Endocrine part 3

Adrenal Insufficiency

S/s: appear @ 90% of nonfunctional adrenal cortex; darken/bronzed hyperpigmentation, weakness, weight loss, fatigue, nausea, ABD pain, gastroenteritis, emotional lability

Dx:labs, X-ray, CT scan, MRI

-blood electrolytes: increase K, WBC, Ca, decrease Na

-BUN/CRE: increased

-BG: decreased

-blood/salivary cortisol: decreased

-ACTH stimulation test: cortisol level does not rise when ACTH is infused

Medication: cortisol replacement→glucocorticoid

Nursing management:

-assess:vital, I&O, labs

-IV access, medication, safety precautions

Education: medication, s/s of adrenal insufficiency/corticosteroid excess

Acute adrenal insufficiency: Addisonian Crisis

Life-threatening, insufficient of cortisol

S/s: sepsis, trauma, stress(MI, surgery, hypothermia, volume loss, hypoglycemia), adrenal hemorrhage, steroid withdrawal, hypovolemia, hypotension, hyperkalemia, hypoglycemia

Cushing’s disease

S/s: weakness, fatigue, back/joint pain, altered emotional state, decreased libido, hyperglycemia, fluid retention, hypokalemia, abnormal fat distribution(central), decreased muscle mass

Dx: labs, X-ray, CT-MRI

-increased cortisol level

-elevated ACTH level

-decreased K, Ca and increased Na

-decreased lymphocytes

-dexamethasone suppression test: non suppression dx of cushing’s

Treatment: cause, ketoconazole(suppress ACTH/glucocorticoid) , hydrocortisone replacement→adrenal removal, tumor/pituitary→transsphenoidal hypophysectomy, hypersecreting adrenal cortex tumor→adrenalectomy

Complications: damage(heart, vascular system, kidney, eyes), fractures, infection, cardiac dysrhythmias, adrenal crisis(addisonian crisis)

Nursing care: assess(I&O, daily weight, vital, hypervolemia, BG, K, WBC, skin/wound healing); intervention(medication, elevate HOB, Turn→skin, prevent fractures)

Diabetes insipidus

Due to decrease ADH; low ADH→more urine; high ADH→less urine

Complication: uncontrolled diuresis, dehydration, extreme thirst

2 types: central DI( insufficiency production of ADH→pituitary gland); nephrogenic DI(resistance by kidney)

Risk: Central DI(neurosurgery, head trauma, autoimmune, vascular disease, sarcoidosis, ischemia, infection); nephrogenic DI(gene mutations, renal disease, pregnancy, hypercalcemia, hypokalemia, medications)

S/s: polyuria, polydipsia, nocturia, hypernatremia, large→dilute urine, irritability, lethargy, weakness

Impact on health: dehydration, electrolyte imbalance, nocturia, higher morality→elderly

Nurse role: monitor UO, electrolytes, vitals, skin integrity; IV replacement(500-750ml/hr), medication(desmopressin, thiazide)

Education: s/s/prevention of dehydration, electrolyte imbalance

Syndrome of inappropriate antidiuretic hormone(SIADH)

Inability to suppress the release of ADH→impaired water excretion→hyponatremia

Cause: malignancies, medications, hormone deficiencies, CNS disorders

-malignancies: small cell lung cancer, extra pulmonary small cell carcinomas, head and neck cancer

-medications: chemotherapy, carbamazepine, oxcarbazepine, chlorpromazine, SSI

-hormone deficiencies: hypothyroids, hypopituitary

-CNS disorders: stroke, hemorrhage, infection(pneumonia, HIV, meningitis), Trauma, Surgery of pituitary gland

Impact on health: hyponatremia(decrease UO, weakness, fatigue, confusion, muscle cramps, headache, mental status changes(lethargy, coma), seizures)

Nursing: strict PO fluids, neurological changes, I&O, hypertonic IV fluids, loop diuretics, seizure precautions, orthostatic hypotension

Education: accurate I&O, fluid restriction, complications

Hypothyroidism

Hashimoto’s thyroiditis

Risk: female, 30-60, lithium/amiodarone use, inadequate iodine intake, radiation(neck/head)

S/s: fatigue, constipation, weight gain, reduce sweating, dry skin, cold intolerance, hair loss, menstrual changes, disrupted sleep

Dx: lab(increase TSH, low T3/T4), thyroid scan, US

Medication: Levothyroxine

Complications: hyperlipidemia, cardiovascular disease, weight gain, depression, infertility

Nursing: vital, O2, daily weight, Ca level, skin(texture, color, turgor)

Education: same day/everyday, caution with narcotics/sedatives, warming blankets, skin integrity

Hyperthyroidism

Risk: female, 20-40

Cause: grave’s disease-autoimmune, thyroiditis, toxic adenoma, nodular, exogenous(excess thyroid hormone dosage)

S/s: increase HR, cardiac dysrhythmias, increase heart sounds, thyroid bruit, increase gastric activity/appetite, weight loss, fatigue, nervousness, insomnia, light-absent menses, hair loss

Dx: increase TSH/T3/T4/Thyroid stimulating immunoglobulins, thyrotropin receptor antibodies; US, thyroid scan

Management: fluid intake, non-stressful environment

Medication: anti thyroid meds, iodine preparation, beta-adrenergic blockers; thyroidectomy

Hypoparathyroidism

Ca no mobilized from bones→hypocacemia(Numbness/tinging, hand/feet, muscle cramps, hand/feet, tetany) pos(chvostek, trousseau sign)

Dx: low ca, mg, parathyroid hormone, night P

Medication: Ca and vitamin D supplement

Nursing: s/s of hypocalcemia, vital, ca/mg level, Acid-base

Education: medication, diet(high Ca, low P), s/s of hypo/hypercalcemia

Hyperparathyroidism

S/s: polyuria, anorexia, constipation, ECG changes, ABD pain, lethargy, confusion, muscle weakness, fatigue, bone pain

Dx: lab(PTH, ionized calcium increased)

Treatment: decrease Ca level( intake, loop diuretics, oral phosphate, calcium chelagtors), increase fluid intake, subtotal parathyroidectomy

Nursing: s/s hypercalcemia, cardiac monitoring, acid-base, prevent fracture

Education: s/s of hypocalcemia, low-Ca diet, increase fluid/fiber