MEDSURG

Cards (285)

  • Endocrine disorders
    Consequences of hypo function and hyper function of each endocrine gland
  • Health history and clinical manifestation of endocrine disorders

    • Widespread effects on the body and a wide variety of signs and symptoms
    • Changes in energy level and fatigue
    • Tolerance of heat and cold as well as recent changes in weight
    • Changes in sexual function and secondary sex characteristics
    • Changes in mood, memory, and ability to concentrate and altered sleep patterns
  • Physical assessment of endocrine disorders

    • Changes in skin texture with both hypo function and hyperfunction
    • Eye changes, such as exophthalmos
    • Changes in physical appearance (e.g., appearance of facial hair in women, "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, increased size of the feet and hands, edema)
    • Elevated B.P. may occur with hyper function of the adrenal cortex or tumor of the adrenal medulla and Decreased blood pressure may occur with hypo function of the adrenal cortex
  • Pituitary gland
    • The master gland that controls the secretion of hormones by other endocrine glands
    • Divided into the anterior and posterior lobes
    • Controlled by the hypothalamus
  • Anterior pituitary hormones
    • Follicle-stimulating hormone (FSH)
    • Luteinizing hormone (LH)
    • Prolactin
    • ACTH
    • TSH
    • Growth hormone (somatotropin)
    • Melanocyte-stimulating hormone
    • Betalipotropin
  • Posterior pituitary hormones
    • Vasopressin, also called antidiuretic hormone or ADH
    • Oxytocin
  • Hypopituitarism
    Hypofunction of the pituitary gland, resulting in extreme weight loss, emaciation, atrophy of all endocrine glands and organs, hair loss, impotence, amenorrhea, hypo metabolism
  • Causes of hypopituitarism
    • Disease of the pituitary gland itself or disease of the hypothalamus
    • Complication of radiation therapy to the head and neck area
    • Total destruction of the pituitary gland by trauma, tumor, or vascular lesion
  • Hypersecretion (oversecretion)
    • Cushing's syndrome- over secretion of ACTH
    • Acromegaly- a disorder caused by an excess of GH in adults
    • Gigantism- over secretion of GH in children
  • Hyposecretion (undersecretion)
    • Dwarfism- insufficient secretion of GH during childhood
    • Panhypopituitarism- Under secretion (hyposecretion) commonly involves all of the anterior pituitary hormones
    • Hypopituitarism- may result from destruction of the anterior lobe of the pituitary gland
  • Posterior pituitary disorder
    Diabetes insipidus- deficiency in ADH resulting in a physiologic imbalance of water
  • Pituitary tumors
    • Usually benign types representing an overgrowth of eosinophilic cells, basophilic cells, or chromophobic cells
  • Gigantism
    Overgrowth of the long bones in children before the age when the epiphyses of the bones close, resulting in clients growing to 9 feet tall
  • Acromegaly
    Disease of adults developing after closure of the epiphyses of the long bones, resulting in increase in bone thickness and hypertrophy of the soft tissues
  • Etiology of gigantism and acromegaly: GH adenomas of the anterior pituitary
  • Complications of gigantism and acromegaly
    • Hyperglycemia, full-blown diabetes mellitus, destruction of the entire pituitary gland leading to hypopituitarism, pressure on the optic nerve leading to blindness
  • Clinical manifestations of gigantism
    More than 7 ft tall and large in all proportions, weak and lethargic
  • Clinical manifestations of acromegaly
    Excessive skeletal growth in the feet, hands (broad with spade like fingers), superciliary ridge, molar eminences, nose, and chin, Prognathism (protrusion of the jaw), Diplopia, Headache, Blindness, Lethargy, Diabetes mellitus, Goiter, Cushing's disease, Changes in libido and Menstrual disorders
  • Medical management of gigantism and acromegaly
    1. Irradiation of the pituitary gland to destroy the tumor
    2. Pharmacologic management with bromocriptine (Parlodel) to reduce growth hormone levels and decrease tumor size
    3. Surgical treatment with partial or complete removal of the pituitary gland
  • Nursing management of gigantism and acromegaly
    • Nursing diagnoses: Knowledge Deficit R/T surgery and possible outcomes, High risk for injury R/T postoperative complications, Knowledge Deficit R/T self administration of pituitary replacement hormones
  • Hypopituitarism
    • Deficiency of one or more of the hormones produced by the anterior lobe of the pituitary
    • When both anterior and posterior lobes fail to secrete hormones, the condition is called panypopituitarism (Simmond's disease)
  • Causes of hypopituitarism
    • Hypophysectomy
    • Nonsecreting Pituitary Tumors: Nonfunctioning chromophobe adenoma and craniopharyngioma
    • Decreased Growth Hormone
    • Postpartum Pituitary Necrosis
    • Functional Disorders: anorexia nervosa, severe anemia, and disorders
  • Clinical manifestations of hypopituitarism
    • Short stature, stunted growth, Secondary adrenocortical insufficiency due to diminished synthesis of ACTH, Hypothyroidism, Sexual and reproductive disorders r/t deficiencies of the gonadotropins (LH and FSH)
  • Medical management of hypopituitarism
    1. Removal, if possible, of the causative factor (e.g., tumors)
    2. Permanent replacement of the hormones secreted by the target organs
    3. Pharmacologic management with injections of HGH, corticosteroids, thyroid hormone, and sex hormones
  • Diabetes insipidus
    Deficiency in ADH resulting in a physiologic imbalance of water
  • Causes of diabetes insipidus
    • Primary: Abnormalities in the hypothalamus and pituitary gland from familial or idiopathic causes
    • Secondary: Destruction of the gland by tumors, trauma, infectious processes, vascular accidents, or metastatic tumors
    • Medications: phenytoin (Dilantin), alcohol, and lithium carbonate
    • Nephrogenic: Inherited defect where the kidney tubules cannot respond to ADH
  • Clinical manifestations of diabetes insipidus
    • Polyuria (urine is diluted with specific gravity of 1.001 to 1.005)
    • Polydipsia (The client can drink and excrete 5 to 10 liters of fluid per day)
  • Diagnostic test for diabetes insipidus
    Water deprivation test
  • Medical management of diabetes insipidus
    1. Replace ADH (long-term therapeutic program)
    2. Ensure adequate fluid replacement
    3. Identify and correct the underlying intracranial pathology
  • Pharmacologic management of diabetes insipidus
    • Desmopressin (DDAVP)
    • Chlorpropamide (Diabinese)
    • Thiazide diuretics
  • Nursing management of diabetes insipidus
    • Physical assessment and patient education
    • Educate patient, family, and other caregivers about follow-up care, prevention of complications, and emergency measures
    • Demonstrate and observe medication administration
  • SIADH (Syndrome of Inappropriate Antidiuretic-Hormone)
    Disorder associated with excessive amounts of ADH, resulting in a water imbalance
  • Causes of SIADH
    • Wide variety of causes, including the stress of surgery and many disorders and medications
    • Treatment of diabetes insipidus with vasopressin can lead to SIADH if excessive amounts are administered
  • Nurse's responsibilities
    • Reviews patient history and physical assessment
    • Educates patient, family, and other caregivers about follow-up care, prevention of complications, and emergency measures
    • Demonstrates and observes return demonstration of medication administration to ensure patient received prescribed dosage
  • Patient is advised to wear a medical identification bracelet and carry required medication and information about DI at all times
  • SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)

    Disorder associated with excessive amounts of ADH, resulting in a water imbalance
  • SIADH is one of the most common causes of hyponatremia, although the exact incidence of SIADH itself is not known
  • Causes of SIADH
    • Stress of surgery
    • Many disorders
    • Medications
  • Treatment of diabetes insipidus with vasopressin can lead to SIADH if excessive amounts are administered
  • Risk factors for SIADH
    • Variety of malignancies