Chapter 41: Endocrine Disorders

Psychosocial dwarfism

seen in emotionally deprived children; GH function can return to normal after removal from bad environment

A child is born with dwarfism to normal-sized parents. The physician is explaining how growth hormone (GH) plays a central role in the increase in stature that characterizes childhood and adolescence. What is the first step in the growth hormone chain of events?

the hypothalamus secretes GHRH

Primary thyroid disorder originate at the ______

thyroid gland

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

using an insulin infusion pump

Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?

Fatty acids

The nurse has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the nurse to conclude that additional teaching is needed?

"I can stop my insulin if i start an exercise program"

Hyperthyroidism signs and symptoms

**Suggests overactivity of the sympathetic nervous system. **Increased metabolic rate and oxygen consumption **Increased use of metabolic fuels -Tachycardia -Palpitations -Sweating -Tremor -Restlessness -Anxiety -Diarrhea

Hypothyroidism signs and symptoms

-Decrease in metabolic rate -Accumulation of hydrophilic mucopolysaccharide substances (myxedema) in the connective tissues throughout the body -Elevated serum cholesterol

Effects of GH excess in adults

-Vocal changes, bronchitis -Kyphosis -Arthralgias, degen of spine, knees, hips, nerve entrapment -Hypertension -Accelerated atherosclerosis -Altered fat and carb metabolism -Impaired glucose tolerance

GH deficiency in adults

1. GH deficiency present in childhood 2. GH deficiency that developed in adulthood as the result of hypopituitarism

causes of acromegaly

1. Somatotroph adenoma (most common) 2. Excess secretion of GHRH by hypothalamic tumors 3. Ectopic GHRH secretion by nonendocrine tumors such as carcinoid tumors or small cell lung cancer 4. Ectopic secretions of GH by neuroendocrine tumors

3 Major Thyroid binding proteins

1. Thyroid Hormone Binding Globulin (TBG): Carries approx 70% of T4 and T3 2. Thyroxine Binding Prealbumin (TBPA): Binds approx 10% of circulating T4 and lesser amounts of T3 3. Albumin: Bindings 15% of circulating T3 and T4

True/False: Goiters are always associated with increased production of thyroid hormone

False

True/False: Most hormones are regulated via positive feedback

False

A client has been diagnosed with dysfunction of the anterior pituitary gland. The nurse is aware that which hormones will likely be affected? Select all that apply

ACTH TSH LH GH

GH excess after puberty will cause ______

Acromegaly

The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis?

Beta cell exhaustion due to long standing insulin resistance

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels?

Blood glucose will elevate

True/False: Thyroid storm results in delayed puberty

False

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.

Blurred vision weight loss thirst

The newborn nursery nurse is obtaining a blood sample to determine if a newborn has congenital hypothyroidism. What long-term complication is the nurse aware can occur if this test is not performed and the infant has congenital hypothyroidism?

Cretinism

Which hormone(s) is/are secreted by the anterior pituitary to stimulate ovaries and testes

FSH and LH

Which effect of thyroid hormone deficit alters the function of all major organs in the body?

decrease metabolism

A 23-year-old man is admitted to the hospital. He is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on very suddenly. This client is likely to require what treatment?

Exogenous insulin injections

Hormones essential for normal body growth and maturation

GH Insulin Thyroid Hormone Androgens

GH excess before puberty will cause ______

Gigantism (before fusion of epiphyses)

The family of a client in the hospital with diabetes mellitus that is out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?

Glucose is unused without insulin, so body fat is used for energy

A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.

Glyburide Insulin

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?

HR 110 and bounding

GH secretion is stimulated by:

Hypoglycemia Fasting Starvation Decreased blood levels of fatty acids Stress conditions: Trauma, excitement, emotional stress, and heavy exercise

Goiter

Increase in the size of the thyroid gland (can occur in hypothyroid or hyperthyroid states) -Goiters can diffuse (nodular) -Toxic (extreme hyperthyroidism)

GH is inhibited by

Increased glucose levels Levels of free fatty acids in the blood Cortisol Obesity Aging

GH functions

Increased protein synthesis (which increases linear growth, increases body organ size and function, and increases lean muscle mass), Uses fatty acids for fuel, Increases linear bone growth,

Which pancreatic hormone decreases blood glucose levels?

Insulin

Which condition is a cause of tall stature?

Marfan syndrome

Secondary thyroid disorders originate at the _____

Pituitary gland

__________ disorder results from lesions or damage at the gland

Primary

A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?

Promotion of glucose uptake by target cells

Physical findings of children with GH deficiency

Short stature (pituitary dwarfism) Increased subcutaneous fat in abdomen immature facial features delayed dentition underdeveloped nasal bridge

Primary hypothyroidism causes

T3 and T4 levels are low but TSH level is elevated

The pituitary gland releases _______, this stimulates the thyroid gland to release ____ and ____

TSH, T3 and T4

A client has presented to a clinic for the treatment of severe dermatitis after contact with poison ivy on a camping trip. The client has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client's care provider has emphasized that dosages of the drug will be gradually tapered off rather than stopped upon resolution of the symptoms. Which rationale is the most accurate for this dosing protocol?

The client's hypothalamic-pituitary-adrenal (HPA) system will require recovery time before normal function is restored.

Laron Type Dwarfism

The pathophysiologic problem is hormone resistance because of abnormal GH receptors GH levels are normal or elevated; however, levels of IGF-1 are low Cause: Autosomal recessive inheritance Treatment: IGF-1 replacement

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?

Thin extremeties and muscle weakness

Major Functions of Thyroid Hormone

Thyroid gland releases T3 and T4 T3: Stimulates metabolism T4: Is inactive until converted to T3 in the tissues Thyroid hormones: Increase metabolism and protein synthesis, influence growth and development in children

A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these findings as manifestations of which complication?

Thyroid storm

True/False: GH deficiency may result in dwarfism

True

Which of the following is not a complication of DM? a. Neuropathy b. Retinopathy c. Neuropathy d. All are complications

d

A patient has an adrenal tumor that secretes high levels of ACTH. What effect would you expect this to have on corticotrophin-releasing hormone (CRH) from the hypothalamus and cortisol from the adrenal cortex? A.Increased CRH and cortisol B.Increased CRH, decreased cortisol C.Decreased CRH, increased cortisol D.Decreased CRH and cortisol

c

Which of the following is a characteristic of a hormone? A. A single hormone can exert various effects in different tissues. B. A single function can be regulated by several hormones. C. Both

c

A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which assessments should the nurse prioritize?

eye health and visual acuity

True/False: The pituitary gland controls the release of thyroid hormone

True

Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition?

Early activation of the hypothalamic-pituitary-gonadal axis

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

Hyperglycemia

A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to?

Hypermetabolic state

A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?

I will have to take medication for the rest of my life

True/False: Type 2 DM is more common than type 1 DM

True

The nurse is providing education for a client diagnosed with hypothyroidism. What information about diet should the nurse be sure to include in this information?

client should maintain a low cholesterol diet

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

complete failure of insulin secretion