Alteration in Endocrine System

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    18-Nov-2014

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<p>Medical-Surgical Nursing Ailyn Pineda</p> <p> Review</p> <p>of the Anatomy and Physiology of the endocrine glands Review of the Common Laboratory procedures Review of the Common endocrine disorders Review of Diabetes Mellitus</p> <p>The</p> <p>endocrine system is composed of ductless glands that release their hormones directly into the bloodstream</p> <p>The</p> <p>Hypothalamus controls most of the endocrinal activity of the pituitary gland</p> <p>The</p> <p>pituitary gland controls most of the activities of the other endocrine glands</p> <p>Hypothalamus Pituitary Gland Endocrine gland Increased Hormones</p> <p>The Hypothalamus This part of the DIENCEPHALON is located below the thalamus and is connected to the pituitary gland by a stalk</p> <p>Secretes</p> <p>RELEASING HORMONES for the pituitary glandReleasing hormones= hypothalamus</p> <p>Secretes</p> <p>OXYTOCIN that is stored in the Posterior pituitary gland</p> <p>Secretes</p> <p>Anti-Diuretic Hormone or VASOPRESSIN that is stored also in the posterior pituitary gland</p> <p>The Pituitary Gland Is a gland located below the hypothalamus at the base of the brain</p> <p>The Pituitary Gland The optic chiasm passes over this structure</p> <p>The Pituitary Gland</p> <p>Is</p> <p>divided into two parts- the anterior or adenohypophysis and the posterior or the neurohypophysis</p> <p>Secretes the following hormones: 1. Growth hormone 2. Prolactin</p> <p>Secretes the following hormones: 3.</p> <p>Gonadotrophins- LH and FSH 4. Stimulating hormones and trophic hormones ACTH TSH MSH</p> <p>Stores and releases 1. OXYTOCIN 2. ADH/Vasopressin</p> <p>The THYROID gland Located in the anterior neck lateral to the trachea</p> <p>The THYROID gland Contains two lobes connected by the isthmus Microscopically composed of thyroid follicles where the hormones are produced and stored</p> <p> Produces</p> <p>the thyroid hormones by the thyroid follicles: 1. Tri-iodothyronine or T3 2. Tetra-iodothyronine or thyroxine or T4</p> <p>The</p> <p>Parafollicular cells secrete CALCITONIN</p> <p>The PARAthyroid glands Located at the back of the thyroid glands Four in number</p> <p> Secretes</p> <p>PARATHYROID hormone (PTH) that controls calcium and phosphorus levels PTH is stimulated by a DECREASED Calcium level</p> <p>Parathyroid Hormone Calcitonin is is released in stimulated by HYPOCALCEMIA HYPERCALCEMIA</p> <p>Parathyroid hormone Calcitonin is inhibited is NOT secreted in by HYPOCALCEMIA HYPERCALCEMIA</p> <p>The Adrenal Glands Located above the kidneys Composed of two parts- the outer Adrenal Cortex and the inner Adrenal medulla</p> <p>Secretes</p> <p>three types of STEROID hormones 1. Glucocorticoids- like Cortisol, cortisone and corticosterone</p> <p> Secretes</p> <p>three types of STEROID hormones 2. Mineralocorticoids- like Aldosterone 3. Sex hormones- like estrogen and testosterone</p> <p> Essentially</p> <p>a part of the SYMPATHETIC autonomic system Secretes Adrenergic Hormones: 1. Epinephrine 2. Nor-epinephrine</p> <p>The Pancreas This retroperitoneal organ has both endocrine and exocrine functions</p> <p>The Pancreas The endocrine function resides in the ISLETS of Langerhans The islets have three types of cells- alpha, beta and delta cells</p> <p> The</p> <p>ALPHA cells secrete GLUCAGON The BETA cells secrete INSULIN The DELTA cells secrete SOMATOSTATIN</p> <p>The GONADS- Ovaries These two almond-shaped glands are found in the pelvic cavity attached to the uterus by the ovarian ligament</p> <p>The GONADS- Testes These two oval-shaped glands are found in the scrotum</p> <p>The</p> <p>Ovaries contains Granulosa and Theca cells which secrete ESTROGEN and Progesterone</p> <p>The</p> <p>testes contains Leydig cells that secrete Testosterone</p> <p>COMMON LABORATORY PROCEDURES</p> <p>Hormone Levels Assay These are blood examinations for the levels of individual hormones</p> <p>Hormone Levels Assay Measurements can also be done after stimulation and suppression of the secretions- Stimulation and Suppression tests</p> <p>Hormone Levels of T3/T4 Usually done to diagnose hypo/hyperthyroidism</p> <p>Hormone Levels of T3/T4 If T3 is elevated, T4 is elevated and TSH is depressed Primary HYPERthyroidism</p> <p>Hormone Levels of T3/T4 If T3 is depressed,T4 is depressed and TSH is elevated Primary HYPOthyoidism</p> <p>Radio-Active iodine uptake (RAI) This is a thyroid function test to measure the absorption of the injected iodine isotope by the thyroid tissue</p> <p>Radio-Active iodine uptake (RAI) Increased uptake may indicate HYPERfunctioning gland Decreased uptake my indicate HYPOfunctioning gland</p> <p>Thyroid Scan Performed to identify nodules or growth in the thyroid gland RAI is used</p> <p>Thyroid Scan Pretest- Check for pregnancy, Thyroid medication may be withheld temporarily, advise NPO Post-test- Ensure proper disposal of body wastes</p> <p>The BMR has a long history in the evaluation of thyroid function. It measures the oxygen consumption under basal conditions of overnight fast and rest from mental and physical exertion. it can be estimated from the oxygen consumed over a timed interval by analysis of samples of expired air</p> <p>BMR The test indirectly measures metabolic energy expenditure or heat production. Results are expressed as the percentage of deviation from normal after appropriate corrections have been made for age, sex, and body surface area.</p> <p>Low values are suggestive of hypothyroidism, and high values reflect thyrotoxicosis.</p> <p>FASTING BLOOD GLUCOSE Aids in the diagnosis of Diabetes Pre-test: NPO for 8 hours Normal FBS- 80-109 mg/dL DM- 126 mg/dL and above</p> <p>GLUCOSE tolerance test Aids in the diagnosis of DM Pre-test: Provide highcarbohydrate foods x 3 days, instruct to avoid caffeine, alcohol and smoking, NPO 10 hours prior to test</p> <p>GLUCOSE tolerance test Post-test: avoid strenuous activity for 8 hours Normal OGTT- 1 and 2 hours post-prandialglucose is less than 200 mg/dL</p> <p>Glycosylated Hemoglobin A 1C Blood glucose bound to RBC hemoglobin Reflects how well blood glucose is controlled for the past 3 months FASTING is NOT required!</p> <p>Glycosylated Hemoglobin A 1-C Normal level- expressed as percentage of total hemoglobin N- 4-7% Good control- 7.5%or less Fair control- 7.5 % to 8.9% Poor control- 9% and above</p> <p>Disorders are generally grouped into: 1. HYPER- when the gland secretes excessive hormones 2. HYPO- when the gland does not secrete enough hormones</p> <p> Hyper</p> <p>and Hypo can be classified as PRIMARY when the Gland itself is the problem or SECONDARY when the pituitary or the hypothalamus is causing the problem</p> <p>PITUITARY GLAND</p> <p>HYPOPITUITARISM Hyposecretion of the anterior pituitary gland CAUSES: Congenital, Postpartal necrosis, infection and tumor</p> <p>HYPOPITUITARISM PATHOPHYSIOLOGY: Depends on the major hormone/s depleted</p> <p>Hypopituitarism: ASSESSMENT Findings 1. Retarded physical growth due to decreased GH dwarfism 2. Low intellectual development 3. poor development of secondary sexual characteristics</p> <p>NURSING INTERVENTIONS 1. Provide emotional support to the family 2. Encourage client and family to express feelings 3. Administer prescribed hormonal replacement therapy</p> <p>HYPERPITUITARISM The hyper-secretion of the gland ACROMEGALY CAUSES: tumor, congenital disorder</p> <p>HYPERPITUITARISM PATHOPHYSIOLOGY Depends on the hormone/s that is/are increased</p> <p> ASSESSMENT</p> <p>FINDINGS for Hyper-pituitarism 1. Increased growth Gigantism or Acromegaly 2. large and thick hands and feet</p> <p> ASSESSMENT</p> <p>FINDINGS for Hyper-pituitarism 3. Visual disturbances 4. Hypertension, hyperglycemia 5. Organomegaly</p> <p> NURSING</p> <p>INTERVENTIONS 1. Provide emotional support to clients and family 2. Provide frequent skin care 3. Prepare patient for surgeryremoval of pituitary gland</p> <p> NURSING</p> <p>INTERVENTIONS Post-operative care 1. Monitor VS, LOC and neurologic status 2. Place patient on Semi-Fowlers</p> <p> NURSING</p> <p>INTERVENTIONS Post-operative care 3. Monitor for Increased ICP, bleeding, CSF leakage 4. Instruct patient to AVOID sneezing, coughing and noseblowing</p> <p> NURSING</p> <p>INTERVENTIONS Post-operative care 5. Monitor development of DImeasure I and O 6. Administer prescribed medications- antibiotics, analgesics and steroids</p> <p>DIABETES INSIPIDUS A hypo-secretion of ADH CAUSES: Conditions that increase ICP, Surgical removal of post pit. tumor</p> <p>DIABETES INSIPIDUS PATHOPHYSIOLOGY Decreased ADH failure of tubular re-absorption of water increased urine volume</p> <p>ASSESSMENT</p> <p>findings 1. Polyuria of more than 4 liters of urine/day 2. Polydipsia</p> <p> ASSESSMENT</p> <p>findings 3. Signs of Dehydration 4. Muscle pain and weakness 5. Postural hypotension and tachycardia</p> <p>DIAGNOSTIC TEST 1. Urinary Specific gravity very low, 1.006 or less 2. Serum Sodium levels high</p> <p>NURSING INTERVENTIONS 1.Monitor VS, neurologic status and cardiovascular status 2. Monitor Intake and Output 3. Monitor urine specific gravity</p> <p>NURSING INTERVENTIONS 4. Provide adequate fluids 5. Administer Chlorpropamide or Clofibrate as prescribed to increase the action of ADH if decreased</p> <p>NURSING INTERVENTIONS 6. Administer VASOPRESIN. Desmopressin or Lypressin are given intranasal. Pitressin is given IM</p> <p>SIADH Hyper-secretion of ADH abnormally CAUSES: tumor, paraneoplastic syndromes</p> <p>SIADH PATHOPHYSIOLOGY Increased ADH water re-absorption water intoxication, hypervolemia</p> <p>DIAGNOSTIC TEST for SIADH 1. Urine specific gravity is increased (concentrated) 2. Hyponatremia 3. CBC shows hemodilution</p> <p>ASSESSMENT findings 1. Signs of Hypervolemia 2. Mental status changes 3. Abnormal weight gain</p> <p>ASSESSMENT findings 4. Hypertension 5. Anorexia, Nausea and Vomiting 6. HYPOnatremia</p> <p>NURSING INTERVENTIONS 1. Monitor VS and neurologic status 2. Provide safe environment 3. Restrict fluid intake (less than 500cc/day)</p> <p>NURSING INTERVENTIONS 4. Monitor I and O and daily weight 5. Administer Diuretics and IVF carefully 6. Administer prescribed Demeclocycline to inhibit action of ADH in the kidney</p> <p>ADRENAL GLAND</p> <p>Hypo-secretion: ADDISONS Disease Decreased secretion of adrenal cortex hormones, especially glucocorticoids and mineralocorticoids CAUSE: tumor, idopathic</p> <p>PATHOPHYSIOLOGY Decreased Glucocorticoids decreased resistance to stress</p> <p>PATHOPHYSIOLOGY Decreased mineralocorticoids decreased retention of sodium and water Hypovolemia</p> <p>Normal functions of Cortisol</p> <p>HYPO functions HYPOGLYCEMIA</p> <p>1. Gluconeogenesis</p> <p>Functions of Mineralocorticoids</p> <p>HYPO functions</p> <p>1. Sodium Retention HYPOnatremia 2.Secondary water HYPOvolemaretention HYPOtension Weight LOSS 3. Potassium excretion Function of androgen: Libido HYPERKALEMIA Decreased libido</p> <p>ASSESSMENT Findings for Addisons disease 1. Weight loss 2. GI disturbances 3. Muscle weakness, lethargy and fatigue 4. Hyponatremia</p> <p>ASSESSMENT Findings for Addisons disease 5. Hyperkalemia 6. Hypoglycemia 7. dehydration and hypovolemia 8. Increased skin pigmentation</p> <p> NURSING</p> <p>INTERVENTIONS 1. Monitor VS especially BP 2. Monitor weight and I and O 3. Monitor blood glucose level and K 4. Administer hormonal agents as prescribed</p> <p> NURSING</p> <p>INTERVENTIONS 5. Observe for ADDISONIAN crisis 6. Educate the client regarding lifelong treatment, avoidance of strenuous activities, stress and seeking prompt consult during illness</p> <p>NURSING INTERVENTIONS7.</p> <p>Provide a high-protein, high carbohydrate and increased sodium intake</p> <p>ADDISONIAN crisis A life-threatening disorders caused by acute severe adrenal insufficiency CAUSES: Severe stress, infection, trauma or surgery</p> <p>ADDISONIAN crisis PATHOPHYSIOLOGY Overwhelming stimuli mobilize body defense decreased stress hormones inadequate coping</p> <p>ASSESSMENT Findings for Addisonian Crisis= severe lahat 1. Severe headache 2. Severe pain 3. Severe weakness 4. Severe hypotension 5. Signs of Shock</p> <p>NURSING INTERVENTIONS 1. Administer IV glucocorticoids, usually hydrocortisone 2. Monitor VS frequently 3. Monitor I and O, neurological status, electrolyte imbalances and blood glucose</p> <p>NURSING INTERVENTIONS 4. Administer IVF 5. Maintain bed rest 6. Administer prescribed antibiotics</p> <p>Hyper-secretion: CUSHINGS DISEASE A condition resulting from the hypersecretion of glucocorticoids from the adrenal cortex CAUSES: Pituitary tumor, adrenal tumor, abuse of steroids</p> <p>Hyper-secretion: CUSHINGS DISEASE PATHOPHYSIOLOGY Increased Glucocorticoids exaggerated effects of the hormone</p> <p>Normal functions of Cortisol</p> <p>Exaggerated functions</p> <p>1. Gluconeogenesis HYPERGLYCEMIA 2. Protein breakdown OSTEOPOROSISS, delayed wound healing Purplish striae , Bleeding Muscle wasting 3. Fat breakdown THIN extremity, Truncal deposition</p> <p>Functions of Mineralocorticoids</p> <p>Exaggerated functions Hypernatremia HypervolemaHypertension HYPOKALEMIA HIRSUTISM</p> <p>1. Sodium Retention 2.Secondary water retention 3. Potassium excretion Function of androgen: Hair growth</p> <p>ASSESSMENT FINDINGS for Cushing 1. Generalized muscle weakness and wasting 2. Truncal obesity</p> <p>ASSESSMENT FINDINGS for Cushing 3. Moon-face 4. Buffalo hump 5. Easy bruisability</p> <p>ASSESSMENT FINDINGS for Cushing 6. Reddish-purplish striae on the abdomen and thighs 7. Hirsutism and acne 8. Hypertension</p> <p>ASSESSMENT FINDINGS for Cushing 9. Hyperglycemia 10. Osteoporosis 11. Amenorrhea</p> <p>DIAGNOSTIC</p> <p>TESTS 1. Serum cortisol level 2. Serum glucose and electrolytes</p> <p> NURSING</p> <p>INTERVENTIONS 1. Monitor I and O , weight and VS 2. Monitor laboratory values- glucose, Na, K and Ca</p> <p> NURSING</p> <p>INTERVENTIONS 3. Provide meticulous skin care 4. Administer prescribed medications like aminogluthetimide to inhibit adrenal hyperfunctioning</p> <p> NURSING</p> <p>INTERVENTIONS 5. Prepare client for surgical managementpituitary surgery and adrenalectomy 6. Protect patient from infection</p> <p> NURSING</p> <p>INTERVENTIONS 7. Improve body image 8. Provide a LOW carbohydrate, LOW sodium and HIGH protein diet</p> <p>Hyper-secretion: CONNS DISEASE Hyper-secretion of Aldosterone from the adrenal cortex CAUSES: pituitary tumor, adrenal tumor</p> <p>Hypersecretion: CONNS DISEASE PATHOPHYSIOLOGY Increased Aldosterone exaggerated effects</p> <p>ASSESSMENT findings in CONNS disease 1. Symptoms of HYPOkalemia 2. Hypertension 3. Hypernatremia</p> <p>ASSESSMENT findings in CONNS disease 4. Headache, N/V 5. Visual changes 6. Muscles weakness, fatigue and nocturia</p> <p>DIAGNOSTIC TEST 1. Urine gravity- low (due to polyuria) 2. Serum Sodium- high 3. Serum Potassium- very low 4. Increased urinary Aldosterone</p> <p> NURSING</p> <p>INTERVENTIONS 1. Monitor VS, I and O and urine sp gravity 2. Monitor serum K and Na 3. Provide Potassium rich foods and supplements</p> <p>NURSING</p> <p>INTERVENTIONS 4. Administer prescribed diuretic- Spironolactone 5. Maintain sodiumrestricted diet</p> <p>NURSING</p> <p>INTERVENTIONS 6. Prepare patient for possible surgical interventions</p> <p>Hyper-secretion: Pheochromocytoma Increased secretion of epinephrine and nor-epinephrine by the adrenal medulla CAUSE: tumor</p> <p>Hypersecretion: Pheochromocytoma PATHOPHYSIOLOGY Increased Adrenergic hormones exaggerated sympathetic effects</p> <p>ASSESSMENT Findings in Pheochromocytoma 1. Hypertension 2. S...</p>

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