NUR3190 Endocrine System

What are three (3) major hormones that are produced in the Anterior Pituitary?

(1) Growth hormone, (2) TSH, and (3) ACTH.

What does Growth Hormone (GH) do?

Stimulates growth in tissue and bone.

What is the name for a deficiency of GH?

Dwarfism.

What is one (1) Tx for Dwarfism?

(1) Somatropin.

What are two (2) nursing considerations for Somatropin?

(1) Monitor glucose everyday, (2) Monitor height once every month.

What are two (2) names for an excess of GH?

(1) Gigantism, (2) Acromegaly.

True or False?

Gigantism = Before puberty.

Acromegaly = After puberty.

True.

What are two (2) Tx for Gigantism and Acromegaly?

(1) Octreotide, (2) Bromocriptine.

What is one (1) Tx for a deficiency of TSH?

(1) Thyrotropin.

What are two (2) Tx for a deficiency of ACTH?

(1) Cosyntropin, (2) Corticotropin.

What is one (1) major hormone that is produced in the Posterior Pituitary?

(1) ADH.

What is the Fx of ADH?

ADH promotes water reabsorption from renal tubules to maintain water balance in body fluids.

(causes body to hold onto water)

What is the name for a deficiency of ADH?

Diabetes Insipidus.

What are two (2) manifestations/symptoms of Diabetes Insipidus?

(1) FVD: Hypotension, Tachycardia, etc, (2) Massive fluid loss.

What are three (3) Tx/nursing considerations for Diabetes Insipidus?

(1) Vasopressin, (2) Desmopressin acetate (DDAVP), (3) Monitor fluids and elctrolytes.

What is the name for an excess of ADH?

SIADH.

What are two (2) manifestations/symptoms of SIADH?

(1) FVE, Massive fluid overload.

What are five (5) Tx/nursing considerations for SIADH?

(1) Hypertonic solution, (2) Demeclocycline, (3) Conivaptan, (4) Tolvaptan, and (5) Fluid restriction.

What are three (3) major hormones that are produced in the Thyroid Gland?

(1) Triiodothyronine (T3), (2) Thyroxine (T4), and (3) Calcitonin.

What is the Fx of the Thyroid Gland?

Regulate metabolism and calcium.

What are five (5) names for a deficiency of thyroid hormones?

(1) Hypothyroidism, (2) Hashimoto, (3) Myxedema, (4) Myxedema Coma, and (5) Cretinism.

What is Hashimoto?

Autoimmune Disorder where antibodies destroy thyroid tissue.

What is Myxedema?

Iodine deficiency (lack of seaweed, shellfish, etc).

What is Myxedema Coma?

Severe, untreated, or poorly managed hypothyroidism where the body's metabolic functions slow down dangerously.

What is Cretinism?

Stunted physical growth and intellectual disability caused by a lack of thyroid hormone during fetal development or early infancy.

What are seven (7) manifestations of hypothyroidism?

(1) Fatigue, (2) Lethargy, (3) Hair Loss, (4) Decreased LOC, (5) Weight Gain, (6) Bradycardia, and (7) Dry skin.

What are three (3) Tx for hypothyroidism?

(1) Levothyroxine Sodium, (2) Liotrix, and (3) Liothyronine.

Which one (1) Tx for hypothyroidism is specifically used for Myexedma Coma?

(1) Liothyronine.

What are three (3) Fx of Levothyroxine Sodium, Liotrix, and Liothyronine?

Increases the (1) Levels of T4, (2) Metabolism, and (3) Body growth.

What are twelve (12) side effects of Levothyroxine Sodium, Liotrix, and Liothyronine?

(1) Nervousness, (2) HA, (3) Insomnia, (4) Weight loss, (5) Tremors, (6) GI distress, (7) Tachycardia, (8) HTN, (9) Dysrhythmias, (10) Palpitations, (11) Angina, and (12) Thyroid crisis.

True or False?

Levothyroxine Sodium, Liotrix, and Liothyronine may increase blood glucose and effects of anticoagulants.

True.

What are two (2) nursing considerations for Levothyroxine Sodium, Liotrix, and Liothyronine?

(1) Bone loss and osteoporosis may occur, (2) Decrease effect of anti-diabetic drugs.

What are three (3) names for an excess of thyroid hormones?

(1) Grave's (thyrotoxicosis), (2) Thyroiditis, and (3) Thyroid Crisis.

What is Grave's (thyrotoxicosis)?

Autoimmune disorder where antibodies attack and causes it to overproduce the hormone thyroxine.

What are eleven (11) manifestations of hyperthyroidism?

(1) Emotional liability, (2) Palpitations, (3) Dry/warm skin, (4) Increased sweating, (5) Increased appetite, (6) Fine hair, (7) Weight loss, (8) Hypermetabolism, (9) Hypermotile bowels, (10) Diarrhea, and (11) Exophthalmos (proptosis).

What are three (3) medical managements of hyperthyroidism?

(1) Pharmacologic Agents, (2) Radioactive Iodine therapy, and (3) Surgery.

What does Radioactive Iodine therapy do in the Tx of hyperthyroidism?

Destroys overactive thyroid cells.

What are seven (7) pharmacological agents for the Tx of hyperthyroidism?

(1) Prophylthiouracil (PTU), (2) Methimazole, (3) Sodium Iodide, (4) Potassium Iodide, (5) Radioactive Iodine, (6) Dexamethasone, and (7) Beta Blockers.

What is one (1) surgery used in the Tx of hyperthyroidism?

Total or subtotal thyroidectomy.

True or False?

PTU administered prior to surgery until signs of hyperthyroidism have disappeared.

True.

What is one (1) action of Methimazole and Propylthiouracil (PTU) for hyperthyroidism?

Control overactive thyroid due to Graves disease.

True or False?

Methimazole and Propylthiouracil (PTU) are also used prior to radioiodine treatment or thyroid surgery.

True.

True or False?

Patients should avoid shellfish if being treated for hyperthyroidism due to the iodine and

potential stimulation.

True.

Parathyroid Glands:

What is one (1) major hormone that is produced in the Parathyroid Gland?

Parathyroid Hormone (PTH).

What are three (3) Fx of PTH?

(1) Enhances Ca++ release from bones,

(2) Enhances Ca++ reabsorption in renal tubules,

(3) Enhances Ca++ absorption in intestines by increasing production of Vitamin D.

What does hypoparathyroidism look like?

Low calcium.

What are five (5) possible causes of hypoparathyroidism?

(1) parathyroid deficiency, (2) Vitamin D deficiency, (3) Renal impairment, (4) Diuretics, and (5) Thyroid damage.

What are two (2) Tx for hypoparathyroidism?

(1)  Calcium Gluconate for immediate Ca++ replacement in the blood,

(2) Calcitriol for immediate replacement of Parathyroid Hormone.

What are two (2) actions of parathyroid hormone replacement such as calcium gluconate and calcitrol?

(1) Promotion of ca++ absorption from the GI tract, (2) Promotion of secretion of calcium from bone to blood.

True or False?

Calcium Gluconate FIRST, Calcitrol SECOND.

True.

What are five (5) possible causes of hyperparathyroidism?

(1) Excess parathyroid hormone secretion, (2) Malignancies, (3) Hormone secretion from lung cancer, (4) Hyperthyroidism, and (5) Prolonged immobility.

What is one (1) Tx for hyperthyroidism?

(1) Partial or Full Parathyroidectomy.

What are three (3) short-term Tx of hyperparathyroidism to promote bone reabsorption of serum calcium?

(1) Pamidronate, Alendronate, Zoledronate.

What are two (2) long-term Tx of hyperthyroidism to stimulate parathyroid receptors?

(1) Calcitonin, (2) Calcimimetic.

What are four (4) major hormones that are produced in the Adrenal Gland?

(1) Epinephrine,

(2) Norepinephrine,

(3) Glucocorticoids such as Coritsol,

(4) Mineralcorticoids such as Aldosterone.

What is the name for Adrenal Insufficiency?

Addison's Disease.

What are two (2) Tx for Addison's Disease?

(1) Glucocorticoids, (2) Mineralcorticoids.

What is the name for an excess of hormones secreted from the Adrenal Glands?

Cushing Syndrome.

What is one (1) Tx for Cushing Syndrome?

(1) Mitotane: Inhibits glucocorticoid synthesis.

What are four (4) examples of Glucocorticoids?

(1) Hydrocortisone, (2) Prednisone, (3) Dexamethasone, and (4) Methylprednisone.

What is one (1) example of a Mineralcorticoid?

(1) Fludrocortisone.

What are four (4) nursing considerations for Glucocorticoids and Mineralcorticoids?

(1) Monitor for Tachycardia, hypertension, hyperglycemia, (2) Monitor for Edema, sodium and water retention, (3) Monitor BS, and (4) Taper off gradually.

True or False?

In the pancreas, alpha cells secrete glucagon and beta cells secrete insulin.

True.

True or False?

The liver stores and releases glycogen.

True.

True or False?

Skeletal muscle and fat are the primary sites for clearing postprandial glucose from the bloodstream.

True.

True or False?

Insulin (1) Promotes glucose uptake by cells, (2) Stimulates glycogen synthesis in liver and muscles, and (3) Inhibits glucose production by the liver.

True.

True or False?

Glucagon (1) Stimulates glycogen breakdown in the liver, and (2) Promotes gluconeogenesis.

True.

Blood Glucose Levels:

What is the normal range of a fasting blood glucose test?

< 100 mg/dL.

True or False?

If fasting blood glucose is greater than 126 on two separate occasions, patient may be diabetic.

True.

True or False?

A1C is a snapshot of blood glucose levels for 90-120

day period.

True.

What is normal range of A1C?

4% - 5.6%

What is prediabetic range of A1C?

5.7 - 6.4%

What is diabetic range of A1C?

> 6.5%

What blood glucose level indicates hypoglycemia?

< 70 mg/dL

What are four (4) nursing considerations for hypoglycemia?

(1) Know your patient, (2) Assess, (3) Tx, and (4) Evaluate.

What are two (2) Tx for hypoglycemia?

(1) Simple carbs, (2) Glucagon.

True or False?

IF Pt is able to swallow, give simple carbs.

True.

True or False?

IF Pt is NOT able to swallow, give Glucagon.

True.

What is one (1) action of Glucagon?

(1) Increase blood glucose by stimulating glycogenolysis in the liver.

What are four (4) routes of Glucagon?

(1) SQ, (2) IM, (3) IV, and (4) Intranasal.

In what scenario is Glucagon used?

Insulin-induced hypoglycemia.

ATI: **Metabolic Syndrome is a group of conditions that increase the risk of heart disease, stroke, and type II diabetes.

Conditions include HTN, hyperglycemia, hyperlipidemia, weight gain, etc.

ATI: **Metabolic Syndrome is a group of conditions that increase the risk of heart disease, stroke, and type II diabetes.

Conditions include HTN, hyperglycemia, hyperlipidemia, weight gain, etc.

What are three (3) causes of Diabetes Mellitus?

(1) Chronic disease that results from deficient glucose metabolism,

(2) Insufficient insulin secretion from beta cells,

(3) Insulin receptors unresponsive or deficient in numbers.

What are three (3) major symptoms of DM?

(1) Polyuria, (2) Polydipsia, and (3) Polyphagia.

(excessive urination, thirst and hunger)

What is Type 1: Insulin-Dependent DM?

Insufficient insulin secretion from beta cells.

What is Type 2: Non-Insulin-Dependent DM?

Pancreas functions are normal but tissues are insulin resistant.

What is Secondary DM?

Due to medications (glucocorticoids).

What is Gestational DM?

Due to hormonal changes.

True or False?

In Type I Diabetes, Insulin-producing pancreatic beta cells are destroyed by a virus or an autoimmune process and Requires Insulin.

True.

True or False?

In Type II diabetes, Insulin Resistance (>greater than 30 years old); Slow onset.

True.

What is the name of hyperglycemia in Type I DM?

DKA. (diabetic ketoacidosis)

In which "type" of DM does DKA occur?

Type I DM.

True or False?

Type I DM burns fat, causing ketones (acid) and metabolic acidosis.

True.

What are four (4) Tx for DKA?

(1) Fluids, (2) Electrolytes, (3) IV Insulin, and (4) Correct the metabolic acidosis.

What is the name of hyperglycemia in Type II DM?

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS or HHS).

True or False?

Type II DM with BS > 600 mg/dL indicates Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS or HHS).

True.

What are three (3) Tx for Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS or HHS)?

(1) Fluids, (2) IV Insulin, and (3) Correct the underlying cause.

True or False?

Control hyperglycemia to prevent/slow complications such as Neuropathy, Gastroparesis, Retinopathy, and Nephropathy. (nerve damage, stomach paralysis and eye damage)

True.