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Endocrine disorders


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Endocrine disorders

  1. 1. Endocrine Disorders
  2. 2. Review <ul><li>Identify the role of the hypothalamus in endocrine function. </li></ul><ul><li>Describe the divisions of the pituitary gland and identify hormones secreted by each division. </li></ul><ul><li>Discuss the difference between releasing hormones, inhibiting hormones and stimulating hormones. </li></ul><ul><li>Describe the process of negative feedback. </li></ul>
  3. 3. Review <ul><li>Identify the function of the following hormones: </li></ul><ul><ul><li>Glucagon </li></ul></ul><ul><ul><li>Aldosterone </li></ul></ul><ul><ul><li>Oxytocin </li></ul></ul><ul><ul><li>Somatotropin </li></ul></ul><ul><ul><li>Vasopressin </li></ul></ul><ul><ul><li>Calcitonin </li></ul></ul><ul><ul><li>Prolactin </li></ul></ul><ul><ul><li>Melatonin </li></ul></ul><ul><ul><li>Parathormone </li></ul></ul><ul><ul><li>Insulin </li></ul></ul>
  4. 4. Four Classifications of Hormones <ul><li>Steroid </li></ul><ul><li>Protein (peptide) </li></ul><ul><li>Amine </li></ul><ul><li>Fatty acid derivatives </li></ul>
  5. 5. Endocrine Dysfunction <ul><li>Assessment </li></ul><ul><ul><li>↓ energy level/fatigue </li></ul></ul><ul><ul><li>Intolerance to heat or cold </li></ul></ul><ul><ul><li>Changes in sexual function </li></ul></ul><ul><ul><li>Development of 2° sex characteristics </li></ul></ul><ul><ul><li>Changes in mood and ability to concentrate </li></ul></ul><ul><ul><li>Changes in memory and sleep patterns </li></ul></ul><ul><ul><li>Exophthalmos </li></ul></ul><ul><ul><li>Hypotension or hypertension </li></ul></ul><ul><li>Diagnostic Evaluation </li></ul><ul><li>Common categories </li></ul><ul><ul><li>Blood tests </li></ul></ul><ul><ul><li>Urine tests </li></ul></ul><ul><ul><li>Stimulation and suppression tests </li></ul></ul><ul><ul><li>Describe the procedure for 24 hour urine specimen collection. </li></ul></ul>
  6. 6. Pituitary Dysfunction <ul><li>Undersecretion or oversecretion </li></ul><ul><li>Hypofunction: Hypopituitarism </li></ul><ul><ul><li>What will occur when there is a complete absence of pituitary function? </li></ul></ul><ul><li>Anterior pituitary hyperfunction </li></ul><ul><ul><li>most commonly involves ACTH or GH </li></ul></ul><ul><li>Posterior pituitary hypofunction </li></ul><ul><ul><li>Most commonly deficient secretion of ADH </li></ul></ul>
  7. 7. Pituitary Tumors <ul><li>Usually benign </li></ul><ul><li>Three types: </li></ul><ul><ul><li>Eosinophilic (result in gigantism) </li></ul></ul><ul><ul><li>Basophilic (cause Cushing’s Syndrome) </li></ul></ul><ul><ul><li>Chromophobic (destroy pituitary) </li></ul></ul><ul><li>Diagnosed through careful assessment, visual acuity and field testing, CT and MRI </li></ul><ul><li>Medical management </li></ul><ul><li>Surgical management </li></ul>
  8. 8. Diabetes Insipidus <ul><li>Posterior pituitary disorder </li></ul><ul><li>ADH deficiency </li></ul><ul><li>Key features: polydipsia and polyuria </li></ul><ul><li>Can occur 2° to head trauma, brain tumor, ablation of pituitary gland, CNS infections, failure of kidney tubules to respond to ADH, and systemic tumors </li></ul><ul><li>Diagnosed by fluid deprivation test and trial of desmopressin (DDAVP) </li></ul>
  9. 9. Diabetes Insipidus <ul><li>Review Case Study </li></ul><ul><li>What are the goals of therapy for DI? </li></ul><ul><li>What is included in pharmacotherapy? </li></ul><ul><li>What is the role of the nurse in management? </li></ul>
  10. 10. Syndrome of Inappropriate ADH Secretion <ul><li>Excess secretion of ADH even with subnormal serum osmolality </li></ul><ul><li>Can not excrete a dilute urine </li></ul><ul><li>Retain fluids and develop dilutional hyponatremia </li></ul><ul><li>Usually nonendocrine cause </li></ul><ul><li>Typical interventions: treat underlying cause and restrict fluids </li></ul><ul><li>May use diuretics (furosemide) is severe ↓ Na </li></ul>
  11. 11. Nursing Managment <ul><li>What are nursing interventions associated with SIADH? </li></ul>
  12. 12. Thyroid Dysfunction <ul><li>Cretinism </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Hyperthyroidism </li></ul>
  13. 14. Diagnostics <ul><li>Labs </li></ul><ul><ul><li>Serum TSH (0.4 – 6.15 μ U/mL) </li></ul></ul><ul><ul><li>Serum Free T4 (0.9 – 1.7 ng/dL) </li></ul></ul><ul><ul><li>Serum T3 (T3 70 – 220 ng/dL) </li></ul></ul><ul><ul><li>Serum T4 (4.5 – 11.5 μ g/dL) </li></ul></ul><ul><ul><li>T3 Resin uptake test (25%-35%) </li></ul></ul><ul><ul><li>Thyroid antibodies </li></ul></ul><ul><ul><li>Serum thyroglobin </li></ul></ul><ul><li>Radioactive iodine uptake test </li></ul><ul><li>Fine-needle bx </li></ul><ul><li>Thyroid scan, radioscan, or scintiscan </li></ul>
  14. 15. Hypothyroid Management <ul><li>Hormone replacement </li></ul><ul><li>Adjust insulin or anti-diabetic agents as needed </li></ul><ul><li>Use sedatives/hypnotic cautiously </li></ul><ul><li>Supportive therapy </li></ul><ul><li>Assisting with ADLs </li></ul><ul><li>Monitor VS + cognition </li></ul><ul><li>Promote comfort </li></ul><ul><li>Enhance coping </li></ul>
  15. 16. Hyperthyroid Management <ul><li>Treatment depends upon underlying cause </li></ul><ul><ul><li>Pharmacotherapy </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><li>Encourage adequate nutrition and fluid balance </li></ul><ul><li>Enhance coping and Improve self-esteem </li></ul><ul><li>Maintain normal body temperature </li></ul><ul><li>Monitor and manage complications </li></ul>
  16. 17. Thyroidectomy <ul><li>Preoperative Preparation </li></ul><ul><li>Diet high in CHO + Protein </li></ul><ul><li>High caloric intake </li></ul><ul><li>Supplemental vitamins </li></ul><ul><li>Avoid stimulants </li></ul><ul><li>Teaching to include demonstration of how to support neck </li></ul><ul><li>Postoperative Care </li></ul><ul><li>Assess dressing for drainage </li></ul><ul><li>Note complaints of pressure or fullness at incision site </li></ul><ul><li>Tracheostomy tray at bedside </li></ul><ul><li>Manage pain </li></ul><ul><li>Semi-Fowler’s with head supported </li></ul><ul><li>IV fluids -> cold liquids, ice-> high calorie diet </li></ul><ul><li>Keep items within reach </li></ul>
  17. 18. Thyroidectomy: Potential Complications <ul><li>Hemorrhage </li></ul><ul><li>Hematoma formation </li></ul><ul><li>Edema of glottis </li></ul><ul><li>Injury to recurrent laryngeal nerve </li></ul><ul><li>Injury to or removal of parathyroid glands </li></ul><ul><ul><li>Tetany </li></ul></ul>
  18. 19. Parathyroid Glands <ul><li>Embedded in posterior aspect of thyroid gland </li></ul><ul><li>Secrete parathromone </li></ul><ul><ul><li>Output regulated by ionized serum calcium levels </li></ul></ul><ul><ul><li>Regulates calcium and phosphorus metabolism </li></ul></ul><ul><ul><li>Actions are enhanced by vitamin D </li></ul></ul><ul><li>Increased serum calcium levels can be life threatening </li></ul>
  19. 20. Hyperparathyroidism <ul><li>Manifestations: </li></ul><ul><ul><li>Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias </li></ul></ul><ul><li>Dx: ↑ serum calcium and ↑ PTH concentrations </li></ul><ul><li>Management: </li></ul><ul><ul><li>Surgical removal if symptoms </li></ul></ul><ul><ul><li>Monitor and wait if no sx </li></ul></ul><ul><ul><li>Avoid dehydration </li></ul></ul><ul><ul><li>Measures to prevent complications of immobility </li></ul></ul>
  20. 21. Acute Hypercalcemic Crisis <ul><li>Extreme serum calcium elevation </li></ul><ul><li>> 15 mg/dL -> neurologic, cardiovascular, and renal symptoms that can be life threatening </li></ul><ul><li>Treatment: </li></ul><ul><ul><li>Rehydration </li></ul></ul><ul><ul><li>Diuretics </li></ul></ul><ul><ul><li>Phosphate treatment </li></ul></ul><ul><li>Emergency treatment to lower calcium </li></ul>
  21. 22. Hypoparathyroidism <ul><li>Manifestations: Tetany </li></ul><ul><ul><li>Latent: numbness, tingling, cramps in extremities, stiff hands and feet </li></ul></ul><ul><ul><li>Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, seizures, photophobia, cardiac dysrhythmias </li></ul></ul><ul><li>Dx: Positive Chvostek’s and Trousseau’s sign </li></ul><ul><li>In acute hypoparathyroidism IV parathormone </li></ul><ul><li>Limit environmental stimuli </li></ul><ul><li>Trach, mechanical ventilation and bronchodilators </li></ul><ul><li>Chronic: diet high in calcium and low in phosphorus </li></ul><ul><li>Oral Ca gluconate, aluminum carbonate, vitamin D </li></ul>
  22. 24. Adrenal Gland Dysfunction: Pheochromocytoma <ul><li>Tumor of the adrenal gland </li></ul><ul><li>Usually benign </li></ul><ul><li>Peak incidence between 40 and 50 </li></ul><ul><li>Symptoms triad: headache, diaphoresis and palpitations </li></ul><ul><li>Hypertension and cardiac disturbances common </li></ul><ul><li>Acute, unpredictible onset with gradual resolution of symptoms </li></ul>
  23. 25. Adrenal Insufficiency <ul><li>Adrenal cortex function is inadequate to meet the needs for cortical hormones </li></ul><ul><li>Primary: Addison’s </li></ul><ul><li>Secondary </li></ul><ul><li>What is the most common cause of Acute Adrenal Insufficiency? </li></ul>
  24. 26. Adrenal Crisis
  25. 27. Adrenal Crisis <ul><li>Medical Management </li></ul><ul><li>Immediate </li></ul><ul><ul><li>Reverse shock </li></ul></ul><ul><ul><li>Restore blood circulation </li></ul></ul><ul><li>Antibiotics if infection </li></ul><ul><li>Identify cause </li></ul><ul><li>Supplement glucocorticoids during stressful procedures or significant illness </li></ul><ul><li>Nursing Management </li></ul><ul><li>Assess fluid balance </li></ul><ul><li>Monitor VS closely </li></ul><ul><li>Good skin assessment </li></ul><ul><li>Limit activity </li></ul><ul><li>Provide quiet, non-stressful environment </li></ul>
  26. 28. Cushing’s Syndrome <ul><li>Excessive adrenocortical activity </li></ul><ul><li>Most often due to corticosteroid use </li></ul><ul><li>Overnight dexamethasone suppression test </li></ul><ul><li>Indicators: ↑ Na+ ↑ glucose ↓ K+ </li></ul>
  27. 29. Cushing’s Syndrome <ul><li>Medical Management </li></ul><ul><li>Pituitary tumor </li></ul><ul><ul><li>Surgical removal </li></ul></ul><ul><ul><li>radiation </li></ul></ul><ul><li>Adrenalectomy </li></ul><ul><li>Adrenal enzyme inhibitors </li></ul><ul><ul><li>Metyrapone, glutethimide, ketoconzole </li></ul></ul><ul><li>attempt to reduce or taper corticosteroid dose </li></ul><ul><li>Nursing Managment </li></ul><ul><li>Prevent injury </li></ul><ul><li>Increased protein, calcium and vitamin D in diet </li></ul><ul><li>Medical asepsis </li></ul><ul><li>Monitor blood glucose </li></ul><ul><li>FOBT </li></ul><ul><li>Moderate activity with rest periods </li></ul><ul><li>Provide restful environment </li></ul>
  28. 30. Primary Aldosteronism <ul><li>Profound ↓ K+ and H+ ions, ↑pH and HCO 3 </li></ul><ul><li>Near normal or ↑ Na </li></ul><ul><li>Universal sign: HTN </li></ul><ul><li>Dx: </li></ul><ul><ul><li>Measurement of aldosterone excretion rate after salt loading </li></ul></ul><ul><ul><li>Renin-aldosterone stimulation test and bilateral adrenal venous sampling </li></ul></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Muscle weakness </li></ul></ul><ul><ul><li>Cramping </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Nonacid urine </li></ul></ul><ul><ul><li>Polyuria </li></ul></ul><ul><ul><li>↑ serum osmolality </li></ul></ul><ul><ul><li>Polydypsia </li></ul></ul><ul><ul><li>Arterial HTN </li></ul></ul>
  29. 31. Primary Aldosteroninsm <ul><li>Medical Management </li></ul><ul><li>Surgical removal </li></ul><ul><li>Spironalactone for persisitent HTN </li></ul><ul><li>Monitor for fluctuations in adrenal hormones </li></ul><ul><ul><li>Corticosteroids, fluids, agents to maintain BP and prevent complications </li></ul></ul><ul><li>Maintain normal serum glucose </li></ul><ul><li>Nursing Management </li></ul><ul><li>Frequently monitor VS </li></ul><ul><li>Explain all procedures and treatment </li></ul><ul><li>Maintain comfort </li></ul><ul><li>Provide rest periods </li></ul>