Cushings/Endocrine misc
what 2 hormones does the thyroid produce?
T3 + T4
what is addisons disease?
hypofunction of adrenal glands
Name at least 3 s/s of hyperthyroidism
Weight loss and nervousness ( earliest sx)
tachycardia, intolerance to heat, unintentional weight loss, increased appetite, palpitations, amenorrhea, insomnia
What is the main difference between hypo and hyperthyroidism?
Hyperthyroidism- excessive thyroid hormone secretion.
Hypothyroidism- decreased thyroid hormone or decreased thyroid tissue (surgical/radiation induced thyroid destruction.)
What is DI?
The body makes large amounts of urine causing fluid volume loss due to decreased production of antidiuretic hormone
Where is TSH released from?
Pituitary gland
s/s of addisions
causes?
orthostatic hypotension, electrolyte imbalance, crave salt, lethargic, weakness, N/V/D.
cancer, autoimmune ( primary) pituitary tumor, radition abrupt withdrawl of glucosteroids. ( Secondary)
what will labs look like in patient with hyperthyroidism?
T4/T3 - increased
List at least 3 s/s of hypothyroidism?
cold intolerance, decreased appetite but increased weight, constipation, hypoventilation, bradycardia, hypotension, depression, anorexia, husky voice, dry skin, lethargy.
Signs and symptoms of DI.
polyuria - 15-20L/day. polydipsia, weakness, fatigue, nocturia, hypernatremia.
dehydration, poor skin turgor, dry cracked mucus membranes, increased h/h, increased BUN.
If not fixed will result in hypovolemic shock.
What is addisons?
causes?
Excess levels of the hormones from adrenal cortex
adrenal hyperfunction, pituitary adenoma, excess steroid intake.
How it is diagnosed?
Treatment?
ACTH stimulation test
address acute needs and maintain chronic hormone replacement
NS bolus, IV steroids ( acute) then taper to PO ( chronic, treat electrolyte imbalance
treatment of hyperthyroidism
ablation therapy-radioactive iodine. precautions taken when handling needles, syringes and other equipment contaminated with blood. precautions with bedpains, urinals and specimens contaminated with urine
methimazole, mild sedatives.
how is hypothyroidism dx? what will lab results look like?
T3/T4- decreased.
TSH- decreased.
How is DI diagnosed?
treatment?
key nursing interventions
24 hour urine measured ( more than 15-20L/24 hours), Fluid deprivation test
Monitor electrolytes/fluid, desmopressin and vasopressin
fluid replacement, monitor for dehydration, I&O daily weights, IV fluids.
s/s of cushings
treatment
nursing considerations
large abdomen, buffalo hump, moon face, thin ectremities, hypernatremia, hyperglycemia, hypokalemia.
tapering off steroids, surgical removal (adrenalectomy), potassium replacement
protect from injury and infection, daily weights, monitor glucose and electrolytes.
Patient teaching for addisons disease?
always carry injectable cotrisol and glucose for emergencies
medical alert bracelet
Steroid therapy: take with food, monitor bs, never stop suddenly. ( life long therapy)
What is graves disease? What is distinguishing feature of graves disease?
autoimmune disease that effects thyroid causing it to produce too much hormone. (T4)
Exophthalmos- bulging eyes
hypothyroidism treatment? Be specific.
Thyroid hormone replacement!
Levothyroxine - everyday on empty stomach- may take 6-8 weeks for full effect
Use sedatoves. marcotics, hyponotics carefully
What is SIADH?
How is it dx?
syndrome of inappropriate antidiuretic hormone
results in water intoxication
urine osmolality, urine specific gravity (high), serum osmolality, BUN, H&H.
if both adrenal glands are removed for treatment of cushings what will the patient need to be on forever?
steroids
what is addisonian crisis ( acute adrenal insufficiency)
what is it caused by?
Number#1 education for patient
life threatening event. increased demand or need for cortisol but decreased supply.
Cause: surgery, trauma, infection. Major cause abrupt cessation of steroid therapy.
Do not stop steroid abruptly!
What is Thyroid storm?
S/S?
TX?
It is a rare life threatening condition where the thyroid makes and releases large amount of thyroid hormone in a short amount of time.
fever, increased HR/ BP, rapid respirations, restlessness, weakness, weight loss, shortness of breath, seizures, coma, death.
Maintain airway, reduce temp, cardiac drugs to slow HR, sedatives such as barbiturates to reduce restlessness.
What is Myxedema coma?
Causes?
s/s?
Treatment?
-Decreased metabolism which causes decreased perfusion and ultimately organ failure.
-abrupt withdrawl of thyroid medication, acute illness, anesthesia, use of sedatives/narcotics, surgery, hypothermia in hypothyroid pt.
-loss of consciousness, hypotension, hypothermia, respiratory failure, hyponatremia, hypoglycemia.
- administer levothyroxine IV, fluids, airway, IV glucose, corticosteroids.
What are the s/s of SIADH?
sodium less than 120 what s/s?
treatment
excessive water retention, hyponatremia, increased body weight, tachycardia, decreased urine output.
NA less than 120- lethary, headaches, agitation, seizures, disorientation, muscle cramps, weakness.
treatment- fluid restriction 500-1000mL/day, daily weights, seizure precautions, frequent neuro checks, diuretics, sodium chloride, demeclocycline, monitor electrolytes