Chapter050

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 50: Caring for Clients with Disorders of the Endocrine System


Acromegaly (Hyperpituitarism) Acromegaly (Hyperpituitarism) • Pathophysiology and Etiology: Oversecretion of GH

due to hyperplasia

– Gigantism: Oversecretion of GH before puberty

– Dwarfism: Insufficient GH during childhood

– Acromegaly: Oversecretion of GH during adulthood

• Assessment Findings: Signs and Symptoms

– Coarse features; Huge lower jaw, thick lips, thickened tongue, bulging forehead

– Bulbous nose, large hands and feet

– Enlarged organs; Muscle weakness


QuestionQuestion

Is the following statement true or false?

Acromegaly is caused by oversecretion of GH before puberty.


AnswerAnswer

False.

Acromegaly is caused by oversecretion of GH during adulthood. Gigantism is caused by oversecretion of GH before puberty.


Acromegaly (Hyperpituitarism) Acromegaly (Hyperpituitarism) • Assessment Findings: Diagnostic Findings

– GH level; Glucose tolerance test

• Medical and Surgical Management

– Surgery; Hormone therapy; Drug therapy

• Nursing Management

– Psychological support; Pacing activities

– Pain relief; Self-care; Postoperative care


Simmonds’ Disease (Panhypopituitarism) Simmonds’ Disease (Panhypopituitarism) • Pathophysiology and Etiology

– Anterior pituitary hormone activity stops


– Hypothyroidism, hypoglycemia, adrenal insufficiency; Gonads and genitalia atrophy; Premature aging; Cachexia

• Medical Management

– Substitute hormones

• Nursing Management: Client Teaching

– Adherence: Medication schedule; Monitor: Blood hormone level


QuestionQuestion

Is the following statement true or false?

A sign of panhypopituitarism is premature aging.


AnswerAnswer

True.

A sign of panhypopituitarism is premature aging. Also included in the signs and symptoms are hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, and cachexia.


Diabetes Insipidus Diabetes Insipidus • Pathophysiology and Etiology

– Role of ADH; Neurogenic, nephrogenic DI


• Polyuria; Weight loss; Thirst; Weakness; Dehydration

• Diagnostic Findings: Fluid deprivation test; Urine specific gravity


– Drug therapy; IV fluids; Thiazide diuretic



Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)• Pathophysiology and Etiology: Causes of SIADH,

Hyponatremia

• Assessment Findings

– Water retention; Headaches; Muscle cramps; Anorexia

– Changes in LOC

• Diagnostic Findings: Serum, urine levels; Sodium, osmolarity levels

• Medical Management: Osmotic diuretics; IV administration



Hyperthyroidism (Graves Disease)Hyperthyroidism (Graves Disease)• Pathophysiology and Etiology: Hypersecretion of

thyroid hormones


– Restless; Agitated; Hand tremors; Diarrhea

– Increased appetite; Weight loss; Visual changes; Exophthalmos; Neck swelling

– Diagnostic findings: Serum T3, T4, TSH; Thyroid scan and ultrasonography

• Medical and Surgical Management: Antithyroid drugs; Radiation; Thyroidectomy



QuestionQuestionIs the following statement true or false?

The etiology of Graves Disease is the hyposecretion of thyroid hormones.


AnswerAnswerFalse.

The etiology of Graves Disease is the hypersecretion of thyroid hormones.


Thyrotoxic Crisis (Thyroid Storm)Thyrotoxic Crisis (Thyroid Storm)• Pathophysiology and Etiology: Triggering factors; T3,

T4 oversecretion; Epinephrine release


– High temperature; Rapid pulse; Dyspnea

– Cardiac dysrhythmias; Vomiting; Delirium

– Hyperthyroidism history; Laboratory tests


– Immediate treatment; Antithyroid drugs; IV treatment



Hypothyroidism Hypothyroidism • Pathophysiology and Etiology

– Inadequate thyroid hormone secretion: Myxedema


– Slow metabolic rate; Lethargy; Weight gain; Dry skin; Menstrual disorders

– Enlarged heart; Atherosclerosis; Anemia

– Diagnostic findings: Serum TSH, T3, T4; FT4; RAI uptake

• Medical Management: Thyroid replacement therapy



Thyroid Tumors Thyroid Tumors • Pathophysiology and Etiology

– Follicular adenoma; Papillary carcinoma


– Nodular thyroid; Hoarseness; Swallowing difficulty; Biopsy; Physical examination


– Thyroidectomy; HRT; Radiation


– Emotional support; Handling body fluids

– RAI: Postoperative; Radiation precautions


Endemic and Multinodular Goiters Endemic and Multinodular Goiters • Pathophysiology and Etiology

– Iodine deficiency; Goitrogenic foods


– Enlarged thyroid gland; Difficulty swallowing; Thyroid scan


– Foods high in iodine; Potassium iodide; Thyroidectomy


– Monitor for and relieve respiratory symptoms; Provide appropriate diet


Thyroiditis Thyroiditis

• Pathophysiology and Etiology

– Types: Acute; Subacute; Hashimoto’s


– High fever, malaise, and swollen

– Tender thyroid gland

– Diagnostic findings: Thyroid scan; Lab tests


– Antibiotics; Analgesics; Corticosteroids; Thyroid HRT; Surgery



Hyperparathyroidism Hyperparathyroidism


– Primary or secondary condition

– Primary: Adenoma; Increased secretions of PTH

– Secondary: Increased secretions in response to hypocalcemia


– Fatigue; Hypotonic muscles

– Skeletal tenderness and pain

– Cardiac dysrhythmias


Hyperparathyroidism Hyperparathyroidism • Assessment Findings: Diagnostic Findings

– Laboratory tests; MRI; CT scan


– Sodium, phosphorus replacements; Surgery


– Monitor I and O; Urinary calculi; Self-care; Safe environment

– Encourage fluid intake

– Provide postoperative care

– Client education: Effects of disease; Adherence to treatment


Hypoparathyroidism Hypoparathyroidism • Pathophysiology and Etiology

– Deficiency of parathormone; Trauma to the glands; Hypocalcemia


– Tetany; Chvostek’s and Trousseau’s signs; Laryngeal spasm

• Assessment Findings: Diagnostic Findings

– Serum: Calcium and phosphorus; Radiographs

• Medical Management: IV calcium salt; Endotracheal intubation; Mechanical ventilation; Oral calcium



Adrenal Insufficiency (Addison’s Disease)Adrenal Insufficiency (Addison’s Disease)


– Primary: Destruction of adrenal cortex

– Secondary: Surgical removal, hemorrhagic infarction, hypopituitarism, medications


• Assessment Findings: Diagnostic Findings

– Laboratory tests; Radiographs; CT scan


– Daily corticosteroid replacement therapy



Acute Adrenal Crisis (Addisonian Crisis)Acute Adrenal Crisis (Addisonian Crisis)• Pathophysiology and Etiology

– Abnormal stress; Trauma; Salt deprivation


– Anorexia; Vomiting; Diarrhea; Abdominal pain; Hypotension; Fever

– Diagnosis: Symptoms; History


– Corticosteroids; Antibiotics



Pheochromocytoma Pheochromocytoma • Pathophysiology and Etiology

– Benign tumor

– Excessive catecholamine secretion

• Epinephrine and norepinephrine

• Assessment Findings: Elevated BP; Tremors; Hyperglycemia; Polyuria ; Vertigo, headache, N/V

• Diagnostic Findings: 24-hour urine; CT; MRI; Ultrasonography; Retrograde pyelography

• Medical, Surgical Management: Unilateral adrenalectomy; Drug therapy



Cushing’s SyndromeCushing’s Syndrome• Pathophysiology and Etiology: Excess ACTH;

Tumors; Corticosteroids


– Cushingoid syndrome; Muscle wasting

– Moon face; Buffalo hump; Wounds; Masculinization; Kyphosis

– Diagnostic findings: Dexamethasone suppression test; 24-hour urine; Blood test; Radiographs; IV pyelogram; CT; MRI

• Medical and Surgical Management : Radiation; Drug therapy; Surgery



Hyperaldosteronism Hyperaldosteronism • Pathophysiology and Etiology

– Aldosterone: Secreting adenoma


– Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension

– Laboratory tests; CT; MRI; Adrenal venography


– Unilateral adrenalectomy

– Drug therapy; Diet therapy



End of Presentation

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