hyperthyroidism s/s
intolerance to heat, fine-straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, atrial fibrilation, increased SBP, gynecomastia, weight loss, muscle wasting, menstrual changes (amenorrhea), localized edema, increased diarrhea, tremo
hypothyroidism s/s
intolerance to cold, receding hairline, facial & eyelid edema, dull-blank expression, extreme fatigue, decreased appetite, thick tongue-slow speech, anorexia, brittle nails & hair, menstrual disturbances, hair loss, apathy, lethargy, dyspnea, dry skin (co
Cushing's Syndrome s/s
personality changes, hyperglycemia, moon face, CNS irritability, increased susceptibility to infection, Na & fluid retention, gynecomastia (males), thin extremities, fat deposits on back, GI distress, increased acidemia, amenorrhea & hirsutism (females),
Addison's Disease s/s
bronze pigmentation of skin, changes in distribution of body hair, hypoglycemia, GI disturbances, wieght loss, weakness
Addisonian/Adrenal Crisis s/s
profound fatigue, dehydration, vascular collapse, renal shutdown, decreased serum Na, increased serum K
osmolality formula
2Na + K + BUN/3 + Glucose/20
Hyperpituitarism
An excessive secretion of pituitary hormones (i.e. GH, ACTH, TSH, LH)
Acromegaly
Gradual enlargement of bony and soft tissues (bones of the face, jaw, hands, feet, and skull) causes by excessive growth hormone (GH). Occurs in adults.
Gigantism
Overgrowth of the long bones due to excessive growth hormone. Occurs in childhood before the closure of the epiphyseal plates.
complications of Acromegaly
Enlarged tongue leads to hoarseness, speech difficulties, sleep apnea.
Vocal cord thickening & upper airway obstruction lead to sleep apnea, snoring
GH mobilizes stored fat for energy leading to increased risk for atherosclerosis.
GH is an insulin antagon
diagnostic tests for Acromegaly
-increased IGF-I levels (w/ GH excess)
-Head CT scan/ MRI showing pituitary tumor
-Skeletal x-rays
-Ophthalmic exam
assessing for Acromegaly
-evaluate growth & development of children
-question adults about increases in hat, ring, glove & shoe size
-assess for s/s of diabetes mellitus
-assess for cardiovascular s/s: angina, HTN, CHF
treatment for Acromegaly
-octreotide
-radiation
-transsphenoidal hypophysectomy
complications of transsphenoidal hypophysectomy
increased ICP, CSF leak, meningitis, transient, diabetes insipidus, hypopituitarism
pre-op transsphenoidal hypophysectomy
-bacitracin nose gtts, pain control, hormone replacement
-teach mouth breathing, mouth care
-teach to avoid valsalva maneuver, coughig, sneezing, straining
post-op transsphenoidal hypophysectomy
monitor for increased ICP and treat accordingly, monitor for CSF leak, mouth care q 4 hr - rinses only (no tooth brushing for 10 days), neuro checks, daily chemistry profile (including serum Na), monitor for signs of hypopituitarism, analgesics, IV antibi
Antidiuretic Hormone (Vasopressin)
Hormone that regulates water balance. Increased secretion leads to increased water reabsorption from renal tubules leading to water conservation and decreased urinary output. This hormone is also a potent vasoconstrictor.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Too much ADH resulting in water retention, hyponaturemia and low serum osmolality, increased in urine Na, specific gravity, and osmolality. The most common cause is small cell lung cancer.
SIADH s/s
decreased urine output, increased urine specific gravity, increased intravascular fluid volume, weight gain, dyspnea on exercition (DOE) & fatigue, muscle cramps & weakness d/t hyponatremia, increased cerebral edema leading to lethargy, anorexia, confusio
nursing management for SIADH
ID patient's at risk, treat underlying disorder, I&O, daily weights, monitor neuro status/seizure prec., monitor labs: Na, osmolality, urine specific gravity, fluid restriction 800 - 1000mL/d, decrease thirst: ice chips, sugarless gum especially if FR is
demeclocycline (Declomycin)
Medication that blocks the action of ADH. Used for chronic SIADH. May induce Diabetes Insipidus (polyuria, polydipsia, weakness).
Diabetes Insipidus
Posterior pituitary disorder caused by an insufficiency of or resistance to ADH resulting in water loss, increased serum Na, increased serum osmalality , decreased urine Na. May be transient or life-long. May be the result of injury to the posterior pitui
Diabetes Insipidus s/s
severe polyuria (5 - 20L/day), dilute urine, nocturia, enuresis, polydipsia, craving cold water, fatigue, irritability, weakness, weight loss, dehydration, constipation
diagnostic tests for DI
-UA: decreased osmolality & spec gravity of urine
-increased serum Na & osmolality
-CT/MRI
-CMP (*renal function)
-psychological evaluation
nursing management for DI
ID patients at risk, identify & treat underlying cause, monitor I&O, VS, daily weight; assess for dehydration; fluid replacement: IV or oral; monitor lab work; administer meds
treatment for DI
-Vasopressin: SC, IM or IV or desmopressin acetate (DDAVP) intranasal or SC
-Indocin: increases responsiveness of ADH
-Thiazide diuretics
Iodine
Chemical used by the thyroid gland to synthesize Triiodothyronine (T3) and Thyroxine (T4). May be given in large doses to inhibit synthesis of T3 and T4 and block their release into circulation. In large doses, this can decrease vascularity of thyroid gla
Grave's disease
An autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism).
diagnostic tests for Hyperthyroidism
-Opthalmologic examination
-ECG
-TSH
-free thyroxine (T4)
-Total T3 & T4
-Radioactive iodine uptake (RAIU)
Antithyroid medications
PTU (Propylthiouracil) & methimazole (Tapazole). Therapy for 6 to 15 months with improvement seen in 1 - 2 weeks. Good results in 4 - 8 weeks.
treatment for Hyperthyroidism
-Antithyroid medications
-Radioactive iodine therapy (RAI)
-Subtotal thyroidectomy
-Iodine
-Beta blockers
Radioactive Iodine Therapy (RAI)
First choice hyperthyroidism treatment in non-pregnant adults. Destroys thyroid tissue. Takes 2 to 3 months. Antithyroid drugs and Inderal while waiting for the drug to be effective.
nursing management for hyperthyroidism
-Nutritional therapy: high-calorie diet (4,000 - 5,000 cal/day) for hunger and prevention of tissue breakdown; protein allowance of 1 to 2 g/kg ideal body weight; avoid caffeine, highly seasoned foods, and high-fiber foods; vitamins
-Monitor for cardiac d
post-op thyroidectomy
Every 2 hours for 24 hours assess for signs of hemorrhage (fullness at site) and assess for tracheal compression (irregular breathing, neck swelling, frequent swallowing, choking)
Position patient in Semi-Fowler's position and support the head with pillow
discharge teaching post-thyroidectomy
Monitor hormone balance periodically. Total thyroidectomys require lifelong therapy.
Decrease caloric intake to prevent wieght gain.
Adequate iodine intake is a priority.
No radiation safety precautions are necessary for radioactive iodine therpay.
Thyrotoxicosis (Thyroid crisis, thyroid storm)
Acute condition where all manifestations of hyperthyroidism are heightened. Death rare when treatment initiated. Presumed causes are additional stressors.
treatment for Thyrotoxic crisis
-Decrease thyroid hormone levels and clinical manifestations with drug therapy.
-Manage respiratory distress, fever reduction, fluid replacement, and manage stressors.
Hypothyroidism
Thyroid hormone deficiency leading to slowing of the metabolic process. The most common cause worldwide is Iodine deficiency. Atrophy of the thyroid gland and overtreatment of hyperthyroidism are other, less common, causes.
diagnostic tests for Hypothyroidism
-Decreased T3, T4, and RBC levels.
-TSH: decreased if pituitary disease or increased if thyroid disease
-Increased cholesterol
-Anemia
-CT/MRI
-ECG (bradycardia)
levothyronine (Synthroid)
Drug used for thyroid hormone replacement. Dosage measured in mcg. Monitor cardiac function when administering this medication especially to the elderly. This drug increases the effects of anticoagulants and decreases the effects of insulin, oral hypoglyc
myxedema coma
Life threatening complication of hypothyroidism due to persistently low thyroid hormone levels. May be triggered by sedatives, infection, or other stress on the body. Signs and symptoms include hypothermia, respiratory depression, hypoventilation, bradyca
nursing management for myxedema coma
Monitor cardiopulmonary, neurologic and renal function. Warm the patient's body gradually (not quickly) to avoid quick vasodilation resulting in a rapid drop in BP.
glucocorticoids, mineralocorticoids, androgens
The three types of hormones produced by the adrenal cortex categorized as corticosteroids. These steroids affect the 3 S's (Sugar, Salt, Sex)
catecholamines
The category of hormones produced in the adrenal medulla which includes epinephrine and norepinephrine.
Cushing's syndrome
A rare endocrine disorder caused by chronic exposure of the body's tissues to exogenous or endogenous excess cortisol (glucocorticoids, mineral corticoids; Sugar, Salt). Most commonly caused by a pituitary gland tumor secreting too much adrenocorticotropi
Adrenocortical Insufficiency
Lack of some or all adrenal corticosteroids. This caused by either destruction of the adrenal glands or underproduction of hormones in the adrenal cortex.
Addison's disease
Underproduction of hormones in the adrenal cortex.
treatment for Cushing's syndrome
-Surgery: Transphenoidal hypophysectomy or adrenalectomy (depends on the underlying cause)
-Radiation
-Medication to suppress cortisol production (ketoconazole, aminoglutethimide)
discharge teaching for adrenocorticoid insufficiency/excess
Lifelong hormone replacement therapy (for insufficiency)
Medic alert bracelet
Never stop corticosteroids abruptly
Alternate day therapy
Dose may be increased during periods of stress
Diurnal (daytime) pattern for administration
Addisonian/Adrenal crisis
An acute life threatening condition characterized by extremely low levels of adrenocortical hormone. Caused by an abrupt cessation of adrenocorticotropic meds and/or increased stress, illness, surgery, dehydration. Exaggerated symptoms of adrenal insuffic
treatment for Addisonian/Adrenal crisis
-Treat hypovolemic shock: fluids, vasopressors, position in Trendelenburg's position
-Monitor and replace blood glucose, electrolytes (Na+)
-Steroid replacement: IV hydrocortisone
-Avoid stressors
pheochromocytoma
An adrenal medulla tumor which causes an overproduction of the catecholamines epinephrine and norepinephrine. 95% are benign or encapsulated. Causes overstimulation of the sympathetic nervous system.
pheochromocytoma s/s
Severe, episodic HTN, severe pounding headache, tachycardia, palpitations, diaphoresis, chest pain
diagnostic tests for pheochromocytoma
-Plasma catecholamines
-Urine: catecholamine metabolites
-CT/MRI/US to localize tumor
-Clonidine (alpha2-agonist) suppression test
treatment for pheochromocytoma
-Alpha adrenergic blockers to lower BP
-Beta blockers to lower BP
-Mitotane (Lysodren)
-Adrenalectomy
pre-op Adrenalectomy
-Monitor VS, CP status
-IV corticosteroids pre-op
-raise HOB
-monitor fluid and electrolytes
-administer medications to reduce BP
post-op Adrenalectomy
-Basic post-op care as for any abdominal surgery
-Monitor BP, blood glucose levels closely
-Administer hydrocortisone
PTU (Propylthiouracil), methimazole (Tapazole)
Two common Antithyroid medications
octreotide
Medication used to treat Acromegaly.
aminoglutethimide, ketoconazole
2 medications commonly used to treat Cushing's syndrome