adults exam 3

not all organs are glands, but all glands are —-

organs

what is involved in the negative feedback loop with the endocrine system

low metabolism detected, hypothalamus releases TRH to stimulate pituitary to release TSH, this stimulates the target organ (thyroid gland), which then produces T3 and T4, then feedback is given to hypothalamus that adequate levels have been reached and the pituitary stops stimulating the hormones

what is the job of the anterior pituitary

regulates body temp, reproduction, and some autonomic functions, releases TRH and GnRH

what is the job of the middle pituitary

connects hypothalamus to pituitary gland, releases CRH, GHRH, somatostatin, and dopamine

what is the job of the posterior pituitary

controls autonomic and endocrine functions, controls aspects of sleep-wake cycle, releases oxytocin and vasopressin (ADH)

what things influence dopamine levels

food, exercise, social interaction, achievement and success, learning, entertainment and hobbies, love, intimacy, risk and reward, sleep and rest, addictive substances, sexual activity

what is the technical name of the pituitary gland

hypophysis

what are the major functions of the pituitary gland (hypophysis)

growth and development, metabolism, stress response, reproductive function, lactation, water and electrolyte balance, social and reproductive behaviors

what hormones are released from the anterior pituitary (adenohypophysis)

GH, TSH, ACTH, LH, FSH, PRL, MSH

what hormones are released from the posterior pituitary

ADH, oxytocin

the pancreas controls…

sugar

the thymus trains — — in order to mature

T cells

the adrenal glands control…

fight or flight

the parathyroid controls — levels

calcium

the thyroid controls…

metabolism

the pineal gland produces…

melatonin

calcitonin regulates what blood levels and opposes —-

calcium and phosphate, PTH

what is a normal TSH

0.4-4

what are the causes of hypothyroidism

Hashimoto’s, over response to hyperthyroid treatment, thyroid surgery, radiation, lithium, tumor, iodine deficiency

what is occurring with hormone levels in hypothyroidism

thyroid not producing T3 and T4 in response to TSH. high TSH and and low T3 and T4

how will the client present with hypothyroidism

fatigue, weight gain, increased sensitivity to cold, constipation, dry skin, muscle weakness, hypercholesteremia, abnormal menses, thinning hair, slow heart rate, depression, memory impairment

what medication treats hypothyroidism

levothyroxine (synthetic T4)

what complications can occur from hypothyroidism

goiter, decreased CO, depression, peripheral neuropathy, infertility, birth defects, myxedema

what labs and diagnostic tests are used for hypothyroidism

TSH levels, antibody testing, US/thyroid scan, biopsy, CT/MRI

what causes a myxedema crisis

sedatives, infection, stress to body, undiagnosed/under treated hypothyroidism

how will the client present with a myxedema crisis

decreased respirations (hypercapnia), hyponatremia, hypothermia, confusion, shock, low blood oxygen, coma, seizures, swelling

what are the treatments for myxedema crisis

leveothyroxine IV, steroids, antibiotics, respiratory care, temperature control

when is levothyroxine given

1 hour prior to food and other meds, given in the AM

what causes hyperthyroidism

grave’s disease, Plummer’s disease, thyroiditis

there is an increased likelihood of hyperthyroidism occurring if…

there is, family history, anemia, type I DM, Addisons disease, over 60, pregnancy

what is occurring with hormone levels in hyperthyroidism

thyroid producing too much T4, metabolism accelerated

how will the patient present with hyperthyroidism

eat more and higher metabolism, palpitations, tumors, very hot, muscle and joint pain, diarrhea, light period cycles, thinning hair, expothalamus (grave’s)

what occurs with exopthalamos in grave’s disease

protrusion of eyeballs, red/swollen eyes, drying and irritation, diplopia (double vision), light sensitivity, eye pain/pressure/difficulty closing eyes, reduced eye movement

what ate the treatments for graves exopthalamos

radioactive iodine ablation, corticosteroids, artificial tears, radiation therapy, orbital decompression surgery, eye muscle surgery

what are the treatments for hyperthyroidism

radioactive iodine, anti thyroid meds (methimazole, PTU), surgery, beta blockers to ease symptoms

when does a thyroid storm occur and what is it due to

can occur in those with hyperthyroid after trauma, surgery, severe emotional distress, infection, contrast dye allergy and it is due to an extreme overproduction of T3 and T4

what are the symptoms of a thyroid storm

tachycardia (>140), HTN, febrile (104), restlessness, anxiety, profuse sweating, N/V/D, SOB, respiratory distress, ALOC

what are the treatments for a thyroid storm

beta blockers, PTU, methimazole, iodine solutions, corticosteroids, cooling measures, fluids and electrolytes, O2

what are the possible complications from a thyroidectomy

bleeding, infection, surgical damage, removal of the parathyroid glands, damage to laryngeal nerve (vocal cords), hypothyroidism

what does the parathyroid gland release and what levels does it regulate

PTH, calcium/phosphorus

how does PTH release in response to low serum calcium increase calcium levels in the blood

1. causes bones to release calcium into the blood

2. blocks kidneys from releasing calcium and increases vitamin D metabolism

3. causes kidneys to increase activation of vitamin D and gut increases calcium absorption

what are the causes of hypoparathyroidism

neck surgery, autoimmune disease, hereditary hypoparathyroidism, low serum magnesium (mg is used to create PTH), cancer radiation treatment of face/neck

what is occurring in hypoparathyroidism

too low PTH = unable to regulate calcium and phosphorus = low serum calcium = higher phosphorus

how will the client present with hypoparathyroidism

hypocalcemia symptoms, irregular heart beat, ALOC, weaker teeth, facial twitches (Chvostek), carpal spasms (trousseau’s)

what are the treatments for hypoparathyroidism

dietary adjustments (high Ca, low phosphorus), oral calcium carbonate tablets, vitamin D (calcitriol), magnesium, thiazide diuretics, parathyroid hormone (risk of bone cancer)

what are the complications from hypoparathyroidism that if treated promptly are reversible

cramping hand spasms, tingling in the face and fingers and toes, seizures, malformed teeth, heart arrhythmias, syncope, heart failure, kidney issues

what are the complications from hypoparathyroidism that if not treated promptly are irreversible

stunted growth, slow mental development, Ca deposes in brain, clouded vision d/t cataracts

what are the nursing care points of hypoparathyroidism

IV calcium (slow), oral calcium tablets, cardiac monitor, possible phosphate binders, monitor airway and diet

what are the patient education points of hypoparathyroidism

diet rich in calcium, diet low in phosphorus, ca and phos checks monthly, brittle nails, depression/anxiety, prolonged QT

what are the causes of hyperparathyroidism

primary (something wrong w/ parathyroid), secondary (from CKD or vitamin D deficiency)

what is happening in hyperparathyroidism

too much PTH in blood stream, high serum calcium = low serum phosphorus

how will the client present in hyperparathyroidism

weakened bones, kidney stones, N/V, abdominal pain, depression, irritability, muscle weakness and pain, heart arrhythmias

how is hyperparathyroidism diagnosed

fasting serum calcium, serum PTH levels, phosphate levels, vitamin D levels, bone mineral density test, urine test, US, CT of kidneys

how is hyperparathyroidism treated

calcimimetics, bisphosphonates, vitamin D and calcium supplements (caution in secondary), phosphate binders (secondary only)

what complications can arise from hyperparathyroidism

osteoporosis, kidney stones, peptic ulcers CVD, confusion, dehydration, coma

what are the nursing care points with surgery in hyperparathyroidism

monitor for hypocalcemia (confusion, muscle spasms, cramps, depression, brittle nails), fluid management

what are the pt education points of hyperparathyroidism

surgical removal of three or four, monitor Ca and vitamin D in diet, drink plenty of fluids, exercise regularly, don’t smoke, avoid calcium raising drugs

what are the causes of hypopituitarism

pituitary tumors, brain surgery, radiation, head trauma, infections, genetic mutations

what is happening in hypopituitarism

failure of pituitary to produce one or more hormones, reduction in the production of hormones

how will the patient present with hypopituitarism of growth hormone

growth problems, short stature, fatigue, muscle weakness, lack of ambition, social isolation

how will the patient present with hypopituitarism of ACTH

symptoms of Addisons disease

how will the patient present with hypopituitarism of TSH

hypothyroid: fatigue, weight gain, dry skin, constipation, sensitivity to cold

how will the patient present with hypopituitarism of gonadotropin (LH and FSH)

females: irregular/absence periods, infertility, decreased libido, vaginal dryness

males: ED, low testosterone, decreased libido, decreased muscle mass

how will the patient present with hypopituitarism of prolactin

impaired milk production after birth

how will the patient present with hypopituitarism of ADH

symptoms of SIADH

how will the patient present with hypopituitarism of oxytocin

impaired uterine contractions during birth and affect emotional bonding

what are the causes of hyperpituitarism

noncancerous tumors (pituitary adenoma)

what is happening in hyperpituitarism

pituitary secreting excessive amounts of certain hormones

what conditions are associated with hyperpituitarism

curshings syndrome (excessive ACTH), acromegaly (excessive GH, prolactinoma (excessive prolactin), hyperthyroidism (excessive TSH)

what are the causes of acromegaly

pituitary tumors (benign), non pituitary tumors (lungs/pancreas)

what happens in acromegaly

excess secretion of growth hormone in adults

how will the client present with acromegaly

enlarged hands and feet, changes in facial structure, skin thickens and becomes coarse or oily, excessive sweating/body oder, fatigue, joint and muscle weakness, deepened husky voice, severe snoring, vision changes, HA

what are the labs/diagnostics for acromegaly

IGF-1 measurement, growth hormone suppression test, MRI to assess for pituitary tumors

what medications are used for acromegaly

somatostatin analogues (octreotide and lanreotide), dopamine agonists (bromocruptine), growth hormone antagonist (pegvisomant)

what are the treatment options for acromegaly

radiation, transpehnoidal hypophysectomy (remove through sphenoid sinus)

what are the nursing considerations for acromegaly

monitor neuro status, monitor for CSF leak, monitor for DI and infection, pain management, monitor hormone levels, encourage deep breathing, education, emotional support

what is prolactinoma

tumor on the pituitary = too much prolactin, disrupt hormones of testes and ovaries

what occurs in women with prolactinoma

tenderness of breasts, production of breast milk, irregular periods, painful intercourse

what occurs in men with prolactinoma

ED, loss of sex drive, lower fertility, loss of energy, possible gynecomastia

what are the causes of diabetes insipidus

central DI, nephrogenic DI, dispogenic DI, gestational DI

what is happening with diabetes insipidus

problem with ADH release, fluid imbalance

how will the client present with diabetes insipidus

extreme thirst, excessive urination, nocturia, dehydration, electrolyte imbalances (increased sodium), 3-20L of urine/day, hypernatremia

how is central diabetes insipidus treated

mild=increase water intake, DDAVP (synthetic ADH), chlorpropamide (increases sensitivity of kidneys to ADH)

what is central diabetes insipidus

hypothalamus/pituitary isn’t releasing ADH

how is nephrogenic diabetes insipidus treated

HCTZ (kidneys concentrate urine more effectively), indomethacin (NSAID- help kidneys respond to ADH)

what are the nursing considerations for diabetes insipidus

monitor fluid balance, strict I&O, monitor urine characteristics, dry mouth, hypotension, tachycardia, electrolyte imbalance

what are the causes of SIADH

head trauma, stroke, meningitis, lung diseases, lung cancer, medications, surgery, HIV/AIDS

how will the client present with SIADH

hyponatremia (so much blood volume-fluid balance changed), fluid overload (hyperconcentrated urine), low urine output

how is SIADH diagnosed

BMP, serum sodium levels (<135), high urine osmolaririty, high urine sodium, chest X ray/CT

what are the treatments and medications for SIADH

limit fluid, hypertonic saline 3%, demeclocyline, vasopressin receptor antagonists

what are the complications of SIADH

acute hyponatremia leading to decreased consciousness, hallucinations or coma, brain herniation, death

what hormones are released from the adrenal gland

cortisol (stress hormone), aldosterone (fluid balance), DHEA, androgen/estrogen, adrenaline (epi and norepi)

what are the causes of Addisons disease

autoimmune disorders, infections, cancer, genetic factors, TB

what is happening in Addisons disease

hypofunction of the adrenal glands aka adrenal insufficiency, failure to produce cortisol and aldosterone, body keeps producing ACTH to stimulate, adrenals unresponsive

how will the client present with Addisons disease

fatigue, weight loss, decreased appetite, darker skin, hypotensive, syncope, salt cravings, hypoglycemia, N/V/D, muscle/joint pain, irritability, depression

what is the glucocorticoid cortisol involved in

energy metabolism-increasing glucose production and fat breakdown, regulation of immune response-reduces inflammation and immune activity, coping with stress-supports bodys stress response by making energy available, maintenance of homeostasis-influence on other hormones and body systems

what medications are used for Addisons disease

hydrocortisone, prednisone, methylprednisone, fludrocortisome acetate (synthetic aldosterone), salt

how are medications given with Addisons disease

higher dose in morning, taper throughout the day. increase meds with stress

what are the symptoms of an addiosnian crisis

severe weakness/fatigue, hypotension, severe dehydration, abdominal pain, N/V/D, confusion, disorientation, LOC, hypoglycemia, hyponatremia, hyperkalemia, fever; life threatening, body begins to shut down in 30 min (shock/coma/death)

what is the emergent care required for an addisonian crisis

IV corticosteroids, normal saline, electrolyte management, antibiotics for infection