Medical-Surgical Nursing - Endocrine Disorders with 100% correct answers already graded a+.

Acromegaly Excess of growth hormone as an adult, after the epiphyseal plate closure Generally affects middle-aged adults Starts gradually (average of 7-9 years, btw onset and finalDX Causes of Acromegaly most common in pituitary adenoma The life expectancy of these patients are reduced 5 to 10 years If untreated, these patients are likely to have cardiac, respiratory, diabetes, and types of cancer Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:00 Full screen S/S of Acromegaly Thickening of hands, feet, nose and mouth Speech difficulties Sleep Apnea Peripheral Neuropathy Muscle Weakness Visual changes / headache Diagnosis of Acromegaly Often prompted by headaches and or visual changes MRI or CT to assess pituitary tumor Opthalmologic exam Pressure from turmor may increase causing pressure an optic nervee Treatment of Acromegaly Hypophysectomy - removal of the pituitary tumor This procedure is generally done transphenoid An incision is made just under the inner, upper lip Reduction GH levels followed by a drop in IGF - 1 levels Will be seen within just a few weeks Radiation if surgery fails The goal is to have complete remission This is done in combination with drugs Medications: octreotide reduces growth hormone SQ 3 times weekly Sandostatin and Lareotide > longer acting IM every 2-4 weeks Trans-spenoidal Hypophysectomy Nursing Interventions Assess neuro changes HOB 30 degrees Instruct patient to avoid: vigorous coughing, sneezing, straining, blowing their nose Trans-spenoidal Hypophysectomy Prevent cerebrospinal fluid leakage Glucose level greater than 30mg indicates CSF leakage The patient is at risk for meningitis at this point If the patient complains of consistent supraorbital headache, this may indicate a CSF leak. CSF leak usually resolves within 72 hours, if it does not, surgery may have to happen Trans-spenoidal Hypopophysectomy Frequent neuro assessments Give mild analgesics for headache Mouth care every 4 hours Avoid brushing teeth for at least 10 days S/S SIADH Hyponatremia (normal 135-145) Hypo-osmolatity (Normal 285-295) Headache/Change in LOC Muscle cramps, muscle twitching Weakness, vomiting, abdominal cramps Fluid retention & concentrated urine with normal kidney function Syndrome of SIADH Inappropriate ADH causes too much water to be retained Bronchogenic Small Cell Cancer Oat Cell Ca Synthesizes and releases ADH Head injuries Brain infection, viral pneumonia Syndrome of Inappropriate Antidiurectic Hormone Seizure precautions Frequent assessments - VS & LOC Fluid restriction of 500-1000cc/24 hr. & diuretics Treat with IV hypertonic saline (3% or 5%) - slowly & carefully Hyponatremia IV mannitol Po Diuretic - Lasix sodium tablets Hypertonic saline SIADH Distract patient from thirst with ice chips, sugar (distract from thirst) less gum, frozen grapes, frequent oral hygiene Chronic SIADH pt needs to always be on a fluid restriction of 500ml - 1000ml/24 hr / diuretics and potassium and sodium supplements Strict I & O Daily weights Lasix cause Lower Potassium Diabetes Insipidus - VAST quantities of dilute urine Central DI - lack of ADH production or release Brain injury, CNS infection, brain tumor or head surgery Dilantin (seizures) Draw labs S/S of diabetes insipidus Massive diuresis (urine output 4 to 30 liter/24 hr Low urine specific gravity Low urine osmolality & high serum osmolality Increased thirst Generalized weakness Weight loss Constipation Poor skin turgor Hypotension Tachycardia Shock (hypovolemic) More s/s of diabetes insipidus decrease ADH Serum hyperosmolarity High Sodium High serum osmolarity Increase urine output urine specific gravity low urine osmolality low DI treatment Central DI - desmopressin DDAVP (SQ, IV, nasal) nasal / tablets / sc - pt not to drink more than 3 liters of fluid a day weigh daily / make MD aware of more than 2 lb weight gain in 24 hrs IVF titrate to replace urine output A dying patient would have a high osmolarity SBP 60, 130 BPM Give IV fluids Thyroid Gland Hormone thyroxine (T4) and (T3) regulate energy metabolism, growth & development Goiter - hypertrophy and enlargement of thyroid gland (Palpate) Hyper/hypothyroidism or normal thyroid function Treat underlying cause will prevent further growth, surgical removal of existing goiter Commonly found in patients with Graves disease The most common cause of goiter is lack of iodine in the diet Thyroiditis inflammation of the thyroid gland Viral or bacterial or autoimmune in nature Happens to post partum women, T3/T4 levels are elevated then decreased Treatment of thyroiditis Bacterial antibiotic. If hypothyroid, needs thyroid replacement Hyperthyroidism Excess circulating levels of T3 & T4. Effects women more than men Primary ages effected 20-40 yr old Graves disease S/S Hyperthyroidism HTN Increased HR and bounding pulse Systolic murmer - r/t hypervolemia & hypertension Dysrhytmias - increased myocardial oxygen consumption Palpitations Exophthalmos - protusion of eyeballs (one or both) Corneal Abrasions S/S of Hyprethyroidism Increased appetite Weight loss Diarrhea - r/t increased peristalsis Hair loss Thinning nails Thyroid Storm - Thyroid Crisis Hyperthyroidism untreated may lead to thyroid storm All hyperthyroid manifestations are heightened Critical illness lasts 7-10 days - potentially lethal Often seems sudden if early S/S are missed Thought to be caused by several stressors Infection, trauma, surgery...heart and nerve tissue become more sensitive Thyroid Storm - Thyroid Crisis (S/S) r/t increased tissue sensitivity to thyroid hormones Severe tachycardia, heart failure, high temp (105), shock, restlessness, agitation,, seizures, abdominal pain, nausea, vomiting, diarrhea, delirium & coma Labs & Treatment Low TSH and increased Thyroxine Tx - antithyroid drugs, iodine and B-adrenergic blockers Propylthiouracil (PTU) and methimazole (Tapazole) inhibit synthesis of thyroid hormones Iodine inhibits synthesis of T3 and T4. B-adrenergic blockers treat symptoms slow heart rate (metropolol) Hyperthyroidism Low TSH level Elevated free thyroxine T4 The most reliable and most common is the thyroid function > tsh and free t4 normal tsh levels 0.3 to 5.4 mu/ml, normal t4 or thyroxine levels 5-12mcg these values along with signs, symptoms, and history will confirm the diagnosis Differentiation of Grave's Disease vs other forms of thyroiditis utilize a RAIU (radioactive iodine uptake test) -With Grave's, uptake 35-95% -With thyroiditis, uptake < 2% Antithyroid Drugs: Propylthioracil (PTU) & Methimazole (Tapazole) Antithyroid drugs block the synthesis of thyroid hormones. PTU also blocks conversion of T4 to T3 PTU only orally absorbed, so PO or NG Take 1 to 2 weeks to work May be used long term (6-15 months) Iodine used with antithyroid drugs to prepare patient for thyroidectomy or for treatment of thyrotoxic crisis NOT used long-term Large doses of iodine inhibit synthesis of T3 and T4 B-Adrenergic blockers utilized to treat symptoms caused by tissue responses to catecholamines Radioactive iodine (RAI) destroys thyroid tissue thus limiting the secretion of thyroid hormone RAI maximal effect is seen in 2-3 months, patient remains on therapy until maximal effects seen from RAI Surgical therapy utilized when patient is unresponsive to other forms of therapy also used when patient has a large goiter compressing on their trachea OR POSSIBLE MALIGNANCY Subtotal thyroidectomy surgery of choice, significant portion of thyroid removed total thyroidectomy 90% of thyroid removed Watch thyroidectomy site for swelling of neck tissues, hemorrhage, hematoma laryngeal stridor (harsh vibratory sound) Tracheosotomy tray in room in case of an emergency AIRWAY MAY GET BLOCKED WITH TOO MUCH SWELLING Frequent vitals frequent oxygen checks, HOB up to decrease swelling Watch for signs of tetany due to hypoparathyroidism trousseaus sign chvosteks sign Concern with total thyroidectomy is that too much tissue is taken and patient will become hypothyroid Swallowing excessively bleeding Hypothyroidism Insufficient circulating thyroid hormone r/t Destruction of thyroid tissue Defective hormone synthesis Lithium Amiodarone Iodine deficiency May be transient: thyroiditis, d/c of therapy Pathophysiology of Hypothyroidism Decreased protein synthesis -May lead to absent RBC & amino acid production Incomplete fat & cholesterol metabolism -Inadequate gluconeogenesis Ineffective lipolysis -High cholesterol levels Hyaluronic acid (gel-like substance) in interstitial tissues) -Puffy face and eyes -Accumulates in muscles, esp. heart, tongue, pharynx & esophagus S/Sx of Hypothroidism Fatigue, lethargy Personality changes Impaired memory, slowed speech Depressed appearance Disruptive sleep patterns SOB, exercise intolerance Constipation Hair loss, brittle nails Weight gain Everything slows down w/hypothyroidism Cardiovascular function decreased overall Respiratory muscles weak Gastric motility decreased -Decreased nutrition absorption -Hypoglycemia Kidneys -Decreased GFR -Increased ADH secretion -Inability to maintain body heat Myxedema Coma Mental sluggishness can lead to coma This is A MEDICAL EMERGENCY! -Subnormal temperature -Hypotension -Hypoventilation Patient needs (myxedema coma) IV thyroid replacement therapy Vital organ support - in ICU -ICU with warming blanked on, perhaps IV warming fluids, ventilator and medications to help blood pressure Diagnostic Tests Serum TSH level can be indicative of the cause of the hypothyroidism