Endocrine Exam 4

nursing care post-thyroidectomy

-assess airway and breathing -assess for bleeding -pain control -supine positioning -cold fluids and soft foods

Nursing care pre- thyroidectomy

-normalize thyroid hormone levels -how to support neck and incision -high protein and calorie diet -avoid caffeine/stimulants

Complications of thyroidectomy

-Airway edema -laryngeal spasms -changes in voice - Hemorrhage -hypocalcemia -removal of parathyroid -tetany

decrease in ACTH results in? Increase?

lack of corticosteroids Cushings disease

decrease FSH and LH

loss of secondary sexual characteristics

How does hypoparathyroidism happen?

most often because of surgical removal of glands

Which hormone is released from the posterior pituitary gland?

oxytocin and ADH

Hyperpituitarism causes

pituitary tumor (usually benign)

Hashimoto's thyroiditis

primary hypothyroidism

What does parathyroid hormone do?

regulates calcium and phosphorus levels by secreting PTH if Ca+ is too low and pulling Ca+ out of the bone into the blood

What does the thyroid gland do?

regulates metabolism, growth and development

endocrine system

regulates metabolism, tissue function, reproduction, growth, and development through synthesis of release of hormones

Priority concern with Cushings

Protect from infection due to cortisol Consider nursing assignments: no highly infectious patients Low sodium, low carb, high protein Prevent from falls, skin, and fractures

Aldosterone controls what?

Reabsorption of sodium, excretion of potassium, and regulates BP

Disorders of the Pituitary Gland

*dysfunction of pituitary gland or hypothalamus -Anterior: >Growth Hormone (GH) >prolactin >ACTH (adrenocorticotropic hormone) -Posterior:- ADH (antidiuretic hormone)

three D's of diabetes insipidus

- Diabetes insipidus - decreased ADH - Diuresis

Cushing's disease

- Excessive secretion of ACTH - masculinization - amenorrhea - truncal obesity - hypertension - moon face - osteoporosis

Diagnostic results for hyperparathyroidism

- Increased Ca+ and PTH levels - decreased Phosphate - X-ray shows demineralization and fractures

s/s of hypoparathyroidism

- aches and pain (initial) - tetany (Trousseau or Chvostek's sign) - laryngeal spasm - dysrhythmias - seizures - tremor and spasmodic or uncoordinated contractions

medical treatment for hypoparathyroidism

- bring Ca+ to 9-10 - IV calcium gluconate in emergency situations - can give parental PTH - Chronic: Oral Ca+ replacement and vit. D - diet high in Ca+ and low in phosphorus

Diagnostic results for hypoparathyroidism

- decreased Ca+ and PTH - increased phosphate

S/S acromegaly

- enlargement of hands and feet - joint pain - HA - thickening and enlargement of bony and soft tissues on the face and head - Slanting forehead - protruding jaw - increased BP - voice deepening - sleep apnea - menstrual disturbances - visual disturbances

Nursing care for hyperparathyroidism

- hydration >2000mL/day to prevent renal stones - ambulate (keeping Ca+ in the bones) - prevent constipation - emotional support - close monitoring of Ca+ levels

s/s of hyperparathyroidism

- hypercalcemia - irritability - dysrhythmias - renal calculi - bone pain and fractures - peptic ulcers - fatigue - apathy - muscle weakness - n/v - constipation

treatment for hypercalcemic crisis

- large vol of IVF to prevent Ca+ resorption - loop diuretics to promote Ca+ excretion - phosphate replacement - dialysis - calcitonin

Goals of hypophysectomy postoperative

- preventing infection - promote healing - antimicrobial agents - corticosteroids - analgesic agents for discomfort - control of diabetes insipidus

Hypoparathyroidism- foods that are high in Ca+ and low in Phosphorus

- rice milk and nondairy creamer - refined white bread - green beans, broccoli, cucumbers -fish

Causes of hypopituitarism

- tumors - trauma - infection - autoimmune disorder

increase ADH secretion

SIADH (syndrome of inappropriate ADH)

Three D's of pleural effusion (hypothyroidism)

1) dull to percussion 2) decreased breath sound 3) decreased respiratory excursion on affected side

Late manifestations of hypothyroidism

Slow speech, subdued emotional response, apathy, absence of sweating, cold intolerance, constipation, thickening of skin, dyspnea, weight gain, thinning of hair.

S/S of Hypercalcemia:

Stones: renal Bones: bone pain, osteoporosis, fractures Abdominal Moans Psychic groans

Focused assessment for hyperthyroidism would include what?

respiratory- possible distress r/t thyroid obstruction of airway; stridor and dysphagia ECG- tachycardia Myocardial hypertrophy cardiac decompensation Increased T3 and T4 decreased TSH

Goal of treating hypothyroidism

restore normal metabolic state by replacing the missing hormone

Hypercalcemic crisis

serum Ca+ levels >15mg/dL resulting in neurologic, cardiovascular, and renal symptoms that are LIFE-THREATENING

diagnostic tests for thyroid function

serum levels: T3, T4, TSH radioactive iodine uptake test thyroid scan

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

Myxedema coma

severe stage of hypothyroidism hypothermic increasing lethargy ->coma hypoventilation- because of respiratory depression

treatment for hyperparathyroidism

surgical removal of parathyroid

manifestations of hyperthyroidism

symptoms of nervousness cannot sit still tachycardia and palpitations exophthalmos weakness osteoporosis and fractures thyroid gland is enlarged- thrill and bruit

s/s of pheochromocytoma

5 H's: HTN, headache, hyperhydrosis (sweating), hypermetabolism, hyperglycemia

Why is radioactive iodine the preferred treatment for hyperthyroidism?

95% of patients are cured by one dose effective and avoids the side effects of antithyroid medications

What should the nurse be monitoring for during radioactive iodine treatment?

thyroid storm initially causes an acute release of thyroid hormone

Treatment for thyroid cancer

thyroidectomy possible hypothyroidism post surgery monitor T4, TSH, serum calcium and phosphorus

Three hormones produced by the thyroid gland

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

panhypopituitarism

total pituitary impairment that brings about a progressive and general loss of hormone activity

Complication after adrenalectomy, withdrawal from meds, or pituitary gland removal?

Addisonian crisis (hypovolemic shock)

Treatment goal of hyperthyroidism

treat the underlying cause

radioactive iodine

treatment for hyperthyroidism by destroying overactive thyroid cells

Teaching preoperative hypophysectomy

Avoid: - coughing - blowing nose - sucking through a straw - brushing teeth BREATHE through the mouth instead of the nose

Primary hyperparathyroidism

tumor of parathyroid gland

Nursing care of hypothyroidism

vital signs monitor cognitive level ABGs cautiously administer fluids encourage mobility provide extra clothing and blankets enhance coping mechanisms

imaging studies for hypopituitarism

CT and MRI

What hormones are secreted by the adrenal glands?

Cortisol and aldosterone

Which hormones are insufficient in Addison's?

Cortisol and aldosterone

Excessive cortisol and aldosterone is called?

Cushings

Early manifestation of hypothyroidism

Nonspecific symptoms- fatigue to somnolence, loss of libido to amenorrhea, mental and physical sluggishness,, reports of hair loss, brittle nails, dry skin, etc.

Signs and symptoms of Addison's?

Dehydrated and hypotensive GI symptoms Skin hyperpigmentation Confusion, apathy, and depression Low sodium due to low aldosterone Hypoglycemic due to low cortisol

Which disease is caused by the deficiency of antidiuretic hormone?

Diabetes insipidus

Beck's triad for cardiac tamponade (hypothyroidism)

Distant heart sounds Distended jugular veins Decreased cardiac output

What teaching must be done after a Endoscopic transsphenoidal hypohsectomy?

Don't brush teeth Avoid bending over Don't blow nose Don't suck through a straw

What is the surgical option to remove a tumor in the pituitary gland?

Endoscopic transsphenoidal hypohsectomy

Pathophysiology of pheochromocytoma

Excessive release of catecholamines (epi and norepi)

Priority treatment for Addison's?

Fluids Trendelenburg, recumbent Telemetry Decrease activity and stress free environment

A nurse is caring for an adult client with acromegaly. What clinical manifestation does the nurse expect the client to exhibit?

Prominent jaw

What is the primary concern for Addison's?

Hypovolemic shock- low BP high HR high RR

Cortisol controls

Increases blood glucose, increases fat metabolism, decreases WBC migration, and decreases inflammatory response

hormone replacement therapy

Levothyroxine based on patient's serum TSH levels treatment is lifelong

Contact doctor after a Endoscopic transsphenoidal hypohsectomy when s/s of this happen:

Meningitis: fever, severe headache, nu Hal rigidity, altered LOC

What is the primary concern with a patient who has SIADH?

Monitor electrolytes and seizure precautions Treatment: eliminate excess fluid volume and fluid restriction

S/S of Cushing's Syndrome?

Moon face appearance and buffalo hump, thin skin, facial hair, purple striae, acne, hypertension, edema Hyperglycemia-high cortisol Hypernatremia- excessive aldosterone Low potassium- because of excessive aldosterone

negative feedback

a decrease in one hormone triggers release of another

The nurse is providing care for a client with small-cell carcinoma of the lung who develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply. a) Edema b) Polyuria c) Bradycardia d) Hypotension e) Hyponatremia

a) Edema e) Hyponatremia Edema results as fluid is retained because of the increased secretion of antidiuretic hormone. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia. A decreased urine output occurs with SIADH because ADH causes reabsorption of fluid in the kidney glomeruli. The increased fluid volume associated with SIADH results in tachycardia, tachypnea, and crackles. The increased fluid volume associated with SIADH results in hypertension, not hypotension.

A nurse is assessing a client with diabetes insipidus. Which signs indicative of diabetes insipidus should the nurse identify when assessing the client? Select all that apply. a) Excessive thirst b) Increased blood glucose c) Dry mucous membranes d) Increased blood pressure e) Decreased serum osmolarity f) Decreased urine specific gravity

a) Excessive thirst c) Dry mucous membranes f) Decreased urine specific gravity

During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? Select all that apply. a) palpitations b) tachycardia c) thickened skin d) apathetic attitude e) missed menstrual periods

a) palpitations b) tachycardia e) missed menstrual periods

positive feedback

an increase in one hormone triggers release of another insulin in response to glucose

foods that are restricted in hypoparathyroidism

egg yokes, milk and milk products, spinach

Types of treatment for hyperthyroidism

anti-thyroid drugs iodine treatment propranolol thyroidectomy

Primary hyperthyroidism- Graves

autoimmune thyroiditis

s/s of severe hypothyroidism

elevated serum cholesterol levels, atherosclerosis, CAD, poor LV function, pericardial effusion, low heart rate & temperature

hyperpituitarism

excessive production of one or more ANTERIOR pituitary hormones- GH, ACTH, and prolactin

acromegaly

excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones (also increased size of internal organs)

parathyroid glands

four small glands on the posterior of the thyroid gland that secrete parathyroid hormone (PTH)

endoscopic transsphenoidal hypophysectomy

go through the nose rather than doing a full craniotomy for treatment of pituitary tumor; lower risk of trauma and hemorrhage

Secondary hyperparathyroidism

chronic renal failure due to elevated phosphorus levels

hyperparathyroidism

hypersecretion of the parathyroid glands, usually caused by a tumor

Thyroid storm

hyperthermia, nervousness, delirium, disorientation, and heart failure

decrease in TSH results in? increase?

hypothyroidism; hyperthyroidism

Hyperthyroidism serum labs

increased T3, T4 decreased TSH

Hypothyroidism serum labs

decreased T3 and T4 increased TSH

Hypoparathyroidism

deficient production of parathyroid hormone resulting in hypocalcemia and hyperphosphatemia

The shift of calcium from bone to blood puts the patient at risk for?

demineralization of bones (increased fractures) and increased renal calculi (stones)

decrease in ADH causes

diabetes insipidus

A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment?

dry skin

Decrease in growth hormone results in? Increase?

dwarfism, gigantism, acromegaly

what s/s would we see with cardiac decompensation?

dyspnea, JVD, S3 heart sounds, crackles