Endocrine Disorders
Adrenal Cortical Insufficiency (Addison's Disease)
Decreased Cortisol & Aldosterone →
diabetes insipidus Decrease ADH results in an inability of collecting ducts to reabsorb water → large volumes of very dilute urine.
Decreased secretion of antidiuretic hormone (ADH, vasopressin) from posterior pituitary Secondary to: Brain tumors Neuorsurgery Head trauma
Hypoparathyroidism
PTH Insufficiency (hypocalcemia& hyperphosphatemia)
Acute adrenal crisis Patients must be tapered to prevent this
Patient receiving exogenous corticosteroids for >2 weeks are at risk if abruptly discontinued
Sodium reabsorption
The client experiencing increased aldosteronism will experience which electrolyte abnormality? Sodium reabsorption Potassium reabsorption Glucose loss Magnesium loss
Parathyroid gland
The client is experiencing problems with reabsorption of calcium. Which endocrine gland requires evaluation? Parathyroid gland Pancreas Hypothalamus Anterior pituitary
Antidiuretic hormone
. Which hormone is either deficient or excess in Diabetes Insipidus and SIADH? ACTH Parathyroid hormone Antidiuretic hormone Cortisol Aldosterone
8.5-10.5
normal calcium levels
Hypovolemia
A patient has been receiving doses of prednisone for treatment of rheumatoid arthritis for the past three months. If this medication is suddenly discontinued, for which complication is the patient at risk (due to acute adrenal crisis)? Hypovolemia Hypernatremia Hypokalemia Hyperglycemia
C. Decreased serum potassium
A patient is undergoing a stimulation test to assess adrenal function. After the administration of cortisol, which laboratory result indicates normal function? A. Decreased blood glucose B. Decreased serum sodium C. Decreased serum potassium D. Decreased serum calcium
-Additional doses of steroids will be required if they experience stress such as surgery, trauma, or infection.
A patient with Addison's disease should be taught which of the following, in order to prevent adrenal crisis? -Additional doses of steroids will be required if they experience stress such as surgery, trauma, or infection. -Stop taking oral steroids immediately if you begin to show signs of crisis (profound hypotension and hypovolemia). -Track your urine periodically for the presence of ketones, as this will indicate impending adrenal crisis. -Limiting dietary intake of sodium will help to prevent adrenal crisis.
Tachycardia Hypotension Adrenal crisis/Addisonian crisis = severe hypovolemia and hypotension.
A patient with COPD has been receiving prednisone for several months. The patient is unable to pay for the prescription. What manifestations would indicate acute adrenal crisis? SELECT ALL THAT APPLY: Hypertension Tachycardia Fever >101 F Hypotension
Trousseau's sign
A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.
Hypersecretion of a tumor in the adrenal cortex Causes Primary: direct oversecretion from adrenal cortex (often a tumor) Secondary: oversecretion of ACTH from anterior pituitary (often a tumor) Tertiary: oversecretion of CRH from hypothalamus
Adrenal cortex can hyper excrete either glucocorticoid (Cushing's) or aldosterone (Conn's). Which of the following is a PRIMARY cause of hyperfunction? Hypersecretion of ACTH from the anterior pituitary (often a tumor) Hypersecreation of CRH from the hypothalamus Hypersecretion of a tumor in the adrenal cortex Removal of the adrenal gland (adrenalectomy)
Hypothalamus secretes CRH → anterior pituitary secretes ACTH (bound to MSH) → Adrenal cortex to secrete: *Glucocorticoids (cortisol) *Mineralocorticoids (aldosterone) *Sex hormones (androgens & estrogens)
Adrenal cortex secretes:
Urine output is approximately equal to oral fluid intake
After administering vasopressin (DDAVP), the nurse assesses for which of the following expected outcomes? Urine specific gravity is <1.001 Blood pressure decreases from baseline Urine output is approximately equal to oral fluid intake Serum sodium is <130 mEq/L
Aldosterone (mineralcorticoid) Target: a. kidneys Action: a. Promotes reabsorption of sodium and water b. Promotes excretion of potassium
Aldosterone (mineralcorticoid) Target: Action:
Hormone: Androgen & Estrogens (sex hormones) Target: Numerous Action: Sex characteristics
Androgen & Estrogens (sex hormones) Target: Action:
Phospherous
Calcium has an inverse relationship with __
Polyuria - Enormous output of "water-like urine" w/ urine specific gravity < 1.005 (normally 1.010-1.030). ℅ nocturia. Polydipsia - Intense thirst Hemoconcentration - Elevated serum sodium (>145 mEq/L) and hematocrit (>50%) Volume deficit - hypotension, tachycardia, tenting turgor, fatigue, prolonged capillary refill (Body is dumping a lot of water even if there isnt much to dump!)
Cinical manifestations of Diabetes insipidus
-Increased cortisol → hyperglycemia (d/t gluconeogenesis) leading to poor wound healing, abnormal fat distribution (d/t fat synthesis), muscle mass decreased (d/t protein breakdown), decreases inflammatory/immune response (risk for infection), easily bruised, osteoporosis (d/t effects on bone metabolism) -Increased aldosterone→ hypernatremia, fluid retention, hypertension & hypokalemia (cardiac irregularities) -Increased androgen and estrogen → male sex hormone characteristics in women (decreased breast size, amenorrhea, deep voice, hirsutism) and female ones in men (gynecomastia, erectile dysfunction). Diagnosis -Cortisol levels drawn in afternoon (normally lower as the day progresses). Elevated (>16 mcg/dL) is diagnostic. Serum aldosterone levels (elevated with hyperaldosteronism) May also do: 24 hour urine for free-cortisol level Dexamethasone suppression test Serum electrolytes: hyperglycemia (with hypercortisolism) hypernatremia and hypokalemia (with hyperaldosteronism) -Imaging tests-CT/MRI-to show the shape and size of pituitary and adrenal glands
Clinical manifestations of Adrenal Cortex Hyperfunction
-Decreased cortisol (can't stimulate gluconeogenesis and fat synthesis) → low BG, weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, and emotional lability. -Decreased aldosterone (can't reabsorb NA or excrete K)→ leads to water loss, dehydration and hypotension. -ACTH increases (related to MSH) → hyperpigmentation of the skin and mucous membranes -Androgen & estrogen decreased → decreased pubic and axillary hair. Diagnostic Tests -Serum cortisol levels (collected in a.m. d/t dec during day) Low with <5 mcg/dL with Addison's (normally 5-25 mcg/dL). Serum electrolytes affected by Addison's: Hyponatremia (<135 mEq/L) d/t low aldosterone. Hyperkalemia (>5.0 mEq/L) d/t low aldosterone. Hypoglycemia (<60 mg/dL) d/t low cortisol Imaging studies: CT/MRI - to assess size and morphology of adrenal glands. Small adrenal associated with autoimmune destruction. Enlarged with infection.
Clinical manifestations of Adrenocortical Insufficiency
*Primarily related to hyponatremia -Early (Na <135): Anorexia, nausea and malaise -Moderate (Na <125): HA, irritability, confusion, and weakness) -Severe (Na <120): Seizures and coma -Neurologic signs d/t cerebral edema secondary to water intoxication resulting in increased ICP Other manifestations: -Weight gain -Intake > output - Urine is concentrated (elevated SG, but no other ---s/s of dehydration. -No peripheral edema (excess fluid in vascular system not interstitial space)
Clinical manifestations of SIADH
-May be asymptomatic -Polyuria -Bone decalcification and bone pain -Renal calculi -Fatigue, muscle weakness -Nausea, vomiting, constipation -Hypertension & cardiac dysrhythmias Diagnostic Tests: Elevated calcium/ionized calcium and PTH levels
Clinical manifestations of hyperparathyroidism
Cortisol (glucocorticoid) Target: a. Liver b. Cells c. Bone marrow Action: a. Promotes gluconeogenesis (increasing BG) b. Slows cell use of BG, promotes protein breakdown, promotes fat synthesis c. Supressess inflammatory processes
Cortisol (glucocorticoid) Target: Action:
Hyperparathyroidsim
Excess PTH (hypercalcemia & hypophosphatemia)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (Syndrome of Increased Antidiuretic Hormone is another way to remember)
Excessive amount of ADH → kidney reabsorbs too much H2O → decreases urine output (urine concentrated) → water overload → hemodilution (hyponatremia, decreased serum osmolality, decreased hematocrit).
Hormone: Parathyroid hormone (PTH) Target: bones, kidneys, small intestines Action: pull calcium from bones, conserve calcium in kidneys, absorb calcium in small intestine
Hormone: Parathyroid hormone (PTH) Target: Action:
Women over age 50 *Most frequently parathyroid adenomas are cause by secreting Elevated levels of PTH hormone.
Hyperparathyroidism occurs mostly in who?
Glucocorticoids, Mineralocorticoids
Identify the hormones secreted from the adrenal cortex. Select all that apply. Glucocorticoids Adrenocorticotropic hormone Catecholamines Mineralocorticoids Corticotropin-releasing hormone
Hyperglycemia, Elevated sodium level
Identify the lab abnormalities found with hypercortisolism. Select all that apply. Hypercalcemia Hyperglycemia Elevated sodium level Hyperkalemia Hypermagnesemia
Adrenal Cortex Hyperfunction (Cushing's Disease)
Increased Cortisol & Aldosterone →
A. Decreased urine output
Increased secretion of ADH results in which action? A. Decreased urine output B. Increased urine output C. Decreased serum potassium D. Increased serum potassium
Acute adrenal insufficiency: -Replacement of cortisol IV hydrocortisone sodium succinate (Solu-Cortef) 50 to 100 mg (contains both glucocorticoid/cortisol and mineralcorticoid/aldosterone). If chronic, will need a corticosteroid (replaces cortisol) like prednisone, and a mineralcorticoid (replaces aldosterone) like fludrocortisone/Florinef. -Fluid replacement -IVFs with glucose -Monitor frequently -VS -LOC -Labs (sodium, glucose and potassium) -If hyperkalemic Potassium binding or excreting agents (Kayexalate) -If hypotension persists Vasopressors (dopamine)
Management of Adrenal insufficiency
-Treat hyponatremia -Fluid restriction <1000ml/day -Severe: IV Hypertonic saline (3%) **Must be central line, careful monitoring for volume overload -Diuretic (furosemide) - increase U/O
Medical managment of SIADH
Hyponatremia
Most of the neurologic manifestations for SIADH are related to which of the following electrolyte imbalances? Hypocalcemia Hypokalemia Hypoglycemia Hyponatremia
40-50%
Normal HCT
135-145 mEq/L
Normal Na
275-295 mOsm/kg
Normal serum osmolality
normally 1.010-1.030
Normal urine specific gravity
CRH is released from the hypothalamus, targeting the anterior pituitary gland to release ACTH.
Releasing gland of corticotropin-releasing hormone (CRH)
Cortisol (glucocorticoids) are released from the adrenal cortex, targeting the liver, cells, and bone marrow. It causes the liver to increase blood glucose levels. In the cells it decreases glucose use, promotes protein catabolism, and promotes fat synthesis. In the bone marrow it suppresses inflammatory processes.
Releasing gland of cortisol
FSH is released from the anterior pituitary, targeting the ovaries to stimulate maturation of ovarian follicles, ovulation, and estrogen secretion.
Releasing gland of follicle-stimulating hormone (FSH)
Glucagon is released from the pancreas, targeting the liver and muscles to promote glycogenolysis which increases blood glucose levels.
Releasing gland of glucagon
Insulin is release from the pancreas, targeting the cells of the body to lower blood glucose levels by moving glucose into the cells.
Releasing gland of insulin
PTH is released from the parathyroid gland targeting bones, kidney, and intestines to increase osteoclastic activity, reabsorption of calcium, and gastrointestinal reabsorption of calcium.
Releasing gland of parathyroid hormone (PTH)
Testosterone is released from the testes, targeting male reproductive organs to promote maturation of sex organs, sperm production, and development of secondary sex characters.
Releasing gland of testosterone
TSH is released from the anterior pituitary, targeting the thyroid glands to release T3 and T4.
Releasing gland of thyroid-stimulating hormone (TSH)
T3 and T4 are released from the thyroid gland to the cells of the body to increase metabolic rate and response of catecholamines.
Releasing gland of triiodothyronine (T3) and thyroxine (T4)
Adrenocortical Insufficiency Causes (of primary or Addison's) Primary: autoimmune, infectious, cancerous or traumatic processes that lead to direct insult of adrenal cortex Secondary: disorders of anterior pituitary Tertiary: disorders of hypothalamus
Results from destruction of adrenals (primary insufficiency AKA Addison's disease), decreases ACTH from anterior pituitary (secondary insufficiency) or dysfunction of hypothalamus (tertiary insufficiency) Most common among females 30 to 50 years old
Adrenal Cortex Hyperfunction
Results from excess secretion of glucocorticoids (hypercortisolism/Cushing's Syndrome) or excessive secretion of aldosterone (hyperaldosteronism/Conn's Syndrome). Most common among females 25 to 50 years old Causes Primary: direct oversecretion from adrenal cortex (often a tumor) Secondary: oversecretion of ACTH from anterior pituitary (often a tumor) Tertiary: oversecretion of CRH from hypothalamus
-Numbness and tingling in fingertips, toes and lips -Muscle aches/cramps in legs, feet, abdomen and face -Tetany, twitching muscles, particularly around your mouth, but also i--In your hands, arms and throat -Bronchospasm, laryngeal spasm -ECG changes Diagnostics -Low serum PTH levels -Serum calcium <8.0 (normal 8.5-10.5 mg/dL) -Ionized calcium <4.5 (normal 4.5-5.5 mg/dL) (required is serum ---albumin low, as binds with Ca) -Magnesium - <1.5 (normal 1.5-2.5 mg/dL) -Phosphorous >4.5 (normal 2.5-4.5 mg/dL) -ECG - detect dysrhythmias -Xray/bone density tests -Albumin - if low will have low serum calcium, need ionized Ca
S/S Hypoparathyroidism
Small cell lung cancer
SIADH is very commonly caused by which of the following? Small cell lung cancer Neurosurgery Hypertension End Stage Renal Disease
Chovstek's sign
Sign of hypocalcemia or hypomagnesemia; abnormal functioning of the facial nerve causes a twitch on the same side of the face
Negative feedback system
The functioning of the endocrine system works on what type of system? Negative feedback system Positive feedback system Alternating negative and positive feedback system Closed loop system
IV sodium succinate (Solu-Cortef) Oral corticosteroid (prednisone) IV fluids containing glucose Potassium binding agents (kayexalate)
The nurse anticipates which of the following interventions for a patient with ACUTE adrenal insufficiency? SELECT ALL THAT APPLY: IV sodium succinate (Solu-Cortef) Oral corticosteroid (prednisone) Oral mineralcorticoid (aldosterone) IV fluids containing glucose Potassium binding agents (kayexalate) Vasodilating medications such as sodium nitroprusside, via continuous titrating IV drip
elevated serum glucose elevated BP
The nurse assesses for which clinical manifestations in the patient admitted with primary hypercortisolism? (select all that apply): elevated serum glucose elevated serum potassium elevated urine specific gravity elevated BP elevated temperature
Parathyroid hormone (PTH)
The nurse correlates a positive Chvostek's sign to hyposecretion of which hormone? Thyroxin (T4) Thyrocalcitonin Parathyroid hormone (PTH) Triiodothyronine (T3)
C. Thyroid stimulating hormone (TSH)
The nurse correlates an increase in the secretion of which hormone with the release of thyrotropin-releasing hormone? A. Triiodothyronine (T3) B. Thyroxine C. Thyroid stimulating hormone (TSH) D. Thyrocalcitonin
Hypoglycemia (because cortisol helps with gluconeogenesis, so without it we are hypoglycemic)
The nurse correlates which clinical manifestation to the pathophysiology of adrenal insufficiency? Heat intolerance Weight gain Peripheral edema Hypoglycemia
Decreased urine output
The nurse correlates which finding to a diagnosis of SIADH? Polyuria Polyphagia Decreased urine output Glycosuria
B. Decreased libido D. Vaginal dryness E. Insomnia
The nurse correlates which findings with age-related changes of the endocrine system in a 55-year-old female? (Select all that apply.) A. Breast enlargement B. Decreased libido C. Increased sweating D. Vaginal dryness E. Insomnia
serum sodium of 140 mEq/L (Normal sodium 135-145)
The nurse correlates which laboratory value as an indication that desmopressin is effective in the treatment of DI? serum sodium of 140 mEq/L Serum osmolality of 305 mOsm/kg Urine specific gravity of 1.004 Serum hematocrit of 50%
Fluid intake is significantly greater than urine output Serum sodium <135 mEq/L Neurologic problems progressing from malaise to confusion to seizures and coma.
The nurse is assessing a patient with small cell lung cancer. Which of the following findings suggests the complication of SIADH? SELECT ALL THAT APPLY: Weight loss Fluid intake is significantly greater than urine output Peripheral edema Serum sodium <135 mEq/L Neurologic problems progressing from malaise to confusion to seizures and coma.
Hypoactive bowel sounds Diaphoresis Hypertension
The nurse is caring for a client with excess catecholamine. What assessment changes should be anticipated? Select all that apply. Bradycardia Hypoactive bowel sounds Diaphoresis Pupil constriction Hypertension
A patient with a newly diagnosed brain tumor A patient postoperative neurosurgery A patient being evaluated for head trauma
The nurse is providing care to the following patients. Which of these patients would the nurse assess for the complication of Diabetes Insipidus? SELECT ALL THAT APPLY: A patient admitted with uncontrolled diabetes type II. A patient with a newly diagnosed brain tumor A patient postoperative neurosurgery A patient being evaluated for head trauma A patient admitted for pancreatitis
Decreased ACTH, decreased aldosterone
The nurse monitors for which effects of daily cortisol therapy on a patient's circulating levels of adrenocorticotropic hormone (ACTH) and aldosterone? Decreased ACTH, decreased aldosterone Decreased ACTH, increased aldosterone Increased ACTH, decreased aldosterone Increased ACTH, increased aldosterone
Dysrhythmias
The nurse monitors the calcium levels closely in the patient taking digoxin (Lanoxin) because hypocalcemia may lead to which complication? Elevated heart rate Dysrhythmias Increased cardiac contractility Hypertension
Seizures
The nurse monitors the patient with SIADH for which complication secondary to serum sodium level of <120 mEq/L? Hypotension Hyperglycemia Seizures Bradycardia
Because of the hypernatremia there is a resulting CNS dysfunction that leads to seizures, but could also cause confusion and coma).
The nurse places a patient with diabetes insipidus on seizure precautions for what reason? This would only be necessary if the patient has underlying epilepsy Patients with diabetes insipidus are all at risk of seizures due to the cause of diabetes insipidus being neurologic in nature. Patients with diabetes insipidus experience hypoglycemia and subsequent volume excess which causes a fluid shift into the brain resulting in the risk of seizures. Because of the hypernatremia there is a resulting CNS dysfunction that leads to seizures, but could also cause confusion and coma).
Increased weight bearing exercises
The nurse questions which interventions in the patient diagnosed with hypercortisolism? limit salt intake Limit foods containing potassium Increased weight bearing exercises Avoid use of skin tape
35 year old female (Females 30-50 at greatest risk)
The nurse recognizes which patient is at greatest risk of adrenal insufficiency? 19 year old male 35 year old female 45 year old male 80 year old female
Hyperparathyroidism (due to elevated levels of PTH and calcium)
The nursing diagnosis Acute pain r/t ureteral pressure and obstruction secondary to renal lithiasis is most appropriate for the patient with which endocrine disorder? Hypothyroidism Hypoparathyroidism Hyperthyroidism Hyperparathyroidism
D. "Swallow a sip of water."
To better locate the isthmus of the thyroid gland in preparation for palpation, the nurse asks the patient to perform which action? A. "Say 'ah.'" B. "Touch your chin to your chest." C. "Look at the ceiling." D. "Swallow a sip of water."
Goal: Increase serum calcium level to 9—10 mg/dL Acute hypocalcemia: -Calcium gluconate or calcium chloride IV, followed by oral calcium and vitamin D when stable. -May also use sedatives such as pentobarbital to decrease neuromuscular irritability -Environment free of noise, drafts, bright lights, sudden movement -May need trach/mechanical ventilation or bronchodilators for respiratory distress -Diet high in calcium and low in phosphorus -Phosphorus binders (calcium acetate/Phoslo or sevelamer hydrochloride/Renagel Nursing Management Nursing Diagnoses Risk for ineffective airway clearance r/t laryngospasm Decreased cardiac output r/t supressed myocardial contractility Nursing Interventions Assess - VS (hypotension or dysrhythmia), Serum labs (ionized Ca, magnesium, albumin, calcium, phosphorus), Cardiac monitoring, Neuromuscular activity (Trousseau/Chvosteks) Do - Administer calcium replacement (IV calcium, slow IVP), administer vitamin D Teach - Calcium supplementation, diet rich in calcium/low in phosphorus, signs of hypocalcemia
Treatment for hypoparathyroidism
Hypercortisolism -Aminoglutethimide - Medication to decrease cortisol production -Cyproheptadine - Medication to decrease ACTH production -Pasireotide - Medication inhibits release of ACTH (new med) **When administering these be sure to watch for adrenal supression/insufficiency (hypoglycemia, hyponatremia) -Treat causative factor (Pituitary tumor - transphenoidal hypophysectomy (to remove tumor, Adrenal tumor: adrenalectomy). Post-op may need hormone replacement to avoid adrenal insufficiency (symptoms of Addisons). If bilateral adrenalectomy will require lifetime replacement Hyperaldosteronism Control HTN and manage hypokalemia Treat causative factor (usually tumors)
Treatment of Adrenal Cortex Hyperfunction
Replace Fluids P.O. water Hypotonic IV fluids if unable to take p.o. (D5W) Monitor for hyperglycemia, volume overload and slowly decreasing the serum sodium (so that we do not have fluid shifts) Replace ADH Desmopressin (DDAVP) or Vasopressin (Pitressin) - synthetic ADH (SQ, IN, or oral). Monitor U/O, serum electrolytes, fluid status (skin turgor, cap refill, daily weight)
Treatment of Diabetes Insipidus
-Acute: large volumes of IV fluids, diuretics to increase excretion -Subacute: oral fluids, avoid calcium containing antacids and vitamin D. -May need calcitonin & dialysis in emergency situations to decrease serum calcium levels quickly. -May also require a parathyroidectomy (if this is the cause) Nursing Management Nursing Diagnoses: Acute pain (renal tubules/renal calculi), High risk for falls (r/t bone demineralization) Nursing Interventions: Assess - VS, I&O, Serum ionized calcium, PTH, phosphorous, ECG Do - Increase fluid intake to 3L/day. NS IV fluid of choice if necessary, diuretic (furosemide), oral phosphate medications, lift sheets to prevent injury, strain urine (suspected calculi) Teach - s/s of hypercalcemia,, Low calcium diet, increase fluids and fiber to decrease complication of constipation
Treatment of hyperparathyroidism
Primary disorder
What is it referred to when an endocrine gland itself causes the hypersecretion or hyposecretion of a hormone? Primary disorder Secondary disorder Tertiary disorder Organ disorder
Hypothalamus Pituitary gland Adrenal gland (HPA)
When a client is experiencing a lack of cortisol, which glands could be the cause? Select all that apply. Adrenal gland Parathyroid gland Hypothalamus Pituitary gland Thyroid gland
Hypernatremia and hypokalemia Aldosterone levels elevate
Which diagnostic tests are consistent with adrenal cortex hyperfunction? SELECT ALL THAT APPLY: Cortisol levels 5 mcg/dL Hypoglycemia Hypernatremia and hypokalemia Aldosterone levels elevate
Decreased cortisol Increased ACTH (adrenocorticotropic hormone)/MSH (melanocyte stimulating hormone)
Which hormones are affected by primary adrenocorticol insufficiency? SELECT ALL THAT APPLY: Decreased cortisol Increased aldosterone Increased ACTH (adrenocorticotropic hormone)/MSH (melanocyte stimulating hormone) Decreased androgen & estrogen Increased insulin
B. Antidiuretic hormone E. Oxytocin
Which hormones are released from the posterior pituitary gland? (Select all that apply). A. Aldosterone B. Antidiuretic hormone C. Follicle-stimulating hormone D. Luteinizing hormone E. Oxytocin
T3 T4
Which hormones of the body function to maintain the metabolism of the body? Select all that apply. T3 PTH T4 FSH CRH
Hyponatremia Hyperkalemia Hyperpigmentation Hypotension
Which of the following are manifestations consistent with Adrenal Insufficiency? SELECT ALL THAT APPLY: Hyperglycemia Hyponatremia Hyperkalemia Cortisol level 20 mcg/dL Peripheral edema Hyperpigmentation Hypotension Excess hair growth
Poor wound healing Decreased ability to fight infection Easily bruised Osteoporsis Gynecomastia in men
Which of the following assessment findings are consistent with adrenal hyperfunction? SELECT ALL THAT APPLY: Poor wound healing Decreased ability to fight infection Easily bruised Osteoporsis Increased breast size in women Menorrhagia Gynecomastia in men Priapism in men
-Increases serum calcium by pulling it from bones, conserving from kidneys and absorbing it in the small intestine. -Decreases serum phosphorus because it increases the amount of calcium in the blood available to bind to, and inactivate phosphorus
Which of the following correctly reflects the expected action of parathyroid hormone? SELECT ALL THAT APPLY: -Increases serum calcium by pulling it from bones, conserving from kidneys and absorbing it in the small intestine. -Decreases serum calcium by depositing it into bones, conserving from kidneys and absorbing it in the small intestine. -Increases serum phosphorus because it decreases the amount of calcium in the blood to bind to and inactivate phosphorus. -Decreases serum phosphorus because it increases the amount of calcium in the blood available to bind to, and inactivate phosphorus
Desmopressin (DDAVP) administered subcutaneously (SQ)
Which of the following interventions will the nurse anticipate for the patient with diabetes insipidus? Hypertonic saline (7.5% sodium chloride) Desmopressin (DDAVP) administered subcutaneously (SQ) Fluid restriction of 1000 mL/day Continuous, titrating insulin drip
Hypertonic saline (3% sodium chloride)
Which of the following interventions would e appropriate for a patient experiencing SIADH? Encourage oral fluids of 2 to 3 liters/day Hypertonic saline (3% sodium chloride) Vasopressin (DDAVP) administered subcutaneously Hourly blood glucose monitoring
28 year old female
Which of the following is at greatest risk for primary hypercortisolism? 65 year old male 56 year old female 44 year old male 28 year old female
Aminoglutethimide - Medication to decrease cortisol production
Which of the following medications may be used for treatment of Hypercortisolism? potassium binder (Kayexalate) Insulin Aminoglutethimide prednisone
40 year old with an autoimmune process affecting the adrenal cortex Primary: autoimmune, infectious, cancerous or traumatic processes that lead to direct insult of adrenal cortex Secondary: disorders of anterior pituitary Tertiary: disorders of hypothalamus (Most common among females 30 to 50 years old)
Which of the following patients would be most likely to develop primary adrenal insufficiency (Addison's Disease)? 19 year old with injury to the hypothalamus 39 year old with anterior pituitary tumor 40 year old with an autoimmune process affecting the adrenal cortex 50 year old with a posterior pituitary tumor
Serum sodium of 155 mEq/L Serum hematocrit 59%
While assessing a patient status post craniotomy, which of the following findings would indicate the complication of diabetes insipidus? SELECT ALL THAT APPLY: Oliguria (urine output is 25 mL/hr for 2 hours) Polyphagia (intense hunger) Serum sodium of 155 mEq/L Urine osmolality 310 mOsm/kg Serum hematocrit 59% Urine specific gravity 1.030 JVD and peripheral edema
Adrenal crisis/Addisonian crisis BE SURE TO TAPER IF TAKING STEROIDS FOR 2 OR MORE WEEKS!
severe hypovolemia and hypotension. Risk factors: underlying adrenal insufficiency who then undergo stress such as trauma, surgery, infection. Will require additional doses of glucocorticoids during periods of stress (surgery, trauma or infection).
