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Chapter050

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 50: Caring for Clients with Disorders of the Endocrine System Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Acromegaly (Hyperpituitarism) • Pathophysiology and Etiology: Oversecretion of GH due to hyperplasia – Gigantism: Oversecretion of GH before puberty – Dwarfism: Insufficient GH during childhood – Acromegaly: Oversecretion of GH during adulthood • Assessment Findings: Signs and Symptoms – Coarse features; Huge lower jaw, thick lips, thickened tongue, bulging forehead – Bulbous nose, large hands and feet – Enlarged organs; Muscle weakness Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Question Is the following statement true or false? Acromegaly is caused by oversecretion of GH before puberty. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Answer False. Acromegaly is caused by oversecretion of GH during adulthood. Gigantism is caused by oversecretion of GH before puberty. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Acromegaly (Hyperpituitarism) • Assessment Findings: Diagnostic Findings – GH level; Glucose tolerance test • Medical and Surgical Management – Surgery; Hormone therapy; Drug therapy • Nursing Management – Psychological support; Pacing activities – Pain relief; Self-care; Postoperative care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Simmonds’ Disease (Panhypopituitarism) • Pathophysiology and Etiology – Anterior pituitary hormone activity stops • Assessment Findings: Signs and Symptoms – Hypothyroidism, hypoglycemia, adrenal insufficiency; Gonads and genitalia atrophy; Premature aging; Cachexia • Medical Management – Substitute hormones • Nursing Management: Client Teaching – Adherence: Medication schedule; Monitor: Blood hormone level Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Question Is the following statement true or false? A sign of panhypopituitarism is premature aging. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Answer True. A sign of panhypopituitarism is premature aging. Also included in the signs and symptoms are hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, and cachexia. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Diabetes Insipidus • Pathophysiology and Etiology – Role of ADH; Neurogenic, nephrogenic DI • Assessment Findings: Signs and Symptoms • Polyuria; Weight loss; Thirst; Weakness; Dehydration • Diagnostic Findings: Fluid deprivation test; Urine specific gravity • Medical Management – Drug therapy; IV fluids; Thiazide diuretic • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) • Pathophysiology and Etiology: Causes of SIADH, Hyponatremia • Assessment Findings – Water retention; Headaches; Muscle cramps; Anorexia – Changes in LOC • Diagnostic Findings: Serum, urine levels; Sodium, osmolarity levels • Medical Management: Osmotic diuretics; IV administration • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Hyperthyroidism (Graves Disease) • Pathophysiology and Etiology: Hypersecretion of thyroid hormones • Assessment Findings: Signs and Symptoms – Restless; Agitated; Hand tremors; Diarrhea – Increased appetite; Weight loss; Visual changes; Exophthalmos; Neck swelling – Diagnostic findings: Serum T3, T4, TSH; Thyroid scan and ultrasonography • Medical and Surgical Management: Antithyroid drugs; Radiation; Thyroidectomy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Question Is the following statement true or false? The etiology of Graves Disease is the hyposecretion of thyroid hormones. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Answer False. The etiology of Graves Disease is the hypersecretion of thyroid hormones. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Thyrotoxic Crisis (Thyroid Storm) • Pathophysiology and Etiology: Triggering factors; T3, T4 oversecretion; Epinephrine release • Assessment Findings – High temperature; Rapid pulse; Dyspnea – Cardiac dysrhythmias; Vomiting; Delirium – Hyperthyroidism history; Laboratory tests • Medical Management – Immediate treatment; Antithyroid drugs; IV treatment • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Hypothyroidism • Pathophysiology and Etiology – Inadequate thyroid hormone secretion: Myxedema • Assessment Findings: Signs and Symptoms – Slow metabolic rate; Lethargy; Weight gain; Dry skin; Menstrual disorders – Enlarged heart; Atherosclerosis; Anemia – Diagnostic findings: Serum TSH, T3, T4; FT4; RAI uptake • Medical Management: Thyroid replacement therapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Thyroid Tumors • Pathophysiology and Etiology – Follicular adenoma; Papillary carcinoma • Assessment Findings – Nodular thyroid; Hoarseness; Swallowing difficulty; Biopsy; Physical examination • Medical and Surgical Management – Thyroidectomy; HRT; Radiation • Nursing Management – Emotional support; Handling body fluids – RAI: Postoperative; Radiation precautions Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Endemic and Multinodular Goiters • Pathophysiology and Etiology – Iodine deficiency; Goitrogenic foods • Assessment Findings – Enlarged thyroid gland; Difficulty swallowing; Thyroid scan • Medical Management – Foods high in iodine; Potassium iodide; Thyroidectomy • Nursing Management – Monitor for and relieve respiratory symptoms; Provide appropriate diet Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Thyroiditis • Pathophysiology and Etiology – Types: Acute; Subacute; Hashimoto’s • Assessment Findings: Signs and Symptoms – High fever, malaise, and swollen – Tender thyroid gland – Diagnostic findings: Thyroid scan; Lab tests • Medical and Surgical Management – Antibiotics; Analgesics; Corticosteroids; Thyroid HRT; Surgery • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Hyperparathyroidism • Pathophysiology and Etiology – Primary or secondary condition – Primary: Adenoma; Increased secretions of PTH – Secondary: Increased secretions in response to hypocalcemia • Assessment Findings: Signs and Symptoms – Fatigue; Hypotonic muscles – Skeletal tenderness and pain – Cardiac dysrhythmias Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Hyperparathyroidism • Assessment Findings: Diagnostic Findings – Laboratory tests; MRI; CT scan • Medical and Surgical Management – Sodium, phosphorus replacements; Surgery • Nursing Management – Monitor I and O; Urinary calculi; Self-care; Safe environment – Encourage fluid intake – Provide postoperative care – Client education: Effects of disease; Adherence to treatment Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Hypoparathyroidism • Pathophysiology and Etiology – Deficiency of parathormone; Trauma to the glands; Hypocalcemia • Assessment Findings: Signs and Symptoms – Tetany; Chvostek’s and Trousseau’s signs; Laryngeal spasm • Assessment Findings: Diagnostic Findings – Serum: Calcium and phosphorus; Radiographs • Medical Management: IV calcium salt; Endotracheal intubation; Mechanical ventilation; Oral calcium • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Adrenal Insufficiency (Addison’s Disease) • Pathophysiology and Etiology – Primary: Destruction of adrenal cortex – Secondary: Surgical removal, hemorrhagic infarction, hypopituitarism, medications • Assessment Findings: Signs and Symptoms • Assessment Findings: Diagnostic Findings – Laboratory tests; Radiographs; CT scan • Medical Management – Daily corticosteroid replacement therapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Acute Adrenal Crisis (Addisonian Crisis) • Pathophysiology and Etiology – Abnormal stress; Trauma; Salt deprivation • Assessment Findings – Anorexia; Vomiting; Diarrhea; Abdominal pain; Hypotension; Fever – Diagnosis: Symptoms; History • Medical Management – Corticosteroids; Antibiotics • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Pheochromocytoma • Pathophysiology and Etiology – Benign tumor – Excessive catecholamine secretion • Epinephrine and norepinephrine • Assessment Findings: Elevated BP; Tremors; Hyperglycemia; Polyuria ; Vertigo, headache, N/V • Diagnostic Findings: 24-hour urine; CT; MRI; Ultrasonography; Retrograde pyelography • Medical, Surgical Management: Unilateral adrenalectomy; Drug therapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Cushing’s Syndrome • Pathophysiology and Etiology: Excess ACTH; Tumors; Corticosteroids • Assessment Findings: Signs and Symptoms – Cushingoid syndrome; Muscle wasting – Moon face; Buffalo hump; Wounds; Masculinization; Kyphosis – Diagnostic findings: Dexamethasone suppression test; 24-hour urine; Blood test; Radiographs; IV pyelogram; CT; MRI • Medical and Surgical Management : Radiation; Drug therapy; Surgery • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Hyperaldosteronism • Pathophysiology and Etiology – Aldosterone: Secreting adenoma • Assessment Findings – Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension – Laboratory tests; CT; MRI; Adrenal venography • Medical and Surgical Management – Unilateral adrenalectomy – Drug therapy; Diet therapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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