Week 2: Endocrine

What is pheochromocytoma?

A rare tumor (normally benign) of the adrenal medulla that produces too much catecholamines (epi and norepi)

What are s/s of pheochromocytoma?

Persistent hypertension and related symptoms such as headache, pallor, diaphoresis, tachycardia, palpitations

How is pheochromocytoma diagnosed?

Elevated urine plasma catecholamines from 24hr sample

What is Intractable High Blood Pressure?

High BP that does not respond to antihypertensive medications

What should a nurse monitor for regarding pheochromocytoma?

Intractable High BP and triad of symptoms (Palpitations, Headache, Episodic sweating)

What does treatment for pheochromocytoma look like?

Surgical excision of the tumor, medical therapy to stabilize the blood pressure before/during/after surgery

What is the antidiuretic hormone?

“anti-pee” hormone that controls plasma osmolality (water/electrolyte balance)

What is Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)?

Too much ADH (increased anti-pee hormone)

What is the serum osmolality like for a patient with SIADH?

Low (hypoosmolality); lots of fluid volume/ diluted electrolytes

What is the sodium level like for a patient with SIADH?

Dilutional hyponatremia

Is the urine in a patient with SIADH concentrated or dilute?

Concentrated urine

What are s/s of SIADH?

Related to hyponatremia; muscle cramping, dyspnea, fatigue, neuro changes, confusion, lethargy, impaired taste, anorexia

What are the priority nursing problems for a patient with SIADH?

Excess fluid volume, risk for injury due to altered mental status

What are nursing interventions related to fluid volume excess caused by SIADH?

Assess for fluid volume overload, weight gain with no edema (fluid in vasculature), monitor I&Os, monitor mental status, restrict fluids, administer hypertonic (salty) IVF but slowly, patient support

Why does a nurse need to monitor and ensure slow administration of hypertonic (salty) IVF to a patient with SIADH who has excess fluid volume?

Can cause swelling of the brain and ultimately death

What does treatment look like for a patient with SIADH?

Restore normal fluid volume; fluid restrictions, 3-5% saline (hypertonic-extra salty), sometimes diuretics

What is diabetes insipidus (DI)?

A deficiency of ADH or a decreased renal response to ADH characterized by excessive water loss through urine and decreased fluid volume (dry inside)

What is the sodium level like for a patient with DI?

Hypernatremia

What are the two types of DI?

Neurogenic and nephrogenic

What is neurogenic DI?

Caused by insufficient secretion of ADH, usually an abrupt/severe onset if caused by head trauma and self-limiting

What is nephrogenic DI?

Caused by inadequate response of the renal tubules; issue is with the kidneys

What are s/s of a patient with DI?

Polyuria, Polydipsia, Dehydration, electrolyte imbalances, hypovolemic shock if severe

What is the urine osmolality like for a patient with DI?

Very low (hypoosmolality)

What is the urine specific gravity like for a patient with DI?

Very low

What is the serum osmolality like for a patient with DI?

High (hyperosmolality)

What are priority nursing problems for a patient with DI?

Deficient fluid volume and risk for injury due to altered mental status

What are nursing interventions for a patient with DI?

Maintain F/E balance, administer IVF (hypotonic or NS), I&Os, daily weights, monitor labs, notify HCP if labs are trending in the wrong direction

What is desmopressin (vasopressin) used for?

Neurogenic DI

What is Cushing Syndrome?

Too much Cortisol production in the body

What are glucose levels like in a patient with Cushings disease?

hyperglycemia

What are s/s of Cushing’s disease?

Hyperglycemia, hypertension, muscle wasting/weakness, bone demineralization (osteoporosis), weight gain, awkward gait, redistribution of fat (moon face and buffalo hump), impaired wound healing, mood swings, insomnia

What are the potassium levels like in a patient with Cushing’s disease?

Hypokalemia

What are priority nursing problems for a patient with Cushing’s disease?

Risk for infect, weight gain, impaired skin integrity, risk for injury, ineffective coping, body image concerns, unstable glucose, hypokalemia

What does treatment for Cushing’s disease look like?

Normalize cortisol hormone secretion, treat underlying cause (remove tumors, gradual d/c of long-term steroid use)

What are nursing interventions for a patient with Cushing’s disease?

Monitor fluid balance, I&Os, daily weight, monitor glucose via FSBS, monitor VS, assess skin, monitor WBCs, observe behaviors, provide emotional support, diet

What should a diet look like for a patient with Cushing disease?

Increased protein, increased potassium, decreased calories, decreased sodium (steroids increase appetite so this could be challenging)

What is Addison’s disease?

Not enough cortisol (ADH) in the body

What are s/s for a patient who has Addison’s disease?

Anorexia, weight loss, weakness, malaise, apathy (flat affect), electrolyte imbalances, skin hyperpigmentation (bronze glow), hypotension, salt cravings, dehydration, weakness, fatigue

What are potassium levels like in a patient with Addison’s disease?

Hyperkalemia

What are the glucose levels like in a patient with Addison’s disease?

Hypoglycemia

What are priority nursing problems for a patient with Addison’s disease?

Deficient fluid volume, malnourishment, activity intolerance, potential for Addisonian crisis

What does treatment look like for a patient with Addison’s disease?

Daily hydrocortisone (2/3 on awakening, 1/3 in late afternoon to mimic natural cortisol levels in the body), daily fludrocortisone, salt additives for heat/humidity, increased doses when stressed

What are important rules about cortisol replacement therapy for a patient with Addison’s disease?

Closely follow dosing schedule, NEVER abruptly stop, replacement therapy is life-long, 3×3 rule when stressed, always have emergency supply kit, wear medic alert bracelet

What is the 3×3 rule for cortisol replacement therapy?

3 times the normal dose for 3 days when stressed (surgery, exams, big presentation)

What is an Addisonian Crisis?

Medical emergency; Acute adrenal insufficiency caused by a sudden insufficiency of serum corticosteroids

What can cause an Addisonian Crisis?

Sudden loss of gland via surgery without proper prep, sudden increase in stress, sudden cessation of corticosteroid drug therapy

What are s/s of an Addisonian Crisis?

Sudden penetrating pain in the lower back, abd, or legs, severe V/D, dehydration, low BP, loss of consciousness

What does treatment look like for an Addisonian Crisis?

IV Hydrocortisone/saline/dextrose combo

What are nursing interventions for patient with Addison’s disease aside from steroid replacement therapy?

Frequent VS, striving for a stress free environment (noise, light, temperature), cluster care

What is a negative feedback loop?

Where the output of a system reduces the input that is driving the system; helps keep a variable in a certain range and maintain homeostasis

What are hormones?

Chemical substances made by endocrine glands that control and regulate activity in target cells or organs

What is a water deprivation test?

Differentiates the type of DI; tells us if the problem is from the posterior pituitary gland or the kidneys

Describe a normal/natural cortisol pattern in the body?

Highest in the morning, slowly drops during the day, and lowest around midnight (may change if patient works nightshift)