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Endocrine

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  • 1. ALTERATION IN REGULATION ENDOCRINE DISORDERS C. Washington RN, MSNEd
  • 2.  
  • 3.  
  • 4. Thyroid Gland
  • 5. Thyroid Disorders
    • Thyroid Gland produces three hormones:
      • Thyroxine (T 4 )
      • Triiodothyronine (T 3 )
      • Calcitonin
      • T 3 + T 4 are referred to collectively as thyroid hormone.
  • 6. Thyroid-iodine connection
    • Iodine is used by the thyroid to produce its hormones
        • T 4 - thyroxine
        • T 3 - triiodothyronine
        • Calcitonin
  • 7. Calcitonin
    • Secreted by the thyroid gland.
    • Secreted in response to high plasma levels of calcium
    • Decreases circulating plasma Ca ++ levels by increasing its deposition in bone
  • 8. Thyroid Hormone: Hypofunction
      • Subjective :
      • Fatigue, weakness, forgetfulness,
      • Objective :
      • Labile BP, CO, bradycardia, MI d/t hyperlipidemia, constipation, weight gain, cold intolerance, prone to infections, depression, anxiety,
  • 9. Thyroid Hormone: Hyperfunction
      • Subjective :
      • Palpitations, fatigue
      • Objective :
      • HTN, HR, RR & CO, arrythmias, diarrhea, weight loss, heat intolerance, fine tremors, labile moods, insomnia, exhaustion,
      • Goiter, exothalmus
  • 10. Goiter
  • 11. Nursing Diagnosis of Thyroid Dysfunction
    • Altered metabolic function
    • Activity intolerance
    • Impaired cardiac output
    • Imbalanced nutrition
    • Anxiety
    • Potential for injury
    • Hypo/hyperthermia
    • Disturbed thought process
    • Knowledge deficit
  • 12. Nursing Management of Thyroid Dysfunction
    • Goal:
      • Restore normal/optimal metabolic state
      • Prevent complications
  • 13. Abnormal Thyroid Function
    • Hypothyroidism
      • the thyroid releases too little hormone so the body's metabolism goes too slowly
    • Hyperthyroidism
      • where the thyroid releases too much hormone and the body's metabolism goes too fast
  • 14. Abnormal Thyroid Function
    • Thyroid nodules and swellings
      • overgrowth of thyroid tissue
      • resulting in a nodule or small lump, in part of the gland
      • a small percentage of the inactive lumps may be cancerous
  • 15. Hypothyroidism
    • Hypothyroidism
      • The body's normal rate of functioning slows, causing mental and physical sluggishness
  • 16. Thyroiditis
    • Inflammation of the thyroid gland
    • Hashimoto’s Disease
      • Chronic thyroiditis
      • Reaction of the immune system against the thyroid gland
  • 17. Hypothyroidism
    • Fatigue or lack of energy
    • Weight gain
    • Feeling cold
    • Dry skin and hair
    • Heavy menstrual periods
    • Constipation
    • Slowed thinking
  • 18. Hyperthyroidism
    • 2 nd most common endocrine disorder (after diabetes mellitus)
    • Graves’ Disease
      • Excessive output of thyroid hormone caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
    • Other causes
      • Thyroiditis
      • Excessive ingestion of thyroid hormone
  • 19.  
  • 20. Hyperthyroidism
    • Jitteriness, shaking, increased nervousness, irritability
    • Rapid heart beat or palpitations
    • Feeling hot
    • Weight loss
    • Fatigue, feeling exhausted
    • More frequent bowel movements
    • Shorter or lighter menstrual periods
  • 21. Nursing Management: Hyperthyroidism
    • Reducing thyroid hyperactivity to relieve symptoms and accompanying complications
    • Radioactive Iodine (RAI)
      • Disrupts the function of some of the thyroid cells
      • Given as a single dose
      • Low side effects
  • 22. Collaborative Management: Hyperthyroidism
    • Medications
      • Require long-term compliance
      • High rate of relapse
    • Surgery
      • Subtotal thyroidectomy
  • 23. Thyroidectomy
  • 24. Parathyroid Glands
  • 25. Parathyroid Glands
    • Secretes parathormone (PTH)
    • PTH regulates calcium and phosphorous
  • 26. Parathyroid and Calcium Regulation
    • Calcium
    • most closely regulated element in our bodies! 
    • important in conduction of electrical impulses in nervous and muscular systems
    • ONLY element / mineral that has its own regulatory system  the parathyroid glands
  • 27. Hyperparathyroidism
    • Increase in the production of PTH
      • Due to a benign growth of 1:4 parathyroid glands
    • Induces:
    • abnormally high serum Ca ++ levels
    • bone decalcification
    • development of kidney stones
  • 28. Hyperparathyroidism
    • Fatigue
    • Apathy
    • muscle weakness
    • Vomiting
    • Hypertension
    • Bone demineralization
    • kidney stones
    • Symptoms of have become
    • known as:
    • "moans, groans, stones, and bones...with psychic overtones".
  • 29. Hypoparathyroidism
    • Accidental removal of parathyroid glands during thyriod surgery
    • Symptoms r/t hypocalcemia & hyperphosphatemia
      • Neuromuscular irritability
      • Tetany
        • Numbness, tingling, cramps 
        • Bronchospasm, laryngeal spasm, carpopedal spasm
          • Ca+ Gluconate
  • 30. Hypoparathyroidism
    • Trousseau’s Sign of latent tetany
      • Compression of the forearm in clients having undue neuromuscular excitability due to hypocalcaemia produces spasm in the hand and wrist.
  • 31. Hypoparathyroidism
    • Chvostek’s sign of latent tetany
      • contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve.
      • The examiner taps gently over the facial nerve in front of the ear.
  • 32. Nursing care of parathyroid dysfunction
    • Subjective & objective data similar to thyroid dysfunction
    • Blood level >10 or
    • < 3 very significant
    • Nursing Diagnosis
      • Altered metabolism
      • Altered cardiac output
      • Anxiety
      • Altered comfort
      • Impaired memory
  • 33. Corticosteroid Therapy “Steroids”
    • Used to treat adrenal insufficiency
    • Suppress inflammation & autoimmune reactions, control allergic reactions & reduce organ transplant rejection
    • Side effects of high doses over long-term turned steroid use into “scare-oids”
  • 34. “ Steroids” - How do they work?
      • Cortisol controls salt & water balance in the body
      • Stress  pituitary gland releases adrenocorticotropic hormone (ACTH) which stimulates adrenals to produce cortisol
      • Extra cortisol allows body to cope with stress of infections, trauma, surgery, or emotional problems
      • When stressful situation resolves, adrenal hormone function returns to normal
  • 35. Corticosteroid Therapy
    • Block production of substances that trigger allergic and inflammatory actions (i.e. prostaglandins).
    • Impede the function of WBC’s which help keep the immune system functioning properly
    • Undesirable side effect: susceptibility to infection

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