapy (designed to reduce levels of growth hormone); surgery (hypophysectomy most common) or irradiation
What are signs/symptoms of Addison's disease when there is an insufficiency of glicocorticoids?
hypoglycemia; decreased secretion of gastro enzymes resulting in anorexia, n/v, flatulence, diarrhea; anxiety; depression; loss of mental acuity
What are signs/symptoms of Addison's disease when there is a insufficiency of mineralocorticoids?
hyponatremi; hyperkalemia; malaise; muscle weakness; muscle pain; orthostatic hypotension; vulnerability to cardiac dysrhythmias
What is the nursing management of preoperative nursing care of thyroidectomy?
if patient appears nervous, tense and apprehensive, report it to physician due to it contributing to thyroid crisis postoperatively
What will a decrease in GH lead to?
in children- short stature; in adults- an increase in bone breakdown, resulting in increased bone fragility and risk for osteoporosis
What does a thyroid storm cause?
increase in temp (>106) & pulse (up to 200 b/m); respirations are rapid; marked apprehension & restlessness; if not relieved, quickly passes from delirium to coma to death from heart failure
What are the affects of the pituitary adenoma?
increased pressure with the optic chiasm will destroy the optic nerve, & it antagonizes the effect of insulin causing an increase in blood glucose and glucose intolerance.
What is thyroiditis?
inflammation of the thyroid gland
What is the nursing management for a goiter?
iodine preparation should be given well diluted and through a straw to prevent staining of the teeth; adverse effects of iodine preparations include GI upset, metallic taste, skin rashes, allergic reactions, and epigastric pain
Levothyroxine...
is a life-long therapy that should be taken on an empty stomach at the same time each day (preferably in the am); can take 6-8 weeks to for benefit/improvement of symptoms
What is the treatment for hyperparathyroidism?
isotonic sodium chloride and diuretics promote excretion of excess calcium; phosphate therapy; mithramycin binds calcium and enhances secretion; calcitonin decreases rate of skeletal calcium release; surgery
If a patient coughs after a transsphenoidal hypophysectomy...
it mat lead to a cerebrospinal fluid leak.
What medication should not be given to patients with hyperparathyroidism?
thiazide diuretics due to the potential to cause hypecalcemia
What is the treatment for thyroiditis?
thyroid hormone to prevent hypothyroidism and suppress TSH secretion; surgery
What is the goal of therapy for thyroiditis?
to decrease the size of the thyroid and prevent hypothyroidism
What is the treatment and nursing management for pheochromocytoma?
treatment- surgery; nursing management- monitor vitals; administer antihypertensive medication; monitor for signs of orthostatic hypotension
What are the treatments for thyroid cancer?
treatment- thyroidectomy; radioactive iodine therapy; vandetanib which inhibits tumor growth in symptomatic medullary thyroid cancer
How is thyroid cancer diagnosed?
ultrasond examination to assess size and locare any nodules; iodine uptake to check for nodules; fine-needle aspiration
What is autoimmune thyroiditis?
also known as Hashimoto's thyroiditis; the body produces antibodies against the thyroid and destroys the gland
What is a goiter?
an enlarged thyroid gland which may be caused by deficiency of iodine in the diet and can be prevented by increasing iodine intake
Pituitary tumors...
are usually benign pituitary adenoma which secrets growth hormone (GH), leading to continued growth of bones and soft tissues.
What medication should never be given to patients during a thyroid storm?
aspirin because it increases serum levels of T3 and T4; give acetaminophen instead
How is hypoparathyroidism diagnosed?
EEG; CT scan; serum calcium; phosphate; magnesium; vitamin D; parathyroid hormone assay; urine cyclic adenosine monophosphate (cAMP)
What are nursing managements of postoperative nursing care of thyroidectomy?
Fowler's position to facilitate breathing and reduce swelling; vitals checked continuously then hourly once stable; monitored for signs of bleeding and swelling; increase in temp/pulse/respiration, difficulty swallowing/breathing, tetany, or thyroid crisis should be reported immediately;
What is the treatment for hypoparathyroidism?
IV calcium gluconate; calcium salts (oral or parenteral); parathormone replacement therapy; vitamin D in massive doses; oral calcium salts
What are the local signs and symptoms of pituitary adenoma?
headache from pressure of tumor; visual disturbance (possibly blindness) from pressure with the optic chiasm.
What is the most common pituitary hormone deficiency?
a decrease in the amount of GH and gonadotropins; results in metabolic problems and sexual dysfunction
What is hypofunction of the pituitary gland?
a decrease in the level of one or more of the pituitary hormones caused by a tumor (most common), autoimmune disorders, infections, or destruction of the pituitary
What is hypoparathyroidism?
a deficiency of parathormone which causes a drop in serum calcium levels and an increase in phosphorus levels
What is ablation therapy?
a definitive therapy for hyperthyroidism of radioactive iodine; disadvantage is possible hypothyroidism caused by "overeffective treatment"
What is myxedema coma?
a life threatening abrupt withdrawal of thyroid therapy, acute illness, anesthesia, use of sedatives or narcotics, surgery, or hypothermia in the hypothyroid patient
What is Sheehan syndrome?
a postpartum condition of pituitary necrosis and hypopituitarism after circulatory collapse resulting from uterine hemorrhaging
What is acromegaly?
a result of pituitary adenoma in adults where the lips thicken, the nose enlarges, the forehead develops a bulge, and the hands and feet become enlarged; muscle weakness may occur, and oseteoporosis and joint pain is common
What is thyroid crisis/thyroid storm?
a sudden increase in the output of thyroxine, improper reduction of thyroid medication before surgery, or overdose of levothyroxine by patients with hypothyroidism
What is pheochromocytoma?
a tumor fo the adrenal medulla that secretes catecholamines (epinephrine and norepinephrine)
What is primary hyperthyroidism?
abnormality of function involving the thyroid gland itself; greatest risk are women 30-50 y/o; also called Grave's disease or toxic goiter
What are the three types of thyroiditis?
acute (infection related); subacute (ex. related to upper respiratory viral infection); chronic (most common type)
What are the treatments for hyperthyroidism?
administering radioactive iodine & antithyroid drugs, mild sedatives, and beta-adrenergic blocking agents to control tremor; temperature elevation; restlessness; tachycardia
What are common causes of a thyroid storm?
administration of drugs or dyes containing iodine; childbirth; CHF; diabetic ketoacidosis; inadequate hormone replacement; infection; pulmonary embolism; severe emotional distress; stroke; trauma or surgery
What is the treatment for myxedema coma?
administration of levothyroxine IV, fluid replacement, maintenance of an airway and respiration, IV glucose administration, corticosteroids, and provision of warmth
Thyroidectomy...
can be partially removed for those who do not respond we to antithyroid drug therapy, unable to take radioactive iodine, or have greatly enlarged thyroid glands; those with malignancy undergo total thyroidectomy
What disease is hyperthyroidism similar to?
cardiovascular disease
What are the 3 primary mechanisms of DI?
central DI; nephrogenic DI; dipsogenic DI
How are pituitary tumors diagnosed?
complete history & physical examination; MRI and CT scan with contrast media may be used to identify, localize, and determine the extent of the tumor; thorough ophthalmologic examination needed to evaluate pressure on the optic chiasm or optic nerve.
How is DI diagnosed?
complete history; physical examination; urine and plasma osmolality; urine specific gravity; water deprivation test to confirm suspected central DI
What are signs/symptoms of SIADH?
confusion; seizure; loss of consciousness; weight gain; edema; hyponatremia which causes muscle cramps and weakness; urine output diminished
What is the treatment for SIADH?
correcting the underlying cause; restricting fluids to 500-1000 mL/day; administering sodium chloride, diuretics, and demeclocycline ( a tetracycline) to increase excretion of water; hypertonic enemas
Genetic defects can cause congenital hypothyroidism called what?
cretinism; caused by a severe lack of thyroid hormone during fetal life and infancy and is characterized by growth failure
What are signs/symptoms of hypothyroidism?
decreased appetite; increased weight due to slow metabolism; bagginess under eyes; swelling of the face; lethargic; sleep for abnormal long periods; slurred speech; sluggish mental and physical activity; cold intolerance; constipation; abdominal distention; flatulence; impaired memory; depression; husky voice; thinning eyebrows; hair loss; brittle nails; easy bruising; fatigue; muscle cramps; numbness/tingling; dry skin; nonpitting edema
What is Addison's disease?
decreased function of the adrenal cortex causing a deficit of all three hormones secreted by the adrenal cortex
What is hypothyroidism?
deficient activity of the thyroid gland that can be caused by inflammation of the gland, iodine deficiency,decreased TSH secretion, hypothalamus dysfunction, atrophy of the gland, or by treatment that results in destroying too many thyroid cells
What are the signs/symptoms of hyperparathyroidism?
dehydration; confusion; lethargy; arrhythmias;anorexia;nausea; vomiting; weight loss; constipation; thirst; frequent urination; hypertension; skeletal changes from hypercalcemia
Signs and symptoms of pituitary hypofunction...
depends on the cause of pituitary failure; if cause is a tumor, it may cause headaches, visual changes, anosmia (loss of the sense of smell), or seizures
What are the signs/symptoms of DI?
diuresis (production of a large amount of urine, often as much as 15-20L in 24 hours); thirst; weakness; fatigue often from nocturia; signs of deficient fluid volume (tachycardia, hypotension, weight loss, constipation, and poor skin turgor)
What is the nursing management for DI?
early detection; maintenance of fluid and electrolyte balance; patient education; baseline weight and vital signs are critical throughout therapy; strict I&O are essential to correct fluid losses and to titrate hypertonic saline infusion
What is nursing managements for hypoparathyroidism?
electrolyte replacement and patient teaching; remind patient that treatment is life-long and to wear a medical-alert bracelet; eat foods high in calcium but low in phosphorus
What are the signs/symptoms of a goiter?
enlargement of the front of the neck; can press against esophagus and cause difficulty swallowing; can press against trachea and cause difficulty breathing
How is Addison's disease diagnosed?
examining blood and urine electrolytes; ACTH stimulatiom test can determine if problem is in adrenal or pituitary gland; CT/MRI
What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
excessive amounts of ADH are produced, resulting in fluid retention which can be cause by malignancies and tumors pressing on the pituitary
What is hyperparathyroidism?
excessive synthesis and secretion of parathormone; causes hypercalcemia
What is gigantism?
excessively tall stature, as the bone growth plates have not closed yet in children which results from excessive secretion of growth hormone causes by pituitary adenoma
What are the physical changes caused by hyperthyroidism?
exophthalmos (protruding of the eyeballs); and enlarged thyroid gland imprint on neck
What is the nursing management for SIADH?
focus on cardiovascular and neurologic systems; alert to possible fluid shifts; promptly notify physician of any change in level of consciousness; monitor electrolytes; weigh daily
What is the nursing management for thyroiditis?
focus on patient teaching and providing for comfort
What are some nursing management skills?
kept in semi-Fowler's position; note/communicate promptly any change in vision, mental status, level of consciousness, or strength; monitor vital signs and complications such as diabetes insipidus; nasal drip pad is placed and changed as needed for 2-3 days; cannot brush teeth, cough, sneeze, blow nose, or bend forward
What is the diagnosis for hyperthyroidism?
lab test for thyroid hormone levels; assessment of heart rate while asleep; ECG to evaluate cardiac dysrhythmias; CT or MRI to rule out ocular complications
What is the diagnosis for hypothyroidism?
lab test of serum levels of thyroid hormones/TSH; clinical signs/symptoms
How is thyroiditis diagnosed?
lab tests including serum thyroid hormone levels; TSH levels; radioactive iodine uptake; needle biopsy may be performed
What are the signs that indicate elderly patients are demonstrating hypothyroidism rather than dementia?
lethargy, slow thought processes; lack of enthusiasm
What are the treatments for hypofunction of the pituitary?
lifelong replacement of the hormone(s) affected (patient must be taught method and frequency, side effects, and follow-up); surgery or radiation for tumor removal followed by hormone therapy
What are the signs/symptoms of myxedema coma?
loss of consciousness, hypotension, hypothermia, respiratory failure, hyponatremia, amd hypoglycemia
What are the nursing managements for hypothyroidism?
lotion and cream massages to prevent cracking and peeling of very dry skin; provisions for extra warmth; awareness of look-alike/sound-alike products; avoid rushing patients
Systemic symptoms of the pituitary adenoma...
may be vague, and progress slowly; personality changes, weakness, fatigue, and vague abdominal pain can be present for years before diagnosed.
What are signs/symptoms of thyroid cancer?
may find a nodule; fatigue; depression; weight changes
What are the nursing managements for hyperparatyroidism?
measure I&O (every 2-4 hours); daily weight; monitor serum electrolytes; assessment for electrolytr imbalance; cardiac monitoring
How is pheochromocytoma diagnosed?
measurement of serum catecholamines; 24-hour urine measurement of catecholamine metabolites; CT; MRI
What are the treatments for a goiter?
medications with preparations containing elemental iodine; surgery
What are the signs/symptoms of hyoparathyroidism?
mild tingling; numbness; muscle cramps; mental changes; Chcostek sign; Trousseau sign; tetany; convulsions; cardiac dysrhythmias; spasms of larynx
What is apathetic thyrotoxicosis?
milder hyperthyroidism signs/symptoms seen in the elderly patient compared with symptoms seen in the typical adult patient
What may the elderly exhibit with hyperthyroidism?
milder signs/symptoms; atypical presentation, such as shortness of breath, palpitations, or chest pain; apathetic thyrotoxicosis may be the only presentation
What is tetany?
muscle twitching and spasms resulting from injury to, or accidental removal of the parathyroid gland which regulates body calcium and phosphorus levels; treatment is administration of IV calcium gluconate
What is secondary hyperthyroidism?
overactive thyroid gland due to the abnormality of another gland that can produce too much TSH
What are the signs/symptoms of thyroiditis?
painless enlargement of the thyroid; may have dysphagia fr inflammation
What is the most common form of thyroid cancer?
papillary carcinoma that mostly occurs in women and is a slow growing tumor that can be present for years before diagnosis
What are the causes of hyperparathyroidism?
parathyroid tumor; congenital enlargement; neck trauma or irradiation; vitamin D deficiency; chronic renal failure with hypocalcemia; lung, kidney, or GI tract cancers
What are some nursing managements of thyroidectomy?
physical and emotional rest is critical due to the possibility of physical stress and emotional upset stimulating greater activity in the thyroid; diet should be high in calories; patient education of ongoing medication and frequent monitoring to assess effectiveness
What can induce secondary hypothyroidism?
pituitary or hypothalamus dysfunction
What is nursing management of hyperthyroidism?
precautions may be taken with equipment containing blood and urine; larger doses of ablation therapy require isolation for 8 days; if receiving radioactive iodine, must be observed for signs of thyroid crisis
What is diabetes insipidus (DI)?
production of copious amounts (usually more that 2.5L/day) of dilute urine, which results from decreased production of antidiuretic hormone (ADH), which decreased amounts of ADH allows for excretion of water in the urine
What is the treatment for thyroid crisis?
reduction of temp; cardiac drugs given to reduce heart rate; sedatives are given to reduce restlessness and anxiety
What is hypophysectomy?
removal of the pituitary gland
What is the treatment for DI?
replacement of fluid and electrolytes (hypertonic solutions are used and have to be titrated); hormone therapy
What are the treatments for hypothyroidism?
replacement of thyroid hormones
What may happen it DI is left untreated?
shock and CNS manisfestations from irritability to eventually coma may occur, resulting from hypernatremia and severe dehydration
What are the signs/symptoms of pheochromocytoma?
tachycardia; sever hypertension; profuse diaphoresis; severe headache; palpitations
What will a decrease in gonadotropins lead to?
testicular failure and ultimately sterility in men; ovarian failure, amenorrhea, and infertility in women
What are the signs/symptoms of hyperthyroidism?
weight loss; nervousness; weakness; insomnia; tremulousness; agitation; tachycardia; palpitations; exertional dyspnea; ankle edema; difficulty concentrating; diarrhea; increased thirst and urination; decreased libido; scanty menstruation; infertility
