System Disorders

Risk Factors of Osteoporosis

• Female

• White/Asian

• >50 years old

• Malnutrition (decreased calcium and vitamin D)

• Caffeine

• Smoking

• Alcohol

• Sedentary lifestyle

Expected Findings of Osteoporosis

• Decreased bone density

• Back pain

• Restricted movement

• Bone fractures

Laboratory Tests of Osteoporosis

• Calcium

• Vitamin D

• Phosphorus

Diagnostic Procedures of Osteoporosis

• Bone density test

• X-ray

Safety Consideration of Osteoporosis

Falls

Health Promotion of Osteoporosis

Calcium and vitamin D intake

Nursing Care of Osteoporosis

Diet:

• Increase calcium and vitamin D intake

Client Education of Osteoporosis

• Weight bearing activities

• Foods high in calcium (milk, dairy, green leafy vegetables, cereals, breads)

• Decrease caffeine

• Avoid alcohol

Medications for Osteoporosis

• Calcium

• Vitamin D

• Calcitonin

• Bisphosphonate-alendronate

Prototype of Bisphosphonate for Osteoporosis

Alendronate

Complications of Osteoporosis

Fractures

Other name for Addison’s Disease

Adrenocortical insufficiency

Pathophysiology of Addison’s Disease

• Decreased glucocorticoids (cortisol, stress hormone)

• Decreased mineralocorticoids (aldosterone, saves salt and water, gets rid of potassium)

Risk Factors of Addison’s Disease

• Autoimmune

• Adrenalectomy (surgical removal of one or both adrenal glands)

• Cancer, radiation (treatment that uses high energy rays to destroy cancer cells)

Expected Findings of Addison’s Disease

• Weight loss

• Salt cravings

• Hyperpigmentation of skin

• Weakness/fatigue

• Anorexia

• Nausea/vomiting

• Decreased volume (reduced amount of fluid in the body)

Laboratory Tests of Addison’s Disease

• Decreased sodium

• Increased potassium

• Decreased glucose

• BUN/creatinine

Diagnostic Procedures of Addison’s Disease

• X-ray

• CT

• MRI

Safety Consideration of Addison’s Disease

Skin (hyperpigmentation)

Nursing Care of Addison’s Disease

• Monitor kidney function

• I&O

• Electrolytes (sodium/potassium)

• Glucose

• Postural hypotension

• Treat increased potassium

Medications for Addison’s Disease

• Hydrocortisone

• Prednisone

• Cortisone

• Fludrocortisone

Client Education of Addison’s Disease

• Decrease caffeine and alcohol

Complications of Addison’s Disease

• Circulatory collapse/shock

• Addisonian crisis (life threatening emergency, extremely low cortisol levels)

Findings of Addisonian Crisis

• Decreased volume

• Decreased blood glucose

• Increased potassium

Addison’s Disease

• Damaged adrenal glands fail to produce sufficient cortisol and aldosterone

• Signs and symptoms:

  • Hyperkalemia

  • Hypoglycemia

  • Lethargy

  • Muscle weakness

Treatment of Addisonian Crisis

• Fluids

• Dextrose

• Insulin (to treat increased potassium)

Pathophysiology of Cushing’s

• Increased cortisol

• Pituitary tumor

• Hyperplasia (excessive cell growth) of the adrenal cortex

Risk Factors of Cushing’s

Females 20-40 years old

Expected Findings of Cushing’s

• Rounded face (moon face)

• Increased weight

• Buffalo hump

• Fatigue

• Muscle weakness

• Sleep disturbances

• Menstrual cycle changes

• Decreased immunity (weakened immune system)

• Emotional instability

Laboratory Tests of Cushing’s

• Increased cortisol

• Increased blood glucose

• Increased sodium

• Increased ACTH

• Decreased potassium

• Decreased lymphocytes (WBCs)

Diagnostic Procedures of Cushing’s

• X-ray

• MRI

• CT

Safety Consideration of Cushing’s

GI ulceration

Health Promotion of Cushing’s

Monitor blood glucose and blood pressure

Nursing Care of Cushing’s

• Monitor vital signs

• Blood glucose

• Electrolytes (sodium and potassium)

• Monitor volume (turgor, weights)

• Skin care

• Nutrition

Medications for Cushing’s

Ketoconazole (antifungal)

Interprofessional Care of Cushing’s

• Dietary

• Endocrinology (study of hormones and glands)

• Neurosurgery (surgery involving the brain, spine, and nervous system)

• PT/OT

  • PT: Helps improve movement and strength

  • OT: Helps patients perform daily activities

• Home health

Complications of Cushing’s

• Infections

• Bone fractures (osteoporosis)

• Adrenal crisis

Other Name for Hypothyroidism (Autoimmune Cause)

Hashimoto’s

Pathophysiology of Hypothyroidism

• Autoimmune

• Medications

• Loss of thyroid

Risk Factors of Hypothyroidism

• Females

• Family history

• Medications

• Decreased iodine intake

• Radiation

Expected Findings of Hypothyroidism

• Weight gain

• Hair loss

• Fatigue

• Constipation

• Hypersomnia (excessive sleepiness)

• Dry skin

• Irritable

• Cold intolerance

• Bradycardia

• Menstrual irregularities

Laboratory Tests of Hypothyroidism

• Decreased T4 (thyroid hormone that helps regulate metabolism)

• Increased TSH (tells the thyroid gland to produce T3 and T4 hormones)

Diagnostic Procedures of Hypothyroidism

• Thyroid scan

• US (ultrasound)

Safety Consideration of Hypothyroidism

CVD (cardiovascular disease)

Nursing Care of Hypothyroidism

• Vital signs (heart rate and blood pressure)

• Monitor weight

• Stool softeners

• High fiber/fluids

Medication for Hypothyroidism

Levothyroxine

Nursing Considerations/Teaching of Levothyroxine

• Take first thing in the morning with water

• Takes time to work

• Frequent lab draws

• Stay on the same formula

Interprofessional Care of Hypothyroidism

Dietary

Complications of Hypothyroidism

Myxedema coma (life threatening emergency, severe hypothyroidism [extremely low thyroid hormones])

Findings of Hypothyroidism

• Respiratory failure

• Decreased heart rate

• Decreased blood pressure

• Decreased sodium

• Decreased glucose

• Hypothermia (abnormally low body temperature)

Pathophysiology of Hyperthyroidism

• Increased T4

• Grave’s disease (causes thyroid to produce too much thyroid)

• Extra exogenous T4 (taking too much thyroid medication)

Risk Factors of Hyperthyroidism

• Female

• Family history

Expected Findings of Hyperthyroidism

• Hunger

• Heat intolerance

• Weight loss

• Irritable

• Tachycardia

• Insomnia

• Sweaty

• Goiter (abnormal enlargement of thyroid gland, swelling in the neck)

• Exophthalmos (bulging, protruding eyes)

• Increased stools

• Thinning hair

Laboratory Tests of Hyperthyroidism

• Decreased TSH

• Increased T4

Diagnostic Procedures of Hyperthyroidism

• US

• Palpation

• Thyroid scans

Nursing Care of Hyperthyroidism

• Daily weights

• Take replacement hormone

• Limit activity

• Monitor electrolytes (related to GI losses from vomiting/diarrhea)

• Vital signs

• EKG (measure heart’s electrical activity)

• Nutrition

Medications for Hyperthyroidism

• Methimazole

• PTU (propylthiouracil)

• Radioactive iodine

Adverse Effects of Methimazole/PTU

• Decreased WBC

• Decreased platelets

• Hepatotoxic

Client Education of Methimazole/PTU

• Report fever and infection

• Signs and symptoms of hyperthyroidism

Interprofessional Care of Hyperthyroidism

Nutrition

Complications of Hyperthyroidism

• Thyroid storm (life threatening emergency, extremely high thyroid hormone activity)

• Heat damage (body become overheated)

Pathophysiology of Diabetes Insipidus (DI)

• Decreased ADH (antidiuretic hormone)

• Decreased ability of the kidneys to concentrate urine

Risk Factors of Diabetes Insipidus (DI)

• Kidney disease

• TBI (traumatic brain injury)

• Tumor

Expected Findings of Diabetes Insipidus (DI)

• Increased urine output

• Increase thirst

• Increased fluid intake

• Diluted urine

• Increased heart rate

• Decreased blood pressure

• Dehydration

• Decreased weight

Urine Labs of Diabetes Insipidus (DI)

• Decreased urine specific gravity (diluted urine)

• Decreased osmolality

• Decreased sodium and potassium

Blood Labs of Diabetes Insipidus (DI)

• Increased osmolality (blood becomes more concentrated)

• Increased sodium

• Increased potassium

Nursing Care of Diabetes Insipidus (DI)

• I&O

• Weights

• Vital signs

• Hydrated

• Diet

• Neuro status

• Manage fluids and electrolytes

Medications for Diabetes Insipidus (DI)

• Desmopressin (DDAVP)

• Vasopressin

Therapeutic Procedures of Diabetes Insipidus (DI)

None

Interprofessional Care of Diabetes Insipidus (DI)

Dietary

Adverse Effects of Desmopressin/Vasopressin

• Fluid overload

• Decreased urine output

• Decreased serum osmolality (blood is more diluted)

• Decreased serum sodium (low sodium levels in blood)

Complications of Diabetes Insipidus (DI)

• Dehydration

• Increased osmolality

• Increased sodium

• Circulatory collapse

• Seizures