Endocrine Disorders

Nursing Interventions for SIADH

- Monitor Na+ levels and - Watch for S/S seizures - Monitor I&O's and restrict fluids - Daily weights

Also known as vasopressin, regulates reabsorption of water by the kidneys, stored in the posterior pituitary

ADH (antidiuretic hormone)

In adults: Bone size increases leading to enlarged facial features, hands and feet. Long bones get wider but not longer

Acromegaly

S/S internal organs and glands enlarge, change in ring/shoe size, teeth may become displaced, enlarged tongue, visual disturbances (if tumor), DM may develop, increase in sub Q connective tissue

Acromegaly (giantism)

What causes DI? This then results in the body losing water

Decreased ADH

S/S polyuria, polydipsia, dehydration, urinates 3-15L a day, concentrated blood (increased serum osmolality), decreased BP, low urine osmolality ( dilute urine)

Diabetes Insipidus (DI)

Etiology: tumors/trauma to posterior pituitary gland, severe emotional stress, malnutrition

GH Imbalance

Diagnostic test for acromegaly

GH levels measured, CT/MRI to locate tumor if present

Diagnostic testing for Growth hormone imbalance

GH stimulation test, timing on test is important, MRI to detect tumor, genetic testing

S/S children: short 3-4ft, delayed sexual maturation, mental retardation adults: fatigue, muscle loss and bone loss, sexual dysfunction, high cholesterol, increased risk of MI/CVA, headaches, mental slowness and psychological disturbances

Growth Hormone Imbalance (Dwarfism)

Normally occurs in women over 50

Hypothyroidism

S/S everything slows down, HR slows, intolerant to cold, fatigue, mental slowness, confusion, decrease appetite and weight gain, elevated serum lipid, decreased sex drive, constipation

Hypothyroidism

s/s decreased urine output, weight gain w/o edema, concentrated urine, low blood osmolality, electrolyte imbalance causing muscle cramps/weakness cerebral edema, confusion, seizures, coma and death

SIADH symptoms of inappropriate antidiuretic hormone

Dilutional hyponatremia occurs in which disorder?

SIADH.Patients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

Dx for hypothyroidism

T3 and T4 low, TSH may be high or low, serum cholesterol and triglycerides high, antibodies if autoimmune disease

Etiology of DI

Tumors, Trauma, sometimes surgery, drugs such as glucocorticoids and alochol

Preop Care for Hypophysectomy

baseline neuro, pt teaching, no coughing/sneezing/straining/bending at the waist

Dilutional hyponatremia s/s

bounding pulse, elevated bp, muscle weakness, headache, personality changes, nausea, coma

Hashimoto's thyroiditis

chronic lymphocytic thyroiditis, autoimmune disorder that destroys thyroid tissue

myxedema coma

comatose state from severe hypothyroidism and low T3, T4 levels

Growth hormone

controls bone growth, cartilage and soft tissue. secreted by the anterior pituitary

central obesity common in

growth hormone imbalance

4 types of this disease, each with own etiology

hypothyroidism

Treatment of hyperthyroidism can lead to

hypothyroidism

Tx for DI

hypotonic saline solution, replacement of ADH/vasopressin, long term synthetic ADH which desmopressin (DDAVP), thiazide diuretic, hypophysectomy (if tumor, removes pituitary gland)

Nursing Diagnosis for growth hormone imbalance

ineffective health management, fatigue, deficient knowledge

Therapeutic measures for acromegaly

medications to block GH hypophysectomy

Nursing Interventions for DI

monitor daily weights (gain/loss greater than 2lbs call HCP), I&O, monitor restlessness/weakness, drop in bp and raise in pr may be hypovolemic shock

Post Op Care for Hypophysectomy

neuro assessment, check UA (DI may develop), monitor for CSF leaking, hormone therapy replacement

myxedema

nonpitting edema of the face, hands and feet

Acromegly

overproduction of GH in adults overproduction of GH in children=giantism

Diagnosing SIADH

serum sodium and osmolality are low, urine sodium and osmolality are high, serum ADH high

Post Op Teaching for hypophysectomy

small amount of bloody mucous, blow nose gently, stool softeners, cough suppressants

Dx testing for DI

specific gravity <1.005, sodium levels appear high, plasma osmolality (high/concentrated) , CT/MRI, check glucose to rule out DM, after hypertonic saline or fluid restriction adh should be in the blood if ADH is not elevated than positive

Therapeutic Measures for growth hormone imbalance

surgery if tumor present synthetic GH

Treatment of hypothyroidism

thyroid hormone replacement

Treatment for SIADH

underlying cause, surgical removal of tumor, restricting fluids 800-1000mL daily helps symptoms, furosemide (lasix), conivaptan (vasopril)