2nd half of endocrine Test 2

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1

watch for test info friday on BB
5 math questions
50 questions total
each unit will be about 1/3 of test

...

2

growth hormone imbalances

too little= hypopituitarism

too much= hyperpituitarism (gigantism,acromegaly)

3

patho of hypopituitarism

deficient GH
or
normal amounts of GH but body doesn't respond
(usually genetic)

4

possible causes of hypopituitarism

Pituitary Tumor
Failure of Pituitary to Develop
Head Trauma
Head Radiation
Malnutrition
Cause Cannot be Found

5

S/S of hypopituitarism

Weakness
Hypoglycemia
Sexual Dysfunction
Risk for Cardiovascular Disease
Risk for Cerebrovascular Disease

6

Dx tests for hypopituitarism

GH Level
GH Response to Induced Hypoglycemia
CT/MRI for Tumor

7

nursing Dx for hypopituitarism

disturbed body image

8

patho of hyperpituitarism (acromegaly)

Excess GH in Adults
Bones Grow in Width, Not Length
Organs and Connective Tissues Also Enlarge

9

causes of hyperpituitarism (acromegaly)

Pituitary Hyperplasia
Pituitary Tumor
Hypothalamic Dysfunction

10

S/S of hyperpituitarism (acromegaly)

Change in Shoe or Ring Size
Nose, Jaw, Brow Enlarge
Teeth May Be Displaced
Difficulty Speaking and Swallowing
Sleep Apnea
Headaches, Visual Changes
Diabetes Mellitus
Arthritis
Sexual Dysfunction

11

Dx tests for hyperpituitarism (acromegaly)

GH Level
Bone X-Rays
MRI

12

adrenal cortex hormone imbalances

Hyposecretion = Addison’s Disease
Hypersecretion = Cushing’s Syndrome

13

patho of Addison's disease

Deficient Cortisol
and/or Aldosterone
and/or Androgens

14

causes of Addison's disease

Autoimmune
AIDS
CA
TB
Pituitary or Hypothalamus Problem
ABRUPT DISCONTINUANCE OF STEROIDS (BECAUSE THEY SUPPRESS PITUITARY FUNCTION)

15

S/S of Addison's disease

Hypotension
Sodium Loss
Potassium Retention
Hypoglycemia
Mental status changes – depression, apathy, anger, confusion
Weakness
Fatigue
Bronze Skin (caused by elevated ACTH levels)
Nausea and Vomiting
Emaciated, anorexia

16

Dx tests for Addison's disease

Serum and Urine Cortisol Level –early morning
Blood Glucose (low)
Electrolytes (sodium low, potassium high)
BUN/HCT (elevated due to dehydration)
ACTH Stimulation Test (positive test= no increase)

17

complications of Addison's disease

Adrenal Crisis
Profound Dehydration
Hypotension
Hypoglycemia
Shock
Coma
Death
Low cortisol will see:
pale,apprehensive,rapid pulse,rapid respirations all related to hypotension and hypoglycemia...need injection of steroids

18

Nursing Dx for Addison's disease

Risk for Deficient Fluid Volume
Risk for Ineffective Health Maintenance
Altered Body Image
Risk for Injury

19

patho of Cushing's disease

Excess Adrenal Cortex Hormones
Cortisol
Aldosterone
Androgens

20

Women between the ages of 20 and 40years are 5 x’s more likely than man to develop _____________

Cushing's disease

21

causes of Cushing's

Disease = Pituitary Tumor or Hyperplasia
Syndrome = Prolonged Glucocorticoid Therapy

22

S/S of Cushing's

Central –type obesity
“buffalo hump”
Weakness
Muscle wasting/osteoporosis
Kyphosis
“Moon- face”
Mood Alteration/ Psychosis
Salt and Water Retention
Hypokalemia
Thin Fragile Skin
Acne
Facial Hair in Women (Hirsutism)
Amenorrhea
Impaired Wound Healing

23

Dx tests for Cushing's

Based on Appearance
Plasma and Urine Cortisol
ACTH
Dexamethasone Suppression Test

24

Dexamethasone Suppression Test

test for Cushing's

Overnight: 8 a.m. plasma cortisol < 1.8 mcg/dl
Standard: Urinary free cortisol on day 3 < 10 mcg/day
High dose:
Overnight: > 50% reduction in plasma cortisol
Standard: > 90% reduction in urinary free cortisol

25

nursing DX for Cushing's

Excess Fluid Volume
Risk for Impaired Skin Integrity
Risk for Infection
Risk for Injury
Body Image Disturbance

26

PHEOCHROMOCYTOMA

Tumor of Chromaffin Cells of Adrenal Medulla
Secretes Epinephrine and Norepinephrine (regulate HR and BP)
Usually Benign
Cause Unknown
Occurs at any age, but peaks at 40 and 50, in men and women equally.

27

S/S of Pheochromocytoma

Fight or Flight
Hypertension
Tachycardia
Palpitations
Tremor
Diaphoresis
Anxiety
Hyperglycemia
Headache
Vision Changes
Risk for Stroke
Risk for Organ Damage

28

Dx tests for Pheochromocytoma

24-Hour Urine for catecholamines (Metanephrine and vanillylmandelic acid {VMA})
No Caffeine or Medications Before Test

CT or MRI to Find Tumor

29

nursing Dx for Pheochromocytoma

Risk for Injury Related to Hypertensive Crisis
Monitor VS
Quiet, Calm Environment
No Caffeine

30

Thyroid hormone imbalances

Hypothyroidism
Hyperthyroidism

31

patho of Hypothyroid

TH Deficiency or resistance to thyroid hormone,Metabolic Rate Reduced

Primary = Not Enough TH (T3 & T4), so pit increases amt of TSH

Secondary = Not Enough TSH to stimulate the release of TH

32

causes of Hypothyroid

Autoimmune thyroiditis; Hashimoto’s disease (most common cause)

33

S/S of Hypothyroid

Fatigue
Bradycardia
Constipation
Mental Dullness
Cold Intolerance
Hypoventilation
5 x’s more common in women than men.
Dry Skin and Hair
Weight Gain
Heart Failure
Hyperlipidemia
Myxedema (hypothyroidism in an adult)

34

complications of Hypothyroid

Myxedema Coma
Hypothermia
Decreased VS and LOC
Respiratory Failure
Death

35

Dx tests done for Hypothyroid

T3 and T4 Low
TSH High in Primary
TSH Low in Secondary

36

nursing Dx for Hypothyroid

Activity Intolerance
Constipation
Impaired Skin Integrity
Imbalanced Nutrition
Impaired Comfort/Imbalanced Body Temperature
Ineffective Breathing Pattern
Disturbed Thought Process
Risk for Myxedema Coma

37

patho of Hyperthyroid

Increased Metabolic Rate
Increased Beta Receptors
Primary = Too Much TH
Secondary = Too Much TSH causing overstimulation of the thyroid gland

38

BP for Addison's versus Cushing's

Addison's = low BP

Cushing's = high BP

Due to fluid volumes

39

causes of Hyperthyroid

Grave’s Disease (most common form, autoimmune)
Hyperthyroidism
Exophthalmos
Thyroid gland enlargement (goiter)
Disturbed Body Image
Pituitary Tumor (Secondary)
Synthroid Overdose

40

S/S of Hyperthyroid

Hypermetabolic State
Heat Intolerance
Increased Appetite
Weight Loss/Weight Gain
Frequent Stools
Nervousness
Tachycardia, Palpitations
Tremor
Heart Failure
Warm Smooth Skin
Exophthalmos (Grave’s Disease)

41

S/S of Hyperthyroid in the elderly

Heart Failure
Atrial Fibrillation
Fatigue
Apathy
Depression

42

Dx testing for hyperthyroid

Elevated T3 and T4
TSH Low in Primary
TSH High in Secondary
TRH Stimulation Test
TSI
CT/MRI If Tumor Suspected

43

Complications of Hyperthyroid

Thyrotoxicosis (Thyroid Storm)
Tachycardia, Hypertension
Fever, Dehydration
Coma
Death

44

Parathyroid disorders

Hypoparathyroidism
Hyperparathyroidism

45

Patho of Hypoparathyroidism

Decrease in Parathyroid Hormone (PTH)
Calcium Stays in Bones
Hypocalcemia (normal range 8.2 – 10.2 mg/dL)
Hyperphosphatemia (normal range 2.5 – 4.5 mg/dL)

46

causes of Hypoparathyroidism

Injury
Heredity
Accidental Removal of Parathyroid Glands During Thyroidectomy

47

S/S of Hypoparathyroidism

Tetany
Neuromuscular Irritability
Numbness and Tingling of Fingers and Perioral Area
Muscle Spasms
Cardiac Dysrhythmias
Positive Chvostek’s Sign
Positive Trousseau’s Sign

48

Dx tests for Hypoparathyroidism

PTH Low
Serum Calcium Low
Serum Phosphorus High
Serum Magnesium Low ( normal range 1.6 – 2.6 mg/dL)
Positive Chvostek’s Sign
Positive Trousseau’s Sign

49

Nursing Dx for Hypoparathyroidism

Activity Intolerance
Impaired Skin Integrity
Ineffective Breathing Pattern
Disturbed Thought Process
Risk for Injury
Body Image Disturbance
Risk for Electrolyte Imbalance
Decreased cardiac output r/t dysrhythmia

50

patho of Hyperparathyroidism

Parathyroid Overactivity
Increased PTH
Hypercalcemia
Hypophosphatemia

51

causes of Hyperparathyroidism

Parathyroid Hyperplasia (enlargement)
Idiopathic
Renal Failure
Benign Parathyroid Tumor
Heredity

52

types of Hyperparathyroidism

Primary
Secondary
Tertiary

53

S/S of Hyperparathyroidism

Fatigue
Depression
Confusion
Nausea and Vomiting
Kidney Stones
Pain
Pathologic Fractures
Dysrhythmias
Coma
Cardiac Arrest

54

Nursing Dx for Hyperparathyroidism

Risk for Injury: Fracture r/t Hypercalcemia/decrease calcium in Bones
Risk for Injury
Body Image Disturbance
Risk for Electrolyte Imbalance
Decreased Cardiac Output r/t dysrhythmia
Impaired Comfort r/t itching
Disturbed Thought Process

55

patho of Diabetes Mellitis

Glucose Intolerance
Faulty Production of Insulin (Type 1)
Tissue Insensitivity to Insulin (Type 2)
Altered CHO, Fat, Protein Metabolism
Long Term Complications

56

causes of type 2 diabetes

Decreased Beta Cell Responsiveness to Glucose
Reduced Number of Beta Cells
Reduced quality of insulin
Reduced amount of insulin
Reduced Tissue Sensitivity to Insulin

57

other types of diabetes

Gestational - Pregnancy
Prediabetes – Glucose Intolerance
Secondary Diabetes
Drugs
Pancreatic Trauma

58

Glucose levels for Dx of diabetes

Fasting Plasma Glucose > 126 mg/dL

Casual Plasma Glucose > 200 mg/dL

Glucose Tolerance Test
> 200 mg/dL after 2h

59

other tests for Diabetes

Glycated Hemoglovin/HgbA1c – Normal 4 - 6%
Lipid Profile
Serum Creatinine (kidney fxn)
Urine Microalbumin (kidney fxn)

60

goals for diabetics

Preprandial Glucose 90 – 130 mg/dL
Peak Postprandial Glucose < 200 mg/dL
Blood Pressure < 130/80 mm Hg
HgbA1c < 7%

61

Ketouria (ketones in urine)

If BS 240-300 mg/dl

62

3 P's of hyperglycemia

Polyuria (excessive urination)
polydipsia (excessive thirst)
polyphagia (excessive hunger b/c glucose available can't be used)

63

patho of ketoacidosis (more common in type 1 diabetes)

Blood glucose levels are high
Cells cannot utilize the glucose without insulin so it cannot be used as a fuel source
Body begins to use fat as a fuel source
When fat is metabolized, ketones (a by-product of fat metabolism) build up in the blood and spill over into the urine
This causes the blood to become more acidic than body tissues (ketoacidosis)

64

hypoglycemia

BS <50

65

Neuroglycopenia

symptom of hypoglycemia that can lead to:
Irritability
Confusion
Seizures, Coma

66

complications of diabetes (eye)

Cataracts
Diabetic Retinopathy
Glaucoma
Macular edema

67

Nursing Dx of diabetes

Adult Failure to Thrive r/t undetected disease
Imbalanced Nutrition
Ineffective Health Maintenance
Ineffective Tissue Perfusion
Noncompliance
Risk for Disturbed Though Process r/t hypo/hyper glycemia; reduced brain perfusion
Risk for Impaired Skin Integrity
Risk for Infection
Risk for Injury r/t hypo/hyper glycemia; reduced brain perfusion; peripheral vascular disease; vision changes; lack of pain
Sexual dysfunction