Nursing Care of Patients with Endocrine Disorders

Flashcards covering endocrine disorders, their pathophysiology, signs, symptoms, and treatments.

Endocrine Disorders

Too much or too little hormone activity due to issues with production/secretion or tissue sensitivity

Primary endocrine disorder

Problem within the gland that is out of balance

Secondary endocrine disorder

Problems outside the gland, such as an imbalance in a tropic hormone, certain drugs, trauma, surgery, or a problem in the feedback mechanism

Antidiuretic Hormone (ADH)

Hormone made in the hypothalamus and stored/secreted by posterior pituitary gland, responsible for reabsorption of water

Diabetes Insipidus (DI)

Increased urine output; caused by too little ADH

Syndrome of Inappropriate ADH (SIADH)

Decreased urine output; caused by too much ADH

Diabetes Insipidus Pathophysiology

Insufficient ADH, kidneys do not reabsorb water, diurese 3 to 15 liters per day, leads to dehydration, increased serum osmolality

Diabetes Insipidus Causes

Pituitary tumor, head trauma, problems in the hypothalamus or pituitary gland, surgery, certain drugs (glucocorticoids or alcohol)

Diabetes Insipidus Signs and Symptoms

Polyuria, polydipsia, nocturia, dilute (light-colored) urine, decreased urine specific gravity, dehydration, hypovolemic shock, decreased level of conciousness, death

Diabetes Insipidus Diagnostic Tests

Urine specific gravity <1.005 (normal: 1.005-1.030), plasma osmolality increased, hypernatremia (from concentrated blood), CT scan or MRI for cause, Water deprivation test

Diabetes Insipidus Therapeutic Interventions

Hypotonic IV fluids (0.45% NS), IV or subcutaneous (SQ) vasopressin, DDAVP (synthetic ADH for long-term treatment), Hypophysectomy if tumor

Nursing Process for the Patient With Diabetes Insipidus

Daily weights, accurate I&O’s, monitor skin turgor, mucous membranes, skin integrity, monitor for fluid overload after treatment is started

Diabetes Insipidus Nursing Diagnosis

Deficient Fluid Volume related to failure of regulatory mechanisms

SIADH Pathophysiology

Too much ADH, water retention, decreased serum osmolality

SIADH Causes

Nervous system disorders, cancer, pulmonary diseases, medications that stimulate ADH release

SIADH Signs and Symptoms

Weight gain without edema, dilutional hyponatremia

SIADH Diagnostic Tests

Serum- sodium & osmolality (low), urine- sodium & osmolality (high), serum ADH (high), CT scan or MRI for underlying cause

SIADH Therapeutic Interventions

Eliminate cause, surgical removal of tumor, fluid restriction, hypertonic saline IV, oral sodium tablet, furosemide (Lasix), Conivaptan (Vaprisol)

SIADH Nursing Diagnosis

Excess Fluid Volume related to compromised regulatory mechanism; monitor vital signs, daily weight, I &O, urine specific gravity, skin turgor, serum sodium levels

Cue Recognition 39.1

States he gets “very dizzy” when he stands up; check vital signs both sitting and standing and document

Growth Hormone (Somatotropin)

Secreted by anterior pituitary gland; too little = short stature; too much = gigantism, acromegaly

Growth Hormone Deficiency Pathophysiology

Deficient growth hormone (GH) in childhood; GH deficiency in adults does not affect growth

Growth Hormone Deficiency Causes

Pituitary tumor, surgery, heredity, trauma, psychosocial, malnutrition, idiopathic

Growth Hormone Deficiency Signs and Symptoms in Children

Grow only to 3 to 4 feet (5th percentile), slowed sexual maturation, may have developmental delays, other symptoms depend on other pituitary hormones involved

Growth Hormone Deficiency Signs and Symptoms in Adults

Fatigue, weakness, excess body fat, hypercholesterolemia, decreased muscle and bone mass, sexual dysfunction, risk for cardiovascular & cerebrovascular disease, headaches, mental slowness, and psychological disturbances

Growth Hormone Deficiency Diagnostic Tests

GH level, GH stimulation test, MRI for tumor, X-rays

Growth Hormone Deficiency Therapeutic Interventions

SQ injection- Synthetic GH (Somatropin), surgery if a tumor is the cause

Growth Hormone Deficiency Nursing Care

Respectful approach, ask about current problems, observe self-administration of somatropin, collaborate with RN to educate patient

Acromegaly Pathophysiology

Excess GH in adults, long bones grow in width, not length, internal organs and glands enlarge, impaired tolerance of carbs leads to elevated blood glucose

Acromegaly Causes

Pituitary hyperplasia, pituitary tumor, hypothalamic dysfunction

Acromegaly Signs and Symptoms

Change in shoe or ring size, nose, jaw, brow enlarge (broaden), teeth may be displaced, tongue becomes thick, sleep apnea, headaches, visual changes, diabetes mellitus

Acromegaly Diagnostic Tests

GH level, oral glucose tolerance test, CT scan or MRI

Acromegaly Therapeutic Interventions

Medications to block GH, Hypophysectomy (removal of the pituitary gland), Radiation if tumor cause

Hypophysectomy

Removal of the pituitary gland

Hypophysectomy Preoperative Care

Collect baseline neurological data; teach to avoid actions that increase pressure on surgical site (coughing, sneezing, straining); deep-breathing exercises, incentive spirometry

Hypophysectomy Postoperative Care

Neurological assessment, urine for specific gravity (risk for DI), nasal packing and “mustache” dressing, report cerebrospinal fluid drainage (contains glucose), hormone replacement therapy with target hormones

Hypophysectomy Patient Education

Gently blow nose, take stool softeners and antitussives as needed, take care with brushing teeth, take hormones as prescribed, notify MD of fever, drainage, frequent urination, unusual thirst

Cue Recognition 39.2 Post-Hypophysectomy

Check fluid with a glucose testing strip

Thyroid Hormone

T3 & T4 (thyroid hormones secreted by thyroid gland), Thyroid-Stimulating Hormone (TSH)- secreted by pituitary gland

Thyroid Hormone Imbalance

Hypothyroidism (deficient secretion of TH) , Hyperthyroidism (excess TH)

Hypothyroidism Pathophysiology

TH deficiency, metabolic rate reduced

Hypothyroidism Causes

Congenital, inflammatory, iodine deficiency, thyroidectomy, autoimmune (Hashimoto thyroiditis), lithium, lesion on pituitary or hypothalamus

Hypothyroidism Signs and Symptoms

Fatigue, bradycardia, constipation, mental dullness, cold intolerance, shortness of breath (hypoventilation), dry skin and hair, weight gain, heart failure

Myxedema Coma Treatment

Monitor vital signs, warming blanket, mechanical ventilation, IV fluids, IV levothyroxine (Synthroid)

Hypothyroidism Diagnostic Tests

T3 and T4 low, TSH high in primary, TSH low in secondary, serum cholesterol and triglycerides are elevated

Hypothyroidism Therapeutic Interventions

Levothyroxine (Synthroid), oral hormone replacement

Hypothyroidism Patient Education

Instruction on the importance of consistent thyroid replacement & regular blood tests; report symptoms of hyperthyroidism

Hyperthyroidism Pathophysiology

Increased metabolic rate, increased beta receptors

Hyperthyroidism Causes

Autoimmune (Graves disease), thyroid nodules that secrete excess TH, thyroiditis, thyroid tumor, pituitary tumor (secondary), Levothyroxine (Synthroid) overdose

Hyperthyroidism Signs and Symptoms

Hypermetabolic state, heat intolerance, increased appetite, weight loss, frequent stools, nervousness, tachycardia, palpitations, tremor, heart failure, warm, smooth skin, exophthalmos (Graves disease)

Thyrotoxic Crisis (Thyroid Storm)

Tachycardia, extreme hypertension, high fever, dehydration, restlessness, delirium coma, death

Hyperthyroidism Diagnostic Tests

Elevated T3 and T4; TSH low in primary; TSH high in secondary; thyroid-stimulating immunoglobulin; CT scan or MRI if tumor suspected

Hyperthyroidism Therapeutic Interventions

Methimazole (Tapazole), beta blockers, radioactive iodine (I-131 or RAI), thyroidectomy; IV fluids, cooling blanket, beta blocker, acetaminophen (avoid aspirin) for fever, oxygen, elevate head of bed (for thyrotoxic crisis)

Nursing Care of the Patient Receiving Radioactive Iodine (in hospital)

Limit time spent with patient; glove and gown; avoid being the caregiver if pregnant; take precautions with urine, emesis, body fluids; double flush toilet; call radiation safety officer for emesis or incontinence

Nursing Care of the Patient Receiving Radioactive Iodine (at home)

Avoid close contact with family members; sleep alone; wash hands carefully after urinating; avoid oral contact; wash eating utensils thoroughly ; drink plenty of fluids & void frequently; avoid pregnancy for at least a year

Goiter Pathophysiology

Enlarged thyroid gland, elevated TSH, autoimmune process (Graves disease)

Goiter Causes

Low TH, iodine deficiency, virus, genetic, goitrogens (medications)

Goiter Signs and Symptoms

Enlarged thyroid, swelling at the base of the neck, dysphagia, difficulty breathing, full sensation in the neck, hypothyroid or hyperthyroid, or euthyroid

Goiter Diagnostic Tests

Thyroid scan, TSH, T3, and T4 levels

Goiter Therapeutic Interventions

Treat cause, avoid goitrogens, treat hypothyroidism or hyperthyroidism, thyroidectomy if size causing symptoms

Cancer of the Thyroid Gland Signs and Symptoms

Hard, painless nodule; dysphagia; dyspnea if obstruction; persistent cough; changes in the voice; TH usually normal

Cancer of the Thyroid Gland Diagnostic Tests

Thyroid scan shows “cold spot” with malignancy, biopsy

Cancer of the Thyroid Gland Therapeutic Interventions

Radioactive iodine therapy, chemotherapy, thyroidectomy (partial or total)

Thyroidectomy: Preoperative nursing care

Obtain baseline vital signs and voice quality, explain what to expect before, during, and after surgery, administer iodine or antithyroid drugs as ordered to achieve euthyroid state.

Thyroidectomy Preoperative Teaching

Make sure the patient understands that lifelong replacement hormone medication must be taken after a total thyroidectomy.

Thyroidectomy Postoperative care

Monitor VS, O2 sat, drain, dressing q 15 mins and progressing to q 4hrs, check the back of the neck for pooling blood, watch for signs of respiratory distress, listen for hoarseness, monitor calcium levels

Tetany Post Thyroidectomy

Caused by low calcium levels and is characterized by tingling in the fingers, around the mouth, muscle spasms, twitching and cardiac arrhythmias

Parathyroid Hormone

Secrete PTH in response to low serum calcium levels

Parathyroid Hormone Disorders

Hypoparathyroidism (decreased PTH & hypocalcemia), hyperparathyroidism (increased PTH & hypercalcemia)

Hypoparathyroidism Pathophysiology

Decrease in parathyroid hormone (PTH), calcium stays in bones, hypocalcemia, hyperphosphatemia

Hypoparathyroidism Causes

Heredity, accidental removal of parathyroid glands during thyroidectomy, hypomagnesemia

Hypoparathyroidism Signs and Symptoms

Tetany, chronic hypocalcemia

Hypoparathyroidism- Early indications of tetany

Positive Chvostek sign, positive Trousseau sign

Hypoparathyroidism Diagnostic Tests

PTH low, serum calcium low, serum phosphorus high, ECG- cardiac function, X-ray- bone changes

Hypoparathyroidism Therapeutic Interventions

IV calcium gluconate, High calcium diet, oral calcium with vitamin D

Hyperparathyroidism pathophysiology

Overactivity, increased PTH, hypercalcemia, hypophosphatemia

Hyperparathyroidism Causes

Parathyroid hyperplasia, benign parathyroid tumor, heredity

Hyperparathyroidism Signs and Symptoms

Fatigue, depression, confusion, increased urination, anorexia, nausea and vomiting, kidney stones, cardiac arrhythmias, joint pain, pathological fractures, coma

Hyperparathyroidism Diagnostic tests

Serum calcium elevated, PTH elevated, phosphate decreased, 24-hour urine for calcium, X-rays for bone density

Hyperparathyroidism Therapeutic Interventions

Oral or IV fluids to dilute calcium, furosemide (Lasix), Cinacalcet (Sensipar), calcitonin, alendronate, estrogen therapy (women), parathyroidectomy, weight-bearing exercise

Pheochromocytoma

Tumor of adrenal medulla, causes hypersecretion of epinephrine and norepinephrine

Pheochromocytoma Signs and Symptoms

Exaggerated fight or flight symptoms such as hypertension, tachycardia, palpitations, tremor, diaphoresis, anxiety

Pheochromocytoma Diagnostic Tests

24-hour urine for metanephrines and VMA, CT scan or MRI to find tumor

Pheochromocytoma Therapeutic Interventions

Avoid high-tyramine foods, calcium channel blockers, alpha blockers, beta blockers, adrenalectomy

Cue Recognition 39.2 Regarding Pheochromocytoma

Measure pulse and BP

Adrenal Cortex Hormone Imbalance

Hyposecretion = Addison disease, hypersecretion = Cushing syndrome

Addison Disease Pathophysiology

Deficient cortisol, aldosterone, and/or androgens

Addison Disease Causes

Autoimmune, AIDS, cancer, pituitary or hypothalamus problem, abrupt discontinuance of long-term steroids

Addison Disease Signs and Symptoms

Hypotension, sodium loss, potassium retention, hypoglycemia, weakness, fatigue, bronze skin, nausea and vomiting

Addisonian (Adrenal) Crisis

Profound hypotension, dehydration, tachycardia, hypoglycemia, cardiac arrhythmias, coma

Addisonian Crisis Causes

Caused by stress, infection, trauma, psychological pressure

Addison Disease Diagnostic Tests

Serum and urine cortisol level, blood glucose, electrolytes, blood urea nitrogen and hematocrit levels, ACTH stimulation test, CT or MRI

Addison Disease Therapeutic Interventions

Glucocorticoids and mineralocorticoids daily for life, high-sodium diet

Cushing Syndrome Pathophysiology

Excess adrenal cortex hormones such as cortisol, aldosterone, and androgens

Cushing Syndrome Causes

Hypersecretion of ACTH, hypersecretion of cortisol, prolonged use of exogenous glucocorticoids

Cushing Syndrome Signs and symptoms

Thinning hair, red cheeks, moon face, fat pads (Buffalo hump), easy bruising, pendulous abdomen, slow wound healing, osteoporosis, thin extremities

Cushing Syndrome Diagnostic Tests

Based on appearance, plasma and urine cortisol, ACTH, 24-hour urine test, dexamethasone suppression test

Cushing Syndrome Therapeutic Interventions

Surgery if tumor, reduce dose of steroid, change schedule of steroid administration, low-sodium, high-potassium diet, diabetes treatment

Adrenalectomy Preoperative Care

Monitor electrolytes, glucose, administer glucocorticoids as prescribed

Adrenalectomy Postoperative Care

Monitor for adrenal crisis; require lifelong hormone replacement if both adrenals removed