Alterations of Endocrine Function


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Alterations of Endocrine Function

  1. 1. Lincoln Memorial University Caylor School of Nursing Nursing 241 Spring 2008 TITLE: Nursing Strategies: Alterations of Endocrine Function DATES: See Syllabus TIMES: See Syllabus OBJECTIVES: Upon completion of this unit, the student will be able to demonstrate, in the clinical/campus laboratory setting, in individual and group conferences and on written material the ability to: 1. Using the four adaptive modes of Roy’s Adaptation Model (RAM), recognize human adaptive responses to behavior or stimuli that affect endocrine function. 2. Describe the parameters appropriate for determining the status of endocrine functioning including the characteristics and functions of hormone and the basic regulatory mechanisms of hormones. 3. Describe the pathophysiology, clinical manifestations, management and associated use of the RAM nursing process to provide care for adults with alterations of the pituitary, thyroid, parathyroid, and adrenal glands. 4. Identify the physical and psychosocial discharge planning needs of adults with compromised endocrine functioning. 5. Explain how the following diagnostic tests are performed, pre- and post-test nursing responsibilities, and recognize the implications of abnormal results: a. Resin T3 Uptake b. T3, T4, TSH c. radioactive iodine uptake d. total serum calcium e. ACTH test f. thyroid scan g. water deprivation test 6. Describe the surgical procedures, postoperative nursing care, postoperative complications, and discharge planning needs of adults undergoing surgery of the pituitary, thyroid, parathyroid, and adrenal glands. 7. Identify the stimuli of emotional stress and its relationship to the adult with endocrine disorders. 8. Identify the stimuli and behaviors which are common to endocrine disorders: hypopituitarism, hyperpituitarism, hypothyroidism, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, Addison’s disease, and Cushing’s disease. 9. Discuss acute and chronic complications of diabetes mellitus and explain their relationship to adaptive versus ineffective behaviors in the four adaptive modes. 10. Identify the medications on the drug list by generic name, classification, mechanism of action, clinically significant side effects, normal dosage, and nursing implications and be able to correctly calculate IV, IM and oral dosages. 1
  2. 2. TOPICAL OUTLINE I. Anatomic and physiologic review A. Glands of the endocrine system– to be covered with disorders of each gland 1. Pituitary gland 2. Thyroid gland 3. Parathyroid gland 4. Adrenal glands B. Function and regulation of hormones – general brief overview C. Classification and action of hormones – to be covered with disorders of each gland 1. Posterior pituitary hormones a. Vasopressin (ADH) 2. Anterior pituitary hormones a. Adrenocorticotropic hormone (ACTH) b. Thyroid-stimulating hormone (TSH) 3. Thyroid hormones a. Thyroid hormone --thyroxine (T4) and triiodothyronine (T3) b. Calcitonin 4. Parathyroid hormones a. Parathyroid hormone or parathormone 5. Adrenal gland hormones a. Adrenal medulla hormones- catecholamines i. Epinephrine ii. Norepinephrine b. Adrenal cortex i. Glucocorticoids ii. Mineralcorticoids II. Health history and physical assessment III. Diagnostic evaluation IV. Nursing care of adults with disorders of the pituitary gland A. Hypopituitarism – diabetes insipidus B. Hyperpituitarism - SIADH C. Pituitary tumors – Transsphenoidal Hypophysectomy V. Nursing care of adults with disorders of the thyroid gland A. Hypothyroidism B. Hyperthyroidism – Grave’s Disease (Thyroid storm, thyroiditis) C. Thyroid cancer - (Thyroidectomy) VI. Nursing care of adults with disorders of the parathyroid gland A. Hypoparathyroidism B. Hyperparathyroidism VII. Nursing care of adults with disorders of the adrenal gland A. Adrenal Medulla - Pheochromocytoma B. Adrenal Cortex 1. Adrenocortical insufficiency - Addison’s disease 2
  3. 3. 2. Adrenocortical excess - Cushing’s syndrome (Adrenalectomy) C. Corticosteroid therapy VIII. Complications of diabetes A. Acute Complications 1. Hypoglycemia (insulin reaction) 2. Diabetic ketoacidosis (DKA) 3. Hypergylcemic hyperosmolar nonketotic syndrome B. Chronic complications 1. Macrovascular complications 2. Microvascular complications a. Diabetic retinopathy b. Nephropathy c. Neuropathies 4. Foot and leg problems 5. Special issues in diabetes care a. Diabetic patient undergoing surgery b. Care of hospitalized diabetic patient REQUIRED READINGS: Smeltzer, S.C., Bare, B.G., Hinkle, J.L. and Cheever, K. H. (2008). Brunner & Suddarth's Medical surgical nursing. (11th ed.). Philadelphia: Lippincott, Williams & Wilkins. Chapters 41(pp. 1410-1438), 42, 61 (p. 2189-2190). CLINICAL SKILLS: 1. Identify potential endocrine/metabolic abnormalities utilizing appropriate assessment skills. 2. Manage care for selected clients experiencing commonly occurring alterations in endocrine function. VOCABULARY LIST: See pp. 1376 and 1440: Glossary of Terms Drug List: Desmopressin (DDAVP Mithramycin Vasopressin tannate in oil Calcitonin Clofibrate Etidronate (Didronel) Chlopropamide (Diabinese) Pamidronate (Aredia) Thiazide diuretics Calcium gluconate Levothyroxine (Synthroid, Levothroid) Phentolamine (Regitine) Radioisotope iodine 131 (I 131) Sodium nitroprusside (Nipride) Propylthiouracil (PTU) Nifedipine (Procardia) Methimazole (Tapazole) Hydrocortisone (Solu-Cortef) Liothyroxine (Cytomel) Cortisone Sodium iodine Prednisone Potassium iodine Prednisolone Saturated solution of potassium iodine (SSKI) Methylprednisolone (solu-Medrol) Dexamethasone (Decadron) Beclomethasone (Vancenase) Propanolol (Inderal) 3
  4. 4. OVERVIEW OF ENDOCRINE HORMONES 1. POSTERIOR PITUITARY (neurohypophysis) - smaller - stores and secretes 2 hormones (only covering one) ADH - Antidiuretic Hormone {Diabetes insipidus, SIADH} causes renal and collecting tubules to be more permeable to water altering urine concentration 2. ANTERIOR PITUITARY secretes 6 hormones TSH, FSH, LH, Prolactin GH, ACTH – We are only covering the following: ACTH - Adrenocorticotropic Hormone (corticotropin) • adrenal cortex to produce glucocorticoids (cortisol) 3 Factors regulate ACTH secretion 1. circulating cortisol levels (negative feedback) 2. stress 3. diurnal variation (circadian rhythm) > cortisol levels peak at 8AM > lowest point 9PM - 12MN TSH - Thyroid Stimulating Hormone (thyrotropin) –stimulates thyroid gland to release T3 / T4 (thyroid hormone) 3. THYROID GLAND {Hyper/hypothyroidism} below larynx, in front of trachea - butterfly shape - 2 lobes joined by isthmus - highly vascular T3 (triiodothyronine)  T4 (thyroxine) (together called thyroid hormone) metabolic function of all body tissue • rate of nutrient use • CV function / GI function • mental processes • accelerate growth in children • activity of other endocrine glands 4
  5. 5. calcitonin (thyrocalcitonin) - also produced by parathyroid gland • inhibits calcium loss from bone • renal excretion of calcium • serum calcium levels 4. PARATHYROID GLANDS {Hyper/hypoparathyroidism} - usually 4 glands below larynx, in front of trachea - imbedded in 4 corners of thyroid PTH (parathyroid hormone /parathormone) (opposite of calcitonin) • promotes loss of calcium from bone • kidney excretion of calcium • serum calcium levels 5. ADRENAL GLANDS ADRENAL MEDULLA {Pheochromocytoma} - smaller inner portion of the adrenal gland which produces catecholamines, also produced as neurotransmitters in the nervous system epinephrine (adrenalin) & norepinephrine (noradrenalin) ANS stimulation-fight or flight response ADRENAL CORTEX - larger outside portion glucocorticoids (cortisol) {Cushings, Addison’s disease) • help maintain F/E balance thru sodium & water retention and K+ excretion • promote protein and fat breakdown to glucose alter glucose metabolism to increase it during stress • suppress inflammatory & immune responses • are critical for body’s response to stress mineralocorticoids (aldosterone) {Primary Aldosteronism} • stimulates renin-angiotensin system in kidneys • aldosterone acts on renal tubules which leads to reabsorption and retention of Na+ and excretion of K+ • Factors controlling aldosterone release - Main control thru  angiotensin II 5
  6. 6. LINCOLN MEMORIAL UNIVERSITY CAYLOR SCHOOL OF NURSING NURSING 241 DRUG STUDY GUIDE 1. Discuss nursing care and teaching associated with the administration of endocrine hormone replacement therapy. 2. Discuss nursing care and teaching with the administration of the following categories of drugs: • Calcium replacement drugs • Anti-thyroid drugs • Hormone replacement drugs • Steroids Indicate T for true and F for false on the following questions and explain why you answered as you did. 3. __ A patient who is started on thyroid hormone medication today has immediate relief from hypothyroid symptoms. 4. __ The nurse should check the pulse rate before administering thyroid hormone medication and hold it if an adult's pulse rate is over 100. 5. __ Patients with hypothyroidism are more sensitive to central nervous system depressants. 6. __ Synthroid is given to a patient with Hashimoto's thyroiditis to cure the infection in the gland. Answer the following questions: 7. How do iodides work to treat hyperthyroidism? 8. Why is Lugol solution given in juice or milk and through a straw? 9. Describe nursing measures that need to be taken when a patient is taking radioactive iodine (I 131). 10. During a thyroid storm or thyroid crisis what category of drugs is commonly given to alleviate adrenergic (sympathetic nervous system) problems such as tachycardia, tremors, and sweating? Give specific drug names. 11. Discuss the common drug used to treat tetany associated with hypoparathyroidism. 12. Discuss the drugs associated with long-term maintenance of patients with hypothyroidism. 13. Discuss patient teaching associated with the administration of oral calcium. 14. Discuss the alpha-adrenergic blocking agents used to treat pheochromocytoma preoperatively. 15. What point in a 24 hour period do corticosteroids least suppress adrenal activity? 16. Discuss disease conditions in which glucocorticoids are used and explain briefly why. 6
  7. 7. ENDOCRINE CONCEPT MAP Developed by Claire Meggs, MSN, RN HYPOTHALAMUS TSH ANTERIOR POSTERIOR PITUITARY ACTH PITUITARY OXYTOCIN GH FSH/LH PROLACTIN ADH KIDNEYS >Renin if BP low TOO MUCH ADH TOO LITTLE ADH SIADH DI Syndrome of Inappropriate ADH Diabetes Insipidus >Angiotensin II Aldosterone Polyuria secretion Decreased urine output Polydipsia Is increased Decreased serum osmolality <1.005 specific gravity & promotes the (dilutional hyponatremia) (Normal 1.012-1.025) reabsorption of Na+ Increased urine SG Crave cold water 4-40L qd In exchange for Increased osmolality (sodium) Hypernatremia K+ Severe dehydration By the Kidneys & GI Tract 7
  8. 8. ENDOCRINE CONCEPT MAP Developed by Claire Meggs, MSN HYPOTHALAMUS OXYTOCIN RELEASING FACTORS POSTERIOR TSH ANTERIOR PITUITARY ADH PITUITARY THYROID FSH/LH ACTH ADRENOCORTICOTROPIC T3 / T4 HORMONE CALCITONIN  activity, PROLACTIN serum Ca levels  mental inhibits Ca loss from bone process,etc <Serum Ca++ ADRENAL 8.5-10mg/dL  GH ADRENAL Somatotropin CORTEX MEDULLA Neg. feedback w PTH PARATHYROID Sex hormones- CATECHOLAMINES 2nd sex characteristics Epinephrine Norepinephrine PTH Corrects hypocalcemia Aldosterone (mineralcorticoids) Fight/Flight Promotes loss of Ca from bone Cortisol (glucocrticoids) Na+ K+ response P serum Ca levels Supress inflamm, immune (>Ca++ <PO4) response, stress response blood loss response Inversely proportional lolosslorresponsere 8