adult health II exam #5 - endocrine

anterior pituitary

it synthesizes and secretes hormones that regulate growth, metabolism, stress, and reproduction—often by telling other glands what to do

a few hormones the AP makes include:

• growth hormone

• FSH (follicle stimulating hormone)

• TSH (thyroid stimulating hormone)

• LH (lutenizing hormone)

pituitary adenoma (definition, S/E, comps, and tx)

a benign (noncancerous) tumor that develops in the pituitary gland, most often in the anterior pituitary. this tumor causes the pituitary to create and secrete too many hormones.

S/E: joint pain, cardiovascular disease

comps: decreased lifespan by 5-10 years

treatment: octreotide (medication that inhibits hormone release) and/or surgery to remove the tumor

pituitary hypofunction (definition, comps, tx)

a rare disease of the anterior pituitary that causes decreased production of LH, GH, and FSH.

comps: organ failure

tx: surgery, radiation, and life-long hormone replacement

one of your patients just came back from surgery to repair pituitary hypofunction. to do this, the pituitary gland was removed.

what comps should the nurse assess for post-op?

1. hematoma (could compress the optic nerve and increase ICP! if this occurs, the patient will complain of vision changes!)

2. CSF leaks

3. epistaxis

what does the posterior pituitary do?

this part of the pituitary does NOT produce hormones; however, it secretes ADH and oxytocin and stores other hormones until needed.

syndrome of inappropriate ADH (SIADH) (definition)

a condition where the body releases too much ADH, leading to water retention and dilution of sodium in the blood (hyponatremia)

what is the MAIN complication of SIADH? what can you do to prevent further patient harm in this scenario?

hyponatremia!! this causes neurological changes, such as confusion, seizures, coma, irritability, and balance issues

interventions:

• seizure precautions

• fall precautions

• strict I&Os and DWs

• administration of hypertonic solution administered SLOWLY to prevent shock

• diuretics if Na+ is AT LEAST 125 or lower

diabetes insipidus (caused by posterior pituitary issues) (definition, S/S)

diabetes insipidus (type 1) caused by inadequate ADH production and secretion due to a brain tumor compressing on PP or a TBI

S/S: polydipsia, polyuria, polyphagia are the main S/S

what is the treatment for DI caused by pituitary issues? (3)

• fluids!!!!! these patients are severly dehydrated

• hormone therapy → usually vasopressin (medication form of ADH)

• try to fix the initial issue that caused the PP to act up

graves disease (definition, S/S)

an autoimmune disorder that attacks the thyroid gland, causing it to become hyperactive → leads to hyperthyroidism

S/S:

• tachy

• wt loss

• agitation

• goiter formation

• enlarged eyes

what is the #1 most common cause of hyperthyroidism?

graves disease

hyperthyroidism (definition, S/S, treatment)

a condition where the thyroid gland produces too much thyroid hormone (T3 and T4), which speeds up the body’s metabolism

S/S: tachy, wt loss, agitation, goiter formation, enlarged eyes

treatment: antithyroid meds, beta blockers to decrease HR, and radioactive iodine therapy

what is the #1 complication of hyperthyroidism?

thyroid storm! this is a medical emergency!

thyroid storm (definition, S/S, treatment)

a rare, life-threatening complication of untreated or poorly controlled hyperthyroidism. It occurs when the thyroid gland suddenly releases excessive amounts of thyroid hormones (like a major bolus!!), causing extreme metabolic acceleration.

S/S: severe tachy, HF, delirium (thyroid toxicosis), seizures, hyperthermia, coma

treatment:

• meds to decrease thyroid function

• ICU treatment, strict monitoring

• manage S/S (cool the patient down, IVF, BBs to lower HR, antipyretics to stop fever)

• seizure precautions

thyroiditis (definition, main concern, treatment)

the inflammation of the thyroid

can compress the trachea, which obstructs the airway

treatment: NSAIDs to reduce inflammation, abx, and corticosteroids

your patient needed their thyroid removed because of uncontrolled hyperthyroidism. what is the nurse most concerned about after surgery? what are some precautions you can have in place?

AIRWAY ISSUES → the thyroid is sitting on top of the thyroid, so issues can severely impact the airway!!

interventions;

• set up suction and keep it ready

• tracheostomy tray at bedside

your patient who just had a thyroidectomy was doing okay, but now they’re experiencing stridor, hoarseness, and they’re clearing their throat often.

should you be concerned?

yes — the thyroid is becoming inflamed and is obstructing the airway. keep the patient on oxygen, call the provider, and continue monitoring.

the parathyroid gland is underneath the thyroid. how can you tell the parathyroid is struggling?

low calcium levels in the blood

(the parathyroid regulates these levels)

hypothyroidism (definition, S/S, treatment)

a decrease in hormone production — T3 and T4 — causing decreased metabolism.

S/S: lethargy, wt gain, slow speech, mental sluggishness/brain fog, depression

treatment: lifetime T3/T4 supplement medication such as levothyroxine

what does HIGH TSH levels signify?

what does LOW TSH levels signify?

high TSH = signifies the thyroid is the problem, because the thyroid is producing and secreting too much when stimulated by the brain/PP

low TSH = signifies the brain or pituitary gland is the issue, because the thyroid needs to be stimulated to begin producing TSH